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MRCS part B- JMB > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Name parts of cervical, thoracic and lumbar vertebrae

A

https://www.getbodysmart.com/skeletal-system-quizzes/cervical-vertebrae-quiz

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2
Q

Divisions of subclavian artery

A

Vertebral
Internal thoracic
Thoraco dorsal

Cervical
Dorsal scapular

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3
Q

What is the path of the vertebral artery?

A 
1st part of subclavian
Posterior to ant scalene
To c6 transverse process for amen
Up to c2
At c1 horizontal extradural part in occipital triangle
Enters spinal canal
Joins basilar artery
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4
Q

Most common c spine fracture?

Types and management?

A

Odontoid peg
Type 1 tip of peg- Miami j
Type 2 waist of peg- high risk of non union- watershed blood supply from vertebral artery
Type 3 extension into c2 body- Miami j

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5
Q

What is the origin of the mental nerve?

A

V3 and inf alveolar nerve

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6
Q

Muscles of mastication?

A

Temporalis
Masseter
Lateral- opens jaw
Medial pterygoid- closed jaw

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7
Q

Muscles of the tongue?

A 
Intrinsic- longitudinal, transverse, vertical
Extrinsic- genioglossus- cn xii
Myoglossus cnxii
Hyoglossus cn xii
Palatoglossus- cn x
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8
Q

Tongue sensation?

A

Anterior 2/3
Somatic sensation- lingual of v3
Taste- chords tympani

Post 1/3
Glossopharyngeal

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9
Q

Structures that run through parotid gland?

A

Cnvii
External carotid a
Retromandibular vein
Lymph nodes

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10
Q

Course of facial nerve?

A 
Pontine medullary junction
Through internal auditory meatus
To geniculate ganglion
Gives off staepedius, greater pertrosal, chorda tympani
Stylomastoid foramen
To parotid gland
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11
Q

Blood supply of thyroid gland?

A

Superior thyroid a
Inf thyroid a
Thyroid ima

Sup and middle thyroid being drain to ijv
Inferior thyroid being drains to brachiocephalic vein

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12
Q

Nerve supply of laryngeal muscles?

A

Recurrently laryngeal to all bar…
Cricothroid muscle- external laryngeal

Sensation above vocal cords is internal laryngeal n
Below is recurrent laryngeal

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13
Q

Recurrent laryngeal nerve palsy symptoms?

External laryngeal?

A

Hoarseness

High pitched voice

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14
Q

Facial compartments of the neck?

A

Investing
Pretracheal
Prevertebral
Carotid sheath

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15
Q

Name parts of the rib

A 
Head- 2 articular facets
Neck
Shaft
Tubercle
Costal groove
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16
Q

Structures around scalene anterior?

A

Anterior- subclavian vein and phrenic nerve

Post- subclavian a and brachial plexsus

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17
Q

Thoracic outlet syndrome definition and aetiology and test

A

Compression of NV bundle going from neck to arm

Anatomical- cervical rib, fibromuscular bands
Traumatic- axillary vein thrombosis, repetitive movements- squash
Costoclavicular space entrapment

Roo’s test- arm. Abducted, ext rotation and flex. Hand flexion. Symptoms recreated

Adsons

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18
Q

Superior mediastinum contents?

A 
Thymus
Trachea
Thoracic duct
Phrenic and vagus nerves
Symph chain
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19
Q

Inferior mediastinum contents?

A

Ant- thymus
Middle- phrenic, pericardium
Post- vagus, thoracic duct, azygous, symph trunk (DATES)

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20
Q

What blood vessel supplies the san and avn?
And what veins drain them?
And what is heart dominance

A

San- rca/LCX
Avn- RCA/LCX

Veins
Great cardiac- drains lad
Middle cardiac drains pda

Heart dominance- which artery the PDA comes off

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21
Q

What are the impression in the lung hilum?

A

Right- svc superior
Azygous vein inferior

Left- aortic arch
Heart

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22
Q

Diaphragmatic openings?

A

Caval- ivc and right phrenic
Oesophageal- oesophageal, vagus nerves, left gastric vessels
Aortic- aorta, thoracic duct, azygous, hemiazygous

Left phrenic pierced diaphragm
Sup epigastric vessels
Symph trunk

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23
Q

Adrenal bloody supply

A

Superior from inf phrenic
Middle from aorta
Inferior from renal a

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24
Q

Retroperitoneal structures?

A 
Ivc
Supra renal glands
Aorta and ivc
Duodenum- all bar first 2cm
Pancreas- all bar tail
Ureters
Colon ascending and descending
Kidneys
Esophageus
Rectum (upper 2/3)
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25
Q

Layers of scrotum?

A 
Skin
Dartos
External
Cremasteric
Internal
Tunica vaginalis
Tunica albuginea
Testes
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26
Q

Lymphatic drainage of scrotum and testis?

A

Scrotal skin to inguinal

Testis to para aortic

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27
Q

Spermatic cord contents?

