Flashcards in Anatomy 1 Deck (282):
Where do the presynaptic sympathetic axons for the heart synapse?
T1 or cervical PARAvertebral gangli
Where are post-synaptic axons for the heart?
They pass through cardiopulmonary splanchnic nerves to the SA&AV nodes and the myocardium
What does the T9 myotome supply?
The 8th-10th intercostal spaces and some of the anterolateral abdominal wall muscles
Where do the presynaptic sympathetic axons for the lung synapse?
Synapse in the upper thoracic PARAvertebral ganglia
Where do the post-synaptic sympathetic axons for the lung travel
Pass in cardiopulmonary splanchnic nerves to the bronchiolar smooth muscle and mucous glands
Where do the abdominopelive sympathetic presynaptic axons synapse?
Synapse in one of the PREvertebral ganglia
Celiac ganglion of celiac plexus
Superior mesenteric ganglion of the SM plexus
Hindgut and pelvic/perineal organ ganglion
Inferior mesenteric ganglion
What is special about the sympathetic supply to the kidney?
Presynaptic axons pass directly through the aorticorenal ganglion to synapse directly onto the adrenaline/noradrenaline secreting cells of the adrenal medulla
How do parasympathetic axons reach the eye?
Via the ciliary ganglion
Which glands in the head are under parasympathetic supply?
The lacrimal and salivary glands
How do PARAsympathetic axons reach the hindgut, pelvis and perineum?
They are "carried" on sacral spinal nerves
What do the extrinsic back muscles do?
Move the upper limb
Where does the trapezius attach to superiorly?
The occipital bone
Where do the levator scapulae attach superiorly?
To the cervical vertebrae
Superficial intrinsic back muscles
Deep intrinsic back muscles
Function of the intrinsic back muscles?
Maintain back posture
The 3 parts of the trapezius
Descending part (to spine of scapula)
Ascending part (to spine of scapula)
Low back pain may be due to what
Erector spinae strain
Which muscles allow extension of the spine?
Intrinsic back muscles
Nerve supply to the intrinsic back muscles?
The posterior rami (of cervical, thoracic, lumbar etc)
Primary curvatures of the vertebral column?
Thoracic primary curvature
Sacral primary curvature
(Cervical and lumbar are secondary)
What makes the vertebral canal for the spinal cord?
The vertebral foraminae combine to form the vertebral canal
Which foraminae do the spinal nerves emerge from?
Which joints affected in arthritis?
What makes the facet joint?
Between 2 articular processes
Intervertebral discs are between all vertebrae except?
Except C1-C2 and the fused sacrum/coccyx
What attaches the laminae together?
The ligamentum flavum
Function of the posterior longitudinal ligament?
Prevents over-flexion of spin
Function of the anterior longitudinal ligament?
Prevents over-extension of the spine
This ligament connects tips of spinous processes
This ligament connects superior and inferior surfaces of adjacent spinous processes
This vertebra doesn't have a body or spinous process
(has a posterior and anterior arch instead)
This vertebrae has an odontiod process
First palpable spinous process
Main movements of the atlanto-occipital joints
Flexion and extension (i.e. nodding)
This is a synovial joint
Main movement of the atlanto-axial joint?
Rotations (i.e. head looking side to side)
This joint is made of 3 synovial joints
What are the anterior sacral foraminae for?
For the anterior rami of the sacral spinal nerves
In caudal anasthaesia, where is local anaesthetic injected into?
Into the sacral hiatus
(numbs the sacral spinal nerves of the cauda equina)
Where does the spinal cord begin?
Where does the spinal cord end?
L2 (conus medullaris)
(this then continues as the filum terminale)
What makes up the cauda equina?
All the spinal nerve roots from L2 to C0 that have to descend to their numbered verterbae where there spinal nerve is lovated within the intervertebral foramen
Why is a laminectomy performed?
To access the spinal cord
How do you perform a laminectomy?
Removal of one or more of the spinous processes and the adjacent lamina
Common location of a CVA?
When you are examining dermatomes, what do the following mean:
0 - absent
1 - impaired
2 - normal
NT - not testable
Spinal nerve has no significant cutaneous sensory axons
Back of scalp and adam's apple
Back of neck and jugular notch
Clavicle and shoulder tip
Medial arm and sternal angle
Dorsum of foot
Femoral nerve roots
L2, L3, L4
(so will supply anterior thigh, anterior knee and medial malleolus)
Great auricular nerve?
