Anatomy Revision

Question 1

what structures are in the RUQ

Answer 1

Liver, gallbladder, stomach (pylorus), duodenum (parts1-3), head of pancreas, right kidney,
right suprarenal gland, hepatic flexure, ascending colon (superior part), transverse colon (right
half)

Question 2

what structures are in the LUQ

Answer 2

– Liver (left lobe), stomach, spleen, jejunum, proximal ileum, pancreas (body and tail), left
kidney, left suprarenal gland, splenic flexure, descending colon (superior part), transverse colon
(left half)

Question 3

what structures are in the RLQ

Answer 3

Cecum, appendix, ileum, ascending colon (inferior part), right ovary and uterine tube (female),
right spermatic cord (abdominal part, male), right ureter (abdominal part)

Question 4

what structures are in the LLQ

Answer 4

Sigmoid colon, descending colon (inferior part), left ovary and uterine tube (female), left
spermatic cord (abdominal part, male), left ureter (abdominal part)

Question 5

what structures are normally palpated in the abdomen

Answer 5

Xiphoid process/costal margin, 
rectus abdominis, 
sigmoid colon, 
caecum, 
lower border of liver, 
lower pole of right kidney may be palpable, 
abdominal aorta pulse may be palpable, 
full/distended bladder,
enlarged uterus, 
sacral promontory may be palpable

Question 6

describe the arterial blood supply pathway of the abdomen

Answer 6

Abdominal aorta:

• Coelic trunk (Hepatic, splenic and left gastric),
• SMA (right colic, middle colic, ileocolic, inferior pancreaticoduodenal),
• IMA (left colic, sigmoid, superior
  rectal) ,
• Renal/Suprarenal arteries,
• Gonadal arteries

Question 7

what are the paracolic gutters

Answer 7

grooves lying bilaterally between ascending/descending colon and the
posterolateral abdominal wall

Question 8

what is the pouch in males

Answer 8

rectovesical

Question 9

what are the pouches in females

Answer 9

Vesicouterine pouch and rectouterine pouch

Question 10

where can liver/ diaphragm pain refer to

Answer 10

shoulder

Question 11

where can stomach pain refer to

Answer 11

between shoulder blades

Question 12

where can pancreas pain refer to

Answer 12

mid back

Question 13

where can kidney pain refer to

Answer 13

thighs

Question 14

what are the nerve injuries and deficits (motor and sensory) associated with a surgical neck # of the humerus

Answer 14

axillary:
m= abduction of shoulder
joint
s= regimental badge

Question 15

what are the nerve injuries and deficits (motor and sensory) associated with a mid shaft # of the humerus

Answer 15

radial 
m=wrist drop, possibly
elbow extension
s= posterior forearm,
posterior hand lateral
side

Question 16

what are the nerve injuries and deficits (motor and sensory) associated with a supracondylar # of the humerus

Answer 16

ulnar 
m= claw hand,
abduction/adduction of
fingers, adduction of
thumb, wasting of
hypothenar eminence,
guttering
s= medial palm and dorsum
and medial one and a
half fingers

Question 17

what are the nerve injuries and deficits (motor and sensory) associated with a neck # of the fibula

Answer 17

common
fibular
(peroneal)
m= foot drop 
s= dorsum of foot, cleft
between big and second
toe

Question 18

what are the nerve injuries and deficits (motor and sensory) associated with a posterior hip dislocation

Answer 18

sciatic 
m= weak extension of hip
joint, flexion of knee, all
movements of ankle and
foot
s= loss of sensation
posterior thigh, all skin
inferior to knee except
medial calf

Question 19

what parts of the heart form the anterior surface

Answer 19

right ventricle

Question 20

what parts of the heart form the posterior surface

Answer 20

both atria

Question 21

what parts of the heart form the inferior surface

Answer 21

both ventricles

Question 22

what parts of the heart form the right border

Answer 22

right atrium (and IVC and SVC)

Question 23

what parts of the heart form the left border

Answer 23

left ventricle (and part of left atrium)

Question 24

what parts of the heart form the inferior border

Answer 24

right ventricle

Question 25

what parts of the heart form the superior border

Answer 25

both artia SVC ascending aorta pulmonary trunk

Question 26

Name the ‘space’ posterior to the pulmonary trunk and ascending aorta and anterior to the superior vena cava. What is the clinical significance of this space?

Answer 26

Transverse pericardial sinus – it allows cardiac surgeons to identify/clamp the ascending aorta/pulmonary trunk during surgery

Question 27

Name the peripheral pulses | where you would palpate them

Answer 27

Carotid pulse - Bifurcation of common carotid, at level of thyroid cartilage Brachial Pulse -Anterior to elbow joint Radial pulse - Radial side of volar aspect of wrist Femoral Pulse - Midpoint of groin Popliteal pulse - Posterior to knee joint Posterior tibial pulse - Posterior to medial malleolus of tibia Dorsalis pedis pulse -On dorsum of foot

Question 28

Describe the blood supply to the heart

Answer 28

supplied by the right and left coronary arteries, which arise as branches of the aorta from sinuses within or slightly superior to the cusps of the aortic valve. The left coronary artery gives off: left anterior descending (anterior interventricular), circumflex artery and left marginal. The right coronary artery gives off: right marginal and posterior interventricular.

