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MRCS Part B > Anatomy PTMRCS > Flashcards

Anatomy PTMRCS Flashcards

1
Q

What organs are normally palpable in the abdomen?

A

Aorta +/- lower pole right kidney

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2
Q

What is the surface marking for the neck of the pancreas?

A

Transpyloric plane - L1 - halfway between jugular notch of manubrium and upper border of symphysis pubis

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3
Q

What is the surface marking for the liver?

A

Nipple line superiorly, right 10th rib inferiorly, left 5th ICS MCL

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4
Q

What is the surface marking for the gallbladder?

A

9th c.c, MCL

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5
Q

What is the surface marking for the spleen?

A

Ribs 9-11 on left side posteriorly

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6
Q

Name the branches of the abdominal aorta descending?

A 
Inferior phrenic arteries - T12
Coeliac trunk - L1
Suprarenal arteries/middle adrenal - L1
SMA - L1
Renal arteries - L1/2
Gonadal arteries - L2
Four paired lumbar arteries from L1-4
IMA - L3
Bifurcates at L4 to common iliacs and median sacral artery at L4
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7
Q

What is the surface marking of the abdominal aorta?

A

T12 2 finger breadths above transpyloric plane in midline

Runs down to L4 in midline

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8
Q

What is anterior to the aorta at L1?

A

Neck of pancreas and SMA

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9
Q

What is in the midline of the transpyloric plane? Back to front

A 
L1 vertebra and conus
Aorta
SMA
Neck of pancreas
SMV
Pylorus
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10
Q

What is laterally at the transpyloric plane?

A 
Kidney hila
Spleen hilum
Renal vein
D2 and DJ flexure
Portal vein origin
Fundus of GB
9th c.c.
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11
Q

What is the epiploic foramen of Winslow? What are its boundaries? Clinical significance in terms of pathology?

A

Boundary between greater and lesser sacs of peritoneum
Above is caudate lobe, below is D1
Anterior is lesser omentum with CBD/portal vein/CHA in free edge
Posterior is IVC
Lesser sac is site for potential internal herniation of bowel

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12
Q

What is Pringle’s manoeuvre?

A

Clamp hepatoduodenal ligament (containing portal vein and CHA) to control major liver bleeding during laparotomy

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13
Q

FISH of functions of the spleen?

A

Filtration of encapsulated organs and blood cells
Immunological function
Storage of platelets
Haematopoiesis (fetus)

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14
Q

Organs at risk during splenectomy?

A 
Pancreas (tail) - in relation to hilum
Left diaphragm
Splenic flexure
Left kidney/suprarenal gland
Stomach
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15
Q

2 ligaments of the spleen? Where do they attach and what do they contain?

A

Gastrosplenic - short gastrics and left gastro-epiploics

Lienorenal - splenic vessels and tail of pancreas

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16
Q

5 sites of porto-systemic anastamoses?

A 
Oesophagus - lower end
Umbilicus 
Upper anal canal/lower rectum
Retroperitoneum 
Bare area of liver
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17
Q

What is the oesophageal anastomoses between in portosystemic shunts?

A

Left gastric/portal

Azygous/hemiazygos veins

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18
Q

Common sites of abdominal collections?

A 
Right subhepatic space - hepatorenal pouch of Rutherford Morrison
Pelvis
Between bowel loops
Right and left subphrenic spaces
Right and left paracolic gutters
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19
Q

What is the surface marking for the superior pole of the kidney?

A

12th rib posteriorly

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20
Q

What is the surface marking for dorsalis pedis?

A

Between first 2 metatarsal bones proximally just lateral to tendon of EHL

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21
Q

Dorsalis pedis is a continuation of?

A

Anterior tibial artery

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22
Q

What passes posteriorly to the malleolus? Tom Dick And Very Naughty Harry

A 
From anterior to posterior
Tibialis posterior tendon
flexor Digitorum longus tendon
Posterior tibial Artery
Posterior tibial Vein
Tibial nerve
flexor Hallucis longus tendon
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23
Q

What muscles make up the achilles tendon? What compartment is this?

