Anatomy Deck Flashcards
1
Q
Female urethra lymphatic drainage
A
Internal iliac nodes
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
3
Q
What is the nerve root value of the external urethral sphincter
A
s2 s3 s4
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.
5
Q
Hypokalaemia and metabolism
A
Hypokalaemia leads to alkalosis and urine acidosis. Hyper leads to the opposite.
6
Q
Which of the following structures would be encountered first during a posterior approach to the hilum of the right kidney?
A
Ureter
7
Q
As the catheter enters the prostatic urethra which of the following changes will occur?
A
Resistance will DECREASE
8
Q
At what site is most dietary iron absorbed?
A
Duodenum
9
Q
What is the arterial blood supply to the lacrimal apparatus
A
Ophthalmic artery
10
Q
At what level do the renal arteries generally leave the aorta
A
L2
11
Q
Through which of the following foramina does the genital branch of the genitofemoral nerve exit the abdominal cavity?
A
Deep inguinal ring
12
Q
Where are sarcomas usually found
A
In the extremities (40%)
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
14
Q
From which of the following is the tunica vaginalis derived?
A
Peritoneum
15
Q
This dorsalis pedis vessel is the continuation of which of the following?
A
Anterior tibial artery
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
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)
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
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
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
21
Q
What attaches the periosteum to the bone
A
Sharpey’s fibres
22
Q
External iliac artery thrombus
A
BK fasciotomy and embolectomy to prevent re-perfusion related compartment syndrome
23
Q
Bochdalek hernias
A
The finding of a scaphoid abdomen and respiratory distress suggests extensive intra thoracic herniation of the abdominal contents
24
Q
APTT and PT factors
A
PT: Vitamin K dependent factors 2, 7, 9, 10
APTT: Factors 8, 9, 11, 12
25
Most superficial to deep structures
Tibial nerve -> pop vein -> pop artery
Common fibular nerve comes off on the lateral side of the popliteal fossa
26
Which muscle lies posterior to the lateral malleolus
Peronius longus and brevis.
Peroneus tertius is located in the anterior compartment
!Antertius compartment!
27
How many compartments are there in the lower leg
4
28
What are the muscles of the different compartments of the lower limb below knee
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)
29
Cranial nerves carrying parasympathetic fibres
10 9 7 3
30
Which of the following nerves is most often permanently damaged during a superficial parotidectomy?
Greater auricular nerve
31
Which of these location best describes the initial location of the metanephric cap from which the kidney is derived?
Medial to the ureteric bud in the pelvis
32
Parasympathetic fibres innervating the parotid gland originate from which area?
Otic ganglion
33
What is the embryological origin of the descending colon
The left colon is embryologically part of the hind gut. Which accounts for its separate blood supply via the IMA.
34
What nerve roots does erbs palsy involve
Erb's palsy involving brachial trunks C5-6.
35
What is a unilateral cleft lip a sign of?
Unilateral isolated cleft lip represents a failure of nasolabial ring fusion
36
Which structure suspends the spinal cord in the dural sheath?
Denticulate ligament
37
What are then branches of the subclavian artery
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
38
Which lymph nodes does the lobule of the ear drain into?
The lobule of the ear drains to the superficial cervical nodes.
39
Platysma muscle innervtion
Innervated by the cervical branch of the fascial nerve
40
Athlete knee injury
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
41
How should you divide the strap muscles in a thyroidectomy
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.
42
What do leukotrienes cause
A Decreased vascular permeability, bronchoconstriction, chemotaxis
43
At which level does the inferior thyroid artery enter the thyroid gland?
c6
44
Which of the following fingers is not a point of attachment for the palmar interossei?
Middle finger
45
Where does the hypoglossal nerve exit from
Hypoglossal foramen in the skull
46
Areas where the ureter is physiologically narrower
VUJ, PUJ and Iliac vessel area
47
Fascia during a laparotomy
Superficial fatty is camper fascia and deep is Scarpa's fascia
48
What is the most important structure involved in supporting the uterus?
