Anatomy Flashcards
1
Q
What is the origin of pectoralis major?
A
- Medial third of clavicle.
- Sternum.
- Costal cartilages.
2
Q
What are the 4 vertical lines of the chest wall called?
A
- Mid-clavicular.
- Anterior axillary line.
- Mid axillary line.
- Posterior axillary line.
3
Q
What is the insertion of pecotralis major?
A
Humerus.
4
Q
What is the origin and insertion of a muscle?
A
The origin is the fixed attachment of the muscle, where the muscle starts. The insertion will move with contraction and is where the muscle ends.
5
Q
What is the innervation of pectoralis major?
A
Medial and lateral pectoral nerves.
6
Q
What is the action of pectoralis major?
A
Adduction and medial rotation of the humerus at the shoulder.
7
Q
What is the origin of pectoralis minor?
A
Ribs 3-5.
8
Q
What is the insertion of pectoralis minor?
A
The coracoid process of the scapula.
9
Q
What is the innervation of pectoralis minor?
A
Medial pectoral nerve.
10
Q
What is the action of pectoralis minor?
A
Protraction of the shoulder.
11
Q
What is the origin of serratus anterior?
A
Upper 8 ribs.
12
Q
What is the insertion of serratus anterior?
A
Costal surface of the scapula.
13
Q
What is the innervation of serratus anterior?
A
Long thoracic nerve.
14
Q
What is the action of serratus anterior?
A
Protraction of the scapula.
15
Q
What is the function of the lungs?
A
Oxygenates blood by bringing inspired air into contact with O2 poor blood in the pulmonary capillaries.
16
Q
What is the innervation of the intercostal muscles?
A
The intercostal nerves.
17
Q
What does the internal thoracic artery branch into?
A
- Musculophrenic - supplies the diaphragm.
2. Superior epigastric arteries - supplies the front of the abdomen.
18
Q
What is the pleural cavity?
A
A potential space between the visceral and parietal pleura.
19
Q
Name 2 functions of the serous fluid within the pleural cavity?
A
- Lubricates the pleurae.
2. Creates a surface tension helping the lungs to expand on inspiration.
20
Q
Name the 4 main structures that are found at the hilum of the lung.
A
- Pulmonary artery x1.
- Bronchus x1.
- Pulmonary vein x2.
21
Q
What branch does the right main bronchus give off outside of the right lung?
A
Superior lobar bronchus.
22
Q
What other smaller vessels are found at the hilum of the lung?
A
- Bronchial arteries.
- Pulmonary plexus of autonomic nerves.
- Lymph nodes.
23
Q
Which lung are inhaled foreign bodies most likely to be found in and why?
A
The right lung. The right main bronchus is shorter and more vertical.
24
Q
How many lobes does the right lung have and what are they called?
A
3 lobes.
Superior, middle and inferior.
25
How many lobes does the left lung have and what are they called?
2 lobes.
| Superior and Inferior.
26
What is the fissure in the left lung called?
Oblique (lies along 6th rib).
27
What are the fissures in the right lung called?
Horizontal (extends from mid-axiallry line anteriorly along the 4th rib) and Oblique (lies along 6th rib).
28
Name the 3 surfaces of the lungs.
1. Costal.
2. Mediastinal.
3. Diaphragmatic.
29
Name the 3 borders of the lungs.
1. Anterior.
2. Posterior.
3. Inferior.
30
Describe the innervation of the lungs?
1. Parasympathetic innervation derived from vagus nerve.
2. Sympathetic innervation derived from sympathetic trunks.
3. Visceral afferent - conducts pain impulses to sensory ganglion.
31
What is the action of parasympathetic innervation in the lung?
Bronchoconstriction and vasodilation of pulmonary vessels.
32
What is the action of sympathetic innervation in the lung?
Bronchodilation and vasoconstriction of vessels that are poorly ventilated.
33
What is the surface marking for the apex of the lung?
2 finger breadths (3cm) above the medial clavicle in the neck.
34
What are the surface markings for the lower border of the lung?
6th rib anteriorly, 8th rib in the mid-axillary line and 10th rib posteriorly.
35
What are the surface markings for the lower border or the pleural cavity?
8th rib anteriorly, 10th rib in the mid-axillary line and 12th rib posteriorly.
36
What are the 3 branches of the arch of the aorta?
1. Brachiocephalic trunk.
2. Left common carotid artery.
3. Left subclavian artery.
37
What are the branches of the brachiocephalic trunk?
```
Right common carotid (LHS).
Right subclavian (RHS).
```
38
What is the ligamentum arteriosum a remnant of and what was its function in the foetus?
Remnant of the ductus arteriosum.
| It's function was to shunt blood between the pulmonary trunk and the aorta in order to bypass the non-functioning lungs.
39
What branch does the left vagus nerve give off as it crosses the arch of the aorta?
The left recurrent laryngeal nerve.
40
Briefly describe the anatomical course of the right phrenic nerve.
Lies on large veins (brachiocephalic, SVC etc) and along the right side of the heart. Crosses in front of root of the lung.
41
Briefly describe the anatomical course of the left phrenic nerve.
Crosses the arch of the aorta and descends in front of the root of the lung.
42
What spinal roots is the phrenic nerve derived?
C3, 4 and 5 (cervical plexus).
43
What does the phrenic nerve supply?
Motor innervation to the diaphragm.
| Sensory innervation to the pleura, peritoneum and pericardium.
44
Briefly describe the anatomical course of the left vagus nerve.
Crosses the aorta and behind the root of the lung. Breaks up into branches on the oesophagus (oesophageal plexus) and leaves the thorax as the anterior gastric nerve.
45
Briefly describe the anatomical course of the right vagus nerve.
Lies on the trachea and crosses behind the root of the lung. Breaks up into branches on the oesophagus and leaves the thorax as the posterior gastric nerve.
46
Does the phrenic nerve enter the diaphragm? If so where?
Yes. It pierces the central tendon of the diaphragm alongside the IVC on the right (T8).
47
Does the vagus nerve enter the diaphragm? If so where?
Yes. Through the oesophageal hiatus (T10).
48
What are the layers of the pericardium?
1. Outer fibrous layer.
2. Parietal serous layer.
3. Visceral serous layer.
49
What structures form the left border of the heart?
1. Left pulmonary artery.
2. Left auricular appendage.
3. Left ventricle.
50
What is the surface marking for the apex of the heart?
5th intercostal space in the mid-clavicular line.
51
What forms the right border of the heart?
The right sternal edge.
52
On what aspect of the heart would you find the left atrium?
The posterior aspect. It is closely related to the oesophagus.
53
Where is the RCA found?
In the atrio-ventricular sulcus.
54
Name the 3 main branches of the RCA.
1. Sino-atrial nodal branch.
2. Right marginal branch.
3. Posterior inter-ventricular branch.
55
In 90% of hearts where does the posterior inter-ventricular artery arise from?
RCA.
56
In 30% of hearts where does the posterior inter-ventricular artery arise from?
The circumflex artery.
57
In 20% of hearts where does the posterior inter-ventricular artery arise from?
The RCA and the circumflex artery.
58
Name the 2 main branches of the LCA.
1. Circumflex.
| 2. Left anterior descending (LAD).
59
In what sulcus does the circumflex artery lie? What other large vessel can be found here?
Left atrio-ventricular sulcus.
| The coronary sinus can also be found here. IT passes posteriorly and drains into the RA.
60
Where is the SAN located?
The upper aspect of the crista terminalis in the RA.
61
Where is the AVN located?
Inter-atrial septum.
62
Name the artery that supplies:
a) The SAN
b) The AVN
a) Sino-atrial nodal branch of RCA.
| b) Posterior inter-ventricular branch, usually RCA.
63
At what phase of the cardiac cycle do the coronary arteries fill?
Diastole; when the ventricles are relaxed.
64
What 2 spaces does the crista terminalis divide in the RA?
It divides the smooth walled atrium from the trabeculated auricle - ridges = musculi pecanti.
65
What is the Fossa Ovalis a remnant of?
The Foramen Ovale. In the foetus the foramen ovale shunted blood from the RA to the LA so as to bypass the lungs.
66
In the ventricles, what are the chordae tendinae attached to?
The valves (mitral or tricuspid) and the papillary muscles.
67
How do the mitral and tricuspid valves work?
They open passively when the atria contract and then close afterwards to prevent backflow. The papillary muscles and chordae tendinae work to keep the valves closed during ventricular contraction.
68
How do the atrial and pulmonary valves work?
They open passively when the ventricles contract. Towards the end of systole they close to prevent the back flow of blood. The pressure of blood on the valves keeps them closed.
69
How would you know if the atrial and pulmonary valves were incompetent?
You would get regurgitation of blood into the ventricles. This could be heard as a diastolic murmur.
70
Where can you hear the pulmonary valve?
Left of the sternum, 2nd intercostal space.
71
Where can you hear the aortic valve?
Right of the sternum, 2nd intercostal space.
72
What is the midline connection called of the two lateral thyroid gland lobes?
Isthmus.
73
What tracheal rings does the isthmus of the thyroid gland lie in front of?
2nd, 3rd and 4th.
74
Where do the thyroid arteries arise from?
1. Superior thyroid artery - External carotid artery.
| 2. Inferior thyroid artery - Thyrocervical trunk, a branch of the Subclavian artery.
75
What vessels are contained within the carotid sheath?
1. Carotid artery.
2. Jugular vein.
3. Vagus nerve.
76
What is the origin of sternocleidomastoid?
The manubrium of the sternum and the clavicle.
77
What is the insertion of sternocleidomastoid?
Mastoid process.
78
What nerve(s) are related to the superior thyroid arteries?
The external laryngeal nerves.
79
What nerve(s) are related to the inferior thyroid arteries?
The recurrent laryngeal nerve crosses the inferior thyroid artery.
80
How many parathyroid glands are there?
4.
81
Where are the parathyroid glands located?
Posterior surface of thyroid glands.
82
How are the parathyroid glands developed?
From the pharyngeal pouches.
83
Name 3 functions of the larynx.
1. Phonation.
2. Cough reflex.
3. Protection of the lower respiratory tract.
84
What is the epithelium of the vocal folds? and why?
Stratified squamous epithelium. This is more robust and can withstand the vibrations and wear and tear.
85
What is the blood supply to the larynx?
Superior and inferior laryngeal arteries (branches of the thyroid arteries).
86
What does the recurrent laryngeal nerve supply?
Motor innervation to intrinsic muscles of the larynx (except cricothyroid).
87
What does the internal branch of the superior laryngeal nerve supply?
Sensory innervation to laryngopharynx and larynx.
88
What does the external branch of the superior laryngeal nerve supply?
Motor innervation to the cricothyroid muscle.
89
Name the 3 unpaired cartilages in the larynx.
1. Epiglottis (elastic cartilage).
2. Thyroid (hyaline cartilage).
3. Cricoid (hyaline cartilage).
90
What do the two sheets of thyroid cartilage form in the midline?
The laryngeal prominence (Adam's apple).
91
What do the inferior horns of the thyroid cartilage articulate with?
They form a synovial joint with the cricoid cartilage.
92
What do the superior horns of the thyroid cartilage articulate with?
The hyoid bone.
93
What vertebral level is the inferior border of the larynx at?
C6.
94
Name the 3 paired cartilages in the larynx.
1. Arytenoid.
2. Cuneiform.
3. Corniculate.
95
What do the arytenoid cartilages articulate with?
The base articulates with the cricoid cartilage and the apex articulates with the corniculate cartilages.
96
Where are cuneiform cartilages located?
Within the ary-epiglottic folds. They strengthen the folds.
97
What is the space between the vocal cords called?
Rima glottidis.
98
What is the superior vestibular folds also known as?
False vocal folds.
99
What are the extrinsic muscles of the pharynx?
The suprahyoids, infrahyoids and stylopharyngeus.
100
What is the function of the extrinsic muscles of the larynx?
They move the larynx superiorly and inferiorly during swallowing.
101
Name the 4 infrahyoid muscles.
1. Omohyoid (scapula to hyoid).
2. Sternohyoid (sternum to hyoid).
3. Sternothyroid (sternum to thyroid).
4. Thyrohyoid (thyroid to hyoid).
102
What is the function of the intrinsic muscles of the larynx?
They control the shape of the rima glottidis, and the length and tension of the vocal folds.
103
What is the innervation of the intrinsic laryngeal muscles?
Recurrent laryngeal nerve.
104
What intrinsic laryngeal muscle is not innervated by the recurrent laryngeal nerve?
Cricothyroid.
105
What is the innervation of the cricothyroid muscle?
External branch of the superior laryngeal nerve.
106
What is the function of the cricothyroid muscles?
Stretches and tenses the vocal cords. Important for the creation of speech.
107
What is the function of the thyroarytenoid muscles?
Relaxes the vocal ligament, allowing for a softer voice.
108
What is the function of the posterior cricoarytenoid muscles?
Abduction of the vocal cords; the only muscles capable of widening the rima glottidis.
109
What is the function of the lateral cricoarytenoid muscles?
Adduction of the vocal folds; narrow the rima glottidis.
110
What is the function of the transverse arytenoids muscles?
Adduction of the arytenoid cartilages, narrows the laryngeal inlet.
111
What nerve passes through the parotid gland?
The facial nerve - Cn 7.
112
What are the 5 branches of Cn 7.
1. Temporal.
2. Zygomatic.
3. Buccal.
4. Mandibular.
5. Cervical.
113
Where does the pharynx extend from and to?
The base of the skull to the cricoid cartilage (C6).
114
What are the 3 sections of the pharynx called?
1. Nasopharynx.
2. Oropharynx.
3. Laryngopharynx.
115
What is the function of the pharyngeal constrictor muscles?
They contract sequentially to propel food into the oesophagus.
116
What is the origin of the superior constrictor?
