Anatomy Q's from the booklet Flashcards
1
Q
How do we count inter-costal spaces in the living?
A
Feel for the ridge between the manubrium and body of the sternum. feel laterally and you will feel a costal cartilage, this is the second cartilage. Count the ribs up and down from here.
2
Q
What happens if the valves are incompetent?
A
During ventricular systole blood some of the blood flow backwards through the valve into the atria. This will make a noise heard as a heart murmer and can over load the atria.
3
Q
What is the purpose of having cartilage in the trachea and bronchi?
A
In the trachea above the first rib – it stops the airway collapsing on inspiration.
In the airways below the first rib (in the chest), it stops the airways collapsing on forced expiration.
4
Q
Do the trachea and bronchi have muscle in them?
A
Yes, to alter the calibre of the airways.
5
Q
Where would you listen to the upper lobe of a lung?
A
Anteriorly high up on the chest wall.
6
Q
Where would you listen to the right middle lobe?
A
5th intercostal space just to the right of the sternum.
7
Q
Name three of the abdominal organs that the lung overlaps
A
Liver, spleen, upper poles of the kidneys (just), adrenal glands, stomach
8
Q
How do you distinguish between the vessels at the hilum of the lung?
A
Bronchus has cartilage in the wall. The pulmonary artery is thicker walled and usually superior. The pulmonary veins are thinner walled and tend to be posterior.
9
Q
How many pairs of ribs are there?
A
12
10
Q
What are the contents of the intercostal space?
A
Intercostal artery, vein and nerve.
11
Q
What connects the ribs to each other?
A
The intercostals muscles.
12
Q
What bones do the ribs articulate with?
A
The sternum at the front and the thoracic vertebrae at the back
13
Q
Do bronchioles have cartilage in their walls?
A
NO
14
Q
What happens to the vertical diameter of the thoracic cavity when the diaphragm contracts?
A
It increases because the diaphragm is pulled downwards.
15
Q
What happens to the transverse diameter of the thoracic cavity when the intercostals muscles contract?
A
It increases by lifting the lower ribs upwards towards the first rib which is fixed.
16
Q
Look at this lovely diagram and learn it
A
17
Q
Which morphology has the greatest power?
A
Multipennate muscles
18
Q
Which morphology can pull the furthest distance?
A
Strap muscles
19
Q
Where does the pectoralis major muscle insert?
A
The humerus
20
Q
Describe the terms origin and insertion in muscle?
A
Origin is where the muscle starts, usually it does not move when the muscle contracts (eg. the ribs for pectoralis major). Insertion is where the muscle ends, it usually does move when the muscle contracts (eg. humerus for pectoralis major).
21
Q
Where does the lymphatics of the breat drain into?
A
Lateral half to the axillary lymph nodes, medial half to internal mammary lymph nodes (in the chest).
22
Q
What are accessory muscles of respiration?
A
Muscles which are not usually used in respiration (breathing) but which can be used during respiratory distress, such as asthma.
23
Q
What is the ligamentum arteriosum?
A
It is the reminant of the embryological shunt between the pulmonary artery and the aorta.
24
Q
Does the vagus nerve enter the abdomen?
A
Yes, passing through the oesophageal hiatus in the diaphragm.
25
What are the surface markings of the heart (right border and the apex)?
a) right border of the heart – right sternal edge
b) the apex of the heart 5th intercostals space mid-clavicular line.
26
Where is the SAN?
A ‘large’ crescent shaped area on the crista terminalis at the superior border of the right atrium (the crista terminalis is where the smooth and trabeculated parts of the right venous chamber meet.
27
Where is the AV node?
Small nodule just above the septal cusp of the trisuspid valve in the inter-atrial septum.
28
What is the thoracic duct? Where does it join the CVS?
The channel draining all the lymph from the Gastrointestinal tract back to the blood stream. The left subclavian vein.
29
Which is the lowermost palpable costal cartilage?
T10
30
Where is the subcostal plane?
Horizontally from the lower border of the tenth costal cartilage.
31
What is the transpyloric plane?
A horizontal plane through L1 vertebra. On the anterior abdominal wall it passes through the ninth costal cartilage which is also where the lateral border of the rectus sheath crosses the costal margin.
32
What lies in the transpyloric plane?
Gall bladder, hilum of the right kidney, second part of the duodenum, head of the pancreas, pylorus, body of the pancreas, hilum of the spleen.
33
What are the dermatomes of the anterior abdominal wall?
T6-T12, T10 round the unbilicus
34
What is the surgical importance of the tendinous intersections?
They allow the rectus muscle to be divided (to allow operations on the abdominal contents) with out the muscle completely retracting to its each end of the rectus sheath.
35
What are the contents of the rectus sheath?
Rectus muscle, inferior epigastric artery and vein, superior epigastric artery and vein, sympathetics nerves (with the arteries), lymphatics (follow the arteries backwards), terminal branches of spinal nerves.
36
What structures are supplied by the internal thoracic artery?
Anterior chest wall as far laterally as the midclavicular line, the medial breast, the anterior abdominal; wall down to the umbilicus and as far laterally as the lateral edge of the rectus sheath.
37
Where does the inferior epigastric artery come from?
External iliac artery
38
What is the arcuate line?
The lower limit of the posterior rectus sheath
39
What travels in the free border of the lesser omentum?
Common bile duct, hepatic artery, portal vein.
40
What is pringles manoeuvre?
Passing a finger into the lesser sac through the epiploic foramina and compressing the portal trad to stop blood flowing into the liver.
41
With a patient in the supine position, where would fluid collect in the abdomen?
