Anatomy

Question 1

Planes of the body

horizontal/transverse
vertical
sagittal
coronal
median

Answer 1

in line with the horizon (aka transverse)

right angle to horizontal

top to bottom - separating L and R

vertical plane - separating back and front

Question 2

Types of epithelia: SQAMOUS

2 types? Examples of each

Answer 2

squamous

simple: lymphatic and blood vessels, pleura, and peritoneum
stratified: skin, esophagus, lower half of the anal canal

Question 3

Types of epithelia: CUBOIDAL

Examples in the body

Answer 3

Bowman’s capsule, convoluted tubules (kidney), thyroid follicles

Question 4

Types of epithelia: COLUMNAR

3 types? Examples of each

Answer 4

columna

simple: lining of the gastrointestinal tract
stratified: uterine tube
pseudostratified: respiratory tract

Question 5

Types of epithelia: TRANSITIONAL

Examples in the body

Answer 5

ureter, urinary bladder and most of the urethra

Question 6

The body develops from an embryo which at the end of the Week ___ has 2 layers [bilaminar] and at the
end of the Week ___ of gestation has 3 germinal layers [trilaminar]

Answer 6

The body develops from an embryo which at the end of the Week 2 has 2 layers [bilaminar] and at the
end of the Week 3 of gestation has 3 germinal layers [trilaminar]

Question 7

Endoderm gives rise to… (3)

Answer 7

epithelium of the respiratory, GI and GU tract

Question 8

Ectoderm gives rise to (4)

Answer 8

o epidermis including hair
o retina and lens
o Central Nervous System, Peripheral Nervous System, pia and arachnoid mater
o adrenal medulla

Question 9

Mesoderm gives rise to (4)

Answer 9

o bones and muscles of the trunk and extremities
o cardiovascular system and most of the genitourinary system
o cartilage and muscle of the respiratory system
o adrenal cortex, dermis of the skin and dura mater of the spinal cord

Question 10

Suboccipital Triangle

Boundaries (3):
Roof (1):
Floor (1):
Contents (3):

All of the muscles forming its boundaries are supplied by the ______ ________ of ___.

Answer 10

Suboccipital Triangle

Boundaries: rectus capitis posterior major, obliquus capitis superior, obliquus capitis inferior

Roof: deep fascia covered by semispinalis capitis

Floor: posterior arch of C1 and posterior atlanto-occipital membrane

Contents: 3rd part of vertebral artery, suboccipital nerve [CI] and suboccipital veins

All of the muscles forming its boundaries are supplied by the dorsal ramus of C1

Question 11

Anterior Cervical Triangle

Boundaries:
Roof:
Floor:
Contents:

Answer 11

Anterior Cervical Triangle
 Boundaries: anterior midline, inferior ramus of mandible and anterior border of SCM
 Roof: skin, superficial fascia and investing layer of deep cervical fascia
 Contents: carotid, submandibular, submental and muscular triangles

Question 12

Carotid Triangle

Boundaries:
Roof:
Floor:
Contents:

Answer 12

 Boundaries: SCM, posterior belly of digastric and superior belly of omohyoid
 Roof: skin, subcutaneous fascia and investing layer of deep cervical fascia
 Floor: hyoglossus, middle and inferior constrictor muscles
 Contents: CN XI, XII and the carotid sheath containing common carotid artery, external carotid
artery, internal carotid artery, internal jugular vein and CN X; lying anterior to the carotid
sheath are lymph nodes and the ansa cervicalis

Question 13

Submandibular Triangle [aka digastric triangle]

Boundaries:
Roof:
Floor:
Contents:

Answer 13

 Boundaries: posterior and anterior bellies of digastric and inferior ramus of mandible
 Roof: skin, superficial fascia
 Floor: mylohyoid, hyoglossus and part of middle constrictor
 Contents: submandibular gland, nodes, facial vein and artery, hypoglossal and mylohyoid nerve

Question 14

Submental Triangle [aka suprahyoid triangle]

Boundaries:
Roof:
Floor:
Contents:

Answer 14

 Boundaries: anterior bellies of both digastric and hyoid bone
 Roof: skin, subcutaneous fascia
 Floor: mylohyoid muscles
 Contents: submental lymph nodes and submental veins

Question 15

Muscular Triangle

Boundaries:
Roof:
Contents:

Answer 15

 Boundaries: sternocleidomastoid, superior belly of omohyoid and anterior midline of neck
 Roof: skin and superficial fascia
 Contents: sternohyoid, sternothyroid and thyrohyoid muscles, thyroid, trachea and larynx

Question 16

Posterior Cervical Triangle

Boundaries:
Roof:
Floor:
Contents:

Answer 16

 It is subdivided by inferior belly of omohyoid into the occipital and supraclavicular triangles [2]
 Boundaries: sternocleidomastoid, trapezius and middle third of the clavicle [3]
 Roof: Skin, superficial fascia, platysma and investing layer of deep cervical fascia [4]
 Floor: splenius capitis, levator scapulae, scalenus posterior, medius and anterior [5]
 Contents:
o [6 vessels] subclavian artery, suprascapular, transverse cervical, occipital arteries, the
subclavian and external jugular veins
o [7 nerves] great auricular, lesser occipital, supraclavicular, transverse cervical nerves,
trunks of the brachial plexus and CN XI*

Question 17

Triangle of Auscultation

Boundaries:
Roof:
Floor:
Contents:

Answer 17

 Boundaries: trapezius, latissimus dorsi and medial border of scapula
 Roof: skin and superficial fascia
 Floor: rhomboid major
 Contents: none

Question 18

Lumbar Triangle [of Petit]

Boundaries:
Roof:
Floor:
Contents:

Answer 18

 Boundaries: latissimus dorsi, external oblique and iliac crest
 Roof: skin and superficial fascia
 Floor: transverses abdominis
 Contents: none

Question 19

Inguinal Triangle [of Hesselbach]

Boundaries:
Roof:
Floor:
Contents:

Direct vs. indirect hernias?

Answer 19

o Boundaries: rectus abdominis, inferior epigastric vessels and inguinal ligament
o Inguinal ligament is the infolding of the lower end of the aponeurosis of External oblique
and extends from the Anterior Superior Iliac Spine to the pubic tubercle
 Roof: skin and external oblique aponeurosis
 Floor: transversalis fascia

 Direct hernias pass through Hesselbach’striangle
 Indirect hernias pass through the deep inguinal ring which is a defect in the transversalis fascia

Question 20

Femoral Triangle [of Scarpa]

Boundaries:
Roof:
Floor:
Contents:

Answer 20

 Boundaries: inguinal ligament, medial borders of sartorius and adductor longus*
 Roof: skin, superficial fascia and fascia lata
 Floor: iliopsoas, pectineus and adductor longus*
 Contents: femoral nerve, femoral artery, femoral vein and femoral canal
 The femoral artery, vein and canal lie inside the femoral sheath which is formed from the fascia
related to the transversalis and iliacus muscles
 The femoral nerve lies outside of the femoral sheath

Question 21

Thoracic Outlet [aka Superior Thoracic Aperture]

Boundaries:
Roof:
Contents:

Answer 21

 Boundaries: T1 vertebra [posterior], 1
st
ribs [lateral] and the manubrium of sternum [anterior]
 Roof: suprapleural membrane [Sibson’s fascia] which extends:
o from the tip of the transverse process of C7
o to the inner aspect of 1st rib
 Contents: trachea, esophagus, thoracic duct, brachiocephalic trunk, left common carotid and left
subclavian arteries, right and left brachiocephalic veins, right and left vagus nerves, phrenic nerves,
right and left sympathetic trunks, T1 of the brachial plexus and the sternohyoid, sternothyroid and
longus coli muscles

Question 22

Axilla

Boundaries:
Roof:
Floor:
Content (APICAL-lymph nodes groups):

Answer 22

 Boundaries: pectoralis major and minor [anterior], subscapularis, teres major and latissimus dorsi
[posterior], upper 4 ribs and serratus anterior [medial] and bicipital groove of the humerus [lateral]
 Roof:
o triangular interval bounded by:
 clavicle [anterior]
 1st rib [medial]
 scapula [posterior]
 Floor:
o skin
o superficial fascia
 Contents: axillary artery and branches, axillary vein and tributaries, cords of the brachial plexus and…

six groups of lymph nodes: 
o  Anterior [pectoral] 
o  Posterior [subscapular] 
o  Infraclavicular 
o  Central 
o  Apical 
o  Lateral [along the axillary vein]

Question 23

Triangular Space

Boundaries:
Contents:

Answer 23

 Boundaries: teres minor [superior], teres major [inferior], long head of triceps [lateral]
 Contents: circumflex scapular branch of the subscapular artery
 Roof: none
 Floor: none

Question 24

Cubital Fossa

Boundaries:
Roof:
Floor:
Content:

Answer 24

 Boundaries: pronator teres [medial], brachioradialis [lateral], imaginary line between humeral
epicondyles [superior]
 Roof: skin, superficial fascia containing median cubital vein, deep fascia and the bicipital
aponeurosis
 Floor:
o brachialis [medial]
o supinator muscle [lateral]
 Contents from lateral to medial: radial nerve, tendon of biceps brachii, brachial artery [and its
terminal branches-radial and ulnar] and the median nerve

Question 25

Anatomical Snuffbox Boundaries: Roof: Floor: Content:

Answer 25

 Boundaries: tendons of abductor pollicis longus and extensor pollicis brevis [anterior] and tendon of extensor pollicis longus [posterior]  Roof: skin, superficial fascia with cephalic vein and superficial branch of the radial nerve  Floor: o styloid process of radius o scaphoid o trapezium o base of the 1st metacarpus  Contents: radial artery and tendons of extensor carpi radialis longus and brevis

Question 26

Carpal Tunnel Roof (STOP): Floor: Content:

Answer 26

 Roof: flexor retinaculum-1” fibrous square attached to the following carpal bones:  o Scaphoid, Trapezium, Os hamate and Pisiform bones [STOP]  Floor: carpal bones [trapezium, trapezoid, capitate and hamate]  Contents: the median nerve, tendons of Flexor digitorum superficialis and profundus and tendon of Flexor pollicis longus [Flexor carpi radialis lies in a separate compartment]  NB: the superficial palmar branch of the median nerve passes over the retinaculum and therefore is not compressed allowing for the sensation of the palm to be intact in carpal tunnel syndrome

Question 27

Guyon’s canal [aka ulnar tunnel] Boundaries: Roof: Floor: Content:

Answer 27

```  Floor: flexor retinaculum  Roof: pisohamate ligament  Medial border: pisiform  Lateral border: hamate  Contents: ulnar nerve and ulnar artery ```

Question 28

Inguinal Canal [of 2’s] Boundaries: Roof: Floor: Content:

Answer 28

 Boundaries: external oblique aponeurosis and internal oblique [anterior] with the conjoint tendon and transversalis fascia [posterior]  Roof: arching fibers of internal oblique and transversus abdominis  Floor: inguinal ligament and lacunar ligament medially  Extent: between the deep and superficial inguinal rings  Contents: o ilioinguinal nerve o spermatic cord in males o round ligament of uterus in females  Extent: from the deep ring [above a point midway between the ASIS and pubic tubercle] to the superficial ring [medial to the pubic tubercle and above the pubic crest]

Question 29

Femoral Canal Boundaries: Roof: Floor: Content:

Answer 29

 Boundaries: lacunar ligament [medial], inguinal ligament [anterior], femoral vein [lateral] and pectineus and pectineal ligament [posteriorly]  Roof: connective tissue  Contents: lymph node [Cloquet or Rosenmuller], lymphatics and connective tissue

Question 30

Adductor Canal [Subsartorial or Hunter’s canal] Boundaries: Content:

Answer 30

