Download term 2 answers to questions - Hatzalah of Miami-Dade

TERM 2
ANSWERS TO QUESTIONS
SESSION 1 - Skull, Meninges, Venous Sinuses, Foramina, Cranial Nerves - IX, X, XI, XII...................................... 2
SESSION 2 - Eyelids, Orbit And Nerves Entering It ................................................................................................ 3
SESSION 3 - Face, Scalp, Trigeminal (V) And Facial (VII) Nerves.......................................................................... 5
SESSION 4 - Nasal Cavity, Sinuses, Nasopharynx, Olfactory (I) & Vestibulocochlear (VIII) Nerves ........................ 7
SESSION 5 - Oral Cavity ....................................................................................................................................... 9
SESSION 6 - Pharynx, Temporomandibular Joint, Muscles Of Mastication & Infratemporal Fossa........................ 11
SESSION 7 - Larynx And Trachea ....................................................................................................................... 13
SESSION 9 - Pleural Cavity, Lungs, Phrenic And Vagus (X) Nerves..................................................................... 15
SESSION 10 - Middle Mediastinum, Pericardium, Heart And Great Vessels ......................................................... 17
SESSION 11 - Posterior Mediastinum, Diaphragm, Thoracic Wall And Respiration............................................... 19
SESSION 12 - The Abdomen - First Look............................................................................................................. 21
SESSION 13 - Mesenteries, Bowel And Stomach................................................................................................. 23
SESSION 14 - Duodenum, Liver, Biliary System, Pancreas And Spleen............................................................... 25
SESSION 15 - Posterior Abdominal Wall.............................................................................................................. 27
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SESSION 1 - Skull, Meninges, Venous Sinuses, Foramina, Cranial Nerves IX, X, XI, XII
1.
Spinal cord (lower medulla), dura mater, arachnoid mater, pia mater, left/right vertebral arteries,
anterior spinal artery, left/right posterior spinal arteries, left/right spinal roots of accessory nerve,
internal vertebral plexus, cruciform ligament, tectorial membrane, CSF, sympathetic fibres on the
arteries.
2.
Glossopharyngeal (IX), vagus (X) and accessory (XI).
3.
As it lies just anterior to the occipital condyle.
4.
Motor only.
5.
IX, X and sympathetic.
6.
The vagus (X) brings in motor fibres from the cranial root of the accessory (XI).
7.
Because the mucous membrane of both areas is supplied by the glossopharyngeal nerve (IX).
8.
Endosteal (periosteal) and meningeal (fibrous) layers of the dura mater.
9.
Sagittal.
10. Inferior sagittal.
11. Emissary veins.
12. Sphenoid.
13. There are valve-free venous connections between the facial veins, the pterygoid plexus of veins and
the cavernous sinus that can carry infection in any direction with the risk of thrombosis.
14. Inferior petrosal sinus.
15. It dampens down the effect of sudden pressure changes on brain tissue.
16. Foramen spinosum.
17. Maxillary artery which is a terminal branch of the external carotid artery.
18. It lies outside the dura mater.
19. The cribriform plate of the ethmoid.
20. The optic nerve is sensory only.
21. III and IV run in the lateral wall and VI runs within the sinus lying on the lateral aspect of the internal
carotid artery.
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SESSION 2 - Eyelids, Orbit And Nerves Entering It
1.
Superior rectus and inferior oblique.
2.
Because of the angle that the superior rectus approaches the eyeball, it tends to pull the eye inwards
as well as upwards. The inferior oblique corrects this with its upwards and outwards pull.
3.
By looking down and in, the action of the inferior rectus is largely negated.
4.
Superior oblique (IV) and lateral rectus (VI).
5.
Anterior to lens but posterior to the iris.
6.
From lateral to medial.
7.
Ptosis and a small pupil.
8.
Meibomian glands are modified sebaceous glands.
9.
Fatter. During accommodation the suspensory ligaments are relaxed by the action of the ciliary
muscle and the lens is allowed to revert to its natural "fatter" state.
10. Orbital part of the orbicularis oculi.
11. The Meibomian glands deposit a thin layer of oil on the surface of the tears which slows their
evaporation.
