Anatomy Flashcards
Hook of hamate fracture
Involvement of which nerve?
Ulnar nerve injury
LOAF is a pneumonic for which and what does it stands for?
Median nerve supply of hand muscles
2 lateral lumbricals
Opponens pollicis
Flexor pollicis brevis
Abductor pollicis brevis
Right and left subphrenic space is divided by?
Falciform ligament
The subphrenic space is a peritoneal space between the anterior part of the liver and the diaphragm, separated into right and left by the falciform ligament, and postero-superiorly bounded by thecoronary ligament
Which structure separates the cephalic vein and the brachial artery in the antecubital fossa?
Biceps Tendon
Cavernous sinus runs from?
superior orbital fissure to the petrous temporal bone.
subclavian converts to axillary artery at which Level?
Lateral edge of 1st in
Denticulate Ligament?
continuation of pia mater and attaches to dUra mater laterally for suspension of spinal cord
Stapes from which pharyngeal arch
2nd
Left hilum of kidney
L1
Vocal Cords or glottic lymphatic drainage?
No lymphatic supply and act as watershed -
axillary sentinel lymph node biopsy
Structure damaged below
Intercostobrachial nerve
Left and right pulmonary artery pharyngeal arch
6th
cerebello-pontine angle lesion
Trigeminal V nerve damage
Acoustic
neuroma
site of lesion
Cerebello pontine angle
Axillary artery divided into how many parts and by which muscle
3 parts by pectoralis minor
*Proximal to PM
*Behind
*Distal to
Homonymous hemianopia
Optictract lesion
normal angle between the femoral neck and the femoral shaft?
130° in male
Ileocolic artery isa branch of
Superior Mesenteric artery
Froment sign
Ulnar nerve palsy test
Holding a paper between thumb and index finger
Because of weakness or loss of function in adductor pollicis muscle
Blood supply of GIT
the celiac trunk for the foregut and accessory organs of GIT
the superior mesenteric artery for the midgut
the inferior mesenteric artery for the hindgut
Branches of celiac trunk
Common hepatic artery
Splenic artery
Left gastric artery
complication with posterior duodenal ulcers
Perforation of gastroduodenal artery as it runs post to duodenum
Which branch of celiac trunk is apart of portal triad
Hepatic artery proper
Blood supply of Greater and lesser curvature of stomach
Left and right gastric artery supplies lesser curvature
left and right Gastro epiploic artery supply greater curvature
More common gastric ulcer site?
At lesser curvature more than greater
Thus bleeding of left and right gastric artery
Gastric fondas is supplied by?
Shortgastric artery a branch of splenic artery.
Which part of the stomach has single blood supply
Funds
Lesser and greater curvature has dual supply
SMA originates from aorta
at
L1
3rd part of duodenum is post to.
SMA
Structures post to superior mesenteric artery
3rd part of duodenm
Left renal vein
Acute mesenteric ischemia is more common due to
SMA than IMA
GIT branches originate from
Anterior aspect of aorta
Foregut ends at
Major duodenal papilla of 1st part
Celiatrunk arises at
L1 upper level
Inferior Mesentric artery arises from
L3 level
All veins of GIT goes to
Portal vein
Splenic Vein runs immediately posterior to
Pancreas body
Portal Vein relation to bileduct
BD is ant to PV
Hepaticportal wein is madeby
superior Mesenteric and splenic vein
IMA originates from aorta while inferior mesenteric vein drains into
Splenic vein
Neck body and tail of pancreas by
Splenic artery while head by gastroduodenal artery
Greater omentum is supplied by
Both R and L epiploic/omental arteries
Cystic artery of GB arises for
R hepatic artery
Head of pancreas blood supply.
.
Superior Pancreaticoduodenal by Gastroduodenal a branch of celiac artery.
Inferior Pancreaticoduodenal by SMA.
Both have ant and post branches.
Relation of sold
Ant to left renal Vin and 3rd part of duodenm
Medial to SM vein
Below and post to splenic vein
Post to neck of pancreas
First branch of SMA
Inferior pancreatico duodenal artery
Abdominal Aorta spans
from Tiz to L4
super ior rectaI artery span
Runs ant to ilac vessels and enter to pelvic cavity
3 branches of IIMA
Left colic ascending branch
Left colic descending branch
Superior rectal artery
Borders of inferior lumbar triangle
The lumbar triangle (through which these may occur) is bounded by:
Crest of ilium (inferiorly)
External oblique (laterally)
Latissimus dorsi (medially)
Obturator hernia usually lies behind and front of which muscle
Behind Pectineus muscle
Front of obturator externus
Richter hernia
strangulation without obstruction.
Antimesentric border
Vomiting due to peritonitis 2° to perforation
What is Jenkin Rule?
Jenkins Ruleshould be followed and this necessitates a suture length 4x length of incision with bites taken at 1cm intervals, 1 cm from the wound edge
Hernia containing Meckels diverticulum
Litters Hernia
Hypoglossal nerve supply / Tumor damaging hypoglossal canal which muscle will be affected
hyoglossus
intrinsic
genioglossus and
styloglossus muscles
Upper trunk of brachial plexus direct branches
Nerve to subclavius
Suprascapular nerve
Upper limb injury and nerve damage
1. Dislocation of shoulder joint
2. # anatomical neck of humerus
3. # surgical neck of humerus
4. # shaft of humerus
5. # medial epicondyle of humerus
6# supracondylar # of humerus
- Axillary nerve
- Radial nerve
- Axillary nerve and post circumflex artery
- Radial nerve and profunda brachii artery
- Ulnar nerve and ulnar collateral artery
- Median nerve and brachial artery
Difference between anatomical and and surgical neck of humerus
The anatomical neck is the part between the head and the tuberosities.
The surgical neck is the part between the tuberosities and the shaft
costodiaphragmatic recess lies at
which level
10th rib at midaxillary line
Relation of left and right supra renal gland
LEFT
Ant: stomach, lesser sac, pancreas and spleen.
RIGHT
Ant: Right lobe of liver and IVC
Diaphragm resides on post aspect of both
Dvt and PE due to which vein involvement mostly
DVT: Popliteal vein
Embolism: Femoral vein
Nerve supply of 👂 outer ear
Sensory innervation to the external ear is supplied by both cranial and spinal nerves. Branches of the trigeminal, facial, and vagus nerves (CN V, VII, X) are the cranial nerve components, while the lesser occipital (C2, C3) and greater auricular (C2, C3) nerves are the spinal nerve components involved
Contents of Carpal Tunnel
The carpal tunnel contains a total of 9 tendons, surrounded by synovial sheaths, and the median nerve
The tendon of flexor pollicis longus
Four tendons of flexor digitorum profundus
Four tendons of flexor digitorum superficialis
Rectal blood supply.
Superior rectal artery – terminal continuation of the inferior mesenteric artery.
Middle rectal artery – branch of the internal iliac artery.
Inferior rectal artery – branch of the internal pudendal artery
Rectal relations
Anterior in
Male Sacrum and coccyx
Piriformis
Coccygeus
Levator ani
Sacral plexus
Rectovesical pouch
Sigmoid colon
Ileum
Bladder
Prostate
Seminal vesicles
Rectouterine pouch
Sigmoid colon
Ileum
Vagina
Cervix
Infection spread between two ischiorectal fossa through
Deep post natal space
Present below anococcygeal ligament and above levator ani muscle.
Mnemonic for cranial nerve being motor, sensory or both
1 Some
2 Say
3 Marry
4 Money
5 But
6 My
7 Brother
8 Says
9 Big
10Boobs
11 Matter
12 More
S means Sensory
M means motor
B mean both
Only nerve arising from dorsal aspect of brain stem
Trochlear nerve
Only supply superior oblique muscle.
Which nerve Arise from interpeduncular fossa of midbrain
Oculomotor nerve
Which cranial nerve has both brain and spinal roots
Accesory Nerve
XI
Greater and lesser sciatic notch are separated by
Sacrospinous ligament
Borders of Greater sciatic foramen
The greater sciatic foramen is bordered by:
Superior – anterior sacroiliac ligament
Posteromedial – sacrotuberous ligament
Anterolateral – greater sciatic notch of the ilium
Inferior – sacrospinous ligament and ischial spine
Contents of Greater Sciatic Foramen
The greater sciatic foramen is divided into two parts by the presence of the piriformis muscle – the suprapiriform and infrapiriform foramina.
Suprapiriform foramen:
Superior gluteal artery and vein
Superior gluteal nerve
Infrapiriform foramen:
Sciatic nerve
Pudendal nerve
Inferior gluteal artery and vein
Inferior gluteal nerve
Posterior femoral cutaneous nerve
Nerve to obturator internus
Nerve to quadratus femoris
Common content of Greater and Lesser Sciatic foramen
Pudendal nerve
Nerve to obturator internus
Content of lesser sciatic foramen
*Internal pudendal artery and vein
*Pudendal nerve (note the pudendal nerve first leaves the pelvis via the greater sciatic foramen, and then re-enters via the lesser sciatic foramen)
*Obturator internus tendon
*Nerve to obturator internus
Median nerve relation to brachial artery in cybital fossa
Median nerve is medial to brachial artery
foot muscle supplied by deep common peroneal nerve
Extensor digitorum brevis and extensor hallucis brevis
Others are supplied by tibial
Function of hand interossei muscles
PAD and DAB
Palmer interosseiADduct
Dorsal interosseiABduct
lumbricals in flexion at the MCP joints and extension at the IP joints.
Contents of Femoral Triangle
Mnemonic for contents from lateral to medialis NAVEL
Nerve artery vein then lymphatic
The only content of femoral triangle out of femoral sheath is
Femoral nerve
Borders of femoral triangle
Mnemonic for borders of femoral Triangle is SAIL
Laterally by sartorius
Medially by adductor longus
Superiorly by inguinal ligament
Roof – fascia lata.
Floor – pectineus, iliopsoas, and adductor longus muscles.
The lymphatic of femoral triangle is different from other content in which way
It is in femoral canal
Significant for the femoral herniation
Motor ans sensory supply of axillary nerve
Deltoid and Teres minor
Lateral aspect of upper area, a patch
Axillary nerve leaves axilla through
Quadrangle space
Deep ring of inguinal canal is made of
The transversalis fascia forms the superolateral edge of the deep inguinal ring.
The epigastric vessels form its inferomedial wall.
Constrictor of esophagus
Constrictions of the oesophagus : ABCD
A- Arch of the Aorta
B- Left main Bronchus
C- Cricoid Cartilage
D- Diaphragmatic Hiatus
Carina is present at which level
T5 or T6 vertebral level
Muscle attachment of Greater Trochanter
Mnemonic for muscle attachment on greater trochanter is POGO:
Piriformis
Obturator internus
Gemelli
Obturator externus
Avulsion # of greaterand lesser trochanter occurs when-
forceful contraction of the gluteus medius causes avulsion of greater
forceful contraction of the iliopsoas causes avulsion # of lesser trochanter
What I’d the angle of neck of femur
It is set at an angle of approximately 135 degrees to the shaft.
Site of attachment of iliofemoral ligament is
Intertrochanteric line is the site of attachment for the iliofemoral ligament (the strongest ligament of the hip joint).