A

Artery to vas
Cremasteric artery
Testicular a

Pampiniform plexuss
Lymphatics
Vas deferens

Genital branch of genitofemoral n
Ilioinguinal n- runs outside canal
Symphathetics

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28
Q

Axillary a divisions

A

Save the lawyer, screw a patient

Superior thoracic
Thoracoacromial
Lateral thoracic
Subscapular
Anterior humeral circumflex
Post humeral circumflex
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29
Q

Rotator cuff muscles?

A

Suprascapular- abduction- greater trochanter
Infrascapular- external rotation gt
Subscaparis- internal rotation- lt
Teres minor adduction + external rotation- gt

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30
Q

Boarders and contents of antecubital fossa?

A

Lateral epi to medial epi
Brachioradialis
Pronator teres

Contents
Median nerve
Brachial a 
Biceps tendon
Radial nerve- between brachialis and brachioradialis
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31
Q

Contents of carpal tunnel?

A

Fpl
Fdp
Median nerve
Fpl

Fcr runs outside

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32
Q

Extensor compartments of the wrist?

A 
Lateral to medial
1-epb and apl
2- ecrl and ecrb
3- epl
4- extensor in incidis + post interosseous n + extensor digitorum
5- edm
6-ecu
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33
Q

Short rotators of the hip?

A

Piriformis
Gemelli
Obturator
Quadratus femoris

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34
Q

Blood supply of the femoral head?

A

Retinacular vessels from circumflex femoral a
Interosseous
Ligamentum teres artery

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35
Q

Paths of great and short saphenous veins?

A 
Great drains medial dorsal arch
Ant to medial malleolus
Posteromedial to patella
Through saphenous tunnel?
Piercers tensor fascia Lata
Joins at saphenofemoral junction- below and lateral to pubic tubercle

Short
Lay margin of dorsal arch
Post to lateral malleolus
Joins popliteal vein

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36
Q

Femoral triangle content boarders floor

A

Navy + lymphatics
Sartorial inguinal ligament adductor longus

Iliopsoas, pectineus, adductor longus

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37
Q

Femoral canal boarders and content?

A

Inguinal lig, femoral vein, lacunae ligament medially, pubic rami/pectineus

Empty space- allows for expansion of femoral vein
Cloquet’s lymph node

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38
Q

Boarders of inguinal canal and locations of ring?

A

Ant- eo
Sup- arching fibres of io and ta
Post- tf
Inferior- inguinal ligament

Deep ring- superior to mid inguinal point
Superficial- above pubic tubercle

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39
Q

Contents of adductor canal?

A 
Sfa
Descending genicular arteries
Femoral vein
Long saphenous n
N to Vastus medialis
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40
Q

Popliteal fossa boundaries

A

Semimembranosus/semitendinosus
Biceps femoris
Gastrocnemius

Contents- deep to superficial
Popliteal a
Popliteal vein
Tibial nerve

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41
Q

Lower limb compartments and nerve and blood supply?

A

Anterior- tibia ant, ehl, extensor digitorum, peroneus tertius
Deep peroneal and ant tibia artery

Lateral peroneal longus and brevis
Superficial peroneal and peroneal artery

Posterior deep- fdl, fhl, tibialis post, popliteus
Superficial- gastrocnemius, soleus, plantaris

Tibia nerve, post tibial a

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42
Q

Structures posterior to medial malleolus

A

Tom dick and very nervous Harry
Ant to post

Tibialis post
Flexor digitorum
Post tibial a
Post Tibial vein
Tibial nerve
Fhl
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43
Q

Ankle ligaments?

A

Tibular and fibula ant and post
Laterally- talofibular ant and post
Calcaneofibular and bifurcate

Medially deltoid ligament
Superficial tibionavicular and tibicalcaneal log
Deep tibiotalar ant and post

Arches
Long and short plantar reinforce lateral arch
Spring ligament- reinforces medial arch

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44
Q

Cranial fossa and structures passing through

+ cranial fossa boundaries

A

Ant fossa- frontal, ethmoidal and sphenoid bones
Frontal bone + lesser wings/limbus of sphenoid bone

Middle fossa- sphenoid and temporal bones
Lesser wings/limbus of sphenoid bone anterior to petrous temporal and dorsum sella posteriorly

Post fossa- occipital, temporal bones
Ant- dorsum sella/clivus and petrous temporal bones to squamous occipital bone

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45
Q

Contents of superior orbital fissure?

Inferior orbital?

A 
Cn 3
Cn 4
Cn 6
Cn v1- ophthalmic
Ophthalmic vein

Inferior ophthalmic vein
Cnv2- zygomatic n
Infraorbital artery and vein and nerve

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46
Q

Csf
Volume
Secreted by?
Cycle

A 
150-200 mls circulating volume
Secreted by choroid plexus
Into lateral ventricles
Foramen of Munro to 3rd ventricle
Slyvius aqueduct to 4th ventricle
Magedie and Lusaka to subarachnoid space
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47
Q

Cranial nerve origins ?

