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MRCS Part B > Anatomy PTMRCS 2 > Flashcards

Anatomy PTMRCS 2 Flashcards

1
Q

What arteries supply the transverse colon?

A

Middle colic artery to 2/3

Left colic artery distally

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2
Q

What is the major anastomotic artery between the SMA and IMA?

A

Marginal artery of Drummond - in mesentery

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3
Q

What arteries are most commonly implicated in diverticular bleeds?

A

Sigmoid branches of IMA

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4
Q

Where does the inferior mesenteric vein drain?

A

Splenic vein

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5
Q

What forms the portal vein?

A

SMV and splenic vein

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6
Q

What positions can the appendix lie in?

A

Retrocaecal
Pelvic
Subcaecal
Anterior or posterior to terminal ileum

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7
Q

Blood supply to rectum?

A

Superior rectal artery from IMA
Middle rectal artery from internal iliac
Inferior rectal artery from internal pudendal

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8
Q

Describe nerve supply to rectum?

A

PNS = S2 3 4, causes bowel contraction and relaxation of internal sphincter
Symp from superior hypogastric plexus and lumbar splanchnic nerves = painful stimuli, contract internal sphincter

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9
Q

Is rectum retroperitoneal?

A

Yes - upper 1/3 has peritoneum over front and sides, middle 1/3 just over front and bottom 1/3 below peritoneal reflection

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10
Q

What are the 5 branches of the SMA?

A 
Inferior pancreaticoduodenal artery
Jejunal and ileal arteries
Ileocolic artery
Right colic artery
Middle colic artery
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11
Q

What are the bones of the orbit?

A 
Frontal bone
Lacrimal bone
Ethmoidal bone
Zygoma
Maxillary bone
Sphenoid
Palatine
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12
Q

Structures passing through superior orbital fissure?

A

CN 3, 4, 6
Superior ophthalmic vein
Ophthalmic nerve - lacrimal, frontal and nasociliary branches (branch of CN5)

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13
Q

Structures passing through inferior orbital fissure?

A

Inferior ophthalmic vein
Maxillary nerve infraorbital and zygomatic branches
Branches of pterygopalatine ganglion

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14
Q

Structures passing through the optic canal?

A

Optic nerve

Ophthalmic artery and associated sympathetic fibres

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15
Q

Nerve supply to lacrimal gland?

A

PNS - pterygopalatine ganglion
SNS - superior cervical plexus and deep petrosal nerve
Sensation - lacrimal branch of ophthalmic nerve

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16
Q

7 extrinsic muscles of the eyeball?

A

Superior and inferior, medial and lateral rectus
Inferior oblique and superior oblique
Levator palpebrae superioris

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17
Q

Innervation of superior and inferior oblique muscles?

A

Sup oblique = trochlear

Inf oblique = oculomotor

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18
Q

Nerve supply to levator palpebrae superioris?

A

Dual innervation from CN3 and sympathetic ganglion

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19
Q

What are the features of Horner’s syndrome?

A

Miosis
Ipsilateral anhidrosis
Ptosis
Enophthalmos

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20
Q

Where do the ophthalmic veins drain?

A

Cavernous sinus

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21
Q

4 clinical features of orbital blowout fractures?

A

Enophthalmos
Diplopia
Infraorbital numbness due to infraorbital nerve compression
Orbital emphysema

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22
Q

3 signs of inferior orbital blowout fracture on XR?

A

Orbital emphysema
Tear drop sign - fat into sinus
Blood in sinus

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23
Q

Layers go through in lumbar puncture?

A 
Skin
Subcutaenous tissue
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space w venous plexus
Dura
Subdural space
Arachnoid
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24
Q

Blood supply to spinal cord?

A

1 anterior and 2 posterior spinal arteries
Anterior from vertebrals
Posteriors from PICAs
Segmental supply from radicular arteries at each level - Artery of Adamkiewicz is largest

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25
Q

What is the Artery of Adamkiewicz and where does it arise?

A

Largest segemental radicular artery, arises from left T8-L1 area

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26
Q

Fascial layers of neck for an ACDF? What do they contain?

A

Superficial fascia - platysma, fat
Investing deep fascia - trapezius and SCM
Carotid sheaths - common carotid, IJV, vagus
Pretracheal fascia - thyroid gland, trachea, oesophagus, strap/infrahyoid muscles
Prevertebral fascia - vertebral column and associated muscles

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27
Q

Within which fascial layer does post-op haematoma occur in ACDF, thyroidectomy etc.?

A

Pretracheal

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28
Q

What are the surface markings for the liver anteriorly?

