Paper 2 Flashcards
Sinuses draining into the transverse sinuses
- Receives the superior sagittal, occipital and straight sinuses
Drainage of the inferior anastamotic vein of Labbe
Transverse sinus
Circle of Willis variants
- Hypoplasia of one or both PCOM
- Hypoplastic/absent segment A1 segment of ACA
- Absent or fenestrated ACOM
- Origin of PCA from the ICA with absent/hypoplastic P1 segment
- Infundibular dilatation of the PCOM origin
Common or important variants of the corpus callosum
- Dysgenesis of the corpus callosum
- Primary = corpus never forms
- Secondary: forms normally and is subsequently destroyed
- Absent septum pellucidum
- Holoprosencephaly
- Hypoplastic fornices
- Cavum abnormalities
Four parts of the MCA
- Sphenoidal - Insular - Opercular - Cortical
Posterior cranial fossa variants
- Chiari malformations - Dandy Walker malformations - Mega cisterna magna - Posterior fossa arachnoid cysts - Vermian hypoplasia - Cerebellar dysplasia - Pontocerebellar hypoplasia
Name the nerves which pass through the cavernous sinus in order from superior to inferior
a. Occulomotor b. Ophthalmic division of V c. Trochlear d. Maxillary division of V e. Abducens
Variants of the septum pellucidum
- Cavum septum pellucidum - Cavum septum pellucidum et vergae - Cavum veli interpositi
Describe and compare variants of the variants of the septum pellucidum
- Cavum septum pellucidum describes a dilation within the anterior portion fo the septum pellucidum - When it continues further posteriorly it is called cavum septum pellucidum et vergae - Cavum veli interpositi – dilation of the normal cistern of the velum interpositum
4 branches of the supraclinoid branches and terminal segments of the ICA excluding the ACA and the MCA
- Ophthalmic artery - Superior hypophyseal - PCOM - Ant choroidal
Describe the blood supply of the pituitary gland
- Complex supply via the hypophyseal portal system, composed of 6 arteries, three from below and three from above. - Above o Superior hypophyseal artery o Infundibular artery o Prechiasmal artery - Below o Inferior hypohyseal artery o Capsular artery o Artery of the inferior cavernous sinus
List 2 variants of the basal cisterns
- Arachnoid cysts - Cavum velum interpositi
List and briefly describe the congenital anastomoses between the carotid and vertebrobasilar arterial systems
- Persistent primitive trigeminal artery (ICA exits the carotid canal, runs posterolaterally along the trigerminal nerve, associated with small PCOM and vertebrals) - Persistent primitive hypoglossal artery (through the hypoglossal canal parallel to the nerve, connecting the cervical ICA with the basilar artery. Single artery which hsupplies the brainstem and cerebellum) - Persistent otic artery - Persistent proatlantal artery
Innervation of the larynx
- Motor: recurrent laryngeal nerve, except cricothyroid which is supplied by the external laryngeal nerve - Sensory: o Above the vocal cords – internal laryngeal N o Below the vocal cords: recurrent laryngeal nerve
3 common or important variants of the thyroid gland (no vascular)
- Pyramidal lobe - Lobar hemiagnenesis - Thyroglossal duct cyst - Ectopic thyroid tissue - Zuckerandl’s tubercle
2 common or important variants of the parathyroid glands (no vascular)
- Supranumary glands - Fewer than 4 parathyroid glands - Ectopic parathyroid gland
Variants of the calvarial sutures
- Persistent metopic suture - Wormian bones - Craniosynostosis - Continuation of the occipitomastoid suture - Second symmetric occipitomastoid suture - Accessory parietal suture - Mendosal suture
Pharyngeal impression
- Cricopharyngeus - Aorta - Left main bronchus - Left atrium - (Aberrant right subclavian artery) - (aberrant left pulmonary artery)
Innervation of the 3 constrictor muscles
- Superior and middle: Pharyngeal plexus - Inferior: pharyngeal plexus with possible innervation from recurrent laryngeal and/or external laryngeal nerve
Structure located in the trachea-oesophageal groove, Origin and function
- Recurrent laryngeal nerve - Originates: vagus N - Function: Motor supply to the intrinsic muscles of the larynx (except cricopharyngeus) - Sensory and secretomor supply to the laryngeal mucosal structures below the level of the vocal cords
5 important/common variants of the paranasal sinuses
- Mainly size and bony septation - Sphenoid sinus: optic nerve relationship o 1: adjacent to the sphenoid sinus o 2: indenting the sinus o 3: Traversing the sinus o 4: Adjacent to the posterior ethmoid sinus - Frontal o Aplastic o Hypoplastic o Enlarged - Agger nasi, Haller, Onodi cells, concha bullosa - Supraorbital air cells
What enters the skull with the internal carotid artery
- Enters through the carotid canal - Sympathetic plexus is carried with it.
