flow Flashcards
What is the main structure that determines the descent path of the testicle?
Gubernaculum. Connects the testis to the inferior aspect of the scrotum. Embrionically, it is long and connected to the posterior abdominal wall. During fetal growth the body grows relative to gubernaculum, which results in the descent of the testis.
Where are the testis located in the 3rd month and 7th months of gestation?
3rd - iliac fossae, 7th - deep inguinal ring.
Which harmstring muscle is located most laterally?
Biceps femoris. Long head.
Which arteries may bleed after cross clamping abdominal aorta?
Lumbar arteries. They are posteriorly cited.
What is a Trendelenburg gait?
Damage to the superior gluteal nerve (hip replacement, nephrectomy, injection) → weakness of abductor muscles (glueteus medius) → drop of pelvis to contralateral side + unability to abduct the thigh. Compenstated Tr. sign - the trunk lurches to the weakened side.
Which is the correct embryological origin of the stapes?
2nd pharyngeal arch.
What nerve may Gantzer muscle affects?
Median and anterior interosseous nerves. A loss of pincer grip is related to the anterior interosseous nerve.
What are the motor functions of the brachial plexus myotomes?
C5 - abduction
C6 - flexion of the elbow
C7 - extension
C8 - finger flexion
T1 - finger abduction
What are the sensory functions of the brachial plexus?
C5, C6 (upper roots) - lateral side.
C7, C8 (middle root) - hand
T1 (lower root) - medial part of arm and forearm
What are the borders of Calot’s triangle?
Upper - liver; lateral - cystic duct; medial - common hepatic duct. Inside is the cystic artery. Original borders of Calot - with the cystic artery above.
What does the Calot’s triangle contain?
Cystic artery; below her - the Mascagni’s lymph node (or Lund’s node).
Sometimes - the accessory right hepatic artery.
What does Cholecystokinin?
Causes contraction of the gallbladder
What contains cavernous sinus?
OTOM CAT
Oculomotor (III), Trochlear (IV), Ophthalmic (5V1), Maxillary (5V2) nerves
Carotid internal artery, Abducens nerve (VI), Trochlear,
What is a cavernous sinus syndrome?
Most commonly caused by tumours.
Pain, proptosis, ophthalmoplegia, trigeminal nerve lesion, Horner’s syndrome
Which nerve can be injured during parotidectomy?
Greater auricular. Facial nerve injury is less common.
What causes a winged scapula?
Damage to the long thoracic nerve (lymphadenectomy in breast cancer) (from C5, C6, C7; innervates serratus anterior muscle. Its origin is in the medial border of the scapula).
What damages in a crutch palsy?
Radial nerve. As it is derived from the posterior cord. Wrist drop.
What is the most common position of the appendix?
Retrocaecal - 64%, pelvic - 32%.
What is located at the transpyloric plane?
Addison plane. Halfway between the suprasternal notch and the upper border of symphisis, at the level of the L1. Spleen - lower pole. Itself is above. The fundus of the gallbladder is the most superfifical; at right of the rectus sheath.
Injury to which nerve causes a foot drop? Tight casting.
Common peroneal nerve. Wraps around the fibular head.
What are the borders of epiploic foramen?
Anteriorly - common bile duct, portal vein, hepatic artery (hepatoduodenal ligament)
Posteriorly - inferior vena cava
Inferiorly - 1st part of the duodenum
Superiorly - caudate process of the liver.
Where does the psoas muscle connect?
Lesser trochanter.
How to distinguish upper vs lower motor neuron lesion of Facial nerve?
Upper motor neurons receive innervation bilaterally; lower motor neuron only from contralateral side. The border line is between the eyes. So eyebrows are indicators of upper motor lesion.
What is Sibson’s fascia?
A thickening of endothoracic fascia in the apex of the lungs. It prevents the neck being inflated on inhale and runs from C1 to C7.