Pterigoid plate and pterygomandibular raphe.
117
What is the origin of the middle constrictor?
Hyoid bone.
118
What is the origin of the inferior constrictor?
Thyroid and cricoid cartilages.
119
What is the innervation of the pharyngeal constrictors?
The pharyngeal branch of the Vagus nerve.
120
What is the function of the longitudinal pharyngeal muscles?
They shorten and widen the pharynx. They also elevate the pharynx during swallowing.
121
What are the 3 longitudinal pharyngeal muscles called?
1. Stylopharyngeus.
2. Salpingopharyngeus.
3. Palatopharyngeus.
122
What is the origin of the stylopharyngeus and what is its innervation?
Origin: Styloid process of temporal bone.
Innervation: Glossopharyngeal, Cn 9.
123
What is Killian's dehiscence?
The weakest part of the pharyngeal wall. Located inferiorly in the midline. It is the commonest site for a pharyngeal diverticulum.
124
What vessels are found in the carotid sheath?
1. Common carotid artery.
2. Vagus nerve.
3. Internal jugular vein.
125
Where is the carotid sinus located?
At the bifurcation of the common carotid artery.
126
Where does the glossopharyngeal nerve exit the cranial cavity?
Through the jugular foramen.
127
What nerve supplies sensory and taste innervation to the posterior 1/3 of the tongue.
The glossopharyngeal nerve.
128
What does elevation of the soft palate do?
It closes the orifice between the nasopharynx and oropharynx. This occurse during swallowing to prevent food refluxing into the nose. It also occurs in phonation.
129
What nerve supplies sensory sensation to the anterior 2/3 of the tongue?
The trigeminal nerve, Cn 5.
130
What nerve supplies taste sensation to the anterior 2/3 of the tongue?
The facial nerve, Cn 7.
131
What folds bind the tonsilar fossa?
Palatoglossal (anterior) and Palatopharyngeal (posterior) folds.
132
What is the function of the tonsils?
The tonsils are a consolidation of lymphoid tissue. They prevent infection by stopping germs entering the mouth and nose.
133
Give 4 functions of the nasal cavity.
1. Warms and humidifies air.
2. Olfaction.
3. Removes and traps pathogens.
4. Drains and clears para-nasal sinuses.
134
What is the function of the nasal conchae?
They increase the SA of the nose and they disrupt the fast flow of air. This means the air spends more time in the nasal cavity so it can be humidified.
135
What opens into the inferior meatus?
Nasolacrimal duct.
136
What opens into the middle meatus?
The frontal, maxillary and anterior ethmoid sinuses open at the hiatus semilunaris. The middle ethmoid sinus opens onto the ethmoidal bulla.
137
What opens into the superior meatus?
The posterior ethmoid sinus.
138
Where does the sphenoid sinuses open into the nasal cavity?
At the spheno-ethmoidal recess.
139
Why does the nose have a rich vascular supply?
This means it can change the humidity and temperature of inspired air.
140
What nerve supplies general sensation to the nose?
Branches of the trigeminal nerve.
141
What vertebral level is the tracheal bifurcation?
T4.
142
What is the function of the thoracic duct?
It drains all the lymph from the lower half of the body and bowel back into the blood stream.
143
Where does the thoracic duct drain into?
The confluence between the left jugular vein and left subclavian vein.
144
Where does the azygous vein drain into?
The superior vena cava.
145
What are the names of the three splanchnic nerves?
The greater (T5-9), the lesser (T10-11) and the least (T12).
146
What is the function of the splanchnic nerves?
They provide sympathetic innervation to the foregut, midgut and hindgut.
147
Occlusion of which vessel is most likely to result in a fatal heart attack?
The left main coronary artery.
148
Which artery provides the main blood supply to the left ventricle?
The left anterior descending artery.
149
Which vessel is most likely to become occluded without producing any symptoms?
Right marginal artery.
150
What is stenosis?
Narrowing.
151
Which artery most frequently supplies the AVN?
The right main coronary artery.
152
What 2 vertical lines divide the abdomen into it's 9 nine regions?
Mid-clavicular lines that extend to the mid-inguinal point.
153
What 2 horizontal lines divide the abdomen into it's 9 nine regions?
Upper - Subcostal: joins lower costal margins.
| Lower - Intertubercular: connects the iliac crests.
154
How would you draw the transpyloric plane?
Half way between the suprasternal notch and the pubic symphysis.
155
What vertebral level is the transpyloric plane found?
L1.
156
Name 5 structures found on the transpyloric plane.
1. Pylorus of stomach.
2. Fundus of gall bladder.
3. Pancreas.
4. Hilum of Kidneys.
5. Duodenojejunal flexure.
157
How would you draw the transtubercular plane?
Joins the iliac crests of the pelvis.
158
What vertebral level is the transtubercular plane found at?
L4. (Same level as the bifurcation of the abdominal aorta).
159
What is the intercristal plane?
It joins the highest points of the pelvis at the back.
160
What vertebral level is the intercristal plane found at? Why is this important?
Between the L4 and L5 vertebrae. This is important for lumbar punctures and epidurals.
161
What is the subcostal plane and at what vertebral level does it lie?
It joins the lower points of the costal margins and lies at the L2 level.
162
What can the subcostal plane (L2) be a marker for?
- The end of the spinal cord.
| - The superior mesenteric artery.
163
What is McBurney's point?
2/3 of the way along a line extending from the umbilicus to the right anterior superior iliac spine.
164
What is the significance of McBurney's point?
Marks the base of the appendix and can act as a guide for the location of the caecum.
165
Name the 3 flat muscles of the Abdominal wall.
1. External Oblique.
2. Internal Oblique.
3. Transversus Abdominis.
166
In what direction do the fibres of the flat muscles run in?
1. External oblique - inferiorly and medially (down and in).
2. Internal oblique - superiorly and medially (up and in).
3. Transversus abdominis - transversely.
167
What is the origin of external oblique?
Lower 8 ribs and thoraco-lumbar fascia.
168
What is the insertion of external oblique?
Pubic crest, pubic tubercle, iliac crest and linea alba.
169
What is the origin of internal oblique?
Thoraco-lumbar fascia, iliac crest, lateral 1/2 of the inguinal ligament.
170
What is the insertion of internal oblique?
Linea alba, pubic tubercle.
171
What is the origin of transversus abdominis?
Thoraco-lumbar fascia, iliac crest, lateral 1/3 of the inguinal ligament.
172
What is the insertion of transversus abdominis?
Linea alba, pubic tubercle.
173
What are the fibrous intersections of the rectus abdominis called?
Tendinous intersections.
174
What are the attachments of rectus abdominis?
Rectus sheath, pubis, costal cartilages.
175
Name 5 structures contained within the rectus sheath.
1. Rectus Abdominis.
2. Sup and inf epigastric arteries.
3. Sup and inf epigastric veins.
4. Nerves.
5. Lymphatics.
176
What is the inferior epigastric artery a branch of?
The external iliac artery.
177
What is the internal thoracic artery a branch of? And what does it supply?
It is a branch of the subclavian artery and it supplies the anterior chest and abdominal wall and also the breasts.
178
Define dermatome.
An area of skin supplied by nerves from a single spinal root.
179
What are the dermatomes of the abdominal wall?
T7 to L1.
180
If a disease process involves the peritoneum of the abdominal wall, then the pain is localised. Why is this?
The peritoneum covering the inside of the abdominal wall has the same sensory nerve supply as the overlying skin.
181
What is the epithelium lining of the abdominal cavity?
Simple squamous epithelium.
182
What is the peritoneal cavity?
A potential space between the visceral and parietal peritoneum. It is filled with peritoneal fluid.
183
What is a retroperitoneal organ?
An organ that only has it's anterior surface covered by peritoneum. These organs lie behind the peritoneum.
184
Name 6 retroperitoneal organs.
Duodenum, ascending colon, descending colon, pancreas, oesophagus, kidneys. (DADPOK).
185
What is an intraperitoneal organ?
An organ fully covered in visceral peritoneum. It is suspended in the peritoneal cavity.
186
Name 6 intraperitoneal organs.
Sigmoid colon, appendix, liver, transverse colon, stomach, small intestine. (SALTSS).
187
What connects the lesser sac to the greater sac?
The epiploic foramen.
188
What does the lesser omentum attach to?
It extends from the liver and attaches to the lesser curvature of the stomach and the first part of the duodenum.
189
What is found in the right free border of the lesser omentum?
- Common bile duct.
- Hepatic artery.
- Hepatic portal vein.
190
Where is attached to the greater curvature of the stomach?
The greater omentum.
191
Describe the position and folding of the greater omentum in the peritoneal cavity.
It hangs down like an apron and then folds back on itself meaning there are 4 layers. The posterior 2 layers go on to enclose the transverse colon (transverse mesocolon) and then form the parietal peritoneum of the posterior abdominal wall.
192
What is it called when the peritoneal cavity becomes distended by fluid?
Ascites.
193
With a patient in a supine (lying down) position, where might fluid collect in the abdomen?
In the right retrohepatic space.
194
What embryological structure forms the ligamentum teres?
The umbilical vein.
195
Which structures surround the epiploic foramen?
- Anteriorly: lesser omentum.
- Posteriorly: IVC.
- Inferiorly: duodenum.
- Superiorly: caudate lobe of liver.
196
What connects the jejunum to the posterior abdominal wall?
Small intestine mesentery.
197
What parts of the large intestine are intraperitoneal?
The transverse and sigmoid colon.
198
Define lesser sac.
A peritoneal sac that lies posteriorly to the stomach and lesser omentum. It communicates with the greater sac through the epiploic foramen.
199
What lies in the free border of the lesser omentum?
The hepatic artery, hepatic portal vein and common bile duct.
200
What structures lie posteriorly to the stomach?
Pancreas, diaphragm, splenic artery and vein.
201
Name the 4 main regions of the stomach.
1. Cardia.
2. Fundus.
3. Body.
4. Pylorus.
202
What vertebral levels does the stomach lie between?
T7 to L3.
203
What are the folds of the internal stomach surface called?
Rugae.
204
Name the 2 sphincters of the stomach.
1. Inferior oesophageal sphincter.
| 2. Pyloric sphincter.
205
Which sphincter of the stomach is physiological (containing no sphincteric muscle)?
The inferior oesophageal sphincter.
206
What forces act on the inferior oesophageal sphincter?
1. The diaphragm exerts a pressure on the hiatus.
2. The lumen is collapsed in the normal state.
3. The oesophagus enters the stomach at a right angle; when the stomach is full this is closed off.
207
What is the function of the pyloric sphincter?
Controls the exit of chyme from the stomach.
208
What vertebral level is the coeliac trunk found?
T12.
209
Where does the foregut begin and end?
The mouth to the 2nd part of the duodenum (major duodenal papilla).
210
What is the blood supply to the greater curvature of the stomach?
The short gastrics, and the right and left gastro-epiploic arteries.
211
What is the blood supply to the lesser curvature of the stomach?
The left and right gastric arteries.
212
What is the right gastric artery a branch of?
The proper hepatic artery which arises from the common hepatic artery from the coeliac trunk.
213
What is the right gastro-epiploic artery a branch of?
It is the terminal branch of the gastroduodenal artery, this arises from the common hepatic artery which arises from the coeliac trunk.
214
What is the left gastro-epiploic artery a branch of?
The splenic artery which arises from the coeliac trunk.
215
What vein does venous blood from the GI tract, liver and spleen drain into?
The hepatic portal vein (goes to the liver).
216
What supplies sympathetic innervation to the stomach (foregut)?
The greater splanchnic nerve (T5-T9).
217
What supplies parasympathetic innervation to the stomach (foregut)?
The Vagus nerve Cn 10.
218
Is contraction of the stomach sphincters a sympathetic or parasympathetic action?
Sympathetic. (Parasympathetic = rest and digest).
219
At what vertebral level does the oesophagus pass through the stomach?
T10.
220
What structures pass through the diaphragm along side the oesophagus?
Vagus nerves and the oesophageal arteries and veins.
221
What does the left gastric artery supply?
The superior part of the lesser curvature of the stomach.
222
What structures lie anterior to the stomach?
The anterior abdominal wall and the left lobe of the liver.
223
What nerve lies anterior to the abdominal oesophagus and which posterior?
Left vagus - anterior.
Right vagus - posterior.
(LARP)
224
What are the 3 divisions of the small intestine called?
1. Duodenum.
2. Jejunum.
3. Ileum.
225
What is the principle function of the small intestine?
Digestion and absorption of food.
226
What are the folds of mucosa inside the small intestine called?
Plicae circulares.
227
What are Peyer's patches?
Large, sub-mucosal, lymph nodules.
228
Where in the small intestine would you find Peyer's patches?
Ileum.
229
Is the duodenum intraperitoneal or retroperitoneal?
Retroperitoneal.
230
The first part of the duodenum is prone to peptic ulceration. What artery can this affect?
The gastro-duodenal artery. This artery lies in direct contact with the posterior wall of the first part of the duodenum.
231
Would you describe the jejunum and ileum as intraperitoneal or retroperitoneal?
Intraperitoneal.
232
What part(s) of the small intestine can become twisted? This results in strangulation and ischaemia.
Jejunum and ileum.
233
Which has a thicker intestinal wall, the jejunum or the ileum?
Jejunum.
234
Describe 5 characteristics of the Jejunum.
1. Thick intestinal walls.
2. Longer vasa recta.
3. Less arterial arcades.
4. Pronounced plicae circulares.
5. Red in colour.
235
Describe 5 characteristics of the Ileum.
1. Thin intestinal walls.
2. Shorter vasa recta.
3. More arterial arcades.
4. Peyer's patches.
5. Pink in colour.
236
Where might you find Meckel's diverticulum?
1 meter from the termination of the ileum.
237
What is Meckel's diverticulum an embryonic remnant of?
