Anatomy Flashcards
Safe triangle for chest drain insertion borders
anterior edge of latissimus dorsi
lateral border of pectoralis major
line superior to horizontal level of nipple
apex below the axilla
Anatomical location for chest drain insertion
5th ICS, mid axillary line
Muscles that attach the scapula to chest wall (7)
pectoralis minor omohyoid rhomboid major + minor trapezius levator scapulae serrates anterior
Muscles that originate from scapula and insert into the humerus (6)
teres minor infraspinatus supraspinatous subscapularis teres major deltoid
Rotator cuff muscles
teres minor
infraspinatus
supraspinatous
subscapularis
Muscles of the forearm (med-lat) (4,3)
superficial: pronator teres flexor carpi radialis palmaris longus pollicus digitorum superficialis
deep:
flexor pollicus longus
flexor digitorum profundus
pronator quadratus
Brachioradialis function
Elbow flexor
Beer Raising muscle
What sits behind the Brachioradialis mucle
Radial nerve (in cubital fossa)
Innervation of serrates anterior
long thoracic nerve
Long thoracic nerve roots
C5-7
Shoulder abduction + adduction nerve roots
C5
C7
Elbow flexion + extension nerve roots
C5
C7
Supination/pronation nerve root
C6
Wrist flexion + extension nerve roots
C6/C7
Finger flexion/extension nerve roots
C7/C8
Small muscles of hand nerve roots
T1
Mastectomy commonly causes which nerve injury?
long thoracic nerve
Nerves frequently injured in axillary dissection
intercostobrachial nerves
Erb’s palsy nerve root injury
C5,6
Klumpke’s palsy nerve root injury
C7,8 T1 (lower trunk)
Muscles supplied by radial nerve (4)
brachioradialis
extensors
supinator
triceps
Relation of median nerve to brachial artery
lateral –> anterior –> medial
Musculocutaneous nerve innervates which muscles (3)
biceps brachii
brachialis
coracobrachialis
Axillary artery branches
1: superior thoracic
2: thoracoacromial, lateral thoracic
3: sub scapular, ant + post circumflex humeral
Innervation of diaphragm
Phrenic nerve
C3-5
Thenar eminence laceration most likely causes damage to which nerve?
Recurrent branch of median nerve
Commonest electrolyte disturbance following crush injury?
Potassium
due to tissue lysis and necrosis
Vein that lies anterior to medial malleolus of tibia
Long saphenous vein
What does the breast lie on?
Pectoral fascia
Pectoralis major
Serratus anterior
External oblique
Nerve supply to breast
branches of intercostal nerves T4-T6
Arterial supply of breast
Internal mammary (thoracic) artery
External mammary artery
Anterior intercostal arteries
Thoraco-acromial artery
Venous drainage of breast
Superficial venous plexus to subclavian, axillary and intercostal veins
Lymphatic drainage of breast
70% to axillary nodes
Internal mammary chain
Deep cervical + supraclavicular fossa (later in disease)
Axillary LN levels
1 - inferior to pec minor
2 - behind pec minor
3 - above pec minor
Structures passing through caval foramen in diaphragm
IVC
R phrenic nerve
LNs
Structures passing through aortic hiatus in diaphragm
Aorta
Thoracic duct
Azygos vein
Structures passing through oesophageal hiatus in diaphragm
Oesophagus
Vagal trunks
L gastric vessels
Level of canal foramen
T8
Level of oesophageal hiatus
T20
Level of aortic hiatus
T12
Anatomical/congenital cause of indirect inguinal hernia
Abdo contents enter the inguinal canal through a patent processes vaginalis
Calot’s triangle borders
inferior surface of liver (superior)
cystic duct (lateral)
common hepatic duct (medial)
LN spread of pancreatic CA (5)
LNs of: coeliac axis paraduodenal peritoneum lesser curvature of stomach greater curvature of stomach hilum of spleen
Borders of perineum
pubic symphysis (anterior)
ischiopubic rami + ischial tuberosity + sacrotuberous ligament (lateral)
tip of coccyx (posterior)
MALT tissue
pharyngeal tonsil
palatine tonsils x2
tubal tonsils x2
lingual tonsil
Anatomical cause for Meckel’s diverticulum
failure of vitelline duct to obliterate
Embryological precursor of female reproductive organs
Müllerian ducts
Embryological precursor of male reproductive organs
Wolffian ducts
Anatomical cause for bronchogenic cysts
anomalous development of ventral foregut
Level of hilum of kidneys
Left - L1
Right L1-2
Only organ in direct contact with kidney
Pancreas
Posterior relations of kidneys
subcostal nerve ilioinguinal nerve iliohypogastric nerve quadrates lumborum transversus abdominis psoas major diaphragm arcuate ligaments
Fascia covering kidneys
Gerotas fascia
Gerotas fascia derived from
transversalis fascia
Structures at the renal hilum (ant to post)
renal vein
renal artery
ureter
IVC lies in front of which structure in the abdomen
right renal artery
Renal arteries are direct or indirect branches off aorta?
