Anatomy Flashcards
What nerve(s) innervates the anterior abdominal wall muscles (external and internal oblique, transversus abdominis)?
Thoracoabdominal T7-T11 and subcostal nerve T12 (and branches of lumbar plexus for internal oblique + transversus abdominis)
The internal oblique muscle inserts into ___
Ribs 10-12
The linea semilunaris demarcates the ____ and runs from the 9th rib to the ____
Lateral border of the rectus abdominis muscles; pubic tubercle
The trans pyloric plane is at approximately what vertebral level?
L1
The deep inguinal ring is located where along the inguinal ligament? It is an oval defect in which structure?
Mid-point (between ASIS and pubic tubercle); transversalis fascia
The superficial inguinal ring sits MEDIALLY/ LATERALLY to the inferior epigastric artery? It is a defect in which structure?
Medially; external oblique aponeurosis
True or false: the ilioinguinal nerve passes through the deep inguinal ring into the inguinal canal?
False - it is a structure contained in the inguinal canal but gains access via the anterior wall/ piercing the roof midway along the canal (it is NOT transmitted through the deep ring)
Describe the fascial linings of the spermatic cord and their origins?
External spermatic fascia - from external oblique aponeurosis
Cremasteric muscle/ fascia - from internal oblique muscle and fascia
Internal spermatic fascia - from transversalis fascia
The cremaster artery arises from the ____
inferior epigastric artery
List the retroperitoneal structures
SAD PUCKER - Suprarenal glands, Aorta/ IVC, D2/3, Pancreas (except the tail), Ureters, Colon (ascending + descending), Kidneys, Esophagus, Rectum
The inguinal ligament is formed by ____
The free inferior border of the external oblique aponeurosis. It extends from the ASIS to pubic tubercle
What is the approximate length of the inguinal canal? What are its contents?
4cm (6cm in Last’s); Spermatic cord (males) / round ligament (females) and ilioinguinal nerve
The arcuate line is the horizontal delineation of the lower posterior rectus sheath. Where is it usually positioned?
Approx 2.5cm below the umbilicus. It is also known as the Semicircular line of Douglas
Describe the aponeurotic layers of the rectus sheath superior and inferior to the arcuate line
SUPERIOR: external oblique aponeurosis is anterior, the internal oblique aponeurosis splits and has a ‘laminae’ anterior and posterior to rectus muscle, transverses aponeurosis lies deep
INFERIOR: external, internal oblique aponeurosis and transversus aponeurosis lie anteriorly (transversalis fascia lies deep)
The median umbilical ligament runs from ____ to ____ and contains the ____
Superior bladder to midline of internal anterior abdominal wall. Urachal remnant
The medial umbilical ligaments (x2) are formed due to ___
The obliterated umbilical artery
The lateral umbilical folds (NOT ligamentous structures) are formed by ____
The inferior epigastric arteries
(the epigastric vessels sit post to rectus abdominis, in the post rectus sheath (above arcuate line) or superficial to transversalis fascia (below))
The foregut is from mouth to ____ (supplied by X), midgut from ____ to _____ (supplied by Y) and hindgut from ____ to anus (supplied by Z)
The foregut is from mouth to D1 (coeliac artery), midgut from D1 to L colic (splenic) flexure (SMA) and hindgut from L colic (splenic flexure) to anus (IMA)
The duodenum sits anterior/ posterior to the bile duct, portal vein and pancreas
Anterior
The major duodenal papilla empties into which part of the duodenum?
D2 (descending)
Psoas major, the IVC, aorta, right ureter and gonadal vessels pass anteriorly/posteriorly to the duodenum, and the SMA/ SMV pass anteriorly/ posteriorly
posteriorly; anteriorly
Which structures suspends the duodenojejunal flexure from the posterior body wall?
Ligament of Treitz
The jejunum is usually thicker/ thinner walled than the ileum, has more/ less plicae circulares and single/ multiple layers of vascular arcades with short/ long vasa recta
Thicker walls; more; single; long (allows for ‘windows’ in mesentery - thinner between vasa rectae)
Where are Peyer’s patches located?
Ileum.
These are palpable lymphatic nodules part of the MALT (mucosa associated lymphoid tissue), and distinguish ileum from jejunum
The appendix is (intra/retro)peritoneal
Intraperitoneal
What is the marginal artery of Drummond?
The anastomotic network of vessels from middle colic branch of SMA and left colic of IMA that runs around mesenteric border of the large intestine
What are the origins of the rectal arteries?
Superior rectal from IMA; middle rectal from internal iliac; inferior rectal from internal pudendal artery (the venous drainage follows a similar pattern: superior rectal veins drain to portal vein, whilst middle and inferior to internal iliac vein)
Connect the type of muscle fibre to its corresponding benefit: parallel vs oblique to the pull of the whole muscle; stronger vs more mobile
Parallel = more mobile
Oblique = stronger
Give examples of uni-, bi- and multipennate muscles
Unipennate - flexor pollicis longus
Bipennate - rectus femoris
Multipennate - deltoid (acromial fibres), subscapularis, tibialis anterior, soleus
True or false: in the limbs, when a nerve pierces a muscle it supplies that muscle
True. The motor branch usually leaves the nerve proximal to the muscle
Which 4 bones contain red (active haematopoiesis) bone marrow for lifetime
Ribs, sternum, vertebrae, skull bone
What are Sharpey’s fibres?
Connective tissue that anchors periosteum to underlying bone. This is particularly stronger over attachments of tendons/ ligaments
What is the blood supply of the synovial membrane?
‘Circulus vasculosus’. The synovial membrane, joint mesenchyme and its derivates are supplied from a vascular plexus that surrounds the epiphysis and sends branches to the joint structures ; it lies between the capsule and synovial membrane at its attachment to the epiphysis (Last’s p16)
What is Hilton’s Law?
The motor nerve to a muscle tends to give a branch of supply to the joint which the muscle moves and another branch to the skin over the joint (Last’s p16)
Which structure typically plays the most important role in joint stabilisation?
Muscles (then ligaments > bony contours)
Which layer is missing in the wall of the IVC?
Tunica media
Which veins do NOT have valves?
IVC, SVC, head/ neck , vertebral, cardiac, pulmonary, hepatic and portal vein, pelvic veins
Describe the structure of the thymus
Outer capsule with inward septae, dividing it into lobules. Within these there is a
- Cortex: lymphocytes are concentrated in dense band structures around the outer regions
- Medulla: inner paler region containing thymic corpuscles of Hassall = remnants of epithelium of the 3rd pharyngeal pouches from which the thymus developed
(compare this to other lymphoid organs where lymphocytes are congregated into spherical collections aka ‘follicles’ with central germinal centre)
The great nerve plexuses (cervical, brachial, lumbar, sacral) are formed from which nerve rami?
Anterior rami
The lower [number] thoracic nerves supply the skin of the anterior abdominal wall
6
The lower 6 thoracic nerves supply the skin of the anterior abdominal wall
The nerves of the body wall lie in which muscle plane? And lie [above/ below] the arteries
Between the middle and deepest of the 3 muscle layers; lie below arteries in this plane, but cross over the arteries at the vertebral column and ventral midline, lying closer to the skin surface
The sympathetic chain lies [anteriorly/ posteriorly] to the segmental vessels (vertebral, post intercostal, lumbar and lateral sacral arteries)
Anterior
What is the only joint that connects the pectoral girdle/ upper limb to the axial skeleton?
Sternoclavicular - this is a synovial double plane joint with an intra-articular disc and minimal ROM
What are the four corner attachments of the flexor retinaculum?
Hook of hamate, scaphoid tubercle, trapezium tubercle and the pisiform
The trapezoid ligament (of the coracoclavicular ligament) sits [MEDIALLY / LATERALLY] to the conoid ligament portion
Laterally
What are the attachments of biceps brachii long and short heads, and its distal tendon?
Long - supraglenoid tubercle via intertuberculargroove
Short - coracoid process
Tendon - radial tuberosity
The distal anterior transverse crease of the wrist represents the base of the [hypo]thenar eminences. What does the proximal crease indicate?
Axis between radial and ulnar styloid process
What type of joint is the thumb carpometacarpal (CMC)? What movement does this allow?