Which part of femur fracture causes head necrosis
Intracapsular part of neck of femur which affects medial circumflex femoral artery
Only source of motor innervation to diaphragm
Phrenic nerve is the only source of motor innervation to the diaphragm and therefore plays a crucial role in breathing.
Overview of Phrenic Nerve
Overview
Nerve roots – anterior rami of C3, C4 and C5.
Motor functions – innervates the diaphragm.
Sensory functions – innervates the central part of the diaphragm, the pericardium and the mediastinal part of the parietal pleura.
Phrenic Nerve relationship to anterior scalene muscle
arise from the lateral border of anterior scalene
Middle part of Medial of thigh is supplied by
Obturator Nerve
Which muscle of medial compartment of thigh laterally rotates it alon with adduction
Obturator externus
Adrenal gland origin
1st develops at 6th week gestation with no reticularis zone
Cortex from mesoderm
Medulla from ectoderm, neuralcrest cells
Adrenal gland origin
1st develops at 6th week gestation with no reticularis zone
Cortex from mesoderm
Medulla from ectoderm, neuralcrest cells
Immediately lateral to pisiform bone is which Nerve
Ulnar Nerve
Flexor of IP joint of thumb
Flexor Pollicis Longus
Dupuytrens contracture affect which fingers
Little . and ring finger
Keypoint of Dupuytrens contracture
Flexed ring and little finger towards palm
.Contracture of parmar aponeurosis
*Common in maleover 40 years
Intrinsic hand Muscle
Mnemonic for intrinsic hand muscles
‘A OF A OF A’
)
A bductor pollicis brevis
O pponens pollicis
F lexor pollicis brevis
A dductor pollicis (thenar muscles)
O pponens digiti minimi
F lexor digiti minimi brevis
A bductor digiti minimi (hypothenar muscles)
Which of the following fingers is not a point of attachment for the palmar interossei?
The middle finger has no attachment of the palmar interosseous.
Which muscle is responsible for causing flexion of the distal interphalangeal joint of the ring finger?
Flexor digitorom Profundus
Ccervical rib arises at which level
C 7
Adsons test
To confirm Cervical Rib
(lateral flexion of the neck away from symptomatic side and traction of the symptomatic arm- leads to obliteration of radial pulse)
Contents of Clavipectoral fascia
- Thoracoacromial artery
- cephalic vein
- Lateralpectoral nerve (neweto pectoris major )
40 Lymphaticsfross, breast to apical lymph nodes
What is Erb’s point?
Sensory nerves of cervical plexus enter the skin at the middle of the posterior border of the sternocleidomastoid. This area is known as the nerve point of the neck (Erb’s point), and is utilised when performing a cervical plexus nerve block.
What is posterior interosseous nerve?
When the deep branch of the radial nerve penetrates the supinator muscle of the forearm,
What are penicilliary radicles
In white pulp of spleen
The germinal centres are supplied by arterioles called penicilliary radicles.
To perform an open inguinal hernia repair under local anaesthesia. Which dermatomal level will require blockade?
T12
Which nerves get damaged during submandibular gland excision
Three cranial nerves may be injured during submandibular gland excision.
Marginal mandibular branch of the facial nerve
Lingual nerve
Hypoglossal nerve
Which nerv3 supplies skin over axilla
Intercostobrachial nerve
Innervation of short and long head of biceps femoris
The short head of biceps femoris, which may occasionally be absent, is innervated by the common peroneal component of the sciatic nerve. The long head is innervated by the tibial division of the sciatic nerve.
Cranial nerves which carry Parasympathetic supply
III (oculomotor) Pupillary constriction and accommodation
VII (facial) Lacrimal gland, submandibular and sublingual glands
IX (glossopharyngeal) Parotid
X (vagus) Heart and abdominal viscera
Diagastric nerve supply
The posterior belly of digastric is innervated by the facial nerve and the anterior belly by the mylohoid nerve.
Waldeyers fascia-
Sibsons fascia-
Bucks fascia-
Gerotas fascia-
Denoviller fascia-
Waldeyers fascia- Posterior ano-rectum
Sibsons fascia- Lung apex
Bucks fascia- Base of penis
Gerotas fascia- Surrounding kidney
Denonvilliers fascia- Between rectum and prostate
Contents of foramen ovale
Mnemonic: OVALE
O tic ganglion
V3 (Mandibular nerve:3rd branch of trigeminal)
A ccessory meningeal artery
L esser petrosal nerve
E missary veins
Branches of internal carotid artery
Mnemonic for branches of the cerebral portion of the internal carotid artery ‘Only Press Carotid Arteries Momentarily’
Only = Opthalmic
Press = Posterior communicating
Carotid = Choroidal
Arteries = Anterior cerebral
Momentarily = Middle cerebralBrach
Marginal mandibular nerve supplies
The marginal mandibular nerve lies deep to platysma. It supplies the depressor anguli oris and the depressor labii inferioris. If injured it may lead to facial asymmetry and dribbling.
Amomg vessels and nerves which structure is the most superficial to wub,andibulae gland
Mandibular branch of facial nerve
Submandibular duct stones are
Radio opaque
Seromucinous
Distal stones removed orally and proximal stones and infections need excision
Siadadenitis is caused by
Staphylococcus aureus infection
What us Branchial cyst
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Most common cause of neck swelling
Reactive lymphadenopathy
Pharyngeal pouch
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Which nerves leaves from middle cranial fossa and causes lacrimation issue
Greater petrosal nerve
Nerves of superior orbital fissure
SUPERIOR ORBITAL FISSURE:
Outside
L - lacrimal F - frontal T - trochlear done
Inside
N - nasociliary A - abducent nerve O - oculomotor nerve
LFT done outside No Abnormality Occurred inside
Palatine bone forms which partof bony orbit
Inferior Wall of orbit
Position of ant and post ethmoidal artery
Ant and postethmoidal foramina are present B/w roof and medial wall orbitassociated with fronto ethmvidal Suture.
Position of superior and inf orbital fissure
Sup. is b/w greater and lesser wing of sphenoid
Inf. is b/ w greaterwing and maxillary bone
Air in orbit is due to# of
D ledial wall as it contains ethmoidal sinuses
Exit of trigeminal nerves from cranium
Standing Room Only -Exit of branches of trigeminal nerve from the skull
V1 -Superior orbital fissure
V2 -foramen Rotundum
V3 -foramen Ovale
Sphenopalatine Foramen contains what and connection between what cavities
At the level of the superior meatus, the sphenopalatine foramen is located. This hole allows communication between the nasal cavity and the pterygopalatine fossa. The sphenopalatine artery, nasopalatine and superior nasal nerves pass through here.
Terminal branch of maxillary artery
Sphenopalatine artery
External nasal nerve
*Branch of ant etthmoidal nerve ,a branch of opthalmic nerve
Supplies skin around nares, nasaIvestibule and tip of nose.
Structure passing through incisive canal
Nasopalatine nerve passes from nasal cavity to oral
Greater palatine artery passes from oral to nasal cavity through this foramen.
Patellar ligament
Distal part of quadriceps
On both side it is supp9rted by ligaments ofvastus m3dialis ND lateralis
Difference between medial and lateral collateral ligament
Both attach to medial/lateral epicondyle and condyle of femur and tibia
BUTonly medial one attaches to the meniscus
While on lateral side there is another light called anterolatreal lig which attaches to meniscus
What is anserine bursa
Anserine bursa
deep to Semitendinosus, Gracilis, and Sartorius tendons
Attachment of ant cruciate
Sup on medial side of lateral condyle of femur
Inf ant intercondylar area of tibiq just behind the meniscus
How many bursa around knee
12
Ant part of menisci of knee are joined by
Transverse ligament
MCL vs LCL ligqment
MCL damage if positive valgus
LCLdamage if positive varus
Which ligament splits tendon of biceps femoris
Lateral collateral ligament passes from the lateral epicondyle of the femur to the head of the fibula in front of its highest point and splits the tendon of biceps femoris
primary restraint to valgus tilting of the talus.
Deltoid ligament
Syndesmosis
It consists of (from anterior to posterior) the
anterior-inferior tibiofibular ligament (AITFL),
the transverse tibiofibular ligament (TTFL),
the interosseous membrane, and
the posterior-inferior tibiofibular ligament (PITFL).
Mortise view
mortise views (20 degrees internal rotation of foot
Function of ankle vs subtalar joint
Ankle: dorsi and plantar flexion
Subtalar: inversion and eversion
Ankle reflex spinal nerve
S1 and S2
Muscles of planter flexion and dorsi flexion
Plantarflexion by muscles of posterior compartment of leg which are gastrokenemies solius posterior tibialis and plantaris
Dorsiflexion – produced by the muscles in the anterior compartment of the leg (tibialis anterior, extensor hallucis longus and extensor digitorum longus).
Nervesupply to ankle
By tibial, superficial and common fibular
Which intrinsic muscle of the foot is not innervated by tibial nerve
Extensor digitorum brevis
Foot inversion muscles
Tibialis anterior and posterior
Which foot branch of tibial nerve arises before tarsal tunnel
Medial Calcaneal branch
1web spaceof toes is supplied by
Deep Peroneal Nerve
Medial and lateral sural cutaneous nerves origin
Medial is from Tibial Nerve
Lateralis from Common fibular nerve
Function of Fibularis longus
- Eversion
- Plantar Flexion
- Supports medial and lateral arches of foot
Position of Femoral artery
The femoral artery at the groin constantly lies halfway between the anterior superior iliac spine and the midline (the pubicsymphysis nottuberule)
Position ofsuprarenal and the gonadal (ovarian or testicular) arteriesin relation to renal arteries
suprarenal and the gonadal (ovarian or testicular) arteries as separate branches, respectively above andbelow the origins of the renal arteries on each side at L1 level
Caudate lobe blood flow
The caudate lobe receives an independent blood supply from the hepatic portal vein and artery and its branch ofthe hepatic vein drains directly into the inferior vena cava.4.
Normal portal pressure
Normal portal pressure is 5–8 mmHg
Which organ lies anterior in direct contact with the left kidney without separation by visceral peritoneum?
The suprarenal, pancreatic, and colic areas are devoid of peritoneum.5.
Function of psoas major muscle
inserts on the lesser trochanter of the femur and thus flexes the thigh at the hip joint arnel external rotation.
a subcostal flank approach to the kidney, which of the following may be incised to increase upward mobility of the 12th rib?
costovertebral ligament is a strong fascial attachment between the transverse process of the first and second lumbarvertebrae and the inferior margin of the 12th rib.
descending duodenumalso called
2nd part of duodenum
descending duodenum relation
The descending part of the duodenum (the second part) descends vertically, directly anterior to the hilum of the right kidney,and as a result is intimately related on its posterior aspect to the medial margin of the right kidney, renal pelvis, pelviureteric
3
junction, and often the right proximal ureter. The common bile duct also lies posterior and drains into the descendingduodenum. Directly medial and intimately related to the descending duodenum lies the pancreatic head.8.
Lies post to transverse colon
anteriorly the right ureter is related to
anteriorly the right ureter is related to the terminal ileum, caecum, appendix,and ascending colon and their mesenteries.
injury to the ilioinguinal nerve
Loss Of sensation to the mons pubis and anterior scrotum in the male and labia majora inthe female.