direct
Level of renal arteries
upper border of L2
Blood supply to ureters
renal artery aortic branches gonadal branches common iliac internal iliac
Ureter lies …. to bifurcation of iliac vessels
anterior
Ureter related to …. ligament of uterus
broad ligament
Embryological site of uranchus
medial umbilical ligament
Arterial supply to bladder
superior and inferior vesical arteries (branches of internal iliac)
Venous drainage of bladder
Vesicoprostatic/vesicouterine venous plexus to internal iliac veins
Lymphatic drainage of bladder
external iliac, internal iliac and obturator nodes
Innervation of bladder
Parasympathetic: pelvic splanchnic nerves
Sympathetic: L1 + 2 via hypogastric plexuses
Micturition control centre
Pons
Fascia separating prostate from rectum
Denonvilliers fascia
Blood supply of prostate
Internal iliacs
Artery that crosses ureter + where
Uterine artery 2cm superior to ischial spine
Urogenital triangle borders
Ischiopubic inferior rami
Ischial tuberosities
Innervation of penis
S2-4 (pudendal nerve)
Narrowest part of urethra
Membranous urethra
Cremasteric fascia derived from?
internal oblique fascial coverings
External spermatic fascia derived from?
external oblique aponeurosis
Internal spermatic fascia derived from?
Transversalis fascia
Innervation of scrotum
Ilioinguinal + pudendal nerve
Important nerve in posterior triangle LN biopsy
accessory nerve
Important nerve in posterior approach to hip
sciatic
Important nerve in Lloyd Davies positioning
common peroneal
Important nerve in axillary node clearance
long thoracic
Important nerve in pelvic cancer surgery
pelvic autonomic nerves
Important nerve in thyroid surgery
recurrent laryngeal nerves
Important nerve in carotid endarterectomy
hypoglossal nerve
Important nerve in upper limb fracture repairs
ulnar and median nerves
Important nerve in inguinal hernia surgery
ilioinguinal nerve
Which vessel do you use for conduit for coronary artery bypass
internal mammary artery
Thyroid isthmus overlies which tracheal rings?
2-4
Recurrent laryngeal nerve runs through which groove?
Tracheoesophageal groove
External laryngeal nerve supplies which muscle?
Cricothyroid
Recurrent laryngeal nerve supplies which muscles?
All intrinsic muscles of the thyroid except cricothyroid
Superior parathyroid glands derived from which pharyngeal pouch
4th
Inferior parathyroid glands derived from which pharyngeal pouch
3rd
Arterial supply to parathyroid glands
Inferior and superior thyroid arteries
Venus drainage of parathyroid glands
Thyroid veins
Adrenal zona glomerulosa secretes?
Mineralocorticoids eg aldosterone
Adrenal zona fasciculata secretes?
Glucocorticoids eg cortisol
Adrenal zona reticular is secretes?