Right retrohepatic space.
42
What did the ligamentum teres used to be?
Umbilical vein
43
What structures surround the epiploic foramen?
Anteriorly; the free edge of the lesser omentum
Posteriorly; Inferior vena cava
Inferiorly; duodenum
Superiorly; caudate lobe of the liver
44
What connects the jejunum to the posterior abdominal wall?
Small bowel mesentry
45
What parts of the large bowel and in mesentery?
Transverse colon and sigmoid colon
46
What is the arrangement of the vessels in the liver hiatus?
Hepatic ducts, hepatic arteries, portal vein (at the back)
47
What are the sides of Calot's triangle?
Side one; right hepatic and common hepatic duct
Side two; gall bladder and cystic duct
Side three; the liver
48
What are the contents of Calot's triangle?
A lymph node
49
What does the cystic artery come from?
A lymph node
50
What structures are in the porta hepatis?
Hepatic arteries, hepatic ducts, portal vein, lymphatics, sympathetic nerves (follow the artery)
51
Where is the bare area of the liver?
Under the tendinous part of the right hemidiaphragm.
52
What is the surface marking of the fundus of the gall bladder?
Tip of the ninth costal cartilage, where the lateral edge of the rectus sheath joins the costal margin
53
Where do the hepatic veins drain?
Inferior vena cava
54
Where is the coronary ligament?
It is where the visceral peritoneum reflects onto the diaphragm at the bare area of the liver.
55
How do you identify the pylorus?
Thickenned, has a small artery running across it.
56
Which nerve lies in front of the abdominal oesophagus and which one behind?
Left vagus in front, right vagus behind.
57
What is the blood supply of the stomach?
Coelic axis; left gastric (lesser curve from oesophagus down), right gastric (lesser curve from duodenum up), right gastroepiloic (greater curve duodenum up), left gastroepiploic (greater curve spleen down), short gastrics (fundus)
58
Which structure goes through the diaphragm with the oesophagus?
Right and left vagus and inferior oesophageal artery and vein.
59
Which structures does the left gastric artery supply?
Superior part of the lesser curve of the stomach and the lower 1/3 of the oesophagus.
60
What is the nerve supply of the stomach?
Somatic; none
Parasympathetic; vagus
Sympathetic; greater splanchnic nerve, from T5 to T9.
61
Which structure attaches the stomach to the liver?
Lesser omentum
62
Which structure lies in front of the stomach?
Left lobe of the liver, abdominal wall.
63
Which structures lie behind the stomach?
Pancreas, splenic artery and vein, diaphragm.
64
Where does the jejunum and ileum blood supply drain?
Superior mesenteric vein
65
What structures does the root of the small bowel mesentery cover?
Aorta, inferior vena cava, right ureter, right gonadal vein and artery.
66
How do the arterial arcades of the jejunum and ileum differ?
Jejunum, long and single; ilium, short and multiple
67
What food is absorbed through the lymphatic system?
Fats
68
What is the innervation of the small bowel?
Somatic; None
Sympathetic; lesser splanchnic nerve from T10-T11,
Parasympathetic; vagus (cranial nerve X)
69
Which four mechanisms ensure a high surface area of the bowel for maximum absorption?
Coiled length, plicae circularis, Villi, micrvilli.
70
Which artery normally supplies the descending colon?
Left colic branch of the middle colic superiorly and left colic branch of the inferior mesenteric inferiorly.
71
What is the significance of the wandering artery of Drummond?
It is an anastomosis between the middle colic and sigmoid arteries, if the inferior mesenteric artery occludes slowly (eg. With atheroma) then the superior mesenteric artery takes over the blood supply of the hind gut through this artery.
72
What is the blood supply of the appendix?
Appendicular artery; a branch of the ileal artery.
73
How do you distinguish large intestine from small intenstine?
Large bowel has teniae coli, appendices epiploicae, position, haustrations, calibre (but not reliable in disease).
74
Which artery lies behind the first part of the duodenum?
The gastro-duodenal artery
75
What are the sites of porto-systemic anastomosis? What is their clinical importance?
Between tributaries of the left gastric vein and the azygos vein in the lower third of the oesophagus (forms oesophageal varices), between tributaries of the superior rectal vein and the anal veins (drain to the internal iliac veins) in the anal canal (form haemorrhoids).
76
How is the common bile duct formed and what is its course?
From the confluence of the cystic duct and the common hepatic duct. It runs in the free border of the lesser omentum, passes posterior to the first part of the duodenum and into the substance of the pancreas, it curves to the right to enter the duodenum at the Ampulla of Vater along side the pancreatic duct.
77
Where is the sphincter of Oddi?
Between the second and third parts of the duodenum on the left wall, about 5cm distal to the pylorus in the adult.
78
Where does the splenic vein join the superior mesenteric vein?
Behind the neck of the pancreas.
79
What is the duodenal cap?
The highest part of the duodenum, the first part.
80
How many pancreatic ducts are there?
Two; the pancreas forms from an anterior and posterior bud from the gut tube, each bud has its own duct. During development the buds rotate and fuse, trapping the superior mesenteric artery between the two.
81
What is the difference between a male and female pelvis?
Female, Thinner bone and lighter, Oval inlet, wide shallow true pelvis, outlet large, ishial spines point parallel to outlet, wide angle at inferior pubic symphysis. Male, thicker bone heaver build, heart shaped inlet, small outlet with ishial spines pointing into outlet, narrow angle at inferior pubic symphysis.
82
What makes the sacroiliac joint strong?
