Anatomy Q's from the booklet Flashcards
How do we count inter-costal spaces in the living?
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.
What happens if the valves are incompetent?
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.
What is the purpose of having cartilage in the trachea and bronchi?
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.
Do the trachea and bronchi have muscle in them?
Yes, to alter the calibre of the airways.
Where would you listen to the upper lobe of a lung?
Anteriorly high up on the chest wall.
Where would you listen to the right middle lobe?
5th intercostal space just to the right of the sternum.
Name three of the abdominal organs that the lung overlaps
Liver, spleen, upper poles of the kidneys (just), adrenal glands, stomach
How do you distinguish between the vessels at the hilum of the lung?
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.
How many pairs of ribs are there?
12
What are the contents of the intercostal space?
Intercostal artery, vein and nerve.
What connects the ribs to each other?
The intercostals muscles.
What bones do the ribs articulate with?
The sternum at the front and the thoracic vertebrae at the back
Do bronchioles have cartilage in their walls?
NO
What happens to the vertical diameter of the thoracic cavity when the diaphragm contracts?
It increases because the diaphragm is pulled downwards.
What happens to the transverse diameter of the thoracic cavity when the intercostals muscles contract?
It increases by lifting the lower ribs upwards towards the first rib which is fixed.
Look at this lovely diagram and learn it
Which morphology has the greatest power?
Multipennate muscles
Which morphology can pull the furthest distance?
Strap muscles
Where does the pectoralis major muscle insert?
The humerus
Describe the terms origin and insertion in muscle?
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).
Where does the lymphatics of the breat drain into?
Lateral half to the axillary lymph nodes, medial half to internal mammary lymph nodes (in the chest).
What are accessory muscles of respiration?
Muscles which are not usually used in respiration (breathing) but which can be used during respiratory distress, such as asthma.
What is the ligamentum arteriosum?
It is the reminant of the embryological shunt between the pulmonary artery and the aorta.
Does the vagus nerve enter the abdomen?
Yes, passing through the oesophageal hiatus in the diaphragm.
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.
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.
Where is the AV node?
Small nodule just above the septal cusp of the trisuspid valve in the inter-atrial septum.
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.
Which is the lowermost palpable costal cartilage?
T10
Where is the subcostal plane?
Horizontally from the lower border of the tenth costal cartilage.
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.
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.
What are the dermatomes of the anterior abdominal wall?
T6-T12, T10 round the unbilicus
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.
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.
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.
Where does the inferior epigastric artery come from?
External iliac artery
What is the arcuate line?
The lower limit of the posterior rectus sheath
What travels in the free border of the lesser omentum?
Common bile duct, hepatic artery, portal vein.
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.
With a patient in the supine position, where would fluid collect in the abdomen?
Right retrohepatic space.
What did the ligamentum teres used to be?
Umbilical vein
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
What connects the jejunum to the posterior abdominal wall?
Small bowel mesentry
What parts of the large bowel and in mesentery?
Transverse colon and sigmoid colon
What is the arrangement of the vessels in the liver hiatus?
Hepatic ducts, hepatic arteries, portal vein (at the back)
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
What are the contents of Calot’s triangle?
A lymph node
What does the cystic artery come from?
A lymph node
What structures are in the porta hepatis?
Hepatic arteries, hepatic ducts, portal vein, lymphatics, sympathetic nerves (follow the artery)
Where is the bare area of the liver?
Under the tendinous part of the right hemidiaphragm.
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
Where do the hepatic veins drain?
Inferior vena cava
Where is the coronary ligament?
It is where the visceral peritoneum reflects onto the diaphragm at the bare area of the liver.
How do you identify the pylorus?
Thickenned, has a small artery running across it.
Which nerve lies in front of the abdominal oesophagus and which one behind?
Left vagus in front, right vagus behind.
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)
Which structure goes through the diaphragm with the oesophagus?
Right and left vagus and inferior oesophageal artery and vein.
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.
What is the nerve supply of the stomach?
Somatic; none
Parasympathetic; vagus
Sympathetic; greater splanchnic nerve, from T5 to T9.
Which structure attaches the stomach to the liver?
Lesser omentum
Which structure lies in front of the stomach?
Left lobe of the liver, abdominal wall.
Which structures lie behind the stomach?
Pancreas, splenic artery and vein, diaphragm.
Where does the jejunum and ileum blood supply drain?
Superior mesenteric vein
What structures does the root of the small bowel mesentery cover?
Aorta, inferior vena cava, right ureter, right gonadal vein and artery.
How do the arterial arcades of the jejunum and ileum differ?
Jejunum, long and single; ilium, short and multiple
What food is absorbed through the lymphatic system?
Fats
What is the innervation of the small bowel?
Somatic; None
Sympathetic; lesser splanchnic nerve from T10-T11,
Parasympathetic; vagus (cranial nerve X)
Which four mechanisms ensure a high surface area of the bowel for maximum absorption?
Coiled length, plicae circularis, Villi, micrvilli.
Which artery normally supplies the descending colon?
Left colic branch of the middle colic superiorly and left colic branch of the inferior mesenteric inferiorly.
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.
What is the blood supply of the appendix?
Appendicular artery; a branch of the ileal artery.
How do you distinguish large intestine from small intenstine?
Large bowel has teniae coli, appendices epiploicae, position, haustrations, calibre (but not reliable in disease).
Which artery lies behind the first part of the duodenum?
The gastro-duodenal artery
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).
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.
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.
Where does the splenic vein join the superior mesenteric vein?
Behind the neck of the pancreas.
What is the duodenal cap?
The highest part of the duodenum, the first part.
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.
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.
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.
What is the perineum?
The area below (superficial to) the levator ani muscle.
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.
Does the subarachnoid space end where the spinal cord does?
NO! It extends down to the lower sacrum
What does the ligamentum flavum do?
Connects adjacent laminae
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
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.
Where does radicular arteries enter the vertebral canal?
They enter the vertebral canal through the intervertebral foramina.
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!
What is the dermatome of the thumb?
C6
What is the dermatome of the nipple line?
T4
What is the dermatome of the knee?
L3
What is the dermatome of the big toe?
L5
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.
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.
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.
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.
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.
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
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%.
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
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.
What lobe is the hippocampus in?
Temporal lobe
What lobe is the amygdala in?
Temporal lobe
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.
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.
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.
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.
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.
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.
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.
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.
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.
Do the eyes converge during the accomodation reflex?
YES
What happens to the accomodation reflex if there is a lesion to the oculomotor nerve?
It is abolished because we lose motor control
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.
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.
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.
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.
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
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.
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
Name the branches of the femoral artery?
Profunda femoris (deep femoral), superficial femoral, (superficial epigastric artery, superficial external pudendal artery, superficial circumflex iliac artery)
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
Wht structures pass through the lesser sciatic foramen?
Pudendal nerve, internal pudendal artery and vein, tendon and nerve of obturator internus
What nerve winds round the neck of the fibula?
The common peroneal nerve
