Anatomy Flashcards
(398 cards)
1
Q
What are the contents of the femoral triangle?
A
NAVEL – Nerve, Artery, Vein, Empty space, Lymphatics (lateral to medial)
2
Q
What nerve is commonly injured in a midshaft humerus fracture?
A
Radial nerve – leads to wrist drop
3
Q
What is the anatomical course of the facial nerve?
A
Exits stylomastoid foramen → enters parotid gland → 5 branches: Temporal, Zygomatic, Buccal, Marginal Mandibular, Cervical
4
Q
What layers are pierced during an open inguinal hernia repair?
A
Skin → Subcutaneous tissue → External oblique → Cremasteric fascia → Hernia sac
5
Q
What structures pass through the foramen magnum?
A
Spinal cord, vertebral arteries, spinal accessory nerve (XI), meninges
6
Q
How do you differentiate a lipoma from a sebaceous cyst?
A
Lipoma: soft, mobile, non-tender. Sebaceous cyst: punctum, may be inflamed, firmer
7
Q
What are red flag features of a thyroid nodule?
A
Hoarseness, rapid growth, hard/fixed nodule, cervical lymphadenopathy, family history
8
Q
What is the triple assessment for a breast lump?
A
- Clinical examination 2. Imaging (USS/mammogram) 3. Biopsy (FNA/core)
9
Q
What are signs of an irreducible inguinal hernia?
A
Tender, non-reducible lump, erythema, signs of bowel obstruction
10
Q
What are differentials for acute scrotal pain?
A
Testicular torsion (emergency), epididymo-orchitis, torsion of appendage, trauma, inguinal hernia
11
Q
What are the branches of the external carotid artery?
A
‘Some Anatomists Like Freaking Out Poor Medical Students’ – Superior thyroid, Ascending pharyngeal, Lingual, Facial, Occipital, Posterior auricular, Maxillary, Superficial temporal
12
Q
What are the boundaries of the anatomical snuffbox?
A
Tendons: Abductor pollicis longus & extensor pollicis brevis (anterior); Extensor pollicis longus (posterior). Floor: scaphoid and trapezium. Contents: radial artery.
13
Q
What structures pass through the carpal tunnel?
A
4 x flexor digitorum profundus tendons, 4 x flexor digitorum superficialis tendons, flexor pollicis longus tendon, median nerve
14
Q
What is the motor supply of the recurrent laryngeal nerve?
A
All intrinsic muscles of the larynx EXCEPT cricothyroid (supplied by external branch of superior laryngeal nerve)
15
Q
What are the contents of the posterior triangle of the neck?
A
Accessory nerve (CN XI), brachial plexus, subclavian artery (3rd part), external jugular vein, lymph nodes
16
Q
What anatomical structure is at risk in a parotidectomy?
A
Facial nerve (CN VII) – it passes through the parotid gland and divides into 5 terminal branches
17
Q
What level does the spinal cord end in adults?
A
L1–L2 vertebral level
18
Q
What nerve is responsible for sensation over the anatomical snuffbox?
A
Superficial branch of the radial nerve
19
Q
What are the boundaries of the inguinal canal?
A
Floor: inguinal ligament; Roof: arching fibres of IO and TA; Anterior: EO aponeurosis; Posterior: transversalis fascia and conjoint tendon
20
Q
What passes through the greater sciatic foramen?
A
Piriformis muscle, sciatic nerve, superior/inferior gluteal nerves and vessels, pudendal nerve (exits and re-enters via lesser sciatic foramen)
21
Q
What is the surface marking of the appendix?
A
McBurney’s point: one-third of the distance from the right ASIS to the umbilicus
22
Q
What is the surface marking of the common carotid artery bifurcation?
A
At the level of C4 – upper border of thyroid cartilage
23
Q
What are the key features seen in a normal lateral CXR?
A
Diaphragms (R > L), retrosternal air space, heart border, vertebral bodies (should get darker inferiorly), trachea and carina
24
Q
What vertebral level is the renal hilum found at?
A
L1 on the left, L2 on the right (due to liver displacement)
25
What is the surface marking of the femoral artery pulse?
Mid-inguinal point – halfway between ASIS and pubic symphysis
26
Which bone is fractured in a 'dinner fork deformity'?
Distal radius – Colles' fracture
27
What structures form the borders of the cubital fossa?
Medially: pronator teres; Laterally: brachioradialis; Roof: bicipital aponeurosis; Contents: TAN – Tendon (biceps), Artery (brachial), Nerve (median)
28
Which radiographic view best shows a scaphoid fracture?
Scaphoid view – PA with ulnar deviation
29
What anatomical landmark indicates safe chest drain insertion?
'Safe triangle': lateral edge of pectoralis major, anterior edge of latissimus dorsi, 5th intercostal space (nipple level), apex below axilla
30
What is the arterial supply of the femoral head?
Medial circumflex femoral artery – vulnerable in femoral neck fractures
31
32
What are the 12 cranial nerves in order?
I. Olfactory, II. Optic, III. Oculomotor, IV. Trochlear, V. Trigeminal, VI. Abducens, VII. Facial, VIII. Vestibulocochlear, IX. Glossopharyngeal, X. Vagus, XI. Accessory, XII. Hypoglossal
33
What are the functions of the olfactory nerve (CN I)?
Sensory: Smell – damage leads to anosmia (loss of smell)
34
What are the functions of the optic nerve (CN II)?
Sensory: Vision – damage leads to blindness, field defects (e.g., homonymous hemianopia)
35
What is the foramen for the oculomotor nerve (CN III)?
Superior orbital fissure
36
What are the functions of the trochlear nerve (CN IV)?
Motor: Controls superior oblique muscle – damage leads to diplopia (double vision) and difficulty looking down
37
What is the foramen for the trigeminal nerve (CN V)?
V1 (ophthalmic): Superior orbital fissure; V2 (maxillary): Foramen rotundum; V3 (mandibular): Foramen ovale
38
What are the three branches of the trigeminal nerve (CN V)?
V1: Ophthalmic, V2: Maxillary, V3: Mandibular
39
What is the function of the abducens nerve (CN VI)?
