High Yield Flashcards

Question

Temporal Lobe: Vasculature

Answer 1

* Arterial supply: * Anterior choroidal * Middle cerebral * Basilar * Venous drainage: * Superficial middle cerebral vein * Inferior anastomotic vein of Labbe * Posterior choroidal vein

Answer 2

Wernicke’s area can be on either side, most commonly the left

Answer 3

The frontal lobe is by far the largest of the four lobes of the cerebrum (along with the parietal lobe, temporal lobe, and occipital lobe), and is responsible for many of the functions which produce voluntary and purposeful action.

Answer 4

The frontal lobe is the largest lobe accounting for 41% of the total neocortical volume. The frontal lobe resides largely in the anterior cranial fossa. Its most anterior part is known as the frontal pole, and extends posteriorly to the central (Rolandic) sulcus which separates it from the parietal lobe. Posteroinferiorly it is separated from the temporal lobe by the lateral sulcus (sylvian fissure), although not seen from the surface is the insular cortex which is hidden deep to the lateral sulcus The interhemispheric fissure separates its medial surface from the contralateral frontal lobe. The frontal lobe is roughly pyramidal in shape, with three cortical surfaces: * Lateral surface (largest) * Medial (inter-hemispheric) surface * Inferior surface

Answer 5

* Gyri: * superior frontal gyrus * middle frontal gyrus * inferior frontal gyrus * precentral gyrus (primary motor area) * Sulci: * superior frontal sulcus * inferior frontal sulcus * precentral sulcus

Answer 6

The medial surface of the frontal lobe, abutting the falx in the midline, is primarily divided by the curving cingulate sulcus, which parallels the outer outline of the corpus callosum. Above the cingulate sulcus is the medial continuation of the superior frontal gyrus which is usually divided into two parts by a short ascending branch from the cingulate sulcus. * medial frontal gyrus * paracentral lobule

Answer 7

Gyrus recti medially Orbital gyri arranged in a H configuration (Medial, lateral, anterior and posterior orbital gyri)

Answer 8

* anterior: frontal bone * superiorly: frontal bone (anteriorly), coronal suture, and parietal bone (posteriorly) * posterior: central sulcus and parietal lobe * inferolaterally: lateral sulcus and temporal lobes * inferior: floor of anterior cranial fossa

Answer 9

* middle cerebral artery (MCA): lateral frontal lobe * anterior cerebral artery (ACA): medial frontal lobe

Answer 10

The occipital lobe is the smallest of the four lobes of the brain. Location: Posterior to the temporal and parietal lobes, sitting on top of the tentorium Function: Primary and secondary visual cortex

Answer 11

* Triangular in shape * Seperated from the parietal and temporal lobes by the parieto-occipital sulcus and the parietotemporal line * Medially it is devided into hemisphere by the longitudinal fissure * The calcarine sulcus runs horizontally across with the cuneus above and the lingual gyrus below

Answer 12

* Primary visual cortex – primary visual processing * Secondary visual cortex – visual association

Answer 13

* Anterior: parietal and temporal lobes * Posterior: occipital bone * Superior: Parietal lobe and parietal bone * Inferior: tentorium cerebelli * Medial: transverse sinuses, confluence of sinuses, straight sinus

Answer 14

* Arterial supply: * Branches of the posterior cerebral artery * Venous: * Straight sinus * Superior sagittal sinus * Transverse sinuses

Answer 15

The parietal lobe is one of the four lobes of the brain located between the frontal and occipital lobes. Function: Sensory processing, communication, proprioception

Answer 16

* Lobe extends from the central sulcus anteriorly to the parieto-occipital fissure posteriorly. * The lateral sulcus corresponds to its inferolateral boundary, separating it from the temporal lobe. Divided by the medial longitudinal fissure Gyri: * postcentral gyrus (primary sensory area) * superior parietal lobule * inferior parietal lobule (Wernicke's area)

Answer 17

* Anterior: frontal lobe * Posterior: occipital lobe * Superior: parietal bone * Inferior: temporal lobe

Answer 18

* Blood supply: * middle cerebral artery (MCA) * anterior cerebral artery (ACA): medial parietal lobe * posterior cerebral artery (PCA): posterior medial parietal lobe * Venous: * Superior sagittal sinus * Straight sinus * Inferior superficial cerebral vein (Labbe)

Answer 19

The cerebellum is a specialised part of the brain located in the posterior cranial fossa **Function:** Computation of movement and proprioceptive data

Answer 20

* Superior cerebellar from the basilar –supplies the superior surface * Anterior inferior cerebellar from the basilar – anterior inferior * Posterior inferior cerebellar from the vertebral – posterior inferior

Answer 21

The basilar artery is a large artery of the posterior circulation of the brain.

Answer 22

**Origin:** Formed from the confluence of the vertebral arteries at the base of the pons. **Course:** Ascends parallel to the ventral pons in the central groove of the pons in the pre-pontine cistern **Branches:** Numerus small braches to the pons and cerebellum including the: * The anterior inferior cerebellar artery (AICA) * Labyrinthine arteries (normally from AICA) * Superior cerebellar arteries **Termination:** bifurcates to form the two posterior cerebral arteries at the upper pontine boarder

Answer 23

* Anterior: clivus * Posterior: Basilar pons * Superior: Posterior cerebral arteries * Inferior: vertebral arteries * Lateral: Origin; origin of the abducens nerve, termination: origin of the oculomotor nerve

Answer 24

* Fenestration * Persistent carotid-basilar artery anastomosis

Answer 25

Internal carotid arteries are the primary supply to the anterior circulation of the brain **Function:** supply oxygenated blood to the brain and meninges

Answer 26

Divides into the following segments (Bouthillier classification): * Cervical * Petrosal * Lacerum * Clinoid * Caverous * Ophthalmic * Communicating **Origin:** Bifurcation of the common carotid at the level ~L4 **Course:** ascending through the carotid space, enters the cranial cavity via the carotid canal **Termination:** Branches to for the anterior and middle cerebral arteries

Answer 27

2^nd segment: * Caroticotympanic * Vidian 4^th segment: * Meningohypophyseal * Inferolateral trunk 6^th segment * Ophthalmic artery * Superior hypophyseal 7^th segment: * Posterior communicating artery * Anterior choroidal artery * Anterior communicating artery * Middle cerebral artery

Answer 28

* Anterior: External carotid artery * Lateral: internal jugular vein * Medial: larynx, oropharynx, nasopharynx * Superior: suprasellar cistern * Inferior: Carotid bulb

Answer 29

* Aberrant ICA course * Kissing carotids * Persistent carotid-vertebrobasilar anastomoses * Retropharyngeal ICA

Answer 30

**Origin:** Terminal bifurcation of the Internal carotid artery (the other branch is the anterior cerebral artery **Course:** **Divided into segments: (HIOC)** * M1 – the horizontal segment – from origin to bi/trifurcation * M2 – insular segment from bi/trifurcation to the circular sulcus of the insular lobe * M3 – Opercular branches – within the sylvian fissure * M4 – Cortical segment – branches emerging from the sylvian fissure

Answer 31

**Branches:** **M1: (PAUL)** * Medial and lateral lenticulostriate * Anterior temporal * Polar temporal * **M2:** * Superior and inferior trunks

Answer 32

**M1:** * Basal ganglia * External and internal capsule * Anterior third of the superior, middle and inferior temporal gyri * Polar Regions of the temporal lobe

Answer 33

The cerebral venous sinus are venous system formed from folds of the meninges **Function:** return of deoxygentated blood from the brain to the system circulation

Answer 34

Folded dura form sinus which drain from veins to other sinuses or veins Valveless There are paired and unpaired cerebral venous sinuses

Answer 35

Transverse sinuses – from the confluence of sinuses to the sagittal sinuses, receives the superficial cerebral vein of labbe Sigmoid sinuses – from the transverse sinus s-shaped course draining into the jugular bulbs , also receives the sphenoparietal sinus and the superior petrosal sinsu Superior and inferior petrosal sinuses – From the right and left cavernous sinuses to the sagittal and jugular bulb respectively Sphenoperietal sinus courses along the ridge of the greater wing of the sphenoid to the cavernous sinsus, also receives the middle superficial cerebral vein Caverous sinuses located either side of the sella, receives the ophthalmic veins (superior and inferior) connected by the anterior and posterior intercavernous sinsus, drains into the superior and inferior petrosal sinuses and basiclival plexus

Answer 36

Internal cavernous sinuses as noted earlier Superior sagittal sinus midline between the falx drains into the confluence of sinuses Inferior sagittal sinus runs in the over the corpus callosum drains into the straight sinus Straight sinus – from the vein of Galen to the confluence of sinuses Occipital sinus – from the occipital bone midline between the cerebellar hemispheres drains into the confluence of sinuses

Answer 37

No confluence – straight and superior sagittal sinuses drain into the right and left transverse sinuses separately No confluence – straight and superior sagittal sinuses fork prior to drain into the straight sinuses

Answer 38

The cerebral veins drain the brain parenchyma and are located in the subarachnoid space. They pierce the meninges and drain further into the cranial venous sinuses.

