First FRCR Anatomy: Mock Papers Matthew Budak, Magdalena Szewczyk Bieda, Richard White, Menelaos Philippou, Ganapathy Ananthakrishnan
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Mock paper 1Chapter 1

20 cases to be answered in 75 minutes
2
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Case 1.1
Case 1.1
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure that inserts into the structure labelled E.
Case 1.1
  1. Proximal tibiofibular joint
  2. Patella
  3. Infrapatellar (Hoffa's) fat pad
  4. Distal femoral diaphysis
  5. Patellar tendon
The patella lies in the anterior trochlear groove of the femur and is stabilised by the quadriceps tendon superiorly and the patellar tendon inferiorly. The patellar tendon courses superficial to Hoffa's fat pad and inserts onto the tibial tuberosity.
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Case 1.2
Case 1.2
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the lobar segment labelled D.
E
Name the chamber labelled E.
Case 1.2
  1. Apicoposterior segment bronchus of the left upper lobe
  2. Anteromedial basal segment of the left lower lobe
  3. Left lower lobe bronchus
  4. Superior lingular segmental bronchus
  5. Left ventricle
The left lung comprises two lobes, the upper and lower lobes.
The segmental anatomy of the left upper lobe includes:
  • apicoposterior segment
  • anterior segment
  • lingula
    • superior lingular segment
    • inferior lingular segment
The segmental anatomy of the left lower lobe includes:
  • superior (apical) segment
  • anteromedial basal segment
  • lateral basal segment
  • posterior basal segment
The key to answering this question is dependent on identifying whether one is on the left or right side of the thorax. The clue lies in (E), a thick muscular walled chamber of the heart - the left ventricle.
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Case 1.3
Case 1.3
QUESTION
WRITE YOUR ANSWER HERE
A
Name the vein labelled A.
B
Which plexus of veins is depicted by B?
C
Name the foramen labelled C.
D
Name the joint labelled D.
E
Name the osseous line labelled E.
Case 1.3
  1. Left testicular vein
  2. Left pampiniform plexus
  3. Left obturator foramen
  4. Symphysis pubis
  5. Left Iliopectineal line
The testicular vein drains venous blood from the pampiniform plexus of the testes. They usually drain into the left renal vein on the left and inferior vena cava on the right, but considerable variation may be seen. Understanding of venous anatomy is necessary prior to attempting embolisation for varicocoeles.
Testicular arteries are branches of the abdominal aorta arising at the level of the renal arteries.
5
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Case 1.4
Case 1.4
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.4
  1. Intrahepatic segment of inferior vena cava
  2. Right hepatic vein
  3. Branch of right portal vein
  4. Middle hepatic vein
  5. Left hepatic vein
This ultrasound image clearly shows the three hepatic veins (right, middle and left) converging to join the intrahepatic segment of the inferior vena cava, just before it drains into the right atrium. Other than different directions of flow, branches of the portal vein demonstrate increased echogenicity of the vessel wall as compared to hepatic veins.
6
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Case 1.5
Case 1.5
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Which anatomical variant ispresenton this image?
Case 1.5
  1. Left common carotid artery
  2. Left vertebral artery
  3. Brachiocephalic trunk/innominate artery
  4. Right common carotid artery
  5. Common origin of left common carotid artery and brachiocephalic trunk
The second most common variant of aortic arch branching occurs when the left common carotid artery has a common origin with the innominate artery. Rather than arising directly from the aortic arch as a separate branch, the left common carotid artery origin is moved to the right and merges with the origin of the innominate artery. This variant is often termed a 'bovine aortic arch' which is a misnomer as it has no resemblance to the arterial branching pattern seen in cattle.
7
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Case 1.6
Case 1.6
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the cranial nerve labelled E.
Case 1.6
  1. Right middle cerebral artery
  2. Pituitary gland
  3. Sphenoid sinus
  4. Cavernous portion of the right internal carotid artery
  5. Oculomotor nerve (CN III)
Cavernous sinuses are paired extradural venous channels situated on either side of the pituitary fossa. They communicate posteriorly with the transverse sinuses and serve as a pathway for the internal carotid artery and the III, IV, V1, V2 and VI cranial nerves.