Central perineal tendon
49
Cortical mastoidectomy
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
50
Where is the transpyloric plane
Located at L1 and is an imaginary horizontal line located halfway between the suprasternal notch and the pubic symphysis
51
The male urethra develops from which structure
Cloaca
52
What are the relations of the brachial artery to the median nerve
Relations of median nerve to the brachial artery:
Lateral -> Anterior -> Medial
53
Fascia overlying the lungs
Sibson's fascia overlies the apices of both lungs
54
What is the primary area of venous drainage of the bladder
vesicoprostatic plexus
55
What is the difference between vasculogenesis and angiogenesis
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.
56
AA branches
57
FACT
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
Which central venous system is unpaired
Superior sagital sinus
59
Anatomy of lymphatic drainage of the vagina
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
Which structure pass posterior to the medial malleolus
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
What nerves are at the greatest risk during a carotid endarterectomy
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
What type of cells is the oesophagus lined with
The oesphagus is lined by non keratinised stratified squamous epithelium
63
What are the contents of the carotid sheath
Contents of carotid sheath:
Common carotid artery
Internal carotid artery
Internal jugular vein
Vagus nerve
64
Branches of the internal carotid artery
Only = Opthalmic
Press = Posterior communicating
Carotid = Choroidal
Arteries = Anterior cerebral
Momentarily = Middle cerebral
65
What is the longest part of the male urethra?
Spongy 15cm
66
Where is the spleen dervied from
Most of the gut is derived endodermally except for the spleen which is from mesenchymal tissue.
67
How are rectal cancers with threatened margins treated
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
What are the muscles supplied by the ansa cervicalis
Ansa cervicalis muscles:
GHost THought SOmeone Stupid Shot Irene
GenioHyoid
ThyroidHyoid
Superior Omohyoid
SternoThyroid
SternoHyoid
Inferior Omohyoid
69
What are the levels of constriction of the oesophagus?
Constrictions of the oesophagus: ABCD
A- Arch of the Aorta
B- Left main Bronchus
C- Cricoid Cartilage
D- Diaphragmatic Hiatus
70
Sensory information of the external ear
Auriculotemporal nerve
71
When a singer has surgery and can no longer sings high notes
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
Recurrent laryngeal nerve damage causes non function of which throat muscle
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
How does a needle pass through when doing a lumbar puncture
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
Where does the neonatal spinal cord end
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
The motor nucleus of cranial nerve V supplies all except which
Posterior belly of digastric and this is supplied by the facial nerve
76
Which muscle is responsible for the winged scapula appearance
Serratus anterior muscle and this is supplied by the long thoracic nerve. It inserts into the anteriomedial scapular border
77
Where is the majority of the venous drainage for the breast
Axillary vein
78
Bicornuate uterus is the result of which embryological abnormality
Mullerian duct
79
What is in-utero anchephaly
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
Diaphragm holes
T8 - IVC and phrenic nerve
T10 - Oeso and vagus
T12 - Aorta and azygous and thoracic duct
81
Which ligaments contain the arterial blood supply for the NOF
Ligament teres
82
Which structure forms the largest tributary of the coronary sinus?
The great cardia vein
83
Which nerve is the tensor tympani innervated by
Trigeminal nerve
84
Where does the AA bifurcate
The aorta bifurcates at L4
85
Another name for inguinal ligament
Poupart's
86
Pectineal ligament also known as
Coopers ligament
87
The duct of Santorini
Accessory pancreatic duct
88
Suspensory ligaments of the breast
Ligaments of Cooper
89
Which canal contains the pudendal system
Alcocks canal. Lateral wall of the ishiorectal fossa
90
What is the lymphatic drainage of the rectum
Lymphatic drainage
Mesorectal lymph nodes (superior to dentate line)
Inguinal nodes (inferior to dentate line)
91
Where does the inferior mesenteric artery arise from
L3 level Aorta
92
What is berry's signs
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
Holstein-Lewis fracture
Simple spiral fracture of the humerus and the radial nerve is at risk
94
What is the most posterior structure of the porta hepatis
Portal vein
95
Cardiooesophageal junction level
T11
96
Treatment for hydrocele in young children
Ligation of the patent processus vaginalis is performed via an inguinal approach.
