18.05 anatomy revision Flashcards by Oleg Alexandrov

Sciatic nerve relations to gluteus medius and long head of biceps femoris?

It does not have any contact to gluteal medius and lies behind the biceps femoris

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Posterior compartment of the leg?

Superficial - soleus, gastrocnemius, PLANTARIS

Deep - tibialis posterior, flexor digitorum longus, flexor hallucis longus, POPLITEUS

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Lymph drainage of the tongue?

Anterior - ipsilateral
Posterior - bilateral deep
Tip - submental
Lateral - submandibular - deep cervical
Mid tongue lateral - ipsilateral deep
Mid tongue central - bilateral deep
 -

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Blood supply to lacrimal apparatus?

Ophthalmic artery

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Bleeding after hypophyesctomy symptom?

Bitemporal hemianopia. It is contained in the dural sac, so acts like tumour

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Whic muscle is innervated by cervical branch of the VII?

Platysma

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Which muscle is not innervated by the trigeminal nerve?

Medial pterygoid

Mylohyoid

Stylohyoid

Masseter

Temporalis

Stylohyoid is innervated by the facial nerve.

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Which of the structures listed below lies posterior to the carotid sheath at the level of the 6th cervical vertebra?

Hypoglossal nerve

Vagus nerve

Cervical sympathetic chain

Ansa cervicalis

Glossopharyngeal nerve

The carotid sheath is crossed anteriorly by the hypoglossal nerves and the ansa cervicalis. The vagus lies within it. The cervical sympathetic chain lies posteriorly between the sheath and the prevertebral fascia.

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Where are accessory spleens not found?

Gonads

Tail of pancreas

Greater omentum

Splenorenal ligament

Ureter

Accessory spleens

10% population
1 cm size
locations: hilum of the spleen, tail of the pancreas, along the splenic vessels, in the gastrosplenic ligament, the splenorenal ligament, the walls of the stomach or intestines, the greater omentum, the mesentery, the gonads

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During a right hemicolectomy the caecum is mobilised. As the bowel is retracted medially a vessel is injured, posterior to the colon. Which of the following is the most likely vessel?

Right colic artery

Inferior vena cava

Aorta

External iliac artery

Gonadal vessels

The key in this question is that its during the caecal mobilization. The gonadal vessels and ureter are important posterior relations that are at risk during a right hemicolectomy. During latter stages of the procedure, the ileocolic artery and vein are traced along the anterior aspect of the duodenum. At this point it is possible to injure these, the superior mesenteric vein or the middle colic vein, injury to any of these can result in torrential bleeding that is very difficult to control.

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Which of the following statements relating to the vertebral column is false?

There are 7 cervical vertebrae

The cervical and lumbar lordosis are secondary curves developing after birth due to change in shape of the intervertebral discs

The lumbar vertebrae do not have a transverse process foramina

The lumbar vertebrae receive blood directly from the aorta

The spinous process is formed by the junction of the pedicles posteriorly

The spinous process is formed by 2 laminae posteriorly.

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Which of the following statements relating to the vertebral column is false?

There are 7 cervical vertebrae

The cervical and lumbar lordosis are secondary curves developing after birth due to change in shape of the intervertebral discs

The lumbar vertebrae do not have a transverse process foramina

The lumbar vertebrae receive blood directly from the aorta

The spinous process is formed by the junction of the pedicles posteriorly

The spinous process is formed by 2 laminae posteriorly.

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What type of visual field defect is most likely to be noted in a patient with a craniopharyngioma?

Lower bitemporal hemianopia

Upper bitemporal hemianopia

Right superior quadranopia

Right homonymous hemianopia

Left homonymous hemianopia

Lesions at the optic chiasm classically produce a bitemporal hemianopia, however note lesions that spread up from below ie pituitary tumours, the defect is worse in the upper fields and if a lesion spreads down from above ie craniopharyngiomas, the visual defect is worse in the lower quadrants. Therefore this patient is likely to have a lower bitemporal hemianopia.

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Damage during mastectomy

Long thoracic nerve (of Bell) Derived from C5-C7 and passes behind the brachial plexus to enter the axilla. It lies on the medial chest wall and supplies serratus anterior. Its location puts it at risk during axillary surgery and damage will lead to winging of the scapula.
Thoracodorsal nerve and thoracodorsal trunk Innervate and vascularise latissimus dorsi.
Axillary vein Lies at the apex of the axilla, it is the continuation of the basilic vein. Becomes the subclavian vein at the outer border of the first rib.
Intercostobrachial nerves Traverse the axillary lymph nodes and are often divided during axillary surgery. They provide cutaneous sensation to the axillary skin.
Lymph nodes The axilla is the main site of lymphatic drainage for the breast.

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A 43 year old man suffers a pelvic fracture which is complicated by an injury to the junction of the membranous urethra to the bulbar urethra. In which of the following directions is the extravasated urine most likely to pass?

Posteriorly into extra peritoneal tissues

Laterally into the buttocks

Into the abdomen

Anteriorly into the connective tissues surrounding the scrotum

None of the above

The superficial perineal pouch is a compartment bounded superficially by the superficial perineal fascia, deep by the perineal membrane (inferior fascia of the urogenital diaphragm), and laterally by the ischiopubic ramus. It contains the crura of the penis or clitoris, muscles, viscera, blood vessels, nerves, the proximal part of the spongy urethra in males, and the greater vestibular glands in females.
When urethral rupture occurs as in this case the urine will tend to pass anteriorly because the fascial condensations will prevent lateral and posterior passage of the urine.

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A 42 year old woman is admitted to the vascular ward for an endarterectomy. Her CT report confirms a left temporal lobe infarct. What is the most likely visual defect to be encountered?

Right homonymous hemianopia

Right superior quadranopia

Right inferior quadranopia

Left superior quadranopia

Left homonymous hemianopia

Temporal lesions cause a contralateral superior quadranopia. Think temporal area is at the top of the head i.e. superior quadranopia.

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Which of the following is not contained within the middle mediastinum?

Main bronchi

Arch of the azygos vein

Thoracic duct

Pericardium

Aortic root

The thoracic duct lies within the posterior and superior mediastinum.

Arch of azygous is within the MIDDLE MED.
Azygous vein is in the POST. MED.

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Which of the following structures accompanies the posterior interventricular artery within the posterior interventricular groove?

Great cardiac vein

Middle cardiac vein

Small cardiac vein

Anterior cardiac vein

Coronary sinus

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What is the lymphatic drainage of the male spongy urethra?

External iliac nodes

Internal iliac nodes

Para aortic nodes

Deep inguinal nodes

Meso rectal nodes

The lymphatic drainage of the spongy urethra and the glans penis is to the deep inguinal nodes. The prostatic and membranous urethra drains to the internal iliac nodes.

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Which of the nerves below innervates the tensor tympani muscle?

Vestibulocochlear

Facial

Vagus

Trigeminal

Hypoglossal

The tensor tympani muscle (in conjunction with stapedius) helps to mitigate the effects of loud sounds. The tensor tympani is innervated by the trigeminal nerve (the stapedius by the facial). In some people with hyperacousia, the tensor tympani muscle does not function normally.

Where does Stensens duct primarily open?

Immediately lateral to the foramen caecum

Floor of mouth

Opposite the second molar tooth

Opposite the fifth molar tooth

Into the post nasal space

Stensens duct conveys secretions from the parotid gland and these enter the oral cavity at the level of the second molar tooth.

SSSSStenenSSSS - SSSSSecond malar
W(U)harton - subLigUalis

A 72 year old man presents with haemoptysis and undergoes a bronchoscopy. The carina is noted to be widened. At which level does the trachea bifurcate?

The trachea bifurcates at the level of the angle of Louis which is the intervertebral space between the fourth and fifth thoracic vertebra.

A 63 year old man is due to undergo a splenectomy. Which splenic structure lies most posteriorly?

Gastrosplenic ligament

Splenic vein

Splenic artery

Splenic notch

Lienorenal ligament

The lienorenal ligament lies most posteriorly. The antero-lateral connection is via the phrenicocolic ligament. Anteriorly the gastro splenic ligament. These structures condense around the vessels at the splenic hilum.

A man develops an infection in his external ear. The infection is extremely painful. Which of the following nerves conveys sensation from this region?

Occipital branch of the trigeminal nerve

Vestibulocochlear nerve

Glossophrayngeal nerve

Auriculotemporal nerve

Maxillary branch of the trigeminal nerve

Tensor tympania and stapedius are the only two muscles of the middle ear. Contraction of tensor tympani will tend to dampen the vibrations produced by loud sounds, it is innervated by a branch of the trigeminal nerve. The stapedius dampens movements of the ossicles in response to loud sounds and is innervated by a branch of the facial nerve.
The auriculotemporal nerve, which is derived from the mandibular branch of the trigeminal nerve supplies this area.
Some areas may also be innervated by the vagus.

Which of the following nerves is responsible for the cremasteric reflex? Lateral femoral cutaneous nerve Femoral nerve Obturator nerve Genitofemoral nerve None of the above

The motor and sensory fibres of the genitofemoral nerve are tested in the cremasteric reflex. A small contribution is also played by the ilioinguinal nerve and thus the reflex may be lost following an inguinal hernia repair.

A 53 year old man is admitted to the vascular ward for a carotid endarterectomy. His CT head report confirms a left parietal lobe infarct. What type of visual field defect might be noted? Right inferior quadranopia Right superior quadranopia Right homonymous hemianopia Left superior quadranopia Lower bitemporal hemianopia

Superior quadranopia = temporal lobe lesion Inferior quadranopia = parietal lobe lesion PITS!

A 56 year old man suddenly develops severe back pain. His pain has a radicular pattern. On examination, he is unable to extend his great toe. Which of the spinal levels listed below is most likely to have been affected? L5 L4 L3 L2 L1

Extensor hallucis longus is derived from L5 and loss of EHL function is a useful test to determine whether this level is involved.

Which of the following represents the root values of the sciatic nerve? L4 to S3 L1 to L4 L3 to S1 S1 to S4 L5 to S1

The sciatic nerve most commonly arises from L4 to S3.

A 32 year old lady complains of carpal tunnel syndrome. The carpal tunnel is explored surgically. Which of the following structures will lie in closest proximity to the hamate bone within the carpal tunnel? The tendon of abductor pollicis longus The tendons of flexor digitorum profundus The tendons of flexor carpi radialis longus Median nerve Radial artery

The carpal tunnel contains nine flexor tendons: Flexor digitorum profundus Flexor digitorum superficialis Flexor pollicis longus The tendon of flexor digitorum profundus lies deepest in the tunnel and will thus lie nearest to the hamate bone.

A 28 year old man has a pleomorphic adenoma and the decision is made to resect this surgically. Which of the following structures is least likely to be encountered during surgical resection of the parotid gland? External carotid artery Retromandibular vein Auriculotemporal nerve Mandibular branch of trigeminal nerve Zygomatic branch of the facial nerve

Structures passing through the parotid gland Facial nerve and branches External carotid artery (and its branches; the maxillary and superficial temporal) Retromandibular vein Auriculotemporal nerve The mandibular nerve is well separated from the parotid gland. The maxillary vein joins to the superficial temporal vein and they form the retromandibular vein which then runs through the parotid gland. The auriculotemporal nerve runs through the gland. Following a parotidectomy this nerve may be damaged and during neuronal regrowth may then attach to sweat glands in this region. This can then cause gustatory sweating (Freys Syndrome). The facial nerve branch is the marginal mandibular branch and this is related to the gland.

A 21 year old man has an inguinal hernia and is undergoing a surgical repair. As the surgeons approach the inguinal canal they expose the superficial inguinal ring. Which of the following forms the lateral edge of this structure? Inferior epigastric artery Conjoint tendon Rectus abdominis muscle External oblique aponeurosis Transversalis fascia

The external oblique aponeurosis forms the anterior wall of the inguinal canal and also the lateral edge of the superficial inguinal ring. The rectus abdominis lies posteromedially and the transversalis posterior to this.

A 73 year old man is due to undergo a radical prostatectomy for carcinoma of the prostate gland. To which of these lymph nodes will the tumour drain primarily? Para aortic Internal iliac Superficial inguinal Meso rectal None of the above

The prostate lymphatic drainage is primarily to the internal iliac nodes and also the sacral nodes. Although internal iliac is the first site.

A 6 year old sustains a supracondylar fracture of the distal humerus. There are concerns that the radial nerve may have been injured. What is the relationship of the radial nerve to the humerus at this point? Anterolateral Anteromedial Posterolateral Posteromedial Immediately anterior

The radial nerve lies anterolateral to the humerus in the supracondylar area.

A 21 year old post man notices leg pain after 5 minutes walking during his round. It improves 3 minutes after stopping. Clinically, he is noted to have reduced hair of the lower limb and his calf muscles appear atrophied. There is a weak popliteal pulse, but it is still present when the knee is fully extended. What is the most likely diagnosis? Occlusive arterial disease caused by atherosclerosis Popliteal fossa entrapment Cerebral vascular accident Diabetes mellitus Adductor canal compression syndrome

Adductor canal compression syndrome most commonly presents in young males and is an important differential diagnosis in men presenting with symptoms of acute limb ischaemia on exertion. It is caused by compression of the femoral artery by the musculotendinous band from adductor magnus muscle. The treatment consists of the division of the abnormal band and restoration of the arterial circulation. Popliteal fossa entrapment is the main differential diagnosis, however the pulse disappears when the knee is fully extended.

The superior aspect of the vagina drains to which of the following lymph node groups? Superficial inguinal nodes Para-aortic nodes Iliac nodes Meso rectal nodes Obturator nodes

Lymphatic drainage of the vagina The lymph vessels from the superior aspect of the vagina join the internal and external iliac nodes, those from the inferior aspect of the vagina drain to the superficial inguinal nodes.

What is the lymphatic drainage of the membranous urethra? Deep inguinal nodes Superficial inguinal nodes Internal iliac nodes External iliac nodes Para-aortic nodes

The prostatic and membranous urethra drain to the internal iliac nodes.

What type of visual field defect is most likely to be noted in a patient with a craniopharyngioma? ``` Lower bitemporal hemianopia 53% Upper bitemporal hemianopia 39% Right superior quadranopia 4% Right homonymous hemianopia 3% Left homonymous hemianopia 1% ```

Transection of the radial nerve at the level of the axilla will result in all of the following except: Loss of elbow extension. Loss of extension of the interphalangeal joints. Loss of metacarpophalangeal extension. Loss of triceps reflex. Loss of sensation overlying the first dorsal interosseous.

These may still extend by virtue of retained lumbrical muscle function.

A 22 year old man undergoes a superficial parotidectomy for a pleomorphic adenoma. The operation does not proceed well and a diathermy malfunction results in division of the buccal branch of the facial nerve. Which of the following muscles will not demonstrate impaired function as a result? Zygomaticus minor Mentalis Buccinator Levator anguli oris Orbicularis oris

mentalis Buccal branch supplies Zygomaticus minor Elevates upper lip Buccinator Pulls corner of mouth backward and compresses cheek Levator anguli oris Pulls angles of mouth upward and toward midline Orbicularis Closes and tightens lips together Nasalis Flares nostrils and compresses nostrils The orbicularis oris has innervation by both the buccal and marginal mandibular branches of the facial nerve.

