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MRCS Part A > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Where is the origin of the abdominal aorta?

A

T12

Passes through the aortic opening of the diaphragm beneath the median arcuate ligament between the crura of the diaphragm

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2
Q

Where does the abdominal aorta terminate?

A

L4

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3
Q

What are the posterior relations of the abdominal aorta?

A

L1-L4 vertebral bodies

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4
Q

What are the anterior relations of the abdominal aorta?

A

3 L’s, 3 P’s, IT

Lesser omentum
Liver
Left renal vein
Inferior mesenteric vein
Third part of duodenum
Pancreas
Parietal peritoneum
Peritoneal cavity

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5
Q

What are the right lateral relations of the abdominal aorta?

A

Right crus of the diaphragm
Cisterna chyli (abdominal origin of thoracic duct)
IVC (becomes posterior distally)

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6
Q

What are the left lateral relations of the abdominal aorta?

A

4th part of duodenum
Duodenal-jejunal flexure
Left sympathetic trunk

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7
Q

What are the 10 branches of the abdominal aorta?

A

Inferior phrenic
Coeliac
Superior mesenteric
Middle suprarenal
Renal
Gonadal
Lumbar
Inferior mesenteric
Median sacral
Common iliac

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8
Q

At what level does the phrenic artery branch from the abdominal aorta?

A

T12

(paired - give rise to superior suprarenal arteries)

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9
Q

At what level does the coeliac artery branch from the abdominal aorta?

A

T12

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10
Q

At what level does the superior mesenteric artery branch from the abdominal aorta?

A

L1

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11
Q

At what level does the middle suprarenal artery branch from the abdominal aorta?

A

L1

(paired)

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12
Q

At what level does the renal artery arise from the abdominal aorta?

A

L1-L2

(paired)

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13
Q

At what level does the gonadal artery arise from the abdominal aorta?

A

L2

(paired)

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14
Q

At what level does the lumbar artery arise from the abdominal artery?

A

L1-L4

(paired - one artery bilaterally at each vertebral level)

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15
Q

At what level does the inferior mesenteric artery branch from the abdominal aorta?

A

L3

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16
Q

At what level does the median sacral artery branch from the abdominal aorta?

A

L4

(where the aorta divides into the common iliac arteries)

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17
Q

At what level does the common iliac artery divide from the abdominal aorta?

A

L4

(paired - these are a continuation of the aorta and mark it’s end point)

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18
Q

What layers are divided in a midline abdominal incision?

A

Skin
Subcutaneous fat and fascia
Linea alba
Transversalis fascia
Extraperitoneal fat
Peritoneum

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19
Q

What layers are divided in a paramedian incision?

A

Skin
Subcutaneous fat and fascia
Anterior rectus sheath
Rectus abdominis
Posterior rectus sheath
Transversalis fascia
Extraperitoneal fat
Peritoneum

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20
Q

When is a Kocher incision used?

A

Open cholecystectomy

Incision under right subcostal margin

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21
Q

When is a Lanz incision used?

A

Open appendicectomy

Incision in the right iliac fossa

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22
Q

When is a gridiron incision used?

A

Open appendicectomy

Oblique incision over McBurney’s point which is less commonly used than Lanz incision as it is less cosmetically acceptable

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23
Q

Describe the Gable incision

A

Rooftop incision

Used in liver transplantation, adrenalectomy, duodenal surgery

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24
Q

What structures will be divided in lateral abdominal wall incisions?

A

Skin
Subcutaneous fat and fascia
External oblique (runs towards midline inferiorly)
Internal oblique (runs away from midline inferiorly)
Transversus abdominis
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum

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25
Q

When is a Pfannenstiel incision used?

A

To gain access to the pelvic organs

It is a transverse suprapubic incision.

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26
Q

When is the Rutherford-Morrison incision used?

A

To gain extraperitoneal access to the abdomen

It is the incision used for first-time renal transplantation, and gives access to iliac vessels

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27
Q

Which muscle forms the posterior abdominal wall?

A

Quadratus lumborum

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28
Q

What is the origin of the external oblique muscle?

A

Ribs 5-12 laterally

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29
Q

What is the insertion of the external oblique muscle?

A

Iliac crest
Linea alba
Pubic tubercle

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30
Q

What does the lower border of the external oblique form?

A

The inguinal ligament

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31
Q

What is the origin of the internal oblique muscle?

A

Thoracolumbar fascia
Anterior 2/3 of the iliac crest
Lateral 2/3 of the inguinal ligament

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32
Q

What is the insertion of the internal oblique muscle?

A

Cartilages of the inferior 3 ribs

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33
Q

What is the origin of the transversus abdominis muscle?

A

Inner aspect of the costal cartilages of the inferior 6 ribs
Anterior 2/3 of the iliac crest
Lateral 1/3 of the inguinal ligament

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34
Q

What is the origin of the rectus abdominis?

A

Pubic crest

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35
Q

What is the insertion of the rectus abdominis muscle?

A

Xiphoid process
5th, 6th, 7th costal cartilages

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36
Q

What is the nerve supply to the transversus abdominis?

A

Anterior primary rami of T7-T12

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37
Q

What is the origin of the abductor pollicis brevis?

A

Fleshy fibres from the flexor retinaculum, scaphoid and trapezium

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38
Q

What is the insertion of the abductor pollicis brevis?

A

Via a short tendon into the radial side of the proximal phalanx of the thumb

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39
Q

What is the nervous supply to the abductor pollicis brevis?

A

Recurrent branch of median nerve in the palm

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40
Q

What is the action of the abductor pollicis brevis?

A

Abducts the thumb at the carpometacarpal and metacarpophalangeal joints, resulting in both radial and palmar abduction

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41
Q

What is the origin of the cranial portion of the accessory nerve?

A

Arises from the caudal two thirds of the nucleus ambiguus and the caudal four fifths of the dorsal nucleus of the vagus.

Emerges as four rootlets from the dorsolateral surface of the medulla oblongata below those of the vagus.

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42
Q

Describe the path of the cranial portion of the accessory nerve.

A

Arises from the medulla oblongata, then exits the skull via the jugular foramen.

Combines with the vagus nerve at the inferior ganglion of the vagus nerve, and it’s fibres are then distributed throughout the vagus nerve

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43
Q

What does the cranial portion of the accessory nerve supply?

A

Palatal muscles (with CN X)

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44
Q

Describe the path of the spinal portion of the accessory nerve.

A

Arises from C1-5/6, which traverse superiorly and enter the skull via the foramen magnum. Traverses the posterior cranial fossa and exits the skull via the jugular foramen.

Descends alongside the internal carotid artery to the sternoicleidomastoid which it innervates. Moves across the posterior triangle of the neck along the levator scapulae to innervate the trapezius.

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45
Q

Describe the location of the adductor canal

A

Immediately distal to the apex of the femoral triangle, lying in the middle third of the thigh

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46
Q

Where does the adductor canal terminate?

A

The adductor hiatus

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47
Q

What is the lateral border of the adductor canal?

A

Vastus medialis

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48
Q

What are the contents of the adductor canal?

A

Saphenous nerve

Superficial femoral artery

Superficial femoral vein

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49
Q

What is the posterior border of the adductor canal?

A

Adductor longus, adductor magnus

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50
Q

What structure forms the anterior/medial aspect of the adductor canal?

A

Sartorius

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51
Q

What is the origin of the adductor longus?

A

Anterior body of the pubis

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52
Q

What is the insertion of the adductor longus?

A

Middle third of the linea aspera

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53
Q

What is the function of the adductor longus?

A

Adducts and flexes the thigh, medially rotates the hip.

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54
Q

What is the innervation of the adductor longus?

A

Anterior division of the obturator nerve (L 2, 3, 4)

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55
Q

What is the origin of the adductor pollicis?

A

Tendon sheath of flexor carpi radialis

Oblique head comes from bases of second, third and fourth metacarpals

Transverse head comes from the third metacarpal

Anterior aspect of the trapezoid and capitate bones

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56
Q

What is the insertion of the adductor pollicis?

A

Fibres converge into the ulnar aspect of the base of the proximal phalanx of the thumb

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57
Q

What is the nervous supply to the adductor pollicis?

A

Deep branch of the ulnar nerve (C8, T1)

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58
Q

What is the action of the adductor pollicis?

A

Draws the thumb towards the midline in the palmar plane of the hand

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59
Q

What is the location of the adrenal glands?

A

Superomedially to the upper pole of the kidney

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60
Q

Describe the posterior relations of the right adrenal gland

A

Diaphragm

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61
Q

Describe the inferior relations of the right adrenal gland

A

Kidney

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62
Q

Describe the medial relations of the right adrenal gland

A

Inferior vena cava

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63
Q

Describe the anterior relations of the right adrenal gland

A

Hepato-renal pouch and bare area of the liver

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64
Q

Describe the postero-medial relations of the left adrenal gland

A

Crus of the diaphragm

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65
Q

Describe the inferior relations of the left adrenal gland

A

Pancreas and splenic vessels

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66
Q

Describe the anterior relations of the left adrenal gland

A

Lesser sac and stomach

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67
Q

Describe the arterial supply to the adrenal glands

A

Superior adrenal arteries (branch of inferior phrenic arteries)

Middle suprarenal arteries (AKA middle adrenal arteries - arise from aorta)

Inferior adrenal arteries (branch of renal arteries)

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68
Q

Describe the venous drainage of the right adrenal gland

A

One central vein directly into the IVC

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69
Q

Describe the venous drainage of the left adrenal gland

A

One central artery into the left renal vein

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70
Q

What is the embryological origin of the adrenal cortex?

A

Mesoderm of the posterior abdominal wall

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71
Q

When is the adrenal gland first embryologically evident?

A

6 weeks gestation

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72
Q

When does steroid secretion from the adrenal cortex begin?

A

Shortly after embryological development at 6 weeks

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73
Q

What is the embryological origin of the adrenal medulla?

A

Ectoderm, arising from neural crest cells that migrate to the medial aspect of the developing cortex

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74
Q

Describe the size of the fetal adrenal gland

A

At 4 months’ gestation, it is 4 times the size of the kidney; however, at birth, it is a third of the size of the kidney.

This is because of the rapid regression of the fetal cortex at birth. It disappears almost completely by age 1 year; by age 4-5 years, the permanent adult-type adrenal cortex has fully developed.

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75
Q

Describe the embryological association between the adrenal gland and the kidney

A

Develop with close association.

If there is adrenal agenesis there is also ipsilateral renal agenesis.

If there is adrenal fusion across the midline there is also renal fusion.

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76
Q

Describe the 2 forms of adrenal hypoplasia

A

(1) hypoplasia or absence of the fetal cortex with a poorly formed medulla

(2) disorganised fetal cortex and medulla with no permanent cortex present

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77
Q

Describe adrenal heterotropia

A

Normal adrenal gland in an abnormal location (i.e. within renal or hepatic capsule)

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78
Q

What is the most common location of accessory adrenal tissue?

A

Broad ligament or spermatic cord but can be found anywhere within the abdomen

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79
Q

Describe the histological structure of the internal anal sphincter

A

Smooth muscle continuous with the circular muscle of the rectum

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80
Q

Describe the location of the internal anal sphincter

A

Upper 2/3 of the anal canal

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81
Q

Describe the histology of the external anal sphincter

A

Striated muscle which surrounds the internal sphincter but extends more distally.