5 common or important variants of the vertebral arteries
- Enters the transverse foramina at the level of C7 - Hypoplastic - Terminates as the PICA - Variable origin o Aortic arch o Second branch of subclavian artery o Common carotid o External carotid o Internal carotid - Duplication - Fenestration
4 structures embedded in the parotid glands
- Retromandibular vein - Facial nerve - External carotid artery - Intraparotid lymph nodes
5 common or important variants of the ophthalmic artery
- Middle meningeal can arise from ophthalmic artery - Origin from MCA - Origin from PCom - Communicating branch between the ophthalmic and middle meningeal – sphenoidal artery - Meningo-ophthalmic artery
Arterial blood supply to the thyroid gland
- Superior thyroid (from ECA) - Inferior thyroid artery (from thyrocervical trunk)
Superior and inferior borders of the cervical lymph level III nodes in the neck
- Superior: inferior border of the hyoid bone - Inferior: inferior border of the cricoid cartilage
Nerves entering the eye through the tendinous annulus of Zinn
- Superior division of the oculomotor nerve - Nasociliary nerve - Inferior division of the oculomotor nerve - Abducens nerve
Which nerve carries parasympathetic innervation to the lacrimal gland and which ganglion does it involve
- Greater petrosal nerve - Pterygopalatine ganglion
Where do the superior and inferior orbital veins drain to?
- Cavernous sinus
Which nerves passing through the superior orbital fissure outside the ring of Zinn
- Trochlear - Lacrimal nerve - Frontal nerve
Name the muscles supplied by the oculomotor nerve
- SR, MR, IR, IO
Layers of the scalp
- Skin - Connective tissue - Aponeurosis - Loose areolar tissue - Pericranium
Nerve supply of the scalp
- Anterior: o Supratrochlear o Supraorbital o Lacrima - Superior scalp o Supraorbital - Posterior scalp o Greater occipital N o Third occipital N - Lateral nerve o Zygomaticotemporal o Zygomatricofacial o Auriculotemporal o Lesser occipital nerve - Muscles of the scalp o Facial nerve
Variants of the calvarial structures
- Microcephaly - Persistent Metopic suture - Wormian bones - Cloverleaf skull - Craniosynostosis
Structures traversing the jugular foramen
- Pars nervosa o Inferior petrosal sinus o CN IC - Pars vascularis o Jugular bulb o CN X. XI
Nerve that supplies the motor innervation to the mylohyoid muscle and the posterior belly of the digastric
Facial nerve
Nerve supplying taste sensory innervation to the anterior 2.3 of the tongue
Chorda tympani
Nerve supplying parasympathetic innervation to the parotid salivary gland and which ganglia it involves
Lesser petrosal nerve Otic ganglion
Contents of the masticator space
- Muscles of mastication - Inferior alveolar artery, vein and nerve - Ramus and body of mandible - Mandibular division of the trigeminal nerve - Pterygoid venous plexus
Structures passing through the foramen spinosum
- Middle meningeal artery - Middle meningeal vein - Nervus spinosus
Boundaries of the epiploic foramen of winslow
- A: free edge of the lesser omentum (hepatoduodenal ligament) - P: IVC - S: caudate lobe - I: commencement of the duodenum
Liver segments between the right and middle hepatic veins
V and VIII
Segments drained by the left hepatic veins
II.III
Structure separating segments 2 and 3 from 4
Left hepatic vein
Structure in the horizontal plane dividing the superior and inferior liver segments
Portal plane - bifurcation of the portal vein
5 important/common variants of the pancreas and its ducts
- Ansa pancreaticum - Pancreatic divisium o Minor papilla drains the pancreas o Major papilla drains the bile duct - Meandering pancreatic duct - Anomalous pancreaticobiliary junction