The oculomotor nerve is the uppermost cranial nerve in the cavernous sinus, and is located lateral to the cavernous portion of the carotid artery. CN IV, V1, V2, VI lie inferior to CN III, in that order.
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Case 1.7
Case 1.7
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the colonic segment labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.7
  1. Right lobe of liver
  2. Left rectus abdominis muscle belly
  3. Transverse colon
  4. Left psoas major muscle
  5. Right quadratus lumborum muscle belly
The abdominal wall can be divided into three parts: anterior, lateral and posterior. Each part of the abdominal wall is comprised of multiple layers, including skin, subcutaneous fat, fascial and muscular layers and parietal peritoneum. The muscular layer of the posterior abdominal wall consists of the following muscles:
  • psoas major and minor muscles medially
  • quadratus lumborum and erector spinae muscles laterally
  • iliacus muscle inferiorly
  • diaphragm superiorly
9
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Case 1.8
Case 1.8
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
What part of the urethra does C correspond to?
D
What part of the urethra does D correspond to?
E
What part of the urethra does E correspond to?
Case 1.8
  1. Cowper's (bulbourethral) gland
  2. Duct of bulbourethral gland
  3. Penile urethra
  4. Bulbous urethra
  5. Prostatic urethra
Retrograde urethrography is used to demonstrate structural abnormalities of the urethra, including strictures and (in the event of trauma) urethral disruption. It is performed by placing the tip of a catheter inside the navicular fossa - a focal dilatation just proximal to the urethral meatus - and instilling contrast in a retrograde manner. Anatomically, the male urethra is divided into posterior and anterior portions. The posterior urethra comprises the prostatic urethra (the portion passing from the bladder neck through the prostate) and the membranous urethra (which extends through the urogenital diaphragm). The anterior urethra is composed of the bulbar urethra (between the urogenital diaphragm and root of the penis) and the penile urethra. The navicular fossa and meatus may also be included with the anterior urethra.
The paired Cowper's (or bulbourethral) glands are exocrine glands which are equivalent to Bartholin's glands in females.
10
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Case 1.9
Case 1.9
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the linear structure labelled E.
Case 1.9
  1. Anterior junctional line
  2. Ascending aorta
  3. Anterior segmental bronchus of right upper lobe
  4. Apical segmental bronchus of right upper lobe
  5. Left oblique fissure
The right main bronchus divides into the right upper lobe bronchus and bronchus intermedius. The bronchus intermedius gives off the middle and lower lobe bronchi.
11
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Case 1.10
Case 1.10
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the spaces labelled E.
Case 1.10
  1. Lens
  2. Superior rectus muscle
  3. Retro-orbital fat
  4. Optic nerve
  5. Cerebellar folia
The striated extraocular muscles, responsible for eye movements, form the conus. The conus divides the orbit into intraconal and extraconal compartments.
The conus is bounded by seven muscles which insert anteriorly into the orbital sclera and posteriorly into the sheath of the optic nerve:
  • four recti muscles: medial (the largest), lateral, superior and inferior
  • two oblique muscles: superior and inferior
  • levator palpebrae superioris.
12
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Case 1.11
Case 1.11
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.11
  1. Intrahepatic inferior vena cava
  2. Gastric lumen
  3. Right suprarenal gland
  4. Body of L4 vertebra
  5. Gluteus medius muscle
Both triangular shaped suprarenal (adrenal) glands can usually be identified lying superior to the upper pole of each kidney. Note the relation of the right suprarenal gland superior and medial to the right kidney. The left suprarenal gland may not be visible at the same axial level as it is often found in a slightly more superior position compared to the right.
13
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Case 1.12
Case 1.12
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.12
  1. Left brachiocephalic vein
  2. Right cephalic vein
  3. Left internal carotid artery
  4. Basilar artery
  5. Superior vena cava
This coronal maximum intensity projection (MIP) slab nicely demonstrates the vascular anatomy of the chest and neck.
The cephalic vein joins the axillary vein to form the subclavian vein. The basilar artery is formed by the union of both vertebral arteries.
