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Regarding the diaphragm, The greater and lesser splanchnic veins pierce the crura at the level of
Regarding the diaphragm, The left dome reaches the
-5th rib in expiration.
Regarding the diaphragm, The sympathetic chain passes behind the
-medial arcuate ligament lying on psoas major.
Diaphragm, The azygous vein is transmitted through the diaphragm at the level of
The oesophagus length is
The oesophagus: Passes behind the
-left main bronchus in the thorax.
The oesophagus:Is lined with
- - The upper 2/3 of the oesophagus is lined by stratified squamous epithelium
- - lower 1/3 is lined with columnar epithelium.
The blood supply of the oesophagus is as follows:
- • In the neck: inferior thyroid arteries
- • In the thorax: branches of the aorta
- • In the abdomen: left gastric artery and inferior phrenic artery
The oesophagus extends from the level of the
- lower border of the criocoid cartilage to the cardiac orifice of the stomach.
The venous drainage of the oesophagus is into the
-inferior thyroid, azygos and left gastric veins. There is a communication between the azygos and left gastric veins which is an important porto-systemic anastomosis that can be the site of oesophageal varices.
The patella assists with
-knee extension by displacing the quadriceps tendon anteriorly and thereby increasing the leverage that the patellar tendon can exert on the femur.
Ossification of the patellar occurs between
-3 and 6 years of age.
Vastus intermedialis attaches to the
-base of the patella. Vastus lateralis and vastus medialis attach to its lateral and medial borders respectively.
The tail of the pancreas lies at the
-splenic hilum and runs in the lienorenal ligament.
- -The body and neck of the pancreas drain into the splenic vein.
- -The head of the pancreas drains into the superior mesenteric and hepatic portal veins.
Anatomy of the calf: Gastrocnemius is innervated by the
-tibial nerve and specifically nerve roots S1 and S2.
There is frequently a sesamoid bone gastrocnemius called the
-fabella lying in the lateral head of the gastrocnemius muscle. It is present in 10-30% of the population and can be mistaken for a loose body or an osteophyte.
Plantaris assists gastrocnemius in
-plantar-flexion of the ankle and flexion of the knee.
Anatomy of the calf: The sural arteries are two large branches arising from the
-popliteal artery that supply gastrocnemius, soleus and plantaris.
Regarding volar plate injuries of the finger
forced hyper-extension injuries
volar plate injuries of the finger -Sequelae
- Swan neck deformity.
Regarding X-rays of the wrist
- distal radial articular surface tilts 17 degrees towards the ulna
- lateral X-ray -> capitate articulating with the concave surface of the lunate
- distal end of the radius is angled 15 degrees ANTERIORLY.
The width of the intercarpal joints is uniform and approximately
The posterior relations of the ascending colon include:
- • Quadratus lumborum
- • Iliacus
- • Perirenal fascia and lateral kidney
Regarding Gamekeeper's thumb:It is caused by
- forced abduction or hyperextension of the proximal phalanx of the thumb which results in a valgus force to the MCP joint.
- instability of the MCP joint and weakness of pinch grasp.
- tear of the ulnar collateral ligament of the thumb
Gamekeeper's thumb It can be associated with an
avulsion fracture -> proximal portion (at the ulnar base) of the proximal phalanx of the thumb.
Regarding the celiac trunk:arises from the aorta at the level of
The coeliac trunk has 3 main divisions:
- • Left gastric artery, which branches into:
- • - Oesophageal branch
- • - Hepatic branch
- • Common hepatic artery, which branches into:
- • - Proper hepatic artery
- • - Right gastric artery
- • - Gastroduodenal artery
- • - Cystic artery
- • Splenic artery, which branches into:
- • - Dorsal pancreatic artery
- • - Short gastric arteries
- • - Left gastro-omental artery
- • - Greater pancreatic artery
The boundaries of the anterior triangle of the neck are:
- • Superiorly (base): inferior border of the mandible
- • Inferiorly (apex): jugular notch of the manubrium sterni
- • Anteriorly: midline of the neck from the chin to the jugular notch
- • Posteriorly: anterior margin of sternocleidomastoid
The contents of the anterior triangle of the neck include:
- • Muscles: digastric, stylohyoid, mylohyoid, geniohyoid, sternohyoid, omohyoid, thyrohyoid, sternothyroid and platysma
- • Veins: internal jugular, facial, retromandibular, anterior jugular and external jugular veins
- • Arteries: carotid sheath and branches of external carotid artery
- • Nerves: nerve to mylohyoid and ansa cervicalis
- • Bones: Hyoid and larynx bones
- • Glands: thyroid and parathyroids
- • Other structures: lymph nodes, submandibular gland, trachea and oesophagus
When present the thyreoidea ima usually arises from the
- brachiocephalic trunk.
