MyPasTest Online: MRCS A - Jan Exam 2015
01. Anatomy-Head, Neck & Spine (163Qs) 61
01. The inferior sagittal sinus: Single best answer question – choose ONE true option only.
Drains directly into the confluence of sinuses« YOUR ANSWER
Is found in the falx cerebelli
Is formed within the free, inferior border of the falx cerebri« CORRECT ANSWER
Drains into the superior petrosal sinus Page | 1
Contains valves, unlike the other venous dural sinuses.
The inferior sagittal sinus is enclosed in the posterior half or two thirds of the free margin of the
falx cerebri. It is cylindrical in shape. It increases in size as it passes backward and ends in the
straight sinus. It receives several veins from the falx cerebri and occasionally receives a few veins
from the medial surfaces of the hemispheres.
02. You are performing a cranial nerve examination on a patient who has a mild head injury. You
ask them to stick out their tongue. With regards to the examination of the tongue:
It is depressed by the hyoglossus« YOUR ANSWER
It is passive during the voluntary phase of swallowing
It is protruded by the styloglossus
It is retracted by the hyoglossus muscle
It receives sensory innervation from the vagus nerve.
The sensory innervation to the tongue is from the VIIth (facial) and IXth (glossopharyngeal) cranial
nerves and the lingual nerve. The tongue deviates to the side of a XIIth cranial nerve lesion on
protrusion, is active during the first stage of swallowing and contains the lingual tonsil in the
dorsum of its posterior third. The tongue is retracted up and back by the styloglossus muscle,
protruded by genioglossus and depressed by the hyoglossus.
03. The total length of the trachea is 10cm. At what level does the trachea begin?
Bifurcation of common carotid artery« YOUR ANSWER
Cricoid cartilage« CORRECT ANSWER
Hyoid bone
Suprasternal notch
Thyroid cartilage.
The trachea commences just below the cricoid cartilage (at the level of C6). Within the thorax and
on the right, the trachea is in contact with the pleura, vagus and subclavian artery. On its left, the
trachea is in contact with the left recurrent laryngeal nerve, aortic arch and the left common carotid
and subclavian arteries. The trachea ends at the upper border of T5, where it bifurcates.
04. A 72-year-old male presents with a swelling in the anterior triangle of the neck. Biopsy confirms
a superficial submandibular gland carcinoma. Which structure is least likely to be involved? Select
one answer only.
Deep cervical fascia« YOUR ANSWER
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail:
, MyPasTest Online: MRCS A - Jan Exam 2015
01. Anatomy-Head, Neck & Spine (163Qs) 61
Platysma
The cervical branch of the facial nerve« CORRECT ANSWER
The facial artery
The facial vein.
Page | 2
The submandibular gland is a lobulated gland made up of a superficial and a deep part, which are
continuous with each other around the posterior border of the mylohyoid muscle. Part of the gland
lies infero-laterally, enclosed in an investing layer of deep cervical fascia, platysma muscle and
skin. Laterally it is crossed by the cervical branch of the facial nerve and vein.
The facial artery is related to the posterior and superior aspects of the superficial part of the gland.
The marginal mandibular branch of the facial nerve passes beneath platysma and depressor
angulioris in the proximity of the submandibular gland where it may be damaged during surgery.
05. A 21-year-old male is seen in A&E after an assault outside a night club with pain in his jaw. An
X-ray confirms a fracture of the mandible. Which of the following regions is the weakest part of the
mandible? Select one answer only.
Angle« YOUR ANSWER
Canine region« CORRECT ANSWER
Coronoid process
Head
Ramus.
Mandibular fractures are commonly the result of blows to the face and it is not uncommon for both
sides to be affected. Fractures of the condyles lead to temporo-mandibular joint dislocation and
usually are as a result of a blow to the chin. The canine region is the weakest part of the bone due
to the length of the root. Angle fractures can run downwards and forwards, which leads to
impaction and so prevents displacement. Fractures of the body always cause laceration to the
buccal mucosa.
06. A 50-year-old man who had suffered long-standingback pain presents to the accident and
emergency department with a sudden deterioration and pain radiating to the lateral malleolus.