Saddle (with trapezium). Opposition, rotation, flexion/ extension, ab-/adduction, circumduction
(compared to thumb MCPJ - ellipsoid, and remaining hand joints - hinge)
What 2 muscles of the shoulder are supplied by the axillary nerve?
Deltoid and teres minor
What is the nerve supply of latissimus dorsi?
Thoracodorsal nerve (C6-8)
What are the rotator cuff muscles?
Subscapularis + Supraspinatus + Infraspinatus + Teres minor (‘SITS’)
The common triceps tendon inserts onto ___
The olecranon
The anterior muscle compartment of the arm is supplied by ____ (nerve)
Musculocutaneous nerve
The musculocutaneous nerve pierces which muscle in the arm?
Coracobrachialis
The common flexor origin of forearm flexors is attached to which epicondyle?
Medial
(The common extensor origin is from the lateral epicondyle)
The pectoralis major muscle has a trilaminar arrangement of muscle fibres from clavicular and sternocostal heads, whereby the fibres which arise lowest insert [lowest/ highest].
Highest
Which structure does the medial pectoral nerve pierce?
Pectoralis minor
What four structures pierce the clavipectoral fascia?
1-Lateral pectoral nerve (passing out)
2-thoracoacromial vessels (passing out)
3-lymphatics from infraclavicular nodes (passing in)
4-cephalic vein (passing in)
The pectoralis major arises from ___ (tissue type), whereas pectoralis minor arises from ____
Costal cartilage; bone (ribs)
The _____ is a sheet of membrane filling the space between clavicle and pectoralis minor, limited laterally by the coracoid process and passing medially to fuse with the external intercostal membrane of the upper two spaces
Clavipectoral fascia (Last’s p71)
The most superior aspect of the trapezius originates from the ____
Medial 1/3rd of the superior nuchal line
The accessory nerve fibres (to trapezius) emerge from (behind/ within) the sternocleidomastoid, and the cervical plexus fibres emerge from (behind/ within)
Accessory - within; cervical - behind
What are the borders of the lumbar triangle (of Petit)?
Anterior: external oblique
Posterior: Latissimus dorsi
Inferior: iliac crest
Floor: internal oblique
Significance: site of a rare lumbar hernia
Last’s p376
What vertebral levels do rhomboid minor and major arise from respectively?
Minor - C7-T1
Major - T2-5
Which muscles are supplied by the dorsal scapula nerve (from C5)?
Rhomboid major, rhomboid minor, levator scapulae
Describe the borders and contents of the posterior triangle of the neck
Borders: posterior - trapezius, anterior - sternocleidomastoid, inferior (base) - clavicle
Roof = investing layer of fascia
Floor = prevertebral fascia
Contents:
- muscle (scalenes, levator scapulae, omohyoid inferior belly, first digitation of serratus anterior),
- veins (EJV, subclavian, suprascapular),
- arteries (distal subclavian, suprascapular, transverse cervical, occipital),
- nerves (accessory, cervical plexus, trunks of brachial plexus)
- lymph nodes
What structure is the main stabilising factor of the sternoclavicular joint?
The costoclavicular ligament (anterior and posterior parts) Last’s p78
The sternoclavicular and acromioclavicular joints are synovial with [fibro/ hyaline] cartilage
Fibrocartilage - Last’s p79
What structure is the main stabilising factor of the acromioclavicular joint?
Coracoclavicular ligament (this also acts as the main fulcrum around which the scapula swings) - Last’s p79-80
The axillary nerve gives off __ branches in the axilla, and then leaves the axilla through the ____ space.
0 branches. Quadrangular space
True or false: the intercostobrachial nerve (T2) is purely sensory
True - it supplies a variable amount of skin on the inner aspect of the axilla & upper arm. it emerges from the 2nd intercostal space in midaxillary line. It is usually excised in a full axillary clearance, leaving some sensory impairment (improves with time, may be temporary/ permanent)
What is the largest thoracic spinal nerve?
T1 - The 1st thoracic spinal nerve
The superior thoracic artery comes off which part of the axillary artery, and supplies which muscles?
Part 1; pectoral muscles
What is the largest branch of the axillary artery?
Subscapular (off part 3)
What structure(s) pass through the quadranglular and upper triangular spaces respectively?
Quadrangular - axillary nerve; posterior circumflex humeral artery
Upper triangular - thoracodorsal artery (off subscapular artery)
The scapula ossifies in ____ but the clavicle and mandible ossify in ___
Cartilage, membrane
The glenoid fossa points in which direction?
Antero-laterally
Name the 12 cranial nerves and their embryological origins
1 - olfactory
2 - optic
3 - oculomotor
4 - trochlear
5 - trigeminal
6 - abducens
7 - facial
8 - vestibulocochlear
9 - glossopharyngeal
10 - vagus
11 - accessory
12 - hypoglossal
Origins: 1 comes off telencephalon, 2 from diencephalon, 3-4 off mesenephalon and 5-12 off rhombencephalon
What is the rhombencephalon?
The hindbrain
It includes the metencephalon (pons + cerebellum) and myelencephalon (medulla)
The cerebrum develops from which embryological neural tube structure?
Telencephalon (part of the prosencephalon aka forebrain)
The brainstem is made up of ___ [embryological structures]
The midbrain (mesencephalon) and hindbrain (rhombencephalon, which includes pons and medulla)
What are the myelin-producing glial cells in the central and peripheral nervous system respectively?
CNS - oligodendrocytes
PNS - Schwann cells
(Glial cells: 4 types - myelin-producing, supporting i.e. astrocytes (CNS) and satellite cells (PNS), phagocytic i.e. microglia (CNS), and ventricular i.e. ependymal cells (CNS))
True or false: the CNS consumes 25% of glucose energy source and 20% O2
True
What percentage of CNS blood supply comes from the common carotid arteries?
80%
Which structures are WITHIN the cavernous sinus? (as opposed to in the adjacent wall)
Internal carotid artery + abducens nerve
(The oculomotor, trochlear, opthalmic and maxillary nerves lie in the wall)
The lateral (intermediate) horn of the spinal cord relays what type of information?
Autonomic efferents (SM, cardiac muscle, glands) - only located in the thoracic spinal cord
Which nerve pierces psoas major?
Genitofemoral (L1-2)
What are the nerve roots of the femoral nerve?
L2-4
The ____ nerve of the lumbosacral plexus appears between psoas major and iliacus
Femoral nerve
What is the nerve supply of the gluteal muscles?
Gluteus maximus - inferior gluteal nerve (L5-S1)
Gluteus medius & minimus - superior gluteal nerve (L4-S1)
The sciatic nerve exits the pelvis via the ____
Greater sciatic foramen
The pudendal nerve also exits here, then winds around the ischial spine and through the lesser sciatic foramen into pudendal ‘Alcock’s’ canal
Axons of the lateral corticospinal tract (80%) decussate at what level?
Medullary pyramids
These supply contralateral limb muscles
(20% axons do not cross and continue as anterior/ ventral corticospinal tract. These supply proximal axial muscles)
What is the origin of the rubrospinal tract (RST)?
Red nucleus (midbrain)
These descending fibres excite flexor muscle motor neurons and inhibit extensors. They cross the midline at the pons and continue in the dorsolateral spinal cord)
True or false: the vestibulospinal tract fibres do NOT cross the midline
True
They provide ipsilateral tone/posture and balance control
The ___ tract originates in the superior colliculus
Tectospinal tract
The corpus callosum connects which lobes?
Frontal, parietal, occipital
The anterior and fornical commisures connect the ___ lobes
Temporal
True or false: all projection fibres from/ to the cerebral cortex pass through the corona radiata and external capsule
False - they pass through the corona radiata and INTERNAL capsule
What are the cell types/ corpuscles for each of the following superficial sensory inputs?
Touch;
Temperature;
two-point discrimination/ pressure;
pain
Touch - Meissner’s corpuscle and Merkel cells, hair cells
Temperature - Ruffini’s corpuscle (hot) and Krausse’s endbulbs (cold)
Two-point discrimination/ pressure - Pacinian corpuscle
Pain - free nerve endings
Which afferent (ascending) sensory tracts carry information for touch/ proprioception and temperature/ pain/ itch respectively?
