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Phase I MD > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What is the origin and attachment of the mesentery?

A

Duodenal flexture L2 to R sacroiliac joint

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2
Q

Outline the blood supply to the pancreas and venous drainage

A

Arterial supply:

  • Gastroduodenal artery gives of the R gastroomental and pancreatoduodenal arteries: supply the anterior and posterior head of the pacreas
  • Splenic artery branches supply the head neck and tail

Venous drainage:

  • Splenic vein drains into portal vein
  • Pancreaticoduodenal dains into SMV and sometimes into portal vein
  • inferior pancreaticoduodenal drains into SMV
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3
Q

Outline why the liver is a common site for pancreatic cancer metastasis

A

Venous drainage from the pancreas goes to portal vein

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4
Q

Outline the surfaces of the spleen

A 
Diaphragmatic surface
Gastic impression
renal impression
colic impression
pancreatic impression
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5
Q

Describe the structures forming the lesser omentum

A

Double layer of peritoneum formed by the hepatogastric ligament and the hepatoduodenal ligament

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6
Q

What structures are contained within the portal triad?

A

portal vein, hepatic artery proper and common bile duct

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7
Q

What is the arterial supply of the gall bladder and where does this artery usually arise from?

A

Cystic artery, typically arising from the R branch of the proper hepatic a

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8
Q

Which structures form the hepatic vein?

A

Splenic vein, inferior mesenteric vein and the superior mesenteric vein join to form the portal vein, the L gastric vein and oesophageal vein also drain into the portal vein

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9
Q

Which ligament is the portal triad located in?

A

Hepatoduodenal

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10
Q

Outline the lobes of the liver, what is the significance of the quadrate lobe

A

Right and Left lobes, caudate superior btw R and L lobes, quadrate inferior between groove for ligamentum teres and the fossa for the gall bladder. Quadrate lobe recieves blood supply from both sides of the liver

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11
Q

What proportion of blood do the hepatic artery and portal vein bring in to the liver respectively

A

Hepatic artery brings 30% of total blood - 50% of which is oxygenated
Portal vein brings in 70% of total blood - 50% of which is oxygenated

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12
Q

What is Meckels diverticulum?

A

Congenital abnormality resulting in a full diverticulum (of 2 or more types of mucosal layers) occuring the the distal ileum. It is an embryological remnant.

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13
Q

Describe the arterial supply of the small intestine

A

SMA: gives off inferior pancreatic duodenal, illeal and jejunal arteries

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14
Q

Describe the difference between the meso appendix and the veriform appendix

A

Mesoappendix: the peritoneum suspending the appendix from the ileum
Veriform Appendix: blind muscular diverticulum containing lymphoid tissue

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15
Q

Where is McBurneys Point?

A

One third of the distance between the anterior superior iliac spine and the umbilicus. Roughly corresponds to most common site of appendix

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16
Q

What are the names of the three tenia coli? And which tenia coli is most likely to be affected by diverticulum

A

Tenia Coli Libra (free), omental, mesenteric

Mesenteric tenia coli most likely to be affected by diverticulum as it is the site of greatest weakness

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17
Q

Why is the descending colon the most likely place for diverticulum to occur?

A

Site of highest pressure and lowest motility in the large intestine

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18
Q

What forms the longitudinal muscles of the rectum?

A

the meeting of the tenia coli

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19
Q

What forms the longitudinal muscles of the rectum?

A

the meeting of the tenia coli

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20
Q

Outline the blood supply of the Large intestine

A

SMA –> branches to iliocolic (which branches to superior and inferior, inferior branches to colic, appendicular and ileal)
SMA —> right colic (ascending colon)
SMA —> middle transverse colon until distal 1/3
IMA —> Left colic (ascending and descending branches)
IMA —> Sigmoid artery

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21
Q

Outlne the arterial and venous supply of the rectum and outline the significance of the venous supply

A

Arterial supply:

  • Superior rectal artery from IMA
  • Middle rectal artery from inferior vesicle arteries (internal iliac)
  • Inferior rectal arteries branch from internal iliac

Venous supply:

  • Superior rectal veins drain into IMV and portal vein
  • Middle and rectal veins drain into the systemic venous system

Clinical significance: portal hypertension —> internal hemorrhoids due to drainage of IMV into portal vein
AND
Suppositories distributed systemically due to uptake of inferior rectal and middle rectal veins

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22
Q

Outline which structures may be palpated in a PR exam in males and females

A

Males: prostate and seminal vesicles
Females: cervix
Both: sacrum, coccycx and ischial spines and tuberosities

