CSFA Advanced Surgical Anatomy 4 — Questions and Answers
Question 1: During laparoscopic Nissen fundoplication, which anatomical structure must be divided to achieve adequate esophageal mobilization and reduce hiatal tension?
- Gastrohepatic ligament (pars flaccida)
- Short gastric vessels (Correct answer)
- Gastrophrenic ligament
- Left gastroepiploic artery
Correct answer: Short gastric vessels
Division of the short gastric vessels allows full fundic mobilization so the wrap can be created without tension.
Question 2: The brachial plexus terminal branches arise from which anatomical levels?
- C4-C8
- C5-T1 (Correct answer)
- C6-T1
- C4-T1
Correct answer: C5-T1
The brachial plexus is formed from the ventral rami of C5 through T1, giving rise to all major nerves of the upper extremity.
Question 3: Which compartment of the neck contains the carotid artery, internal jugular vein, and vagus nerve traveling together?
- Visceral compartment
- Carotid sheath (Correct answer)
- Retropharyngeal space
- Posterior triangle
Correct answer: Carotid sheath
The carotid sheath is a fascial compartment containing the common carotid artery, internal jugular vein, and vagus nerve.
Question 4: During a radical nephrectomy, the left renal vein receives which additional tributaries not present on the right?
- Inferior mesenteric vein only
- Left gonadal vein and left adrenal vein (Correct answer)
- Left gonadal vein only
- Left adrenal vein and hemiazygos vein
Correct answer: Left gonadal vein and left adrenal vein
The left renal vein receives the left gonadal (testicular/ovarian) vein and left adrenal vein, which drain directly into it rather than the IVC.
Question 5: The zona orbicularis of the hip joint is best described as:
- A circular band of fibers in the articular capsule that encircles the femoral neck (Correct answer)
- The transverse ligament spanning the acetabular notch
- The fibrocartilaginous labrum of the acetabulum
- The iliofemoral ligament thickening anteriorly
Correct answer: A circular band of fibers in the articular capsule that encircles the femoral neck
The zona orbicularis is a circular band of capsular fibers that encircles the femoral neck and helps retain the femoral head within the acetabulum.
Question 6: Which space, located between the parietal peritoneum and the transversalis fascia, allows for extraperitoneal dissection during laparoscopic hernia repair (TEP)?
- Preperitoneal (Retzius) space (Correct answer)
- Space of Bogros
- Prevesical space
- Retropubic space
Correct answer: Preperitoneal (Retzius) space
The preperitoneal space (space of Retzius) lies between the transversalis fascia and parietal peritoneum, and is developed during totally extraperitoneal hernia repair.
Question 7: During aortic valve replacement, the bundle of His is at risk because it passes through which anatomical region?
- Anterior leaflet of the mitral valve
- Membranous interventricular septum near the non-coronary and right coronary cusp junction (Correct answer)
- Muscular interventricular septum
- Posterior commissure of the aortic valve
Correct answer: Membranous interventricular septum near the non-coronary and right coronary cusp junction
The bundle of His traverses the membranous septum just below the commissure between the non-coronary and right coronary cusps, making it vulnerable during aortic valve suturing.
CSFA Advanced Surgical Anatomy 4
During laparoscopic Nissen fundoplication, which anatomical structure must be divided to achieve adequate esophageal mobilization and reduce hiatal tension?