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MRCS Sciences deck > Anatomy Deck > Flashcards

Anatomy Deck Flashcards

1
Q

Female urethra lymphatic drainage

A

Internal iliac nodes

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2
Q

What are the boundaries of the femoral triangle

A

Superiorly Inguinal ligament
Laterally Sartorius
Medially Adductor longus
Floor Iliopsoas, adductor longus and pectineus
Roof Fascia lata and Superficial fascia
Superficial inguinal lymph nodes (palpable below the inguinal ligament)
Long saphenous vein

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3
Q

What is the nerve root value of the external urethral sphincter

A

s2 s3 s4

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4
Q

Common Nerve Injuries and Surgery

A

Posterior triangle lymph node biopsy and accessory nerve lesion.
Lloyd Davies stirrups and common peroneal nerve.
Thyroidectomy and laryngeal nerve.
Anterior resection of rectum and hypogastric autonomic nerves.
Axillary node clearance; long thoracic nerve, thoracodorsal nerve and intercostobrachial nerve.
Inguinal hernia surgery and ilioinguinal nerve.
Varicose vein surgery- sural and saphenous nerves.
Posterior approach to the hip and sciatic nerve.
Carotid endarterectomy and hypoglossal nerve.

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5
Q

Hypokalaemia and metabolism

A

Hypokalaemia leads to alkalosis and urine acidosis. Hyper leads to the opposite.

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6
Q

Which of the following structures would be encountered first during a posterior approach to the hilum of the right kidney?

A

Ureter

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7
Q

As the catheter enters the prostatic urethra which of the following changes will occur?

A

Resistance will DECREASE

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8
Q

At what site is most dietary iron absorbed?

A

Duodenum

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9
Q

What is the arterial blood supply to the lacrimal apparatus

A

Ophthalmic artery

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10
Q

At what level do the renal arteries generally leave the aorta

A

L2

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11
Q

Through which of the following foramina does the genital branch of the genitofemoral nerve exit the abdominal cavity?

A

Deep inguinal ring

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12
Q

Where are sarcomas usually found

A

In the extremities (40%)

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13
Q

Loss of taste sensation from the posterior third of the tongue is most likely the result to an injury to which of the structures listed below?

A

Glossopharyngeal

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14
Q

From which of the following is the tunica vaginalis derived?

A

Peritoneum

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15
Q

This dorsalis pedis vessel is the continuation of which of the following?

A

Anterior tibial artery

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16
Q

What are the borders of the anatomical snuff box

A

Posterior border: Tendon of extensor pollicis longus
Anterior border: Tendons of extensor pollicis brevis and abductor pollicis longus
Proximal border: Styloid process of the radius
Distal border: Apex of snuffbox triangle
Floor: Trapezium and scaphoid
Content: Radial artery

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17
Q

How do you manage nutritional TPN and decide how much to give

A

For people not severely ill and not at risk of refeeding syndrome aim to give
25-35 kcal/kg/day (lower if BMI > 25)
0.8-1.5g protein /kg/day
30-35 ml fluid/kg/day
Adequate electrolytes, minerals, vitamins
Severely ill patients aim to give < 50% of the energy and protein levels over the first 24-48h.

For people at high risk of the refeeding syndrome:
Start at up to 10 kcal/kg/day increasing to full needs over 4-7 days
Start immediately before and during feeding: oral thiamine 200-300mg/day, vitamin B co strong 1 tds and supplements
Give K+ (2-4 mmol/kg/day), phosphate (0.3-0.6 mmol/kg/day), magnesium (0.2-0.4 mmol/kg/day)

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18
Q

Where do the adrenal arteries arise from

A

Superior adrenal arteries- from the inferior phrenic artery
Middle adrenal arteries - from the aorta
Inferior adrenal arteries -from the renal arteries

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19
Q

Epiploic foramen

A

The epiploic foramen has the following boundaries:
Anteriorly (in the free edge of the lesser omentum): Bile duct to the right, portal vein behind and hepatic artery to the left.
Posteriorly: Inferior vena cava
Inferiorly: 1st part of the duodenum
Superiorly: Caudate process of the liver

