Anatomy Flashcards

(191 cards)

1
Q

Which hormones are released from anterior pituitary ?

A

GH
TSH
LH & FSH
ACTH
Prolactin
Melanocyte releasing hormone

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2
Q

Which hormones are released from Posterior pituitary ?

A

Oxytocin
ADH

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3
Q

What is the mneumonic to remember branches of external carotid?

A

“Some Ancient Lovers Find Old Positions More Stimulating”

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4
Q

What are the branches of the external carotid?

A

Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior Auricular
Maxillary
Superficial temporal

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5
Q

What does “face, ear, taste, tear” demonstrate?

A

Supply of facial nerve:
Muscles of facial expression
Nerve to stapedius
Taste to ant 2/3 of tongue
Parasympathetic fibres to lacrimal and salivary glands

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6
Q

Which foramen is cartilaginous and closed?

A

Foreman Lacerum

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7
Q

Which formamen does olfactory nerve pass through?

A

Cribriform foramina

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8
Q

Which nerve and artery pass through optic canal?

A

Optic nerve
Ophthalmic artery

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9
Q

Which 4 CNs pass through superior orbital fissure?

A

CN 3, 4, 6 & Ophthalmic division of trigeminal nerve (V1)

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10
Q

Name the foramen which the 3 branches of trigeminal nerve pass through?

A

V1 - Ophthalmic - Superior orbital fissure
V2 - Maxillary - Foramen Rotundum
V3 - Mandibular - Foramen Ovale

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11
Q

Which foramen transmits the middle meningeal artery?

A

Foramen spinosum

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12
Q

What is the middle meningeal artery a branch of?

A

The maxillary artery (which is a branch of the external carotid)

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13
Q

The internal carotid artery passes over the surface of which foramen?

A

Foramen Lacerum - internal carotid passes over it’s superior aspect

The foramen itself is cartilaginous

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14
Q

Which 2 CNs pass through the internal auditory meatus?

A

Facial nerve
Vestibulocochlear nerve

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15
Q

Which 3 CNs pass through the Jugular foramen?

A

CN 9, 10, 11

Glossopharygeal
Vagus
Accessory (the cranial part of accessory nerve)

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16
Q

Which foramen does the hypoglossal nerve pass through?

A

The hypoglossal canal

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17
Q

What 3 components pass through the Foramen Magnum?

A

Medulla Oblongata
Vertebral arteries
Spinal part of accessory nerve

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18
Q

Which artery passes through foramen spinosum? What is it a branch of?

A

Middle Meningeal Artery

A branch of the maxillary artery, which is a terminal branch of external carotid

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19
Q

Name the 4 branches of the basilar artery? (inferior to superior)

A

Anterior inferior cerebellar arteries
Labrythine arteries
Pontine arteries
Superior cerebellar arteries

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20
Q

Which foramen do the labrythine arteries pass through, with which 2 CNs?

A

Internal acoustic meatus

alongside the facial nerve and vestibulocochlear nerve

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21
Q

What does the basilar artery bifurcate into?
What do these form?

A

Left and right posterior cerebral arteries

The posterior part of the circle of willis

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22
Q

Which artery can be decompressed to treat trigeminal neuralgia?

A

Superior cerebral artery

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23
Q

Branches of which 2 arteries make up the circle of willis?

A

Internal carotid artery
Vertebral artery

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24
Q

Which 3 muscles does musclocutaneous nerve supply?