High contact area between the bones. Interlocking surfaces. Fibrous connection between the bones within the joint space. Strong surrounding ligaments.
83
What is the perineum?
The area below (superficial to) the levator ani muscle.
84
What is an epidural and how does it differ from a lumbar puncture?
An epidural involves the injection of a substance (analgesia/anaesthesia etc) into the epidural space anywhere along the vertebral column. Whereas in a lumbar puncture a hollow needle is inserted below the level of the spinal cord into the subarachnoid space in order to remove Cerebro-Spinal Fluid for diagnostic purposes.
85
Does the subarachnoid space end where the spinal cord does?
NO! It extends down to the lower sacrum
86
What does the ligamentum flavum do?
Connects adjacent laminae
87
What fibres does the dorsal ramus contain?
It carries visceral motor, somatic motor, and sensory information to and from the skin and deep muscles of the back
88
Why are the articular surfaces of the cervical facets horizontal?
The articular surfaces of the cervical facet joints are horizontal so that dislocation can occur without fracture.
89
Where does radicular arteries enter the vertebral canal?
They enter the vertebral canal through the intervertebral foramina.
90
What is a dermatome?
A dermatome is that area of skin supplied by a single spinal nerve, there will be two dermatomes for each vertebral level, one on each side!
91
What is the dermatome of the thumb?
C6
92
What is the dermatome of the nipple line?
T4
93
What is the dermatome of the knee?
L3
94
What is the dermatome of the big toe?
L5
95
What is the arterial supply of the spinal cord?
The blood supply of the spinal cord is derived from the anterior and posterior spinal arteries. The anterior spinal arteries supply the cord in front of the posterior grey column. The posterior spinal arteries supply the posterior grey columns and the dorsal columns.
96
What are the two parts of the intervertebral disc?
The two parts are the annulus fibrosus and nucleus pulposus. The nucleus pulposus is at the center of the disc and has a jelly consistency, the annulus fibrosus is formed from dense fibrous tissue and hyaline cartilage and surround the nucleus pulposus.
97
What structures make up the intervertebral foramina?
The intervertebral foramina are on the lateral aspect of the vertebral column and lie between the pedicles of adjoining vertebrae. They are bounded anteriorly by the vertebral bodies and the disc and posteriorly by the facet joints.
98
A stroke where would cause ataxia (lack of control over voluntary movement)?
Cerebellar ataxia can arise from a posterior circulation stroke. The stroke will affect the vertebral or basilar arteries. The Superior cerebellar arteries and the anterior inferior cerebellar arteries stem from the basilar artery, and the posterior inferior cerebellar arteries originate from the vertebral arteries.
99
A stroke where would cause hemianopia?
An Hemianopia would occur from a stroke affecting the visual pathways from the optic chiasm onwards to the occipital lobe. The most likely type would be a homonymous hemianopia which would occur from an occlusion of the Posterior cerebral artery, therefore a posterior circulation stroke would be more likely.
100
A stroke where would cause motor weakness?
Motor weakness can occur from any stroke that affects the motor cortex or motor tracts of the brain and spinal cord. The anterior and middle cerebral arteries supply the primary motor cortex, this means that strokes of the anterior circulation will produce motor weakness. However, as the corticospinal tracts have to through the brainstem and spinal cord, a stroke affecting the brainstem could also produce weakness, therefore as the basilar arteries supply the brainstem a posterior circulation stroke could also produce motor weakness
101
A stroke where would make you unable to speak words?
Expressive aphasia will occur from a stroke of the artery supplying Brocca’s area in the frontal lobe of the brain. In right handed people Brocca’s area is almost always on the left so is supplied by the Left middle cerebral artery, so it is an anterior circulation stroke. In left handed people Brocca’s area is on the right in about 60% and left in 40%.
102
A stroke where would make you unable to understand speech?
Receptive aphasia occurs in strokes involving Wernicke’s area, which is also supplied by the middle cerebral artery, so this is also in the anterior circulation
103
A stroke where would cause cranial nerve impairment?
Cranial nerve involvement will occur in strokes affecting the midbrain, pons and medulla, which are supplied by the posterior circulation.
104
What lobe is the hippocampus in?
Temporal lobe
105
What lobe is the amygdala in?
Temporal lobe
106
Where do headaches arise from?
Pain can arise from the Meninges, head and neck muscles and cranial/spinal nerves. Although the brain itself does not have any pain receptors, the large blood vessels of the brain do carry sympathetic nerve fibers which may transmit pain.
107
How does the internal carotid artery enter the brain?
Enters the skull via the carotid canal then travels horizontally through the temporal bone to enter the cranium through the foramen lacerum.
108
What bone does the optic nerve come through to enter the brain?
Enters through the optic canal in the lesser wing of the sphenoid bone.
109
Where does the facial nerve exit the cranium?
Exits the cranium through the internal acoustic meatus in the petrous part of the temporal bone and emerges from the skull through the stylomastoid foramina.
110
How does the oculomotor nerve enter the brain?
Enters the orbit via the superior orbital fissure between the greater and lesser wings of the sphenoid bone.
111
Which artery supplies the visual cortex?
The visual cortex is located in the occipital lobe of the brain. The occipital lobe is supplied by the posterior cerebral arteries.
112
How would the eye look if there was a lesion on the oculomotor nerve?
The oculomotor nerve supplies all extraocular muscles except superior oblique and lateral rectus. A lesion to the oculomotor nerve would result in unopposed action of superior oblique and lateral rectus forcing the eye to look downwards and outwards. The eye will be fixed in this position.
113
What do the suspensory ligaments do in the accomodation reflex (looking at a near object)?