Inferior epi vessel lies
Between transverse abd muscle and peritoneum
Aorta relation to left main bronchus
Azygous vein to Right main bronchus
Posterior to bronchus
Nerves post and ant to hila of Lungs
vagus post toit
Phresic ant to it
Medial and Lateral femoral circumflex arteries are direct branches of
Profunda femurus artery
Relationship of femoral artery to profanda femorus artery
Femoral artery is medial to it
Interior and posterior circumflex arteries are branches of
Obturator artery
Site of ectopic pregnancies
Most common site is ampula off filopian tube
2nd most common site is isthmus/ of uterine tube
Type a aortic dissection versus type b
Type Ain ascending andarch of aorta
B in descending aortaa after brachioaphallic trunkorigin
Parasympathetic Ganglion and Nerves
.
.
4 ganglions and 4 cranial Nerves
Edinger-Westphal nucleus»Oculomotor Neve»>Ciliary Ganglion
Superior salivatory nucleus»>Facial Nerve»_space;>Pteaygopalatine ganglion and Submandibular ganglion
Inferior salivatory nucleus»> Glossopharrygeal Nerve»_space;>Otic Ganglion
Uterine artery is a branch of
Internal iliac artery
Post int Nerve runs b/w
Two heads of spuinator
Medion nerve enters forearm bfw
two heads of pronator teres
Ulnar nerve enters Forearm b /w
Two heads of flexor carpi ulnaris
post to medial epicondyle
Intraosseous access
typically undertaken at the anteromedial aspect of the proximal tibia
Content of cubital fossa
Mnemonic for contents of the cubital fossa – Really Need (radial nerve) Beer To (biceps tendon) Be At (brachial artery) My Nicest (median nerve).
Volkmann’s ischaemic contracture
brachial artery, if not repaired, can cause Volkmann’s ischaemic contracture (uncontrolled flexion of the hand) as the forearm flexor muscles become fibrotic and short.
subclavian artery division
The subclavian artery travels laterally towards the axilla. It can be divided into three parts based on its position relative to the anterior scalene muscle:
Axillary artery is divided into 3 parts by which muscle
he artery can be divided into three parts based on its position relative to the pectoralis minor muscle
Axillary artery converts to brachial artery by
The brachial artery is a continuation of the axillary artery past the lower border of the teres major. It is the main supply of blood for the arm.
Relation of medion nerve and brachial artery
In proximal humerus M lies lateral to Band switch to Medial by moving ant over it
Which nerve runs with Profundq Brachi artery
Radial Nerve in spiral groove
Ganglia of sympathetic system is found in
Paraspinal region billaterally
Camper vs scarpa fascia of abdominal wall
Camper is superficial and fatty
Scarpa is deep than this and membramous
Colle fascia
Continuation of scarpa fascia from abd to perineum and it separates base of penis from prostate
Dartos fascia
Continuation of scarpa fascia into scrotum
Fascia lata joins which fascia under inguinal ligament
Scarpa fascia
1Tester drains into which lymph nodes
2 Scrotal skin drainage ?
1Para aortic lymph nodes
2 inguinal lymph nodes
Ligament nuchae
The ligamentum nuchae is a midline intervertebral syndesmosis that spans the cervical spine, and its posterior border is firmly attached to the external occipital protuberance and to the spinous process of C7.
Triangular in shape
Ligament nuchae vs supraspinous ligament
1st one attaches from occipital protuberance till C7 apinous process
2nd one from C7 to sacrum
Tectorial membrane
Upperr part of posterior longitudinal ligament from occipital to C2
Posterior longitudinal membrane
On the anterior surface of vertebral column
IVC relation to epiploic foramen
Forms Posterior wall of epiploic foramen
Pringle Manoeuvre
During liver surgery Pringles manoeuvre, this involves placing a vascular clamp across the anterior aspect of the epiploic foramen. Thereby occluding:
Common bile duct
Blood supply of omentum
The vessels supplying the omentum are the omental branches of the right and left gastro-epiploic arteries
he arterial supply to the gastric component is mainly provided by which of these vessels?
Right gastroepiploic artery
Stomach venous drainage
right and left gastric veins drain directly into the portal vein
right gastro-epiploic vein either drains into the SMV or middle colic vein.
left gastro-epiploic and short gastric veins drain into the splenic vein
which peritoneal ligament is absent in infants but present in adults
Gastro colic ligament
Left border of lesser sac
Made by
Splenorenal ligament
Gastrosplenic ligament
Structures post and ant to lesserseac
Post: Pancreas,Left Kidney
Ant: Caudate lobe of liver, post border of Lesseromentum,post side of stomach and postaspect of ant two layers of greateromentum
Omental bossa is also called
Lesser sac
Epiploic foramen is found at which vertebral level
T12
Position of cardia of stomach and pyloricsphincter
Cardin at T11 leveI
pyloricsphincter atL1 Level of transpyloric plane
Ligaments of Lesser omentum
Hepatoduodenal ligament Hepatogastric ligament
junction of the body and pyloric region of stomach is present at
The most inferior part of the lesser curvature, the angular notch, indicates the junction of the body and pyloric region.
Normal constrictions of esophagus
There are 3
cervical constriction: due to cricoid cartilage at the level of C5/6. thoracic constriction: due to aortic arch at the level of T4/5. abdominal constriction: at esophageal hiatus at T10/11.
dividing line b/w supra and infra colic greater sac
transverse mesocolon attachment to post abdominal wall
Equivalent of bulbourethral gland in women
Bartholin cyst
Bulbourethral glands are also called
Cowper gland
Structures arising from urogenital sinus
Bulbourethral gland
Urethra
Bladder except trigone
Prostate gland
PRostate specific antigen is produced by
Bulbourethral gland
Structures of deep perennial pouch in men
Membranous urethra
sphincter urethra muscle
bulbourethral glands
deep transverse perennial muscles
internal Pudendal vessels and
dorsal nerve of the penis
Superficial perennial fascia forms what
Inf boundary of superficial perineal pouch
Suprachiasmatic nucleus deals with
Regulation of circadian Rhythm
Fossa navicularis
Normal dilation at distal penile region
Widest part of male urethra
Prosotatic
Urethra is lined by
Proximal..pseudosttatified columnar epi
Distal… squamous epi
Palmar digital veins drain into dorsal through
Intercapitular veins
Cardiac catherization is done incephalic or basilic ?
In Basilic vein bCZ cep has a very difficult path
anterior and posterior circumflex humeral veins feed into
Basilic vein below lower border of teres major
The thoracoacromial arteryarises at upper border of which muscle
upper edge of the Pectoralis minor.
The level 3 axillary nodes lie between which muscles.
The level 3 axillary nodes lie between pectoralis major and minor.
The level 3 axillary nodes clearance affect which artery
Thoracoacromial artery
Thoracoacromial artery gives it’s branchesnafter piercing
Clavipectoral fascia or voracoclavicular fascia
Acromial anastomosis is formed by which arteries
suprascapular, thoracoacromial, and posterior humeral circumflex arteries.
Clavicle branch of thoracoacromial artery supplies
sternoclavicular joint, supplying this articulation, and the Subclavius.
Deltoid branch of thoracoacromial artery supplies
Pectoralis major and Deltoid
Which structures run in delto pectoral groove
Cephalic vein and deltoid branch of thoracoacromial artery
Isthmus of thyroid location
Rhyme isthmus location:
Rings 2,3,4 make the isthmus floor
Thyroidea ima Origin
Thyroidea ima (in 10% of population -from brachiocephalic artery or aorta)
Ansa cervicalis loops around
Subclavian artery on right side
Arch of Aorta on left side
Thyroid attaches to which foramen of skull
attached to foramen caecum at the base of the tongue
What is ligament of berry
Posteriomedially each thyroid lobe is ttached to 2nd, 3rd, 4th tracheal rings or cricoid cartilage (attached via Ligament of Berry)
Superior and inferior thyroid arteries are in relation to which nerves
External laryngeal nerve (near superior thyroid artery)
Recurrent laryngeal nerve (near inferior thyroid artery
The two bellies of omohyoid are attached in front of?
Internal jugular vein
Anterior jugular vein is anterior to which part of thyroid gland
Isthmus
Which structures are prone to damage while cutting ligament of berry
Recurrent laryngeal nerve and inferior thyroid artery can be injured during cutting ligament of berry
Which muscles attach at oblique line of thyroid cartilage
Sterno thyroid
Inf constrictor
Thyrohyoid
which muscle is dissected during thyroidectomy
Sternohyoid muscle is dissected during thyroidectomy as they are connected together by a median raphe
1st branch of external carotid artery
Superior thyroid artery (1st branch of external carotid)
Ist branch of Thyrocervical Trunk
Inf thyroid artery
Blood supply of Parathyroid glands
InF thyroidartery
Arterial supply of thyroid
Superior thyroid artery (1st branch of external carotid)
Inferior thyroid artery (from thyrocervical trunk)
Demifacets of which ribs
2nd and 7th rib
Relation of Left brachiocephalic vein with sternum
The left brachiocephalic vein lies posterior to the manubrium, at the level of its upper border
Structures at sternal angle
Costal cartilages of the 2nd ribs
Transition point between superior and inferior mediastinum
Arch of the aorta
Tracheal bifurcation
Union of the azygos vein and superior vena cava
The thoracic duct crosses to the midline
sternoclavicular joint is what Kind of joint
fibrocartilage
The sternoclavicular joint consists of?
The sternoclavicular joint consists of the sternal end of the clavicle, the manubrium of the sternum, and part of the 1st costal cartilage
sternoclavicular joint is which Kind of joint
Type of joint – being a saddle joint it can move in two axes.
which ligament is main for sternoclavicular joint stabilizing
Costoclavicular ligament is the main
stabilising force for the joint, resisting elevation of the pectoral girdle.
Costoclavicular joint is reinforced superiorly by
Interclavicular ligament
What are Hassall’s corpuscles
Hassall’s corpuscles are the concentric ring of epithelial cells seen in the medulla of the thymus.
The thymus develops from which pharyngeal structure
The thymus develops from the third and fourth pharyngeal pouches
Vascular supply of thymus
Its arterial supply is from the internal mammary artery or pericardiophrenic arteries. Venous drainage is to the left brachiocephalic vein.
Pericardial artery of thoracic aota supplies
Dorsal portion of pericardium
Superior phrenic artery is a branch of
Thoracic aorta
it supplies the superior portion of the diaphragm
Difference between right and left bronchial arteries
Left side arise thoracic aorta from while right side ones arise from third posterior intercostal artery
Subcostal arteries arise from
First 2 from subclavian artery
Further 9 arises from posterior aspect of thoracic aorta
Muscles supplied by Ansa cervicalis
Ansa cervicalis
Superior Omohyoid
SternoThyroid
SternoHyoid
Inferior Omohyoid
Cell bodies of the pre-ganglionic efferent neurones of sympathetic system lies in which horn
lateral horn of the grey matter of the spinal cord ‘
Thoracic sympathetic chain is ssurrounded by which structure
Parietal pleura
Cervical sympathetic chain is present ant and post to which regions
Lie anterior to the transverse processes of the cervical vertebrae and posterior to the carotid sheath.