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23
Q

Outline the nervous supply to the anal canal and its clinical significance

A
  • Inferior hypogastric plexus (symp and parasymp) provide visceral innervation to anal canal superior to pectinate line —> SENSITIVE TO STRETCHING
  • Inferior rectal nerve (branches of pudendal nerve) provides somatic innervation to the anal canal below the pectinate line —-> SENSITIVE TO PAIN TOUCH AND TEMP
  • Clinical significance: external haemorrhoids occur below pectinate line and will therefore be painful as they are innervated somatically. Internal haemorrhoids will not be painful as they are innervated viscerally
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24
Q

Outline the process of defecation

A
  1. Faeces moves into rectum - activation of stretch receptors
  2. Puborectalis and anal sphincters relax –> straightening of anorectal junction
  3. intra-abdominal and intrarectal pressure increase resulting in evacuation
  4. puborectalis and external sphincter contract to close anal canal
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25
Q

Which muscle is responsible for depressing the tounge

A

Hypoglossus (think under tounge)

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26
Q

Which muscle is responsible for pulling the tounge forward

A

Genioglossus (think: stick your tounge out at geniuses)

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27
Q

What is the motor and sensory innervation of the muscles of the soft palate

A

Sensory: Glossopharyngeal N
Motor: Vagus N

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28
Q

Which muscle is responsible for elevating and retracting the tounge?

A

Styloglossus

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29
Q

Outline the sensory and motor innervation of the tounge

A

Sensory

  • Ant 2/3 general: facial; special (taste): lingual
  • Post 1/3 glossopharyngeal nerve and vagus

Motor:
- hypoglossal nerve for all except palatoglossus (vagus)

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30
Q

Outline where fractures of the mandible usually occur in adults, how does this differ from children and the elderly?

A
  • Usually occurs at the angle or neck of the mandible and affect the contralateral side due to transmission of force through the bone (angle if mouth open, neck if mouth closed)
  • children and elderly less likely to avoid impact and so usually fracture the mental protuberance or the condylar processes
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31
Q

What muscles make up the pelvic floor?

A

Pubococcygeus, illiococcygeus, ischiococcygeus, puborectalis

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32
Q

What muscles make up the levator ani

A

pubococcygeus, illiococcygeus and puborectalis

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33
Q

Outline the deep and superficial perineal spaces

A
  • The deep perineal space lies inferior to the fibrous fascia of the pelvic diaphragm and superior to the perineal membrane and contains the external urethral sphincter
  • the superficial perineal space lies inferior to the perineal membrane and contains muscles associated with the external genitalia
  • the perineal membrane gives a point of attachment for external genitalia
34
Q

Outline the layers of the perineum and pelvic floor from most superficial to deepest

A
  1. superficial perineal space
  2. perineal membrane
  3. deep perineal space
  4. pelvic diaphragm fascia
  5. pelvic diaphragm: puborectalis, ileococcygeus, ischiococcygeus, pubococcygeus
35
Q

Outline the arterial supply to the perineum

A

Internal pudendal artery –> inferior rectal artery and perineal artery

36
Q

Outline the nervous innervation of the perineum

A

Innervated by the pudendal nerve S2-4 which branches into:

  • Inferior rectal nerve –> motor to external anal sphincter and sensory to skin of anal triangle
  • Perineal nerve —> skeletal muscles in the deep and superficial pouch and posterior labial region
37
Q

Why are some drugs administered sublingually? Outline the pathway sublingual drugs take

A

Bypass 1st pass metabolism to the liver and therefore are not metabolised before they reach their target. Sublingual vein –> deep lingual vein –> external jugular –> SVC –> heart

38
Q

Outline the pathways involved in erection and ejaculation

A
  • Erection: Parasympathic stimulation via the pelvic nerve
  • Emmision: Sympathetic stimulation via the hypogastric nerve
  • Ejaculation: Sympathetic stimulation via the pudendal nerve
39
Q

What is the contents of the Superior Mediastinum

A
  • Great vessels, trachea, oesophagus, thoracic duct and thymus
40
Q

In which mediastinal compartment does the heart lie?

A

The middle compartment of the inferior mediastinum

41
Q

What is the role of the azygous and hemiazygous system

A

The azygous system drains the thoracic and anteriolateral abdominal walls

42
Q

Outline the blood supply and nervous innervation to pericardium, why is this clinically significant?