A

Superior - 5th ICS right, 4th ICS left
Lateral - 5th ICS right, 8-10th rib
Oblique - line between the 2

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29
Q

Which lobe do the quadrate and caudate arise from?

A

Right

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30
Q

What is the surface marking for the gallbladder?

A

Angle between 9th costal cartilage and lateral border of rectus

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31
Q

What are the 3 functions of the gallbladder?

A

Storage of bile
Concentrating bile
Addition of mucus to bile

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32
Q

How much bile does the gallbladder hold?

A

50ml

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33
Q

Blood supply to the gallbladder?

A

Cystic artery, from right hepatic artery from hepatic artery proper
Also collaterals from liver bed

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34
Q

What are the branches of the biliary tree?

A 
Intralobular ducts
Intrahepatic ducts
Right and left hepatic ducts
Common hepatic duct
Cystic duct
CBD
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35
Q

What is Calot’s triangle? What is it’s clinical significance?

A

Cystic duct
Inferior border of liver
Common hepatic duct
Contains cystic artery and LNs, important to isolate and ligate cystic artery during lap chole

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36
Q

What is Courvoisier’s Law? Why is it true?

A

Palpable gallbladder and painless obstructive jaundice unlikely to be gallstones - ?Cancer
Because chronic gallstones cause fibrosed, contracted gallbladder rather than enlargement, or CBD stone causes pain

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37
Q

What are Kehr’s and Boas’ sign?

A

Kehrs - shoulder tip pain in acute cholecystitis

Boas - area of hyperaesthesia just below right scapula in acute cholecystitis

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38
Q

3 signs associated with acute cholecystitis?

A

Murphys
Kehrs
Boas

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39
Q

Surface anatomy of breast?

A

2nd to 6th rib

Sternum to mid axillary line

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40
Q

Deep muscular relations of the breast?

A 
Pectoralis major (2/3)
Serratus anterior (1/3)
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41
Q

3 major constituents of breast tissue?

A

Fat
Glandular tissue
Fibrous tissue

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42
Q

How many lobules are there within the breast?

A

15-20, each drained by a lactiferous duct

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43
Q

What are Cooper’s ligaments? Clinical signifiance?

A

Suspensory ligaments of breast
Fibrous tissue from pectoral fascia to subcutaneous tissue separating lobules of the breast
Malignant infiltration causes puckering/induration - p’eau d’orange

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44
Q

Arterial blood supply to breast?

A

Internal thoracic/mammary artery - from SCA
Lateral thoracic - from axillary 2
Thoraco-acromial - from axillary 2
Intercostal arteries

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45
Q

Lymph drainage of breast?

A

Axillary lymph nodes - 3 levels with respect to pectoralis minor
Parasternal LNs - along internal thoracics
Posterior intercostal LNs

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46
Q

Sensory nerve supply to breast?

A

Anterior and lateral cutaneous branches of 4th-6th intercostal nerves

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47
Q

What level do the renal veins join the IVC?

A

L1

48
Q

What crosses the ureter anteriorly on each side of the abdomen?

A

Gonadal vessels
On right - right colic and ileocolic vessels
On left– left colic vessels

49
Q

What is the blood supply to the ureter?

A 
Upper = renal artery branches
Middle = from common iliac and gonadal arteries
Lower = common iliac and internal iliac - uterine and superior vesicular arteries
50
Q

Anterior relations of right kidney?

A 
Right lobe of liver
Gallbladder
Adrenal
D2
Hepatic flexure
Small intestine
51
Q

Where does the IVC originate and from what?

A

L5 - from common iliac veins

52
Q

What lies anterior to the IVC at its origin?

A

Right common iliac artery

53
Q

Anatomical relationship of IVC to aorta?

A

Proximally - to right and anterior

Distally - to right and posterior

54
Q

What are the retroperitoneal structures?

A 
IVC
Aorta and para-aortic nodes
Kidneys and adrenals
Duodenum except 1st part
Ureters
Splenic and hepatic flexures
Ascending and descending colon
Rectum, bladder, vagina
Pancreas
55
Q

Name the parts of the stomach?

A 
Cardia
Fundus
Body
Pylorus
Antrum
Also greater + lesser curvatures with incisura on lesser
56
Q

Which part of the duodenum does the CBD enter?

A

D2 - posteromedial wall

57
Q

Differences between jejunum and ileum?

A

Jej is slightly wider diameter, thicker walls, longer vasa recta with fewer arcades, also thinner mesentery

58
Q

Large vs small bowel on radiograph?