Nerve supply to the upper anterolateral abdominal wall
Nerve supply to the lower anterolateral abdominal wall
Iliohypogastric and ilioinguinal nerves (formed from L1)
Nerve supply to the posterior parts of the dermatome
Supplied by posterior rami
- supplied segmentally by the intercostal nerves
What is special about T1 and T2 dermatomes?
Explains the pain from an MI! (because the dermatome extends into the arm etc)
Cutaneous branch of the musculocutaneous nerve
C5, C6, C7
C6, C7, C8
C6, C7, C8, T1
C7, C8, T1
What does the cervical motor plexus supply?
Neck postural & strap muscles
What does the brachial motor plexus supply?
The upper limb muscles
The extrinsic back muscles
Which motor axons supply:
-postural back muscles (via posterior rami)
-intercostal muscles (via anterior motor rami)
-anterolateral abdominal wall muscles (via thoracoabdominal, subcostal, iliohypogastic and ilioinguinal nerves)
What does the lumbosacral motor plexus supply?
Plexus= L1 -S4
-Supplies lower limb muscles &
-Perineal skeletal muscles
What is the intracranial part of the spinal nerve course?
Between their base of skill foraminae and their connection with the CNS
V1, V2, V3
V1 - sensory
V2 - sensory
V3 - sensory and motor
The only cranial nerve to attach to the pons
Which foramen does V1 pass through?
Superior orbital fissure
Which foramen does V2 pass through?
Which foramen does V3 pass through?
This nerve supplies the:
-all the conjunctiva
-the skin of the root/bridge/tip of the nose
This nerve supplies:
-the skin of the lower eyelid
-the skin over the maxilla
-the skin of the ala of the nose
-the skin/mucosa of the upper lip
This nerve supplies:
-the skin over the mandible and temperomandibular joint (apart from the angle of the mandible - supplied by C2, C3 spinal nerves)
Which nerve supplies the skin over the angle of the mandible and some of the external ear
The great auricular nerve (C2, C3)
This nerve supplies the:
-bones and soft tissue of the orbit
-the upper anterior nasal cavity
-all paranasal sinuses (except antrum)
-the anterior and posterior cranial fossa
CN V1 (deep sensory territory)
This nerve supplies:
-the lowest posterior nasal cavity
-the maxilla and maxillary sinus
-the floor of the nasal cavity/palate
-the maxillary teeth and the associated soft tissues (gingivae and mucosae)
CN V2 (deep sensory territory)
Which nerve supplies:
-the MIDDLE cranial fossa
-the anterior 2/3rds of the tongue
-the floor of the mouth
-the buccal mucosa
-the mandibular teeth
CN V3 (deep territory)
Recap: which CN supplies the paranasal sinuses?
CN V1 (except antrum)
Recap, which CN supplies the anterior and posterior fossa?
Recap, which CN supplies the antrum? (maxilla and maxillary sinus)
Recap, which CN supplies the middle fossa?
Where does the masseter attach?
From the angle of the mandible TO
the zygomatic arch / bone
Where does the temporalis attach?
From the CORONOID process of the mandible to the neurocranium
Where does the middle pterygoid attach?
From the (medial) part of the angle of the mandible TO
the ptyergoid plates (of sphenoid bone)
Where does the lateral pterygoid attach?
From the CORACOID process AND articuar disc of TMJ to the ptyergoid plates of spehnoid bone
Which nerve supplies the tensor veli palatini?
Which nerve supplies the tensor tympani?
These nerves supply the first part of the afferent limb of the corneal (blink) reflex?
Which foraminae does the facial nerve pass through?
The internal acoustic meatus and the stylomastoid foramen
(stylomastoid foramen really visible if you look at skull from the bottom)
This supplies taste to the anterior 2/3rds of the tongue
This supplies parasympathetic supply to the submandibular and mandibular glands
This muscle reduces stapes movement to protect the internal ear from excessive noise
Where would you find the facial nerve in the facial canal?
In the petrous temporal bone
Why is the facial canal nice?
