Imaging of import and archetypic anatomy Flashcards

Question

Risk factors for developing Barrett's

Answer 1

Age (60+) Caucasian Male GORD Obesity Hiatus hernia Smoking Maybe red meat (unclear)

Answer 2

Posterior * IVC Inferior * D1 Anterior * Portal triad Superior * Caudate lobe

Answer 3

Cranial nerves S2-4

Answer 4

Head and uncinate * Anterior and posterior, superior pancreaticoduodenal arteries * From coeliac * Anterior and posterior, inferior pancreaticoduodenal arteries * From SMA Neck, body, tail * Dorsal pancreatic (level of neck/body) * Splenic * Greater pancreatic (level of body/tail) * Splenic

Answer 5

Parallel pisoelectric nodes simultaneously transmit and sense ultrasonic waves Return signal speed and intensity is shown in imaging format

Answer 6

Attenuating

Answer 7

Hepatocyte specific gadolinium contrast agent

Answer 8

Weight 10-20g Bilobed butterfly shaped gland * Pyramidal lobe in 30% Attached to tracheal rings 2,3,4

Answer 9

External iliac becomes femoral artery as it passes behind the inguinal ligament Femoral nerve lies lateral, vein medial * As they descend the they rotate with nerve passing anteriorly and vein posteriorly to invert this arrangement 4cm below the inguinal ligament th profunda arises Run inferiorly in the groove between iliacus and pectineus on the psoas tendon Traverses the femoral triangle to pass behind sartorius descends along the medial border of vastus medialis to enter the adductor hiatus On the posterior aspect of the distal femur the artery is medial to the vein As the vessels arise throught the posterior aspect of the hiatus they are joined by the tibial branch of sciatic nerve which runs posterior to the vessels * The common peroneal branches higher (2/3 down femur) and passes laterally Below the tibial plateau the artery generally gives off anterior tibial artery ans runs a variable distance as the TP trunk * then divides into peroneal and posterior tibial arteries. * PT artery runs with the tibial nerve

Answer 10

Superficial * GSV medial aspect, passes a hands breadth behind the medial border of the patella * Gentle anterior course to join the SFV Deep * Anterior * Not much * Posterior * Femoral artery and vein usually through the adductor hiatus (within adductor magnus) and therefore on the back of the femur * Sciatic nerve is encountered above, below or at is bifurcation to common peroneal and tibial nerves * The tibial branch becomes intimate with the vascular bundle on the posterior aspect of the femur

Answer 11

GSV joins the femoral vein by passing through the cribriform fascia covering the saphenous opening of the fascia lata in the femoral triangle * The landmark for this opening is 3.5cm inferior and lateral to the pubic tubercle * Groin crease is used clinically most often GSV recieves multiple tributaries * Variable but usually at least 4 * Superficial circumflex iliac * Superficial eigastric * Superficial external pudendal * Deep external pudendal The femoral vein receives ONLY the GSV at this level

Answer 12

Origin: * Right * brachiocephalic after division of carotid * Left * from the arch of aorta Passes behind scalenius anterior * Three parts divided by this muscle * First part (medial) * Vertebral * Thyrocervical trunk * Internal mammary * Second part (behind) * Costocervical trunk * Third part (lateral) * Dorsal scapular Termination * Becomes axillary artery at outer border of first rib

Answer 13

Lymph nodes * most notable at the apex Nerves * Accessory nerve * Emerges **FROM** posterior border of SCM * Half way down posterior border * Passes almost vertically downward * Cutaneous brances of cervical plexus * Emerge **BEHIND** SCM Arteries * Subclavian (but very low) * Transverse cervical * Suprascapular Vein * External jugular traverses the lower anterior corner * NB the subclavian vein is not in the posterior triangle

Answer 14

* Sternohyoid * Omohyoid * Thyrohyoid * Sternothyroid

Answer 15

* Digastric * Stylohyoid * Mylohyoid * Geniohyoid

Answer 16

Pubic tubercle

Answer 17

The mid inguinal point * midway between ASIS and symphysis

Answer 18

The midpoint of the inguinal ligament The femoral artery enters the thigh more posteriorly at the **midinguinal point** which is more medial than the midpoint of the inguinal ligament

Answer 19

the artery runs behind and above the vein

Answer 20

The artery passes behind the IVC and runs behind the renal vein

Answer 21

the gonadal vessels pass from medial to lateral anterior to the ureters

Answer 22

transversalis internal oblique

Answer 23

the IVC forms behind the right iliac artery

Answer 24

Venous tributaries * Inferior phrenic (inconstant- may drain to IVC) * Suprarenal * Gonadal * Anastomosis with lumbar azygous and hence to the azygous and vertebral systems Embryological remnant of the obliteration of the left cardinal vein and preservation of the right

