Anatomy PTMRCS 2 Flashcards
1
Q
What arteries supply the transverse colon?
A
Middle colic artery to 2/3
Left colic artery distally
2
Q
What is the major anastomotic artery between the SMA and IMA?
A
Marginal artery of Drummond - in mesentery
3
Q
What arteries are most commonly implicated in diverticular bleeds?
A
Sigmoid branches of IMA
4
Q
Where does the inferior mesenteric vein drain?
A
Splenic vein
5
Q
What forms the portal vein?
A
SMV and splenic vein
6
Q
What positions can the appendix lie in?
A
Retrocaecal
Pelvic
Subcaecal
Anterior or posterior to terminal ileum
7
Q
Blood supply to rectum?
A
Superior rectal artery from IMA
Middle rectal artery from internal iliac
Inferior rectal artery from internal pudendal
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
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
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
11
Q
What are the bones of the orbit?
A
Frontal bone Lacrimal bone Ethmoidal bone Zygoma Maxillary bone Sphenoid Palatine
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)
13
Q
Structures passing through inferior orbital fissure?
A
Inferior ophthalmic vein
Maxillary nerve infraorbital and zygomatic branches
Branches of pterygopalatine ganglion
14
Q
Structures passing through the optic canal?
A
Optic nerve
Ophthalmic artery and associated sympathetic fibres
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
16
Q
7 extrinsic muscles of the eyeball?
A
Superior and inferior, medial and lateral rectus
Inferior oblique and superior oblique
Levator palpebrae superioris
17
Q
Innervation of superior and inferior oblique muscles?
A
Sup oblique = trochlear
Inf oblique = oculomotor
18
Q
Nerve supply to levator palpebrae superioris?
A
Dual innervation from CN3 and sympathetic ganglion
19
Q
What are the features of Horner’s syndrome?
A
Miosis
Ipsilateral anhidrosis
Ptosis
Enophthalmos
20
Q
Where do the ophthalmic veins drain?
A
Cavernous sinus
21
Q
4 clinical features of orbital blowout fractures?
A
Enophthalmos
Diplopia
Infraorbital numbness due to infraorbital nerve compression
Orbital emphysema
22
Q
3 signs of inferior orbital blowout fracture on XR?
A
Orbital emphysema
Tear drop sign - fat into sinus
Blood in sinus
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
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
25
What is the Artery of Adamkiewicz and where does it arise?
Largest segemental radicular artery, arises from left T8-L1 area
26
Fascial layers of neck for an ACDF? What do they contain?
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
27
Within which fascial layer does post-op haematoma occur in ACDF, thyroidectomy etc.?
Pretracheal
28
What are the surface markings for the liver anteriorly?
Superior - 5th ICS right, 4th ICS left
Lateral - 5th ICS right, 8-10th rib
Oblique - line between the 2
29
Which lobe do the quadrate and caudate arise from?
Right
30
What is the surface marking for the gallbladder?
Angle between 9th costal cartilage and lateral border of rectus
31
What are the 3 functions of the gallbladder?
Storage of bile
Concentrating bile
Addition of mucus to bile
32
How much bile does the gallbladder hold?
50ml
33
Blood supply to the gallbladder?
Cystic artery, from right hepatic artery from hepatic artery proper
Also collaterals from liver bed
34
What are the branches of the biliary tree?
```
Intralobular ducts
Intrahepatic ducts
Right and left hepatic ducts
Common hepatic duct
Cystic duct
CBD
```
35
What is Calot's triangle? What is it's clinical significance?
Cystic duct
Inferior border of liver
Common hepatic duct
Contains cystic artery and LNs, important to isolate and ligate cystic artery during lap chole
36
What is Courvoisier's Law? Why is it true?
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
37
What are Kehr's and Boas' sign?
Kehrs - shoulder tip pain in acute cholecystitis
| Boas - area of hyperaesthesia just below right scapula in acute cholecystitis
38
3 signs associated with acute cholecystitis?
Murphys
Kehrs
Boas
39
Surface anatomy of breast?
2nd to 6th rib
| Sternum to mid axillary line
40
Deep muscular relations of the breast?