What is the lymphatic drainage of ovaries?
Paraaortic nodes
What is the lymphatic drainage of the uterus?
Fundus - along with ovarian vessels to paraaortic nodes + along the round ligament to the inguinal nodes.
Body - broad ligament to iliac lymph nodes
Cervix - laterally along
Which parts form the celiac plexus?
Celiac → aorticorenal → superior mesenteric
Where is coeliac plexus located?
Anterior to aorta
What proportion of saliva is produced by submandibular gland?
70%. 25% - parotid. 5% - sublingual.
What is an anterior border of posterior mediastinum?
Prevertebral fascia. It means that vertebras are not in the mediastinum!
How ulnar artery corresponds to the ulnar nerve in the level of the wrist joint?
lateral
What structures pass through the great sciatic foramen?
Greater sciatic foramen itself is divided in two parts by piriformis muscle (from sacrum to the great trochanter).
Suprapiriform: Sup. gluteal artery, Sup. gluteal nerve
Infrapiriform: POPS IQ = Pudendal nerve to Obturator internus, Posterior femoral cutaneous nerve, Sciatic nerve, Inferior gluteal artery + nerve, nerve to Quadratus femoris.
Pudendal nerve exits greater foramen then goes through the lesser one.
At which level does the aorta traverse the diaphragm?
Th12
I ate 10 Eggs At 12’ I (IVC) ate (T8) 10 (T10) eggs (eosophagus) At (aorta) 12 (T12)
What does separate spinal cord from the intervertebral disk?
Post. Longitudinal ligament
What is the lymph drainage of the ureter?
Upper - paraaortic nodes; lower - common iliac.
What are the hormones of posterior pituitary gland?
Oxytocin + ADH
What are the hormones of the anterior pituitary gland?
Growth hormone; TSH; ACTH; LH + FSH; Prolactine; Melanocyte releasing hormone
FLAT PeG
FSH, LH, ACTH, TSH, Prolactine, Growth
What separates pituitary gland from optic chiasm?
Dural fold!
Which vessels can be damaged during a removal of the submandibular gland?
Facial artery + vein. Later, when the Whartons duct is mobilised - lingular artery
What are the birth injuries to the brachial plexus?
Erbb’s uPPer roots = Waiter’s tip C5 C6
kLumpke’s Lower roots = Klawing C8 T1
Which muscles are not innervated by median nerve at the forearm?
Flexor carpi ulnaris; median half of flexor digitorum profundus.
Ape hand - lesion to the median nerve. 4 and 5 fingers will bend!
Which branch of median nerve goes above the carpal tunnel?
Palmar branch.
What is the cause of claw hand?
Lesion to the ulnar nerve. It innervates ulnar half of flexor digitorum profundus, flexor carpi ulnaris. More proximal lesion (at elbow), lesser is contracture due to the activity of extensor digitorum
Motor branch of the median nerve?
Anterior interosseous nerve. May be impared in humerus fracture at elbow. Abnormal OK sign due to the impairment of radial hal of flexor digitorum profundus. Plus Benedictine sign!
How to remember radial nerve supply?
BEAST - brachialis, Extensors, Anconeus, Supinators, Triceps
What can be injured during saphenous grafting?
Deep external pudendal vessels
Where does axillary artery and radial nerve passes on the arm?
Quadratum space; radial - triceps hiatus
Which muscles ulnar nerve supplies at the hand?
All intrinsic muscles except LOAF:
Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
They are innervated by median nerve
How to distinguish abductor interossei of the fingers from adductors?
PAD DAB
Palmar - adductors; Dorsal - abductors
What is special about thumb innervation?
All goes from median nerve EXCEPT adductor pollicis - goes from ulnar nerve.
If ulnar nerve is damaged you can not do ADDUCTION of the thumb
Features of carpal tunnel syndrome?
Inability to oppose the thumb.
