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GOBBLERS 2023 > Justin's Anatomy + 2018 > Flashcards

Justin's Anatomy + 2018 Flashcards

1
Q

Injury to which nerves causes “wrist drop”?
What is spinal root

A

C5-T1
Radial nerve palsy

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2
Q

Which of the following is not a branch of the femoral artery?
a. deep circumflex iliac
b. superficial epigastric
c. superficial iliac circumflex
d. superficial/deep external pudendal
e. deep femoral

A

a. deep circumflex–comes from the external iliac artery

femoral artery ends as the popliteal artery
external iliac branches before going under inguinal ligament are: inferior epigastric and deep circumflex iliac artery

Branches arising from the common femoral artery include
- superficial epigastric artery,
- superficial circumflex artery, and
- external pudendal artery.
Distal to these smaller branches, the common femoral artery bifurcates into the
- deep femoral (or profunda femoris) and
- superficial femoral artery.

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3
Q

Where does the superior mesenteric vein drain into?

A

Portal vein

The portal vein is made of the splenic vein and the superior mesenteric vein

Also in Angela’s

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4
Q

Where does the inferior mesenteric vein drain into?

A

The splenic vein

Also in Angela’s

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5
Q

Where does the superficial epigastric artery arise from?

A

The femoral artery

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6
Q

Where does the internal pudendal artery arise from?

A

The anterior division of the internal iliac artery

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7
Q

Where does the external pudendal artery arise from?

A

The femoral artery

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8
Q

Where does the deep/inferior epigastric artery arise from?

A

The external iliac artery

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9
Q

Injury to which nerves is associated with “foot drop”?

A

The common peroneal nerve (L4-S2)

Arises from the sciatic nerve

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10
Q

What are the draining lymph nodes for structures below the pectinate (or dentate) line?

A

Below the pectinate line: inguinal lymph nodes; blood supply from the middle and inferior rectal arteries

Above the pectinate line: inferior mesenteric (and internal iliac) lymph nodes; blood supply from the terminal branches of the superior rectal artery

Anal canal divided into superior and inferior segments by the pectinate line; it is formed from the inferior aspect of longitudinal folds known as the anal columns or valves. Line separates upper 2/3s from lower 1/3

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11
Q

Where does the R gastro-epiploic artery arise from?

A

The gastroduodenal artery

Which arises from the common hepatic artery which is one of the three branches from the celiac trunk (L gastric, splenic, common hepatic)

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12
Q

Which artery is transected with en-bloc rectosigmoid resection?

a. middle rectal
b. inferior rectal
c. superior rectal
d. marginal artery of Drummond

A

c. superior rectal artery

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13
Q

What are the two main arterial branches from the external iliac artery? The external artery terminates as what artery?

A

Inferior epigastric artery and deep circumflex iliac artery
Terminates as the femoral artery

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14
Q

The inferior mesenteric artery is transected, what should be done next?

A

Ligate the artery and continue with surgery; enough collateral vessels that it can be ligated without significant consequence

This is in his set twice

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15
Q

What is the course of the femoral nerve?

A

From posterior to the psoas muscle, it emerges at the lower part of the lateral border between the psoas and iliacus muscle and goes beneath the inguinal ligament to enter the femoral triangle

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16
Q

What is the origin of the middle rectal artery?

A

The anterior division of the internal iliac artery

Also in Angela’s

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17
Q

What nerves are found in the femoral triangle?

A

From lateral to medial:

Lateral femoral cutaneous nerve (L2-3)-supplies the skin on the lateral part of the thigh

Femoral nerve (L2-4)- supplies quadriceps, sartorius, iliacus and pectineus muscle and skin on anterior thigh; divisions=saphenous nerve, nerves to the anterior compartment of the thigh and anterior cutaneous branches

Femoral branch of the genitofemoral nerve (L1-2)-supplies the majority of the skin over the femoral triangle, and labia majora

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18
Q

What is the most common symptom after axillary lymph node dissection?
a. lymphedema
b. numbness of arm

A

b. numbness of arm

Up to 42% will have subjective/objective arm impairment after 1 year (UTD)

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19
Q

What is the most common cause of an ilioinguinal nerve injury?
a. retractor placement
b. transverse incision
c. hyperflexion

A

b. transverse incision

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20
Q

What is the main blood supply of the jejunum?

A

Superior mesenteric artery

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21
Q

Which of the following does NOT share collateral blood supply with the inferior mesenteric artery?

a. superior mesenteric artery
b. internal iliac artery
c. external iliac artery

A

c. external iliac artery

superior mesenteric artery and inferior mesenteric artery communicate via the marginal artery of Drummond; splenic flexure is at risk of ischemia

internal iliac artery and inferior mesenteric artery communicate between the superior and middle/inferior rectal arteries

external iliac artery does not share any blood supply with the inferior mesenteric artery

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22
Q

What are the borders of the femoral triangle?