What is the most likely cause of these symptoms?
A prolapsed intervertebral disc at the L4/5 interspace« YOUR ANSWER
A prolapsed intervertebral disc at he L5/S1 interspace« CORRECT ANSWER
A prolapsed intervertebral disc compressing the cauda equina
A prolapsed intervertebral disc compressing the sacral segments of the cord
Collapse of a vertebral body secondary to osteoporosis with subsequent compression of the spinal
canal.
A prolapsed L5–S1 disc presses on the S1 spinal nerve (the L5 nerve passes above the prolapsed
disc in the intervertebral foramen and so escapes damage). At the level of prolapse, the spinal
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail:
, MyPasTest Online: MRCS A - Jan Exam 2015
01. Anatomy-Head, Neck & Spine (163Qs) 61
canal contains the cauda equina and not cord per se. The S1 dermatome lies over the lateral
malleolus. Exaggerated reflexes are diagnostic of an upper motor neurone lesion.
The S2 dermatome occupies the posterior aspect of the calf. Osteoporosis can cause painful
collapse of vertebral bodies but rarely causes neurological symptoms and most often affects older
women.
Page | 3
07. You are assisting your neurosurgical consultant performing an anterior cervical discectomy. He
is concerned about injuring the recurrent laryngeal nerve. Which of the following is correct
regarding the right recurrent laryngeal nerve? Single best answer - select one answer only.
Arises from a cranial nerve passing through the foramen magnum« YOUR ANSWER
Is related to the inferior thyroid artery« CORRECT ANSWER
Passes behind the ligamentum arteriosum
Runs posterior to the oesophagus but anterior to the trachea
Winds around the aortic arch.
The recurrent laryngeal nerves arise from the vagus. On the right, the recurrent laryngeal nerve
winds around the subclavian artery; on the left, it winds around the aortic arch, passing behind the
ligamentum arteriosum. Both nerves run in a groove between the trachea and oesophagus and are
closely related to the inferior thyroid artery.
08. A 63-year-old female undergoes a subtotal thyroidectomy for a toxic multinodular goitre.
Which of the following statements is most likely to be true? Select one answer only.
Damage to the external laryngeal nerve causes loss of low pitched phonation« YOUR ANSWER
The inferior thyroid artery arises from the origin of the external carotid artery
The inferior thyroid artery should be ligated as far laterally as possible« CORRECT ANSWER
The isthmus lies anterior to the thyroid cartilage
The superior thyroid artery enters the upper pole of the thyroid gland close to the recurrent laryngeal
nerve.
The superior thyroid artery arises from the external carotid artery and enters the upper pole of the
thyroid gland close to the external laryngeal nerve, which supplies the cricothyroid muscle, a
tensor of the vocal cord. Damage to this nerve causes the loss of high-pitched phonation. The
inferior thyroid artery, absent in 5%, arises from the thyrocervical trunk of the subclavian artery.
The inferior thyroid artery should be ligated as far laterally as possible to avoid damaging the
recurrent laryngeal nerve. Damage to one recurrent laryngeal nerve causes a weakened voice,
damage to both causes semiadduction and respiratory difficulties. The isthmus is normally in front
of the second and third tracheal rings, although variations are common.
09. A 22-year-old man sustained facial injuries playing rugby. Which radiological investigation is
the most helpful to plan surgery?
Angiography« YOUR ANSWER
Computed tomography (CT) scanning« CORRECT ANSWER
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail:
, MyPasTest Online: MRCS A - Jan Exam 2015
01. Anatomy-Head, Neck & Spine (163Qs) 61
Facial view X-rays showing fluid in the paranasal sinuses
MRI
Waters’ facial view.
Computed tomography (CT) scanning is essential when planning reconstruction of facial fractures, Page | 4
especially complex ones. CT scanning also delineates soft tissue damage adequately. Indirect
signs of a fracture include soft tissue swelling, periorbital or intracranial air and fluid in the
paranasal sinus.
