Anatomy

Question 1

Phrenic Nerve

Answer 1

C3,4,5, anterior to lung root, on scalenus anterior, b/w subclavian artery and vein, pierces diaphragm

Question 2

Vagus Nerve

Answer 2

C X, posterior to lung root, alongside trachea, anterior oesophegus

Question 3

Fusiform Aneurysm

Answer 3

Dilation of both sides

Question 4

Saccular Aneurysm

Answer 4

Dilation of one side

Question 5

Pericardium Location (& anterior mediastinum)

Answer 5

1-4 sternebrae, T5-T8 vertebrae

Question 6

Inferior mediastinum

Answer 6

T5-T12

Question 7

Ligamentum Arteriosum

Answer 7

Fibrus band remenant of ductus arteriosus

Question 8

Vertebrae

Answer 8

7 Cervical
- typical & atypical
- foramen in transverse processes
12 Thoracic
- costal facets for ribs
- articular processes in coronal plane
5 Lumbar
- articular processes in saggital(ish) plane
5 Sacral (fused)
2-5 Coccyx

Question 9

Trachea

Answer 9

Begins at C6

Bifurcates at T4/5

Question 10

Pain referred from lungs and pleura

Answer 10

Visceral = shares AUTONOMIC NERVE SUPPLY of heart and lungs. Pain referred is DULL, NOT SEVERE, POORLY LOCATED.

Parietal = shares SOMATIC NERVE SUPPLY of diaphragm, ribs, intercostals. Pain referred is SHARP, SEVER, WELL LOCATED.

Question 11

Chest X Ray technique

Answer 11

Full inspiration (7 ribs anterior, 11 ribs posterior)
Posterior to Anterior
‘hug x-ray’ - rotate scapulae
Erect

Check vertebrae is straight (spinous processes)

Question 12

Airway features
Trachea
Bronchi
Bronchioles

Answer 12

Trachea

• hyaline C shaped cartilages (in adventitia) with muscle bridge
• submucosa contains glandular structures

Bronchi

• cartilage plates
• smooth muscle complete ring between lamina propria and submucosa

Bronchioles

• no cartilage
• loses goblet cells, gains clara cells
• has some smooth muscle

Question 13

External Oblique

Answer 13

“front pockets”
anterior surface of lower 8 ribs
free posterior muscular edge
interdigitate in vertical raphe (aponeurotic)
free inferior edge
ASIS (anterior superior iliac spine) -> pubic tubercle
Δ opening between pub tub & pub crest

Question 14

Internal Oblique

Answer 14

“back pockets”
attach to costal margin
attach to thorocolumbar fascia posteriorly
aponeurotic medially
anterior 2/3 of inguinal ligament -> pub crest

Question 15

TVA

Answer 15

horizontal
underlap costal margin, continuous with plane of diaphragm
attach to thorocolumbar fascia
attach to midline raphe (linea alba)
lateral 1/2 inguinal ligament -> pub crest

Question 16

Rectus Abdominus

Answer 16

vertical, tendinous inscription (umbilicus, xyphisternum, 1/2 way between)
anterior surface of ribs 5,6,7
linear semilunaris (lateral border)
linea alba medially
insert pubic crest
posterior sheath ceases at arcuate line (TVA + int oblq become anterior)

Question 17

Nerves of anterior abdominal wall

Answer 17

T10 - umbilicus

L1 - groin

Question 18

Arteries of anterior abdominal wall

Answer 18

superior epigastric
- branch of internal thoracic
- anastamose posterior rectus sheath
inferior epigastric
- branch of internal iliac
superficial epigastric
- in superficial fascia

Question 19

Veins of abdominal wall

Answer 19

dual veinous drainage

• portal
• IVC

Question 20

Inguinal Canal

Answer 20

DEEP RING: deficiency in transcersalis half way between ASIS & pub tubercle
4cm long
parallel to inguinal ligament
roof is arching fibres of internal oblique & TVA

Question 21

Inguinal Canal Layers

Answer 21

1. Internal Spermatic Fascia (transversalis fascia)
2. Cremasteric Fascia (has muscle to retract testicle - internal oblique)
3. External Spermatic Fascia

Question 22

Quadratus Lumborum

Answer 22

tip of transverse processes, 12th rib, iliac crest

kidneys lay on top (anterior)

Question 23

Psoas

Answer 23

inferior border of T12 to upper border of L5
attaches to medial ends of transverse processes
lumbar arteries & veins behind
lumbar plexus within
sympathetic trunk anterior
insertion on lesser trochanter (shared with iliacus)

Question 24

Kidneys

Answer 24

T12 - L3
right sits lower than left
adrenals (right pyramid, left crescent)
hilum (artery, vein, pelvis) faces anteromedially
cortex (outer, pale striated)
medulla (discontinuous, darkened)
minor calyces (2-3) -> major calyces (3) -> pelvis -> ureter
left renal vein under superior mesenteric artery
5 artery segments

Question 25

Ureter

Answer 25

``` descend on posterior abdominal wall on psoas parallel to tips of transverse processes over pelvic brim cross over common iliac artery and vein below uterine artery / vas deferens bladder ``` 3 sites that can become obstructed by kidney stones - narrowing renal pelvis -> ureter - compression ureter over pelvic brim (mid ureter) - narrowing ureter -> bladder

Question 26

Abdominal Vessels (3 branches)

Answer 26

aorta bifuricates at L4 (into common iliac arteries) three vascular planes 1. anterior branch (coeliac trunk, superior/inferior mesenteric) 2. lateral branches (kidneys) 3. posterior branches (intercostals/obliques)

Question 27

Foregut

Answer 27

start at abdominal oesophegus ends at duodenal papilla (1/2 way down 2nd part of duodenum on posteromedial wall) supplied by coeliac trunk? Preganglionic Sympathetic T6-T9 (&afferent) Parasympathetic - Vagus

Question 28

Midgut

Answer 28

unclear demarcation include most of transverse colon (to short splenic flexture) supplied by superior mesenteric? Preganglionic Sympathetic T8-T12 (&afferent) Parasympathetic - Vagus

Question 29

Hindgut

Answer 29

descending and sigmoid colon and rectum supplied by inferior mesenteric? Preganglionic Sympathetic T12-L2 Parasympathetic - Pelvic Splanchnics S2-S4 (afferents sympathetic until sigmoid, then parasympathetic)

Question 30

Abdominal Vessel Names & Locations

Answer 30

COELIAC TRUNK - T12 - Splenic Artery (pancreas, upper greater curvature - left gastroepiploic artery) - Common hepatic (proper hepatic, right gastric, pancreaticoduodenal/gastroduodenal) - Left gastric (lesser curvature) SUPERIOR MESENTERIC - L1 - (jejunum) long vasa rectae, few vascular arcades - (ilium) short vasa rectae, many vascular arcades - right colic (supplies ascending colon) - middle colic (supplies transverse colon) INFERIOR MESENTERIC - L3 - left colic (descending colon) SUPERIOR RECTAL ARTERY - passes into pelvis

Question 31

Portal Venous Drainage

Answer 31

Portal vein low pressure and valveless Behind neck of pancreas at level of L2 Left gastric vein can drain to azygous. Superficial abdominal wall veins anastomose with portal vein tributaries. Rectal veins anastamose. Portal hypertension can present as haemorrhoids.

Question 32

Abdominal Lymphatics

Answer 32

Pre-Aortic (anterior) - around unpaired three branches; liver, pancreas, gallbladder, spleen (coeliac, inferior/superior mesenteric) Para-Aortic (side) - from posterior wall, kindeys, adrenals, testes, ovaries, pelvis and lower limb Trunks - intestinal (from pre-aortic lymph nodes) - right & left lumbar lymph trunks - Coalesce to form CISTERNA CHYLI (adjacent to aortic hiatus)

Question 33

X-Ray absorption factors

Answer 33

1. THICKNESS of tissue 2. DENSITY of tissue 3. ATOMIC number of tissue (to 4th power) H = 1 C = 6 O = 8 Ca = 20 Io = 53 Ba = 56

Question 34

Abdominal X-Ray Contrast Techniques

Answer 34

Endoscopic Retrograde Cholangio-pancreatography (inject iodine into bile duct - endoscopically) Percutaneous Transhepatic Cholangiography (inject into bile duct - through abdominal wall) Intravascular (distribution through blood vessels, excretion by kidney) (bilirubin like tagging for excretion into bile duct)

Question 35

Radioisotope Imaging

Answer 35

Emit gamma rays (recorded by gamma camera)

Question 36

MRI

Answer 36

Alters H+ spin (tissue must have water) 0.3 - 3.0 Tesla ``` Good spacial and contrast resolution Good for soft tissue (brain) and bone marrow Bad for bones (low H+ appears black) Good for inside joints Availability variable Contraindications (pacemaker, cochlear implant etc.) More Expensive Long Scan Times ```

Question 37

GI sacks

Answer 37

``` Lesser Sack (Foramen of Winslow) - hangs over transverse colon and fuses to form greater omentum ``` pocket with pancreas posterior and stomach/lesser omentum anterior

Question 38

Liver - blood supply - segment

Answer 38

75% Portal Vein 25% Hepatic Artery Falciform ligament demarcates left and right anatomically IVC-Gallbladder demarcates left and right physiologically Caudate lobe (fissure/IVC/hilum) Quadrate lobe (fissure/Gallbladder/hilum) Falciform -> ligamentum teres -> umbilical ligamentum venosum - shunt to IVC bypassing liver in foetus

Question 39

Abdominal Viscera Layers

Answer 39

Layer 1: Paired Viscera - retroperitoneal = kidneys/ureter Layer 2: Unpaired Viscera - retroperitoneal = ascending & descending colon = duodenum = pancreas Layer 3: Intraperitoneal Unpaired Viscera = mesogastrum / stomach = mesentery / jejunum/ilieum = transverse mesocolon

Question 40

Pancreas - structure - functions - histology

Answer 40

retroperitoneal head (uncinate process), neck, body, tail principal & accessory pancreatic duct EXOCRINE: enzymes for digestion (protein, starches, fat) - proteases - amylases - nucleases bicarbonate ACINI with basal RER, luminal ZYMOGEN GRANULES ``` ENDOCRINE: insulin glucagon somatostatins ISLETS OF LANGERHANS, vascular, pale pink ```

Question 41

Spleen

Answer 41

``` Highly vascular LUQ notched smooth diaphragmatic surface axis lies along shaft of 10th rib thin capsule (trauma can rupture spleen) ```

Question 42

Hepatocytes, Liver, and Models

Answer 42

Hepatocytes RER, Golgi = protein synthesis SER = fat & steroid metabolism Hepatocytes organised in LOBULES supported by Reticular fibres - Central vein (sinusoids) - Portal Triads (hepatic artery, portal vein, bile duct [canaliculi], lymphatic) Sinusoids: - Discontinous lining - gap between endothelium and hepatocyte = SPACE OF DISSE - KUPFER CELLS (macrophages) on inner walls 1. Classic Lobule Model (central vein) 2. Portal Lobule Model (portal triad) 3. Acinar Model (O2 conc. gradients)

Question 43

Synovial Joint Structures

Answer 43

1. Articular (hyaline) Cartilage - aneural, avascular 2. Fibrous Capsule - collagen, elastin, fibroblasts 3. Intrinsic Ligaments 4. Extrinsic Ligaments 5. Synovial Membrane - highly vascular Ligaments typically have poor blood supply and don't repair very rapidly

Question 44

``` Special Joint Structures Labrum Fat Pad Disc Menisci Bursae Ligament Tendon ```

Answer 44

Labrum - fibrocartilaginous rim deepening joint Fat Pad - within joint, external to membrane Disc / Menisci - shock absorb, bear weight, blood & nerve supply to outer third Bursae - contain synovial fluid and communicates with joint Ligament - thickening of capsule (intrinsic of extrinsic) Tendon (intracapsular) - labrum provide joining site

Question 45

Shoulder (glenohumeral) Anatomy (Layers)