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82
Q

Describe the nerve supply to the external anal sphincter.

A

Inferior rectal branch of the pudendal nerve (S2 and S3) and the perineal branch of the S4 nerve roots

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83
Q

Define the posterior border of the anatomical snuffbox

A

Tendon of extensor pollicis longus

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84
Q

Define the anterior border of the anatomical snuffbox

A

Tendons of extensor pollicis brevis and abductor pollicis longus

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85
Q

Define the proximal border of the anatomical snuffbox

A

Styloid process of the radius

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86
Q

Define the distal border of the anatomical snuffbox

A

Apex of the snuffbox triangle

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87
Q

What structures form the floor of the anatomical snuffbox?

A

Trapezium and scaphoid

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88
Q

What structure lies within the anatomical snuffbox?

A

Radial artery

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89
Q

Which muscles lie within the superficial anterior compartment of the forearm?

A

Brachioradialis

Pronator teres

Flexor carpi radialis

Palmaris longus

Flexor carpi ulnaris

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90
Q

Which muscle lies within the middle anterior compartment of the forearm?

A

Flexor digitorum superficialis

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91
Q

Which muscles lie within the deep anterior compartment of the forearm?

A

Flexor digitorum profundus

Pronator quadratus

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92
Q

What structure is labelled 1?

A

Flexor carpi radialis

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93
Q

What structure is labelled 2?

A

Palmaris longus

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94
Q

What structure is labelled 3?

A

Flexor carpi ulnaris

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95
Q

What structure is labelled 4?

A

Pronator teres

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96
Q

What structure is labelled 5?

A

Brachioradialis

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97
Q

What structure is labelled 1?

A

Flexor pollicis longus

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98
Q

What structure is labelled 2?

A

Pronator quadratus

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99
Q

What structure is labelled 3?

A

Flexor digitorum profundus

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100
Q

What is the origin of flexor carpi radialis?

A

Common flexor origin and surrounding fascia

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101
Q

What is the origin of palmaris longus?

A

Common flexor origin

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102
Q

What is the origin of flexor carpi ulnaris?

A

Small humeral head arises from the common flexor origin and adjacent fascia.

Ulnar head comes from medial border of olecranon and posterior border of ulna.

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103
Q

What is the origin of flexor digitorum superficialis?

A

Common flexor tendon, adjacent fascia and septa and medial border of the coronoid process

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104
Q

Describe the origin of the flexor digitorum profundus

A

Upper two thirds of the medial and anterior surface of the ulna, medial side of the olecranon, medial half of the interosseous membrane

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105
Q

Describe the insertion of the flexor carpi radialis

A

Front of bases of second and third metacarpals

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106
Q

Describe the insertion of the palmaris longus muscle

A

Apex of the palmar aponeurosis

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107
Q

Describe the insertion of the flexor carpi ulnaris

A

Pisiform and base of the fifth metacarpal

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108
Q

Describe the insertion of the flexor digitorum superficialis

A

Via tendons in the fibrous flexor sheath. At the level of the metacarpophalangeal joint each tendon split into two, these bands pass distally to their insertions

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109
Q

Describe the insertion of the flexor digitorum profundus

A

Via tendons that lie deep to those of flexor digitorum superficialis to insert into the distal phalanx

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110
Q

What is the nerve supply to flexor carpi radialis?

A

Median

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111
Q

What is the nerve supply to palmaris longus?

A

Median

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112
Q

What is the nerve supply to flexor carpi ulnaris?

A

Ulnar

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113
Q

What is the nerve supply to flexor digitorum superficialis?

A

Median

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114
Q

What is the nerve supply to flexor digitorum profundus?

A

Medial part= ulnar

Lateral part=anterior interosseous nerve

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115
Q

What is the action of flexor carpi radialis?

A

Flexes and abducts the carpus, part flexes the elbow and part pronates forearm

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116
Q

What is the action of palmaris longus?

A

Wrist flexor

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117
Q

What is the action of flexor carpi ulnaris?

A

Flexes and adducts the carpus

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118
Q

What is the action of flexor digitorum superficialis?

A

Flexor of metacarpophalangeal joint and proximal interphalangeal joint

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119
Q

What is the action of flexor digitorum profundus?

A

Flexes the distal interphalangeal joints and the wrist

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120
Q

What are the 8 carpal bones?

A

Lateral to medial (in two layers of 4):

Scaphoid
Lunate
Triquetrium
Pisiform
Trapezium
Trapezoid
Capitate
Hamate

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121
Q

What is the nerve supply to the interosseous bones of the hand?

A

Ulnar

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122
Q

How many interosseous bones of the hand are there?

A

8

4 dorsal (abduct fingers)
4 palmar (adduct fingers)

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123
Q

Describe the function of the lumbrical muscles of the hand

A

Flex MCPJ and extend IPJ

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124
Q

Describe the origin of the lumbrical muscles of the hand

A

Flexor digitorum profundus tendons in the hand

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125
Q

Describe the insertion of the lumbrical muscles of the hand

A

Dorsal extensor hood mechanism

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126
Q

Describe the innervation of the lumbrical muscles of the hand

A

1st and 2nd- median nerve

3rd and 4th- deep branch of the ulnar nerve.

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127
Q

Which muscles form the thenar eminence?

A

Abductor pollicis brevis

Opponens pollicis

Flexor pollicis brevis

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128
Q

What structure is labelled 1?

A

Flexor pollicis brevis

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129
Q

What structure is labelled 2?

A

Abductor pollicis brevis

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130
Q

What structure is labelled 3?

A

Opponens pollicis

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131
Q

Which muscles form the hypothenar eminence?

A

Opponens digiti minimi

Flexor digiti minimi brevis

Abductor digiti minimi

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132
Q

What structure is labelled 1?

A

Flexor digiti minimi brevis

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133
Q

What structure is labelled 2?

A

Abductor digiti minimi

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134
Q

What structure is labelled 3?

A

Opponens digiti minimi

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135
Q

Which structures is the fascia of the palm continuous with?

A

Antebrachial fascia and the fascia of the dorsum of the hand

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136
Q

Which structures is the palmar aponeurosis continuous with?

A

Flexor retinaculum and the palmaris longus tendon

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137
Q

What lies between the thenar and hypothenar eminences of the hand, and what does it contain?

A

The central compartment of the hand

Contains the flexor tendons and their sheaths, the lumbricals, the superficial palmar arterial arch and the digital vessels and nerves.

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138
Q

What is the deepest muscular plane of the forearm?

A

The adductor compartment, containing the adductor pollicis.

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139
Q

What is contained within the fibrous digital sheath?

A

Flexor tendons and their synovial sheaths

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140
Q

Where does the fibrous digital sheath lie?

A

Extend from the heads of the metacarpals to the base of the distal phalanges

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141
Q

What structures are supplied by the superior gluteal nerve?

A

Gluteus medius

Gluteus minimis

Tensor fascia lata

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142
Q

What symptom will develop from damage to the superior gluteal nerve?

A

Trendelenburg gait

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143
Q

What structure does the inferior gluteal nerve supply?

A

Gluteus maximus

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144
Q

Name the 4 deep lateral hip rotators

A

Piriformis

Gemelli

Obturator internus

Quadratus femoris

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145
Q

Which structures run in the antecubital fossa?

A

Cephalic vein
Cubital vein
Brachial artery
Median nerve

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146
Q

Describe the action of the gluteal muscles

A

Extend and abduct the hip.

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147
Q

Which bones form the ankle joint?

A

Tibia and fibula proximally, talus distally.

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148
Q

Which ligaments form the ankle joint?

A

Deltoid ligament (medially)

Lateral collateral ligament

Talo-fibular ligaments (anteriorly and posteriorly)

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149
Q

What are the components of the syndesmosis of the ankle?

A

Antero-inferior tibiofibular ligament

Postero-inferior tibiofibular ligament

Inferior transverse tibiofibular ligament

Interosseous ligament

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150
Q

What is the range of plantarflexion of the ankle joint?

A

55 degrees

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151
Q

What is the range of dorsiflexion of the ankle joint?

A

35 degrees

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152
Q

What is the inferior root of the ansa cervicalis?

A

C2, C3 - passes posterolateral to the internal jugular vein, lying either deep or superficial to it

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153
Q

At which level do inversion and eversion movements of the ankle ovvur?

A

The subtalar joint

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154
Q

What is the nerve supply to the ankle joint?

A

Branches of the deep peroneal and tibial nerves

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155
Q

What is the superior root of the ansa cervicalis?

A

C1 - branch anterolateral to the carotid sheath

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156
Q

What structures does the ansa cervicalis supply?

A

Sternohyoid
Sternothyroid
Omohyoid

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157
Q

Where does the nerve supply to the inferior strap muscles enter and what is it’s clinical significance?

A

Their inferior aspect.

When dividing these muscles to expose a large goitre, the muscles should be divided in their upper half.

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158
Q

What is the nerve supply to the inferior strap muscles?

A

Ansa cervicalis

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159
Q

Which nerve root is tested by the ankle reflex?

A

S1 and S2

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160
Q

Which pathology will typically cause a delayed ankle jerk reflex?

A

Disc prolapse at L5/S1

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161
Q

Which structures run in the antecubital fossa?

A

Cephalic vein
Cubital vein
Brachial artery
Median nerve

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162
Q

What structure is labelled 1?

A

Median antecubital vein

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163
Q

What structure is labelled 2?

A

Basilic vein

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164
Q

What structure is labelled 3?

A

Cephalic vein

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165
Q

What are the sub-triangles of the anterior triangle of the neck?

A

Muscular triangle

Carotid triangle

Digastric triangle (submandibular triangle)

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166
Q

Which structures form the anterior triangle of the neck?

A

Anterior border of sternocleidomastoid

Lower border of the mandible

Anterior midline

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167
Q

What are the contents of the muscular triangle of the neck?

A

Strap muscles

External jugular vein

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168
Q

What are the contents of the carotid triangle of the neck?

A

Carotid sheath

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169
Q

What are the contents of the digastric triangle of the neck?

A

Submandibular gland

Submandibular nodes

Facial vessels

Hypoglossal nerve

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170
Q

What is the nerve supply to the digastric muscle?

A

Anterior: Mylohyoid nerve

Posterior: Facial nerve

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171
Q

What does the external jugular vein drain?

A

Superficial aspect of scalp and neck

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172
Q

Where does the external jugular vein commence?

A

Near the angle of the mandible either below or within the parotid.

Formed from posterior divisions of the retromandibular and posterior auricular veins.

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173
Q

Where does the anterior jugular vein commence?

A

Near the hyoid bone by the confluence of the superficial mandibular veins

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174
Q

Describe the path of the anterior jugular vein

A

It descends between the midline and the anterior border of the sternocleidomastoid. It eventually descends deep to this muscle to join either the external jugular or the subclavian vein.

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175
Q

Describe the origin of the internal jugular vein

A

The cranial base in the posterior compartment of the jugular foramen and is continuous with the sigmoid sinus

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176
Q

Describe the path of the internal jugular vein

A

The vein is contained within the carotid sheath and eventually unites with the subclavian vein posterior to the sternal end of the clavicle.