A 
Olfactory epithelium cn 1
Retinal epithelium cn 2
Midbrain cn 3/4/5
Pons cn 6/7
Cerebellopontine angle cn 8
Medulla cn 9/10/11/12
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48
Q

Types of spinal cord nerve pathways

A

Ascending
Spinothalamic- pain and temp
Dorsal columns- fine touch vibration and proprioception
Spinocerebellar- unconscious propioception

Decscending
Corticospinal- skilled and discrete movements
Extrapyramidal system- modulation and regulation of movement

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49
Q

Draw brachial plexus

A
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50
Q

Contents of carotid sheath

Where does carotid divide?

A

Cca, vagus, ivc
And a cervicalis
Cn 9.11,12

Splits at c4

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51
Q

Divisions of ica?

A 
Opthalmic a
Ant choroidal
An cerebral
Middle cerebral
Post communicating
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52
Q

Describe the parasympathetic nervous system

A

3, 7,9,10
S2-4

3 to ciliary ganglion
7 to pterygopalatine and submandibular ganglion
9 to otic ganglion
10 to rest of body

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53
Q

location and contents of transpyloric plane?

A

L1- halfway between pubic symphysis and jugular notch

Contains
Pylorus, neck of pancreas, joining of SMV and splenic vein, SMA, Renal hilum, end of spinal cord, fundus of gallbladder, splenic hilla, cisterna chyli, colonic/hepatic flexure

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54
Q

Surface anatomy of the liver?

A

5th IC to 10th IC in midclavicular line then to 5th IC

Runs along nipple line

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55
Q

Splenic surface anatomy?

A

Overlied by ribs 9-11 posteriorly

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56
Q

Aorta paired and unpaired branches?

A 
Paired- phrenic arteries T12
Renal As L1/2
Testicular As L2
Iliac As L4
Lumbar As L1-4
Middle suprarenal As L1
Unpaired
Coelia
SMA
IMA
Middle sacral
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57
Q

Surface anatomy of the kidneys?

A

Right is 12 th rib

Left is 11/12th rib

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58
Q

Function of the spleen?

A 
FISH
Filtration of encapsulated organisms (n.menigitidis, s.pneumonia, pneumococcus)/WBC/RBCs/Platelets
Immunological (lymphocyte production)
Storage of platelets
Haemtopoesis in fetus
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59
Q

Portosystemic anastomosis areas?

A 
Bare area of liver
Periumbilical area
Upper rectum
Oesophageal
Retroperitoneum
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60
Q

Areas where fluid/pus collects in abdomen?

A 
R and left paracolic gutters
R subhepatic space
Pelvis
Inbetween bowel loops
R and left subphrenic spaces
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61
Q

Stomach and pancreas parts?

A

Stomach- antrum, fundus, pylorus, cardia, body

Pancreas- head, ucinate process, neck, body, tail

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62
Q

Difference between jejunum and ileum

A

Jejunum more proximal
Bigger and thicker
Longer vasa recta, fewer arcade

Jejunum has thinner mesentry and more arcades
More vascular?

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63
Q

Describe the endocrine and exocrine function of the pancreas?

A

Exocrine function- acinic cells, produce digestive enzymes

Endocrine- alpha cells- glucagon
Beta cells- insulin
Delta cells- somatostatin (inhibitory hormone of the others)

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64
Q

What is a Meckel’s diverticulum and what is its hernia?

A

Failure of the obliteration of the Vitelointestinal duct
Littre’s hernia

Rule of 2s, 2% population, 2:1 male to femal, 2 feet from ileocaecal junction, 2 inches in length

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65
Q

What is produced in the adrenals?

A

Adrenal cortex- GFR ACE
Zona glomerulosa- Aldosterone
Zona fasculata- Cortisol (gluccocorticoids)
Zona reticularis- Androgens

Adrenal medulla- epi/norepi

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66
Q

Order of vessels at renal hila?

A

Ant to post

Vein
Artery
Ureter (runs posteriorly over psoas major and iliacus

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67
Q

What is the ureter crossed by?

A

Gonadal vessels
Left side is crossed by left colic A
Right by ileocolic and right colic As

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68
Q

What is the blood supply to the ureter?

A

Segmental
Superior- Renal
Middle- gonadal and common iliac
Inferior- internal iliac- uterine and superior vesicular

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69
Q

Different positions of the appendix?

A 
Retrocaecal
Subcaecal
Pelvic
Preileal
Post ileal
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70
Q

Blood supply and nerve supply of rectum?

A

Sup rectal A- from IMA
Middle Rectal A from internal iliac
Inferior rectal A from Internal pudendal

Symph from sup hypogastric plexus and lumbar splanchnics
Parasymph from S2,3,4

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71
Q

How many valves are there in the ureter?

A

Just one- false valve
Detrusor muscle forms muscular sphincter
When contraction of detrusor muscle in closes ureter and prevents back flow

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72
Q

Nerve supply to bladder?

A

Hypogastric plexus- symph

S2-4 gives parasymph

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73
Q

What makes up the conjoint tendon and lacunar ligament of the inguinal canal?