12. Into the inferior meatus of the nose.
13. Pterygopalatine.
14. Superior tarsal plate.
15. In skin it might be called a carbuncle but in the lid it is called a stye.
16. Inferior rectus and superior oblique.
17. Abducent (VI).
18. Before. It divides within the cavernous sinus.
19. Superior oblique, inferior oblique and levator palpebrae superioris.
20. Uncontrollable, lateral or sometimes rotatory oscillations of the eyeball caused by disturbances of
vision, labyrinthine or central nervous system function. If labyrinthine in origin, there is usually a
slow and fast component to the nystagmus.
21. (a) No.
(b) No.
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22. (a) Yes.
(b) Yes.
23. Down and out under the influence of lateral rectus (VI) and superior oblique (IV).
24. Ptosis: loss of somatic supply to levator palpebrae superioris (this is needed as well as the
sympathetic supply). Proptosis: from lack of tone of muscles supplied by III. Dilated pupil: loss of
parasympathetic from the Edinger Westphal nucleus to constrict the pupil.
25. III and IV are damaged as they pass over the edge of the tentorium celebelli. VI is distracted
downwards by the descending brain. In IV lesion the patient could not look down and in. In VI lesion
the patient is unable to look laterally.
26. The apex of the petrous temporal bone.
27. The ganglion lies partially under the postero-inferior wall of the sinus.
28. No.
29. Mandibular division (Vc).
30. Parasympathetic secretomotor fibres via the pterygopalatine ganglion, the zygomaticotemporal nerve
and the lateral wall of the orbit.
31. Anterior ethmoidal branch of the nasociliary branch of the ophthalmic division (Va) of the trigeminal
nerve.
32. They leave the internal carotid artery in the cavernous sinus to pass onto the nasociliary nerve and
then to its long ciliary branches.
33. The optic disc where the optic nerve enters the retina.
34. Ophthalmic artery with sympathetics on it and three layers of meninges.
35. Small pupil due to the unopposed action of the parasympathetic in III and ptosis as both sympathetic
and the somatic fibres in III are needed to avoid ptosis.
36. Sensory: nasociliary from ophthalmic division (Va) of trigeminal. Motor: facial (VII) for orbicularis
oculi.
37. (a) Small. Loss of sympathetic, unopposed parasympathetic in III.
(b) Large. Loss of parasympathetic, unopposed sympathetic.
(c) Large. Sympathetic discharge.
(d) Small. As part of the "near reflex". Parasympathetic in III.
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SESSION 3 - Face, Scalp, Trigeminal (V) And Facial (VII) Nerves
1.
Supra-orbital, infra-orbital and mental.
2.
The vessels are held open by the connective tissue under the skin and they bleed from both cut ends
as there is widespread anastomosis of the vessels.
3.
Occipital, posterior auricular and superficial temporal from external carotid. Supra-orbital and
supratrochlear from internal carotid (ophthalmic artery).
4.
Lesser occipital, greater occipital, great auricular.
5.
Great auricular.
6.
Pterygomandibular raph? . Superior constrictor also arises from it.
7.
Orbital part.
8.
Modiolus.
9.
Facial expression as it supplied by the facial nerve (VII).
Greater occipital.
10. By pulling the outer edges of the mouth down and open.
11. Posterior belly of digastric, stylohyoid and occipital belly of occipitofrontalis. (Also auricular
muscles).
12. It dips below the jaw line before ascending to reach the muscles by the mouth and is thus liable to
damage.
13. Upper face muscles, the supranuclear supply of which is bilateral.
14. If the lesion is proximal to where chorda tympani leaves the facial nerve in the middle ear, taste on
the anterior two thirds of the tongue would be lost.
15. If the lesion is proximal to where the nerve to stapedius leaves the facial nerve in the middle ear,
there could be hyperacusis - an increased perception of low, rumbling, vibrating noises.
16. Supra-orbital, supratrochlear, lacrimal, Infratrochlear and external nasal.
17. Buccinator.
18. Pterygomaxillary fissure.
19. Maxillary.
20. Foramen rotundum.
21. Nerve of the pterygoid canal which is a combination of the greater petrosal and deep petrosal
(sympathetic).
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22. Pharyngeal branch.
23. Taste, sympathetic and parasympathetic (secretomotor).
24. Zygomatic and then zygomaticotemporal.
25. Anterior belly : nerve to mylohyoid from mandibular division (Vc) of trigeminal. Posterior belly:
facial (VII) before it enters the parotid gland.
26. Lingual.
27. Chorda tympani.
28. Parotid.
29. Sympathetic and somatic sensory from the auriculotemporal nerve.
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SESSION 4 - Nasal Cavity, Sinuses, Nasopharynx, Olfactory (I) &
Vestibulocochlear (VIII) Nerves
1.