The attachment of the mid-gut to the yolk sac.
238
Where does the mid-gut begin and end?
3rd part of duodenum to 2/3 along the transverse colon.
239
What is the blood supply to the midgut?
Superior mesenteric artery (L1).
240
What is the first branch of the SMA?
Inferior pancreaticoduodenal artery?
241
Name 3 major branches of the SMA.
1. Ileo-colic.
2. Right colic.
3. Middle colic.
242
What does the right colic artery supply?
The ascending colon.
243
What does the middle colic artery supply?
The transverse colon.
244
Into which vein does blood from the jejunum and ileum drain and what is the final destination of the blood?
Drains into the superior mesenteric vein.
| This vein combines with the splenic vein to form the hepatic portal vein which then goes on to the liver.
245
Which foodstuffs are absorbed through the lymphatic system?
Fats.
246
What is the innervation of the small intestine?
Sympathetic: Lesser splanchnic (T10-11). Parasympathetic: Vagus. No somatic innervation.
247
Name 4 mechanisms that ensure a high surface area for absorption of nutrients in the intestine.
1. Pliae circularis.
2. Coiled length.
3. Villi.
4. Microvilli.
248
What is the main function of the large intestine?
Water absorption and the formation of faeces.
249
State whether the caecum is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.
- Intraperitoneal.
- Ileocolic artery.
- Ileocolic vein; drains into superior mesenteric vein.
250
State whether the ascending colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.
- Retroperitoneal.
- Ileocolic and right colic arteries.
- Ileocolic and right colic veins.
251
State whether the transverse colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.
- Intraperitoneal.
- Middle colic artery.
- Superior mesenteric vein.
252
State whether the descending colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.
- Retroperitoneal.
- Left colic and superior sigmoid arteries.
- Inferior mesenteric vein.
253
State whether the sigmoid colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.
- Intraperitoneal.
- Sigmoid arteries.
- Inferior mesenteric vein.
254
What is the marginal artery of Drummond?
An artery that forms important anastomosis between SMA and IMA. It extends the length of the colon.
255
What vertebral level is the inferior mesenteric artery found at?
L3.
256
Name 3 characteristic features of the large intestine that allow it to be distinguished from other abdominal organs.
1. Haustrations.
2. Tenia coli.
3. Appendices epiploicae.
257
What are appendices epiploicae?
Small pouches of peritoneum filled with fat. They mark where blood vessels enter the bowel to supply the mucosa.
258
What are tenia coli?
3 strips of longitudinally running muscle on the outer surface of the large intestine.
259
What are haustrations?
Sacculations produced from where the tenia coli contract to shorten the wall of the bowel.
260
Where does the hind gut begin and end?
Distal 1/3 of the transverse colon to the anal canal.
261
What is the innervation of the hind gut?
Sympathetic: least splanchnic nerve (T12). Parasympathetic: S2-4. No somatic innervation.
262
What artery normally supplies the descending colon?
The left colic artery.
263
What is the importance of the marginal artery of Drummond?
If there is an occlusion to the IMA, blood can still be supplied to the large intestine via the SMA through this artery.
264
Give 4 locations where the distal end of the appendix may lie.
1. In the pouch of Douglas.
2. Behind the caecum.
3. Behind the umbilicus.
4. Below the liver.
265
Name the intraperitoneal parts of the large intestine.
Caecum, transverse colon, sigmoid colon.
266
Give 4 functions of the liver.
1. Synthesis of bile.
2. Glycogen storage.
3. Clotting factor production.
4. Detoxification of blood.
267
What is the liver an embryological derivative of and in which mesentery does it develop?
Derivative of the foregut. Develops in the ventral mesentery.
268
What structure(s) lie anterior to the liver?
The rib cage and the anterior abdominal wall.
269
What structure(s) lie superior to the liver?
The diaphragm.
270
What structure(s) lie posterior to the liver?
Oesophagus, stomach, gall bladder, first part of duodenum. (All are foregut derived organs).
271
What aspects of the liver does the diaphragmatic surface refer to?
The anterior superior aspects. This surface is smooth and convex.
272
What aspects of the liver does the visceral surface refer to?
The posterior inferior aspects. It is moulded by the shape of surrounding organs and so is irregular.
273
Name the 3 liver ligaments.
1. The falciform ligament.
2. The right and left coronary ligaments.
3. The right and left triangular ligaments.
274
What is the function of the falciform ligament?
To attach the liver to the anterior abdominal wall.
275
What is found in the free edge of this ligament?
The ligamentum teres (remnant of the umbilical vein).
276
What is the function of the coronary and triangular ligaments?
They attach the superior surface of the diaphragm to the liver.
277
Name the 4 lobes of the liver.
1. Right.
2. Left.
3. Caudate.
4. Quadrate.
278
What structures bind the Caudate lobe and where is it located?
The IVC and a fossa produced by the ligamentum venosum. It is located on the upper aspect of the right lobe on the visceral surface.
279
What structures bind the Quadrate lobe and where is it located?
The gall bladder and a fossa produced by the ligamentum teres. It is located on the lower aspect of the right lobe on the visceral surface.
280
What divides the liver into the right and left lobes?
The falciform ligament.
281
What vein supplies the liver with dexoygenated blood?
The hepatic portal vein.
282
What vein supplies the liver with oxygenated blood?
The hepatic artery proper.
283
What is the function of the gall bladder?
A temporary storage for bile.
284
What is the storage capacity of the gall bladder?
30-50ml.
285
What are the 3 divisions of the gall bladder?
Fundus, body and neck. The neck is where the gall bladder tapers and becomes continuous with the cystic duct.
286
Briefly describe the biliary tree.
Left and right hepatic ducts = common hepatic duct.
Common hepatic duct + cystic duct = common bile duct. Common bile duct + pancreatic duct = hepatopancreatic ampulla of Vater.
287
What is it called where the common bile duct and pancreatic duct meet?
The hepatopancreatic ampulla of Vater.
288
What is the orifice called where bile empties into the duodenum?
The major duodenal papilla.
289
What sphincter regulates the emptying of bile into the duodenum?
The sphincter of Oddi.
290
What artery supplies blood to the gall bladder?
The cystic artery.
291
Does parasympathetic or sympathetic innervation result in contraction of the gall bladder and the secretion of bile?
Parasympathetic.
292
What is the arrangement anterior to posterior of the ducts, artery and portal vein at the porta hepatis?
Anterior: Common bile duct, hepatic artery, hepatic portal vein.
(DAV)
293
What is Calot's triangle?
An anatomic space bounded by the liver superiorly, the cystic duct laterally and the common hepatic duct medially.
294
What is the cystic artery a branch of?
The right hepatic artery - hepatic artery proper - common hepatic artery - coeliac trunk.
295
Where is the bare area of the liver?
Under the tendinous part of the right hemi-diaphragm. This area has no peritoneal covering.
296
What is the surface marking for the gall bladder?
The tip of the 9th costal cartilage. Where the lateral rectus sheath joins the costal margin.
297
Where do the hepatic veins drain?
Into the IVC.
298
What are the 3 major branches of the Coeliac trunk?
The left gastric, the splenic and the common hepatic.
299
What does the left gastric artery supply?
The lesser curvature of the stomach and lower oesophagus.
300
What branches does the splenic artery give off?
- The short gastric arteries.
- The pancreatic arteries.
- The left gastroepiploic artery.
- 5 branches just before it reaches the Spleen.
301
What do the short gastric arteries supply?
The greater curvature of the stomach.
302
What does the left gastroepiploic artery supply? What does anastomose with?
It supplies the greater curvature of the stomach. It anastomoses with the right gastroepiploic artery.
303
Name the 2 branches of the common hepatic artery.
1. Proper hepatic artery.
| 2. Gastroduodenal artery.
304
Name the 2 branches of the Gastroduodenal artery.
1. Right gastroepiploic artery (supplies greater curvature of the stomach).
2. Superior pancreaticoduodenal artery (supplies head of pancreas).
305
Name the 3 branches of the proper hepatic artery?
1. Right hepatic artery.
2. Left hepatic artery.
3. Right gastric artery.
306
What does the right gastric artery supply?
The lesser curvature of the stomach.
307
What is a branch of the right hepatic artery?
The cystic artery (supplies the gall bladder).
308
Name the 4 divisions of the Duodenum.
1. Superior.
2. Descending.
3. Inferior.
4. Ascending.
309
Where in the duodenum are ulcers most likely? And which artery would they affect?
Most likely in the superior duodenum (1st part). If the ulcers erode through the posterior wall they may effect the gastroduodenal artery and cause haemorrhage.
310
What does the descending portion of the Duodenum lie posteriorly and anteriorly to?
Posteriorly to transverse colon. Anteriorly to the right kidney.
311
What vessels lie anteriorly to the inferior part of the duodenum? (3rd part)
The superior mesenteric artery and vein.
312
Is the duodenum retroperitoneal or intraperitoneal?
The duodenal cap is intraperitoneal but the rest of the duodenum is retroperitoneal.
313
Is the pancreas retroperitoneal or intraperitoneal?
The tail is intraperitoneal but the rest of the pancreas is retroperitoneal.
314
Name the 5 parts of the Pancreas.
1. The head.
2. The uncinate process.
3. The neck.
4. The body.
5. The tail.
315
What does the tail of the pancreas lie in close proximity to?
The hilum of the spleen.
316
Why can diseases of the pancreas spread to adjacent tissues?
Because it isn't contained within a capsule.
317
What is the blood supply to the head of the pancreas?
The superior and inferior pancraticoduodenal arteries.
318
What is the superior pancraticoduodenal artery a branch of?
The gastroduodenal artery.
319
What is the inferior pancraticoduodenal artery a branch of?
The SMA.
320
What is the blood supply to the rest of the pancreas?
Pancreatic branches of the splenic artery.
321
What is the venous drainage of the pancreas?
The head drains into the SMV (drains into hepatic portal vein). the pancreatic veins drain the rest of the pancreas (these drain into the splenic vein).
322
What is the function of the spleen?
In an adult it functions mainly as a blood filter, removing old RBC's from circulation.
323
Is the spleen intraperitoneal or retroperitoneal?
Intraperitoneal.
324
What ligaments of the greater omentum connect the spleen to the stomach and kidney?
Gastrosplenic and Splenorenal.
325
How far away is the major duodenal papilla from the pylorus of the stomach?
5cm.
326
What is the embryological significance of the major duodenal papilla?
It marks the junction between the foregut and the midgut.
327
What is the importance of the plicae circularis?
They increase the intestinal SA available for absorption.
328
What are gyri?
Rolls of cerebral cortex.
329
What are sulci?
Grooves/depressions between gyri.
330
What sulcus separates the frontal lobe from the parietal?
The central sulcus.
331
What sulcus separates the temporal lobe from the frontal and parietal lobe?
The lateral sulcus (sylvian fissure).
332
Define insula.
A portion of cerebral cortex folded deep in the lateral sulcus; forms the floor of the lateral sulcus.
333
What divides the brain into right and left hemispheres?
The deep longitudinal fissure.
334
What white matter structure holds the hemispheres together?
The corpus callosum.
335
Within what lobe is broca's area located?
The dominant (usually left) frontal lobe.
336
What is the function of Broca's area?
Language production.
337
Within what lobe is Wernicke's area located?
The dominant (usually left) temporal lobe.
338
What is the function of Wernicke's area?
It is involved in the comprehension of written and spoken language.
339
Where is the primary motor cortex located?
In the pre-central gyrus of the frontal lobe.
340
What are the functions of the frontal lobes?
Motor function, problem solving, judgement, personality, social and sexual behaviour.
341
What is the pre-frontal cortex responsible for?
Higher cognitive functions e.g. personality.
342
Where is the primary somatosensory cortex located?
In the post-central gyrus of the parietal lobe.
343
What are the functions of the parietal lobes?
Somatosensory function. The dominant lobe is involved in perception, interpretation of sensory information, language and mathematical operations. The non dominant lobe has visiospatial functions.
344
What cortex are located in the occipital lobes?
Primary visual and vision association cortex.
345
What cortex is located in the temporal lobe?
Primary auditory cortex.
346
What are the functions of the temporal lobe?
Hearing, language comprehension (wernicke's area). It also contains the hippocampus and amygdala.
347
What is the function of the hippocampus?
Important in the formation of long term memories.
348
What are the motor and sensory homunculi?
Proportional somatotopical representations of how much of the cortex innervates certain body parts.
349
How many horns does the lateral ventricle have and what are they called?
3 horns.
| Anterior, posterior and inferior.
350
What is the foramen between the lateral ventricles and 3rd ventricle called?
The foramen of Munro.
351
What is the foramen between the 3rd and 4th ventricle called?
The cerebral aqueduct.
352
What are the foramen called that connect the 4th ventricle to the subarachnoid space?
The foramina of luschka (lateral) and the foramen of magendie (medial).
353
Where is choroid plexus located?
Along the choroid fissure of the lateral ventricle and in the roof of the 3rd and 4th ventricle.
354
How is CSF reabsorbed into dural venous sinuses?
Via arachnoid granulations. CSF drains through the endothelium into the dural venous sinus.
355
What are the 4 anatomical divisions of the corpus callosum?
1. Rostrum.
2. Genu.
3. Body.
4. Splenium.
356
Which anatomical division of the corpus callosum lies most posteriorly?
The splenium.
357
What gyrus lies immediately above the corpus callosum?
The cingulate gyrus.
358
What structure forms the roof of the lateral ventricles?
The corpus callosum.
359
What are commissural fibres?
Fibres linking similar functional areas of the two hemispheres together e.g. the corpus callosum is composed of commissural fibres.
360
What is the brainstem composed of?
The midbrain, pons and medulla oblangata.
361
What structure divides the midbrain into dorsal and ventral parts?