- It is present in 3-10% of the population.
The brachiocephalic artery arises at the level of
The following structures pass under the inguinal ligament:
- • Tendon of psoas major
- • Femoral branch of genitofemoral nerve
- • Femoral nerve
nerve supplies adductor pollicis brevis.
The median nerve supplies the other muscles of the thenar eminence
- adductor pollicis
- flexor pollicis brevis
- abductor pollicis brevis
- opponens pollicis.
Tensor fasciae latae is supplied by the
superior gluteal nerve.
The sciatic nerve supplies no muscles in the gluteal region. Outside of the gluteal region it supplies:
- • Biceps femoris
- • Semitendinosus
- • Semimembranosus
- • Adductor magnus
Quadratus femoris is supplied by the
nerve to quadratus femoris.
The following structures lie at the vertebral level of L1
- transpyloric plane of Addison.
- origin of the superior mesenteric artery.
- fundus of the gallbladder.
- hila of the kidney.
Hasselbach's triangle is a region of the abdominal wall. It contains a depression called the
- medial inguinal fossa
- direct inguinal hernias
The borders of Hasselbach's triangle are:
- • Medial – rectus sheath
- • Lateral – inferior epigastric artery
- • Inferior – inguinal ligament
Examples of type II hypersensitivity reactions include:
- • Autoimmune haemolytic anaemia.
- • Haemolytic disease of the newborn.
- • ANCA associated vasculitides.
- • Goodpasture's syndrome.
- • Myasthenia gravis.
- • Rhesus incompatibility.
- • Transfusion reactions.
Plasmodium falciparum malaria is transmitted by
- female of the Anopheles genus of mosquito.
- incubation period is 7-14 days
The Aedes genus is responsible for transmitting diseases such as
- dengue fever
- yellow fever.
Plasmodium falciparum Sporozoites invade
hepatocytes.->asexual reproduction occurs ->merozoites->into the blood stream ->invade the red blood cells of the host.
Plasmodium falciparum -drug treatment of choice
- often combination therapy with drugs such as doxyclycline or fansidar are required.
The absolute contraindications to fibrinolytic therapy are:
- • Previous haemorrhagic stroke
- • Ischaemic stroke within the past 6 months
- • CNS damage or neoplasm
- • Recent major trauma, major surgery or head injury (within 3 weeks)
- • Acute internal or GI bleeding
- • Known or suspected aortic dissection
- • Known bleeding disorder
There are two types of WPW syndrome:
- • Type A – the delta wave and QRS complex are predominantly upright in the praecordial leads with a dominant R wave in V1. The dominant R wave in V1 can be mistaken for RBBB.
- • Type B – the delta wave and QRS complex are predominantly negative in leads V1 and V2 and positive in the other praecordial leads, resembling LBBB.
The ‘pump handle' action of the ribs is their
forward and upward movement-> increasing the antero-posterior diameter of the chest.
The ‘bucket handle' action of the ribs is their
upward and lateral movement-> increasing the transverse diameter of the chest.
Forced inspiration requires the use of the accessory muscles of respiration:
sternocleidomastoid, scalenes, pectoralis major, pectoralis minor and serratus anterior.
Forced expiration requires the use of:
rectus abdominis, external and internal obliques, transversus abdominis and latissimus dorsi.
Bumetanide decreases neuronal chloride concentration making the action of GABA more depolarizing. It is currently under evaluation as an
antiepileptic in the neonatal period.