Ethmoid, vomer, inferior concha, palatine, maxilla and medial pterygoid plate of sphenoid.
2.
Directly backwards.
3.
Leakage of CSF down the nose. Most commonly caused by fracture of the cribriform plate of
ethmoid.
4.
Under surface of the cribriform plate of ethmoid, upper nasal septum and superior surface of superior
concha.
5.
The choanae (posterior limit of nasal septum).
6.
The bony contributions to the nasal septum are the perpendicular plate of the ethmoid bone and the
vomer. The vomer is a separate bone.
7.
Warms, moistens and filters inspired air.
8.
Inferior concha is a separate bone. The superior and middle are part of the ethmoid.
9.
Maxillary, which drains into the middle meatus.
10. Anterior and middle ethmoidal and frontal.
11. Cilia.
12. It causes intense vasoconstriction of the oedematous mucosa.
13. Internal carotid: anterior/posterior ethmoidal from ophthalmic. External carotid: branches of
sphenopalatine, greater palatine and infra-orbital from maxillary; branches from facial.
14. Pterygopalatine.
15. Pharyngobasilar fascia.
16. At the lowest border of the soft palate (uvula).
17. Cartilaginous part.
18. Salpingopharyngeus, levator palati and tensor palati.
19. From nasopharynx to middle ear as the pressure within the middle ear and mastoid air cells is
constantly dropping due to gaseous absorption.
20. Adenoid (pharyngeal tonsil) and tubal tonsil around opening of Eustachian tube.
21. Pharyngeal branch of maxillary division (Vb) of trigeminal.
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22. Hearing and balance.
23. Sphenopalatine artery and nasopalatine nerve.
24. It is an very vascular area of the antero-inferior aspect of the nasal septum where branches of three
arteries anastomose. Many nose bleeds occur here. Branches from external carotid: ascending
branches of greater palatine and sphenopalatine (maxillary), septal branches of superior labial
(facial).
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SESSION 5 - Oral Cavity
1.
Styloglossus (hypoglossal XII), stylopharyngeus (glossopharyngeal IX) and stylohyoid (facial VII).
2.
It absorbs pressure on the teeth during mastication without causing reabsorption of bone.
3.
There are four genial tubercles on the anterior inside of the mandible. Muscles from the upper two
pass to the tongue and are supplied by the hypoglossal nerve. Muscles from the lower two pass to the
hyoid and are supplied by the C1 fibres on the hypoglossal nerve.
4.
(c) old age as the teeth fall out and the gum margin recedes.
5.
Maxilla and palatine.
6.
Hyoglossus is supplied by the hypoglossal nerve (XII). Lateral to it: hypoglossal nerve (XII) and its
venae commitantes, the submandibular duct and lingual nerve. Medial to it: lingual artery,
glossopharyngeal nerve (IX) and stylohyoid ligament.
7.
Buccinator and superior constrictor.
8.
Supero/medial.
9.
No. It is the other way round with a little inserted into the hyoid and the majority into the midline
raph? .
10. Superior root of ansa cervicalis.
11. Mixed.
12. Deep part.
13. Lingual.
14. (c) under the tongue.
15. The nuclei are in the superior salivary nucleus and reach the facial nerve by way of the nervus
intermedius. In the middle ear the fibres leave as the chorda tympani which joins the lingual nerve
which is a branch of the mandibular division of the trigeminal nerve. The fibres leave this nerve and
pass into the submandibular ganglion where they synapse before passing to the two glands.
16. Sympathetic and somatic sensory which is always a branch of the trigeminal.
17. All the muscles of the tongue are supplied by the hypoglossal nerve except one, palatoglossus,
which is supplied by the pharyngeal plexus which consists of IX, X and sympathetic.
18. Palatoglossal.
19. Filiform: tips of keratin for gripping food. Fungiform: taste buds.
20. Because they are supplied by the glossopharyngeal nerve (IX) which also supplies the posterior third
of the tongue.
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21. Chorda tympani whose cell bodies are in the geniculate ganglion.
22. Glossopharyngeal nerve (IX)
23. The internal branch of the superior laryngeal nerve, a branch of the vagus (X).
24. To the side of the lesion as the good muscles push it across.
25. Lingual, palatine, tubal and pharyngeal tonsils.
26. Tonsillar and ascending palatine branches of the facial artery. Also a branch of the ascending
pharyngeal.