DHEA
Androgens
Muscles that depress the hyoid bone
Sternothyroid
Sternohyoid
Thyrohyoid
Omohyoid
Infrahyoid muscles
Digastric
Mylohyoid
Stylohyoid
Geniohyoid
Anterior belly of digastric develops from which pharyngeal arch
1st
Posterior belly of digastric develops from which pharyngeal arch
2nd
Posterior belly of digastric crosses the carotid…?
superiorly
Origin of abdominal aorta
T12
Termination of abdominal aorta
L4
Branches of abdominal aorta (10)
Inferior phrenic - T12 Coeliac - T12 Sup mesenteric - L1 Middle suprarenal - L1 Renal - L1-L2 Gonadal - L2 Lumbar - L1-L4 Inf mesenteric - L3 Median sacral -L4 Common iliac - L4
How many paired branches come off abdominal aorta?
6
Which artery is divided to gain surgical access for AAA?
Left renal artery
Branches of coeliac axis
Left gastric
Hepatic branches
Splenic branches
Internal iliac artery branches
I Love Going Places In My Very Own Underwear
[From posterior division]
Ileolumbar
Lateral sacral
Gluteal (superior)
[From anterior division] Pudendal (internal) Inferior vesicle/Uterine Middle rectal Vaginal Obturator Umbilical
Gastroduodenal artery supplies
Pylorus, proximal part of duodenum, indirectly to pancreatic head
Level of origin of inferior vena cava
L5
Level of carval foramen passing through diaphragm
T8
Level of aortic hiatus
T12
Level of oesophageal hiatus
T10
Level of hepatic vein
T8
Level of inferior phrenic vein
T8
Level of suprarenal veins + renal vein
L1
Level of gonadal vein
L2
Level of lumbar veins
L1 to 5
Level of common iliac vein
L5
Level of formation of IVC
L5
IVC branches
I like to rise so high
Iliacs Lumbar Testicular (right)/ovarian Renal Suprarenal (right( Hepatic vein
How many collateral venous circulation to IVC
4
Azygos
Internal mammary venous
Long thoracic venous system (2 pathways)
Level of superior mesenteric artery
L1
SMA supplies?
Duodenum to mid transverse colon
SMA branches
Middle colic Iliocolic (+ appendicular) Inferior pancreaticoduodenal Right colic Jejunal + ileal
Cremasteric reflex caused by
Genitofemoral nerve
Transpyloric plane level
L1
IMA level
L3
Bifurcation of aorta into common iliac arteries
L4
Oesophagus levels
C6-T11
Upper third of oesophagus blood supply
A&V: inferior thyroid vessels
Mid third of oesophagus blood supply
A: aortic branches
V: azygos branches
Nerve supply to upper half of oesophagus
recurrent laryngeal nerve
Nerve supply to lower had of oesophagus
oesophageal plexus (vagus)
Abdominal wall muscles
Rectus abdominis (ant) External oblique Internal oblique Transversus abdominis Quadratus lumborum (post)
External oblique origins
Ribs 5-12
Hesselbach’s triangle borders
Sup: Inferior epigastric vessels
Med: lat edge of rectus muscle
inf: Inguinal ligament
Blood supply of spleen
A: splenic artery (coeliac axis)
V: splenic vein (joined by IMV + united with SMV)
Retroperitoneal structures
SAD PUCKER Suprarenal glands Aorta + IVC Duodenum (except 1st part) Pancreas Colon (ascending + descending) Kidneys Oesophagus Rectum
Pringle’s maneouvre
vascular clamp across anterior aspect of epiploic foramen Occludes: CBD Hepatic artery portal vein
McBurney’s point
1/3 way from ASIS to umbilicus
Blood supply of ascending colon
Ileocolic and right colic vessels
Blood supply of transverse colon
middle colic vessels
Blood supply of descending and sigmoid colon
inferior mesenteric vessels
Midgut
2nd part of duodenum to 2/3 transverse colon
Hindgut
Distal 1/3 transverse colon to anus
Narrowest part of urethra
Membranous urethra
Ilioinguinal nerve supplies
sensation to skin over medial aspect of thigh, upper part of scrotum and penile root
Motor innervation to internal oblique + transverses abdominis
Fermoral nerve supplies
muscles of anterior compartment of thigh which extend knee joint
Obturator nerve supplies
sensation to small area of medial thigh
motor supply to adductor muscles
Common peroneal nerve supplies
sensation to skin of upper lateral leg, lower posterolateral leg and dorsum of foot
Sciatic nerve supplies
motor function to muscles of posterior thigh
Tibial nerve supplies
sensation to skin of lateral leg, lateral foot and plantar surface of foot
Muscles of posterior compartment of leg
Inguinal canal
sup: transversals abdominis + internal oblique fibres
post: transversals fascia
inf/floor: inguinal ligament
ant: internal + external oblique aponeuroses
Duodenum nerve supply
sympathetic: coeliac plexus branches
parasympathetic: hepatic + coeliac branches
4 parts of duodenum
1: bulb - connected by hepatoduodenal ligament to inferior part of liver
2: descending
3: horizontal
4: ascending
Umbilicus level
T10
Denonvillier’s fascia
rectoprostatic
Waldeyer’s fascia
rectosacral
Tips of scapulae level
T7
Superior margin of iliac crests level
L4
Collateral venous systems if SVC obstruction
azygos
internal mammary pathway
long thoracic + femoral/vertebral veins
Central tendon of diaphragmatic crura derived from?