Atrophy to thenar eminence, thumb is ADDUCTED (adductor is innervated by ulnaris) and extended - SIMIAN hand
How anatomical structures are located in the cubital fossa?
TAN - tendon Artery Nerve
What are relations of median nerve to brachial artery?
LAM - it starts lateral on the arm then traverse anteriorly and after is situated medially
What is a Froment’s sign?
Laceration to ulnar nerve - impaired adduction of thenar. Compensates by flexion by median nerve
How can scapula be supplied if subclaavian artery is divided?
Anastomosis between dorsal scapulae (last branch of subclavian) and subscapular artery (its branch circumflex scapular artery)
Borders of cubital fossa?
Lateral - brachioradials; medial - pronator teres; floor - brachialis.
When the patient will be able to extend his dropped wrist but won’t be able to extend his fingers?
Posterior interosseous nerve injury
Injury to median nerve?
Supracondylar fracture. Unable to flex the wrist. Pointing index finger. 1-2-3 do not flex.
At the level of the wrist - unable to ABDUCT the thumb (adductors are by ulnar nerve).
Injury to ulnar nerve?
Ebove epicondyle - claw hand
Interossei - adduction, abduction of fingers, crossing, adduction of 5th, thumb
High lesion - less claw hand
Innervation of the middle finger?
C7
How does the lymph drain from the rectum?
Superior to dentate line → mesorectal nodes
Inferior to dentate line → inguinal nodes (need to be removed from the groin)
Lymph drainage of prostate?
Internal iliacs!!!
What causes a shoulder abduction?
Suprascapular nerve. Aided by deltoid, which is innervated by axillary nerve, after first 15 degrees.
Which nerves goes directly from brachial plexus?
Long thoracic nerve
Dorsal scapular
Suprascapular
Subclavius
Where is the spinal cord located in newborns?
L3. In adulthood L1-2. In fetus it takes all the vertebral canal
How is adrenal gland supplied?
Superior adrenal artery - from phrenic
Middle adrenal artery - from aorta
Inferior adrenal artery - from renal artery
Which muscle divides subclavian artery?
Anterior scalene
Which dermatome is responsible for knee area?
L3
Which nerve roots flexes and extend the hip?
Flexion - L2, L3
Extension - L4, L5
Arterial supply of lacrimal gland?
Ophthalmic artery
The most common site of congenital diaphragmatic hernia?
Bochdalek space
Projection of Inferior mesenteric artery?
L3
Formation of IVC?
L5 (union of common iliac veins)
How does the persistent left-sided SVC drains to the heart?
via coronary sinus
The most susceptible cranial nerve for raised ICP?
Abducens CN VI. It has a long intracranial course. It also passes over the petrous temporal bone, so can be damaged in mastoiditis.
Which structure is not located in superficial perineal space in females?
Pudendal nerve. It lies in the deep perineal space
Which of the laryngeal tumours will not typically metastasise to deep cervical nodes?
Glottic. The vocal cords have no lymphatic draingage
Blood supply to rectum?
Superior rectal artery - inferior mesenteric artery
Middle rectal artery - internal iliac artery
Inferior rectal artery - internal pudendal artery
Mnemonic for layers of testis?
Some (skin) Damned (dartos) Examiner (externa; spermatic fascia) Called (cremasteric fascia) It (internal spermatic fascia) The (tunica vaginalis) Testis.
Some Damned Examiner Called It The Testis
Which muscles are inserted to the greater trochanter?
POGO
Piriformis
Obturator internus
Gemelli
Obturator externus
From which roots phrenic nerve is dervied?
C3,4,5
Keeps the diaphragm alive!
Which nerves are at risk during carotid endarterectomy?
Hypoglossal
Greater auricular
Superior laryngeal
Structures of sciatic foramens?
Lesser:
Posterior cutaneous nerve of the thigh
Inferior gluteal artery, nerve
Nerve to quadratus femoris
Pudendal nerve
Internal pudendal artery and vein
Nerve to obturator internus
Sciatic nerve
PIN PINS
What is the most important structure involved in supporting the uterus?
