Medium Yield Flashcards
Patellofemoral joint
synovial joint between the femoral condyles and the articular surface of the patella
- forms part of the knee joint
- medial, lateral and odd facet of the posterior patella surface articulates with the medial and lateral condyles of the femur
- the lateral facet is the larger and steepest facet
- hyaline cartilage lined
- fibrous capsule and synovial membrane continuous with knee joint
Ligaments:
- quadriceps tendon continuing to become the patella tendon
- medial and lateral patellar retinaculum
- medial patellofemoral ligament
relations:
anterior: patella
posterior: femoral condyles and intercondylar groove
inferior: patellar tendon, infrapatella bursa, infrapatellar fat pad, knee joint
superior: suprapatellar bursa, quadriceps tendon
blood supply:
superior medial and lateral geniculate arteries
inferior medial and lateral geniculate arteries
descending geniculate bracnhes
innvervation
femoral, tibial, common peroneal and obturator nerves
variants bipartite or multipartite patella absent patella variable patellar shape and position dorsal defect of the patella
Fifth lumbar vertebrae
5th lumbar vertebrae (L5) is the last of the 5 lumbar vertebrae
- atypical lumbar vertebrae
- broadest and biggest kidney shaped vertebral body
- contributes to lumbar lordosis with wedging of the posterior body height in relation to the front
- thick and broad lamina
- broad transverse processes
- short thick single spinous process
- supeior and inferior facets joints
articulations
- S1 via the L5/S1 intervertebral disc
- L4 via the L4/5 intervertebral disc
- superior facet of L5 articulates with L4 inferior facets
- inferior facet of L5 articulates with superior facet of S1
relations
anterior: anterior longitudinal ligament
posterior: posterior longitudinal ligament, ligamentum flava, interspinous ligament, supraspinous ligament, external vertebral venous plexus
lateral: iliolumbar ligament, lumbar fascia, quadratus lumborum muscle, intertransverse ligament
superior: L4/5 disc
inferior: L5/S1 disc
central: vertebral foramen, cauda equina, basivertebral and internal vertebral venous plexus
Scaphoid
the radial most carpal bone in the proximal carpal row of the wrist
- boat shaped
- oblique axis with long axis directed to base of 1st MT
- proximal and distal pole with a waist in the middle
- ventral surface: scaphoid tubercle
- forms part of the carpal tunnel
blood supply
- recurrent branches from the radial artery
- inserts via perforators in the dorsal aspect near the tubercle and waist, retrograde flow into the proximal pole
- makes the proximal pole susceptible to avascular necrosis
ligaments radioscaphoid ligament dorsal radiocarpal ligament scapholunate ligament flexor retinaculum radioscapholunate ligament radial collateral ligament
articulations
radioscaphoid
scapho-lunate
scaphoid with the trapezius, trapezoid and capitate
variants bipartite scaphoid absent scaphoid scapholunate coalition hypoplastic scaphoid
diaphragm
diaphragm is a musculotendinous sheet which encloses the inferior thoracic aperture
- arises from the circumference of the inferior thorax and coverge to the central tendon
- 3 major openings:
> vena caval (T8), oesophageal (T10), aortic hiatus (T12) - minor openings:
> 2 right crus for greater and lesser right splanchnic nerves
> 3 left crus for greater and lesser splanchnic nerves, hemiazygos vein
> median arcuate: sympathetic trunk
> lateral : subcostal nerve and vessels
> left phrenic nerve pierces through left hemidiaphragm - arises from muscle slips from different origins:
sternal (xiphoid)
costal (inner surfaces of lower 6 costal cartilages interdigitating with transversus abdominus muscle)
