CST Surgical Anatomy by Specialty 3 — Questions and Answers
Question 1: During a femoral hernia repair, which anatomical landmark defines the medial boundary of the femoral ring?
- Femoral vein
- Lacunar (Gimbernat's) ligament (Correct answer)
- Inguinal ligament
- Pectineal (Cooper's) ligament
Correct answer: Lacunar (Gimbernat's) ligament
The lacunar (Gimbernat's) ligament forms the sharp medial boundary of the femoral ring and must be incised with care to reduce an incarcerated femoral hernia.
Question 2: In neurosurgery, the middle meningeal artery is a branch of which vessel and runs in which cranial layer?
- Internal carotid artery; subarachnoid space
- Maxillary artery; epidural space (Correct answer)
- External carotid artery; subdural space
- Ophthalmic artery; epidural space
Correct answer: Maxillary artery; epidural space
The middle meningeal artery is a branch of the maxillary artery (from the external carotid) and runs in the epidural space; injury causes epidural hematoma.
Question 3: During a colectomy, which structure must be identified and preserved as it courses near the inferior mesenteric artery?
- Left ureter (Correct answer)
- Gonadal vein
- Sympathetic hypogastric plexus
- Lumbar lymphatic trunk
Correct answer: Left ureter
The left ureter crosses the left common iliac artery near the IMA origin and must be identified before ligation of the inferior mesenteric artery to prevent ureteral injury.
Question 4: In shoulder arthroplasty, the axillary nerve is at greatest risk during which surgical step?
- Detachment of the subscapularis tendon
- Inferior capsular release (Correct answer)
- Glenoid exposure and reaming
- Humeral head osteotomy
Correct answer: Inferior capsular release
The axillary nerve courses 5–7 mm inferior to the glenohumeral joint capsule and is most vulnerable during inferior capsular release.
Question 5: During an anterior cervical discectomy and fusion (ACDF), retraction of the carotid sheath laterally exposes which structure that must be protected medially?
- Vertebral artery
- Esophagus and trachea (Correct answer)
- Thoracic duct
- Phrenic nerve
Correct answer: Esophagus and trachea
Medial structures—the esophagus and trachea—are retracted medially during ACDF; injury to the esophagus is a serious and potentially life-threatening complication.
Question 6: In hepatic surgery, Couinaud's segmental liver anatomy divides the liver into how many independent functional segments?
- 4
- 6
- 8 (Correct answer)
- 10
Correct answer: 8
Couinaud's classification divides the liver into 8 independent functional segments, each with its own portal pedicle and hepatic venous drainage.
Question 7: During a Whipple procedure (pancreaticoduodenectomy), the superior mesenteric vein (SMV) is a key landmark because it defines the boundary between which two resection planes?
- Head and neck of the pancreas (Correct answer)
- Body and tail of the pancreas
- Uncinate process and head
- Duodenum and jejunum
Correct answer: Head and neck of the pancreas
The SMV/portal vein confluence marks the division between the pancreatic head (resected) and the neck/body (retained), and the tunnel posterior to it confirms resectability.
CST Surgical Anatomy by Specialty 3
During a femoral hernia repair, which anatomical landmark defines the medial boundary of the femoral ring?