Central perineal tendon. Provides main support to the uterus. Damage is associated with a prolapse.
Which muscle at the hand is innervated by median?
abductor policis brevis
Which artery goes anterior to the lowest part of the pancreas? (uncinate)
Superior mesenteric
Which structure lies medial to arteria dorsal pedia?
Tendon of extensor hallucis longus. Laterally - extensor hallucis brevis muscle
Abdominal incision for renal transplant?
Rutherford Morrison
- Embryological aortic arches???
- Embryological aortic arches???1+2 - disappears early. 1 - maxillary artery. 2 - external carotid artery.3 - internal carotid artery4 - right - right subclavia, left - arch of the aorta5 - regresses6 - pulmonary artery, ductus arteriosus
Origins of triceps?
Long head - infraglenoid tubercle
Medial head - posterior surface of the humerus inferior to radial groove
Lateral head - posterior surface of the humerus superior to radial groove
How is the inguinal ligament formed?
From external oblique aponeurosis
Auscultation points?
Pulmonary - 2 left
Aortic - 2 right
Mitral - 5 left medial to mid clavicular line
Tricuspid - 4 left at the lower sternal border
Innervation of external anal sphincter?
S2,3,4 Keeps poo of the floor
60% of supply to the breast is derived from?
Internal mammary artery
Which finger does not have interossei muscle?
3
At which level superior mesenteric artery branches from aorta?
L1
Which of the nerves listed below is directly responsible for the innervation of the lateral aspect of flexor digitorum profundus?
Ulnar nerve
Anterior interosseous nerve
Radial nerve
Median nerve
Posterior interosseous nerve
The anterior interosseous nerve is a branch of the median nerve and is responsible for innervation of the lateral aspect of the flexor digitorum profundus.
Which of the following statements relating to the knee joint is false?
It is the largest synovial joint in the body
When the knee is fully extended all ligaments (bar the anterolateral aspect of the posterior cruciate ligament) of the knee joint are taut
Rupture of the anterior cruciate ligament may result in haemarthrosis
The posterior aspect of the patella is extrasynovial
The joint is innervated by the femoral, sciatic and obturator nerves
The posterior aspect is intrasynovial and the knee itself comprises the largest synovial joint in the body. It may swell considerably following trauma such as ACL injury. Which may be extremely painful owing to rich innervation from femoral, sciatic and ( a smaller) contribution from the obturator nerve. During full extension all ligaments are taut and the knee is locked.
In a patient with an ectopic kidney where is the adrenal gland most likely to be located?
In the pelvis
On the contralateral side
In its usual position
Superior to the spleen
It will be absent
Because the kidney is present, rather than absent, the adrenal will usually develop and in the normal location.
An 18 year old man is cutting some plants when a small piece of vegetable matter enters his eye. His eye becomes watery. Which of the following is responsible for relaying parasympathetic neuronal signals to the lacrimal apparatus?
Pterygopalatine ganglion
Otic ganglion
Submandibular ganglion
Ciliary ganglion
None of the above
The parasympathetic fibres to the lacrimal apparatus transit via the pterygopalatine ganglion.
A 28 year old man is stabbed outside a nightclub in the upper arm. The median nerve is transected. Which of the following muscles will demonstrate impaired function as a result?
Palmaris brevis
Second and third interossei
Adductor pollicis
Abductor pollicis longus
Abductor pollicis brevis
Palmaris brevis - Ulnar nerve
Palmar interossei- Ulnar nerve
Adductor pollicis - Ulnar nerve
Abductor pollicis longus - Posterior interosseous nerve
Abductor pollicis brevis - Median nerve
T
he median nerve innervates all the short muscles of the thumb except the adductor and the deep head of the short flexor. Palmaris and the interossei are innervated by the ulnar nerve.