Septum traverse
Lower sternal angle structures
aortic arch thoracic duct crosses midline azygous joins sac tracheal bifurcation costal cartilage 2nd rib
muscle medial to long thoracic nerve
serrates anterior
kidney transplant anastomosed to which vessels
external iliac
Gerotas fascia
surrounds kidney
Sibson’s fascia
lung apex
what separates subclavian artery + vein
scalenus anterior
carpal bones
scaphoid lunate triquetral pisiform trapezium trapezoid capitate hamate
Muscles originating from scapula + inserting into humerus
rotator cuff muscles: Teres minor infraspinatous supraspinatous subscapularis
teres major
deltoid
superficial layer of muscles of anterior forearm (med-lat above-down) (5)
pronator teres flexor carpi radialis palmaris longus flexor carpi ulnaris flexor digitorum superficialis
deep layer of muscles of anterior forearm (med-lat above-down) (3)
flexor pollicis longus
flexor digitorum profundus
pronator quadratus
superficial layer of muscles of posterior forearm (med-lat above-down) (7)
brachioradialis extensor carpi radialis longus extensor carpi radialis brevis extensor digitorum extensor digiti minimi extensor carpi ulnaris anconeus
shoulder abduction nerve root
C5
shoulder adduction nerve root
C7
elbow flexion nerve root
C5
elbow extension nerve root
C7
supination/pronation nerve root
C6
write flexion/extension nerve root
C6/C7
finger flexion/extension nerve root
C7/8
small muscles of hand nerve root
T1
sections of brachial plexus
roots trunks divisions cords branches
branches of brachial plexus (lat to med)
My Aunt Raped My Uncle musculocutaneous axillary radial median ulnar
radial nerve supplies which muscles (4)
BEST brachioradialis extensors supinator triceps
relations of median nerve to brachial artery
lateral – anterior – medial
musculocutaneous nerve supplies which muscles (3)
BBC
coracobrachialis
biceps brachii
brachialis
thenar eminence muscles (lat-med on palm) (4)
abductor pollicis brevis
opponens pollicis
flexor pollicis brevis
adductor pollicis
hypothenar eminence muscles (lat-med on palm) (3)
opponens digiti minimi
flexor digiti minimi
abductor digiti minimi
structures passing through carpal tunnel (5)
median nerve flexor pollicis longus flexor digitorum superficialis flexor digitorum profundus radial + ulnar bursa
structures passing superficial to carpal tunnel (4)
palmaris longus
ulnar nerve
cutaneous branch ulnar nerve
cutaneous branches median nerve
Guyon’s canal contents
ulnar nerve + artery
antecubital fossa contents (lat-med) (4)
radial nerve
biceps tendon
brachial artery
medial nerve
anatomical snuffbox boundaries + contents
med: extensor pollicis longus
lat: abductor pollicis longus + extensor pollicis brevis
floor: scaphoid + trapezium
loss of pincer grip + normal sensation nerve lesion
anterior interosseous nerve
interossei supplied by which nerve
ulnar
muscles supplied by ulnar nerve (5)