14
zoom view
Case 1.13
Case 1.13
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.13
  1. Right sesamoid bone (in flexor hallucis brevis tendon)
  2. Left fourth metatarsophalangeal joint
  3. Right navicular bone
  4. Tuft of the distal phalanx of the left great toe
  5. Left intermediate cuneiform bone
Remember to name the side of the labelled structure when this information is provided on the image in question. The anatomy exam is testing your understanding of radiological anatomy but is also seeing if you can translate this into a report that is understandable by clinicians.
The osseous anatomy of the mid- and forefoot is fundamental knowledge and if you are struggling with this question please refer back to an anatomy text/atlas.
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Case 1.14
Case 1.14
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the space labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Which anatomical variant ispresent on this image?
Case 1.14
  1. Falx cerebri
  2. Interhemispheric fissure
  3. Occipital horn of the right lateral ventricle
  4. Superior sagittal sinus
  5. Cavum septum pellucidum et vergae
Septum pellucidum separates the anterior horns and bodies of the lateral ventricles. It consists of two laminae which attach anteriorly to the corpus callosum and posteriorly to the fornix.
In neonates, there is a narrow cavity between the laminae which does not communicate with the subarachnoid space, called cavum septum pellucidum (CSP). Over 85% of them fuse by 3-6 months of age. In the remaining 15%, the CSP persists as a normal anatomical variant.
Cavum septum pellucidum et vergae is a variant of CSP in which it continues posteriorly, inferior to the splenium and superior fornix.
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Case 1.15
Case 1.15
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.15
  1. Mitral valve (anterior leaflet)
  2. Muscular portion of interventricular septum
  3. Tricuspid valve (anterior leaflet)
  4. Left inferior pulmonary vein
  5. Spinal cord
Note that the septal leaflet of the mitral valve inserts into the septum at a different level to the septal leaflet of the tricuspid valve, being located more inferiorly towards the right ventricle. This is an important normal anatomical relationship and this offset should be looked for when performing a fetal heart scan at 18 weeks gestation. Tricuspid and mitral leaflets at the same level are often an indication of serious septal defects, e.g. atrioventricular defects. Also note that with this normal offset relationship, there is the potential for a septal defect to occur between the left ventricle and the right atrium, a rare occurrence known as a Gerbode defect.
17
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Case 1.16
Case 1.16
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the lucent structure labelled B.
C
Name the soft tissue density structure outlined by the arrows labelled C.
D
Name the structure labelled D.
E
At what vertebral level does the oesophagus normally traverse the diaphragm?
Case 1.16
  1. Right hemidiaphragm
  2. Left main bronchus
  3. Aortic arch
  4. Left clavicle
  5. T10
There are three main diaphragmatic hiatuses: the caval hiatus at T8 (most anterior); the oesophageal hiatus at T10 (middle); and the aortic hiatus at T12 (most posterior). The oesophagus is normally indented at several points along its length by anatomical structures. The most inferior of these is at the oesophageal hiatus, caused by a diaphragmatic impression. The left atrium causes a longer impression above this; due to this anatomical relationship, contrast swallow examinations have been used as a means of diagnosing left atrial enlargement. Superiorly to this a combination of the aortic arch and the left main bronchus cause an indentation in the left anterior aspect of the oesophagus.
18
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Case 1.17
Case 1.17
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.17
  1. L4/L5 intervertebral disc
  2. Right pectineus muscle
  3. Right iliotibial band/tract
  4. Left obturator internus muscle
  5. Right gracilis muscle
The iliotibial band is a lateral fibrous tract which originates from the iliac tubercle and inserts into the lateral condyle of the tibia. Due to its fibrous nature, it is distinctively shown as a low signal band on the lateral aspect of the thigh within the subcutaneous fat.
The pectineus muscle originates from the pectineal line of the pubis and inserts into the pectineal line of the superomedial femur - remember pectineus = PPP.
19
zoom view
Case 1.18
Case 1.18
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.18
  1. Right external auditory canal
  2. Right carotid canal
  3. Right zygomatic arch
  4. Left nasal bone
  5. Left jugular foramen
The petrous portion of the temporal bone contains two important foramina:
The jugular foramen lies inferior to the middle ear cavity and posterior to the carotid canal. It transmits the jugular vein and glossopharyngeal (CN IX), vagus (CN X) and accessory (CN XI) cranial nerves. Jugular foramina often differ in size, with the right usually larger than the left.