A

Biceps
Coracobrachialis
Brachialis

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25
Which nerve is responsible for supination and extension of the forearm?
Radial nerve
26
Which nerve is responsible for pronation and flexion of the forearm ?
Median nerve
27
Which nerve comes off the inferior trunk of brachial plexus (C8-T1)
Ulnar nerve
28
Which nerve innervates the lateral 2 lumbricals, abductor pollicus brevis, flexor pollicus brevis, opponens pollicus?
median nerve
29
Which muscles make up the thenar muscles?
Lateral 2 lumbricals Abductor pollicus brevis Flexor pollicus brevis Opponens pollicus
30
Which nerve innervates all intrinsic muscles of the hand except the thenar muscles?
Deep branch of Ulnar nerve
31
Compare the muscles of the hand innervated by the ulnar nerve v median nerve?
Ulnar - all intrinsic muscles of the hand except thenar muscles Median nerve - thenar muscles (lat 2 lumbricals, **ab**ductor pollicus brevis, **f**lexor pollicus brevis, opponens pollicus) "ABsolutley F**ked"
32
Which is the only muscle of the hand innervated by the superficial branch of the ulnar nerve?
Palmaris Brevis
33
Compare the innervation of ABductor pollicus brevis vs ADDuctor pollicus brevis?
ABductor pollicus brevis = Median nerve ADDuctor pollicus brevis = Ulnar nerve (deep branch)
34
Which nerve innervates tricep?
Radial nerve
35
Name 3 nerves affected in erb's palsy?
Axillary Musclocutaenous Suprascapular
36
Compare which trunks are affected in Erb's palsy and claw hand (Klumpkes) deformity?
Erb's palsy - C5, C6 axillary, musculocutaenous, suprascapular Claw hand (Klumpkes) deformity - C8 - T1 Ulnar nerve
37
Which nerve most likely to be injured in medial condyle #?
Ulnar nerve (C8-T1)
38
Damage to which nerve is associated with wrist drop? Damage to which bone, where, predisposes to its injury?
Radial nerve Can be damaged in MIDSHAFT humeral #s
39
Compare nerves affected in surgical neck of humerus #s and humeral mid shaft #s?
Surgical neck of humerus #s - axillary nerve Humeral mid shaft #s - radial nerve (Radial wRaps round the humerus)
40
Name the levels the oesophagus, aorta and vena cava traverse the diaphragm?
T8 - Vena cava T10 - Oesophagus T12 - Aorta
41
What 3 structures contained in the thoracic outlet?
Brachial plexus Subclavian artery Subclavian vein
42
Which nerve roots most commonly affected in thoracic outlet syndrome?
The lower cervical roots (C8-T1) Ie - ulnar distribution
43
Which nerve is the cricothyroid supplied by?
The external laryngeal nerve (not recurrent)
44
Which compartment of the leg is supplied by the deep fibular nerve?
Anterior compartment of the leg
45
Which artery supplies the anterior compartment of the leg?
Deep tibial (fibular) artery
46
Name the 4 muscles in the anterior compartment of the lower limb?
Tibialis anterior - strongest dorsiflexor Extensor Digitorum longus Extensor hallicus longus Peroneus tertius
47
Which nerve innervates the anterior compartment of the lower limb ?
The Deep fibular nerve
48
Damage to which nerve results in foot drop? (inability to dorsiflex foot)
Damage to common fibular nerve
49
Describe the nerve roots of the deep fibular nerve?
L4-S2
50
Compare which muscles form the medial and lateral border of the anatomical snuffbox?
Lateral border - abductor pollicus longus, extensor pollicus brevis Medial border - extensor pollicus longus
51
What nerve roots are tested in the ankle reflex?
S1 and S2
52
Which carpal bone is a sesamoid bone in the tendon of flexor carpi ulnaris?
Pisiform bone
53
Compare the percentages of blood supplied to the liver by the portal vein and the hepatic artery?
Portal vein supplies 70% Hepatic artery supplies 30%
54
What is the most common position for the appendix to lie?
Retroceacal
55
What nerve is the middle meningeal artery closely associated with?
The auriculotemporal nerve Can be damaged during surgery, resulting in parasthesia of the affected ear
56
What is the level of the transpyloric plane?
L1
57
What is the course of the median nerve relative to the brachial artery in the upper arm?
Lateral to anterior to medial
58
Which nerve innervates the trapezius muscle? What action does this have on the scapula ?
Spinal accessory nerve Retracts scapula and upwardly rotates it
59
Name the 3 components of the epiploic foramen?
Hepatic artery Portal vein Common bile duct Can be clamped during liver surgery to control bleeding - Pringles manoeuvre
60
Which nerve is responsible for innervation of the lateral aspect of the flexor digitorum profundus? What nerve is this a branch of?
