Anatomy Flashcards
Thyroid gland is invested by what structure?
Pretracheal fascia
Cranial nerve that descends through the neck in the Carotid sheath?
Vagus nerve
Dental abscess. Pathway in which infection spread to the mediastinum?
Retropharyngeal space
Ludwig’s angina primarily involves which fascial planes?
Submandibular space
Hyoid bone approximately lies at what level of cervical vertebrae?
C3
Suprahyoid muscles?
Digastric (ant&post)
Mylohyoid
Stylohyod
Geniohyoid
Action of suprahyoid muscles
Elevates hyoid bone
Infrahyoid muscles
Deep
Thyrohyoid
Sternothyroid
Superficial
Omohyoid
Sternohyoid
The right and left thyroid gland is connected by a narrow __________ located at the ________tracheal rings
ISTHMUS
2nd 3rd and 4th tracheal rings
How many grams is the thyroid?
20 grams
Blood supply of the thyroid?
Venous drainage?
Superior thyroid artery from external carotid
Inferior thyroid artery from thyrocervical trunk
Venous drainage:
Superior thyroid - IJV
Middle thyroid - IJV
Inferior thyroid- brachiocephalic
Present in 12% of individuals, its a small midline artery
Thyroidea Ima artery
First endocrine gland to develop; 24 days after fertilization
Thyroid gland
The developing thyroid gland is connected to the tongue by ?
The thyroglossal duct
The most common site of an ectopic thyroid?
Lingual
Primary tumors to oral cavity metastasize to nodes?
Level I,II and III
Tumors to oropharynx, hypopharynx and larynx will metastasize to nodes?
LN II, III AND IV
Nasopharyngeal and thyroid cancers will metastasize to what level of nodes?
Level V
The cricoid cartilage of the larynx is at the level of which cervical vertebrae?
Cricoid cartilage - C6
Nerve injured during ligation of superior thyroid artery? Inferior thyroid artery?
Superior thyroid artery - External laryngeal nerve
Inferior thyroid artery- inferior/recurrent laryngeal
Laryngeal muscle acts as the chief tensor of the vocal cords? Relaxor?
Cricothyroid - tensor
Thyroarytenoid - relaxor
What side of the recurrent laryngeal nerve is more commonly injured?
Left side is more commonly injured
In tracheotomy, opening is made in the trachea at what tracheal ring?
Between 1st and 2nd
Or second through 4th tracheal rings
What cells produces the parathyroid hormone?
Parathyroid gland : chief cells (PTH) and oxyphil cell
Thyroid gland: follicular cell and para follicular cell
Motor supply to the diaphragm?
Phrenic nerve from C3C4C5
In the neck it lies on scalenus anterior
In gb inflammation pain is referred to C 4 distribution
Which zones of the neck is most commonly injured? Which zones obstruct the airway and have the greatest risk for morbidity and mortality?
ZONES I AND III - obstruct the airway
ZONE II - most common
Crutch injury. What nerve is affected?
Radial nerve - manifests as weakness un extending the forearm and wrist drop
Bones involved in transmission of weight while standing?
Sacrum
Pelvis
Femur
Tibia
Equivalent layer of deep investing fascia of abdomen in perineum? And in penis?
Deep investing fascia: Gallaudet’s
deep investing fascia: buck’s facia
Equivalent of camper’s fascia in the perineum and penis?
Camper’s fascia (fatty superficial layer): fatty superficial layer: dartos muscle (first layers)
Equivalent of dartos fascia in the abdomen and perineum?
Dartos fascia (middle layer): scarpas fascia (membranous superficial layer) : colle’s fascia (MSL)
Which part of the pelvis has an obstetrical significance?
Lesser pelvis, true pelvis, pelvis minor
Below the arcuate line that has a obstetrical significance
Shape of right and left adrenal glands
Right : triangle
Left : crescent
Cartilage that is pyramidal n shape?
Arytenoid
FSH IS SECRETED BY WHAT TYPE OF CELL IN the PITUITARY?
Basophils - FSH, LH, TSH, ACTH
acidophils - GROWTH HORMONE AND PROLACTIN
supraoptic nuclei - Vasopressin mainly
Paraventricular nuclei - Oxytocin mainly
Costal line of pleural reflection?