Answer 39

The cerebral veins lack muscular tissue and valves. The cerebral venous system can be divided into: * superficial (cortical) cerebral veins * deep (subependymal) cerebral veins

Answer 40

The venous drainage of the orbit is the venous system to drain deoxygenated blood from the orbit to the systemic circulation.

Answer 41

The subarachnoid cisterns are discrete named spaces within the subarachnoid space where the pia mater and arachnoid membrane are not in close approximation. The subarachnoid tissue is not as abundant here as in the normal subarachnoid space and cerebrospinal fluid (CSF) gathers to form pools or cisterns (Latin: "box"). As they are interconnected, the patency is essential for CSF circulation. Being within the subarachnoid space, the cisterns may have vessels and/or cranial nerves passing through them.

Answer 42

* cisterna magna: the largest of the subarachnoid cisterns * prepontine cistern: anterior to the pons * suprasellar cistern: surrounding the infundibulum * interpeduncular cistern: between the cerebral crura * quadrigeminal cistern: superior cistern or cistern of the great cerebral vein * ambient cistern: surrounds the back of the midbrain * cerebellopontine cistern: at the cerebellopontine angle * premedullary cistern: anterior to the medulla * sylvian cistern: superficial to the insular cortex

Answer 43

* Gross anatomy * Superiorly * Frontal bone * Sphenoid (lesser wing) * Medially * Maxilla * Lacrimal bone * Ethmoid (lamina papyracea) * Sphenoid (lesser wing)+/- palatine * Inferiorly * Maxilla * Zygomatic (laterally) * Palatine(inferomedial) * Laterally * Zygomatic * Sphenoid (greater wing) * Foramina * Optic foramina * Superior orbital fissure * Inferior orbital fissure * Contents * Orbit * Lacrimal gland * Optic foramina * Optic nerve (CN2) * Ophthalmic artery (C6 ICA) * Superior orbital fissure * CN 3 occulomotor * CN 4 trochlea * CN 5 (V1 ophthalmic division of trigeminal) * CN 6 abducens * +/- middle meningeal contribution to ophthalmic artery (variantion) * Inferior orbital fissure * Infraorbital nerve * Infraorbital artery * Inferior ophthalmic vein

Answer 44

The bony orbit is made up of: * Maxillary bone * Lacrimal bone * Ethmoid bone * Zygomatic bone * Frontal bone * Orbital process of the palatine bone * Greater and lesser wings of the sphenoid

Answer 45

* Optic nerve sheath complex – optic nerve, central retinal artery and vein, meninges * Intraconal space – orbital fat, ophthalmic artery, cranial nerves * Conal space – extra ocular muscles * Extraconal space – fat, lacrimal gland, lacrimal and frontal braches of V1

Answer 46

* Optic canal to intracranial cavity * Superior orbital fissure also to the intracranial cavity * Inferior orbital fissure to infratemporal fossa * Anterior ethmoidal foramen * Posterior ethmoidal foramen * Supra and infra orbital foramen * Nasolacrimal foramen

Answer 47

The mandible is a large single midline bone of the lower face **Function:** respiration, verbalisation, mastication **Location:** Jaw

Answer 48

Irregular bone. It consists of a curved horizontal portion the body and two perpendicular portions, the rami. The rami and the body unite at almost right angles (the angle of the jaw).

Answer 49

**Body:** * Mandibular symphysis – midline point of fusion * Mental foramen - inferior to the second pre-molar (mental vessels and nerve, the terminal branches of the inferior alveolar vessels and nerves) * Fossae for the sublinguinal and submandibular glands * Alveolar process of the teeth * Groove for the facial artery of the inferior border **Ramus:** * Mandibular foramen – opening of the mandibular canal, which transmits the inferior alveolar vessels and nerves * Coronoid process – anteriorly * Condylar process – posterior * Mandibular notch – space between the above two * Mandibular canal – between the mandibular foramen and the mental foramen

Answer 50

* Gomphosis joints with the lower row of teeth * Temporomandibular joint – between the condylar process of the mandible and the mandibular fossa and the articular eminence of the temporal bone. Atypical synovial joint with a fibrocartilage articular disc

Answer 51

Bilateral joint of the jaw. Modified hinge joint. **Function:** Mastication, verbalisation, respiration

Answer 52

The temporomandibular joint (TMJ) is an atypical synovial joint located between the condylar process of the mandible and the mandibular fossa and articular eminence of the temporal bone. It is divided into a superior discotemporal space and inferior discomandibular space by the TMJ disc (or meniscus).