The carotid canal lies anteromedial to the jugular foramen in the petrous apex. It transmits the internal carotid artery from the neck to the cranium.
20
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Case 1.19
Case 1.19
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
What name is given to the ligament connecting the laminae of adjacent vertebrae?
Case 1.19
  1. Tectorial membrane
  2. Posterior arch of C1
  3. Transverse ligament
  4. Posterior longitudinal ligament
  5. Ligamentum flavum
A range of ligaments are involved in maintaining the stability of the spine and in particular the craniocervical junction. The posterior longitudinal ligament runs up the posterior aspects of the vertebral bodies and intervertebral discs, being continuous with the tectorial membrane superiorly which blends with dura at the level of foramen magnum. The transverse ligament arches across the C1 ring to support the odontoid peg. Fibres from the midpoint of this ligament pass superiorly and inferiorly to form the cruciate ligament. Ligamentum flavum connects laminae of adjacent vertebrae from the level of C2-S1. Hypertrophy of this ligament may be evident on MRI as a potential cause of neurological symptoms.
21
zoom view
Case 1.20
Case 1.20
QUESTION
WRITE YOUR ANSWER HERE
A
Name the ossification centre labelled A.
B
Name the ossification centre labelled B.
C
Name the ossification centre labelled C.
D
Name the ossification centre labelled D.
E
Name the ossification centre labelled E.
Case 1.20
  1. Olecranon
  2. Medial epicondyle
  3. Trochlea
  4. Radial head
  5. Capitulum
In a patient of this age (9 years old), typically the only ossification centre not yet visible is the lateral epicondyle (usually visible at approximately 11 years of age). The olecranon is usually more readily identifiable on the lateral radiograph but can be clearly seen here. The mnemonic CRITOL can be used to help remember the order in which different ossification centres become visible, which can be very important in the context of trauma. The order is usually Capitulum (approximately 1 year of age), Radial head (3 years of age), Internal (medial) epicondyle (5 years of age), Trochlea (7 years of age), Olecranon (9 years of age) and Lateral epicondyle (11 years of age). The numerical sequence 1 – 3 – 5 – 7 – 9 – 11 is a useful approximation of the age at which each centre begins to ossify.
22
Answers
Case 1.1
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure that inserts into the structure labelled E.
Case 1.1
  1. Proximal tibiofibular joint
  2. Patella
  3. Infrapatellar (Hoffa's) fat pad
  4. Distal femoral diaphysis
  5. Patellar tendon
The patella lies in the anterior trochlear groove of the femur and is stabilised by the quadriceps tendon superiorly and the patellar tendon inferiorly. The patellar tendon courses superficial to Hoffa's fat pad and inserts onto the tibial tuberosity.
Case 1.2
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the lobar segment labelled D.
E
Name the chamber labelled E.
Case 1.2
  1. Apicoposterior segment bronchus of the left upper lobe
  2. Anteromedial basal segment of the left lower lobe
  3. Left lower lobe bronchus
  4. Superior lingular segmental bronchus
  5. Left ventricle
The left lung comprises two lobes, the upper and lower lobes.
The segmental anatomy of the left upper lobe includes:
  • apicoposterior segment
  • anterior segment
  • lingula
    • superior lingular segment
    • inferior lingular segment
The segmental anatomy of the left lower lobe includes:
  • superior (apical) segment
  • anteromedial basal segment
  • lateral basal segment
  • posterior basal segment
The key to answering this question is dependent on identifying whether one is on the left or right side of the thorax. The clue lies in (E), a thick muscular walled chamber of the heart - the left ventricle.23
Case 1.3
QUESTION
WRITE YOUR ANSWER HERE
A
Name the vein labelled A.
B
Which plexus of veins is depicted by B?
C
Name the foramen labelled C.
D
Name the joint labelled D.
E
Name the osseous line labelled E.