During liver surgery bleeding may be controlled using a Pringles manoeuvre, this involves placing a vascular clamp across the anterior aspect of the epiploic foramen. Thereby occluding:
Common bile duct
Hepatic artery
Portal vein

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20
Q

What is the blood supply of the ureter

A

The proximal ureter is supplied by branches from the renal artery. For the other feeding vessels
Other info:
25-35 cm long
Muscular tube lined by transitional epithelium
Surrounded by thick muscular coat. Becomes 3 muscular layers as it crosses the bony pelvis
Retroperitoneal structure overlying transverse processes L2-L5
Lies anterior to bifurcation of iliac vessels
Blood supply is segmental; renal artery, aortic branches, gonadal branches, common iliac and internal iliac
Lies beneath the uterine artery

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21
Q

What attaches the periosteum to the bone

A

Sharpey’s fibres

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22
Q

External iliac artery thrombus

A

BK fasciotomy and embolectomy to prevent re-perfusion related compartment syndrome

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23
Q

Bochdalek hernias

A

The finding of a scaphoid abdomen and respiratory distress suggests extensive intra thoracic herniation of the abdominal contents

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24
Q

APTT and PT factors

A

PT: Vitamin K dependent factors 2, 7, 9, 10
APTT: Factors 8, 9, 11, 12

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25
Q

Most superficial to deep structures

A

Tibial nerve -> pop vein -> pop artery
Common fibular nerve comes off on the lateral side of the popliteal fossa

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26
Q

Which muscle lies posterior to the lateral malleolus

A

Peronius longus and brevis.
Peroneus tertius is located in the anterior compartment
!Antertius compartment!

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27
Q

How many compartments are there in the lower leg

A

4

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28
Q

What are the muscles of the different compartments of the lower limb below knee

A

Peronius longus and brevis is lateral (Long and brave)
Superficial post: Gastro, soleus and plantar (GASOLPLANT)
Deep post: Pop and Flex digitalis and flexor hallucis longus
Ant: Tib ant and all extensors + Peronius tetius (fronTertius)

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29
Q

Cranial nerves carrying parasympathetic fibres

A

10 9 7 3

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30
Q

Which of the following nerves is most often permanently damaged during a superficial parotidectomy?

A

Greater auricular nerve

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31
Q

Which of these location best describes the initial location of the metanephric cap from which the kidney is derived?

A

Medial to the ureteric bud in the pelvis

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32
Q

Parasympathetic fibres innervating the parotid gland originate from which area?

A

Otic ganglion

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33
Q

What is the embryological origin of the descending colon

A

The left colon is embryologically part of the hind gut. Which accounts for its separate blood supply via the IMA.

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34
Q

What nerve roots does erbs palsy involve

A

Erb’s palsy involving brachial trunks C5-6.

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35
Q

What is a unilateral cleft lip a sign of?

A

Unilateral isolated cleft lip represents a failure of nasolabial ring fusion

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36
Q

Which structure suspends the spinal cord in the dural sheath?

A

Denticulate ligament

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37
Q

What are then branches of the subclavian artery

A

The superior thoracic artery is the first branch of the axillary artery arises from the first part
Two branches arise from the second part, thoraco acromial and lateral thoracic
Three branches from the third part, subscapular artery, anterior and posterior circumflex humeral arteries

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38
Q

Which lymph nodes does the lobule of the ear drain into?

A

The lobule of the ear drains to the superficial cervical nodes.

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39
Q

Platysma muscle innervtion

A

Innervated by the cervical branch of the fascial nerve

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40
Q

Athlete knee injury

A

The biceps femoris is commonly injured in sports that require explosive bending of the knee as seen in sprinting, especially if the athlete has not warmed up first

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41
Q

How should you divide the strap muscles in a thyroidectomy

A

Should the strap muscles require division during surgery they should be divided in their upper half. This is because their nerve supply from the ansa cervicalis enters in their lower half.

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42
Q

What do leukotrienes cause

A

A Decreased vascular permeability, bronchoconstriction, chemotaxis

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43
Q

At which level does the inferior thyroid artery enter the thyroid gland?

A

c6

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44
Q

Which of the following fingers is not a point of attachment for the palmar interossei?

A

Middle finger

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45
Q

Where does the hypoglossal nerve exit from

A

Hypoglossal foramen in the skull

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46
Q

Areas where the ureter is physiologically narrower

A

VUJ, PUJ and Iliac vessel area

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47
Q

Fascia during a laparotomy

A

Superficial fatty is camper fascia and deep is Scarpa’s fascia

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48
Q

What is the most important structure involved in supporting the uterus?

A

Central perineal tendon

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49
Q

Cortical mastoidectomy

A

The mastoid fossa is deemed as the safe area to begin as it does not seem to have any important structures apart from the mastoid air cells. These air cells may need to be removed in the even of an infection. Hence, drilling can begin here

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50
Q

Where is the transpyloric plane

A

Located at L1 and is an imaginary horizontal line located halfway between the suprasternal notch and the pubic symphysis

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51
Q

The male urethra develops from which structure

A

Cloaca

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52
Q

What are the relations of the brachial artery to the median nerve

A

Relations of median nerve to the brachial artery:
Lateral -> Anterior -> Medial

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53
Q

Fascia overlying the lungs

A

Sibson’s fascia overlies the apices of both lungs

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54
Q

What is the primary area of venous drainage of the bladder

A

vesicoprostatic plexus

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55
Q

What is the difference between vasculogenesis and angiogenesis

A

Vascu is new. Angi is pre

Vasculogenesis is new vessels developing in situ from existing mesenchyme.
Angiogenesis is vessels develop from sprouting off pre-existing arteries.

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56
Q

AA branches

A
57
Q

FACT

A

The vagus nerve lies in the carotid sheath and can get potentially damaged during exploration. It is important to remember that the hypoglossal nerve crosses the carotid sheath but never stays in it

58
Q

Which central venous system is unpaired

A

Superior sagital sinus

59
Q

Anatomy of lymphatic drainage of the vagina

A

The lymph vessels from the superior aspect of the vagina join the internal and external iliac nodes, those from the inferior aspect of the vagina drain to the superficial inguinal nodes.

60
Q

Which structure pass posterior to the medial malleolus

A

Mnemonic for structures posterior to the medial malleolus:

Tom Dick And Nervous Harry

       T ibialis posterior tendon flexor Digitorum longus
       A rtery
      N serve
      H allucis longus
61
Q

What nerves are at the greatest risk during a carotid endarterectomy

A

During a carotid endarterectomy the sternocleidomastoid muscle is dissected, with ligation of the common facial vein and then the internal jugular is dissected exposing the common and the internal carotid arteries. The nerves at risk during the operation include:

Hypoglossal nerve
Greater auricular nerve
Superior laryngeal nerve
The sympathetic chain lies posteriorly and is less prone to injury in this procedure.

62
Q

What type of cells is the oesophagus lined with

A

The oesphagus is lined by non keratinised stratified squamous epithelium

63
Q

What are the contents of the carotid sheath

A

Contents of carotid sheath:
Common carotid artery
Internal carotid artery
Internal jugular vein
Vagus nerve

64
Q

Branches of the internal carotid artery

A

Only = Opthalmic
Press = Posterior communicating
Carotid = Choroidal
Arteries = Anterior cerebral
Momentarily = Middle cerebral

65
Q

What is the longest part of the male urethra?

A

Spongy 15cm

66
Q

Where is the spleen dervied from

A

Most of the gut is derived endodermally except for the spleen which is from mesenchymal tissue.

67
Q

How are rectal cancers with threatened margins treated

A

Rectal cancers with threatened resection margins are managed with radiotherapy and chemotherapy initially. This is not the case with colonic cancers which are usually primarily resected.

68
Q

What are the muscles supplied by the ansa cervicalis

A

Ansa cervicalis muscles:

GHost THought SOmeone Stupid Shot Irene

GenioHyoid
ThyroidHyoid
Superior Omohyoid
SternoThyroid
SternoHyoid
Inferior Omohyoid

69
Q

What are the levels of constriction of the oesophagus?