Lower margin of lungs?
Costal:
8th rib MCL
10th rib MAL
12th rib Sides of vertebral column
lower margin:
6th rib MCL
8th rib MAL
10th rib sides of vertebral column
Layers passed in doing spinal tap
Skin, supraspinatous ligament, interspinous ligament, dura mater and subarachnoid space
Tumor cells in the gonads will affect which nodes initially?
Lumbar (aortic) lymph nodes
Blood supply of the fundus of the stomach?
Short gastric artery
Lesser curvature : right and left gastric artery
Greater curvature: right and left gastroomental artery
May thurner syndrome?
The LEFT common iliac VEIN is compressed by the RIGHT common iliac ARTERT
Predisposes to deep vein thrombosis
Keisselbach’s plexus
Arterial supply - MOF : GrAPeS Sa Labi
Sphenopalatine artery and Greater palatine artery of the MAXILLARY artery
Anterior and Posterior Ethmoidal artery of the OPHTHALMIC branch
Superior labial artery AND Lateral nasal branches of the FACIAL ARTERY
What differentiates the PCT to DCT?
Brush border
The inner ear is housed in which bone?
Temporal bone
Pelvis :
Transverse > AP diameter
“FLAT” : platypelloid
Pelivs:
AP > transverse
AnthroPoid
Tumor compressing brachial plexus and and cervical stellate ganglion
Pancoast syndrome
Structures passed in passing a needle at the pleural space in MAL
Internal intercostals
External intercostals
Innermost intercostals
Parietal pleura
Right border of the heart
Right atrium
Inferior border of the heart
Right ventricle
Quadrate lobe. Bile drainage? Blood supply?
Quadrate lobe is part of the LEFT LOBE and thus drains bile to the LEFT HEPATIC DUCT and is supplied by the LEFT HEPATIC ARTERY
MALFORMATION of the TRANSVERSALIS muscle will lead to a defective ___________.
Deep inguinal ring
Other inguinal ligaments and ring is from the aponeurosis of the EOM
Remnant of the left umbilical vein?
LEFT umbilical vein = ROUND LIGAMENT
RIGHT umbilical vein degenerates during early embryonic period
Remnant of the ductus venosus? Ductus areteriosus? Umbilical artery?
Ductus Venosus - ligamentum venosum
Ductus arteriosus-ligamentum arteriosum
UMBILICAL ARTERY- MEDIAL UMBILICAL LIGAMENT
Great cardiac vein: ——
Middle cardiac vein:——-
Anterior cardiac vein: ——-
Small cardiac vein:—–
Great cardiac vein: Anterior Interventricular artery
Middle cardiac vein:accompanies POST INTERVENTICULAR ARTERY
Anterior cardiac vein: drains directly to Right atrium
Small cardiac vein: marginal artery
What muscle forms boundaries of the triangle of auscultation and lumbar triangles?
Latissimus dorsi supplied by the thoracodorsal artery
The isthmus of the thyroid gland lies anterior to the….
2-3 tracheal ring
What comprises the nasal septum?
Septal cartilage
Vomer
Perpendicular plate of ethmoid
Nasolacrimal duct drains to what nasal meatus?
Inferior nasal meatus
Forms the fascial floor of the posterior triangle
Prevertebral layer
What innervates the muscles of facial expression?
Cervical branch of facial nerve
The only bone that does not articulate with another bone?
Hyoid bone
At what cervical level does the common carotid and Internal and external carotid artery bifurcate?
At the c4 at the level of e superior border of the thyroid cartilage
If the patient is stabbed at the occipital triangle , what artery will be more likely be injured? What nerve?
Occipital artery and Accessory nerve
What vessels cross the supraclavicular triangle?
External jugular vein
Subclavian artery
A fibrous band that connects the pyramidal lobe to the hyoid bone?
Levator glandula thyroidea
Remnant of the thyroglossal duct?
Foramen cecum
Muscles of deglutition?
SUPERIOR CONSTRICTOR MIDDLE CONSTRICTOR INFERIOR CONSTRICTOR CRICOPHARYNGEUS STYLOPHARYNGEUS SALPHINGOPHARYNGEUS PALATOPHARYNGEUS
Innervation of the muscles for deglutition?
Afferent : Cranial nerve 9 - glossopharyngeal nerve
Efferent fibers: cranial nerve 10- vagus nerve
What nerve is injured that results to a monotonous speech?
Superior laryngeal nerve -external branch
Osteoclastic activity of bone is a result of what hormone?
Pth
What cell of the parathyroid produces the pth?
Chief cells - pth
Follicular cells produces?
Parafollicular cells produces?
Follicular cells : t3t4
Parafollicular cells : calcitonin
Reabsorption of calcium occurs at what part of the kidney?
Proximal convoluted tubules
Common location of ectopic parathyroid?
Superior mediastinum
Zones of penetrating neck trauma
Zone I, II, III
Most commonly injured zone of the neck?
Zone 2
Zone or zones of the neck that has the greatest risk for morbidity and mortality?
Zones 1 & 3
At what level of the vertebra does the trachea bifurcates?
At the sternal angle at T4
Commonly fractured ribs? And which area?
The 5th-9th ribs at the anterior of its angle
True ribs? False ribs? Floating ribs?
1-7 true
8-12 false
11 and 12 floating
Patient presents with pain down the medial forearm and hand with wasting of the hand muscles
Thoracic outlet syndrome where there is pressure on the LOWER TRUNK OF THE BRACHIAL PLEXUS
Three muscles that depresses the ribs
Serratus posterior inferior
Internal intercostal muscles
Transversus thoracis muscles
What is the sternal plane?
An imaginary line that passes fron the angle of louie anteriorly and t4 posteriorly
In DiGeorge syndrome, the thymus gland is absent. What else will be missing in the anterior mediastinum?
Parathyroid gland
Normal pericardial fluid
30ml
You noticed that a patient’s jugular veins distend upon inspiration…what sign is this?
Kussmaul sign
You were assigned to do a pericardiocentesis… Where will you insert the needle?
At the left xiphocostal angle to insert until the serous layer of the parietal pericardium
What are the hearts auscultatory areas?
Pulmonic - left 2nd ics
Aortic -right 2nd ics
Mitral - 5th ics MCL LEFT
tricuspid - right lower and of sternum 5th ics
The second heart sound is due to the closure of what valves?
Aortic and pulmonic valves
Common site of myocardial infarction
Anterior interventricular artery
Coronary artery lesion at the circumflex will lead to what wall defect?
Posterolateral wall seen at V4-V6 of the ECG
Fossa ovalis is seen at what chamber of the heart?
Right atrium
Most anterior portion of the heart?
Right ventricle
Chamber with a moderator band?
Right ventricle
Most posterior chamber of the heart
Left Atrium
Primitive atrium
Left atrium
Primitive ventricle
Left ventricle
Right atrium is from?
Right horn of sinus venosus
The left horn of the sinus venosus forms the?
Coronary sinus
The right ventricle is formed from?
The bulbos cordis
The truncus areteriosus becomes the?
Root of the aorta and pulmonary trunk
Most common form of an ASD?
Patent foramen ovale
Most common type of CHD?
VSD
Most common cause of cyanotic heart disease?
Transposition of the great arteries
Components of TOF
P-pulmonary stenosis
R-right ventricular hypertrophy
O-overriding of the aorta
V- vsd
Ductus arteriosus becomes the?
Ligamentum arteriosum
Foramen ovale becomes the?
Fossa ovalis
Ductus venosus becomes the
Ligamentum venosum
Umbilical VEIN becomes the ?
Ligamentum teres
Umbilical ARTERIES becomes the?
Medial umbilical ligaments
Foramen ovale will completely close at what age?
3rd month
Most common congenital anomaly related with maternal rubella?
PDA
Aortic arch derivative
Common carotid arteries?
Pulmonary arteries?
Arch of aorta?
Carotids : 3rd
Arch : 4th
Pulmo art : 6th
Derivative of the portal system?
Vitelline or the omphalomesenteric veins
The cardinal veins becomes the?
Caval system
In thoracentesis, where is the needle inserted?
Midaxillary line between ribs 8 and 10
Anatomical and surgical units if the lungs?
