Abstract
Anatomy and Surgical Approaches Structured SBA Questions
Anatomy and Surgical Approaches Structured SBA Questions
Upper Limb
1. A 20-year-old male is stabbed in the axilla. Surgical exploration is performed, and a bleeding artery is identified and repaired.
When does the axillary artery nominally become the brachial artery?
2. During the posterior approach to the scapular body, excessive medial retraction of a muscle results in significant arterial bleeding, and the surgeon is concerned there is associated nerve injury following this bleed.
If this is true, which of the following movements will likely be chronically weakened?
3. A posterior portal is created to carry out a diagnostic shoulder arthroscopy.
Which structure is most at risk of injury if a portal is created that is too medial than the typically described approach?
4. Which of the following shoulder muscles are innervated by a nerve that arises from the upper trunk of the brachial plexus?
5. A bone reduction clamp is placed under the inferior surface of the clavicle, positioned between the clavicle and a slender muscle running along the inferior surface.
The innervation to this specific muscle arises from which of the following root(s) of the brachial plexus?
6. You are assisting a consultant in exploring the brachial plexus at the axilla. The part of the axillary artery below pectoralis minor is noted to have two nerve roots joining anterior to it, to form a nerve which lies just lateral to the artery.
What is this nerve?
7. With respect to the muscles of the pectoral girdle, which muscle inserts into the lateral lip of the intertubercular (bicipital) sulcus of the humerus and receives its innervation that is derived from both the medial and lateral cords of the brachial plexus?
8. The subscapularis muscle is dually innervated. These nerves arise as two branches from the same cord of the brachial plexus.
Of the following nerves, which nerve also originates from this specific cord of the brachial plexus?
9. A male patient presents to clinic after a game of rugby with pain over the volar surface of the distal phalanx to the ring finger; examination has confirmed no active flexion at the distal interphalangeal joint, and this joint was held in slight relative extension to the other digits.
Which zone does this injury correspond to?
10. A patient presents with signs consistent with medial scapular winging.
The injured nerve is a branch from which of the following nerve root(s)?
11. A 50-year-old male presents with acute arm pain, swelling, bruising, and weakness on resisted forearm supination and flexion.
The nerve supply of this muscle is derived from which of the following nerve roots?
12. During exploration of the cubital fossa, what structure is typically expected to be running ulnar (medial) to a tendon that inserts at the radial tuberosity.
13. The superficial anterior forearm compartment contains five muscles that cross the elbow joint.
Which of the following muscles is NOT a superficial flexor of the forearm?
14. During the volar (Henry) approach to the proximal third of the radius, which structure is protected from the field by retracting the supinator muscle radially (laterally)?
15. A 21-year-old male undergoes open reduction and internal fixation for an open radial shaft fracture. Postoperatively, this patient is noted to have significant weakness of extension to the wrist and digits.
What nerve has most likely been injured?
16. An open median nerve decompression is performed for carpal tunnel syndrome.
What is the structure that is expected to arise between the tendons of palmaris longus and flexor carpi radialis, and course superficial to the flexor retinaculum?
17. During median nerve decompression surgery, a branch of the median nerve is severed inadvertently as the flexor retinaculum is divided, where it was later noted that this branch had pierced the retinaculum.
This injury will most likely result in weakness of which of the following muscles?
18. With respect to the flexor tendons of the hand, an injury is noted to involve the flexor digitorum profundus (FDP) tendons just distal to the flexor retinaculum but proximal to the A1 pulley.
Which flexor zone does this injury correspond to?
20. Following Henry’s approach to the forearm, the patient is noted to have a new wrist drop.
Which of the following structures has likely been excessively retracted during this procedure?
21. A 65-year-old male, who has been non-operatively managed for a distal radial fracture, is assessed in clinic. They had difficulty extending their thumb at the interphalangeal joint, with also reduced power extending the thumb at the metacarpophalangeal joint, and a tendon rupture is diagnosed.
Which extensor compartment does this specific tendon belong to?
22. You are exploring a wound located within flexor zone III of the hand. A structure is noted that is radial to the ring finger metacarpophalangeal joint and originates from a tendon rather than bone, where the origin of this structure is noted to also be bicipital.
What is this structure and its most common nerve supply?
23. You are teaching second year medical students the anatomy of the hand, and a student points to one of the annular pulleys that is situated at the level of the proximal interphalangeal joint of the index finger.
What annular pulley does this correspond to?
24. A major nerve was accidentally completely transected following division of the arcade of Struthers.
If left unrepaired, which of the following clinical signs will this patient likely develop?