Answer 25

from the third pharyngeal pouch The thymus also arises here before descending along the thyrothymic tract to the superior mediastinum

Answer 26

The fourth pharyngeal pouch. the parafollicular C cells also arise here from the ultimobranchial body

Answer 27

Supernumary glands are seen in 13% of patients \<3% have fewer than four glands

Answer 28

Endodermal in origin derived from the 3rd and 4th pharyngeal pouches. Usually 4 in number * 13% will have supernumerary * 3% have 3 or fewer Weight 30-50mg each (combined weight not more than 200mg) * approximately the size of a grain if rice Endocrine function is secretion of PTH and thence maintenance of calcium homeostasis by direct feedback of ionized calcium Blood supply * 80% of people derive both inferior and superior gland supply from the inferior thyroid aretry * 20% will have superior supplied by superior thyroid artery

Answer 29

1. vein 2. phrenic nerve 3. anterior scalene 4. artery 5. middle scalene

Answer 30

Midline Anterior border of SCM Inferior border of mandible

Answer 31

Posterior border of SCM Anterior border of trapezius Middle third of clavicle

Answer 32

Branch from vagus nerve bilaterally Function: innervation of the muscles of the larynx * except crichothyroid (superior laryngeal) Right wraps anterior to posterior around subclavian Left wraps anterior to posterior around arch of aorta * between left carotid and subclavian branches * lateral to ductus arteriosus both run up the tracheosophegeal groove to enter the larynx beneath crichopharyngeus portion of inferior pharyngeal constrictor

Answer 33

Superior laryngeal

Answer 34

T4-5 plane Ascending and descending aorta seen Branching of the pulmonary artery

Answer 35

Well-demarcated homogeneous hyperechoic mass May be hypoechoic in patients with fatty infiltration of the liver due to the bright signal from the surrounding parenchyma No flow should be seen on USS doppler due to slow and chaotic flow

Answer 36

Well-demarcated hypodense mass on precontrast study Peripheral nodular enhancement in the early phase, followed by a centripetal pattern or "filling in" during the late phase Lesion usually opacifies after a delay of ≥3 minutes and remains isodense or hyperdense on delayed scans

Answer 37

Smooth, well-demarcated homogeneous lesion that has low-signal intensity on T1-weighted images and is hyperintense on T2-weighted images With contrast enhancement, early **peripheral discontinuous nodular** or globular **enhancement** is seen in the arterial phase with progressive centripetal enhancement or "filling-in" on delayed scans

Answer 38

Variable appearance: May be homogenous hyper-, hypo-, or isoechoic lesion Central hyperechoic area (central scar)

Answer 39

Hypo- or isodense on noncontrast imaging with a central scar Hyperdense during the arterial phase Typically isodense during the portal venous phase, although the central scar may become hyperdense as contrast diffuses into the scar

Answer 40

As FNH is a liver cell hamartoma they image like liver without contrast and may not be well seen. * an isointense lesion is noted on T1-weighted images, while an isointense to slightly hyperintense mass appears on T2-weighted images Contrast administration shows **homogenous bright enhancement** in arterial phase. * This remains as **prolonged** enhancement **on delayed imaging**

Answer 41

Heterogenous, hyperechoic lesion in relation to the surrounding liver parenchyma

Answer 42

Typically well-demarcated lesion with peripheral enhancement during early phase with centripetal flow during portal venous phase Hepatocellular adenoma with recent hemorrhage appears as a high attenuating lesion

Answer 43

Typically a well-demarcated lesion with arterial phase enhancement Enhancement pattern in subsequent phases varies with lesion subtype

Answer 44

Poorly-defined margins and coarse, irregular internal echoes

Answer 45

Hypervascular relative to the liver parenchyma during the arterial phase, with washout of the contrast during later phases

Answer 46

Lesion with low-intensity pattern on T1-weighted images and high-intensity pattern on T2-weighted images Liver specific and extracellular contrast are both effective and show arterial hyperenhancement with washout

Answer 47

Homogenous hypoechoic mass

Answer 48

Hypodense lesion with peripheral (rim) enhancement

Answer 49

Hypointense lesion on T1-weighted images and hyperintense lesion on T2-weighted images Dynamic images show peripheral rim enhancement followed by progressive and concentric filling-in of the tumor with contrast material

Answer 50

Usually multiple lesions Metastases from adenocarcinoma are hypoechoic in comparison with the surrounding liver parenchyma

Answer 51

Metastatic liver lesions from the colon, stomach, and pancreas usually show lower attenuation (ie, are darker) in contrast to the brighter surrounding liver parenchyma Hypervascular metastases (eg, neuroendocrine tumor, renal cell carcinoma) appear as rapidly enhancing lesions visible on the arterial phase

Answer 52

Low-signal areas on T1-weighted images and moderately high-signal areas on T2-weighted images. Hepatocyte specific gadolinium contrast media (e.g primovist) show enhancement on arterial phase (usually peripheral or perilesional) but as the lesions are not hepatocyte derived there is rapid and complete washout on delayed imaging.