```  Boundaries: o vastus medialis [anterolateral] o sartorius [medial] o adductor longus [posterior] o magnus [posterior]  Contents: o femoral artery o femoral vein o saphenous nerve o nerve to vastus medialis ```

Question 31

Popliteal Fossa Boundaries: Roof: Floor: Content:

Answer 31

 Boundaries: biceps femoris [superolateral], semitendinosus and semimembranosus [superomedial], lateral and medial heads of gastrocnemius [inferolateral and inferomedial]  Roof: skin, superficial fascia with short saphenous vein and deep fascia  Floor: lower end of femur, posterior aspect of knee joint, popliteus muscle and fascia  Contents: o tibial nerve o popliteal vein and artery o common peroneal [fibular] nerve o nodes o fat o the artery is deepest, the tibial nerve is most superficial and the vein is in between

Question 32

Tarsal Tunnel Contents (Tom, Dick, ANd, Harry)

Answer 32

 Contents: o Tibialis posterior tendon o Flexor Digitorum longus tendon o posterior tibial Artery, vein and Nerve o Flexor Hallucis longus tendon o [Tom, Dick ANd Harry] in that order from anterior t

Question 33

Embryology - Heart The heart develops in the __________in the cephalic region of the developing fetus at Week 3. __________ tissue coalesce to form the right and left ________ tubes which fuse to form the ________heart tube. the _______heart tube folds on itself and develops three dilations-atrial, ventricular and the ______ cordis. the proximal end of the heart tube is formed by the sinus _______the distal end is formed by the truncus ______

Answer 33

The heart develops in the mesoderm in the cephalic region of the developing fetus at Week 3. Angioblastic tissue coalesce to form the right and left endocardial tubes which fuse to form the primitive heart tube. the primitive heart tube folds on itself and develops three dilations-atrial, ventricular and the bulbus cordis. the proximal end of the heart tube is formed by the sinus venosus the distal end is formed by the truncus arteriosus

Question 34

Embryology - Heart The atrial dilation is divided by a septum _______ in Week 5. Another septum appears to the right of the septum primum called the septum ________. This septum is incomplete inferiorly remaining as the limbus of the fossa _____.

Answer 34

the atrial dilation is divided by a septum [septum primum] in the 5th week a hole appears in the upper part of the septum primum-ostium secundum another septum appear to the right of the septum primum called the septum secundum this septum is incomplete inferiorly remaining as the limbus of the fossa ovalis. the ventricular dilation is divided by a septum which goes upwards towards the endocardial cushions

Question 35

Embryology - Heart Truncus arteriosus is divided into two separate tubes-aortic and pulmonary in Week 7 and 8. The two tubes twist on each other to allow the pulmonary ______ to lie anterior to the aorta initially and then posterior there is a connection called the ______ arteriosus in the fetus that allows ___________ blood to be shunted from the ____pulmonary artery to the arch of the aorta. This ductus closes shortly after birth to form the ligamentum ___________

Answer 35

 the truncus arteriosus is divided into two separate tubes-aortic and pulmonary in the 7th and 8th weeks  the two tubes twist on each other to allow the pulmonary artery to lie anterior to the aorta initially and then posterior  there is a connection called the ductus arteriosus in the fetus that allows oxygenated blood to be shunted from the left pulmonary artery to the arch of the aorta  this ductus closes shortly after birth to form the ligamentum arteriosum

Question 36

Embryology - Heart (Congenital anomalies): ``` VSD - MC congenital heart disease ASD - MC is a ostium ________ defect Fallot's tetralogy - MC cause of cyanotic heart disease Patent foramen ovale Persistent ductus arteriorsus (PDA) ``` Which of the following are acyanotic?

Answer 36

o Ventricular Septal Defect: most common congenital heart disease] (acyanotic) o Atrial Septal Defect: most common is an ostium secundum defect (acyanotic) o Fallot’s tetralogy: most common congenital cyanotic heart disease o Patent Foramen Ovale (acyanotic) o Persistent Ductus Arteriosus (acyanotic) cyanosis is due to the mixing of arterial blood with deoxygenated blood and occurs in right to left shunts

Question 37

Fallot’s tetralogy is described by what 4 findings?

Answer 37

pulmonary stenosis VSD R ventricular hypertrophy over-riding (dextroposition) of the aorta PS VSD RVH DP of aorta boot shaped heart! recall that image with the cowboy

Question 38

Surface markings of the heart ___ right costal cartilage1 finger’s breath from the sternal edge ___ right costal cartilage 1 finger’s breath from the sternal edge ___ left costal cartilage 1 finger’s breath from the sternal edge ___ left intercostal space 7-9 cm from the midsternal line

Answer 38

Surface markings of the heart 3rd right costal cartilage1 finger’s breath from the sternal edge 6th right costal cartilage 1 finger’s breath from the sternal edge 2nd left costal cartilage 1 finger’s breath from the sternal edge 5th left intercostal space 7-9 cm from the midsternal line

Question 39

Cardiac Chambers Right heart border is made up of the ? Inferior heart border is made up of the ? Left heart border is made of the left ventricle and left _____ of left atrium

Answer 39

 Right heart border is made up of the right atrium  Inferior heart border is made up of the right ventricle  Left heart border is made of the left ventricle and left auricle of left atrium

Question 40

Right atrium 2 origins = rough and smooth Rough part is derived from the ____ ______ which contains the pectinate muscles! Smooth part is derived from the ______ ______ They are separated by a ridge called _____ _________

Answer 40

 it has two origins-from the sinus venosus and from the true atrium  the rough part is derived from the true atrium o the rough part of the atrium has the pectinate muscle bundles  the smooth part is derived from the sinus venosus embryologically  they are separated by a ridge called the crista terminalis

Question 41

Right atrium oval depression on the interatrial septum = ? limbus of the fossa ovalis is remnant of the septum ________ 70% of myocardial venous blood drains into the heart via the coronary _______

Answer 41

fossa ovale ( fetal foramen ovalis - the septum primum) septum secundum coronary sinus

Question 42

Left atrium __ openings carrying _________ blood from the ______

Answer 42

4 veins, oxygenated blood, from the lungs

Question 43

Right ventricle has large fleshy trabeculae _______ and ________ muscles septomarginal branch is also known as the _______ _____ which carries majority of the right bundle branch infundibulum is the smooth ______shaped inlet to the pulmonary _______

Answer 43

large fleshy trabeculae carneae and papillary muscles moderator band infundibulum is a smooth funnel-shaped inlet to the opening of the pulmonary valves

Question 44

Left ventricle has a thick muscular wall with trabeculae _______ divided from the R ventricle by the ?

Answer 44

carneae interventricular septum

Question 45

Surface Markings of heart valve sound (APTM) 2nd R IC space (1.25 cm from sternum) 2nd L IC space (1.25 cm from sternum) 4th L IC space (1.25 cm from sternum) 5th L IC space (7-9 cm from midsternal line)

Answer 45

2R - Aortic (semilunar valves) 2L - Pulmonary (semilunar valves) 4L - Tricuspid (right atrioventricular valve) 5L - Mitral (bicuspid valve or left atrioventricular valve)

Question 46

Heart Valves RA to RV RV to pulmonary trunk LA to LV LV to ascending aorta The valve leaflets are attached to _____ muscles by fibrous cords called the chorda _______ .

Answer 46

RA to RV - tricuspid (R AV) RV to pulmonary trunk - pulmonary (semilunar valves) LA to LV - mitral (bicuspid or L AV) LV to ascending aorta - aortic (semilunar valves) The valve leaflets are attached to papillary muscles by fibrous cords called the chorda tendinae.

Question 47

Heart The heart is supplied by two branches that arise from the ______ part of the aorta o right _______ artery o left _______ artery

Answer 47

 the heart is supplied by two branches that arise from the ascending part of the aorta o right coronary artery o left coronary artery

Question 48

Right coronary artery Originates from the R aortic coronary _____. Runs between the R auricle and pulmonary trunk in the anterior AV sulcus. It is distributed to which (6) locations/branches?

Answer 48

sinus ``` o RA o RV o 30% of LA o SA node [55% of the population] o AV node [85% of the population] o posterior 1/3 of the IV septum ```

Question 49

Left coronary artery Originates from the L aortic coronary _____. Runs between L auricle and pulmonary trunk. What are the 3 branches? Where is the blood distributed?

Answer 49

o circumflex o anterior Interventricular [aka left anterior descending] o left marginal o LV o 70% of LA o anterior 2/3 of the IV septum

Question 50

Venous Drainage Coronary sinus drains 70% of venous blood via the follow 4 cardiac veins. The rest is drained via the _____ cardiac vein which opens into the RA.

Answer 50

o great cardiac vein [accompanies the left anterior descending artery] o small cardiac vein [accompanies the right marginal artery] o middle cardiac vein [accompanies the posterior interventricular artery] o oblique cardiac vein the anterior cardiac vein which opens into the right atrium

Question 51

Cardiac Conduction System SA node is located in the upper right ____ near the SVC. It is sympathetically AND parasympathetically innervated by? AV node is located posteroinferior in the ______ septum Bundle of HIs is located in the ______ septum (membranous) R and L bundle branches are located in the muscular part of the IV septem. Bundle branches end at _________ fibers

Answer 51

 The Sino-Atrial node is located in the upper right atrium near the opening of SVC. The SA node is innervated by cardiac plexuses with sympathetic fibers from T1-5 and parasympathetic fibers from CN X  The Atrio-Ventricular node is located in the posteroinferior part of the interatrial septum  The Bundle of His is located in the membranous part of the interventricular septum  Right and left bundle branches are located in the muscular part of the interventricular septum  Bundle branches end as the subendocardial Purkinje fibers

Question 52

Cardiac Plexuses Divided into 2 parts: deep and superficial Superficial plexus has fibers from (2) Deep plexus has fibers from (3)

Answer 52

superficial part receives fibers from: o superior cervical sympathetic ganglion o inferior cardiac branch of the vagus deep plexus receives contributions from the (1) superior, middle and inferior cervical sympathetic ganglia (2) superior and inferior cardiac branches of the vagus (3) branches from the recurrent laryngeal nerves from the vagus nerve

Question 53

Branches of the thoracic aorta Just flip and view!