27. Because mucosa in both regions is supplied by the glossopharyngeal nerve (IX).
28. The carotid sheath (with its contents of internal carotid artery, internal jugular vein and vagus nerve)
and the glossopharyngeal nerve (IX).
29. Tensor palati: mandibular division (Vc) of trigeminal. Levator palati: Pharyngeal plexus (IX, X and
sympathetic).
30. Adult: 32. Child: 20.
31. The inferior end of the pterygomandibular raph? . The proximity of the lingual nerve to the inferior
alveolar nerve ensures a numb tongue too.
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SESSION 6 - Pharynx, Temporomandibular Joint, Muscles Of Mastication &
Infratemporal Fossa
1.
The larynx is pulled up under the tongue, the aryepiglotticus muscles close the aditus, the cords close
and the epiglottis can be bent over backwards to cover the aditus.
2.
Pharyngobasilar fascia.
3.
The lower (cricopharyngeus) part of the inferior constrictor.
4.
It is supplied by the recurrent laryngeal nerve instead of the pharyngeal plexus.
5.
Linear mucosal tears are caused by the high pressure in the oesophagus with subsequent bleeding
(Mallory-Weiss syndrome).
6.
Stylohyoid, geniohyoid, mylohyoid, digastric, stylopharyngeus, palatopharyngeus and
salpingopharyngeus.
7.
Gravity aided by lateral pterygoid.
8.
It has fibrocartilage on its bony surfaces.
9.
Articular tubercle of the temporal bone.
10. Lateral pterygoid.
11. The parotid gland would be trapped behind the mandible and the inferior alveolar nerve would be
stretched.
12. Through each lingula where the sphenomandibular ligaments attach.
13. Lower compartment.
14. Branches of the mandibular division (Vc) of the trigeminal nerve.
15. Opening of the auditory tube, pharyngeal tonsil, pharyngeal recess, tubal tonsil, salpingopharyngeus
and levator palati.
16. Palatine tonsils, lingual tonsil and valleculae.
17. Aditus to larynx and piriform fossa.
18. Internal laryngeal branch of the superior laryngeal nerve down to the equivalent level of the cords
then recurrent laryngeal nerve downwards from that level. There is some overlap in the
laryngopharynx.
19. Entries: Nose and mouth. Exits: Trachea and oesophagus.
20. Medial pterygoids close the mouth, lateral pterygoids open the mouth.
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21. Masseter.
22. They both close the jaw but the posterior fibres also retract it.
23. Temporalis on one side anchors the condyle in its fossa whilst the lateral pterygoid on the opposite
side pulls its condyle forward. The teeth are held almost together with masseter and medial pterygoid.
24. Lingual nerve with chorda tympani joining it, inferior alveolar, buccal (Vc) and auriculotemporal
nerves, maxillary artery and its branches.
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SESSION 7 - Larynx And Trachea
1.
Coughing, swallowing and straining.
2.
The larger the laryngeal prominence the longer the cords and the deeper the voice.
3.
The cricoid cartilage by synovial joints.
4.
The lateral thyrohyoid ligaments.
5.
Vocal, muscular and apical.
6.
Rotation and medial/lateral gliding.
7.
Elastic cartilage. Mucosa on top and on anterior surface is stratified squamous; on the rest of it, it is
respiratory (pseudostratified ciliated columnar).
8.
Aryepiglottic and vestibular folds.
9.
Cricothyroid membrane which is attached to the inner margin of the cricoid cartilage.
10. Laryngeal sinus or ventricle. The laryngeal saccule opens into it.
11. To lubricate the vocal cords.
12. The area defined by the upper epiglottis and the aryepiglottic folds is the aditus to (of) the larynx
whilst the area within the larynx but above the false cords is the vestibule of the larynx. The opening
between the true cords is the rima glottidis.
13. The larynx is pulled up under the tongue, the aryepiglotticus muscles close the aditus, the cords close
and the epiglottis can be bent over backwards to cover the aditus.
14. They rotate the vocal processes laterally and they slide the arytenoids down and laterally on the
cricoid arch.
15. Lateral crico-arytenoid, transverse and oblique arytenoids.
16. Thyro-arytenoid which attaches from the back of the anterior surface of the thyroid cartilage to the
vocal process of the arytenoid. That is, it lies alongside the vocal cord.
17. Vocalis. It can oppose greater amounts of vocal cord to alter the quality of the voice and to give
coughing more power.