A

Inguinal ligament (superior), sartorius muscle (lateral), adductor longus (medial)

Floor (from lateral to medial): iliopsoas, pectineus muscle
Roof: fascia lata and cribiform fascia, subcutaneous tissue, skin

Contents: NAVL; femoral nerve*, artery**, vein (greater saphenous vein is at inferior portion), lymphatics

*all nerves lateral to medial: lateral femoral cutaneous nerve, femoral nerve, femoral branch of the genitofemoral nerve
**all vessels: superficial circumflex iliac, superficial inferior epigastric, superficial and deep external pudendal artery

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23
Q

There is a nerve injury at the lateral edge of an inguinal lymph node dissection, what nerve is injured and what is the consequence?
a. unable to adduct thigh
b. unable to extend knee
c. unable to abduct thigh
d. unable to dorsiflex or plantarflex foot

A

The femoral nerve is injured
Consequence: can’t extend knee (b)

adduct thigh: obturator n.
abduct thigh: superior gluteal n.
dorsiflex/plantarflex foot: common peroneal/tibial

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24
Q

What is the consequence of an obturator nerve injury?

A

Loss of adduction, can’t cross/close legs (motor only)

Can’t ride a horse !

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25
Q

What is the consequence of a genitofemoral nerve injury?

A

Loss of sensation to ipsilateral mons and labia majora, loss of sensation to upper anterior thigh (sensory only)

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26
Q

What is the consequence of a femoral nerve injury?

A

Loss of hip flexion, knee extension, deep tendon reflexes of the knee (motor)
Loss of sensation to anteriomedial thigh/leg/foot (sensory)

Femoral nerve arises from L2-4

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27
Q

Which artery has collateral circulation with the obturator artery?

A

Inferior epigastric artery

Obturator artery comes from the anterior division of the internal iliac artery

Inferior epigastric artery comes from the external iliac artery

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28
Q

You encounter brisk bleeding during a deep pelvic lymph node dissection, what have you encountered?

A

The accessory obturator vein

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29
Q

What are the branches of the internal iliac artery?

A

Anterior division: obturator, umbilical, uterine (vaginal) superior vesicular (inferior vesicular) middle rectal, internal pudendal, inferior gluteal

“Oranges Under Some Ice Might Peel”

Posterior division: iliolumbar, lateral sacral superior gluteal

“I like Spaghetti(Sex)”

Also in Angela’s

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30
Q

What are the branches of the superior mesenteric artery?

A

Inferior pancreatico-duodenal
Jejunal/Ileal branches
Ileocolic
R colic
M colic

31
Q

What are the branches of the inferior mesenteric artery?

A

L colic artery
Sigmoidal branches
Superior rectal artery

32
Q

What are the branches of the celiac trunk?

A

Common hepatic–>R gastric, gastroduodenal (R gastro-epiploic, duodenal branches, anterior/posterior superior pancreaticoduodenal), proper hepatic

L gastric

Splenic–>short gastrics, L gastro-epiploic, pancreatic branches

33
Q

What blood vessel is most likely to be damaged during diaphragm stripping?

A

Phrenic artery

34
Q

What is the blood supply to the lesser omentum?

A

L gastric artery (and right too….?)

Arises from celiac trunk

35
Q

What blood supply is used during gracilis flap formation?

A

Medial circumflex femoral artery

36
Q

What forms the base of the femoral triangle?
a. adductor longus
b. pectineus
c. Sartorius

A

b. pectineus

37
Q

What artery is found in the inguinal triangle?

A

Inferior epigastric artery
Arises from external iliac artery

Borders: medial–lateral border of the rectus abdominis muscle; lateral–inferior epigastric vessels; inferior–inguinal ligament

Referred to as Hesselbach’s Triangle

38
Q

Which of the following has the most collateral circulation with the inferior mesenteric artery?
a. external iliac
b. internal iliac
c. inferior pancreaticoduodenal

A

b. internal iliac (middle rectal from anterior division of internal iliac, inferior rectal from internal pudendal from anterior division of internal iliac; Superior rectal from inferior mesenteric artery)

inferior pancreatico-duodenal comes from the superior mesenteric artery which does share the marginal artery of Drummond with the inferior mesenteric artery

39
Q

What vessels are encountered in the femoral triangle?

A

Superficial circumflex iliac, superficial inferior epigastric, superficial and deep external pudendal arteries

40
Q

What nerve injury is associated with numbness over the thigh after a pelvic lymph node dissection?