Four facial X-rays are usually taken: Waters‟ view (posterior–anterior (PA) with cephalad
angulation), Caldwell (PA view), lateral view and occipito-submentovertex view. Waters‟ view tends
to show all facial structures the best. Lines of Dolan (I–III) are three anatomic contours that
correspond to facially important structures.
10. A 25-year-old male who is in Burns intensive care having sustained 42% burns in a house fire is
on day 12 post injury and remains intubated and ventilated. The Consultant Anaesthetist feels he
will not be ready for extubation for a while and the decision is made to perform a tracheostomy. A
size 7 tracheostomy tube is used. Which of the following does the tube size relate to? Select one
answer only.
Distance from tracheostomy tube tip to carina« YOUR ANSWER
Distance of tracheostomy tube from vocal cords
Internal diameter of the tracheostomy tube« CORRECT ANSWER
Length of the tracheostomy tube
Outer diameter of the tracheostomy tube.
The first tracheal ring is complete in children and must not be excised for fear of tracheal stenosis.
The preferred method is excision of rings 2–4. Tracheostomy should be performed if prolonged
intubation is expected; either percutaneous or open approaches are used.
Fenestrated tubes allow air to be diverted superiorly through the vocal cords so speech can be
possible, but this can also be attained if the tube is occluded with a finger. A size 7 tracheostomy
tube relates to an internal diameter (ID) of 7 mm, not the outer diameter or length.
11. The thyroid gland in some cases can have a thyroidea ima artery that supplies the isthmus of
the thyroid. If present, it would take origin: Single best answer question – choose ONE true option
only.
From the inferior thyroid artery« YOUR ANSWER
Directly from the thyrocervical trunk
From the superior thyroid artery
From the brachiocephalic trunk« CORRECT ANSWER
Directly from the external carotid artery.
The thyroidea ima artery, when present, arises from the brachiocephalic trunk (innominate artery)
and ascends in front of the trachea to the lower part of the thyroid gland, which it supplies. It varies
greatly in size and appears to compensate for deficiency or absence of one of the other thyroid
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail:
01. Anatomy-Head, Neck & Spine (163Qs) 61
01. The inferior sagittal sinus: Single best answer question – choose ONE true option only.
Drains directly into the confluence of sinuses« YOUR ANSWER
Is found in the falx cerebelli
Is formed within the free, inferior border of the falx cerebri« CORRECT ANSWER
Drains into the superior petrosal sinus Page | 1
Contains valves, unlike the other venous dural sinuses.
The inferior sagittal sinus is enclosed in the posterior half or two thirds of the free margin of the
falx cerebri. It is cylindrical in shape. It increases in size as it passes backward and ends in the
straight sinus. It receives several veins from the falx cerebri and occasionally receives a few veins
from the medial surfaces of the hemispheres.
02. You are performing a cranial nerve examination on a patient who has a mild head injury. You
ask them to stick out their tongue. With regards to the examination of the tongue:
It is depressed by the hyoglossus« YOUR ANSWER
It is passive during the voluntary phase of swallowing
It is protruded by the styloglossus
It is retracted by the hyoglossus muscle
It receives sensory innervation from the vagus nerve.
The sensory innervation to the tongue is from the VIIth (facial) and IXth (glossopharyngeal) cranial
nerves and the lingual nerve. The tongue deviates to the side of a XIIth cranial nerve lesion on
protrusion, is active during the first stage of swallowing and contains the lingual tonsil in the
dorsum of its posterior third. The tongue is retracted up and back by the styloglossus muscle,
protruded by genioglossus and depressed by the hyoglossus.
03. The total length of the trachea is 10cm. At what level does the trachea begin?
Bifurcation of common carotid artery« YOUR ANSWER
Cricoid cartilage« CORRECT ANSWER
Hyoid bone
Suprasternal notch
Thyroid cartilage.
The trachea commences just below the cricoid cartilage (at the level of C6). Within the thorax and
on the right, the trachea is in contact with the pleura, vagus and subclavian artery. On its left, the
trachea is in contact with the left recurrent laryngeal nerve, aortic arch and the left common carotid
and subclavian arteries. The trachea ends at the upper border of T5, where it bifurcates.