18. The cricothyroid muscle is a bit special for the following reasons:
(a) It is the only intrinsic muscle of the larynx that is situated on the outside of the larynx.
(b) It is the only muscle that tightens the cords.
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(c) It is the only intrinsic muscle that is not supplied by the recurrent laryngeal nerve but instead by
the external branch of the superior laryngeal nerve.
19. Cranial accessory (XI) which dumps its fibres on the vagus just below the jugular foramen.
20. Internal branch of the superior laryngeal nerve supplies down to the cords and the recurrent laryngeal
below this. Virtually no overlap.
21. Complete transection: cords are paralysed and lying in mid-abducted (cadaveric) position. Partial
lesion: Complete adduction of cords due to overwhelming action of muscles closing cords with only
posterior crico-arytenoid attempting and failing to open them.
22. May be no effect or some hoarseness which may recover but leave inability to reach high notes.
Thus, cords cannot fully tighten.
23. Superior and inferior thyroid arteries.
24. At C6 vertebral level the larynx becomes the trachea, the pharynx becomes the oesophagus and the
vertebral arteries enter the foramina transversaria.
25. To control the diameter of the trachea. It can decrease the diameter during coughing to give it a more
explosive force.
26. The recurrent laryngeal nerve.
27. Pseudostratified ciliated columnar.
28. Cricothyroidotomy. Feel and aim for the gap between the lower edge of the thyroid cartilage and the
upper cricoid cartilage in the midline.
29. Second and third rings.
30. The lower border of the last cartilage of the trachea that straddles the bifurcation.
31. Dilatation: sympathetic to meet respiratory demands. Constriction: parasympathetic (vagus) to
decrease dead space in quiet respiration.
32. Upper trachea: branches of the inferior thyroid artery. Lymphatics to deep cervical nodes. Lower
trachea: bronchial arteries from aorta. Lymphatics to pre- and paratracheal nodes.
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SESSION 9 - Pleural Cavity, Lungs, Phrenic And Vagus (X) Nerves
1.
Superior: thoracic inlet (top of manubrium, first ribs and T1 vertebra). Inferior: a line between
sternomanubrial junction (angle of Louis) and intervertebral disc between T4/5.
2.
Thymus gland or its remnant.
3.
Oesophagus, thoracic aorta, azygos veins, sympathetic chains and thoracic duct.
4.
Potential space.
5.
Hilum and pulmonary ligament.
6.
Pneumothorax with collapse of lung. Yes, if a lung bulla ruptures.
7.
(a) 8. (b) 10. (c) 12.
8.
(b) 2 spaces.
9.
Medial border of abducted scapula.
10. (a) The pulmonary artery lying anterosuperiorly,
(b) The pulmonary veins lying more inferiorly and
(c) the bronchi lying more posteriorly.
11. Superior vena cava, right atrium and right phrenic nerve.
12. Which statements are correct:
(a) false.
(b) true.
(c) false.
(d) false.
(e) false.
13. Right phrenic.
14. On left: on inferolateral side of arch of aorta. On right: on antero-inferior side of right subclavian
artery.
15. The vagus nerves pass posterior to the hilum of the lung.
The phrenic nerves pass anterior to the hilum of the lung.
15
16. Medial.
17. (a) false
(b) false
(c) true
(d) false
18. Right.
19. Bronchial arteries from thoracic aorta.
20. (a) false
(b) false
(c) false
(d) true
21. (c) 10
22. Lower.
23. Bronchopulmonary or hilar nodes.
24. Ptosis and small pupil.
16
SESSION 10 - Middle Mediastinum, Pericardium, Heart And Great Vessels
1.
Second left rib to third right rib to sixth right rib, all parasternal. Then to fifth inter-space for apex of
heart.
2.
Pulmonary artery and aorta anterior to finger, pulmonary veins and superior vena cava behind finger.
3.
As a pocket of pericardium at the base of the heart between the points of entry of the pulmonary
veins.
4.
Internal thoracic and pericardiacophrenic arteries. Phrenic to fibrous and parietal serous. Sympathetic
to visceral layer.
5.
Two thirds right.
6.
Left atrium.
7.
Left atrium.
8.
T4/5.
9.
Apex of left ventricle. Mitral valve.
10. Anterior sinus. To sinu-atrial node.
11. Marginal and posterior interventricular.
12. When both anterior and posterior interventricular arteries are supplied by the left coronary artery.
13. Septal branches of the anterior and posterior interventricular arteries from left and right coronary
arteries.
