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MD1 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Phrenic Nerve

A

C3,4,5, anterior to lung root, on scalenus anterior, b/w subclavian artery and vein, pierces diaphragm

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2
Q

Vagus Nerve

A

C X, posterior to lung root, alongside trachea, anterior oesophegus

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3
Q

Fusiform Aneurysm

A

Dilation of both sides

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4
Q

Saccular Aneurysm

A

Dilation of one side

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5
Q

Pericardium Location (& anterior mediastinum)

A

1-4 sternebrae, T5-T8 vertebrae

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6
Q

Inferior mediastinum

A

T5-T12

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7
Q

Ligamentum Arteriosum

A

Fibrus band remenant of ductus arteriosus

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8
Q

Vertebrae

A 
7 Cervical
- typical & atypical
- foramen in transverse processes
12 Thoracic
- costal facets for ribs
- articular processes in coronal plane
5 Lumbar
- articular processes in saggital(ish) plane
5 Sacral (fused)
2-5 Coccyx
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9
Q

Trachea

A

Begins at C6

Bifurcates at T4/5

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10
Q

Pain referred from lungs and pleura

A

Visceral = shares AUTONOMIC NERVE SUPPLY of heart and lungs. Pain referred is DULL, NOT SEVERE, POORLY LOCATED.

Parietal = shares SOMATIC NERVE SUPPLY of diaphragm, ribs, intercostals. Pain referred is SHARP, SEVER, WELL LOCATED.

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11
Q

Chest X Ray technique

A

Full inspiration (7 ribs anterior, 11 ribs posterior)
Posterior to Anterior
‘hug x-ray’ - rotate scapulae
Erect

Check vertebrae is straight (spinous processes)

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12
Q

Airway features
Trachea
Bronchi
Bronchioles

A

Trachea

  • hyaline C shaped cartilages (in adventitia) with muscle bridge
  • submucosa contains glandular structures

Bronchi

  • cartilage plates
  • smooth muscle complete ring between lamina propria and submucosa

Bronchioles

  • no cartilage
  • loses goblet cells, gains clara cells
  • has some smooth muscle
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13
Q

External Oblique

A

“front pockets”
anterior surface of lower 8 ribs
free posterior muscular edge
interdigitate in vertical raphe (aponeurotic)
free inferior edge
ASIS (anterior superior iliac spine) -> pubic tubercle
Δ opening between pub tub & pub crest

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14
Q

Internal Oblique

A

“back pockets”
attach to costal margin
attach to thorocolumbar fascia posteriorly
aponeurotic medially
anterior 2/3 of inguinal ligament -> pub crest

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15
Q

TVA

A

horizontal
underlap costal margin, continuous with plane of diaphragm
attach to thorocolumbar fascia
attach to midline raphe (linea alba)
lateral 1/2 inguinal ligament -> pub crest

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16
Q

Rectus Abdominus

A

vertical, tendinous inscription (umbilicus, xyphisternum, 1/2 way between)
anterior surface of ribs 5,6,7
linear semilunaris (lateral border)
linea alba medially
insert pubic crest
posterior sheath ceases at arcuate line (TVA + int oblq become anterior)

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17
Q

Nerves of anterior abdominal wall

A

T10 - umbilicus

L1 - groin

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18
Q

Arteries of anterior abdominal wall

A 
superior epigastric
- branch of internal thoracic
- anastamose posterior rectus sheath
inferior epigastric
- branch of internal iliac
superficial epigastric
- in superficial fascia
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19
Q

Veins of abdominal wall

A

dual veinous drainage

  • portal
  • IVC
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20
Q

Inguinal Canal

A

DEEP RING: deficiency in transcersalis half way between ASIS & pub tubercle
4cm long
parallel to inguinal ligament
roof is arching fibres of internal oblique & TVA

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21
Q

Inguinal Canal Layers

A
  1. Internal Spermatic Fascia (transversalis fascia)
  2. Cremasteric Fascia (has muscle to retract testicle - internal oblique)
  3. External Spermatic Fascia
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22
Q

Quadratus Lumborum

A

tip of transverse processes, 12th rib, iliac crest

kidneys lay on top (anterior)

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23
Q

Psoas

A

inferior border of T12 to upper border of L5
attaches to medial ends of transverse processes
lumbar arteries & veins behind
lumbar plexus within
sympathetic trunk anterior
insertion on lesser trochanter (shared with iliacus)

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24
Q

Kidneys

A

T12 - L3
right sits lower than left
adrenals (right pyramid, left crescent)
hilum (artery, vein, pelvis) faces anteromedially
cortex (outer, pale striated)
medulla (discontinuous, darkened)
minor calyces (2-3) -> major calyces (3) -> pelvis -> ureter
left renal vein under superior mesenteric artery
5 artery segments

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25
Q

Ureter

A 
descend on posterior abdominal wall on psoas
parallel to tips of transverse processes
over pelvic brim
cross over common iliac artery and vein
below uterine artery / vas deferens
bladder

3 sites that can become obstructed by kidney stones

  • narrowing renal pelvis -> ureter
  • compression ureter over pelvic brim (mid ureter)
  • narrowing ureter -> bladder
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26
Q

Abdominal Vessels (3 branches)

A

aorta bifuricates at L4 (into common iliac arteries)
three vascular planes
1. anterior branch (coeliac trunk, superior/inferior mesenteric)
2. lateral branches (kidneys)
3. posterior branches (intercostals/obliques)

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27
Q

Foregut

A

start at abdominal oesophegus
ends at duodenal papilla (1/2 way down 2nd part of duodenum on posteromedial wall)
supplied by coeliac trunk?
Preganglionic Sympathetic T6-T9 (&afferent)
Parasympathetic - Vagus

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28
Q

Midgut

A

unclear demarcation
include most of transverse colon (to short splenic flexture)
supplied by superior mesenteric?
Preganglionic Sympathetic T8-T12 (&afferent)
Parasympathetic - Vagus

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29
Q

Hindgut

A

descending and sigmoid colon and rectum
supplied by inferior mesenteric?
Preganglionic Sympathetic T12-L2
Parasympathetic - Pelvic Splanchnics S2-S4
(afferents sympathetic until sigmoid, then parasympathetic)

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30
Q

Abdominal Vessel Names & Locations

A

COELIAC TRUNK - T12
- Splenic Artery (pancreas, upper greater curvature - left gastroepiploic artery)
- Common hepatic (proper hepatic, right gastric, pancreaticoduodenal/gastroduodenal)
- Left gastric (lesser curvature)
SUPERIOR MESENTERIC - L1
- (jejunum) long vasa rectae, few vascular arcades
- (ilium) short vasa rectae, many vascular arcades
- right colic (supplies ascending colon)
- middle colic (supplies transverse colon)
INFERIOR MESENTERIC - L3
- left colic (descending colon)
SUPERIOR RECTAL ARTERY
- passes into pelvis

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31
Q

Portal Venous Drainage

A

Portal vein low pressure and valveless
Behind neck of pancreas at level of L2

Left gastric vein can drain to azygous.
Superficial abdominal wall veins anastomose with portal vein tributaries.
Rectal veins anastamose. Portal hypertension can present as haemorrhoids.

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32
Q

Abdominal Lymphatics

A

Pre-Aortic (anterior)
- around unpaired three branches; liver, pancreas, gallbladder, spleen (coeliac, inferior/superior mesenteric)

Para-Aortic (side)
- from posterior wall, kindeys, adrenals, testes, ovaries, pelvis and lower limb

Trunks

  • intestinal (from pre-aortic lymph nodes)
  • right & left lumbar lymph trunks
  • Coalesce to form CISTERNA CHYLI (adjacent to aortic hiatus)
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33
Q

X-Ray absorption factors

A
  1. THICKNESS of tissue
  2. DENSITY of tissue
  3. ATOMIC number of tissue (to 4th power)
    H = 1
    C = 6
    O = 8
    Ca = 20
    Io = 53
    Ba = 56
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34
Q

Abdominal X-Ray Contrast Techniques

A

Endoscopic Retrograde Cholangio-pancreatography
(inject iodine into bile duct - endoscopically)
Percutaneous Transhepatic Cholangiography
(inject into bile duct - through abdominal wall)
Intravascular
(distribution through blood vessels, excretion by kidney)
(bilirubin like tagging for excretion into bile duct)

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35
Q

Radioisotope Imaging

A

Emit gamma rays (recorded by gamma camera)

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36
Q

MRI

A

Alters H+ spin (tissue must have water)
0.3 - 3.0 Tesla

Good spacial and contrast resolution
Good for soft tissue (brain) and bone marrow
Bad for bones (low H+ appears black)
Good for inside joints
Availability variable
Contraindications (pacemaker, cochlear implant etc.)
More Expensive
Long Scan Times
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37
Q

GI sacks

A 
Lesser Sack (Foramen of Winslow)
- hangs over transverse colon and fuses to form greater omentum

pocket with pancreas posterior and stomach/lesser omentum anterior

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38
Q

Liver

  • blood supply
  • segment
A

75% Portal Vein
25% Hepatic Artery

Falciform ligament demarcates left and right anatomically
IVC-Gallbladder demarcates left and right physiologically
Caudate lobe (fissure/IVC/hilum)
Quadrate lobe (fissure/Gallbladder/hilum)

Falciform -> ligamentum teres -> umbilical
ligamentum venosum - shunt to IVC bypassing liver in foetus

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39
Q

Abdominal Viscera Layers

A

Layer 1: Paired Viscera - retroperitoneal
= kidneys/ureter

Layer 2: Unpaired Viscera - retroperitoneal
= ascending & descending colon
= duodenum
= pancreas

Layer 3: Intraperitoneal Unpaired Viscera
= mesogastrum / stomach
= mesentery / jejunum/ilieum
= transverse mesocolon

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40
Q

Pancreas

  • structure
  • functions
  • histology
A

retroperitoneal
head (uncinate process), neck, body, tail
principal & accessory pancreatic duct

EXOCRINE:
enzymes for digestion (protein, starches, fat)
- proteases
- amylases
- nucleases
bicarbonate
ACINI with basal RER, luminal ZYMOGEN GRANULES

ENDOCRINE:
insulin
glucagon
somatostatins
ISLETS OF LANGERHANS, vascular, pale pink
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41
Q

Spleen

A 
Highly vascular
LUQ
notched
smooth diaphragmatic surface
axis lies along shaft of 10th rib
thin capsule (trauma can rupture spleen)
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42
Q

Hepatocytes, Liver, and Models

A

Hepatocytes
RER, Golgi = protein synthesis
SER = fat & steroid metabolism

Hepatocytes organised in LOBULES supported by Reticular fibres

  • Central vein (sinusoids)
  • Portal Triads (hepatic artery, portal vein, bile duct [canaliculi], lymphatic)

Sinusoids:

  • Discontinous lining
  • gap between endothelium and hepatocyte = SPACE OF DISSE
  • KUPFER CELLS (macrophages) on inner walls
  1. Classic Lobule Model (central vein)
  2. Portal Lobule Model (portal triad)
  3. Acinar Model (O2 conc. gradients)
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43
Q

Synovial Joint Structures

A
  1. Articular (hyaline) Cartilage - aneural, avascular
  2. Fibrous Capsule - collagen, elastin, fibroblasts
  3. Intrinsic Ligaments
  4. Extrinsic Ligaments
  5. Synovial Membrane - highly vascular

Ligaments typically have poor blood supply and don’t repair very rapidly

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44
Q 
Special Joint Structures
Labrum
Fat Pad
Disc
Menisci
Bursae
Ligament
Tendon
A

Labrum - fibrocartilaginous rim deepening joint
Fat Pad - within joint, external to membrane
Disc / Menisci - shock absorb, bear weight, blood & nerve supply to outer third
Bursae - contain synovial fluid and communicates with joint
Ligament - thickening of capsule (intrinsic of extrinsic)
Tendon (intracapsular) - labrum provide joining site

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45
Q

Shoulder (glenohumeral) Anatomy (Layers)

A
  1. Bones (glenoid fossa of scapula)
  2. Labrum
  3. Capsule (reinforced by intrinsic ligaments)
    - attach to anatomical neck above
    - attach to surgical neck below
    - anterior deficiencies for bicep long head and bursa (subscapular)
  4. Tendons (rotator cuff - originate from scapula and insert into capsule)
    - infraspinatus: external rotation
    - subscapularis: internal rotation
    - supraspinatus: abduction (+ deltoid)
  5. Coraco-acromial ligament/arch & sub-acromial bursa
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46
Q