A

Gastrocnemius
Soleus
Plantaris
Superficial posterior compartment

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24
Q

What nerve supplies the muscles of the superficial posterior compartment of the leg?

A

Tibial nerve

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25
Q

What nerve supplies the muscles of the deep posterior compartment of the leg?

A

Tibial nerve

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26
Q

What muscles are in the deep posterior compartment of the leg?

A

Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior
Popliteus

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27
Q

What innervates the muscles of the anterior compartment of the leg?

A

Deep peroneal nerve

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28
Q

What innervates the muscles of the lateral compartment of the leg?

A

Superficial peroneal nerve

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29
Q

Which peroneus muscle is not like the others?

A

Peroneus tertius - in anterior compartment rather than lateral

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30
Q

Where does peroneus longus originate from and insert?

A

Head of fibula to medial cuneiform/base of first metatarsal

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31
Q

Where does peroneus brevis originate from and insert?

A

Lower 2/3 of lateral surface of fibula medial to peroneus longus, to base of fifth metatarsal

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32
Q

Where does peroneus tertius originate from and insert?

A

Lower 1/3 of anterior surface of fibular / lower interosseus membrane to base of fifth metatarsal, under extensor retinaculum

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33
Q

Where would you test sensation for S1?

A

Lateral aspect of foot

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34
Q

Where would you test sensation for L4?

A

Medial malleolus

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35
Q

Where would you test sensation for deep peroneal nerve?

A

First web interspace

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36
Q

Where would you test sensation for superficial peroneal nerve?

A

Dorsum of foot (not first web interspace)

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37
Q

Where would you test sensation for sural nerve?

A

Lateral border of foot, similar to S1

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38
Q

What movements does EHL do?

A

Extension of big toe

Also foot dorsiflexion and inversion of foot

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39
Q

What vessels are deep to EHL in leg? Which nerve?

A

Anterior tibial artery and vein

Deep peroneal nerve

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40
Q

Nerve roots for knee reflex?

A

L3/4

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41
Q

Nerve roots for ankle reflex?

A

S1/2

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42
Q

Nerve roots for biceps reflex?

A

C5/6

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43
Q

Nerve roots for triceps reflex?

A

C7/8

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44
Q

Between what bones does ankle dorsiflexion occur?

A

Tibia/fibula and talus

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45
Q

Muscles that dorsiflex foot?

A 
Anterior compartment:
Tibialis anterior
EHL
EDL
Peroneus tertius
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46
Q

Muscles that plantarflex foot?

A

Gastrocnemius
Soleus
Plantaris
Flexor hallucis longus, flexor digitorum longus and tibialis posterior (whole deep compartment except popliteus)

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47
Q

Why can people with achilles tendon rupture still plantarflex?

A

Superficial posterior compartment insert into achilles tendon but deep posterior compartment except popliteus also plantarflex

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48
Q

What muscles contracting together cause eversion of ankle?

A

Peroneus longus and brevis

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49
Q

What muscles contracting together cause inversion of ankle?

A

Tibialis anterior and posterior

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50
Q

At what joint do ankle inversion and eversion occur?

A

Subtalar

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51
Q

What sensorimotor loss occurs with damage to superficial peroneal nerve?

A

Loss of sensation to dorsum of foot except first dorsal webspace
Weak ankle eversion

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52
Q

Outline the ligaments supporting the ankle joint?

A

Deltoid ligament - medial, with strong deep part and weak superficial part
Anterior and posterior talofibular ligaments, and calcaneofibular ligament - lateral
Syndesmosis - normal alignment of distul tib-fib joint

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53
Q

What forms the syndesmosis of the ankle?

A

Anterior and posterior tibio-fibular ligaments
Interosseus ligament
Inferior transverse ligament

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54
Q

Where would you test saphenous nerve sensation?

A

Medial aspect of foot

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55
Q

Where would you test tibial nerve sensation?

A

Posterior sole of foot

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56
Q

Difference between right and left vertebral arteries?

A

Left often larger

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57
Q

What are the 4 parts of the vertebral artery?

