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Anatomy Prep FRCEM ExamPrep.co.uk Your Passport to Success in the FRCEM exam Main Menu User Menu= Strabismus SBAQ: Anatomy Question: SBAQ1028 Strabismus: ^ Tag Report A 16-year-old girl presents with double vision. She is holding her head tilted to the right-hand side. On this examination of her eye movements you note that both eyes can look normally to the left but on looking to the question right, her right eye cannot turn outwards past the midline. The left eye is unaffected when looking to the right. What is the SINGLE most likely nerve to be involved in this case? Answer Option Question Statistics Left oculomotor nerve I m ] Left trochlear nerve | m ] Right trochlear nerve |J itm ) Left abducens nerve 1 m 1 Right abducens nerve L— — fBEfck ] Explanation: This patient has an right-sided abducens nerve palsy (6th cranial nerve palsy), which has resulted in paralysis of the lateral rectus muscle. The lateral rectus muscle is responsible for abduction of the eye. Inability to abduct the eye will result in the affected eye being unable to turn outwards. In this case it can be seen that the patients right eye is unable to turn outwards. This will result in a convergent strabismus and diplopia. Patients often hold their head turned towards the side of the paralysed muscle in an attempt to neutralise the diplopia. Hide Correct Answer * FRCEMExamPrep.co.uk -I f V Your Passport to Success In the FRCEM Exam Main Menu Head and Neck - SBAQ - 50 View Take Results Statistics Quezon SBAQ: Anatomy Question 5BA: #1213C Anatomical consideration5 in airway management: S*ore 1 1 Tag ^ A patient in the resus area of yotir Emergency Department is being prepared for a rapid sequence intubation; You make a careful airway assessment as part of the preparation. tQ Report this question which SINGLE statement regarding the anatomy of airways is true? Answer Option Question Statistics When attemptfng intubation witb a curved aryngoscope it is essentialto avoid the valleculas ^ Foreign bodies can lodge in the piriform fossa and lead to airway |£gjjj ] obstruction The recurrent laryngeal nerves Supplies roughly half or the intrinsic S# ! muscles of the arynx that are responsib e for movement of the vocal ' cords Emergency crieothyroidotomy is performed through the cricotracheal membrane A bilateral recurrent ^aryngea: nerve palsy renders the glottis unable to [iM J close Explanation: The valieculae are shallow depressions just beh - ntl the root of the tongue. They are an important iandmark in laryngoscopy. When attempting intubation. the laiyngoscopc should be irserted as far as possible into the val eculae to optimise the view of the glottis. The piriform fossa {or recess) is the space between the aryep gintrie membrane and the s des of the thyroid cartilage. It is a common site for :oreign bodies to become stuck. Trie recurrent laryngeal nerves supply all the intrinsic muscles of the la-ynx that a -e responsible for movement of the vocal cords. In complete palsy the vocal cards take up a neutral position,, midway between closed and open. In a unilateral complete palsy die other cord din compensate so symptoms can bo minimal. In bilateral complete palsy both cords taka up a neutral position anti the glottis Is partially obstructed, n an incomplete palsy the vocal cord abductors are affected more than the vocal cord adductors (Semcm' s Law) so the cord lies fully adducted. In bilateral incomplete palsy there will be adduction of both vocal cords and complete obstruction of the glottis. A cricothyroidotomy is performed through the cricothyroid membrane which extends from the thyroid cartilage to tho crico'd carr iage and is palpab e as a depression inferior to the laryngeal prominence. The tricotcached membrane is lower In the neck, extending from the cricoid carriage to the first tracheal rirg. Next question FRCEMExamPrep.co.uk Your Passport to Success in the FRCEM Exam Main Menu User Menu= Anatomy - FRCEM SBAQ - 50 View Take Results Statistics Question 8 of 50 SBAQ: Anatomy Question SBA: #29021 Cervical radiculopathy: Score 1 of 1 Tag ^ A 71-year-old-man presents with an 8-week history of worsening pain over the ulnar aspect of his left forearm. On examination the grip strength of his left hand is weakened and he has reduced sensation over Report the ulnar aspect of his left forearm. His upper limb reflexes are all intact. You suspect a diagnosis of cervical this radiculopathy. question Which interspace is most likely to have been affected in this case? Select ONE answer only. Answer Option Question Statistics C4-C5 T1-T2 C6-C7 m C7-T1 57% C5-C6 E Explanation: The following table outlines the classic patterns of cervical radiculopathy: Nerve Pain Interspace Abnormalities root distribution Motor - None Lower neck Sensory - Cape distribution (i.e. lower neck and upper C4 C3-C4 Trapezius shoulder girdle) Reflex - None Motor - Deltoid, elbow flexion Neck C5 C4-C5 Shoulder Sensory - Lateral arm Lateral arm Reflex - Biceps Motor Biceps, wrist extension Neck - Dorsal lateral C6 C5-C6 Sensory Lateral forearm, thumb arm - Thumb