Anatomy Block 2 Questions COPY Flashcards
A 3 years old boy was brought in with features suggestive of a congenital heart condition, further examination and history revealed a diagnosis of Co arctation of the aorta. What arteries contribute to the collateral blood supply of the lower limb?
A 3 years old boy was brought in with features suggestive of a congenital heart condition, further examination and history revealed a diagnosis of Co arctation of the aorta. What arteries contribute to the collateral blood supply of the lower limb?
Inferior epigastric artery
A 65 year old woman presents in the Dermatology clinic with a lesion on the skin located in the Right hypochondrial region. A biopsy of the lesion was done which revealed a malignant carcinoma. What group of lymph nodes would be expected to be enlarged?
A 65 year old woman presents in the Dermatology clinic with a lesion on the skin located in the Right hypochondrial region. A biopsy of the lesion was done which revealed a malignant carcinoma. What group of lymph nodes would be expected to be enlarged?
C. Pectoral group of Lymph node (Axillary group )
A 3 years old boy was brought in with features suggestive of a congenital heart condition, further examination and history revealed a diagnosis of Co arctation of the aorta.
a. Identify the Collateral blood supply which passes through the Anterior Abdominal wall
b. Identify the neurovascular layer of the Anterior Abdominal wall
A 34 year old man present to the emergency room with severe abdominal pain of 2 days duration. Further history and examination revealed a swelling in the genital region which had persisted for about 8 months. The swelling is noticed to superior to the inguinal canal and lateral to the lateral umbilical fold.
What is the hernia described above?
a) Indirect inguinal hernia
b) Direct inguinal hernia
c) Femoral hernia
d) Incisional hernia
e) Umbilical hernia
Indirect inguinal hernia- Answer
A 65 year old man presents at the emergency room with a bulge above the inguinal canal which increases in size on straining. Which of the following landmarks would aid the surgeon in distinguishing an indirect from a direct hernia?
a. Cooper’s ligament
b. Medical umbilical ligament
c. Inferior epigastric artery
d. Spermatic Cord
e. Femoral vein
Inferior epigastric artery- Answer
A 54 year old man presents to you with an enlarged bag of worms in his left testes, he is a known hypertensive with a poor managed blood pressure. Which of the following structures accounts for the swelling in the scrotal sac?
A. Carcinoma of the testes
B. Ductus deferens
C. Pampiniform plexus
D. Seminal vessicle
E. Prostrate.
Pampiniform plexus- Answer
What are 2 actions of the quadratus lumborum muscle? What is its innervation?
The quadratus lumborum muscle causes lateral flexion of lumbar spine and Assists in inspiration by anchoring rib 12 during diaphragmatic contraction. It is innovated by Subcostal n. and ventral rami of L1-L4.
Psoas Major
Psoas Major
- Fuses with the iliacus within the pelvis to form the iliopsoas which attaches to the femur.
- Action: Powerful flexor of the thigh and lumbar spine.
- Innervation: Ventral rami of L1-L3
Iliacus
Iliacus
- Action: Combines with the psoas major and minor to form the iliopsoas and flex the thigh.
- Innervation: Femoral nerve (L2-L4)
What is the name of the opening to the lesser sac?
What is the name of the opening to the lesser sac?
The opening into omental bursa (lesser sac) is called the epiploic foramen of Winslow.
lesser omentum
lesser omentum
The lesser omentum is a bilayered peritoneal sheet that extends from the lesser curvature of the stomach and superior part of the duodenum up to the visceral surface of the liver. It is composed of the hepatogastric and hepatoduodenal ligaments.
The hepatoduodenal ligament carries the portal triad.
Deep ring (of the inguinal)
Deep ring is the site of evagination of the transversalis fascia. Found lateral to the inferior epigastric artery.
The deep ring is continuous with the internal spermatic fascia.
What is a inguinal canal?
- The inguinal canal is comprised of superficial and deep rings.
Superficial ring of the inguinal
Superficial ring: continuous with the external spermatic fascia.
The Superficial ring is laterally formed by the inguinal ligament.
The Superficial ring is medially formed by the aponeurosis of the external abdominal oblique.
Ilioinguinal nerve is within what and innervates….?
Ilioinguinal nerve: Travels within the spermatic cord and provides sensation to the skin of the anterior scrotum and upper, medial thigh
What abdominal fascial layer gives rise to the external spermatic fascia?
The external spermatic fascia is the outermost fascial layer. It is continuous with the deep fascia of the external abdominal oblique muscle.
What are 2 actions of the quadratus lumborum muscle? What is its innervation?
Action: Lateral flexion of lumbar spine. Assists in inspiration by anchoring rib 12 during diaphragmatic contraction.
Innervation: Subcostal n. and ventral rami of L1-L4.
Which “gutter” communicates with Morrison’s pouch?
The right paracolic gutter communicates superiorly with Morrison’s pouch.
The paracolic gutters run lateral to the ascending and descending colon, allowing communication of the ~50ml of peritoneal fluid between the supra- and infracolic subspaces.
Which “gutter” communicates with the phrenicocolic ligament?
The left paracolic gutter is limited superiorly by the phrenicocolic ligament.
The paracolic gutters run lateral to the ascending and descending colon, allowing communication of the ~50ml of peritoneal fluid between the supra- and infracolic subspaces.
What muscle fibers give rise to the cremaster muscle?
The cremaster muscle is derived from muscle fibers of the internal abdominal oblique muscle.
Action: Draws the testis toward the abdominal wall to reduce heat loss
Innervation: Genital branch of the genitofemoral n.