04. A 72-year-old male presents with a swelling in the anterior triangle of the neck. Biopsy confirms
a superficial submandibular gland carcinoma. Which structure is least likely to be involved? Select
one answer only.
Deep cervical fascia« YOUR ANSWER
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail:
, MyPasTest Online: MRCS A - Jan Exam 2015
01. Anatomy-Head, Neck & Spine (163Qs) 61
Platysma
The cervical branch of the facial nerve« CORRECT ANSWER
The facial artery
The facial vein.
Page | 2
The submandibular gland is a lobulated gland made up of a superficial and a deep part, which are
continuous with each other around the posterior border of the mylohyoid muscle. Part of the gland
lies infero-laterally, enclosed in an investing layer of deep cervical fascia, platysma muscle and
skin. Laterally it is crossed by the cervical branch of the facial nerve and vein.
The facial artery is related to the posterior and superior aspects of the superficial part of the gland.
The marginal mandibular branch of the facial nerve passes beneath platysma and depressor
angulioris in the proximity of the submandibular gland where it may be damaged during surgery.
05. A 21-year-old male is seen in A&E after an assault outside a night club with pain in his jaw. An
X-ray confirms a fracture of the mandible. Which of the following regions is the weakest part of the
mandible? Select one answer only.
Angle« YOUR ANSWER
Canine region« CORRECT ANSWER
Coronoid process
Head
Ramus.
Mandibular fractures are commonly the result of blows to the face and it is not uncommon for both
sides to be affected. Fractures of the condyles lead to temporo-mandibular joint dislocation and
usually are as a result of a blow to the chin. The canine region is the weakest part of the bone due
to the length of the root. Angle fractures can run downwards and forwards, which leads to
impaction and so prevents displacement. Fractures of the body always cause laceration to the
buccal mucosa.
06. A 50-year-old man who had suffered long-standingback pain presents to the accident and
emergency department with a sudden deterioration and pain radiating to the lateral malleolus.
What is the most likely cause of these symptoms?
A prolapsed intervertebral disc at the L4/5 interspace« YOUR ANSWER
A prolapsed intervertebral disc at he L5/S1 interspace« CORRECT ANSWER
A prolapsed intervertebral disc compressing the cauda equina
A prolapsed intervertebral disc compressing the sacral segments of the cord
Collapse of a vertebral body secondary to osteoporosis with subsequent compression of the spinal
canal.
A prolapsed L5–S1 disc presses on the S1 spinal nerve (the L5 nerve passes above the prolapsed
disc in the intervertebral foramen and so escapes damage). At the level of prolapse, the spinal
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail:
, MyPasTest Online: MRCS A - Jan Exam 2015
01. Anatomy-Head, Neck & Spine (163Qs) 61
canal contains the cauda equina and not cord per se. The S1 dermatome lies over the lateral
malleolus. Exaggerated reflexes are diagnostic of an upper motor neurone lesion.
The S2 dermatome occupies the posterior aspect of the calf. Osteoporosis can cause painful
collapse of vertebral bodies but rarely causes neurological symptoms and most often affects older
women.
Page | 3
07. You are assisting your neurosurgical consultant performing an anterior cervical discectomy. He
is concerned about injuring the recurrent laryngeal nerve. Which of the following is correct
regarding the right recurrent laryngeal nerve? Single best answer - select one answer only.
Arises from a cranial nerve passing through the foramen magnum« YOUR ANSWER
Is related to the inferior thyroid artery« CORRECT ANSWER
Passes behind the ligamentum arteriosum
Runs posterior to the oesophagus but anterior to the trachea
Winds around the aortic arch.
The recurrent laryngeal nerves arise from the vagus. On the right, the recurrent laryngeal nerve
winds around the subclavian artery; on the left, it winds around the aortic arch, passing behind the
ligamentum arteriosum. Both nerves run in a groove between the trachea and oesophagus and are
closely related to the inferior thyroid artery.
08. A 63-year-old female undergoes a subtotal thyroidectomy for a toxic multinodular goitre.
Which of the following statements is most likely to be true? Select one answer only.