Answer 53

Branches of the thoracic aorta  right and left coronary arteries [from the ascending aorta]  brachiocephalic trunk [from the arch of aorta]  left common carotid [from the arch of aorta]  left subclavian artery [from the arch of aorta]  3rd to 11th posterior intercostals [from the descending part of thoracic aorta]  bronchial [from the descending part of thoracic aorta]  esophageal [from the descending part of thoracic aorta]

Question 54

Branches of the abdominal aorta - rules of 4 4 paired _____ arteries 4 paired parietal arteries 4 UNPAIRED _____ arteries aorta ends at __ by bifurcating into common iliac arteries (origin of internal and external iliac arteries)

Answer 54

```  4 paired visceral arteries: o inferior phrenic o middle adrenal o renal o gonadal ```  4 paired parietal-1st to 4th lumbar arteries  4 unpaired visceral: o celiac trunk [at the level of T12] o superior mesenteric [at the level of L1] o inferior mesenteric [at the level of L3] o median sacral [at the level of L4]  aorta ends at L4 by bifurcating into: o common iliac arteries which then divide into o internal and external iliac arteries

Question 55

Internal Iliac Artery - 9 branches (6 anterior, 3 posterior) Some Inherit Money, Others Inherit Insanity, Usually. Isn't Life Silly?

Answer 55

```  anterior division [6 branches]: o Superior vesical o Inferior vesical o Middle rectal o Obturator o Inferior gluteal o Internal pudendal o plus the Uterine and vaginal arteries in females ```  posterior division [3 branches]: o Iliolumbar o Lateral sacral o Superior gluteal

Question 56

External Iliac Artery - 3 branches. Then it continues as the femoral artery...they it branches into what 4 branches.

Answer 56

 the external iliac artery has three branches [CID]: o Cremasteric artery [only in males] o Inferior epigastric artery o Deep circumflex artery  continues as the femoral artery beyond the inguinal ligament with the following branches: o Superficial external pudendal o Deep external pudendal o Superficial circumflex iliac o Deep femoral with its medial and lateral circumflex branches

Question 57

Femoral artery passes through the _____ canal and becomes which artery? What does the femoral nerve accompany?

Answer 57

adductor popliteal artery  the saphenous nerve accompanies the femoral artery in the mid-thigh

Question 58

Popliteal artery bifurcates into what? What nerve does it accompany?

Answer 58

anterior and posterior tibial arteries posterior tibial then divides into the medial and lateral plantar arteries behind the medial malleolus. Accompanied by posterior tibial nerve anterior tibial continues into the foot as the dorsalis pedis artery (passing through 1st and 2nd toe). It also accompanies the deep peroneal nerve in the anterior leg compartment. Its branch called the arcuate artery supplies the dorsum of the foot. dorsalis pedis connects with lateral plantar branch of the posterior tibial artery to form the plantar arch  the popliteal artery accompanies the tibial nerve in the popliteal fossa

Question 59

Subclavian Artery  the ____ subclavian artery comes off of the arch of the aorta  the ____ subclavian artery comes off of the ______________ trunk  both pass over the 1st rib behind the Scalenus anterior muscle

Answer 59

Subclavian Artery  the left subclavian artery comes off of the arch of the aorta  the right subclavian artery comes off of the brachiocephalic trunk  both pass over the 1st rib behind the Scalenus anterior muscle

Question 60

Subclavian artery - 4 branches

Answer 60

``` internal thoracic vertebral thyrocervical trunk (branches are suprascapular, inferior thyroid, transverse cervical) costocervical trunk (branches are superior intercostal and deep cervical) ```

Question 61

Subclavian artery Becomes the _______ artery which divides into 3 parts by pectoralis minor. Then it becomes the ________ artery

Answer 61

axillary artery o 1st part [proximal to pectoralis minor]-superior thoracic artery o 2nd part [beneath pectoralis minor]-thoraco-acromial and lateral thoracic arteries o 3rd part [distal to pectoralis minor]-subscapular, posterior and anterior circumflex humeral arteries brachial artery

Question 62

Brachial artery terminates where and then bifurcates into which two arteries? What nerve does it accompany?

Answer 62

cubital fossa at the level of the neck of the radius by bifurcating into the radial and ulnar arteries median nerve

Question 63

Radial artery - 4 branches

Answer 63

```  the branches of the radial artery include [RCMP]: o Radial recurrent o Carpal o Muscular o superficial Palmar arteries ```

Question 64

Ulnar artery - 5 branches What nerve does it accompany?

Answer 64

 the branches of the ulnar artery are: o anterior and posterior ulnar collateral o common interosseous o muscular o anterior and posterior carpal o deep palmar ulnar artery

Question 65

The radial and ulnar arteries form two arches in the palm - what are they?

Answer 65

o the superficial palmar arch is the continuation of the ulnar artery  lies between the palmar aponeurosis and the digital flexor tendons  it is completed by the superficial palmar branch of the radial artery o the deep palmar arch is the continuation of the radial artery  lies between the palmar interossei and the deep digital flexor tendons  it lies proximal to the superficial palmar arch

Question 66

Pituitary gland Location? Covered by a dura called? Anterior lobe (Rathke's pouch from ectoderm) produces which 6 hormones? Posterior lobe STORES but not produce the following 2 hormones?

Answer 66

location = sella turcica within sphenoid bone below optic chiasma fold of dura = diaphragm sellae Anterior lobe (Rathke's pouch) = FSH, LH, ACTH, TSH, PRL (prolactin), GH. These hormones (except PRL) are influenced by releasing factors from the hypothalamus. oxytocin and ADH/vasopressin. Oxytocin is produced by paraventricular nuclei. ADH/vasopressin is produced by supraoptic nuclei in the hypothalamus

Question 67

Thyroid gland Shape? Two sides are connected by the _______. Consists of ________ cell-lined follicles which secrete _____ from which T_ is developed. Para________ cells are found in between the follicles and these cells secrete _________. Weighs ___ grams and lies in the ______ cervical triangle (under the cover of SCM and infrahyoid muscles) The connective tissue wrapping it is continuous with what structure? Supplied by the 3 following arteries?

Answer 67

2 pear shape lobes linked by isthmus consists of cuboidal cell-lined follicles secrete thyroxin from which T3 is developed parafollicular cells are found in between the follicles. these cells secrete calcitonin 25 g in the anterior cervical triangle pre-tracheal layer of deep cervical fascia o superior thyroid artery from External Carotid Artery (accompanied by the superior laryngeal nerve) o inferior thyroid artery from the thyrocervical trunk (accompanied by the recurrent laryngeal nerve o thyroidea ima which occurs in 3-10%

Question 68

Parathyroid glands Contains which two types of cells? Function of PTH hormone

Answer 68

chief cells (secretes PTH) and oxyphils PTH allows for bone resorption (take Ca out of bone) and into the blood stream

Question 69

Pancreas T or F: only an exocrine gland. Islets of Langerhans consists of what 3 cell types and what do each of them secrete? The main pancreatic duct joins with what duct to open into the ampulla of Vater in the main duodenal papilla in the duodenum? Which sphincter is here? Blood supply (3)

Answer 69

F - endo and exocrine beta - insulin alpha - glucagon delta - somatostatin (aka growth hormone-inhibiting hormone (GHIH)) the main pancreatic duct joins with the common bile duct to open into the ampulla of Vater in the main duodenal papilla into the duodenum. Smooth muscle sphincter of Oddi. o superior pacreaticodudodenal artery [from the gastoduodenal artery of the celiac trunk] o inferior pacreaticoduodenal artery [from the superior mesenteric artery] o great pancreatic artery [from the splenic artery]

Question 70

Adrenal Gland R gland - smaller and trangular L gland is semilunar and LARGER 3 structural zones in the CORTEX and the related hormones The medulla secretes what?

Answer 70

o zona Glomerulosa – Mineralocorticoids – Aldosterone [under Renin control]-Salt o zona Fasciculata – Glucocorticoids [under ATCH control]-Sweet o zone Reticularis – Sex hormones-Sex the deeper you go the sweeter the sex gets the medulla secretes norepinephrine under sympathetic control

Question 71

Embryology of GI anatomy foregut - gives rise to (3) midgut - gives rise to (3) hindgut - gives rise...

Answer 71

 esophagus  stomach  proximal half of the duodenum-up to major duodenal papilla  distal half of duodenum  small intestine  proximal half of large intestine up to the proximal two thirds of transverse colon gives rise to the rest of the large intestine from the distal third of the transverse colon to the proximal half of the anal canal

Question 72

Merkel's diverticulum (Rule of 2s)

Answer 72

o this is an uncommon congenital anomaly o it occurs in 2% of the population o it is 2 inches long o it is located 2 feet proximal to the ileocecal junction o it may contain 2 types of ectopic tissue-gastric and pancreatic tissue o it is found 2 times more common in males

Question 73

Regional Topographical Anatomy of the abdomen ``` o epigastric o right hypochondrium o left hypochondrium o umbilical o right and left flanks o right Iliac fossa o left Iliac fossa o hypogastric ```

Answer 73

o epigastric-stomach, duodenum and pancreas o right hypochondrium-liver and gallbladder o left hypochondrium-spleen o umbilical-small intestine o right and left flanks-kidneys o right Iliac fossa-appendix, right ovary and right uterine tube and cecum o left Iliac fossa-left ovary, left uterine tube and sigmoid colon o hypogastric [suprapubic]-bladder and uterus

Question 74

The dermatomes and underlying parietal peritoneum are innervated by the lower 6 thoracic and

Answer 74

o T7-xiphoid level o T10-umbilical level o L1-inguinal region

Question 75

Anterior Abdominal Wall - 6 layers. Innervated by T7-L1 - which nerves?

Answer 75

skin subcutaneous tissue (fatty later and membranous layer) muscles: external and internal oblique and TA transversalis fascia extraperitoneal fat parietal peritoneum The anterior abdominal wall is innervated by the lower 5 intercostal nerves [T7-11], the subcostal nerve [T12], the iliohypogastric and ilioinguinal nerves [L1]

Question 76

Rectus sheath Contents (3)

Answer 76

 Contents of the rectus sheath o rectus abdominis muscle o pyramidalis muscle [absent in 15% of the population] o superior and inferior epigastric arteries and veins which lie below the rectus muscle

Question 77

Peritoneum (inner lining of the abdominal cavity) Parietal layer Visceral layer

Answer 77

o the parietal layer is sensitive to pain and is innervated by the lower intercostal and subcostal nerves like the anterior abdominal wall o the visceral layer is not sensitive to pain but sensitive to distension

Question 78

Abdominal cavity is divided into two comparments.

Answer 78

greater and lesser sacs  the lesser sac lies behind the stomach and opens into the greater sac via the epiploeic foramen of Winslow

Question 79

Retroperitoneal structures [AC DC PARK AID]

Answer 79

retroperitoneal structures [AC DC PARK AID]: ``` ascending colon, descending colon, pancreas, adrenals, rectum [lower 2/3], kidneys, aorta, IVC, duodenum [2nd to 4th parts] ```

Question 80

Stomach J-shaped sac lined by _________ epithelium 3 layers of smooth muscle? 2 notches? 2 attached omentas? 2 sphincters? Contains 2 main cell types - what do each of then produce?