A

Constrictions of the oesophagus: ABCD
A- Arch of the Aorta
B- Left main Bronchus
C- Cricoid Cartilage
D- Diaphragmatic Hiatus

70
Q

Sensory information of the external ear

A

Auriculotemporal nerve

71
Q

When a singer has surgery and can no longer sings high notes

A

The most likely injury is to the superior laryngeal nerve which innervates the cricothyroid muscle. Since this tenses the vocal cords, singing high notes becomes a problem.

72
Q

Recurrent laryngeal nerve damage causes non function of which throat muscle

A

Posterior cricoarteynoid. It is innervated by the inferior laryngeal nerve that is a branch of the RLN. It is the only muscle that abducts the vocal cords and without this, the vocal cords can become paralysed and remain in the abducted position and hence not allow any air to pass through the trachea

73
Q

How does a needle pass through when doing a lumbar puncture

A

During the procedure the needle passes through:

The supraspinous ligament which connects the tips of spinous processes and the interspinous ligaments between adjacent borders of spinous processes
Then the needle passes through the ligamentum flavum, which may cause a give as it is penetrated
A second give represents penetration of the needle through the dura mater into the subarachnoid space. Clear CSF should be obtained at this point

74
Q

Where does the neonatal spinal cord end

A

At the 3rd month the foetus’s spinal cord occupies the entire length of the vertebral canal. The vertebral column then grows longer exceeding the growth rate of the spinal cord. This results with the cord being at L3 at birth and L1-2 by adulthood.

75
Q

The motor nucleus of cranial nerve V supplies all except which

A

Posterior belly of digastric and this is supplied by the facial nerve

76
Q

Which muscle is responsible for the winged scapula appearance

A

Serratus anterior muscle and this is supplied by the long thoracic nerve. It inserts into the anteriomedial scapular border

77
Q

Where is the majority of the venous drainage for the breast

A

Axillary vein

78
Q

Bicornuate uterus is the result of which embryological abnormality

A

Mullerian duct

79
Q

What is in-utero anchephaly

A

No brain in utero as the neuropore fails to close around day 25. This results in the brain being developed outside the cranium and hence is severely damaged or destroyed

80
Q

Diaphragm holes

A

T8 - IVC and phrenic nerve
T10 - Oeso and vagus
T12 - Aorta and azygous and thoracic duct

81
Q

Which ligaments contain the arterial blood supply for the NOF

A

Ligament teres

82
Q

Which structure forms the largest tributary of the coronary sinus?

A

The great cardia vein

83
Q

Which nerve is the tensor tympani innervated by

A

Trigeminal nerve

84
Q

Where does the AA bifurcate

A

The aorta bifurcates at L4

85
Q

Another name for inguinal ligament

A

Poupart’s

86
Q

Pectineal ligament also known as

A

Coopers ligament

87
Q

The duct of Santorini

A

Accessory pancreatic duct

88
Q

Suspensory ligaments of the breast

A

Ligaments of Cooper

89
Q

Which canal contains the pudendal system

A

Alcocks canal. Lateral wall of the ishiorectal fossa

90
Q

What is the lymphatic drainage of the rectum

A

Lymphatic drainage
Mesorectal lymph nodes (superior to dentate line)
Inguinal nodes (inferior to dentate line)

91
Q

Where does the inferior mesenteric artery arise from

A

L3 level Aorta

92
Q

What is berry’s signs

A

Berrys sign= Absence of carotid pulse due to malignant thyromegaly.
Papillary thyroid cancers will tend to spread via lymphatics and present with disease that is nearly always confined to the neck. Follicular carcinomas may metastasise haematogenously and the skull may be the presenting site of disease in between 2 and 8% of patients.

93
Q

Holstein-Lewis fracture

A

Simple spiral fracture of the humerus and the radial nerve is at risk

94
Q

What is the most posterior structure of the porta hepatis

A

Portal vein

95
Q

Cardiooesophageal junction level

A

T11

96
Q

Treatment for hydrocele in young children

A

Ligation of the patent processus vaginalis is performed via an inguinal approach.

97
Q

Which of the following structures separates the posterior cruciate ligament from the popliteal artery?

A

Oblique popliteal ligament

98
Q

Where does the thyroid ima come from

A

Brachiocephalic artery

99
Q

Which vessel is routinely ligated in an IVOR lewis procedure

A

Azygos vein

100
Q

What kind of incision is used to gain access to the pancreas in resectional surgery

A

A rooftop incision is typically used to access the pancreas for resectional surgery.