They would weaken because the lens needs to be more convex to shorten its focal length.
114
What do the pupils do during the accomodation reflex?
The pupils constrict to prevent divergent light rays from hitting the periphery of the retina and producing a blurred image.
115
Do the eyes converge during the accomodation reflex?
YES
116
What happens to the accomodation reflex if there is a lesion to the oculomotor nerve?
It is abolished because we lose motor control
117
Where do the majority of the fibres in the corticospinal tract decussate?
80% of the corticospinal tract decussate in the medullary pyramids and travel in the lateral corticospinal tract. 10% join the ipsilateral lateral corticospinal tract and 10% travel in the anterior corticospinal tract and cross in the spinal cord.
118
What fibres do the superior peduncles carry?
Efferent fibres from the dentate, emboliform and globose nuclei. These axons send feedback to the motor cortex in the frontal lobe.
Afferent fibres from the ventrospinocerebellar tract take ‘unconscious proprioceptive’ information from the lower body.
119
What fibres are carried in the middle peduncles?
Corticopontocerebellar information. A copy of the information from the primary motor cortex which the pyramidal tract is carrying down to lower motor neurons.
120
What fibres does the inferior peduncle carry?
Vestibulocerebellar tract (vestibular impulses from labyrinths, directly and via the vestibular nucleus. Also ‘unconcious proprioceptive’ information from the dorsospinocerebellar tract.
121
What is the blood supply to the cerebellum?
Posterior inferior cerebellar arteries from the vertebral arteries
Anterior inferior cerebellar arteries from the basilar artery
Superior cerebellar arteries from the basilar artery
122
What is the function of the dentate nucleus? Where do it's fibres go?
The dentate nucleus is responsible for the planning, initiation and control of voluntary movements.
Efferent fibres travel via the superior cerebellar peduncles through the red nucleus to the thalamus.
123
What fibres does the vermis receive?
It receives fibres from the dorsal and ventral spinocerebellar tracts carrying information from muscle, joint and cutaneous receptors through the inferior and superior cerebellar peduncles respectively.
124
What term do we use for the white matter that connects the cortex of the cerebral hemisphere to other structures?
This particular white matter is known as the internal capsule.
125
What makes up the papez circuit and what does it do?
The papez circuit consists of the hippocampus, fornix, mammillary bodies, cingulate gyrus, thalamus, singulum and parahippocampal gyrus.
The papez circuit is involved in memory, emotions or emotional memory
126
Would a direct inguinal hernia be medial or lateral to the inferior epigastric artery?
Medial to the inferior epigastric artery
127
How many layers of spermatic fascia cover an indirect hernia?
Three once it is through the superficial inguinal ring.
128
Where would you palpate the ductus deferens? By palpation alone, how would you identify the ductus deferens?
In the spermatic cord between the upper pole of the testis and the superficial inguinal ring. Hard, incompressible cord.
129
What is a varicocele?
Dilated veins in the pampiniform plexus.
130
What anatomical feature would you use to distinguish between inguinal and femoral hernias?
Inguinal hernias pass above and medial to the pubic tubercle and down into the scrotum. Femoral hernias arise below and lateral to the pubic tubercle and pass vertically down into the thigh, they are entirely below the inguinal ligament.
131
Where would you try to palpate lymph nodes to assess the spread of testicular cancer?
In the epigastrium. Remember that as a rule lymphatics follow the arteries backwards, hence the lymphatics from the testis follow the testicular artery back to the upper abdominal aorta in the epigastrium.
132
Testicular pain may radiate to the loin. Why?
The nocioceptive (nasty sensation) nerve fibers to the testis are sympathetic and follow the testicular artery from the aortic sympathetic plexus which is formed from the T11 and T12 nerve roots.
133
Where might you look for an undescended testis? Is it worth surgically correcting this anomaly?
It may be found anywhere along the line of descent from the lower pole of the kidney, down the posterior abdominal wall, through the inguinal canal. It must be corrected if sperm production is to occur normally.
134
What anatomical structure in the glans penis might impede the progress of a catheter?
Navicular fossa
135
Which nerves provide sensory innervation to the scrotal skin?
Anterior 1/3 – ilioinguinal nerve
Posterior 2/3 – perineal nerves and branches from the posterior nerve of the thigh
136
Renal tumors can become very large before they invade adjacent structures. What anatomical features explain this?
Fibrous capsule (inner layer) closely applied to the renal substance, perirenal fat, renal fascia (encloses the kidney and adrenal glands together), pararenal fat. So the tumor has to grow through multiple tough layers before invading adjacent structures.
137
Describe at least two common variations in the anatomy of the renal pelvis and ureter.
Duplex system, pelvoureteric junction obstruction.
138
What veins do the right and left gonadal veins drain into?
Right into the Inferior vena cava, left into the left renal vein
139
What is a polar artery? Explain why polar arteries exist.
An accessory renal artery usually supplying the lower pole of the kidney. The kidney develops as a number of separate kidneys which fuse together during development, if this fusion is incomplete duplex kidney can occur or part of the kidney can have a separate blood supply.
140
Where would you palpate an abdominal aortic aneurysm?
In the epigastrium (above the umbilicaus).
141
What features of the ureter aid its identification at operation?
Position, writhes like a worm when touched
142
At what sites does the ureter narrow (sites where renal stones may arrest)?
Pelvoureteric junction, over iliac vessels, entering the bladder
143
Why is the ureter in danger of being damaged during a hysterectomy (removal of the uterus)?
The ureter runs immediately under the uterine artery which needs to be ligated during hysterectomy. (Water under the bridge)
144
Give a brief account of the nervous control of micturition (urination).