The cerebral aqueduct.
362
What forms the dorsal midbrain?
The tectum.
363
What is the tectum of the midbrain composed of?
The inferior and superior colliculi.
364
What forms the ventral midbrain?
The cerebral peduncle.
365
What is the cerebral peduncle of the midbrain composed of?
A dorsal tegmentum and a ventral crus cerebri.
366
What structure divides the tegmentum from the crus cerebri?
The substantia nigra.
367
What are the crus cerebri?
White matter bundles emerging from the cerebral hemispheres.
368
What is the attachment between the midbrain and cerebellum called?
The superior cerebellar peduncles.
369
What is the function of the pineal gland?
Synthesises melatonin.
370
What is the midline sulcus on the ventral surface of the pons called?
The basilar sulcus (where the basilar artery lies).
371
What is the sulcus called that forms the caudal border of the pons?
The bulbopontine sulcus.
372
What is the medullary striae?
Ponto-cerebellar fibres that divide the floor of the 4th ventricle into a rostral pontine half and a caudal medullary half.
373
What is the obex?
The inferior apex of the rhomboid fossa.
374
What are the midline fissures of the medulla called?
- The anterior median fissure (ventral).
| - The posterior median fissure (dorsal).
375
What is the medullary olive?
An eminence caused by the presence of the inferior olivary nucleus underneath. Located lateral to the ventrolateral sulcus.
376
What lies lateral to the posterior median sulcus?
The gracile tubercle (dorsal column nuclei that participate in the sensation of fine touch and proprioception of the lower body).
377
What lies lateral to the gracile tubercle?
The cuneate tubercle (dorsal column nuclei that participate in the sensation of fine touch and proprioception of the upper body).
378
What are the functions of the kidneys?
They act to filter and excrete waste products from the blood. They are also responsible for H2O and electrolyte balance.
379
What are the posterior relations to the kidneys?
Diaphragm, psoas major, quadratus lumborum and transversus abdominis.
380
What are the anterior relations to the right kidney?
Liver and duodenum, coils of intestine.
381
What are the anterior relations to the left kidney?
Stomach, spleen, pancreas, coils of intestine.
382
What is found at the renal hilum?
Renal arteries and veins, ureter, nerves and lymphatics.
383
Which kidney is often positioned lower in the abdomen and why?
The right kidney, this is due to the presence of the liver.
384
What are the renal arteries a branch of?
The abdominal aorta just below the SMA.
385
Which renal artery is longer?
The right renal artery, this is due to the position of the aorta being slightly to the left.
386
Which artery crosses the IVC posteriorly?
The right renal artery.
387
Describe the branching of the renal artery.
Renal artery -> interlobar artery -> arcuate artery -> interlobular artery -> afferent arteriole.
388
Where do the renal veins drain?
Into the IVC.
389
How would you describe the shape of the:
a) right adrenal gland?
b) left adrenal gland?
a) Tetrahedral.
| b) Crescent-shaped.
390
Which adrenal gland does the IVC lie anteriorly to?
The right adrenal gland.
391
What are the 3 main layers of an adrenal gland?
1. An outer connective tissue capsule.
2. A cortex.
3. A medulla at the centre.
392
Adrenal glands: What are the 3 layers of the cortex?
1. Zona glomerulus.
2. Zona fasciculata.
3. Zona reticularis.
393
Adrenal glands: What cells are contained within the medulla and what do they secrete?
Chromaffin cells - they secrete catecholamines e.g. adrenaline. This is a 'fight or flight' response.
394
What are the 3 arteries that supply the adrenal glands?
1. Superior adrenal artery.
2. Middle adrenal artery.
3. Inferior adrenal artery.
395
What is the superior adrenal artery a branch of?
The inferior phrenic artery.
396
What is the middle adrenal artery a branch of?
The abdominal aorta.
397
What is the inferior adrenal artery a branch of?
The renal arteries.
398
What does the right adrenal vein drain into?
The IVC.
399
What does the left adrenal vein drain into?
The left renal vein (and then into the IVC).
400
What section of the spine is found in the posterior abdominal wall?
The lumbar section.
401
What muscle lies superficially to psoas major?
Quadratus lumborum.
402
What is the origin of quadratus lumborum?
Iliac crest and the iliolumbar ligament.
403
What is the insertion of quadratus lumborum?
The transverse processes of L1 to L4 and the 12th rib.
404
What is the action of quadratus lumborum?
Extension and flexion of the vertebral column.
405
What is the innervation of quadratus lumborum?
T12-L4 nerves.
406
What is the origin of psoas major?
T12-L5 vertebrae.
407
What is the insertion of psoas major?
The lesser trochanter of the femus.
408
What is the action of psoas major?
Flexion of the hip.
409
What is the innervation of psoas major?
L1-3 nerves.
410
What nerves lies on the anterior surface of psoas major?
The genitofemoral nerve.
411
Where does the femoral branch of the genitofemoral nerve go?
It passes under the inguinal ligament and supplies sensory innervation to the inner thigh.
412
Where does the genital branch of the genitofemoral nerve go?
It passes through the deep inguinal ring to enter the inguinal canal. It supplies the cremaster muscle.
413
Why can renal tumours become very large before invading adjacent structures?
The tumour has to grow through multiple tough layers: fibrous capsule, perirenal fat, renal fascia and pararenal fat.
414
What vein does the right gonadal vein drain into?
The IVC.
415
What vein does the left gonadal vein drain into?
The left renal vein (and then the IVC).
416
Where would you palpate an abdominal aortic aneurysm?
In the epigastrium, above the umbilicus.
417
What is the origin of psoas major?
T12-L5.
418
What is the insertion of psoas major and iliacus muscles?
Lesser trochanter of femur.
419
What is the origin of iliacus muscle?
Iliac fossa and anterior inferior iliac spine.
420
What is the innervation of iliacus muscle?
Femoral nerve (L2-4).
421
What nerve lies in the groove between the iliacus and psoas major?
The femoral nerve.
422
What nerve emerges from psoas major medially?
Obturator nerve.
423
What does the femoral nerve give motor innervation to?
The anterior thigh muscles that flex the hip and extend the knee.
424
What is the action of iliacus?
Flexion of the hip.
425
What does the femoral nerve give sensory innervation to?
Cutaneous branches pass to the antero-medial thigh. The terminal branch, saphenous nerve, supplies the medial side of the leg and foot.
426
What are the nerve roots for the femoral and obtruator nerves?
L2-L4.
427
What does the obtruator nerve give motor innervation to?
The medial thigh muscles inolved in adduction.
428
What does the obtruator nerve give sensory innervation to?
The skin of the medial thigh.
429
What are the sciatic nerve roots?
L4 - S3 (lumbosacral plexus).
430
What is the largest nerve in the body?
The sciatic nerve.
431
What does the sciatic nerve give motor innervation to?
Muscles of the posterior thigh and hamstring of adductor magnus.
432
When the sciatic nerve terminates it bifurcates into 2 nerves. What are they?
- Tibial.
| - Common fibular.
433
What are the walls of ureters composed of and why?
Smooth muscle walls. When the muscle contracts it produces peristaltic waves that propels the urine into the bladder.
434
What is the name of the point at which the renal pelvis narrows?
The ureteropelvic junction.
435
What is the significance of the ureters piercing the bladder obliquely?
It creates a physiological valve that acts to prevent the back flow of urine.
436
Do the ureters cross the ovarian arteries and the ductus deferens anteriorly or posteriorly?
Posteriorly. (Water (ureters) under the bridge (artery)).
437
What is the function of the bladder?
Collection, temporary storage and expulsion of urine.
438
Give 3 ways in which the bladder is specialised for storage.
1. Rugae give the bladder a great capacity to expand.
2. Detrusor muscle relaxes in storage, increasing bladder volume.
3. Urethral sphincters contract.
439
What is the interureteric bar?
A ridge of muscle between the two ureteric orficies.
440
What is the significance of the trigone?
It marks the two ureteric orifices and the urethral orifice. It is located in the fundus and it has a smooth wall in contrast to the rest of the bladder.
441
Which urethral sphincter is composed of skeletal muscle?
The external urethral sphincter.
442
Which urethral sphincter is under voluntary control?
The external urethral sphincter.
443
Which urethral sphincter is composed of smooth muscle?
The internal urethral sphincter.
444
Which urethral sphincter is under autonomic control?
The internal urethral sphincter.
445
What is the specialised smooth muscle of the bladder wall called?
The detrusor muscle.
446
What is the blood supply to the bladder?
The internal iliac arteries.
447
What nerve provides sympathetic innervation to the bladder?
The hypogastric nerve (T12-L2).
448
What is the affect of sympathetic innervation on the bladder?
Relaxation of the detrusor muscle and constriction of the internal urethral sphincters - this promotes urine retention.
449
What is the affect of parasympathetic innervation on the bladder?
Contraction of the detrusor muscle and relaxation of the internal urethral sphincters - this promotes micturition.
450
What is the role of the sensory nerves in the bladder wall?
They signal the need to urinate to the brain when the bladder becomes full.
451
Name 3 locations where the ureter narrows and renal stones may be present.
1. Ureteropelvic junction.
2. As the ureter passes the pelvic brim.
2. Where the ureters enter the bladder.
452
Why is the ureter at danger of being damaged in a hysterectomy?
The uterine artery is ligated in a hysterectomy. The ureter passes immediately posteriorly to the uterine artery and so may be damaged.
453
What two lumbar plexus nerves have the same nerve roots?
Femoral and Obtruator - L2,3,4.
454
What 3 bones make up the hip bone?
1. Ilium.
2. Pubis.
3. Ischium.
455
What is the socket called formed from the fusion of the ilium, pubis and ischium?
The acetabulum.
456
What bone articulates with the acetabulum?
The head of the femur.
457
Name 2 important ligaments that attach from the sacrum to the ischium.
1. sacrospinous ligament.
| 2. sacrotuberous ligament.
458
Where does the sacrospinous ligament run between?
The sacrum to the ischial spine.
459
Where does the sacrotuberous ligament run between?
The sacrum to the ischial tuberosity.
460
Why are female pelvis' different to males?
Female pelvis' have special adaptations for childbirth.
461
What are the 3 main differences between male and female pelvis'?
1. The female has a larger angled sub-pubic arch.
2. The pelvic outlet is rounder in females.
3. The ischial spine projects further into the male pelvic cavity.
462
What do the left gonadal veins (ovarian and testicular) drain into?
The left renal vein!
463
What forms the floor of the inguinal canal?
The inguinal ligament.
464
What does the inguinal canal transmit in males?
The spermatic cord.
465
What does the inguinal canal transmit in females?
The round ligament of the uterus.
466
What are the nerve roots for the ilio-inguinal nerve?
L1.
467
What does the ilio-inguinal nerve give sensory innervation to?
- Skin on the upper middle thigh.
- In males it supplies the skin over the penis and scrotum.
- In females it supplies the skin over the mons pubis and labium majora.
468
How do the testes move from the posterior abdominal wall to the scrotum?
The paired gubernacula aid in the descent of the testes. The testes are guided through the inguinal canal and then into the scrotum.
469
Define hernia.
Protusion of an organ through the wall of cavity that normally contains it.
470
What type of hernia is lateral to the inferior epigastric artery?
An indirect hernia.
471
Where does the inferior epigastric artery lie?
Immediately medial to the deep inguinal ring.
472
What are the 3 layers of tissue surrounding the spermatic cord?
1. External spermatic fasica.
2. Cremaster muscle and fascia.
3. Internal spermatic fascia.
473
What layer of the abdominal wall is the external spermatic fascia derived?
Derived from the aponeurosis of external oblique.
474
What layer of the abdominal wall is the internal spermatic fascia derived?
Transversalis fascia.
475
What layer of the abdominal wall is the cremaster muscle and fascia derived?
Internal oblique.
476
What is the function of the cremaster muscle?
To raise and lower the testes in order to regulate scrotal temperature for optimum spermatogenesis.
477
What is the vas deferens?
The duct that transports sperm from the epididymis to the ejaculatory ducts.
478
What 3 arteries are contained within the spermatic cord?
1. Testicular artery.
2. Cremasteric artery.
3. Artery of the vas.
479
What 3 veins are contained within the spermatic cord?
1. Testicular vein.
2. Cremasteric vein.
3. Vein of the vas.
480
What 3 nerves are contained within the spermatic cord?
1. Ilio-inguinal nerve.
2. Genitofemoral nerve.
3. Sympathetic plexus.
481
What are '3 others' contained within the spermatic cord?
1. Vas deferens.
2. Lymphatics.
3. Tunica vaginalis.
482
What is the midline fusion of the scrotum called?
The midline raphe.
483
Where is the dartos muscle located?
Immediately underneath the scrotal skin.
484
What is the function of the dartos muscle?
It helps to regulate temperature by wrinkling the skin of the scrotum - this decreases SA and reduces heat loss.
485
What are the 3 erectile tissues contianed within the root of the penis?
1. 2x Crura (form corpus cavernosum in body).
| 2. 1x Bulb (forms corpus spongiosum in body).
486
What is the glans of the penis?
The most distal part of the penis formed by the expansion of the corpus spongiosum. It contains the urethral orifice.
487
Is ejaculation caused by parasympathetic or sympathetic innervation?
Sympathetic.
488
What is a varicocele?
Pampiniform plexus of veins has dilated in the testicle.
489
Where will inguinal hernias lie in relation to the pubic tubercle?
Superiorly and medially.
490
What is a hydrocele?
Swelling of the scrotum caused by distension of the tunica vaginalis.
491
Which nerves provide sensory innervation to the scrotal skin?
- Ilio-inguinal.
- Genital branch of genitofemoral.
- Branches from the perineal nerve.
492
Give 4 functions of the paranasal sinuses.
