High Yield Anatomy Supplement Flashcards
What are the names for the junctions of the parietal bones with the frontal bone and occipital bone on the scalp?
Anterior - Bregma
Posterior - Lambda
What are Galludet’s and Buck’s fascia?
Buck’s fascia - Deep Fascia of Penis - directly covers the corpus cavernosa / spongiosum
Galludet’s - Deep perineal fascia - covers the ischiocavernosus and bulbospongiosus muscles which lie overtop of Buck’s fascia
What is Colle’s vs Darto’s fascia?
Both are superficial perineal fascia, which form a compartment between Galludet’s (Deep) and this superficial layer.
Darto’s is only present in males and is superficial perineal fascia which contains SMOOTH MUSCLE around the scrotum, involved in temperature regulation.
What is Darto’s continuous with superiorly?
Scarpa’s fascia. Thus, a cut of the anterior chest wall can lead to bleeding which seeds downward and leads to swelling around penis and scrotum.
What are the boundaries of the femoral triangle? What structures are contained within it?
Laterally - Sartorius muscle
Medially - Adductor longus muscle
Superiorly - Inguinal ligament
Includes nerve, artery, vein, and lymphatic (NAVL)
What is the femoral sheath and what structures are contained within it?
Sheath made by transversalis fascia which surrounds the artery, vein, and lymphatics of the structures in the femoral triangle, but NOT the nerve
What is the femoral canal and why is it clinically relevant?
Medial-most part of femoral sheath which contains the lymphatics
-> this is the site of femoral hernia, a type of hernia more common in females.
Weakness in the communication of the abdomen with the leg here.
What are the boundaries of Hesselbach’s triangle?
This is the inguinal triangle, where direct inguinal hernias occur
Laterally - inferior epigastric vessels, arising from the external iliac artery before it becomes femoral artery under the inguinal ligament
Medially - Lateral border of rectus abdominis muscle
Inferiorly - Inguinal ligament
What is the femoral ring?
The proximal opening of the femoral canal into the abdominal cavity -> contains lymphatics
What two female structures are derived from the gubernaculum?
Remember, the gubernaculum is the structure responsible for pulling the gonads into their spot. Pulls the testes into the scrotum in males.
- Ovarian ligament - attaches to the inferior pole of the ovary, and latches to the uterine fundus (near junction of fallopian tubes with uterus)
- Round ligament - goes through the “round” inguinal canal. Extends from same spot on uterine fundus, all the way to the labia majora. So it’s almost like the ligament got pasted on there.
What is the cardinal ligament and what is contained within it?
Ligament in the base of the broad ligament which holds the uterine artery and ureter. Ureter may be ligated during hysterectomy as uterine vessels are ligated (water goes under the bridge).
What is the infundibulopelvic ligament? What happens if it gets twisted and how can this happen?
The other name for the suspensory ligament of the ovary which attaches to the superior pole. Contains the ovarian vessels.
Ovarian torsion - Can get twisted if there is an ovarian cyst or mass
-> will cause acute onset unilateral pelvic pain and edema / ischemia of ovary, with possible infarct
What structures form the pelvic diaphragm?
- Levator ani, consists of: Pubococcygeus, iliococcygeus, puborectalis (maintains fecal continence)
- Coccygeus muscle
How is cauda equina syndrome told apart from pudendal nerve injury? What typically causes each?
Cauda equina is generally much more painful, involves structures other than the S2-S4 dermatomes (e.g. there will be foot drop hyporeflexia), and bladder / fecal incontinence will happen much later than in pudendal nerve injury.
Cauda equina - Tumor or intervertebral disc hernation which impinges on cord below conus medullaris
Pudendal - stretch injury during childbirth
What is the function of the superior laryngeal nerve? What does it pass thru?
It is a branch of the vagus nerve
Internal branch - pure sensory - it branches thru thyrohyoid membrane to supply sensory to the larynx and aryepiglotic folds above the vocal cords
External branch - smaller, pure motor - supplies the cricothyroid muscle only
How does the cough reflex differ from the gag reflex?
Cough reflex - afferent is the internal branch of the superior laryngeal nerve (CNX), causes coughing due to URT irritation
Gag reflex - afferent is glossopharyngeal nerve (CNIX) due to touching pharynx / back of throat
What arteries / structures do the superior and inferior laryngeal nerves relate to?
Superior laryngeal nerve - relates to superior thyroid artery, especially the external branch
Recurrent laryngeal nerve - relates to the inferior thyroid artery. Wraps around brachiocephalic artery on the right and arch of the aorta on the left #1747
How can the internal branch of the superior laryngeal nerve be damaged?