Answer 80

 J-shaped sac lined by columnar epithelium and covered by three layers of smooth muscle-outer longitudinal, inner circular and innermost oblique  the stomach has 2 notches-cardiac and angular  there are 2 curvatures-lesser and greater  there are 2 attached omenta-greater and lesser  it is guarded by 2 sphincters-lower esophageal and pyloric it contains 2 main types of cells-chief cells producing pepsinogen and parietal [oxyntic] cells which produce hydrochloric acid and Intrinsic Factor

Question 81

Duodenum 10-inch C-shaped tube surrounding the head of the pancreas 4 parts

Answer 81

o 1st [2” long] – superior part o 2nd [3” long] – descending part (common bile duct opens into here) o 3rd [4” long] – horizontal part o 4th [1” long] – ascending part (continuous with jejunum at duodenum-jejunal junction). This junction is secured by the suspensory ligament (of Treitz) which is attached to the R crus of the diaphragm  the first inch of the first part of the duodenum is intraperitoneal  the rest of the duodenum is retroperitoneal

Question 82

Biliary Tree Made up of what 6 parts

Answer 82

 the biliary tree is made up of the following: o right and left hepatic ducts join to form the common hepatic duct o the cystic duct of the gallbladder joins with the common hepatic duct to form the common bile duct o the triangle between the cystic duct, common hepatic duct and the liver is known as Callot’s triangle and it contains the cystic artery o the common bile duct travels in the free edge of the lesser omentum along with the proper hepatic artery and the portal vein o the common bile duct passes through the head of the pancreas and is joined by the main pancreatic duct to open into the second part of the duodenum o the opening into the duodenum is guarded by the smooth muscle sphincter of Oddi

Question 83

Ileum has numerous ________ aggregates called _____ patches?

Answer 83

lymphoid Peyer's - [Gut Associated Lymphoid Tissue]

Question 84

Difference between large vs. small intestine

Answer 84

 large intestine has haustra, teniae coli, appendices epiploica and a larger diameter  small intestine has no haustra, teniae coli or appendices epiploica

Question 85

Colon 4 parts? Which organ is found with McBurney's point (2/3 along a line from umbilicus and ASIS)

Answer 85

ascending tranverse, descending, sigmoid its base is located at McBurney’s point-2/3 along a line from the umbilicus to the ASIS

Question 86

Anal Canal Guarded by two sphincters - one involuntary and the other involuntary

Answer 86

o internal circular sphincter which is made up of smooth muscle (involuntary) o external sphincter [skeletal muscle] which has three parts (voluntary). the external sphincter is supplied by the inferior rectal branch of the pudendal nerve

Question 87

T or F: clavicle is the 1st bone to begin ossification and the last the completely ossify. T or F: all long bones except the clavicle have intra-cartilaginous ossification

Answer 87

T T

Question 88

T or F: clavicle, flat skull bones and the axial skeleton have intra-membranous ossification

Answer 88

T

Question 89

Synarthrosis vs. amphiarthrosis vs. diarthrosis SADISM

Answer 89

S - immobile (fibrous jt) A - slightly mobile (cartilaginous jt) D - mobile (synovial jt)

Question 90

Fibrous joints 3 types

Answer 90

 Synostosis [sutural]  Syndesmosis [interosseous membrane]  Gomphosis [tooth and tooth socket in the gum]

Question 91

Cartilaginous joints 2 types

Answer 91

synchondrosis (primary cartilaginous) - growing ends of long bones symphysis (secondary cartilaginous) - IVD, pubic symphysis, manubriosternal jt)

Question 92

Synovial joints ```  planar  ginglymus  trochoid  condylar  sellar  spheroidal ```

Answer 92

 planar [gliding] zygapophyseal, acromio-clavicular  ginglymus [hinge] humero-ulnar  trochoid [pivot] medial atlanto-axial, proximal radio-ulnar  condylar [ellipsoid] metacarpophalangeal  sellar [saddle] 1 st carpo-metacarpal  spheroidal [ball and socket] hip and shoulder

Question 93

T or F: All midline joints are secondary cartilaginous except the median atlanto-axial (atlantodental) jt which is a trochoid synovial jt

Answer 93

T Remember all midline joints are secondary cartilaginous joints EXCEPT the following:  the median atlanto-axial [atlantodental] joint which is a trochoid synovial joint

Question 94

Synovial jts have articular surfaces covered by ______ cartilage except which 3 joints which are fibrocartilage?

Answer 94

 the articular surfaces of all synovial joints are covered by hyaline cartilage o EXCEPT the temporomandibular, sternoclavicular and acromioclavicular joints  which are covered by fibrocartilage [each of these also have complete or partial intra-articular discs]

Question 95

 the synovial membrane lines the interior of the fibrous joint capsule and the _____________ surfaces of the nearby bones

Answer 95

 the synovial membrane lines the interior of the fibrous joint capsule and the non-articular surfaces of the nearby bones

Question 96

Synovium is made up of _____ cells derived from which embryological layer?

Answer 96

 the synovium is made up of plump cells derived from mesoderm o Type A synoviocytes which are macrophagic cells o Type B synoviocytes secretes synovial fluid which contains hyaluronic acid and glycoproteins

Question 97

What is Hilton's law of innervation of joints?

Answer 97

 the nerve which innervates a muscle that acts on a joint, will supply the joint and an area of skin over the joint

Question 98

Bone is made up of: (1) Central ______ canals - connected by Volkmann's canals (supply nutrients and removing waste) (2) _______ lamella - comprise of lacunae which have the osteocytes (matured osteoblasts) (3) bone matrix - comprised of which to types of cells?

Answer 98

o central Haversian canals o concentric lamella o bone mat  central Haversian canals with blood vessels o the canals are connect by Volkmann’s canals  supplying nutrients and removing waste concentric lamellae surround the Haversian canals o the lamellae are comprised of lacunae which the osteocytes o the lacunae are connected by canaliculi which contain thin cytoplasmic strands  allowing the osteocytes to communicate with each other  bone matrix-calcified intercellular material comprised of o osteoblasts synthesize the matrix [build bone] and later become osteocytes o osteoclasts reabsorb and remodel bone tissue [clears bone away]

Question 99

_____blasts and blood vessels can be found in the cartilage outer layer called the ____________

Answer 99

perichondrium

Question 100

Cartilage is comprised of 95% of what and 5 % of what in lacunae?

Answer 100

mainly comprised of [95%] extracellular matrix of gylcosaminoglycans and proteogylcans and few chondrocytes [5%] in lacunae chondrocytes arise from chrondroblasts cells

Question 101

T or F: cartilage has no blood supply or nerves

Answer 101

T

Question 102

3 types of cartilage hyaline elastic fibrocartilage

Answer 102

o Hyaline: most abundant, consisting mainly of Type II collagen fibers covers joint o Elastic: contains Type II collagen fibers and elastin; found in the larynx o Fibrocartilage: dense compact Type I collagen fibers; found in intra-articular discs