Case 1.3
  1. Left testicular vein
  2. Left pampiniform plexus
  3. Left obturator foramen
  4. Symphysis pubis
  5. Left Iliopectineal line
The testicular vein drains venous blood from the pampiniform plexus of the testes. They usually drain into the left renal vein on the left and inferior vena cava on the right, but considerable variation may be seen. Understanding of venous anatomy is necessary prior to attempting embolisation for varicocoeles.
Testicular arteries are branches of the abdominal aorta arising at the level of the renal arteries.
Case 1.4
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.4
  1. Intrahepatic segment of inferior vena cava
  2. Right hepatic vein
  3. Branch of right portal vein
  4. Middle hepatic vein
  5. Left hepatic vein
This ultrasound image clearly shows the three hepatic veins (right, middle and left) converging to join the intrahepatic segment of the inferior vena cava, just before it drains into the right atrium. Other than different directions of flow, branches of the portal vein demonstrate increased echogenicity of the vessel wall as compared to hepatic veins.
Case 1.5
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Which anatomical variant ispresenton this image?
Case 1.5
  1. Left common carotid artery
  2. Left vertebral artery
  3. Brachiocephalic trunk/innominate artery
  4. Right common carotid artery
  5. Common origin of left common carotid artery and brachiocephalic trunk
The second most common variant of aortic arch branching occurs when the left common carotid artery has a common origin with the innominate artery. Rather 24than arising directly from the aortic arch as a separate branch, the left common carotid artery origin is moved to the right and merges with the origin of the innominate artery. This variant is often termed a 'bovine aortic arch' which is a misnomer as it has no resemblance to the arterial branching pattern seen in cattle.
Case 1.6
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the cranial nerve labelled E.
Case 1.6
  1. Right middle cerebral artery
  2. Pituitary gland
  3. Sphenoid sinus
  4. Cavernous portion of the right internal carotid artery
  5. Oculomotor nerve (CN III)
Cavernous sinuses are paired extradural venous channels situated on either side of the pituitary fossa. They communicate posteriorly with the transverse sinuses and serve as a pathway for the internal carotid artery and the III, IV, V1, V2 and VI cranial nerves.
The oculomotor nerve is the uppermost cranial nerve in the cavernous sinus, and is located lateral to the cavernous portion of the carotid artery. CN IV, V1, V2, VI lie inferior to CN III, in that order.
Case 1.7
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the colonic segment labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.7
  1. Right lobe of liver
  2. Left rectus abdominis muscle belly
  3. Transverse colon
  4. Left psoas major muscle
  5. Right quadratus lumborum muscle belly
The abdominal wall can be divided into three parts: anterior, lateral and posterior. Each part of the abdominal wall is comprised of multiple layers, including skin, subcutaneous fat, fascial and muscular layers and parietal peritoneum. The muscular layer of the posterior abdominal wall consists of the following muscles:
  • psoas major and minor muscles medially
  • quadratus lumborum and erector spinae muscles laterally
  • iliacus muscle inferiorly
  • diaphragm superiorly
Case 1.8
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
What part of the urethra does C correspond to?
D
What part of the urethra does D correspond to?
E
What part of the urethra does E correspond to?
Case 1.8
  1. Cowper's (bulbourethral) gland
  2. Duct of bulbourethral gland
  3. Penile urethra
    25
  4. Bulbous urethra
  5. Prostatic urethra
Retrograde urethrography is used to demonstrate structural abnormalities of the urethra, including strictures and (in the event of trauma) urethral disruption. It is performed by placing the tip of a catheter inside the navicular fossa - a focal dilatation just proximal to the urethral meatus - and instilling contrast in a retrograde manner. Anatomically, the male urethra is divided into posterior and anterior portions. The posterior urethra comprises the prostatic urethra (the portion passing from the bladder neck through the prostate) and the membranous urethra (which extends through the urogenital diaphragm). The anterior urethra is composed of the bulbar urethra (between the urogenital diaphragm and root of the penis) and the penile urethra. The navicular fossa and meatus may also be included with the anterior urethra.
The paired Cowper's (or bulbourethral) glands are exocrine glands which are equivalent to Bartholin's glands in females.
Case 1.9
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the linear structure labelled E.