A

From origin running in front of C7 and sympathetic trunk
Foraminal part from C6-C2
Part crossing C1 transverse foramen
Passes through dura and anterior to medulla

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58
Q

What are the branches of the subclavian artery? VIT C D. Which parts? What does it turn into and where?

A

1st part - vertebral, internal thoracic, thyrocervical trunk
2nd part - costocervical trunk
3rd part - dorsal scapular
Becomes axillary artery at lateral border of 1st rib

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59
Q

Describe anatomical route of vertebral artery?

A

Arises from subclavian artery at C7
Enters transverse process at C6 and ascends through to C1
After exiting C1 it traverses posterior arch before entering foramen magnum and forming basilar at base of medulla

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60
Q

Branches of the basilar artery?

A

AICA
Pontine branches
Superior cerebellar artery
Posterior cerebral artery

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61
Q

How may a basilar tip aneurysm present?

A

With rupture - SAH

Bitemporal hemianopia due to compression of optic chiasm

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62
Q

Where is the thyroid gland? Where does it attach and by what?

A

Located below thyroid cartilage with thyroid isthmus below cricoid cartilage
Attached to 2nd and 4th tracheal rings by Berry’s ligament, invested in pretracheal fascia

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63
Q

Why does the thyroid move on swallowing?

A

Attached to tracheal rings by Berry’s ligament

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64
Q

How are thyroglossal cysts formed?

A

During development the thyroid descends from tongue base through thyroglossal duct
When duct fails to regress, TG cyst can form

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65
Q

What should you also remove during removal of thyroglossal cyst to prevent recurrence?

A

Middle 1/3 of hyoid bone

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66
Q

Describe how to do needle cricothyroidotomy?

A

14G needle with syringe half filled with sterile water, asepsis where possible
Extend neck if able
Palpate cricothyroid recess between thyroid notch and cricoid cartilage
Needle into midline through cricothyroid membrane aiming caudally and continually aspirate watching for air bubbles
Then attach to O2

67
Q

What does thyrohyoid do? What innervates it?

A

Depresses hyoid and elevates larynx

C1 - ansa cervicalis

68
Q

Blood supply to thyroid?

A

Superior thyroid artery from ECA
Inferior thyroid artery from thyrocervical trunk from SCA
+/- thyroid ima from brachiocephalic trunk

69
Q

Venous drainage of thyroid?

A

Superior thyroid vein to IJV
Middle thyroid vein to IJV
Inferior thyroid vein to brachiocephalic vein

70
Q

Hoarse voice post thyroidectomy? Cause and mechanism? Semon’s law?

A

Recurrent laryngeal nerve damage - causes paralysis of vocal cords - if progressive then abductor paralysis then adductor paralysis
In bilateral RLN palsies, airway compromise as cords paralysed in midline requiring emergency e.g. tracheostomy

71
Q

Why are recurrent laryngeal nerves at risk during thyroid surgery?

A

Run close to inferior thyroid artery

72
Q

Which muscle of the larynx is not innervated by the recurrent laryngeal nerve?

A

Cricothyroid

73
Q

What is cricothyroid muscle innervated by?

A

External laryngeal nerve

74
Q

What are the muscles of the pharynx innervated by? What is the exception?

A

Pharyngeal plexus CN9, CN10 and symp

Exception is stylopharyngeus - CN9

75
Q

What is the innervation of the tongue? What is the exception?

A

CN12

Exception is palatoglossus - pharyngeal plexus

76
Q

What is the innervation of muscles of mastication? What is the exception?

A

Trigeminal nerve - mandibular branch

Exception is buccinator - facial nerve

77
Q

Which vessel runs close to the external laryngeal nerve?

A

Superior thyroid artery

78
Q

How may external laryngeal nerve palsy present? Why?

A

Inability to hit high notes / monotonous voice

Innervates cricothyroid which tenses vocal cords to increase pitch

79
Q

Sensory supply to the larynx?

A

Above vocal folds - internal laryngeal nerve (from superior laryngeal nerve)
Below vocal folds - recurrent laryngeal nerve

80
Q

What does the recurrent laryngeal nerve innervate? Sensory?