Humerous Anatomical Features

A

Greater & Lesser tuberosities (anterior / superior)
Bicipital groove in between for bicep long head

Surgical neck - endangers axilliary nerve
mid-shaft - endangers radial nerve (in groove)
supracondylar - endangers median nerve & brachial artery

Condyles (capitulum anteromedial, trochlea anterolateral)
Epicondyles

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47
Q

Clavicle Anatomical Featues

A

Medial 2/3 curve anteriorly
Lateral 1/3 curve posteriorly
Articulates with scapula

Sternoclavicular Joint

  • tight capsule
  • disc (outer 1/3 has nerve and blood supply)
  • costoclavicular acessory ligament (attach to superior medial surface of first rib)
  • subluxation rare - endanger subclavian vein & artery

Acromioclavicular Joint

  • plane synovial joint in saggital plane
  • weak capsule
  • coracoclavicular lig. (conoid, trapezoid) main stabilizer
  • subluxation (Grade 1-3)
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48
Q

Radius & Ulna Anatomical Features

A

Share synovial cavity at elbow
Radius articulates with lateral side of ulna
Radius processes (coronoid anterior, olecranon posterior)

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49
Q

Elbow Joint Complex

  • Ligaments
  • other
A

LIGAMENTS:

  • Medial Collateral Ligament (attaches to medial epicondyle)
  • Lateral Collateral Ligament (attaches to lateral epicondyle)
  • Annular ligament (encloses head of radius allowing rotation and provides point of attachment for LCL)

OTHER:
Intracapsular fat pads fill fossae
Olecranon bursa
Most stable in extension

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50
Q

Muscles of forearm

A

PRONATION/SUPINATION
Pronator teres
supinator
pronator quadratus

FLEXION/EXTENSION (also enhance stability of carpals)
extensor carpi radialis brevis (wrist extensor originating from lateral epicondyle)
flexor carpi radialis

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51
Q

Wrist / Hand bones

  • Proximal (lateral to medial)
  • Distal (lateral to medial)

Some Lovers Try Positions That They Can’t Handle

S
L
Tri
P
Trai
Trao
C
H
A

Scaphoid (most frequently fractured - at waist)
Lunate (most frequently subluxed)
Triquetral
Pisiform (sesamoid bone in tendon - flexor carpi ulnaris, ossifies at 11/12yo)
Trapezium
Trapezoid
Capitate (largest, first to ossify at 2 years)
Hamate (with hook)

Metacarpals
- sesamoid on 1st distally
Phalanges
- proximal
- middle
-distal
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52
Q

Wrist Ligaments

A

Palmar-radio-carpal ligaments - prevent carpals from sliding medially (moreso than dorsal)
- transmit vessels to carpal bones

Radio-scapho-lunate ligament - keeps scaphoid and lunate in position

Deep transverse metacarpal ligament (holds 4 metacarpals together - but not thumb)

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53
Q

Structures of fingers

  • Ligaments
  • Plates
A 
I Carpometacarpal - Saddle 
II-III Carpometacarpal - Immobile
IV-V Carpometacarpal - Hinge (f/e)
Metocarpophalangeal - Condyloid Joints
Volar & Dorsal Plates (extend surface area for articulation - site of pathology)
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54
Q

Wrist Joints

A

Radiocarpal - synovial ellipsoid

  • scaphoid (medial/lateral)
  • lunate (anterior/posterior)
  • F>E, UD>RD

Intercarpal (midcarpal) - condylar

  • E>F
  • RD>UD
  • flexion / extension
  • radial / ulnar deviation
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55
Q

Rule of deep muscles

A

Arise from shaft of long bone that they overlie (and adjacent interosseous membrane)

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56
Q

Rule of superficial muscles

A

proximal origin, distal insertion

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57
Q

Muscles involved in wrist radial deviation

A

Extensor carpi radialis longus
Extensor carpi radialis brevis
Flexor carpi radialis

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58
Q

Muscles involved in wrist unlar deviation

A

Flexor carpi ulnaris

Extensor carpi ulnaris

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59
Q

Radiolucent

A

Dark structures on XRay

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60
Q

Radio-opaque

A

Light structures on XRay

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61
Q

T1 vs T2 MRI Imaging Signal Intensity

A 
T1 WEIGHTED
Fluid - Dark
Fat - Bright
Muscle - Intermediate
Spinal Cord - Intermediate
Cortical Bone - Very Dark
Flowing Blood - Dark
T2 WEIGHTED
Fluid - Bright
Fat - Intermediate to Bright
Muscle - Intermediate
Spinal Cord - Intermediate
Cortical Bone - Very Dark
Flowing Blood - Dark

can use fat suppression to darken fat

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62
Q

Age of Elbow Epiphyses Appearance

A

1st year - Capitulum (+ lat trochlear)
5th year - Medial epicondyle & Radial head
10th year - Trochlear (medial), lat epicondyle, olecranon

Medial and lat epicondyle, radial head, olecranon fuse between 15-20

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63
Q

Muscles attaching pectoral girdle to trunk

A 
THORACIC WALL:
Pectoralis Major
Pectoralis Minor
Subclavius
Serratus Anterior
VERTEBRAL COLUMN
Trapezium
Latissimus Dorsi
Levator Scapulae
Rhomboid Minor
Rhomboid Major
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64
Q

Subclavius

A

ORIGIN: Anteromedial part of first rib
INSERTION: Inferior surface of clavicle

Stabilizes clavicle

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65
Q

Pectoralis Minor

A

ORIGIN: costal cartilage ribs 3,4,5
INSERTION: converge on coracoid process

Stabilizes scapula

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66
Q

Serratus Anterior

A

ORIGIN: lateral aspect of ribs 1-8
INSERTION: medial border of scapula
INNERVATION: long thoracic nerve

Strong protractor

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67
Q

Muscles attaching at humerus to scapula / rotator cuff

A 
Deltoid
Subscapularis*
Supraspinatus*
Infraspinatus*
Teres Minor*
Teres Major
  • rotator cuff muscles
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68
Q

Supraspinatus

A

ORIGIN: Supraspinatus Fossa
INSERTION: Superior facet on greater tubercle of humerus

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69
Q

Infraspinatus

A

ORIGIN: Infraspinatus fossa (posterior)
INSERTION: middle facet on greater tubercle of humerus

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70
Q

Teres Minor

A

ORIGIN: lateral border of the scapula
INSERTION: inferior facet on greater tubercle of humerus

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71
Q

Deltoid

A

ORIGIN:
INSERTION:

Abductor (need supraspinatus to initiate)

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72
Q

Subscapularis

A

ORIGIN: subscapular fossa (anterior)
INSERTION: lesser tubercle of humerus

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73
Q

Teres Major

A

ORIGIN: inferior angle of scapula (bottom of triangle)
INSERTION: proximal humerus just below lesser tubercle

Adducts and medially rotates

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74
Q

Muscles of Upper Arm

A

ANTERIOR:
Coracobrachialis
Biceps
Brachialis

POSTERIOR:
Triceps

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75
Q

Biceps

A

ORIGIN: supraglenoid tubercle (long head through bicipital groove), coracoid process (short head)
INSERTION: radial tuberosity

Flexor (in supination) and primary supinator

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76
Q

Coracobrachialis

A

ORIGIN: coracoid process
INSERTION: mid-shaft of humerus

Assists in flexion and adduction of shoulder

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77
Q

Brachialis

A

ORIGIN: whole of anterior aspect of distal humerus
INSERTION: coronoid process of ulna

flexor of elbow joint (in all position)

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78
Q

Rule for Deep Muscles

A

Arise from shaft of long bone they overly (and adjacent interosseous membrane)

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79
Q

Triceps

A

ORIGIN: infraglenoid tubercle (long head), proximal aspect of posterior shaft of humerus (lateral head), shaft of posterior humerus (medial)
INSERTION: olecranon of ulna

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80
Q

Muscles of Forearm - Anterior

A 
SUPERFICIAL
Pronator Teres
Flexor Carpi Radialis
Palmaris Longus
Flexor Digitrum superficialis
Flexor Carpi Ulnaris
(all attach to common flexor origin: front of medial epicondyle)

DEEP
Flexor pollicis longus
Flexor digitorum profundus
Pronator Quadratus

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81
Q

Muscles of Forearm - Posterior

A

SUPERFICIAL
Brachioradialis
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis*

Extensor Digitorum*
Extensor Digitorum minimi*
Extensor Carpi Ulnaris*

Abductor Pollicis Longus
Extensor Polllicis Brevis
Extensor Pollicis Longus

DEEP:
Aconeus
Supinator
Extensor Indicis

*arise from common extensor origin (lateral epicondyle)

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82
Q

Flexor Carpi Radialis (FCR)

A

ORIGIN: Common Flexor Origin
INSERTION: base of 2nd and 3rd metacarpals

has separate tunnel to Carpal Tunnel

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83
Q

Palmaris Longus

A

ORIGIN: Common Flexor Origin
INSERTION: blends with flexor retinaculum and palmar aponeurosis

absent in 10% of people

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84
Q

Flexor Carpi Ulnaris (FCU)

A

ORIGIN: Common Flexor Origin AND wide aponeurotic attachment to subcutaneous border of ulna
INSERTION: base of 5th metacarpal*
* actually inserts on pisiform which gives rise to pisometacarpal ligament

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85
Q

Pronator Quadratus

A

ORIGIN/INSERTION: across distal portions of anterior aspect of shaft of radius and ulna

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86
Q

Pronator Teres

A

ORIGIN: Common Flexor Origin AND medial aspect of coronoid process
INSERTION: point of greatest convexity on radius

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87
Q

Flexor Digitorum Superficialis (FDS)

A

ORIGIN: Common Flexor Origin (humeral-ulnar head) AND fibrous arch to radius
INSERTION: 4 tendons inserting on base either side of middle phalynx

*girly fist

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88
Q

Flexor Digitorum Profundus (FDP)

A

ORIGIN: Shaft of ulna and adjacent interosseous membrane
INSERTION: 4 tendons inserting on base of distal phalynx

*proper fist

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89
Q

Flexor Pollicis Longus

A

ORIGIN: shaft of radius and adjacent interosseous membrane
INSERTION: base of distal phalynx (thumb)

Thumb version of FDP

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90
Q

Flexor Retinaculum

A 
STOP
Scaphoid
Trapezium
hook Of hamate
Pisiform

Tunnel Contents: Palm to Deep
FDS 3,4
FDS 2,5
FDP

median nerve lateral
Flexor Pollicis Longus more lateral

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91
Q

Brachioradialis

A

ORIGIN: lateral supracondylar ridge (above common extensor origin)
INSERTION: styloid process of radius (distal)

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92
Q

Extensor Carpi Radialis Longus

A

ORIGIN: lateral supraconylar ridge (above common extensor origin)
INSERTION: base of 2nd and 3rd metacarpals posteriorly

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93
Q

Extensor Carpi Radialis Brevis

A

ORIGIN: Common Extensor Origin
INSERTION: base of 2nd and 3rd metacarpals posteriorly

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94
Q

Extensor Digitorum

A

ORIGIN: Common Extensor Origin
INSERTION: 4 tendons inserting base of middle and distal phalynx (like FDS and FDP)

Also tendinous communications between digits

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95
Q

Extensor Digiti Minimi

A

ORIGIN: Common Extensor Origin
INSERTION: 5th middle and distal phalynx (merge with extensor digitorum)

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96
Q

Extensor Carpi Ulnaris

A

ORIGIN: Common Extensor Origin
INSERTION: base of 5th metacarpal

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97
Q

Abductor Pollicis Longus

A

ORIGIN: Posterior aspect of radius, ulna, and interosseous membrane
INSERTION: base of first metacarpal

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98
Q

Extensor Pollicis Brevis

A

ORIGIN: Posterior aspect of radius, ulna, and interosseous membrane
INSERTION: base of proximal phalynx

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99
Q

Extensor Pollicis Longus

A

ORIGIN: Posterior aspect of radius, ulna, and interosseous membrane
INSERTION: base of distal phalynx

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100
Q

Anconeus

A

ORIGIN: Common Extensor Origin
INSERTION: posterior aspect of proximal ulna

small triangular muscle

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101
Q

Supinator

A

Encircles and obscures view of proximal shaft of radius

Has superficial and deep heads which is the passage for nerve supply to enter posterior compartment

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102
Q

Extensor Indicis

A

Extensor of index finger (not a major player in pathology)

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103
Q

Extensor Retinaculum

A

Vertical Septa separate tendons into 6 compartments numbered lateral to medial

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104
Q

Layers of Palm

A
  1. Skin and palmaris brevis
  2. Palmar aponeurosis*
  3. Thenar and hypothenar muscles
  4. Neurovascular plane
  5. Long flexor tendons^ and lumbricals
  6. Adductor pollicis and neurovascular plane
  7. Interossei and metacarpals

*does not cover layer 3 muscles. Inserts into skin creases at base of fingers, flexor tendons, and bases of proximal phalanges.

^ synovial sheath for middle three fingers ends just distal to flexor retinaculum and starts again as separate sheath lining fibrous sheath over phalanges

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105
Q

Intrinsic Muscles of the Hand (Anterior)

A

All For One
And
One For All

Abductor Pollicis Brevis
Flexor Pollicis Brevis
Opponens Pollicis

Adductor Pollicis Brevis

Opponens Digiti Minimi
Flexor Digiti Minimi
Abductor Digiti Minimi

All arise from flexor retinaculum and adjacent carpal bones

Adductor pollicis Brevis arises from shaft of 3rd metacarpal and base of 2nd and 3rd metacarpal and attaches to proximal phalynx of thumb

Abductors and Flexors insert into proximal Phalynx
Opponens inserts into metacarpals

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106
Q

Lumbricals

A

Arise from Flexor Digitorum Profundus Tendons over metacarpals
Wind around radial side of heach finger inserting into dorsal extensor expansion

extend interphalangeal joints at teh same time as flexing intermetacarpal joints
wave bye-bye

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107
Q

Intrinsic Muscles of the Hand (Deep & Dorsal)

A

Palmar Interosseous muscles (3)
Originate on metacarpal medial to middle finger
Wind around finger and insert into extensor expansion
wave bye-bye

Dorsal Interosseous muscles (4)
webbing between metacarpals
wind around side lateral to middle finger and attach to extensor expansion

PAD - Palmar interosseous adduct
DAB - Dorsal interosseous abduct

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108
Q

Brachial Plexus

A

Ganglion (C7-T1)
Trunks (superior, middle, inferior) - supraclaviclular
Divisions (anterior, posterior) - behind clavicle
Cords (lateral, middle, posterior - named according to relationship to axiliary artery)
Nerves

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109
Q

Musculocutaneous Nerve

A

C5,6,7 anterior division
pierces coracobrachialis
descends in anterior compartment of arm (biceps superficial, brachialis deep)
at elbow - lateral to tendon of biceps - becomes superficial - lateral cutaneous nerve of forarm

Motor Functions:
Brachialis, Biceps brachii, Corocobrachialis .

Sensory Functions: lateral half of the anterior forearm, and a small lateral portion of the posterior forearm.

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110
Q

Ulnar Nerve

A

(C7),8.T1 anterior division
down medial side of artery
passes behind medial epicondyle (pins & needles)
slips between two heads of FCU (humoral and ulnar)
tucks in under FCU (FDP deep)
passes superficial to flexor retinaculum (next to pisiform)

Motor Functions: Innervates the muscles of the hand (apart from the thenar muscles and two lateral lumbricals), flexor carpi ulnaris and medial half of flexor digitorum profundus.

Sensory Functions: Innervates the anterior and posterior surfaces of the medial one and half fingers, and associated palm area.

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111
Q

Median Nerve

A

C5, 6, 7, 8, T1, medial & lateral root
anterior/lateral to artery
crosses diagonally in front and ends medial at elbow
comes through centre of cubital fossa
slips between fibrous arch of FDS
FDS superficial, FDP deep
beneath flexor retinaculum (carpal tunnel)

Motor Functions: Innervates most of the flexor muscles in the forearm (except FCU and half FDP), the thenar muscles, and the two lateral lumbrical muscles that move the index and middle fingers.

Sensory Functions: Gives off the palmar cutaneous branch, which innervates the lateral part of the palm, and the digital cutaneous branch, which innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand.

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112
Q

Axiliary Nerve

A

C5, 6.
Emerges above teres major

Motor Functions: Innervates the deltoid, teres minor and the long head of the triceps brachii.

Sensory Functions: Gives off the superior lateral cutaneous nerve of arm, which innervates the inferior region of the deltoid (“regimental badge area”).

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113
Q

Radial Nerve

A

C5, 6, 7, 8, T1
Emerges below teres major
runs diagonally across posterior aspect of shaft of humerus (prone to injury)
tucks in under cover of brachioradialis
splits into (superficial) radial nerve and (deep) posterior interosseous
superficial - continues under brachioradialis, onto back of hand, over anatomical snuff box onto dorsum of hand
deep - passes through supinator to deep layer of posterior compartment and supplies all 12 muscles

Motor Functions: innervates the triceps brachii, and the extensor muscles in the posterior compartment of the forearm.

Sensory Functions: Innervates the posterior aspect of the arm and forearm, and the posterior, lateral aspect of the hand.

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114
Q

Arteries of Upper Arm Segments

A 
SUBCLAVIAN
(outer border of first rib)
AXILARY
(lower border of teres major)
BRACHIAL
(elbow joint)
RADIAL & ULNAR

Main arteries are on flexor segments so they aren’t stretched

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115
Q

Veins of Arm

A

DEEP VEINS
usually paired vena comitantes
connected at intervals by short transverse branches
relatively small, most drainage is superficial

SUPERFICIAL VEINS
commence at dorsal venous arch (fist forces blood in)
BASILIC and CEPHALIC veins come from medial and lateral sides of dorsal venous arch

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116
Q

Basilic Vein

A

From medial side of DORSAL VENOUS ARCH
winds around ulnar border to anterior surface
pierces fascia on medial side of biceps
joins with brachial veins to form AXILIARY VEIN

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117
Q

Cephalic Vein

A

From lateral side of DORSAL VENOUS ARCH
winds around radial border of forearm to anterior surface
gives off MEDIAL CUBITAL VEIN
runs up lateral side of biceps into deltopectoral groove to merge with AXILIARY VEIN

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118
Q

Axiliary Artery

A

3 segments based on relationship to pec minor
- above, distal, deep

supplies wall of axila, anterior chest, and anastamoses around humerus

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119
Q

Brachial Artery

A

Starts medial to humerus, at elbow becomes anterior
Tendon of biceps lateral
Brachial artery in middle
Median nerve medial

Gives off PROFUNDUS BRACHII (deep brachail artery)
winds around back of humerus diagonally into posterior compartment, runs together with radial nerve

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120
Q

Radial Artery

A

Tucks under cover of brachioradialis with superficial branch of radial nerve
Wind onto back of dorsum of hand
radial artery passes beneath tendons of anatomical snuffbox (abd policus longus, ext policus brevis)
radial nerve forms part of the roof
superficial palmar branch crosses superficial to flexor retinaculum and onto superficial part of hand

Gives off DEEP PALMAR ARCH (more proximal than superficial palmar arch)

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121
Q

Ulnar Artery

A

Disappears under cover of FCU with ulnar nerve
Crosses superficial to flexor retinaculum (exposed to wrist lacerations)
Gives rise to SUPERFICIAL PALMAR ARCH

Gives off COMMON INTEROSSEOUS ARTERY (split into posterior and anterior)

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122
Q

White matter vs Grey matter

A

White matter = myelinated

Grey matter = cell bodies

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123
Q

Spinal Nerve Ending

A

L1/L2

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124
Q

Thalamus

A

Part of diencephelon

Major sensory relay to cortex
Many subnuclei

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125
Q

Hypothalamus

A

Part of diencephalon

Regulates homeostasis (temp, blood volume / pressure, ion concentration, pH, O2, glucose)
Controls pituitary
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126
Q

Peripheral Nerve Layers

A

Axon
Schwann Cells
Endoneurium - loose supporting tissue within fascicle
Perineurium - surrounds fascicle
Epineurium - surrounds collection of fascicles

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127
Q

Meissner Corpuscles

A 
Epidermis
Rapidly Adapting
High Density
40% of total
Type II (Aβ) Fiber
Dynamic Deformation, skin motion, detecting slipping objects
128
Q

Merkel Complexes

A 
Epidermis/Dermis 
Slowly Adapting
Smallest Receptor Field
25% of total
Type II (Aβ) Fiber
Fine tactile, form and texture
129
Q

Ruffini Organs

A 
Dermis
Slowly Adapting
Sensitive to stretch and direction, position
Proprioceptive
20% of total
Type II (Aβ) Fiber
130
Q

Pacinian Corpuscles

A 
Dermis/Subcutaneous
Rapidly Adapting
Low density
Most sensitive
Vibration (e.g. when grasping)
15% of total
Type II (Aβ) Fiber
131
Q

Proprioception

  • Receptor Type
  • Afferent Axon Type
  • Axon Size
  • Conduction Velocity
A

Muscle Spindle (around individual muscle fibres)

Type Ia (Aα) Fiber Ia, 
Type II (Aβ) Fiber

12-30µm (largest)

80-120 m/s

132
Q

Touch

  • Receptor Type
  • Afferent Axon Type
  • Axon Size
  • Conduction Velocity
A

Merkel, Meissner, Pacinian, Ruffini

Type II (Aβ) Fiber

6-12µm

35-75 m/s

133
Q

Pain / Temperature

  • Receptor Type
  • Afferent Axon Type
  • Axon Size
  • Conduction Velocity
A

Free nerve endings

Type III (Aδ) Fiber

1-5µm

5-30 m/s

134
Q

Pain / Temperature / Itch

  • Receptor Type
  • Afferent Axon Type
  • Axon Size
  • Conduction Velocity
A

Free nerve endings (unmyelenated)

Type IV (C) Fiber

  1. 2-1.5µm
  2. 5-2 m/s
135
Q

End of Spinal Cord

A

L1/2

Lumbar puncture at L3/4 into Cauda Equina

136
Q

Foramen of Skull and their structures

A

Cribriform Plate - CNI
Optic Canal - CNII, Opthalamic Artery
Superior Orbital Fissure - CNIII, CNIV, CNV1, CNVI
Foramen Rotundum - CNV2 (maxillary)
Foramen ovale - CNV3 (mandibular)
Foramen Spinosum - Middle Meningeal Artery
Foramen Lacerum - Filled with cartilage - internal carotid exits here towards cavernous sinous and exits under optic canal
Internal Auditory Meatus - CNVII, CNVIII
Jugular Foramen - CNIX, X, XI, sigmoid sinus / internal jugular
Hypoglossal Canal - CNXII

137
Q

Veins of Skull

A

Emissary - drain blood from scalp (can infect sinuses)
Diploic - drain spongy bone
Supperior Saggital Sinus
Superior Cerebral Veins (drain into saggital sinus)
Inferior Saggital Sinus
Great Cerebral Vein
Straight Sinus
Confluence of Sinuses
Transverse Sinus
Sigmoid Sinus (at petrous part of temporal bone)
Inferior Petrosal Sinus
Superior Petrosal Sinus
Cavernous Sinus (either side of body of sphenoid)

138
Q

Middle Meningeal Artery origins

A

Enters through Foramen Spinosum and branches to Anterior / Posterior divisions
Lies in extradural space (fracture of Pterion can rupture artery)

Largest, most important branch of maxillary artery
Maxillary artery branches from External Carotid (also gives off Superficial Temporal and Occipital arteries)

139
Q

Layers of SCALP

A

Skin
Connective Tissue (dense - contains neurovascular structures)
Aponeurotic Layer (of occipotofronralis)
Loose Connective Tissue (allows scalp to move)
Pericranium / Periosteum

Fibrous septa in connective tissue hold vessels open and decrease ability to clot
Rich anastamosis of branches of external/internal carotids
Small lacerations will bleed profusely

140
Q

Occipitofrontalis

A

Wrinkles Forehead (frontalis) / Raises Eyebrows (w/ occipitalis)

From external occipital protruberance to supraorbital margins (eyebrows)
Extends laterally to zygomatic arches

Lacerations of aponeurosis will gape (frontalis & occipitalis will pull in either direction)

141
Q

Muscles of Facial Expression (4 layers)

A

Same as SCALP but missing loose connective tissue (L)
Instead of aponeurosis has muscles of facial expression
- obicularis (around orrifices)
- levators/depressors
Attach to skin of face and bone/fascia underlying - produce expression
Supplied by CNVII

142
Q

Dermatomes of Head & Neck

A

VI (opthalmic) - nose, eyes, posterior to level of ears
V2 (maxillary) upper lip, cheek, temporal
V3 (mandibular) - chin, jaw, anterior to ears
X (auricular branch) - external meatus
Cervical Plexus - Neck & behind ear
C2/C3 posterior head and neck

143
Q

Arterial Supply of Face and skull

A 
(branches from external carotid artery)
Lingual Artery (deep to hyoglossus)
Facial Artery (winds over inferior angle of mandible, tortuous course towards medial angle of eye)
Superficial Temporal Artery
Posteterior Auricular Artery
Occipital Artery
Ascending pharyngeal

(branches of opthalmic artery / internal carotid)
Supratrochlear branches
Supraorbital branches

144
Q

Parotid Gland

A

Serous Salivery Gland
Sits below Zygomatic Arch, in front of mastoid process pf temporal bone, above angle of mandible, behind massiter, superficial to styloid process
Wrapped in dense fibrous fascia (mumps is inflammation of glands - causes pain when fascia stretches)
Produces Saliva, duct emerges from anterior aspect of gland, onto massiter, turns inwards, pierces buccinator and enters oral cavity near second upper molar.

145
Q

CNI

A

Olfactory Nerve
Sensory (smell)
Exit: Cribriform Plate

Special Somatic - Smell

146
Q

CNII

A

Optic Nerve
Sensory (sight)

Exit: Optic canal

Some axons cross optic chiasm
Travel to Lateral Genticulate Nucleus within Thalamus
Thalamus to visual cortex (optic radiation)
- temporal: superior visual field
- parietal: inferior visual field

Special Somatic - Vision

147
Q

CNIII

A

Occulomotor
Motor

Exit: Superior Orbital Fissure

Nuclei:

  • Midbrain General Somatic Motor (Superior Rectus, Inferior Rectus, Medial Rectus, Inferior Oblique, levator palpebrae superioris)
  • Midbrain General Visceral Motor (parasympathetic from Edinger Westphal nucleus - iris/sphincter pupillae[pupils], ciliary muscle[accomodation])

Dysfunction:
Down and out, ptosis, dilation (mydriosis)
third nerve paulsy due to uncal herniation

148
Q

CNIV

A

Trochlear
Motor

Exit: Superior Orbital Fissure
Exits dorsal surface of brainstem & crosses to contralateral side

Nuclei:
- Midbrain General Somatic Motor (Superior Oblique)

Dysfunction:
Diplopia (double vision) - can’t look down and in

149
Q

CNV

A

Trigeminal Nerve
Mixed (motor and sensory)
Nuclei:
- Midbrain General Somatic Sensory [mesencephalic-proprioception]
- Pons General Somatic Sensory [chief sensory - temp/touch]
- Pons/Medulla/Spinal Cord General Somatic Sensory [spinal trigeminal nucleus - pain]
- Pons Branchial Motor (motor nucleus - mastication, mylohyoid, tensor tympani, tensor veli palatini)

(trigeminal ganglion sits at petrous part of temporal bone)
V1 - OPTHALAMIC (superior orbital fissure)
- supraorbital
- supratrochlear
V2 - MAXILLARY (foramen rotundum)
V3 - MANDIBULAR (foramen ovale)

Sensory input from face, teeth, eyes, nose, external ear, anterior 2/3 tongue (lingual) & dura
Mastication & mylohyoid
Lateral & Medial pterygoids 
Temporalis
Tensor Tympani (inner ear)
Tensor Veli Palatini (raise soft palate)
150
Q

CNVI

A

Abducent Nerve
Motor
Exit: Superior Orbital Fissure

Nuclei:
- Pons General Somatic Motor (Lateral Rectus)

Dysfunction:
Diplopia (double vision) - can’t abduct

151
Q

CNVII

A

Facial Nerve
Mixed (motor and sensory)

Wraps around behind CNVI nucleus
Exit: Internal Acoustic Meatus

Nuclei:

  • Pons Branchial Motor (facial expression, stapedius, digastric)
  • Pons General Visceral Motor (parasympathetic/greater petrosal - lacrimal, sublingual, submandibular salivary glands)
  • Pons/Medulla/Spinal Cord General Somatic Sensory (small region near external auditory meatus)
  • Medulla General and Special Visceral Sensory (nucleus solitarius - chorda tympani - taste anterior 2/3)

Exits skull via stylomastoid foramen (through internal auditory meatus), between mastoid and styloid process inferior
gives off posterior auricular nerve and supplies occipitalis (and digastric)
enters posteromedial surface of parotid
creates plexiform arrangement (pes anserinus)
gives off 5 terminal branches
- Temporal (frontalis)
- Zygomatic (orbicularis occuli)
- Buccal (buccinator)
- Mandibular (orbicularis oris)
- Cervical (platysma - clench teeth)

152
Q

CNVIII

A

Vestibulocochlear
Sensory
Exit: Internal Auditory Meatus

Nuclei:

  • Pons/Medulla Special Somatic (hearing/equilibrium)
  • Pons Special Somatic (hearing/equilibrium)

Dysfunction:
Nystagmus, vertigo, hearing loss, tinitus

153
Q

CNIX

A

Glossopharyngeal
Mixed (motor and sensory)
Exit: Jugular Foramen

Nuclei:

  • Medulla: Branchial Motor (nucleus ambiguus - stylopharyngeus)
  • General Visceral Motor (parasympathetic to parotid - from inferior salivatory nucleus)
  • Pons/Medulla/Spinal General Somatic (pharynx, middle ear, posterior 1/3 touch)
  • Medulla General and Special Visceral (nucleus solitarius - taste post 1/3, carotid body)
154
Q

CNX

A

Vagus
Mixed (motor and sensory)
Exit: Jugular Foramen
Inside carotid sheath, alongside trachea, posterior to hilum of lung, anterior to oesophegus

Nuclei:

  • Medulla Branchial Motor (nucleus ambiguus - levator palati, pharynx, larynx, upper oesophegus, soft palate, palatoglossus(tongue))
  • Medulla General Visceral Motor (dorsal motor nucleus - parasympathetic - organs from pharynx to abdomen)
  • Pons/Medulla/Spinal General Somatic Sensory (pharynx, larynx, oesophagus, behind ear & auditory meatus)
  • Medulla General and Special Visceral (nucleus solitarius - baroreceptors and chemoreceptors of aortic arch, afferents from visceral organs)

Dysfunction:
Hoarse voice, dysphasia

155
Q

CNXI

A

Spinal Accessory (upper 5-6 of cervical spinal cord)
Motor
Exit: Jugular Foramen (enters via Foramen Magnum)
Heads beneath or through sternocleidomastoid to floor of posterior triangle, crosses obliquely on levator scapulae and dissapears under trapezius)

Nuclei:
- Spinal Branchial Motor (sternocleidomastoid, upper trapezius)

Dysfunction:
Won’t be able to shrug ipsilateral shoulder,
can’t turn head to contralateral side

156
Q

CNXII

A

Hypoglossal
Motor
Exit: Hypoglossal Foramen

Nuclei:
Medulla General Somatic Motor (tongue intrinsic and extrinsic - hyoglossus, genioglossus, styloglossus) (all except palatoglossus)

Dysfunciton:
Tongue deviates towards side of lesion

157
Q

Cranial Nerve Nuclei in Motor Columns (medial to lateral)

  • General Somatic
  • Branchial (gill/face)
  • Visceral
A 
General Somatic
CNIII (eye)
CNIV (eye)
CNVI (eye)
XI (neck muscles)
XII (tongue)

Branchial
V (mastication)
VII (facial expression)
X & IX (nucleus ambiguus - levator palati, stylopharyngeus)

Visceral
III (edinger-westfall nucleus - pupil/iris)
VII (superior salivatory nucleus)
IX (inferior salivatory nucleus)
X (dorsal motor nucleus of vagus)
158
Q

Cranial Nerve Nuclei in Sensory Columns (medial to lateral)

  • General/Special Visceral
  • General Somatic (pain/fine touch)
  • Special Somatic
A

General/Special Visceral
VII, IX, X (nucleus solitarius) - taste & autonomic
I (smell)

General Somatic
V (sensation of face and cranial dura)
V,VII,IX,X (skin behind ear & auditory meatus)

Special Somatic
VIII (hearing and equilibrium)
II (vision)

159
Q

Reticular Formation

A

In tegmentum. Thalamus -> grey of spinal cord

Rostral (midbrain & upper pons): maintain alert conscious state, modulate forebrain activity (reticular activating system)

Caudal (pons & medulla): carry out important motor reflex and autonomic functions through cranial nerve nuclei and spinal cord (e.g. breathing, HR, etc.)

160
Q

Nucleus Ambiguus

A

Mostly Motor
Lies behind inferior olive
CNIX: stylopharyngeus
CNX: levator palati, pharynx, larynx, upper oesophegus, palatoglossus(tongue)

(soft palate muscles for speech and swallowing)

161
Q

Nucleus Solitarius

A

Extends from Pons to nucleus gracilis (mostly medulla)

Rostral (gustatory nucleus);
afferents from taste and palate (VII, IX, X)

Caudal (visceral sensory)
afferents from heart, abdominal viscera, aortic body (X)
baroreceptors & chemoreceptors from carotid body and sinus (IX)

mediate the gag reflex, the carotid sinus reflex, the aortic reflex, the cough reflex, the baroreceptor and chemoreceptor reflexes, several respiratory reflexes and reflexes within the gastrointestinal system regulating motility and secretion.

162
Q

Brain XRAY, MRI, CT, Ultrasound

A

XRAY
- shows skull and bony lesions

MRI

  • best for soft tissue (not bones)
  • non ionising radiation
  • fMRI track blood oxygen level
  • expensive
  • contraindicated for pt’s with metal implants
  • better contrast resolution

CT

  • positron emition tomography(identify metabolic function with glucose labelling)
  • fast
  • good for bones
  • better spatial resolution
  • Grey & White matter almost appear the same
  • Ionising RADIATION!

Ultrasound

  • used in neonates
  • fontanel act as acoustic window
  • good for viewing glands (thyroid, submandibular, carotids)
163
Q

Amygdala

A

Implicit emotional learning
Related to depression and anxiety
Kluver-Bucy Syndrome: tameness/loss of fear

164
Q

Sympathetic NS Origins

A

T1-L2
Preganglionic neurons in intermediolateral cell column

Sympathetic Chain
Prevertebral Ganglia

Generally more distant from organs

165
Q

Parasympathetic NS Origins

A

Cranial
S2-S4

Generally closer to or within organs

166
Q

Fovea

A

Area of high visual acuity
Avascular (gets nutrients form choroid)
High density of cones (colour)
No rods (nightvision)

167
Q

Lamina Cribosa

A

continuation of 1/3 of scleral fibres (dense connective tissue) in the eye creating web/holes for axons of optic nerve

In glaucoma lamina cribosa can be pushed out and damage axons travelling through it

168
Q

Blood supply to the eye

A

Central renal artery (tributary of opthalamic artery, branch of internal carotid) - supplies internal retina

Long Posterior Ciliary artery - travel in chroroid all the way to the front of the eyeball & feeds photoreceptors

Short Posterior Ciliary Artery - doesn’t travel far in choroid, supplies photoreceptors

Anterior Ciliary Artery - supplies anterior structures like conjunctiva

169
Q

Edinger-Westphall nucleus

A

Parasympathetic cranial nerve nucleus of the oculomotor nerve (cranial nerve III), supplying the constricting muscles of the Iris and the ciliary muscle.

170
Q

Photoreceptors

A

Light activates Rhodopsin -> transducin -> Phosphodiesterase -> cGMP breaks down to GMP -> Na+ influx ceases -> Cell becomes hyperpolarized -> releases less neurotransmitter (glutamate)

171
Q

Bipolar Cells (Vision)

A

ON or OFF types
Important in ‘through’/’central’ pathway
Important for spatial vision & colour vision

ON -> depolarize in response to light
OFF -> hyperpolarize in response to light

172
Q

Ganglion Cells (Vision)

A

Types: ON, OFF, M, P
Release Glutamate
Fire action potentials (increase/decrease in response to light)
Have a ‘receptive field’
synapse in LGN of thalamus
P&M cell pathways terminate in seperate layers of Primary Visual Cortex (V1)

M: Magnocellular (10%)
- big cells 
- motion 
P: Parvocellular (80%)
- small cells
- colour vision & acuity
173
Q

Amacrine Cells (Vision)

A

Lateral inhibition
Axonless
Allow us to see movement

174
Q

Horizontal Cells (Vision)

A

Lateral inhibition between photoreceptors
Use GABA (inhibitory)
respond to light by hyperpolarizing
Involved in ‘surround’ response pathway of receptive field.

175
Q

Lateral Genticulate Nucleus (LGN)

A

Thalamic relay station for visual pathway
Magnocellular Layers 1&2
Parvocellular Layers 3,4,5,6

Ipsilateral Eye Layers: 2,3,5
Contralateral Eye Layers 1,4,6

Give off Optic Radiations to Primary Visual Cortex V1 (around calcarine fissure, central vision most posterior)

176
Q

Intrinsically Photosensitive Ganglion Cell

A 
Contain melanopsin
Responsible for 
- Circadian rhythm / sleep (SCN)
- Pupil response (CNII -> OPN -> Erdinger-Westphal-> CNIII -> Ciliary Ganglion -> sphincter pupillae)
- Information about light levels
- photophobia
177
Q

Suprachiasmatic Nucleus (SCN)

A

ipGCs project to SCN in Hypothalamus

Drives circadian rhythm

178
Q

Semicircular Canals

A 
Sensory information about Head Position
Hair follicles (cupula) in Ampulla
Discharge in relation to changes in position (directional) due to flow of endolymph
179
Q

Otolith Organs (saccule & utricle)

A

Sensory information about linear acceleration

180
Q

Dorsal Visual Stream

A 
Area MT (Middle Temporal Lobe) specialized for processing object motion
Directional selective
Respond to different types of motion
181
Q

Ventral Visual Stream

A

Area V4
Orientation and colour selective
Important for perception of shape and colour

Area IT (Inferior Temporal)
Major output area of V4
Important for visual memory and perception (esp faces)

182
Q

Ossicles

A

Bones of middle ear
Malleus
Incus
Stapes

Match impedance of air to impedance of fluid within inner ear
Size: 20:1 (tympanic membrane&raquo_space; oval window)
Lever action 1.3:1

183
Q

Lower Motor Fiber

  • Efferent Axon Type
  • Axon Size
  • Conduction Velocity
A

Type α (Aα) Fiber,

13-20µm

80-120m/s

184
Q 
Sensory Fiber & associated receptor
Type Ia (Aα)
Type Ib (Aα)
Type II (Aβ)
Type III (Aδ)
Type IV (C)
A

Ia - muscle spindle
Ib - golgi tendon organ
II - muscle spindle & cutaneous mechanoreceptors
III - touch and pressure noiceceptors, temp (cold)
IV - noiceceptors, temp (warmth)

185
Q

Basal Ganglia

A

In telencephalon
Help Motor Cortex formulate and execute movement
Allow selection of patterns (‘subroutines’)
Evaluate success of actions in achieving goals
Initiate movement
Damage leads to Parkinsons & Huntingtons

Striatum (caudate and putamen)
Globus Pallidus (GPi & GPe)
Subthalamic Nucleus
Substantia Nigra

Direct (select subroutines)
MC (+)-> Striatum (-)-> GPi (-)-> Thalamus (+)-> SMC

Indirect (suppress movement)
MC (+)-> Striatum (-)-> GPe (-)-> Subthalmic (+)-> GPi (-)-> Thalamus (+)-> SMC

Initiation
MC (+)-> Striatum (-)-> Sub Nigra (+)(-)-> Striatum (direct or indirect)

186
Q

Middle Cerebral Artery

A

Origin: ICA (bifurcation with ACA)
Gives of lenticulostriate arteries (supply basal ganglia and internal capsule)

Supplies: Lateral surface
Territories: motor & sensory (except lower limb), parieto-occipital association, language (on dominant side)

187
Q

Anterior Cerebral Artery

A

Origin: ICA (bifurcation w/ MCA)
has anterior communicating artery (gives off small branches to supply optic chiasm & anterior hypothalamus)

Supplies: Medial frontal and parietal lobes
Territores: Motor & sensory (lower limbs)

188
Q

Posterior Cerebral Artery

A

Origin: Basilar (from joining of vertebral)
give off small brances to ventral midbrain, thalamus, posterior hypothalamus

Supplies: Medial and inferior temporal and occipital lobes
Territores: visual cortex

189
Q

Misc CNS arteries

  • Opthalmic
  • Anterior Choroidal
  • Superior Cerebellar Artery
  • Pontine perforating arteries
  • Anterior Inferior Cerebellar Artery
  • Posterior Inferior Cerebellar Artery
  • Anterior Spinal Artery
  • Posterior Spinal Artery
A

Opthalmic: from ICA to optic cavity, top of nasal cavity, and frontal scalp
Anterior Choroidal: from ICA to structures in deep lateral hemispheres, optic tract, lateral ventricles, hippocampus
SCA: from basilar artery
Pontine: from basilar to Pons
AICA: from basilar a.
PICA: from basilar or vertebral a.
Anterior Spinal: from both vertebral a. (& segmental branches of aorta)
Posterior spinal: one from each vertebral a. (& segmental branches of aorta)
*spinal arteries anastamose through circumferential branches

190
Q

Cochlea Structure

A 
Scala Vestibuli
Scala Media (endolymph - high K+)
- stria vascularis (recycle K+)
- tectorial membrane
- inner hair cells (project ot brainstem nuclei)
- outer hair cells (amplify movements of basilar membrane)*
- basilar membrane (wider at apex)
Scala Tympaniy (perilymph - low K+)

*antibiotics cause loss of OHC & loss of hearing (100 fold less sensitive)

191
Q

Blood Supply of Nasal Cavity

A

SUPERIOR
- ethmoidal arteries (branches of opthalmic arteries)
INFERIOR
- greater palatine artery (branch of maxillary artery - ECA)
POSTERIOR
- sphenopalatine artery (branch of ECA) - nosebleed (epistaxis)
ANTERIOR
- superior labial arteries (branch of facial artery)
- lateral branch of facial arteries (from ECA)
- anastomoses from superior/inferior/posterior

192
Q

Nerve supply of Nasal Cavity

A 
SUPERIOR/ANTERIOR
- CNI - olfactory
- CNV1 - Anterior ethmoidal nerves
INFERIOR/POSTERIOR
- CNV2 - Greater/Lesser palatine
193
Q

Pharynx Range

A

Base of skull -> C6

194
Q

Cerebellum

A

Coordinate Timing and Sequence
Maintain Muscle Tone
Motor Learning
Planning Sequences of muscle activation for complex movement

ATAXIA: inability to integrate / cordinate movement
Effects of unilateral lesion are ipsilateral

Anterior Lobe Syndrome:

  • ataxic gait (drunken sailor) - can’t walk in a line
  • loss of inter-limb coordination (heel-shin test)

Posterior Lobe Syndrome:

  • Dysmetria (nose-finger overextension)
  • Dysdiadochokinesia (rapid alternate movements - palm test)
  • Speech abnormality (slurring, explosive speech)

Flocculonodular Lobe Syndrome:
- Truncal Ataxia (can’t stabilize trunk)

195
Q

Hippocampus

A

In Medial Temporal Lobe
Critical for learning and memory

Most sensitive structure for induction of seizures (epilepsy)

196
Q

Venous Drainage of Skull

A 
Superior Venous Sinus
Inferior Venous Sinus
Great Cerebral Artery
Straight Sinus
Confluence
Transverse Sinus
Sigmoid Sinus
Petrosal Sinus (inferior superior)
Cavernous Sinus
Superior Orbital Vein
197
Q

Muscles of tongue (intrinsic, extrinsic) & mouth

A

Floor of Mouth:
Digastric -
Mylohyoid - (large) mandible to hyoid
Geniohyoid - (small) mandible to hyoid

Extrinsic Tongue:
Genioglossus - tongue to mandible (protrude tongue) -XII
Palatoglossus - tongue to palate (elevate tongue) - X
Styloglossus - tongue to styloid process (retract tongue) - XII
Hypoglossus - tongue to hyoid (depress tongue) -XII

Intrinsic Tongue:
Transverse, vertical, superior/inferior longitudinal - XII

198
Q

Tongue innervation

  • motor
  • sensory (touch)
  • sensory (taste)
A

Motor:
XII (except palatoglossus - X)

Sensory (touch):
Ant 2/3 - V3
Pos 1/3 IX

Sensory (taste):
Ant 2/3 - VII
Pos 1/3 - IX

199
Q

Teeth #

A

Incisors (4)
Canine (2)
Premolars (4)
Molars (6) - including wisdom

x2 for upper and lower

supplied by superior/inferior alveolar nerve - V2/V3
supplied by maxillary artery -> alveolar arteries

200
Q

Larynx length

A

Epiglottis -> C6/lower border of cricoid

201
Q

Structures of larynx

A 
Hyoid bone
Epiglottic cartilage
Thyroid cartilage (open posteriorly)
Cricoid cartilage (lamina & arch)
Arytenoid cartilages (vocal & muscular processes)
vestibular fold (false vocal chords)
vocal ligaments (adduct = phonation)

Muscles
Posterior cricoarytenoid (abduct vocal ligaments)
Lateral cricoarytenoid (adduct vocal ligaments)
cricothyroid (lengthen vocal fold)
vocalis / thyroarytenoid (relax vocal fold)
transverse/oblique arytenoids (close rima glottis)

Nerves
superior laryngeal
- external laryngeal (cricothyroid muscle)
- internal laryngeal (sensory above vocal ligaments)
inferior laryngeal (sensory below vocal ligaments)
recurrent laryngeal (all other muscles - hoarse voice)

Blood supply
superior laryngeal vessels (lateral to larynx)
inferior thyroid vein (medial to larynx)

202
Q

Tracheotomy location

A

cricothyoid membrane

203
Q

Anterior Triangle of Neck

  • Borders
  • Structures
A

Mandible, Sternocleidomastoid, Manubrium

204
Q

Posterior Triangle of Neck

  • Borders
  • Structures
A

Behind sternocleidomastoid, in front of trapezius, above medial 1/3 of clavicle

Transmitting structures to upper limb and back (e.g. brachial plexus)

205
Q

Organisation and Fasica of Neck

  • Superficial Fascia
  • Investing Fascia
  • Pretracheal/Buccopharyngeal Layer
  • Prevertebral Layer
  • Carotid Sheath
A

SUPERFICIAL

  • platysma (blends with muscles of face - CNVII)
  • EJV (angle of mandible -> descent on SCM)
  • AJV

INVESTING

  • trapezius
  • sternocleidomastoid (SCM)

[between] - strap muscles
Suprahyoid msucles (hyoid to skull - elevate larynx)
Infrahyoid muscles (hyoid to sternum/clavicle/etc - depress larynx)
innervated by anterior rami of cervical nerves

PRETRACHEAL(to hyoid)/BUCCPHARYNGEAL

  • Thyroid / Parathyroid
  • Thymus
  • Trachea
  • Oesophegus

PREVERTEBRAL
- vertebra
- scalenus anterior (attach to anterior tubercles & first rib)
(subclavian & brachial plexus passes between)
- scalenus medius (attach to posterior tubercles & first rib)
- longus colli (maintains curvature of lordosis)

CAROTID (expansile)

  • Carotid
  • Jugular
  • Vagus
206
Q

Cervical Vertebra Features

A

NERVE ROOTS PASS IN FRONT FACET JOINTS!

Transverse mass - anterior & posterior tubercles w/ transverse foramen

bifid spinous process (increased surface area for muscle attachment) - C7 has longest

articular surfaces at 45degrees w/ uncinate processes on C3-6 (keep movement in saggital plane) - innervated by posterior rami

Largest intervertebral discs throughout vertebral column (prolapse usually trauma related)

207
Q

Atypical Cervical Vertebra Features

  • Atlas
  • Axis
A

NERVE ROOTS PASS BEHIND FACET JOINTS!

Atlas (C1)

  • No body
  • anteiror/posterior arches
  • facet for dens
  • saucer-shaped upper surfaces for occipital condyles
  • longest transverse process
  • loose fibrous capsule permits nodding (F/E) - 20% of ROM

Axis (C2)

  • Dens (odontoid process) - body from C1 (atlas)
  • 2 lateral facet joiunts
  • allow 50% of spinal rotation
  • Strong spinous process (muscles of stabilisation)
  • rectus capitis posterior major/miinor
  • superior/inferior oblique
  • Ligaments stabilize dens (endagement of cord)
  • transverse ligament / cruciform
  • alar ligaments (resist range of rotation of head around dens)
208
Q

Internal Carotid Course & Branches

A

Branch of common carotid (C4)
runs in carotid sheath
through carotid canal, above foramen lacerum, through cavernous sinus
gives off opthalmic, MCA, ACA, anterior choroidal, posterior communicating

Contains carotid sinus and body

209
Q

External Carotid Course & Branches

A 
Branch of common carotid (C4)
Anterior Branches
- Superior thyroid artery
- Lingual artery
- Facial artery

Posterior Branches

  • Occipital
  • Posterior Auricular (behind ear)

Deep
- Ascending pharyngeal artery

Terminal

  • Maxillary artery (middle meningeal, sphenopalatine, alveolar)
  • Transverse facial (eye level)
  • Superficial temporal artery

**Some Anatomists Like Freaking Out Poor Medical Students

S - superior thyroid artery
A - ascending pharyngeal artery
L - lingual artery
F - facial artery
O - occipital artery
P - posterior auricular artery
M - maxillary artery
S - superficial temporal artery
210
Q

Level of bifurcation of carotid artery

A

C4

C3/4 is also upper border of thyroid cartilage

211
Q

Ligaments of Cervical Spine

A

Resist movement in saggital plane (F/E) - susceptible to whiplash injury

Ligamentum Nuchae (from supraspinatus)

ATLAS to occiput
Posterior atlanto-occipital membrane (from ligamentum flavum)

AXIS to occiput
Anterior atlanto-occipital membrane (from anterior longitudinal ligament)
Membrana tectoria (from posterior longitudinal ligament)
212
Q

Thyroid

A

Between Tyroid cartilage & 6th Tracheal ring
Isthmus between 2nd & 3rd Tracheal rings
encased in pretracheal fascia

50% of cases have pyramidal lobe
Descends from Foramen Caecum during development

Superior Thyroid Artery (from external carotid)
Inferior thyroid artery (from subclavian)
(10%) Thyroid ima artery (subclavian)

Superior Thyroid Veins (IJV)
Middle Thyroid Veins (IJV)
Inferior Thyroid Veins (subclavian)

Internal/External branch of superior laryngeal (CNX)
recurrent laryngeal (CNX)
213
Q

Cervical Plexus

A

from ventral rami of C1-C4

Phrenix (C3,4,5) - descends on scalenus anterior in posterior triangle into thorax

Superficial (cutaneous) (C2,3,4)

  • lesser occipital
  • greater auricular
  • transverse cervical
  • suprascapula

Deep branches
- ansa cervicalis (motor - strap muscles of neck)

214
Q

Imaging modalities of Orbit

A

CT
MRI
Ultrasound (of globe)
Dacrystogram (imaging of lacrimal duct with dye)

215
Q

Best Imaging modality for paransal sinuses

A

CT - excellent delineation of bony anatomy

MRI good for suspected soft tissue tumors

216
Q

Best imaging modality for mandible and maxilla

A

OPG (Orthopantomogram) - dentist XRAY

217
Q

Best Imaging modalities for thyroid

A

CT, Ultrasound, PET

218
Q

Best Imaging modalities for vessels

A

Ultrasound
CT/CT angiography
MRI/MRI angiography
Digital subtraction angiography

219
Q

Best Imaging modality for temporal bones

A

thin slice CT
due to complicated bony anatomy of the region

Can image:
inner ear bony labrynth
ossicles
mastoid air cells
facial nerve course
220
Q

Adrenal Layers (from outer to inner) and their products

A

Capsule
- N/A

Zona Glomerulosa
- Aldosterone

Zona Fasciculata
- Cortisol

Zona Reticularis
- Dehydroepiandrosterone (DHEA), Androgens, Oestrogens

Medulla
- Catecholamines (Adrenaline, NA, Dopamine)

221
Q

Hip joint & Acetabulum

A
  • Ilium (superior)
  • ischium (postero-inferior)
  • pubis (antero-inferior)
    meet to form lunate surface of acetabulum w/ notch
  • labrum (fibrocartilage deepens cup & increases surface area)

Blood supply via anastamoses from Medial & Lateral Femoral Circumflex Arteries from femoral artery

ligaments:
iliofemoral (front, strong - upside down V shape)
pubofemoral & ischiofemoral (behind, weak)

Cuff of ‘fixator muscles’ to stabalise head of femur (‘rotator cuff’).

  • external/outward rotators
  • run parallel to neck of femur
  • pull head of femur into socket

Gluteal muscles cover joint posteriorly
Gluteus medius & minimus abduct hip & maintain position in coronal plane (injury = trendellenberg gait)

Adductor muscles from pubis/symphisis to medial femur

Innervation:

  • Femoral (crosses in front of joint)
  • Obturator (L2,3,4 - crosses medial aspect of joint)
  • Sciatic (passes posterior and medial)

Referred pain:
FROM hip via obturator to knee/thigh
TO hip from lumbar spine

Hip dislocation usually posteriorly, endanger blood supply and sciatic nerve

222
Q

Femur

A 
Head - directed upwards, medially, forwards
- with fovea - non articular, has ligament attached regresses after puberty)
- protected by psoas bursa anteriorly
Anatomical Neck - line of growth plate
Greater Trochanter - gluteal muscles
Lesser Trochanter
Intertrochanteric Line (anterior)
Intertrochanteric Crest (posterior)

Superior Trabecular System:

  • Arcuate - resist bending forces
  • Vertical - resist compression

Inferior Trabecular system
- Medial & Lateral - resist pull on greater & lesser trochanter

Retinacular fibres provide blood supply to head of femur

223
Q

Hip close packed position

A

Hip extended
Abducted
Medially Rotated

Position of greatest stability

Ligaments taught

224
Q

Knee Joint

A

2 joints in one

  • femur with tibia (tibiofemoral)
  • femur with patella (patellofemoral)

Large ROM – most stable in extension (close packed)

Anterior & posterior cruciate ligaments (intracapsular but extrasynovial)

  • Anterior tibial to posterior lateral condyle of femur
  • Posterior tibial to medial condyle of femur
  • Primary stabilisers in A-P direction
  • PCL prone to injury w/ impact to knee during flexion

Medial & lateral collateral ligaments

  • M: resists valgus (abduction) and lateral tibial rotation, blends with capsule, attaches to meniscus, commonly injured
  • L: resists varus (adduction), seperated from meniscus by popliteus tendon

Medial condyle 1cm larger than lateral
Femur rotates medially on tibia during extension (around tight ACL in last 15-20degrees)
Active contraction of popliteus (medial surface of tibia, lateral condyle) for flexion

Condyles surrounded by meniscus (fibrocartilagenous disc)

  • increase area of contact by 33%
  • medial meniscus is longer, less mobile, prone to injury
  • ‘locked knee’ - torn meniscus & stuck
  • no meniscus -> weight focused on centre -> osteoarthritis

Capsule reinforcements:
- Anterior - patella tendon & retinacular fibres
- Lateral - popliteus, biceps femoris, iliotibial tract
- Medial - ‘pes anserinus’ - Sartorius, Gracilis, Bursa, Semiteninosus
Posterior - oblique popliteal ligament

225
Q

Pes Anserinus of Knee

A

Say Grace Before Tea

Sartorius - anterior compartment
Gracilis - medial compartment
Bursa
semiTendinosus - anterior compartment

226
Q

Patellofemoral Joint

A

Maintained by 3 structures

  • Strong vastus medialis muscle - pull patella medially
  • Medial patellar retinaculum - keep patella medial
  • Raised lip on lateral femoral condyle - prevent patella from moving laterally

Patella wants to move laterally because quadriceps aligned obliquely laterally

Problem with tracking = chondromalacia patellae

227
Q

Gluteus Maximus

A

ORIGIN: Gluteal surface of ilium & sacrum
INSERTION: posterior iliotibial tract and gluteal tuberosity
INNERVATION: Inferior gluteal nerve
ACTION: Extend, lateral rotation, abduct thigh at hip
* Similar to posterior deltoid

228
Q

Gluteus Medius & Minimus

A

ORIGIN: Superior posterior ilium
INSERTION: anterolateral aspect of greater trochanter
INNERVATION: Superior gluteal nerve
ACTION: medial rotation, abduction of hip
* similar to lateral fibres of deltoid
* prevent hip drop when walking

229
Q

Piriformis, Obutrator, Gemelli, Quadratus Femoris

A

ORIGIN: Anterior surface of sacrum exiting via greater sciatic notch, inferior pubic ramus, inferior ischial ramus
INSERTION: (gluteal region) greater trochanter
INNERVATION: from sacral plexus
ACTION: lateral rotation

Piriformis:
Trianglular muscle forming part of wall of pelvis
Arises from middle 3 segments of sacrum anteriorly
exits via greater sciatic foramen
attaches on greater trochanter
Sacral plexus lies on piriformis

Obturator internus:
arises from internal surface of obturator membrane, margins of obturator foramen, and extends onto postero-superior bony surface and exits via the lesser sciatic foramen

230
Q

Iliacus

A

ORIGIN: iliac fossa and passes beneath inguinal ligament
INSERTION: lesser trochanter
INNERVATION: femoral nerve
ACTION: Flex hip and maintains lumbar lordosis (w/ psoas)

231
Q

Muscles of medial compartment of thigh

A

Adductors of hip (mostly)

  • Pectineus
  • Gracilis
  • Adductor Brevis
  • Adductor Longus
  • Adductor Magnus
232
Q

Muscles of anterior compartment of thigh

A

Flexion of hip and extension of knee

  • Pectineus
  • Sartorius
  • Rectus Femoris
  • Vastus Lateralis
  • Vastus Intermedius
  • Vastus Medialis
  • Articularis Genus
233
Q

Muscles of posterior compartment of thigh

A

Flexion of knee

  • Biceps Femoris
  • Semitendinosus
  • Semimembranosus
234
Q

Muscles of anterior compartment of leg

A

Dorsiflex foot and extend toes
Tibialis anterior
Extensor Hallucis Longus
Extensor Digitorum Longus w/ fibularis tertius

235
Q

Muscles of posterior compartment of leg

A 
Plantarflex foot and flex toes
Gastrocnemius
Soleus
Tibialis Anterior
Flexor Hallucis Longus
Flexor Digitorum Longus
236
Q

Muscles of lateral compartment of leg

A

Evert foot
Fibularis longus
Fibularis brevis

237
Q

Tensor fascia lata

A

ORIGIN: below lateral iliac spine
INSERTION: Iliotibial tract
INNERVATION: superior gluteal nerve
ACTION: Flexes, abducts, medially rotates
* similar to anterior and lateral deltoid

238
Q

Iliotibial tract

A

Lateral thickening of fascia lata of thigh
Extends from iliac crest to lateral proximal tibia
shared aponeurotic tendon of gluteus maximus (inserts posteriorly) and tensor fascia lata (inserts superior/anterior)

  • prevent tilt/drop during swing phase
239
Q

Pectineus

A

ORIGIN: Pubic crest
INSERTION: below lesser trochanter
INNERVATION: femoral and obturator nerves
ACTION: flexion of hip w/ iliopsoas, adduction of hip w/ adductors

240
Q

Sartorius

A

ORIGIN: Anterior superior iliac spine
INSERTION: below medial condyle of tibia
INNERVATION: femoral nerve
ACTION: ‘dog poo muscle’ - sitting cross legged

241
Q

Vastus Medialis

A

ORIGIN: anterior to lesser trochanter of femur and linea aspra
INSERTION: tibial tuberosity (anterior)
INNERVATION: femoral nerve
ACTION: extensor of knee

242
Q

Vastus Lateralis

A

ORIGIN: below greater trochanter of femur and linea aspra
INSERTION: tibial tuberosity (anterior)
INNERVATION: femoral nerve
ACTION: extensor of knee

243
Q

Rectus Femoris

A

ORIGIN: Anterior inferior iliac spine and above acetabulum
INSERTION: tibial tuberosity (anterior)
INNERVATION: fermoral nerve
ACTION: thigh flexion, knee extension

244
Q

Vastus Intermedius

A

ORIGIN: Anterior shaft of femur
INSERTION: aponeurosis blends with quadriceps tendon and inserts on tibial tuberosity (anterior)
INNERVATION: femoral nerve
ACTION: extensor of knee

245
Q

Adductor longus & brevis

A

ORIGIN: Inferior pubic ramus
INSERTION: posterior femur (linea aspra)
INNERVATION: Obturator nerve
ACTION: adductor

246
Q

Adductor magnus

A

ORIGIN: Inferior pubic ramus around to ischial ramus
INSERTION: linea aspra to above medial condyle of femur
INNERVATION: Obturator nerve & sciatic (tibial)
ACTION: adductor & partial flexor of knee

247
Q

Gracilis

A

ORIGIN: Inferior pubic ramus
INSERTION: below medial condyle of tibia
INNERVATION: Obturator
ACTION: adductor

248
Q

Semitendinosus

A

ORIGIN: Inferior ischial ramus (tuberosity of ischium)
INSERTION: Inferior pubic ramus
INNERVATION: tibial nerve (from sciatic)
ACTION: Hamstring - hip extension, knee flexion

249
Q

Biceps Femoris

A

ORIGIN: Inferior ischial ramus (tuberosity of ischium) (long head), linea aspra (short head)
INSERTION: proximal lateral fibula
INNERVATION: tibial nerve (except short heat - common fibular)
ACTION: Hamstring - hip extension, knee flexion

250
Q

Semimembrinosus

A

ORIGIN: Inferior ischial ramus (tuberosity of ischium)
INSERTION: posterior medial condyle of tibia
INNERVATION: tibial nerve (from sciatic)
ACTION: Hamstring - hip extension, knee flexion

251
Q

Popliteus

A

ORIGIN: lateral condyle of femur and meniscus
INSERTION: below medial condyle of tibia
INNERVATION: Tibial nerve
ACTION: medial rotation and flexion of knee

252
Q

Tibialis anterior

A

ORIGIN: anterior aspect of shaft of tibia/fibula/interosseous membrane
INSERTION: medial cuneiform and base of first metatarsal
INNERVATION: Deep fibular nerve
ACTION: dorsiflexion and inversion

253
Q

Extensor Hallucis Longus

A

ORIGIN: anterior aspect of shaft of tibia/fibula/interosseous membrane
INSERTION: distal phalynx and middle phalynx
INNERVATION:
ACTION: big toe extension

254
Q

Extensor Digitorum Longus

A

ORIGIN: anterior aspect of shaft of tibia/fibula/interosseous membrane
INSERTION: distal phalynx and middle phalynx
INNERVATION:
ACTION: toes (except big toe) extension

*gives off Fibularis Tertius to base of 5th metatarsal

255
Q

Medial to Lateral structures of Dorsum of Foot

A

Timothy has a nasty, dirty toe

Tibialis anterior
eHl
Artery (anterior tibial / dorsalis pedis)
Nerve (deep fibular nerve)
eDl
fibularis Tertius
256
Q

Fibularis Longus

A

ORIGIN: Proximal shaft of fibula, groves cuboid, passes beneath sole of foot
INSERTION: medial cuneiform and base of 1st metatarsal
INNERVATION:
ACTION: eversion of foot

257
Q

Fibularis Brevis

A

ORIGIN: Distal shaft of fibula, groves lateral malleolus
INSERTION: base of 5th metatarsal
INNERVATION:
ACTION: eversion of foot

258
Q

Gastrocnemius

A

ORIGIN: each condyle of femur
INSERTION: achilles tendon - calcaneus of heel
INNERVATION:
ACTION:

259
Q

Soleus

A

ORIGIN: proximal tibia and fibula w/ arch for neurovascular bundle
INSERTION: archilles tendon - calcaneus of heel
INNERVATION:
ACTION:

260
Q

Flexor Digitorum Longus

A

ORIGIN: Shaft of tibia, fibular and interosseus membrane
INSERTION: 4 toes (2nd - 5th metatarsals)
INNERVATION:
ACTION:

261
Q

Flexor hallucis Longus

A

ORIGIN: Shaft of tibia, fibular and interosseus membrane
INSERTION: 1st metatarsal (big toe)
INNERVATION:
ACTION:

262
Q

Tibialis Posterior

A

ORIGIN: Shaft of tibia, fibular and interosseus membrane
INSERTION: medial cuneiform and base of 1st metatarsal
INNERVATION:
ACTION: Plantar flexion and inversion

263
Q

Structures from medial malleolus to calcaneus

A

Tom Dick and Very Naughty Harry

Tibialis posterior
fDl
Artery (posterior tibial artery)
Vein (vena comitantes)
Nerve (tibial nerve)
fHl
264
Q

Tibia & Fibula

A 
TIBIA
Weight bearing
Condyles
Intercondylar eminence
Tibial tuberosity
Soleal line
Medial Malleolus
FIBULA
Non-weight bearing, muscle attachment
Head
Shaft
Lateral Malleolus

SUPERIOR JOINT:
Synovial - anterior & posterior ligaments

INFERIOR JOINT:
Fibrous
prevents separation
- anterior, posterior, and interosseous ligaments
malleolar mortise (oblique angle)
- inferior transverse ligament
265
Q

Bones of foot (posterior to anterior)

A

Calcaneus
Talus
Navicular
Cuboid
Cuneiforms (medial, intermediate, lateral)
Metatarsals (5)
Phalanges (distal, proximal, middle - except hallux)
+ sesamoid bones - under metatarsals
+ accessory bones - unfused centres of ossification

266
Q

Lumbar Plexus

A

Ventral rami L1-L4
Within Psoas Major

From Lateral Border:
Ilioinguinal and iliohypogastric (L1)
Lateral cutaneous nerve of thigh (L2,3)
Femoral nerve (L2,3,4)

Onto Anterior Surface
Genitofemoral (L1,2)
- L1 is femoral branch
- L2 is genital branch

From medial border
Obturator (L2,3,4)

*L5 forms lumbosacral trunk and joins with sacral plexus

267
Q

Iliohypogastric & Ilioinguinal nerve

A

From Lumbar Plexus within Psoas
L1
Slip in between Transversus Abdominus and Internal Oblique and track around to supply anterior abdominal wall

268
Q

Lateral Cutaneous Nerve of Thigh

A

From Lumbar Plexus within Psoas
L2,3
Swings wide and tucks under beginning of inguinal ligament.

Supplies thigh and skin down lateral side of thigh

Can be compressed during pregnancy = numbness and tingling.

269
Q

Femoral Nerve

A

From Lumbar Plexus within Psoas
L2,3,4 posterior divisions
Emerges and tucks into gutter between iliacus and psoas
Runs under inguinal ligament (lateral to artery, vein, lymph)
Divides into terminal branches distal to ligament (2.5cm)

MOTOR to extensors (quads, sartorius, pectineus)

SENSORY to anteromedial thigh, knee, leg, ankle (up to but not beyond 1st metatarsal) via Anterior Cutaneous Branches and Saphenous Nerve
Articular branches to hip and knee

270
Q

Genitofemoral Nerve

A

From Lumbar Plexus within Psoas
L1 - femoral branch, supplies area of skin beow middle of inguinal ligament
L2 - genital branch, supplies spermatic cord

271
Q

Obturator Nerve

A

From Lumbar Plexus within Psoas
L2,3,4 anterior divisions
Crosses pelvic brim
Runs along lateral wall of pelvis into obturator canal and into medial compartment of thigh
- anterior branch (between longus and brevis)
- posterior branch (between brevis and magnus)

MOTOR to adductors (gracilis, longus, brevis, magnus, pectineus)

SENSORY to peritoneum and medial patch above knee (inflammation of peritoneum can refer pain here)
Articular branches to hip

272
Q

Sacral Plexus

A

Lumbosacral Trunk (L5) joins S1-4 on piriformis
Visceral branches to pelvic viscera
Somatic branches to walls and floor of pelvis
Somatic branches that exit pelvis with piriformis and supply structures of lower limb
- Sciatic Nerves (L4,5, S1-3)
- Superior and Inferior Gluteal Nerves
- Posterior Cutaneous Nerve of Thigh

273
Q

Sciatic Nerve

A

L4,5, S1-3 anterior and posterior divisions
Exits pelvis via Greater Sciatic Foramen
Emerges beneath Piriformis in gluteal region (posterior to hip)
Descends posterior to thigh
Divides at apex of popliteal fossa
- Tibial
- Common Fibular

MOTOR to hamstrings (tibial except SHOB - common fib.)

SENSORY via terminal branches only
Articular branchess to hip

274
Q

Tibial Nerve

A

L4,5, S1-3 anterior divisions (sciatic)
Vertical descent through popliteal fossa, beneath fibrous arch of soleus, descends on tibialis posterior, posterior to medial malleolus onto sole of foot, gives off medial and lateral plantar nerves
- lateral plantar (similar to ulnar) - supplies lateral 1.5 toes and all intrinsic muscles of sole of foot
- medial plantar (similar to median) - supplies medial 3.5 digits

MOTOR to muscles of posterior leg and sole of foot

SENSORY to posterior leg (sural nerve), heel, and sole of foot (medial calcaneal, medial and lateral plantar)

  • lateral plantar (similar to ulnar) - supplies lateral 1.5 toes and all intrinsic muscles of sole of foot
  • medial plantar
275
Q

Common Fibular Nerve

A

L4,5, S1-3 posterior divisions (sciatic)
Runs medial to biceps femoris, superficial to lateral head of gastrocnemius, winds around neck of fibula onto fibularis longus and gives off terminal branches
- deep fibular nerve (descends deep to EDL, anterior to interosseous membrane, beneath extensor retinaculum, onto dorsum of foot)
- superficial fibular nerve (descends in lateral compartment)

Deep Fibular Nerve
MOTOR to anterior compartment of leg and Extensor Digitorum Brevis
SENSORY to 1st toe cleft
Articular branches to ankle and foot

Superficial Fibular Nerve
MOTOR to lateral compartment of leg (Fibularis longus and brevis)
SENSORY to lower lateral leg and dorsum of foot

276
Q

Posterior Cutaneous Nerve of Thigh

A

Branch from sacral plexus

SENSORY to posterior thigh

277
Q

Leg Myotomes

  • Hip Flexion/Extension
  • Knee Extension/Flexion
  • Ankle Dorsiflexion/Plantarflexion
  • Foot Inversion/Eversion
  • Big to Dorsiflexion/Plantarflexion
A

HIP
L2,3 / L4,5

KNEE
L3,4 / L5,S1

ANKLE
L4,5 / S1,2

FOOT
L4 / L5, S1

BIG TOE
L5, S1 / S1, S2

278
Q

Branches of Arteries of Lower Limb

A

External Iliac
Femoral
- Profunda femoris
- Popliteal

Popliteal (under adductor hiatus)

  • Genicular anastamoses
  • Anterior Tibial
  • Posterior Tibial

Anterior Tibial
- Dorsalis Pedis (pierces first interossei)

Posterior Tibial (Inferior border of popliteus)

  • Fibular
  • Medial and Lateral Plantar (under flexor retinaculum)

Lateral Plantar artery
- swings wide and creates deep plantar arch - completed by termination of dorsalis pedis from dorsum of foot)

279
Q

Veins of Lower Limb

A

Greater Saphenous Vein (acompanies saphenous nerve)

  • from dorsal venous arch
  • anterior to medial malleolus
  • up medial side of leg
  • hands breadth behind patella
  • medial thigh
  • through saphneous opening emptying into femoral vein

Superficial Saphenous Vein

  • from dorsal venous arch
  • posterior to lateral malleolus
  • posterior leg
  • pierces deep facia and joins paired vena comitantes of anterior and posterior tibial arteries to become popliteal vein

(vertical) Superficial inguinal lymph drain lower limb
(horizontal) Superficial inguinal lymph drain abdominal wall, external genitalia, and anal canal
Drain to deep lymph (following arteries)
Superficial lymph follows veins

280
Q

Structures of Dorsum of the Foot

A
  1. EXTENSOR DIGITORUM BREVIS
    - arises from superolateral part of calcaneus, deep to long extensor tendons, joins EDL tendons
  2. EXTENSOR HOODS
    - Triangular, apex inserts into base of distal phalynx, centre of each hood attaches to sides of middle phalynx and wrapped over metatarsalphalyngeal joint
  3. DEEP FIBULAR NERVE
    - Supplies EDB (as well as extensors), sensory to webbed space between 1st and 2nd toes
  4. DORSALIS PEDIS ARTERY
    - name change of anterior tibial artery
    - gives off arcuate artery laterally which gives off metatarsal and digital arteries
    - continues to first web space and gives off deep plantar artery which dives through first dorsal interosseous and completes deep plantar arch
281
Q

Layers of Sole of Foot

A

Plantar Aponeurosis

  • thickening of deep fascia from medial process of calcaneal tuberosity dividing into five slips
  • vertical septa divide plantar aspect into medial, deep, lateral compartments
  1. Short
    - abductor digiti minimi & abductor hallucis insert into base of proximal phalynx
    - Flexor digitorum brevis splits and inserts into base of middle phalynx (FDL passes through and inserts distally)
    - arise from calcaneal tuberosity, aponeurosis and septa
    - assist and maintain arches
    - neurovascular structures run here.
  2. Long
    - FDL, FHL
    - lumbricals on medial side of toes and insert into expansion of FDL
    - quadratus plantae - arises from two heads on calcaneus and inserts into border of FDL (optimises function and straightens line of pull)
  3. Short
    - short flexor for each of the big (flexor hallucis brevis) and little toes (flexor digiti minimi brevis), and an adductor hallucis
  4. Short
    - interossei in intermetatarsal spaces
    - abduction/adduction around plane of second digit
    - 3 plantar adducting (PAD)
    - 4 dorsal abducting (DAB)
    - insertions of fibularis longus and tibialis posterior into base of first metatarsal
282
Q

Demarcation of false pelvis from true pelvis

A

iliopectineal line demarcates false pelvis above from true pelvis below

283
Q

What structures seperate the greater and lesser sciatic foramen?

A

ischial spine, sacrospinous ligament, and sacrotuberous ligament, seperates greater and lesser sciatic foramen

284
Q

Levator Ani

A

pubococcygeus and iliococcygeus (not ischiococcygeus)
Forms pelvic floor
Closes off pelvic outlet
LATERAL ORIGIN
- internal aspect of body of pubis
- along side wall of pelvis (across half of obturator internus fascia)
- to ischial spine
INSERTION
- raphe (tip of coccyx to anorectal junction)
large opening anteromedially for passage of viscera to perineum

ACTIONS:
lifts pelvic floor / anus,
w/ contraction of diagphram causes increased intraabdominal pressure and compression of pelvic contents and promotes evacuation
slings are vital for support of pelvic viscera (prolapse)
helps rotate babies head during birth

285
Q

Pubococcygeus

A
  • part of levator ani (anterior fibres)
  • origin: internal aspect of body of pubis
  • insertion: anococcygeal raphe
    (also includes puborectalis and pubovaginalis/prostaticus slings)
    overlaps iliococcygeus
286
Q

Puborectalis

A
  • anterior fibres of pubococcygeus (levator ani)
  • origin/insertion: internal aspect of body of pubis
  • sling extending around and blending with anorectal junction
  • important for fecal continence
287
Q

Pubovaginalis/Puboprostaticus

A
  • most anterior fibres of pubococcygeous (levator ani)
  • origin/insertion: internal aspect of body of pubis
  • slings around vagina / prostate
288
Q

Iliococcygeus

A
  • part of levator ani (posterior fibres)
  • origin across half of obturator internus fascia to ischial spine
  • insertion: anococcygeal raphe
289
Q

Ischiococcygeus

A
  • origin coxxyx/sacrum
  • insertion ischial spine
    (same as sacrospinous ligament)
  • used by dogs to wag tail
  • closes posterior part of pelvic floor
290
Q

Parietal fascia of pelvic cavity

A
  • covers piriformis, obturator internus, and levator ani
  • continuation of fascia of anterior abdominal wall (Fascia Transversalis)
  • continuation of fascia of posterior abdominal wall (Fascia iliacus)
291
Q

Visceral fascia of pelvic cavity

A
  • continous with extraperitoneal fat layer of abdomen
  • many thickenings (called ligaments) which are condensations of fascia around neurovascular structures
  • significant support structures to pelvic viscera
    female: rectouterine ligament
    lateral cervical (cadinal) ligament
    lateral vesical ligament
    pubovesical ligament
292
Q

Epiphysis of pelvis

A

iliac crest
ASIS & AIIS
ischial tuberosity
pubic tubercle
acetabulum
- common sites of avulsion fractures (tendon stronger than bone)
- length of time epiphysis stays open determins pelvic shape

293
Q

Boundaries of Pelvic Inlet

A
  • pubic symphysis/crest/tubercle
  • pectineal lineof pubis
  • arcuate line of ilium
  • sacral alar joint
  • body of sacrum (promotary)
294
Q

Boundaries of Pelvic Outlet

A
  • inferior margin of pubic symphysis
  • ischial tuberosity
    (sacrotuberous ligament)
  • tip of coccyx
    (can be broken up into anterior - urogenital, and posterior - anal, triangles of the perineum)
295
Q

Perineal Pouches

A
  • superficial and deep pouches
  • seperated by perineal membrane
  • superficial and deep transverse perineal muscles in posterior edge between perineal body and ischial tuberosities
  • perineal body (site of muscle attachment in posteromedial perineal membrane)
  • deep pouch contains sphincters (external urethral, sphincter urethrovaginalis)
  • roots of external genitalia attach to external surface of perineal membrane
296
Q

Ligaments of Pelvis

A
  • interosseous sacroiliac
  • iliolumbar
  • sacrotuberous
  • sacrospinous
297
Q

Boundaries of pelvic plane of least dimensions

A
  • S4 vertebra
  • through ischial spine
  • inferior part of pubis

“Pelvic Pain Line”
above = sympathetic visceral afferents nerves (above L1)
below = parasympathetic visceral afferents (S2,3,4)

298
Q

Examples of secondary cartilagenous joints

A

pubic symphysis
intervertebral discs
manubriosternal
(all have a disc)

299
Q

Obturator Foramen

A
  • covered by obturator membrane
  • gives rise to obturator internus internally
  • gives rise to obturator externus externally
  • obturator nerve, artery, vein pass through obturator canal
300
Q

Greater Sciatic Foramen

A
  • bounded by sacrospinous and sacrotuberous ligamennts
  • sciatic nerve
  • pudendal nerve, internal pudendal artery (out)
301
Q

Lesser Sciatic Foramen

A
  • bounded by sacrospinous and sacrotuberous ligamennts

- pudendal nerve, internal pudendal artery (in)

302
Q

Pudendal Nerve

A
  • branch of sacral plexus
  • arises from S2,3,4
  • exits greater sciatic foramen with piriformis
  • curls behind ischial spine
  • runs in pudendal canal on obturator internus
  • enters lesser sciatic foramen
    branches:
  • inferior rectal nerve (to external anal sphincter)
  • perineal nerve (supplies structures in urogenital triangle - motor and cutaneous including genitals)
303
Q

Broad Ligament

A

parietal peritoneum draping over uterine (fallopian) tubes and extending to side wall of pelvis
contains proper ovarian ligament attaching to ovary on posterior side of broad ligament
suspensory ligament holds ovary in place (inside peritoneum)

304
Q

Pelvic Shapes

A

50% - Gynaecoid
30% - Android
20% - Anthropoid
2% - Platypelloid

305
Q

Anteversion

Anteflexed

A

Anteversion
- curvature related to other structure (i.e. uterus & vagina)

Anteflexed
- curvature within organ (i.e. uterus)

306
Q

Bladder

A

shaped like pyramid tipped forward (apex towards pubic bone)
detrusor muscle in wall of bladder (contraction = urination)
- when full can push up peritoneum 8-10cm (suprapubic aspirate)
base of bladder has smooth triangular region - trigone - entry/exit at each point of the triangle (ureters, urethra)

307
Q

Uterus

A 
fundus, body, cervix (internal/externial uterine opening)
fallopian tubes (intramural, isthmus, ampulla, infundibulum, fimbria)
cervix stabilized by lateral cervical (cardinal) ligament
308
Q

Structures associated with bladder (male)

A
  • vas deferens (originates at epididymus, ascends as component of spermatic cord in inguinal canal, through deep ring, passes along side wall of pelvis, along lateral bladder, above ureter, to posterior bladder)
  • seminal vesicles (coiled tubules, join w/ vas deferens to form ejaculatory duct and empty into prostate/urethra)
  • prostate (between neck of bladder and levator ani, above urogenital diaphragm, anterior to rectum)
309
Q

Structures associated with bladder (female)

A
  • uterus (anteverted and anteflexed)

- uterine artery (from internal iliac artery, to uterus, passes over ureter)

310
Q

Lowest point in female peritoneum

A
  • recto-uterine pouch (pouch of douglas)

- can palpate or aspirate free fluid via vagina

311
Q

Rectum

A

beneath peritoneum, does not have mesentary

no teniae coli - span to become one longitudinal muscle coat

situated in concavity of sacrum

312
Q

Upper Anal Canal

A

upper 2/3 of anal canal divided by pectinate line

lined by mucosa

supplied by superior rectal artery (inferior mesenteric from abdominal aorta)

venous drainage to portal system

innervated by autonomic nerves (dull, poorly localised pain)

internal sphincter (thickening in smooth muscle wall under autonomic innervation)

313
Q

Lower Anal Canal

A

lower 1/3 of anal canal divided by pectinate line

lined by skin

supplied by inferior rectal artery (internal iliac branch)

venous draining to IVC

innervated by pudendal somatic nerves (sharp, intense, well localised)

deep external sphincter (fuses with puborectalis)

superficial external sphincter (attached anteriorly to perineal body and tip of coccyx)

subcutaneous external sphincter (immediately beneath skin)

314
Q

Blood supply of Pelvic Structures

A

FROM ABOVE:
- ovarian from aorta (uterus, fallopian tube, artery)
- superior rectal arteries (terminal inferior mesenteric) from aorta
FROM SIDES:
- anterior branches of internal iliac from side wall
- superior vesical arteries (paired)
- inferior vesical arteries (male - prostate and vas deferens)
- uterine artery (cervix)
- vaginal artery (female - vagina)
- middle rectal arteries

315
Q

Branches of Internal iliac artery

A

Arises at pelvic brim opposite sacroiliac joint
Posterior division (parietal branches only)
Anterior division (to visceral and parietal)
- superior vesical arteries (paired)
- inferior vesical arteries (male - prostate and vas deferens)
- uterine artery (female - in lateral cervical ligament, over ureter, gives off cervical and vaginal branches, turns upwards within broad ligament alongside uterus, along fallopian tube and and meets ovarian artery)
- vaginal artery (female - vagina)
- inferior rectal artery (anal canal)

316
Q

Male vs Female pelvis

A 
MALE
Thick and heavy
Heart Shaped
Narrow inverted v greater sciatic notch
acute subpubic arch
large acetabulum
round obturator foramen
Larger overall
FEMALE
Thin and light
Transverse oval
90 degree greater sciatic notch
obtuse subpubic arch
small acetabulum
oval obturator foramen
true pelvic inlet broader/rounder
317
Q

At what level do each of the following structures perforate the diaphragm?

  • aorta
  • oesophagus
  • IVC
A

AORTA - T12

OESOPHAGUS - T10

IVC - T8

MD1 (11 decks)

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