A

Blood supply: pericardial arteries from the internal thoracic arteries supply fibrous, coronary supply visceral/epicardium

Innervation: phrenic nerve C3, C4, C5

Clinically significant bc pain during an MI can radiate to the L shoulder due to innervation of the phrenic nerve and corresponding dermatomes

43
Q

What is JVP a measure of and where is it measured?

A

Right internal jugular vein, measure of central venous pressure (R atrial pressure)

The R internal vein is used because it connects directly into the R atrium

44
Q

What does the internal jugular vein drain?

A

Drains the brain, skull and superficial face and neck

45
Q

What does the internal jugular vein drain?

A

Drains the brain, skull and superficial face and neck

46
Q

Which vertebral bodies does the heart lie in front of?

A

T5-T8

THINK: opening of the inf vena cava in the diaphragm is T8 therefore heart must lie above it

47
Q

Where does the apex of the heart usually lie on an Xray image

A

Anterior 5th intercostal space in the midclavicular line

48
Q

How is the thoracic index calculated?

What is a normal CT index for an adult and for a child?

Why is the CT index larger in an infant?

A

CT = (MRD + MLD)/ID

where MLD: midline to right heart border
MLD: midline to L heart border
ID: internal diameter of chest

Adult value: <50%
Baby 0-1yr: 53-58%
1-6 years: 45-49%

Because in babies the heart is in a more transverse position in the chest

49
Q

Which bronchi are you most likely to get something caught in and why?

A

-

50
Q

Outline the innervation of the tounge

A

Motor: Hypoglossal n. CN XII innervates the deep muscles of the tounge

Sensory:

  • Ant 2/3 special sensory (taste): Facial
  • Ant 2/3 general sensation: Lingual (V3)
  • Post 2/3 general and special: Glossopharyngeal

THINK: “taste –> “7th sense” —> therefore seventh nerve –> facial nerve

51
Q

Outline the 3 phases of swallowing

A

Oral: formation of food bolus, sensing of uvula
Pharyngeal: bolus moves back into pharynx, tensing of levator palentine and tensor veli
Oesophageal: primary and secondary peristaltic motions

52
Q

Why does the LES open before the food bolus is near the LES?

A

Allows for passage of liquids and solids

53
Q

What lower limb artery supplies the dorsum of the foot to give the dorsal pedis pulse?

A

Anterior Tibial artery

54
Q

What artery supplies the plantar surface of the foot and gives off the posterior tibial pulse? Where is this pulse felt?

A

Posterior tibial artery, felt posterior to the medial malleolus

55
Q

What artery gives off the fibular artery?

A

The posterior tibial artery

56
Q

What artery gives off the popliteal artery

A

The common femoral artery

57
Q

Describe the genicular anatomosis, which arteries contribute to these anastomoses

A

The Poplitial artery gives off the lateral and medial superior genicular branches and the anterior tibial arteries

58
Q

Describe the gluteal anatomoses

A

The medial and lateral circumflex arteries from the deep femoral artery and the inferior gluteal arteries contribute to the hip anatomoses

59
Q

Where would you find the great saphenous vein

A

from the medial surface of the dorsal venous network running on the medial side of the leg. Joins the femoral vein just distal to the inguinal ligament. Contains multiple valves

60
Q

What are the 6 signs of acute ischemia

A

6 Ps: pain, pallor, pulse-lessness, parethesia, paralysis and poikilothermy

61
Q

Describe the contents of the femoral triangle including which are most medial and which are most lateral

A

Femoral v. most medial, femoral a., femoral n most lateral

62
Q

What are the borders of the femoral triangle?

A

Inguinal lig roof, sartorius lateral border and adductor longus medially

63
Q

Where does the femoral artery pass through to become the popliteal artery

A

Adductor hiatus

64
Q

In which compartment does the superficial femoral artery run? In which does the deep femoral artery run?

A

Superficial runs in Anterior compartment. Deep runs in medial compartment

65
Q

Describe the arterial supply to the foot

A

Posterior tibeal divides into medial and lateral plantar arteries, the anterior tibial gives off the arcuate artery

66
Q

A woman has cancerous tissue being removed from the pinned location. Where else would
the surgeon check for cancerous tissue that has physically spread within the same space?

A

The perinephric space within the renal fascia between both kidneys

67
Q

Which muscles attach to the perineal body?

A

Bulbospongiousus, deep and superficial transverse, ext anal sphincter and puborectalis

68
Q

Outline the innervation of the scrotum

A

Somatic innervation from the genital branch of the genitofemoral nerve and the ilioinguinal nerve.