Motor: Lateral rectus muscle – damage leads to inability to abduct the eye (strabismus)
40
What is the foramen for the facial nerve (CN VII)?
Internal acoustic meatus → Stylomastoid foramen
41
What is the function of the facial nerve (CN VII)?
Motor: Muscles of facial expression, taste to anterior 2/3 of tongue, parasympathetic (lacrimal, submandibular, sublingual glands)
42
What is the foramen for the vestibulocochlear nerve (CN VIII)?
Internal acoustic meatus
43
What are the functions of the glossopharyngeal nerve (CN IX)?
Sensory: Taste to posterior 1/3 of tongue, pharynx sensation, carotid body reflex; Motor: Stylopharyngeus muscle
44
What is the foramen for the vagus nerve (CN X)?
Jugular foramen
45
What are the functions of the vagus nerve (CN X)?
Motor: Pharynx and larynx muscles; Sensory: Pharynx, larynx, and organs (thoracoabdominal); Parasympathetic: Heart, lungs, digestive system
46
What is the foramen for the accessory nerve (CN XI)?
Foramen magnum → Jugular foramen
47
What is the function of the accessory nerve (CN XI)?
Motor: Sternocleidomastoid and trapezius muscles – damage causes shoulder droop and difficulty turning the head
48
What is the foramen for the hypoglossal nerve (CN XII)?
Hypoglossal canal
49
What is the function of the hypoglossal nerve (CN XII)?
Motor: Controls intrinsic and extrinsic tongue muscles – damage causes tongue atrophy and fasciculations
50
What are the main structures passing through the foramen magnum?
Spinal cord, vertebral arteries, spinal accessory nerve (CN XI), meninges
51
What cranial nerve is responsible for the corneal reflex?
Trigeminal nerve (CN V) – Sensory limb, Facial nerve (CN VII) – Motor limb
52
What is the clinical sign of a CN III (oculomotor) lesion?
Ptosis (drooping eyelid), fixed and dilated pupil, eye is abducted and depressed (down and out)
53
What spinal cord level is the phrenic nerve derived from?
C3–C5 – responsible for diaphragm innervation
54
What is the spinal cord level for the brachial plexus?
C5–T1 – supplies the upper limb
55
What are the spinal cord levels of the lumbosacral plexus?
L1–S4 – supplies the lower limb
56
Which dermatome corresponds to the nipple line?
T4
57
Which dermatome corresponds to the umbilicus?
T10
58
What dermatome is responsible for sensation to the thumb?
C6
59
Which dermatome corresponds to the little finger?
C8
60
Which dermatome corresponds to the knee cap?
L4
61
Which dermatome corresponds to the lateral side of the foot?
S1
62
Which spinal cord levels are responsible for the patellar reflex?
L2–L4
63
Which spinal cord levels are responsible for the Achilles reflex?
S1–S2
64
What spinal cord levels are responsible for the biceps reflex?
C5–C6
65
What spinal cord levels are responsible for the triceps reflex?
C6–C8
66
What is the spinal cord level for the pelvic splanchnic nerves?
S2–S4 – parasympathetic innervation for the bladder and rectum
67
What is the clinical significance of the T12 dermatome?
Loss of sensation here may indicate lower abdominal or groin injury
68
What spinal level is the cauda equina found?
L2–S5 – nerve roots of the lower limbs and pelvic organs
69
At what level does the spinal cord end in adults?
L1–L2 vertebral level
70
Which spinal cord level corresponds to the lower extremity flexion reflex (withdrawal reflex)?
L5–S2
71
What clinical sign indicates a C5–C6 nerve root lesion?
Weakness in elbow flexion and loss of sensation in the lateral forearm and thumb (C6 dermatome)
72
Which spinal segment corresponds to the cremasteric reflex?
L1–L2 – gentle stroking of the inner thigh causes ipsilateral testicular elevation
73
What are the main branches of the femoral artery?
Profunda femoris, superficial epigastric, superficial circumflex iliac, external pudendal arteries
74
What is the course of the sciatic nerve?
Exits the pelvis through the greater sciatic foramen, runs deep to the gluteus maximus, and bifurcates into the tibial and common peroneal nerves at the popliteal fossa
75
What are the boundaries of the femoral triangle?
Superior: Inguinal ligament; Lateral: Sartorius; Medial: Adductor longus; Roof: Skin and fascia; Floor: Iliopsoas and pectineus
76
What are the structures at risk during femoral hernia repair?
Femoral artery, vein, and the femoral nerve
77
What are the common causes of sciatic nerve injury?
Pelvic fractures, hip dislocations, prolonged compression (e.g., during surgery), or piriformis syndrome
78
What is the surgical approach to accessing the femoral artery?
Inguinal approach, at the midpoint of the inguinal ligament, just below the pubic tubercle
79
What is the clinical sign of obturator nerve injury?
Weakness of hip adduction and sensory loss in the medial thigh (obturator dermatome)
80
What structures pass through the popliteal fossa?
Popliteal artery and vein, tibial and common peroneal nerves, lymphatics
81
What are the motor and sensory functions of the tibial nerve?
Motor: Plantar flexion and toe flexion; Sensory: Sole of the foot
82
What is the sensory distribution of the common peroneal nerve?
Anterior and lateral lower leg, dorsum of the foot
83
What is the course of the femoral nerve?
Exits the pelvis through the inguinal ligament, runs along the anterior thigh, and supplies motor innervation to the quadriceps, sartorius, and iliopsoas muscles
84
Where is the femoral nerve most vulnerable to injury?
At the inguinal ligament (especially after pelvic fractures or during femoral hernia surgery)
85
What are the boundaries of the popliteal fossa?
Superomedial: Semimembranosus and semitendinosus muscles; Superolateral: Biceps femoris; Inferior: Gastrocnemius (medial and lateral heads)
86
What are the structures at risk in a hip replacement surgery?
Femoral artery and vein, sciatic nerve, femoral nerve
87
What is the clinical presentation of femoral nerve injury?
Weakness in knee extension, difficulty with walking, and loss of sensation over the anterior thigh and medial aspect of the leg
88
What is the role of the peroneal nerve in foot drop?