14. Right, via the posterior interventricular artery.
15. Circumflex branch of the left coronary artery.
16. Anterior interventricular groove.
17. Venae cordis minimae.
18. Just to the left of the valve of the inferior vena cava in the right atrium.
19. Concerning the fetal circulation, which statements are correct:
(a) false.
(b) true.
(c) false
17
(d) true
(e) false
20. Musculi pectinati.
21. Sinus venosus.
22. To direct oxygenated blood through the foramen ovale into the left atrium.
23. Anterior, posterior and septal.
24. Fossa ovalis. It was septum primum.
25. It lies at the top of the sulcus terminalis in the wall of the right atrium, just where the superior vena
cava joins it.
26. The septomarginal trabecula or moderator band.
27. (b) two.
28. Second right intercostal space parasternally.
29. (a) 10mm.
30. Two. Anterior and posterior.
31. Internal thoracic.
32. Left and right brachiocephalic veins at lower border of right first costal cartilage.
33. Vagus: superior and inferior cardiac branches in neck and from recurrent laryngeal nerve.
Sympathetic: branches from each cervical ganglion and from ganglia T1-5 of the thoracic chain.
34. (a) no.
(b) yes.
(c) no.
(d) yes.
(e) no.
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SESSION 11 - Posterior Mediastinum, Diaphragm, Thoracic Wall And
Respiration
1.
T4 to T12.
2.
Oesophagus, bronchi, posterior intercostal spaces and spinal cord.
3.
T1 to L2.
4.
Medial.
5.
No. They synapse in the abdominal ganglia - coeliac, aorticorenal, etc.
6.
Grey rami communicantes.
7.
Greater: T5-9. Lesser: T10, 11. Least: T12.
8.
Through the crura.
9.
T10 with the left and right vagus nerves and the oesophageal branches of the left gastric vessels.
10. Right crus, arising from the sides of the vertebral bodies L1-3.
11. Circular fibres in the diaphragm, right crus and oesophagus, the pull of the right crus, the phrenicooesophageal ligament (a fold of connective tissue), the angle of the oesophagogastric junction,
apposition of mucosal folds and intra-abdominal pressure acting laterally on the intra-abdominal
oesophagus.
12. Azygos and hemi-azygos veins and oesophageal branches of the left gastric veins.
13. Haematemesis (vomiting blood).
14. Subcostal and ascending lumbar veins.
15. Aortic orifice, behind the median arcuate ligament.
16. The aorta and the thoracic duct.
17. Superior vena cava.
18. The hemi-azygos and accessory hemi-azygos veins.
19. 45cm. See also femur, transverse colon, teeth to cardia of stomach, spinal cord.
20. T5 vertebral level. It enters the junction of the left subclavian and internal jugular veins.
21. Chylothorax.
22. Through its own opening in the muscular part of the left dome.
19
23. Medial: side of body of L1 to tip of transverse process of L1. Lateral: tip of transverse process of L1
to tip of twelfth rib.
24. Seventh costal cartilage.
25. They flatten and descend.
26. Sympathetic chain.
27. Upper: anteroposterior expansion (pump handle movement). Rotation at costotransverse joints.
Lower: lateral expansion but becoming bucket handle movement at the height of inspiration.
Plane/gliding movement at costotransverse joints.
28. (c) correct.
29. Seventh.
30. 11 and 12.
31. (b) correct
32. Musculophrenic and internal thoracic.
33. (d) correct
34. External intercostal muscle.
35. (c) correct.
36. External intercostal muscle.
37. No arm fixation: scalenes, platysma, sternocleidomastoid, latissimus dorsi during expiration, external
oblique abdominis. Arm fixation needed: pectoralis minor and major, latissimus dorsi during
inspiration.
38. (a) Primary cartilaginous.
(b) Secondary cartilaginous.
(c) Atypical synovial.
(d) Primary cartilaginous.
(e) Atypical synovial.
(f) Synovial.
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SESSION 12 - The Abdomen - First Look
1. Secondary cartilaginous.
2. At the pelvic brim.
3. T10.
4. The transpyloric plane is defined as a horizontal line half way between the suprasternal notch and the
pubis.
5. Pylorus, neck of pancreas, hilum of kidneys, hilum of spleen, second part of duodenum, ninth costal
cartilage, fundus of gallbladder, duodenojejunal junction, end of spinal cord, start of portal vein, L1
vertebra.