Via sharp objects or damage upon attempted removal of sharp objects in the piriform recess -> nerve is very superficial underneath the mucosa on the lateral wall of this recess
What will damage to the external branch of the superior laryngeal nerve do?
Causes monotonous voice -> cricothyroid muscle is responsible for raising voice pitch.
What nerve roots give rise to the iliohypogastric nerve and how can it be damaged? What are the symptoms?
T12-L1
-> Damaged via abdominal surgery, especially appendectomy
Functions:
Motor - Abdominal wall muscles
Sensory - Suprapubic region + lateral gluteal region
Symptoms - burning / tingling radiating to inguinal / suprapubic regino
What nerves control erection in males and where do they travel?
Cavernous nerves (S2-S4), autonomics from the inferior hypogastric plexus
- > travel in the prostatic venous plexus, can be damaged in prostate surgery and cause erectile dysfunction
- > # 11800
What is the most distinctive way to tell femoral hernias apart from inguinal hernias, anatomically?
Femoral hernias lie INFERIOR to the inguinal ligament, and thus abdominal contents are protruding thru the femoral ring into the femoral canal (most medial portion of femoral sheath, a part of the femoral triangle)
Inguinal hernias lie ABOVE the inguinal ligament, and are either medial (direct) or lateral (indirect) to the inferior epigastric vessels, a branch of the external iliac before it becomes the femoral artery below the inguinal ligament
What type of hernia is most prone to strangulation / incarceration?
Femoral hernia is most likely to have both, since herniations thru the femoral ring are not easily reducible by compression
Incarceration - lack of ability to reduce
Strangulation - loss of blood supply due to obstruction and prolonged strangulation
What are the dependent segments of the lungs when the patient is in supine position?
Posterior segments of upper lobes
Superior segments of lower lobes
#2102
What do the superficial inguinal nodes drain, in general? What are the exceptions?
All skin below the umbilicus, the anal canal below the pectinate line, as well as scrotum / vulva
Exceptions - glans penis and popliteal node chain
Where do the glans penis / popliteal nodes drain?
They bypass the superficial inguinal nodes and drain directly into the deep inguinal nodes
Where are the deep inguinal nodes located and what drains into them?
Located in the femoral region, deep inside the femoral canal and then going inward (think NAVL with emphasis on that L).
All of the superficial inguinal nodes drain into them, as well as the lymph from the glans penis / popliteal nodes which drain directly into them
Why do we say that the veins of leg drain into superficial nodes and arteries into deep nodes?
Superficial inguinal nodes - follow the saphenous vein - medial leg including medial foot drains into superficial inguinal nodes, bypassing popliteal nodes
Deep inguinal nodes - drainage follows the popliteal artery and its branches - drains the lateral leg, dorsolateral foot, and posterior calf. Popliteal lymph nodes will also be enlarged from infections of the lateral foot. #11830
What nodes drain the lymph to the lower rectum above the pectinate line?
Although there is some IMA contribution, much of it follows the middle rectal vein to drain into the internal iliac nodes. It is not entirely the IMA since your kneejerk reaction is that the primary artery supplying the rectum above the dentate line is the superior rectal artery, a branch of the IMA. Remember that the middle rectal artery is a branch of the internal iliac and also partially supplies the area above the dentate line.
What provides sensation to the external ear canal? Why is this relevant?
Mostly the auriculotemporal nerve (V3)
However, posterior part of external canal receives innervation from Vagus nerve -> can cause vasovagal syncope if stimulated #1814
What do the epicardial vessels refer to? Are they what’s being dilated in the coronary steal syndrome? What does coronary steal refer to?
Refers to the very large vessel branches on the surface of the heart, not the smaller coronary arteries and arterioles which branch into the myocardium
- > NO, these are not what’s the problem in coronary steal
- > problem in coronary steal is dilation of all smaller vessels -> diversion of blood away from ischemic tissue
- > induces ischemia in myocardium downstream a stenosis which is reliant on collaterals, which are only well perfused due to relative vasoconstriction of other vessels
Generalized vasodilation inducible by dipyridamole / adenosine
What vessel is responsible for hemorrhage secondary to posterior duodenal ulcer? How about lesser curvature gastric ulcer?
Duodenal ulcer - gastroduodenal artery, a branch of the common hepatic
Lesser curvature - Left gastric artery
Where are the three lines and at what ribs can you insert the needle for thoracentesis?
Midclavicular line - between ribs 6 and 8 -> insert above 8th
Midaxillary line - between ribs 8 and 10 -> insert above 10th rib
Paravertebral line (posteriorly) - between ribs 10 and 12 -> insert above 12th rib
See #844 if confused
What is the underlying pathophysiology of direct inguinal hernia and who is it classic in?
Classic in older men due to repetitive connective tissue damage
Due to weakpoint in transversalis fascia “directly through the weakpoint”
What is the underlying pathophysiology of indirect inguinal hernia and who is it classic in?
Pathophysiology - patent processus vaginalis
Classically seen in male infants #8669
What condition can occur distal to the dentate line, posteriorly, related to constipation and high anal pressures?
Anal fissures - leads to severe bleeding
-> occurs posteriorly due to poor perfusion
Associated with low fiber diets and constipation
What is superior mesenteric artery syndrome and what causes it?
Diminished mesenteric fat -> decreased angle between superior mesenteric artery and 3rd part of duodenum
-> acute small bowel obstruction
Can also be caused by correction of scoliosis
What nerve is characteristically impinged in piriformis syndrome? What causes this?
Sciatic nerve -> can cause sciatica-like symptoms
Caused my hypertrophy or inflammation of the piriforms muscle, impinges sciatic nerve as it exit below it in the greater sciatic foramen (above sacrospinous ligament)
What is the pathogenesis of apple peel deformity in a neonate?
319
Jejunal / ileal ischemia -> necrosis and failure to properly develop a section of small intestine.
This results in an atretic blind pouch proximally, and distally the small bowel will wrap around a segment of the ileocolic artery. This results in something that looks like a “apple peel” or “Christmas tree” twirled around the central artery.
What is a common site for the radial artery to get injured to cause “finger drop” with preservation of triceps / ECRL, but relative weakness of other extensors? What causes it?
Supinator canal -> anterior to the elbow, where the deep branch of the radial nerve dives in and then emerges as the posterior interosseous nerve
Due to repetitive pronation and supination (i.e. using a screwdriver)
Will hand sensation be affected in finger drop?
No -> the superficial branch of the radial nerve is what supplies the dorsal surface of the hand
What vessel serves as a good indicator of right atrial pressure?
Coronary sinus - since it communicates freely with the right atrium (junction of IVC and near the tricuspid valve orifice) -> will become dilated with increased right atrial pressures
-> #2124
Where will pain from phrenic nerve irritation refer to?
Shoulder area -> innervated by supraclavicular area (C3, C4)
-> phrenic nerve distribution is C3/C4
What is the more medial of the two bones which articulates with the radius?
Lunate.
(Scaphoid is the other one, and is more lateral).
Where does the lymph of the vagina drain?
Lower 1/3 - derived from UG sinus -> superficial inguinal nodes
Upper 2/3 - derived from Mullerian ducts -> internal iliac nodes
Where are the leads for a biventricular pacemaker generally placed?
Generally there are three: 1. Right atrium 2. Right ventricle 3. Left ventricle - via entering thru the coronary sinus and wrapping around the lateral venous tributaries #7646
Where does the coronary sinus sit?
The atrioventricular groove u fkboy #7646
How far does the bladder extend?
Far anteriorly, can be seen overtop of the pubic symphysis in its most anterior portion #1737
What are the two watershed areas of the intestines which are most susceptible to infarct?
- Splenic flexture - junction of SMA / IMA
- Rectosigmoid junction - junction of sigmoid artery and superior rectal artery of IMA
#413
What delivers the sympathetics vs parasympathetics of the face?
Sympathetics - travel on the artery plexuses to innervate their targets (i.e. for sweating of the face)
Parasympathetics - travel with the nerves (i.e. facial nerve to lacrimal, sublingual, and submandibular glands) #8329
What nerve passes between the humeral and ulnar heads of the pronator teres?
Median nerve
What is Kehr sign?
Referred pain to the shoulder due to peritoneal inflammation.
Left-sided Kehr sign is a classic symptom of splenic rupture -> referred pain to C3-C5 from irritation / bleeding on diaphragm. #11753
What lobes obstruct the right heart border and left hemidiaphragm (Silhouette sign)?
Right heart border - Right middle lobe. Note that the right atrium makes the right border of the heart. #1883
Left hemidiaphragm - Left lower lobe
What obscures the left heart border and right hemidiaphragm (silhouette sign)?
Left heart border - Lingula (LUL)
Right hemidiaphragm - Right lower lobe
What structure is most likely to be injured in a posterior dislocation of the tibia relative to the femur: tibial nerve, popliteal artery, or popliteal vein/
Popliteal artery, since it is the deepest structure #6516
How do you treat axillary hyperhidrosis?
T2 sympathetic ganglion sympathectomy
Targeting only the T1 / lower cervical ganglion (stellate ganglion) would fix the hands, but not the axilla (axilla recieves sympathetics from T2 level as well, not supplied by brachial plexus)