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177
Q

Describe the surface markings of the internal jugular vein

A

This is from the ear lobe to the medial end of the clavicle.

The inferior bulb lies in a depression between the sternal and clavicular heads of the sternocleidomastoid, the lesser clavicular fossa.

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178
Q

What is the origin of the external carotid artery?

A

Immediately lateral to the pharyngeal side wall

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179
Q

Describe the path of the external carotid artery

A

Ascends and lies anterior to the internal carotid and posterior to the posterior belly of digastric and stylohyoid

It then pierces the fascia of the parotid gland finally dividing into its terminal branches within the gland itself.

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180
Q

Describe the surface markings of the external carotid artery

A

This is an imaginary line drawn from the bifurcation of the common carotid passing behind the angle of the jaw to a point immediately anterior to the tragus of the ear.

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181
Q

What are the anterior branches of the external carotid artery?

A

Superior thyroid

Lingual

Facial

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182
Q

What are the posterior branches of the external carotid artery?

A

Occipital

Posterior auricular

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183
Q

What is the deep branch of the external carotid artery?

A

Ascending pharyngeal

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184
Q

How does the external carotid artery terminate?

A

By dividing into the maxillary and superficial temporal arteries.

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185
Q

Which structures run through the superior orbital fissure?

A

Recurrent meningeal artery
Lacrimal nerve

Trochlear nerve

Abducens nerve

Superior ophthalmic vein

Superior division of the oculomotor nerve

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186
Q

Which structures run through the inferior orbital fissure?

A

Maxillary nerve

Inferior ophthalmic vein

Zygomatic nerve

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187
Q

Which structures run through the optic foramen?

A

Optic nerve

Ophthalmic artery

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188
Q

What is the origin of the anterior interosseous nerve?

A

Median nerve

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189
Q

What does the anterior interosseous nerve supply?

A

Deep muscles of the anterior forearm, except the ulnar half of the flexor digitorum profundus

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190
Q

Describe the path of the anterior interosseous nerve

A

Accompanies the anterior interosseous artery along the anterior of the interosseous membrane of the forearm, in the interval between the flexor pollicis longus and flexor digitorum profundus.

It ends in the pronator quadratus and wrist joint.

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191
Q

What structures does the anterior interosseous nerve supply?

A

2 and 1/2 muscles:

-Flexor pollicis longus

-Pronator quadratus

-The radial half of flexor digitorum profundus (the lateral two out of the four tendons).

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192
Q

Where does the anterior tibial artery originate?

A

Opposite the distal border of popliteus

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193
Q

Where does the anterior tibial artery terminate?

A

In front of the ankle, continuing as the dorsalis pedis artery

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194
Q

Describe the path of the anterior tibial artery

A

Lies on the interosseous membrane, distal part of the tibia and front of the ankle joint

Passes between the tendons of extensor digitorum and extensor hallucis longus distally.

It is related to the deep peroneal nerve, it lies anterior to the middle third of the vessel and lateral to it in the lower third

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195
Q

Where is the appendix located?

A

Base of caecum

It is intra-peritoneal

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196
Q

What is the size of the appendix?

A

Up to 10cm

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197
Q

What is the structure of the appendix?

A

Mainly lymphoid tissue.

Caecal taenia coli converge at base of appendix and form a longitudinal muscle cover over the appendix (this convergence should facilitate its identification at surgery if it is retrocaecal and difficult to find)

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198
Q

Describe the blood supply to the appendix

A

Appendicular artery (branch of the ileocolic)

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199
Q

Describe the location of McBurney’s point

A

1/3 of the way along a line drawn from the Anterior Superior Iliac Spine to the Umbilicus

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200
Q

What are the 6 positions in which the appendix may lie?

A

Retrocaecal (74%)
Pelvic (21%)
Postileal
Subcaecal
Paracaecal
Preileal

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201
Q

What structure forms the medial border of the axilla?

A

Chest wall
Serratus anterior

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202
Q

What structure forms the lateral border of the axilla?

A

Humeral head

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203
Q

What structure forms the floor of the axilla?

A

Subscapularis

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204
Q

What structure forms the anterior aspect of the axilla?

A

Lateral border of pectoralis major

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205
Q

What are the contents of the axilla?

A

Long thoracic nerve

Thoracodorsal nerve and thoracodorsal trunk

Axillary vein

Intercostobrachial nerves

Lymph nodes

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206
Q

Describe the path of the long thoracic nerve

A

Derived from C5-C7 and passes behind the brachial plexus to enter the axilla. It lies on the medial chest wall

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207
Q

What does the long thoracic nerve supply?

A

Serratus anterior

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208
Q

What will damage to the long thoracic nerve cause?

A

Winging of the scapula

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209
Q

What structure is innervated by the thoracodorsal nerve and thoracodorsal trunk?

A

Latissimus dorsi

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210
Q

What is the origin of the axillary vein?

A

It is the continuation of the basilic vein

(it becomes the subclavian vein at the outer border of the first rib)

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211
Q

Describe the path of the intercostobrachial nerves

A

Traverse the axillary lymph nodes

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212
Q

What do the intercostobrachial nerves supply?

A

Cutaneous sensation to the axillary skin

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213
Q

Which lymph nodes does breast tissue drain to?

A

Axillary nodes

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214
Q

What are the branches of the axillary artery?

A

Superior thoracic artery

Thoraco-acromial artery

Lateral thoracic artery

Subscapular artery

Posterior circumflex humeral artery

Anterior circumflex humeral artery

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215
Q

Describe the path of the axillary artery

A

Originates at the outer border of the first rib as a continuation of the subclavian artery.

Terminates at the lower border of teres major where it becomes the brachial artery.

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216
Q

Where does the first part of the axillary artery lie?

A

Above the pectoralis major

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217
Q

Where does the second part of the axillary artery lie?

A

Posterior to the pectoralis major

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218
Q

Where does the third part of the axillary artery lie?

A

Inferior to the pectoralis major

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219
Q

What are the roots of the axillary nerve?

A

C5, C6

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220
Q

Describe the path of the axillary nerve

A

Descends posterior to the axillary artery at the lower border of subscapularis and then passes through quadrangular space with the posterior circumflex humeral vessels

Divides into anterior and posterior branches

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221
Q

What does the axillary nerve innervate?

A

Deltoid muscle and small patch of skin over deltoid

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222
Q

What is the origin of the basilic vein?

A

Palmar venous arch

Originates on the medial side of the dorsal venous network of the hand

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223
Q

What structure does the basilic vein become proximally?

A

Axillary vein

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224
Q

Describe the path of the basilic vein

A

Runs superficially up the forearm to the ACF where it is joined by the median cephalic vein, a branch of the cephalic vein.

Midway up the humerus it runs deep under the muscles. At the lower border of the teres major muscle, the anterior and posterior circumflex humeral veins feed into it.

It is often joined by the medial brachial vein before draining into the axillary vein.

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225
Q

What is the origin of the long head of the biceps femoris?

A

Ischial tuberosity

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226
Q

Where does the long head of the biceps femoris insert?

A

Fibular head

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227
Q

What is the action of the long head of the biceps femoris?

A

Knee flexion

Lateral rotation of the tibia

Extension of the hip

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228
Q

What is the innervation of the long head of the biceps femoris?

A

Tibial division of sciatic nerve (L5, S1, S2)

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229
Q

What is the arterial supply to the long head of the biceps femoris?

A

Profunda femoris artery

Inferior gluteal artery

Superior muscular branches of popliteal artery

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230
Q

What is the origin of the short head of the biceps femoris?

A

Lateral lip of linea aspera, lateral supracondylar ridge of femur

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231
Q

What is the insertion of the short head of the biceps femoris?

A

Fibular head

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232
Q

What is the action of the short head of the biceps femoris?

A

Knee flexion

Lateral rotation tibia

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233
Q

What is the innervation of the short head of the biceps femoris?

A

Common peroneal division of sciatic nerve (L5, S1, S2)

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234
Q

What is the arterial supply to the short head of the biceps femoris?

A

Profunda femoris artery

Inferior gluteal artery

Superior muscular branches of popliteal artery

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235
Q

Describe the structure of the bladder

A

Three sided pyramid.

Apex of the bladder points forwards towards the symphysis pubis and the base lies immediately anterior to the rectum or vagina.

Continuous with the apex is the median umbilical ligament, during development this was the site of the urachus.

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236
Q

Is the bladder intra- or extra-peritoneal?

A

Inferior aspect of the bladder is retroperitoneal and the superior aspect covered by peritoneum.

As the bladder distends it will tend to separate the peritoneum from the fascia of transversalis. For this reason a bladder that is distended due to acute urinary retention may be approached with a suprapubic catheter that avoids entry into the peritoneal cavity.

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237
Q

Describe the arterial supply to the bladder

A

The superior and inferior vesical arteries provide the main blood supply to the bladder.

These are branches of the internal iliac artery.

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238
Q

Describe the venous drainage of the bladder

A

In males the bladder is drained by the vesicoprostatic venous plexus.

In females the bladder is drained by the vesicouterine venous plexus.

In both sexes this venous plexus will ultimately drain to the internal iliac veins.

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239
Q

Describe the lymphatic drainage of the bladder

A

Lymphatic drainage is predominantly to the external iliac nodes.

Internal iliac and obturator nodes also form sites of bladder lymphatic drainage.

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240
Q

Describe the parasympathetic supply to the bladder

A

Parasympathetic nerve fibres innervate the bladder from the pelvic splanchnic nerves.

The parasympathetic nerve fibres will typically cause detrusor muscle contraction and result in voiding.

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241
Q

Describe the sympathetic supply to the bladder

A

Sympathetic nerve fibres are derived from L1 and L2 via the hypogastric nerve plexuses.

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242
Q

Describe the trigone of the bladder

A

The least mobile part of the bladder.

Forms the site of the ureteric orifices and internal urethral orifice.

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243
Q

Describe the path of the brachial artery

A

Begins at the lower border of teres major as a continuation of the axillary artery.

Terminates in the cubital fossa at the level of the neck of the radius by dividing into the radial and ulnar arteries.

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244
Q

Describe the posterior relations of the brachial artery

A

Long head of triceps with the radial nerve and profunda vessels intervening

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245
Q

Describe the anterior relations of the brachial artery

A

Overlapped by the medial border of biceps.

It is crossed by the median nerve in the middle of the arm.

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246
Q

What separated the median cubital vein and the brachial artery in the antecubital fossa?

A

Bicipital aponeurosis

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247
Q

Describe the path of the brachiocephalic artery

A

Ascends superiorly from it’s origin anterior to the trachea, before traversing to the right hand side of the trachea.

It then branches into the right common carotid and right subclavian artery at the level of the sternoclavicular joint.

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248
Q

Describe the anterior relations of the brachiocephalic artery

A

Sternohyoid

Sternothyroid

Left brachiocephalic vein

Right inferior thyroid veins

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249
Q

Describe the posterior relations of the brachiocephalic artery

A

Trachea

Right pleura

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250
Q

Describe the right lateral relations of the brachiocephalic artery

A

Right brachiocephalic vein

Superior aspect of SVC

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251
Q

Describe the left lateral relations of the brachiocephalic artery

A

Origin of left common carotid

Inferior thyroid veins

Trachea (higher level)

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252
Q

Which muscles does the breast lie upon?