Case 1.9
  1. Anterior junctional line
  2. Ascending aorta
  3. Anterior segmental bronchus of right upper lobe
  4. Apical segmental bronchus of right upper lobe
  5. Left oblique fissure
The right main bronchus divides into the right upper lobe bronchus and bronchus intermedius. The bronchus intermedius gives off the middle and lower lobe bronchi.
Case 1.10
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the spaces labelled E.
Case 1.10
  1. Lens
  2. Superior rectus muscle
  3. Retro-orbital fat
  4. Optic nerve
  5. Cerebellar folia
The striated extraocular muscles, responsible for eye movements, form the conus. The conus divides the orbit into intraconal and extraconal compartments.
The conus is bounded by seven muscles which insert anteriorly into the orbital sclera and posteriorly into the sheath of the optic nerve:
  • four recti muscles: medial (the largest), lateral, superior and inferior
  • two oblique muscles: superior and inferior
  • levator palpebrae superioris.26
Case 1.11
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.11
  1. Intrahepatic inferior vena cava
  2. Gastric lumen
  3. Right suprarenal gland
  4. Body of L4 vertebra
  5. Gluteus medius muscle
Both triangular shaped suprarenal (adrenal) glands can usually be identified lying superior to the upper pole of each kidney. Note the relation of the right suprarenal gland superior and medial to the right kidney. The left suprarenal gland may not be visible at the same axial level as it is often found in a slightly more superior position compared to the right.
Case 1.12
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.12
  1. Left brachiocephalic vein
  2. Right cephalic vein
  3. Left internal carotid artery
  4. Basilar artery
  5. Superior vena cava
This coronal maximum intensity projection (MIP) slab nicely demonstrates the vascular anatomy of the chest and neck.
The cephalic vein joins the axillary vein to form the subclavian vein. The basilar artery is formed by the union of both vertebral arteries.
Case 1.13
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.13
  1. Right sesamoid bone (in flexor hallucis brevis tendon)
  2. Left fourth metatarsophalangeal joint
  3. Right navicular bone
  4. Tuft of the distal phalanx of the left great toe
  5. Left intermediate cuneiform bone
Remember to name the side of the labelled structure when this information is provided on the image in question. The anatomy exam is testing your understanding of radiological anatomy but is also seeing if you can translate this into a report that is understandable by clinicians.
The osseous anatomy of the mid- and forefoot is fundamental knowledge and if you are struggling with this question please refer back to an anatomy text/atlas.27
Case 1.14
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the space labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Which anatomical variant ispresent on this image?
Case 1.14
  1. Falx cerebri
  2. Interhemispheric fissure
  3. Occipital horn of the right lateral ventricle
  4. Superior sagittal sinus
  5. Cavum septum pellucidum et vergae
Septum pellucidum separates the anterior horns and bodies of the lateral ventricles. It consists of two laminae which attach anteriorly to the corpus callosum and posteriorly to the fornix.
In neonates, there is a narrow cavity between the laminae which does not communicate with the subarachnoid space, called cavum septum pellucidum (CSP). Over 85% of them fuse by 3-6 months of age. In the remaining 15%, the CSP persists as a normal anatomical variant.
Cavum septum pellucidum et vergae is a variant of CSP in which it continues posteriorly, inferior to the splenium and superior fornix.
Case 1.15
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.15
  1. Mitral valve (anterior leaflet)
  2. Muscular portion of interventricular septum
  3. Tricuspid valve (anterior leaflet)
  4. Left inferior pulmonary vein
  5. Spinal cord
Note that the septal leaflet of the mitral valve inserts into the septum at a different level to the septal leaflet of the tricuspid valve, being located more inferiorly towards the right ventricle. This is an important normal anatomical relationship and this offset should be looked for when performing a fetal heart scan at 18 weeks gestation. Tricuspid and mitral leaflets at the same level are often an indication of serious septal defects, e.g. atrioventricular defects. Also note that with this normal offset relationship, there is the potential for a septal defect to occur between the left ventricle and the right atrium, a rare occurrence known as a Gerbode defect.
Case 1.16
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the lucent structure labelled B.
C
Name the soft tissue density structure outlined by the arrows labelled C.
D
Name the structure labelled D.
E
At what vertebral level does the oesophagus normally traverse the diaphragm?