6. Linea alba: the midline fibrous junction of the two rectus sheaths. Linea semilunaris: lateral edge of
the rectus sheath.
7. A third of the way along a line from the anterior superior iliac spine to the umbilicus. It is the
position of the appendix for diagnosis and surgery of appendicitis.
8. (a) correct. It is nearly always higher than in (b)
9.
Anterior superior iliac spine and pubic tubercle.
10. It can move around in the abdomen and "wall off" areas of inflammation.
11. Colon.
12. On the right of S2, anterior to the sacro-iliac joint.
13. At right, free border of lesser omentum, just superior to the first part of the duodenum.
14. Ventral mesentery.
15. Due to rotation of stomach in embryo.
16. Dorsal mesentery.
17. Stomach: yes. Second part of duodenum: no. Jejunum: yes. Caecum: yes. Sigmoid colon: yes. Second
part of rectum: no.
18. To allow posterior distension of the stomach.
19. Ligamentum teres. It is the remnant of the left umbilical vein.
20. Bile duct, hepatic artery and portal vein.
21. (a) Anterior: bile duct, hepatic artery and portal vein.
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(b) Posterior: inferior vena cava.
(c) Superior: caudate process of caudate lobe.
(d) Inferior: first part of duodenum.
22. A layer of peritoneum between the greater omentum and its attachment to the transverse colon.
23. Middle colic from superior mesenteric artery.
24. (a) Right hypochondrium.
(b) Left iliac fossa.
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SESSION 13 - Mesenteries, Bowel And Stomach
1.
Right ureter, inferior vena cava, aorta, third and fourth parts of duodenum, right psoas.
2.
Appendicular from posterior caecal branch of ileocolic artery.
3.
The three taenia coli lead to it.
4.
Lymphatics and autonomic nerves.
5.
Small pouches of peritoneum filled with fat. Tiny or absent in the appendix and caecum, absent from
rectum and plentiful elsewhere in colon.
6.
Veins that drain from one organ or a group of organs to another organ before returning to the heart.
7.
Kidneys and suprarenal glands.
8.
Superior mesenteric vein and splenic vein behind the neck of the pancreas.
9.
Left.
10. Two thirds. The vagal parasympathetic supply ceases and supply beyond this is from S2, 3, 4.
11. (a) Systemic: middle and inferior rectal veins. Portal: superior rectal vein.
(b) Systemic: azygos and hemi-azygos. Portal: left gastric veins.
(c) Systemic: epigastric veins. Portal: veins of ligamentum teres.
(d) Systemic: Inferior phrenic. Portal: hepatic veins.
12. Splenic to left renal behind the pancreas. Portal to inferior vena cava in opening of lesseer sac.
13. The foregut is supplied by branches of the coeliac artery, the midgut by the superior mesenteric
artery and the hind gut by the inferior mesenteric artery.
14. Inferior pancreaticoduodenal.
15. Marginal artery.
16. Pouches or sacculations in the colon caused by the fact that the taenia coli are shorter than the bowel
itself.
17. 3cm. Circular fibres in the diaphragm, right crus and oesophagus, the pull of the right crus, the
phrenico-oesophageal ligament (a fold of connective tissue), the angle of the oesophagogastric
junction, apposition of mucosal folds and intra-abdominal pressure acting laterally on the intraabdominal oesophagus.
18. Hiatus hernia.
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19. Left gastric artery.
20. From the splenic artery beyond the spleen to supply the fundus of the stomach and the upper part of
the greater curvature. They travel in the gastrosplenic ligament with the left gastro-epiploic artery.
21. Splenic artery and vein and tail of pancreas.
22. Yes.
23. Anterior and posterior vagus nerves.
24. Upwards, backwards and to the right.
25. Pain from the right side of the transverse colon is detected by the sympathetic part of the autonomic
nervous system and because this part of the colon belongs to the mid gut, the pain is carried by the
lesser splanchnic nerves and hence is referred to dermatomes T10 & T11, which are peri-umbilical in
their distribution.
26. Left and right kidneys.
27. Vitello-intestinal duct. Mimics appendicitis.
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SESSION 14 - Duodenum, Liver, Biliary System, Pancreas And Spleen
1.
Pyloric stenosis. The thickened circular muscle is split surgically.
2.
Half and half.
3.
Hilum of right kidney.
4.
L3.
5.
Anterior.
6.