Touch/ proprioception - dorsal-column medial lemniscus tract
Temperature/ pain/ itch - anterolateral spinothalamic tract
True or false: all sensory information is transmitted through the thalamus
True
The anterolateral ascending sensory tracts decussate in the ___
Spinal cord
Acidosis, hypotension and hypoxia cause cerebral [vasodilation/vasoconstriction]
VasoDILATION
The substantia nigra is located in the ___
Cerebral peduncles (midbrain)
The trigeminal nerve arises antero-lateral to the ___
Pons
Where does each part of the cerebellar peduncle (superior, middle, inferior) come from?
Superior - midbrain
Middle - pons
Inferior - medulla
The lateral geniculate body is an important ___ relay centre
Visual
The spinocerebellar tracts enter via the ___ cerebellar peduncle, whereas the cortico-bulbar tracts enter via the ___ cerebellar peduncle
Inferior cerebellar peduncle
Middle cerebellar peduncle
(These are both afferent tracts; the efferent tracts pass through the superior cerebellar peduncle)
The anterior pituitary gland (adenohypophysis) is derived from the ___
Pharynx, from Rathke’s pouch
The lentiform nucleus consists of which 2 structures?
Putamen and globus pallidus
The __ nucleus is adjacent (lateral) to the lateral ventricles
Caudate nucleus
The vertebral artery enters the cranium via ____
Foramen magnum
The falx cerebri projects into the ___ fissure
Longitudinal
What is the blood supply to the adrenal glands?
superior, middle and inferior adrenal arteries - branches of the phrenic, aorta and renal arteries respectively
The cords of the brachial plexus are named in relation to the ___
Axillary artery (lateral, medial or posterior to this)
What is the blood supply of the anterior and posterior pituitary?
Anterior (adenohypophysis) - superior hypophyseal arteries (off ICA)
Posterior (neurohypophysis) - inferior hypophyseal arteries (off ICA)
What vertebral level/s does the thyroid sit at?
C5-T1
(The isthmus lies in front of the 2nd-4th tracheal rings)
The thyroid lies ____ to the carotid sheath
Anterior
What is Berry’s ligament?
The posterior suspensory ligament of the thyroid gland: connects thyroid with cricoid/ thyroid cartilage
The isthmus of the thyroid gland lies over the ___ tracheal rings
2nd-4th
The superior thyroid arteries are branches of ____ and the inferior thyroid arteries are branches of ___
Superior - external carotid
Inferior - thyrocervical trunk (branch of subclavian)
~10% have an extra artery ‘thyroid ima artery’, which is a branch of the brachiocephalic trunk
The ____ nerve runs in close relation to the inferior thyroid arteries
Recurrent laryngeal nerve
Describe the venous drainage of the thyroid gland
3 thyroid veins: superior (into internal jugular or facial vein), middle (into internal jugular vein) and inferior (drains into brachiocephalic vein)
True or false: the parathyroid glands lie on the posterior thyroid within its sheath the pre-tracheal fascia
True
Although they can also lie outside the sheath
The superior parathyroid glands are derived from the ___
4th pharyngeal pouch
(The inferior from the 3rd)
What is the arterial supply to the adrenal glands?
Superior suprarenal arteries: small branches off inferior phrenic artery
Middle suprarenal arteries: off abdominal aorta
Inferior suprarenal arteries: off renal artery
The tunica vaginalis of the testis is derived from ___ (which lining) and lies superficial/ deep to the tunica albuginea
Abdominal peritoneum
Superficial
True or false: the venous drainage of the adrenal glands and testes/ ovaries is similar in that the left vein drains into the left renal vein and right directly into the IVC
True
Pair the organ and it’s end lymphatic drainage
(Para)Thyroid, pancreas, adrenals, testes / ovaries
Coeliac & superior mesenteric nodes; mediastinal nodes; para-aortic nodes; lumbar nodes
(para)Thyroid - mediastinal
Pancreas - coeliac & mesenteric
Adrenals - lumbar
Ovaries/ testes - para-aortic
The cardiac orifice is located to the ____ of midline at level ___
The pyloric opening is located to the ___ of midline at level ___
Left; T10
Right; L1
The IMA originates at which vertebral level? It runs above/ below D3-4
L4
Below
The superior mesenteric artery terminates at the ____ after giving off all branches to SI/ prox LI
Terminal ileum, approx 60cm proximal to caecum
This is the site of the embryological apex of the midgut loop
The apex of the sigmoid mesentery lies over the bifurcation of the ___
Left common iliac artery
The apex of the sigmoid mesentery lies over the bifurcation of the ___
Common iliac artery
The transpyloric plane sits at which vertebral level? What other structures sit at this plane?
L1
9th costal cartilage
Pylorus
SMA origin
Termination of spinal cord (conus medullaris)
Pancreatic neck
Fundus of gallbladder (or just above)
DJ flexure
Hilum of kidneys + spleen
The SMA passes ___ to the left renal vein, uncinate process of the pancreas and anterior surface of D3
Anterior
What are the contents of the superior mediastinum?
Great vessels
- Aortic arch (and branches - brachiocephalic artery, left common carotid + subclavian artery)
- SVC & tributaries (brachiocephalic veins, left sup intercostal vein, supreme intercostal veins, azygos)
Nerves
- vagus
- phrenic
- Cardiac nerves (from superficial/ deep cardiac plexuses) & sympathetic trunk
Other
- Thoracic duct
- Thymus
- Trachea
- Oesophagus
- Muscles: sternohyoid, sternothyroid, longus colli
Which mediastinal compartment is the heart located?
Middle (of the inferior mediastinum)
Which bony landmarks demarcate the division of superior and inferior mediastinum?
Sternal angle/ T4
The transverse sinus of the pericardium is between ____
The outflow (aorta, pulmonary trunk - anteriorly) and inflow tracts (SVC, left atrium - posteriorly) of the heart
Regarding coronary circulation, the left anterior descending (LAD) artery gives off ___ branches whilst the circumflex artery gives of ___ branches
LAD - Diagonal
Circumflex - marginal
The posterior descending (interventricular) artery is usually given off by which main coronary artery?
Right coronary artery
Some blood drains directly into heart chambers via ____
Thesbian veins
What is the crista terminalis?
A ridge of tissue in the heart separating the smooth and pectinate areas
What are the borders of the triangle of Koch (in the heart) and what does it contain?
Tendon of Todaro, anterior septal leaflet and the ostium of the coronary sinus posteriorly.
It contains the AV node
What are the 3 cusps of the aortic valve? Pulmonary valve?
Aortic - right coronary, left coronary and non-coronary (posterior)
Pulmonary - anterior, right and left semilunar
Where is the SA node located? What is its arterial supply?
Near the junction of the RA and SVC.
Usually RCA (60%) - 40% from LCA - circumflex
What is the only part of the conducting system that is exposed?
Septomarginal trabecula (‘moderator band’)
The ductus arteriosus connects which structures?
Root of the left pulmonary artery and the aortic arch
What are the 3 foetal shunts?
Ductus venosus
Foramen ovale
Ductus arteriosus
Describe the path of the LEFT vagus nerve and its recurrent laryngeal branch relative to the aorta
Vagus nerve passes down LATERAL aspect of aortic arch and gives off recurrent laryngeal branch, which turns back UNDER the aortic arch POSTERIOR to ligamentum arteriosum and ASCENDS in the mediastinum to the larynx
The right recurrent laryngeal branch passes under ___ and the left recurrent laryngeal branch passes under ____
Right - right subclavian/ brachiocephalic trunk
Left - aortic arch
The upper two intercostal spaces are supplied from ___ (arterial)
branches of the costocervical trunk off the subclavian arteries
What are the branches of the subclavian artery?
Mnemonic: VIT C and D
1st part (VIT): Vertebral, internal thoracic and thyrocervical trunk
2nd part (C): Costocervical trunk
3rd part (D): dorsal scapular
The aorta divides into the common iliac arteries at which vertebral level?
L4
What are the 2 terminal branches of the external carotid artery
Superficial temporal artery and maxillary artery
The middle meningeal artery comes off ___
The maxillary artery, a terminal branch of the external carotid artery
True or false: the internal jugular vein runs inside the carotid sheath
True
Note: the sheath is thinner over the vein to allow expansion, compared with over the artery
Between which muscle layers does the intercostal neurovascular bundle run?
Between internal intercostals and innermost (intercostals, subcostals, transversus thoracis)
The diaphragm attaches to the lower __ (number) ribs
4
What are the corresponding ‘ligament’ openings in the diaphragm for the:
- aorta
- psoas major
- quadratus lumborum
- Sympathetic trunk
- Subcostal bundle
Aorta: medIAN arcuate ligament
Psoas major & sympathetic trunk: medIAL arcuate ligament
Quadratus lumborum & subcostal bundle: lateral arcuate ligament
The right crus of the diaphragm attaches to ___ (vertebral body) and the left crus to ___
Right - L4
Left - L3
The intercostobrachial nerve (lateral branch off 2nd intercostal nerve) pierces which muscle?
Serratus anterior
Compare the origins of the posterior and anterior intercostal arteries
Posterior - off descending thoracic aorta (1st-2nd branches from costocervical trunk)
Anterior - off internal thoracic (mammary) artery
The breast sits at which rib levels?
Ribs 2-6
The lateral part and axillary tail of the breast drains into ___ vein
The axillary vein
(the medial part drains into the internal thoracic vein)
What are the 5 groups of axillary nodes?
Pectoral, posterior, lateral, central and apical
What muscle runs posterior to the trachea
Trachealis
The trachea typically bifurcates at which vertebral level?
T4
The parietal pleura gets its sensory nerve supply from ___
Intercostal nerves
What is the most common blood supply to the SA and AV nodes?
Right coronary artery
Where do the venae cordis minimae drain?
Each of the four cardiac chambers; most commonly the RA
Also known as Thebesian veins, small group of valveless myocardial coronary veins draining venous blood directly into their respective chamber
At which costal level do the brachiocephalic veins unite to form the SVC?
1st costal cartilage (Right)
The azygos vein empties into the ___
SVC
What is the order of structures in the intercostal neurovascular bundle (superior -> inferior)?
Intercostal VEIN -> intercostal ARTERY -> intercostal NERVE
The right phrenic nerve pierces the central tendon of the diaphragm at T___ with the ___, and supplies the diaphragm from its ___ surface
T8, IVC, lower surface
The left vagal nerve passes (anteriorly/ posteriorly) to the oesophagus at the hiatus T10
Anteriorly
(The right vagal nerve passes posteriorly)
The diaphragmatic opening at T12 transmits which 4 structures?
Aorta; azygos & hemi-azygos vein; thoracic duct
The linea aspera of the femur is located on the ___ aspect of the shaft
Posterior
Of the femur, the intertrochanteric line is ___ whereas the intertrochanteric crest is ___
Line - Anterior;
Crest - Posterior
What are the 7 tarsal bones?
Calcaneus, talus, cuboid, navicular, medial cuneiform, lateral cuneiform, intermediate cuneiform
Which bones form the transverse tarsal joint?
Talus & calcaneus (posterior) with navicular and cuboid (anterior)
The cruciate ligaments are named according to their ___ attachment.
What are each of their roles
Tibial attachment
Anterior tightens in extension to stop femur slipping backwards
Posterior tightens in flexion, to stop femur slipping forwards
The ___ collateral ligament of the knee attaches to the joint capsule and __ meniscus
Medial; medial
(lateral collateral ligament is separate)
What shapes are the medial and lateral menisci of the knee, respectively?
Medial - semicircle (more prone to injury)
Lateral - circular (more free)
The lateral collateral ligament of the ankle is made up of which 3 ligaments?
Posterior & anterior talofibular + calcaenofibular
Eversion ankle injury will damage the ___ collateral ligament, whereas inversion injury will damage the ____ collateral ligament
Eversion - medial
Inversion - lateral
What is the action of tensor fascia lata muscle?
Stabilise hip and knee, hip ABduction
What are the 6 short lateral rotators of the gluteal region?
(ordered superior -> inferior)
Piriformis
Superior gemellus
Obturator internus / Obturator externus
Inferior gemellus
Quadratus femoris
Gluteus maximus inserts into ___
The iliotibial tract and gluteus tuberosity of the femur
What is the nerve supply to the anterior compartment of the thigh?
Femoral nerve
What are the attachments of the rectus femoris?
Origin: ilium
- Reflected head: above acetabulum
- Straight head: AIIS (above iliofemoral ligament)
Insertion: quadriceps tendon (onto the base of the patella)
**Note it crosses the hip joint
What muscles make up quadriceps femoris?
Rectus femoris
Vastus medialis/ intermedius / lateralis
Sartorius is part of which thigh compartment?
Anterior
What are the borders and contents of the femoral triangle?
Borders: inguinal ligament, sartorius & adductor LONGUS
Contents: (lat -> med) femoral nerve -> artery -> vein, femoral canal (containing deep inguinal LNs)
The femoral nerve lies (INSIDE/OUTSIDE) the femoral sheath?
OUTSIDE
The medial compartment of the thigh is mostly supplied by __ nerve. List the exceptions
Obturator nerve
EXCEPT
- Hamstring part of adductor magnus: tibial nerve
- Pectineus: femoral nerve
The adductor hiatus transmits the ___
Superficial femoral artery –> popliteal artery
The sciatic nerve supplies which compartment of the thigh?
Posterior
Tibial (semimembranosus, semitendinosus & long head of biceps femoris) & common fibular nerve (short head of biceps femoris) bound in sheath
Where is the pes anserinus and what attaches here?
Medial upper tibia
Sartorius, gracilis & semitendinosus
(‘Say Grace before Tea’ - superficial to deep)
What are the muscular compartments of the leg and their nerve supply?
Anterior (deep fibular nerve), posterior (deep & superficial; tibial nerve) & lateral (superficial fibular nerve)
In the leg the interosseous membrane separates which muscle compartments?
Anterior & posterior (deep)
Which muscles insert onto the medial cuneiform and base of 1st metatarsal?
Tibialis anterior and peroneus (fibularis) longus
Fibularis (peroneus) tertius is often the lower part of which muscle?
Extensor digitorum longus
What is the main action of the lateral compartment leg muscles?
Foot eversion
List the muscles in the superficial and deep posterior compartments of the leg
Superficial
- Gastrocnemius
- Soleus
- Plantaris
Deep
- Popliteus
- Tibialis posterior
- Flexor digitorum longus
- Flexor hallucis longus
What are the borders of the popliteal fossa?
Inferior - Gastrocnemius
Superior - Hamstrings
Medial - semimembranosus/ tendinosus
Lateral - biceps femoris (long)
Roof - fascia lata
Floor - popliteal surface of femur, knee joint capsule, popliteus
What is the most superficial structure in the popliteal fossa (and hence vulnerable during trauma/ surgery)?
Tibial nerve
True or false: the superficial venous system of the leg has surrounding muscles producing a musculovenous pump
False - no musculovenous pump
The small (short) saphenous vein is (MEDIAL/ LATERAL) to the great (long) saphenous vein
Lateral
Which muscle demarcates the branches of obturator nerve into anterior and posterior divisions?
Adductor brevis
The sciatic nerve emerges below ___ in the gluteal region
Piriformis
Quadratus plantae and the lumbricals are in which muscle layer of the sole of the foot?
2nd
(1st - AbH, FDB, AbDM
3rd - FHB, FDMB, AdH
4th - dorsal & plantar interosseous ‘PAD, DAB’)
What is the nerve supply to the plantar foot muscles?
True or false: they also supply sensory to the sole
Medial & lateral plantar nerve (off tibial nerve)
- Medial: AbD, FDB, FHB, 1st lumbrical
- Lateral: QP, AbDM, FDMB, AdH, lumbricals 2-4, interossei)
True (medial/ lateral halves respectively)
The anterior tibial artery enters (SUPERFICIAL/ DEEP) to the extensor retinaculum, to become the ____
Deep
Dorsalis pedis artery
What is a Richter hernia?
Hernia where the antimesenteric border of bowel gets stuck in hernial defect causing strangulation without obstruction
The linea alba is thinner/ weaker (ABOVE/ BELOW) the umbilicus
Below
What vertebral level is the aortic bifurcation and what is the surface anatomy?
L4-5 intervertebral disc
Just below & to the left of the umbilicus
At which structure does the brachial artery give radial + ulnar branches?
At the neck of the radius
What is the order of structures in the cubital fossa?
(medial) median nerve -> brachial artery -> biceps tendon (lateral)
True or false: the power of a muscle is dependent on the number of muscle fibres it contains, and not on their length
True
What is the most common artery affected in peripheral vascular disease?
Superficial femoral artery
The dorsalis pedis artery enters (DEEP/ SUPERFICIAL) to the extensor retinaculum
Deep
What factors allow venous blood to flow upwards against gravity?
- Musculo-venous pump
- arterial inflow
- respiratory pressure changes
Compare and contrast the anatomical vs surgical neck of the humerus
- Anatomical neck - articular margin; thickest part of prox humerus
- Surgical neck - extra-articular; common site of #, just below epiphyseal line at upper shaft.
> The axillary nerve winds around behind here
The capitulum (=capitellum) of the humerus articulates with the ____
Head of the radius
The ulna articulates with the ___ of the humerus (3 structures)
(ulnar) Trochlea notch - Trochlea
Coronoid process - coronoid fossa
Olecranon process - olecranon fossa
The ulna articulates with the ___ of the humerus (3 structures)
(ulnar) Trochlea notch - Trochlea
Coronoid process - coronoid fossa
Olecranon process - olecranon fossa
What is Lister’s tubercle?
Aka the dorsal tubercle of the radius
Bony protuberance on dorsal, distal radius
Functions
- Separates attachment of 2nd (ECRB & ECRL) & 3rd (EPL) extensor compartments;
- acts as a pulley for EPL tendon
- attachment for extensor retinaculum
The distal radius articulates with which carpal bones?
Scaphoid and lunate
List the carpal bones in their rows
‘Some Lovers TRy Positions That They Can’t Handle’
Prox: Scaphoid Lunate Triquetrum Pisiform
Distal: Trapezium (under the thumb) Trapezoid Capitate Hamate
What are the 4 attachments of the flexor retinaculum?
Pisiform, Hook of Hamate, Trapezium tubercle and scaphoid tubercle
What type of joint is the sternoclavicular joint?
Synovial double plane
What do the proximal and distal transverse creases of the wrist indicate?
Proximal - axis of radial/ ulna styloid processes
Distal - base of (hypo)thenar eminences
Which structures pass THROUGH the carpal tunnel?
Median nerve
Tendons of flexor digitorum superficialis (4) & profundus (4)
Tendon of flexor pollicis longus
The palmar aponeurosis is triangular shaped and at its apex is continuous with which tendon?
Palmaris longus
Which 3 muscles make up the thenar eminence?
Abductor pollicis brevis (AbPB), flexor pollicis brevis (FPB), opponens pollicis
Which nerve supplies the thenar eminence?
Recurrent branch of median nerve
Which structure demarcates the 3 parts of the axillary artery?
Pectoralis minor
The superficial branch of the radial nerve comes off (above/ below) the elbow, continues into the forearm under ____ and is mainly (motor/ sensory) supply
Above
Brachioradialis
Sensory
The musculocutaneous nerve pierces ___
Coracobrachialis
Which nerve supplies sensation for the radial anterior forearm?
Lateral antebrachial cutaneous nerve (continuation of musculocutaneous nerve)
The ulnar nerve runs ___ to the axillary & brachial arteries
Medial
The upper 1/3rd of the oesophagus is ___ muscle and the lower 2/3rds are ____
Striated skeletal muscle
Non-striated smooth muscle
Which is the only cranial nerve that arises dorsally from the brainstem?
Trochlear nerve (CNIV)
Which structures pass between the internal and external carotid arteries?
Nerves: glossopharyngeal, pharyngeal branches of vagus
Muscles: stylopharyngeus
Other: a portion of the parotid
The recurrent laryngeal nerve supplies the intrinsic laryngeal muscles except ____
Cricothyroid (supplied by external laryngeal nerve)
What is the sensory innervation for the laryngeal mucosa above and below the vocal cords?
Above - internal laryngeal
Below - recurrent laryngeal
What are the boundaries of the pelvic inlet?
Posterior: sacral promontory
Lateral: ala & arcuate line of ilium
Anterior: sup pubic rami & pubis
Which ligaments convert the greater & lesser sciatic notches into foramen?
Sacrotuberous (vertical) + sacrospinous (horizontal)
What muscles make up levator ani?
Iliococcygeus + pubococcygeus + puborectalis
The pelvic diaphragm (___ + ___ muscles) and urogenital diaphragm (___ + ___ muscles) make up the ____
Levator ani + coccygeus
Deep + superficial perineal
Pelvic floor
The urogenital diaphragm sits (above i.e. deep vs below i.e. superficial) to the pelvic diaphragm in the (anterior/ posterior) 1/2.
It is less developed in (females/ males)
Below
Anterior 1/2
Females
The perineum is the area between ___ & ___, (above/ below) the pelvic diaphragm
Anus and scrotum/ labia
Below
The pudendal (Alcock’s) canal runs on the lateral wall of the ___ fossa
Ischiorectal (= ‘ischioanal’)
Compare female vs male:
- Pelvic inlet
- Acetabulum
- Obturator foramen
Pelvic inlet: larger in female
Acetabulum: larger in male
Obturator foramen: oval in female, round in male
What are the branches of the anterior division of the internal iliac artery?
- Umbilical;
- vesical branches;
- obturator;
- uterine;
- middle rectal;
- int pudendal &
- inf gluteal arteries
The superior gluteal artery is a branch of ___
The posterior branch of the internal iliac artery
Which 3 arteries pass through the greater sciatic foramen?
Superior & inferior gluteal arteries
Internal pudendal artery (loops around ischial spine then passes back into pelvis via lesser sciatic foramen)
Which nervous system is responsible for erection & ejaculation respectively?
Erection - parasympathetic (‘point’)
Ejaculation - sympathetic (‘shoot)
Which muscle demarcates the anorectal junction?
Puborectalis
The ___ kidney sits slightly lower than the ____
Right lower than the left
What are the layers external to the kidney?
Para-renal fat –> Gerota’s fascia –> perinephric space (containing fat) –> renal capsule
What demarcates the trigone of the bladder?
Triangle formed by ureteric orifices x2 + internal urethral meatus
It is smooth and has an extra smooth muscle layer in the submucosa
Compare the length of the urethra in males vs females
Males ~20cm
Females ~4cm
What are the 4 parts of the male urethra? Which is the least distensible and most difficult to navigate?
Prostatic, membranous, bulbar, spongy (penile)
Membranous
The spongy urethra courses through which penile structures?
Corpus spongiosum, body & glans
Which branchial arch disappears completely?
The 5th
The Glossopharyngeal nerve is a derivative of which branchial arch?
The 3rd
Which embryological structure is the appendix testis derived from?
Paramesophric (Mullerian) duct (upper end)
What are the 3 stages of renal development?
Pronephros (caudal) -> mesonephros -> metanephros (rostral - forms permanent kidney derived from ureteric bud of mesonephric duct)
At which week do the kidneys ‘ascend’ (actually due to growth of body) to lumbar region
Week 6-9
What are the layers of the scrotum?
‘Some Damn Cockney Englishman Called It The Testes’
Skin
Dartos
Colles (superficial fascia)
Ext spermatic fascia
Cremaster muscle + fascia
Int spermatic fascia
Tunica vaginalis
Tunica albuginea
Colles (superficial fascia of the scrotum) is continuous with ____ anteriorly
Scarpa’s fascia of the abdominal wall
The epididymis sits on the___ surface of the testis
Posterio-lateral
The ductus (vas) deferens forms from the ___ pole of the epididymis
Lower
What is the nerve supply to the testes (including spinal root level)?
T10 sympathetic nerves (via splanchnic nerves & coeliac ganglion)
What is the ‘false’ capsule of the prostate?
A condensation of pelvic fascia sitting external to the ‘true’ fascia (thin connective tissue covering)
What are the 3 zones of the prostate, what does each surround and which are implicated in BPH & prostate cancer respectively?
