Anatomy Flashcards
First branch of internal carotid a
Ophthalmic a.
Numbness over the lower lip after tooth extraction
Inferior alveolar n.
Loss of general sensation at the side / anterior of the tongue
Lingual n.
Submandibular gland injury and pt tongue deviation
Hypoglossal n.
Nerve injury during Submandibular gland surgery near the duct
Lingual n.
Most common Nerve injury in the cav. Sinus
Abducent.
Site of origin of vagus and CN9 nerve
Medulla.
Unilateral soft palate and tongue reduced sensation, site of origin of involved CN
Medulla.
Which cranial N. that doesn’t contain parasympathetic fibers
Optic n.
Origin of the 3rd CN”Occulomotor”
Midbrain.
Numbness at the chin. N involved
Mental n branch of Inf alveolar n. (V3).
Numbness over the cheek. N involved
Infra-orbital n.
Nerve supplying forehead above eye
supra-orbital n.
Numbness over the lower lip. N involved
Inferior-alveolar n.
Numbness over the lower lip and paralysis of ms of mastication. N involved
(V3).
With intracranial hge Increase Internal cranial pressure, which N is commonly affected
Abducent n.
Single test to differentiate between UMNL and LMNL for the facial n.
Inability of Eyebrow elevation.
N. Injury during parotid gland surgery nerve injured
Facial N.
N. Injury during parotid gland surgery dropping of the lip asymmetrical smile
Marginal mandibular branch of facial n.
N Injury during superficial dissection of the parotid gland
Great auricular n.
Hoarseness of voice following thyroidectomy
Vagus n or its branch RLN.
Which N. gives motor supply to the trapezius and sternocleidomastoid
Accessory n.
N. Injury in the post triangle
Spinal accessory n. (CN11)
Patient unable to shrug the shoulder. N involved
Spinal accessory n.
Patient with torticollis. N involved
Spinal accessory n.
After endarterectomy, the patient had deviated tongue. N involved
Hypoglossal n.
Numbness at the angle of the lower jaw. N involved
Great auricular n. (C2-3).
All of the following passes through SOF except
Ophthalmic a.
Ophthalmic A passes through
Optic canal.
Maxillary N. passes through
Foramen Rotundum.
Mandibular N. passes through
Foramen Ovale.
CN9, 10, 11 passes through
Jugular foramen.
MMA passes through
Foramen Spinosum.
Internal carotid A passes over
Foramen lacerum.
Hypoglossal N. passes through
Hypoglossal canal (Anterior condylar foramen).
Ophthalmic N. passes through
SOF.
Cerebello-pontine angle lesion, what is the lesion and affected nerves
Acoustic neuroma which affects CN 7, 8.
The patient hit on the vertex, which sinus is affected
Superior sagittal sinus.
Vertebral A. is a branch from
Subclavian a.
Vertebral A. passes through
Foramen transversium of C6.
Fracture of the middle 1/3 of the clavicle, which vessel will be affected
Subclavian vein.
Branches of the internal carotid A.
Ophthalmic A, Anterior choroidal A, Anterior cerebral A, Middle cerebral A & posterior communicating A.
Stroke with ACA. Presentation
Lower Limb more affected.
N. is not contained in the post. Triangle
Ansa cervicalis 1 2 3.
Phrenic N. is in which triangle
Post triangle of neck.
During the thyroidectomy, the infra hyoid strap ms are divided in its
near Upper part
Neurovascular structures in the parotid gland
N.V.A N. Facial n V, Retromandibular v. A,ECA and its 2 terminal branches
Pharyngeal pouch lies between which ms
Cricopharyngeous and thyropharyngeous. Through inf constrictor.
Ganglia responsible for lacrimation
Sphenopalatine ganglion CN7.
Nucleus of glossopharyngeal N. located in
Medulla.
Trigiminal N. nucleus present in
Pons.
Layers of scalp
Skin, dense Connective tissue, Aponeurosis, Loose CT, Periosteum
Dangerous area of scalp
Extracranial in loose connective tissue / Emissary veins connected to intracranial veins.