Answer 45

1. Bones (glenoid fossa of scapula) 2. Labrum 3. Capsule (reinforced by intrinsic ligaments) - attach to anatomical neck above - attach to surgical neck below - anterior deficiencies for bicep long head and bursa (subscapular) 4. Tendons (rotator cuff - originate from scapula and insert into capsule) - infraspinatus: external rotation - subscapularis: internal rotation - supraspinatus: abduction (+ deltoid) 5. Coraco-acromial ligament/arch & sub-acromial bursa

Question 46

Humerous Anatomical Features

Answer 46

Greater & Lesser tuberosities (anterior / superior) Bicipital groove in between for bicep long head Surgical neck - endangers axilliary nerve mid-shaft - endangers radial nerve (in groove) supracondylar - endangers median nerve & brachial artery Condyles (capitulum anteromedial, trochlea anterolateral) Epicondyles

Question 47

Clavicle Anatomical Featues

Answer 47

Medial 2/3 curve anteriorly Lateral 1/3 curve posteriorly Articulates with scapula Sternoclavicular Joint - tight capsule - disc (outer 1/3 has nerve and blood supply) - costoclavicular acessory ligament (attach to superior medial surface of first rib) - subluxation rare - endanger subclavian vein & artery Acromioclavicular Joint - plane synovial joint in saggital plane - weak capsule - coracoclavicular lig. (conoid, trapezoid) main stabilizer - subluxation (Grade 1-3)

Question 48

Radius & Ulna Anatomical Features

Answer 48

Share synovial cavity at elbow Radius articulates with lateral side of ulna Radius processes (coronoid anterior, olecranon posterior)

Question 49

Elbow Joint Complex - Ligaments - other

Answer 49

LIGAMENTS: - Medial Collateral Ligament (attaches to medial epicondyle) - Lateral Collateral Ligament (attaches to lateral epicondyle) - Annular ligament (encloses head of radius allowing rotation and provides point of attachment for LCL) OTHER: Intracapsular fat pads fill fossae Olecranon bursa Most stable in extension

Question 50

Muscles of forearm

Answer 50

PRONATION/SUPINATION Pronator teres supinator pronator quadratus FLEXION/EXTENSION (also enhance stability of carpals) extensor carpi radialis brevis (wrist extensor originating from lateral epicondyle) flexor carpi radialis

Question 51

Wrist / Hand bones - Proximal (lateral to medial) - Distal (lateral to medial) Some Lovers Try Positions That They Can't Handle ``` S L Tri P Trai Trao C H ```

Answer 51

Scaphoid (most frequently fractured - at waist) Lunate (most frequently subluxed) Triquetral Pisiform (sesamoid bone in tendon - flexor carpi ulnaris, ossifies at 11/12yo) Trapezium Trapezoid Capitate (largest, first to ossify at 2 years) Hamate (with hook) ``` Metacarpals - sesamoid on 1st distally Phalanges - proximal - middle -distal ```

Question 52

Wrist Ligaments

Answer 52

Palmar-radio-carpal ligaments - prevent carpals from sliding medially (moreso than dorsal) - transmit vessels to carpal bones Radio-scapho-lunate ligament - keeps scaphoid and lunate in position Deep transverse metacarpal ligament (holds 4 metacarpals together - but not thumb)

Question 53

Structures of fingers - Ligaments - Plates

Answer 53

``` I Carpometacarpal - Saddle II-III Carpometacarpal - Immobile IV-V Carpometacarpal - Hinge (f/e) Metocarpophalangeal - Condyloid Joints Volar & Dorsal Plates (extend surface area for articulation - site of pathology) ```

Question 54

Wrist Joints

Answer 54

Radiocarpal - synovial ellipsoid - scaphoid (medial/lateral) - lunate (anterior/posterior) - F>E, UD>RD Intercarpal (midcarpal) - condylar - E>F - RD>UD - flexion / extension - radial / ulnar deviation

Question 55

Rule of deep muscles

Answer 55

Arise from shaft of long bone that they overlie (and adjacent interosseous membrane)

Question 56

Rule of superficial muscles

Answer 56

proximal origin, distal insertion

Question 57

Muscles involved in wrist radial deviation

Answer 57

Extensor carpi radialis longus Extensor carpi radialis brevis Flexor carpi radialis

Question 58

Muscles involved in wrist unlar deviation

Answer 58

Flexor carpi ulnaris | Extensor carpi ulnaris

Question 59

Radiolucent

Answer 59

Dark structures on XRay

Question 60

Radio-opaque

Answer 60

Light structures on XRay

Question 61

T1 vs T2 MRI Imaging Signal Intensity

Answer 61

``` T1 WEIGHTED Fluid - Dark Fat - Bright Muscle - Intermediate Spinal Cord - Intermediate Cortical Bone - Very Dark Flowing Blood - Dark ``` ``` T2 WEIGHTED Fluid - Bright Fat - Intermediate to Bright Muscle - Intermediate Spinal Cord - Intermediate Cortical Bone - Very Dark Flowing Blood - Dark ``` can use fat suppression to darken fat

Question 62

Age of Elbow Epiphyses Appearance

Answer 62

1st year - Capitulum (+ lat trochlear) 5th year - Medial epicondyle & Radial head 10th year - Trochlear (medial), lat epicondyle, olecranon Medial and lat epicondyle, radial head, olecranon fuse between 15-20

Question 63

Muscles attaching pectoral girdle to trunk

Answer 63

``` THORACIC WALL: Pectoralis Major Pectoralis Minor Subclavius Serratus Anterior ``` ``` VERTEBRAL COLUMN Trapezium Latissimus Dorsi Levator Scapulae Rhomboid Minor Rhomboid Major ```

Question 64

Subclavius

Answer 64

ORIGIN: Anteromedial part of first rib INSERTION: Inferior surface of clavicle Stabilizes clavicle

Question 65

Pectoralis Minor

Answer 65

ORIGIN: costal cartilage ribs 3,4,5 INSERTION: converge on coracoid process Stabilizes scapula

Question 66

Serratus Anterior

Answer 66

ORIGIN: lateral aspect of ribs 1-8 INSERTION: medial border of scapula INNERVATION: long thoracic nerve Strong protractor

Question 67

Muscles attaching at humerus to scapula / rotator cuff

Answer 67

``` Deltoid Subscapularis* Supraspinatus* Infraspinatus* Teres Minor* Teres Major ``` * rotator cuff muscles

Question 68

Supraspinatus

Answer 68

ORIGIN: Supraspinatus Fossa INSERTION: Superior facet on greater tubercle of humerus

Question 69

Infraspinatus

Answer 69

ORIGIN: Infraspinatus fossa (posterior) INSERTION: middle facet on greater tubercle of humerus

Question 70

Teres Minor

Answer 70

ORIGIN: lateral border of the scapula INSERTION: inferior facet on greater tubercle of humerus

Question 71

Deltoid

Answer 71

ORIGIN: INSERTION: Abductor (need supraspinatus to initiate)

Question 72

Subscapularis

Answer 72

ORIGIN: subscapular fossa (anterior) INSERTION: lesser tubercle of humerus

Question 73

Teres Major

Answer 73

ORIGIN: inferior angle of scapula (bottom of triangle) INSERTION: proximal humerus just below lesser tubercle Adducts and medially rotates

Question 74

Muscles of Upper Arm

Answer 74

ANTERIOR: Coracobrachialis Biceps Brachialis POSTERIOR: Triceps

Question 75

Biceps

Answer 75

ORIGIN: supraglenoid tubercle (long head through bicipital groove), coracoid process (short head) INSERTION: radial tuberosity Flexor (in supination) and primary supinator

Question 76

Coracobrachialis

Answer 76

ORIGIN: coracoid process INSERTION: mid-shaft of humerus Assists in flexion and adduction of shoulder

Question 77

Brachialis

Answer 77

ORIGIN: whole of anterior aspect of distal humerus INSERTION: coronoid process of ulna flexor of elbow joint (in all position)

Question 78

Rule for Deep Muscles

Answer 78

Arise from shaft of long bone they overly (and adjacent interosseous membrane)

Question 79

Triceps

Answer 79

ORIGIN: infraglenoid tubercle (long head), proximal aspect of posterior shaft of humerus (lateral head), shaft of posterior humerus (medial) INSERTION: olecranon of ulna

Question 80

Muscles of Forearm - Anterior

Answer 80

``` SUPERFICIAL Pronator Teres Flexor Carpi Radialis Palmaris Longus Flexor Digitrum superficialis Flexor Carpi Ulnaris (all attach to common flexor origin: front of medial epicondyle) ``` DEEP Flexor pollicis longus Flexor digitorum profundus Pronator Quadratus

Question 81

Muscles of Forearm - Posterior

Answer 81

SUPERFICIAL Brachioradialis Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis* Extensor Digitorum* Extensor Digitorum minimi* Extensor Carpi Ulnaris* Abductor Pollicis Longus Extensor Polllicis Brevis Extensor Pollicis Longus DEEP: Aconeus Supinator Extensor Indicis *arise from common extensor origin (lateral epicondyle)

Question 82

Flexor Carpi Radialis (FCR)

Answer 82

ORIGIN: Common Flexor Origin INSERTION: base of 2nd and 3rd metacarpals has separate tunnel to Carpal Tunnel

Question 83

Palmaris Longus

Answer 83

ORIGIN: Common Flexor Origin INSERTION: blends with flexor retinaculum and palmar aponeurosis absent in 10% of people

Question 84

Flexor Carpi Ulnaris (FCU)

Answer 84

ORIGIN: Common Flexor Origin AND wide aponeurotic attachment to subcutaneous border of ulna INSERTION: base of 5th metacarpal* * actually inserts on pisiform which gives rise to pisometacarpal ligament

Question 85

Pronator Quadratus

Answer 85

ORIGIN/INSERTION: across distal portions of anterior aspect of shaft of radius and ulna

Question 86

Pronator Teres

Answer 86

ORIGIN: Common Flexor Origin AND medial aspect of coronoid process INSERTION: point of greatest convexity on radius

Question 87

Flexor Digitorum Superficialis (FDS)

Answer 87

ORIGIN: Common Flexor Origin (humeral-ulnar head) AND fibrous arch to radius INSERTION: 4 tendons inserting on base either side of middle phalynx *girly fist

Question 88

Flexor Digitorum Profundus (FDP)

Answer 88

ORIGIN: Shaft of ulna and adjacent interosseous membrane INSERTION: 4 tendons inserting on base of distal phalynx *proper fist

Question 89

Flexor Pollicis Longus

Answer 89

ORIGIN: shaft of radius and adjacent interosseous membrane INSERTION: base of distal phalynx (thumb) Thumb version of FDP

Question 90

Flexor Retinaculum

Answer 90

``` STOP Scaphoid Trapezium hook Of hamate Pisiform ``` Tunnel Contents: Palm to Deep FDS 3,4 FDS 2,5 FDP median nerve lateral Flexor Pollicis Longus more lateral

Question 91

Brachioradialis

Answer 91

ORIGIN: lateral supracondylar ridge (above common extensor origin) INSERTION: styloid process of radius (distal)

Question 92

Extensor Carpi Radialis Longus

Answer 92

ORIGIN: lateral supraconylar ridge (above common extensor origin) INSERTION: base of 2nd and 3rd metacarpals posteriorly

Question 93

Extensor Carpi Radialis Brevis

Answer 93

ORIGIN: Common Extensor Origin INSERTION: base of 2nd and 3rd metacarpals posteriorly

Question 94

Extensor Digitorum

Answer 94

ORIGIN: Common Extensor Origin INSERTION: 4 tendons inserting base of middle and distal phalynx (like FDS and FDP) Also tendinous communications between digits

Question 95

Extensor Digiti Minimi

Answer 95

ORIGIN: Common Extensor Origin INSERTION: 5th middle and distal phalynx (merge with extensor digitorum)

Question 96

Extensor Carpi Ulnaris

Answer 96

ORIGIN: Common Extensor Origin INSERTION: base of 5th metacarpal

Question 97

Abductor Pollicis Longus

Answer 97

ORIGIN: Posterior aspect of radius, ulna, and interosseous membrane INSERTION: base of first metacarpal