Anterior Interosseous nerve It is a branch of the median nerve
61
Compare the lateral and medial innervation of the flexor digitorum profundus? Describe the digits that this distribution covers
Lateral innervation = Anterior interosseous nerve (branch of median nerve). Digits 2-3 Medial innervation = Ulnar nerve. Digits 4-5.
62
Which nerve innervates all hip adductors?
Orbturator nerve
63
Compare the superior, middle and inferior adrenal arteries- from which artery do they all branch from?
Superior adrenal arteries - Inferior Phrenic artery Middle adrenal arteries - aorta Inferior adrenal arteries - renal arteries
64
Which nerve is closely associated to the short saphenous vein and can be damaged in surgery?
Sural nerve
65
Which artery does the gastroduodenal artery arise from?
Common hepatic artery
66
Compare the innervation of stapedius and tensor tympani muscles?
Stapedius - facial nerve Tensor Tympani - mandibular branch of the Trigeminal nerve
67
Damage to innervation to muscle is associated with winged scapula? What is it innervated by?
Serratus anterior Innervated by long thoracic nerve
68
Which nerve supplies posterior muscles of the lower limb and is responsible for plantar flexion and inversion?
Tibial nerve
69
Which nerve supplies anterior and lateral muscles of the lower limb and is responsible for dorsiflexion and eversion?
Common fibular nerve
70
Compare the tibial nerve with the common fibular nerve. Ie - innervation and action of the muscles
Tibial nerve - posterior compartment. Plantarflexion and inversion Common Fibular - anterior and lateral compartments. Dorsiflexion and eversion
71
Compare the innervations of superficial and deep fibular (peroneal) nerve?
Deep fibular - innervates anterior compartment of leg and 1st web space Superficial fibular- innervates lateral compartment of leg and sensory innervation to anterolateral leg and dorsal of foot
72
If trendelenberg's sign is positive, which side is the hip drop on?
Hip drop on unaffected side
73
Which nerve is damaged in trendelenbergs positive cases? Which muscle is therefore affected?
Superior gluteal nerve Gluteus medius and gluteus minimus
74
Which artery is contained in the anatomical snuffbox?
Radial artery
75
Which level does the coeliac axis split from aorta? Name the 3 branches of coeliac axis?
Branches off aorta at T12 Branches: Left gastric Common hepatic Splenic artery "Left Hand Side"
76
Compare the nerves damaged in humeral mid shaft fractures and surgical neck fractures
Surgical neck fractures= axillary nerve Midshaft fractures = radial nerve
77
Name the 4 components of the carotid sheath?
Common and internal carotid artery Internal Jugular vein Vagus nerve
78
Describe the muscles and their innervations involved in shoulder ABDuction?
Supraspinatus- shoulder abduction to 15 degrees, innervated by suprascapsular nerve Deltoid - shoulder abduction >15 degrees, innervated by axillary nerve
79
Which visual field defect is caused by a lesion at the optic chiasm?
Bitemporal hemianopia
80
What is the most anteriorly located structure in the lung root?
Phrenic nerve
81
Compare the location of direct and indirect hernias with respect to the inferior epigastric artery?
direct hernias - medial to IEA Indirect hernias - lateral to IEA
82
Describe the medial, lateral and inferior borders of hesselbach's (inguinal) triangle?
Medial - Rectus abdominus Lateral - Inferior epigastric Artery Inferior - inguinal ligament
82
Which structure is most likely to be encountered in an axillary sentinel LN biopsy?
Intercostobrachial nerve
83
Name 4 clinical features of Horner's syndrome?
Ptosis Miosis Anhydrosis Enopthalmos
84
What visual field defect is seen in pituitary tumours?
Bitemporal hemianopia
85
Compare the anterior and posterior innervation of the scrotal skin
Anterior - illioinguinal nerve Posterior - pudendal nerve
86
Which nerve innervates the web space between 1st and 2nd toe?
Deep fibular nerve
87
Which muscle is the termination of the adductor canal located in?
Adductor Magnus
88
89
Which structure is most at risk during dissection at the saphenofemoral junction?
Deep external pudendal artery
90
Which region of the male urethra is surrounded entirely by Bucks fascia?
Spongiose part The membranous part may partially pass through
91
Name the 2.5 muscles innervated by the anterior interosseous nerve?
Flexor pollicus longus Pronator quadratus Flexor digitorum profundus (radial half)
92
Pneumonic and branches of internal carotid?
"Only Press Carotid Arteries Momentarily" Ophthalmic Posterior communicating Choriodial Anterior cerebral Middle cerebral