Regarding afterload: It is closely related to both
- aortic pressure
- ventricular wall stress.
Afterload is increased by increases in
systemic vascular resistance.
The following hormones act via a rise in intracellular calcium levels:
- • GnRH
- • TRH
- • Adrenaline (alpha receptors)
AP pelvic fractures suggest trauma that has applied a major force to the patient and there is a demonstrable increase in the incidence of
tears of the thoracic aorta in this patient group.
the commonest pattern of pelvic fracture (60-70%)
- Lateral compression
- AP compression accounts for 15-20% of pelvic fractures.
Anterior-posterior compression usually results in
open book type fractures/pelvic fractures.
The following are the boundaries of the popliteal fossa:
- • Superolaterally – biceps femoris
- • Superomedially – semimembranosus and semitendinosus
- • Inferomedially – medial head of gastrconemius
- • Inferolaterally – lateral head of gastrocnemius
- • Roof – skin and fascia
- • Floor – popliteal surface of femur, oblique popliteal ligament, fascia over popliteus
The popliteal pulse lies deep to other structures and is difficult to feel. If it can be easily felt then
aneurysmal change should be considered.
From superficial to deep the structures within the popliteal fossa are:
- • Tibial nerve (most superficial)
- • Popliteal vein
- • Popliteal artery (deepest)
The common peroneal nerve runs along the
medial border of the biceps femoris tendon before exiting the fossa.
West’s zones 3 zones:
- • Zone 1: the alveolar pressure may exceed that of the arterial and venous pressure and thus little perfusion will occur as the vessels collapse. This results in dead space.
- • Zone 2: the arterial pressure will exceed that of the alveolar pressure but not the venous pressure.
- • Zone 3: both the arterial and venous pressures exceed the alveolar pressure.
The deep peroneal nerve innervates the following muscles:
- • Tibialis anterior
- • Extensor hallucis longus
- • Extensor digitorum longus
- • Peroneus tertius
Peroneus longus is innervated by the
superficial peroneal nerve.
ANAs Homogenous staining is suggestive of
ANAs speckled staining is suggestive of
mixed connective tissue disease
ANAs nucleolar staining is suggestive of
ANAs centromere staining is suggestive of
Anti-DsDNA is suggestive of
anti-histone antibodies are highly suggestive of
Methaemoglobinaemia: Is associated with
- pyruvate kinase deficiency-> impaired production of NADH
- ->significant degree of cyanosis with concentrations greater than 1.5 g/dl
Drugs that can cause methaemoglobinaemia include
- antibiotics such as trimethoprim and sulfonamides
- local anaethesetics such as prilocaine
This is the most common complication in a patient with a human fight bite due to direct inoculation of bacteria such as
Eikenella Corrodens, Staphylococcus spp or Streptococcus spp into the MCP joint.
Regarding the vertebral artery:
- from the subclavian artery.
- contains a plexus of POST-ganglionic sympathetic nerve derived from the stellate ganglion.
- The first part is crossed by the INFERIOR thyroid artery.
- The left vertebral artery is crossed by -> thoracic duct.
The ultrafiltrate that enters the distal convoluted tubule has a
low osmolality and therefore water is reabsorbed here.
The distal convoluted tubule assists in the regulation of
pH by the absorption and secretion bicarbonate and hydrogen ions.
A blast crisis is diagnosed if any of the following features are present in a patient with CML:
- • > 20% myeloblasts or lymphoblasts in the blood or bone marrow
- • Large clusters of blasts found on bone marrow biopsy
- • The presence of a chloroma (a solid tumour comprised of myeloblasts that occurs outside of the bone marrow)
CML can be treated with
tyrosine kinase inhibitors such as imatinib and dasatinib.
Regarding the anatomical snuffbox:
- proximal border -> styloid process of the radius.
- posterior border -> tendon of extensor pollicis longus.
The anatomical snuffbox contains
- • Trapezium
- • Scaphoid
- • radial artery
- • Cephalic vein.
The mean blood pressure at the start of the arterioles is approximately
Q fever is caused by
Clostridium sordelli is a rare cause of
toxic shock syndrome - pregnancy and, medical abortions, intravenous drug use and trauma.