Sensory input from bladder to spinal cord through parasympathetic nerves to S2,3,4, tells the cord and brain that the bladder if filling. Spinal reflex passes some of these signals to the motor parasympathetic nerves which supply the detrusor muscle and inhibit the internal urethral sphincter. If it is not socially convenient to urinate brain inhibits these impulses. When in toilet (hopefully) brain stops inhibition and parasympathetic motor nerves via s2,3,4 cause detrusor muscle to contract and internal sphincter to relax.
145
Where does the arterial blood supply to the bladder come from?
Internal iliac arteries
146
Explain why inflammation of the ovary may cause pain along the medial aspect of the thigh.
The ovary sits along side the lateral pelvic side wall where the obturator nerve runs, irritation of the nerve leads to medial thigh pain as a REFERRED pain.
147
What is a retroverted uterus?
The uterus normally lies tilted forwards over the bladder, retroversion is when it lies backwards impinging on the anterior wall of the rectum.
148
What factors maintain the normal position of the uterus?
Tone in the levator ani muscles
Transverse cervical ligaments (cardinal)
Pubocervical ligaments
Sacrocervical ligaments Broad ligaments
149
To which lymph nodes would cervical cancer spread?
Internal iliac
150
What structures are palpable during vaginal examination?
Anteriorly, base of bladder, urethra, lower ureters (if they contain a stone)
Laterally, ureter, levator ani muscle, ovary by bimanual palpation
Posteriorly, rectum, Pouch of Douglas, perineal body.
151
Outline the signs and symptoms produced by an enlarged prostate gland. How would you determine that the prostate was enlarged?
Symptoms, poor stream, terminal dribbling, hesitancy, nocturia, frequency.
Signs, large prostate on rectal examination
152
What are the lobes of the prostate gland? Which lobes are more prone to malignant tumours? Is this the same for benign tumours?
Malignant - lateral lobes
Benign – median lobe
153
Would urine from a ruptured penile urethra enter the superficial or deep perineal pouch?
Superficial perineal pouch
154
List in sequence the tubular structures along which spermatozoa pass to the exterior following onset of ejaculation.
Epididymis, vas deferens, ejaculatory duct, prostatic urethra, membrinous urethra, penile urethra.
155
What nerve supplies the anterior compartment of the thigh?
Femoral nerve
156
What does the obturator nerve supply:
a) adductor longus
b) sartorius
c) obturator internus
d) piriformis
The adductor longus
157
Which part of the quadriceps femoris muscle is related to the suprapatellar bursa?
The lower part
158
What is the function of the adductor brevis?
Prevents forced abduction of the thigh
159
What is the surface marking of the saphenous opening?
Two finger breadths (4cm in adults) below and lateral to the pubic tubercle. 4cm below the inguinal ligament just medial to the femoral pulse
160
What are the tributaries of the great saphenous vein in the saphenous opening?
The superficial epigastric vein, superficial external pudendal vein, superficial circumflex iliac vein.
161
What is the iliotibial tract?
A thickened lateral aspect of the deep fascia of the leg, the tensor facia lata muscle is inserted into its deep surface. (the fascia lata)
162
What are the function of the iliotibial tract?
When standing up straight tension on the iliotibial tract keeps the knee locked straight.
163
What are the boundaries of the femoral triangle?
Superiorly-inguinal ligament
Laterally-medial border of sartorius muscle
Medially- lateral border of adductor longus muscle.
164
What are the contents of the femoral sheath?
Femoral artery and vein, lymphatics
165
Is the femoral artery pulsation palpable? If so, where do you feel the pulsation?
Yes, below the mid-inguinal point
166
What is the surface marking of the femoral artery?
2cm below the mid-inguinal point in the adult
167
How does the blood reach the femoral artery from the aorta?
Common iliac artery -\> external iliac artery -\> femoral artery
168
Name the branches of the femoral artery?
Profunda femoris (deep femoral), superficial femoral, (superficial epigastric artery, superficial external pudendal artery, superficial circumflex iliac artery)
169
Which vein becomes the common femoral vein?
Superficial femoral and profunda femoris veins joint to form the common femoral vein
170
How does blood from the femoral vein reach the heart?
External iliac vein -\> common iliac vein -\> inferior vena cava
171
If you do a femoral puncture to take blood from the femoral vein, do you introduce the needle lateral to the femoral artery pulsation or medially?
Medially
172
How do you distinguish between the femoral and great saphenous beins when you do a cut down?
Great saphenous has valves and lies outside the deep fascia
173
What is the femoral canal?
A potential space medial to the femoral vein
174
What does the femoral canal contain?
A lymph node and sometimes a hernia
175
What are the boundaries of the femoral canal?
Superficial-inguinal ligament
Medial-lacuna ligament
Deep-pectinate line on the superior pubic ramus
Lateral-femoral vein
176
What is a femoral hernia?
Protrusion of bowel through the femoral canal
177
Why do femoral hernias often get obstructed or strangulated?
The walls of the femoral canal are rigid and do not dilate so the neck of the hernia is tight
178
How is the femoral nerve formed?
Femoral plexus, L2-L4 nerve roots
179
What is the motor and sensory supply of the femoral nerve?
Medial cutaneous nerve of the thigh - intermediate cutaneous nerves, nerve to sartorius and pectineus. Saphenous nerve - rectus femoris, sensory to hip and knee.
180
Does the femoral nerve supply joints? If so, which ones?
Yes, hip and knee. (RULE: If a nerve supplies a muscle it also supplies the joint that the muscle moves, this is true for all nerves)
181
What are the boundaries of the adductor canal?