Sensory supply of scalp
Cervical plexus (greater & lesser occipital N. ) & Trigeminal N (Supratrochlear & Supraorbital N from Ophthalmic, Zygomaticotemporal N from Maxillary & Auriculotemporal N from Mandibular).
Internal Cartoid Artery branches in neck
No Branch in Neck.
Venous drainage of scalp
Facial vein.
Posterior triangle of neck contains which part of Brachial Plexus
Trunks.
Behind middle 1/3 of clavicle lie which part of Brachial Plexus
Division.
Axilla contains which part of Brachial Plexus
Cords & Branches.
Suprascapular and Transverse cervical A branch of
Thyrocervical Trunk.
Enlarged left subclavicular Lymph nodes. Dx
Gastric Cancer (Red flag).
Muscles dividing of triangle in posterior neck
Inferior belly of omohyoid Muscle.
Structures passing in posterior tringle
Nerves and plexuses: Spinal accessory nerve (Cranial Nerve XI), Branches of cervical plexus, Roots and trunks of brachial plexus & Phrenic nerve (C3, 4, 5). Vessels: Subclavian artery (Third part) & Terminal part of external jugular V. Muscles: Inferior belly of omohyoid & 3 Scalenae. + Supraclavicular & occipital LNs.
Structures passing in anterior tringle
Facial vessels, Hypoglossal N, Anterior Jugular V , carotid sheath ( Common Carotid A, Vagus & Internal Jugular V), Ansa cervicalis & Strap Muscles. + Submandibular Gland & Nodes.
Sites of CN nuclei
(cereberal hemisphere 1+2) (midbrain 3+4) (Pons 5+6+7+8) (Medulla9+10+11+12).
Parasympthatic Ganglia
1973 (3 ciliary for pupil constriction and accomodation) (7pytrogylopalatine for lacrimation) (submandibular for submandibular+ sublingual glands secretion) (9 Otic for Parotid gland secretion) (10 vagus).
Tongue movement. N
Hypoglossal N.
Tongue sensation & lymph drainage / metastasis
the anterior 2/3 sesation: (taste= corda tympani) (General sensation =lingual N). Lymph drainage: The tip to submental, while the anterior 2/3 to unilateral sub-mandibular then deep cervical. The posterior 1/3 sensation (glosspharngeal N give both taste and general sensation). The lymph drainage is bilateral to upper deep cervical node directly (extensive bilateral communication).
CSF flow
Lateral ventricles to 3rd ventricle (Monro) 3rd to 4th ventricle (aqueduct sylvius) to subarachnoid space through 2 Lateral Luchka and Median magendi. Obstruction in sylvus cause hydrocephalus
Submandibular Warthon duct opens in
Frenulum in the floor of the mouth.
Parotid Stensons ducts open
opposite to 2nd upper Molar teeth.
Course of RLN on RT side
Hooks around Rt subclavian A.
Superior thyroid A&V is from/drain into
External Cartoid Artery/ Drains into Int. Jagular Vein.
Inferior thyroid A&V is from/ drain into
Thyrocervical trunk of Subclavian A / drains into Lt Brachiocephalic vein.
Course of RLN on LT side
Hooks around Arch o f Aorta.
Level of Hyoid bone
C3.
Level of common carotid birufcation
C4.
Level of angle of luise and arch of Aorta
T4.
Level of pulsation of CCA and end of Trachea
C6.
Referred pain to ear during tonsillitis through
Glosspharngeal Nerve.
Abducent CN6 supplies
Lateral rectus M, if injured pt can’t look lateral.
Trocheal CN4 supplyies
Superior oblique M . pt can’t look downwards and outwards e.g Diplopia on going down the stairs.
Prominent C- vertbrea felt behind the neck
C7.
Pt hear hyperacoustic sound. N. affected (hyperaccusis)
Facial Nerve (Nerve to stapdius).
Verberal A intracranial branch
posterior inferior cerebellar Artery (PICA).
Basilar Artery gives which cerebellar branches
Superior & Anterior inferior cerebellar A.