Reflex - Brachioradialis Motor - Triceps, wrist flexion Neck Dorsal lateral C7 C6 C7 Sensory Dorsal forearm, middle finger - forearm - Middle finger Reflex - Triceps Motor - Finger flexors Neck C8 C7-T1 Medial forearm Sensory - Medial forearm, ulnar digits Ulnar digits Reflex - None Motor - Finger instrinsics T1 T1-T2 Ulnar forearm Sensory - Ulnar forearm Reflex - None Next question FRCEM ExamPrep.co.uk Your Passport to Success in the FRCEM exam Main Menu User Menu= Cervical spine anatomy SBAQ: Anatomy Question: SBAQ1113 Cervical spine anatomy: ^ Tag Report You examine the cervical spine of a 25-year-old man that has been involved in a road traffic accident. this question At which vertebral level does the most clearly palpable spinous process lie at? Select ONE answer only. Answer Option Question Statistics C6 a m C2 i] m C7 C5 | ST C3 IJ m Explanation: The most clearly palpable spinous process lies at C7, for this reason it has been given the name vertebra prominens. It has a long and prominent spinous process that is easily palpable from the skin surface. Body Transverse . process • - 'V Ant.root ( - * / .• : -- Bust. root Superior f, articular surface i Spinous process The vertebra prominens (from Gray's Anatomy) Hide Correct Answer FRCEM ExamPrep.co.uk Your Passport to Success in the FRCEM exam Main Menu User Menu= Cervical spine injuries SBAQ: Anatomy Question: SBAQ1036 Cervical spine injuries: ^ Tag Report A 44-year-old woman has been involved in a road traffic accident 1 hour ago. She has been brought in by this ambulance to the resus area of your ED. She is complaining of neck pain and is unable to move her hands and question legs. She is able to extend her wrists and shrug her shoulders. A CT scan of her C-spine is performed and is shown below: At what vertebral level has her injury occurred? Select ONE answer only. Answer Option Question Statistics C7-C8 1 ] C4-C5 1 m ] C3-C4 | mC C5-C6 m i C6-C7 Explanation: This CT scan shows a fracture-dislocation at the level of C6-C7 (three column injury). On performing her neurological examination her sensory level should be over her thumb as the C6 nerve emerges between C5 and C6 and should be unaffected. This patient should have immediate C-spine immobilisation if not already instituted. She will require an urgent neurosurgical referral and the use of IV methylprednisolone (30mg/ kg over 15 minutes) should be considered. Image sourced from Wikipedia d? Courtesy of Frank Gaiiiard CC BY-SA 3.0 C Hide Correct Answer The cranial nerves exit the skull at the following anatomical locations: Anatomical location Nerve Cribiform plate Olfactory nerve (CN 1) Optic foramen Optic nerve (CN II) Oculomotor nerve (CN III) Trochlear nerve (CN IV) Superior orbital fissure Trigeminal nerve (CN V1 - Ophthalmic nerve) Abducens nerve (CN VI) Trigeminal nerve (CN V2 - Foramen rotundum Maxillary nerve) Trigeminal nerve (CN V3 - Foramen ovale Mandibular nerve) Facial nerve (CN VII) Internal auditory canal Vestibulocochlear nerve (CN VIII) Glossopharyngeal nerve (CN IX) Jugular foramen Vagus nerve (CN X) Accessory nerve (CN XI) Hypoglossal canal Hypoglossal nerve (CN XII) FRCEMExamPrep.co.uk Your Passport to Success in the FRCEM Exam Main Menu User Menu= Anatomy - FRCEM SBAQ - 50 View Take Results Statistics Question 29 of 50 SBAQ: Anatomy Question SBA: #29031 Cranial nerves: Score 1 of 1 Tag ^ You are asked to perform a cranial nerve examination on a patient that has presented with neurological symptoms. Report this question Which of the following cranial nerves originates in the cerebrum? Select ONE answer only. Answer Option Question Statistics Trigeminal nerve Olfactory nerve 93% Vagus nerve Abducens nerve Oculomotor nerve \ Explanation: There are twelve paired cranial nerves in total and they all arise directly from the brain. The cranial nerves are accordingly numbered by the location within the brainstem, (superior to inferior then medial to lateral), and the order of their exit from the cranium (anterior to posterior). The first two cranial nerves, the olfactory nerve and the optic nerve, arise from the cerebrum, whereas the remaining ten cranial nerves arise from the brainstem. They either arise from a specific part of the brainstem (midbrain, pons, or medulla), or from a junction between the two parts. Cranial nerves lll-XII arise from the following locations within the brainstem: Location arisen from Cranial nerve Midbrain Trochlear nerve (CN IV) Midbrain-pontine junction Oculomotor nerve (CN III) Pons Trigeminal nerve (CN V) Abducens nerve (CN VI) Pontine-medulla junction Facial nerve (VII) Vestibulocochlear nerve (CN VIII) Glossopharyngeal nerve (CN IX) Medulla oblongata Vagus nerve (CN X) (posterior to the olive) Accessory nerve (CN XI) Medulla oblongata Hypoglossal nerve (CN XII) (anterior to the olive) Olfactory ) l V I Optic Oculomotor ^ V // l \ , \| Trigeminal Trochlear VJSTI / Y UK Abducens & i \ki^ Facial v Vestibulocochlear I l ^ Glossopharyngeal Hypoglossal pv/ I p Vagus / / Accessory Image sourced from Wikipediai ' Courtesy of Patrick J.
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