Bronchopulmonary segments
The apex of both lungs is how many cm above the clavicle?
2.5 cm
FB aspiration in a patient lying on the left side
Fb at the inferior lingular BPS of the left upper lobe
Fb aspiration while sitting
Right bronchus at the posterobasal BPS right lower lobe
FB aspiration in supine
Superior BPS right lower lobe
Lying on right side
Posterior BPS of the right upper lobe
Boot shaped heart in The xray
TOF
Rib notching in the xray
Coarctation of the aorta
The SVC drains to the atrium at the level of:
3rd right costal cartilage
Dimpling of the breast in breast cancer is due to?
Shortening of the suspensory ligament of cooper
Nipple inversion in breast CA is due to?
Pulling of the lactiferous ducts by cancer cells
Pau d orange sign is due to
Interference with lymphatic drainage
Most common location of breast carcinoma?
Upper lateral quadrant
What nerve is injured in winging of scapula?
Long thoracic nerve
Patient presents with difficulty in horizontal extension of upper extremities. What nerve is injured?
Thoracodorsal nerve
Loss of sensation on the upper inner aspect of the arm is due to injury of what nerve?
Intercostal nerve
Difficulty in lifting her child, flapping her arms and doing arm wrestling, what nerve is injured?
Medial pectoral nerve
Breast lymphatic drainage
Lateral quadrants:______
Medial quadrants:_______
Lateral: axillary lymph nodes
Medial: parasternal nodes
Nerve supply of the breasts
4th to 6th intercostal nerves
Phrenic nerve arises from?
C3 C4 C5
The thoracic duct empties into what vein?
Left brachiocephalic vein
Structures transmitted by the AORTIC OPENING?
Azygous vein
aorta
Thoracic duct
Umbilicus is normally in what vertebral level?
L3
Hesselbach triangle boundaries
RAMILES
Rectus Abdominis- medially
inguinal ligament- inferiorly and laterally
Epigastric artery - superiorly
Direct hernia lies _______ to epigastric vessels while indirect lies _______ to epigastric vessels
‘MD’
Medial : direct
Lateral: indirect
Cremasteric muscle is derived from what layer of the abdominal wall?
INTERNAL OBLIQUE MUSCLES
Layers of abdominal wall
Skin Campers Scarpas Deep fascia Muscles Transversalis fascia Extraperitoneal fat Parietal peritoneum
The tunica vaginalis is derived from what abdominal wall layer?
Peritoneum
The dartos muscle is derived fro what abdominal wall layer?
Superficial fascia
When eliciting the cremasteric reflex, what nerve are we testing?
Genitofemoral nerve
Rectum in relation with the peritoneum
“PRE”
Superior - peritoneal
Middle- retroperitoneal
Inferior- extaperitoneal
What organs lie in the peritoneal cavity?
NO ORGANS LIE IN THIS POTENTIAL SPACE!
Abdominal policemen
Omentum
Largest arterial supply and smallest branch of celiac trunk
Left gastric artery
Perforation to the posterior wall of the stomach wall will accumulate in the?
Omental bursa
Surgical incision at the fundus of the stomach would require you to clamp which artery?
Short gastric artery
Gastric ulcers are usually found in what part of the stomach?
At the body near the lesser curvature above the incisura angularis
Carcinomas of the stomach are most commonly found at?
The pylorus
Ulcers in the duodenum most commonly occurs at which part?
Anterior wall of the first part of duodenum
Ulcers where pain is relieved with food and antacids? Pain occurs after 1-3 hours of food intake.
Duodenal ulcers
Burning pain occurs soon after eating, not relieved by food or antacids
Gastric ulcers
Bleeding distal from the ligament of trietz will manifest most commonly as?
Hematochezia
Hematemesis occurs when there is bleeding ________ to the ligament of trietz
Proximal
Jejunum lies at the ________
Ileum lies at the __________
Jej : LUQ
IL: RLQ
Caused by hyperplasia of lymphatic tissues in the wall of the intestine
Intussusception
Most common form of intussusception?
Ileocecal
Endocrine function of the pancreas
Islets of langerhans
Exocrine function of pancreas?
Pancreatic acinar
Tumor of the uncinate process of the pancreas will most likely compress which structure?