medial lumbricals adductor pollicis flexor digitorum profundus/digiti minimi interossei abductor digiti minimi + opponens
Froment’s sign tests which muscle/nerve
adductor pollicis muscle
deep branch of ulnar nerve palsy
flexes FPL to compensate
muscles supplied by median nerve (4)
LOAF lat 2 lumbricals opponens pollicis abductor pollicis brevis flexor pollicis brevis
intrinsic muscles of hand (7)
A OF A OF A abductor pollicis brevis opponens pollicis flexor pollicis brevis adductor pollicis opponens digiti minimi flexor digiti minimi brevis abductor digiti minimi
Nerve supply to anterior compartment of thigh
femoral nerve
Nerve supply to medial compartment of thigh
obturator nerve
Nerve supply to posterior compartment of thigh
sciatic nerve
Muscles in anterior compartment of thigh
iliac
tensor fasciae latae
sartorius
quadriceps femoris
Muscles in medial compartment of thigh
adductor longus/magnus/brevis
gracilis
obturator externus
Muscles in posterior compartment of thigh
semimembranosus
semitendinosus
biceps femoris
Nerve supply to anterior compartment of lower leg
deep perineal nerve
Nerve supply to posterior compartment of lower leg
tibial nerve
Nerve supply to lateral compartment of lower leg
superficial peroneal nerve
Muscles in anterior compartment of lower leg
tibialis anterior extensor digitorum longus extensor digitorum brevis extensor hallucis longus peroneus tertius
Muscles in posterior compartment of lower leg
deep: flexor hallucis longus flexor digitorum longus tibialis posterior popliteus
sup:
gastrocnemius
soleus
plantaris
Muscles in lateral compartment of lower leg
peroneus longus/brevis
Blood supply to anterior compartment of lower leg
anterior tibial
Blood supply to posterior compartment of lower leg
posterior tibial
Blood supply to lateral compartment of lower leg
anterior tibial
Ankle reflex nerve root
S1,2
Knee jerk reflex nerve root
L 3, 4
biceps and supinator reflex nerve root
C5,6
triceps reflex nerve root
C7,8
hip flexion nerve root
L2,3
knee extension nerve root
L3,4
foot dorsiflexion nerve root
L4,5
foot inversion nerve root
L4,5
hip extension nerve root
L4,5
knee flexion nerve root
L5,S1
foot plantar flexion nerve root
S1,2
foot eversion nerve root
L5,S1
great toe extension nerve root
L5
1st web space of foot sensory innervation
deep peroneal nerve
Pudendal nerve exits pelvis through
Greater sciatic foramen
Pudendal nerve re-enters pelvis through
Lesser sciatic foramen
Femoral triangle boundaries
sup: inguinal ligament
med: adductor longus
lat: sartorius
contents: NAVY
adductor canal boundaries
lat: vastus medialis
post: adductor longus + Magnus
roof: sartorius
contents: saphenous nerve, femoral vessels
deepest structure in popliteal fossa
popliteal artery
tarsal bones
Tall Californian Navy Medical Interns Lay Cuties
T alus; C alcanous; N avicular; M edial cuneiform; I ntermediate cuneiform; L ateral cuneiform; C uboid
sciatic nerve roots
L4-S3
adductor longus innervation
obturator nerve
trendelenburg tests ?
