CSFA Advanced Surgical Anatomy 5 — Questions and Answers
Question 1: During a carotid endarterectomy, injury to which nerve results in hoarseness and difficulty swallowing?
- Hypoglossal nerve (CN XII)
- Superior laryngeal nerve
- Recurrent laryngeal nerve (Correct answer)
- Glossopharyngeal nerve (CN IX)
Correct answer: Recurrent laryngeal nerve
The recurrent laryngeal nerve innervates the intrinsic laryngeal muscles, and injury causes ipsilateral vocal cord paralysis with hoarseness.
Question 2: The arcuate line (linea semicircularis) of the rectus sheath is significant because below it:
- The anterior wall of the rectus sheath is absent
- The posterior wall of the rectus sheath is absent (Correct answer)
- Both walls are absent
- The transversalis fascia is absent
Correct answer: The posterior wall of the rectus sheath is absent
Below the arcuate line, all aponeurotic layers pass anterior to the rectus abdominis, leaving the posterior wall formed only by transversalis fascia.
Question 3: Which ligament of the knee contains the blood supply to the anterior cruciate ligament (ACL) and must be respected during arthroscopic ACL reconstruction?
- Lateral capsular ligament
- Infrapatellar fat pad vessels
- Middle geniculate artery via the synovial sheath (Correct answer)
- Posterior oblique ligament
Correct answer: Middle geniculate artery via the synovial sheath
The ACL receives its blood supply primarily from the middle geniculate artery through the synovial sheath surrounding it.
Question 4: During open Roux-en-Y gastric bypass, the Roux limb must pass through which anatomical route to reach the gastric pouch?
- Antecolic, antegastric route (Correct answer)
- Retrocolic, retrogastric route
- Antecolic, retrogastric route
- Retrocolic, antegastric route
Correct answer: Antecolic, antegastric route
The antecolic, antegastric route is preferred in most laparoscopic gastric bypass procedures as it avoids internal hernias through the mesocolon.
Question 5: The pudendal nerve (S2-S4) exits the pelvis through the greater sciatic foramen and re-enters through the lesser sciatic foramen to travel in which canal?
- Obturator canal
- Alcock's canal (Correct answer)
- Adductor canal
- Femoral canal
Correct answer: Alcock's canal
The pudendal nerve travels through Alcock's canal (pudendal canal) along the lateral wall of the ischioanal fossa after re-entering through the lesser sciatic foramen.
Question 6: During thoracoscopic sympathectomy for hyperhidrosis, the sympathetic chain is transected at T2-T4 level. Horner's syndrome results if the chain is disrupted at which level?
- T4
- T3
- T2
- T1 or above (Correct answer)
Correct answer: T1 or above
Horner's syndrome (ptosis, miosis, anhidrosis) results from disruption of sympathetic fibers at T1 or the stellate ganglion, which is above the intended T2-T4 level.
Question 7: The coronary ligament of the liver marks the boundary between which two hepatic surfaces?
- Left lobe and caudate lobe
- Diaphragmatic surface and the bare area (Correct answer)
- Visceral surface and the falciform ligament
- Right lobe and the porta hepatis
Correct answer: Diaphragmatic surface and the bare area
The coronary ligament reflects from the diaphragm to the liver, marking the boundary of the bare area (area nuda) on the diaphragmatic surface.
CSFA Advanced Surgical Anatomy 5
During a carotid endarterectomy, injury to which nerve results in hoarseness and difficulty swallowing?