Erb's palsy results in loss of
- biceps brachii.
Erb's palsy -Results in pronation of the forearm due to the
unopposed action of pronator teres (C6,7).
The long flexor tendons lie within the
The tendons of tibialis posterior and peroneus longus are part of the
Regarding the sole of the foot:The neurovascular plane lies between the
first and second layers The statement is true.
The skin over the heel is innervated by the
Extensor pollicis longus extends the
- distal phalanx of the thumb joint
- Abductor digiti minimi
- abducts the little finger.
- Abductor pollicis brevis
- abducts the thumb and helps to oppose it.
Opponens pollicis opposes the thumb
towards the palm and rotates it medially.
Brown-Sequard syndrome It results in
- • ipsilateral motor loss (corticospinal tracts)
- • ipsilateral loss of position sense (posterior columns)
- • contralateral pain and temperature sensation loss (spinolthalamic tracts) below the level of the injury.
The rectus sheath is formed by the aponeuroses of the
- transversus abdominis
- external and internal oblique muscles.
Regarding the rectus sheath It contains the
- rectus abdominis
- pyramidalis muscles.
The bificurcation of the common carotids occurs at
The 1st palpable spinous process lies at
The xiphisternal joint lies at
The rectum commences at
The most common level of cervical vertebral fracture is
C5-> where the greatest amount of flexion and extension can occur.
Hangman's fracture involves the
posterior elements of C2 - the pars interarticularis and pedicles.
Atlanto-occipital dislocation is usually
fatal due to brainstem injury and apnoea or severe neurological impairment.
C1 rotary subluxation is most common in
- children and may occur spontaneously or following minor trauma.
- It can also occur in association with an upper respiratory tract infection.
- It presents as persistent torticollis.
Central cord syndrome classically follows a
neck hyperextension injury in elderly patients with pre-existing cervical canal stenosis secondary to degenerative osteoarthritic changes.
Central cord syndrome It most common in
Central cord syndrome There is generally
- variable sensory loss below the level of injury
- with associated bladder dysfunction and urinary retention.
Central cord syndrome There is disproportionately greater motor loss in the
upper extremities than lower extremities.
Pain originating from the pancreas can be referred to the
Is formed by the
- medial and lateral cords of the brachial plexus
- Crosses superficial to brachial artery at midhumeral level.
- Enters the forearm between the two heads of pronator teres
The median nerve supplies
- all muscles of the flexor aspect of the forearm
- except flexor carpi ulnaris and the ulnar half of flexor digitorum profundus which are supplied by the ulnar nerve.
The spinal cord terminates at
The cauda equina commences at the termination of the spinal cord at
The spinal cord commences at the
The filum terminale is approximately
20 cm in length.
Supraspinatus is innervated by the
abducts the arm with the assistance of deltoid.
Infrasinatus acts with teres minor to
externally rotate the arm.
Teres minor is innervated by the
Carpal tunnel syndrome It is associated with
- Pregnancy ->fluid retention causes swelling of the tenosynovium
- dupuytren's contracture
- rheumatoid arthritis
- previous wrist injuries..
The celiac trunk may also give rise to the
inferior phrenic arteries.
The adult human has
32 permanent teeth.The statement is true.
The deciduous incisors erupt at
deciduous canines erupt at
deciduous molars erupt at
The permanent incisors erupt at
permanent canines and premolars at
permanent molars at
The majority of the crown is composed of dentine surrounded by
enamel with an inner pulp chamber.
Popliteus is innervated by nerve roots
- L4, L5 and S1
- The posterior tibial artery is derived from the
- popliteal artery.The statement is true.
Regarding the ossification centres of the elbow: The centres appear earlier in
girls than in boys.
The ossification centers/elbow and the sequence with which they appear can be remembered by the mnemonic CRITOL:
- C = capitellum
- R = radial head
- I = internal (medial) epicondyle
- T = trochlea
- O = olecranon
- L = lateral epicondyle
Elbow the medial epicondyle fuses last at between
17-19 years of age.
The apophysis for the lateral epicondyle /elbow fuses with the
capitellum before fusing with the humerus.