lumbar: lumbocostal arches and from the lumbar crura
lumbocostal arches: medial arcuate ligament - L2 vertebral body - L1-2 transverse process lateral arcuate ligament - L1 transverse process
crura: right crus - L1-3 left crus - L1-2
blood supply
- lower 5 intercostal arteries, subcostal arteries
- right and left inferior phrenic arteries
- superior phrenic artery and musculophrenic artery
innervation
phrenic nerves C3-5
lower intercostal nerves
variant muscle slips scalloped or serrate appearance dromedary diaphragm accessory diaphragm morgagni hernia bochdalek hernia eventration
Basal ganglia
group of grey matter nuclei interconnected with cerebral cortex, thalami and brain stem
corpus striatum
- caudate, putamen, globus pallidus (internus and externus)
2 other functional nuclei:
subthalamic nuclei and substantia nigra
caudate
- ventral most nucleus
anteromedially forms the lateral border of the frontal horn of the lateral ventricles
- laterally bounded by the anterior limb of the internal capsule
- inferior border terminates at the level of the temporal horn of the lateral ventricle
putamen and globus pallidus
- lentiform nucleus due to its shape
- laterally bound by the external capsule
- medially by the body and posterior limb of the internal capsule
arterial
- recurrent Heubner artery
- medial and lateral lenticulostriate arteries
venous
- thalamostriate veins
- internal cerebral vein
- vein of Galen
- inferior sagittal sinus
Variant Heubner can be from A1 or M1 segment Variable venous drainage Asymmetrical size of nuclei Dysgenesis of one or more nuclei
Nasal cavity- arterial supply
Arterial supply of the nasal cavity could be divided into multiple areas
Rich arterial supply with 2 main areas of anatomosis
Nasal septum:
- superior: anterior and posterior ethmoidal arteries
- postero-inferiorly: sphenopalatine arteries
- anterior: greater palatine artery
Floor:
- superior labial
- greater palatine
Lateral wall:
- superior: anterior and posterior ethmoidal arteries
- middle and inferior: sphenopalatine artery
- posterior: pharyngeal artery
Anastomosis:
Woodruff area:posterolateral nasal cavity
- pharyngeal and sphenopalatine
Kiesselbach area:
- anterior
- greater palatine, superior labial, anterior ethmoid, sphenopalatine
Breast
paired apocrine glands. functionally different in post partum females for milk production
- paired glands in the anterior chest
- extends from 2nd to 6th rib (variable)
- composed of glandular and adipose tissue
- held by suspensory ligaments of cooper
- 14-18 lactiferous lobes which drain into lactiferous ducts which drain into the nipple-areolar complex
- multiple openings in the nipple
- overlies pect major
relations:
superior: clavicle
inferior: middle of sternum
lateral: mid axillary line
medial: sternum
arterial
- internal mammary
- lateral thoracic artery
- intercostal arteries 3rd to 8th perforators
- thoracoacromial artery
- vessels to serratus anterior
veins
- internal mammary
- axillary
- posterior intercostal veins
lymphatics
- axillary: via sappey’s plexus and satellite lymphatics to the inferior border of pect major to pect grp of lymph nodes
- internal mammary: drains medial and lateral breast, dives into pec major muscle and may connect to the contralateral breast
- retromammary: posterior aspect of breast
- may drain into the rectus sheath
- subhepatic or subperitoneal plexi
nerves
- intercostal nerves T3-5
- supraclavicular nerve
variants
polymastia
amastia
polythelia
Mediastinum superior to T5
Mediastinum superior to T5 lies above the transthoracic plane is known as the superior mediastinum
boundaries:
anterior: sternum, costal cartilages T1-4
lateral: 1st to 4th ribs