A

Pectoralis major

Serratus anterior

External oblique

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253
Q

What is the nervous supply to the breast?

A

Branches of the intercostal nerves from T4-T6

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254
Q

Describe the arterial supply to the breast

A

Internal mammary artery

External mammary artery

Anterior intercostal arteries

Thoraco-acromial artery

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255
Q

Describe the venous drainage of the breast

A

Superficial venous plexus to the subclavian, axillary and intercostal veins.

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256
Q

Describe the lymphatic drainage of the breast

A

70% to the axillary lymph nodes

Internal mammary chain

May drain to deep cervical and supraclavicular fossa lymph nodes.

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257
Q

Describe the location of the caecum

A

Intraperitoneal

Proximal right colon below the ileocaecal valve

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258
Q

Describe the posterior relations of the caecum

A

Psoas

Iliacus

Femoral nerve

Genitofemoral nerve

Gonadal vessels

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259
Q

Describe the anterior relations of the caecum

A

Greater omentum

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260
Q

Describe the arterial supply to the caecum

A

Ileocolic artery

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261
Q

Describe the lymphatic drainage of the caecum

A

Mesenteric nodes accompany the venous drainage

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262
Q

What is the most likely site of perforation in complete large bowel obstruction?

A

The caecum

It is the most distensible part of the colon, but with a competent ileocaecal valve it is the most likely area.

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263
Q

Which bones does the capitate articulate with?

A

Scaphoid and lunate (proximally)

Hamate (medially)

Trapezoid (laterally)

Middle metacarpal (distally)

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264
Q

What are the 8 carpal bones?

A

Scaphoid

Lunate

Triquetrium

Pisiform

Trapezium

Trapezoid

Capitate

Hamate

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265
Q

To which carpal bones do no tendons attach?

A

Scaphoid

Lunate

Triquetrium

(they are stabilised by ligaments)

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266
Q

Describe the location of the cavernous sinuses

A

Paired and situated on the sphenoid bone.

They run from the superior orbital fissure to the petrous temporal bone.

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267
Q

Describe the medial relations of the cavernous sinuses

A

Pituitary fossa

Sphenoid sinus

268
Q

Describe the lateral relations of the cavernous sinuses

A

Temporal lobe

269
Q

Describe the lateral wall components of the cavernous sinus

A

Oculomotor nerve

Trochlear nerve

Ophthalmic nerve

Maxillary nerve

270
Q

Describe the contents of the cavernous sinus

A

Internal carotid artery (and sympathetic plexus)

Abducens nerve

271
Q

Describe the blood supply to the cavernous sinus

A

Ophthalmic vein

Superficial cortical veins

Basilar plexus of veins

272
Q

Describe the drainage of the cavernous sinus

A

Internal jugular vein via the superior and inferior petrosal sinuses

273
Q

Describe the blood supply to the cepahlic vein

A

Dorsal venous arch

274
Q

Describe the path of the cephalic vein

A

Crosses the anatomical snuffbox and travels laterally up the arm.

Connects to the basilic vein in the antecubital fossa via the median cubital vein

Pierces deep fascia of deltopectoral groove to join axillary vein

275
Q

Describe the anatomical triangle of safety for chest drain insertion

A

Mid-axillary line of the 5th intercostal space. It is bordered by:

Anterior edge latissimus dorsi
The lateral border of pectoralis major
A line superior to the horizontal level of the nipple
The apex below the axilla.

276
Q

Which vessels supply the circle of willis?

A

Anterior communicating artery

Anterior cerebral arteries

Internal carotid arteries

Posterior communicating arteries

Posterior cerebral arteries

The termination of the basilar artery

277
Q

Describe the anatomical path of the vertebral arteries

A

Enter the cranial cavity via foramen magnum

Lie in the subarachnoid space

Ascend on anterior surface of medulla oblongata

Unite to form the basilar artery at the base of the pons

278
Q

Describe the branches of the vertebral arteries

A

Posterior spinal artery

Anterior spinal artery

Posterior inferior cerebellar artery

279
Q

What are the branches of the basilar artery?

A

Anterior inferior cerebellar arteries

Labyrinthine artery

Pontine arteries

Superior cerebellar arteries

Posterior cerebral artery (at the point where it bifurcates)

280
Q

What are the branches of the internal carotid arteries?

A

Posterior communicating arteries

Anterior cerebral arteries

Middle cerebral arteries

Anterior choroidal arteries

Ophthalmic arteries

281
Q

Describe the inferior surface of the clavicle

A

Irregular and strongly marked by ligaments at each end

Laterally, lies the trapezoid line and this runs anterolaterally. Posteriorly, lies the conoid tubercle. These give attachment to the conoid and trapezoid parts of the coracoclavicular ligament.

The medial part of the inferior surface has an irregular surface which marks the surface attachment of the costoclavicular ligament.

The intermediate portion is marked by a groove for the subclavius muscle.

282
Q

Describe the medial aspect of the clavicle

A

The superior part of the bone has a raised surface which gives attachment to the clavicular head of sternocleidomastoid.

Sternohyoid gains attachment to the posterior surface.

283
Q

Describe the lateral aspect of the clavicle

A

Laterally there is an oval articular facet for the acromion and a disk lies between the clavicle and acromion.

The capsule of the joint is attached to the ridge on the margin of the facet.

284
Q

What are the branches of the coeliac axis?

A

Left gastric artery

Splenic artery

Common hepatic artery

285
Q

What are the branches of the common hepatic artery?

A

Right Gastric

Gastroduodenal

Superior Pancreaticoduodenal

Cystic (occasionally).

286
Q

What are the branches of the splenic artery?

A

Pancreatic

Short Gastric

Left Gastroepiploic

287
Q

What are the anterior relations of the coeliac axis?

A

Lesser omentum

288
Q

What are the right lateral relations of the coeliac axis?

A

Right coeliac ganglion and caudate process of liver

289
Q

What are the left lateral relations of the coeliac axis?

A

Left coeliac ganglion and gastric cardia

290
Q

What are the inferior relations of the coeliac axis?

A

Upper border of pancreas and renal vein

291
Q

Where is the coeliac plexus located?

A

T12-L1

Surrounds the coeliac axis and the SMA.

It lies posterior to the stomach and lesser sac, and anterior to the crura of the diaphragm and the aorta.

292
Q

What joins the coeliac plexus and coeliac ganglion?

A

Greater and lesser splanchnic nerves

293
Q

Where do teniae coli converge?

A

Base of the caecum

This is where the appendix is located

294
Q

Describe the caecum in relation to the peritoneum

A

Intraperitoneal

295
Q

Describe the ascending colon in relation to the peritoneum

A

Retroperitoneal (mostly)

The line of demarcation between the intra- and retro-peritoneal ascending colon is visible as a white line and forms the line of incision for colonic resection.

296
Q

Describe the transverse colon in relation to the peritoneum

A

Intraperitoneal

Enclosed be the transverse mesocolon.

297
Q

Describe the descending colon in relation to the peritoneum

A

Retroperitoneal

Runs anterior to the left kidney

298
Q

Which structure connects the splenic flexure of the colon to the diaphragm?

A

The phrenicocolic ligament.

299
Q

Describe the paracolic gutters

A

Spaces formed between the ascending/descending colon and the postero-lateral abdominal wall.

These allow substances released by inflamed/infected tissue to accumulate elsewhere in the abdomen.

300
Q

Where does the colon attach to the greater omentum?

A

Superior aspect of the transverse colon

Division of these structures permits entry into the lesser sac

301
Q

Between what levels does the sigmoid colon run?

A

L4-S3

302
Q

Describe the rectum in relation to the peritoneum

A

Begins intraperitoneal, but becomes extraperitoneal distally as it passes through the peritoneal reflection.

303
Q

At which macroscopically visible point does the sigmoid colon become the rectum?

A

Where the teniae coli fuse

304
Q

Which aortic branches form the arterial supply to the colon?

A

Superior and inferior mesenteric arteries, linked by the marginal artery

305
Q

Describe the arterial supply to the ascending colon

A

Ileocolic artery (SMA)

Right colic artery (SMA)

306
Q

Describe the arterial supply to the transverse colon

A

Proximal 2/3: Middle colic artery (SMA)

Distal 1/3: Left colic artery (IMA)

307
Q

Describe the arterial supply to the descending colon

A

Left colic artery (IMA)

308
Q

Describe the arterial supply to the sigmoid colon

A

Sigmoid arteries (IMA)

309
Q

What is the function of the marginal artery of
Drummond?

A

To provide collateral blood supply to the colon.

310
Q

Describe the origin of the marginal artery

A

As the terminal vessels of the superior mesenteric and inferior mesenteric artery approach the colon, they split into many branches, which anastomose with each other. These anastomoses form a continuous arterial channel which extends the length of the colon.

Long, straight arterial branches (called vasa recta) arise from the marginal artery to supply the colon.

311
Q

Describe the venous drainage of the ascending colon

A

Ileocolic and right colic veins

Empty into the superior mesenteric vein

312
Q

Describe the venous drainage of the transverse colon

A

Middle colic vein

Empties into the superior mesenteric vein

313
Q

Describe the venous drainage of the descending colon

A

Left colic vein

Drains into the inferior mesenteric vein

314
Q

Describe the venous drainage of the sigmoid colon

A

Sigmoid veins

Drains into the inferior mesenteric vein

315
Q

Describe the lymphatic drainage of the colon

A

Along nodal chains that accompany the supplying arteries

Ultimately drain into para-aortic nodes

316
Q

Which structures are embryologically derived from the midgut?

A

Second part of the duodenum to 2/3 of the way along the transverse colon

317
Q

Which structures are embryologically derived from the hindgut?

A

Distal 1/3 of the transverse colon to the anus.

318
Q

Describe the anatomical relations of the caecum and right colon

A

Right ureter

Gonadal vessels

319
Q

Describe the anatomical relations of the hepatic flexure of the colon

A

Gallbladder (medially)

320
Q

Describe the anatomical relations of the splenic flexure of the colon

A

Spleen

Tail of the pancreas

321
Q

Describe the anatomical relations of the distal sigmoid colon and the upper rectum

A

Left ureter

322
Q

Describe the anatomical relations of the rectum

A

Ureters

Autonomic nerves

Seminal vesicles

Prostate

Urethra (distally)

323
Q

What is the origin of the right common carotid artery?

A

Bifurcation of the brachiocephalic artery

324
Q

What is the origin of the left common carotid artery?

A

2nd branch of the aortic arch

325
Q

At what level do the common carotid arteries terminate?

A

Upper border of the thyroid cartilage where it divides into the external/internal carotids

(Lower border of C3)

326
Q

Describe the thoracic relations of the left common carotid

A

Trachea

Left recurrent laryngeal nerve

Left margin of the oesophagus

Left brachiocephalic vein runs anteriorly

Cardiac branches of the left vagus descend anteriorly

327
Q

Describe the course of the left common carotid

A

Runs superiorly in the thorax, and enters the neck where it runs deep to sternocleidomastoid and enters the anterior triangle.