Circle of Willis anastomosis between
2 Internal C.A + basilar A.
Source of bleeding during lumbar puncture
Lumbar venous plexus.
Cervical Vert. which has a long bifid spine
Axis v (C2).
Dorsal root ganglion carries
Sensory fibers.
Enlarged lateral ventricles and the 3rd ventricle. Dx
Adequate of salivius oclusion.
Lateral horn of the dorsal spinal cord is part of
Sympathetic nervous system.
What is the last ligament to be encountered during lumbar puncture
as most resistance felt when penetrating Ligamintum flavum.
First to be encountered in lumber puncture
supraspinous ligamgnt, interspinous then ligmantium flavum.
CSF is collected from which space
Subarachenoid space.
CSF is Absorebed in
archanoid plexus.
Disc herniation happens when
nucleus palposus herniates through a defect in annulous fibrosus.
Bony mark iliac crest is at which level
L4-L5 is site for lumbar puncture.
Adult spinal cords terminates at level
L1
In children spinal cords terminates at
L3.
Spinal cord tract carries sensory for pain and temp
spinothalamic.
Spinal cord tract carries motor signals
corticospinal.
Ant. Surface of the heart is formed by
RT atrium and RT ventricle + Lt ventricle.
Post surface of the heart is formed by
Lt atrium and Lt ventricle.
Inferior surface of heart (diaphramtic) formed by
Rt ventrivle + part of Lt ventricle at apex.
Rt border of heart (stab injury at to RT side of sternum)
Rt atrium will be injured.
Lt Border of heart formed by
Mostly Lt ventricle + tip of Lt Auricle +upper part of Rt ventricle.
Inf. Border formed by
Rt ventricle and only apex of the Lt ventricle.
Left coronary a passes behind
Pulmonary trunk.
Rt coronary a originates from
Ant. Aortic sinus.
Left coronary A. originates from
left Post. Aortic sinus.
Rt coronary A. originates
Above the Rt cusp.
Lt coronary A. originates
Above the Lt cusp.
Not contained in the posterior mediastinum
Vert. bodies
Coin in the esophagus reached some where opposite to T10, what is the distance that the coin passes from the incisors to that point
38-40 cm.
A coin in the esophagus at C6 level which narrowing is this
15 cm circopharyngeus.
Other constrictions of esophagus
T4- 22.5 cm Aortic Arch / T5 - 27cm LT Bronchus / T10- 40 cm Esophgus haitus
The esophagus has no
Serosa layer.
Vagus nerve inverted SA node
Indirect innervations through cardiac plexus.
The heart auscultatory areas
Aortic 2nd ICS Rt parasternal edge. Pulmonary 2nd ICS Lt parasternal edge. Tricuspid 4th ICS Lt parasternal edge. Mitral 5th ICS at MCL.
Pt has left superior vena cava . where will it drain
into the coronary sinus.
Great cardiac vein runs in
Anterior IVG
Great cardiac drains into
coronary sinus.
Pleura nerve supply by
Intercostal nerve / phrenic nerve.
Branch of abdominal aorta exits against the body of L2
Gonadal & Rt Renal A + 2nd Lumber branches.
Unpaired branches of abdominal aorta & there levels
Coeliac at L12, SMA at L1 , IMA at L3 & Median sacral at L4.
Most inferior Single branch
Median sacral a.
Most inferior Anterior Branch of the aorta
IMA.
Rt. Testicular vein drains into
IVC.
Lt testicular vein drains into
LEFT RENAL VEIN.
Rt Gastro-epiploic A is a branch from
Gastro-duodenal a.
Lt gastro- epipoic A is a branch form
splenic A.
Gastro-duodenal a branch from
Hepatic a.
Rt gastric A is from
Hepatic A.
Lt Gastric A is from
coeliac trunk.
Gut rotation occurs around
SMA.
Short gastric veins drain into
Splenic vein.
Splenic vessels pass through
Lieno Renal Ligament.
Short gastric vessels pass through
Gastro splenic ligament.
Inferior and Short gastric drain into
Splenic vein.