Injury to the common peroneal nerve leads to weakness in dorsiflexion (foot drop) and loss of sensation on the dorsum of the foot
89
Where does the great saphenous vein drain?
Into the femoral vein at the saphenofemoral junction, just below the inguinal ligament
90
How do you access the sciatic nerve surgically?
Midline or lateral incision at the gluteal region, or through the posterior approach to the hip (using the greater sciatic foramen)
91
What is the motor function of the superior gluteal nerve?
Innervates gluteus medius and minimus, important for hip abduction and pelvic stabilization
92
What are the most common benign tumors of the parotid gland?
Pleomorphic adenoma (most common) and Warthin’s tumor
93
What is the most common malignant tumor of the parotid gland?
Mucoepidermoid carcinoma
94
What is the most common type of thyroid cancer?
Papillary thyroid carcinoma
95
What is the anatomical location of the thyroid gland?
Located in the anterior neck, at the level of C5–T1, with the isthmus crossing over the 2nd and 3rd tracheal rings
96
What are the boundaries of the lateral neck for surgical exploration of tumors?
Anterior: Sternocleidomastoid; Posterior: Trapezius; Inferior: Clavicle; Superior: Mandible
97
What is the risk of recurrent laryngeal nerve injury during thyroidectomy?
The recurrent laryngeal nerve runs posterior to the thyroid and can be damaged, leading to hoarseness or loss of voice
98
What are the key features of a nasopharyngeal carcinoma?
Common in young adults and associated with EBV, presents with nasal obstruction, epistaxis, and neck mass due to cervical lymph node involvement
99
What is the most common site of oral squamous cell carcinoma?
The tongue, particularly the lateral borders
100
What are common signs of laryngeal carcinoma?
Hoarseness, dysphagia, neck mass, stridor
101
What is the clinical significance of the jugular foramen in relation to tumors?
The jugular foramen transmits the glossopharyngeal (CN IX), vagus (CN X), and accessory (CN XI) nerves. Tumors here can cause cranial nerve palsies (e.g., hoarseness, dysphagia)
102
How does a tumor of the carotid body (paraganglioma) present?
Pulsatile neck mass at the carotid bifurcation, often with a bruit, may present with cranial nerve deficits
103
What are the common sites of metastasis in head and neck cancers?
Lymph nodes in the neck (especially in the submandibular, submental, and cervical regions)
104
What are the most common malignant tumors of the sinuses?
Squamous cell carcinoma, followed by adenocarcinoma
105
What is the most common cause of neck mass in a child?
Lymphadenopathy due to viral or bacterial infections, followed by congenital cysts (e.g., branchial cleft cysts)
106
What are the features of a branchial cleft cyst?
Typically located in the anterior border of the sternocleidomastoid, firm, non-tender, and may become infected
107
What are the potential complications of removing a tumor near the facial nerve?
Facial nerve injury (resulting in facial paralysis) is a major risk, particularly during parotidectomy
108
What is the risk of cervical spine injury during a tumor resection near the cervical vertebrae?
Tumors near the cervical spine (e.g., metastases) may put pressure on the spinal cord or nerve roots, leading to neurologic deficits
109
What is the clinical presentation of a nasopharyngeal carcinoma?
Persistent nasal congestion, epistaxis, neck mass, hearing loss (due to Eustachian tube involvement)
110
What is the surgical approach for a mandibular tumor?
Submandibular or transoral approaches, depending on the location, with possible bone resection
111
What anatomical structures are at risk during thyroidectomy?
Recurrent laryngeal nerve, superior laryngeal nerve, parathyroid glands (risk of hypocalcemia)
112
When do cranial sutures ossify.
18 - 24 months
113
Which bones meet at the pterion?
Frontal
Parietal
Temporal
Greater wing of sphenoid
114
What is the estimated location of the pterion?
2 fingers above zygomatic arch and thumbs breath behind frontal process of zygomatic bone
115
Layers of burr hole at pterion
Skin
Connective tissue
Aponeurosis
Loose connective tissue
Temporalis muscle
Pericranium
116
Contents of superior orbital fissure
Oculomotor nerve
Frontal Nerve (branch of V1)
Lacrimal nerve
trochlear nerve
abducens nerve
superior ophthalmic vein
117
Boundaries of middle cranial fossa
Anterolateral; lesser wings of sphenoid
Anteromedial; anterior clinoid process
Posterolateral; petrous part of temporal bone
Posteromedial; dorsum sellae
Floor; body & greater wing of sphenoid, petrous & squamous temporal bone
118
Contents of middle cranial fossa
Pituitary gland
temporal lobes
119
Contents of posterior cranial fossa
brainstem
cerebellum
120
What are the boundaries of the posterior triangle?
Anterior: Posterior border of SCM; Posterior: Anterior border of trapezius; Base: Clavicle; Apex: Occipital bone; Roof: Investing fascia; Floor: Prevertebral fascia.
121
Causes of lytic skull lesions
Bones mets (renal, lung)
Multiple myeloma
Osteomyelitis
Pagets
Sarcoidosis
Haemangioma
122
Causes of sclerotic skull lesions
Prostate cancer
123
TMJ type
Bi arthrodial hinge joint
124
Articular surfaces of TMJ
Head of mandible
Mandibular fossa of squamous temporal bone
Articular tubercle of temporal bone
Articular disc
Covered by fibrocartilage not hyaline
125
Muscles opening the mouth
DLGM
Digastric
Geniohyoid
Lateral pterygoid
Mylohyoid
126
Muscles of mastication
Masseter
Temporalis
Medial
Lateral pterygoids
127
Blood supply of temporalis and overlying skin
Muscle: deep temporal arteries from maxillary (ECA)
Skin: sup. Temporal artery (ECA)
128
What structures pass through the posterior triangle?
Accessory nerve (CN XI), roots/trunks of brachial plexus, external jugular vein, cervical plexus branches, transverse cervical and suprascapular vessels, lymph node
129
What are the subdivisions of the anterior triangle?
Submental triangle, submandibular triangle, carotid triangle, and muscular triangle.
130
What are the boundaries of the submental triangle?
Lateral: Anterior bellies of digastric; Inferior: Hyoid bone; Floor: Mylohyoid.
131
What are the contents of the submental triangle?