Question 29

Which surface and artery | is affected in an anterior myocardial infarction

Answer 29

anterior surface, left anterior descending artery

Question 30

is affected in an inferior myocardial infarction

Answer 30

``` Inferior (diaphragmatic) surface, right coronary artery (80% of time), circumflex artery (20% of time ```

Question 31

what is the normal path of electrical conduction in the heart

Answer 31

sa node AV node bundle of his purkinje fibres (in myocardium)

Question 32

Which two major arteries supply blood to the brain?

Answer 32

vertebral, internal carotid

Question 33

what skull foramen does the vertebral artery pass through

Answer 33

foramen magnum

Question 34

what skull foramen does the internal carotid artery pass through

Answer 34

carotid canal

Question 35

where is the primary motor cortex

Answer 35

precentral gyrus

Question 36

where in body would a lesion in the ACA affect

Answer 36

lower limb

Question 37

where in body would a lesion in the MCA affect

Answer 37

upper limb, thorax, head

Question 38

what are three signs of a lesion in the corticospinal tract

Answer 38

brisk reflexes increased tone muscle weakness

Question 39

explain why patients with a lower motor neurone lesion of the facial nerve (CN VII) are unable to show their teeth (smile) and unable to raise their eyebrows, whereas patients with an upper motor neurone lesion are unable to show their teeth, but still able to raise their eyebrows

Answer 39

Muscles of forehead (frontalis) receive bilateral corticonuclear innervation from facial nerve; therefore muscles used to raise eyebrows still function after UMNL. Muscles used for smiling receive only contralateral facial nerve innervation, so are affected.

Question 40

what is another names for the hilar lymph nodes

Answer 40

bronchopulmonary

Question 41

what is the path of lymph from lung tissue and visceral pleura

Answer 41

drains into the superficial subpleural plexus first | before draining into the hilar lymph nodes

Question 42

what is the route of lymphatic drainage from the left lung | upper lobe to the left venous angle.

Answer 42

drain towards the hilar lymph nodes, then towards the tracheobronchial lymph nodes then towards the thoracic duct, via the bronchomediastinal lymph trunk before eventually draining into the left venous angle

Question 43

What is unusual about lymphatic drainage from the left lung lower lobe? Why is this clinically important?

Answer 43

Some lymph from the left lower lobe will drain via the right tracheobronchial nodes into the right lymphatic duct. This is clinically important when investigating the spread of disease (i.e. cancer) along these routes

Question 44

Where does lymph from the parietal pleura drain to?

Answer 44

To lymph nodes of the thoracic wall – intercostal, parasternal, mediastinal and phrenic

Question 45

describe the extent of the lung fields in anatomical terms i.e. how far do the lungs reach superiorly, inferiorly, medially and laterally?

Answer 45

Superiorly – Superior to rib 1 into root of neck Inferiorly – Contour following ribs 6 (anteriorly), 8 (laterally) and 10 (posteriorly) Medially – Mediastinum (cardiac notch on left side) Laterally – Rib cage

Question 46

Describe the pleura

Answer 46

Thin layer of simple squamous epithelium that secretes pleural fluid, found covering the external surface of the lungs (visceral pleura) and the internal surface of the thoracic cavity (parietal pleura). It is named according to its position (cervical, mediastinal, costal, diaphragmatic). The two layers are continuous with each other at the pleural reflections

Question 47

what are the recesses found in the pleural cavities

Answer 47

Costodiaphragmatic and costomediastinal (Reflections of pleura between the structures they are named after I.e. pleural reflection between diaphragm and ribs, or between ribs (sternum) and mediastinum.)

Question 48

why are the pleural recesses important

Answer 48

They are important in the pooling of excess fluid in the pleural cavity. In an upright patient, excess fluid will collect in the costodiaphragmatic recess and will be visible on a standard CXR

Question 49

which phase of respiration is the diaphragm active in

Answer 49

inspiration

Question 50

what muscle groups are active during quiet respiration

Answer 50

diaphragm Internal intercostal muscles External intercostal muscles Innermost intercostal muscles

Question 51

what nerve supplies the diaphragm

Answer 51

phrenic nerve (C3, C4, C5)

Question 52

what nerve supplies intercostal muscles

Answer 52

intercostal nerve

Question 53

Why do runners bend over and hold on to their knees at the end of a race?

Answer 53

hold on to knees to fix scapula; accessory muscles of respiration can then be recruited to raise ribs: pectoralis major, pectoralis minor, serratus anterior

Question 54

what is between the two layers of pleura

Answer 54

pleural fluid

Question 55

what are the functions of pleural fluid

Answer 55

allows the two layers of pleura to slide over each other during respiration provides surface tension to prevent two layers from separating

Question 56

what can cause the separation of the two players of pleura

Answer 56

blood - haemothorax air - pneumothorax excess pleural fluid – pleural effusion