Lt and RT gastric drain into
Portal vein.
Rt Gastroepiploic drain into
SMV.
Cyctic A of gall bladder comes from
Rt hepatic A.
Common Hepatic A gives
Gastrodudenal A and Hepatic proper.
Blood supply to upper 1/3 of esophagus
from inferior Thyroid A.
Large vessel is identified during Whipple procedure
SMA.
Inferior Mesenteric V drains into
plenic vein.
Splenic V + SMV vein join and forms
Portal vein.
Bleeding gastric ulcer at the ant. Wall of the greater curvature. A involved
RT gastroepiploic a.
True regarding the lesser sac
the portal vein is in its ANT. FREE EDGE.
Relation of the 3rd part of the duodenum, which is NOT in relation
Tail of the Pancreas.
Bleeding Post duodenal ulcer. A involved
Gastro-deudenal A.
Rt hemicolectomy, which A is ligated
Rt Colic a.
Blood supply of the transverse colon
Middle colic.
Blood supply of the left colon
IMA.
Artery causing ischemia to the colon at the splenic flexure
IMA.
Artery ligation during anterior resection
IMA.
During Lt hemicolectomy, A ligated will not affect the circulation
Marginal A from Rt arm of middle colic.
During sigmoidectomy, which A is ligated to stop bleeding from the distal colon
Lower Left colic a.
Callot triangle, medial boundary
Hepatic duct.
Pringles maneuver, what is in direct risk of injury
CBD.
Lt renal vein compression near SMA…
Nutcracker syndrome
Cystic duct supplied by
cystic a.
Common bile duct supplied by
Hepatic Artery.
Which vessel pass in front of the uncinate process of the pancreas
SMA.
Ant. To the neck of the pancreas
Pylorodueodenal junction.
Post. relation of the body of the pancreas
Left crus of the diaphragm.
The upper end of the Rt Kidney
doesn’t reach the 11th rib post.
Left renal vein relation to the SMA
Post.
Posterior relation to both 1st and 3rd of duodenum
Inferior vena Cava.
Which aortic branch is likely to be affected with AAA near the renal vein
SMA.
Left renal vein relation to the left renal A at the hilum
Vein is Anterior.
Ant. relation of the Rt suprarenal gland
IVC and the Liver.
Post. relation to the Rt suprarenal gland
Rt Cruss of the diaphragm.
Ant. Relation to the Lt suprarenal gland
Stomach.
Veins descend Ant. To the ureters
Gonadal veins.
N. Injury after Gridirons incision
Illio-inguinal n.
N. Injury after inguinal hernia surgery
Illio-inguinal n.
While giving local anesthesia for inguinal hernia surgery. N. Injury
Femoral n. may be affected resulting in weakness in hip flexion and knee extension.
Nerve injury after Ant. Resection or Abdomino-perineal excision
Hypogastric plexus.
Erectile dysfunction after abdominal surgery
Splanchnic n. injury.
Fecal incontinent after normal delivery
Pueodendal n. injury (S234).
During ligation of short gastric arteries for splenectomy. Which organ can be injured
Tail of pancreas.
Suprarenal blood supply 3 Arteries
Inf. Phrenic → Superior, Aorta → Middle & Renal → inferior.
What are the ant./post. relations of ureters in pelvis
Post (birofication of CIA, Genito-Femoral
N) , Ant (Gonadal vessels + caecum, appendix & ascending colon in Rt side / descending colon & sigmoid in Lt side). “In Abdomen 3rd part of duodenum, small bowel & transverse colon with their mesenteries lie anterior to ureters”.
Nerve blocked or cut during episiotomy pt has incontance
peuodendal n.
External spermatic fascia comes from
External oblique apponurosis.
Site for fluid collection after perforated appendix in Female
Recto-Uterine pouch (Doglas pouch).
Site for fluid collection after perforated appendix in male
Recto-vesical pouch.
Subcutaneous scrotal tissue is
Dartos muscle.
Fibrous capsule in testis is
Tunica Albuginea.