97
Which of the following structures separates the posterior cruciate ligament from the popliteal artery?
Oblique popliteal ligament
98
Where does the thyroid ima come from
Brachiocephalic artery
99
Which vessel is routinely ligated in an IVOR lewis procedure
Azygos vein
100
What kind of incision is used to gain access to the pancreas in resectional surgery
A rooftop incision is typically used to access the pancreas for resectional surgery.
101
What is the most common way to manage back pain in metastatic pancreatic cancer
Pancreatic cancer can cause severe pain as a result of retroperitoneal nerve infiltration. It can be managed with chemical neurectomy/ nerve blocks.
102
What is the main structure that determines the descent path of the testicle?
Gerbenaculum
103
Drain used after breast surgery
Closed suction system to prevent development of seromas
104
FACT
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
Where do all the tinea coli converge in the caecum
The tenia coli converge at the base of the appendix.
106
Structures passing through the superior orbital fissure
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
FACT
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
What nerve is at greatest risk of injury on short saphenous vein mobilisation
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
What is the most posteriorly located structure in the lung root
The vagus nerve is the most posteriorly located structure at the lung root. The phrenic nerve lies most anteriorly.
110
Pancreatic blood supply
Pancreatic head is supplied by the pancreaticoduodenal artery
Pancreatic tail is supplied by branches of the splenic artery
111
FACT
The fascial nerve innervates the motor response of the corneal reflex
112
Which nerve is at risk during submandibular gland excision?
Marginal mandibular nerve
113
Parathyroid gland origin
Originates from the third and fourth brachial pouches
114
Which nerve is affected in tarsal tunnel syndrome
Tibial nerve. Medial aspect of the foot will loose sensation
115
What are the hand muscles supplied by the median nerve
Hand muscles supplied by the median nerve
L Lateral two lumbricals
O Opponens pollicis
A Abductor pollicis brevis
F Flexor pollicis brevis
116
Walls of the inguinal canal
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
Lymph supply of the scrotum
Superficial inguinal nodes
118
Different fascia
Scrapas - Anterior abdominal wall
Colles - Root of penis
Deno - seperates rectum from prostate and bladder
Gerotas - Kidney
Spigalein - Ant abdominal wall
119
Which nerve lies medially to the lobes of the thyroid gland, in the groove between the oesophagus and trachea?
Rec lar
120
Which of the following regions of the male urethra is entirely surrounded by Bucks fascia?
Spongiose part
121
What controls pincer grip
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
Which bony landmark of the sternum lies at the level of the sternoclavicular joint?
2nd
123
Which of the following ligaments can only be found in the thoracic spine?
Costotransverse ligament
124
FACT
The external carotid artery runs through the parotid gland and gives off the superficial temporal and the maxillary
125
Pneumonic for muscles attaching to the greater trochanter
Mnemonic for muscle attachment on greater trochanter is POGO:
Piriformis
Obturator internus
Gemelli
Obturator externus
126
Eponymous fractures
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
Breast imaging
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
Boas sign
Boas' sign refers to hyperaesthesia of the tip of the right scapula and is seen classically in association with acute cholecystitis.
129
Hoe to calculate sensitivity and specificity
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
What is contained in the spermatic cord
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
FACT
Intubation in children is difficult as a result of caudally placed larynx and a smaller angle of jaw
132
Which muscle confers dynamic stability to the patella
Vastus medialis
133
Where does the uncinate process of the pancreas lie
The uncinate process of the pancreas lies between the AA and SMA
134
Where is the trigeminal nerve ganglion located
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
How long is the male penis
20cm
136
Submandibular gland excision
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
Which of the vessels listed below is the most inferiorly sited single aortic branch?
Median sacral artery
138
How do you differentiate between bochdalek and morgagni hernia
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