Hamstring part of adductor magnus medially, femur medially, adductor part of adductor magnus superiorly
182
What passes through the adductor canal?
Popliteal vein, to form the superficial femoral vein. Superficial femoral artery, to form the politeal artery. Posterior division of the obturator nerve
183
What are the functions of the quadriceps?
Flex the hip, extend the knee
184
What are the problems produced by a weak quadriceps?
Difficulty going DOWN stairs
185
Where is the obturator nerve formed?
Femoral plexus, L2-L4 (NB same as femoral nerve)
186
What is referred pain?
Pain arising in one area but felt in another area
187
Give some exmples of referred pain in the leg?
Sciatica. Pain in medial thigh caused by inflammation of the ovary irritating obturator nerve
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Where does the bieps femoris muscle insert?
Into the head of the fibula
189
What is the function of the hamstring muscles?
Extend the thigh at the hip joint
190
What does the sciatic nerve split into?
The common perineal and the tibial nerves
191
How do you examine the hamstrings in the living?
Active flexion of the knee
192
What muscles insert into the condyle?
The semitendinosus, sartorius, semi-membrinosis, gracilis
193
Is the head of the fibula palpable?
Yes
194
What is the effect of injury to the common perineal nerve?
Failure to extend the ankle joint on the lateral side of the foot, ie. Foot drop
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What is the relation of the nerve artery and vein in the popliteal fossa?
Artery medial, vein lateral
196
How does the popliteal artery reach the popliteal fossa?
Through the adductor canal
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How do you examine the pulsation of the popliteal artery?
Knee flexed at 90 degrees finger wrapped round the gastrocnemius muscle, pressing the artery against the back of the tibia
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Which superficial vein drains into the popliteal vein?
Short saphenous vein
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Which area of the leg is drained by the superficial short saphenous vein?
Back of the calf, lateral side of the foot
200
What are the extensors of the hip joint?
Gluteus maximus, medius, hamstrings
201
When do the extensors of the hip joint act?
climbing stairs
202
What are the structures passing through the greater sciatic foramen?
Sciatic nerve, pudendal nerve, superior and inferior gluteal nerves, posterior cutaneous nerve of the thigh. Piriformis muscle
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Wht structures pass through the lesser sciatic foramen?
Pudendal nerve, internal pudendal artery and vein, tendon and nerve of obturator internus
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Is the ischial spine palpable in the living? If so, how do you palpate it?
Yes, either trans rectally of trans vaginally.
205
When do you abduct the hip joint?
When walking
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What is the usual function of the abductors of the hip joint?
To hold the pelvis level when you take one leg off the ground
207
What is Trendelenburg's test?
To test if the pelvis remains level (or raises slightly) when the ipsilateral leg is lifted off the ground
208
What is the importance of knowing the surface marking of the sciatic nerve?
To avoid it when giving injections into the buttocks
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What nerve winds round the neck of the fibula?
The common peroneal nerve
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What does complete transection of the common peroneal nerve cause?
Foot drop
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Where does the Achilles tendon insert into?
The gastrocnemius, the plateris and the soleus
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Does the long saphenous vein cross in front or behind the medial malleolus?
In front
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Give the surface marking of the long saphenous vein until it drains into the femoral vein?
Up the medial leg medial to the knee, up the medial thigh onto the anteromedial thigh to the sapheno-femoral junction
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What are the tributaries of the long saphenous veins?
All the superficial vein from the foot, leg and thigh EXCEPT the posterior leg and lateral foot which drain into the short saphenous vein
215
What is the venous drainage of the leg?
Superficial via the short and long saphenous vein which drain into the popliteal and femoral veins respectively. The deep veins follow the arteries. The superficial veins communicate with the deep veins via ‘perforators’ which pass through (perforate) the deep fascia. There are multiple valves which only allow blood to flow from the bottom of the leg to the top and from the outside to the inside.
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Where does the superficial peroneal nerve supply skin sensation?
Lower 1/3 anterolateral leg onto the dorsum of the foot,
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Where does the deep peroneal nerve supply skin sensation?
Dorsum of first web space on foot,
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Where does the saphenous nerve supply skin sensation?
Medial side of leg
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Where does the sural nerve supply skin sensation?
Back of leg onto lateral border and sole of foot
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Where does the posterior cutaneous nerve of the thigh supply skin sensation?
Popliteal fossa
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Where does the tibial nerve supply skin sensation?
Medial sole of the foot
222
What is compartment syndrome?
Bleeing ,oedema or infection within a compartment causes swelling which results in the pressure in the compartment increasing. Eventually the pressure will exceed venous pressure and blood flow will cease and the compartment will become ischaemic.
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How do you test for the tibialis anterior?
Dorsiflexion at the ankle
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How do you test for the extensor digitorum longus?
Extension of the toes
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How do you test for the extensor hallucis longus?
Extension of the big toe
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How does the deep peroneal nerve reach the anterior compartment?
Between the tibia and fibula above the upper extent of the intercostals membrane
227
What muscle compartment is supplied by the deep peroneal nerve?
Anterior compartment of the leg
228
Does the deep peroneal nerve supply skin? If so, where?
Yes, first web space on foot
229
What is the anterior tibial artery a branch of?
Popliteal artery
230
How does the anterior tibial artery reach the anterior compartment from the lower part of the popliteal fossa?
Between the tibia and fibula above the upper extent of the intercostal membrane
231
Where do you palpate the pulsation of the dorsalis pedis artery?
Between the first and second metatarsal
232
What are the actions of the peroneii muscles?