Submental lymph nodes and small veins forming the anterior jugular vein
132
Extrinsic muscles of the tongue
SHPG
Styloglossus - XII
Hyoglossus - XII
Genioglossus - XII
Palatoglossus - X
133
Muscle to retract tongue
Styloglossus
134
Taste & sensory innervation of the tongue
Posterior 1/3 - IX (glossopharyngeal)
Anterior 2/3 - Sensory - V3 (Mandibular via lingual), Taste VII - chorda tympani
135
136
Contents of posterior neck triangle
Nerves: accessory, phrenic, brachial and cervical plexus
Vessels: ext JV, subclavian
Muscles: omohyoid, scalene, levator scap
Lymph; supraclavicular, occipital
137
Regions drained by pre-auricular lymph node
Upper half of face
Temporal region
Auricle and ext acoustic meatus
Gums
138
Blood supply of thyroid gland
Arterial Sup. Thyroid art
Inf thyroid art, thyroid IMA
Venous
Superior and middle thyroid drain to internal JV
Inferior into brachiocephalic veins
139
Lymph drainage of thyroid gland
Pre laryngeal, pre tracheal, paratracheal, upper and lower deep Cx, brachiocephalic
140
Level of thyroid
C4-6
141
Why does thyroid move with deglutition?
Thyroid contained in pretracheal fascia attached to Thyroid cartilage and hyoid bone
Hyoid bone pulled up during swallowing and pulls pretracheal fascia and therefore the Thyroid
142
Late complications of thyroidectomy
Hypothyroidism
Hypoparathyeoidism
Hypocalcaemia
143
surface markings for transpyloric plane
halfway between jugular notch and upper border of pubic symphysis
144
145
causes/risk factors for aneurysm
HTN secondary to atherosclerosis & smoking
Marfan
bicuspid aortic valve
146
tributaries of the IVC
L5 - common iliac veins
L1-5 lumbar veins
L2 Rt gonadal vein
L1 renal veins and suprarenal vein (rt)
T8 hepatic veins and inf. phrenic veins
147
Anterior relations of the renal veins
Rt side - 2nd part of the duodenum
Lt side body of pancreas, SMA, splenic
148
splenic blood supply
coeliac trunk - splenic artery
splenic vein - SMV - portal vein
149
ribs related to spleen
9-11
150
course of splenic artery
coeliac trunk - passes to left above upper pancreas border - behind stomach - passes lienorena ligament - ends by giving terminal branches inside spleen hilum
151
splenic artery supplies
spleen, stomach, pancreas
152
blood supply to pancreas
sup. pancreatico-duodenal art (from gastroduodenal_ = head & neck
inf. pancreatico-duodenal art (from SMA) = head & neck
pancreatic branches from splenic = body & tail
153
pancreatic ducts
main duct drains head, body, tail - opens to major duodenal papilla
accessory duct - drains uncinate process - opens to minor duodenal papilla
154
vessels in a whipples
AA
SMA
Lt renal vein
sup. & inf. pancreato-dudodenal art
splenic vein
SMV
portal vein
155
ligament connecting tail of pancreas to spleen
lienorenal ligament
156
posterior relations to the neck of the pancreas
SMV & splenic vein unite to form hepatic portal vein
157
development of pancreas
1. ventral bud = from hepatic diverticulum = lower part of head and uncinate process & main pancreatic duct
2. dorsal bud = dorsal aspect of duodenum = upper head, neck, body, tail and accs. pancreatic duct
3. ventral bud rotates dorsally to fuse with dorsal bud
158
what demarcates the left and right lobe of the liver
falciform lig.
fissure for ligamentum teres and ligamentum venosum
surgically - line from IVC to fossa of gallbladder
159
what artery of coeliac trunk supplies liver and stomach
hepatic art
160
ligaments supporting the liver
falciform
lesser omentum
rt & lt triangular ligament
upper and lower coronary ligament
161
surface marking for the gallbladder
angle between 9th costal cartilage and lateral margin of the rectus sheath
162
parts of the stomach
fundus, body, pylorus
163
blood supply to stomach
lt gastric - coelic truck
rt gastric - hepatic
lt gastroepiploic from splenic
rt gastroepiploic from gastroduodenal (hepatic)
short gastric from splenic
164
venous drainage from stomach
lt & rt gastric veins to portal vein
lt gastroepiploic & short gastric to splenic
rt gastroepiploic vein to SMV
165
posterior relations to the stomach
lesser sac
pancreas
left kidney & adrenal gland
spleen
splenic artery
166
167
relations to the 1st part of the duodenum
anterior - quadrate lobe of liver & gallbladder
posterior - portal vein, gastroduodenal art, CBD
sup - epiploic foramen
inf - head & neck of pancreas
168
relations to the 2nd part of the duodenum
ant - gallbladder and right lobe of liver, transverse colon
post - rt kidney, rt renal vessels, rt edge of IVC, rt psoas
medially - head of pancreas
laterally - ascending colon, rt colic flexure, rt lobe of liver
169
relations to 3rd part of duodenum
ant - root of mesentery, SM vessels, jejunum
post - rt psoas, rt ureter, IVC, AA, rt gonadal vessels
sup - head of pancreas
inf - coils of jejunum
170
relations to 4th part of duodenum
anterior - transverse colon
post - lt psoas, left sympathetic chain, lt gonadal vessels, IMV
sup - body of pancrease
to left - lt kidney and ureter
171
where is the major duodenal papilla
8-10cm distal to the pylorus
172
possible appendix positions
retrocecal
pelvic
subcaecal
pre-ileal, post ileal
173
blood supply to appendix
appendicular art - from ileocolic art
appendicular vein to SMV
174
nerve injured during appendicectomy
ilioinguinal nerve (l1)
175
bladder blood supply
art - sup & inf vesical arteries from internal iliac
venous - vesical venous plexus to internal iliac vein
176
nerve supply to detrouser
sympathetic - inhibits contraction = L1/2