Superior mesenteric artery
Zone of the liver acinus that receives most of the oxygen delivered?
Zone 1
Zone of the liver acinus that is susceptible to ischemic injury?
Zone 3
What is the portal triad?
Portal vein
Hepatic artery
Bile duct
Tumor of porta hepatis will most likely affect what structure?
Branches of portal vein
Liver is supplied by?
Portal vein 70%
Hepatic artery 30%
Portal vein is formed by the union of which structures?
Superior mesenteric and splenic vein
Pringle maneuver is used to clamp what part of the liver?
Clamping the hepatoduodenal ligament which contains both hepatic artery and portal vein
Common site for liver biopsy?
Right 10th ICS IN MAL
GB CAPACITY?
30-50 ml
Infundibulum of GB is called?
Hartmann pouch
Triangle of calot boundaries?
Superiorly - liver
Inferiorly - cystic duct
Medially - common hepatic duct
Common site of impacted gallstone
Hepatopancreatic ampulla
Valve of Houston is associated with what organ?
Rectum
Most common position of the appendix?
Retrocecal
Most common cause of appendicitis in children?
Hyperplasia of the lymphatic tissue
Most common cause of appendicitis in adults?
Fecalith
What could have been injured post appendectomy where patient presents with weakening of the anterior abdominal wall?
Iliohypogastric nerve
Three hemorrhoidal cushions?
Left lateral
Right anterior
Right posterior
Persistence of remant of vitelline duct forming an outpouching of of the ileum
Meckel diverticulum
Meckels rules if two
Twrue diverticulum
That occurs in 2% of pop
Located 2 ft from ileocecal junxn
2 inches long
Usual site of renal transplant
Iliac fossa
In renal transplant where is the renal artery anastomosed?
Internal iliac artery
Renal vein is to external iliac vein
Nutcracker syndrome resulted from compression of what structures?
Compression of left renal vein by the Superior mesenteric artery and aorta
Embryologic structure
Cortex : _________
Medulla: ________
Cortex: mesoderm
Medulla: neural crests
Adrenal Cortex zones and their products
Zona glomerulosa : aldosterone(mineralocorticoids)
Zona fasiculata: cortisol(glucocorticoids)
Zona reticularis: androgens (sex hormones)
Adrenal gland
Triangle :_________
Crescent: __________
Right : triangle
Left: crescent
Adrenal medulla secretes?
Epi norepi
Venous drainage of adrenal gland?
Right adrenal vein to IVC
Left adrenal vein to renal vein to IVC
Hyposecretion of adrenal cortex?
Addison disease - bronze skin
Hypersecretion of adrenal cortex
Cushing’s disease
Constrictions of the ureters
- Renal pelvis
- Pelvic brim
- Enters the UB
Shortest part of the male urethra?
Membranous part
Widest part of the male urethra
Prostatic part
Embryonic origin of the urinary bladder
Vesical part of the urogenital sinus
Fascia enclosing three erectile tissue in body of penis
Buck’s fascia
What is significant in obstetric examination? True conjugate or the diagonal conjugate?
Diagonal conjugate diameter
How do we measure the diagonal conjugate diameter?
From sacral promontory to inferior margin of symphysis pubis
How do we measure the true conjugate diameter?
From sacral promontory to SUPERIOR MARGIN of the symphysis pubis
Distance between two ischial tuberosities
Transverse diameter
Muscle that enters the greater sciatic foramen
PIRIFORMIS
What structures goes to both the greater and lesser foramen?
Pudendal nerves
Internal pudendal VESSELS
Nerve to the obturator internus
Pelvic diaphragm consists of the?
Levator ani muscles
Coccygeus
Components of the Levator ani muscles
Puborectalis
Pubococcygeus
Iliococcygeus
Most important of the levator ani muscles?
Pubococcygeus
What is traversed when there is a laceration to include the rectal mucosa?
Bulbospongiosus
Central perineal tendon / superficial transverse perineal muscle
External anal sphincter
Contents of the ischiorectal / ischioanal fossae?