Sites for Natural constrictions of urters
Peliviureteric junction, pelvic brim (crosses over CIAs) & vesicoureteric junction any ischail spine
Arrangement of substances in the scrotum
SDECITT “SKIN, Dartos ms, External spermatic fascia, Cremasteric fascia, Internal spermatic fascia, Tunica vaginalis & Tunica albuginea”.
On PR examination, which structure is felt posterolateral 4cm from the anal verge in male
Puborectalis ms. in female base of bladder
The superior pancreaticoduodenal A is from
Gastrodoudnal artery branching from Common hepatic.
The inferior pancreaticoduodenal A is from
Superior mesenteric Artery.
Greater pancreatic A is from
Splenic A.
Rectum LN drainage
Upper 1/3 → Inferior Mesentric - lower 2/3 → Int. Iliac.
Anal LN drainage
above dentate line” Endoderm” → Internal Iliac, below dentate “ectoderm”
horizontal superficial inguinal.
What drains in Para Aortic LNs
TOF “Testicles, Ovaries and Fundus of uterus”.
In Kocher incision for open choleycystomy which muscle devided
Rectus Abdominis.
In paramedian inscision
Displace rectus abdominis to lateral side.
In pfannesteil incision which is divded
Fascia Transvaslis.
Injury to conj. tenden/ medial to inf. epigastric V or through hasslebach tringle
Direct ing.hernia.
Hernia lateral to inf. epigastric vessel
Indirect Inguina hernia.
Location of femoral A pulsations
Mid Inguinal Point (symphysis pubis to ASIS) 1-2 cm inferior.
Location of deep ring
Mid point of inguinal ligament (pubic tubercle to ASIS).
Below the mid way from umbilicus to symphysis pubis
Arcuate Line “defective Post rectus sheath (NO muscle only fascia transvaslis) No it is. But anterior there will be 3M (external and internal oblique and transveris abdomins)”.
Umblical area Lymphatic drainage
above umblicus Axillary LN, below umblicus Inguinal LN.
The Neurovescular bundle in Abdomen is btw
Internal oblique & transverse abdominis.
Below the arcuate line layers form post. Rectus sheath
ONLY facia transvasalis.
Muscle initiate shoulder abduction
Supraspinatous.
Radial head articulates with
capitulum.
Radial head is inclosed in
Annular lig.
Pt can’t flex Distal Phalanx
Flexor Digitorum Profundus injury.
Adductor polices muscle is supplied by
Ulnar N.
Abductor polices Brevis of hand is supplied by
Median N.
Pt’s hand on table can’t left thump to seiling
Abductor Policis Brevis affected.
Pt injured in the wrist on medial side in pinch paper froment’s test, pt do abnormal pinching by flexing
his thump
weak Adductor policis.
Thenar Muscle supplied by
Median N except Adductor policis.
Hypothenar Muscle supplied by
UlnarN.
Test to assess median nerve muscles
Tinnle and phalen’s tests.
In carpal tunnel release what muscle encountered superficial to it
Palmaris longus.
Scaphoid gets blood supply form
the distal pole. Necrosis in proximal part.
Relation of the ulnar n. to the ulnar a
Nerve is ULNAR to the artery.
Relation of the Median n. to the brachial a.
Lateral, Anterior then Medial.
Wingining of the scapula
n. to serratus ant. (Long thoracic n)C5, 6, 7.
After axillary clearance, when she pick up a knife, her wrist flexes
Posterior cord Injury Not radial N.
Axillary n. injury, the deltoid ms is affected, 2nd ms affected
Teres minor ms.
Wrist injury + Thenar imminence atrophy
Median nerve injury.
Nerve specific for opposition
Recurrent branch of median n.
Loss of thumb adduction
deep ulnar n.
Muscle extending the thump
Extensor policis longus and brevis.
Muscle abducting the thump over palm
abductor policis brevis.
Loss of the little and ring finger movements
Ulnar n.
Loss of interossei of the 4th finger
Ulnar n.
Mid shaft humeral fracture / spiral groove #
Radial n.
Loss of sensation over the medial part of the hand
Ulnar n.