parasympathetic - stimulates contraction S2-4
177
most common bladder ca
TCC
SCC
mixed
adenocarcinoma
178
risk factors for bladder ca
aniline dyes
smoking
b-naphthalamine
s.haematobium
179
how does ureter enter bladder
base of bladder, corner of trigone
180
peritoneal relations of the bladder
covers the superior surface and upper part of the post. surface
181
layers in suprapubic catheterisation
skin
subcut
scarpa's
linea alba
fascia transversalis
pre-peritoneal fat
182
post relations of the bladder
male - retrovesical pouch + 2 vas deferens + terminal part of the 2 ureters
183
diaphragm attachments
sternal - xiphoid process
costal - inner surface of 6 costal cartilages
lumbar vertebrae
insertion - central tendon
184
diaphragm openings
T8 - Vena Cava + phrenic nerve
T10 - Oesophagus - vagus
T12 - abdominal aorta - azygous, thoracic duct
185
external oblique muscle
origin - 5-12th rib
insertion - xiphoid process, linea alba, pubic tubercle
nerve - T7-12 & subcostal
fibre direction - down and medial
186
internal oblique muscle
origin - lumbar fascia, iliac crest
insertion - inf borders of 10-12 ribs, linea alba
nerve - t7-12
fibre direction - up and medial
187
rectus sheath
anterior & posterior of upper 3/4
only anterior in lower 1/4
anterior wall = EO aponeurosis with IO
post wall = IO aponeurosis with TA aponeurosis
188
oesophagus
begins - lower border of cricoid cartilage C6
ends opposite T11
189
blood supply to oesophagus
art - neck = inf thyroid art, thorax = aorta branches, abdomen = lt gastric
venous neck = inf thyroid vein, tx = azygous, abdomen = lt gastric and azygous
190
cells lining oesophagus
stratified squamous
191
barretts oesophagus
columnar metaplasia with increased risk of adenocarcinoma Ca
192
achalasia
oesophageal motility disorder of smooth muscle layer of oesophagus & lower oesophageal sphincter
incomplete LOS relaxation
increased LOS tone
193
microscopic picture of achalasia
hypertrophied musculature with absence of myenteric plexus
194
what indents the oesophagus
junction with pharynx
arch of the aorta
left main bronchus
oesophageal hiatus in diaphragm
195
complications of perforated oesophagus
mediastinitus
pneumomediastinum
196
how many cusps do the pul valve have
3
197
vertebral level of pul valve
T6
198
level of pul trunk division
T5
199
branches of ascending aorta
Rt & Lt coronary artery from aortic sinus
200
branches of pul trunk
rt and lt pul arteries
201
how many pul veins
4
202
Tributaries of the azygous vein
rt sup intercostal
hemiazygous
pericardial veins
mediastinal veins
oesophageal veins
203
where do the preganglionic fibres for the sympathetic nervous system come from
T1-L2
204
how do the sympathetic nerves leave the sympathetic chain
through spinal nerves
form plexus around blood vessels
205
structures passing through lung hilum
pul vein
pul artery
Rt & lt main bronchus
bronchial art & vein
LN
206
what is the pul ligament
pleural fold that connects mediastinal surface of lung and the pericardium
207
surface anatomy of lung
Apex - curved line of SCJ to 3cm above junction between medial 1/3 and middle 1/3 of clavicle
ant border - SCJ to xiphisternal joint behind lateral border on the sternum
inf border 6th rib - 8th rib - 10th rub to vertebral column
post - transverse process c7 to t.process t10
hilum - opposite t5,6,7
carina - t4
208
how many bronchopul segments are there
10
209
describe course of clot from deep veins of calf to pul artery
pop vein - femoral vein - ext. iliac - common iliac - IVC - rt atrium - AV valve to rt vent - pul valve to pul artery
210
nerve supply of intercostal muscles
intercostal nerves
211
subclavian steel syndrome
retrograde flow of blood flow down vertebral art due to sterno-occulsive disease in subclavian artery prox to vertebral artery
= brainstem ischaemia on arm exercise
212
why do you get bradycardia after chest tube insertion
vagus nerve irritation
213
posterior mediastinum boundaries
ant - pericardium
post - lower tx vertebrae t5-12
either side - mediastinal pleura
214
contents of post mediastinum
tx duct
tx aorta
post mediastinal LN
azygous & hemiazygous
oesophagus
sympathetic truck
215
boundaries of superior mediastinum
superior - tx inlet
inferior - cont with inf mediastinum at level of sternal angle
ant - sternum
post T1-4
lateral lung pleurae
216
layers passed for lumbar puncture
skin, sc, fat, fascia
supraspinous ligament
interspinous lig
ligamentum flavum
epidural space
dura mater
arachnoid mater
CSF
217
anatomy of an intervertebral disc
internal nucleus pulposus surrounded by fibrocartilagenous annulus fibrosus
218
degenerative disc change
spondylosis
219
what type of joint is the intervertebral joint
secondary cartilaginous joint
220
location of the paravertebral venous plexus
anterior & posterior external vertebral venous plexus
anterior & posterior internal vertebral venous plexus
221
tumours that metastasise to the spine
lung
breast
lymphoma
prostate
222
223
classify shock
cardiogenic
obstructive - heart pumps, but outflow is obstructed
hypovolaemic - fluid loss
distributive - septic, anaphylactic, neurogenic
224
225
muscles supplied by musculocutaneous nerve
biceps
brachialis
coracobrachialis
226
action of brachioradialis
weak forearm flexion
maximal when in midpronated position
227
sensory supply of the musculocutaneous nerve
lateral border of forearm
228
sensory supply of radial nerve
superficial branch - back of the hand
post. cutaneous nerve of forearm = back of forearm and elbow