Lumbar sympathetic chain relation
Lie anteriorly to the vertebrae and medial to psoas major.
origin of the sympathetic nervous system is found within which part of sspinal cord
thoracolumbar division (T1 to L2,3).
he cell bodies of the preganglionic neurons of the SNS are found only in the
are found only in the intermediolateral cell columns (ICLs) of the spinal cord, one
intermediolateral cell columns (ICLs) belong to which horn of spinal cord
ICLs are part of the lateral horns of the gray matter of the thoracic (T1-12) and upper lumbar (L2 or L3) spinal cord
what is ganglion impar /ganglion of Walther
Paravertebral Column converge anteriorly at the coccyx, forming the ganglion impar (ganglion of Walther)
Prevertebral ganglia of SNS are
Celiac
Aorticorenal
Superior mesenteric ganglia.
Inferior mesenteric ganglia.
SNS cell bodies and their supply
/T1-6 cell bodies that are located superiorly innervate the head, upper limb and thoracic viscera.
T7-11 located in the middle innervate the body wall and abdominal viscera,
T11-L2(3) located inferiorly innervate the lower limb and pelvic viscera.
Middle cervical ganglion location
C6 level
Superior cervical ganglion Location
lies anterior to C2 and C3.
For treatment of hyperhidrosis. what is done
hyperhidrosis the sympathetic denervation can be achieved by removing the second and third thoracic ganglia with their ram
why T1 not denervated for hyperhidrosis
Removal of T1 will cause a Horners syndrome and is therefore not performed.
Why ganglia till L2 and below are disrupted and not above this location
If L1 is removed then ejaculation may be compromised (and little additional benefit conferred as the preganglionic fibres do not arise below L2.
The preganglionic fibres of SNS only arise from T1 to L2 level
Catecholamine is made ofwhich Amino Acids
Catecholamine (phenylalanine and tyrosine)
which adrenergic receptors on SKELETAL mseles
β 2 receptors in skeletal muscle vessels-causing vasodilation
How adrenaline causes narrow pulse pressure
Vasoconstriction in the skin and kidneys causing anarrow pulse pressure
Adrenaline effects on alpha receptors
β adrenergic receptors:
Stimulates glucagon secretion in the pancreas
Stimulates ACTH
Stimulates lipolysis by adipose tissue
Adrenaline
effecton beta receptors
β adrenergic receptors:
Stimulates glucagon secretion in the pancreas
Stimulates ACTH
Stimulates lipolysis by adipose tissue
How insulin and glucagon levels are affected by adrenaline
α adrenergic receptors: action adrenaline stimulates insulin secretion by the pancreas
By beta adrenergic action adrenaline stimulates glucagon secretion
Carotid Sinus contains
Baro receptors
Carotid Sinis Location
At bifurcation of Common Carotid artery
C4 Level / Upper border of thyroid Cartilage
cervical sympathetic chainand prevertebral fascia relation
The cervical sympathetic chain lies anteriorly to prevertebral fascia.
I
Superficial layer of deep cervical fasci encloses which muscle
Ant Sternocleidomastoid
Postero laterally Trapezius muscle
Aortic arch is covered superiorly by which neck fascia
Pretracheal
Whichstructure is completely Surrounded by pretracheal fascia
Thyroid gland
Retropharyngeal space location
Post to Buccopharyngeal fascia and anterior to Alar fascia and Prevertebral fascia
Scalone muscles are present in which fascia
Prevertebrald fascia
which structure Lies posterior to the carotid sheath at the level of the 6th cervical vertebra?
Middle Cervical ganglion of SNS
At which vertebral level common carotid can be compressed
The anterior tubercle of C6 transverse process is prominent and the artery can be compressed against this structure
Level of cricoid cartilage
C6
Diff of Right and left common carotid course in the neck
there is no thoracic duct on the right. The oesophagus is less closely related to the right carotid than the left
Internal carotid artery supply
forehead, nose, eyes and the ipsilateral cerebral hemisphere (internal carotid artery)
Carotid Sinus location
The carotid sinus is a dilation of the base of the internal carotid artery, referred to as a baroreceptor and is innervated by the carotid branch of the glossopharyngeal nerve.
Carotid Body location
located posterior to the carotid bifurcation, involved in relaying information about the arterial chemical composition to respiratory centres in the brainstem. Like the carotid sinus, it is innervated by the carotid branch of the glossopharyngeal nerve.
What is carotid tubercle
carotid tubercle (transverse process 6th cervical vertebra
Stellate ganglion location
anterior to transverse process of C7, lies posterior to the subclavian artery, vertebral artery and cervical pleura
If Hyperhidrosis of hands and feet, which area’s sympathectomy needs to be done
Superior cervical ganglion at T2 and T3
Nerves at risk during a carotid endarterectomy:
Hypoglossal nerve
Greater auricular nerve
Superior laryngeal nerve
From which pharyngeal pouch does sup and inf parathyroid arises
The inferior parathyroid is a derivative of the third pharyngeal pouch.
The superior parathyroid originates from the fourth pharyngeal pouch.
Improve
Superior parathyroid is in relation to which artery
Inferior thyroid artery
What is a roof top incision
A rooftop incision is typically used to access the pancreas for resectional surgery.
What is the space of Retzius
Bladder can be accessed via an extraperitoneal approach through the space of Retzius
What is battle incision
Similar location to paramedian but rectus displaced medially (and thus denervated
Kocher incision
Incision under right subcostal margin e.g. Cholecystectomy (open)
What is the classical indication for a Mercedes Benz incision?
Liver transplantation
McEvedy’s incision
Groin incision e.g. Emergency repair strangulated femoral hernia
the incision approach of choice for first time renal transplantation
.Rutherford Morrison
Which structure is runs in coronary sulcus
Right coronary artery
Which pericardial sinus is used for CABG
The transverse pericardial sinus is found superiorly on the heart. It can be used in coronary artery bypass grafting
Which pericardial layer causes problem during tamponade
Fibrous pericardium rigid structure prevents rapid overfilling of the heart, but can contribute to serious clinical consequences (see cardiac tamponade).
Whichpericardium Continuous with the central tendon of the diaphragm
Fibrous
The purkinje fibres are located in which layer.
Subendocardial layer
Cause of myocarditis
often due to viruses such asadenovirusandcoxsackie B.
superior and inferior vena cavae opens in which part of RA
Sinus venarum
Location of coronary sinus
opens into the right atrium between the inferior vena cava orifice and the right atrioventricular orifice.
Auricle are formed by
Pectinate muscles
What is supraventricular crest
The right ventricle can be divided into an inflow and outflow portion, which are separated by a muscular ridge known as the supraventricular crest.
Derivation of bulbus cordis
The outflow portion of left and right ventricle
Location of SA NOd3
Where where SVC enters
Av node is present at
Near the opening of coronary sinus in the AV septum
Contents of carotid sheath:
Common carotid artery
Internal carotid artery
Internal jugular vein
Vagus nerve
Conus arteriosus
The conus arteriosus (infundibulum) is the smooth walled outflow tract of the right ventricle leading to the pulmonary trunk.
most common anomaly of the thoracic venous system
Persistent left superior vena cava is the
Persistent LEFT SVC drains into heart through
Coronary sinus
Sup and Infquadranopia and site of lesion
Superior quadranopia = temporal lobe lesion
Inferior quadranopia = parietal lobe lesion
What are thespian veins
contribute to the venous drainage of the heart into right atrium
Lower bitemporal hemianopia
What type of visual field defect is most likely to be noted in a patient with a craniopharyngioma?
Carina location
The trachea bifurcates at the level of the angle of Louis which is the intervertebral space between the fourth and fifth thoracic vertebra.
Sternocleidpmastoid movement damages which structure
Accessory nerve
Where is a gomphoses type of fibrous joint typically found?
Teeth
Location of roots of brachial plexus
between the anterior and medial scalene muscles to enter the base of the neck.
Which pa4t of brachial plexus is located in post triangle
Root
Nerve arising from C5 root of BPlexus
Dorsal scapular nerve
It supplies rhomoid major and minor muscles
Thoracodorsal nerve arises from
Roots of C5,6 and 7
And supplies serratus anterior muscle
Nerves arising from roots of brachial plexus
Dorsal scapular and long thoracic nerve
Nerves arising from trunk of brachial plexus
Suprascapular nerve
Nerve to subclavius
3hich part of brachial plexus doesn’t have any branches
DIVISIONS
Pneumonic for branches of posterior cord
ULTRA
Upper subscapular
Lower subscapular
Thoracodorsal
Radial
Axillary
Cords of brachial pl3xus relation axillary artery
To 2md part of axillary artery
Which nerve forms in front of the last part of Axillary Artery
Median nerve forms by the combination of medial and lateral chord in front of it
Transverse process In the thoracic vertebrae,
In the thoracic vertebrae, the transverse processes articulate with the ribs.
Pedicles of vertebra
connect the vertebral body to the transverse processes
Lamina of vertebra
Lamina – connect the transverse and spinous processes.
Unique feature of cervical vertebra
Bufid spinous process except C1 and C7
Transverse foramina
Triangular vertebral column in C1 and C2
Unique features of thoracic vertebra
Demi factes for articulation with heads of two diff ribs
Coastal facet for articulation with shaft of the respective rib
Spinous process is oblique and jnferior
Which vertebrae has no arches
Coccyx
What is ligamentum flavum
Ligamentum flavum – extends between lamina of adjacent vertebrae.
Which intervertebral area doesn’t have disc
There is one disc between each pair of vertebrae, except for C1/2 and the sacrococcygeal vertebrae.
Right subclavian and left embryo origin
Right:4th aortic arch of right dorsal aorta and 7th intersegmental artery
Left: 7th intersegmental artery
Pulsation of which part of subclavian artery can be felt
3rd part in omoclavicular triangle
Brachiocephalic trunkip and subclavian relation
Inferior trunk lies posteriorly to 3rd part of subclavian artery
Branches of subclavian artery
Branches
Vertebral artery
Internal thoracic artery
Thyrocervical trunk
Costocervical trunk
Dorsal scapular artery
Mnemonic: ‘VIT C and D’
Subclavian artery is divided through which muscle
In 3 parts by ant scalene muscle
Blood supply to upper back
Dorsal scapular artery a branch of subclavian artery
Which nerves is present in investing layer of neck
Cervical branch of facial nerve
Transverse cutaneousnerve of neck
Digastric muscle nerve supply
Nerve supply to digastric muscle
Anterior: Mylohyoid nerve
Posterior: Facial nerve
Potato tumor
/enlargement of carotid body
Which part of ANSA CERVICALIS in carotid triangle
Upper root/ descends root
Nerves damaged during axillary node clearance
INTER COSTOBRQCHIAL
LONG THORACIC NERVE
Uncinate process of pancreas arise from which bud
Ventral bud
Also pancreatic duct also arises from this structure
Minor duct of Santorini
The minor duct of pancreas which arises from dorsal bud
annular pancreas where is the most likely site of obstruction
2nd part of duodenum
Blood supply of head of pancreas
Head: pancreaticoduodenal artery
Rest: splenic artery
Location of SMA to pancreass
The superior mesenteric artery lies behind the neck of the pancreas and anterior to the uncinate process.
the superior and inferior pancreaticoduodenal arteries are branches of
superior and inferior pancreaticoduodenal arteries which are branches of the gastroduodenal (from coeliac trunk) and superior mesenteric arteries, respectively.
