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MRCS Part B > Anatomy 4 > Flashcards

Anatomy 4 Flashcards

1
Q

Describe the makeup of the hip joint capsule?

A

Anteriorly arises from intertrochanteric line
Posteriorly originates from 1.5cm above the intertrochanteric crest
Ligamentum teres in the middle joining to the head of femur

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2
Q

What are the 3 ligaments of the hip joint and which is strongest?

A

Iliofemoral - strongest (Y ligament) - taut when standing so maintains upright posture
Pubofemoral
Ischiofemoral

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3
Q

Blood supply to head of femur?

A

Medial and lateral circumflex femoral arteries - from profunda femoris
Minor contributions from sup and inf gluteal arteries, artery of ligamentum teres

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4
Q

Muscle attaching to lesser trochanter?

A

Iliopsoas

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5
Q

Where does psoas major originate and what does it do?

A

2 parts deep and superficial
Deep from transverse processes L1-4
Superficial from T12-L4 bodies and discs
Flex and externally rotate hip

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6
Q

Where does the iliotibial tract go from and to and what does it do? What muscles are related?

A

From iliac crest - anterolateral iliac tubercle
To lateral tibial condyle (of Gerdy)
Tensor fascia lata keeps taught - keeps extension stable, important in walking and running
Also gluteus maximus

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7
Q

Where does gluteus maximus insert? Nerve supply?

A

Gluteal tuberosity of femur
Iliotibial tract
Inferior gluteal nerve - L5-S2

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8
Q

Action of gluteus maximus?

A

Hip extender and external rotator

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9
Q

Nerve supply of tensor fascia lata?

A

Superior gluteal nerve

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10
Q

2 muscles inserting on greater trochanter of femur? Their roles?

A

Gluteus medius and minimus

Hip abduction when standing, when walking prevents pelvic drop

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11
Q

Where may the superior gluteal nerve be damaged during surgery and what may this cause?

A

Passes 5cm superior to greater trochanter - may be damaged during hip surgery which would cause Trendelenburg / hip drop

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12
Q

Roots and surface marking/route of sciatic nerve?

A

L4-S3
Exits pelvis via greater sciatic foramen below piriformis
Surface marking is a curved line between 1/2 PSIS to ischial tuberosity, and 1/2 ischial tuberosity to greater trochanter

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13
Q

Things exiting greater sciatic foramen above piriformis?

A

Superior gluteal nerve, artery and vein

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14
Q

Things exiting greater sciatic foramen below piriformis?

A 
Inferior gluteal artery and vein
Sciatic nerve
Pudendal nerve
Inferior gluteal nerve
Posterior femoral cutaneous nerve
Nerve to quadratus femoris
Nerve to obturator internus
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15
Q

Things exiting lesser sciatic foramen?

A 
Internal pudendal artery and vein
Pudendal nerve (re-enters pelvis)
Obturator internus tendon and nerve
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16
Q

What separates the greater and lesser sciatic foramen?

A

Sacrospinous ligament - from sacrum to ischial spine

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17
Q

Borders of greater sciatic foramen?

A

Superior - Anterior sacroiliac ligament
Posteromedial - sacrotuberous ligament
Anterolateral - Greater sciatic notch of ilium
Inferior - sacrospinous ligament and ischial spine

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18
Q

Borders of lesser sciatic foramen?

A

Superior - sacrospinous ligament and ischial spine
Anterior - ischial spine, lesser sciatic notch and ischial tuberosity
Posterior - sacrotuberous ligament

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19
Q

What variations may occur in the sciatic nerve exiting the pelvis?

A

May split and go above and below piriformis
Or all above
However usually goes below

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20
Q

What muscles attach to the greater tuberosity of humerus?

A

Supraspinatus, infarspinatus and teres minor

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21
Q

Where does subscapularis attach?

A

Lesser tuberosity of humerus

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22
Q

Where on the humerus is the spiral groove?

A

Posterolateral

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23
Q

What runs in the spiral groove of the humerus? What would injury here cause?

A

Radial nerve

Injury would cause wrist drop and loss of sensation of 1st dorsal webspace

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24
Q

What is the only thenar muscle affected in an ulnar injury?

A

Adductor pollicis

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25
What lies in the bicipital (intertubercular) groove of the humerus?
Long head of biceps
26
What is the only structure that passes through the shoulder joint?
Long head of biceps
27
What is lady between 2 majors of attachments of muscles on humerus?
Pec major laterally Teres major medially Latissimus dorsi superiorly and between
28
What nerve can be damaged in fractures of the surgical neck of the humerus?
Axillary nerve as it wraps around
29
2 pathologies that may physically damage axillary nerve?
Anterior dislocation of shoulder joint | Fracture of surgical neck of humerus
30
What would the limitation on shoulder abduction be in axillary nerve damage?
Restricted beyond 30 degrees
31
Describe the muscles involved in full abduction of the shoulder?
First 15-20 degrees is supraspinatus Up to 90 degrees is deltoid Beyond 90 is rotation of scapula
32
What is the difference between the surgical and anatomical neck of humerus? Which is more commonly fractured?
Anatomical - fusion of growth plate (epiphyseal plate) at proximal junction of articular surface Surgical - distal to anatomical neck Surgical significantly more likely to fracture
33
What 3 muscles are innervated by the musculocutaneous nerve? Where do these originate?
Biceps brachii - long head supraglenoid tubercle, short head coracoid process Brachialis - humerus, lower half of anterior surface Coracobrachialis - coracoid process
34
What is the sensory supply of musculocutaneous nerve?
As lateral cutaneous nerve of forearm - volar surface of radial half of forearm
35
What 3 muscles are attached to the coracoid process?
Short head of bicepps Corachobrachialis Pectoralis minor
36
Where does the biceps tendon insert?
Radial tuberosity | Bicipital aponeurosis to antebrachial fascia
37
Wrist extension is what myotome?
C6
38
C5/6 paralysis would cause what?
Erb's palsy - waiters tip - shoulder adducted and medially rotated, wrist flexed, forearm extended Numbness on radial edge of arm
39
What is Klumpke's paralysis and what would it cause?
C7/8/T1 paralysis - causes flexed elbow, claw hand, paralysis of intrisic muscles, sensory loss
40
What is the classical cause of Klumpke paralysis and what syndrome may it be associated with?
Forced traction on abducted arm | Can cause Horner's syndrome
41
Why may swelling occur in ACL injury? What investigations should be done?
Haemarthrosis | Do XR to rule out bony injury, then MRI to visualise ligaments
42
Where does the ACL attach and go? 2 tests for it?
Hands in pockets! Proximally is lateral and posterior on lateral wall of intercondylar notch of femur Distally is anteromedial between the tibial spines Anterior drawer and Lachman's test
43
Nerve at risk during blow to lateral knee? Risk?
Common peroneal nerve as wraps round fibula | If completely damaged could have decreased function of anterior and lateral compartments - foot drop and sensory loss
44
Which artery runs between the superficial and deep peroneal nerves?
Anterior tibial artery
45
3 structures at risk during anteromedially approach to knee surgery?
Saphenous nerve Geniculate arteries Great saphenous vein
46
3 main arteries that supply the knee via anastomotic mesh?
Popliteal Femoral Crural
47
5 branches of the popliteal artery that supply knee?
Medial and lateral superior geniculates Medial and lateral inferior geniculates Middle genicular - supplies ACL + PCL
48
Which artery supplies the ACL and PCL?
Middle genicular - from popliteal
49
What attaches to the tibial tuberosity?
Patellar tendon
50
What movements to the quadriceps do?
Extend knee Also flex hips Vastus medialis stabilises knee during gait
51
Nerve and roots of quadriceps muscles?
Femoral nerve - posterior/dorsal divisions of L2-4
52
What do the anterior/ventral divisions of L2-4 form?
Obturator nerve
53
Where do semimembranosus and semitendinosus both originate and how can you tell the difference?
Both come from ischial tuberosity Difference is that semimembranosus is medial, has membranous insertion extending into aponeurosis vs semitendinosus that has large tendon
54
Contents of popliteal fossa from deep to superficial?
``` Popliteal artery Popliteal vein with short saphenous draining into it Common peroneal nerve Tibial nerve Lymph nodes ```
55
Boundaries of popliteal fossa?
Superiorly - medially = semimemrabnosus and semitendinosus, laterally = biceps femoris Inferiorly = medial and lateral heads of gastrocnemius Roof = skin and fascia Floor = Posterior aspect of knee joint, femur and popliteus
56
Which nerve splits from tibial nerve to run superficially to gastrocnmius?
Sural
57
Which area do the popliteal LNs drain?
Area drained by short saphenous vein