Central - around ejaculatory ducts
Transitional - around urethra; enlarged in BPH
Peripheral - around the other zones, main site for prostate cancer (~70%)
The deep dorsal vein/ artery & nerve of the penis are contained within (below) ____ whereas the superficial dorsal vein is below ____
Buck’s fascia
Skin
The ___ is the embryonic remnant of the mesonephric (Wolffian) duct
Appendix epididymis
The external pudendal and internal pudendal arteries are branches of which vessels?
External - off femoral artery
Internal - off internal iliac (anterior division)
What structures open in the vaginal vestibule?
Urethra, vagina, greater vestibular (Bartholin’s) glands, para-urethral glands
The obturator notch/ canal is situated ___ to the obturator membrane
Supero-anteriorly
Levator ani has a high proportion of (slow/ fast) twitch muscle fibres
Slow twitch
The ureters and bladder have __ layers of smooth muscle, which are _____.
The detrusor muscle is part of the ___ layer
3 - circular, longitudinal, spiral bundles.
Detrusor = circular
How frequently does the ureter vermiculate?
1-5 times/ minute
The acetabular notch is covered in ____ cartilage
Hyaline
Ligamentum teres (of the femoral head) attaches to ____
The transverse ligament filling the acetabular notch (it does not attach to bone)
The supracristal plane is _____ and lies at which vertebral level
The horizontal line joining the highest parts of the iliac crests
L4
Describe the attachments of the gluteal muscles in relation to the gluteal lines on the posterior ilium
Gluteus maximus - arises BEHIND posterior gluteal line
Gluteus medius - arises in between middle & posterior gluteal lines
Gluteus minimus - arises in between inferior & middle gluteal lines
The inguinal ligament runs from ___ to ___ and forms the ___ of the inguinal canal
ASIS to pubic tubercle
Floor
What type of joint is the pubic symphysis?
Secondary cartilaginous joint
Compare primary and secondary cartilaginous joints
Primary (‘synchondrosis’) - junction of bone & hyaline cartilage (which may ossify). Typically immobile, strong
Secondary (‘symphysis’) - union between bones whose articular surfaces are covered with a thin lamina of hyaline cartilage (typically with fibrocartilage in between); limited movement
The inguinal ligament attaches to ___ (pubis) whereas the lacunar ligament attaches to ___ (pubis)
Inguinal - Pubic tubercle
Lacunar - Pectineal line
The obturator internus emerges through the ___ sciatic foramen into the buttock
Lesser
What is the angle of the pelvic brim / inlet
60 degrees
True or false: the inner surface of the body & sup pubic ramis is bare bone, with no attachments
True
True or false: the distance from pubic tubercle to acetabular margin is greater than the diameter of the acetabulum in males
False. This is the case in females (males is equal or less)
At what age does the acetabulum a) begin to ossify and b) close
a) 12yo
b) ~15yo (after puberty)
What is the mechanism of spread for a ‘horseshoe abscess’ (from one ischioanal fossa to the other)?
Via retrosphincteric space (above anococcygeal ligament, below levator ani)
The fat of the anal triangle extends into the ___ (but not ___) perineal pouch
Deep (not superficial)
The pudendal nerve passes ___ to piriformis
Inferior
The perineal nerve & artery pass in the ___ perineal pouch and the dorsal nerve (of penis/ clitoris) and internal pudendal artery pass in the ___ perineal pouch
Superficial
Deep
The fascia of Denonvilliers separates the ____ from the ____
Ant wall of rectum from prostate/ seminal vesicles
What foramen is the glossopharyngeal nerve transmitted through?
Jugular foramen
What foramen is V2 (maxillary division of trigeminal nerve) transmitted through?
Foramen rotundum
Which four cranial nerves are transmitted through the superior orbital fissure?
Oculomotor, trochlear, ophthalmic division of trigeminal nerve and abducens nerves
Which nerve exits via the stylomastoid foramen?
Facial nerve (CNVII)
Which cranial nerves contain parasympathetic fibres?
3 (III), 7 (VII), 9 (IX) & 10 (X)
The paraS fibres of CN3 relay in the small ciliary ganglion and cause miosis and accommodation
True or false: cranial nerves 1 & 2 have nuclei in the brainstem?
False. They are extensions of the olfactory/ optic tract from the cerebrum, and do NOT have brainstem nuclei
Which cranial nerves originate at the pontomedullary junction?
CN VI, VII, VIII (6-8)
What are the 2 sensory cell bodies of the trigeminal nerve and what does each contain?
Trigeminal ganglion - touch sensation
Mesencephalic nucleus: proprioceptive fibres from mastication, facial & extraocular muscles
*These are the only primary sensory cell bodies in the CNS
Which division(s) of the trigeminal nerve carries motor information?
Mandibular V3
What are the branches of the facial nerve before and after exiting the skull
Before:
- Greater petrosal nerve
- Nerve to stapedius
- Chorda tympani
After
- Temporal
- Zygomatic
- Buccal
- Marginal mandibular
- Cervical
- Posterior auricular
What is the nerve supply (and associated ganlgion) for secretion of the 3 main salivary glands?
Parotid - glossopharyngeal (via otic ganglion)
Submandibular & sublingual - facial nerve (via submandibular ganglion)
True or false: the facial nerve passes through and supplies the parotid gland
False
It passes through, however does not supply. The glossopharyngeal nerve (CNIX) supplies the parotid secretory activity via the otic ganglion. The facial nerve supplies the submandibular & sublingual glands
The ____ nerve conveys afferent information from carotid sinus baroreceptors to regulate BP
Glossopharyngeal (CNIX)
The vagus nerve lies (within/ outside) the carotid sheath
Within
The recurrent laryngeal nerve provides motor supply to all the larynx muscles except ___
Cricothyroid
This is supplied by the external branch of the superior laryngeal nerve
The nerve to mylohyoid is a branch of ___ and supplies mylohyoid and ____
Branch of inferior alveolar nerve (from V3 mandibular of trigeminal nerve CNV)
Ant belly of digastric
The facial nerve has a bundle of branchial motor fibres supplying muscles derived from the ____ pharyngeal arch
2nd
True or false: a muscle supplied by the facial nerve receives its proprioceptive innervation from branches of the sensory nerve supplying the skin over the muscle
True
(i.e. mostly the trigeminal nerve)
The ___ nerve is in danger when an incision is made along the lower border of the mandible
Marginal mandibular (extracranial branch of facial nerve)
Emerges from lower border of parotid and in ~20% passes into the neck below the angle of the mandible
The ____ is the nerve of the 3rd branchial arch
Glossopharyngeal nerve CNIX
The hypoglossal nerve supplies all the intrinsic/ extrinsic muscles to the tongue except ____
Palatoglossus
Ansa cervicalis supplies ____ (muscles)
Sternohyoid (C1-3), omohyoid (C1-3), sternothyroid (C2-3), thyrohyoid (C1), geniohyoid (C1)
Which cranial nerves are most likely to be affected by trauma?
CNI, II, III, VI, VII
The facial artery is a branch of the ____ and sits (anterior/ posterior) to the submandibular gland
External carotid artery (anterior branch)
Posterior to submandibular gland
The middle meningeal artery is a branch of ___
The maxillary artery
This itself is a terminal branch of the external carotid artery
Other significant branches of the maxillary artery are inferior alveolar & sphenopalatine arteries
The vertebral artery runs up through the foramen transversarium of C____ and enters the skull through ___
C6-1
Foramen magnum
The carotid bifurcation is at ____ (vertebral level + other landmark)
C4, upper thyroid cartilage
Carotid biFOURcation (C-FOUR)
No major structure passes through which skull opening?
Foramen lacerum
Nt a true foramen, usually filled with cartilage.
Foramen rotundum leads into the ___ and the inferior orbital fissure leads into the ___
Pterygopalatine fossa
Infratemporal fossa
The hyoid bone sits at which vertebral level?
C3
The hypothalamus lies on the floor of the ___ ventricle
3rd
The lateral geniculate body is an important ___ relay centre
Visual
Efferent neural tracts convey information from the cerebellum to thalamus via the ___ cerebellar peduncle
Superior
Which nerve conveys the afferent signals of the cough reflex?