Causes of pancreatitis
GET SMASHED:
Gall stones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion stings
Hypertriglyceridemia, hypercalcaemia and hyperparathyroidism
ERCP – endoscopic retrograde cholangiopancreatography
Drugs – such as sodium valproate, azathioprine and sulphonamides
Function of biceps
Flex the shoulder and elbow
Supinates the arm
brachioradialis function
Flexion at elbow and supination of forearm
Triangular ligament
On right and left side of hepatic formed when upper and lower coronary Ligaments join
Saphenous Nerve
It contains the saphenous nerve, femoral vein and the superficial branch of the femoral artery.
Nerve supply of tensor tympani and stapedius muscle
The tensor tympani is innervated by the trigeminal nerve
the stapedius by the facial
Witch nerve is associated with middle meningeal artery
The middle meningeal artery is intimately associated with the auriculotemporal nerve
Capitate is not associated with which nerve
Ulnar
Capitate articulates with which other bones
The capitate bone articulates with the lunate, scaphoid, hamate and trapezoid bones, which are therefore closely related to it.
Ulnar nerve and artery are adjacent to which carpal bone
Pisiform
The spinal accessory nerve innervates
The spinal accessory nerve innervates trapezius. The entire muscle will retract the scapula. However, its upper and lower fibres act together to upwardly rotate it.
Pudenal nerve relation to Perineal space
The pudendal nerve is located in the deep perineal space and then branches to innervate more superficial structures
What happens to Anatomical dead space after tracheostomy
Decreased by 50%
which nerve lies between the superior cerebelar and posterior cerebral arteries
Oculomotor nerve
Which artery is decompressed to treat Trigeminal Neuralgia
Superior cerebellar artery
The posterior inferior cerebelar artery arise from
Vertebral artery
labyrinthine artery origin and relation
Arise from lower partof basilar
Accompanies facial and vestibule cochlear Nerve
Adductor of shoulder joint
Pectoralis major, Teresa major, corachobrachialis, lats dorsi
the point of aortic bifurcation
L4
ectopic testis
A testis at the base of the penis is ectopic, not listed is the superficial inguinal pouc
arterial supply to the prostate gland
The arterial supply to the prostate gland is from the inferior vesical artery
inferior vesical artery is a branch of
Internal iliac artery
inability to adduct the thumb
Damage to the deep branch of the ulnar nerve may result in an inability to adduct the thumb
first branch of the axillary artery
The superior thoracic artery is the first branch of the axillary artery arises from the first part
long head of the triceps muscle arise?
The long head arises from the infraglenoid tubercle
At which of the following levels does the inferior thyroid artery enter the thyroid gland?
It enters the gland at C6
The space between the vocal cords is referred to as which of the following?
The rima glottidis is the narrowest part of the laryngeal cavity.
Improve
clinically distinguish between an upper and lower motor neurone lesion of the facial nerve?
Upper motor neurone lesions of the facial nerve- Paralysis of the lower half of face.
Lower motor neurone lesion- Paralysis of the entire ipsilateral face
Patey Mastectom
During a Patey Mastectomy surgeons divide pectoralis minor to gain access to level 3 node
How many compartments are there in the lower leg?
4
Waldeyers fascia
Waldeyers fascia separates the mesorectum from the sacrum
Fascial layers surrounding the rectum
Fascial layers surrounding the rectum:
Anteriorly lies the fascia of Denonvilliers
Posteriorly lies Waldeyers fascia
The terminal part of the thoracic duct relation
The terminal part of the thoracic duct inserts into the left subclavian vein and it passes posterior to the jugular vein.
Superior mesenteric artery first branch
inferior pancreatico-duodenal artery.
Improve
The superior adrenal artery is a branch of
The superior adrenal artery is a branch of the inferior phrenic artery.
Improve
Cardiooesophageal junction leve
Cardiooesophageal junction level = T11
Spinal level of ext4nsor hallucis longus
Extensor hallucis longus is derived from L5 a
Muscles supplied by recurrent laryngeal nerve
All larynx muscles except cricothyroid
Nerve supply to cricoid muscle
The external branch of the superior laryngeal nerve innervates the cricothyroid muscle.
The internal spermatic fascia (derived from transversalis fascia) invests:
The internal spermatic fascia (derived from transversalis fascia) invests:
Ductus deferens
Testicular vessels
Structures made from transversalis fascia
Deep inguinal ring
Internal spermatic fascia
annular pancreas is caused by which part of pancreas
Ventral
External carotid artery branches mnemonic:
External carotid artery branches mnemonic:
‘Some Angry Lady Figured Out PMS’
Superior thyroid (superior laryngeal artery branch)
Ascending pharyngeal
Lingual
Facial (tonsillar and labial artery)
Occipital
Posterior auricular
Maxillary (inferior alveolar artery, middle meningeal artery)
Superficial temporal
The psoas major inserts
The psoas major inserts into the lesser trochante
ulnar paradox
The ulnar paradox- the higher the lesion, the less the clawing of the fingers seen clinically.’
Damage to the which nerve will result in a Trendelenburg gait.
Damage to the superior gluteal nerve will result in a Trendelenburg gait.
Where does the spinal cord terminate in neonates?
L3
In TURP if thigh twitches then which nerve could be involved
The obturator nerve is most closely related to the bladder (see below)
Which of the structures are most closely related to the axillary nerve within the quadrangular space
The posterior circumflex humeral vessels which are branches of the axillary artery are related to the axillary nerve within the quadrangular space.
Improve
biopsy from the posterolateral aspect of the right neck is planned. Which nerve is at greatest risk?
The accessory nerve has a superficial course and is easily injured. It lies under platysma and may be divided during the early part of the procedure.
Improve
division of which fascial layers will expose the ansa cervicalis?
The ansa cervicalis lies anterior to the carotid artery and on the carotid sheath. It may be exposed by division of the pretracheal fascia at the posterolateral aspect of the thyroid gland
A man undergoes a high anterior resection for carcinoma of the upper rectum. Which vessels will require ligation?
The IMA is usually divided during anterior resection.
which structure is the central tendon of the diaphragm derived?
The septum transversum is a thick ridge of mesodermal tissue in the developing embryo that separates the thoracic and abdominal cavities and forms the central tendon of the diaphragm
The left main bronchus lies at
The left main bronchus lies at T6.
structures passing behind the medial malleolus from anterior to posterior include
tibialis posterior, flexor digitorum longus, posterior tibial vein, posterior tibial artery, nerve, flexor hallucis longus.
McEvedy’s incision
Emergency repair strangulated femoral hernia
pulsatile swelling between the greater trochanter and pubic tubercle which vessel is more likely to be affected?
The level specified would lie within the femoral triangle and therefore represents the femoral artery
Level of vertebra of
Hyoid
Notch of the thyroid cartilage
Cricoid cartilage(termination)
Hyoid C3
Notch of the thyroid cartilage C4
Cricoid cartilage(termination) C6
Thoracicduct relationto esophagus
The thoracic duct lies posterior to the oesophagus and passes to the left at the level of the Angle of Louis. It enters the thorax at T12 alongside with the aorta.
safe triangle for chest drain
Anterior edge latissimus dorsi, the lateral border of pectoralis major, a line superior to the horizontal level of the nipple, and the apex below the axilla.
root values of the sciatic nerve?
The sciatic nerve most commonly arises from L4 to S3.
winging of the scapular laterally vs mediaaly
If Mediaaly then due to LONG THORQCIC NERVE
If laterally then SPINAL ACCEROSY NERVE
Which area of face is not supplied by trigeminal nerve
The trigeminal nerve is the major sensory nerve to the face except over the angle of the jaw. The angle of the jaw is innervated by the greater auricular nerve.
Sibson’s fascia encloses
Sibson’s fascia overlies the apices of both lungs
suprapleural fascia (Sibson’s fascia) runs from C7 to the first rib and overlies the apex of both lungs.I
Post hysterectomy reports pain and reduced sensation over the medial aspect of her thigh. Clinically thigh adduction is weak
The obturator nerve supplies sensation to the medial aspect of the thigh and causes adduction and internal rotation of the thigh.
Sigmood sinus drains into
The sigmoid sinus is joined by the inferior petrosal sinus to drain into the internal jugular vein.
Hip internal rotators
Mnemonic lateral hip rotators: P-GO-GO-Q (top to bottom)
Piriformis
Gemellus superior
Obturator internus
Gemellus inferior
Obturator externus
Quadratus femoris
Which structure forms the largest tributary of the coronary sinus?
The great cardiac vein runs in the anterior interventricular groove, and is the largest tributary of the coronary sinus
Foramen spinosum transmits
The foramen spinosum transmits the middle meningeal artery
Bile duct vs cystic duct is supplied by
Bile: hepatic and re/troduodenal branches of the gastroduodenal artery
Cystic: only hepatic artery
superior vena caval obstruction. How many collateral circulations exist as alternative pathways of venous return?
None
There are 4 collateral venous systems:
Azygos venous system
Internal mammary venous pathway
Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)
prostate lymphatic drainage
The prostate lymphatic drainage is primarily to the internal iliac nodes and also the sacral nodes.
Middle meningeal artery is a branch of
middle meningeal arterys a branch of the maxillary artery
Ovarian lymphatic supply
Para aortic lymph nodes
Uterine funds drains into which lymphatic
Para aortic arch
May also to inguinal
Uterine body ,ymphatic drainage
To iliac lymph nodes via broad ligament
Cervix drains into
three potential nodal stations; laterally through the broad ligament to the external iliac nodes,
along the lymphatics of the uterosacral fold to the presacral nodes and
posterolaterally along lymphatics lying alongside the uterine vessels to the internal iliac nodes.
In left hemicolectomy which structure will be on inf aspect of psoas major
Left ureter
Boundaries of femoral 🔺️
Superiorly Inguinal ligament
Laterally Sartorius
Medially Adductor longus
Floor Iliopsoas, adductor longus and pectineus
Roof
Fascia lata and Superficial fascia
Superficial inguinal lymph nodes (palpable below the inguinal ligament)
Long saphenous vein
carpal bones is a sesamoid bone in the tendon of flexor carpi ulnaris?
Pisiform
The tenia coli converge at
The tenia coli converge at the base of the appendix.
Blood I’m paracolic gutter after traction of left hemicolon
Injury in
Spleen
Ligament important in providing support to the duodenojejunal flexure?
ligament of Treitz
cuboid’s distal articular surface?
The cuboid is located at the lateral aspect of the foot between the calcaneus posteriorly and the 4th and 5th metatarsals distally.
most important structure involved in supporting theuterus
The central perineal tendon provides the main structural support to the uterus.
Pain and temperature sensation transmitted through
Spinothalamic tract- Pain and temperature
Pectoralis minor is supplied by which nerve
Pectoralis minor is supplied by the medial pectoral nerve
initial location of the metanephric cap from which the kidney is derived?
Medial tobureteric bud in pelvis
A 6 day old child is suspected of having a malrotation and requires urgent abdominal exploration. What is the most appropriate surgical approach?
In young children, laparotomy is performed via transverse supra umbilical incision
aberrant Gantzer muscle.
accessory of the flexor pollicis longus and is a risk factor for anterior interosseous nerve compression.
Ant interosseous nerve lesion key point
Remember loss of pincer grip and normal sensation indicates an interosseous nerve lesion.
Which structure is at greatest risk of injury during the flush ligation of the saphenofemoral junction.
The deep external pudendal artery runs under the long saphenous vein close to its origin
Which nerve supplies general sensation to the posterior third of the tongue?
Glossopharyngeal nerve
lymphatic drainage of the male spongy urethra?
lymphatic drainage of the spongy urethra and the glans penis is to the deep inguinal nodes.
The prostatic and membranous urethra drains to which nodes
The prostatic and membranous urethra drains to the internal iliac nodes.
nerves is the primary source of innervation to the anterior scrotal skin?
primarily provided by the ilioinguinal nerve. The genital branch of the genitofemoral nerve provides a smaller contribution.
Popliteal fossa entrapment is the main differential diagnosis of adductor canal compression syndrome however the pulse disappears when the knee is fully extended in popliteal entrapment
Which structures will lie in closest proximity to the hamate bone within the carpal tunnel?
Flexor digitorum profundus tendon
No tendons attach to which carpal bones
Scaphoid, lunate, triquetrum (stabilised by ligaments)
Which ligament keeps the head of the radius connected to the radial notch of the ulna?
The annular ligament connects the radial head to the radial notch of the ulna. This
origin of the superior and inferior gluteal artery?
The inferior gluteal artery arises from the anterior trunk of the internal iliac artery
The superior gluteal artery arises from the posterior trunk of the internal iliac artery
Ureter is related to which ligament of uterus
is related to the broad ligament and is within 1.5cm of the supravaginal part of the cervix.
Spleen is derived from which embryological memb
Most of the gut is derived endodermally except for the spleen which is from mesenchymal tissue.
Spleen measurements
1,3,5,7,9,11 (odd numbers up to 11)
The spleen is: 1 inch thick, 3 inches wide, 5 inches long, weighs 7oz (150-200g), lies between the 9th and 11th ribs
Mid inguinal point vs Mid point of the inguinal ligament
Mid inguinal point= surface marking for femoral artery
Mid point of the inguinal ligament = surface marking for deep inguinal ring.
Improve
Which structure herniated during disc prolapse
nucleus pulposus is the structure which usually herniates
Main contributor of arterial supply of femoral head
The vessels which form the anastomoses around the femoral head are derived from the medial and lateral circumflex femoral arteries. These are usually derived from the profunda femoris artery
tendon lies medial to the dorsalis pedis artery.
The extensor hallucis longus tendon lies medial to the dorsalis pedis artery.
Nerve medial to brachial artery in cubital fossa is
Median Nerve
Which splenic structure lies most posteriorly?
The lienorenal ligament lies most posteriorly
structures lies posterolaterally to the external carotid at it’s origin
The internal carotid artery lies posterolaterally to the external carotid artery at it’s origi
The right testicular vein drains into
The right testicular vein drains into the inferior vena cava.
Structures within the right atrium:
Musculi pectinati
Crista terminalis
Opening of the coronary sinus
Fossa ovalis
Lesions distal to the dentate line drain to
Lesions distal to the dentate line drain to the inguinal nodes.
structures in the porta hepatis
Portal vein
Hepatic artery
Common hepatic duc
Liver segments
Right lobe V to VIII
Left Lobe II to IV
Caudate I
Quadrate lobe belongs to which side of liver
Part of the right lobe anatomically, functionally is part of the left
Couinaud segment IV
Which part of liver gets blood from both R and L hepatic arteries
Caudate lobe
ligamentum teres is
ligamentum teres, a remnant of the umbilical vein is arteroinferior free part of faIciform ligament
Ligamentum teres
Ligamentum teres Joins the left branch of the portal vein in the porta hepatis
Portal Triad lies in
Gastro duodenal ligament
Hepatic Recesses
Subphrenic
Subhepatic
Morrison pouch
Which recess will have fluid in supine patient first as it’s deepest
Morison’s pouch, a space b/w liver and Kidney
deepest part of the peritoneal cavity when supine (lying flat
Morison’s pouch
Caudate lobe lies b/w
IV C on rightside and ligamentum venosum on Left side
Quadrate lobe lies b/w
gallbladder and a fossa produced by the ligamentum teres (a remnant of the fetal umbilical vein).
porta hepatis transmits all the vessels, nerves and ducts entering or leaving the liver with the exception of
hepatic veins.
Structure above and below Porta hepatis
Caudate superiorly
Quadrate inferiorly
Glisson’s capsule.
The liver is covered by a fibrous layer, known
Content of Portal Triad
Arteriole
Venule
Bile duct
Vagus Nerve
- Lymphatic Vessels
Blood supply of Liver
Hepatic artery proper (25%) – supplies the non-parenchymal structures
Hepatic portal vein (75%) – supplies the liver parenchyma
Glisson’s Capsule Nerve Supply
Glisson’s capsule, the fibrous covering of the liver, is innervated by branches of the lower intercostal nerves.Distension of the capsule results in a sharp, well localised pain.
Lymph node of Lund –
the first lymph node of the gallbladder
Border of Calot Triangle
Medial – common hepatic duct.
Inferior – cystic duct.
Superior – inferior surface of the liver.
cystic artery is a branch of
right hepatic artery not left
contents of the Calot’s triangle
Right hepatic artery
Cystic artery
Lymph node of Lund
Lymphatics
Hartmann’s Pouch
The neck of GB contains a mucosal fold, known as Hartmann’s Pouch. This is a common location for gallstones to become lodged, causing cholestasis
Sinus Tarsi
Between talus and calcaneus
Retropulsion by which muscle
Extensor pollicis longus
Most medial part of femoral triangle
Femoral canal
Content of femoral canal
The femoral canal contains:
Lymphatic vessels – draining the deep inguinal lymph nodes.
Deep lymph node – the lacunar node.
Empty space.
Loose connective tissue.
Relation of Genital branch of genitofemoral nerve and
Femoral branch of genitofemoral nerve to inguinal ligament
Genital passes above itwhile femoral passes below it
Which lymph nodes in femoral canal
Cloquet
Hernia occurring 2° to r3nal surgery
Lumbar hernia
hernia occurring at the level of the arcuate line
Spigelian
obturator hernia points
More common in women and elders
Also in peoplewho has lost weight ver fast
Positive Howship-Romberg sig
positive Howship-Romberg sig
hip and knee pain exacerbated by thigh extension, medial rotation, and abduction).
Axillary tail
smaller part, runs along the inferior lateral edge of the pectoralis major towards the axillary fossa.
Breast position in horizontal and vertical fashion
Horizontally from the lateral border of the sternum to the mid-axillary line.
Vertically, it spans between the 2nd and 6th costal cartilages.
Retromammary space
There is a layer of loose connective tissue between the breast and pectoral fascia – known as the
Breast arises in embryo from
Milkline of Schultz
Which axillary node lies in contact with axillary vein
Lateral nodes
Injury of which axillary node affects intercostobrachial nerve
Central lymph nodes
In which position axillary apex is small in size
arm abduction. The apex decreases in size most markedly when the arm is fully abducted
quadrangular space content
The axillary nerve and posterior circumflex humeral artery and vein pass through the quadrangular space
Border of quadrangular space
Superior – inferior aspect of teres minor
Inferior – superior aspect of teres major
Lateral – surgical neck of humerus.
Medial – long head of triceps brachii
Anterior – subscapularis
Muscles enclosed by clavipectoral fascia
Subclavius
Pectoralis minor
Which part of adductor longus forms medial border of femoral triangle
Medial border not lateral
Function of femoral nerve
innervates the anterior compartment of the thigh, and provides sensory branches for the leg and foot.
spinal cord terminate in neonates at
L3
What structure anchors the cord to the first coccygeal vertebra.
the meninges form a strand of fibrous tissue, the filum terminale anchors the cord to the first coccygeal vertebra.
Two point of enlargement in spinalcord location
The cervical enlargement is located proximally, at the C4-T1 level. It represents the origin of the brachial plexus.
Between T11 and L1 is the lumbar enlargement, representing the origin of the lumbar and sacral plexi.
depressions on spinal cord surface
The anterior median fissure is a deep groove extending the length of the anterior surface of the spinal cord.
On the posterior aspect there is a slightly shallower depression – the posterior median sulcus.
Signs of cauda equina syndrome
Saddle-area anaesthesia.
Incontinence / retention of urine or faeces.
Reduced anal tone.
Paralysis ± sensory loss.
Cauda euina lies in which region
Subarachnoid space
internal vertebral venous plexus is found in which space
Epi dural space
Which meninges convert to epineurium
Dura
What is lumbar cistern.
Distal to the conus medullaris, the subarachnoid space expands,
space accessed during a lumbar puncture
What is denticulate/dentate Ligament
Between the nerve roots the pia mater thickens as a triangular shaped ligaments that anchor the spinal cord along its length, at each side, to the dura mater.
What are Rexeds laminae.
The grey matter of spinal cord is sub divided cytoarchitecturally into VIII lamina
Cauda equina runs from across which levels of vertebra
The nerve roots L2-S5 arise from the distal end of the spinal cord, forming a bundle of nerves known as the cauda equina.
Ant vs Post Rami
Post rami skin supplies nerve fibres to the synovial joints of the vertebral column, deep muscles of the back, and the overlying skin.
Ant Rami supplies the rest
What is Lissauer’s tract
pathway formed from the proximal end of small unmyelinated and poorly myelinated fibers in peripheral nerves, which enter at the lateral aspect of the dorsal horn and ascend and descend up to four segments, and terminate in Rexed’s laminae I through to VI (principally I, II, and V) of the ipsilateral dorsal horn.
What is artery of Adamkiewicz
the dominant thoracolumbar segmental medullary artery, which supplies the lower spinal cord by reinforcing the anterior spinal artery
intercostal or upper lumbar arteries, and supplies the inferior 2/3 of the spinal cord.
Segmental spinal arteries are branches of which artery in the Thorax
Posterior intercostal ardri
Internal Venus plexus of spinal cord is present in
Epidural space
intermediate column and lateral horn of spinal cord contains
neurons that innervate visceral and pelvic organs.
Spinal cord grey matter can be functionally classified in three different ways
1) into four main columns;
2) into six different nuclei; or
3) into ten Rexed laminae.
Nucleus of spinal cord grey matter
Six different nuclei
marginal zone,
substantia gelatinosa,
nucleus proprius,
dorsal nucleus of Clarke,
intermediolateral nucleus and
the lower motor neuron nuclei.
Which spinal cord nuclei relays sensory information from viscera to the brain, and autonomic signals from the brain to the visceral organs.
Interomediolateral nucleus (IMN
carpal bones is a sesamoid bone in the tendon of flexor carpi ulnaris?