A

Large has haustra, wider, more peipheral

Small has valvulae conniventes, thinner, more central

59
Q

What are the parts of the pancreas?

A 
Head
Neck
Body
Uncinate process
Tail
60
Q

Blood supply to pancreas?

A

Pancreatic branches of splenic artery

Superior (coeliac, via gastroduodenal) and inferior (SMA) pancreaticoduodenal arteries to head

61
Q

What are the 3 main divisions of the coeliac axis?

A

Splenic artery
Common hepatic
Left gastric

62
Q

Blood supply to lesser curve of stomach?

A

Left and right gastric arteries

63
Q

Blood supply to greater curve of stomach?

A

Right (from gastroduodenal) and left (from splenic) gastroepiploic arteries

64
Q

What arteries can be eroded into by ulcers in the duodenum?

A

Posterior bit of D1/2 = gastroduodenal

D3/4 = pancreaticoduodenal

65
Q

How may Meckel’s diverticulum present?

A 
Acute inflammation - appendicitis mimic
GI bleed
Perforation
Hernia - Littre's hernia
Intussusception
Obstruction
66
Q

Layers of adrenal gland?

A

Cortex - GFR (glomerulosa - aldosterone, fasciculata - glucocortiocids, reticularis - androgens)
Medulla - catecholamines

67
Q

Which way does the patella usually dislocate? Why?

A

Laterally - as knee normally held in valgus

68
Q

Which muscles attach onto the linea aspera?

A

Adductors (magnus, longus, brevis)
Pectineus
Short head of biceps femoris
Vastus medialis and lateralis

69
Q

Innervation and function of tibialis anterior?

A

Deep peroneal nerve

Dorsiflexion and inversion

70
Q

Muscles in anterior compartment of leg?

A

Tibialis anterior
EHL
EDL
Peroneus tertius

71
Q

Muscles in lateral compartment of leg?

A

Peroneus longus and brevis

72
Q

Muscles in deep posterior compartment of leg?

A

Popliteus
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus

73
Q

Muscles in superficial posterior compartment of leg?

A

Plantaris
Gastrocnemius
Soleus

74
Q

What separates the anterior and posterior compartments of leg?

A

Interosseus membrane

75
Q

What separates the anterior and lateral compartments of leg?

A

Anterior fascial septum

76
Q

What separates the lateral and posterior compartments of leg?

A

Posterior fascial septum

77
Q

What separates the deep and superficial posterior compartments of leg?

A

Deep transverse fascial septum

78
Q

How would you perform a lower limb fasciotomy?

A

4 compartment decompression
2cm anterior to fibula anteriolateral incision to decompress ant/lat compartments, from tibial tuberosity to ankle
Posteromedial incision from tuberosity to 5cm above medial malleolus
Divide underlying fascia and debride any necrotic tissue

79
Q

3 muscles attaching to medial cuneiform bone? Think ankle inversion

A

Peroneus longus

Tibialis anterior and posterior

80
Q

Describe arterial supply to lower leg? On angiogram where are they?

A

Popliteal artery divides into anterior tibial artery and tibioperoneal trunk just under arch of soleus below knee
Anterior tibial is most lateral
Tibioperoneal trunk divides into peroneal and posterior tibial
Peroneal is middle of the 3 arteries on angio and supplies lateral compartment
Posterior tibial is most medial and supplies posterior compartments

81
Q

What nerve does the small saphenous vein run with up the leg and what does it drain into?

A

Sural nerve in posterior compartment

Drains into popliteal vein

82
Q

Where does the vas deferens run and what is its function?

A

Runs from epididymis in scrotum, up through inguinal canal, down into ejaculatory ducts
Carries sperm which are released under sympathetic stimulation via peristalsis of tube into urethra, mixed with seminiferous fluid and secretions

83
Q

At what angle do the ureters enter the bladder?

A

Posterior aspect of bladder through trigone, at an oblique angle

84
Q

What stops reflux of urine into the ureters from the bladder?

A

Ureters pass through detrusor in bladder wall

So when detrusor contracts it brings wall down and closes ureters

85
Q

What vessel is near a common site for kidney stone impaction?

A

Common iliac - at pelvic brim

86
Q

What is the most common type of bladder cancer worldwide and in the UK? Why difference?

A 
UK = TCC = related to smoking, dyes etc
Worldwide = SCC = schistosoma haematobium causing squamous metaplasia
87
Q

Initial investigation of visible painless haematuria?

A

CT urogram and flexible cystoscopy

88
Q

Initial investigation of invisible painless haematuria (microscopic)?