It connects the internal acoustic meatus to the stylomastoid foramen
What nerve does the chorda tympani attach to?
Attaches to CN V3 and then carries taste axons (to anterior 2/3rds of tongue) and parasympathetic axons (to salivary glands)
This border must be carefully sutured by a specialist
Loss of this special pad in illness leads to sunken cheek- what is this pad and why is this sign important?
Buccal fat pad
-important as a clinical sign of malnutrition
Which foramen does the glosspharyngeal nerve pass through?
The jugular foramen
Special sensory to the vallat papillae
Parasympathetic to the parotid salivary gland
Visceral afferent to the carotid sinus baroreceptors and carotid body chemoreceptors
General sensory to the posterior 1/3rd of tongue
General sensory to the mucosa of most of the nasopharynx
General sensory to the mucosa of the oropharynx
General sensory to the palatine tonsil
General sensory to the eustachian tube
General sensory to the middle ear cavity
Somatic motor to the stylopharyngeus
Which foramen does the vagus nerve pass through?
The jugular foramen
How does the vagus nerve pass through the neck?
In the carotid sheath
Which muscles does the spinal accessory nerve supply?
The trapezius and the sternocleidomastoid
In relation to the triangle of the neck, where would you find the spinal accessory nerve?
It crosses the posterior triangle of the neck
(named nerves of the cervical plexus ALSO pass the posterior border of the sternocleidomastoid but they do NOT pass DEEP to the trapezius like the spinal accessory nerve does)
Which foramen does the hypoglossal nerve pass through?
At which level does the hypoglossal nerve pass anteriorly?
At the level of the hyoid bone
--> passes anteriorly towards the lateral aspect of the tongue (because it supplies muscles of the tongue obv)
Five layers of the SCALP
Loose connective tissue
Which layer of the scalp contains the arteries of the scalp?
Layer 2 (connective tissue)
How can you tell the difference between the internal and external carotid artery?
The internal doesn't have any branches in the neck
The opthalmic artery is a branch of which artery?
The internal carotid
Pterygoid is a joint between which bones?
Which artery crosses the deep aspect of the pterion?
The middle meningeal artery
The optic canal is in which bone?
The sphenoid bone
There is a groove across the deep surface of the pteriod, what is this made by?
Made by the middle meningeal artery
Parts of the ethmoid bone i probably shouldn't forget
This is a tough sheet of dura mater forming a roof over the pituitary fossa
This separates the right and left cerebral hemispheres
Where does the left sigmoid sinus drain into?
Drains into the internal jugular at the jugular foramen
Where is the confluence of the sinuses?
In the midline at the internal occipital protuberance (this is deep to the external occipital protuberance)
What arteries form the basilar artery?
The vertebral arteries
What level would you access the spinal cord?
Lumbar puncture at L3/L4 or L4/L5 intervertebral disc
This connects the third and fourth ventricles in the midline
How does the CSF pass from the lateral ventricles to the 3rd ventricle?
FORAMINAE OF MUNRO
How does CSF pass from 3rd ventricle to 4th ventricle
Treatment of hydrocephalus
Ventricular peritoneal shunt
What type of haemorrhage:
-middle meningeal artery
-trauma to the pterion
Which type of haemorrhage:
-torn cerebral veins
-falls in the elderly and alcoholics
Which type of haemorrhage:
-into the CSF of the subarachnoid space
-ruptured circle of willis "berry aneurysm"
In epidural anaesthesia/lumbar puncture, where is the needle most safely inserted?
1) the subarachnoid space that surrounds the cauda equina NOT the spinal cord
2) where the vertebrae are not fused (i.e. NOT the sacrum)
This is why they usually go for L3/L4
Where does the subarachnoid space end?
Which nerves make up the cauda equina?
Which level does the spinal cord end?
How do you know if its an uncal/transtentorial herniation?
The uncus (medial part) of the temporal love herniates INFERIOR to the tentorium cerebelli
An uncal herniation could compress which nerve?
The occulomotor nerve
--> this leads to an IPSILATERAL, fixed DILATED pupil
-a "blown" pupil
What is a downward/tonsillar herniation
The cerebellar tonsils herniate into the foramen magnum
Where are the ischial spines palpable on vag exam?