Damage to the external laryngeal nerve causes loss of low pitched phonation« YOUR ANSWER
The inferior thyroid artery arises from the origin of the external carotid artery
The inferior thyroid artery should be ligated as far laterally as possible« CORRECT ANSWER
The isthmus lies anterior to the thyroid cartilage
The superior thyroid artery enters the upper pole of the thyroid gland close to the recurrent laryngeal
nerve.
The superior thyroid artery arises from the external carotid artery and enters the upper pole of the
thyroid gland close to the external laryngeal nerve, which supplies the cricothyroid muscle, a
tensor of the vocal cord. Damage to this nerve causes the loss of high-pitched phonation. The
inferior thyroid artery, absent in 5%, arises from the thyrocervical trunk of the subclavian artery.
The inferior thyroid artery should be ligated as far laterally as possible to avoid damaging the
recurrent laryngeal nerve. Damage to one recurrent laryngeal nerve causes a weakened voice,
damage to both causes semiadduction and respiratory difficulties. The isthmus is normally in front
of the second and third tracheal rings, although variations are common.
09. A 22-year-old man sustained facial injuries playing rugby. Which radiological investigation is
the most helpful to plan surgery?
Angiography« YOUR ANSWER
Computed tomography (CT) scanning« CORRECT ANSWER
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail:
, MyPasTest Online: MRCS A - Jan Exam 2015
01. Anatomy-Head, Neck & Spine (163Qs) 61
Facial view X-rays showing fluid in the paranasal sinuses
MRI
Waters’ facial view.
Computed tomography (CT) scanning is essential when planning reconstruction of facial fractures, Page | 4
especially complex ones. CT scanning also delineates soft tissue damage adequately. Indirect
signs of a fracture include soft tissue swelling, periorbital or intracranial air and fluid in the
paranasal sinus.
Four facial X-rays are usually taken: Waters‟ view (posterior–anterior (PA) with cephalad
angulation), Caldwell (PA view), lateral view and occipito-submentovertex view. Waters‟ view tends
to show all facial structures the best. Lines of Dolan (I–III) are three anatomic contours that
correspond to facially important structures.
10. A 25-year-old male who is in Burns intensive care having sustained 42% burns in a house fire is
on day 12 post injury and remains intubated and ventilated. The Consultant Anaesthetist feels he
will not be ready for extubation for a while and the decision is made to perform a tracheostomy. A
size 7 tracheostomy tube is used. Which of the following does the tube size relate to? Select one
answer only.
Distance from tracheostomy tube tip to carina« YOUR ANSWER
Distance of tracheostomy tube from vocal cords
Internal diameter of the tracheostomy tube« CORRECT ANSWER
Length of the tracheostomy tube
Outer diameter of the tracheostomy tube.
The first tracheal ring is complete in children and must not be excised for fear of tracheal stenosis.
The preferred method is excision of rings 2–4. Tracheostomy should be performed if prolonged
intubation is expected; either percutaneous or open approaches are used.
Fenestrated tubes allow air to be diverted superiorly through the vocal cords so speech can be
possible, but this can also be attained if the tube is occluded with a finger. A size 7 tracheostomy
tube relates to an internal diameter (ID) of 7 mm, not the outer diameter or length.
11. The thyroid gland in some cases can have a thyroidea ima artery that supplies the isthmus of
the thyroid. If present, it would take origin: Single best answer question – choose ONE true option
only.
From the inferior thyroid artery« YOUR ANSWER
Directly from the thyrocervical trunk
From the superior thyroid artery
From the brachiocephalic trunk« CORRECT ANSWER
Directly from the external carotid artery.
The thyroidea ima artery, when present, arises from the brachiocephalic trunk (innominate artery)
and ascends in front of the trachea to the lower part of the thyroid gland, which it supplies. It varies
greatly in size and appears to compensate for deficiency or absence of one of the other thyroid
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------
Dr Mohammed Shamsul Islam Khan, Medical Officer, Clinical Neuro-Surgery, National Institute of Neuro-Sciences and Hospital
Sher-E-Bangla Nagar, Dhaka-1207, Bangladesh. Mobile: +880 1713 455 662, +880 1685 811979. E-mail:
