18.05 anatomy revision Flashcards
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
Posterior compartment of the leg?
Superficial - soleus, gastrocnemius, PLANTARIS
Deep - tibialis posterior, flexor digitorum longus, flexor hallucis longus, POPLITEUS
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 -
Blood supply to lacrimal apparatus?
Ophthalmic artery
Bleeding after hypophyesctomy symptom?
Bitemporal hemianopia. It is contained in the dural sac, so acts like tumour
Whic muscle is innervated by cervical branch of the VII?
Platysma
Which muscle is not innervated by the trigeminal nerve?
Medial pterygoid
Mylohyoid
Stylohyoid
Masseter
Temporalis
Stylohyoid is innervated by the facial nerve.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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?
T3
T5
T7
T2
T8
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 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%
V
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.