Case 1.16
  1. Right hemidiaphragm
  2. Left main bronchus
  3. Aortic arch
  4. Left clavicle
  5. T10
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There are three main diaphragmatic hiatuses: the caval hiatus at T8 (most anterior); the oesophageal hiatus at T10 (middle); and the aortic hiatus at T12 (most posterior). The oesophagus is normally indented at several points along its length by anatomical structures. The most inferior of these is at the oesophageal hiatus, caused by a diaphragmatic impression. The left atrium causes a longer impression above this; due to this anatomical relationship, contrast swallow examinations have been used as a means of diagnosing left atrial enlargement. Superiorly to this a combination of the aortic arch and the left main bronchus cause an indentation in the left anterior aspect of the oesophagus.
Case 1.17
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.17
  1. L4/L5 intervertebral disc
  2. Right pectineus muscle
  3. Right iliotibial band/tract
  4. Left obturator internus muscle
  5. Right gracilis muscle
The iliotibial band is a lateral fibrous tract which originates from the iliac tubercle and inserts into the lateral condyle of the tibia. Due to its fibrous nature, it is distinctively shown as a low signal band on the lateral aspect of the thigh within the subcutaneous fat.
The pectineus muscle originates from the pectineal line of the pubis and inserts into the pectineal line of the superomedial femur - remember pectineus = PPP.
Case 1.18
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
Name the structure labelled E.
Case 1.18
  1. Right external auditory canal
  2. Right carotid canal
  3. Right zygomatic arch
  4. Left nasal bone
  5. Left jugular foramen
The petrous portion of the temporal bone contains two important foramina:
The jugular foramen lies inferior to the middle ear cavity and posterior to the carotid canal. It transmits the jugular vein and glossopharyngeal (CN IX), vagus (CN X) and accessory (CN XI) cranial nerves. Jugular foramina often differ in size, with the right usually larger than the left.
The carotid canal lies anteromedial to the jugular foramen in the petrous apex. It transmits the internal carotid artery from the neck to the cranium.29
Case 1.19
QUESTION
WRITE YOUR ANSWER HERE
A
Name the structure labelled A.
B
Name the structure labelled B.
C
Name the structure labelled C.
D
Name the structure labelled D.
E
What name is given to the ligament connecting the laminae of adjacent vertebrae?
Case 1.19
  1. Tectorial membrane
  2. Posterior arch of C1
  3. Transverse ligament
  4. Posterior longitudinal ligament
  5. Ligamentum flavum
A range of ligaments are involved in maintaining the stability of the spine and in particular the craniocervical junction. The posterior longitudinal ligament runs up the posterior aspects of the vertebral bodies and intervertebral discs, being continuous with the tectorial membrane superiorly which blends with dura at the level of foramen magnum. The transverse ligament arches across the C1 ring to support the odontoid peg. Fibres from the midpoint of this ligament pass superiorly and inferiorly to form the cruciate ligament. Ligamentum flavum connects laminae of adjacent vertebrae from the level of C2-S1. Hypertrophy of this ligament may be evident on MRI as a potential cause of neurological symptoms.
Case 1.20
QUESTION
WRITE YOUR ANSWER HERE
A
Name the ossification centre labelled A.
B
Name the ossification centre labelled B.
C
Name the ossification centre labelled C.
D
Name the ossification centre labelled D.
E
Name the ossification centre labelled E.
Case 1.20
  1. Olecranon
  2. Medial epicondyle
  3. Trochlea
  4. Radial head
  5. Capitulum
In a patient of this age (9 years old), typically the only ossification centre not yet visible is the lateral epicondyle (usually visible at approximately 11 years of age). The olecranon is usually more readily identifiable on the lateral radiograph but can be clearly seen here. The mnemonic CRITOL can be used to help remember the order in which different ossification centres become visible, which can be very important in the context of trauma. The order is usually Capitulum (approximately 1 year of age), Radial head (3 years of age), Internal (medial) epicondyle (5 years of age), Trochlea (7 years of age), Olecranon (9 years of age) and Lateral epicondyle (11 years of age). The numerical sequence 1 – 3 – 5 – 7 – 9 – 11 is a useful approximation of the age at which each centre begins to ossify.
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