At which of the following levels does the inferior thyroid artery enter the thyroid gland?
C6
C2
C4
C3
C5
It enters the gland at C6.
What is the lymphatic drainage of the male spongy urethra?
External iliac nodes
Internal iliac nodes
Para aortic nodes
Deep inguinal nodes
Meso rectal nodes
The lymphatic drainage of the spongy urethra and the glans penis is to the deep inguinal nodes. The prostatic and membranous urethra drains to the internal iliac nodes.
Which of the muscles listed below is attached to the anterior aspect of the fibrous capsule that encases the elbow joint?
Pronator teres
Biceps
Brachialis
Triceps
Extensor carpi radialis longus
The brachialis inserts some of its fibres into the fibrous joint of the elbow capsule and when it contracts, it helps to flex the joint.
A 78 year old lady falls over in her nursing home and sustains a displaced intracapsular fracture of the femoral neck. A decision is made to perform a hemi arthroplasty through a lateral approach. Which of these vessels will be divided to facilitate access?
Saphenous vein
Superior gluteal artery
Superficial circumflex iliac artery
Profunda femoris artery
Transverse branch of the lateral circumflex artery
During the Hardinge style lateral approach the transverse branch of the lateral circumflex artery is divided to gain access. The vessels and its branches are illustrated below:
A 10 year old child has a grommet inserted for a glue ear. What type of epithelium is present on the external aspect of the tympanic membrane?
Stratified squamous
Ciliated columnar
Non ciliated columnar
Non stratified squamous
None of the above
The external aspect of the tympanic membrane is lined by stratified squamous epithelium. This is significant clinically in the development of middle ear infections when this type of epithelium may migrate inside the middle ear.
During a neck dissection, a nerve is noted to pass posterior to the medial aspect of the first rib. Which of the nerves listed below is this most likely to be?
Medial cord of the brachial plexus
Long thoracic nerve
Nerve to subclavius
Medial pectoral nerve
Phrenic nerve
The key point is that the phrenic nerve runs posterior to the medial aspect of the first rib. Superiorly, it lies on the surface of scalenus anterior.
A 45 year old motor cyclist sustains a tibial fracture and is noted to have anaesthesia of the web space between his first and second toes. Which of the nerves listed below is most likely to be compromised?
Superficial peroneal nerve
Deep peroneal nerve
Sural nerve
Long saphenous nerve
Tibial nerve
The deep peroneal nerve lies in the anterior muscular compartment of the lower leg and can be compromised by compartment syndrome affecting this area. It provides cutaneous sensation to the first web space. The superficial peroneal nerve provides more lateral cutaneous innervation.
A 44 year old man is undergoing a parotidectomy and the surgeon is carefully preserving the facial nerve. Unfortunately his trainee then proceeds to divide it. Which of the following will not be affected as a result?
Taste sensation from anterior two thirds of the tongue
Closing the ipsilateral eyelid
Raising the ipsilateral side of the lip
Ipsilateral corneal reflex
Buccinator muscle
The chorda tympani branches inside the facial canal and will therefore be unaffected by this most unfortunate event! The corneal reflex is mediated by the opthalmic branch of the trigeminal nerve sensing the stimulus on the cornea, lid or conjunctiva; the facial nerve initiates the motor response of the reflex.
Which of the following is true in relation to the sartorius muscle?
Innervated by the deep branch of the femoral nerve
Inserts at the fibula
It is the shortest muscle in the body
Forms the Pes anserinus with Gracilis and semitendinosus muscle
Causes extension of the knee
It is innervated by the superficial branch of the femoral nerve. It is a component of the pes anserinus.
Which cranial nerve provides general sensation to the anterior two thirds of the tongue?
Facial
Trigeminal
Hypoglossal
Vagus
Glossopharyngeal
Taste to the anterior two thirds of the tongue is supplied by the facial nerve, the trigeminal supplies general sensation, this is mediated by the mandibular branch of the trigeminal nerve (via the lingual nerve).