Patient cannot lift his hand from the table and cannot extend the DIP of the thumb
Radial n /PIN.
Loss of pincer movement of the thumb and the index when writing
AIN (pure motor).
Structures in the delto-pectoral groove u will meet during dissesction
Cephalic v., Thoracoacromial a, Lateral pectoral n.
In clavical middle 1/3 # most likely to be injured
Subclavian Vien.
Origin of supraspintus, infraspinatus and teres minor
Dorsal aspect of scapula.
Orgin from ventral aspect of scapula for
Subscapularis.
Bicep attachment to humerus
short head: supraglenoid tubercle, long head: coracoid process.
Tricep attachment to humours
Infragelonid tubercle.
Anatomical snuffbox bounderies
Post or Ulnar or Medial: Extensor pollicis longus, Ant or Radial or Lateral: Abductor pollicis longus + Extensor pollicis brevis.
Relation of Extensor indicis to the Extensor digitorum is
Deep and Ulnar.
Pt has complete loss of elbow extension after having deep wound on the back of arm
Rapture triceps tendon.
Pt fell out on stretched hand, carapl bone pain
Lunate dislocation.
Injury to hamate / pisiformis will affect
Ulnar side flexor digiturom prefondus.
Complete loss of elbow extension and wrist extension after lacerated wound 6 cm above elbow
Radial n.
Olecranon process there is some cutaneous sensory loss
Radial Nerve injury.
Dorsal and palmar introssie function
DAB & PAD “Dorsal Abduct fingers, Palmar Adduct fingers”.
Supracondyler fracture with abscent pulse
Brachial Artery injury.
Injury to upper limb with mild claw hand
Ulnar at elbow.
Injury to upper limb with Marked claw
Ulnar at wrist.
Subclavian Steal syndrome is due to
Obsturcation in subclacian A. diagnosied on Dupplex.
Numbness on the lat. aspect of the forearm, which ms will be affected as well
Biceps, Brachialis & Coracobrachialis.
While the palm is on the table, the patient is unable to take his thumb from the table
Extensor pollicis longus & brevis tendon.
The hand is on the table, and he is unable to bring the thumb to 90 degrees
abducoter pollicis brevis ms tendon.
The patient is able to flex the PIP & unable to flex the DIP, ms affected
Flexor Digitorom Profundus tendon injury.
Sensory n. supply for the ring finger
Ulnar, median and radial n.
Cephalic vein course to arm
Runs in lateral side & Joins axillary vein .
Basilic vien course
Runs in medial side & continue as axillary vein.
Both basilic and cephalic vein join together and form Median cubital vien where we do cannula
Quadrangular space contents
Axillary Nerve and posterior circumflex vessles.
Tringular space contents
Radian nerve, prounda brachii Artery, Circum. scapular Artery.
Bounderies of cubital fossa
Roof: fascia and bicipital aponorosis, floor: brachialis, Base: imajinary line btw the 2 epicondyles, Lat: Brachioradialis, Med: Pronator teres, Apex: meating of med & lat borders.
Contents from medial to leteral
1-median nerve 2-brachial artery-3 Bicep tendon most lateral.
Median Nerve course in Arm
LAM “lateral anterior then Medial to Brachial A.”.
Dupyrtren’s contrcture is due to
Contraction of palmar apnorosis.
Axillary A is divided by
Pectrolis minor. 1st above it, 2nd behind it & 3rd below it.
Branches of Axillary A
1st: superior thoracic A, 2nd: thoracoacromial A & Lat thoracic A & 3rd: subscapular A and 2 cicufmlex humeral As.
Pt has cholycystitis and came with pain in shoulder tip. Cause
Subphrenic abcess, phrenic n C345, C4 gives sesory to shoulder!
Pt injured his neck in football or accident come with policeman’s tip deformity
Erb’s palsy (upper
trunk injury) C5,6.
Pt has clow hand and horner’s syndrome and paresthesia in med 3.5 fingers
Klumpke’s palsy (
lower trunk injury ) C8,T1.