post cutaneous nerve of arm - back of arm
lower lat cutaneous nerve of arm - lateral aspect inferior to deltoid insertion
229
Articulations between humerus, radius and ulna
capitulum of humerus + radial head
trochlea of humerus + trochlear notch of ulna
olecranon and olecranon fossa of humerus
230
what does the EPL tendon wrap around
lister's tubercle
231
scaphoid bone blood supply
receives primarily from lateral and distal branches of radial artery via palmar and dorsal branches
proximal portion relies on retrograde flow
232
Median nerve LOAF muscles
lateral 2 lumbricals
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis
233
flexor retinaculum attachments
proximal - pisiform, tubercle of scaphoid
distal - hook of hamate + trapzium
234
FDS & FDP attachments
FDS tendon splits to either side of middle phalanx
FDP goes through split and inserts onto terminal phalanx
235
how to test FDP & FDS
FDS - PIPJ flexion, block all other fingers
FDP - DIPJ flexion, block all other fingers
236
role of radial nerve during hand grip
radial nerve supplies wrist extensors - provide synergistic activity causing more efficient flexion of digits
237
hand grip more powerful in extension than flexion
in extension, flexors are under more tension than flexion so contraction more powerful
238
which tendon attaches to pisiform
FCU
239
origin, insertion, action of 1st dorsal interosseus
o - 1st metacarpal
i - lateral side of extensor expansion of index finger
action - abduct index finger, flex MCPJ and extend PIPJ
240
functions of interdinous connections in hand
stabilise MCPJ
coordinate finer extension
create space between extensor tendons
241
snuff box boundaries
lateral - EPB & APL
medial EPL
242
anterior compartment of the forearm
superficial layer - pronator teres, FCR, palmaris longus, FCU
intermediate layer - FDS
deep layer - FDP, FPL, pronator quadratus
243
muscles of the posterior forearm compartment
superficial - brachioradialis, ECRL, ECRB, Extensor digitorum, extensor digiti minimi, ECU
deep - supinator
outcropping layer - APL, EPL, EPB, Extensor indicis
244
structures passing through spiral groove
radial nerve
profunda brachii vessels
245
what happens if radial nerve is damaged at spiral groove
loss of wrist extensors and finger extensors
loss of sensation in 1st web space
246
median nerve injury at the elbow
forearm supinated - loss of pronators
weak wrist flexion with adduction due to unopposed FCU
loss of index flexion & middle flexion
loss of IPJ flexion of thumb
247
associated injuries with supracondylar #
brachial art
AIN
Ulnar nerve
radial nerve
248
supraspinatous O,I,N
o: supraspinous fossa
i: greater tuberosity
n: suprascapular
249
infraspinatous muscle O,I,N
o: infraspinous fossa
I: greater tuberosity
N - suprascapular nerve
250
teres minor
O; upper 2/3 of lateral scapula border
I greater tuberosity
n axillary
251
subscapularis
o: subscap fossa
insertion lesser tuborsity
n upper and lower subscap nerve
252
quadrangular space
sup: teres minor
inf: teres major
later: surgical neck of humerus
med: long head of biceps
contents - axillary nerve and post circumflex humeral vessels
253
axillary nerve
motor: deltoid & teres minor
sensory - regimental badge
injury - inability to abduct over 15 degree, sensation loss
254
axillary artery
divided by pec minor into 3 parts
1st part - medial to pecs = superior tx art
2nd part - post to pecs - thoracoacromial, lateral thoracic
3rd: lat to pecs - subscap, ant & post circumflex
255
muscles inserted into bicipital groove
teres major
lat dorsi
pec major
256
biceps muscle OIN
O - long head = supraglenoid tubercle
short head - coracoid process
I - bicipital tendon into radial tuberosity
n: musculocutaneous
257
triceps muscle OIN
O - long head - infraglenoid tubervle
lat - above spiral groove
med - below spiral groove
I - olecranon
n - radial
258
structures attaching to coracoid process
muscles - pec minor, coracobrachialis, short head biceps
ligs - coracoclavicular/humeral/acromial
259
pec major OIN
O - clavicular head - medial half of anterior clavicle
sternocostal head - upper 6 costal cartilages
I - lateral lip of bicipital groove
N medial & lateral pectoral nerve
Action - adduction, medial rotation of arm, aids flexion, access resp muscle
260
trapezius muscle
O- ext. occipital protuberance, sup nuchal line, C7, tx vertebrae spinous processes
I - lat 1/3 clavicle, acromion
N spinal accessory
261
serratus anterior
O - 1-8 ribs
I medial border of scap
N long tx nerve
262
3 arches of the foot
medial longitudinal
lateral longitudinal
transverse
263
components of medial longitudinal arch
calcaneum, talus, navicular, 3 cuneiforms, medial 3 metatarsals
FHL, peroneus longus, tib ant and post
264
components of lateral longitudinal arch
calcaneum, cuboid, lateral 2 metatarsals
peroneus longus & brevis
short plantar muscles
265
components of transverse arch
base of 5 metatarsals
peroneus longus
266
deltoid ligament attachments
medial mal to navicular tuberosity, spring ligament, talus neck and body
267
blood supply of talus
post tibial, DP, fibular arteries
268
movements at subtalar joint
inversion & eversion
269
which muscles perform inversion and eversion of subtalar joint
inversion - tib ant & post
ever - peroneus longus & brevis
270
why is the ankle joint most stable in DF
talus moves posteriorly and wider anterior portion is wedged into ankle mortise
271
what joint type is the inf talofibular
syndesmosis
272
talofibular syndesmosis fracture associate with?