A

US renal tract and flexible cystoscopy

89
Q

If findings on flexible cystoscopy are suspicious for cancer what is undertaken next?

A

Rigid cystoscopy and biopsy under GA

Or TURBT

90
Q

Blood supply to bladder?

A

From internal iliac

Superior, middle and inferior iliacs

91
Q

Nerve supply to bladder?

A

Efferent parasymp from S2-4 (pelvic splanchnic, inferior hypogastric plexus) to bladder wall and inhibitory fibres to internal sphincter - pee
Efferent symp from hypogastric plexus inhibits detrusor and stimulates internal sphincter - no pee

92
Q

Voluntary control of urination?

A

Pudendal nerve - S234 - external sphincter

93
Q

What are the 5 parts of the brachial plexus and where are they?

A

Roots - from intervertebral foraminae in neck between anterior and medial scalene muscles
Trunks - base of posterior triangle of neck, over first rib behind 3rd part of subclavian artery
Divisions - posterior to middle 1/3 of clavicle
Cords - related to 2nd part axillary artery in axilla
Branches - related to 3rd part of axillary artery in axilla

94
Q

Long thoracic nerve of bell innervates? Roots? What does it do?

A

Serratus anterior - C5-7 - lifts and rotates scapula

95
Q

Nerve root medial cutaneous nerve of forearm?

A

C8

96
Q

Nerve root medial cutaneous nerve of arm?

A

T1

97
Q

Which cord of brachial plexus gives rise to the thoracordorsal nerve? Muscle supply?

A

Posterior cord - C6-8

Latissimus dorsi

98
Q

Innervation of pectoralis major? Where do they come from?

A

Medial (C5/6) and lateral (C7/8/T1) pectoral nerves, from medial and lateral cords respectively

99
Q

Innervation of pectoralis minor?

A

Medial pectoral nerve

100
Q

What is a Kulmpke’s palsy? How does it look?

A

Paralysis of lower trunk (C8/T1) of brachial plexus often related to birth trauma e.g. shoulder dystocia
Claw hand due to loss of intrinsic muscles of hand - flexed IP joints, hyperextended MCP joints
May also cause Horner’s

101
Q

What is Erb’s palsy? How does it look?

A

Paralysis of upper trunk (C5/6) of plexus often related to acquired trauma e.g. motorcycle RTAs
Weak shoulder abductors, elbow flexors so arm is adducted and internally rotated with extended and pronated forearm

102
Q

Boundaries of the quadrangular space?

A 
Superiorly = teres minor
Inferiorly = teres major
Laterally = humerus
Medially = long head of triceps
103
Q

Boundaries of triangular space?

A 
Superiorly = teres minor
Inferiorly = teres major
Laterally = long head of triceps
104
Q

What goes through the quadrangular space?

A

Axillary nerve

Posterior circumflex humeral artery

105
Q

Branches of the axillary artery?

A

3 parts and 6 branches - STLSAP
Superior thoracic
Thoracoacromial and Lateral thoracic
Subscapular, Anterior and Posterior circumflex humerals

106
Q

Mid shaft humeral fracture will damage which nerve?

A

Radial - as it goes through spiral groove of humerus

107
Q

What would damage to the radial nerve at mid shaft humerus cause?

A

Wrist drop and sensation loss in first webspace

Elbow extension preserved

108
Q

Which 2 forearm muscles are supplied by the ulnar nerve?

A

Flexor carpi ulnaris and ulnar half of FDP

109
Q

What does damage to ulnar nerve at the wrist cause? Why?

A

Sensory loss of medial 1 1/2 fingers
Motor weakness of intrinsic hand muscles leading to clawing of 4th and 5th digits
Worse clawing than if proximal, as FDP is spared

110
Q

Where does the flexor retinaculum attach?

A

Carpal bones - proximally to pisiform and tubercle of scaphoid, distally to hook of hamate and trapezium

111
Q

Contents of the carpal tunnel?

A

Median nerve
4x FDP tendons
4xFDS tendons
FPL tendon

112
Q

What happens to sensation of thenar eminence in carpal tunnel?

A

Preserved, because palmar cutaneous branch of median nerve is given off before it enters and passes superficial to flexor retinaculum

113
Q

What nerve innervates levator scapula and the rhomboids?

A

Dorsal scapular

114
Q

What does the suprascapular nerve innervate?

A

Supraspinatus and infraspinatus

115
Q

What is subscapularis innervated by?

A

Upper and lower subscapular nerves

MRCS Part B (25 decks)

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