A

Conjoint tendon- medial posterior injuinal canal stabiliser- TA and IO

Lacunar lig- medial floor inguinal canal stabliser

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74
Q

What is the nerve supply to EO?

A

Intercostal N (lower 6) and subcostal N

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75
Q

Why do you get abdominal pain with testicular torsion?

A

T10 nerve supply- radiation to umbilicus

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76
Q

Nerves at risk in hernia repair?

A

Ilioinguinal- runs outside of cord but in canal
Sensation loss to anterior scrotum, base of penis and groin

Iliohypogastric- pierces EO medially, sensation to base of pubis

Genital branch of genfem- Loss of cremaster muscle, sensation scrotum

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77
Q

Oesophageal arterial and lymphatic supply?

A

Segmental!!!

Superior- inferior thyroid artery => deep cervical LNs
Middle- aortic branches=> mediastinal LNs
Inferior- oesophageal branches of left gastric and inf phrenic => left gastric and coeliac nodes

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78
Q

Types of oesophageal hernias?

A

Congenital- Morganis, Bouchdalek’s

Acquired- sliding (90%) and rolling

Fixed by oesophageal fundoplication

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79
Q

What is Barrett’s oeosphageus?

A

Chronic GORD
leads to metaplasia of the lower oesophageus and rolling up the Sq cells to replace columnar cells
Premalignany SqCC of oesophageus

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80
Q

Constriction points of the oesophageus?

A

Arch of aorta
Bronchus- left
Cricoid cartillage
Diaphram

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81
Q

What is the surface A of the GB
The contents of calot’s triangle
And what stiumlates the contraction of the gallbladder?

A

9th costal margin to lateral edge of the rectus muscle
Tranpyloric plane

Cystic A and Nodes of Lund

CCK- cholecystokinin

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82
Q

Surface A of breast?

A

2nd to 6th costal cartilage, sternum to mid axillary line

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83
Q

Deep muscle relations of the breasts?

A

Serratus Ant
Pec major and mine
Rectus
Latissiumus dorsi

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84
Q

Structure of the breast

A

15-20 lobule per breast, each drain to a lactiferous duct and sinus and join via the nipple

85
Q

What are Cooper’s ligament?

A

Suspensory ligaments that extend from the subcutaneous fat to the deep fascia
Malignany infiltration leads to puckering and retraction of the skin

86
Q

What is the lymphatic drainage of the breast?

A

75% via axillary LN
Parasternal and post intercostal LNs
Supraclavicular LNs
ContraL breast

87
Q

What is the nerve and blood supply of the breast?

A

N- intercostal Nerves 4-6

Blood
Internal thoracic A
Lat thoracic/thoraco acromial branch
Intercostal As

88
Q

Location of DP and PT?

A

DP lateral to EHL- between 1 and 2 metatarsal

PT 2-3 cm behind medial malleolus

89
Q

Where do the peroneal muscles insert?

A

Peroneus longus-head of fibula to medial cuneiform and 1st metatarsal base

Brevis- onto 5th metatarsal

Tertius- onto 5th metatarsal

90
Q

Which muscles invert and evert the foot?

A

Inversion- tib ant and post and EHL

Eversio- peroneal muscles

91
Q

What attaches to the linea aspera in the thigh?

A

Lateral ridge- Gleuteal tuberosity- gleuteus maximus/ vastus lateralis
Intermediate ridge- pectineal line- pectineus
Medial ridge- vastus medialis
Adductor magnus
Short head of biceps femoris

92
Q

Describe the fasciotomy incision for the lower leg?

A

4 compartment fasciotomy

2 incisions

Anterior and lateral compartments- 2cm ant to fibula from tibial tuberosity to sup to ankle

Post compartments- posteromedial to tibial, tuberisty to 5cm above medial malleolus

93
Q

Where does popliteal A divide and where does tibioperoneal A divide?

A

Popliteal A divides at soleus arch in fossa into anterior tibial A and tibioperoneal trunk

TP trunk divides 2-5cm below this into post tibial and peroneal A

94
Q

How to tell ACL and PCL apart?

A

ACL is hands in front pockets- post to ant
Lateral post intercondylar notch on femur to medial ant tibial spine

PCL is hands in back pockets
reveres of above

95
Q

What NVI to be aware of in anteromedial approach to the knee?

A

Geniculate As
Long saphenous
Saphenous N

96
Q

What makes up the blood supply to the knee?

A

An anastomotic mesh of femoral, popliteal and cural As

Sup and inf geniculate As
Middle geniculate- supplies ACL and PCL

97
Q

What is contained in popliteal fossa?

A 
Superfiscial to deep
N- common peroneal and tibial
V- popliteal vein
A- popliteal A
LNs

Floor is knee joint, femur and popliteus

98
Q

What are the divisions of the axillary A?

A

1st- Sup thoracic
2nd- Thoracoacromial and Lat thoracic
3rd- Subscapular, ant and post circumflex humeral

Split by pec minor

99
Q

What is the glenoid labrum?