Internal laryngeal nerve
The handle of malleus connects to the ___ and the footplate of the stapes connects to the ____
Tympanic membrane
Oval window
The vocal ligaments are formed from the free upper margin of the ____ ligament
Cricothyroid
What is the action of the cricothyroid muscle (and what sound does this produce)?
Tilt thyroid cartilage forwards & down, tensing vocal cords to produce a high-pitch sound
What are the 4 attachments of the investing layer of deep cervical fascia?
Superior – external occipital protuberance + superior nuchal line of the skull.
Anteriorly – hyoid bone, lower border of mandible
Inferiorly – scapula spine + acromion, clavicle, manubrium of the sternum.
Posterior – along the nuchal ligament of the vertebral column
Platysma muscle is derived from the fascia of ___ & ____ muscles and superiorly inserts into ____
Pectoralis major & deltoid
Inferior border of the mandible
Sternocleidomastoid & trapezius are contained within which fascia of the neck?
Investing layer of deep cervical fascia
This layer also splits to enclose the parotid
The ____ layer of deep cervical fascia fuses with pericardium
Pretracheal
The anterolateral part of the ____ fascial layer forms the floor of the posterior triangle and surrounds the brachial plexus/ subclavian artery
Prevertebral fascial layer (of the deep cervical fascia)
What vertebral level is the manubriosternal junction (angle of Louis)?
What structure bifurcates at this level?
T4-5
Trachea
(It also marks the start of the aortic arch; azygos entering the SVC; thoracic duct reaching left side of the oesophagus; ligamentum arteriosum)
The scapula spans from approximately T__ (superior border) to T__ (inferior angle)
T2 - T7
The coeliac axis comes off at ___ (vertebral level)
T12
The (LEFT/ RIGHT) pleura diverges more from midline at rib __ (#) whereas the (LEFT/ RIGHT) remains parasternal until rib ___ (#)
Left diverges at rib 4
Right at rib 6
What is the best access to a) thoracic aorta, b) oesophagus
a) LEFT thoracotomy
b) RIGHT thoracotomy
The superior and inferior mediastinum are divided by _____
The sternal angle (2nd costal cartilage) & lower order of T4
(above = superior, below = inferior mediastinum)
The inferior mediastinum is further divided into anterior/ middle/ posterior by the fibrous pericardium
What are the contents of the anterior, middle & posterior mediastinum?
Anterior - thymus + fat
Middle - heart + pericardium
Posterior - oesophagus + aorta
Which mediastinal compartments would infections in each area affect?
a) superficial to pretracheal fascia
b) behind prevertebral fascia
c) elsewhere
a) anterior mediastinum
b) superior mediastinum
c) posterior mediastinum
The hemi-azygos vein joins the azygos at which vertebral level (a range)
T7-9
The thymus sits (ANTERIOR/ POSTERIOR) to pretracheal fascia and sternohyoid/thyroid muscles
Posterior
The fibrous pericardium fuses with all vessels except the ____
The IVC
(this is already fused with diaphragm tendons)
The fibrous pericardium is derived from ___
Septum transversum
The ___ layer of serous pericardium is insensate
Visceral
The fossa ovalis is located in which part of the interatrial septum?
Inferior
In heart development, septum secundum grows down to which side of the septum primum?
To the right
The whole formed between the two is the foramen ovale
What are the anatomical abnormalities in a tetralogy of fallot?
Pulmonary stenosis
RVH (Right ventricular hypertrophy)
VSD (Fibrous interventricular septal defect)
Over-riding aorta
Hypoplasia of the ___ aortic arch can lead to coarctation of the aorta
4th
How many pairs of posterior intercostal arteries typically come off the descending thoracic aorta?
9
The oesophagus is a ____cm muscular tube with ___ (anatomical/ functional) sphincters at both ends , and runs from ___ to ___ (include vertebral/ costal level)
25cm
Functional
From cricoid cartilage/ C6 → GOJ & cardiac orifice @ T10 / Left 7th costal cartilage
Where are the narrowest parts of the oesophagus?
Narrowest at cricopharyngeal sphincter (15cm from incisor teeth)
Also constrictions when crossed by aortic arch (22cm from incisor), L bronchus (27cm, ~T5), diaphragmatic opening (38cm)
The thoracic duct drains all of the body except ____
Right: upper limb, 1/2 thorax, 1/2 head/ neck
The thoracic duct empties into the junction of ___ & ____
(the ___ empties into the opposite side)
Left internal jugular vein & left subclavian vein
Right lymphatic duct
The azygos vein is the persistence of which embryological structure?
Right posterior cardinal vein of embryo
Which vertebral level is the azygos vein joined by the 2 hemiazygos veins?
T8/9
How many ganglia are there in the thoracic sympathetic trunk?
Splanchnic nerves come from the lower ___ ganglia
12
(But some are fused e.g. 1st is fused with the inf cervical ganglia -> cervicothoracic (stellate) ganglia)
Lower 8
- Greater splanchnic nerve (5-9th)
- Lesser splanchnic nerve (10-11th)
- Least splanchnic nerve (12th)
Scarpa’s fascia of the abdomen is continuous with the ___ fascia of the lower limb, __ fascia of the penis & ___ fascia of the scrotum
Deep fascia
Buck’s fascia
Colles fascia
The trunks of the brachial plexus lie (SUPERFICIAL/ DEEP) to the prevertebral fascial layer of the neck
Deep
What is Ludwig’s angina?
Cellulitic infection of the submandibular space.
This space extends above the investing layer of deep cervical fascia, between hyoid and mandible to mucous membrane of the floor of the mouth, and includes submandibular and sublingual glands
What is the pulmonary ligament?
A cuff of pleura around the lung root
The hilum of the lungs sits at which costal & vertebral levels?
3rd-4th costal cartilages
T5-7
The right main bronchus (and also right pulmonary artery) give off a branch to the ___ lobe outside of the hilum
Upper
What is respiratory epithelium?
Pseudostratified columnar ciliated with mucous glands
The connective tissue, cartilage and smooth muscle of the bronchial tree originate from (endoderm/ mesoderm/ ectoderm)?
Surfactant secretion begins at ___ months gestation
Mesoderm
6
At the thoracic inlet, the phrenic & vagus nerves enter the chest with the veins ___ and arteries ___ (IN FRONT/ BEHIND)
Veins in front
Arteries behind
True or false: In the trunk, relaxed skin tension lines generally follow the direction of ribs
True
The ___ nerve winds around the surgical neck of the humerus
Axillary
Latissimus dorsi runs from the spine of ___ to sacrum along spinous processes, supraspinous ligaments & post iliac crest
T7
The roots of the brachial plexus are located between ____ and then enter the ___ triangle of the neck
The anterior & middle scalenes
Posterior
Describe the relation of the median nerve & brachial artery
Median nerve crosses anteriorly from lateral to medial side
The ___ muscle arises from the lower 2/3rd of the anterior humerus, just below deltoid
Brachialis
The cephalic vein runs (MEDIALLY/ LATERALLY) and joins the axillary vein (PROXIMALLY/ DISTALLY), whereas the basilic vein runs (MEDIALLY/ LATERALLY) and joins the axillary vein (PROXIMALLY/ DISTALLY).
Cephalic - lateral, proximal
Basilic - medial, distal
Both arise from the dorsal venous network of hand and ascend superficial to the investing layer of fascia
Which 2 muscles arise from the apex of the coracoid process?
Coracobrachialis & biceps brachii short head
The long thoracic nerve runs on the ____ wall of the axilla, and the thoraco-dorsal nerve runs on the ____ wall
Medial
Posterior
Which four structures border the quadrangular space?
Humerus
Long head triceps
Subscapularis
Teres major
The intercostobrachial nerve (T2) is purely (MOTOR/ SENSORY); it emerges from the ___ ICS in the mid-axillary line & crosses the axilla in ____
Sensory
2nd
Axillary fat (surrounded by lymph nodes)
It is usually excised with the specimen for complete therapeutic clearance
The suprascapular artery runs (ABOVE/ BELOW) the transverse scapular ligament, and the nerve runs (ABOVE/ BELOW)
Artery - above
Nerve - below
Different sources state vein as above/ below
Which superficial forearm extensors are supplied by the posterior interosseous branch of the radial nerve?
