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Surgical Anatomy & Approaches MCQs

Practice Set 30 of 102

This practice set contains high-yield board review questions covering key concepts in Surgical Anatomy & Approaches. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 581

Topic: Surgical Anatomy & Approaches

The anterior approach (Smith-Petersen) to the hip utilizes a true internervous plane. Which of the following best describes the specific internervous plane used in the superficial dissection of this surgical approach?

. Between the tensor fasciae latae (superior gluteal nerve) and the sartorius (femoral nerve)
. Between the gluteus medius (superior gluteal nerve) and the tensor fasciae latae (superior gluteal nerve)
. Between the rectus femoris (femoral nerve) and the vastus lateralis (femoral nerve)
. Between the adductor longus (obturator nerve) and the gracilis (obturator nerve)
. Between the gluteus maximus (inferior gluteal nerve) and the gluteus medius (superior gluteal nerve)

Correct Answer & Explanation

. Between the tensor fasciae latae (superior gluteal nerve) and the sartorius (femoral nerve)

Explanation

The superficial internervous plane of the anterior (Smith-Petersen) approach to the hip lies between the sartorius (innervated by the femoral nerve) and the tensor fasciae latae (innervated by the superior gluteal nerve). The deep plane is between the rectus femoris (femoral nerve) and the gluteus medius (superior gluteal nerve).

Question 582

Topic: Surgical Anatomy & Approaches
A 35-year-old male sustains an APC-III pelvic ring injury. During the ilioinguinal approach for anterior ring fixation, massive hemorrhage is encountered as the surgeon dissects near the superior pubic ramus. Which vascular anastomosis was most likely injured?
. External iliac artery and obturator vein
. External iliac vein and obturator artery
. Internal iliac artery and superior gluteal artery
. Inferior epigastric artery (or external iliac) and obturator artery
. External iliac artery and internal pudendal artery

Correct Answer & Explanation

. Inferior epigastric artery (or external iliac) and obturator artery

Explanation

The 'corona mortis' (crown of death) is a vascular anastomosis between the external iliac or inferior epigastric vessels and the obturator vessels. It is located over the superior pubic ramus, typically 4-9 cm from the pubic symphysis, and is at high risk of injury during the ilioinguinal approach or placement of superior pubic ramus screws, leading to massive hemorrhage.

Question 583

Topic: Surgical Anatomy & Approaches
A 25-year-old male sustains an APC-III pelvic ring injury. During the surgical approach via the ilioinguinal approach, massive bleeding is encountered posterior to the superior pubic ramus. Which vascular structure is most likely injured?
. Internal pudendal artery
. Obturator artery
. Corona mortis
. Superior gluteal artery
. Inferior epigastric artery

Correct Answer & Explanation

. Corona mortis

Explanation

The corona mortis (crown of death) is a vascular anastomosis between the external iliac (or inferior epigastric) and obturator vessels. It is located posterior to the superior pubic ramus, roughly 4-6 cm from the symphysis pubis, and is at significant risk of iatrogenic injury during an ilioinguinal or modified Stoppa approach.

Question 584

Topic: Surgical Anatomy & Approaches

During the classic volar Henry approach to the radius, the superficial surgical internervous plane lies between which two muscles?

. Flexor Carpi Radialis and Palmaris Longus
. Brachioradialis and Flexor Carpi Radialis
. Flexor Carpi Ulnaris and Flexor Digitorum Superficialis
. Extensor Carpi Radialis Brevis and Extensor Digitorum Communis
. Pronator Teres and Flexor Carpi Radialis

Correct Answer & Explanation

. Brachioradialis and Flexor Carpi Radialis

Explanation

The superficial internervous plane for the volar Henry approach is between the brachioradialis (innervated by the radial nerve) and the flexor carpi radialis (innervated by the median nerve).

Question 585

Topic: Surgical Anatomy & Approaches

During the anterior intrapelvic (modified Stoppa) approach for acetabular fracture fixation, the surgeon must be mindful of the 'corona mortis'. This vascular anastomosis most commonly connects the obturator vessels with which of the following vascular systems?

. Internal iliac vessels
. External iliac or inferior epigastric vessels
. Superior gluteal vessels
. Internal pudendal vessels
. Deep circumflex iliac vessels

Correct Answer & Explanation

. External iliac or inferior epigastric vessels

Explanation

The 'corona mortis' (crown of death) is a highly variable but clinically significant vascular anastomosis located over the superior pubic ramus, typically 4 to 6 cm from the pubic symphysis. It represents an anastomotic connection between the external iliac vascular system (often the inferior epigastric artery/vein) and the obturator vascular system (which arises from the internal iliac system). Injury to it can cause catastrophic bleeding retracting into the pelvis.