58
Nerve of hamstrings and nerve roots for knee flexion?
Sciatic nerve | L5-S2
59
What is the pes anserinus, what is it formed by and where is it?
Tendinous joining of 3 muscles inserting into anteromedial aspect of proximal tibia Sartorius, gracilis and semitendinosus from anterior to posterior - Say Grace before Tea
60
What is the terrible triad of knee injuries?
ACL, MCL and medial meniscus | Because ACL is weakest cruciate ligament, and MCL and medial meniscus are closely related and relatively immobile
61
Which of the knee ligaments are intra vs extracapsular?
Collaterals are extracapsular | Cruciates are intra
62
What are the surface markings for the liver anteriorly?
Superior - 5th ICS right, 4th ICS left Lateral - 5th ICS right, 8-10th rib Oblique - line between the 2
63
Which lobe do the quadrate and caudate arise from?
Right
64
What is the surface marking for the gallbladder?
Angle between 9th costal cartilage and lateral border of rectus
65
What are the 3 functions of the gallbladder?
Storage of bile Concentrating bile Addition of mucus to bile
66
How much bile does the gallbladder hold?
50ml
67
Blood supply to the gallbladder?
Cystic artery, from right hepatic artery from hepatic artery proper Also collaterals from liver bed
68
What are the branches of the biliary tree?
``` Intralobular ducts Intrahepatic ducts Right and left hepatic ducts Common hepatic duct Cystic duct CBD ```
69
What is Calot's triangle? What is it's clinical significance?
Cystic duct Inferior border of liver Common hepatic duct Contains cystic artery and LNs, important to isolate and ligate cystic artery during lap chole
70
What is Courvoisier's Law? Why is it true?
Palpable gallbladder and painless obstructive jaundice unlikely to be gallstones - ?Cancer Because chronic gallstones cause fibrosed, contracted gallbladder rather than enlargement, or CBD stone causes pain
71
What are Kehr's and Boas' sign?
Kehrs - shoulder tip pain in acute cholecystitis | Boas - area of hyperaesthesia just below right scapula in acute cholecystitis
72
3 signs associated with acute cholecystitis?
Murphys Kehrs Boas
73
Surface markings of pleura?
Apex = 3cm above middle of clavicle Anteriorly to sternum then vetrically down to level of 4th rib Right pleura goes to 6th rib before going to MCL at 8th rib Left pleura goes down to 6th rib at MCL Then travel to midaxillary line at 10th CC and travel along 12th rib
74
Surface markings of lungs?
Apex = 3cm above middle of clavicle Anteriorly to sternum, vertically down to level of 4th rib Right goes to 6th rib before going down to 8th rib MCL Left goes down to 6th rib at MCL Then go down to 12th CC and travel along 12th rib
75
Surface marking of oblique fissures of lung?
Third thoracic spinous process to 6th costochondral junction
76
Surface marking of right horitzontal fissure?
From oblique fissure in mid axillary line to 4th costal cartilage on right
77
What level does the trachea divide?
Sternal angle - between T5 and T7
78
What level does the aorta divide?
L4 - level of umbilicus
79
How can the oblique fissure of lung surface marking be approximate clinically?
Fully abduct shoulder - medial border of scapula lines up with oblique fissure
80
Vertebral level of suprasternal notch?
T2/3
81
Vertebral level of sternal angle of Louis?
T4/5
82
Vertebral level of xiphisternum?
T9
83
Where does the trachea begin? What is it just below?
C6 - lower border of cricoid cartilage
84
What level is the carina?
T4/5 - sternal angle
85
Describe the bronchopulmonary segment set up of the lungs?
Each BP segment ias supplied by a segmental bronchus, artery, vein and lymph so functionally independent Left lung has 2 lobes and 9/10 BP segments (5 in each) Right lung has 3 lobes and 10 segments (3/2/5)
86
Blood supply to lungs?
``` Bronchial arteries (descending aorta) supply bronchi, lung roots and visceral pleura Pulmonary arteries provide deoxygenated blood ```
87
What comprises a lung hilum?
``` Bronchial artery and vein Main bronchus Pulmonary artery and vein Lymph Autonomic nerves ```
88
What goes through the diaphgram caval opening?
IVC, some branches of right phrenic nerve
89
What goes through the diaphragm oesophageal hiatus?
``` Oesophagus Vagal nerves (ant and post trunks) ```
90
What goes through the aortic hiatus of diaphragm?
aorta Azygos vein thoracic duct
91
What goes through the left crus of the diaphgram?
hemiazyogs vein | left splanchnic nerve
92
What goes through the right crus of diaphragm?
right splanchnic nerves
93
Where does the sympathetic trunk traverse the diaphgram?
In a posterior aperture behind the diaphragm which under median lumbocostal arches

MRCS Part B (36 decks)

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