What are the actions of the psoas major muscle? What is its innervation?
What are the actions of the psoas major muscle? What is its innervation?
Action: Powerful flexor of the thigh and lumbar spine.
Innervation: Ventral rami of L1-L3
Psoas Major fuses with the iliacus within the pelvis to form the iliopsoas which attaches to the femur.
What is the main action of the psoas minor muscle? What is its innervation?
Psoas Minor is Immediately anterior to the psoas major.
Action: Flexion of the lumbar spine. Weak flexor of the thigh.
Innervation: Ventral rami of L1-2
What is the clinical and anatomical significance of the superficial epigastric (thoracoepigastric) veins?
The superficial epigastric (aka thoracoepigastric) v. drains to both the SVC and IVC and thus provides an anastomotic link between them.
Clinical Correlate: The portal v. is connected to the thoracoepigastric v. via the paraumbilical vv. Dilation of the thoracoepigastric and paraumbilical vv as a result of portal hypertension is what causes the characteristic finding of caput medusa.
The deep inguinal ring is formed by evagination of what fascial layer? Where can the deep ring be found?
Deep ring: site of evagination of the transversalis fascia. Found lateral to the inferior epigastric a.
The deep ring is continuous with the internal spermatic fascia.
What is the name of the opening to the lesser sac?
The opening into omental bursa (lesser sac) is called the epiploic foramen of Winslow.
The lesser omentum is a bilayered peritoneal sheet that extends from the lesser curvature of the stomach and superior part of the duodenum up to the visceral surface of the liver. It is composed of the hepatogastric and hepatoduodenal ligaments.
The hepatoduodenal ligament carries the portal triad.
Boundaries:
Superiorly: The caudate lobe of the liver
Anteriorly: The stomach
Posteriorly: The posterior abdominal wall
Inferiorly: The duodenum
What abdominal fascial layer gives rise to the internal spermatic fascia?
The internal spermatic fascia is the innermost layer of the spermatic cord. It is continuous with the transversalis fascia.
The external spermatic fascia is the outermost fascial layer. It is continuous with the deep fascia of the external abdominal oblique muscle.
The cremasteric fascia is the intermediate fascial layer of the spermatic cord and testis. It is continuous with the deep fascia of the internal abdominal oblique muscle.
The cremaster muscle is derived from muscle fibers of the internal abdominal oblique muscle.
Action: Draws the testis toward the abdominal wall to reduce heat loss
Innervation: Genital branch of the genitofemoral n.
What is the action of the iliacus muscle? What is its innervation?
Action: Combines with the psoas major and minor to form the iliopsoas and flex the thigh.
Innervation: Femoral nerve (L2-L4)
The aponeurosis of the transversus abdominis muscle fuses with the aponeurosis of the internal abdominal oblique to form what tendon?
The aponeurosis of the transversus abdominis muscle fuses with the aponeurosis of the internal abdominal oblique to form the conjoint tendon.
The following structures are derivatives of External Abdominal Oblique fascia:
External Abdominal Oblique: Most superficial muscular layer. The following structures are derivatives of its fascia:
- Inguinal ligament: The thickened inferior margin of the aponeurosis of the external abdominal oblique.
- Lacunar ligament: The medial portion of the inguinal ligament which attaches to the pecten pubis.
- Pectineal ligament: A fibrous band which communicates with the lacunar ligament and goes posteriorly along the pecten pubis.
The testicular artery is a branch of what artery?
Testicular artery: Branch of the abdominal aorta. Supplies the testicles.
The Cremasteric artery is a branch of what artery?
Cremasteric artery is a branch of inferior epigastric artery. Supplies the cremaster muscle.
The artery to ductus deferens is a branch of what artery?
Artery to ductus deferens is a branch of superior vesical artery.
Pampiniform plexus
Pampiniform plexus is an anastomotic venous network draining the testicles.
Ilioinguinal nerve
Ilioinguinal nerve travels within the spermatic cord and provides sensation to the skin of the anterior scrotum and upper, medial thigh
Genital branch of genitofemoral nerve
Descends within the spermatic cord deep to the internal spermatic fascia. Supplies skin of anterior scrotum and upper medial thigh.
testicular lymphatics drain to?
The testicular lymphatics drain to the lumbar nodes
The scrotal lymphatics drain to?
The scrotal lymphatics drain to the superficial inguinal nodes.
What is proper hepatic? Name the 3 branches of the proper hepatic artery.
Proper hepatic a.: Ascending branch which travels with the common bile duct and hepatic portal vein within the hepatoduodenal ligament.
The proper hepatic artery has 3 main branches:
- Right hepatic a. → gives rise to the cystic a.
- Left hepatic a.
- Right gastric a.: Travels within the lesser curvature of the stomach.
Gastroduodenal artery
Gastroduodenal artery is the descending branch of the common hepatic artery
The gastroduodenal artery splits to form two arteries:
- Superior pancreaticoduodenal artery: Further divides into anterior and posterior branches that descend to supply the head of the pancreas and the proximal duodenum.
- Right gastroepiploic artery. (gastroomental): Courses along the greater curvature of the stomach within the greater omentum and anastomoses with the left gastroepiploic a. (branch of the splenic a.)
What are the 3 branches of the celiac trunk?
The celiac trunk is the first large unpaired branch of the abdominal aorta. It arises at the level of L1, and travels anteriorly for ~1cm before branching into 3 arteries:
- Left gastric a.
- Splenic a.
- Common hepatic a.
