MORE anatomy

Question 1

what should you do before doing entry at Palmer’s point?

Answer 1

stick in an NG tube to decompress the stomach and get it out of the way

Question 2

at what angle do you do entry at Palmer’s point?

Answer 2

90 degrees, irrespective of BMI

Question 3

how many pops do you feel with veress needle entry at Palmer’s point?

Answer 3

3 - anterior rectus sheath, posterior rectus sheath, peritoneum

Question 4

what is open entry for laparoscopy AKA?

Answer 4

Hasson technique

Question 5

landmark for accessory port placement

Answer 5

2 finger-breadths medial + superior to the ASIS

Transluminate the skin to avoid large superficial vessels
and look on the inside to avoid the inferior epigastric artery

Question 6

if you can’t identify the inferior epigastric artery laparoscopically, where can you put the accessory port?

Answer 6

lateral to the insertion of the round ligament into the anterior abdominal wall

Question 7

after L/RLQ accessory ports, where else might you place an accessory port?

Answer 7

suprapubically, 2cm above pubic symphysis
or
at the level of the umbilicus, a hand’s breadth superior from the LQ port, and a hand’s breadth lateral from the umbilical port

Question 8

describe the venous drainage of the scrotum

Answer 8

The veins of the scrotum accompany the arteries, eventually draining into the external
pudendal vein and subsequently the greater saphenous vein.

Question 9

innervation of iliacus

Answer 9

femoral nerve

Question 10

Which structure present on medial side of the ASIS

Answer 10

lateral cutaneous nerve branch of the ileohypogastric

Question 11

approximate location of the arcuate line

Answer 11

midway between umbilicus and pubic symphysis

Question 12

blood supply (chain) to the appendicular artery (artery to the appendix)

Answer 12

SMA –> Ileocolic artery —> appendicular artery

Question 13

What is the most common cause of the female urethral caruncle?

Answer 13

Hypoestrogenism

it is vascularised granulation tissue covered by transitional or stratified squamous epithelium.
arises from posterior wall of ureter

Question 14

how to differentiate urethral caruncle from prolapsed urethral mucosa

Answer 14

caruncle is <0.5cm, bleeds on touch, from posterior wall of urethra
prolapse is from the anterior wall of urethra, can be >0.5cm

Question 15

Contents of the lesser sciatic foramen

Answer 15

the tendon of the obturator internus
internal pudendal vessels
pudendal nerve
nerve to the obturator internus

Question 16

site(s) of ADH production

Answer 16

supraoptic and paraventricular nuclei (of the hypothalamus)

Question 17

describe the layers of the endometrium

Answer 17

2 layers - basal and functional

The basal layer contains stem cells which regenerate the functional layer
The functional layer thickens and then is shed in menstruation.

Thus, the basal layer must be destroyed in ablation for menorrhagia.

Question 18

origin of hepatic artery

Answer 18

coeliac artery

Question 19

branches of the coeliac trunk

Answer 19

left gastric
common hepatic
splenic

Question 20

are the pelvic splanchnic nerve sympathetic or parasympathetic?

Answer 20

parasympathetic, S2,3,4

Question 21

at what level does the spinal cord become the cauda equina?

Answer 21

disc L1/2

Question 22

Iliac crest (posteriolateral highest point of hips) corresponds to which vertebral landmark (used for epidural)?

Answer 22

L4

Question 23

PSIS corresponds to which spinal level?

Answer 23

S2

Question 24

Are Bartholin’s anterior to or posterior to al opening?
what is their homologue in males?

Answer 24

Posterior to
They are homologous to bulbourethral glands in males. However, while Bartholin’s glands are located in the superficial perineal pouch in females, bulbourethral glands are located in the deep perineal pouch in males.

Question 25

What are Skene's glands? Where are they located?

Answer 25

Paraurethral glands, opening in the anterior part of the vestibule of vagina (unlike Bartholins which are posterior to vaginal opening an open into labia minora) homologue of the male prostate

Question 26

prolactine secret from lactotrophes How many lactotrophes in ant pituitary

Answer 26

Answer I was given is 20% Internet says: Whereas lactotrophs constitute only 9% of the pituitary cell population in men and in nulliparous women, they go up to 30% of the total anterior pituitary cell population in multiparous women.

Question 27

The vaginal artery comes off the internal iliac artery (as does the uterine artery, for that matter). Anyway, what is the male homologue for the vaginal artery?