Brachial plexuses medial cord main terminal branch
ulnar nerve
Brachial plesxus posterior cord main terminal branch
axillary nerve
Pt can’t extend elbow has wrist +finger drop. N involved
Radial injury at axilla (Saturday night palsy).
Pt has finger drop only can’t extend fingers or thump no sensory deficit. N involved
PIN branch of Radial N.
Pt has numbness on lateral forearm. N involved
Musculocoutanous nerve.
Pt can’t do OK sign can’t flex thump and index, sensation intact. N involved
AIN of median.
(There is a muscle called Brachioradialis) supplied by Radial nerve (BEST)! It is diff from Brachialis!! OK?!
Foot Cuboid bone distal articulation
4th and 5th metatarsals.
Foot cuniformis bone distal articulation
1st 2nd 3rd metatarsals.
Structure passes in lesser sciatic foramen
Obturator N. /Tendon + Pudendal N/vessles.
Greater sciatic foramen transmits nerve supply to
Tensor fascialata, Gleatus Muscle, Hamstrings and Perianal Ms.
The hipbone composed of
Ileum, Pubis and Ischium.
M inserted in greater trochanter of femor
Gluteal Ms.
M inserted in lesser trochanteric of femor
Pasoas Major * Pasos Flexs the Hip
Anterior boundry of the femoral ring
Inguinal lig. Posterior→ Pectinal lig. Medical→ lacunar lig.
Lateral
femoral vein .
Pt has hernia below and lateral to pubic tubercle
Femoral. common in female, emergency due to risk of strangulation.
Popliteal fossa: Most superficial
Tibial n. Most deep→ Popliteal a. Most lateral → Common peroneal n.
During hip arthroplasty, the surgeon noticed an artery is running on the superior border of pectineus
Inferior gluteal a.
Adductor /hunter canal borders
Roof: saritous M, Floor: adductus magnus M, Lat walls: vastus medialis.
Nerve supply to the adductors of the hip and is stimulated during TURP
Obturator n.
Structures passing below behind the piriformis in the greater sciatic notch
Sciatic n.
N. injury causing waddling (trendlenberg) gait
Superior gluteal nerve supplying Gluteus medius.
During an ovarian mass removal, or pelvic surgery, inner thigh numbness
Obturator n. injury.
N.injury during post hip approach
Sciatic n.
N.injury during distal femoral approach (or # in neck of Fibula)
Common peroneal.
Injury in lower end of fibula
Pott’s fracture.
Nerve emerges at the lower border of the psoas major ms. causing numbness over the thigh
Lateral cut. Nerve of the thigh. (Meralgia Parathetica).
Patient has foot drop. N involved
Sciatic or Common peroneal or Deep peroneal n.
Loss of sensation over the 1st web space
Deep peroneal n.
Loss of sensation over the medial leg
Saphenous n.
During the medial ankle approach, which n. will be affected
Saphenous n.
Surgery to the short saphenous vein, which n will be affected
Sural n.
Knee scope then sensory loss just below the knee on the medial aspect
Infra patellar branch.
Anterior compartment syndrome of the leg, the pain is present with planter flexion of the big toe, associated numbness will be in
1st web space (sensory for DPN).
Patient injured fibular bone #, loss of eversion movement of ankle
superficial perneal Nerve.
Patient has pain with planter flexion after tibial fracture. Dx
Anterior compartment Syndrome
(deep peroneal Nerve first web space).
Tendon posterior to lateral malleous prone to injury
Pernous Brevis.
Nerve supplies to the thigh
Medial Obratuor / Lateral catenous of femoral N. /Posterior sciatic Nerve.
Nerve supply of legs
Anterior extensors: Deep Proneal N, Lateral compartment : superficial Proneal N, Posterior flexors: tibial N.
Superficial peroneal N supplies
Lateral Compartment (peroneus longus M & peroneus Brevis M) and lateral & dorsum of foot except 1st web space.
Deep Peroneal N supplies
Anterior compartment + First dorsal web space
The only sensory nerve of leg that is not part of sciatic
Saphenous N from Femoral nerve.