A

Fibrocartillage collar of glenoid fossa

100
Q

What cause shoulder impingement syndrome?

A

Painful arc from 60-120
Coracoacromial lig- compression of suprascapular lig
Subacromial bursitis

101
Q

What are the boarders of the quadrangular space and what does it contain?

A

Humerus, teres minor and major and latissimus dorsi

Contains- post circumflex humeral a, axillary N

102
Q

Where is the triangular space and its contents?

A

Teres minor and major and long head of triceps

Cicrumflex scapular A

103
Q

Where is the triangular interval and its contents?

A

Triceps long head, teres major and triceps lateral head/humerus

Radial N and profuna brachii artery

104
Q

What supplies the rhomboids?

A

Dorsal scapular Nerve- C5

105
Q

What are the 3 arches of the foot?

A

Transverse- metatarsal heads, peroneus longus and interossei ligs
Medial- spring lig and tarsal bones and interosseous ligs
Lalteral- long and short plantar ligs and bones

106
Q

What are the joints of the elbow?

A

HUmero ulna- trochlea and olecranon
Humero radial- capitelum and radial head
Ulnaradial- radial head and radial notch

107
Q

What are the flexors of the elbow?

A

Brachialis, biceps and brachioradialis

108
Q

What is the contents and boarders of antecubital fossa?

A

Floor- supinator and brachialis
Roof- bicipital apoN
Lateral- brachioradialis
Medial- pronator teres

Contents
Medial to lateral
Median nerve, brachial a, bicipital tendon, radial nerve

109
Q

What are the compartments of the forearm?

A

Volar and dorsal

Volar- superfiscial- FDS, FCR, FCU, PT and PL (from medial epicondyle)
Deep- from forearm- FPL, FDP, PQ

Mobile wad- Brachioradialis and ECRL/B

Dorsal- Superfiscial- ECU and aconeus
Intermediate- EDC and EDM
Deep- APL, EPB, ECU, EPL, EI, supinator

110
Q

What are the incisions for a forearm fasciotomy?

A

Volar- along ulna boarder- FCU to medial epi (avoid ulna nerve)- extend to carpal tunnel

Dorsal- lat epicondyle to dorsal mid line

111
Q

Hand fasciotomy incisions?

A

10 compartments (7 interossei, hypothenar, thenar and adductor pollicis)

Volar- hypothenar and thenar
Dorsal over 2 and 4th metacarpals

+- carpal tunnel

112
Q

What is the contents of the carpal tunnel?

A

FDS, FDP and FPL

Median nerve- medial cuntaneous n of hand has branched off prior

113
Q

What is the gardners classification of NOF?

A

1- incomplete NOF
2- complete undisplaced
3- complete, partially displaced
4- fully displaced, complete

114
Q

What are the ligaments surrounding the hip?

A

Iliofemoral- strongest- prevents hyperextension of hip joint

Pubofemoral and ischiofemoral

115
Q

What is the origin and insertion of iliopsoas?

A

T12-L4

Lesser trochanter

116
Q

What is the surface A of the sciatic N?

A

Runs through the greater sciatic notch generally under piriformis

Trace line curved line between 2 points
1/2 way between Ischial tuberosity and PSIS
1/2 way between Ischial tubersoity and >trochanter

117
Q

What runs through the greater and lesser sciatic notch?

A

Greater
Suprapiriform- super gleuteal Artery and N and vein
Infrapiriform- sciatic N, inferior glutean VAN, pudendal N, N to piriformis

Lesser
Obturator internus
Pudendal N
Internal pudendal V and A

118
Q

What muscles attach to the anterior proximal humerus?

A

Lady between two majors

MEdial to lateral

Teres Major
Lat Dorsi
Pec Major

119
Q

What muscles insert onto the coracoid?

A

Pec minor
Coracobrachilais
Short head of biceps

120
Q

Where to perform LP?

A

L4/5

Between Iliac crests

121
Q

What are the spinal columns?

A

Spinothalamic- pain and temp- decussate at spinal level
Corticospinal- movement and fine control- decussate at in hindbrain
Dorsal columns- sensation and proprioception- high up decussation

122
Q

Blood supply of spinal column?

A

Anterior spinal A- from vertebral As and segmentally from aorta, artery of adamzweich

Post spinal A- post inf cerebellar As

123
Q

What is central cord syndrome?

A

Hyper extension injuries in elderly

Upper limbs affected more than lower limbs
Good prognosis

124
Q

Draw Brachial plexus

A

https://www.physio-pedia.com/index.php?title=Brachial_plexus_injury&veaction=edit&section=42

125
Q

What is the origin of lat dorsi?

A

T7 to L5 spinous process

Adducts, internal rotates and extends arm

126
Q

Where does the spinal cord terminate?

A

L1/2 in adults
L3 in kids

Cauda equina carries on to S2 where the dural sac ends

127
Q

What type of joints are the intervertebral joints?