1. Lighten the head.
2. Warm and humidify air.
3. Speech resonance.
4. Protection against facial trauma.
493
Name the 5 superficial back muscles.
1. Trapezius
2. Latissimus dorsi
3. Leavator scapuli superioris
4. Rhomboid minor
5. Rhomboid major
494
What is the innervation of trapezius?
Cn 11 - accessory
495
What is the action of trapezius?
Elevates the scapula and rotates it during abduction of the arm.
496
Which rhomboid muscle lies most superiorly?
Rhomboid minor lies superior to major.
497
Name the 4 rotator cuff muscles.
1. Supraspinatus
2. Infraspinatus
3. Subscapularis
4. Teres minor
498
What is the function of the rotator cuff muscles?
To give the shoulder joint additional stability.
499
Where do the rotator cuff muscles originate from and insert?
Origin: scapula, insertion: humeral head.
500
Why can posterior dislocation of the shoulder result in deltoid weakness and numb skin above the deltoid tendon?
Because it can stretch the axillary nerve.
501
What is the insertion of deltoid?
Deltoid tuberosity of the humerus.
502
What is the function of deltoid?
To abduct, flex and extend the arm.
503
Give 3 functions of the pelvis.
1. Transfers weight.
2. Provides attachment for muscles and ligaments.
3. Contains and protects pelvic viscera.
504
What are the two hiatuses of the pelvic floor?
1. Urogenital hiatus.
| 2. Rectal hiatus.
505
What passes through the urogenital hiatus of the pelvic floor?
The urethra and the vagina.
506
What passes through the rectal hiatus of the pelvic floor?
The anal canal.
507
Give 3 functions of the pelvic floor muscles.
1. They support abdomino-pelvic viscera.
2. They resist increases in intra pelvic pressures.
3. They maintain urinary and faecal continence.
508
What are the 2 main muscles of the pelvic floor?
1. Levator ani muscles.
| 2. Coccygeus muscle.
509
What is the innervation to the levator ani muscles?
Branches of the pudendal nerve, S2, 3, 4 roots.
510
What is the function of levator ani?
Maintains faecal continence, during defecation this muscle relaxes.
511
Which muscles of levator ani are prone to injury in childbirth?
Pubococcygeus and puborectalis due to their medial position.
512
What is the innervation of coccygeus?
Ventral rami of S4 and 5.
513
What can happen if you damage the pelvic floor?
You may get prolapse of pelvic viscera.
514
What risk factors can increase the chance of prolapse?
1. Increasing age.
2. Number of vaginal deliveries.
3. Family history.
4. Being overweight.
5. Chronic coughing e.g. a lung disorder.
515
What is the perineum?
An anaotmical space located below the pelvic diaphragm; it is diamond shaped and contains urinary, GI and reproductive viscera.
516
What divides the perineum into anterior and posterior triangles?
An imaginary line drawn between the ischial tuberosities.
517
What 2 triangles are formed by the imaginary line dividing the perineum?
1. The posterior anal triangle.
| 2. The anterior urogenital triangle.
518
What line separates the deep and superficial perineal pouches in the urogenital triangle?
The perineal membrane - a sheet of fibrous tissue.
519
Where will urine accumulate if the male urethra is ruptured?
In the superficial perineal pouch.
520
What does the superficial perineal pouch contain?
Erectile tissue that forms the penis and the clitoris.
521
What is the deep perineal pouch?
A space deep to the perineal membrane. It contains part of the urethra.
522
What is the superficial perineal pouch?
An area superficial to the urogenital diaphragm.
523
True or False: the perineal membrane covers the urogenital diaphragm?
True.
524
What perforates the perineal membrane?
The urethra and the vagina.
525
What is the perineal body?
The centre of the perineum located at the junction between the urogenital and anal triangles.
526
Why does the uterus need to be capable of expansion?
So it can accommodate the growth of a foetus.
527
What are the 3 sub-divisions of the uterus?
1. Fundus.
2. Body.
3. Cervix.
528
What is a fornix?
A space between the vagina and the cervix.
529
What are the 2 orifices of the cervix?
1. The internal orifice - communicates with the uterus.
| 2. The external orifice - communicates with the vagina.
530
The uterus is described as anteverted with respect to the vagina, what does this mean?
It is rotated towards the anterior surface of the body.
531
How does the uterus lie with respect to the bladder?
Posterior-superior.
532
What are the three tissue layers that make up the uterus?
1. Peritoneum.
2. Myometrium: smooth muscle layer.
3. Endometrium: inner mucous membrane lining.
533
What are the two divisions of the endometrium?
1. Stratum basalis.
| 2. Stratum functionalis.
534
Which layer of the endometrium is shred in menstruation?
The stratum functionalis.
535
What is the broad ligament?
A double peritoneum layer that attaches the uterus to the pelvis; it acts a mesentery.
536
What is the round ligament and what is its function?
A remnant of the gubernaculum.
| Its function is to maintain the anteverted position of the uterus.
537
What does the cardinal ligament contain?
The uterine artery and vein.
538
What is the uterine artery a branch of?
The internal iliac artery.
539
What ligament do the uterine tubes lie in?
The broad ligament.
540
What is the function of the uterine tubes?
They assist in the transport and transfer of ovum from the ovary to the uterus.
541
Give 2 ways in which the uterine tube is adapted for the transport of ovum to the uterus.
1. Ciliated columnar epithelium wafts the ovum to the uterus.
2. Contraction of the smooth muscle layer.
542
What is the most medial part of the uterine tube?
The isthmus.
543
Where in the uterine tube does fertilisation normally occur?
In the ampulla, this is the widest part of the tube and is lateral to the isthmus.
544
What is the final part of the uterine tube?
The fimbriae, finger-like projections coming off the infundibulum.
545
What is the function of the fimbriae?
To capture the ovum.
546
What is the blood supply to the uterine tubes?
The ovarian and uterine arteries.
547
What is the ovarian artery a branch of?
The abdominal aorta.
548
What forms the ovarian fossa?
The angle between the internal and external iliac arteries.
549
What are the female gonads?
The ovaries.
550
Where do the ovaries lie in relation to the broad ligament?
Posterior.
551
Give 2 functions of the ovaries.
1. To produce oocytes.
| 2. To produce oestrogen and progesterone.
552
Where are the follicles containing oocytes found in the ovary?
In the cortex.
553
What is the epithelium surface of the ovary?
Simple cuboidal epithelium.
554
What area of the ovary contains the neurovascular tissues?
The medulla.
555
What does the ovarian ligament connect?
The ovary to the uterus.
556
What is the blood supply to the ovaries?
Ovarian arteries (branch of the abdominal aorta).
557
What does the left ovarian vein drain into?
The left renal vein.
558
What ligament does the neurovasculature tissue travel through to reach the hilum of the ovary?
The suspensory ligament of the ovary.
559
Give 3 functions of the vagina.
1. It receives the penis in sexual intercourse.
2. It expands providing a delivery channel in childbirth.
3. It serves as a canal for menstrual fluid to leave the body.
560
What 2 things comprise the vaginal mucosa?
1. Stratified squamous epithelium.
| 2. Elastic lamina propria.
561
What is the blood supply to the vagina?
Uterine and vaginal arteries (branches of the internal iliac artery).
562
What are female external genitalia collectively known as?
Vulva.
563
Give 3 functions of the vulva.
1. Sensory tissue in sexual intercourse.
2. Assist in micturition.
3. Defend the internal female reproductive tract from infection.
564
What is the mons pubis?
A mass of fatty tissue lying over the pubis symphysis.
565
What are the labia majora?
Hair bearing external folds that fuse posteriorly and extend anteriorly to the mons pubis.
566
What are the labia minora?
Hairless folds that lie within the labia majora. They fuse anteriorly to form the prepuce (hood) of the clitoris.
567
What is the vestibule?
An area between the labia, the external vagina and urethral orifice are found here.
568
Where are the great vestibular glands located and what is their function?
Glands located either side of the vaginal orifice, they secrete mucous during sexual arousal.
569
What is the clitoris derived from embryologically?
The genital tubercle.
570
What is the main blood supply to the vulva?
Pudendal arteries.
571
What 2 structures combine to form the ejaculatory ducts?
The vas deferens and the seminal vesicle.
572
List in sequence the tubular structures along with spermatozoa pass to the exterior?
Testes -> epididymis -> vas deferens (goes through inguinal canal and along the lateral pelvic wall to the posterior bladder) -> seminal vesicle -> ejaculatory duct -> prostate gland -> prostatic urethra -> membranous urethra -> penile urethra.
573
What is the ampulla of vas?
A large dilation of the vas deferens on the posterior aspect of the bladder.
574
True or False: the seminal vesicles store spermatozoa.
False - they do NOT store spermatozoa.
575
What is the function of the prostate glands?
They secrete proteolytic enzymes which break down clotting factors in the ejaculate and so allowing the semen to remain fluid.
576
What does the prostate lie inferior to?
The neck of the bladder.
577
What does the prostate lie superior to?
The external urethral sphincter.
578
What is the blood supply to the prostate?
Prostatic arteries (derived from internal iliac arteries).
579
Name 2 vessels that pierce the prostate.
The urethra and the ejaculatory ducts.
580
How long is the male urethra?
15-20cm.
581
How long is the female urethra?
4cm.
582
What is the prostatic part of the male urethra?
Where the urethra descends through the prostate (3cm).
583
What is the membranous part of the male urethra?
Where the urethra transverses the urogenital diaphragm (1cm).
584
What is the penile part of the male urethra?
Where the urethra travels through the bulb, corpus spongiosum and glans of the penis (15cm).
585
What dilation in the glans my impede a urethral catheter?
The navicular fossa.
586
Why might inflammation of the ovary cause medial thigh pain?
Inflammation may irritate the obtruator nerve causing medial thigh pain - REFERRED PAIN!
587
What is a retroverted uterus?
One that is rotated towards the posterior abdominal wall, it would lie on the rectum.
588
Give some signs and symptoms of an enlarged prostate gland.
An enlarged prostate would press on the bladder and so cause an increase in urinary frequency, urinary urgency, dribbling, and difficulty initiating micturition.
589
Why might a malignant tumour of the prostate spread to the vertebral column?
The prostatic venous plexus of veins is in direct continuation with the venous plexus of the vertebra and so this represents a possible route of tumour spread.
590
What are the 3 heads of the triceps?
1. Long head (most medial).
2. Lateral head.
3. Medial head.
591
Which head of the triceps lies deepest?
The medial head - cannot be seen unless the lateral and long are dissected away.
592
What is the insertion of triceps?
Olecranon of the ulna.
593
What is the innervation of triceps?
The radial nerve.
594
Which rotator cuff muscle is most likely to be affected in rotator cuff tendinitis?
Supraspinatus - tendon passes through a tight gap between the humerus and acromium of the scapula and so is prone to inflammation. 'Painful arc'.
595
What does the ectoderm form?
Skin, CNS, PNS, teeth, sweat glands, pituitary gland.
596
What are the divisions of the mesoderm?
- Lateral plate - Splanchnic and somatic.
- Paraxial plate.
- Intermediate plate.
597
What does the intermediate plate of mesoderm form?
The UG system - kidneys, gonads etc.
598
What does the paraxial plate of mesoderm form?
Somites.
599
What does the lateral plate of mesoderm form?
- Splanchnic: circulatory system, muscle and connective tissue.
- Somatic: the body wall.
600
What does the endoderm form?
GI tract, respiratory tract, urinary tract, liver, pancreas, auditory tube, thyroid and parathyroid gland.
601
Name the 4 rotator cuff muscles.
1. Supraspinatus.
2. Infraspinatus.
3. Teres minor.
4. Subscapularis.
602
What is the function of the rotator cuff muscles?
To stabilise the shoulder joint.
603
What is the action of supraspinatus?
Abduction.
604
What is the action of infraspinatus?
External rotation.
605
What is the action of teres minor?
External rotation.
606
What is the action of subscapularis?
Internal rotation.
607
What is the innervation of the deltoid muscle?
Axillary nerve.
608
What is the insertion of the deltoid muscle?
Deltoid tuberosity of humerus.
609
What is the action of deltoid?
Abduction of the arm!
610
What type of muscles fibres make up deltoid?
Multi-pennate fibres - these fibres are powerful.
611
What is the function of latissiums dorsi?
Adduction!
612
What is the action of triceps?
Extension of the forearm.
613
What is the axilla?
An area underneath the shoulder joint at the junction between the upper limb and thorax.
614
What structures form the apex of the axilla?
The first rib, clavicle and scapula.
615
What structures form the medial wall of the axilla?
Serratus anterior, ribs and intercostal spaces.
616
What structures form the lateral wall of the axilla?
Upper humerus, biceps brachii and coracobrachialis muscle.
617
What structures form the anterior wall of the axilla?
Pectoralis major and minor.
618
What structures form the posterior wall of the axilla?
Latissimus dorsi, teres major and subscapularis.
619
What structures form the base of the axilla?
Skin and deep fascia.
620
Name 5 things contained wihin the axilla.
1. Fat.
2. Lymph nodes.
3. Axillary artery.
4. Axillary vein.
5. Brachial plexus.
621
What spinal nerve roots form the brachial plexus?
C5 - T1.
622
What are divisions of the brachial plexus?
Roots -> Trunk -> Divisions (anterior and posterior) -> Cords -> Branches.
623
What are the 5 main branches of the brachial plexus?
1. Musculocutaneous.
2. Axillary.
3. Median.
4. Radial.
5. Ulnar.
624
What are the nerve roots for the musculocutaneous branch?
C5, 6, 7.
625
What muscle does the musculocutaneous nerve enter?
Coracobrachialis.
626
What are the nerve roots for the axillary branch?
C5, 6.
627
What are the nerve roots for the median branch?
C6, 7, 8, T1.
628
What are the nerve roots for the radial branch?
C5, 6, 7, 8, T1.