superior gluteal nerve
femoral artery surface marking
mid inguinal point
creamsteric reflex nerve supply
genitofemoral nerve
Muscles that depress hyoid bone + infrahyoid muscles (4)
TOSS thyrohyoid omohyoid sternohyoid sternothyroid
Infrahyoid muscles (4)
digastric
mylohyoid
stylohyoid
geniohyoid
anterior belly of digastric from which pharyngeal arch
1st
posterior belly of digastric from which pharyngeal arch
2nd
muscles of facial expression from which branchial arch
2nd
levator veli palatini supplied by which CN
X
tensor veli palatini supplied by which CN
V
tensor tympani supplied by which CN
V
ansa cervicali supplies sensory information from SCM nerve roots
anterior rami C2 + C3
Common carotids terminate at what level
C3
contents of carotid sheath
common carotid artery
internal carotid artery
internal jugular vein
vagus nerve
external carotid artery branches
Some Aggressive Ladies Find Odd Positions More Stimulating superior thyroid ascending pharyngeal lingul facial occipital posterior auricular maxillary superficial temporal
MMA branch of which vessel
maxillary artery (external carotid)
axillary artery arises from which vessel
subclavian artery
hyperhidrosis treatment denervation
removing T2 + 3 ganglia and rami
sensory CNs
I, II, VIII
motor CNs
III, IV, VI, XI, XII
mixed CNs
V, VII, IX X
branches of facial nerve
temporal zygomatic buccal marginal mandibular cervical
RLN branch of which nerve
vagus
RLN innervates
all intrinsic muscles of larynx except cricothyroid
carotid body innervation
CN IX
CN I foramen
cribriform plate
CN II foramen
optic canal
CN III foramen
superior orbital fissure
CN IV foramen
superior orbital fissure
CN V foramen
V1 - superior orbital fissure
V2 - foramen rotundum
V3 - foramen ovale
CN VI foramen
superior orbital fissure
CN VII foramen
internal acoustic meatus
CN VIII foramen
internal acoustic meatus
CN IX foramen
Jugular foramen
CN X foramen
Jugular foramen
CN XI foramen
Jugular foramen
CN XII foramen
hypoglossal canal
motor supply of tongue
CN XII
sensory supply taste to anterior 2/3 tongue
chorda tympani
CN VII
sensory supply general sensation to anterior 2/3 tongue
lingual
CN V3
sensory supply general sensation and taste to posterior 1/3 tongue
CN IX
Wharton’s duct
submandibular duct
Stensen’s duct
parotid duct
spinal cord ends at what level
L1-2
spinal cord ends at what level in neonates
L3
LP layers
- Skin
- Subcutaneous connective tissue - Supraspinous ligament
- Interspinous ligament
- Ligamentum flavum
- Epidural space
- Dura mater (dural sac)
- Subarachnoid space (lumbar cistern with CSF)
spinothalamic tract
sensory - crude touch, pain, temperature
dorsal column
vibration and proprioception
normal ICP
7-15mmHg
abnormal ICP
> 20mmHg
scalp nerve supply
GLASS greater occipital/auricular lesser occipital auriculotemporal supratrochlear supraorbital
trachea levels
C6-T5 (bifurcation
hyoid bone level
C3
thyroid cartilage level
C4-5
cricoid cartilage level
C6
narrowest site in larynx
rima glottidis
inferior homonymous quadrantanopia
parietal lesion
superior homonymous quadrantanopia
temporal lesion
upper quadrant >lower quadrant bitemporal hemianopia
inferior chiasmal compression eg pituitary tumour
lower quadrant > upper quadrant bitemporal hemianopia
superior chiasmal compressions eg craniopharyngioma
foramen ovale contents
OVALE otic ganglion V3 - mandibular branch accessory meningeal artery lesser petrosal nerve emissary veins
tympanic membrane epithelium
stratified squamous
earlobe LN drainage
superficial cervical nodes
which nerve is closely related to MMA that can be damaged during surgery
auriculotemporal nerve
cerebellopontine angle tumour most likely to affect which CNs
CN VII + VIII
most anterior structure lung hilum
phrenic nerve
CN carrying parasympathetic fibred
III VII IX X
angle of jaw sensory innervation
greater auricular nerve C2-3
pulmonary artery from which pharyngeal arch
6th
Facial nerve from which pharyngeal arch
2nd
Glossopharyngeal nerve from which pharyngeal arch
3rd
Vagus nerve from which pharyngeal arch
Sup laryngeal - 4th
Recurrent laryngeal.- 6th
R subclavian from which aortic arch
4th
Ductus arteriosus from which aortic arch
6th
Medial foot sensation nerve root
L4
Dorsal foot sensation nerve root
L5
Lateral foot sensation nerve root
S1
Structure that provides most significant direct support to uterus
tendon of transverse perineal muscles
internal mammary artery branch of?
subclavian
vertebral arteries a branch of?
subclavian
Killian’s dehiscence occurs between which muscles?
thyropharyngeus + cricopharyngeus (inferior constrictors)