Question 103

Histological types of muscle: smooth skeletal cardiac

Answer 103

``` o smooth  no cross striation [hence smooth]  spindle-shaped cell  central nucleus  involuntary ``` o skeletal  cross striations  elongated peripheral nucleus  voluntary control ``` cardiac  cross striations  branches  intercalated discs  central nucleus  involuntary control ```

Question 104

Skeletal muscle can be further categorized into what 5 categories?

Answer 104

o fusiform  thick in the middle and tapered at each end: biceps brachii, gastrocnemius o parallel  uniform width with parallel fascicles: rectus abdominis and sartorius o triangular  fan-shaped with a broad origin and narrow insertion: pectoralis major ``` o pennate  feather-shaped  unipennate: palmar interossei  bipennate: rectus femoris and dorsal interossei  multipennate: deltoid ``` o circular  forms rings around certain body openings: orbicularis oculi and anal sphincter

Question 105

Temporomandibular Joint Type of joint Bones involved Innervation

Answer 105

Compound hinge and gliding joint. Articular surfaces are covered by fibrocartilage instead of hyaline like most other synovial joints) Condyle of the mandible, mandibular fossa and articular eminence of the temporal bone Auriculotemporal, deep temporal and masseteric branches of CN V3

Question 106

Shoulder [glenohumeral] Joint Type of joint Bones involved Innervation

Answer 106

synovial, ball and socket (spheroidal) Glenoid fossa [deepened by labrum glenoidale] and head of humerus Axillary and suprascapular nerves

Question 107

Sternoclavicular Joint Type of joint Bones involved Innervation

Answer 107

synovial, saddle (sellar) but behaves like a ball and socket (covered with fibrocartilage unlike other synovial joints) Manubrium of sternum and the medial head of the clavicle Medial branch of the supraclavicular nerves [C3]

Question 108

Elbow Joint Type of joint Bones involved Innervation

Answer 108

synovial, hinge Lower end of humerus and the head of the radius and trochlea of the ulna Radial and musculocutaneous nerves

Question 109

Proximal and Distal Radio-ulnar joints Type of joint Bones involved Innervation

Answer 109

synovial, pivot (trochoid) Median, ulnar and radial nerves

Question 110

Wrist Joint Type of joint Bones involved Innervation

Answer 110

synovial condyloid (ellipsoid) Distal end of radius, scaphoid and lunate bones Radial, median and ulnar nerves

Question 111

1st Carpometacarpal Joint Type of joint Bones involved Innervation

Answer 111

synovial, saddle (sellar) trapezium and 1st metacarpal bones Radial and median nerves

Question 112

Metacarpophalangeal Joint Type of joint Bones involved Innervation

Answer 112

synovial, condyloid [ellipsoid] Head of metacarpal and base of proximal phalanx Median, ulnar and radial nerves

Question 113

Good acronym for adduction and abduction of MCP joints

Answer 113

Adduction-palmar interossei [PAd] Abduction-dorsal interossei [DAb]

Question 114

Interphalangeal Joint Type of joint Bones involved Innervation

Answer 114

synovial, hinge (ginglymus) Proximal and middle, and between the middle and distal phalanges Median, ulnar and radial nerves

Question 115

Hip joint Type of joint Bones involved Innervation

Answer 115

synovial, ball and socket (spheroidal) Acetabulum of os coxae [hip bone] and the head of the femur Femoral, obturator and nerve to quadratus femoris

Question 116

1 intra-capsular ligament in the hip joint 3 intracapsular ligament in the hip joint

Answer 116

one intra-articular ligament: o round ligament of the head of the femur from the transverse acetabular ligament and the rim of the nearby acetabular notch to the fovea centralis of the femur. contains the central foveolar artery in children [absent in the adult]  three extra-articular ligaments: o iliofemoral ligament from the anterior inferior iliac spine to the root of the femoral neck - prevents hyperextension o pubofemoral ligament from the superior pubic ramus to lower part of the capsule - prevents hyper-abduction o ischiofemoral ligament from the ischium to the posterior part of the capsule - prevents hyperextension

Question 117

Knee Joint Type of joint Bones involved Innervation

Answer 117

synovial, modified hinge (ginglymus) Lower end of the femur and the upper end of the tibia Femoral, tibial and common peroneal nerves

Question 118

Knee Joint 2 intra-articular ligaments 2 extra-articular ligaments 2 intra-articular discs

Answer 118

o anterior cruciate ligament  originates from the anterior part of the intercondylar ridge  inserted into the posterior side of the medial aspect of the lateral condyle of the femur; prevents anterior movement of tibia on the femur o posterior cruciate ligament  originates from the posterior part of the intercondylar ridge  inserted into the anterior part of the lateral aspect of the medial condyle of the femur; prevents posterior movement of tibia on the femur o medial collateral - thick broad ligament from femur to tibia - attached to the medial meniscus; prevents abduction stress o lateral collateral - thin narrow ligament from femur to head of fibula; prevents adduction stress o medial meniscus  semilunar fibrocartilaginous disc attached to the medial collateral ligament and to the intercondylar ridge o lateral meniscus  nearly circular  attached to the intercondylar ridge  not attached to the lateral collateral ligament

Question 119

Ankle Joint Type of joint Bones involved Innervation

Answer 119

synovial, hinge Lower end of the tibia and fibula and the talus Tibial and deep peroneal nerves

Question 120

Sternocleidomastoid Origin Insertion Innervation Action

Answer 120

Origin Mastoid process and lateral third of superior nuchal line Insertion Manubrium of sternum and medial third of the clavicle Innervation Spinal part of CN XI [motor] and ventral rami of C2, C3 [proprioception] Action Tilts the head towards the shoulder on the same side and rotates the head to the opposite side

Question 121

Trapezius Origin Insertion Innervation Action

Answer 121

Origin Medial third of superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes of C7 and all thoracic vertebrae Insertion Lateral third of clavicle, acromion and spine of scapula Innervation Spinal part of CN XI [motor] and branches of C3 and C4 [proprioception] Action Shrugs the shoulder, retracts and rotates the scapula

Question 122

Latissimus dorsi Origin Insertion Innervation Action

Answer 122

Origin Thoracolumbar fascia, spinous processes of the lower thoracic and lumbar vertebrae Insertion Floor of the bicipital groove Innervation Thoracodorsal nerve [C6, 7, 8] Action Adducts, extends and medially rotates the arm

Question 123

Levator scapulae Origin Insertion Innervation Action

Answer 123

Origin Transverse processes of C1 and C2 Posterior tubercles of the transverse processes of C3 and C4 Insertion From the superior angle to the root of the spine of the scapula Innervation Dorsal scapular nerve [C5] Action Elevates the scapula

Question 124

Scalenus anterior Origin Insertion Innervation Action

Answer 124

Origin Anterior tubercles of the transverse processes of C3, 4, 5 and 6 Insertion Scalene tubercle on the upper inner aspect of the first rib Innervation Anterior rami of C4, 5 and 6 Action Ipsilateral lateral flexion of the neck

Question 125

Scalenus medius Origin Insertion Innervation Action

Answer 125

Origin Posterior tubercles of the transverse processes of C2 to C6 Insertion Upper aspect of the 1st rib between groove for the subclavian artery and the tubercle Innervation Anterior rami of C3 to C7 Action Ipsilateral lateral flexion of the neck

Question 126

Serratus anterior Origin Insertion Innervation Action

Answer 126

Origin Lateral aspects of the upper 8 ribs Insertion Along the medial aspect of the inferior surface of the scapula Innervation Long Thoracic Nerve [C5, 6 and 7] Action Draws the scapula forwards and rotates the scapula

Question 127

Deltoid Origin Insertion Innervation Action

Answer 127

Origin Lateral third of clavicle, acromion and spine of the scapula Insertion Deltoid tubercle of the humerus Innervation Axillary nerve [C5 and C6] Action Abducts the arm [15-90 deg], anterior fibers flex and medially rotates the arm. Posterior fibers extend and laterally rotate arm

Question 128

Pectoralis major Origin Insertion Innervation Action

Answer 128

Origin Sternum, upper 6 costal cartilages and medial half of clavicle Insertion Lateral lip of the bicipital groove Innervation Medial and lateral pectoral nerves [C5, 6, 7 and C8, T1] Action Adducts, flex and medially rotates the arm; it also extends the flexed arm

Question 129

Supraspinatus Origin Insertion Innervation Action

Answer 129

Origin Supraspinous fossa of the scapula Insertion Superior facet of the greater tuberosity of the humerus Innervation Suprascapular nerve [C5 and C6] Action Initiates abduction [0-15 deg] of the arm

Question 130

Infraspinatus Origin Insertion Innervation Action

Answer 130

Origin Infraspinous fossa of the scapula Insertion Middle facet of greater tuberosity of the humerus [just below supraspinatus insertion] Innervation Suprascapular nerve [C5 and C6] Action Externally rotates the humerus

Question 131

Teres major Origin Insertion Innervation Action

Answer 131

Origin Oval depression on the lateral aspect of the dorsum of the scapula above the inferior angle Insertion Medial lip of the bicipital groove Innervation Lower subscapular nerve [C5 and 6] Action Extends, adducts and medially rotates the arm

Question 132

Teres minor Origin Insertion Innervation Action

Answer 132

Origin Middle third of the lateral border of scapula Insertion Inferior facet of greater tuberosity of humerus [just below infraspinatus insertion] Innervation Axillary nerve [C5 and C6] Action Externally rotates the arm

Question 133

Subscapularis Origin Insertion Innervation Action

Answer 133

Origin medial two-thirds of the ventral aspect of the scapula Insertion Lesser tuberosity of the humerus Innervation Upper and lower subscapular nerves [C5 and C6] Action Internally rotates and adducts the arm

Question 134

Biceps brachii Origin Insertion Innervation Action

Answer 134

Origin Coracoid process [short head] and the supraglenoid tubercle [long head] Insertion Posterior border of the radial tuberosity of the radius Innervation Musculocutaneous nerve [C5, 6, 7] Action Flexes and supinates the elbow

Question 135

Triceps Origin Insertion Innervation Action

Answer 135

Origin Infraglenoid tubercle [long head], lateral upper and medial lower parts of the humerus Insertion Olecranon of the ulna Innervation Radial nerve [C7 and C8] Action Extends the forearm and adducts the arm

Question 136

Brachioradialis Origin Insertion Innervation Action

Answer 136

Origin Upper two-thirds of the lateral supracondylar ridge of humerus Insertion Base of the styloid process of the radius Innervation Radial nerve [C6 and C7] Action Flexes the forearm

Question 137

Pronator teres Origin Insertion Innervation Action

Answer 137

Origin Medial epicondyle of the humerus and medial border of the coronoid process of ulna Insertion Upper part of the radius Innervation Median nerve [C6 and 7] which passes between the humeral and ulnar heads Action Pronates the forearm and flexes the elbow

Question 138

Psoas major Origin Insertion Innervation Action

Answer 138

Origin Bodies, intervertebral discs and transverse processes of L1-5 Insertion Lesser trochanter of the femur Innervation L2, 3 and 4 from the lumbar plexus Action Flexes the thigh and trunk

Question 139

Gluteus maximus Origin Insertion Innervation Action

Answer 139

Origin Ilium, sacrum, coccyx and sacrotuberous ligament Insertion Gluteal tuberosity of the femur [25%] and iliotibial band [75%] Innervation Inferior Gluteal nerve [L5, S1 and S2] Action Extends and externally rotates the thigh

Question 140

Piriformis Origin Insertion Innervation Action

Answer 140

Origin Pelvic [anterior] surface of sacrum Insertion Medial aspect of the superior border of the greater trochanter of the femur Innervation S1 and S2 from the sacral plexus Action Externally rotates the thigh

Question 141

TFL Origin Insertion Innervation Action

Answer 141

Origin Outer aspect of iliac crest between the iliac tubercle and anterior superior iliac spine Insertion Iliotibial tract Innervation Superior Gluteal nerve [L4-S1] Action Maintains knee extension and abducts the thigh

Question 142

Quadriceps femoris Origin Insertion Innervation Action

Answer 142

Origin AIIS [straight head of rectus femoris], superior rim of acetabulum [reflected head of rectus femoris] femur [vastus medialis, intermedius and lateralis] Insertion Tibial tuberosity via the patellar tendon which encloses the patella Innervation Femoral nerve [posterior divisions of L2, 3 and 4] Action Extends the knee, stabilizes the patella and flexes the thigh [through the action of rectus femoris]

Question 143

Tibialis anterior Origin Insertion Innervation Action

Answer 143

Origin Upper half of the lateral aspect of the tibial shaft and interosseous membrane Insertion Inferomedial aspect of the medial cuneiform and base of 1st metatarsal bone Innervation Deep Peroneal nerve [L4 and L5] Action Dorsiflexes and inverts the foot

Question 144

Extensor hallucis longus Origin Insertion Innervation Action

Answer 144

Origin Middle half of anterior aspect of fibula, interosseous membrane Insertion Base of the dorsal aspect of the distal phalanx of the 1st toe Innervation Deep peroneal nerve [L5 and S1] Action Extends the big toe and dorsiflexes of the ankle

Question 145

Peroneus longus Origin Insertion Innervation Action

Answer 145

Origin Lateral tibial condyle, head and upper lateral aspect of fibula Insertion Inferolateral aspect of the medial cuneiform and base of 1st metatarsal bone Innervation Superficial Peroneal nerve [L5 and S1] Action Plantar flexes and everts the foot

Question 146

Gastrocnemius Origin Insertion Innervation Action

Answer 146

Origin Posterior aspects of the medial and lateral femoral condyles Insertion Posterior aspect of the calcaneus via the calcaneal tendon [Achilles] Innervation Tibial nerve [S1 and S2] Action Plantar flexes the ankle

Question 147

Soleus Origin Insertion Innervation Action

Answer 147

Origin Soleal line, middle third of the tibia and upper third of the fibula Insertion Calcaneal tendon to the posterior surface of the calcaneus Innervation Tibial nerve [S1 and 2] Action Plantar flexes the ankle and aids in the venous return from the leg

Question 148

Tibialis posterior Origin Insertion Innervation Action

Answer 148

Origin Interosseous membrane and the upper parts of the tibia and fibula Insertion Navicular, the three cuneiform bones and the bases of the 2nd to 4th metatarsal bones Innervation Tibial nerve [L5 and S1] Action Plantar flexes and inverts the foot; supports the medial longitudinal arch of the foot

Question 149

Reproductive System Derived from which of the 3 embryological layers? Males - SEED Females - uterus and upper third of the vagina the primitive testis and ovaries develops from the ____ lying on top of the _______

Answer 149

mesoderm. SEED arises from the mesonephric (Wolffian) duct seminal vesicle epididymis ejaculatory duct ductus deferens the uterus and upper third of the vagina are developed from the paramesonephric [Mullerian] duct which runs parallel to the mesonephric duct the primitive testis/ovaries develops from mesoderm lying on top of the kidney

Question 150

Male Reproductive System ______________ are produced in the seminiferous tubules of the testis testosterone is secreted by the interstitial cells of _____ which is under the influence of what hormone? ________ is attached to ________ cells in the tubules of the testis The testis is suspended by the ________ cord in the lower part of the scrotum Thick fibrous capsule of the testis 7 layers of the testis

Answer 150

spermatozoa Leydig, LH testosterone, Sertoli cells spermatic cord tunica albuginea o skin o dartos muscle within Colles fascia [dartos muscle is under sympathetic control] o external spermatic fascia from the external oblique aponeurosis o cremasteric muscle and fascia from the internal oblique muscle o internal spermatic fascia from transversalis fascia o parietal and visceral layers of tunica vaginalis from the peritoneum

Question 151

Male Reproductive System Sperm travel to the rete testes into the ______ where they mature The epididymus continues as ductus _____ where sperm is stored. This is also where the ____ duct merges forming the ejaculatory duct

Answer 151

epididymus = mature ductus deferens = stored seminal duct --> ejaculatory duct ejaculatory duct then opens into the posterior part of the prostatic urethra

Question 152

Spermatic cord - rule of 3 Lies in the ______ canal and is made up of... 3 coverings 3 arteries 3 nerves 3 other structures

Answer 152

 3 coverings: external spermatic fascia, cremasteric muscle and fascia and internal spermatic fascia  3 arteries: testicular, artery to the ductus deferens and cremasteric artery  3 nerves: testicular nerves, genital branch of the genitofemoral nerve and ilioinguinal nerve [which actually lies outside of the spermatic cord]  3 other structures: ductus deferens, pampiniform plexus of veins and testicular lymphatics [drains to the para-aortic lymph nodes]

Question 153

Penis Dorsal chambers and inferior chamber that fills up with blood in erection Blood supply Innervation NS system control during erection vs. ejaculation

Answer 153