101
Q

What is the most common way to manage back pain in metastatic pancreatic cancer

A

Pancreatic cancer can cause severe pain as a result of retroperitoneal nerve infiltration. It can be managed with chemical neurectomy/ nerve blocks.

102
Q

What is the main structure that determines the descent path of the testicle?

A

Gerbenaculum

103
Q

Drain used after breast surgery

A

Closed suction system to prevent development of seromas

104
Q

FACT

A

The lingual nerve is closely related to the third molar and hence anaesthesia after surgery may be common. Anesthesia on the ipsilateral aspect of the anterior part of the tongue is common.

105
Q

Where do all the tinea coli converge in the caecum

A

The tenia coli converge at the base of the appendix.

106
Q

Structures passing through the superior orbital fissure

A

SUPERIOR ORBITAL FISSURE:
Outside
L - lacrimal F - frontal T - trochlear done
Inside
N - nasociliary A - abducent nerve O - oculomotor nerve
LFT done outside No Abnormality Occurred inside

107
Q

FACT

A

The IVC is valveless

Mnemonic for the Inferior vena cava tributaries: I Like To Rise So High:

Iliacs
Lumbar
Testicular
Renal
Suprarenal
Hepatic vein

108
Q

What nerve is at greatest risk of injury on short saphenous vein mobilisation

A

The sural nerve is closely related and damage to this structure is a major cause of litigation. The other structures may all be injured but the risks are lower.

109
Q

What is the most posteriorly located structure in the lung root

A

The vagus nerve is the most posteriorly located structure at the lung root. The phrenic nerve lies most anteriorly.

110
Q

Pancreatic blood supply

A

Pancreatic head is supplied by the pancreaticoduodenal artery
Pancreatic tail is supplied by branches of the splenic artery

111
Q

FACT

A

The fascial nerve innervates the motor response of the corneal reflex

112
Q

Which nerve is at risk during submandibular gland excision?

A

Marginal mandibular nerve

113
Q

Parathyroid gland origin

A

Originates from the third and fourth brachial pouches

114
Q

Which nerve is affected in tarsal tunnel syndrome

A

Tibial nerve. Medial aspect of the foot will loose sensation

115
Q

What are the hand muscles supplied by the median nerve

A

Hand muscles supplied by the median nerve
L Lateral two lumbricals
O Opponens pollicis
A Abductor pollicis brevis
F Flexor pollicis brevis

116
Q

Walls of the inguinal canal

A

Inguinal canal walls: ‘MALT: 2M, 2A, 2L, 2T’:

Starting from superior, moving around in order to posterior:
Superior wall (roof): 2 Muscles:Internal oblique, transversus abdominis
Anterior wall: 2 Aponeuroses: Aponeurosis of external oblique, Aponeurosis of internal oblique
Lower wall (floor): 2 Ligaments: Inguinal Ligament, Lacunar Ligament Posterior wall: 2Ts: Transversalis fascia, Conjoint Tendon

117
Q

Lymph supply of the scrotum

A

Superficial inguinal nodes

118
Q

Different fascia

A

Scrapas - Anterior abdominal wall
Colles - Root of penis
Deno - seperates rectum from prostate and bladder
Gerotas - Kidney
Spigalein - Ant abdominal wall

119
Q

Which nerve lies medially to the lobes of the thyroid gland, in the groove between the oesophagus and trachea?

A

Rec lar

120
Q

Which of the following regions of the male urethra is entirely surrounded by Bucks fascia?

A

Spongiose part

121
Q

What controls pincer grip

A

The anterior interosseous nerve is a motor branch of the median nerve just below the elbow. When damaged it classically causes:
Pain in the forearm
Loss of pincer movement of the thumb and index finger (innervates the long flexor muscles of flexor pollicis longus & flexor digitorum profundus of the index and middle finger)
Minimal loss of sensation due to lack of a cutaneous branch

122
Q

Which bony landmark of the sternum lies at the level of the sternoclavicular joint?

A

2nd

123
Q

Which of the following ligaments can only be found in the thoracic spine?