Answer 53

The axilla is a pyramidal space between the lateral chest wall and the upper arm through which structures run from the posterior triangle of the neck to the lateral chest wall and the upper arm Boundaries * anterior * pectoralis major * pectoralis minor * subclavius * clavipectoral fascia * posterior * subscapularis * teres major * floor * axillary fascia * extends from serratus fascia to deep fascia of the upper arm * Inferior aspect is defined as the fourth rib * medial * serratus anterior * apex * clavicle * scapula * outer border of first rib

Answer 54

Axillary artery Axillary Vein Brachial plexus Lymph nodes Fibrofatty tissue

Answer 55

The vein runs medial to the artery which is inturn clasped in its second part by the three cords of the brachial plexus

Answer 56

outer border of the first rib

Answer 57

The outer border of teres major

Answer 58

The artery is divided into 3 parts by its relationship to the pectoralis minor * one branch from the first part * superior thoracic * two branches from the second part * thoracoacromial * lateral thoracic * three branches from the third part * subscapular * anterior circumflex humeral * posterior circumflex humeral

Answer 59

superior thoracic

Answer 60

Thoracoacromial Lateral thoracic

Answer 61

subscapular anterior and posterior circumflex humeral

Answer 62

270-290cm * duodenum 20 * jejunum 100-110 * ileum 150-160

Answer 63

From left of L2 to right SIJ

Answer 64

Sympathetics

Answer 65

AKA myenteric plexus Between the inner circular and outer longitudinal muscle layers

Answer 66

The submucosa * it must therefore be incorporated into any anastomosis

Answer 67

Epithelial layer Lamina propria * connective tissue layer with embedded matrix and immune cells Muscularis mucosae * thin layer of smooth muscle * provides the boundary between mucosa and submucosa

Answer 68

The crura arise from the anterolateral curvatures of the bodies of the upper lumbar vertebrae * left L1,2 * right L1,2,3 The oesophageal hiatus is formed by the fibres of the right crus which encircle the opening * The boundaries of the oesophageal hiatus are thus not formed by the right and left crura but rather the right and left pillars of the right crus

Answer 69

Endodermal cells descend from the foramen caecum at the base of the primative tongue Parafollicular C cells of neural crest origin descend from the 4 pharyngeal pouch

Answer 70

Formed within the substance of the psoas muscle from L1 and L2 fibres. Arises from the anterior surface of psoas crossed anteriorly by mesentary (sigmoid or ileocolic), mesenteric vessels, ureter and gonadals Perforates psoas fascia just above the inguinal ligament and dives to form: * genital branch (L2) * passes through transversalis * enters the coverings of the spermatic cord * motor to cremaster * senxory to tunica vaginalis * femoral branch (L1) * runs anterior to femoral artery * pierces femoal sheath and fascia lata * sensory to skin below mid portion of the inguinal ligament

Answer 71

¹⁸F -Fluorodeoxyglucose is a synthetic glucose analog containing radioactive ¹⁸F instead of a normal OH group * The FDG molecule is taken up normally by metabolically active tissues and undergoes phosphorylation which prevents it from moving out of the cell * The next step in metabolism requires the missing OH grouping so FDG sits in tissues until 18F radioactively decays to heavy O- where is picks up an H+ and can then be metabolised normally * ¹⁸F decays by positron emission. * The released positron collides with an electron in the surrounding tissues and converts mass to energy (E=mc²) in the form of 2 photons * the interaction if the positron to the surrounding tissues accounts for the calssic halo on imaging * PET camera detects the photons by scintillation crystals * Imaging is performed at the same time as CT to provide an overlay of the imaging modalities Note the metabolically active tissues of brain and kidney will show significant activity at baseline

Answer 72

Avoid close contact with radiation sensitive individuals (infants, children and pregnant women) for 12 hours

Answer 73

The landmark is a finger breadth medial to the femoral pulse or 3.5cm inferior and lateral to the pubic tubercle The femoral vein receives only the saphaneous vein at the groin The saphenous receives multiple tributaries at the groin Differentiation of the two is critical in ligation of the GSV

Answer 74

Usually 4 veins corresponding to the cutaneous branches of the femoral artery * Pudendals * Superficial * Deep * Superficial circumflex iliac * Superficial epigastric 2 inconstant branches * Anteromedial and posteromedial femoral veins

Answer 75

Anterior to medial malleolus A hands breadth posterior to the medial aspect of the patella A finger breadth medial to the femoral pulse below the inguinal ligament * the artery passes behind the midinguinal point (rather than the midpoint of the inguinal ligament)