``` corpora cavernosa (glans penis is the expanded distal end) corpus spongiosum (contains the penile urethra) ``` internal pudendal artery pudendal nerve and branches of the pelvic splanchnic nerves - both from S2-S4 (S2, 3, 4 keeps the penis off the floor).  parasympathetic stimulation is responsible for erection [point] (PP)  sympathetic stimulation is responsible for ejaculation [shoot] (SS)

Question 154

Uterus 3 components A normal uterus is ______ and _______ Attached to the ovary by the _____ ligament and to he labia majora by the ____ ligament of the uterus and to the _____ ligament

Answer 154

fundus, body, cervix  the normal uterus is anteverted [angled forwards to the vagina] and anteflexed [body is bent forwards to cervix] ovary ligament, round ligament, broad ligament

Question 155

Fallopian (uterine) tubes are long muscular tubes lined by which type of epithelium? 4 parts of the tube

Answer 155

ciliated columnar epithelium o the fimbriated end is funnel-shaped [infundibulum] o the large ampulla where fertilization occurs o a long narrow isthmus o a short intramural part which pass through the cornu [lateral horn] of the uterine cavity

Question 156

Ovary lies in the ovarian fossa between which two arteries? attached to which 3 ligaments Blood supply?

Answer 156

external and internal iliac arteries o posterior aspect of the broad ligament by the mesovarium o suspensory ligament of the ovary to the pelvic wall; contains ovarian blood vessels o ligament of the ovary to the uterus supplied by the ovarian artery, a branch of the abdominal aorta at L2 level  the right ovarian vein drains into the inferior vena cava  the left ovarian vein drains into the left renal vein

Question 157

Ox coxae (hip/pelvic bone): ischium + ilium + pubis Male versus female pelvis

Answer 157

the male pelvis is different from the female pelvis in the following ways: ``` o heavier with more prominent muscular markings o smaller heart-shaped pelvic inlet o subpubic angle is narrow [45 0 in the male compared to 85 0 in the female] o inverted ischial spines o sacrum is more curved ```

Question 158

Respiratory system developed as a respiratory diverticulum from the upper end of the _______ Lung buds become what? Then how is lung tissue then further subdivided Alveoli then develop from the respiratory bronchiole in the _____ trimester

Answer 158

foregut primary bronchi (which then subdivide --> secondary (lobar) ---> tertiary/segmental --> terminal bronchiles --> respiratory bronchioles third

Question 159

Trachea Begins at the level of C6 and the _____ cartilage then runs to the sternal angle at the level of ___ it is a rigid fibrocartilage tube lined by what type of epithelium? V-shaped cartilage marks the bifurcation of the trachea called the... What structure lies behind the trachea? What is the R vs. L bronchi like?

Answer 159

cricoid, T4/5 pseudo-stratified ciliated columnar epithelium carina esophagus (air is more important than food)  the right bronchus is shorter, wider and is more vertical than the left  the left bronchus is longer, narrower and lies more horizontal

Question 160

Lungs 10 segments of the R lung 8/9 segments of the L lung Which of the follow are R vs. L lung structures - oblique fissure - horizontal fissure - lingula - groove for azygous vein - groove for aorta

Answer 160

o upper lobe-apical, posterior and anterior o middle lobe-lateral and medial o lower lobe-superior, lateral, anterior, medial and posterior basal o upper lobe-apicoposterior, anterior, superior and inferior lingual o lower lobe-superior, anterior, lateral and posterior basal Which of the follow are R vs. L lung structures - oblique fissure = L - horizontal fissure = R - lingula = L - groove for azygous vein = R - groove for aorta = L

Question 161

Pleura 2 layers & which layer is sensitive to pain 4 parts of the pleura Superior migration of the lungs are stopped by what membrane? Upper 6 anterior intercostal (IC) arteries are derived from which branch of the 1st part of the subclavian artery? How about the lower 5? 1st and 2nd posterior IC arteries are derived from? 3rd to 11th posterior IC arteries are derived from? Venous drainage of pleura goes into which system?

Answer 161

outer (parietal) - sensitive to pain and is supplied by intercostal and phrenic nerves inner (visceral) - insensitive [has autonomic innervation mainly from the vagus] costal, mediastinal, diaphragmatic, cervical suprapleural membrane (fibrous and extends from TP of C7 to inner border of 1st rib internal thoracic artery, musculophrenic branch (of the internal thoracic artery) costal branch of the costocervical trunk of the subclavian artery, descending part of the thoracic aorta azygos venous system

Question 162

Lung lymphatics

Answer 162

o pulmonary nodes found in the lung parenchyma o then to bronchopulmonary nodes located in the hilum of the lung o then to tracheobronchial nodes located at the bifurcation of the trachea o into para-tracheal nodes found on either side of the trachea o finally into the mediastinal lymphatic trunks

Question 163

Azygos Venous system

Answer 163

 the azygos vein lies on the right side of the lower eight thoracic vertebrae  it receives 2nd through to 11th posterior intercostal and right subcostal veins  it passes through the diaphragm at T12 along with the aorta and the thoracic duct  the hemiazygos vein lies on the left  it receives the left subcostal and the 3 or 4 lower left intercostal veins  the accessory hemiazygos vein is formed by the 5th to the 8th left intercostal veins  the hemiazygos and accessory azygos veins may communicate with each other and with the azygos vein  1st and 2nd posterior intercostal veins may drain separately or together into the brachiocephalic veins which are found in the superior division of the mediastinum  there are many variations of this pattern

Question 164

Diaphragm Origins and insertion 3 major openings at T8, T10, T12 Innervation condensation of fascia over the psoas muscle is called the ______ ______ ligament the ______ ________ ligament is the condensation of fascia over quadratus lumborum

Answer 164

o the right crus from the bodies of L1-3 o the left crus from the bodies of L1 and L2 o the lower 6 ribs o the sternum [posterior aspect of the xiphoid process] Insertion into the central tendon o T8-IVC, the right phrenic nerve and pericardiacophrenic vessels o T10-esophagus and the vagus nerves o T12-aorta, thoracic duct and azygos vein o the inferior vena cava passes through the central tendon o the esophagus passes through the right crus o the aorta passes between and behind the right and left crura C3, 4, 5 - keeps the diaphragm alive medial arcuate ligament lateral arcuate ligament (lateral, lumborum, LL)

Question 165

Lymph node Cortex (1) Medulla (3) Which types of cells are in each?

Answer 165

the cortex is further subdivided into outer and inner layers: o outer cortex consists of mature B cells organized into the follicles o these follicles have germinal centers containing activated B [plasma] cells o inner cortex has mature T cells mainly the medulla contains lymphocytes, plasma cells and macrophages

Question 166

Spleen Largest aggregation of lymphoid tissue Red pulp vs. white pulp Attached by which two ligaments?

Answer 166

 old red blood cells are destroyed in the red pulp  the white pulp is involved in the immune system o gastrosplenic ligament which contains the short gastric and left gastroepiploic arteries and veins o splenorenal ligament which contains the terminal part of the splenic artery

Question 167

Liver Largest organ in the body Attached to the diaphragm via which ligament? Which cells filter out bacteria? How many lobes? Blood supply of the R and L functional lobes of the liver

Answer 167

coronary ligament Kupffer cells Right, left, quadrate (left), caudate (on belongs to R the other belongs to L)  right functional lobe is supplied by the right hepatic artery, a branch of the proper hepatic artery  left functional lobe is supplied by the left hepatic artery

Question 168

Liver the liver is made up of functional units of _____ lined by ________ and Kupffer cells the ______ vein provides the liver with 70% of its blood supply and contains nutrients from the gut Sinusoid venous blood drains into the ______ veins ---> 3 hepatic veins ---> IVC --> RA What do the R and L hepatic ducts do? So what's the common bile duct? Then which duct does this one connect to leading into the duodenum? (ampulla of Vater + sphincter of Oddi which is activated by CCK)

Answer 168

the liver is made up of functional units of sinusoids lined by hepatocytes and Kupffer cells portal vein (formed by the splenic and superior mesenteric veins - at the area of the head of pancreas) central vein  the right and left hepatic ducts join to form the common hepatic duct which then drain bile from the liver and are located in the porta hepatis which lies between the caudate and quadrate lobes of the liver common hepatic duct + cystic duct (gallbladder) = common bile duct main pancreatic duct

Question 169

Thymus Involved in production of what? What happens to it over time? Cortex vs. medulla

Answer 169

T-cell production atrophies into adulthood  cortex is comprised of immature and maturing T cells  medulla has lymphocytes and a particular feature found only in the thymus-Hassall’s corpuscles  Hassal’s corpuscles are oval bodies made up of a central area of degenerated cells surrounded by concentrically arranged flattened keratinized epithelial cell

Question 170

Skin - epidermis Composed the: epidermis, dermis, hypodermis (aka. subcutaneous layer). What type of epithelium is the epidermis made out of? Further subdivisions of the epidermis - CLGiSB What 4 types of cells can you find in the epidermis? Epidermis is thickest at which areas of the body?

Answer 170

stratified keratinized squamous epithelium [Californians Like Girls in String Bikinis] o stratum Corneum o stratum Lucidum [only found in thick skin e.g. palms and soles] o stratum Granulosum o stratum Spinosum produces keratin o stratus Basale [aka stratum germinativum] melanocytes (pigment), Langerhan's cells (immune ID), Merkel (mechanoreceptors), naked nerve endings (nociceptors and heat receptors) sole and palms

Question 171

Skin - dermis T or F: the epidermis is anchored to the dermis 2 layers of the dermis

Answer 171

papillary - loose CT + fibroblasts + collagen fibers reticular - mostly collagen and elastic fibers

Question 172

Skin - hypodermis What cells can you find here?

Answer 172

pacinian corpuscles (vibration), Ruffini (joint position sense)

Question 173

Skin what 3 appendages or structures live in the skin which tumours may arise?

Answer 173

hair follicles sweat glands - eccrine glands + apocrine glands sebaceous glands (sebum) - found everywhere except soles and palms

Question 174

Sweat glands eccrine glands apocrine glands What are each of them innervated by? And what do they produce?