Eversion of the foot
233
How do you test for the peroneii muscles in the living?
Eversion against resistance
234
How does a bone get it's blood supply?
A nutrient artery and from any muscles attached to it
235
Which leg bone has more muscle attached to it?
Fibula
236
Why is the blood supply to the shaft of the ribia relatively poor?
Very little muscle attachment
237
Why do fractures of the tibia take longer to heal?
Poor blood supply
238
Why are compound fractures more common in the tibia?
It is subcutaneous so a little displacement risks piercing the skin in an ‘inside out’ compound fracture.
239
How do you test for the gastrocnemius?
Stand on your tip toes
240
What is an ankle jerk?
Hit the Achilles tendon with a patellar hammer to acutely stretch the gastrocnemious muscle, this should result in a reflex contraction of the muscle.
241
Which segments of the spinal cord are you testing when you elicit the ankle jerk reflex?
S1 and S2
242
Which segments of the spinal cord are you testing when you do the knee jerk reaction?
L2, L3 and L4
243
Which muscle compartment is supplied by the tibial nerve?
The posterior leg
244
Which do you feel the pulsation of the posterior tibial artery?
Just posterior to the tibia at the ankle (back of the medial malleolus)
245
Which muscles support the pelvis when standing on only one leg?
The gluteus medius and minimus
246
In posterior dislocations of the hip which nerve is liable to injury?
The sciatic nerve
247
What does the sciatic nerve supply?
All the muscles below the knee
248
What accompanies the ligament of the head of the femur in children?
The blood supply to the femoral head epiphsis
249
Describe the arterial supply of the head of the femur?
In adults comes along the femoral neck from the arteries in the joint capsule. In children from the nutrient artery of the epiphysis
250
What is the usual cause of avascular necrosis of the head of the femur in adults and children?
Adults - displaced fracture neck of femur, Children – splipped epiphysis
251
A child with a hip joint disease has pain in the knee joint. Why?
Sciatic nerve supplies hip and knee joint, referred pain
252
Describe the bony compartments of the knee joint:
Femoral condyles – markedly curved, tibial plateux – almost flat, patella – sesamoid bone within quadriceps muscle.
253
Name the extracapsular ligament of the hip:
Lateral collateral ligament
254
Give the attachments of the tibial and fibrular collateral ligaments
Tibial – medial femoral EPIcondyle, medial tibial condyle. Fibula – lateral femoral EPIcondyle, head of the fibula
255
Which collateral ligament of more prone to injury?
Medial
256
Outline the functions of the popliteus:
It twists the tibia on the femur to unlock the knee joint so that it can be flexed
257
What are the functions of the quadriceps?
Extension of the knee (as in kicking a ball), NB rectus femoris also flexes the hip joint, Vastus medialis also stabilizes the patella.
258
List the intracapsular structures of the knee joint?
Medial and lateral meniscii, anterior and posterior cruciate ligaments, blood vessels on the cruciate ligaments (these can bleed INTO the joint when the cruciate’s rupture)
259
What are the functions of the cruciate ligaments?
Stabilise the knee in the anterior and posterior direction, particularly when the knee is flexed
260
Describe the attachments of the anterior cruciate ligament?
Anteriorly on the TIBIA on the intercondylar ridge. Posteriorly on the medial side of the lateral condyle of the femur.
261
Describe the attachments of the posterior cruciate ligament?
Posteriorly on the TIBIA on the intercondylar ridge. Anteriorly on the lateral side of the medial condyle of the femur
262
Which is meniscus is more prone to injury? Why?
Medial, it is attached to the medial collateral ligament which means it is less able to move within the knee joint. Extreme forces placed through the joint may be transmitted through the meniscus causing a tear, the lateral meniscus, being more mobile can move more freely to avoid damage
263
What the functions of the menisci?
They sit on the relatively flat surface of the tibia and conform to the curves of the femoral condyles. They allow some rotation of the joint which would not be possible if the tibia and femur fitted together perfectly
264
What are Bakers cyst, house maids knee and clergy mans knee?
They are all clinical presentations of inflammation in different bursae around the knee joint. Bakers; behind the knee, can communicate with the knee joint. Clergymans; infrapatella bursa, from praying. Housemaids; prepatella, from scrubbing floors.
265
Describe the movements of the knee and list the muscles producing them?
Flexion; biceps femoris, gracilis, semimembranosis, sartorius, gastrocnemius, plantaris. Extension; quadriceps femoris. Rotation during extension; passive. Rotation during flexion; popliteus to initiate.
266
What is the function of the patella?
To transfer the force produced by Quadraceps over the bent knee to the tibia. (If the tendon ran directly over the bone it would be damaged
267
What are the attachments of the patella?
Superiorly to the quadriceps and inferiorly to the infrapatella tendon (ligament)
268
how does blood reach the right axillary artery from the left ventricle?
Ascending aorta -\> brachio-cephalic -\> right subclavian -\> right axillary artery
269
Outline the arrangement of the cords of the brachial plexus around the second part of the axillary artery?
Lateral cord is above and lateral to the artery, posterior cord is behind the artery and the medial cord is below and medial to the artery.
270
What is lymphatic drainage?
It is the path lymph takes, along microscopic lymphatic channels, from the bodies tissues back to enter the circulation.
271
Describe the various lymph node groups in the acilla and their clinical significance:
Anterior, posterior, medial, apical: anterior sits just deep to the anterior axillary fold which is formed by the pectoralis major, posterior sits just deep to the posterior axillary fold which is formed by the latissimus dorsii tendon, Medial sits on the chest wall on the medial expent of the axilla, Apical sits just under the vessels and brachial plexus at the apex of the axilla.