629
What are the nerve roots for the ulnar branch?
C8, T1.
630
What are the names of the 3 trunks of the brachial plexus?
1. Superior trunk.
2. Middle trunk.
3. Inferior trunk.
631
What nerve roots contribute to the superior trunk?
C5, C6.
632
What nerve roots contribute to the middle trunk?
C7.
633
What nerve roots contribute to the inferior trunk?
C8, T1.
634
What divisions form the lateral cord?
The anterior divisions of the superior and middle trunks.
635
What divisions form the posterior cord?
The posterior divisions of the superior, middle and inferior trunks.
636
What divisions form the medial cord?
The anterior division of the inferior trunk.
637
What are the names of the 3 cords of the brachial plexus?
1. Lateral cord.
2. Posterior cord.
3. Medial cord.
638
What does the musculocutaneous nerve give motor innervation to?
Anterior flexors - brachialis, biceps brachii and coracobrachialis - BBC.
639
What does the musculocutaneous nerve give sensory innervation to?
Lateral forearm.
640
What would be the effect of damage to the musculotaneous nerve?
Flexion at the shoulder and elbow would be affected. Loss of sensation to the lateral forearms.
641
What does the axillary nerve give motor innervation to?
Abductors of the arm at the shoulder - teres minor, long head of triceps and deltoid.
642
What does the axillary nerve give sensory innervation to?
Innervates the skin over the lower deltoid.
643
What would be the effect of damage to the axillary nerve?
Unable to abduct the arm 15-90 degrees. Loss of sensation over the lower deltoid region.
644
What does the median nerve give sensory innervation to?
Lateral palm of the hand and the lateral 3.5 fingers.
645
What does the median nerve give motor innervation to?
Flexors in the anterior forearm, the thenar muscles and the lateral two lumbricals in the hand.
646
What would be the effect of damage to the median nerve?
Flexion of the forearm would be weakened, thenar muscle atrophy, unable to make a fist with their hands - only the little and ring fingers can flex completely. Loss of sensation over the lateral palm and lateral 3.5 fingers.
647
What does the radial nerve give motor innervation to?
Triceps brachii, responsible for extension at the elbow. It also innervates extensor muscles in the posterior compartment of the forearm.
648
What does the radial nerve give sensory innervation to?
Skin on the posterior side of the forearm and the posterior aspect of the hand.
649
What would be the effect of damage to the radial nerve?
Unable to extend the forearm, wrist and fingers. Unopposed flexion of the wrist: 'wrist drop'. Loss of sensation over the posterior forearm and hand.
650
What would be the effect of damage to the ulnar nerve?
Unable to abduct and adduct the fingers. Movement of the little and ring fingers is reduced. A hand deformity called 'ulnar claw' will develop long term. Loss of sensation to the medial 1.5 fingers and medial palm.
651
What does the ulnar nerve give sensory innervation to?
Medial 1.5 fingers and the medial palm.
652
What does the ulnar nerve give motor innervation to?
Muscles of the hand, flexor carpi ulnaris (flexes and adducts the hand at the wrist) and medial half of the flexor digitorum profundus (flexes the fingers).
653
What is the cubital fossa?
An area of transition between the arm and forearm.
654
What muscle forms the medial border of the cubital fossa?
Pronator teres muscle.
655
What muscle forms the lateral border of the cubital fossa?
Brachioradialis muscle.
656
What are the contents of the cubital fossa lateral to medial?
1. Biceps tendon.
2. Brachial artery.
3. Median nerve.
(TAN)
657
Does the median nerve lie lateral or medial to the brachial artery in the upper arm?
Laterally. It crosses to the medial side as it descends through the arm.
658
What is the origin of brachialis?
Lower half of the anterior humerus.
659
What is the insertion of brachialis?
Coronoid process of the ulna.
660
What is the action of brachialis?
Flexion of the elbow joint.
661
What muscle does brachialis lie deep to?
Biceps brachii.
662
Biceps brachii: what is the origin of the long head?
Supraglenoid tubercle of the scapula.
663
Biceps brachii: what is the origin of the short head?
Coracoid process of the scapula.
664
Where does the biceps tendon insert?
The tuberosity of the radius.
665
What is the action of biceps?
Flexion of the elbow joint and supination of the forearm.
666
What nerve lies on the superficial surface of serratus anterior?
Long thoracic nerve.
667
What is the origin of deltoid?
Clavicle, acromion of scapula, spine of scapula.
668
Name 3 nerves closely related to the humerus.
1. Radius.
2. Ulnar.
3. Axillary.
669
Transection of which cord of the brachial plexus produces paralysis of the biceps, brachialis and coracobrachialis?
Lateral cord.
670
What is the main muscle to abduct the shoulder 0-15 degrees?
Supraspinatus.
671
What is the main muscle to abduct the shoulder 15-90 degrees?
Deltoid.
672
What are the main muscle(s) that abduct the shoulder greater than 90 degrees?
Trapezius and serratus anterior.
673
Name 4 superficial muscles in the anterior compartment of the forearm?
1. Pronator teres.
2. Flexor carpi radialis.
3. Palmaris longus.
4. Flexor carpi ulnaris.
674
Where do the superficial muscles in the anterior compartment of the forearm originate from?
The common tendon which arises from the medial epicondyle of the humerus.
675
What nerve innervates flexor carpi ulnaris?
Ulnar nerve (C8-T1).
676
What is the action of flexor carpi ulnaris?
Flexion and adduction at the wrist.
677
What nerve innervates palmaris longus?
Median nerve (C6-T1).
678
What is the action of palmaris longus?
Flexion at the wrist.
679
What nerve innervates flexor carpi radialis?
Median nerve (C6-T1).
680
What is the action of flexor carpi radialis?
Flexion and abduction at the wrist.
681
What nerve innervates pronator teres?
Median nerve (C6-T1).
682
What is the action of pronator teres?
Pronation of the forearm.
683
What nerve innervates brachioradialis?
Radial nerve (C5-T1).
684
What is the action of brachioradialis?
Flexion of the elbow.
685
What artery is the brachial artery a continuation of?
The axillary artery.
686
What arteries does the brachial artery branch into?
The radial and ulnar arteries.
687
Name 3 deep muscles in the anterior compartment of the forearm.
1. Flexor digitorum profundus.
2. Flexor pollicis longus.
3. Pronator quadratus.
688
What bone does flexor digitorum profundus originate from?
The ulna bone.
689
What is the innervation to flexor digitorum profundus?
- Medial half (little and ring fingers) - ulnar nerve.
| - Lateral half (middle and index fingers) - median nerve.
690
What is the action of flexor digitorum profundus?
It flexes the interphalangeal joints and the metacarphophalangeal joints.
691
What bone does flexor pollicis longus originate from?
The anterius radius.
692
What is the insertion of flexor pollicis longus?
The thumb.
693
What is the innervation of flexor pollicis longus?
Median nerve.
694
What is the action of flexor pollicis longus?
It flexes the interphalangeal joints and the metacarphophalangeal joints of the thumb.
695
What is the action of pronator quadratus?
It pronates the forearm.
696
Name 3 forearm muscles that are not supplied the median nerve.
1. Flexor carpi ulnaris.
2. The medial half of flexor digitorum profundus.
3. Brachioradialis.
697
What are the 3 main groups of bones in the hand?
1. Carpal bones.
2. Metacarpals.
3. Phalanges.
698
How many phalanges does each finger have?
3.
699
How many phalanges does the thumb have?
2.
700
How many carpel bones are there?
8.
701
Why is the skin of the palm adherent to the underlying connective tissue?
To prevent the skin from slipping off the hand whilst gripping.
702
What is the carpal tunnel?
A space between the flexor retinaculum and the carpal bones.
703
What structures pass through the carpal tunnel?
Flexor tendons entering the hand and the median nerve.
704
What is the cause of carpal tunnel syndrome?
Swelling of the tendons increases the pressure in the tunnel and compresses on the median nerve.
705
What are the symptoms of carpal tunnel syndrome?
Pain, diminished sensation the hand and weakness of the thenar muscles.
706
What arteries form the superficial palmar arch?
The ulnar artery and a small contribution from the radial artery.
707
What is the superficial palmar arch?
An arterial arcade formed mainly by the ulnar artery that gives off 4 digital branches to the fingers.
708
What nerve branch arises from the median nerve in the forearm?
Palmar cutaneous nerve.
709
What does the palmar cutaneous branch of the median nerve innervate?
The skin of the lateral palm.
710
What are the two terminal branches of the median nerve?
1. Recurrent branch.
| 2. Palmar digital branch.
711
What does the palmar digital branch of the median nerve innervate?
The palmar surface and fingertips of the lateral 3.5 digits. It also gives motor innervation to the lateral 2 lumbricles.
712
What are the 3 main nerve branches of the ulnar nerve?
1. Palmar cutaneous branch.
2. Dorsal cutaneous branch.
3. Superficial branch.
713
What does the palmar cutaneous branch of the ulnar nerve innervate?
The skin on the medial half of the palm.
714
What does the dorsal cutaneous branch of the ulnar nerve innervate?
Skin of the medial 1.5 digits and the associated dorsal hand area.
715
What does the superficial branch of the ulnar nerve innervate?
The palmar surface of the medial 1.5 fingers.
716
What nerve and artery lie superficial to the flexor retinaculum?
The ulnar nerve and artery.
717
True or false: the ulnar nerve and artery pass through the carpal tunnel.
False. They lies superficial to the flexor retinaculum and so outside of the carpal tunnel.
718
What intrinsic hand muscles are innervated by the median nerve?
The 3 thenar muscles and the lateral 2 lumbricles.
719
Where are the thenar muscles located?
At the base of the thumb.
720
What is the action of the thenar muscles?
Fine movements of the thumb.
721
Name the 3 thenar muscles.
1. Abductors pollicis brevis.
2. Flexor pollicis brevis.
3. Opponens pollicis.
722
Where do the abductors pollicis brevis and flexor pollicis brevis insert?
The lateral aspect of the 1st phalanx of the thumb.
723
What is the action of opponens pollicis?
It opposes the thumb by medially rotating and flexing the metacarpal.
724
Where are the hypothenar muscles attached?
The little finger. They are mirror images of the thenar muscles.
725
What nerve innervates the hypothenar muscles?
The deep branch of the ulnar nerve.
726
Name the 3 hypothenar muscles.
1. Abductor digiti minimi.
2. Flexor digiti minimi.
3. Opponens digiti minimi.
727
How many lumbrical muscles are there in each hand?
4 - each associated with a finger.
728
What is the innervation to the lumbrical muscles.
- The medial 2 = deep branch of ulnar nerve.
| - The lateral 2 = median nerve.
729
What is the origin of the lumbricals?
The flexor digitorum profundus tendon.
730
What is the action of the lumbricals?
Flexion of the metacarphophalangeal joint and extension of the interphalangeal joints.
731
What covers the flexor tendons?
A fibrous flexor sheet that fans out into synovial sheaths.
732
What is the importance of the synovial sheath that covers the flexor tendons?
It reduces friction in flexion and extension.
733
What is the innervation to the interossei muscles?
The deep branch of the ulnar nerve.
734
What is the action of the dorsal interossei muscles?
Abduction.
735
What is the action of the palmar interossei muscles?
Adduction.
736
What carpal bones are most prone to injury?
The scaphoid is most prone to fracture and the lunate is most prone to dislocation.
737
What is the complication of a scaphoid fracture?
The artery supplying the scaphoid bone is often affected and so the bone can be without blood supply: avascular necrosis.
738
The ulnar artery and nerve lie superficially to the flexor retinaculum. Which lies medially?
The ulnar nerve lies medial and the artery lateral.
739
What is the cutaneous distribution of the median nerve?
The lateral palm of the hand and the palmar surface of the lateral 3.5 digits.
740
What is the cutaneous distribution of the ulnar nerve?
The medial palm of the hand and the palmar and dorsal surfaces of the medial 1.5 digits.
741
List the hand muscles supplied by the deep branch of the ulnar nerve.
1. Hypothenar muscles.
2. Medial 2 lumbricles.
3. Interossei muscles.
742
What are the 2 location where the ulnar nerve is often damaged?
At the elbow and at the wrist.
743
What is the termination of the cephalic vein?
Terminates with the axillary vein.
744
What is the common flexor origin?
Medial epicondyle of the humerus. Where the superficial anterior forearm muscles originate.
745
Which muscles in the forearm are supplied by the ulnar nerve?
- Flexor carpi ulnaris.
| - Medial flexor digitorum profundus.
746
Define pronation.
Turning the hand so the palm is facing down.
747
Define supination.
Turning the hand so the palm is facing up.
748
Which muscles are responsible for pronation?
Pronator teres and pronator quadratus.
749
What artery are the cords of the brachial plexus in relation to?
The axillary artery.
750
What artery are the trunks of the brachial plexus in relation to?
The subclavian artery.
751
What are the nerve roots for the long thoracic nerve?
C5-7.
752
What is the function of the pericardium?
It provides a friction free surface to accommodate the heart's sliding movements.
753
What nerve innervates the muscles of the posterior compartment of the forearm?
The radial nerve.
754
What are muscles of the posterior compartment of the forearm commonly known as?
Extensors - their general function is to produce extension at the wrist and fingers.
755
Which muscles of the posterior compartment of the forearm originate from the lateral epicondyle?
1. Extensor carpi radialis brevis.
2. Extensor carpi ulnaris.
3. Extensor digiti minimi.
4. Extensor digitorum.
756
Name the superficial muscles of the posterior compartment of the forearm.
1. Extensor carpi radialis brevis.
2. Extensor carpi radialis longus.
3. Extensor carpi ulnaris.
4. Extensor digiti minimi.
5. Extensor digitorum.
6. Brachioradialis - flexor but has all the characteristics of an extensor.
757
What is the action of brachioradialis?