A

All intrinsic muscles of larynx except cricothyroid

Sensation below vocal folds

81
Q

What vertebral levels are the hyoid bone, thyroid cartilage and cricoid cartilage?

A

C3. C4 and C6

82
Q

What pharyngeal arches do the hyoid, thyroid cartilage and cricoid cartilage derive from?

A

C3, C4 and C6

83
Q

What muscles open the vocal cords?

A

Posterior cricoarytenoids - by externally rotating arytenoids

84
Q

What muscles close the vocal cords?

A

Lateral cricoarytenoids

85
Q

What are the 4 strap muscles and what do they do?

A

Sternothyroid, sternohyoid, thyrohyoid and omohyoid

Depress hyoid bone and larynx during swallowing and speaking

86
Q

What innervates the strap muscles? What is the exception?

A

Ansa cervicalis

Except thyrohyoid - C1

87
Q

Where does the ansa cervicalis sit?

A

Superficial to internal jugular vein in carotid sheath

88
Q

Where do the parathyroids derive embryologically?

A

Superior from 4th branchial arch

Inferior from 3rd branchial arch

89
Q

Why is the position of the inferior thyroids variable?

A

Derive from 3rd branchial arch same as thymus

Sometimes drawn down into mediastinum with thymus

90
Q

Bloods supply to parathyroids?

A

Inferior thyroid artery - to all 4

91
Q

What are the carpal bones?

A

Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezius, capitate, hamate

92
Q

What are the boundaries of the carpal tunnel? Attachments?

A

Floor = carpal bones
Roof = flexor retinaculum
Proximal surface marking = distal skin crease of wrist
Attachments are tubercle of scaphoid and piriform proximally, and trapezium/hook of hamate distally

93
Q

What are the contents of the carpal tunnel?

A

Median nerve
Flexor digitorum superficialis and profundus tendons
Flexor pollicis longus tendon

94
Q

What runs through the canal of Guyon?

A

Ulnar artery

Ulnar nerve

95
Q

Which muscle runs within its own compartment from forearm to wrist? Where abouts?

A

Flexor carpi radialis - runs between superficial and deep flexor retinaculum

96
Q

What are the boundaries of the anatomical snuffbox?

A

Abductor pollicis longus and extensor polilcis brevis laterally
Extensor pollicis longus medially
Proximally = styloid process of radius
Base = bones - base of 1st metacarpal, trapezium, scaphoid
Roof = fascia and skin

97
Q

Contents of anatomical snuffbox?

A 
Radial artery and terminal branches
Cephalic vein (origin)
98
Q

Where does the cephalic vein originate from?

A

Anatomical snuffbox

99
Q

Nerve supply to intrinsic muscles of hand? How to test?

A

1/2 LOAF = median (lateral 2 lumbricals, opponens policis, abductor policis brevis, flexor policis brevis - test by thumb abduction
Rest are ulnar - test by abducting fingers (dorsal interossei)

100
Q

What is the first muscle to waste in ulnar nerve injury?

A

1st dorsal interosseus

101
Q

What do the interossei muscles do?

A

Palmar adduct fingers

Dorsal abduct fingers

102
Q

What do the lumbrical muscles do?

A

Aid in flexion of MCPJs with extension of IPJs

103
Q

What are the insertions and actions of flexor digitorum profundus/superficialis?

A

FDP - inserts onto distal phalanx and flexes DIPJ

FDS - inserts onto middle phalanx and flexes PIPJ

104
Q

What mechanisms prevent bow-stringing of the flexor tendons?

A

Pulleys consisting of fascial thickening - proximally the flexor retinaculum, distally 5 annular pulleys and 3 cruciate pulleys

105
Q

How many compartments of the extensor retinaculum are there?

A 
6:
EPB and APL
ECRL and ECRB
EPL
Extensor indicis proprius and extensor digitorum communis
EDM
ECU
106
Q

What layers make up the deep cervical fascia?

A 
4 layers from deep to superficial
Carotid sheath
Prevertebral fascia
Pretracheal fascia
Investing layer of deep cervical fascia
107
Q

What are the contents of the pretracheal fascia?