272
What parts of the body drain lymph directly into the axillary lymph nodes?
The arm, the breast, the body wall below the clavicle as far down as the umbilicus anteriorly and the mid lumbar area posteriorly.
273
In full abduction of the upper limb what happens to the scapula?
It rotates forward
274
What are the bony points which are palpable in the region of the shoulder?
Subcutaneous clavicle throughout its length, acromian, spine of the scapula, the head of the humerus can be felt deep to deltoid if the muscle is not over developed
275
What are the factors stabilising the shoulder joint?
The rotator cuff muscles, biceps tendons, superiorly acromian and its ligaments.
276
Name the muscles forming the rotator cuff. Where are they inserted?
Subscapularis – lesser tuberosity of the humerus, supraspinatus/infraspinatus/teres minor= greater tuberosity of humerus
277
How may the axillary nerve be damaged?
Posterior dislocation of the shoulder, fracture of the surgical neck of the humerus
278
What is the extent of damage to the axillary nerve? How do you test for it?
Numb patch over the lateral side of the arm adjacent to the insertion of deltoid, paralysis of deltoid and teres minor.
279
Briefly outline the mechanism of abduction of the shoulder?
Initiated by Supraspinatus which abducts the humerus on the scapula. Action of deltoid then assists supraspinatus and trapezius and the lower fibers of serratus anterior rotate the scapula. For every 2 degree of abduction at the shoulder joint there is one degree of rotation of the scapula.
280
Why should paralysis of CN 11 limit abduction?
The trapezius will be paralysed and therefore there will be limited rotation of the scapula.
281
Name 3 muscles supplied by the musculocutaneous nerve?
Coracobrachialis, biceps, brachialis.
282
What is the clinical significance of nerves lying close to bones?
Fracture of the bones may cause nerve damage or external pressure onto the bone may cause nerve damage.
283
Name 3 nerves closely related to the humerus?
Axillary, radial, ulna
284
What is the relation of the median nerve to the brachial artery?
In the upper third of the arm nerve lateral to artery. In the anticubital fossa – nerve medial to artery.
285
Name 3 superficial veins of the forearm:
Cephalic, Basilic, anticubital.
286
What is the common flexor origin?
The medial epicondyle of the humerus where a number of flexors take origin.
287
List the muscles in the superficial group of the forearm and the joint on which they act?
Pronator teres – radius, flexor carpi radialis – base of second and third metacarple and the adjacent carpal bones, palmaris longus – palma fascia, flexor carpi ulnaris, pisiform bone
288
Name three major nerves entering the forearm?
Radial, median and ulna
289
Which muscles are supplied by the median nerve?
Supinator, pronator teren and flexor carpi ulnaris respectively.
290
Briefly describe the course of the ulna artery?
It arises from the brachial artery superficial to the flexor digitorum profundus muscle, runs down the forearm between the superficialis and profundus muscles. Distally passes from under the superficial muscle at the wrist to lie between the flexor digitorum superficialis and flexor carpi ulnaris.
291
Describe the course of the radial artery:
It arises from the brachial artery in the anticubital fossa passes superficial to the superficial flexors just under the brachoradialis. Where the brachoradialis terminates on the radius the artery lies on the distal radius.
292
What are the joints between the radius and the ulna?
Proximally the synovial radioulna joint communicating with the elbow joint. Distally also a synovial joint communicating with the wrist joint.
293
Define pronation:
Rotating the forearm from the anatomical position so that the palm of the hand faces backwards.
294
Define supination:
Rotating the forearm so that the palm faces forwards
295
Which muscles produce supination and pronation?
Pronation – Pronator teres, pronator quadratus, brachoradialis to the midprone point.
Supination – biceps, supinator, brachoradialis to the midprone point.
296
What is the working postition of the forearm - supinated or pronated?
Midprone
297
Which carpal bone is most prone to injury?
Scaphoid
298
What is the complication of a scaphoid fracture?
Avascular necrosis of the proximal part
299
What structures lie superficial to the flexor retinaculum?
Flexor carpi ulnaris tendon ending in the pisiform bone, ulnar nerve, ulna artery, palmar cutaneous nerve of the ulnar nerve, palmaris logus tendon, palmar cutaneous branch of the median nerve.
300
What is the carpal tunnel? What nerve travels through it?
An enclosed “tunnel” at the wrist formed from the carpal bones and the flexor retinaculum, any swelling in the carpal tunnel will cause a great increase in pressure here and affect the function of the median nerve which passes through the tunnel.
301
What is the cutaneous distribution of the median and ulnar nerves in the hand?
Median; lateral three and a half digits on the palmar side extending onto the dorsal surface of the distal phalanx only and the adjacent palm. Ulna; medial one and a half digits on the palmar and dorsal side extending and the adjacent palm.
302
What are the thenar muscles?
The muscles in the hand which act on the thumb: abductor pollicis brevis, flexor pollicis brevis, adductor pollicis, opponens pollicis.
303
What is the nerve supply of the thenar muscles?
Median nerve (use your LOAF) First and second Lumbrical, Opponens, Abductor, Flexor. Adductor is supplied by the ulnar nerve
304
How are the lumbricals innervated?
Lateral two median nerve, medial two ulnar nerve.
305
Which muscles flexes the distal interphalangeal joint?
Flexor digitorum profundus
306
List the muscles supplied by the deep branch of the ulnar nerve?
Hypothenar muscles, medial two lumbricals, adductor pollicis, interossei.