Flexion at the elbow.
758
Where do the tendons of extensor carpi radialis longus and brevis insert?
The metacarpal bones 2 and 3.
759
What is the action of extensor carpi radialis longus and brevis?
Extension and abduction of the wrist.
760
What is the origin of extensor digitorum?
Lateral epicondyle of the humerus.
761
What is the action of extensor digitorum?
Extension of the medial four fingers at the MCP and IP joints.
762
What is the action of extensor digiti minimi?
Extension of the little finger.
763
What is the origin of extensor carpi ulnaris?
Lateral epicondyle of the humerus.
764
What is the insertion of extensor carpi ulnaris?
Base of metacarpal 5.
765
What is the action of extensor carpi ulnaris?
Extension and adduction of the wrist.
766
Where do extensors of the carpus insert?
Metacarpal bones.
767
What is wrist drop?
When the extensor of the wrist are paralysed due to paralysis of the radial nerve above the elbow. The flexors are unopposed and so you get wrist drop.
768
Name the deep muscles of the posterior compartment of the forearm.
1. Supinator.
2. Abductor pollicis longus.
3. Extensor pollicis longus.
4. Extensor pollicis brevis.
5. Extensor indicis.
769
What are the origins of the 2 heads of supinator?
1. Lateral epicondyle of humerus.
| 2. Posterior surface of the ulna.
770
What is the action of supinator?
Supinates the forearm.
771
What tendons forms the lateral wall of the anatomical snuffbox?
1. Extensor pollicis brevis.
| 2. Abductor pollicis longus.
772
What tendon forms the medial wall of the anatomical snuffbox?
Extensor pollicis longus.
773
What is the action of extensor pollicis brevis?
Extension at the metacarpophalangeal and interphalangeal joints of the thumb.
774
What is the action of extensor pollicis longus?
Extends all the joints of the thumb.
775
What is the action of extensor indicis?
It allows the index finger to be independent of the other fingers in extension.
776
What tendon does the tendon of extensor indicis join?
The extensor digitorum tendon.
777
What bone forms the floor of the anatomical snuffbox?
Scaphoid.
778
What might tenderness in the snuffbox region suggest?
Fracture of the scaphoid.
779
What artery, nerve and vein lie in the anatomical snuffbox?
- Radial artery.
- Branch of the radial nerve.
- Cephalic vein.
780
What are the two articulating surfaces of the elbow joint?
1. Trochlear notch of the ulna and trochlea of the humerus.
| 2. Head of the radius and capitulum of the humerus.
781
What are the movements of the elbow joint?
1. Extension of triceps brachii.
| 2. Flexion of brachialis, biceps brachii and brachioradialis.
782
What do the medial and lateral collateral ligaments of the elbow attach to?
The annular ligament.
783
What type of joints are the radioulnar joints?
Pivot joints.
784
What istructures articulate at the proximal radioulnar joint?
The head of the radius and the radial notch of the ulnar.
785
What are the movements of the radioulnar joints?
Pronation and supination.
786
Name 2 muscles responsible for pronation.
1. Pronator teres.
| 2. Pronator quadratus.
787
Name 2 muscles responsible for supination.
1. Supinator.
| 2. Biceps brachii.
788
What is the dermatome of the thumb?
C6.
789
What is the dermatome of the middle and index fingers?
C7.
790
What is the dermatome of the ring and little fingers?
C8.
791
What are the dermatomes of the anterior aspect of the arm?
C5 and T1 centrally. C6 laterally and C8 medially.
792
What separates the wrist joint from the inferior radio-ulnar joint?
Triangular fibrocartilage.
793
What does the head of the radius articulate with?
The capitulum of the humerus.
794
What does the trochlea of the humerus articulate with?
Trochlear notch of the ulna.
795
Contraction of the triceps will result in what action at the elbow?
Extension.
796
What 3 carpal bones form the wrist joint with the distal radius?
Scaphoid, lunate and triquetral bones.
797
What nerve innervates adductor pollicis?
Ulnar.
798
What are the 3 main long bones in the lower limb?
1. Femur (proximal).
2. Fibula (distal and lateral).
3. Tibia (distal and medial).
799
What nerve innervates the muscles in the anterior compartment of the thigh?
The femoral nerve, L2-4.
800
What is the action of the majority of the muscles in the anterior compartment of the thigh?
Extension of the leg at the knee.
801
What is the origin of psoas major?
Transverse processes of T12-L5 vertebrae.
802
What is the origin of iliacus?
The iliac fossa and the pelvis.
803
Where does iliopsoas insert?
The lesser trochanter of the femur.
804
What is the innervation to psoas major?
Anterior rami of L1-3.
805
What is the innervation to iliacus?
Femoral nerve L2-4.
806
What is the action if iliopsoas?
Flexes the lower limb at the hip.
807
What muscles make up quadriceps femoris?
1. Vastus medialis.
2. Vastus intermedius.
3. Vastus lateralis.
4. Rectus femoris.
808
What is the lower part of quadriceps femoris related to?
The suprapatellar bursa.
809
What attaches the patella to the tibia?
The patella ligament.
810
What is the action of the vasti muscles?
Extension at the knee.
811
What is the action of rectus femoris?
Extension at the knee and flexion at the hip.
812
What is the innervation of quadriceps femoris?
Femoral nerve, L2-4.
813
What is the origin of sartorious?
ASIS.
814
What is the action of sartorious?
Flexion, abduction and lateral rotation at the hip. Flexion at the knee.
815
What is the innervation to sartorious?
Femoral nerve, L2-4.
816
How can you test the action of quadriceps femoris?
Ask the patient to extend their legs against resistance whilst lying in a supine position.
817
What nerve innervates the muscles in the medial compartment of the thigh?
Obturator, L2-4.
818
What is the action of the majority of the muscles in the medial compartment of the thigh?
Hip adductors.
819
Name the 5 muscles found in the medial compartment of the thigh.
1. Gracilis.
2. Obturator externus.
3. Adductor brevis.
4. Adductor longus.
5. Adductor magnus.
820
Where do adductor brevis, adductor longus and adductor magnus originate and insert?
Origin: pubis.
Insertion: medial femur.
821
What is the action of adductor brevis, adductor longus and adductor magnus.
Adduction of the thigh.
822
What is the innervation of adductor brevis, adductor longus and adductor magnus.
Obtruator nerve, L2-4.
823
What forms the superior border of the femoral triangle?
The inguinal ligament.
824
What muscle forms the medial border of the femoral triangle?
Adductor longus.
825
What muscle forms the lateral border of the femoral triangle?
Sartorious.
826
What are the contents of the femoral triangle?
Femoral nerve, femoral artery, femoral vein and lymph nodes. NAV lateral to medial.
827
What is the femoral canal and what does it contain?
A potential space medial to the femoral vein. It contains lymph nodes.
828
Define hernia.
The protrusion of an organ through the wall of the cavity containing it.
829
What is a femoral hernia?
Protrusion of bowel into the femoral canal. This manifests as a bulge in the thigh.
830
What is the subsartorial canal?
A passageway for vessels extending from the femoral triangle to the popliteal fossa at the back of the knee.
831
What is the saphenous opening?
An opening in the fascia lacta pierced by the great saphenous vein.
832
What is the surface marking for the saphenous opening?
4cm below and lateral to the pubic tubercle.
833
What are the contents of the femoral sheath?
Femoral artery, veins and lymphatics.
834
What is the surface marking for the femoral artery?
2cm below the mid-inguinal point.
835
Where is the femoral artery pulsation palpable?
Below the mid-inguinal point.
836
Name the arteries in between the aorta and the femoral artery?
Aorta -> common iliac arteries -> external iliac arteries -> femoral artery.
837
Name the 2 main branches of the femoral artery.
1. Profunda femoris artery.
| 2. Superficial femoral artery.
838
Which veins join to become the common femoral vein?
The superficial femoral vein and the profunda femoris vein.
839
Name all the major veins blood flows through from the femoral vein to the heart?
Femoral vein -> external iliac vein -> common iliac vein -> IVC -> heart.
840
If you do a femoral puncture to take blood from the femoral vein, do you introduce the needle lateral or medial to the femoral arterial pulsation?
Medial. NAV therefore vein is medial to artery.
841
What is the motor supply of the femoral nerve?
Anterior thigh compartment muscles.
842
Which joints does the femoral nerve supply?
The hip and knee.
843
What are the problems produced by weak quadriceps?
Difficulty walking downstairs.
844
In what muscle is the obturator nerve formed?
Psoas major.
845
Define referred pain.
Pain arising from one area but it's felt elsewhere.
846
Give an example of referred pain in the leg.
Medial thigh pain can be felt due to inflammation of the ovary irritating the obturator nerve.
847
What is the femoral artery a continuation of?
The external iliac artery.
848
When does the external iliac artery become the femoral artery?
When it crosses under the inguinal ligament into the femoral triangle.
849
What artery does the obturator arise from?
The internal iliac artery.
850
Name the 3 glutei muscles.
1. Gluteus maximus.
2. Gluteus medius.
3. Gluteus minimus.
851
Where does gluteus maximus insert?
The iliotibial tract and the gluteal tuberosity of the femur.
852
What is the action of gluteus maximus?
Extension of the thigh.
853
What is the innervation of gluteus maximus?
Inferior gluteal nerve.
854
What is the action of gluteus medialis and minimus?
Abduction of the lower limb.
855
What is the innervation of gluteus medialis and minimus?
Superior gluteal nerve.
856
When do you abduct the hip joint?
When walking.
857
What is the usual function of the abductors of the hip joint?
They hold the pelvis level when you take one foot off the ground.
858
Where do gluteal vessels and nerves emerge from?
The greater sciatic foramen.
859
What are the nerve roots of the sciatic nerve?
L4-S3.
860
What does the sciatic nerve innervate?
The muscles of the posterior thigh and the hamstring part of adductor magnus.
861
What does the sciatic nerve bifurcate into?
The tibial and common peroneal (common fibular) nerves.
862
What 3 muscles make up the hamstrings?
1. Biceps femoris (lateral).
2. Semimembranous (medial).
3. Semitendinous.
863
What is the action of the muscles in the posterior compartment of the thigh?
Extension at the hip and flexion at the knee.
864
When do the extensors of the hip joint act?
When climbing the stairs.
865
What is the innervation of the muscles in the posterior compartment of the thigh?
Sciatic nerve L4-S3.
866
Where does the biceps femoris tendon insert?
The head of the fibula.
867
What muscle forms the superiomedial border of the politeal fossa?
Semimembranosus muscle.
868
What muscle forms the superiolateral border of the politeal fossa?
Biceps femoris.
869
What muscle forms the inferiormedial border of the politeal fossa?
Medial head of the gastrocnemius.
870
What muscle forms the inferiorlateral border of the politeal fossa?
Lateral head of the gastrocnemius and plantaris.
871
What forms the roof of the popliteal fossa?
Fascia.
872
What are the contents of the popliteal fossa?
1. Popliteal artery.
2. Popliteal vein.
3. Tibial nerve.
4. Common peroneal nerve.
873
How are the arteries, veins and nerves arranged in the popliteal fossa?
Usually NAV from lateral to medial. The nerve is always most superficial and the artery is always deepest.
874
How can you examine the hamstrings in the living?
Active flexion of the knee.
875
Name 4 muscles that insert on to the medial condyle of the tibia.
1. Semitendinosus.
2. Semimembranosus.
3. Sartorious.
4. Gracilis.
876
How does the popliteal artery reach the popliteal fossa?
As the femoral artery through the adductor canal.
877
What superficial vein drains into the popliteal vein?
The great saphenous vein.
878
What is the surface marking of the sciatic nerve?
Lower medial quadrant of the buttock.
879
What is the effect of a complete transection of the sciatic nerve?
Loss of hamstring function and of muscles below the knee.
880
What is the origin of the long head of the biceps, semitendinosus and semimembranosus?
The ischial tuberosity.
881
What is the origin of the short head of the biceps?
Linea aspera.
882
Where does biceps femoris tendon insert?
The head of the fibula.
883
Which of the hamstrings muscles lies most lateral?
The biceps femoris.
884
How can you identify semitendinosus?
It has a very long tendon attaching to the medial condyle of the tibia.
885
Define myotome.
A group of muscles supplied by the same spinal nerve root.
886
What is the dermatome of the clavicle?
C4.
887
What is the dermatome of the nipple?
T4.
888
What is the dermatome of the umbilicus?
T10.
889
What is the dermatome of the inguinal region?
T12.
890
What is the dermatome of the big toe?
L5.
891
What is the dermatome of the little toe?
S1.
892
What is the dermatome of the patella?
L3.
893
What is the myotome of the deltoid?
C5.
894
What is the myotome of the biceps?
C6.
895
What is the myotome of the triceps?
C7.
896
What is the myotome for leg adductors?
L2.
897
What is the myotome for the quadriceps?
L3.
898
You are examining a patient with a large spleen. How do you know on examination that you are palpating the spleen?
- Located in the upper left quadrant.
| - Unable to feel an upper border on palpitation.
899
What is the spinal reflex for the biceps?
C5/6.
900
What is the spinal reflex for the triceps?
C7/8.
901
What is the spinal reflex for the ankle?
S1/2.
902
Hypertrophy of the pyloric sphincter can cause what?
Vomiting of gastric contents.
903
What is the appendicular artery a branch of?
The ileocolic artery (branch of SMA).
904
Name 3 muscles in the anterior compartment of the leg.
1. Tibialis anterior.
2. Extensor digitorum longus.
3. Extensor hallucis longus.
905
What are the actions of the muscles in the anterior compartment of the leg?
Dorsiflexion and inversion. The extensors also extend the toes.
906
Describe dorsiflexion.
Flexing the ankle joint so that the toes are brought closer to the shin.