posterior: T1-4 vertebral bodies, intervertebral discs
inferior: transthoracic plane
superior: thoracic inlet
contents:
viscera:
- right and left lung
- right and left lung pleura
- thymus
- oesophagus
- trachea
neurovascular:
- sympathetic trunk
- phrenic nerves
- vagus nerves
- azygos vein
- superior vena cava
- bilateral brachiocepahlic veins
- right brachiocephalic trunk
- aortic arch
- left subclavian and common carotid arteries
- left superior intercostal vein
muscles:
- sternohyoid
- sternothyroid
- longus colli
Superior mesenteric vein
the superior mesenteric vein is the major venous drainage midgut
- originates from the mesenteric venous arcades to form the jejunal and ileal veins within the small bowel mesentery
- runs on the right of the superior mesenteric artery
- anterior to 3rd part of duodenum and unicate process of the pancreas
- gastrocolic trunk drains to right of SMV just anterior to unicate process
- posterior to neck of pancreas
- confluence with the splenic vein to form the portal vein behind the neck of pancreas
tributaries
- jejunal and ileal veins
- right colic vein
- ileocolic vein
- inferior pancreaticoduodenal vein
- gastrocolic trunk: middle colic vein, right gastroepiploic vein and anterior superior pancreaticoduodenal vein
Variant
- absent common trunk
- malrotation
- venous tributaries drain directly into splenic vein
Basilar artery
the basilar artery forms the posterior circulation of the brain
- right and left vertebral artery confluence at the lower border of the pons to form the basilar artery
- supplies the medulla, pons, cerebellum with multiple branches
- runs in the central groove of the pons towards the midbrain within the pontine cistern
- terminates at the upper border of the pons as the right and left posterior cerebral arteries
branches:
- pontine arteries
- anterior inferior cerebellar arteries
- posterior cerebral arteries
- superior cerebellar artery
- labyrinthine artery
variants
- basilar tip aneurysm
- basilar artery fenestration
- right or left dominant vertebral artery
- single vertebral artery origin
- persistent carotid-basilarvertebral communications
> otic, proatlantal, hypoglossal, trigeminal
Cerebral venous drainage
Cerebral vein drain the brain parenchyma in the subarachnoid space.
can be divided into superficial and deep cerebral veins.
Superficial:
- comprised of sagittal sinuses (superior) and cortical veins
- numerous cortical veins,
- large veins can be identified according to superior, middle and inferior groups:
superficial middle cerebral vein, superior anastomotic vein of Trolard and vein of Labbe
Deep:
- lateral sinuses, sigmoid sinuses, straight sinus and deep cerebral veins
- medullary:
> originate 1-2 cm below cortical grey matter
> drain into subependymal veins - subependymal:
> medullary veins drainage
> septal veins, thalamostriate veins, internal cerebral veins, basal veins of Rosenthal and Galen
Most of these systems drain into the internal jugular vein
Arterial supply of the foot
Primarily supplied by two vessels: posterior tibial artery and anterior tibial artery vessels
Forms the dorsal and plantar arterial supply to the foot
Dorsal supply:
- anterior tibial artery travels in between the medial and lateral malleolus
- becomes the dorsalis pedis
- runs to base of 1st MT where its deep branch joins the plantar arch
- divides into multiple branches:
- medial tarsal artery: anastomoses at the medial malleolus to form the medial malleolar arterial netowkr
- lateral tarsal artery:
anastomoses with the peroneal artery, supplies tarsal bones - 1st dorsal metatarsal artery: supplied the 1st metatarsal and great toe
- arcuate artery
runs beneath extensor digitorum brevis over bases of MT.