Most common branching pattern of the hepatic duct
o Formed by the junction of the right and left hepatic ducts o Joins cystic duct to form the CBD
Most common branching pattern of the portal vein
o Right portal vein Anterior (supplying segments V and VII) Posterior (segments Vi and VII) o Left portal vein Transverse and umbilical portions Supply segments II, III and IV
Most common branching pattern of the hepatic artery
o Common hepatic branch Terminal branch of the Coeliac arteries Branches • Right gastric • Proper hepatic • Gastroduodenal o Proper hepatic Right hepatic Left hepatic (50%) left hepatic o Right hepatic Anterior segmental branch (segments V, VIII) Posterior segmental branch (segmental VI, VII) o Left hepatic Medial segmental Lateral segmental
5 common or important variants of the coeliac artery
• Extracoeliac origin of its three branches o Aortic Left gastric Splenic Common hepatic o SMA Left gastric Splenic Common hepatic • Other branches from the coeliac artery o Dorsal pancreatic o Right hepatic o Gastroduodenal artery o Inferior phrenic
5 common/important variants of the superior mesenteric artery
• Replaced right hepatic artery • Replaced left hepatic artery • Replaced common hepatic artery • Accessory right hepatic artery • Coaeliacomesenteric trunk • Replaced splenic artery • Replaced left gastric artery • Replaced dorsal pancreatic artery • Arc of Buhler • Arc of Riolan
Hepatic vein draining segment 1
Caudate vein draining into the IVC
5 common/important variants of the suprarenal arteries
• Variable origin of the middle suprarenal artery o Inferior phrenic artery o Coeliac trunk o Superior mesenteric artery o Renal artery o Lumbar artery o Gonadal artery • Variable origin for inferior adrenal artery o Terminal branch of the renal artery o From supplementary renal artery o From the aorta o Gonadal artery o Coeliac trunk
All lymphatics drain to which structure in the abdomen and where is it located
- Cisterna Chyli - At the level of L1-2 to the right of the aorta behind the right crus of diaphragm
Which diaphragmatic hiatus does the thoracic duct pass through and what else passes through with it
- Aortic hiatus - With the o Aorta o Azygos vein and hemiazygous vein
Name 4 organs located within the anterior pararenal space
- Duodenum - Pancreas - Ascending and descending colon
Which fascial layer is formed laterally by the fusion of the anterior and posterior pararenal fascia
lateral conal fascia
Name the common and important variants of the extrahepatic biliary tree excluding the gallbladder and pancreatic ducts
- Triple confluence - Aberrant hepatic duct - Low insertion of the RHD into the BHD - Accessory hepatic ducts - RASD inserting into the LHD - RPSD inserting into the LHD
3 pre-aortic plexi which provide autonomic innervation to the GI tract
- Coeliac - Superior mesenteric - Aorticorenal - Inferior mesenteric
What are the sympathetic and parasympathetic inputs of the above plexi
- Coeliac: greater and lesser splanchnic - Superior mesenteric: greater and lesser splanchnic - Inferior mesenteric: least splanchnic - Parasympathetic: vagus
What are the sources of the sympathetic and parasympathetic components of the pelvic plexus
- Parasympathetic: S2,3,4 - Sympathetic: sacral splanchnic
Arterial supply of the ureters
- Renal artery - Abdominal aorta - Superior and inferioer vesical artery - Variably: gonadal, middle rectal and uterine
Innervation of the urinary bladder
- Autonomic: vesical nerve plexus o Symp: hypogastric nerves from the inferior mesenteric ganglion, supplied by lumbar splanchnic nerves o Parasymp: pelvic splanchnics - Somatic: pudendal nerves