Extensor carpi ulnaris (ECU)
Extensor carpi radialis brevis (ECRB)
Extensor digiti minimi (EDM)
Extensor digitorum (communis) (ED)
The ulnar nerve lies ___ to the ulnar artery
Medial (runs parallel)
The two prominent tendons seen in the volar wrist are ___ (medial) & ___ (lateral)
Palmaris longus (medial)
Flexor carpi radialis (lateral)
Pronator teres is a key landmark around the elbow - it has 2 heads, which insert into the CFO on the medial epicondyle (1st head) & ___ (2nd head). The median nerve runs ___ and the ulnar artery runs ___
Coronoid process (2nd head)
Median nerve - in between the 2 heads
Ulnar artery - deep to both
Flexor carpi radialis has a ___ muscle belly and ____ tendon (long/ short)
Short muscle belly
Long tendon
The part of FDS giving rise to 3rd & 4th fingers runs ___, whereas that to the 2nd & 5th runs ___ (superficially/ deep)
3rd-4th : superficial
2nd & 5th: deep
The ulnar nerve enters the forearm between the 2 heads of ____
Flexor carpi ulnaris
What is the space of Parona?
Space superficial to pronator quadratus & deep to the long flexor tendons
Proximal parts of flexor synovial sheaths protrude here, and infection of these can spread to this space.
It is limited proximally by the oblique origin of FDS
What is the insertion of extensor carpi radialis longus & brevis respectively?
Longus - 2nd metacarpal
Brevis - 3rd metacarpal
Regarding extensor pollicis longus & brevis
- Insertion
- Position in anatomical snuff box
EPL - inserts into DISTAL phalanx of thumb; forms superior (medial) border of snuff box
EPB - inserts into PROXIMAL phalanx of thumb; forms lateral border of snuff box (with AbPL)
Note: all tendons of anatomical snuff box lie superficial to ECRL/ECRB
The posterior interosseous branch of the radial nerve passes between the 2 heads of ____
Supinator muscle
(Passes from anterior to posterior compartment)
The radial nerve passes ___ and the artery ___ to the snuff box tendons (deep/ superficial)
Radial Nerve - superficial
Radial artery - deep
In a femoral dissection, access to the deeper nodes is gained ___ to the femoral vein
Medial
The profunda femoris & (superficial) femoral artery proper are separated by which muscle?
Adductor longus
Superior gemellus takes origin from the ___ whereas inferior gemellus takes origin from the ___. They both insert into ___
Sup - Ischial spine
Inf - Ischial tuberosity
Greater trochanter (via lesser sciatic foramen)
Tibialis posterior inserts into ____
The navicular tuberosity
Which muscle arises from the radial collateral ligament of the elbow joint?
Supinator
TRUE or FALSE
Flexor carpi radialis
a) passes deep to the flexor retinaculum
b) travels within the carpal tunnel
a) True
b) False
It is below the flexor retinaculum but outside of the carpal tunnel
Which is a more powerful pronator? Pronator teres or pronator quadratus
Pronator quadratus
Which 3 muscles make up the hypothenar eminence, and what is their common origin?
Abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi
All arise from the flexor retinaculum
AbDM also comes from the pisiform and ODM from hook of the hamate
Which 3 muscles make up the hypothenar eminence, and what is their common origin?
Abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi
All arise from the flexor retinaculum
AbDM also comes from the pisiform and ODM from hook of the hamate
Which 3 muscles make up the hypothenar eminence, and what is their common origin?
Abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi
All arise from the flexor retinaculum
AbDM also comes from the pisiform and ODM from hook of the hamate
The IVC forms at which vertebral level, from which 3 vessels?
Approx L5
Right + left common iliac vein + median sacral vein
What is the arterial supply of the oesophagus?
Oesophageal branches from a) inferior thyroid artery, b) descending aorta, c) left gastric artery
Where are the cell bodies located for each of the following oesophageal innervations?
a) upper skeletal muscle
b) lower smooth muscle (visceral)
c) secretomotor
a) nucleus ambiguus
b) dorsal motor vagal nucleus
c) inferior salivary nucleus
Ligmanetum teres (liver) is a remnant of the ____
Obliterated LEFT umbilical vein
Describe the venous drainage of the anterior abdominal wall?
Anstomosing network radiating out from umbilicus
ABOVE umbilicus → lateral thoracic vein → axillary vein
BELOW umbilicus → deep saphenous vein
The internal oblique has a free ___ border that arches over the spermatic cord. The lateral fibres are ___ and medial fibres are ___ (tissue type, relation to cord)
Free lower border
Lateral - muscle fibres in FRONT of cord
Medial - tendinous fibres BEHIND cord
The tendinous intersections of the rectus abdominis muscle attach to ___
The anterior layer of the rectus sheath
(they sit superficial in muscle, don’t go through to posterior aspect)
Usually 3 (xiphisternum, umbilicus & in-between)
Describe the course of the posterior intercostal & lateral/ anterior cutaneous nerves of the abdominal wall
Posterior intercostal nerves in intercostal bundle below rib -> between int oblique + transversus abdominis (give off lateral cutaneous branches) -> pierce post leaf of int oblique aponeurosis to enter post rectus sheath -> pierce rectus muscle to enter anterior sheath becoming anterior cutaneous nerves
The intercostal nerves pierce the rectus abdominis near ____
Its midline
Weakening of the inguinal canal/ conjoint tendon can occur with division of ____ (2) nerves, and lead to a ___ hernia
Iliohypogastric & ilioinguinal nerves
Direct inguinal hernia
*Note: damage to ilioinguinal nerve IN the inguinal canal will not affect motor function, as these branches have already been given off
The ___ lies at the apex of the sigmoid mesocolon
Left ureter
What is the arrangement of pulmonary artery, bronchi and pulmonary veins in the lung hila?
The Artery is Anterior (right) or Above (left) and the Bronchus is BehInd (rIght) or BeLow (Left)
The pulmonary veins sit the lowest & most anterior (superior & inferior vessels)
What sites are lined by transitional epithelium?
‘Urothelium’
Renal pelvis, ureter, bladder, urethra (prostatic, membranous, bulbar & penile parts)
What structure lies in the triangular gap between the 2 heads of sternocleidomastoid?
Internal jugular vein
What is the relationship of ansa cervicalis to the carotid sheath?
It is embedded within the wall of the anterior sheath, and considered one of its contents
List the supra- and infra-hyoid muscles
Suprahyoid:
- Digastric (anterior & posterior bellies)
- Stylohyoid
- Mylohyoid
- Geniohyoid
Infrahyoid:
- Sternothyroid
- Sternohyoid
- Omohyoid
- Thyrohyoid
The ____ recurrent laryngeal nerve is more likely to run BEHIND the inferior thyroid artery
Left
The superior thyroid artery comes from the ___ and runs with the ___ nerve to the ___ pole of the thyroid
External carotid (anterior)
Ext laryngeal nerve
Upper pole
The parathyroid glands are usually supplied by the ____ artery
Inferior thyroid
The external jugular veins lie (DEEP/ SUPERFICIAL) to the investing layer of deep fascia
Superficial
What are the nerve roots of the tibial & common peroneal nerves?
Tibial: L4-S3
Common peroneal: L4-S2
What is the least mobile part of the bladder?
Trigone
What is the narrowest part of the male urethra?
External meatus
Which 2 nerves pierce the sartorius muscle?
Intermediate cutaneous nerve of the thigh & infrapatellar branch of the saphenous nerve
The parotid duct pierces the ____ muscle
Buccinator
How many permanent adult teeth are there normally?
32
What are the nerve roots of the sciatic nerve?
L4-S3
Muscles of facial expression are derived from the ____ pharyngeal arch, and muscles of mastication from the ____ pharyngeal arch
Facial expression - mesoderm of 2nd arch
Mastication - 1st arch
What contributes to the cisterna chyli, and at what vertebral level does it sit?
Lumbar, intestinal, liver, descending intercostal lymphatic trunks
~L1-2
The overlying skin of the breast is supplied by ______
Cutaneous branches of intercostal nerves T4-6