At this point it lies within the carotid sheath with the vagus nerve and internal jugular vein (which lies laterally).

It bifurcates at the level of the upper border of the thyroid cartilage.

328
Q

Describe the course of the right common carotid

A

Arises from the brachiocephalic artery and traverses into the neck posterior to the sternocleidomastoid and into the anterior triangle.

It enters the carotid sheath and continues to travel superiorly until it’s bifurcation.

329
Q

Describe the relation of the common carotid arteries to the thoracic duct

A

The left common carotid artery lies anterior to the thoracic duct at C7

There is no thoracic duct on the right

330
Q

Describe the anatomical relations of the common carotid arteries

A

C6 - crossed by omohyoid

Passes deep to thyrohyoid, sternohyoid and sternomastoid

Passes anterior to the carotid tubercle of C6 (compression here stops haemorrhage)

The inferior thyroid artery runs posterior to the common carotid

Left common carotid crosses the thoracic duct, right common carotid is crossed by the recurrent laryngeal nerve

331
Q

What is the origin of the common peroneal nerve?

A

Dorsal divisions of the sacral plexus (L4, L5, S1, S2)

332
Q

What is the sensory supply of the common peroneal nerve?

A

Skin and fascia of the anterolateral surface of the leg and the dorsum of the foot

333
Q

What is the motor supply of the common peroneal nerve?

A

Muscles of the anterior and peroneal compartments of the leg

Extensor digitorum brevis

Knee, ankle and foot joints

334
Q

Describe the course of the common peroneal nerve

A

Laterally placed within the sciatic nerve

Bifurcates from the sciatic nerve and passes inferolaterally in the lateral and proximal part of the popliteal fossa beneath the biceps femoris.

It runs to the posterior aspect of the fibular head and winds around the lateral surface of the neck of the fibula in the body of peroneus longus.

Here it divides into the deep and superficial peroneal nerves.

335
Q

What are the branches of the common peroneal nerve within the thigh?

A

Nerve to the short head of the biceps

Articular branch (to the knee)

336
Q

What are the branches of the common peroneal nerve within the popliteal fossa?

A

Lateral cutaneous nerve of the calf

337
Q

What are the branches of the common peroneal nerve at the neck of the fibula?

A

Superficial and deep peroneal nerve

338
Q

According to what structure are the cords of the brachial plexus named?

A

The axillary artery

339
Q

Which structures form the lateral cord of the brachial plexus?

A

Nerve roots C5-C7

340
Q

Which structures form the posterior cord of the brachial plexus?

A

Nerve roots C5-C8

341
Q

Which structures form the medial cord of the brachial plexus?

A

Nerve roots C8-T1

342
Q

Which structures form the long thoracic nerve?

A

Nerve roots C5-C7

343
Q

What structures form the dorsal scapular nerve?

A

Nerve root C5

344
Q

What structures form the suprascapular nerve?

A

Nerve roots C5-C6

From the superior brachial trunk

345
Q

What structures form the nerve to the subclavius?

A

Nerve roots C5-C6

346
Q

What structures form the lateral pectoral nerve?

A

Nerve roots C5-C7

From the lateral cord of the brachial plexus

347
Q

What structures form the medial pectoral nerve?

A

Nerve roots C8-T1

From the medial cord of the brachial plexus

348
Q

What structures form the axillary nerve?

A

Nerve roots C5-C6

It is a direct continuation of the posterior cord of the brachial plexus

349
Q

What structures form the radial nerve?

A

Nerve roots C5-T1

It is a direct continuation of the posterior cord of the brachial plexus

350
Q

Which structures branch from the medial cord of the brachial plexus?

A

Medial pectoral nerve

Medial cutaneous nerve of the arm

Medial cutaneous nerve of the forearm

Ulnar nerve

351
Q

What structures form the ulnar nerve?

A

Nerve roots C8-T1

It is a continuation of the medial cord of the brachial plexus

352
Q

What structures form the median nerve?

A

Nerve roots C6-T1

Derived from the medial and lateral cords of the brachial plexus

353
Q

What structures form the musculocutaneous nerve?

A

Nerve roots C5-C7

It is the terminal branch of the lateral cord of the brachial plexus

354
Q

Which structures branch from the lateral cord of the brachial plexus?

A

Lateral pectoral nerve

Musculocutaneous nerve

355
Q

Which structures branch from the posterior cord of the brachial plexus?

A

Upper subscapular nerve

Thoraco-dorsal nerve

Lower subscapular nerve

Divides into radial and axillary nerves as terminal branches

356
Q

What pathologies cause olfactory nerve damage?

A

Basal skull fracture

Extension of frontal lobe tumour

357
Q

Which pathologies result in pupillary miosis?

A

Opiate toxicity

Horner’s syndrome

358
Q

Describe the Marcus Gunn pupil

A

Light shining on the affected eye will produce a diminished pupillary response in both eyes.

Light shone on the unaffected eye will produce a normal pupillary response in both eyes

359
Q

What pathologies result in the Marcus Gunn pupil?

A

Optic neuritis (i.e. in MS)

360
Q

What will be seen in a CNIII lesion?

A

‘Down and out eye’
Inferolateral deviation of the eye.

Levator palpebrae superioris may also be impaired, resulting in reduced ability to open the eyelid

361
Q

What will be seen in a CNIV lesion?

A

Eye will be unable to look down

Diplopia when descending stairs

362
Q

What are the branches of CNV?

A

Mandibular

Maxillary

Ophthalmic

363
Q

Where do the branches of CNV converge?

A

The trigeminal ganglion located in Meckel’s cave

364
Q

What muscles are supplied by CNV?

A

Muscles of mastication

Tensor veli palatine

Mylohyoid

Anterior belly of digastric

Tensor tympani

365
Q

Which nerve mediates the corneal reflex?

A

CN V

The naso-ciliary branch of the ophthalmic branch of the trigeminal (sensory component) and the facial nerve producing the motor response

The facial nerve innervates orbicularis oculi to produce the efferent arm of the corneal reflex.

366
Q

Which pathology will result in bilaterally absent corneal reflexes?

A

Pathology of the afferent arc

367
Q

Which pathology will result in unilaterally absent corneal reflexes?

A

Pathology of the efferent arc

368
Q

What is seen in CNVI lesion?

A

Inability to abduct the eye

It has a long intracranial course (as originates between brainstem and pons) making it susceptible to injury in raised ICP

369
Q

What is the motor function of CNVII?

A

Muscles of facial expression

370
Q

What is the sensory function of CNVII?

A

Taste from the anterior 2/3 of the tongue

371
Q

Describe the course of CNVII

A

Arises between the pons and the medulla.

Passes into the petrous temporal bone and into the internal auditory meatus.

It then passes through the facial canal and exits at the stylomastoid foramen.

It passes through the parotid gland and divides at this point.

372
Q

What surgical pathologies may result in CNVII palsy?

A

Iatrogenic damage during parotid gland surgery or invasion by malignancies

373
Q

Describe the intra-cranial path of CNVIII

A

Exits from the pons and then passes through the internal auditory meatus

374
Q

What surgical pathologies can cause CNVIII palsy?

A

CNS tumours, ototoxic drugs (i.e. gentamicin) and basal skull fractures

375
Q

What symptoms will be caused by CNVIII palsy?

A

Sensorineural hearing loss

(Weber’s lateralises to normal ear, Rinne’s positive - i.e. air>bone conduction)

376
Q

Describe the sensory nerve distribution of CNIX

A

Posterior 1/3 tongue

Tonsils

Pharynx

Middle ear

377
Q

What is the motor innervation of CNIX?

A

Stylopharyngeaus muscle

378
Q

How is the sensory function of CNIX tested?

A

Gag reflex

379
Q

What is the motor function of CNXI?

A

Trapezius

Sternocleidomastoid

380
Q

What is the motor function of CNXII?

A

Muscles of the tongue (except palatoglossus)

381
Q

During which surgical procedures is CNXII at risk?

A

Carotid surgery (i.e. endarterectomy) as CNXII lies on the carotid sheath before passing deep to the posterior belly of digastric

382
Q

What will be seen in CNXII palsy?

A

Ipsilateral defect in muscle function

383
Q

Within which layer of the meninges are the cranial venous sinuses located?

A

Dura mater

384
Q

Into which structure do the cranial venous sinuses drain?

A

Internal jugular vein

385
Q

Name the cranial venous sinuses

A

Superior sagittal sinus
Inferior sagittal sinus
Straight sinus
Transverse sinus
Sigmoid sinus
Confluence of sinuses
Occipital sinus
Cavernous sinus

386
Q

What are the contents of the deep peroneal pouch?

A

Urethral sphincter

Transversus perinei

Dorsal nerve of penis, muscular branches of the perineal nerve

Deep and dorsal arteries of penis, stem of origin of artery to the bulb of penis, urethral artery.

387
Q

What is the origin of the deep peroneal nerve?

A

From the common peroneal nerve, at the lateral aspect of the fibula, deep to peroneus longus

388
Q

From what nerve roots does the deep peroneal nerve originate?

A

L4, L5, S1, S2

389
Q

Describe the course of the deep peroneal nerve

A

Pierces the anterior intermuscular septum to enter the anterior compartment of the lower leg

Passes anteriorly down to the ankle joint, midway between the two malleoli

390
Q

Where does the deep peroneal nerve terminate?

A

Within the dorsum of the foot

391
Q

Which muscles are innervated by the deep peroneal nerve?

A

Tibialis anterior

Extensor hallucis longus

Extensor digitorum longus

Peroneus tertius

Extensor digitorum brevis

392
Q

What is the cutaneous innervation of the deep peroneal nerve?

A

Web space of the first and second toes

393
Q

What actions are supplied by the innervation of the deep peroneal nerve?

A

Dorsiflexion of ankle joint

Extension of all toes (extensor hallucis longus and extensor digitorum longus)

Eversion of the foot

394
Q

At what level does the inferior vena cava pass through the diaphragm?

A

T8

395
Q

At what level does the oesophagus pass through the diaphragm?

A

T10

396
Q

At what level does the aorta pass through the diaphragm?

A

T12

397
Q

From what embryonic structure does the ductus arteriosus arise?

A

Left 6th embryonic arch

398
Q

To which structures does the ductus arteriosus attach?

A

Final part of the aortic arch (the isthmus of aorta) and the first part of the pulmonary artery.

399
Q

What is the function of the ductus arteriosus

A

Allows blood in the developing foetus to bypass the lungs

400
Q

What drug can be given to stimulate the close of a patent ductus arteriosus?

A

Indomethacin

401
Q

What structure is formed by the closure of the ductus arteriosus?

A

Ligamentum arteriosum

402
Q

Describe the course of the duodenum

A

Begins immediately distal to the pylorus and it runs for around 25cm where it becomes the jejunum at the region of the duodenojejunal flexure

403
Q

Is the duodenum intra- or retro- peritoneal?

A

The first 2-3cm of the superior duodenum are intraperitoneal. The remainder is largely retroperitoneal with the exception of the final 1-2cm.

404
Q

What are the medial relations of the duodenum?

A

Superior pancreatico-duodenal artery

Pancreatic head

405
Q

What is the posterior relation of the duodenum?