A

Type 2 cartillagenous

Like pubic symphsis

128
Q

Where are most disc prolapses?

A

L4/5, L5/S1- 95%

129
Q

What is anterior spinal cord syndrome?

A

Anterior spinal artery normally affected
Lower limbs worse than upper

Dorsal columns are spared

130
Q

What structures are at risk during a subclavian line insertion?

A

Thoracic duct on left
Subclavian a and lung
Phrenic nerves (go over anteriro scalenes)

131
Q

What is the role of thymus

A

PLays role from fetus to puberty and then regresseses

Recognises self t cells and eliminates them

132
Q

What are the atypical ribs?

A

1,2

10, 11, 12

133
Q

What is the contents of the inguinal canal?

A

Spermatic cord
/round ligament

Spermatic cord- 3s

3As- cremasteric, testicular, vas
3Ns- symphatetics, ilioinguinal- runs outside of cord, genital branch
3 others- pampiniform plexus, lymphatics, vas deferens

134
Q

What is at the mid inguinal point and the mid point of the inguinal canal?

A

Mid point of the inguinal ligament= deep ring

Mid inguinal point is femoral A

135
Q

What is the medial aspect of the femoral canal

And what does it contain?

A

Lacunar lig

LN of cloquet + sapce

136
Q

Where is the adductor hiatus and what are its boarders?

A 
2/3 of way from ASIS to adductor tubercle
Sartorius is roof
Adductor magnus is floor
Vastus medialis is lateral
Magnus/longus is medial
137
Q

Difference between CN 3 palsy and horner’s?

A

Key difference is CN3 is parasymph and Horner’s symph interupriton

CN3- eye is down and out, enlarged pupil

Horner’s- miosis, anhidrosis, ptosis and enopthalmos

138
Q

What enters through the foramen magnum?

A 
Medulla oblongata
ANt and post spinal As, vertebral A
3 dural layers
Apical dens ligament
Tentorium
CNXI spinal root
139
Q

Jugular foramen contents?

A

Jugular vein

CN9,10,11 (accessory)

140
Q

ICA branches?

A

MCA, ACA, posterior communicating, anterior choroidal, opthalmic A

141
Q

Tongue muscle nerve supply?

A

All CN12 bar palatoglossus which in CN10

142
Q

What is the course of the facial nerve?

A

From pontine medulla junction
To facial canal via internal auditory meatus
Gives off greater petrosal, chorda tympani and n to staepedius
Exits through stylomastoid foramen
Curves to parotid

143
Q

What exits through superior orbital foramen?

A

Nerves- CN3,4,6 and V1 (lacrimal and frontal, nasocillary)
V- superior opthalmic vein
A- branches of lacrimal and middle meningeal

144
Q

What are the layers of the peridcardium?

A

Fibrous

Serous- parietal and visceral

145
Q

Which parts of the aortic valve supply the right and left coronary arteries?

A

Anterior supplies RCA

Left post supplies LCA

146
Q

What is the venous drainage of the heart?

A

Coronary sinus reasonable for 2/3 of drainage, enters posterior part of RA
Drains, great, middle, small, oblique and post cardiac veins

1/3 drain directly in to right atrium /other chambers
Cardiac veins/venae cordis (thesbian veins)

147
Q

Where is the sinoatrial node and what supplies it?

A

In the right atria christa terminalis

Supplied by RCA in 60% of people and LCA in 40%

148
Q

What is the course of the phrenic nerves?

A

C3,4,5
Anterior to scalene anterio, post to subclavain veins

Right runs with IVC
Left runs with aortic arch, crosses anterior over the pericardium

149
Q

What is the course of the vagus nerves?

A

RIght post to oesophageuas and run with ICA

Left anterior to oesophageus, runs with ICA

150
Q

Where does the trachea begin?

A

C6

151
Q

What is a bronchopulmonary segment?

A

Functionally independent bit of lung
Separated by connective tissue
Receives its own AVB
10 in each lung

152
Q

What is the blood supply to the lung?

A

Pulmonary As

Bronchial As

153
Q

What are the branches of the Exeternal carotid A

A 
SLFOPSM
superior thyroid artery
ascending pharyngeal artery
lingual artery
facial artery
occipital artery
posterior auricular artery
superficial temporal
maxillary
154
Q

What muscles make up the prevertebral muscles?

A

Scalens, levator scapulae

splenius capitus

155
Q

What nerve is at risk in the middle of the post triangle of the neck?

A

Spinal accessory nerve

Runes from 1/3 down SCM to 2/3 down Trapezius

156
Q

What bones make up the orbit?

A

Frontal, maxillary, zygomatic
Lacrimal and ethmoidal
Sphenoid and palatine

157
Q

What goes through the infra orbial fissure?

A

CNV2- infraorbital and zygomatic
Inferior opthalmic vein
Pterygopalatine ganglion

158
Q

What are the clinical signs of an orbital blow out fracture?

A

Traumatic deformity of floor/medial wall

Enopthalmos
Diplopida
Infraorbital numbness
Orbital emphysema

159
Q

Location of the parotid gland surface A?