93
Which nerve is most often permanently damaged during superficial parotidectomy?
Greater Auricular nerve Facial nerve paresis can occur, but this is not permanent
94
What is the sensory nerve supply to the skin overlying the angle of the jaw?
Greater auricular nerve (C2-C3) It is the only area not innervated by the mandibular branch of trigeminal nerve
95
Which 2 nerves are responsible for extension of the knee?
Femoral and obturator nerves
96
What is the lymphatic drainage of the female urethra?
Internal Iliac nodes
97
What which roots represent the sciatic nerve?
L4 - S3
98
Name the contents of the rectus sheath?
Pyrimidalis muscle Rectus Abdominus muscle Superior Epigastric artery and vein Inferior epigastric artery and vein
99
Where does the common fibular nerve bifurcate into the superficial and deep fibular nerves?
At the lateral aspect of the neck of the fibula This predisposes it to injury
100
Name the ligament found on the medial side of the ankle?
Deltoid ligament
101
Name the 3 ligaments found on the lateral ankle?
Anterior talofibular ligament (ATFL) Posterior talofibular ligament (PTFL) Calcaneofibular ligament (CFL)
102
Based on the Danis weber classification, how does level of fibular fracture relate to fracture instability?
The more proximal the fibula fracture, the greater the risk of syndesmotic injury and therefore fracture instability
103
Which layers does the fluid in a hydrocele collect?
Between visceral and parietal layers of the tunica vaginalis
104
Which nerve root is most affected by Klumpkes palsy? How does this present?
C8-T1 - inferior nerve roots Claw hand, loss of flexors of wrist
105
Which 2 heart valves are not attached to the chordae tendinae?
Aortic valve and pulmonary valve Both these valves have 3 cusps
106
Compare the embryological pouches that the inferior and superior parathyroid is derived from?
Superior parathyroid = fourth pouch Inferior parathyroid = third pouch
107
Compare which nerves are related to short saphenous and long saphenous veins? Which procedure can these nerves be damaged in?
Short saphenous - sural nerve Long saphenous - saphenous nerve Nerves can be damaged during vein stripping for varices
108
Compare the lymphatic drainage above and below the dentate line? (Transition area in anal canal)
Above dentate line = Internal iliac LNs Below dentate line = Superficial Inguinal LNs
109
Which nerve supplies cutaneous sensation to skin over thumb?
Median nerve
110
Compare the drainage of lymph from the superior and inferior aspect of the vagina?
Superior - internal and external iliacs Inferior - superficial inguinal lymph nodes
111
Which artery supplies the SA node?
Right coronary artery
112
Compare what the left and right gonadal veins drain into?
Right gonadal drain empties directly into vena cava Left gonadal vein empties into the left renal vein
113
Describe the relations to the right and left lobe of the liver of the quadrate lobe?
The quadrate lobe is anatomically contained within the right lobe, but is functionally part of the left lobe
114
What 2 veins combine to form the retromandibular vein?
Maxillary and superficial temporal veins
115
Which structure separates subclavian artery from subclavian vein?
Anterior scalene muscle The subclavian vein passes anterior to ant scalene muscle, the subclavian artery passes through the scalene triangle with the brachial plexus
116
Name the first branch of the abdominal aorta?
Inferior phrenic arteries The superior phrenic arteries lie in the thorax
117
Which nerve is closely associated to the brachial artery?
The median nerve closely associated in the antecubital fossa
118
What does the brachial artery branch into at the antecubital fossa?
Branches into the radial and ulnar arteries
119
What is the origin of the superior gluteal artery?
Internal iliac artery Superior Gluteal artery arises from posterior trunk of IIA, Inferior Gluteal artery arises from anterior trunk of IIA
120
Where do the phrenic nerves lie in relation to the hilum of the lungs?
Both right and left phrenic nerves lie anterior to lung roots
121
Describe the arterial supply of the 3 areas of the rectum?
Superior rectum = Inferior mesenteric artery Middle rectum = Internal Iliac artery Inferior rectum = Internal pudendal artery
122
What is the arterial supply of the lacrimal apparatus?
Opthalmic artery A branch of internal caroitd
123
What nerve is at risk during submandibular gland excision?
Lingual nerve Greater auricular nerve is most commonly damaged in parotidectomy
124
What artery is the inferior thyroid artery a branch of?