A

Thyroid gland
Trachea
Oesophagus

108
Q

At what level does the common carotid artery bifurcate? What is the surface marking?

A

C4 - superior thyroid notch

109
Q

What are the contents of the carotid sheath?

A

Common carotid artery
Vagus nerves
IJV
Lymph nodes

110
Q

What nerve chain runs in the wall of the carotid sheath?

A

Ansa cervicalis

111
Q

Branches of the external carotid artery

A 
Superior thyroid artery
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
112
Q

Muscles in the prevertebral fascia?

A

Scalenus anterior, medius, posterior
Levator scapulae
Splenius capitus

113
Q

Boundaries of the posterior triangle of the neck?

A 
Posterior edge SCM
Upper border clavicle (middle third)
Anterior border trapezius
Roof = investing layer deep cervical fascia
Floor = prevertebral fascia
114
Q

Contents of the posterior triangle of the neck?

A

Omohyoid muscle
Vessels - subclavian artery, transverse cervical, suprascapular, occipital arteries. Transverse cervical, suprascapular, EJV veins
Nerves - spinal root of accessory nerves, phrenic and roots + trunks of brachial plexus
Lymph nodes

115
Q

Surface marking of spinal branch of accessory nerve? Why is this important?

A

Important as at risk of injury during dissection of posterior neck
Surface marking is 1/3 way down SCM to 1/3 way up anterior border of trapezius

116
Q

What muscles does the spinal accessory nerve innervate? Testing?

A

Trapezius - shrug shoulders

SCM - rotating head to contralateral side

117
Q

Rotator cuff muscles, nerve supply and actions at shoulder?

A

Supraspinatus, infraspinatus, subscapularis and teres minor
Supraspinatus = supraspacular nerve, abduction
Infraspinatus = suprascapular nerve, external rotation
Teres minor = axillary nerve, external rotation
Subscapularis = upper and lower subscapular nerve, internal rotation

118
Q

What joins the coracoid process to the clavicle? What are its component parts?

A

Coracoclavicular ligament

Conoid ligament and trapezoid ligament

119
Q

Under which ligament does the supraspinatus muscle commonly get impinged?

A

Coracoacromial ligament

120
Q

What ligament is excised during subacromial decompression? What is this used to treat?

A

Coracoacromial ligament

Used to treat supraspinatus impingment

121
Q

What structure runs through the bicipital groove?

A

Long head of biceps brachii

122
Q

What is the fibrocartilage collar attached to the glenoid fossa called?

A

Glenoid labrum

123
Q

What type of joint is the sternoclaviclar joint?

A

Atypical synovial joint containing fibrocartilagenous disc

Structurally is saddle, functionally is ball and socket

124
Q

What are the proximal and distal boundaries of the axillary artery?

A 
Proximal = lateral border of first rib
Distally = inferior border of teres major
125
Q

What are the branches of the axillary artery? What are the divisions? Screw The Lawyer Save A Patient

A

1st part proximal to pec minor = superior thoracic artery
2nd part behind pec minor = thoracoacromial trunk and lateral thoracic trunk
3rd part distal to pec minor = subscapular artery, anterior and posterior circumflex

126
Q

Boundaries of the quadrangular space? What passes through it?

A

Medial = long head of triceps
Lateral = medial border of humerus
Superior = inferior border of teres minor
Inferior = superior border of teres major
Contains axillary nerve and posterior circumflex humeral artery and vein

127
Q

What passes through the triangular interval vs the triangular space in the shoulder?

A 
Interval = radial nerve and profunda brachii
Space = circumflex scapular artery and vein
128
Q

Where does the long head of triceps originate?

A

Infraglenoid tubercle of scapula

129
Q

Origin of medial and lateral heads of triceps?

A 
Lateral = posterior surface of humerus just superior to radial groove
Medial = posterior surface of humerus just inferior to radial groove
130
Q

Insertion of triceps?

A

Onto olecranon process of ulna

131
Q

Blood supply to triceps?

A

Branches of deep brachial artery

132
Q

Where does the long head of biceps originate?