A

Anterior to tragus to posterior boarder of masseter

to angle of mandible to mastoid process

160
Q

What runs throug parotid?

A

Facial N
Retromandibular Vein
ECA- gives off superficial temporal and maxillary

161
Q

What is Frey’s syndrome?

A

Iatrogenic damage to auriculotemporal n (provides symph to parotid) unopposed parasymph => gustatory sweating- excessive

162
Q

What may damage to the zygomatic nerve cause?

A

CNV2- numbness of zygoma
Paralysis of obicularis oris
Only muscle that can open eye
Dry eye

163
Q

When do cranial sutures close

Name of condition with fused sutures at birth?

A

18-24 months

Craniosynothsis

164
Q

What runs in the foramen lacerum?

A

ICA

Greater and lesser petrosal nerve- run near by through hiatuses

165
Q

What is the cavernous sinus and what does it contain?

A

Drains the opthalmic veins, superfiscial cerebral vein and sphenopalatine sinus as well as danger area of the face

Contains OTOM and CA

CN3
CN4
CN V1 and V2

Carotid artery
Abducens nerve

166
Q

What does the posterior mediastinum contain and its boundaries?

A

Ant- pericardium to T5-T12 posteriorly
T4 superiorily to diaphram

Contains
DATES
Descending aorta
Azygous vein
Thoracic duct
Symphathetics
Eosphageus
167
Q

What is the azygous vein?

A

Formed by right lumbar and right subcostal veins

Joined by hemiazygous at T8 (left lumbar and left subcostal veins)
And by accessory hemiazygous at T7 (4-8 intercostals)
Drains posterior thorax, trunk and mediastinal viscera

168
Q

What is the right lymphatic duct?

A

Drains right head, neck, arm and breast

Thoracic duct does rest

169
Q

What is the supply of the diagastric muscle?

And other suprahyoid muscles?

A

Ant- CNV3
Post- CNVII

Stylohyoid (CNVII)
Geniohyoid (C1 via hypoglossal n)
Myohyoid (CNV3)

170
Q

What are the strap muscles?

A

Omohyoid, sternothryroid, sternohyoid and thyrohyoid

All bar thyrohyoid (C1) are supplied by cerva ancalis (in wall of carotid sheath)

171
Q

What nerves are risked damage when operating on submandibular gland?t

A

Marginal mandibular nerve

Lingual Nerve
Hyoglossus Nerve

The duct runs with hyoglossus

172
Q

What are the surface landmarks of the lung fissures?

A

Oblique bilaterally run from 4th thoracic spinous process to 6 costochondral cartillage

Horizontal on right runs from 4th constochnodral cartillage to mid axillarly line of the oblique fissure

173
Q

What is the sensation supply to the larynx?

A

Superior to vocal cords- internal laryngeal

Inferior is RLN

174
Q

Draw the vertebral arteries and branches

A

https://thoracickey.com/carotid-and-vertebral-artery-intervention/

175
Q

Where is the most likely place for a circle of willis aneurysm?

A

ANterior cerebral circulation

176
Q

What symptoms does a basilar lip Aneurysm cause?

A

SAH acutely

Bitemporal hemianopia- sits on optic chiasm

177
Q

What are the divisions of the internal iliac artery?

A

Anterior trunk- obturator, umbilical (sup vesical), inf vesical, Women- uterine and vaginal, Middle rectal, internal pudendal (inf rectal), lateral sacral, sup gleuteal

Post- Iliolumbar, lateral sacrals, inferior gleuteal

178
Q

What are the divisions of the lumbar plexus?

A

I I Get Leftovers On Fridays

Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral cutaneous nerve of the thigh
Obturator
Femoral
179
Q

Sacral plexus?

A

Some Irish Sailor Pesters Polly

Sup Gleuteal
Inf Gleuteal
Sciatic
Post Femoral Cutaneous
Pudendal

N to piriformis/obtuartors

180
Q

What muscles make up the pelvic floor?

A

Levator ani (pubococcygeus, iliococcygeus, puborectalis) + coccygeus

181
Q

What supplies IO and TA?

A

Iliohypogastric and ilioinguinal

182
Q

What are the boarders of the perineum?

A

PS to coccyx
Ischial tuberosities
Iscial and pubic rami
Roof is the pelvic floor

183
Q

What structures are contained in the anal triangle of the perineum?

A

Pudendal NAV
Anal aperture
Ischioanal fossae

184
Q

What structures are contained in the urogenital triangle?

A

Deep perineal pouch- urethra, deep fascia, perineal membrane, vagina
Superfiscial perineal pouch- ischiocavernosa, bulbospongiosa, superfiscial transverse perineal muscle, Bartholin’s gland

185
Q

What is the perineal body

A

Sits between anal and urogenital triangle

Where muscles attach

Levator ani
Bulbospongiosa
Ischiocavernosa
Perineal muscles
Ext anal sphincter
186
Q

What are the layers of the scalp?