The thyrocervical trunk The thyrocervical trunk is a branch of the subclavian artery
125
Compare which artery supplies the bile duct and which supplies the gallbladder?
The bile duct = hepatic artery The Gallbladder = cystic artery Damage to hepatic artery in cholecystectomy can cause bile duct strictures
126
Name the 3 nerves at greatest risk during a carotid endarterectomy?
Hypoglossal nerve Greater auricular nerve Superior laryngeal nerve
127
Name the medial and lateral border of the anatomical snuffbox?
Medial = Extensor pollicis longus Lateral= Extensor pollicis brevis and abductor pollicis longus
128
Which nodal region will tumours of the uterus initially spread to?
The Iliac lymph nodes
129
Which nerve is responsible for the cremasteric reflex?
Genitofemoral nerve
130
Which nerve passes through the greater and lesser sciatic foramen?
Pudendal nerve
131
What is the most superficial structure on the parotid?
The facial nerve
132
Which artery supplies the transverse colon?
Middle colic artery
133
Which muscle attaches onto the lesser trochanter of the femur?
Psoas major
134
Which artery supplies the prostate gland?
Inferior vesical artery
135
How many unpaired branches leave the abdominal aorta to supply the abdominal viscera? What are they?
3 SMA IMA Coeliac axis
136
Where do all rotator cuff muscles insert into?
All of them insert into the greater tuberosity of the humerus, EXCEPT subscapularis Subscapularis inserts into the lesser tuberosity of the humerus
137
Name the surgical approach used to access incarcerated femoral hernias?
McEvedy approach - used for groin incisions
138
Where does Stensen's duct open from and where does it open into?
Opens from the parotid gland, enters oral cavity opposite 2nd molar tooth
139
What muscle is most superficial of the abdominal wall muscles?
External oblique muscle
140
From anterior to posterior, name the 3 muscles of the abdominal wall?
External oblique Internal oblique Transverse abdominus
141
Which vessel supplies the SA node and AV node?
Right Coronary Artery Blockage of RCA can cause arrthymias to develop
142
The anterior interosseus nerve is a branch of which nerve? What does it supply?
Branch of the median nerve Supplies motor innervation to deep muscles in anterior compartment of forearm Flexor pollicus longus Flexor digitorum profundus Pronator quadratus (Finger flexion)
143
Which foramina does the genital branch of the genitofemoral nerve exit the abdominal cavity?
The deep inguinal ring
144
Which structure is most at risk of damage during a high anterior resection?
Left ureter
145
If a renal heamtoma occurs, which structure will contain the haematoma?
Gerotas fascia - it surrounds the kidney
146
Which structure attaches periosteum to bone?
Sharpey's fibres They are strong collagenous fibres and also provide attachment for muscles and tendons
147
Name the 4 structures passing through the parotid gland?
Facial nerve and branches External carotid artery Retromandibular vein Auriculotemporal nerve
148
What type of incision is traditionally used for renal transplants?
Rutherford Morrison Provides extraperitoneal access to iliac vessels
149
Which nerve supplies the 1st web space of the foot?
Deep peroneal nerve
150
What is the primary site of venous drainage from the bladder?
Vesicoprostatic venous plexus - can be a site of considerable bleeding in cystectomy This then drains into the internal iliac vein
151
Which nerve passes through the quadrangular space near the humeral head?
Axillary nerve So does the posterior circumflex humeral artery
152
At which vertebral body does the common carotid bifurcate into the external and internal carotids?
C4
153
Damage at what vertebral level downwards will result in LMN signs rather than UMN signs?
L1 For lesions below L1, LMN signs will occur
154
What does the head of the radius articulate with superiorly?
Capitulum of the Humerus "Capital Radio"
155
What is the most posterior structure at the hilum of the right kidney?
The Ureter It would be encountered first in a posterior approach to a nephrectomy
156
Compare what structures are separated by Denonvillers and Waldeyers fascia?
Denonvillers fascia - separates prostate from rectum Waldeyer's Fascia - sperate rectum from sacrum
157
The thoracic duct drains lymph from the whole body, except...?? What are these areas drained by instead?
The right upper limb, right head and neck and right breast and lung They are drained by the right lymphatic duct
158
What surgical incision is used to undergo a Whipple's procedure?
Rooftop incision
159