Question 98

Extensor Pollicis Brevis

Answer 98

ORIGIN: Posterior aspect of radius, ulna, and interosseous membrane INSERTION: base of proximal phalynx

Question 99

Extensor Pollicis Longus

Answer 99

ORIGIN: Posterior aspect of radius, ulna, and interosseous membrane INSERTION: base of distal phalynx

Question 100

Anconeus

Answer 100

ORIGIN: Common Extensor Origin INSERTION: posterior aspect of proximal ulna small triangular muscle

Question 101

Supinator

Answer 101

Encircles and obscures view of proximal shaft of radius | Has superficial and deep heads which is the passage for nerve supply to enter posterior compartment

Question 102

Extensor Indicis

Answer 102

Extensor of index finger (not a major player in pathology)

Question 103

Extensor Retinaculum

Answer 103

Vertical Septa separate tendons into 6 compartments numbered lateral to medial

Question 104

Layers of Palm

Answer 104

1. Skin and palmaris brevis 2. Palmar aponeurosis* 3. Thenar and hypothenar muscles 4. Neurovascular plane 5. Long flexor tendons^ and lumbricals 6. Adductor pollicis and neurovascular plane 7. Interossei and metacarpals *does not cover layer 3 muscles. Inserts into skin creases at base of fingers, flexor tendons, and bases of proximal phalanges. ^ synovial sheath for middle three fingers ends just distal to flexor retinaculum and starts again as separate sheath lining fibrous sheath over phalanges

Question 105

Intrinsic Muscles of the Hand (Anterior)

Answer 105

All For One And One For All Abductor Pollicis Brevis Flexor Pollicis Brevis Opponens Pollicis Adductor Pollicis Brevis Opponens Digiti Minimi Flexor Digiti Minimi Abductor Digiti Minimi All arise from flexor retinaculum and adjacent carpal bones Adductor pollicis Brevis arises from shaft of 3rd metacarpal and base of 2nd and 3rd metacarpal and attaches to proximal phalynx of thumb Abductors and Flexors insert into proximal Phalynx Opponens inserts into metacarpals

Question 106

Lumbricals

Answer 106

Arise from Flexor Digitorum Profundus Tendons over metacarpals Wind around radial side of heach finger inserting into dorsal extensor expansion extend interphalangeal joints at teh same time as flexing intermetacarpal joints wave bye-bye

Question 107

Intrinsic Muscles of the Hand (Deep & Dorsal)

Answer 107

Palmar Interosseous muscles (3) Originate on metacarpal medial to middle finger Wind around finger and insert into extensor expansion wave bye-bye Dorsal Interosseous muscles (4) webbing between metacarpals wind around side lateral to middle finger and attach to extensor expansion PAD - Palmar interosseous adduct DAB - Dorsal interosseous abduct

Question 108

Brachial Plexus

Answer 108

Ganglion (C7-T1) Trunks (superior, middle, inferior) - supraclaviclular Divisions (anterior, posterior) - behind clavicle Cords (lateral, middle, posterior - named according to relationship to axiliary artery) Nerves

Question 109

Musculocutaneous Nerve

Answer 109

C5,6,7 anterior division pierces coracobrachialis descends in anterior compartment of arm (biceps superficial, brachialis deep) at elbow - lateral to tendon of biceps - becomes superficial - lateral cutaneous nerve of forarm Motor Functions: Brachialis, Biceps brachii, Corocobrachialis . Sensory Functions: lateral half of the anterior forearm, and a small lateral portion of the posterior forearm.

Question 110

Ulnar Nerve

Answer 110

(C7),8.T1 anterior division down medial side of artery passes behind medial epicondyle (pins & needles) slips between two heads of FCU (humoral and ulnar) tucks in under FCU (FDP deep) passes superficial to flexor retinaculum (next to pisiform) Motor Functions: Innervates the muscles of the hand (apart from the thenar muscles and two lateral lumbricals), flexor carpi ulnaris and medial half of flexor digitorum profundus. Sensory Functions: Innervates the anterior and posterior surfaces of the medial one and half fingers, and associated palm area.

Question 111

Median Nerve

Answer 111

C5, 6, 7, 8, T1, medial & lateral root anterior/lateral to artery crosses diagonally in front and ends medial at elbow comes through centre of cubital fossa slips between fibrous arch of FDS FDS superficial, FDP deep beneath flexor retinaculum (carpal tunnel) Motor Functions: Innervates most of the flexor muscles in the forearm (except FCU and half FDP), the thenar muscles, and the two lateral lumbrical muscles that move the index and middle fingers. Sensory Functions: Gives off the palmar cutaneous branch, which innervates the lateral part of the palm, and the digital cutaneous branch, which innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand.

Question 112

Axiliary Nerve

Answer 112

C5, 6. Emerges above teres major Motor Functions: Innervates the deltoid, teres minor and the long head of the triceps brachii. Sensory Functions: Gives off the superior lateral cutaneous nerve of arm, which innervates the inferior region of the deltoid (“regimental badge area”).

Question 113

Radial Nerve

Answer 113

C5, 6, 7, 8, T1 Emerges below teres major runs diagonally across posterior aspect of shaft of humerus (prone to injury) tucks in under cover of brachioradialis splits into (superficial) radial nerve and (deep) posterior interosseous superficial - continues under brachioradialis, onto back of hand, over anatomical snuff box onto dorsum of hand deep - passes through supinator to deep layer of posterior compartment and supplies all 12 muscles Motor Functions: innervates the triceps brachii, and the extensor muscles in the posterior compartment of the forearm. Sensory Functions: Innervates the posterior aspect of the arm and forearm, and the posterior, lateral aspect of the hand.

Question 114

Arteries of Upper Arm Segments

Answer 114

``` SUBCLAVIAN (outer border of first rib) AXILARY (lower border of teres major) BRACHIAL (elbow joint) RADIAL & ULNAR ``` Main arteries are on flexor segments so they aren't stretched

Question 115

Veins of Arm

Answer 115

DEEP VEINS usually paired vena comitantes connected at intervals by short transverse branches relatively small, most drainage is superficial SUPERFICIAL VEINS commence at dorsal venous arch (fist forces blood in) BASILIC and CEPHALIC veins come from medial and lateral sides of dorsal venous arch

Question 116

Basilic Vein

Answer 116

From medial side of DORSAL VENOUS ARCH winds around ulnar border to anterior surface pierces fascia on medial side of biceps joins with brachial veins to form AXILIARY VEIN

Question 117

Cephalic Vein

Answer 117

From lateral side of DORSAL VENOUS ARCH winds around radial border of forearm to anterior surface gives off MEDIAL CUBITAL VEIN runs up lateral side of biceps into deltopectoral groove to merge with AXILIARY VEIN

Question 118

Axiliary Artery

Answer 118

3 segments based on relationship to pec minor - above, distal, deep supplies wall of axila, anterior chest, and anastamoses around humerus

Question 119

Brachial Artery

Answer 119

Starts medial to humerus, at elbow becomes anterior Tendon of biceps lateral Brachial artery in middle Median nerve medial Gives off PROFUNDUS BRACHII (deep brachail artery) winds around back of humerus diagonally into posterior compartment, runs together with radial nerve

Question 120

Radial Artery

Answer 120

Tucks under cover of brachioradialis with superficial branch of radial nerve Wind onto back of dorsum of hand radial artery passes beneath tendons of anatomical snuffbox (abd policus longus, ext policus brevis) radial nerve forms part of the roof superficial palmar branch crosses superficial to flexor retinaculum and onto superficial part of hand Gives off DEEP PALMAR ARCH (more proximal than superficial palmar arch)

Question 121

Ulnar Artery

Answer 121

Disappears under cover of FCU with ulnar nerve Crosses superficial to flexor retinaculum (exposed to wrist lacerations) Gives rise to SUPERFICIAL PALMAR ARCH Gives off COMMON INTEROSSEOUS ARTERY (split into posterior and anterior)

Question 122

White matter vs Grey matter

Answer 122

White matter = myelinated | Grey matter = cell bodies

Question 123

Spinal Nerve Ending

Answer 123

L1/L2

Question 124

Thalamus

Answer 124

Part of diencephelon Major sensory relay to cortex Many subnuclei

Question 125

Hypothalamus

Answer 125

Part of diencephalon ``` Regulates homeostasis (temp, blood volume / pressure, ion concentration, pH, O2, glucose) Controls pituitary ```

Question 126

Peripheral Nerve Layers

Answer 126

Axon Schwann Cells Endoneurium - loose supporting tissue within fascicle Perineurium - surrounds fascicle Epineurium - surrounds collection of fascicles

Question 127

Meissner Corpuscles

Answer 127

``` Epidermis Rapidly Adapting High Density 40% of total Type II (Aβ) Fiber Dynamic Deformation, skin motion, detecting slipping objects ```

Question 128

Merkel Complexes

Answer 128

``` Epidermis/Dermis Slowly Adapting Smallest Receptor Field 25% of total Type II (Aβ) Fiber Fine tactile, form and texture ```

Question 129

Ruffini Organs

Answer 129

``` Dermis Slowly Adapting Sensitive to stretch and direction, position Proprioceptive 20% of total Type II (Aβ) Fiber ```

Question 130

Pacinian Corpuscles

Answer 130

``` Dermis/Subcutaneous Rapidly Adapting Low density Most sensitive Vibration (e.g. when grasping) 15% of total Type II (Aβ) Fiber ```

Question 131

Proprioception - Receptor Type - Afferent Axon Type - Axon Size - Conduction Velocity

Answer 131

Muscle Spindle (around individual muscle fibres) ``` Type Ia (Aα) Fiber Ia, Type II (Aβ) Fiber ``` 12-30µm (largest) 80-120 m/s

Question 132

Touch - Receptor Type - Afferent Axon Type - Axon Size - Conduction Velocity

Answer 132

Merkel, Meissner, Pacinian, Ruffini Type II (Aβ) Fiber 6-12µm 35-75 m/s

Question 133

Pain / Temperature - Receptor Type - Afferent Axon Type - Axon Size - Conduction Velocity

Answer 133

Free nerve endings Type III (Aδ) Fiber 1-5µm 5-30 m/s

Question 134

Pain / Temperature / Itch - Receptor Type - Afferent Axon Type - Axon Size - Conduction Velocity

Answer 134

Free nerve endings (unmyelenated) Type IV (C) Fiber 0. 2-1.5µm 0. 5-2 m/s

Question 135

End of Spinal Cord

Answer 135

L1/2 Lumbar puncture at L3/4 into Cauda Equina

Question 136

Foramen of Skull and their structures

Answer 136

Cribriform Plate - CNI Optic Canal - CNII, Opthalamic Artery Superior Orbital Fissure - CNIII, CNIV, CNV1, CNVI Foramen Rotundum - CNV2 (maxillary) Foramen ovale - CNV3 (mandibular) Foramen Spinosum - Middle Meningeal Artery Foramen Lacerum - Filled with cartilage - internal carotid exits here towards cavernous sinous and exits under optic canal Internal Auditory Meatus - CNVII, CNVIII Jugular Foramen - CNIX, X, XI, sigmoid sinus / internal jugular Hypoglossal Canal - CNXII

Question 137

Veins of Skull

Answer 137

Emissary - drain blood from scalp (can infect sinuses) Diploic - drain spongy bone Supperior Saggital Sinus Superior Cerebral Veins (drain into saggital sinus) Inferior Saggital Sinus Great Cerebral Vein Straight Sinus Confluence of Sinuses Transverse Sinus Sigmoid Sinus (at petrous part of temporal bone) Inferior Petrosal Sinus Superior Petrosal Sinus Cavernous Sinus (either side of body of sphenoid)

Question 138

Middle Meningeal Artery origins

Answer 138

Enters through Foramen Spinosum and branches to Anterior / Posterior divisions Lies in extradural space (fracture of Pterion can rupture artery) Largest, most important branch of maxillary artery Maxillary artery branches from External Carotid (also gives off Superficial Temporal and Occipital arteries)

Question 139

Layers of SCALP

Answer 139

Skin Connective Tissue (dense - contains neurovascular structures) Aponeurotic Layer (of occipotofronralis) Loose Connective Tissue (allows scalp to move) Pericranium / Periosteum Fibrous septa in connective tissue hold vessels open and decrease ability to clot Rich anastamosis of branches of external/internal carotids Small lacerations will bleed profusely

Question 140

Occipitofrontalis

Answer 140

Wrinkles Forehead (frontalis) / Raises Eyebrows (w/ occipitalis) From external occipital protruberance to supraorbital margins (eyebrows) Extends laterally to zygomatic arches Lacerations of aponeurosis will gape (frontalis & occipitalis will pull in either direction)

Question 141

Muscles of Facial Expression (4 layers)

Answer 141

Same as SCALP but missing loose connective tissue (L) Instead of aponeurosis has muscles of facial expression - obicularis (around orrifices) - levators/depressors Attach to skin of face and bone/fascia underlying - produce expression Supplied by CNVII

Question 142

Dermatomes of Head & Neck

Answer 142

VI (opthalmic) - nose, eyes, posterior to level of ears V2 (maxillary) upper lip, cheek, temporal V3 (mandibular) - chin, jaw, anterior to ears X (auricular branch) - external meatus Cervical Plexus - Neck & behind ear C2/C3 posterior head and neck

Question 143

Arterial Supply of Face and skull

Answer 143