A 
SCALP
Skin
Connective tissue deep
Epicranial Aponeurosis
Loose areolar connective tissue (containing the emissary veins)
Perisoteum
187
Q

Venous drainage of the brain?

A

Superior and straight (inferior sagittal and great cardiac vein) sinuses drain into the confluence of sinuses

Transverese comes off confluence and anastaomses with superior petrosal sinus to form sigmoid sinus

Greater and less petrosl sinus drain cavernous sinus

Lesser petrosal and sigmoid sinus form IJV

188
Q

Types of joints and examples?

A

Fibrous- sutures (skull), gomphoses (teeth), syndesmoses (radio-ulna/tibiafibula)
Immovable

Cartillagenous- 1o- Hyaline cartillage- at diaphases
2o- fibroelastic cartillage- PS and intervertebral joints

Synovial joints- fluid filled joint cavity with fibrous cavity, freely moveable
Hinge- elbow
Saddle- CMCJ
Plane- Subtalar
Pivot- C1/C2
Condyloid- Wrist
Ball and socket- hip/shoulder
189
Q

Types of cartillage?

A 
Hyaline- weakest, precursor to bone, contains type 2 collagen
Found in growth plates
Articular cartillage (subset of hyaline) found in synovial joints

Elastic cartillage- resislient and flexible
Ear, epiglottis and larynx

Fibro-cartillage- strongest, alternating layers of hyaline matrix and dense collagen
Joint capsules, tendon insertions, intervertebral discs

190
Q

Types of collagen?

A

Type 1- strongest- majority of body
Type 2- spongy/shock absorbing- hyaline cartillage
Type 3- strong but no tensile, found in granulation tissue- early wound bed collagen
Type 4- Solidifies cellular structures- basement membrane
Kidneys/eyes/ears/skin

191
Q

What is the blood supply of the diaphram?

A

Costal portion by subcostal artery and lower 5 intercostal arteries
Inferior phrenic- off abdominal aorta T12
Superior phrenic- off thoracic aorta T11

192
Q

What are the facial nerve branches after the stylomastoid foramen but before it enters the parotid?

A

Posterior auricular
N to stylohyoid
N to posterior digastric

193
Q

What is the clivus?

A

bone posterior to sella turcica

194
Q

What makes up the cervical plexus? Where do they emerge?

A

C1-4
Sensory- all enter the skin at Erb’s point, middle of posterior boarder of SCM
Greater auricular (runs over SCM, parallel to Accessory nerve)
Lesser occipital
Transverse cervical
Supraclavicular

Motor
Phrenic nerve
N to geniohyoid
N to thyrohyoid

Ansa cervicalis- rest of infrahyoid muscles

195
Q

What runs anterior to anterior scalene?

A

A- carotid/transverse cervical/suprascapular aa
V- IJV/subclavia
N- vagus/phrenic
LNs

196
Q

What is the arterial supply to the brain?

A

ACA/MCA/PCA

Post inf cerebellar a
Ant inf cerebellar
Sup cerebellar a

197
Q

Where are the motor and somatosensory cortexs found in the brain?

A

Pre central gyrus- motor

Post central gyrus- sensation

198
Q

What passes through the foramen lacerum?

A

ICA and greater/lesser petrosal nerves

199
Q

What happens at the level C6?

A

Pharynx to oesophageus
Larynx to trachea
Cricoid cartillage

200
Q

What are contained in the anterior triangles of the neck?

A

Sub mental- LNs
Submandibular- gland, LN, facial a, ligual N, hypoglossal N
Carotid triangle- carotid sheath
Muscular- strap muscles, thyroid, trachea, oesophageus

201
Q

What is contained in the posterior triangle?

A 
LNs
External jugular vein, transverse cervical, suprascapular
Superfiscial cervical a, suprascapular a
Cervical plexus + CNXI
Omohyoid
202
Q

What is the surface anatomy of the CNXI?

A

Sup 1/3 of scm
middle 1/3 of post triangle
inf 1/3 of trapezius

203
Q

What is the venous drainage of the danger area of the face?

A

Deep facial veins to pterygoid plexus to cavernous sinus

204
Q

What is the intracranial course of CNVI?

A

Longest intracranial course
Pons to cavernous sinus
to SOF
to LR

205
Q

What is a d-dimer test measuring?

A

The breakdown of fibrin

206
Q

What are the signs of hypovolaemic shock?

A 
Sinus Tachy
Hypotension
Oliguria
Cold Klammy peripheries
Slow cap refi
Dry mucous membranes and low JVP
207
Q

Describe the SA of the lung fissures?

A

Oblique fissures go from T2/3 to 6th rib mid clavicular

Right horizontal goes travels along 4th rib to mid axillarly line meeting oblique fissure

208
Q

Differences between lung hila?

A

Both lungs- Pulmonary veins straddle bronchus- infront and below
In right lung- artery is anterior to bronchus
In left lung artery is superior to bronchus

MRCS part B- JMB (10 decks)

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