A

Supraglenoid tubercle of scapula

133
Q

Where does the short head of biceps originate?

A

Coracoid process of scapula

134
Q

Where does the biceps muscle insert?

A

Radial tuberosity and biciptal aponeurosis

135
Q

Arterial supply to biceps?

A

Brachial artery

136
Q

What is main movement of biceps? Secondary one?

A

Supinator of forearm

Also flexes elbow

137
Q

What nerve is at risk during anterior dislocation of the shoulder? What movement will be restricted?

A

Axillary

Abduction restricted

138
Q

Where does the axillary nerve arise from?

A

Posterior cord of brachial plexus - C5-6

139
Q

What muscles does axillary nerve innervate?

A

Teres minor

Deltoid

140
Q

What nerve supples the rhomboid muscles and where does it come from?

A

Dorsal scapular nerve - from C5 root of brachial plexus

141
Q

What does serratus anterior do on the scapula?

A

Laterally rotates and protracts the scapula

142
Q

Nerve to serratus anterior and nerve root?

A

Long thoracic nerve of bell - C5, 6, 7

143
Q

What muscles attach to the greater tuberosity of humerus?

A

Supraspinatus, infarspinatus and teres minor

144
Q

Where does subscapularis attach?

A

Lesser tuberosity of humerus

145
Q

Where on the humerus is the spiral groove?

A

Posterolateral

146
Q

What runs in the spiral groove of the humerus? What would injury here cause?

A

Radial nerve

Injury would cause wrist drop and loss of sensation of 1st dorsal webspace

147
Q

What is the only thenar muscle affected in an ulnar injury?

A

Adductor pollicis

148
Q

What lies in the bicipital (intertubercular) groove of the humerus?

A

Long head of biceps

149
Q

What is the only structure that passes through the shoulder joint?

A

Long head of biceps

150
Q

What is lady between 2 majors of attachments of muscles on humerus?

A

Pec major laterally
Teres major medially
Latissimus dorsi superiorly and between

151
Q

What nerve can be damaged in fractures of the surgical neck of the humerus?

A

Axillary nerve as it wraps around

152
Q

2 pathologies that may physically damage axillary nerve?

A

Anterior dislocation of shoulder joint

Fracture of surgical neck of humerus

153
Q

What would the limitation on shoulder abduction be in axillary nerve damage?

A

Restricted beyond 30 degrees

154
Q

Describe the muscles involved in full abduction of the shoulder?

A

First 15-20 degrees is supraspinatus
Up to 90 degrees is deltoid
Beyond 90 is rotation of scapula

155
Q

What is the difference between the surgical and anatomical neck of humerus? Which is more commonly fractured?

A

Anatomical - fusion of growth plate (epiphyseal plate) at proximal junction of articular surface
Surgical - distal to anatomical neck
Surgical significantly more likely to fracture

156
Q

What 3 muscles are innervated by the musculocutaneous nerve? Where do these originate?

A

Biceps brachii - long head supraglenoid tubercle, short head coracoid process
Brachialis - humerus, lower half of anterior surface
Coracobrachialis - coracoid process

157
Q

What is the sensory supply of musculocutaneous nerve?

A

As lateral cutaneous nerve of forearm - volar surface of radial half of forearm

158
Q

What 3 muscles are attached to the coracoid process?

A

Short head of bicepps
Corachobrachialis
Pectoralis minor

159
Q

Where does the biceps tendon insert?

A

Radial tuberosity

Bicipital aponeurosis to antebrachial fascia

160
Q

Wrist extension is what myotome?

A

C6

161
Q

C5/6 paralysis would cause what?

A

Erb’s palsy - waiters tip - shoulder adducted and medially rotated, wrist flexed, forearm extended
Numbness on radial edge of arm

162
Q

What is Klumpke’s paralysis and what would it cause?

A

C7/8/T1 paralysis - causes flexed elbow, claw hand, paralysis of intrisic muscles, sensory loss

163
Q

What is the classical cause of Klumpke paralysis and what syndrome may it be associated with?

A

Forced traction on abducted arm

Can cause Horner’s syndrome

MRCS Part B (25 decks)

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