Answer 174

 eccrine which are found all over the body  these are innervated by cholinergic nerves  eccrine glands produce water and salts which are excreted through tiny tubules  involved in thermoregulation  apocrine glands are specialized glands found in the axilla, mons pubis and around the anus  these are innervated by adrenergic nerves  apocrine glands are outgrowths of the upper portions of hair follicles and secrete an oily mixture  involved in body scent

Question 175

Ribs Which ones are true? Which ones are false or floating?

Answer 175

1-7 - true 8-10 - false (cartilaginous ends meet up with the cartilage of the ribs above them 11 & 12 floating (anterior ends are not connected)

Question 176

Typical ribs: 3-9th What makes these ribs typical?

Answer 176

(1) head (2) 2 articular demifacets (upper and lower. Upper articulates with the vertebra above. Lower articulates with the same level vertebra) (3) neck (4) crest (attachment of superior costotransverse ligament) (5) smooth oval facet (articulates with the same level vertebra) (6) rough part (attachment of the lateral costotransverse ligament (7) angle (8) shaft (9) the upper border is smooth and rounded (10) the lower border is sharp and shelters the costal groove (11) the costal groove passes along the inferior border of the internal surface (12) the costal cartilage is the unossified anterior end of the rib (13) the costal ends articulate with the sternum via synovial joints [2-7]

Question 177

T or F: all of the costosternal joints are synovial joints except the 1st which is primary cartilaginous

Answer 177

T

Question 178

Atypical ribs: 1, 2, 10, 11, 12 What makes these ribs typical?

Answer 178

 the 1st is an atypical rib because: o it is the shortest and most curvaceous o its head has only one articular facet o the rib has an additional tubercle [for the attachment of scalenus anterior] o the rib has inner and outer borders and superior and inferior surfaces o there is no costal groove but there is an extra groove for subclavian artery o the 2nd rib is atypical because there is a large rough tuberosity near its middle for the attachment of the serratus anterior  the 10-12th ribs like the 1st rib only possess one facet on the head

Question 179

Intercostal space 3 IC muscles - which direction do they run? What's in the neurovascular bundle? What is it covered by externally and internally?

Answer 179

o external with its fibers running downwards and medially [hands-in-the-pocket fashion] o internal with its fibers running upwards and medially [downwards and backwards] o innermost with its fibers running upwards and medially [downwards and backwards] o intercostal Vein which drains into the azygos venous system o intercostal Artery from the internal thoracic artery and the thoracic aorta o intercostal Nerve which is the ventral ramus of the thoracic spinal nerve  it is covered by skin externally and by parietal pleura internally

Question 180

Breast It is considered a modified _____ sweat gland. Located in the superficial fascia except which part of it? glandular tissue is attached to the skin above and the pectoral fascia below by the _________ ligaments [of Cooper] of the breast glandular tissue opens on to the ________ ducts which are dilated towards the end as the ________ sinuses before opening on to the nipple

Answer 180

apocrine tail of Spence (under the deep fascia of the axilla) suspensory ligaments of Cooper lactiferous, lactiferous

Question 181

Breast Blood supply (3) Lymphatics: 75% of the breast drains to the anterior (aka. _________) group of axillary nodes. Then the rest drains into the central and apical group of nodes.

Answer 181

o lateral thoracic artery o internal thoracic artery o 2nd to 4th anterior intercostal arteries pectoral

Question 182

Mediastinum (space between the lungs) List some structures that can be found here.

Answer 182

o the manubriosternal joint between the manubrium and body of the sternum o the articulation of the second rib with the sternum o the bifurcation of the trachea o the bifurcation of the pulmonary trunk o the arch of the aorta begins o the arch of the aorta ends o the thoracic duct crosses from right to left o the left recurrent laryngeal nerve passes under the aortic arch

Question 183

Mediastinum Superior division - TVPASTER Posterior division - VS DATES

Answer 183

``` o Trachea o Vagus nerves o Phrenic nerves o Arch of the aorta and its branches o Superior Vena Cava o Thoracic duct o Esophagus o Remnant of the thymus gland ``` ``` o Vagus nerves o Splanchnic nerves o Descending thoracic aorta and its branches: o Azygos venous system o Thoracic duct o Esophagus o Sympathetic trunks ```

Question 184

Mediastinum Inferior division Anterior division Middle division

Answer 184

 the inferior mediastinum is further subdivided into three compartments: o middle compartment o anterior compartment lies between the sternum and the heart o posterior compartment lies between the heart and the thoracic vertebra  the anterior compartment contains: o connective tissue o lymph nodes o remnants of the thymus ```  the middle compartment contains: o heart o pericardium o roots of the great vessels o phrenic nerves ```

Question 185

Esophagus Runs from which levels? Type of epithelium (3) - inner, middle, outer

Answer 185

C6 (cricoid cartilage) to T11 (stomach). Crosses L bronchuus at T5. Passes the diaphragm at T10. o inner layer - stratified non-keratinized squamous epithelium o middle layer - submucosa with esophageal glands o outer layer - two layers of muscle, outer longitudinal and inner circular

Question 186

Esophagus Characteristics of the upper, middle, and lower third

Answer 186

upper: surrounded by skeletal muscle, supplied by inferior thyroid artery, drains into the lower deep cervical lymph nodes middle: surrounded by both skeletal and smooth muscle, thoracic aorta, drains into mediastinal lymph nodes lower: both muscle types, supplied by left gastric artery, drains into the L gastric lymph nodes

Question 187

Urinary embryology Where do each of these arise from? kidney ureteric bud baldder

Answer 187

mesoderm mesonephric duct endoderm (urogenital sinus)

Question 188

Kidney bean-shaped __________ organ these 3 structures are situated in the hilum of the kidney posterior relations of the kidney include 4 muscles, 3 nerves, 2 vessels and 1 bone:

Answer 188

retroperitoneal o renal vein o renal artery o ureter o 4 muscles-diaphragm, QL, psoas and TA o 3 nerves-subcostal, iliohypogastric and ilioinguinal nerves o 2 vessels-subcostal vein and artery o 1 bone-12th rib

Question 189

Kidney Artery Vein

Answer 189

renal artery renal vein (IVC) R renal vein - shorter and no tributaries L renal vein - longer and receives the left adrenal vein and left gonadal vein

Question 190

Ureter Epithelium Blood supply

Answer 190

transitional epithelium supplied by branches from the renal, gonadal and internal iliac arteries

Question 191

Bladder  the bladder lies _______ to the prostate in the male  the bladder lies ________ to the uterus in the female

Answer 191

 the bladder lies superior to the prostate in the male |  the bladder lies inferior to the uterus in the female

Question 192

Bladder Made up on smooth ______ muscle lined by _________ epithelium Innervation of the... internal sphincter external sphincter

Answer 192

 the bladder is made up of smooth [detrusor] muscle lined by transitional epithelium o internal sphincter is comprised of smooth muscle which is relaxed by the pelvic splanchnic nerves [S2, 3 and 4] and is contracted by the sympathetic fibers o external sphincter is skeletal and is controlled by the pudendal nerve [S2, 3, 4]

Question 193

Urethra Female vs. male urethra

Answer 193

 male urethra is divided into prostatic, membranous and penile parts  membranous part is the shortest part measuring ½ to ¾ inch  penile part passes through the corpus spongiosum and opens at the urethral orifice which is located in the undersurface of the glans of the penis  bulbourethral glands [of Cowper] in the male lie within the urogenital diaphragm and drain into the penile part of the urethra  shorter female urethra lies anterior to the vagina and its opening lies between the clitoris anteriorly and the vaginal orifice posteriorly

Question 194

Vertebral embryology Arises from which embryological layer? The __________ guides the development of the vertebral column and spinal cord, gives rise to the nucleus pulposus of the intervertebral disc, persists as the nucleus pulposus Condensations of the mesoderm around the notochord are called _________

Answer 194

mesoderm notochord somites

Question 195

Somites 3 types: sclerotomes, myotomes, dermatomes

Answer 195

o sclerotomes from which the vertebrae develop: o myotomes from which muscle develops: o dermatomes from which the peripheral nerves develop

Question 196

Sclerotomes - vertebrae 3 primary ossification centers 5 secondary ossification centers

Answer 196

primary: centrum (body), R and L halves of the neural arch secondary: SP, R and L TPs, upper and lower endplates

Question 197

Myotomes - vertebrae ``` Which types of muscles will arise from these types of myotomes: somatic splanchnic epimere hypomere ```

Answer 197

 somatic skeletal muscles  splanchnic smooth muscles  epimere extensor muscles  hypomere flexor muscles

Question 198

Typical Vertebra - just flip and read

Answer 198

 large weight bearing body anteriorly  2 pedicles posterolaterally  2 transverse processes laterally  2 laminae forming the neural arch  1 spinous process posteriorly  superior articular process with its facet facing backwards  inferior articular process with its facet facing forwards  pars interarticularis between the superior and inferior articular processes  vertebral canal behind the body

Question 199

Cervical vertebrae characteristics

Answer 199

rectangular body, bifid spinous process, transverse foramina in the transverse process which possess anterior and posterior tubercles superior articular facets are oriented BUM (backward, upwards, medially)

Question 200

Thoracic vertebrae characteristics

Answer 200

heart-shaped body, sloping spinous process, costal facets on body and transverse process superior articular facets are oriented BUL (backward, upwards, laterally)

Question 201

Lumbar vertebrae characteristics

Answer 201

kidney-shape body, quadrangular spinous process, mammillary and accessory processes superior articular facets are oriented BM (backward medially)

Question 202

Which are the 3 atypical cervical vertebrae? Why are they unique?

Answer 202

C1 (atlas) - no body, large lateral masses, anterior+posterior arches C2 (axis) - dens/odontoid process C7 (vertebra prominens) - v long non-bifid SPs

Question 203

Vertebral Ligaments - where are they and what motions do they limit ``` ALL PLL Supraspinous ligament Interspinous ligament Ligamentum flavum Intertransverse ligament Alar ligament Apical ligament Cruciate ligament ```

Answer 203

ALL - occiput to sacrum, stops hyperEX PLL - C2 to sacrum, stops hyperFL. Beyond C2, it continues to the tectorial membrane (The tectorial membrane of atlanto-axial joint (occipitoaxial ligaments) is situated within the vertebral canal??)) SSL - connects tips of SPs, stops hyperFL, conitnues as the nuchal ligament upwards and beyond C7 IPL - runs between adjacent SPs, stops posterior translation and FL LF - adjacent vertebrae, high elasticity, stops FL and buckling during EX ITL - between adjacent TPs, stops lateral FL Alar - posterior aspect of dens, inerts into the medial aspect of the condyle of the occiput, limits rotation apical - apex of dens to the anterior aspect of the foramen magnum, stops FL and EX of C2 cruciates:  shaped like a cross  transverse ligament extends from a small medial tubercle [colliculus atlantis] on the lateral mass of the atlas to the same tubercle on the other side  superior longitudinal ligament extends from the middle of the transverse ligament to the anterior lip of the foramen magnum between tectorial membrane and the apical ligament  inferior longitudinal ligament extends from middle of transverse ligament to body of C2  limits lateral translation

Question 204

Intervertebral Disc Outer part (annulus fibrosus, 15-30 concentric laminae, 4-70 deg to vertical) Inner part (nucleus pulposus) T or F: discs are thickest in the thoracic spine. Thinnest in the lumbar spine.

Answer 204

AF: Type I collagen NP: Type II collagen, gelatinous F - vice versa

Question 205

Intervertebral Disc T or F: only the inner third of the AF is innervated. T or F: NP has good access to nutrients 2 sources of innnervation T or F: there are 25 IVDs

Answer 205

F - outer layer only F - no, mostly through diffusion which is facilitated by spinal movements. It is poorly vascularized posteriorly: sinuvertebral (reccurent meningeal) nerve laterally: sensory nerves (grey sympathetic rami) F- 23 IVDs, no disc between C1 and C2.

Question 206

Contents of the IVF (8 items) DRNASVFL

Answer 206