anastomoses with lateral tarsal artery - dorsal metatarsal arteries
3 of them which travel in the lateral three clefts which continue to become the dorsal digital arteries
plantar:
posterior tibial artery divides into medial and lateral plantar arteries
medial plantar: medial plantar aspect of foot and plantar perforators, flexor digitorum brevis, abductor hallucis and big toe
lateral plantar: forms the only plantar arch in foot, oblique course towards the base of 5th MT superficial to the deep flexor tendons. supplies plantar aponeurosis
plantar arch: anastomsis of dorsalis pedis and lateral plantar artery
deep to plantar aponeurosis and superficial to long tendons
travels across 2-4th MT
joins dorsalis pedis in the first intermetatarsal space
plantar metatarsal arteries
- 4 of them
- branch off the plantar arch
- supplies the clefts and digits
- anastomose with dorsal metatarsal arteries via perforating arteries
ECA
external carotid artery is one of the terminal branches of the common carotid artery
supplies multiple structures in the head and neck
- originates at the bifurcation of the common carotid artery at C4
- anterior course as it ascends cranially
- inclines backwards to the space behind the neck of the mandible
- under the submandibular gland before entering the parotid gland
- gives off multiple branches and diminishes in size quickly
- terminates as the superficial temporal artery and maxillary artery
Branches Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial temporal
Relations
anterior: CN VII, CN XII, posterior belly of digastric muscle
between ECA and ICA:
CN IX, X, styloglossus, stylopharyngeus
posterior: pharyngeal wall, CN X, deep lobe of parotid
Variants
- variations in origin C2-5
- absent unilateral or bilateral
- fenestration
- hypoplastic
- linguofacial trunk
- thyrolingual trunk
- common occipito-auricular trunk
Venous drainage of the chest wall
Venous drainage of the chest returns deoxygenated blood from the peripheries of the thorax back into the systemic circulation
anterior
- anterior intercostal veins
originate from the intercostal space inferior to the anterior aspects of their respective ribs, drain into internal thoracic or musculophrenic veins
- internal mammary veins
runs alongside internal mammary artery
tributaries from anterior intercostal veins, musculophrenic and pericardiophrenic veins
drains back into 1st part of subclavian vein
posterior
- posterior intercostal veins
originate inferior to posterior aspects of respective ribs
- azygos system
> azygos vein (lower 8 ribs on the right) formed by union of the right lumbar and right subcostal vein, received tributaries from the hemiazygos and accessory hemiazygos vein
> 4-11th right posteiror intercostal veins
hemiazygos vein
left side of body formed by the left lumbar and subcostal vein, drains 8th- 11th intercostal vein
accessory hemiazygos vein
- left side of body
- 4-7th rib
- crosses midline to join azygos at T7
- superior intercostal vein
> 2-3rd ribs on right and left
> joins to azygos on right and brachiocephalic on left - supreme intercostal vein
> 1st intercostal vein into vertebral or brachiocephalic veins
the veins drain back through the brachiocephalic veins and confluence
superior vena cava back into the right atrium
Duodenum
duodenum is proximal part of the small bowel
part of the gastrointestinal tract
- continuation of the stomach after the pylorus
- 20-30 cm C shaped hollow viscus predominantly on the right side of the midline
- duodenal sweep encompasses the head of the pancreas
- 4 parts: D1: continuation of the pylorus 5cm long right lateral course before making a sharp curve at the superior duodenal flexure posteriorly into the retroperitoneal space to become D2
anterior: gallbladder, liver
posterior: gastroduodenal artery, portal vein, CBD
superior: epiploic foramen
inferior: pancreatic head
D2:
caudal descend of the duodenum in retroperitoneal space
origin from the superior duodenal flexure to L3
medially closely related to the head of the pancreas
posteromedial opening for the major duodenal papillae, drains the common bile duct and pancreatic duct
minor papillae for the accessory pancreatic duct
anterior: transverse mesocolon
superior: liver, gallbladder
lateral: ascending colon, right kidney
D3
- horizontal segment of the duodenum
- crosses from right to left side of the body
- anterior and across L3 vertebral body
- retroperitoneal
anterior: small bowel mesentery
posterior: L3 vertebral body
superior: pancreas
inferior: jejunum
D4
- anterior and superior course to the lower border of the pancreatic body
- anterior curve to the duodenojejunal flexure where it continues as the jejunum
- landmark ligament of Treitz
blood supply
- right gastric
- right gastroepiploic artery
- superior and inferior pancreaticoduodenal artery
venous drainage into portal vein and superior mesenteric veins
innervation
vagal trunk
celiac and superior mesenteric plexus
variants
- gut malrotation
- variable insertion of the common bile duct: anterior, posterior, right
- atresia
- duodenal diverticulum
- duplication