Peroneus longus inserts into the base of the
1st metatarsal and the medial cuneiform.
Tibialis anterior inserts into the
- medial and inferior surfaces of the medial cuneiform
- and the base of the 1st metatarsal.
There are three cuneiform bones in each foot: the
lateral, intermediate and medial cuneiforms.
The central part of the plantar fascia forms the
The relations of the trachea in the thorax are:
- • Anteriorly – brachiocephalic artery, left common carotid artery, left brachiocephalic vein, thymus
- • Posteriorly – both recurrent laryngeal nerves, oesophagus
- • Right side – vagus nerve, azygous vein, pleura
- • Left side – aortic arch, left common carotid artery, left subclavian vein, left recurrent laryngeal nerve, pleura
Central cord syndrome It is thought to be due to
vascular compromise of the cord in the distribution of the anterior spinal artery
Adductor longus is innervated by the
Gracilis is innervated by the
Psoas major in innervated by the
ventral rami of L1, L2 and L3.
The dorsalis pedis artery can be palpated
- medial to the extensor digitorum tendons and lateral to the extensor hallucis longus tendon on the dorsum of the foot.
- is a continuation of the anterior tibial artery.
The order of the structures that pass deep to the extensor retinaculum of the foot can be remembered by using the mnemonic ‘The Himalayas Are Never Dry Places'. From medial to lateral they are:
- Tibialis anterior
- extensor Hallucis longus
- Anterior tibial artery
- deep peroneal Nerve
- Digitorum longus
- Peroneus tertius
Each lung has
10 bronchopulmonary segments.
The right pulmonary artery passes in front of the
right main bronchus.
The right main bronchus gives off the upper lobe branch
before entering the lung.
The terminal bronchioles are lined with
simple columnar epithelium cells that contain Clara cells, which secrete surfactant.
Gluteus maximus and quadratus femoris contribute to
Internal rotation of the hip is performed by the following muscles:
- Gluteus medius
- Gluteus minimus
- Tensor fasciae latae
- Pectineus (with leg abducted)
External rotation of the hip is performed by the following muscles:
- Gluteus maximus
- Quadratus femoris
- The gemelli
Hip Flexion is predominantly performed by
- iliacus and psoas.
- Rectus femoris, Sartorius and pectineus contribute to a lesser degree.
The iliofemoral ligament inhibits
external rotation and extension.
The testes are covered with the
The epididymis is covered by the
tunica vaginalis, except at its posterior margin, where it is free.
The trachea bifurcates into the two main bronchi at the level of
T4/T5 (sternal angle).
The right main bronchus passes
downwards and laterally behind the ascending aorta and the superior vena cava.
The left main bronchus passes
- downwards and laterally below the arch of the aorta
- in front of the oesophagus and descending aorta.
The liver is the largest internal human organ, comprising approximately
2% of body mass.
The liver is divided into four lobes:
- the caudate
- right lobes.
Liver is attached to the anterior abdominal wall by the
The liver has a dual blood supply from the
- hepatic arteries- 25%
- hepatic portal vein- 75% of the liver’s blood supply
The branches of the superior mesenteric artery are:
- Inferior pancreaticoduodenal artery (supplies pancreas and inferior duodenum)
- Intestinal arteries (supplies the ileum and jejunum)
- Ileocolic artery (supplies the ileum, caecum and appendix)
- Right colic artery (supplies the ascending colon)
- Middle colic artery (supplies the transverse colon)
The artery of Drummond (the marginal artery of the colon) is formed by the anastomsis of the
superior and inferior mesenteric arteries.
The cavernous sinus contains the
- oculomotor nerve (CN III)
- trochlear nerve (CN IV)
- ophthalmic nerve (V1 branch of CN V)
- maxillary nerve (V2 branch of CN V)
- cavernous part of the internal carotid artery.
Internal jugular is separated from the sympathetic chain by the
The internal jugular vein lies
anterolateral to the sympathetic chain.
The internal jugular vein is a continuation of the
The left internal jugular vein is generally
smaller than the right vein.
