Surface anatomy

Question 1

Which vertebral level is the suprasternal notch?

Answer 1

T2

Question 2

What is the anterior anatomical landmark for T2?

Answer 2

Suprasternal nothc

Question 3

Which vertebral level is the angle of louis?

Answer 3

T5

Question 4

What is the anterior anatomical landmark for T5?

Answer 4

Angle of Louis

Question 5

What is the vertebral level for the xiphoid process?

Answer 5

T9

Question 6

What is the anterior anatomical landmark for T9?

Answer 6

The xiphoid process

Question 7

What is the vertebral level for the Transpyloric plane of Addison?

Answer 7

L1

Question 8

What is the anterior anatomical landmark for L1?

Answer 8

The transpyloric plane of Addison

Question 9

What is the Transpyloric plane of Addision?

Answer 9

An imaginary line that runs along the anterior surface of the abdomen at the level of L1 posteriorly and 9th cartilage anteriorly. It is mid distance between the xiphoid process and the umbilicus (about a hands breadth below the xiphoid process)

Question 10

Name the significant structures related to the landmark called the “Transpyloric plane of Addison” (intra-abdominal organs, blood vessels, bones, spinal cord)

Answer 10

Duodenal- jejunal flexure
Neck of pancreas
Hilar of both kidneys
Fundus of the gallbladder
Superior mesenteric artery from aorta
9th cartilage of ribs
L1 vertebra
Where the spinal cord terminates

Question 11

What is the anterior abdominal landmark for the kidneys?

Answer 11

Transpyloric plane of Addison bisects the hilar of both kidneys

Question 12

What is the vertebral level for the subcostal plane?

Answer 12

L3

Question 13

What is the anterior abdominal wall landmark for L3?

Answer 13

The subcostal plane - just below 10th rib

Question 14

Where does the iliac crest plane run?

Answer 14

An imaginary line on the anterior abdomen which runs between the two iliac tubercules and therefore is sometimes referred to as the transtubercular plane (5cm superior to ASIS)

Question 15

Which vertebral level is at the iliac crest or transtubercular plane?

Answer 15

L4

Question 16

Which anatomical landmark demarcates the bifurcation of the aorta?

Answer 16

The transtubercular plane (L4)

Question 17

Which vertebral level is the umbilicus?

Answer 17

Variable but typically L3-5

Question 18

Where does the linea semilunaris run?

Answer 18

Anterior abdominal wall, on the lateral borders of the rectus abdominus muscle from the 9th rib to the pubic tubercle

Question 19

Where do spigelian hernias occur?

Answer 19

At the linea semilunaris

Question 20

Where is McBurney’s point?

Answer 20

Draw a line from ASIS to the umbilicus and it is 2/3 away from the umbilicus or 1/3 close the ASIS (whichever way you look at it)

Question 21

What is the clinical significance of McBurney’s point?

Answer 21

It is the point at which the appendix typically attaches to the umbilicus

Question 22

Where is Palmer’s point?

Answer 22

Left upper quadrant, Mid clavicular line, 3cm below the costal margin

Question 23

What is the clinical significance of Palmer’s point?

Answer 23

Laparoscopic port entry point on the superior lateral aspect of anterior abdominal wall for better views on a patient with suspected or known dense adhesions, or large fibroids/large pelvic mass

Question 24

Where does the arcuate line of Douglas run?

Answer 24

Anterior abdominal wall, half way between the umbilicus and the pubic symphsis

Question 25

What is the clinical significance of the arcuate line of Douglas?

Answer 25

It is where the inferior epigastric artery enters the rectus sheath
It is where the posterior rectus sheath terminates

Question 26

Where is the linea alba?

Answer 26

Aponeurosis between the anterior abdominal wall musces - it runs in the midline from xiphoid process to pubic symphysis

Question 27

Where is it safe to perform paracentesis?>

Answer 27

Midline at linea alba or 3cm lateral to McBurney’s point to avoid the inferior epigastric artery

Question 28

What is the difference in terms of position between the Arcuate line of Douglas and the Trans-tubercular plane?

Answer 28

Arcuate line of douglas (midway between pubic crest and umbilicus)
Transtubercle plane is between the iliac tubercles which lie 5cm superior to ASIS

Question 29

What is the difference in terms of clinical significance between the Arcuate line of Douglas and the Trans-tubercular plane?

Answer 29

Arcuate line of douglas - area where the posterior rectus sheath ends and the inferior epigastric artery enters the rectus sheath
Transtubercle plan is at the level of L$ and is the site of the bifurcation of the aorta

Question 30

Which vertebral level does the spinal cord end at?

Answer 30

L1

Question 31

At which point does the epigastric artery enter the rectus sheath?

Answer 31

At the arcuate line of douglas

Question 32

How do you avoid the inferior epigastric arteries during paracentesis?

Answer 32

By entering at either linea alba (midline) or lateral to McBurney’s point