```
Pectoralis major (2/3)
Serratus anterior (1/3)
```
41
3 major constituents of breast tissue?
Fat
Glandular tissue
Fibrous tissue
42
How many lobules are there within the breast?
15-20, each drained by a lactiferous duct
43
What are Cooper's ligaments? Clinical signifiance?
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
44
Arterial blood supply to breast?
Internal thoracic/mammary artery - from SCA
Lateral thoracic - from axillary 2
Thoraco-acromial - from axillary 2
Intercostal arteries
45
Lymph drainage of breast?
Axillary lymph nodes - 3 levels with respect to pectoralis minor
Parasternal LNs - along internal thoracics
Posterior intercostal LNs
46
Sensory nerve supply to breast?
Anterior and lateral cutaneous branches of 4th-6th intercostal nerves
47
What level do the renal veins join the IVC?
L1
48
What crosses the ureter anteriorly on each side of the abdomen?
Gonadal vessels
On right - right colic and ileocolic vessels
On left-- left colic vessels
49
What is the blood supply to the ureter?
```
Upper = renal artery branches
Middle = from common iliac and gonadal arteries
Lower = common iliac and internal iliac - uterine and superior vesicular arteries
```
50
Anterior relations of right kidney?
```
Right lobe of liver
Gallbladder
Adrenal
D2
Hepatic flexure
Small intestine
```
51
Where does the IVC originate and from what?
L5 - from common iliac veins
52
What lies anterior to the IVC at its origin?
Right common iliac artery
53
Anatomical relationship of IVC to aorta?
Proximally - to right and anterior
| Distally - to right and posterior
54
What are the retroperitoneal structures?
```
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
Name the parts of the stomach?
```
Cardia
Fundus
Body
Pylorus
Antrum
Also greater + lesser curvatures with incisura on lesser
```
56
Which part of the duodenum does the CBD enter?
D2 - posteromedial wall
57
Differences between jejunum and ileum?
Jej is slightly wider diameter, thicker walls, longer vasa recta with fewer arcades, also thinner mesentery
58
Large vs small bowel on radiograph?
Large has haustra, wider, more peipheral
| Small has valvulae conniventes, thinner, more central
59
What are the parts of the pancreas?
```
Head
Neck
Body
Uncinate process
Tail
```
60
Blood supply to pancreas?
Pancreatic branches of splenic artery
| Superior (coeliac, via gastroduodenal) and inferior (SMA) pancreaticoduodenal arteries to head
61
What are the 3 main divisions of the coeliac axis?
Splenic artery
Common hepatic
Left gastric
62
Blood supply to lesser curve of stomach?
Left and right gastric arteries
63
Blood supply to greater curve of stomach?
Right (from gastroduodenal) and left (from splenic) gastroepiploic arteries
64
What arteries can be eroded into by ulcers in the duodenum?
Posterior bit of D1/2 = gastroduodenal
| D3/4 = pancreaticoduodenal
65
How may Meckel's diverticulum present?
```
Acute inflammation - appendicitis mimic
GI bleed
Perforation
Hernia - Littre's hernia
Intussusception
Obstruction
```
66
Layers of adrenal gland?
Cortex - GFR (glomerulosa - aldosterone, fasciculata - glucocortiocids, reticularis - androgens)
Medulla - catecholamines
67
Which way does the patella usually dislocate? Why?
Laterally - as knee normally held in valgus
68
Which muscles attach onto the linea aspera?
Adductors (magnus, longus, brevis)
Pectineus
Short head of biceps femoris
Vastus medialis and lateralis
69
Innervation and function of tibialis anterior?
Deep peroneal nerve
| Dorsiflexion and inversion
70
Muscles in anterior compartment of leg?
Tibialis anterior
EHL
EDL
Peroneus tertius
71
Muscles in lateral compartment of leg?
Peroneus longus and brevis
72
Muscles in deep posterior compartment of leg?
Popliteus
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
73
Muscles in superficial posterior compartment of leg?
Plantaris
Gastrocnemius
Soleus
74
What separates the anterior and posterior compartments of leg?
Interosseus membrane
75
What separates the anterior and lateral compartments of leg?
Anterior fascial septum
76
What separates the lateral and posterior compartments of leg?