The inferior border of the scapula lies at
The first palpable spinous process lies at
The sternum runs from
The sacral dimples lie at
The cricoid cartilage lies at
The azygous vein enters the superior vena cava at
The pancreatic neck lies at
The pylorus of the stomach lies at
The arterial supply of the thyroid gland is derived from branches of the
- subclavian artery
- and the external carotid artery.
Thyroid gland is covered in
The isthmus of the thyroid gland overlies the
- 2nd to 4th tracheal rings
- and lies inferiorkly to the cricoid cartilage.
The thyroid epithelial cells (follicular cells) secrete
- T3 and T4
- the parafollicular cells ->calcitonin.
The extensor retinaculum is attached to the
- radial styloid laterally
- pisoform and triquetral laterally.
- It is not attached to the ulna.
Regarding the extensor retinaculum of the hand->Fibrous septa divide it into
- 6 compartments.
- is continuous with the palmar carpal ligament
The inferior mesenteric artery arises from the aorta at the vertebral level of
The branches of the inferior mesenteric artery are:
- Left colic artery (supplies the descending colon)
- Sigmoid branches (supplies the sigmoid colon)
- Superior rectal artery (supplies the rectum)
The territory of inferior mesenteric artery its distribution is equivalent to that of the embryonic
Regarding the anterior cord syndrome:It is due to infarction of the cord supplied by the
anterior spinal artery.
Regarding the anterior cord syndrome: There is loss of
- pain and temperature sensation, which is carried by the spinothalamic tracts
- preservation of touch and proprioception, which is carried by the dorsal columns.
- loss of motor function below the level of injury / infarction.
- poorest prognosis for recovery of all the incomplete spinal cord injuries.
The following nerves pass through the thoracic inlet:
- Phrenic nerve
- Vagus nerve
- Both recurrent laryngeal nerves
- Both sympathetic trunks
The following veins pass through the thoracic inlet:
- Internal jugular veins
- Subclavian veins
- Brachiocephalic veins
The following structures pass under the inguinal ligament:
- Tendon of psoas major
- Femoral branch of genitofemoral nerve
- Femoral nerve
The right dome reaches the
4th costal space (nipple line) in expiration.
The left dome reaches the
5th rib in expiration.
The left common carotid artery lies
anterior to the prevertebral fascia in the neck.
The left inferior thyroid artery arises from the
left thyrocervical trunk.
Adductor longus, brevis and magnus are all supplied by the
In addition the hamstring part of adductor magnus is supplied by
the sciatic nerve.
Pectineus is supplied by the
externally rotates the hip.
Gracilis is supplied by the
During pregnancy: the uterus is an
- intrapelvic organ until ->12th gestational week.
- lies at the costal margin->At 34-36 weeks
All of the lumbricals attach proximally to
flexor digitorum profundus.
- FLEX the metacarpophalangeal joints
- EXTEND both interphalangeal joints of the digits on which they insert.
The 1st and 2nd lumbricals are innervated by the
The 3rd and 4th lumbricals are innverated by the
deep branch of the ulnar nerve.
The lumbricals insert into the aponeuroses of the
- extensor muscles of the back of the hand.
- This is also known as the extensor expansion or dorsal hood.
The apex of the heart lies at the
5th left intercostal space in the mid-clavicular line.
The pulmonary valve lies to the left of the sternum at the upper level of the
3rd costal cartilage.
The mitral valve lies to the left of the sternum at the level of the
4th costal cartilage.
The tricuspid valve lies to the right of the sternum at the level of the
4th costal cartilage.
Flexor hallucis longus is innervated by the
tibial nerve and specifically nerve roots S2 and S3.
The muscles of the calf can be divided into two groups, superficial and deep.
- The superficial group includes gastrocnemius, soleus and plantaris.
- The deep group includes politeus, flexor hallucis longus, flexor digitorum longus and tibialis posterior.
Serratus anterior attaches to the
1st to the 8th ribs.
Pectoralis minor attaches to the
3rd to the 5th ribs.
Pectoralis major attaches to the
1st to the 7th costal cartilages.
External oblique abdominis –
5th to 12th ribs.
Latissimus dorsi –
9th to 12th ribs.