About a finger breadth into the vagina, at 4 and 8 o'clock
Which ligaments form the greater and lesser sciatic foraminae?
The sacrotuberous and sacrospinous ligaments
What forms the pelvic inlet?
-superior pubic ramus
What forms the pelvic outlet?
Why is trauma to the pelvis bad
You can get a life-threatening haemorrhage (common iliac artery, common iliac vein etc)
Difference between the occipitofrontal and the biparietal diameter?
The occipitofrontal diameter is longer than the biparietal diameter
What is the "station"? What does a negative number mean?
The distance of the fetal head from the ischial spine
-a negative number means that the head is above the spines
While descending through the pelvic cavity, the fetal head should what?
-be in a flexed position (i.e chin on chest)
Baby should ideally leave the cavity in which postition?
OA (occiput anterior)
During delivery, the baby's head should be in which position?
(descending through cavity = flexed)
What happens once the baby's head has been delivered?
There is further rotation so the rest of the baby can then be delivered
Superior part of vagina
Inferior part of vagina
Where is the perineum?
Inferior to the levator ani
Where does excess fluid collect in the peritoneal cavity?
Collects in the pouch of douglas
How can you get fluid out of pouch of douglas?
By passing a needle through the posterior fornix of the vagina
Structure and function of the broad ligament?
-Double layer of peritoneum
-Helps maintain the uterus in the correct midline position
Which ligament is an embryological remnant?
Course of the round ligament?
Passes through the deep inguinal ring to attach to the superficial tissue of the female peritoneum
The 3 layers of the uterus and which one is shed
Where does implantation of the zygote occur?
Occurs in the body of the uterus
Name a ligament which helps support the uterus
What is uterine prolapse?
Movement of the uterus inferiorly
Uterus is tipped anteriorly relative to the axis of the VAGINA
Uterus is tipped posteriorly relative to the axis of the VAGINA
Uterus tipped posteriorly in relative to axis of VAGINA
Uterus tipped posteriorly relative to axis of CERVIX
Which part of the cervix are you sampling in a smear?
The squamo-columnar junction
Removal of both uterine tubes and ovaries
Removal of one of the uterine tubes
How can you assess patency of the uterine tubes?
What size are the ovaries
What hormones do the ovaries secrete?
Oestrogen and progesterone
Where do the ovaries develop?
On the posterior abdominal wall
Where is the ovum released into?
Ovum released into the peritoneal cavity !!
How can you check the position of the uterus?
How can you feel the adnexae
-place examining fingers into lateral fornix
-press deeply with other hand in the iliac fossa of the same side
-repeat on other side
-can detect large masses or tenderness affecting these structures.
Nerve supply to levator ani
"nerve to levator ani" S3, S4, S5 sacral plexus
Nerve supply to the perineal muscles?
This is a bundle of collagenous and elastic tissue into which the perineal muscles attach - what is it call, why is it important and where is it located?
-important to pelvic floor strength
-located just deep to the skin
Breast correlates to which ribs?
Ribs 2-6 !!!
What is the retromammary space?
Lies between fascia and breast
What does the breast lie on top of?
Lies on top of deep fascia covering pec major and serratus anterior
Where does most breast lymph drain to?
Drains to ipsilateral axillary lymph nodes and THEN to supraclavicular lymph nodes!!
(problemz with upper limb also draining here etc)
Where could lymph from the lower inner breast drain to?
Drain to the abdominal lymph nodes
Where is the brachial plexus?
In the axilla
Inferior and lateral to pectoralis minor
Deep to pectoralis minor
Superior and medial to pectoralis minor
Incision for lower segment caesarian section
Layers of the anterolateral abdominal wall
Where does the external oblique attach?
Linea alba of external oblique, internal oblique and transversus abdominus?
Made from midline blending of aponeuroses
Where does the internal oblique attach?
Where does the transversus abdominus attach?
How is the aponeuroses of the rectus abdominus made?
From the interweaving of the muscle aponeuroses
Where do the rectus abdominus attach?
Xiphoid process and costal cartilage
Rectus sheaths above and below umbilicus?
Above umbilicus = anterior and posterior rectus sheath
Below umbilicus = anterior rectus sheath only
Which layer would you find the ilioinguinal nerve?