A 24 year old lady is stabbed in the buttock. Following the injury the wound is sutured in the emergency department. Eight weeks later she attends the clinic, as she walks into the clinic room she has a waddling gait and difficulty with thigh abduction. On examination she has buttock muscle wasting. Which nerve has been injured?
Superior gluteal nerve
Obturator nerve
Sciatic nerve
Femoral nerve
Inferior gluteal nerve
Damage to the superior gluteal nerve will result in a Trendelenburg gait.
Which of the following bones is related to the cuboid’s distal articular surface?
All metatarsals
5th metatarsal
Calcaneum
Medial cuneiform
3rd metatarsal
The cuboid is located at the lateral aspect of the foot between the calcaneus posteriorly and the 4th and 5th metatarsals distally.
A 24 year old man falls and sustains a fracture through his scaphoid bone. From which of the following areas does the scaphoid derive the majority of its blood supply?
From its proximal medial border
From its proximal lateral border
From its proximal posterior surface
Superficial palmar arch vessels
Dorsal carpal branch vessels
The dorsal carpal branch vessels supply 80% of the scaphoid via retrograde flow. There is a minor supply from the superficial palmar arch vessels that supplies the distal 20% of the scaphoid.
A 53 year old lady is recovering following a difficult mastectomy and axillary nodal clearance for carcinoma of the breast. She complains of shoulder pain and on examination has obvious winging of the scapula. Loss of innervation to which of the following is the most likely underlying cause?
Latissimus dorsi
Serratus anterior
Pectoralis minor
Pectoralis major
Rhomboids
Winging of the scapula is most commonly the result of long thoracic nerve injury or dysfunction. Iatrogenic damage during the course of the difficult axillary dissection is the most likely cause in this scenario. Damage to the rhomboids may produce winging of the scapula but would be rare in the scenario given.
A 72 year old man with carcinoma of the lung is undergoing a left pneumonectomy. The left main bronchus is divided. Which of the following thoracic vertebrae lies posterior to this structure?
T3
T7
T6
T10
T1
The left main bronchus lies at T6. Topographical anatomy of the thorax is important as it helps surgeons to predict the likely structures to be injured in trauma scenarios (so popular with examiners)
Which of the following nerves conveys sensory information from the laryngeal mucosa?
Glossopharyngeal
Laryngeal branches of the vagus
Ansa cervicalis
Laryngeal branches of the trigeminal
None of the above
The laryngeal branches of the vagus supply sensory information from the larynx.
What is the nerve supply to the muscle indicated by an X on the prosection below?
CN XI
CN IX
Median pectoral nerve
Lateral pectoral nerve
Suprascapular nerve
Be careful not to confuse CN IX with CN XI
The muscle indicated is trapezius and it is innervated by the accessory nerve (CN XI)
Which of the following nerves is responsible for the motor innervation of the sternocleidomastoid muscle?
Ansa cervicalis
Accessory nerve
Hypoglossal nerve
Facial nerve
Vagus nerve
The motor supply to the sternocleidomastoid is from the accessory nerve. The ansa cervicalis supplies sensory information from the muscle.
A 21 year old man undergoes surgical removal of an impacted 3rd molar. Post operatively, he is noted to have anaesthesia on the anterolateral aspect of the tongue. What is the most likely explanation?
Injury to the hypoglossal nerve
Injury to the inferior alveolar nerve
Injury to the lingual nerve
Injury to the mandibular branch of the facial nerve
Injury to the glossopharyngeal nerve
The lingual nerve is closely related to the third molar and up to 10% of patients undergoing surgical extraction of these teeth may subsequently develop a lingual neuropraxia. The result is anaesthesia of the ipsilateral anterior aspect of the tongue. The inferior alveolar nerve innervates the teeth themselves.