A

Costotransverse ligament

124
Q

FACT

A

The external carotid artery runs through the parotid gland and gives off the superficial temporal and the maxillary

125
Q

Pneumonic for muscles attaching to the greater trochanter

A

Mnemonic for muscle attachment on greater trochanter is POGO:

Piriformis
Obturator internus
Gemelli
Obturator externus

126
Q

Eponymous fractures

A

Eponymous fractures

Colles’ fracture (dinner fork deformity)
Fall onto extended outstretched hand
Classical Colles’ fractures have the following 3 features:

  1. Transverse fracture of the radius
  2. 1 inch proximal to the radio-carpal joint
  3. Dorsal displacement and angulation

Smith’s fracture (reverse Colles’ fracture)
Volar angulation of distal radius fragment (Garden spade deformity)
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed

Bennett’s fracture
Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at ulnar base of metacarpal

Image sourced from Wikipedia
Monteggia’s fracture
Dislocation of the proximal radioulnar joint in association with an ulna fracture
Fall on outstretched hand with forced pronation
Needs prompt diagnosis to avoid disability

Image sourced from Wikipedia
Galeazzi fracture
Radial shaft fracture with associated dislocation of the distal radioulnar joint
Direct blow

Pott’s fracture
Bimalleolar ankle fracture
Forced foot eversion

Barton’s fracture
Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation
Fall onto extended and pronated wrist
Involvement of the joint is a defining feature

Holstein Lewis Fracture
A HolsteinLewis fracture is a fracture of the distal third of the humerus resulting in entrapment of the radial nerve.
The radial nerve is one of the major nerves of the upper limb. It innervates all of the muscles in the extensor compartments of the arm.
Conservative treatment includes reduction and use of a functional brace
Vascular injury may require open surgery

127
Q

Breast imaging

A

Breast imaging is undertaken with a combination of USS and mammography in most women presenting with a palpable lump. In younger patients, the denser breasts encountered in this group may make mammography less informative.

In women who present with breast implants with a palpable lump, the imaging of choice remains the same. However, specialized imaging techniques may be needed to obtain optimal mammographic views. Where there are specific concerns about a breast implant, rather than a lump, the imaging modality of choice is MRI scanning.
MRI scanning may be beneficial in screening younger patients with a family history and also in patients with lobular cancers who are being considered for breast conserving surgery.

128
Q

Boas sign

A

Boas’ sign refers to hyperaesthesia of the tip of the right scapula and is seen classically in association with acute cholecystitis.

129
Q

Hoe to calculate sensitivity and specificity

A

Sensitivity: number of true positives/ (number of true positives+number of false negatives)
Specificity: number of true negatives/ (number of true negatives+number of false positives)

130
Q

What is contained in the spermatic cord

A

9 structures
3 arteries: Testicular, cremasteric and vas def artery
3 nerves: genital branch of genitofemoral, ilioinguinal (lies outside but travels with), sympathetic fibres
3 other: Pampniform plexus, vas deferens, lymphatics

131
Q

FACT

A

Intubation in children is difficult as a result of caudally placed larynx and a smaller angle of jaw

132
Q

Which muscle confers dynamic stability to the patella

A

Vastus medialis

133
Q

Where does the uncinate process of the pancreas lie

A

The uncinate process of the pancreas lies between the AA and SMA

134
Q

Where is the trigeminal nerve ganglion located

A

The trigeminal ganglion is located lateral to the cavernous sinus, in a depression of the temporal bone known as the trigeminal cave or Meckel’s cave.

135
Q

How long is the male penis

A

20cm

136
Q

Submandibular gland excision

A

Most superficially there is the facial vein and the lymph nodes. The facial artery passes in the superficial groove on the gland.
The incision is 4cm below the angle of the mandible to prevent injury to the marginal mandibular nerve.
The lingual nerve goes around the duct

137
Q

Which of the vessels listed below is the most inferiorly sited single aortic branch?

A

Median sacral artery

138
Q

How do you differentiate between bochdalek and morgagni hernia

A

Boch is on the left and is often a lot more common, Morg is on the right and also may contain the transverse colon, it is rare and less severe

139
Q
A

MRCS Sciences deck (16 decks)

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