``` (branches from external carotid artery) Lingual Artery (deep to hyoglossus) Facial Artery (winds over inferior angle of mandible, tortuous course towards medial angle of eye) Superficial Temporal Artery Posteterior Auricular Artery Occipital Artery Ascending pharyngeal ``` (branches of opthalmic artery / internal carotid) Supratrochlear branches Supraorbital branches

Question 144

Parotid Gland

Answer 144

Serous Salivery Gland Sits below Zygomatic Arch, in front of mastoid process pf temporal bone, above angle of mandible, behind massiter, superficial to styloid process Wrapped in dense fibrous fascia (mumps is inflammation of glands - causes pain when fascia stretches) Produces Saliva, duct emerges from anterior aspect of gland, onto massiter, turns inwards, pierces buccinator and enters oral cavity near second upper molar.

Question 145

CNI

Answer 145

Olfactory Nerve Sensory (smell) Exit: Cribriform Plate Special Somatic - Smell

Question 146

CNII

Answer 146

Optic Nerve Sensory (sight) Exit: Optic canal Some axons cross optic chiasm Travel to Lateral Genticulate Nucleus within Thalamus Thalamus to visual cortex (optic radiation) - temporal: superior visual field - parietal: inferior visual field Special Somatic - Vision

Question 147

CNIII

Answer 147

Occulomotor Motor Exit: Superior Orbital Fissure Nuclei: - Midbrain General Somatic Motor (Superior Rectus, Inferior Rectus, Medial Rectus, Inferior Oblique, levator palpebrae superioris) - Midbrain General Visceral Motor (parasympathetic from Edinger Westphal nucleus - iris/sphincter pupillae[pupils], ciliary muscle[accomodation]) Dysfunction: Down and out, ptosis, dilation (mydriosis) third nerve paulsy due to uncal herniation

Question 148

CNIV

Answer 148

Trochlear Motor Exit: Superior Orbital Fissure Exits dorsal surface of brainstem & crosses to contralateral side Nuclei: - Midbrain General Somatic Motor (Superior Oblique) Dysfunction: Diplopia (double vision) - can't look down and in

Question 149

CNV

Answer 149

Trigeminal Nerve Mixed (motor and sensory) Nuclei: - Midbrain General Somatic Sensory [mesencephalic-proprioception] - Pons General Somatic Sensory [chief sensory - temp/touch] - Pons/Medulla/Spinal Cord General Somatic Sensory [spinal trigeminal nucleus - pain] - Pons Branchial Motor (motor nucleus - mastication, mylohyoid, tensor tympani, tensor veli palatini) (trigeminal ganglion sits at petrous part of temporal bone) V1 - OPTHALAMIC (superior orbital fissure) - supraorbital - supratrochlear V2 - MAXILLARY (foramen rotundum) V3 - MANDIBULAR (foramen ovale) ``` Sensory input from face, teeth, eyes, nose, external ear, anterior 2/3 tongue (lingual) & dura Mastication & mylohyoid Lateral & Medial pterygoids Temporalis Tensor Tympani (inner ear) Tensor Veli Palatini (raise soft palate) ```

Question 150

CNVI

Answer 150

Abducent Nerve Motor Exit: Superior Orbital Fissure Nuclei: - Pons General Somatic Motor (Lateral Rectus) Dysfunction: Diplopia (double vision) - can't abduct

Question 151

CNVII

Answer 151

Facial Nerve Mixed (motor and sensory) Wraps around behind CNVI nucleus Exit: Internal Acoustic Meatus Nuclei: - Pons Branchial Motor (facial expression, stapedius, digastric) - Pons General Visceral Motor (parasympathetic/greater petrosal - lacrimal, sublingual, submandibular salivary glands) - Pons/Medulla/Spinal Cord General Somatic Sensory (small region near external auditory meatus) - Medulla General and Special Visceral Sensory (nucleus solitarius - chorda tympani - taste anterior 2/3) Exits skull via stylomastoid foramen (through internal auditory meatus), between mastoid and styloid process inferior gives off posterior auricular nerve and supplies occipitalis (and digastric) enters posteromedial surface of parotid creates plexiform arrangement (pes anserinus) gives off 5 terminal branches - Temporal (frontalis) - Zygomatic (orbicularis occuli) - Buccal (buccinator) - Mandibular (orbicularis oris) - Cervical (platysma - clench teeth)

Question 152

CNVIII

Answer 152

Vestibulocochlear Sensory Exit: Internal Auditory Meatus Nuclei: - Pons/Medulla Special Somatic (hearing/equilibrium) - Pons Special Somatic (hearing/equilibrium) Dysfunction: Nystagmus, vertigo, hearing loss, tinitus

Question 153

CNIX

Answer 153

Glossopharyngeal Mixed (motor and sensory) Exit: Jugular Foramen Nuclei: - Medulla: Branchial Motor (nucleus ambiguus - stylopharyngeus) - General Visceral Motor (parasympathetic to parotid - from inferior salivatory nucleus) - Pons/Medulla/Spinal General Somatic (pharynx, middle ear, posterior 1/3 touch) - Medulla General and Special Visceral (nucleus solitarius - taste post 1/3, carotid body)

Question 154

CNX

Answer 154

Vagus Mixed (motor and sensory) Exit: Jugular Foramen Inside carotid sheath, alongside trachea, posterior to hilum of lung, anterior to oesophegus Nuclei: - Medulla Branchial Motor (nucleus ambiguus - levator palati, pharynx, larynx, upper oesophegus, soft palate, palatoglossus(tongue)) - Medulla General Visceral Motor (dorsal motor nucleus - parasympathetic - organs from pharynx to abdomen) - Pons/Medulla/Spinal General Somatic Sensory (pharynx, larynx, oesophagus, behind ear & auditory meatus) - Medulla General and Special Visceral (nucleus solitarius - baroreceptors and chemoreceptors of aortic arch, afferents from visceral organs) Dysfunction: Hoarse voice, dysphasia

Question 155

CNXI

Answer 155

Spinal Accessory (upper 5-6 of cervical spinal cord) Motor Exit: Jugular Foramen (enters via Foramen Magnum) Heads beneath or through sternocleidomastoid to floor of posterior triangle, crosses obliquely on levator scapulae and dissapears under trapezius) Nuclei: - Spinal Branchial Motor (sternocleidomastoid, upper trapezius) Dysfunction: Won't be able to shrug ipsilateral shoulder, can't turn head to contralateral side

Question 156

CNXII

Answer 156

Hypoglossal Motor Exit: Hypoglossal Foramen Nuclei: Medulla General Somatic Motor (tongue intrinsic and extrinsic - hyoglossus, genioglossus, styloglossus) (all except palatoglossus) Dysfunciton: Tongue deviates towards side of lesion

Question 157

Cranial Nerve Nuclei in Motor Columns (medial to lateral) - General Somatic - Branchial (gill/face) - Visceral

Answer 157

``` General Somatic CNIII (eye) CNIV (eye) CNVI (eye) XI (neck muscles) XII (tongue) ``` Branchial V (mastication) VII (facial expression) X & IX (nucleus ambiguus - levator palati, stylopharyngeus) ``` Visceral III (edinger-westfall nucleus - pupil/iris) VII (superior salivatory nucleus) IX (inferior salivatory nucleus) X (dorsal motor nucleus of vagus) ```

Question 158

Cranial Nerve Nuclei in Sensory Columns (medial to lateral) - General/Special Visceral - General Somatic (pain/fine touch) - Special Somatic

Answer 158

General/Special Visceral VII, IX, X (nucleus solitarius) - taste & autonomic I (smell) General Somatic V (sensation of face and cranial dura) V,VII,IX,X (skin behind ear & auditory meatus) Special Somatic VIII (hearing and equilibrium) II (vision)

Question 159

Reticular Formation

Answer 159

In tegmentum. Thalamus -> grey of spinal cord Rostral (midbrain & upper pons): maintain alert conscious state, modulate forebrain activity (reticular activating system) Caudal (pons & medulla): carry out important motor reflex and autonomic functions through cranial nerve nuclei and spinal cord (e.g. breathing, HR, etc.)

Question 160

Nucleus Ambiguus

Answer 160

Mostly Motor Lies behind inferior olive CNIX: stylopharyngeus CNX: levator palati, pharynx, larynx, upper oesophegus, palatoglossus(tongue) (soft palate muscles for speech and swallowing)

Question 161

Nucleus Solitarius

Answer 161

Extends from Pons to nucleus gracilis (mostly medulla) Rostral (gustatory nucleus); afferents from taste and palate (VII, IX, X) Caudal (visceral sensory) afferents from heart, abdominal viscera, aortic body (X) baroreceptors & chemoreceptors from carotid body and sinus (IX) mediate the gag reflex, the carotid sinus reflex, the aortic reflex, the cough reflex, the baroreceptor and chemoreceptor reflexes, several respiratory reflexes and reflexes within the gastrointestinal system regulating motility and secretion.

Question 162

Brain XRAY, MRI, CT, Ultrasound

Answer 162

XRAY - shows skull and bony lesions MRI - best for soft tissue (not bones) - non ionising radiation - fMRI track blood oxygen level - expensive - contraindicated for pt's with metal implants - better contrast resolution CT - positron emition tomography(identify metabolic function with glucose labelling) - fast - good for bones - better spatial resolution - Grey & White matter almost appear the same - Ionising RADIATION! Ultrasound - used in neonates - fontanel act as acoustic window - good for viewing glands (thyroid, submandibular, carotids)

Question 163

Amygdala

Answer 163

Implicit emotional learning Related to depression and anxiety Kluver-Bucy Syndrome: tameness/loss of fear

Question 164

Sympathetic NS Origins

Answer 164

T1-L2 Preganglionic neurons in intermediolateral cell column Sympathetic Chain Prevertebral Ganglia Generally more distant from organs

Question 165

Parasympathetic NS Origins

Answer 165

Cranial S2-S4 Generally closer to or within organs

Question 166

Fovea

Answer 166

Area of high visual acuity Avascular (gets nutrients form choroid) High density of cones (colour) No rods (nightvision)

Question 167

Lamina Cribosa

Answer 167

continuation of 1/3 of scleral fibres (dense connective tissue) in the eye creating web/holes for axons of optic nerve In glaucoma lamina cribosa can be pushed out and damage axons travelling through it

Question 168

Blood supply to the eye

Answer 168

Central renal artery (tributary of opthalamic artery, branch of internal carotid) - supplies internal retina Long Posterior Ciliary artery - travel in chroroid all the way to the front of the eyeball & feeds photoreceptors Short Posterior Ciliary Artery - doesn't travel far in choroid, supplies photoreceptors Anterior Ciliary Artery - supplies anterior structures like conjunctiva

Question 169

Edinger-Westphall nucleus

Answer 169

Parasympathetic cranial nerve nucleus of the oculomotor nerve (cranial nerve III), supplying the constricting muscles of the Iris and the ciliary muscle.

Question 170

Photoreceptors

Answer 170

Light activates Rhodopsin -> transducin -> Phosphodiesterase -> cGMP breaks down to GMP -> Na+ influx ceases -> Cell becomes hyperpolarized -> releases less neurotransmitter (glutamate)

Question 171

Bipolar Cells (Vision)

Answer 171

ON or OFF types Important in 'through'/'central' pathway Important for spatial vision & colour vision ON -> depolarize in response to light OFF -> hyperpolarize in response to light

Question 172

Ganglion Cells (Vision)

Answer 172

Types: ON, OFF, M, P Release Glutamate Fire action potentials (increase/decrease in response to light) Have a 'receptive field' synapse in LGN of thalamus P&M cell pathways terminate in seperate layers of Primary Visual Cortex (V1) ``` M: Magnocellular (10%) - big cells - motion P: Parvocellular (80%) - small cells - colour vision & acuity ```

Question 173

Amacrine Cells (Vision)

Answer 173

Lateral inhibition Axonless Allow us to see movement

Question 174

Horizontal Cells (Vision)

Answer 174

Lateral inhibition between photoreceptors Use GABA (inhibitory) respond to light by hyperpolarizing Involved in 'surround' response pathway of receptive field.

Question 175

Lateral Genticulate Nucleus (LGN)

Answer 175

Thalamic relay station for visual pathway Magnocellular Layers 1&2 Parvocellular Layers 3,4,5,6 Ipsilateral Eye Layers: 2,3,5 Contralateral Eye Layers 1,4,6 Give off Optic Radiations to Primary Visual Cortex V1 (around calcarine fissure, central vision most posterior)

Question 176

Intrinsically Photosensitive Ganglion Cell

Answer 176