Posterior fascial septum
77
What separates the deep and superficial posterior compartments of leg?
Deep transverse fascial septum
78
How would you perform a lower limb fasciotomy?
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
3 muscles attaching to medial cuneiform bone? Think ankle inversion
Peroneus longus
| Tibialis anterior and posterior
80
Describe arterial supply to lower leg? On angiogram where are they?
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
What nerve does the small saphenous vein run with up the leg and what does it drain into?
Sural nerve in posterior compartment
| Drains into popliteal vein
82
Where does the vas deferens run and what is its function?
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
At what angle do the ureters enter the bladder?
Posterior aspect of bladder through trigone, at an oblique angle
84
What stops reflux of urine into the ureters from the bladder?
Ureters pass through detrusor in bladder wall
| So when detrusor contracts it brings wall down and closes ureters
85
What vessel is near a common site for kidney stone impaction?
Common iliac - at pelvic brim
86
What is the most common type of bladder cancer worldwide and in the UK? Why difference?
```
UK = TCC = related to smoking, dyes etc
Worldwide = SCC = schistosoma haematobium causing squamous metaplasia
```
87
Initial investigation of visible painless haematuria?
CT urogram and flexible cystoscopy
88
Initial investigation of invisible painless haematuria (microscopic)?
US renal tract and flexible cystoscopy
89
If findings on flexible cystoscopy are suspicious for cancer what is undertaken next?
Rigid cystoscopy and biopsy under GA
| Or TURBT
90
Blood supply to bladder?
From internal iliac
| Superior, middle and inferior iliacs
91
Nerve supply to bladder?
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
Voluntary control of urination?
Pudendal nerve - S234 - external sphincter
93
What are the 5 parts of the brachial plexus and where are they?
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
Long thoracic nerve of bell innervates? Roots? What does it do?
Serratus anterior - C5-7 - lifts and rotates scapula
95
Nerve root medial cutaneous nerve of forearm?
C8
96
Nerve root medial cutaneous nerve of arm?
T1
97
Which cord of brachial plexus gives rise to the thoracordorsal nerve? Muscle supply?
Posterior cord - C6-8
| Latissimus dorsi
98
Innervation of pectoralis major? Where do they come from?
Medial (C5/6) and lateral (C7/8/T1) pectoral nerves, from medial and lateral cords respectively
99
Innervation of pectoralis minor?
Medial pectoral nerve
100
What is a Kulmpke's palsy? How does it look?
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
What is Erb's palsy? How does it look?
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
Boundaries of the quadrangular space?
```
Superiorly = teres minor
Inferiorly = teres major
Laterally = humerus
Medially = long head of triceps
```
103
Boundaries of triangular space?
```
Superiorly = teres minor
Inferiorly = teres major
Laterally = long head of triceps
```
104
What goes through the quadrangular space?
Axillary nerve
| Posterior circumflex humeral artery
105
Branches of the axillary artery?
3 parts and 6 branches - STLSAP
Superior thoracic
Thoracoacromial and Lateral thoracic
Subscapular, Anterior and Posterior circumflex humerals
106
Mid shaft humeral fracture will damage which nerve?
Radial - as it goes through spiral groove of humerus
107
What would damage to the radial nerve at mid shaft humerus cause?
Wrist drop and sensation loss in first webspace
| Elbow extension preserved
108
Which 2 forearm muscles are supplied by the ulnar nerve?
Flexor carpi ulnaris and ulnar half of FDP
109
What does damage to ulnar nerve at the wrist cause? Why?
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
Where does the flexor retinaculum attach?
Carpal bones - proximally to pisiform and tubercle of scaphoid, distally to hook of hamate and trapezium
111
Contents of the carpal tunnel?
Median nerve
4x FDP tendons
4xFDS tendons
FPL tendon
112
What happens to sensation of thenar eminence in carpal tunnel?
Preserved, because palmar cutaneous branch of median nerve is given off before it enters and passes superficial to flexor retinaculum
113
What nerve innervates levator scapula and the rhomboids?
Dorsal scapular
114
What does the suprascapular nerve innervate?
Supraspinatus and infraspinatus
115
What is subscapularis innervated by?
Upper and lower subscapular nerves