Pt had injury and is unable to extend his knees. Ms affected
Quadracip femours M.
Commonest site of peripheral aneurysm
Popliteal Artery .
Lymph Drainage of facia-lata
to Deep Inguinal node.
Course of posterior Tibial A.
Mid way btw Medial mallous and tendocalceneous.
Course of anterior Tibial A.
It continues as dorsalis Pedis lateral to extensor hallucis longus tendon.
Pt twisted his ankle on inversion most likely ligament injured
Anterior talofibular lig. & Calceneofibular lig.
Pt had accident leg short, adducted & interenly rotated. Dx
Posterior hip dislocation (sciatic N iinjury involved).
Appendix is derived from
Mid gut.
Mother found meconium in front of the diper. Dx
persistence of the Vitello-intestinal duct.
Persistence of Uracus after birth due to
Median umbilical lig. Remnants.
Median umblical fold urachus Urinary bladder.
Medial umblical fold. Embryological origin
obliterated Umblical Artery.
Lateral Umblical fold. Formed by
inferior epigasirc vessles.
Epidymis vas deferns. Embryological origin
Mesonpheric Wolffian.
Utrerus /Vagina. Embryological origin
Paranephric mullern.
Inguinal hernia congintal due to
Patent Processus vaginalis.
Testicular descend is guided by
the Gubernaculum.
Branchial cyst Origin from
2nd branchial arch.
Cleft palate due to
Failure of fusion of the palatine shelves of maxilla.
Cleft lip due to
failure of fusion of Ms of upper lip & nasolabial region.
Neonate with recto-vesical fistula due to
Deffect in Cloaca.
Embryological Origin of Inferior parathyroid
3rd Pharangeal pouch. Superior parathyroid→ 4th pharangeal pouch . thymus( is 3rd pharangeal thymus)
Surface anatomy of Internal Jagular V
(Lobule of the ear sterno clavical joint).
Surface anatomy of External JagularV
(the angle of mandible middle of clavical).
Level of of T5
Angle of Luis, Trachial birfucation T5, Thoraxic duct goes behind the esophagus to the left crossing, junction between aorta & its arch.
Diaphragm opening
T8 for Vena Cava, T10 for Esophagous, T12 for Aorta and thoracic Duct.
Chest tube insertion location
just Ant. To Mid axillary line 5th intercostal space.
Site for pericardiosentesis location
5th intercostal space lateral to the sternium with needle directed to the Lt shoulder tip & 45 degrees to the chest wall.
Thoracocentesis (plural tap)
level should be confirmed radilogicaly, but usualy 5th intercostal Space, Pt is bending torward the table, mid axillary line or mid scapular line or posterior axillary line.
Mc Burnny point
junction btw lat & middle1/3 in a line from umblicus and ASIS for appenx surgery.
Contents of posterior mediastinum
Esophagous, thoracid duct, vagus N, azygos vein, sympathetic trunk, splanchnic nerves & decending thorax aorta.
The Narrowest part of urethera in male
Memberanous urethera.
Branches of Rectal arteries
superior from IMA, Middle from Internal Iliac, lower from Pudandal A branch of internal iliac A.
Which level of spinal cord level that will cause the least spastic paralysis/ lower motor neuron lesion
L3/L4 (the most far level after ending of the spinal cord at L1).
Which level of spinal cord that cause autonomic hyperreflexia “UMNL”
at or above T6 spinal cord level.
Common root values, reflexes and dermatoms : Myotomes: Hip flexion (L2, 3), knee extention (L3, 4), foot dorsiflexion (L4, 5) and invertion (L4, 5), Big toe extention (L5), Hip extention (L4, 5), knee flexion (L5, S1), foot planterflexion (S1, 2) and evertion (L5, S1). Dermatomes: Nipples T4 - Inguinal canal L1– Umblicus T10 - Knee front L3 - Shoulder tip C4 - Medial side of ankle & leg L4 - Lateral side of leg L5 - Lateral foot S1 -Dorsom of foot L5 Reflexes: Knee L3, 4, big toe jerk L5 & ankle S1, 2.