A

Right kidney

406
Q

What are the parts of the duodenum?

A

Superior

Descending

Horizontal

Ascending

407
Q

How is the duodenojejunal flexure held in place?

A

Suspensory muscle of the duodenum

(AKA Ligament of Treitz)

408
Q

What is the auricle comprised of?

A

Elastic cartilage covered by skin

409
Q

What is the lobule of the ear comprised of?

A

Fat and fibrous tissue

410
Q

What is the composition of the external auditory canal?

A

Lateral third of the external auditory meatus is cartilaginous and the medial two thirds is bony.

411
Q

What is supplied by the auriculotemporal branch of the trigeminal nerve?

A

Most of the external auditory meatus and the lateral surface of the auricle

412
Q

What is supplied by the greater auricular nerve?

A

The skin over the external ear, the angle of the mandible and the parotid gland

413
Q

What is the spinal root of the greater auricular nerve?

A

C2-C3

Cutaneous branch of the brachial plexus

414
Q

Which space forms the middle ear?

A

Space between the tympanic membrane and the cochlea

415
Q

What structure connects the middle ear to the naso-pharynx?

A

Eustachian tube

416
Q

What is the histological structure of the tympanic membrane?

A

Outer layer of stratified squamous epithelium.

Middle layer of fibrous tissue.

Inner layer of mucous membrane continuous with the middle ear.

417
Q

What is the innervation of the middle ear?

A

Glossopharyngeal nerve

418
Q

Where may pain following tonsillectomy radiate?

A

Middle ear (via glossopharyngeal nerve)

419
Q

Which part of the tympanic membrane does the malleus attach to?

A

The umbo

420
Q

Via what type of joint does the malleus articulate with the incus?

A

Synovial

421
Q

Via what type of joint does the incus articulate with the stapes?

A

Synovial

422
Q

Which structures form the inner ear?

A

Cochlea

Semi-circular canals

Vestibule

423
Q

What is the sense organ of hearing, and where is it located?

A

Organ of Corti

On the inside of the cochlear duct on the basilar membrane.

424
Q

Which structures form the vestibule of the ear?

A

Utricule and the saccule

They contain endolymph and are contained within perilymph in the vestibule

425
Q

What structure joins the proximal radius and ulna?

A

Anular ligament of the radius

426
Q

Which structure is labelled 1?

A

Trochlea

427
Q

Which structure is labelled 2?

A

Capitulum

428
Q

Which distal humeral structures form the articular surface?

A

The grooved trochlea

The spheroidal capitulum

The sulcus between them

429
Q

What structure is labelled 3?

A

Olecranon fossa

430
Q

What structure is labelled 4?

A

Coronoid fossa

431
Q

What structure is labelled 6?

A

Medial epicondyle

432
Q

What structure is labelled 7?

A

Lateral epicondyle

433
Q

What structure is labelled 5?

A

Radial fossa

434
Q

Where is the fibrous capsule of the elbow strongest?

A

Medially and laterally - forming the radial and ulnar collateral ligaments.

435
Q

Where does the anterior part of the elbow capsule attach to the humerus?

A

Immediately superior to the radial and coronoid fossae

436
Q

What are the embryological aortic arches?

A

a series of six paired embryological vascular structures which give rise to the great arteries of the neck and head

437
Q

What does the first aortic arch form?

A

part of the maxillary artery

438
Q

What structure is formed by the regression of the first two embryological aortic arches?

A

External carotid arteries

They bud from the horns of the aortic sac, which is left behind by the regression of the first two arches.

439
Q

What structure is formed by the third embryological aortic arch?

A

The commencement of the internal carotid artery

It contributes to the common carotid artery and the proximal portion of the internal carotid artery

440
Q

What structure is formed by the fourth right embryological aortic arch?

A

the right subclavian as far as the origin of its internal mammary branch

441
Q

What structure is formed by the fourth left embryological aortic arch?

A

the arch of the aorta between the origin of the left carotid artery and the termination of the ductus arteriosus

442
Q

What structure is formed by the fifth embryological aortic arch?

A

Nothing, it regresses or forms incompletely

443
Q

What structure is formed by the sixth right embryological aortic arch?

A

proximal part of the right pulmonary artery

444
Q

What structure is formed by the sixth left embryological aortic arch?

A

the left pulmonary artery and forms the ductus arteriosus

445
Q

Describe the embryological formation of the diaphragm

A

formed between the 5th and 7th weeks of gestation through the progressive fusion of the septum transversum, pleuroperitoneal folds and via lateral muscular ingrowth

446
Q

What embryological structure forms the central tendon of the diaphragm?

A

Septum transversum

447
Q

What embryological structure forms the muscular component of the diaphragm?

A

Cervical somites C3 to C5

448
Q

Describe the features of a Morgagni diaphragmatic hernia

A

Anteriorly located
Minimal compromise on lung development
Minimal signs on antenatal ultrasound
Usually present later
Usually good prognosis

449
Q

Describe the features of a Bochdalek diaphragmatic hernia

A

Posteriorly located
Larger defect
Often diagnosed antenatally
Associated with pulmonary hypoplasia
Poor prognosis

450
Q

Describe the anatomical path of the inferior epigastric artery

A

passes along the medial margin of the deep inguinal ring. From here it continues superiorly to lie behind the rectus abdominis muscle

450
Q

What embryological structure forms the ureter, the pelvis, calyces and the collecting tubules of the kidney

A

Ureteric bud of the mesonephric duct

450
Q

What is the origin of the inferior epigastric artery?

A

external iliac artery immediately above the inguinal ligament

451
Q

What structure forms the inferior border of the epiploic foramen?

A

1st part of the duodenum

451
Q

What is the epiploic foramen?

A

A communication between the greater sac and lesser sac

AKA Foramen of Winslow

451
Q

What structures form the anterior border of the epiploic foramen?

A

Bile duct

Hepatic Artery

Portal vein

451
Q

What structure forms the posterior border of the epiploic foramen?

A

Inferior vena cava

452
Q

What structure forms the superior border of the epiploic foramen?

A

Caudate process of the liver

452
Q

What is a Pringle’s maneuvre?

A

Placing a vascular clamp across the anterior aspect of the epiploic foramen to occlude the bile duct, hepatic artery and portal vein

452
Q

What is the extensor retinaculum?

A

a thickening of the deep fascia that stretches across the back of the wrist and holds the long extensor tendons in position

453
Q

What are the attachments of the extensor retinaculum?

A

The pisiform and triquetral medially

The end of the radius laterally

454
Q

What structures lie deep to the extensor retinaculum?

A

Extensor carpi ulnaris tendon
Extensor digiti minimi tendon
Extensor digitorum and extensor indicis tendon
Extensor pollicis longus tendon
Extensor carpi radialis longus tendon
Extensor carpi radialis brevis tendon
Abductor pollicis longus and extensor pollicis brevis tendons

454
Q

Describe the passage of the radial artery through the wrist

A

within the extensor retinaculum

passes between the lateral collateral ligament of the wrist joint and the tendons of the abductor pollicis longus and extensor pollicis brevis

454
Q

What are the posterior branches of the external carotid artery?

A

Occipital
Posterior auricular

454
Q

Where does the external carotid artery terminate?

A

Within the parotid gland, it divides into it’s terminal branches

454
Q

What structures lie superficial to the extensor retinaculum?

A

Basilic vein
Dorsal cutaneous branch of the ulnar nerve
Cephalic vein
Superficial branch of the radial nerve

454
Q

What is the deep branch of the external carotid artery?

A

Ascending pharyngeal

454
Q

What are the anterior branches of the external carotid artery?

A

Superior thyroid
Lingual
Facial

455
Q

What are the terminal branches of the external carotid artery?

A

Superficial temporal artery

Maxillary artery

456
Q

What is the origin of the external oblique?

A

Outer surfaces of the lowest eight ribs

457
Q

What are the insertions of the external oblique?

A

Anterior two thirds of the outer lip of the iliac crest.

The remainder becomes the aponeurosis that fuses with the linea alba in the midline.

458
Q

What is the nerve supply to the external oblique?

A

Ventral rami of the lower six thoracic nerves

459
Q

What are the actions of the external oblique?

A

Contains the abdominal viscera, may contract to raise intra abdominal pressure. Moves trunk to one side.

460
Q

What structures are supplied by the facial nerve?

A

‘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 glands

460
Q

Where does the facial nerve originate?

A

motor- pons

sensory- nervus intermedius

460
Q

Describe the subarachnoid path of the facial nerve

A

Pass through the petrous temporal bone into the internal auditory meatus with the vestibulocochlear nerve. Here they combine to become the facial nerve.

460
Q

What are the three main branches of the facial nerve in the facial canal?

A
  1. greater petrosal nerve
  2. nerve to stapedius
  3. chorda tympani
460
Q

What are the three main branches of the facial nerve after passing through the stylomastoid foramen?

A

Posterior auricular nerve

Nerve to the digastric

Nerve to stylohyoid

461
Q

What are the 5 terminal motor branches of the facial nerve?

A

Temporal

Zygomatic

Buccal

Marginal Mandibular

Cervical

461
Q

What is the name of the facial nerve ganglion within the middle ear?

A

Geniculate ganglion

461
Q

What nerve supplies the anterior compartment of the thigh?

A

Femoral

461
Q

What nerve supplies the medial compartment of the thigh?

A

Obturator

461
Q

What nerve supplies the posterior compartment of the thigh?

A

Sciatic

461
Q

What is the arterial supply to the anterior compartment of the thigh?

A

Femoral

461
Q

What is the arterial supply to the medial compartment of the thigh?

A

Profunda femoris artery and obturator artery

461
Q

What is the arterial supply to the posterior compartment of the thigh?

A

Branches of Profunda femoris artery

461
Q

What muscles are contained within the anterior compartment of the thigh?

A

Iliacus

Tensor fasciae latae

Sartorius

Quadriceps femoris

461
Q

What muscles are contained within the medial compartment of the thigh?

A

Adductor longus/magnus/brevis

Gracilis

Obturator externus

461
Q

What muscles are contained within the posterior compartment of the thigh?

A

Semimembranosus

Semitendinosus

Biceps femoris

461
Q

What nerve supplies the anterior compartment of the lower leg?

A

Deep peroneal

461
Q

What nerve supplies the posterior compartment of the lower leg?

A

Tibial

461
Q

What nerve supplies the lateral compartment of the lower leg?

A

Superficial peroneal

461
Q

What is the arterial supply to the anterior compartment of the lower leg?

A

Anterior tibial

461
Q

What is the arterial supply to the posterior compartment of the lower leg?

A

Posterior tibial

462
Q

What is the arterial supply to the lateral compartment of the lower leg?

A

Peroneal

463
Q

What muscles are contained within the anterior compartment of the lower leg?

A

Tibialis anterior

Extensor digitorum longus

Extensor hallucis longus

Peroneus tertius

464
Q

What muscles are contained within the posterior compartment of the lower leg?

A

Muscles: deep and superficial compartments (separated by deep transverse fascia)

Deep: Flexor hallucis longus, Flexor digitalis longus, Tibialis posterior, Popliteus

Superficial: Gastrocnemius, Soleus, Plantaris

465
Q

What muscles are contained within the lateral compartment of the lower leg?