Question 586

Topic: Surgical Anatomy & Approaches

The 'Corona Mortis' is an important vascular anastomosis encountered during the ilioinguinal approach to the pelvis. It typically connects which two vascular systems?

. External iliac/inferior epigastric and Obturator
. Internal iliac and Superior gluteal
. External pudendal and Obturator
. Femoral and Inferior gluteal
. Deep circumflex iliac and Internal pudendal

Correct Answer & Explanation

. External iliac/inferior epigastric and Obturator

Explanation

The Corona Mortis is a vascular anastomosis between the external iliac or inferior epigastric vessels and the obturator vessels. It crosses the superior pubic ramus and is highly susceptible to injury during pelvic approaches or screw placement, leading to severe hemorrhage.

Question 587

Topic: Surgical Anatomy & Approaches

During an ilioinguinal approach for the fixation of an anterior column acetabular fracture, significant arterial bleeding is encountered posterior to the superior pubic ramus. Which of the following anatomical connections is the most likely source of this bleeding (Corona Mortis)?

. Superior gluteal artery and inferior gluteal artery
. Inferior epigastric artery and obturator artery
. Internal pudendal artery and obturator artery
. Deep circumflex iliac artery and femoral artery
. External pudendal artery and obturator artery

Correct Answer & Explanation

. Inferior epigastric artery and obturator artery

Explanation

The Corona Mortis (Crown of Death) represents a vascular anastomosis between the external iliac system (usually via the inferior epigastric artery or vein) and the internal iliac system (obturator artery or vein). It is located posterior to the superior pubic ramus at a variable distance (average 4-6 cm) from the symphysis pubis. Iatrogenic injury during the ilioinguinal approach or placement of superior pubic ramus screws can lead to life-threatening hemorrhage.

Question 588

Topic: Surgical Anatomy & Approaches

During the ilioinguinal approach to the acetabulum, severe bleeding is encountered while dissecting over the superior pubic ramus. This is likely due to injury to the 'corona mortis'. What is the correct anatomical description of this structure?

. An anastomosis between the external iliac vein and the obturator vein only
. An anastomosis between the internal iliac artery and the external pudendal artery
. An anastomosis between the obturator vessels and the external iliac or inferior epigastric vessels
. An anastomosis between the superior gluteal artery and the internal pudendal artery
. An anastomosis between the femoral artery and the obturator artery

Correct Answer & Explanation

. An anastomosis between the obturator vessels and the external iliac or inferior epigastric vessels

Explanation

The corona mortis ('crown of death') is a vascular anastomosis between the obturator system (internal iliac system) and the external iliac or inferior epigastric system. It typically crosses the superior pubic ramus and is highly vulnerable to injury during anterior approaches to the pelvis (e.g., ilioinguinal approach) or during placement of superior pubic ramus screws.

Question 589

Topic: Surgical Anatomy & Approaches

During an anterior intrapelvic (modified Stoppa) approach to the acetabulum, severe hemorrhage is encountered just superior to the superior pubic ramus. This bleeding is most likely originating from the corona mortis, which is an anastomotic connection between which two vascular systems?

. Internal iliac artery and internal pudendal artery
. External iliac (or inferior epigastric) vessels and the obturator vessels
. Femoral artery and external iliac artery
. Superior gluteal artery and inferior gluteal artery
. Deep circumflex iliac artery and the external iliac vein

Correct Answer & Explanation

. External iliac (or inferior epigastric) vessels and the obturator vessels

Explanation

The corona mortis ('crown of death') is an anatomical variant representing a vascular anastomosis between the external iliac (or its inferior epigastric branch) and the obturator vessels (a branch of the internal iliac). It crosses the superior pubic ramus at an average distance of 5-6 cm from the pubic symphysis and is at high risk of iatrogenic injury during anterior pelvic exposures.

Question 590

Topic: Surgical Anatomy & Approaches

A 55-year-old male sustains a traumatic anterior shoulder dislocation. After a successful closed reduction, he complains of profound weakness in shoulder abduction and external rotation. Electromyography (EMG) at 6 weeks confirms an isolated peripheral nerve injury. Which of the following nerve roots primarily contribute to the affected nerve?