Central role in carbohydrate, fat and protein metabolism; storage of minerals and vitamins;
metabolism of drugs and ingested food; a reticulo-endothelial and immune function.
7.
Left and right triangular ligaments joined by a superior and inferior coronary ligament.
8.
Right subphrenic is anterior, between the right lobe of the liver and the diaphragm. Right subhepatic
is inferior and posterior to the right lobe of the liver. Left subhepatic is in the lesser sac.
9.
Falciform ligament is remnant of the ventral mesentery of stomach. Ligamentum teres is the remnant
of the left umbilical vein.
10. Porta hepatis.
11. Left lobe.
12. Inside lesser sac.
13. The common hepatic duct is formed by the junction of the left and right hepatic ducts and measures
4 cm long and is 4 mm in diameter. It is joined by the cystic duct which is approximately 3 cm long
and 3 mm in diameter. Together they make the bile duct which is 8 cm long and 8 mm in diameter.
14. Sphincters surround bile duct, pancreatic duct, and the ampulla of Vater. The biliary sphincter is
always present.
15. Usually behind. Calot's triangle.
16. Posteromedial.
17. 10cm.
18. Veins usually pass directly into the liver from the gallbladder bed and then to the hepatic veins.
19. Splenic (arteria pancreatica magna), gastroduodenal, inferior and superior pancreaticoduodenal.
20. Superior mesenteric artery and vein.
21. The tail.
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22. Islets of Langerhans.
23. The portal vein is formed from the superior mesenteric and splenic veins.
24. Which of the three structures in the free edge of the lesser omentum lies most:
(a) Hepatic artery.
(b) Bile duct.
(c) Portal vein.
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SESSION 15 - Posterior Abdominal Wall
1.
Psoas: segmentally in abdomen by L1 and 2. Iliacus: femoral nerve in abdomen (L2, 3).
2.
Quadratus lumborum.
3.
Iliohypogastric is the main nerve with its lateral cutaneous branch supplying an area of buttock. Its
anterior cutaneous branch supplies skin of mons pubis. The ilio-inguinal nerve is the collateral
(muscular) branch supplying the conjoint tendon and lower transversus abdominis and internal
oblique abdominis.
4.
The genital branch passes laterally to reach the deep inguinal ring. The femoral branch passes on
down to pierce the femoral sheath.
5.
Lateral to psoas.
6.
Obturator nerve as in the developing limbs of the embryo the medial thigh lies anteriorly.
7.
Between internal oblique and transversus abdominis.
8.
Sympathetic and somatic in genital branch of genitofemoral.
9.
Obturator externus.
10. (a) Coeliac artery commencing at the T12 vertebral level
(b) Superior mesenteric artery commencing at the L1 vertebral level
(c) Inferior mesenteric artery commencing at the L3 vertebral level
11. Anterior.
12. Left.
13. Superior mesenteric artery.
14. The left vein joins the left renal. The right joins the inferior vena cava directly.
15. Varicocele. Failure of the venous valve immediately below the junction of the left testicular vein with
the left renal vein.
16. Aorta: L4. Inferior vena cava: L5.
17. A collection of sympathetic and parasympathetic autonomic nerves connecting the left and right
coeliac ganglia and feeding fibres onto the coeliac artery and its branches.
18. The whole abdominal contents including the suprarenal glands.
19. On arteries for immediate distribution and lying free in the superior hypogastric plexus for
transmission to the pelvic plexus.
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20. Unused sympathetic fibres descending from around the aorta and its various ganglia and plexuses
together with lumbar splanchnics that have come in from the lumbar sympathetic chain. This superior
hypogastric plexus is a mixture of pre- and postganglionic fibres and lies on and below the
bifurcation of the aorta. Via the hypogastric nerves it feeds the pelvic plexus.
21. Root values are S2, 3, 4. These fibres supply motor fibres to the left one third of the transverse colon,
all the colon and rectum beyond, and all pelvic organs. They also carry sensory fibres from some
pelvic organs (e.g. lower uterus, lower rectum and part of the bladder).
22. Gonadal vessels.
23. Anteromedial.
24. Renal, gonadal and vesical.
25. Pelviureteric junction, ureterovesical junction and where the ureter crosses the iliac vessels.
26. Tips of the lumbar transverse processes, the sacro-iliac joint and ischial spines.
27. Inferior phrenic, aorta and renal.
28. The left suprarenal vein drains into the left renal vein. The right suprarenal vein is short and stubby
and drains directly into the inferior vena cava.
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