A

Peroneus longus/brevis

466
Q

What are the roots of the femoral nerve?

A

L2/3/4

467
Q

What muscles are innervated by the femoral nerve?

A

Pectineus

Sartorius

Quadriceps femoris

Vastus lateralis/medialis/intermedius

Rectus femoris

468
Q

What are the three main branches of the femoral nerve?

A

Medial cutaneous nerve of thigh

Saphenous nerve

Intermediate cutaneous nerve of thigh

469
Q

Describe the path of the femoral nerve

A

Penetrates psoas major and exits the pelvis by passing under the inguinal ligament to enter the femoral triangle, lateral to the femoral artery and vein.

470
Q

What is the pnemonic for supply of the femoral nerve?

A

(don’t) M I S V Q Scan for PE:

M edial cutaneous nerve of the thigh
I ntermediate cutaneous nerve of the thigh
S aphenous nerve

V astus
Q uadriceps femoris
S artorius

PE ectineus

471
Q

What is the superior boundary of the femoral triangle?

A

Inguinal ligament

472
Q

What is the lateral boundary of the femoral triangle?

A

Sartorius

473
Q

What is the medial boundary of the femoral canal?

A

Adductor longus

474
Q

What structures form the floor of the femoral triangle?

A

Iliopsoas

Adductor longus

Pectineus

475
Q

What structures form the roof of the femoral triangle?

A

Fascia lata and Superficial fascia

Superficial inguinal lymph nodes (palpable below the inguinal ligament)

Long saphenous vein

476
Q

What are the contents of the femoral triangle?

A

Femoral vein (medial to lateral)

Femoral artery-pulse palpated at the mid inguinal point

Femoral nerve

Deep and superficial inguinal lymph nodes

Lateral cutaneous nerve

Great saphenous vein

Femoral branch of the genitofemoral nerve

477
Q

What is the normal angle between the neck and body of the femur?

A

125 degrees

478
Q

What bones form the subtalar joint?

A

Talus

Calcaneus

479
Q

What are the tarsal bones of the foot?

A

Calcaneus

Talus

Navicular

Cuboids

Cuneiforms

480
Q

What are the ligaments of the ankle and foot?

A

Talotibial

Talocalcaneal

Deltoid

Talonavicular

Calcaneonavicular

481
Q

What is the nerve supply to abductor hallucis?

A

Medial plantar nerve

482
Q

What is the nerve supply to flexor digitorum brevis?

A

Medial plantar nerve

483
Q

What is the nerve supply to abductor digit minimi?

A

Lateral plantar nerve

484
Q

What is the nerve supply to flexor hallucis brevis?

A

Medial plantar nerve

485
Q

What is the nerve supplt yo adductor hallucis?

A

Lateral plantar nerve

486
Q

What is the nerve supply to extensor digitorum brevis?

A

Deep peroneal

487
Q

Describe the course of the dorsalis pedis artery

A

Direct continuation of the anterior tibial artery.

Commences on the front of the ankle joint and runs to the proximal end of the first metatarsal space.

Here it gives off the arcuate artery and continues forwards as the first dorsal metatarsal artery.

488
Q

What are the two plantar arteries?

A

Medial and lateral plantar arteries

489
Q

What are the two plantar nerves?

A

Medial and lateral plantar nerves

490
Q

What nerve supplies the lateral plantar cutaneous sensation?

A

Sural

491
Q

What nerve supplies the dorsal cutaneous sensation of the foot (excluding 1st web space)?

A

Superficial peroneal

492
Q

What nerve supplies the cutaneous sensation to the first web space of the foot?

A

Deep peroneal

493
Q

What nerves supply the cutaneous sensation to the extremities of the toes?

A

Medial and lateral plantar nerves

494
Q

What nerve supplies cutaneous sensation to the proximal plantar aspect of the foot?

A

Tibial

495
Q

What nerve supplies cutaneous sensation to the medial plantar aspect of the foot?

A

Medial plantar nerve

496
Q

What nerve supplies cutaneous sensation to the lateral plantar aspect of the foot?

A

Lateral plantar nerve

497
Q

In which bone is the foramen ovale?

A

Sphenoid

498
Q

What are the contents of the foramen ovale?

A

Otic ganglion

V3 (Mandibular nerve:3rd branch of
trigeminal)

Accessory meningeal artery

Lesser petrosal nerve

Emissary veins

499
Q

In which bone is the foramen spinosum?

A

Sphenoid

500
Q

What are the contents of the foramen spinosum?

A

Middle meningeal artery

Meningeal branch of the Mandibular nerve

501
Q

In which bone is the foramen rotundum?

A

Sphenoid

502
Q

What are the contents of the foramen rotundum?

A

Maxillary nerve (V2)

503
Q

Between which bones does the foramen lacerum/carotid canal sit?

A

Located between the sphenoid, the apex of the petrous temporal and the basilar part of the occipital

In life the foramen lacerum is filled with cartilage

504
Q

What are the contents of the carotid canal?

A

Base of the medial pterygoid plate.

Internal carotid artery

Nerve and artery of the pterygoid canal

505
Q

In which bone is the jugular foramen?

A

Temporal

506
Q

What are the contents of the jugular foramen?

A

Anterior: inferior petrosal sinus

Intermediate: glossopharyngeal, vagus, and accessory nerves.

Posterior: sigmoid sinus (becoming the internal jugular vein) and some meningeal branches from the occipital and ascending pharyngeal arteries.

507
Q

In which bone is the foramen magnum?

A

Occipital

508
Q

What are the contents of the foramen magnum?

A

Anterior and posterior spinal arteries

Vertebral arteries

Medulla oblongata

509
Q

In which bone is the stylomastoid foramen?

A

Temporal

510
Q

What are the contents of the stylomastoid foramen?

A

Stylomastoid artery

Facial nerve

511
Q

What are the contents of the superior orbital fissure?

A

Oculomotor nerve (III)

Recurrent meningeal artery

Trochlear nerve (IV)

Lacrimal, frontal and nasociliary branches of opthalmic nerve (V1)

Abducens nerve (VI)

Superior ophthalmic vein

512
Q

In what bone is the superior orbital fissure?

A

Sphenoid

513
Q

Which nerve passes through the cribriform plate?

A

CN I (olfactory)

514
Q

Which nerve sits in the optic canal?

A

CN II (optic)

515
Q

Which nerves pass through the internal acoustic meatus?

A

CN VII (facial)

CN VIII (vestibulocochlear)

516
Q

Which nerve passes through the hypoglossal canal?

A

CN XII (hypoglossal)

517
Q

What is the volume of the gallbladder?

A

50mL

518
Q

Which cells line the interior surface of the gallbladder?

A

Columnar epithelium

519
Q

What are the anterior relations of the gallbladder?

A

Liver

520
Q

What are the posterior relations of the gallbladder?

A

Covered by peritoneum

Transverse colon

1st part of the duodenum

521
Q

What are the lateral relations of the gallbladder?

A

Right lobe of liver

522
Q

What are the medial relations of the gallbladder?

A

Caudate lobe of liver

523
Q

What is the arterial supply to the gallbladder?

A

Cystic artery (branch of RHA)

524
Q

What is the venous drainage of the gallbladder?

A

Directly to the liver

525
Q

What is the nerve supply to the gallbladder?

A

Sympathetic- mid thoracic spinal cord

Parasympathetic- anterior vagal trunk

526
Q

What is the origin of the common bile duct?

A

Confluence of cystic and common hepatic ducts

527
Q

What are the relations of the common bile duct at it’s origin?

A

Medially - Hepatic artery

Posteriorly- Portal vein

528
Q

What are the relations of the common bile ducts distally?

A

Duodenum - anteriorly

Pancreas - medially and laterally

Right renal vein - posteriorly

529
Q

What is the arterial supply to the common bile duct?

A

Branches of hepatic artery and retroduodenal branches of gastroduodenal artery

530
Q

What are the borders of the hepatobiliary triangle?

A

Medially - Common hepatic duct

Inferiorly - Cystic duct

Superiorly - Inferior edge of liver

531
Q

What are the contents of the hepatobiliary triangle?

A

Cystic artery

532
Q

What structures are supplied by the gastroduodenal artery?

A

Pylorus

Proximal part of the duodenum

Indirectly to the pancreatic head (via the anterior and posterior superior pancreaticoduodenal arteries)

533
Q

Describe the path of the gastroduodenal artery

A

Arises from the common hepatic artery of the coeliac trunk

Terminates by bifurcating into the right gastroepiploic artery and the superior pancreaticoduodenal artery

534
Q

Which area receives cutaneous sensory nerve supply from the genitofemoral nerve?

A

Small area of the upper medial thigh

535
Q

What is the origin of the genitofemoral nerve?

A

Arises from the first and second lumbar nerves.

536
Q

Describe the path of the genitofemoral nerve

A

Passes through psoas major, and emerges opposite the fibrocartilage between the third and fourth lumbar vertebrae.

It then descends on the surface of psoas major.

Divides into genital and femoral branches.

537
Q

Describe the path of the genital branch of the genitofemoral nerve

A

Passes through the inguinal canal, within the spermatic cord, to supply the skin and fascia of the scrotum.

538
Q

Describe the path of the femoral branch of the genitofemoral nerve

A

Enters the thigh posterior to the inguinal ligament, lateral to the femoral artery.

It supplies an area of skin and fascia over the femoral triangle.

539
Q

What is the insertion of gluteus maximus?

A

Gluteal tuberosity of the femur and iliotibial tract

540
Q

What is the insertion of gluteus medius?

A

Lateral greater trochanter

541
Q

What is the insertion of gluteus minimis?

A

Anterior greater trochanter

542
Q

What is the function of the gluteal muscles?

A

All extend and abduct the hip

543
Q

What are the 4 deep lateral hip rotators?

A

Piriformis

Gemelli

Obturator internus

Quadratus femoris

544
Q

What is the origin of the superior gluteal nerve?

A

L4, L5, S1

545
Q

Which structures are supplied by the superior gluteal nerve?

A

Gluteus medius

Gluteus minimis

Tensor fascia lata

546
Q

What is the origin of the inferior gluteal nerve?

A

L5, S1, S2

547
Q

Which structure is supplied by the inferior gluteal nerve?

A

Gluteus maximus

548
Q

What will result due to damage to the superior gluteal nerve?

A

Trendelenberg gait

Inability to abduct the thigh at the hip joint. Weakened abductor muscles allow the pelvis to tilt down on the opposite side. To compensate, the trunk lurches to the weakened side to attempt to maintain a level pelvis. The pelvis sags on the opposite side of the lesioned superior gluteal nerve.

549
Q

Which nerves lie within the greater sciatic foramen?

A

Sciatic Nerve

Superior and Inferior Gluteal Nerves

Pudendal Nerve

Posterior Femoral Cutaneous Nerve

Nerve to Quadratus Femoris

Nerve to Obturator internus

550
Q

Which vessels lie within the greater sciatic foramen?

A

Superior Gluteal Artery and vein

Inferior Gluteal Artery and vein

Internal Pudendal Artery and vein

551
Q

What is the anterolateral border of the greater sciatic foramen?

A

Greater sciatic notch of the ilium

552
Q

What is the posteromedial border of the greater sciatic foramen?