``` Contain melanopsin Responsible for - Circadian rhythm / sleep (SCN) - Pupil response (CNII -> OPN -> Erdinger-Westphal-> CNIII -> Ciliary Ganglion -> sphincter pupillae) - Information about light levels - photophobia ```

Question 177

Suprachiasmatic Nucleus (SCN)

Answer 177

ipGCs project to SCN in Hypothalamus | Drives circadian rhythm

Question 178

Semicircular Canals

Answer 178

``` Sensory information about Head Position Hair follicles (cupula) in Ampulla Discharge in relation to changes in position (directional) due to flow of endolymph ```

Question 179

Otolith Organs (saccule & utricle)

Answer 179

Sensory information about linear acceleration

Question 180

Dorsal Visual Stream

Answer 180

``` Area MT (Middle Temporal Lobe) specialized for processing object motion Directional selective Respond to different types of motion ```

Question 181

Ventral Visual Stream

Answer 181

Area V4 Orientation and colour selective Important for perception of shape and colour Area IT (Inferior Temporal) Major output area of V4 Important for visual memory and perception (esp faces)

Question 182

Ossicles

Answer 182

Bones of middle ear Malleus Incus Stapes Match impedance of air to impedance of fluid within inner ear Size: 20:1 (tympanic membrane >> oval window) Lever action 1.3:1

Question 183

Lower Motor Fiber - Efferent Axon Type - Axon Size - Conduction Velocity

Answer 183

Type α (Aα) Fiber, 13-20µm 80-120m/s

Question 184

``` Sensory Fiber & associated receptor Type Ia (Aα) Type Ib (Aα) Type II (Aβ) Type III (Aδ) Type IV (C) ```

Answer 184

Ia - muscle spindle Ib - golgi tendon organ II - muscle spindle & cutaneous mechanoreceptors III - touch and pressure noiceceptors, temp (cold) IV - noiceceptors, temp (warmth)

Question 185

Basal Ganglia

Answer 185

In telencephalon Help Motor Cortex formulate and execute movement Allow selection of patterns ('subroutines') Evaluate success of actions in achieving goals Initiate movement Damage leads to Parkinsons & Huntingtons Striatum (caudate and putamen) Globus Pallidus (GPi & GPe) Subthalamic Nucleus Substantia Nigra Direct (select subroutines) MC (+)-> Striatum (-)-> GPi (-)-> Thalamus (+)-> SMC Indirect (suppress movement) MC (+)-> Striatum (-)-> GPe (-)-> Subthalmic (+)-> GPi (-)-> Thalamus (+)-> SMC Initiation MC (+)-> Striatum (-)-> Sub Nigra (+)(-)-> Striatum (direct or indirect)

Question 186

Middle Cerebral Artery

Answer 186

Origin: ICA (bifurcation with ACA) Gives of lenticulostriate arteries (supply basal ganglia and internal capsule) Supplies: Lateral surface Territories: motor & sensory (except lower limb), parieto-occipital association, language (on dominant side)

Question 187

Anterior Cerebral Artery

Answer 187

Origin: ICA (bifurcation w/ MCA) has anterior communicating artery (gives off small branches to supply optic chiasm & anterior hypothalamus) Supplies: Medial frontal and parietal lobes Territores: Motor & sensory (lower limbs)

Question 188

Posterior Cerebral Artery

Answer 188

Origin: Basilar (from joining of vertebral) give off small brances to ventral midbrain, thalamus, posterior hypothalamus Supplies: Medial and inferior temporal and occipital lobes Territores: visual cortex

Question 189

Misc CNS arteries - Opthalmic - Anterior Choroidal - Superior Cerebellar Artery - Pontine perforating arteries - Anterior Inferior Cerebellar Artery - Posterior Inferior Cerebellar Artery - Anterior Spinal Artery - Posterior Spinal Artery

Answer 189

Opthalmic: from ICA to optic cavity, top of nasal cavity, and frontal scalp Anterior Choroidal: from ICA to structures in deep lateral hemispheres, optic tract, lateral ventricles, hippocampus SCA: from basilar artery Pontine: from basilar to Pons AICA: from basilar a. PICA: from basilar or vertebral a. Anterior Spinal: from both vertebral a. (& segmental branches of aorta) Posterior spinal: one from each vertebral a. (& segmental branches of aorta) *spinal arteries anastamose through circumferential branches

Question 190

Cochlea Structure

Answer 190

``` Scala Vestibuli Scala Media (endolymph - high K+) - stria vascularis (recycle K+) - tectorial membrane - inner hair cells (project ot brainstem nuclei) - outer hair cells (amplify movements of basilar membrane)* - basilar membrane (wider at apex) Scala Tympaniy (perilymph - low K+) ``` *antibiotics cause loss of OHC & loss of hearing (100 fold less sensitive)

Question 191

Blood Supply of Nasal Cavity

Answer 191

SUPERIOR - ethmoidal arteries (branches of opthalmic arteries) INFERIOR - greater palatine artery (branch of maxillary artery - ECA) POSTERIOR - sphenopalatine artery (branch of ECA) - nosebleed (epistaxis) ANTERIOR - superior labial arteries (branch of facial artery) - lateral branch of facial arteries (from ECA) - anastomoses from superior/inferior/posterior

Question 192

Nerve supply of Nasal Cavity

Answer 192

``` SUPERIOR/ANTERIOR - CNI - olfactory - CNV1 - Anterior ethmoidal nerves INFERIOR/POSTERIOR - CNV2 - Greater/Lesser palatine ```

Question 193

Pharynx Range

Answer 193

Base of skull -> C6

Question 194

Cerebellum

Answer 194

Coordinate Timing and Sequence Maintain Muscle Tone Motor Learning Planning Sequences of muscle activation for complex movement ATAXIA: inability to integrate / cordinate movement Effects of unilateral lesion are ipsilateral Anterior Lobe Syndrome: - ataxic gait (drunken sailor) - can't walk in a line - loss of inter-limb coordination (heel-shin test) Posterior Lobe Syndrome: - Dysmetria (nose-finger overextension) - Dysdiadochokinesia (rapid alternate movements - palm test) - Speech abnormality (slurring, explosive speech) Flocculonodular Lobe Syndrome: - Truncal Ataxia (can't stabilize trunk)

Question 195

Hippocampus

Answer 195

In Medial Temporal Lobe Critical for learning and memory Most sensitive structure for induction of seizures (epilepsy)

Question 196

Venous Drainage of Skull

Answer 196

``` Superior Venous Sinus Inferior Venous Sinus Great Cerebral Artery Straight Sinus Confluence Transverse Sinus Sigmoid Sinus Petrosal Sinus (inferior superior) Cavernous Sinus Superior Orbital Vein ```

Question 197

Muscles of tongue (intrinsic, extrinsic) & mouth

Answer 197

Floor of Mouth: Digastric - Mylohyoid - (large) mandible to hyoid Geniohyoid - (small) mandible to hyoid Extrinsic Tongue: Genioglossus - tongue to mandible (protrude tongue) -XII Palatoglossus - tongue to palate (elevate tongue) - X Styloglossus - tongue to styloid process (retract tongue) - XII Hypoglossus - tongue to hyoid (depress tongue) -XII Intrinsic Tongue: Transverse, vertical, superior/inferior longitudinal - XII

Question 198

Tongue innervation - motor - sensory (touch) - sensory (taste)

Answer 198

Motor: XII (except palatoglossus - X) Sensory (touch): Ant 2/3 - V3 Pos 1/3 IX Sensory (taste): Ant 2/3 - VII Pos 1/3 - IX

Question 199

Teeth #

Answer 199

Incisors (4) Canine (2) Premolars (4) Molars (6) - including wisdom x2 for upper and lower supplied by superior/inferior alveolar nerve - V2/V3 supplied by maxillary artery -> alveolar arteries

Question 200

Larynx length

Answer 200

Epiglottis -> C6/lower border of cricoid

Question 201

Structures of larynx

Answer 201

``` Hyoid bone Epiglottic cartilage Thyroid cartilage (open posteriorly) Cricoid cartilage (lamina & arch) Arytenoid cartilages (vocal & muscular processes) vestibular fold (false vocal chords) vocal ligaments (adduct = phonation) ``` Muscles Posterior cricoarytenoid (abduct vocal ligaments) Lateral cricoarytenoid (adduct vocal ligaments) cricothyroid (lengthen vocal fold) vocalis / thyroarytenoid (relax vocal fold) transverse/oblique arytenoids (close rima glottis) Nerves superior laryngeal - external laryngeal (cricothyroid muscle) - internal laryngeal (sensory above vocal ligaments) inferior laryngeal (sensory below vocal ligaments) recurrent laryngeal (all other muscles - hoarse voice) Blood supply superior laryngeal vessels (lateral to larynx) inferior thyroid vein (medial to larynx)

Question 202

Tracheotomy location

Answer 202

cricothyoid membrane

Question 203

Anterior Triangle of Neck - Borders - Structures

Answer 203

Mandible, Sternocleidomastoid, Manubrium

Question 204

Posterior Triangle of Neck - Borders - Structures

Answer 204

Behind sternocleidomastoid, in front of trapezius, above medial 1/3 of clavicle Transmitting structures to upper limb and back (e.g. brachial plexus)

Question 205

Organisation and Fasica of Neck - Superficial Fascia - Investing Fascia - Pretracheal/Buccopharyngeal Layer - Prevertebral Layer - Carotid Sheath

Answer 205

SUPERFICIAL - platysma (blends with muscles of face - CNVII) - EJV (angle of mandible -> descent on SCM) - AJV INVESTING - trapezius - sternocleidomastoid (SCM) [between] - strap muscles Suprahyoid msucles (hyoid to skull - elevate larynx) Infrahyoid muscles (hyoid to sternum/clavicle/etc - depress larynx) innervated by anterior rami of cervical nerves PRETRACHEAL(to hyoid)/BUCCPHARYNGEAL - Thyroid / Parathyroid - Thymus - Trachea - Oesophegus PREVERTEBRAL - vertebra - scalenus anterior (attach to anterior tubercles & first rib) (subclavian & brachial plexus passes between) - scalenus medius (attach to posterior tubercles & first rib) - longus colli (maintains curvature of lordosis) CAROTID (expansile) - Carotid - Jugular - Vagus

Question 206

Cervical Vertebra Features

Answer 206

NERVE ROOTS PASS IN FRONT FACET JOINTS! Transverse mass - anterior & posterior tubercles w/ transverse foramen bifid spinous process (increased surface area for muscle attachment) - C7 has longest articular surfaces at 45degrees w/ uncinate processes on C3-6 (keep movement in saggital plane) - innervated by posterior rami Largest intervertebral discs throughout vertebral column (prolapse usually trauma related)

Question 207

Atypical Cervical Vertebra Features - Atlas - Axis

Answer 207

NERVE ROOTS PASS BEHIND FACET JOINTS! Atlas (C1) - No body - anteiror/posterior arches - facet for dens - saucer-shaped upper surfaces for occipital condyles - longest transverse process - loose fibrous capsule permits nodding (F/E) - 20% of ROM Axis (C2) - Dens (odontoid process) - body from C1 (atlas) - 2 lateral facet joiunts - allow 50% of spinal rotation - Strong spinous process (muscles of stabilisation) * rectus capitis posterior major/miinor * superior/inferior oblique - Ligaments stabilize dens (endagement of cord) * transverse ligament / cruciform * alar ligaments (resist range of rotation of head around dens)

Question 208

Internal Carotid Course & Branches

Answer 208

Branch of common carotid (C4) runs in carotid sheath through carotid canal, above foramen lacerum, through cavernous sinus gives off opthalmic, MCA, ACA, anterior choroidal, posterior communicating Contains carotid sinus and body

Question 209

External Carotid Course & Branches

Answer 209