Pisiform
Which carpel bone has retro grade blood supply
Scaphoid
Which carpal bones don’t have any tendons attached to
Scaphoid, lunate, triquetrum
Wrist joint proximal and distal
P: Radius and articular disk.
D: Proximal row of wrists ( Scaphoid, Lunate, Triquetrum except pisiform)
Ligaments of Wrist Joint
Palmar radiocarpal
Dorsal radio carpal
Ulnar collateral
Radial collateral
Dorsal vs Palmar radiocarpal helps in which movement
D: Pronation
P: Supination
Dorsal vs Palmar radiocarpal helps in which movement
D: Pronation
P: Supination
Ulnar vs radial collateral ligament of wrist attachment
U: ulna/ Triquetrum and Pisiform
R: radius/ scaphoid and Trapezium
Abduction versus adduction atwrist joint
Adduction – Produced by the extensor carpi ulnaris and flexor carpi ulnaris
Abduction – Produced by the abductor pollicis longus, flexor carpi radialis, extensor carpi radialis longus and brevis.
Anterior Dislocation of the Lunate occurs
Anterior Dislocation of the Lunate
Innervation to the wrist is delivered by
Median nerve – Anterior interosseous branch.
Radial nerve – Posterior interosseous branch.
Ulnar nerve – deep and dorsal branches.
anterior and posterior interosseous arteries are branches of
Ulnar artery
Superficial and palmar arterial arch sandwiched
Palmar aponeurosis»superficial palmar arch»flexor tendons»deep palmar arch»metacarpal bones
Kaplan’s cardinal line.
To locate palmar arches.
This line extends from the apex of the interdigital fold between the abducted thumb and index finger toward the hook of hamate on the ulnar side of the hand, parallel with the middle crease of the hand.
Deep palmar arch lies in relation with
Ulnar nerve
Deep Parmar arch is direct continuation of
Radial artery
Deep Parmar arch arises between heads of
Adductor . Pollicis longus
Branches of deep palmar arch
Palmar metacarpal arteries, perforating branches, recurrent branches
which digit is not supplied by palmer arch
Thumb and lateral aspect of index finger
They are directly supplied by radial artery
Radial artery enters palnor aspect from dorsal
Between first dorsal interossei
How superficial and deep palmar arches anastomose
Common palmar branch of superficial and Palmar metacarpal of deep .
Arterial supply of fingers
Ulmer supply MediaI half of index + other 3 fingers
Radial supply lateral half of index and Thumb
Dorsal anastomosis of radial and ulnar artery
Through dorsal branches to form dorsal arch
PaImar and dorsal arteries anastomose in hand through
Perforating branches
Superficial palmar artery of radial arises
Just before radial artery curves around 1st metacarpal to dorsal aspect
Stylopharyngeus pharyngeal arch
3rd
Position of external and internal oblique
External: fibres run inferomedially
Internal: fibers run superomedially
Attachment of external oblique and internal oblique
External : Originates from ribs 5-12, and inserts into the iliac crest and pubic tubercle.
Internal: Originates from the inguinal ligament, iliac crest and lumbodorsal fascia, and inserts into ribs 10-12.
Nerve supply of ant abd muscles
Thoracoabdominal nerves (T7-T11) and subcostal nerve (T12).
linea semilunaris.
lateral borders of the muscle rectus create a surface
Transpyloric plane
halfway between the jugular notch and the pubic symphysis, approximately the level of the L1 vertebrae.
Intertubercular plane
horizontal line that runs between the superior aspect of the right and left iliac crests.
Superior dental plexus is made of
Ant
Middle and
Post superior alveolar nerve
All are branches of maxillary nerve
All smuscles of 1st pharyngeal arch are supplied by
Mandibular nerve
Otic ganglion is sandwiched between whichstructures
Mandibular nerve and Ternsor vali paliti muscle
Lower part of face is supplied by mandibular nerve except which region
Angle of mandible and auricle
Supplied by great auricular nerve
which nerve surrounds abducen s nucleus in pons
facial nerve
which nerve passes between posterior cerebral and superior cerebellar arteries,
Trochlear
Stylohyoid is innervated by the
facial nerve
Muscles supplied by Trigeminal nerve
Muscles of mastication
Mylohyoid
Anterior belly of digastric
Tensor tympani
Tensor palati
general sensation to the posterior third of the tongue?
Glosso Pharyngeal
stylopharyngeaus muscle nerve supply
Glossopharyngeal
The sensory function of which nerve is tested using the gag reflex.
Glossopharyngeal nerve
which branches of facial nerve arise in facial canal
3 branches:
1. greater petrosal nerve
2. nerve to stapedius
3. chorda tympani
which branch of facial nerve arise inStylomastoid foramen
Posterior auricular nerve and branch to posterior belly of digastric and stylohyoid muscle
The facial nerve is associated with the derivatives of which pharyngeal arch:
the second
sup vs inf salivatory nucleus nerves arising
Sup: Sensory part of facial nerve
Inf: Glossopharyngeal
Nucleus of Facial Nerves
- Facial motor nucleus> Muscular branch
- Sup salivatory Nucleus> Glandular branch
- Nucleus of Solitary tract: carry taste sensation
- Spinal trigeminal nucleus> Carry sensation from outer ear
Supply of Facial Nerve
Supply - ‘face, ear, taste, tear’
Face: muscles of facial expression
Ear: nerve to stapedius
Taste: supplies anterior two-thirds of tongue
Tear: parasympathetic fibres to lacrimal glands, also salivary
Nerve to platysma
Cervical branch of facial
2 nerve roots of facial nerve
- Motor root
- Intermediate Nerve carries sympathetic and sensory fibres.
Facial nerve takes how mant 90° turn
3turns
1. In temporal bone at geniculate ganglion ( where the two roots combine)
2.
Glandular supply to submandibular and sublingual glands nerve
Chorda tympani nerve of facial nerve
Parasympathetic of facial nerve
Submandibular and sublingual salivary glands.
Nasal, palatine and pharyngeal mucous glands.
Lacrimal glands.
Nerves in internal acoustic meatus,
VII and VIII
Gag reflex
Glossopharyngeal
hyperacusis nerve damage
Two nerves
Facial supplies to stapedius
Trigeminal supplies to tensor tympani muscle
Branches of Mandibular nerve V3
Auriculotemporal nerve
Lingual
Inferior alveolar
Nerve to the mylohyoid
Mental
Most superficial structure on the parotid gland =
facial nerve
Structures passing through parotid
Facial nerve
External carotid artery
Retromandibular vein
Auriculotemporal nerve
Sensory nerve supply of parotid
Auriculotemporal(gland) and greaterauricular nerve(fascia).
Artery of parotid
posterior auricular and superficial temporal arteries
ECA giveseise to which artery in parotid
posterior auricular artery
Medial branch if External carotid artery
Ascending pharyngeal
Which structure lies posterolaterally to the external carotid artery at it’s origin from the common carotid.
The internal carotid artery
Structure which can be damaged sec to tonsillectomy
External palatine vein
SCALP
contents
Skin, Dense Connective Tissue, Epicranial Aponeurosis, Loose Areolar Connective Tissue and Periosteum.
Emissary veins are present in which layer of scalp
Loose areolar Connective tissue
danger area” of the scalp
loose connective tissue layer
Venous drainage of scalp
Superficial follows artery
Deep through pterygoid venous plexus. This is a large plexus of veins situated between the temporalis and lateral pterygoid muscles,and drains into the maxillary vein.
Sudden collapse and loss of consciousness
Which brain issue
Subarachnoid hemorrhage
Intraventricular haemorrhage is Present in
neonates spontaneously
Intraventricular haemorrhage in neonates occur
first 72 hours after birth
Arterial supply of scalp
Post auricular
Superficial temporal
Occipital
External Jugular Vein is formed by
Postauricular vein
Post branch of retro mandibular vein
Posterior auricular vein drains
the area of scalp superior and posterior to the outer ear.
Ant vs post branch of retromandibular vein
Ant combines with facial vein»common facial vein»IJV
Post combines with post auricular vein»_space; EJV
At base of skull what lies between IJV and Internal carotid Rtery
Last 4 cranial nerves
Tributaries of IJV
Inferior petrosal sinus, vein of cochlear duct, meningeal veins, pharyngeal venous plexus, lingual vein, common facial vein, sternocleidomastoid vein, superior and middle
Which structure lies at midpoint of IJV
Ansa cervicalis
Below the transverse process of the atlas IJV is crossed on its lateral side by the
accessory nerve
Middle cervical sympathetic ganglion, recurrent laryngeal nerve, and parathyroid glands are all closely related with which blood vessel?
inferior thyroid artery
branches from thyrocervical trunk to supply posterior side of thyroid gland and parathyroid glands
Which of the following nerves are responsible for relaying information to/from the carotid sinus?
vagus and glossopharyngeal nerves are both involved in the relaying of information from the carotid sinus. If the question was asking what nerve carries the sensory information from the pressure receptors the answer would have been the glossopharyngeal alone
The muscular (omotracheal) triangle contains
the infrahyoid muscles
, thyroid gland
and parathyroid glands.
Muscle innervated by the spinal accessory nerve
Both the trapezius and the SCM are
Stylohyoid attaches to which part if hyoid
Lesser horn
Which muscle form floor of mouth
Mylohyoid
posterolateral gluteal skin in the pubic region sensory supply
Iliohypogastric
Cutaneous innervation over femoral triangle/upper anterior thigh
Femoral branch of genitofemoral
Cremasteric muscle innervatiom
Genital branch of genitofemoral
Ilioinguinal and iliohypogastric muscular supply
Transverse abdominis
Internal oblique
Femoral nerve gives rise to which branches before inguinal ligament
Nerve to iliacus
Nerve to pectineus
sartorius Nervesupply
Sartorius is supplied by the anterior (superficial) branch of the femoral nerve.
Most of the branches of the superficial femoral nerve are cutaneous. However, it does also supply sartorius.
classical description of a femoral nerve injury
weak hip flexion, weak knee extension, and impaired quadriceps tendon reflex, as well as sensory deficit in the anteromedial aspect of the thigh.
Nerve supply of lateral hip rotators
-
Piriformis: ventral rami S1, S2
Obturator internus: nerve to obturator internus
Superior gemellus: nerve to obturator internus
Inferior gemellus: nerve to quadratus femoris
Quadrator femoris: nerve to quadrator femoris
patients may develop impotence following rectal cancer surgery due to damageto
Nervi erigentes
All muscles of ant compartment ofthigh are innervated by Femoral except
psoas major
L1-L3
The only muscle of the quadriceps to cross both the hip and knee joints. It flexes the thigh at the hip joint, and extends at the knee joint.
Rectus Femoris
which muscle of ant compartment is supplied by both formoral and obturator
Pectinus
Muscles which are attached to linea aspera and supracondylar Line of femur
Biceps femoris short head origin on lateral side
Adductor magnus medialside
The subsartorial plexus is formed by
: the medial cutaneous nerve of the thigh (a branch of the femoral nerve).
the saphenous nerve (a branch from femoral nerve).
the cutaneous branch of anterior division of the obturator nerve.
Pfannenstiel incision.