. C5, C6
. C6, C7
. C7, C8
. C8, T1
. C5, C6, C7

Correct Answer & Explanation

. C5, C6

Explanation

Anterior shoulder dislocations are frequently associated with axillary nerve palsy. The axillary nerve innervates the deltoid (shoulder abduction) and teres minor (external rotation). The axillary nerve arises from the posterior cord of the brachial plexus and carries nerve fibers primarily from the C5 and C6 nerve roots.

Question 591

Topic: Surgical Anatomy & Approaches

A 6-year-old boy sustains a completely displaced, extension-type supracondylar humerus fracture with posterolateral displacement of the distal fragment. On examination, he is unable to make an 'OK' sign. Which nerve is most likely injured?

. Radial nerve
. Ulnar nerve
. Anterior interosseous nerve (AIN)
. Musculocutaneous nerve
. Axillary nerve

Correct Answer & Explanation

. Anterior interosseous nerve (AIN)

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar humerus fractures, particularly those with posterolateral displacement. The inability to flex the IP joint of the thumb and DIP joint of the index finger (the 'OK' sign) indicates AIN palsy.

Question 592

Topic: Surgical Anatomy & Approaches

During the ilioinguinal approach to the acetabulum for an anterior column fracture, the surgeon must be careful to identify and ligate the 'corona mortis'. This vascular structure represents an anastomosis between the external iliac (or deep inferior epigastric) and obturator vessels. Over which bony structure is this anastomosis most commonly found?

. Superior pubic ramus
. Inferior pubic ramus
. Iliopectineal eminence
. Ischial spine
. Symphysis pubis

Correct Answer & Explanation

. Superior pubic ramus

Explanation

The corona mortis is a vascular anastomosis between the external iliac (or deep inferior epigastric) and the obturator systems. It typically crosses the superior pubic ramus at an average of 5 to 7 cm from the pubic symphysis. Iatrogenic injury during the ilioinguinal or intrapelvic approaches can cause massive, difficult-to-control hemorrhage.

Question 593

Topic: Surgical Anatomy & Approaches

During the ilioinguinal approach to the acetabulum, the surgeon must carefully identify and ligate the 'corona mortis' to prevent life-threatening hemorrhage. This vascular structure is an anastomosis between the obturator vessels and which of the following vascular systems?

. Internal iliac or superior gluteal vessels
. External iliac or inferior epigastric vessels
. Internal pudendal vessels
. Femoral or deep circumflex iliac vessels
. Superior vesical vessels

Correct Answer & Explanation

. External iliac or inferior epigastric vessels

Explanation

The corona mortis ('crown of death') is a retropubic vascular anastomosis between the obturator system and the external iliac or inferior epigastric systems. It is found traversing the superior pubic ramus at an average distance of 5-6 cm from the pubic symphysis and is at high risk of iatrogenic injury during anterior pelvic surgical exposures.

Question 594

Topic: Surgical Anatomy & Approaches

During an anterior intrapelvic (modified Stoppa) approach for fixation of an acetabular fracture, life-threatening hemorrhage is encountered just posterior to the superior pubic ramus. This is most likely due to an iatrogenic injury to the 'corona mortis,' which represents an abnormal vascular anastomosis between which two systems?

. Internal iliac vein and external iliac vein
. External iliac and obturator vessels
. Superior gluteal and inferior gluteal vessels
. Internal pudendal and obturator vessels
. Deep circumflex iliac and inferior epigastric vessels

Correct Answer & Explanation

. External iliac and obturator vessels

Explanation

The corona mortis ('crown of death') is a common and clinically significant anatomical variant representing an anastomosis between the external iliac system (or its inferior epigastric branch) and the obturator system (a branch of the internal iliac). It crosses the superior pubic ramus approximately 4-5 cm lateral to the symphysis pubis and is at high risk of injury during anterior pelvic and acetabular exposures.

Question 595

Topic: Surgical Anatomy & Approaches

A 40-year-old man sustains a closed, high-energy distal tibia intra-articular fracture (AO/OTA 43-C3). On presentation, he has massive soft tissue swelling and hemorrhagic fracture blisters over the medial ankle. A spanning external fixator is placed. Which of the following is the most reliable clinical indicator that the soft tissues are amenable to definitive open reduction and internal fixation?

. Re-epithelialization of hemorrhagic blisters
. Re-epithelialization of clear fluid blisters
. Return of skin wrinkles and a positive 'pinch test'
. Decrease in compartment pressures below 30 mmHg
. Normalization of the erythrocyte sedimentation rate (ESR)

Correct Answer & Explanation

. Return of skin wrinkles and a positive 'pinch test'

Explanation

In high-energy pilon fractures, definitive open internal fixation should be delayed until the soft tissue envelope has recovered, to minimize the risk of wound breakdown and deep infection. The most reliable clinical sign of sufficient edema resolution is the return of normal skin wrinkles and a positive 'pinch test' (the ability to pinch the skin over the planned surgical approach). Hemorrhagic blisters represent a full-thickness epidermal injury and require extensive time to heal; incisions should ideally bypass them.