``` Branch of common carotid (C4) Anterior Branches - Superior thyroid artery - Lingual artery - Facial artery ``` Posterior Branches - Occipital - Posterior Auricular (behind ear) Deep - Ascending pharyngeal artery Terminal - Maxillary artery (middle meningeal, sphenopalatine, alveolar) - Transverse facial (eye level) - Superficial temporal artery **Some Anatomists Like Freaking Out Poor Medical Students ``` S - superior thyroid artery A - ascending pharyngeal artery L - lingual artery F - facial artery O - occipital artery P - posterior auricular artery M - maxillary artery S - superficial temporal artery ```

Question 210

Level of bifurcation of carotid artery

Answer 210

C4 C3/4 is also upper border of thyroid cartilage

Question 211

Ligaments of Cervical Spine

Answer 211

Resist movement in saggital plane (F/E) - susceptible to whiplash injury Ligamentum Nuchae (from supraspinatus) ATLAS to occiput Posterior atlanto-occipital membrane (from ligamentum flavum) ``` AXIS to occiput Anterior atlanto-occipital membrane (from anterior longitudinal ligament) Membrana tectoria (from posterior longitudinal ligament) ```

Question 212

Thyroid

Answer 212

Between Tyroid cartilage & 6th Tracheal ring Isthmus between 2nd & 3rd Tracheal rings encased in pretracheal fascia 50% of cases have pyramidal lobe Descends from Foramen Caecum during development Superior Thyroid Artery (from external carotid) Inferior thyroid artery (from subclavian) (10%) Thyroid ima artery (subclavian) Superior Thyroid Veins (IJV) Middle Thyroid Veins (IJV) Inferior Thyroid Veins (subclavian) ``` Internal/External branch of superior laryngeal (CNX) recurrent laryngeal (CNX) ```

Question 213

Cervical Plexus

Answer 213

from ventral rami of C1-C4 Phrenix (C3,4,5) - descends on scalenus anterior in posterior triangle into thorax Superficial (cutaneous) (C2,3,4) - lesser occipital - greater auricular - transverse cervical - suprascapula Deep branches - ansa cervicalis (motor - strap muscles of neck)

Question 214

Imaging modalities of Orbit

Answer 214

CT MRI Ultrasound (of globe) Dacrystogram (imaging of lacrimal duct with dye)

Question 215

Best Imaging modality for paransal sinuses

Answer 215

CT - excellent delineation of bony anatomy MRI good for suspected soft tissue tumors

Question 216

Best imaging modality for mandible and maxilla

Answer 216

OPG (Orthopantomogram) - dentist XRAY

Question 217

Best Imaging modalities for thyroid

Answer 217

CT, Ultrasound, PET

Question 218

Best Imaging modalities for vessels

Answer 218

Ultrasound CT/CT angiography MRI/MRI angiography Digital subtraction angiography

Question 219

Best Imaging modality for temporal bones

Answer 219

thin slice CT due to complicated bony anatomy of the region ``` Can image: inner ear bony labrynth ossicles mastoid air cells facial nerve course ```

Question 220

Adrenal Layers (from outer to inner) and their products

Answer 220

Capsule - N/A Zona Glomerulosa - Aldosterone Zona Fasciculata - Cortisol Zona Reticularis - Dehydroepiandrosterone (DHEA), Androgens, Oestrogens Medulla - Catecholamines (Adrenaline, NA, Dopamine)

Question 221

Hip joint & Acetabulum

Answer 221

- Ilium (superior) - ischium (postero-inferior) - pubis (antero-inferior) meet to form lunate surface of acetabulum w/ notch - labrum (fibrocartilage deepens cup & increases surface area) Blood supply via anastamoses from Medial & Lateral Femoral Circumflex Arteries from femoral artery ligaments: iliofemoral (front, strong - upside down V shape) pubofemoral & ischiofemoral (behind, weak) Cuff of 'fixator muscles' to stabalise head of femur ('rotator cuff'). - external/outward rotators - run parallel to neck of femur - pull head of femur into socket Gluteal muscles cover joint posteriorly Gluteus medius & minimus abduct hip & maintain position in coronal plane (injury = trendellenberg gait) Adductor muscles from pubis/symphisis to medial femur Innervation: - Femoral (crosses in front of joint) - Obturator (L2,3,4 - crosses medial aspect of joint) - Sciatic (passes posterior and medial) Referred pain: FROM hip via obturator to knee/thigh TO hip from lumbar spine Hip dislocation usually posteriorly, endanger blood supply and sciatic nerve

Question 222

Femur

Answer 222

``` Head - directed upwards, medially, forwards - with fovea - non articular, has ligament attached regresses after puberty) - protected by psoas bursa anteriorly Anatomical Neck - line of growth plate Greater Trochanter - gluteal muscles Lesser Trochanter Intertrochanteric Line (anterior) Intertrochanteric Crest (posterior) ``` Superior Trabecular System: - Arcuate - resist bending forces - Vertical - resist compression Inferior Trabecular system - Medial & Lateral - resist pull on greater & lesser trochanter Retinacular fibres provide blood supply to head of femur

Question 223

Hip close packed position

Answer 223

Hip extended Abducted Medially Rotated Position of greatest stability Ligaments taught

Question 224

Knee Joint

Answer 224

2 joints in one - femur with tibia (tibiofemoral) - femur with patella (patellofemoral) Large ROM -- most stable in extension (close packed) Anterior & posterior cruciate ligaments (intracapsular but extrasynovial) * Anterior tibial to posterior lateral condyle of femur * Posterior tibial to medial condyle of femur * Primary stabilisers in A-P direction * PCL prone to injury w/ impact to knee during flexion Medial & lateral collateral ligaments * M: resists valgus (abduction) and lateral tibial rotation, blends with capsule, attaches to meniscus, commonly injured * L: resists varus (adduction), seperated from meniscus by popliteus tendon Medial condyle 1cm larger than lateral Femur rotates medially on tibia during extension (around tight ACL in last 15-20degrees) Active contraction of popliteus (medial surface of tibia, lateral condyle) for flexion Condyles surrounded by meniscus (fibrocartilagenous disc) * increase area of contact by 33% * medial meniscus is longer, less mobile, prone to injury * 'locked knee' - torn meniscus & stuck * no meniscus -> weight focused on centre -> osteoarthritis Capsule reinforcements: - Anterior - patella tendon & retinacular fibres - Lateral - popliteus, biceps femoris, iliotibial tract - Medial - 'pes anserinus' - Sartorius, Gracilis, Bursa, Semiteninosus Posterior - oblique popliteal ligament

Question 225

Pes Anserinus of Knee

Answer 225

Say Grace Before Tea Sartorius - anterior compartment Gracilis - medial compartment Bursa semiTendinosus - anterior compartment

Question 226

Patellofemoral Joint

Answer 226

Maintained by 3 structures * Strong vastus medialis muscle - pull patella medially * Medial patellar retinaculum - keep patella medial * Raised lip on lateral femoral condyle - prevent patella from moving laterally Patella wants to move laterally because quadriceps aligned obliquely laterally Problem with tracking = chondromalacia patellae

Question 227

Gluteus Maximus

Answer 227

ORIGIN: Gluteal surface of ilium & sacrum INSERTION: posterior iliotibial tract and gluteal tuberosity INNERVATION: Inferior gluteal nerve ACTION: Extend, lateral rotation, abduct thigh at hip * Similar to posterior deltoid

Question 228

Gluteus Medius & Minimus

Answer 228

ORIGIN: Superior posterior ilium INSERTION: anterolateral aspect of greater trochanter INNERVATION: Superior gluteal nerve ACTION: medial rotation, abduction of hip * similar to lateral fibres of deltoid * prevent hip drop when walking

Question 229

Piriformis, Obutrator, Gemelli, Quadratus Femoris

Answer 229

ORIGIN: Anterior surface of sacrum exiting via greater sciatic notch, inferior pubic ramus, inferior ischial ramus INSERTION: (gluteal region) greater trochanter INNERVATION: from sacral plexus ACTION: lateral rotation Piriformis: Trianglular muscle forming part of wall of pelvis Arises from middle 3 segments of sacrum anteriorly exits via greater sciatic foramen attaches on greater trochanter Sacral plexus lies on piriformis Obturator internus: arises from internal surface of obturator membrane, margins of obturator foramen, and extends onto postero-superior bony surface and exits via the lesser sciatic foramen

Question 230

Iliacus

Answer 230

ORIGIN: iliac fossa and passes beneath inguinal ligament INSERTION: lesser trochanter INNERVATION: femoral nerve ACTION: Flex hip and maintains lumbar lordosis (w/ psoas)

Question 231

Muscles of medial compartment of thigh

Answer 231

Adductors of hip (mostly) - Pectineus - Gracilis - Adductor Brevis - Adductor Longus - Adductor Magnus

Question 232

Muscles of anterior compartment of thigh

Answer 232

Flexion of hip and extension of knee - Pectineus - Sartorius - Rectus Femoris - Vastus Lateralis - Vastus Intermedius - Vastus Medialis - Articularis Genus

Question 233

Muscles of posterior compartment of thigh

Answer 233

Flexion of knee - Biceps Femoris - Semitendinosus - Semimembranosus

Question 234

Muscles of anterior compartment of leg

Answer 234

Dorsiflex foot and extend toes Tibialis anterior Extensor Hallucis Longus Extensor Digitorum Longus w/ fibularis tertius

Question 235

Muscles of posterior compartment of leg

Answer 235

``` Plantarflex foot and flex toes Gastrocnemius Soleus Tibialis Anterior Flexor Hallucis Longus Flexor Digitorum Longus ```

Question 236

Muscles of lateral compartment of leg

Answer 236

Evert foot Fibularis longus Fibularis brevis

Question 237

Tensor fascia lata

Answer 237

ORIGIN: below lateral iliac spine INSERTION: Iliotibial tract INNERVATION: superior gluteal nerve ACTION: Flexes, abducts, medially rotates * similar to anterior and lateral deltoid

Question 238

Iliotibial tract

Answer 238

Lateral thickening of fascia lata of thigh Extends from iliac crest to lateral proximal tibia shared aponeurotic tendon of gluteus maximus (inserts posteriorly) and tensor fascia lata (inserts superior/anterior) * prevent tilt/drop during swing phase

Question 239

Pectineus

Answer 239

ORIGIN: Pubic crest INSERTION: below lesser trochanter INNERVATION: femoral and obturator nerves ACTION: flexion of hip w/ iliopsoas, adduction of hip w/ adductors