907
What is the innervation to the muscles in the anterior compartment of the leg?
Deep peroneal nerve (L4-5).
908
What is the deep peroneal nerve a branch of?
The common peroneal nerve, which is a branch of the sciatic nerve.
909
What is the action of tibialis anterior?
Dorsiflexion and inversion of the foot.
910
Describe inversion of the foot.
Turning the ankle so that the plantar surface of the foot faces medially.
911
What is the action of extensor digitorum longus?
Dorsiflexion of the foot and extension of the toes.
912
What is the action of extensor hallucis longus?
Dorsiflexion of the foot and extension of the toes.
913
Where does extensor hallucis longus insert?
The great toe.
914
What is the blood supply to the muscles in the anterior compartment of the leg?
Anterior tibial artery.
915
What is the origin of extensor digitorum longus?
Lateral condyle of the tibia and medial fibula.
916
What can cause foot drop?
Damage to the common peroneal nerve and so paralysis of the dorsiflexors.
917
What is foot drop?
When the foot is permanently plantarflexed as the action of these muscles in unopposed due to paralysis of the dorsiflexors.
918
Name 2 muscles in the lateral compartment of the leg.
Peroneal brevis and longus.
919
What are the actions of the muscles in the lateral compartment of the thigh?
Eversion and plantarflexion.
920
What do the tendons of peroneal brevis and longus pass posteriorly to in the foot?
The lateral malleolus.
921
What is the innervation to the muscles in the lateral compartment of the thigh?
Superficial peroneal nerve.
922
Name 2 superficial muscles in the posterior compartment of the thigh.
Soleus and gastrocnemius.
923
How many heads does gastrocnemius have?
2 - medial and lateral. They form the inferior borders of the popliteal fossa.
924
What is the origin of gastrocnemius?
- Medial head: medial condyle of the femur.
| - Lateral head: lateral condyle of the femur.
925
What is the insertion of gastrocnemius?
It combines with soleus to form the calcaneal tendon which inserts onto the calcaneus.
926
What are the 2 actions of gastrocnemius?
Plantarflexion at the ankle and flexion at the knee.
927
What other muscle combines to form the calcaneal tendon with gastrocnemius?
Soleus.
928
What is the action of soleus?
Plantarflexion.
929
What is the innervation to the posterior compartment of the leg?
Tibial nerve.
930
In what compartment of thelower limb are the hamstrings located?
The posterior thigh.
931
Name 4 deep muscles in the posterior compartment of the leg.
1. Popliteus.
2. Flexor digitorum longus.
3. Flexor hallucis longus.
4. Tibialis posterior.
932
How many tarsal bones are there?
7.
933
Which nerve winds around the neck of the fibula?
The common peroneal nerve.
934
Complete transection of the common peroneal nerve can cause what clinical sign?
Foot drop.
935
The muscles that form the calcaneus tendon are all supplied by which nerve?
Tibial nerve.
936
Does the long saphenous vein cross anterior or posterior to the medial malleolus?
Anterior.
937
What veins drain the superficial leg?
Short and long saphenous veins. The short saphenous vein drains the posterior leg.
938
How do the superficial and deep veins of the leg communicate?
Via perforators which pass through the deep fascia.
939
What area of the leg receives skin sensation from the superficial peroneal nerve?
Anterolateral inferior 1/3 of the leg.
940
What area of the foot receives skin sensation from the deep peroneal nerve?
Dorsum of the first web space.
941
What area of the leg receives skin sensation from the saphenous nerve?
Medial leg.
942
What area of the leg receives skin sensation from the posterior cutaneous nerve of the thigh?
Popliteal fossa.
943
What area of the foot receives skin sensation from the tibial nerve?
Medial sole of foot.
944
Describe compartment syndrome.
Bleeding, oedema or infection increase the pressure in a compartment. The increased pressure means blood flow will cease which results in ischemia.
945
How can you test tibialis anterior?
Dorsiflexion at the ankle.
946
How can you test extensor digitorum longus?
Extension of the toes.
947
How can you test extensor hallucis longus?
Extension of the great toe.
948
Which muscle compartment is supplied by the deep peroneal nerve?
Anterior leg.
949
Does the deep peroneal nerve innervate skin? If so, where?
Innervates the first dorsal web space.
950
What is the anterior tibial artery a branch of?
The popliteal artery. (Popliteal artery is a branch of the femoral artery).
951
Which artery is the dorsal pedis artery a branch of?
The anterior tibial artery.
952
When might the pulsation of the dorsal pedis artery be absent?
If the anterior tibial artery is blocked.
953
What are the actions of the peroneii muscles?
Eversion of the foot.
954
What muscles make up the peroneii muscles?
- Peroneal longus.
| - Peroneal brevis.
955
What nerve innervates the peroneii muscles?
Superficial peroneal nerve.
956
How can you test the peroneii muscles?
Eversion against resistance.
957
Which nerve injury will lead to paralysis of the peroneii muscles?
Superificial peroneal nerve or common peroneal nerve.
958
What muscles are paralysed by damage to the common peroneal nerve?
1. Peroneal longus and brevis (lateral compartment).
| 2. Tibialis anterior, extensor longus digitorum and extensor longus hallucis (anterior compartment).
959
Describe the gait of a patient who has had complete teansection of the common peroneal nerve.
- Foot drop.
| - High steps to avoid stubbing toes.
960
Which leg bone has more muscle attached to it?
Fibula.
961
Why is the blood supply to the shaft of the tibia relatively poor?
The tibia has few muscles attached it. Attached muscles are responsible for supplying the majority of blood to a bone.
962
Why do fractures of the tibia take a long time to heal?
Poor blood supply.
963
How do you test the gastrocnemius?
Ask the patient to stand on their tip toes.
964
What is the fibular artery a branch of?
The posterior tibial artery.
965
Describe the ankle jerk reflex.
Tapping the achilles/calcaneal tendon acutely stretches the gastrocnemius. This results in a reflex contraction of the muscle.
966
Which segments of the spinal cord are you testing when you elicit the ankle jerk reflex?
S1,2.
967
Which segments of the spinal cord are you testing when you elicit the knee jerk reflex?
L2,3,4.
968
Which muscle compartment is supplied by the tibial nerve?
Posterior leg.
969
What are the structures in the tarsal tunnel deep to the retinaculum?
Tibial nerve.
970
What type of joint is the hip joint?
Ball and socket, synovial.
971
What is the main function of the hip joint?
To bear weight - its range of movements is therefore limited.
972
What bones articulate in the hip joint?
The femoral head articulates with the acetabulum of the pelvis.
973
What is the intrascapular ligament of the hip joint?
The ligament of the head of the femur.
974
Name the 3 extrascapular ligaments of the hip joint.
- Iliofemoral.
- Ischiofemoral.
- Pubofemoral.
975
Which extrascapular ligament of the hip joint is located most posteriorly?
Ischiofemoral.
976
Give 2 features of the acetabulum which add stability to the hip joint.
1. It is deep and encompasses nearly all of the head of the femur.
2. It is surrounded by the acetabular labrum which increases its depth and provides a larger articular surface.
977
What is the name of the fibrocartilage collar that surrounds the acetabulum?
The acetabular labrum.
978
Give 2 functions of the acetabular labrum.
1. Increases the depth of the acetabulum.
| 2. Provides a larger articulating surface.
979
The circumflex femoral arteries supply the hip joint. What are they a branch of?
The profunda femoris artery.
980
What nerves innervate the hip joint?
Sciatic, obturator and femoral.
| Any nerve supplying a muscles which moves a joint also innervates the joint
981
What type of joint is the knee joint?
Hinge, synovial.
982
What are the 2 articulations of the knee joint?
1. Tibiofemoral.
| 2. Patellofemoral.
983
What is the function of the tibiofemoral articulation?
It is the weight bearing joint.
984
What is the function of the patellofemoral articulation?
It aloows the quadriceps femoris tendon to be onserted over the knee.
985
Give 3 functions of the medial and lateral menisci.
1. Shock absorbers.
2. Permit some rotation.
3. Deepen the articulating surfaces and so increase stability.
986
What are the medial and lateral menisci both attached to?
The intercondylar area of the tibia.
987
What is the medial meniscus attached to?
1. Intercondylar area of the tibia.
2. Tibial (medial) collateral ligament.
3. Joint capsule.
988
What is the lateral meniscus attached to?
The intercondylar area of the tibia.
989
Which meniscus is more prone to injury?
Medial meniscus - its extra attachments to the medial collateral ligament and joint capsule mean it is less mobile and so more prone to damage.
990
What is the patellar ligament a continuation of?
The quadriceps femoris tendon distal to the patella.
991
What is the function of the collateral ligaments?
To stabilise the hinge motion of the knee.
992
Name the 2 collateral ligaments of the knee.
1. Tibial (medial) - more prone to injury.
| 2. Fibular (lateral) - thinner and rounder.
993
What bones do the cruciate ligaments attach to?
The femur and the tibia.
994
Where does the anterior cruciate ligament attach?
The anterior intercondylar region of the tibia and the posterior femur.
995
Where does the posterior cruciate ligament attach?
The posterior intercondylar region of the tibia and the anterior femur.
996
What is the function of the cruciate ligaments?
They stabilise the knee in the anterior and posterior direction. Prevent dislocation.
997
Which ligament of the knee is extrascapular?
Lateral collateral.
998
What parts of the knee are intrascapular?
Menisci, ACL and PCL.
999
If a force is applied to the lateral aspect of a fixed knee which collateral ligament would be damaged?
This would stretch the medial aspect of the knee resulting in damage to the medial collateral ligaments.
1000
What type of joint is the ankle joint?
Hinge, synovial.
1001
What movements are permitted at the ankle joint?
Dorsiflexion and plantarflexion.
1002
Which muscles of the leg are responsible for dorsiflexion?
Tibialis anterior, extensor hallucis longus and extensor digitorum longus (anterior compartment).
1003
Which muscles of the leg are responsible for plantarflexion?
Gastrocnemius and soleus (posterior compartment).
1004
What 3 bones make up the ankle joint?
Tibia, fibula and talus.
1005
What binds the tibia and fibular?
Tibiofibular ligaments.
1006
What do the tibia and fibula form that the talus articulates with?
A mortise.
1007
What is the name of the ligament originating from the medial malleolus of the foot?
The deltoid ligament.
1008
What 3 ligaments are found on the lateral side of the ankle joint?
1. Anterior talofibular.
2. Posterior talofibular.
3. Calcaneofibular.
1009
What type of joint is the superior tibiofibular joint?
Synovial.
1010
What type of joint is the inferior tibiofibular joint?
Fibrous.
1011
What movements occur at the subtalar joint?
Inversion and eversion.
1012
What movements enable one to walk on uneven ground?
Inversion and eversion.
1013
What 3 bones articulate in the subtalar joint?
1. Talus.
2. Calcaneus.
3. Navicular bone.
1014
What ligament does the talus articulate with in the subtalar joint?
Spring ligament.
1015
What joint shares the same synovial cavity as the subtalar joint?
Midtarsal joint.
1016
What muscles are the predominant invertors?
Tibialis anterior and posterior.
1017
What muscles are the predominant evertors?
Peroneus longus and brevis.
1018
What muscles support the pelvis when standing on one leg?
Gluteus medius and minimus.
1019
In posterior dislocations of the hip which nerve is liable to injury?
Sciatic.
1020
What accompanies the ligament of the head of the femur in children?
Blood vessels supplying the femoral head epiphyses.
1021
What is the usual cause of avascular necrosis of the head of the femur in adults?
Fractured neck of the femur.
1022
A child with a hip joint disease has pain in the knee joint. What is this due to?
The sciatic nerve supplies the hip and the knee and so this is likely to be referred pain.
1023
What is the action of popliteus?
Twists the tibia on the femur to unlock the knee.
1024
What are the functions of the quadriceps?
Extension at the knee and flexion at the hip.
1025
How might the ACL be injured?
Hyperextension, common in sports injuries.
1026
What are bakers cyst and housemaids knee?
Clinical presentations of patella bursae inflammation.
1027
What is the function of the patella?
Transfers force from the quadriceps over the knee to the tibia.
1028
What are the attachments of the patella?
Quadriceps femoris tendon superiorly and patellar ligament inferiorly.
1029
Inversion and eversion take place mainly at which joint?
Subtalar.
1030
What 2 bones does the talus articulate with?
Navicular and calcaneus.
1031
Name 3 things that support the medial longitudinal arch of the foot.
1. The plantar aponeurosis.
2. The spring ligament.
3. The flexor hallucis longus.
1032
Which muscle fibres stabilise the patella?
The vasti muscles of the quadriceps.
1033
What is the nerve supply of the stomach?
Parasympathetic nerve supply comes from the posterior and anterior vagal trunks, derived from the vagus nerve. Sympathetic from the celiac plexus.
1034
What is the blood supply to the anterior compartment of the leg?
Anterior tibial artery.
1035
What is the blood supply to the posterior compartment of the leg?
Posterior tibial artery.
1036
What is the blood supply to the lateral compartment of the leg?
Peroneal artery.
1037
What is the innervation to the anterior compartment of the leg?
Deep peroneal nerve.
1038
What is the innervation to the posterior compartment of the leg?
Tibial nerve.
1039
What is the innervation to the lateral compartment of the leg?
Superficial peroneal nerve.
1040
Which muscles extend the knee?
Quadriceps femoris - anterior thigh.
1041
Which muscles flex the knee?
Hamstrings - posterior thigh.
1042
If you damage the lateral collateral ligament of the knee would there be any blood?
No, the lateral collateral ligament is extrcapsular.
1043
What structure is the median arcuate ligament related to?
The aorta.
1044
What muscle is the medial arcuate ligament related to?
Psoas major.
1045
What muscle is the lateral arcuate ligament related to?
Quadratus lumborum.