Answer 27

inferior vesical artery!

Question 28

the external iliac is kind to me and only has 3 branches. what are they?

Answer 28

inferior epigastric deep circumflex iliac artery femoral artery (which is essentially just its continuation so really it's just 2 branches to remember!)

Question 29

(according to given answers) what is the artery which may be injured in OPEN appendicectomy?

Answer 29

NOT the appendiceal artery - you're TRYING to sever that one no, it's the DEEP CIRCUMFLEX ARTERY - it runs along the iliac crest and ascends laterally toward to anterior abdominal wall. During gridiron or Lanz incisions, it may be damaged when mobilising the right lower abdominal wall. is a branch of the external iliac artery

Question 30

nerve roots to obturator internus

Answer 30

OBTURATOR NERVE L2,3,4 from LUMBAR plexus (I twice get laid on fridays) nerve to obturator INTERNUS L5, S1, S2 from SACRAL plexus

Question 31

common carotid artery bifurcation spinal landmark

Answer 31

C4

Question 32

aorta bifurcation spinal landmark

Answer 32

L4

Question 33

formation of IVC spinal landmark

Answer 33

L5

Question 34

landmark for bifurcation of the common iliac artery

Answer 34

at the pelvic brim, in front of the sacroiliac joints L5/S1

Question 35

muscles cut in ML episiotomy

Answer 35

bulbospongiosus and superficial transverse perineal muscle

Question 36

what is the internal iliac artery AKA

Answer 36

hypogastric artery WHY??! Why must you be this way

Question 37

which nerve is medial to ASIS

Answer 37

Lateral femoral cutaneous nerve of the thigh

Question 38

middle rectal artery is a branch from the

Answer 38

inferior mesenteric artery

Question 39

which nerve pierces internal oblique muscle to enter the deep inguinal ring

Answer 39

ileoinguinal nerve

Question 40

dimples of venus are found overlying

Answer 40

the sacro-iliac joints

Question 41

insertions and innervation of iliacus function

Answer 41

insertions - iliac fossa --> LESSER trochanter (the little one posteriorly) Innervation - femoral nerve together with psoas (to form 'ileopsoas') it is the main flexor of the hip joint

Question 42

where do you find Brunner's glands?

Answer 42

in the duodenum they secrete an alkaline fluid composed of mucin

Question 43

Femoral triangle, from lateral to medial, is it VAN or NAV?

Answer 43

most Lateral is the Nerve most Medial is the Vein could remember that M has a V in it? or NAVY, with Y being the midlYne?

Question 44

what nerve injured in lithotomy position causes foot drop?

Answer 44

common peroneal as it wraps around the head of the fibula and is vulnerable to compression or stretch

Question 45

below the arcuate line, what are the layers deep to the rectus muscle

Answer 45

transversalis fascia peritoneum (there is no posterior rectus sheath below the arcuate line)

Question 46

what artery and vein are in the rectus sheath?

Answer 46

inferior epigastric artery and vein

Question 47

other names for the arcuate line

Answer 47

Linea semicircularis and the semicircular line of Douglas

Question 48

what level is the arcuate line

Answer 48

midway between umbilicus and pubic symphysis

Question 49

in caput medusae, the paraumbilical veins get recanalised. Where do they drain to?

Answer 49

superficial epigastric veins

Question 50

lateral umbilical folds, seen on laparoscopy, contain...

Answer 50

inferior epigastric vessels it's the medial ones that are the umbilical arteries!

Question 51

para-aortic LNs are AKA...

Answer 51

lumbar LNs ridiculous.

Question 52

what is the relationship between the ureter and the internal iliac artery

Answer 52

the ureter is lateral to the internal iliac and then the ureter passes anteriorly to the internal iliac artery (conversely it passes under the ovarian and uterine arteries)

Question 53

which artery is the main blood supply to the breast?

Answer 53

internal thoracic which is also known as the internal mammary! Much easier to remember it supplies the breast other contributors are the lateral thoracic, thoracoacromial, intercostal

Question 55

The arterial supply to levator ani does not follow the nerve supply. Describe both

Answer 55

The arterial supply is from inferior GLUTEAL the nerve supply is: S3 and S4 from the spinal nerves Inferior Rectal (from pudendal) Nerve to levator ani (S4)