Nerve damage
Ilio inguinal nerve
In leg tibial nerve lies on postsurface of which muscle
Tibialis posterior
which part of subclavicular artery can be palpated in neck and where
3rd part of subclavialar artery im, omoclavicular triangle
Branches of Thyrocervical Trunk
1 Inferior Thyroid artery
2 Transverse cervical
3 Suprascapular artery
Branches of Costocervical Trunk
Superior Intercoastal
Deep Cervical
Contents of cubital fossa from medial to lateral
Median Nerve > Brachial artery > Biceps Brachi tendon > Sup Branch of radial nerve
which artery isbehind lateral third part of clavicle
Thoracoacromial
Branches in acromial plexus
1.suprascapular artery,
2 deltoid branch of the thoracoacromial artery
3 posterior circumflex humeral arteries.
4. acromial branch of the thoracoacromial artery
Clavincular branch of of Thoraco acromial artery supplies
sternoclavicular joint
Subclavius
Attachment muscles of supra and infraglenoid tubercle
Supra: long head of biceps
Infra: long head of triceps
Location of subacromial bursa
Subacromial – located deep to the deltoid and acromion, and superficial to the supraspinatus tendon and joint capsule.
Stensen’s duct tract
It passes over Masseter and then pierces buccinator
Function of gluteus mini and medius apart from extension
Abduction and medial rotation
Tibial nerve in popliteal fossa in relation to vessels
Medial>posterior >lateral
Sural Nerve facts
Origin
Medial sural cutaneous nerve, lateral sural cutaneous nerve
Branches
Lateral dorsal cutaneous nerve of foot, lateral calcaneal branches of sural nerve
Supply
Posterolateral aspect of the distal third of the leg, ankle, foot and heel
Origin of superior and inferior gluteal arteries
The inferior gluteal artery arises from the anterior trunk of the internal iliac artery
The superior gluteal artery arises from the posterior trunk of the internal iliac artery
Relation of obturator artery with nerve and vein in pelvis
superior to the obturator vein and inferior to the obturator nerve.
Branches of obturator artery
Pelvic: Iliac, Vesical and pubic branch
Extrapelvic: anterior, posterior and acetabular.
Which branches of obturator and femoral arteries combine
Ant of obt and Post of Femoral
Remnant of Urachus
Median umbilical ligament
Artery to vas defrens and cremaster muscle Arises from
Artery of vas deferens Arises from inferior vesical artery
Cremasteric artery Arises from inferior epigastric artery
Location of testes during intrauterine life
At 3 months in iliac fossa
At 7 months in deep inguinal ring level
Remnant of gubernaculum in females
Round ligament
Ovarian ligament
Supination of forearm is done by
Biceps brachi
Biceps vs tricep tendon reflex test shows which level
C6 for B
C7 for R
What is medial bicipital groove of arm
The space between the medial head of the triceps and the biceps brachii forms the medial bicipital groove, which provides a passageway for the brachial artery and median and ulnar nerves.
Which muscles attach on intertubercular sulcus of humerus
latissimus dorsi attaching between teres major on the medial lip and pectoralis major laterally.
mnemonic “a lady between two majors
Cephalic vein is in relation of which nerve
Lateral cutaneous nerve of forearm
Lateral malleolus posterior relation
Structures posterior to the lateral malleolus and superficial to superior peroneal retinaculum
Sural nerve
Short saphenous vein
Structures posterior to the lateral malleolus and deep to superior peroneal retinaculum
Peroneus longus tendon
Peroneus brevis tendon
Middle of fibula structure
Risk of damage in fibulectomy
Peroneal artery
Tributaries of great saphenous
Medial marginal
Superficial epigastric
Superficial iliac circumflex
Superficial external pudendal veins
Ureter Relation
Ovarian artery
Uterine artery/ vas deferens
Common iliac and pelvic entry
Post to Ovarian at pelvic brim
Post to Uterine 2cm superior to the ischial spine
Ant to common iliac at their bufucation at sacro iliac joint it enter pelvis
Blood supply of ureter
Abdominal – renal artery, testicular/ovarian artery, and ureteral branches directly from the abdominal aorta
Pelvic – superior and inferior vesical arteries.
Eyelids and conjunctiva sensory supply
Opthalmic nerve
Upper eyelid vs lower eyelid sensory supply
Upper by opthalmic
Lower by maxillary
Skull Sinuses sensory supply
maxillary, ethmoid and sphenoid sinuses by Maxillary nerve
Frontal by opthalmic
Tonsillar fossa nerve supply
Glossopharyngeal nerve mainly
Some from lesser palatine nerve
Which nerve is responsiblefor otalgia post tonsillectomy
Glossopharyngeal nerve
Lymph nodes of tonsils
jugulodigastric node and the deep cervical nodes
Tonsillar artery is a branch of
Facial artery
Which structure is most likely to produce hemorrhage during tonsillectomy
The external palatine vein
Waldeyer’s ring
Ring arrangement formed by 4 tonsil groups
Which tonsil is called an adenoid
Pharyngeal
Waldeyer ring border
Superior: Pharyngeal Tonsil
Inferior: Lingual Tonsil
Lateral: Tubal and Palatine Tonsils
Histo of 4 tonsils
Lingual and Palatine: stratified non-keratinised squamous epithelium.
Pharyngeal and Tubal:ciliated pseudostratified epithelium.
Palatine tonsils and tonsillar fossa pharyngeal origin
2nd pouch
Palatine tonsils are located between
located between the palatoglossal arch anteriorly and the palatopharyngeal arch posteriorly
Vasomotor and sudomotor
Vs
Pupillomotor fibers runs over
V and S runs over external carotid artery
P runs over Internal carotid
They separate at common carotid bifurcation level
Few features of C3 and C4 level
superior cervical ganglion at the level of the bifurcation of the common carotid artery (C3-C4).
External anal sphincter in relation with which pelvic floor
Puborectalis
What is anorectal ring
At the junction of the rectum and the anal canal, there is a muscular ring – known as the anorectal ring. It is formed by the fusion of the internal anal sphincter, external anal sphincter and puborectalis muscle, and is palpable on digital rectal examination.
Anal canal arise
Above the pectinate line –
Below the pectinate line –
derived from the embryonic hindgut.
derived from the ectoderm of the proctodeum.
Atrial stretch receptors are located
Located in atria at junction between pulmonary veins and vena cava.
Mnemonic for the nerves passing through the supraorbital fissure:
Live Frankly To See Absolutely No Insult
Lacrimal
Frontal
Trochlear
Superior Division of Oculomotor
Abducens
Nasociliary
Inferior Division of Oculomotor nerve
Right crus of diaphragm forms which opening
Oesophageal
Ureter runs ant to which muscle
Psoas major
Adduction vs abduction of vocal fold
Adduction by Lateral cricoarytenoid
Abduction by posterior cricoarytenoid
Vocal cord tense vs relax by which muscles
Tense by Cricoarytenoid
Relax by Thyroarytenoid
Span of trachea and larynx
Trachea: C6 to T4
Larynx: C3 to C6
Verterbral artery traverses
Transverse process of vertebrae
Not INTERVERTEBRAL FORAMEN
most often permanently damaged during a superficial parotidectomy?
Greater auricular nerve
FACIAL ISN’T PERMANENTLY DAMAGED
Cancer vs BPH zone of prostate
Cancer: peripheral.
BPH : Transitional
Area of prostate felt against DRE
Peripheral
Which zone of prostate which covers
Ejaculatory duct vs urethr
ED: central
Urethra : Transitional
Internal iliac artery bifurcation above
Greater sciatic foramen
Branches of qnt and post brqnch of int iliac arteries.
Branches of the posterior division of the internal iliac
Lateral sacral, superior gluteal, iliolumbar artery.
Branches of the anterior division of the internal iliac artery
Obturator artery, internal pudendal artery, inferior gluteal, inferior vesical artery, artery the ductus deferens, middle rectal, vaginal artery, uterine artery
Ulnar artery lies in distal 2/3 forearm between
From lateral to medial
Flexor digitorum superficialis»ulnar artery»>ulnar nerve
Ulnar artery relation to median and ulnar nerve
It is medial to median in upperforearm
Lateral to ulnar in distal forarm
Division of which structure give passage to
1. lesser sac
2. Coeliac axis
- Greater omentum
- Lesser omentum
Ligaments on clavicle attacheson
Inferior surface
Medial : costoclavicular ligament
Lateral: Trapezoid line and conoid line for coracoacromiql ligament
Middle : subclavius muscle
Sternocleidomastoid attaches on the middle aspect of superior surface
Sternohyoid on posterior surface
Wh9ch structure relaxes to accumulate and temporarily store faeces until defecation occurs.
The final segment of the rectum, the ampulla,
Extra peritoneal rectum
Posterior upper third
Posterior and lateral middle third
Whole lower third
Wh8ch muscle form anorectal flexure
Puborectalis
Anterior relation of rectum in males and females
Anteriorly (Males) :
Rectovesical pouch
Bladder
Prostate
Seminal vesicles
Anteriorly (Females):
Recto-uterine pouch (Douglas)
Cervix
Vaginal wall
Which part of the duodenum is associated with IVC
1st and 3rd part ant to IVC
Ant relation of IVC
Liver
Epiploic foramen
1st duod
Head of Pancreas
3rd duod
Right gonadal artery
R common iliac
Which structure lies 3cm below the 12th rib in the mid scapular line of left side
Left kidney
Which part of the duodenum is at transpyloric plane
2nd
Subcostal plane,
Intertubercular plane
Level
Lowest margin of 10th costal cartilage
Level of body L5
Pronator teres vs palmaris nerve supply
Pro by Median
Pal by ulnar
The lateral meniscus is crossed by which muscle tendon
The lateral meniscus is crossed by the popliteus tendon
Posterior cruciate ligament is separated from the popliteal vessels at its origin by
the oblique popliteal ligament
When sigmoid colon starts
At a level of L3-4 (variable) the left colon becomes the sigmoid colon and wholly intraperitoneal once again
Aorta relation with duodenum
Aorta is Post to 3rd part of duodenum
Lateral to 4th part of duodenum and duodenojejunal flexure
Layers of Periosteum
outer ‘fibrous layer’ and
inner ‘cambium layer’ (or ‘osteogenic layer’).
What are Sharpey’s fibres
Periosteum is attached to bone by strong collagenous fibers called
Which tendon helps in identification of dorsalis pedis artery
The extensor hallucis longus tendon lies medial to the dorsalis pedis artery
Collat3ral venous pathway of SVC
Azygos venous system
Internal mammary venous pathway
Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)
Gantzer muscle is an aberrant accessory muscle
Which nerve involvement
Anterior interosseous nerve
Branch of median nerve
loss of pincer grip and normal sensation indicates which nerve lesion
an anterior interosseous
Lingual nerve is related to which teeth
lingual nerve is closely related to the third molar
Lymph NODES of Vagina
The lymph vessels from the superior aspect of the vagina join the internal and external iliac nodes, those from the inferior aspect of the vagina drain to the superficial inguinal nodes.
which muscle crosses dorsalis pedis artery
Eextensor hallucis brevis
Ext digitorum longus
Nerve root reflexes
1-2 Ankle (S1-S2)
3-4 Knee (L3-L4)
5-6 Biceps (C5-C6)
7-8 Triceps (C7-C8)