lateral mal #
273
274
structures deep to EHL tendon
DP artery, deep peroneal nerve
275
muscles making up achilles tendon
soleus
gastroc
plantaris
276
muscles of anterior compartment of leg
tib ant
EHL
EDL
fibularis tertius
277
innervation of anterior compartment muscles
deep peroneal nerve
278
lateral compartment of leg muscles
fibularis longus & brevis
279
nerve supply to lateral compartment of leg
superficial peroneal nerve
280
superficial posterior compartment of the leg muscles
gastroc
soleus
plantaris
281
innervation of the superficial posterior compartment of the leg
tibial nerve
282
muscles of the deep posterior compartment o the leg
popliteus
FHL
FDL
tib posti
283
innervation to deep posterior compartment of leg
tibial nerve
284
innervation of skin on medial side of leg
saphenous nerve
285
innervation to post & lateral skin on lower leg
sural nerve
286
blood supply to head of the femur
medial and lateral circumflex femoral arteries from profunda femoris
medial = most
contributions from sup & inf gluteal arteries
small amount from ligamentum teres - branch of obturator
287
quads muscles
rectus femoris - AIIS
Vastus lateralis - GT & linea aspera
vastus medialis IT line & linea aspera
vastus intermedius - shaft of femur
insert = common tendon to base of patella, patellar lig to tib tub
innervation femoral nerve
288
semitendinosus muscle OIN
O ischial tuberosity
I medial surface of tibia
N tibial division of sciatic
289
semimembranosus OIN
O ischial tuberosity
I posterior part of medial tibial condyle
N tibial division of sciatic
290
Biceps femoris OIN
O - long head - ischial tuberosity, short head - linea aspera
I lateral side of head of fibula
N long head - tibial division of sciatic, short head - common fibular division
291
what is the femoral sheath
funnel-shaped, passes deep to inguinal ligament
encloses femoral vessels, creates femoral canal medial to them
formed from transversalis and iliopsoas fascia
NO FEMORAL NERVE
292
what is the femoral canal
allows femoral vein to expand when venous return from LL is increased
between medial wall of femoral sheath and the femoral vein
extends to proximal edge of saphenous opening
293
boundaries of the femoral ring
lateral - femoral septum
post - sup. ramus of pubis & pectineal lig
medial - lacunar lig
ant - medial part of inguinal lig
294
Boundaries of adductor canal
anterolateral - vastus medialis
anteromedial - sartorius
posterior - adductor longus & magnus
295
contents of adductor canal
femoral art & vein
saphenous nerve and nerve to vastus medialis (fem nerve branches)
296
surface markings of adductor hiatus
2/3 along line between ASIS and adductor tubercle of femur
297
DD of lump in popliteal fossa
baker's cyst
aneurysm
lipoma
popliteal varicosities
298
where does the iliotibial tract attach
O anterolateral iliac tubercle of the iliac crest
I lat condyle of tibia
299
what muscles attach to iliotibial tract
glut max
tensor fascia lata
300
clinical significance of iliotibial tract
stabilise the knee in extension
important for walking and running
301
glut max OIN
O - ilieum, post to post gluteal line, dorsal surface of sacrum, coccyx
I - iliotibial tract & gluteal tuberosity
N - inf. gluteal nerve S1/2
302
glut med OIN
O - between ant and post glut line
I - greater trochanter
N - sup gluteal L4,5,S1
303
glut min OIN
O - ilium between ant and inf gluteal lines
I - GT
N sup. glut nerve
304
hip muscles responsible for lateral rotation
piriformis
obturator internus
sup and inf gemelli
quadratus femoris
305
quadratus femoris OIN
O - lateral border if ischial tuberosity
I IT crest of femur
N - nerve to quadratus femorus
306
ligaments supporting hip joint
ileofemoral
pubofemoral
ischiofemoral
307
surface markings for sciatic nerve
PSIS to ischial tuberosity and 1/2 way between = start
ischial tuberosity to GT 1/2 way
then curve down between the 2
308
variations with regards to the sciatic nerve exiting the pelvis
sometimes the tibial & common peroneal nerve enter gluteal region separately - one below piriformis and one through it
309
nerve related to the ASIS
lateral cutaneous nerve of the thigh
310
what is meralgia parathetica
painful mononeuropathy of lateral cutaneous nerve of the thigh
due to focal entrapment as it passes under inguinal lig
311
what is vascular lacuna
structure behind/below inguinal lig
lacuna vasorum medial
muscular lacuna lateral
312
contents of lacuna vasorum
deep inguinal LN
Femoral vein & art
femoral branch of genitofemoral nerve
313
contents of lacuna musculorum
femoral nerve
iliopsoas
lateral femoral cutaneous nerve
314
infra-hyoid muscle
deep - sternothyroid, thyrohyoid
superficial - sternohyoid, omohyoid
action depress hyoid bone and larynx during swallowing & speaking
315
embryology of the thyroid gland
from foramen caecum (base of tongue)
passes downwards and loops around until it reaches hyoid bone
316
development thyroid defects
incomplete descent = lingual thyroid
incomplete pathway closure = thyroglossal cyst
317
which is the only thyroid cancer to spread lymphatically
papillary thyroid cancer
318
larynx nerve supply
motor - all RLN except cricothyroid = external laryngeal nerve
sensory - above vocal cords - internal branch of sup. laryngeal nerve
below = RLN
319
vocal cord attachments
ant - thyroid cartilage
post - arytenoid cartilage
lat - laryngeal mm
med - free border
320
embryology of parathyroid glands
inferior parathyroid from 3rd pharyngeal pouch (with thymus)
superior parathyroid from 4th pharyngeal pouch
321
blood supply to parathyroid
inf thyroid art
322
name given if all cranial sutures are fused at birth
craniosynostosis
323
mastoid bone develops by what age
2
324
what do the diploic veins drain
veins in skull that drain diploic space into dural venous sinus
325
muscles attached to styloid process
stylo - glossus, pharnygeus, hyoid
326
contents of foramen lacerum
sup part transmits internal carotid art
327
contents of optic canal
optic nerve
ophthalmic art
328
contents of superior orbital fissure
oculomotor
trochlear
ophthalmic branch of V
abducens
ophthalmic veins
329
contents of foramen rotundum
maxillary branch of V
330
contents of foramen ovale
O - otic ganglion
V - mandibular branch of V
A - accessory meningeal art
L - lesser superficial petrosal nerve
E - emissary veins
331
contents of foramen spinosum
middle meningeal art
332
contents of stylomastoid foramen
facial nerve
stylomastoid art
333
contents of foramen magnum
spinal root of accessory nerve
medulla oblongata & meninges
vertebral & spinal arteries
334
jugular foramen
IX
X
XI
internal jugular vein
inf. petrosal sinus
335
carotid canal contents
int. carotid artery
deep petrosal nerve
emissary veins
336