``` spinal Nerve spinal nerve Roots DRG spinal Artery spinal Vein 2-4 Sinuvertebral nerves Fat transforaminal Ligaments ```

Question 207

Spinal canal Extends from the foramen magnum to where? Contents (8 items)

Answer 207

distal sacrum ``` spinal cord spinal nerve roots dura mater arachnoid mater pia mater CSF blood vessels CT ```

Question 208

Spinal canal T or F: smallest in the thoracic spine. Largest in the cervical region. T or F: cervical region of the spinal cord is the MC location for myelopathy

Answer 208

 the spinal canal is smallest relatively in the thoracic region and largest in the cervical region  cervical region of the spinal canal is the most common site for cord compression [myelopathy] because the spinal cord is widest in this region [C6]

Question 209

Atlanto-Occipital Joint Type

Answer 209

 Type Synovial  Classification Condylar  Bones involved Condyle of occipital bone and superior articular facet of C1  Range of motion Flexion, extension and a little lateral bending and rotation  Muscles acting Flexion-longus capitis and rectus anterior Extension-SCM, semispinalis, splenius Lateral bending-rectus lateralis, SCM and trapezius  Innervation C1

Question 210

Median Atlanto-Axial [Atlanto-Dental] Joint Type

Answer 210

 Type Synovial  Classification Pivot  Bones involved Anterior arch of C1 and the Dens of C2  Range of motion Rotation  Muscles acting Rotation-SCM and semispinalis capitis which are countered by the action of rectus capitis posterior major, obliquus capitis superior and inferior  Innervation C2

Question 211

Lateral Atlanto-Axial Joint Type

Answer 211

 Type Synovial  Classification Planar  Bones involved Lateral masses of C1 and the superior articular facets of C2  Range of motion Rotation and flexion/extension  Muscles acting Rotation-SCM and semispinalis capitis against rectus capitis posterior major, obliquus capitis superior and inferior  Innervation C2

Question 212

Zygapophyseal [facet] Joint Type

Answer 212

 Type Synovial  Classification Planar  Range of motion: depends on the area cervical facet joint capsules are long and loose:  allows for greater movement  especially rotation, flexion and extension  50% of flexion and extension in the cervical region occurs at the C 0 -C 1 joint  50% of rotation in the cervical region occurs at C 1 -C 2 joints Thoracic facets allow primarily for rotation and secondarily flexion lumbar facet joint capsules are short and tight:  restricts movements limiting rotation and lateral bending  Innervation medial branches of the dorsal rami of the corresponding spinal nerve and the nerve below [and perhaps from the one above also]

Question 213

Sacroiliac Joint Type

Answer 213

 Type Compound made up of an anterior synovial joint and posterior syndesmosis  Classification Reciprocal interlocking planar which allows minimal gliding  Bones involved Articular surface of the ilium and the auricular aspect of the sacrum  Range of motion Nutation and counternutation around an axis passing through S2  Nutation-forward movement of the base of the sacrum [like nodding]  Counternutation-backward movement of the base of sacrum  Muscles acting All muscles acting on the lower spine and hip: mainly erector spinae and psoas major  Innervation Superior gluteal nerve and branches from S1 and S2

Question 214

Costovertebral Joint Type

Answer 214

 Type Synovial  Classification Planar  Bones involved Body of the vertebra and the head of the corresponding rib  Range of motion Upper 6 joints-pump handle action; lower 6 joints-bucket handle action  Muscles acting Intercostals and diaphragm  Innervation Segmental spinal nerve

Question 215

Costotransverse Joint Type

Answer 215

 Type Synovial  Classification Planar  Bones involved Tubercle of the rib and the transverse process of the corresponding vertebra  Range of motion Upper six costotransverse joints allow rotation and the lower six joints allow for gliding  Muscles acting Intercostal and diaphragm  Innervation Segmental spinal nerve

Question 216

Costochondral joint Type

Answer 216

 Type Primary cartilaginous  Classification Synchondrosis  Structures Distal end of the rib and cartilage  Range of motion None  Muscles acting Intercostal and diaphragm  Innervation Segmental spinal nerve

Question 217

Sternochondral joint Type

Answer 217

 Type 1st is a primary cartilaginous and 2nd to 7th are synovial  Classification Synchondrosis for the 1 st and planar for the others  Structures Cartilage and sternum  Range of motion Pump handle during respiration  Muscles acting Intercostal  Innervation Segmental spinal nerve

Question 218

Manubriosternal joint

Answer 218

 Type Secondary cartilaginous  Classification Symphysis  Bones involved Manubrium and body of sternum  Range of motion Slight increase and decrease angulation during respiration  Muscles acting Intercostal  Innervation Segmental spinal nerve

Question 219

Xiphisternal joint

Answer 219

 Type Secondary cartilaginous  Classification Symphysis, becomes an synostosis after the 40th year  Bones involved Body of sternum and xiphoid process  Range of motion very little  Muscles acting Intercostals, diaphragm and rectus abdominis  Innervation Segmental spinal nerve

Question 220

Embryology of the spinal cord Derived from the _______ tube, which is influenced by which nutrient in the __ trimester. And which embryological layer does it arise from?

Answer 220

neural tube, folic acid, 1st trimester, ectoderm

Question 221

Neural tube Starts distal to the 4th pair of somites at the 3rd week of gestation. dorsal plates differentiates into the _____ neurons ventral plates differentiates into the _____ neurons Neural canal becomes the ______ canal of the spinal cord Which week does the NT close?

Answer 221

dorsal = sensory ventral = motor central canal Week 4

Question 222

Tissue at the sides of the neutral tube become the neural ______ cells which give rise to DAMMMESS

Answer 222

``` o Dorsal Root Ganglia o Adrenal medulla o Melanocytes, Microglia and Meninges [arachnoid and pia] o Enteric neurons o Schwann cells o Sympathetic ganglia ```

Question 223

Spinal cord foramen magnum to which lumbar segment in adults? 2 areas of enlargement 3 coverings Dural sac ends at S__

Answer 223

L1/2 in adults (conus medullaris) ``` C6-cervical (brachial plexus) Lumbosacral region (lumbar plexus) ``` dura, arachnoid, pia mater

Question 224

3 bundles/funiculi of white matter

Answer 224

posterior, anterior, lateral (intermediate)

Question 225

Posterior/Dorsal Columns 3 Modes 2 tracts

Answer 225

1) vibration 2) fine touch (2 pt discrimination) 3) joint position sense o fibers from the lower limb synapse in the nucleus graciLis in the medulla o fibers from the upper limb synapse in the nucleus cUneatus in the medulla

Question 226

T or F:  the grey matter is arranged in horns: dorsal [sensory], ventral [motor] and lateral [__________]  the lateral [intermediolateral] horn is only found in the thoracic part of the spinal cord from T__ to L___ and represents the region that carries __________fibers

Answer 226

 the grey matter is arranged in horns: dorsal [sensory], ventral [motor] and lateral [sympathetic]  the lateral [intermediolateral] horn is only found in the thoracic part of the spinal cord from T6 to L1 and represents the region that carries sympathetic fibers

Question 227

Spinal cord Blood supply (4) Anteriorly Posteriorly

Answer 227

segmental spinal arteries from the following ascending cervical deep cervical posterior intercostal lumbar 2/3 anterior = ASA (anterior spinal artery) 1/3 posterior = PSA (posterior spinal artery)

Question 228

UMNL vs. LMNL - in terms of... ``` Reflexes Tone Atrophy Fasciculations Babinski sign ```

Answer 228

UMNL ``` Reflexes - increase + clonus Tone - spastic Atrophy - absent Fasciculations - absent Babinski sign - present ``` LMNL ``` Reflexes - decreased or absent Tone - flaccid Atrophy - present Fasciculations - present Babinski sign - absent ```

Question 229

Cells of the CNS neuroglia - 3 examples + function microglia - function

Answer 229

neuroglia: astrocytes (helps with BBB), ependymal (makes CSF), oligodendrocytes+schwann cells (myelination) microglia: macrophages of the nervous system (derived from mesoderm and not neuroectoderm like other cells)

Question 230

Frontal Parietal Occipital Temporal

Answer 230

 Frontal [thinking and motor function] lies in front of the central sulcus  Parietal [sensory] lies between the central sulcus and the parieto-occipital fissure  Occipital [visual] lies behind a line connecting the parieto-occipital fissure and preoccipital notch  Temporal [hearing, smell and memory] lies onferior to he lateral fissur

Question 231

Sympathetic system Location of origin Pre-gang fiber Post-gang fiber NT Parasympathetic system Location of origin Pre-gang fiber Post-gang fiber NT

Answer 231

Sympathetic system Location of origin: paravertebral Pre-gang fiber: short Post-gang fiber: long NT: NOREPI Parasympathetic system Location of origin: intramural Pre-gang fiber: long Post-gang fiber: short NT: Ach

Question 232

 cholinergic [acetylcholine]  adrenergic [norepinephrine] All Ach receptors are _________. Except: postganglionic receptors which _________

Answer 232

nicotinic muscarinic (sweat glands

Question 233

Which tissues do not have BOTH sympathetic and parasympathetic innervation? BABAS

Answer 233

``` blood vessels (symp) arector pili (symp) bronchial glands (parasymp) adrenal medulla (pre-gang symp) sweat glands (symp) ```

Question 234

Adrenergic receptors Two types

Answer 234

 All α adrenergic receptor type cause contraction of smooth muscle including the dilator [radially-arranged fibers] pupillae muscle in the eye  All β adrenergic receptors are β2 type EXCEPT those that are found in the heart which are β1 (responsible for HR and contraction force)

Question 235

Enteric brain Walls of intestine 2 major intramural plexuses (symp and parasymp) include...

Answer 235

Myenteric plexus of Auerbach (inner circular and outer longitudinal smooth muscle layers of the muscularis externa to regulate peristalsis Submuscosal plexus of Meissner (secretion of intestinal glands) Auerbach plexus lies on the Autside and Meissner plexus lies on the inside

Question 236

3 autonomic mediated reflexes VVS

Answer 236

Viscerovisceral reflex - pressure on carotid sinus --> slowing of HR and BP drop Viscerosomatic reflex - inflation of lung triggers diaphragm to relax (afferent-vagus, effort-phrenic n.) Somatovisceral reflex - an example is paraspinal muscle spasm triggered by internal disc disruption causing spinal nerve root irritation which results in visceral dysfunction