Emrcs Flashcards
What are the posterior cranial fossa cranial nerves?
7-12
What are the middle cranial fossa cranial nerves?
2-6
What ligaments are involved in atlanto-occipital joint?
Cruciate ligament: transverse and longitudinal
-Transverse ligament of atlas: arches accross ring of atlas and holds odontoid process in place
Longitudinal:
-Anterior connects transverse ligament to foramen magnum
-Posteiror connects transverse ligament ot C2
Alar ligaments
-Attach odontoid process to base of skull
Attachments of medial and lateral collateral ligaments
Lateral: lateral epicondyle of femur, fibula
Medial: medial epicondyle of femur, tibial surface and medial meniscus
What travels through inferior orbital fissure?
Maxillary nerve
Inferior ophthalmic vein
Zygomatic nerve
What travels through superior orbital fissure?
3, 4, V1 (branches), 6
Superior opthalmic vein
What are the orbital foramina?
-Optic canal
-Superior orbital fissure
-Inferior orbital fissure
What are the boundaries and contents of calot’s triangle?
Boundaries:
-Cystic duct, inferior liver, hepatic duct
Contents
-Right hepatic artery
-Cystic artery
-Lymph node of lund
Where does bile enter the small bowel?
2nd part of the duodenum, ampulla of vater
What ligaments/lobes are there in liver and how are they related to gallbladder/IVC?
Ligamentum venosum: related to caudate lobe and IVC
Quadrate lobe: related to gallbladder
Falciform ligament: anterior surface of the liver
Coronary ligament and bare area: SVC, right side
Left and right triangular ligaments: laterally on each surface
Ligamentum teres (or round ligament): free edge of falciform ligament inferiorly
Structures passing through both greater and lesser sciatic foramen, structures passing through leesser sciatic foramen
Pudendal nerve
Internal pudendal artery and vein
Nerve to obturator internus
structures passing through lesser sciatic foramen
-The above plus tendon of obturator internus
What receives the majority of venous drainage from the heart?
Coronary sinus
What are the tributaries of the coronary sinus?
-Great cardiac vein: originates at apex of heart, runs in anterior interventricular groove and curves to the left, forms coronary sinus
-Small cardiac vein: on anterior surface of heart, in groove between right atrium and right ventricle
-Middle cardiac vein (posterior interventricular)–> posterior interventricular groove
-Posterior cardiac vein: posterior surface left ventricle
Which cardiac veins can be seen anteriorly
-Great cardiac vein: originates at apex of heart, runs in interventricular groove
-Small cardiac vein: in groove between right atrium and right ventricle
What layers lie between the posterior aspect of the sternum and the internal surface of the left ventricle?
-Fibrous pericardium–> continuous with central tendon of diaphragm
-Serous pericardium
—> parietal
—> pericardial fluid
—> visceral (epicardium)
Myocardium
Endocardium
What are the main attachments of the fibrous pericardium?
-Anterior: sternum
-Superior: great vessels
-Inferior: diaphragm central tendon
What is the relationship of the axillary artery to the cords of the brachial plexus?
-First part of axillary artery: lateral and posterior are lateral, medial is behind
-2nd part: cords surround axillary artery and take their names from their relationship to it in this position
Branches of axillary artery
Parts are in relation to pec minor (superior, posterior, inferior)
1st part:
-Superior thoracic
2nd part:
-Thoracoacromial
-Lateral thoracic
3rd part:
-Subscapular
-Anterior circumflex humeral
-Posterior circumflex humeral
Which muscle overlies cords of brachial plexus?
Pec minor
What are the nerves of the posterior abdominal wall and what do they supply?
-Ilioinguinal
–> internal oblique
–> medial thigh skin proximally
–> scrotum/penile root or mons pubis skin
Iliohypogastric
–> transversus abdominis, internal oblique
–> suprapubic skin
Genitofemoral
–> scrotal skin, skin overlying femoral triangle
During what surgery can nerves of posterior abdominal wall be damaged?
Surgery to right colon if mobilisation too posterior:
–> All 3 (ilioinguinal, iliohypogastric, genitofemoral
Appendicectomy
–> iliohypogastric if incision extended laterally
–> denervation of internal oblique/transversus abdominis: more risk of direct inguinal hernia
Inguinal hernia repair
–> ilioinguinal
Factors contributing to stability/instability of shoulder joint and ROM
Instability:
–> shallow glenoid
Stability:
–> rotator cuff muscles
–> surrounding tough fibrous capsule
ROM
–> ball and socket joint
–> scapula can also move relative to torso so can provide greater flexibility
What are the relations of the inferior epigastric artery near its origin?
-Lies medial to deep inguinal ring
-Testicular vessels
-Crossed by Vas deferens in males, round ligament in females
What operative procedures carry greatest risk of injury to inferior epigastrics?
-Insertion of laparascopic ports: appendicectomy
-Extending incision medially open appendicectomy
-Formation of ileostomies and colostomies
Where does inferior epigastric originate?
Just proximal to inguinal ligament
HOw long is the oesophagus and what is its course?
-25cm
-Commences at C6, level with lower border cricoid cartilage
-Traverses posteiror mediastinum
-Enters abdomen through right crus diaphragm T10
-Enters stomach at T11
What is the venous drainage of the oesophagus?
-Cervical: inferior thyroid vein
-Thoracic: azygous venous system
-Abdominal: oesophageal branches left gastric vein
What is the lymphatic drainage of oesophagus
Cervical: deep cervical nodes
Thoracic: mediastinal nodes
Abdominal: nodes around left gastric artery
If you were to perform an oeosphagectomy via a right sided thoracotomy, what structure would routinely require division to access the oesophagus once inside the chest cavity
Azygous vein
What are the constrictions of the oesophagus?
-Cricoid cartilage: anterior relation, 15cm from incisors
-Arch of aorta: left relation, 22.5cm from incisors
-Left main bronchus: anteirior relation, 25cm from incisors
-Diaphragm: T10 vertebra 40cm from incisors
What is the mediastinum?
-Space between the lungs
-Includes mediastinal pleura
-Bounded anteriorly by sternum and posteriorly by thoracic vertebral column
-Extends inferiorly from thoracic inlet to diaphragm
What are the main subdivisions of the mediastinum?
Superior and inferior
INferior: anterior, middle, posterior
What are the components of the circle of willis?
The two internal carotid arteries and two vertebral arteries form an anastomosis known as the Circle of Willis on the inferior surface of the brain. Each half of the circle is formed by:
- Anterior communicating artery
- Anterior cerebral artery
- Internal carotid artery
- Posterior communicating artery
- Posterior cerebral arteries and the termination of the basilar artery
What are the branches of the vertebral artery
Posterior spinal artery
Anterior spinal artery
Posterior inferior cerebellar artery
What are the branches of the basilar artery?
Anterior inferior cerebellar artery
Labyrinthine artery
Pontine arteries
Superior cerebellar artery
Posterior cerebral artery (at the point where it bifurcates)
What are the branches of the internal carotid arteries?
Posterior communicating artery
Anterior cerebral artery
Middle cerebral artery
Anterior choroid artery
ophthalmic