Answer 76

No, not without considered reasoning There is an increased risk of a broad set of rheumatologic, inflammatory, or infiltrative skin conditions and for stillbirth or neonatal death for pregnancies exposed to MRI with gadolinium

Answer 77

1/3 from ASIS to umbilicus

Answer 78

The ear drum and eustacian tube

Answer 79

The palatine tonsil

Answer 80

the thymus and the inferior parathyroid gland

Answer 81

The superior parathyroid gland and the ultimobranchial body (parafollicular c cells)

Answer 82

The first is preserved as the external auditory canal Clefts 2,3,4 are obliterated by the inferior proliferation and descent of the second pharyngeal arch. * failure to obliterate the pharyngeal clefts results in a branchial fistula or cysts * the most common site of cysts/fistula is at the angle of the jaw anterior to SCM

Answer 83

The diaphragm is formed initially in the upper cervical region hence the innervation * phrenic nerve (motor C3,4,5) * sensory from the lower 6 intercostals It passes inferiorly as the respiratory bud forms and the lungs descend pushing the diaphragm beneath it It is formed by the: * Septum transversum * Forms the central tendon * Pleuroperitoneal membranes * Posterolateral component * Dorsal mesentary around the oesophagus and the aorta * Crura * Lateral body walls * Peripheral component

Answer 84

the hiatus is formed by a defect in the fibres of the adductor magnus the medial border is formed by the femur

Answer 85

AKA the submucosal plexus Located within the submucosa

Answer 86

* The nerve to the adductor compartment of the thigh * Branch of the lumbar plexus * L2,3,4 * Formed within the substance of psoas * emerges from the medial border of the muscle * passes along side wall of the pelvis to obturator foramen * deep to internal iliacs * above the fascia of the obturator internus muscle * crossed by ureter * divides into anterior and posterior divisions and passes through the obturator foramen to enter the thigh * The anterior division is briefly present in the femoral triangle running on adductor brevis

Answer 87

The peritoneum overlying the obturator nerve as it passes the normally posistioned ovary is supplied by that nerve

Answer 88

The organ of Zuckerkandl is a chromaffin body derived from the neural crest located at the bifurcation of the aorta or at the origin of the inferior mesenteric artery. It can be the source of a paraganglioma

Answer 89

The common facial vein crosses superficial to the external and internal carotid arteries just above the bifurcation of those vessels. * this vessel is a useful landmark to the bifurcation * It should be ligated to facilitate safe access to the carotid and bifurcation The hypoglossal nerve (CN XII) * Usually crosses above the bifurcation but in a high bifurcation may lie deep to the common facial * this structure should be preserved The non recurrent laryngeal nerve. * more common the left (as per Fischer's) * may cross superficial to the carotid after arising directly from the vagus

Answer 90

Median * obliterated uracus Medial * obliterated umbilical artery Lateral * inferior epigastrics

Answer 91

The lumbar plexus is formed form divisions of T12 to L4 * the plexus is within the substance of the psoas muscle * iliohypogastric T12,L1 * lateral * ilioinguinal L1 * lateral * genitofemoral L1,2 * anterior * lateral femoral cutaneous L2,3 * lateral * obturator L2,3,4 * medial * femoral L2,3,4 * lateral

Answer 92

From the roots of the brachial plexus posterior divisions of C5,6,7

Answer 93

From the posterior cord of the brachial plexus C6,7,8

Answer 94

From the medial cord of the brachial plexus C8, T1

Answer 95

From the lumbar plexus L1

Answer 96

Lumbar plexus L1

Answer 97

From lumbar plexus L2,3

Answer 98

From the lumbar plexus L1,2

Answer 99

From the lumbar plexus L2,3,4

Answer 100

From the lumbar plexus L2,3,4

Answer 101

L4,5 S1,2,3

Answer 102

From the union of medial and lateral cords of the brachial plexus * receives contribution from all the roots (C5-T1)

Answer 103

All of the flexors compartment except for: * the medial aspect of flexor digitorum profundus * flexor carpii ulnaris * these are both supplied by the ulnar nerve

Answer 104

The pes anserinus is formed by the sartorius, gracilis and semitendinosis muscles * it crosses the medial aspect of the knee to insert into the tibia * the operative relavance is in access to the below knee popliteal artery * the tendon will usually need to be divided to gain access to the upper aspect of the soleal arch * the soleus then need to be divided from the posterior aspect of the tibia to access the artery.

Answer 105

In each sex only one important structure runs superficial to the ureter * in the female pelvis * the ureter passes across the pelvic sidewall and passes in the base of the broad ligament the uretine artery passes over the ureter to reach the base of the uterus * in the male pelvis the ureter * the ureter passes deep to the vas deferens

Imaging of import and archetypic anatomy Flashcards

(137 cards)