A 22 year old man is involved in a fight and sustains a skull fracture with an injury to the middle meningeal artery. A craniotomy is performed, and with considerable difficulty the haemorrhage from the middle meningeal artery is controlled by ligating it close to its origin. What is the most likely sensory impairment that the patient may notice post operatively? Parasthesia of the ipsilateral external ear Loss of taste sensation from the anterior two thirds of the tongue Parasthesia overlying the angle of the jaw Loss of sensation from the ipsilateral side of the tongue Loss of taste from the posterior two thirds of the tongue

The auriculotemporal nerve is closely related to the middle meningeal artery and may be damaged in this scenario. The nerve supplies sensation to the external ear and outermost part of the tympanic membrane. The angle of the jaw is innervated by C2,3 roots and would not be affected. The posterior third of the tongue is supplied by the glossopharyngeal nerve.

The transversalis fascia contributes to which of the following? Pectineal ligament Deep inguinal ring Cremaster muscle and fascia Inguinal ligament External spermatic fascia

The internal spermatic fascia (derived from transversalis fascia) invests: Ductus deferens Testicular vessels The principal outpouching of the transversalis fascia is the internal spermatic fascia. The mouth of the outpouching is the deep inguinal ring.

Which of the following structures is not transmitted by the jugular foramen? Hypoglossal nerve Accessory nerve Internal jugular vein Inferior petrosal sinus Vagus nerve

Contents of the jugular foramen: Anterior: inferior petrosal sinus !!!! Intermediate: glossopharyngeal, vagus, and accessory nerves Posterior: sigmoid sinus (becoming the internal jugular vein) and some meningeal branches from the occipital and ascending pharyngeal arteries The jugular foramen may be divided into three compartments: Anterior compartment transmits the inferior petrosal sinus Middle compartment transmits cranial nerves IX, X and XI Posterior compartment transmits the sigmoid sinus

What vessel is the origin of the middle rectal artery? Aorta Inferior mesenteric artery Superior mesenteric artery Internal iliac artery Internal pudendal artery

The rectum is supplied by 3 main vessels Superior rectal artery from inferior mesenteric artery Middle rectal artery from the internal iliac artery Inferior rectal artery from the internal pudendal artery The rectum has a dual blood supply. The superior rectal artery is a branch of the inferior mesenteric artery. Inferiorly, it derives a blood supply from branches of the internal iliac artery.

An 18 year old man develops a severe spreading sepsis of the hand. The palm is explored surgically and the flexor digiti minimi brevis muscle is mobilised to facilitate drainage of the infection. Which of the following structures is not closely related to this muscle? The hook of hamate Median nerve Superficial palmar arterial arch Digital nerves arising from the ulnar nerve None of the above

The flexor digiti minimi brevis originates from the Hamate, on its under- surface lie the ulnar contribution to the superficial palmar arterial arch and digital nerves derived from the ulnar nerve. The median nerve overlies the flexor tendons.

What is the lymphatic drainage of the male spongy urethra? External iliac nodes Internal iliac nodes Para aortic nodes Deep inguinal nodes Meso rectal nodes

The lymphatic drainage of the spongy urethra and the glans penis is to the deep inguinal nodes. The prostatic and membranous urethra drains to the internal iliac nodes.

A baby is found to have a Klumpke's palsy post delivery. Which of the following is most likely to be present? Loss of flexors of the wrist Weak elbow flexion Pronated forearm Adducted shoulder Shoulder medially rotated

Features of Klumpkes Paralysis Claw hand (MCP joints extended and IP joints flexed) Loss of sensation over medial aspect of forearm and hand Horner's syndrome Loss of flexors of the wrist A C8, T1 root lesion is called Klumpke's paralysis and is caused by delivery with the arm extended.

Which of the following structures separates the ulnar artery from the median nerve? Brachioradialis Pronator teres Tendon of biceps brachii Flexor carpi ulnaris Brachialis

It lies deep to pronator teres and this separates it from the median nerve.