Testes innervated by the Lesser and Least splanchnic and lumbar splanchnic (T11-L1) and by pelvic splanchnic S2 S4

69
Q

Outline the innervation of the Dartos and Cremaster muscle and their roles

A

Dartos: innervated by the genitofemoral nerve and contracts to wrinkle skin when cold

Cremaster: innervated by the genital branch of genitofemoral muscle and contracts to raise the testes and maintain temperature

70
Q

Describe the contents of the spermatic cord

A 
Ductus deferens
Testicular a
A. of ductus def
Cremasteric a
pampiniform plexus
genitofemoral n
71
Q

Which bronchi are you most likely to get a foreign object stuck in?

A

the R main bronchus due to its wider and shorter passage and runs more vertically

72
Q

Where is the SA node located? Where is the AV node located?

A

Superior aspect of the cristae terminalis

Just above the orifice of the coronary sinus

73
Q

What is the lingula of the L lobe analogous to?

A

the middle lobe of the Right lung

74
Q

How many bronchopulmonary segments are there in each lung

A

10 in the Right lung: 3 upper, 2 middle, 5 lower

8 in the Left lung: 4 upper 4 lower

75
Q

Where can pareital pleura refer pain to?

A

Supplied by the phrenic nerve to C3,4,5 or by intercostal nerves to trunk wall

76
Q

Describe what happens in choking

A

Laryngeal muscles contract closing the rima glottidus and obstructivting the trachea, the sensitive laryngeal vestibule may lead to coughing reflex

77
Q

Which spinal nerves give the femoral nerve?

What are the motor and sensory innervations of the femoral n?

How do you test the motor and sensory components of the femoral n?

A

Femoral Nerve L2-4

Innervation
Motor: Quadriceps femoris group (RF, VL, VM, VI), pectineus, sartorius, illiacus

Sensory: Anteromedial thigh, knee and leg

Clinical Test
Motor: extension of the knee
Sensory: sensation from the medial thigh, knee and leg

78
Q

What would be the effects of a femoral nerve lesion? What injuries could result in such a lesion?

A

Effects of lesion include

  1. Weakening of hip flexion
  2. Loss of knee extension
  3. Knee instability
  4. Loss of sensation to the anteriomedial thigh knee and leg

Injurys resulting in a femoral n lesion include: Disease in the psoas muscle, or in inguinal canal/femoral triangle, pelvic fracture

79
Q

Which spinal nerves give the obturator nerve?

What are the motor and sensory innervations of the obturator n?

How do you test the motor and sensory components of the obturator n?

A

Obturator nerve L2-L4

Innervation:
Motor: Adductor brevis, adductor longus, gracilis, 1/2 adductor magnus

Sensory: small strip on medial thigh

Clinical test
Motor: adduction of the leg
Sensory: sensation from strip of medial thigh

80
Q

What would be the effects of a obturator nerve lesion? What injuries could result in such a lesion?

A

Effects

  • Weakened hip adduction
  • Weakened external rotation
  • Loss of sensation in strip of medial thigh
  • Instability of pelvis; lateral swing of limb with locomotion

Injury causing lesion

  • Pelvic neoplasms
  • Total hip replacements
  • Pregnancy, childbirth
  • Rare
81
Q

Which spinal nerves give the femoral cutaneous nerve of the thigh?

What are the motor and sensory innervations of the lateral femoral cutaneous nerve of the thigh?

How do you test the motor and sensory components of the lateral femoral cutaneous nerve of the thigh?

What would result from a lesion in this nerve?

A

L2-3

Motor innervation: none
Sensory innervation: lateral thigh

Clinical test: sensation from the lateral thigh

Lesion: loss of sensation to the lateral thigh. Can result from external compression or increases in intraabdominal/pelvic pressure

82
Q

Which spinal nerves give the posterior femoral cutaneous nerve of the thigh?

What are the motor and sensory innervations of the lateral femoral cutaneous nerve of the thigh?

How do you test the motor and sensory components of the lateral femoral cutaneous nerve of the thigh?

What would result from a lesion in this nerve?

A

S1-S3

Innervation
Motor: none
Sensory: sensation to posterior thigh

Clinical test
- Sensation to the posterior thigh

Lesion
- Loss of sensation to the posterior thigh, can result from external compression, or increased intraabdominal or intrapelvic pressure (pregnancy)

Phase I MD (7 decks)

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