A

Sacrotuberous ligament

553
Q

What is the inferior border of the greater sciatic foramen?

A

Sacrospinous ligament and the ischial spine

554
Q

What is the superior border of the greater sciatic foramen?

A

Anterior sacroiliac ligament

555
Q

Which structures exit the greater sciatic foramen superior to piriformis?

A

Superior gluteal vessels

556
Q

Which structures exit the greater sciatic foramen inferior to piriformis?

A

Inferior gluteal vessels

Sciatic nerve

Posterior cutaneous nerve of the thigh

557
Q

What are the contents of the lesser sciatic foramen?

A

Tendon of the obturator internus

Pudendal nerve

Internal pudendal artery and vein

Nerve to the obturator internus

558
Q

What is the nerve supply to the interosseous muscles of the hand?

A

Ulnar

559
Q

How many interosseous muscles of the hand exist, and what is their function?

A

4 palmar-adduct fingers
4 dorsal- abduct fingers

560
Q

What is the origin and insertion of the lumbrical muscles of the hand?

A

Origin: deep flexor tendon

Insertion: dorsal extensor hood mechanism

561
Q

What is the innervation of the lumbrical muscles of the hand?

A

1st and 2nd- median nerve

3rd and 4th- deep branch of the ulnar nerve

562
Q

What is the function of the lumbrical muscles of the hand?

A

Flex MCPJ and extend the IPJ

563
Q

Which muscles form the thenar eminence of the hand?

A

Abductor pollicis brevis

Opponens pollicis

Flexor pollicis brevis

564
Q

Which muscles form the hypothenar eminence of the hand?

A

Opponens digiti minimi

Flexor digiti minimi brevis

Abductor digiti minimi

565
Q

Where do the coronary veins drain into?

A

The coronary sinus

Anterior cardiac vein drains directly into the right atrium

566
Q

What is the origin of the right and left coronary arteries?

A

Right coronary artery arises from the right aortic sinus, the left is derived from the left aortic sinus

567
Q

What structures are supplied by the right coronary artery?

A

Right atrium

Diaphragmatic part of the right ventricle

Usually the posterior third of the interventricular septum

The sino atrial node (60% cases)

The atrio ventricular node (80% cases)

568
Q

Which structures are supplied by the left coronary arteries?

A

Left atrium

Most of left ventricle

Part of the right ventricle

Anterior two thirds of the inter ventricular septum

The sino atrial node (remaining 40% cases)

569
Q

What are the branches of the left coronary artery?

A

Circumflex artery

Left anterior descending artery

570
Q

What is the innervation of the heart?

A

Autonomic nerve fibres from the superficial and deep cardiac plexus.

Parasympathetic supply to the heart is from presynaptic fibres of the vagus nerves.

571
Q

Where can the pulmonary valve sounds be auscultated?

A

Left second intercostal space, at the upper sternal border

572
Q

Where can the aortic valve sounds be auscultated?

A

Right second intercostal space, at the upper sternal border

573
Q

Where can the mitral valve sounds be auscultated?

A

Left fifth intercostal space, just medial to mid clavicular line

574
Q

Where can the tricuspid valve sounds be auscultated?

A

Left fourth intercostal space, at the lower left sternal border

575
Q

Through which structure do direct hernias pass through?

A

Hesselbach’s triangle

576
Q

What is the superolateral border of Hesselbach’s triangle?

A

Epigastric vessels

577
Q

What is the medial border of Hesselbach’s triangle?

A

Lateral edge of rectus muscle

578
Q

What is the inferior border of Hesselbach’s triangle?

A

Inguinal ligament

579
Q

Which bones form the acetabulum?

A

ilium, pubis, and ischium

Meet at the triradiate cartilage

580
Q

Which structure attaches the femoral head to the acetabulum?

A

Ligamentum teres

Runs from acetabular notch to fovea - contains arterial supply to femoral head in children.

581
Q

What are the extracapsular ligaments of the hip joint?

A

Iliofemoral ligament

Pubofemoral ligament

Ischiofemoral ligament

582
Q

What is the blood supply to the femoral head?

A

Medial circumflex femoral and lateral circumflex femoral arteries (Branches of profunda femoris). Also from the inferior gluteal artery.

Have branch retinacular arteries which supply retrograde blood flow to femoral head

583
Q

What are the clinical features of
Horner’s syndrome?

A

Ptosis

Miosis

Enopthalmos

Anhydrosis

584
Q

Where do lesions causing Horner’s syndrome arise?

A

Proximal lesions occur along the hypothalamospinal tract

Distal lesions are usually post ganglionic e.g. at level of internal carotid artery or beyond

585
Q

What does the humeral head articulate with?

A

Glenoid cavity

586
Q

What is the anatomical neck of the humerus?

A

Area which attaches humeral head to humeral body

587
Q

What is the surgical neck of the humerus?

A

The region below the head and tubercles and where they join the shaft

It is the most common site of fracture

588
Q

Where does the capsule of the shoulder joint attach to the humerus?

A

The anatomical neck superiorly but extends down to 1.5cm on the surgical neck

589
Q

What is the greater tubercle of the humerus?

A

The prominence on the lateral side of the upper end of the bone

590
Q

What is the lesser tubercle of the humerus?

A

A distinct prominence on the anterior of the upper end of the bone

591
Q

Which structure runs through the intertubercular groove of the humerus?

A

The biceps tendon, within it’s synovial sheath

592
Q

the contents of the carotid sheath?

A

Common carotid artery

Internal jugular vein

Vagus nerve

Accompanying cervical lymph nodes

593
Q

What are the only branches of the common iliac arteries?

A

internal and external iliac arteries

594
Q

What are the branches of the posterior division of the internal iliac arteries?

A

Lateral sacral

Superior gluteal

Iliolumbar artery.

595
Q

What are the branches of the anterior division of the internal iliac arteries?

A

Obturator artery

Internal pudendal artery

Inferior gluteal artery

Inferior vesical artery

Artery to the ductus deferens

Middle rectal artery

Vaginal artery

Uterine artery.

596
Q

Where does the ilioinguinal nerve originate?

A

first lumbar ventral ramus

597
Q

Describe the path of the ilioinguinal nerve

A

Pierces the internal oblique muscle and passes deep to the aponeurosis of the external oblique muscle. It enters the inguinal canal and then passes through the superficial inguinal ring to reach the skin.

598
Q

What cutaneous distribution is supplied by the ilioinguinal nerve?

A

Skin and fascia over the pubic symphysis, superomedial part of the femoral triangle, surface of the scrotum, root and dorsum of penis or labium majus in females.

599
Q

Describe the path of the inferior mesenteric artery

A

From its aortic origin it passes immediately inferiorly across the anterior aspect of the aorta to eventually lie on its left hand side. At the level of the left common iliac artery it becomes the superior rectal artery.

600
Q

What are the branches of the inferior mesenteric artery?

A

The left colic artery arises from the IMA near its origin. More distally up to three sigmoid arteries will exit the IMA to supply the sigmoid colon.

601
Q

At what level does the inferior vena cava commence?

A

L5

Originates from left and right common iliac veins. Paired segmental lumbar veins drain into the IVC along it’s length.

602
Q

Into what structure does the right gonadal vein drain?

A

Inferior vena cava

603
Q

Into what structure does the left renal vein drain?

A

Left renal vein

604
Q

What structures drain into the inferior vena cava?

A

T8 - Hepatic vein, inferior phrenic vein, pierces diaphragm
L1 - Right suprarenal vein, renal vein
L2 - Gonadal vein
L1-5 - Lumbar veins
L5 - Common iliac vein, formation of IVC

605
Q

What structures form the floor of the inguinal canal?

A

External oblique aponeurosis

Inguinal ligament

Lacunar ligament

606
Q

What structures form the superior aspect of the inguinal canal?

A

Internal oblique

Transversus abdominis

607
Q

What structure forms the anterior wall of the inguinal canal?

A

External oblique aponeurosis

608
Q

What structures form the posterior wall of the inguinal canal?

A

Transversalis fascia

Conjoint tendon

609
Q

What structures form the lateral border of the inguinal canal?

A

Internal ring

Transversalis fascia

Fibres of internal oblique

610
Q

What structures form the medial border of the inguinal canal?

A

External ring

Conjoint tendon

611
Q

What structures are contained within the male inguinal canal?

A

Spermatic cord and ilioinguinal nerve

612
Q

What structures are contained within the female inguinal canal?

A

Broad ligament of the uterus and ilioinguinal nerve

613
Q

What are the 3 coverings of the spermatic cord as it passes through the inguinal canal?

A

External spermatic fascia from external oblique aponeurosis

Cremasteric fascia

Internal spermatic fascia

614
Q

What are the posterior relations of the internal carotid artery?

A

Longus capitis

Pre-vertebral fascia

Sympathetic chain

Superior laryngeal nerve

615
Q

What are the medial relations of the internal carotid artery?

A

External carotid (near origin)

Wall of pharynx

Ascending pharyngeal artery

616
Q

What are the lateral relations of the internal carotid artery?

A

Internal jugular vein

Vagus nerve

617
Q

What are the anterior relations of the internal carotid artery?

A

Sternocleidomastoid

Lingual and facial veins

Hypoglossal nerve

618
Q

What are the branches of the internal carotid artery?

A

Anterior and middle cerebral artery

Ophthalmic artery

Posterior communicating artery

Anterior choroid artery

Meningeal arteries

Hypophyseal arteries

619
Q

What is the nerve supply to the interosseous muscles of the hand?

A

Ulnar

620
Q

What are the anatomical components of each intervertebral disc?

A

Consist of an outer annulus fibrosus and an inner nucleus pulposus.

621
Q

What is the function of the nucleus pulposus?

A

Has a jelly-like structure which acts as a shock absorber

622
Q

What are the origin and attachment of the medial collateral ligament of the knee?

A

Medial epicondyle femur to medial tibial condyle

623
Q

What are the origin and insertion of the lateral collateral ligament of the knee?

A

Lateral epicondyle femur to fibula head

624
Q

What are the origin and insertion of the anterior cruciate ligament of the knee?

A

Anterior tibia to lateral intercondylar notch femur

625
Q

What are the origin and insertion of the posterior cruciate ligament of the knee?

A

Posterior tibia to medial intercondylar notch femur

626
Q

What are the origin and insertion of the patellar tendon?

A

Central band of the tendon of quadriceps femoris, extends from patella to tibial tuberosity

627
Q

What is the function of the menisci of the knee?

A

Compensate for the incongruence of the femoral and tibial condyles

628
Q

What structure is the medial meniscus attached to?

A

Tibial collateral ligament

629
Q

What structure is the lateral meniscus attached to?

A

Loose fibres at the lateral edge of the joint

630
Q

Which structure crosses the lateral meniscus?

A

Popliteus tendon

631
Q

What is the nerve supply to the knee joint?

A

Femoral, tibial and common peroneal divisions of the sciatic and by a branch from the obturator nerve

632
Q

What is the blood supply to the knee joint?

A

Genicular branches of the femoral artery, popliteal and anterior tibial arteries

633
Q

Lacrimal apparatus

A
634
Q
A

MRCS Part A (1 decks)

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