what cranial nerve tracks on clivus
abducens
337
what is the juvenile structure forming the clivus
spheno-occipital synchondrosis
338
type of growth plate the clivus is
hyaline cartliage
339
bones involved in a transphenoidal basilar skull fracture
sphenoid
temporal
340
where do the cavernous sinus lye
one either side of the sella turcica
341
what past through the cavernous sinuses
CN III, IV, VI, V1, V2
internal carotid
342
where does blood drain from and to from the cavernous sinus
from sup. ophthalmic veins & facial veins
sphenoparietal sinuses
to sup. & Inf. petrosal sinuses
IJV
intercavernous sinus
343
what is a cavernous sinus thrombosis
clot in the cavernous sinus
typically caused by an infection from extracranial source
able to spread due to anastomosis between facial vein sup. ophthalmic veins
344
signs/symptoms of a cavernous sinus thrombosis
headache
unilateral periorbital oedema
proptosis
photophobia
CN palsies - IV being the most common
eye pain
345
major vein draining brain parenchyma
great cerebral vein
346
drainage of the superior sagittal sinus
to transverse sinus
to sigmoid sinus
to IJV
347
location of the straight sinus
tentorium cerebelli and flax junction
348
where does the facial nerve originate
between pons & medulla
349
CN that transmit parasympathetic fibres
CN 3, 7, 9, 10
350
structures passing through parotid gland
facial nerve
ECA
retromandibular vein
auriculotemporal nerve
351
what is anterior to the parotid gland
masseter
medial pterygoid
superficial temporal and maxillary art
facial nervewha
352
what is posterior to the parotid gland
post belly of digastric
SCM
stylohyoid
ICA
mastoid & styloid process
353
innervation of the parotid gland
parasympathetic - secretomotor - from otic ganglion
sympathetic - sup. cx ganglion
sensory - greater auricular nerve
354
type of secretions from parotid
serous
parasympathetic = water rich
sympathetic = low vol, enzyme rich
355
type of secretion from submandibular gland
mucous & serous
356
nerves at risk of injury during submandibular gland excision
lingual nerve
hypoglossal
marginal mandibular
357
difference between UMNL & LMNL facial palsy
UMN - forehead sparing
LMN - no forehead sparing
due to tracts crossing in the brain
358
what does the great auricular nerve supply
skin over angle of the mandible
over parotid
lower 1/2 of ear
359
what nerve passes anterior to ECA
hypoglossal
360
what forms the roof of the middle ear
tegmen tympaniho
361
how do middle ear infections cross the skull
direct erosion of tegman tympani
spread to mastoid air cells causing mastoiditis
362
what causes irreversible damage to the CNVIII
acoustic neuroma
363
what are the boundaries of the middle ear
roof - tegmen tympani
floor - thin bone, sup bulb of IJN
ant wall - ICA
post wall - aditus to mastoid antrum
lateral - tympanic membrane
medial - inner ear
364
what are arnold chiari malformations
affects brain
downward displacement of cerebellar tonsils through foramen magnum
causes non-communication hydrocephalus due to obstructed CSF outflow
365
where does a meningioma arise from
arachnoid cap cells of the arachnoid villi in meninges
366
what structures does a meningioma compress
superior sagittal sinus
cerebral hemisphere
367
what area is located in the pre-central gyrus
primary motor cortex
368
which layer of meninges is a meningioma attached tp
dura
369
what is meant by a ring enhancement on a brain MRI or CT
area of increased density surrounded by a bright rim from concentration of enhancing contrast dye
enhancement may = breakdown of BBB or development of inflam capsule
370
what is the circulation pathway of CSF
lateral ventricle - interventricular foramen (monroe) - 3rd vent - aqueduct of sylvius (cerebral aqueduct) - 4th vent - foramen of luschka & magendie - subarachnoid space - arachnoid villi - superior sagittal sinus
371
what arteries form the circle of willis
ICA with vertebral
372
arteries of the circle of willis
ant communicating
ant cerebral
ICA
post communicating
post cerebral
termination of basilar arteries
373
vertebral artery course
through foramen magnum
up, forward, medial in subarachnoid space
to ant aspect of medulla oblongata
unite at pons and form basilar artery
374
what does the vertebral & basilar artery supply
medulla
cerebellum
pons
midbrain
thalamus
occipital cortex
375
which vein drains dangerous area of face
inf ophthalmic vein
376
what happens if a berry aneurysm ruptures
subarachnoid haemorrhage
377
signs of MCA infarct
hemiplegia of lower 1/2 of contralateral face
hemiplegia of contralateral UL & LL
aphasia if in dominant hemisphere
378
attachment of the tentorium cerebelli
superior angle of the petrous part of the temporal bone
379
blood supply to inner table of temporal bone
middle meningeal artery
380
if there is a tumour in the precentral gyrus what bone will it penetrate
parietal
381
what are false localising signs
reflect dysfunction distant or remote from expected anatomical locus of pathology
382
muscles supplied by oculomotor nerve
sup, inf, medial rectus
inf oblique
sphincter pupillae
levator palpebrae
383
what structure is the oculomotor nerve pressed against
petrous part of temporal bone
384
course of oculomotor nerve
oculomotor nucleus (midbrain)
inf to post cerebral artery, sup to sup cerebellar art
pierces dura mater
enters cavernous sinus
exits via sup orbital fissure
385
attachments tentorium cerebelli
post - occipital bone, grooves for transverse sinus
lat - petrous part of temporal bone
ant & med - free
386
anterior relations of the abdominal aorta
coeliac trunk
pancreas body
SMA
3rd part duodenum
splenic vein
lt renal vein
387
1st 2 organs injured in stab to epigastrium
liver
stomach
388
muscle divided to expose upper thyroid lobe
sternohyoid
389
blood vessel aneurysm affects oculomotor nerve
post communicating artery aneurysm
390
vessel related to the anterolateral attachment of tentorium cerebelli
sup. petrosal sinus
391
visual defect in post cerebral artery infarction
homonymous hemianopia
392
why are forehead muscles spared in an UMN lesion
double innervation of facial nerve nucleus from either side of the brain
393
arterial supply of the quadate lobe
rt hepatic art
394
appendix embryology
8th week of gestation
narrow diverticulum of caecal bud arising from midgut
395
complications of injury to ileoinguinal nerve
loss of sensation to L1 dermatome
weakness of conjoint tendon
396
after circumcision which layer of glans will blood collect
dartos (superficial) & Bucks fascia (deep)
397
what is bxo
balantis xerotica obliterans
lichen sclerosus
white inflamm plaques on foreskin and penile glans
considered pre-cancerous
398
histology of BXO
hyperkeratosis
atrophy
sclerosis
lymph infiltration