Question 240

Sartorius

Answer 240

ORIGIN: Anterior superior iliac spine INSERTION: below medial condyle of tibia INNERVATION: femoral nerve ACTION: 'dog poo muscle' - sitting cross legged

Question 241

Vastus Medialis

Answer 241

ORIGIN: anterior to lesser trochanter of femur and linea aspra INSERTION: tibial tuberosity (anterior) INNERVATION: femoral nerve ACTION: extensor of knee

Question 242

Vastus Lateralis

Answer 242

ORIGIN: below greater trochanter of femur and linea aspra INSERTION: tibial tuberosity (anterior) INNERVATION: femoral nerve ACTION: extensor of knee

Question 243

Rectus Femoris

Answer 243

ORIGIN: Anterior inferior iliac spine and above acetabulum INSERTION: tibial tuberosity (anterior) INNERVATION: fermoral nerve ACTION: thigh flexion, knee extension

Question 244

Vastus Intermedius

Answer 244

ORIGIN: Anterior shaft of femur INSERTION: aponeurosis blends with quadriceps tendon and inserts on tibial tuberosity (anterior) INNERVATION: femoral nerve ACTION: extensor of knee

Question 245

Adductor longus & brevis

Answer 245

ORIGIN: Inferior pubic ramus INSERTION: posterior femur (linea aspra) INNERVATION: Obturator nerve ACTION: adductor

Question 246

Adductor magnus

Answer 246

ORIGIN: Inferior pubic ramus around to ischial ramus INSERTION: linea aspra to above medial condyle of femur INNERVATION: Obturator nerve & sciatic (tibial) ACTION: adductor & partial flexor of knee

Question 247

Gracilis

Answer 247

ORIGIN: Inferior pubic ramus INSERTION: below medial condyle of tibia INNERVATION: Obturator ACTION: adductor

Question 248

Semitendinosus

Answer 248

ORIGIN: Inferior ischial ramus (tuberosity of ischium) INSERTION: Inferior pubic ramus INNERVATION: tibial nerve (from sciatic) ACTION: Hamstring - hip extension, knee flexion

Question 249

Biceps Femoris

Answer 249

ORIGIN: Inferior ischial ramus (tuberosity of ischium) (long head), linea aspra (short head) INSERTION: proximal lateral fibula INNERVATION: tibial nerve (except short heat - common fibular) ACTION: Hamstring - hip extension, knee flexion

Question 250

Semimembrinosus

Answer 250

ORIGIN: Inferior ischial ramus (tuberosity of ischium) INSERTION: posterior medial condyle of tibia INNERVATION: tibial nerve (from sciatic) ACTION: Hamstring - hip extension, knee flexion

Question 251

Popliteus

Answer 251

ORIGIN: lateral condyle of femur and meniscus INSERTION: below medial condyle of tibia INNERVATION: Tibial nerve ACTION: medial rotation and flexion of knee

Question 252

Tibialis anterior

Answer 252

ORIGIN: anterior aspect of shaft of tibia/fibula/interosseous membrane INSERTION: medial cuneiform and base of first metatarsal INNERVATION: Deep fibular nerve ACTION: dorsiflexion and inversion

Question 253

Extensor Hallucis Longus

Answer 253

ORIGIN: anterior aspect of shaft of tibia/fibula/interosseous membrane INSERTION: distal phalynx and middle phalynx INNERVATION: ACTION: big toe extension

Question 254

Extensor Digitorum Longus

Answer 254

ORIGIN: anterior aspect of shaft of tibia/fibula/interosseous membrane INSERTION: distal phalynx and middle phalynx INNERVATION: ACTION: toes (except big toe) extension *gives off Fibularis Tertius to base of 5th metatarsal

Question 255

Medial to Lateral structures of Dorsum of Foot

Answer 255

Timothy has a nasty, dirty toe ``` Tibialis anterior eHl Artery (anterior tibial / dorsalis pedis) Nerve (deep fibular nerve) eDl fibularis Tertius ```

Question 256

Fibularis Longus

Answer 256

ORIGIN: Proximal shaft of fibula, groves cuboid, passes beneath sole of foot INSERTION: medial cuneiform and base of 1st metatarsal INNERVATION: ACTION: eversion of foot

Question 257

Fibularis Brevis

Answer 257

ORIGIN: Distal shaft of fibula, groves lateral malleolus INSERTION: base of 5th metatarsal INNERVATION: ACTION: eversion of foot

Question 258

Gastrocnemius

Answer 258

ORIGIN: each condyle of femur INSERTION: achilles tendon - calcaneus of heel INNERVATION: ACTION:

Question 259

Soleus

Answer 259

ORIGIN: proximal tibia and fibula w/ arch for neurovascular bundle INSERTION: archilles tendon - calcaneus of heel INNERVATION: ACTION:

Question 260

Flexor Digitorum Longus

Answer 260

ORIGIN: Shaft of tibia, fibular and interosseus membrane INSERTION: 4 toes (2nd - 5th metatarsals) INNERVATION: ACTION:

Question 261

Flexor hallucis Longus

Answer 261

ORIGIN: Shaft of tibia, fibular and interosseus membrane INSERTION: 1st metatarsal (big toe) INNERVATION: ACTION:

Question 262

Tibialis Posterior

Answer 262

ORIGIN: Shaft of tibia, fibular and interosseus membrane INSERTION: medial cuneiform and base of 1st metatarsal INNERVATION: ACTION: Plantar flexion and inversion

Question 263

Structures from medial malleolus to calcaneus

Answer 263

Tom Dick and Very Naughty Harry ``` Tibialis posterior fDl Artery (posterior tibial artery) Vein (vena comitantes) Nerve (tibial nerve) fHl ```