In between the internal oblique and transversus abdominus
The 7th-11th intercostal nerves become what?
The thoracoabdominal nerves
Thoracoabdominal, subcostal, iliohypogastric and ilioinguinal nerves travel in which plane?
In between the iliohypogastric and ilioinguinal
Superior epigastric arteries are a branch of which artery?
(lie posterior to rectus abdominus)
Inferior epigastric arteries are a branch of which artery?
Branch of external iliac
(lie posterior to rectus sheath)
The intercostal and subcostal arteries are continuations of which arteries?
Posterior intercostal arteries
LSCS layers incised through
Skin and fascia
Fascia and peritoneum
Layers to incise through during lapartomy
Skin and fascia
Why can a midline laparotomy be bad?
Relatively bloodless - increases chances of wound complications
If you need a lateral port in a laparoscopy, what artery MUST you avoid?
MUST avoid inferior epigastric artery
Route of the interior epigastric artery?
-branch of external iliac
-emerges just medial to the deep inguinal ring
-then passes in a SUPEROMEDIAL direction posterior to the rectus abdominus
Which incision would you use for an abdominal hysterectomy?
How can you tell if you are touching the ureter or the uterine artery
-passes inferior to the artery
-will "vermiculate" when touched
Uterine "cramping" (e.g menstruation)
Uterine contraction (e.g. during labour)
Pelvic floor muscle contraction (e.g. during sneezing)
Pain from adnexae
Pain from uterus
Pain from the vagina
Visceral afferents (pelvic part)
Somatic sensory (perineum)
Pain from the perineum
Pain sensation from superior aspect of pelvic organs/touching the peritoneum
Uterine tubes, uterus, ovaries
Visceral afferents carry the info!
These then run alongside the SYMPATHETIC fibres and enter the spinal cord between T11- L2
(pain perceived as suprapubic)
Pain sensation from inferior aspect of pelvic organs/ not touching the peritoneum
Cervix and superior vagina
Visceral afferent also carry the info!
These run alongside the PARASYMPATHETIC fibres and enter the spinal cord at S2, S3, S4
(pain percieved as S2, S3, S4 dermatome i.e. the perineum)
Pain sensation from structures ABOVE levator ani
Visceral afferents carry the infor
Levels S2, S3 and S4
Pain sensation from BELOW levator ani
SOMATIC SENSORY !!!
Spinal cord levels S2, S3 and S4
Localised pain with perineum
The 2 most important spinal cord levels for pain from the repro system
S2-S4 (as in S2,S3,S4)
Spinal cord becomes cauda equina at which level
Subarachnoid space ends at which level
(s for subarachnoid)
Where is the anaesthetic injected into for a spinal/epidural anaesthesia
Injected into subarachnoid space of L3-L5
=anaesthetises the cauda equina
(LP usually L3/L4 or L4/L5)
Layers the needle is passed through for spinal anaesthetic
Finally reaches subarachnoid space (contains CSF)
Layers needle is passed through for epidural
Epidural space (fat and veins)
Sympathetic outflow leaves the spinal column in which levels?
T1 - L2
All spinal nerves and their named nerves contain what?
They all contain sympathetic fibres
-including femoral, sciatic, obturator, pudendal
There fibres supply all arterioles
Signs that spinal anaesthesia is working
Skin of lower limbs looks flushes
Warm lower limbs
Remember this is because you are blocking the sympathetic tone to all the arterioles in the lower limb :)
Pudendal nerve is from which plexus
Branch of sacral plexus S2, S3, S4
When might you consider a pudendal nerve block?
Useful for episiotomy incision, forceps use and perineal stitching post delivery
(anaesthetises majority of perineum)
What is in the pudendal canal?
Pudendal nerve, artery and vein
Also the nerve to obturator internus
Where could you find the nerve to obturator internus?
In the pudendal canal
Which bony landmark can you use to administer pudendal nerve block?
During labour, the branches of which nerve can become stretched?
If your pudendal nerve is stretched in labour, which muscles could be weakened?
Levator ani and external anal sphincter
-this can result in weakened pelvic floor and faecal incontinence
This incision is made into the relatively "safe" fat filled ischioanal fossa and avoids extending into the rectum
The 3 parts of the levator ani