A

Genitofemoral nerve

41
Q

Which of the following is NOT a branch of the femoral artery?

a. superficial circumflex iliac artery
b. superficial inferior epigastric artery
c. deep circumflex iliac artery
d. superficial external pudendal artery
e. deep external pudendal artery

A

c. deep circumflex iliac artery

Arises from the external iliac artery

42
Q

What nerves are associated with Klumpke’s Palsy?

A

C8-T1
Muscles of the forearm are affected
Results in claw hand

43
Q

What nerves are associated with Erb’s Palsy?

A

C5-6
Can’t flex elbow, lift their arm–arm hangs limply from the shoulder, forearm is internally rotated, hand/wrist are flexed
Can happen from Trendelenberg
“Waiters tip”

44
Q

What nerves could be injured in a brachial plexus injury?

A

C5-T1

45
Q

Where does the splenic artery run in relationship to the pancreas?

A

Superior

46
Q

In what percentage of patient’s is the pancreas within 1cm of the splenic hilum?

A

75%

47
Q

What is another name for the lesser omentum?

A

Gastrohepatic ligament

48
Q

What are the components of the portal triad? What is the portal triad encased by?

A

Bile duct, hepatic artery, portal vein
Hepatoduodenal ligament

49
Q

What vessel supplies the sartorius muscle and tensor fascia lata?

A

Lateral femoral circumflex artery

50
Q

What separates the subclavian artery and vein?

A

Anterior scalene muscle

51
Q

What is the venous drainage above and below the pectinate line?

A

Above: Superior rectal (portal) > inferior mesenteric vein; Middle rectal > iliac (Caval)
Below: Inferior rectal/pudendal > iliac (Caval)

52
Q

Which nerves have both sensory and motor function?

A

Pudendal, obturator, femoral

pudendal: Anal and Urethral sphincter muscles

Obturator: thigh adduction

Femoral: knee extension, hip flexion

Peroneal

53
Q

What nerves provide innervation to the bladder?

A

S2-4, parasympathetic–inferior hypogastric plexus; sympathetic–superior hypogastric plexus

54
Q

What lymph nodes does the cervix drain to first?

A

Internal iliac lymph noes

55
Q

What are the boundaries of the inguinal triangle?

A

Rectus muscle, inferior epigastric artery, inguinal ligament

*This is a repeat in this deck

56
Q

Which is NOT a branch of the femoral artery?
a. superficial circumflex iliac
b. superficial inferior epigastric
c. deep circumflex iliac
d. superficial external pudendal
e. deep external pudendal

A

c. deep circumflex iliac

Comes from external iliac artery

57
Q

What ligaments are taken down during liver mobilization?

A

Falciform, coronary, R triangular

58
Q

Where is the most common watershed area of the intestine?

A

Splenic flexure

59
Q

What is the blood supply to the gracilis muscle?

A

Medial circumflex femoral artery

60
Q

What vessels are the collateral blood supply to the IMA? Select all
a. internal iliac
b. external iliac
c. pancreaticoduodenal
d. splenic

A

Internal iliac artery
Pancreaticoduodenal (from superior mesenteric artery)

*Repeat in Justin’s and Angela’s

61
Q

Where does the inferior mesenteric vein drain?

A

Splenic vein

*Repeat in Justin’s and Angela’s

62
Q

Where does the superior mesenteric vein drain?

A

Portal vein

*Repeat in Justin’s and Angela’s

63
Q

What the most significant risk for injury to the ilioinguinal nerve?

A

Transverse incision

*Repeat in Angela’s

64
Q

What muscle makes up the floor of the femoral triangle?

A

Pectineus

*Repeat

65
Q

A patient is post TLH with pelvic LND, now has numbness of the anterior thigh. What nerve was injured?

A

Genitofemoral nerve

66
Q

What muscle is the femoral nerve near?

A

Psoas

67
Q

A nerve near the psoas muscle is injured during an inguinal LND, which nerve is it?

A

Femoral nerve

68
Q

What is the most significant risk factor for femoral nerve injury?

A

Thin patient

Also self retaining retractors

69
Q

What are the presenting symptoms of a femoral nerve injury?

A

Cannot extend the knee or flex the hip

70
Q

What nerve is injured during a sartorius muscle transposition?

A

Lateral femoral cutaneous nerve

71
Q

Where does the R gastro-epiploic artery most commonly arise from?

A

From the gastro-duodenal artery

From the common hepatic artery from the celiac trunk

72
Q

What nerve injury presents with thigh numbness and inability to lift the leg?

A

Femoral nerve injury

73
Q

The middle rectal artery arises from where?

A

Anterior division of the internal iliac artery

74
Q

What muscles make up the pelvic diaphragm?

A

Pubococcygeous
Puborectalis
Iliococcygeous

NOT COCCYGEOUS

GOBBLERS 2023 (32 decks)

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