Question 264

Tibia & Fibula

Answer 264

``` TIBIA Weight bearing Condyles Intercondylar eminence Tibial tuberosity Soleal line Medial Malleolus ``` ``` FIBULA Non-weight bearing, muscle attachment Head Shaft Lateral Malleolus ``` SUPERIOR JOINT: Synovial - anterior & posterior ligaments ``` INFERIOR JOINT: Fibrous prevents separation - anterior, posterior, and interosseous ligaments malleolar mortise (oblique angle) - inferior transverse ligament ```

Question 265

Bones of foot (posterior to anterior)

Answer 265

Calcaneus Talus Navicular Cuboid Cuneiforms (medial, intermediate, lateral) Metatarsals (5) Phalanges (distal, proximal, middle - except hallux) + sesamoid bones - under metatarsals + accessory bones - unfused centres of ossification

Question 266

Lumbar Plexus

Answer 266

Ventral rami L1-L4 Within Psoas Major From Lateral Border: Ilioinguinal and iliohypogastric (L1) Lateral cutaneous nerve of thigh (L2,3) Femoral nerve (L2,3,4) Onto Anterior Surface Genitofemoral (L1,2) - L1 is femoral branch - L2 is genital branch From medial border Obturator (L2,3,4) *L5 forms lumbosacral trunk and joins with sacral plexus

Question 267

Iliohypogastric & Ilioinguinal nerve

Answer 267

From Lumbar Plexus within Psoas L1 Slip in between Transversus Abdominus and Internal Oblique and track around to supply anterior abdominal wall

Question 268

Lateral Cutaneous Nerve of Thigh

Answer 268

From Lumbar Plexus within Psoas L2,3 Swings wide and tucks under beginning of inguinal ligament. Supplies thigh and skin down lateral side of thigh Can be compressed during pregnancy = numbness and tingling.

Question 269

Femoral Nerve

Answer 269

From Lumbar Plexus within Psoas L2,3,4 posterior divisions Emerges and tucks into gutter between iliacus and psoas Runs under inguinal ligament (lateral to artery, vein, lymph) Divides into terminal branches distal to ligament (2.5cm) MOTOR to extensors (quads, sartorius, pectineus) SENSORY to anteromedial thigh, knee, leg, ankle (up to but not beyond 1st metatarsal) via Anterior Cutaneous Branches and Saphenous Nerve Articular branches to hip and knee

Question 270

Genitofemoral Nerve

Answer 270

From Lumbar Plexus within Psoas L1 - femoral branch, supplies area of skin beow middle of inguinal ligament L2 - genital branch, supplies spermatic cord

Question 271

Obturator Nerve

Answer 271

From Lumbar Plexus within Psoas L2,3,4 anterior divisions Crosses pelvic brim Runs along lateral wall of pelvis into obturator canal and into medial compartment of thigh - anterior branch (between longus and brevis) - posterior branch (between brevis and magnus) MOTOR to adductors (gracilis, longus, brevis, magnus, pectineus) SENSORY to peritoneum and medial patch above knee (inflammation of peritoneum can refer pain here) Articular branches to hip

Question 272

Sacral Plexus

Answer 272

Lumbosacral Trunk (L5) joins S1-4 on piriformis Visceral branches to pelvic viscera Somatic branches to walls and floor of pelvis Somatic branches that exit pelvis with piriformis and supply structures of lower limb - Sciatic Nerves (L4,5, S1-3) - Superior and Inferior Gluteal Nerves - Posterior Cutaneous Nerve of Thigh

Question 273

Sciatic Nerve

Answer 273

L4,5, S1-3 anterior and posterior divisions Exits pelvis via Greater Sciatic Foramen Emerges beneath Piriformis in gluteal region (posterior to hip) Descends posterior to thigh Divides at apex of popliteal fossa - Tibial - Common Fibular MOTOR to hamstrings (tibial except SHOB - common fib.) SENSORY via terminal branches only Articular branchess to hip

Question 274

Tibial Nerve

Answer 274

L4,5, S1-3 anterior divisions (sciatic) Vertical descent through popliteal fossa, beneath fibrous arch of soleus, descends on tibialis posterior, posterior to medial malleolus onto sole of foot, gives off medial and lateral plantar nerves - lateral plantar (similar to ulnar) - supplies lateral 1.5 toes and all intrinsic muscles of sole of foot - medial plantar (similar to median) - supplies medial 3.5 digits MOTOR to muscles of posterior leg and sole of foot SENSORY to posterior leg (sural nerve), heel, and sole of foot (medial calcaneal, medial and lateral plantar) - lateral plantar (similar to ulnar) - supplies lateral 1.5 toes and all intrinsic muscles of sole of foot - medial plantar

Question 275

Common Fibular Nerve

Answer 275

L4,5, S1-3 posterior divisions (sciatic) Runs medial to biceps femoris, superficial to lateral head of gastrocnemius, winds around neck of fibula onto fibularis longus and gives off terminal branches - deep fibular nerve (descends deep to EDL, anterior to interosseous membrane, beneath extensor retinaculum, onto dorsum of foot) - superficial fibular nerve (descends in lateral compartment) Deep Fibular Nerve MOTOR to anterior compartment of leg and Extensor Digitorum Brevis SENSORY to 1st toe cleft Articular branches to ankle and foot Superficial Fibular Nerve MOTOR to lateral compartment of leg (Fibularis longus and brevis) SENSORY to lower lateral leg and dorsum of foot

Question 276

Posterior Cutaneous Nerve of Thigh

Answer 276

Branch from sacral plexus | SENSORY to posterior thigh

Question 277

Leg Myotomes - Hip Flexion/Extension - Knee Extension/Flexion - Ankle Dorsiflexion/Plantarflexion - Foot Inversion/Eversion - Big to Dorsiflexion/Plantarflexion

Answer 277

HIP L2,3 / L4,5 KNEE L3,4 / L5,S1 ANKLE L4,5 / S1,2 FOOT L4 / L5, S1 BIG TOE L5, S1 / S1, S2

Question 278

Branches of Arteries of Lower Limb

Answer 278

External Iliac Femoral - Profunda femoris - Popliteal Popliteal (under adductor hiatus) - Genicular anastamoses - Anterior Tibial - Posterior Tibial Anterior Tibial - Dorsalis Pedis (pierces first interossei) Posterior Tibial (Inferior border of popliteus) - Fibular - Medial and Lateral Plantar (under flexor retinaculum) Lateral Plantar artery - swings wide and creates deep plantar arch - completed by termination of dorsalis pedis from dorsum of foot)

Question 279

Veins of Lower Limb

Answer 279

Greater Saphenous Vein (acompanies saphenous nerve) - from dorsal venous arch - anterior to medial malleolus - up medial side of leg - hands breadth behind patella - medial thigh - through saphneous opening emptying into femoral vein Superficial Saphenous Vein - from dorsal venous arch - posterior to lateral malleolus - posterior leg - pierces deep facia and joins paired vena comitantes of anterior and posterior tibial arteries to become popliteal vein (vertical) Superficial inguinal lymph drain lower limb (horizontal) Superficial inguinal lymph drain abdominal wall, external genitalia, and anal canal Drain to deep lymph (following arteries) Superficial lymph follows veins

Question 280

Structures of Dorsum of the Foot

Answer 280

1. EXTENSOR DIGITORUM BREVIS - arises from superolateral part of calcaneus, deep to long extensor tendons, joins EDL tendons 2. EXTENSOR HOODS - Triangular, apex inserts into base of distal phalynx, centre of each hood attaches to sides of middle phalynx and wrapped over metatarsalphalyngeal joint 3. DEEP FIBULAR NERVE - Supplies EDB (as well as extensors), sensory to webbed space between 1st and 2nd toes 4. DORSALIS PEDIS ARTERY - name change of anterior tibial artery - gives off arcuate artery laterally which gives off metatarsal and digital arteries - continues to first web space and gives off deep plantar artery which dives through first dorsal interosseous and completes deep plantar arch

Question 281

Layers of Sole of Foot

Answer 281

Plantar Aponeurosis - thickening of deep fascia from medial process of calcaneal tuberosity dividing into five slips - vertical septa divide plantar aspect into medial, deep, lateral compartments 1. Short - abductor digiti minimi & abductor hallucis insert into base of proximal phalynx - Flexor digitorum brevis splits and inserts into base of middle phalynx (FDL passes through and inserts distally) - arise from calcaneal tuberosity, aponeurosis and septa - assist and maintain arches - neurovascular structures run here. 2. Long - FDL, FHL - lumbricals on medial side of toes and insert into expansion of FDL - quadratus plantae - arises from two heads on calcaneus and inserts into border of FDL (optimises function and straightens line of pull) 3. Short - short flexor for each of the big (flexor hallucis brevis) and little toes (flexor digiti minimi brevis), and an adductor hallucis 4. Short - interossei in intermetatarsal spaces - abduction/adduction around plane of second digit - 3 plantar adducting (PAD) - 4 dorsal abducting (DAB) - insertions of fibularis longus and tibialis posterior into base of first metatarsal

Question 282

Demarcation of false pelvis from true pelvis

Answer 282

iliopectineal line demarcates false pelvis above from true pelvis below

Question 283

What structures seperate the greater and lesser sciatic foramen?

Answer 283

ischial spine, sacrospinous ligament, and sacrotuberous ligament, seperates greater and lesser sciatic foramen

Question 284

Levator Ani

Answer 284

pubococcygeus and iliococcygeus (not ischiococcygeus) Forms pelvic floor Closes off pelvic outlet LATERAL ORIGIN - internal aspect of body of pubis - along side wall of pelvis (across half of obturator internus fascia) - to ischial spine INSERTION - raphe (tip of coccyx to anorectal junction) large opening anteromedially for passage of viscera to perineum ACTIONS: lifts pelvic floor / anus, w/ contraction of diagphram causes increased intraabdominal pressure and compression of pelvic contents and promotes evacuation slings are vital for support of pelvic viscera (prolapse) helps rotate babies head during birth

Question 285

Pubococcygeus

Answer 285

- part of levator ani (anterior fibres) - origin: internal aspect of body of pubis - insertion: anococcygeal raphe (also includes puborectalis and pubovaginalis/prostaticus slings) overlaps iliococcygeus

Question 286

Puborectalis

Answer 286

- anterior fibres of pubococcygeus (levator ani) - origin/insertion: internal aspect of body of pubis - sling extending around and blending with anorectal junction - important for fecal continence

Question 287

Pubovaginalis/Puboprostaticus

Answer 287

- most anterior fibres of pubococcygeous (levator ani) - origin/insertion: internal aspect of body of pubis - slings around vagina / prostate

Question 288

Iliococcygeus

Answer 288

- part of levator ani (posterior fibres) - origin across half of obturator internus fascia to ischial spine - insertion: anococcygeal raphe

Question 289

Ischiococcygeus

Answer 289

- origin coxxyx/sacrum - insertion ischial spine (same as sacrospinous ligament) - used by dogs to wag tail - closes posterior part of pelvic floor

Question 290

Parietal fascia of pelvic cavity

Answer 290

- covers piriformis, obturator internus, and levator ani - continuation of fascia of anterior abdominal wall (Fascia Transversalis) - continuation of fascia of posterior abdominal wall (Fascia iliacus)

Question 291

Visceral fascia of pelvic cavity

Answer 291

- continous with extraperitoneal fat layer of abdomen - many thickenings (called ligaments) which are condensations of fascia around neurovascular structures - significant support structures to pelvic viscera female: rectouterine ligament lateral cervical (cadinal) ligament lateral vesical ligament pubovesical ligament

Question 292

Epiphysis of pelvis

Answer 292

iliac crest ASIS & AIIS ischial tuberosity pubic tubercle acetabulum - common sites of avulsion fractures (tendon stronger than bone) - length of time epiphysis stays open determins pelvic shape

Question 293

Boundaries of Pelvic Inlet

Answer 293

- pubic symphysis/crest/tubercle - pectineal lineof pubis - arcuate line of ilium - sacral alar joint - body of sacrum (promotary)

Question 294

Boundaries of Pelvic Outlet

Answer 294

- inferior margin of pubic symphysis - ischial tuberosity (sacrotuberous ligament) - tip of coccyx (can be broken up into anterior - urogenital, and posterior - anal, triangles of the perineum)

Question 295

Perineal Pouches

Answer 295

- superficial and deep pouches - seperated by perineal membrane - superficial and deep transverse perineal muscles in posterior edge between perineal body and ischial tuberosities - perineal body (site of muscle attachment in posteromedial perineal membrane) - deep pouch contains sphincters (external urethral, sphincter urethrovaginalis) - roots of external genitalia attach to external surface of perineal membrane

Question 296

Ligaments of Pelvis

Answer 296

- interosseous sacroiliac - iliolumbar - sacrotuberous - sacrospinous

Question 297

Boundaries of pelvic plane of least dimensions

Answer 297

- S4 vertebra - through ischial spine - inferior part of pubis "Pelvic Pain Line" above = sympathetic visceral afferents nerves (above L1) below = parasympathetic visceral afferents (S2,3,4)

Question 298

Examples of secondary cartilagenous joints

Answer 298

pubic symphysis intervertebral discs manubriosternal (all have a disc)

Question 299

Obturator Foramen

Answer 299

- covered by obturator membrane - gives rise to obturator internus internally - gives rise to obturator externus externally - obturator nerve, artery, vein pass through obturator canal

Question 300

Greater Sciatic Foramen

Answer 300

- bounded by sacrospinous and sacrotuberous ligamennts - sciatic nerve - pudendal nerve, internal pudendal artery (out)

Question 301

Lesser Sciatic Foramen

Answer 301

- bounded by sacrospinous and sacrotuberous ligamennts | - pudendal nerve, internal pudendal artery (in)

Question 302

Pudendal Nerve

Answer 302

- branch of sacral plexus - arises from S2,3,4 - exits greater sciatic foramen with piriformis - curls behind ischial spine - runs in pudendal canal on obturator internus - enters lesser sciatic foramen branches: - inferior rectal nerve (to external anal sphincter) - perineal nerve (supplies structures in urogenital triangle - motor and cutaneous including genitals)

Question 303

Broad Ligament

Answer 303

parietal peritoneum draping over uterine (fallopian) tubes and extending to side wall of pelvis contains proper ovarian ligament attaching to ovary on posterior side of broad ligament suspensory ligament holds ovary in place (inside peritoneum)

Question 304

Pelvic Shapes

Answer 304

50% - Gynaecoid 30% - Android 20% - Anthropoid 2% - Platypelloid

Question 305

Anteversion | Anteflexed

Answer 305

Anteversion - curvature related to other structure (i.e. uterus & vagina) Anteflexed - curvature within organ (i.e. uterus)

Question 306

Bladder

Answer 306

shaped like pyramid tipped forward (apex towards pubic bone) detrusor muscle in wall of bladder (contraction = urination) - when full can push up peritoneum 8-10cm (suprapubic aspirate) base of bladder has smooth triangular region - trigone - entry/exit at each point of the triangle (ureters, urethra)

Question 307

Uterus

Answer 307

``` fundus, body, cervix (internal/externial uterine opening) fallopian tubes (intramural, isthmus, ampulla, infundibulum, fimbria) cervix stabilized by lateral cervical (cardinal) ligament ```

Question 308

Structures associated with bladder (male)

Answer 308

- vas deferens (originates at epididymus, ascends as component of spermatic cord in inguinal canal, through deep ring, passes along side wall of pelvis, along lateral bladder, above ureter, to posterior bladder) - seminal vesicles (coiled tubules, join w/ vas deferens to form ejaculatory duct and empty into prostate/urethra) - prostate (between neck of bladder and levator ani, above urogenital diaphragm, anterior to rectum)

Question 309

Structures associated with bladder (female)

Answer 309

- uterus (anteverted and anteflexed) | - uterine artery (from internal iliac artery, to uterus, passes over ureter)

Question 310

Lowest point in female peritoneum

Answer 310

- recto-uterine pouch (pouch of douglas) | - can palpate or aspirate free fluid via vagina

Question 311

Rectum

Answer 311

beneath peritoneum, does not have mesentary no teniae coli - span to become one longitudinal muscle coat situated in concavity of sacrum

Question 312

Upper Anal Canal

Answer 312

upper 2/3 of anal canal divided by pectinate line lined by mucosa supplied by superior rectal artery (inferior mesenteric from abdominal aorta) venous drainage to portal system innervated by autonomic nerves (dull, poorly localised pain) internal sphincter (thickening in smooth muscle wall under autonomic innervation)

Question 313

Lower Anal Canal

Answer 313

lower 1/3 of anal canal divided by pectinate line lined by skin supplied by inferior rectal artery (internal iliac branch) venous draining to IVC innervated by pudendal somatic nerves (sharp, intense, well localised) deep external sphincter (fuses with puborectalis) superficial external sphincter (attached anteriorly to perineal body and tip of coccyx) subcutaneous external sphincter (immediately beneath skin)

Question 314

Blood supply of Pelvic Structures

Answer 314

FROM ABOVE: - ovarian from aorta (uterus, fallopian tube, artery) - superior rectal arteries (terminal inferior mesenteric) from aorta FROM SIDES: - anterior branches of internal iliac from side wall - superior vesical arteries (paired) - inferior vesical arteries (male - prostate and vas deferens) - uterine artery (cervix) - vaginal artery (female - vagina) - middle rectal arteries

Question 315

Branches of Internal iliac artery

Answer 315

Arises at pelvic brim opposite sacroiliac joint Posterior division (parietal branches only) Anterior division (to visceral and parietal) - superior vesical arteries (paired) - inferior vesical arteries (male - prostate and vas deferens) - uterine artery (female - in lateral cervical ligament, over ureter, gives off cervical and vaginal branches, turns upwards within broad ligament alongside uterus, along fallopian tube and and meets ovarian artery) - vaginal artery (female - vagina) - inferior rectal artery (anal canal)

Question 316

Male vs Female pelvis

Answer 316

``` MALE Thick and heavy Heart Shaped Narrow inverted v greater sciatic notch acute subpubic arch large acetabulum round obturator foramen Larger overall ``` ``` FEMALE Thin and light Transverse oval 90 degree greater sciatic notch obtuse subpubic arch small acetabulum oval obturator foramen true pelvic inlet broader/rounder ```

Question 317

At what level do each of the following structures perforate the diaphragm? - aorta - oesophagus - IVC

Answer 317

AORTA - T12 OESOPHAGUS - T10 IVC - T8