Hyperextension at the metacarpophalangeal joints and extension of the interphalangeal joints of the ring and little fingers, with dorsal guttering and inability to abduct and adduct the fingers
Hyperextension at the metacarpophalangeal joints and extension of the interphalangeal joints of the ring and little fingers, with dorsal guttering and inability to abduct and adduct the fingers
Hyperflexion at the metacarpophalangeal joints and flexion of the interphalangeal joints of the ring and little fingers, with dorsal guttering and inability to abduct and adduct the fingers
25. A patient undergoes open reduction and internal fixation of a clavicular fracture.
What is the nerve supply to the muscle that is encountered just deep to the skin?
26. An anatomical shoulder replacement is performed.
During this approach, which structure is most at risk when the clavipectoral fascia is incised to expose a specific tendon complex, but especially during retraction of this tendon?
27. While performing an anterior approach to the humeral shaft, the surgeon is trying to manage a haemorrhaging vessel during proximal deep dissection.
Which vessel has likely been severed but should be expected to cross the operative field during this dissection?
28. An anterior approach to the elbow is performed, during which, a nerve is preserved that emerges lateral to a tendon that inserts into the radial tuberosity. This nerve then passes distally and divides into anterior and posterior branches.
Complete transection of this nerve will cause which of the following?
29. During the posterior approach to the radial shaft, the surgeon identifies and preserves a nerve that passes through and innervates supinator.
What is this specific branch within the supinator muscle?
30. With respect to the anatomy of the carpal tunnel, which of the following statements is INCORRECT?
The roof of the carpal tunnel, the flexor retinaculum, extends from the hook of hamate and pisiform medially to the scaphoid tubercle and ridge of the trapezium laterally
The tendon of flexor carpi radialis runs between the deep and superficial layers of the flexor retinaculum and not within the carpal tunnel
The tendons of flexor digitorum superficialis (FDS) to the middle and ring fingers are superficial to the FDS tendons of the index and little fingers
The tendons of FDS to the index and little fingers are superficial to the FDS tendons of the middle and ring fingers
31. A dorsolateral approach to the scaphoid is performed, centred within the anatomical snuffbox.
Regarding the anatomical snuffbox, what structure can be clinically palpated (or visualised during surgical exploration) as it crosses the structure which forms the ulnar (medial) border of the anatomical snuffbox and must be preserved during this approach?
32. Which of the flexor tendon pulleys should be preserved to reduce the risk of bowstringing and significant weakness?
33. A child attends with a fingertip laceration. Examination reveals a longitudinal deep laceration extending from the centre of the thumb nail to involve the distal tip. This laceration involves the deeper soft tissues of the nail.
In terms of nail anatomy, which structures are likely involved?
34. The hand of a 55-year-old manual worker is examined. They have decreased sensation over the little and ring fingers and weakened grip strength. They are asked to grasp a piece of paper between their thumb and the radial border of their index finger. They hold this paper by hyperflexing at the interphalangeal joint to the thumb despite being told not to bend their thumb.
Which muscle is being assessed and is demonstrated to be weakened?
35. A motorcyclist who has had a high-speed crash is noted to have signs of unilateral miosis, partial ptosis and anhidrosis.
These signs are most consistent with an injury to which of the following nerve roots?
Lower Limb
37. You are asked to assess a patient who has had a knife injury to his groin.
The surface anatomy for the common femoral artery within the femoral triangle is defined as which of the following?
38. A child presents with a septic hip, and an anterior approach is performed to irrigate and drain the joint. Regarding this approach, a nerve is at risk as it passes deep to the fascia lata and crosses the lateral border of a muscle which is retracted during the approach.
What is this muscle?
39. An anterior approach is performed for an intra-articular distal tibia fracture.
During this approach, at the level of the ankle joint, which of the following structures is expected to be just deep and medial to a tendon that inserts at the base of the distal phalanx of the great toe?
40. The ilioinguinal approach is performed to reduce and stabilise an acetabular fracture.
Which structure travels outside the spermatic cord but follows its course within the inguinal canal to exit the superficial inguinal ring?
41. A patient is unable to plantar flex at their ankle joint following percutaneous iliosacral screw fixation of an unstable sacroiliac joint.
Which spinal nerve does this complication correlate to?
42. The short external rotators are exposed during a routine posterior approach to the hip joint.
What is the name of the muscle that is exposed during this procedure and has, emerging from above its superior border, the nerve and vessels that supply the hip abductors?
43. A young patient sustains an intracapsular neck of femur fracture and you are explaining the rationale of management, with respect to the blood supply, to a medical student.
Which artery does not contribute towards the trochanteric anastomosis?
44. During the posterior approach to the hip, a major structure is at risk.
As this structure passes through the gluteal region, it lies anterior and inferior to which of the following external rotators?