Inferior rectal artery, vein and nerve
Perineal branch of the femoral cutaneous nerve
Broca’s area s brodmann #
44 &45
Primary motor area is at the __________ on b.a. #
Precentral gyrus at #4
Post central gyrus is at b.a.#
3,2,1 also primary somatosensory area
Auditory area is b.a. #
41,42
Primary visual area is b.a. #
17
Sensory aphasia is also known as?
Wernicke aphasia where there is receptive aphasia
Patient had a stroke that lead him to a motor aphasi aka?
Broca aphasia
All areas are supplied by the ______ except got the legs
MCA
Decussation occurs at ?
Lower medulla
Fasiculations? Umn or lmn?
Lmn
Thalamic nuclei concerned with emotional tone and memory?
Anterior thalamic nuclei
Which part of the brain is involved in Dejerine-roussy syndrome or the central pain syndrome?
Thalamic infarction
Cerebellar lobe in-charge of coordination of limb movements and regulation of muscle tone?
Anterior lobe or spinocerebellum
Cerebellar lobe that coordinates voluntary movement?
Posterior lobe or neocerebellum
Cerebellar lobe responsible for equilibrium?
Vestibulocerebellum or floculonodular lobe
Heel to shin test is done to check which lobe?
Anterior lobe of the cerebellum
Which lobe has a lesion if there is ataxia, dysmetria and dysdiadochokinesia?
Posterior lobe of the cerebellum
Where is the lesion if a patient manifests resting tremors?
Basal ganglia
Trace csf flow
L-M-3S4-ML
Total CSF volume
130-150 ml
Lumbar puncture site?
L3-4 L4-5
Cranial nerves with parasympathetic components?
III, VII, IX, X
CN with only sensory function
I,II, VIII
CN with mixed function?
CN V, VII, IX, X
Most posteriorly situated CN?
Trochlear IV
Largest CN?
Trigeminal V
What goes to the cribriform plate of the anterior cranial fossa?
CN I
What goes to the optical canal?
CN II and Ophthalmic artery
What goes thru the foramen rotundum?
Maxillary nerve V2
What goes thru foramen ovale?
Mandibular nerve V3
CN that passes the foramen magnum?
CN XI (spinal root)
What CN passes the jugular foramen?
IX,X,XI (cranial root)
What passes the hypoglossal canal?
CN XII HYPOGLOSSAL NERVE
What passes the internal acoustic meatus?
CN VII AND VIII
What CNs are located supratentorially?
CN I AND II
Smiling muscle
Zygomaticus
Sarcodonic smile or grin
Risorius
Blowing or sucking muscle
Buccinator
Chin muscle
Mentalis
Kissing muscle
Orbicularis oris
Structures affected by cavernous sinus thrombosis?
CN III,IV,VI AND ophthalmic division and maxillary division of CN V and the INTERNAL CAROTID ARTERY
Perilymph is located in which structure?
Scala tympani
Immovable joints are?
Synarthroses
Freely movable joints are?
Diarthroses
Ball and socket joint example
Shoulder and hip joints
Ellipsoidal joint
Wrist
Saddle joint
Thumb
Hinge type or ginglymus
Elbow, knee and ankle
Condyloid type of joint
Knuckles
Pivot type or trochoid?
Atlantoaxial and radioulnar
Contents of the axilla
Axillary artery, vein and the brachial plexus
Axillary lymph nodes
Long thoracic nerve
Rotator cuff muscles
SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Most common type of shoulder dislocation
Antero inferior dislocation
Main abductor of the shoulder?
Deltoid muscle supplied by the axillary nerve
Most commonly affected in the inflammation of the rotator cuff?
Supraspinatus producing pain during abduction
Which joint is affected in SHOULDER DISLOCATION?
Glenohumeral joint
What joint is affected in SHOULDER SEPARATION?
Acromioclavicular joint
Contents of the quadrangular space?
Axillary nerve (CIRCUMPLEX NERVE) Posterior circumflex humeral vessels
Triangular space content
Circumflex scapular vessels
Anteriorly the arm is innervated by the?
Musculocutaneous nerve
Posteriorly, the arm is innervated by the ?
Radial nerve
Main flexor of the forearm?
Brachialis
Main extensor of the forearm?
Triceps brachii
Main supinator if the forearm?
Biceps brachii