What is Froment's sign? What does it test for?
Front's sign = testing grip strength of patients thumb and index finger by asking them to hold a bit of paper and then pulling it It tests for ulnar nerve palsy in the ADDuctor pollicus muscle
160
Which structure separates the PCL from the popliteal artery?
The Oblique popliteal ligament
161
Why is it easy for sepsis to spread in the cranial venous sinuses?
They have no valves The sinuses are located in the dura mater
162
What is the cystic artery a branch of?
The right hepatic artery
163
What artery is most likely to be damaged in an extradural haematoma?
Middle meningeal artery laceration
164
Name the nerves that provide taste and sensation to the anterior 2/3 of the tongue?
Sensation= facial nerve Taste = Trigeminal nerve
165
Which nerve innervates the stylohyoid?
The facial nerve All other muscles around the hyoid are innervated by trigeminal nerve
166
Which cranial bone does the Foramen spinosum lie?
Sphenoid bone
167
When considering ulnar nerve damage, what is the ulnar paradox?
The ulnar nerve paradox - the higher the lesions, the less clawing of the fingers seen clinically ie - lesion at the elbow will produce less clawing than lesion at the wrist
168
At what level does the aorta bifurcate into the common iliacs?
L4
169
What is the mnemonic for remembering radial nerve muscles? What are the muscles?
BEST Brachioradialis Extensors Supinators Triceps
170
What sympathetic ganglia should be divided to treat hyperhidrosis of the hands and arms?
DIvide sympathetic ganglia at T2 & T3 "Division of T2&T3 keep the hands sweat free" The parietal pleura will need to be divided
171
What CN provides sensation to the posterior 1/3 of tongue?
Glossopharyngeal nerve Also contributes to gag reflex
172
Which 3 arteries make up Littles area of the nose?
Facial, Maxillary and ophthalmic arteries
173
Which branch of the aorta passes anterior to the lower part of the pancreas and may be encountered in a Whipple's procedure?
Superior Mesenteric Artery Invasion of this structure into the pancreatic head is a contra-indication to surgery
174
What level is the lesion in Erb's Palsy?
C5, C6 nerve lesion
175
What is the main arterial source of blood supply to the omentum?
Gastroepiploic artery
176
Where does the scaphoid derive the majority of its blood supply?
Dorsal carpal branch vessels - via retrograde flow Arises from ulnar artery
177
Which branch of the brachial plexus is most commonly injured as a result of a crutch palsy?
Radial nerve - results in wrist drop Ulnar nerve arises from the medial cord so is more protected than radial, which is a branch of the posterior cord
178
Compare the innervations of the anterior and posterior bellies of the digastric muscle?
Anterior belly = mylohyoid nerve Posterior belly = facial nerve
179
What is the correct origin of the pancreas during embryological development?
Ventral and dorsal endodermal outgrowths of the duodenum
180
In the carpal tunnel, which tendon lies deepest and in closest proximity to the hamate bone?
The tendon of flexor digitorum profundus
181
Which CN has a long intracranial course and therefore most susceptible to raised ICP? Which cranial nerve has the longest intracranial course?
Abducens nerve CN6 is most likely to be affected by rasied ICP CN4 has the longest intracranial course tho
182
Which nerve is routinely encountered at the superficial inguinal canal during hernia repairs?
Ileoinguinal nerve Ileoinguinal nerve entrapment may be a cause of neuropathic pain following hernia repair
183
Compare arterial supply of the cervical and thoracic oesophagus?
Cervical = inferior thyroid artery Thoracic= direct branches from the thoracic aorta
184
Where do the common iliac veins fuse with the IVC?
L5 The aorta bifurcates to the common iliac arteries at L4
185
Compare the insertion sites of flexor digitorum profundus and superficalis?
Flexor digitorum profundus inserts onto the DIP joints Flexor digitorum superficialis inserts onto the PIP joints
186
Which nerve gives innervation to anal sphincters and external urethral sphincter?
Pudendal nerve S2,3,4 keeps shit off the floor
187
Name the 5 muscles innervated by the deep peroneal (tibial) nerve?
Tibialis anterior Extensor digitorum longus and extensor digitorum brevis Extensor hallicus longus Peroneus tertius
188
Where are the greatest proportion of musculi pectinati found?
The Right atrium This gives the anterior walls of right atrium an irregular appearance
189
From which structure does the inguinal ligament arise?
The external oblique aponeurosis
190