Question 596

Topic: Surgical Anatomy & Approaches

During an anterior intrapelvic (modified Stoppa) approach for the fixation of an acetabular fracture, meticulous dissection is required over the superior pubic ramus to avoid injury to the 'corona mortis'. This vascular structure represents an anastomosis between which of the following?

. Obturator vessels and inferior epigastric vessels
. Internal iliac and external iliac arteries directly
. Internal pudendal and external pudendal vessels
. Superior gluteal and internal iliac vessels
. Inferior gluteal and obturator vessels

Correct Answer & Explanation

. Obturator vessels and inferior epigastric vessels

Explanation

The 'corona mortis' (crown of death) is a highly variable but critical vascular anastomosis between the external iliac system (inferior epigastric artery/vein) and the internal iliac system (obturator artery/vein). It is located over the posterior aspect of the superior pubic ramus and is at significant risk of iatrogenic injury during anterior intrapelvic approaches, leading to massive, difficult-to-control hemorrhage.

Question 597

Topic: Surgical Anatomy & Approaches

During the ilioinguinal approach for an anterior column acetabular fracture, the surgeon encounters massive hemorrhage from a vascular anastomosis crossing the superior pubic ramus. This vessel, commonly known as the 'corona mortis', connects which two vascular systems?

. External iliac and internal iliac systems
. External iliac vein and internal pudendal vein
. Femoral artery and obturator artery
. External iliac and obturator systems
. Inferior epigastric and superficial circumflex iliac systems

Correct Answer & Explanation

. External iliac and obturator systems

Explanation

The corona mortis ('crown of death') is an anatomical variant where there is an anastomotic connection between the external iliac system (specifically the inferior epigastric vessels) and the obturator system (internal iliac system) crossing the superior pubic ramus. Injury to it during pelvic/acetabular surgery can cause severe, difficult-to-control bleeding.

Question 598

Topic: Surgical Anatomy & Approaches

During the extended deltopectoral approach for open reduction and internal fixation of a proximal humerus fracture, the axillary nerve must be protected during plate placement. What is the typical average distance of the axillary nerve from the tip of the greater tuberosity?

. 2 to 3 cm
. 5 to 7 cm
. 9 to 11 cm
. 12 to 14 cm
. 15 to 17 cm

Correct Answer & Explanation

. 5 to 7 cm

Explanation

The axillary nerve courses laterally around the surgical neck of the humerus. Its average distance from the tip of the greater tuberosity is approximately 5 to 7 cm. Placing retractors or plates blindly below this level poses a significant risk of iatrogenic nerve injury.

Question 599

Topic: Surgical Anatomy & Approaches

During an anterior intrapelvic (modified Stoppa) approach for an acetabular fracture, significant bleeding occurs near the posterior aspect of the superior pubic ramus. This is most likely due to injury to an anastomosis between which of the following vessel systems?

. External iliac artery and internal pudendal artery
. External iliac and obturator systems
. Internal iliac and superior gluteal systems
. Femoral artery and internal pudendal artery
. Inferior epigastric and superficial circumflex iliac vessels

Correct Answer & Explanation

. External iliac and obturator systems

Explanation

The corona mortis is a critical vascular anastomosis between the external iliac (or inferior epigastric) and the obturator systems. It is consistently located on the posterior aspect of the superior pubic ramus and is highly vulnerable to injury during the modified Stoppa or ilioinguinal approach.

Question 600

Topic: Surgical Anatomy & Approaches

A 38-year-old woman fell from a ladder onto her right hip. The radiographs and CT scan are shown in Figures 52a through 52d. What is the best surgical approach for this fracture?

. Kocher-Langenbeck
. Iliofemoral
. Ilioinguinal
. Extended iliofemoral
. Triradiate approach

Correct Answer & Explanation

. Ilioinguinal

Explanation

The fracture is an associated both column fracture. The best approach for this fracture is the ilioinguinal. The Kocher-Langenbeck is best for posterior injuries to the acetabulum and some transverse fractures. The iliofemoral alone is limited to high anterior column injuries. The extended iliofemoral and triradiate approaches although useful for this fracture, have a higher rate of complications. Letournel E: The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res 1993;292:62-76.

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