Answer 53

* upper compartment: protraction, retraction and gliding side-to-side * lower compartment: opening and closing

Answer 54

* temporomandibular * stylomandibular * sphenomandibular

Answer 55

* Medial and lateral pterygoids * Masseter * Temporalis

Answer 56

**Arterial:** Superficial temporal **Vein:** Retromandibular **Innervation:** * auriculotemporal nerve * masseteric nerve

Answer 57

The extra-ocular muscles are the six muscles that insert onto the eye and hence control eye

Answer 58

* superior rectus: elevation, annulus of Zinn to the superior globe * superior oblique: intorsion, sphenoid bone via catelaginous trochlear to superior lateral globe * medial rectus: adduction, annulus of Zinn to the medial globe * lateral rectus: abduction, annulus of Zinn to the lateral globe * inferior oblique: extorsion, Maxillary bone to inferior lateral globe * inferior rectus: depression, annulus of Zinn to the inferior globe

Answer 59

oculomotor nerve: * superior, medial, and inferior rectus * inferior oblique trochlear nerve: * superior oblique abducens nerve: * lateral rectus

Answer 60

**Arterial:** Ophthalmic artery **Vein:** Superior and inferior ophthalmic veins

Answer 61

The nasolacrimal apparatus is the system responsible for drainage of tears. Production of tears by the lacrimal gland is included in some text under this heading.

Answer 62

* Location in the superior lateral orbit in the extraconal space * Almond shaped

Answer 63

Location: From the medial canthus to the inferior concha Consists of: * Lacrimal canaliculi which drain the lacrimal lake via the lacrimal puncta * Lacrimal sac – the superior and inferior lacrimal canaliculi drain into the lacrimal sac which lies in the lacrimal fossa, it drains into the nasolacrimal duct via the valve of Krause, the sac is enclosed in the lacrimal fascia and the orbicularis oculi * Nasolacrimal duct – Is the inferior continuation of the lacrimal sac, it is approximately 17mm in length, it has 2 parts: intraosseous part which lies within the nasolacrimal canal of the maxilla, the membranous part which runs in the nasal mucosa. It terminates below the inferior nasal meatus as a slit like opening where it is covered by a mucosal fold called the valve of Hasner

Answer 64

**Artery:** lacrimal artery from the ophthalmic artery **Vein:** Superior ophthalmic vein **Nerves:** greater petrosal nerve (from facial nerve) and lacrimal nerve (ophthalmic division of the trigeminal nerve)

Answer 65

* Medial: the maxilla * Lateral: Lacrimal lake * Superior: Superior orbital rim * Inferior: Floor of the nasal cavity * Posterior: ethmoid labyrinth and nasal cavity * Aterio-medial: Nasal vestibule

Answer 66

* Incompetent valve of Hasner * Absence * Accessory glands * Draining to the middle meatus

Answer 67

The orbit is a space of the anterior face **Function:** * Contain the globe and associated support structures and organs * Passage of nerve arteries and veins

Answer 68

* Superior: frontal bone, and anterior fossa * Inferior: Maxillary sinus * Lateral: infratemporal space * Medial: ethmoidal air cells * Posterior: the cavernous sinuses * Anterior: Superior and inferior palabra

Answer 69

The constrictor muscles of the pharynx are a set of 3 pharyngeal constrictors that constrict the pharynx to deliver a bolus of food to the oesophagus. Type: skeletal muscles under semi-voluntary control

Answer 70

* Origin: pterygoid hamulus, pterygomandibular raphe and mandible * Insertion: Pharyngeal raphe * Artery: ascending pharyngeal artery, branch of the external carotid artery * Nerve: pharyngeal plexus from vagus

Answer 71

* Origin: Greater and lesser conu of the hyoid bone * Insertion: Pharyngeal raphe * Artery: Ascending pharyngeal artery (external carotid artery) * Nerve: pharyngeal plexus from vagus

Answer 72

* Origin: Cricoid and thyroid cartilage * Insertion: Pharyngeal raphe * Artery: Ascending pharyngeal artery * Nerve: pharyngeal plexus from vagus * Incorporates cricopharyngeus inferiorly

Answer 73

* Anterior – pharynx * Posterior – Cervical spine vertebrae and retrophpharyngeal space * Lateral – carotid sheath and it’s contents * Superior – base of the skull * Inferior – Cricopharyngeus muscle

Answer 74

* Cricopharyngeal bar * Zenker’s diverticulum

Answer 75

The sternocleidomastoid (SCM) is a muscle of the neck. It has two heads that meld to form one insertion. SCM, along with the trapezius muscle, is invested by the superficial layer of the deep cervical fascia, which splits around it. SCM divides the neck into anatomical anterior and posterior triangles.

Answer 76

**origin:** manubrium (sternal head – tendinous), medial clavicle (clavicular head – muscular) **insertion:** mastoid process of the temporal bone, superior nuchal line of the occipital bone **Artery:** Superior thyroid and occipital arteries **innervation:** accessory nerve (CN XI) **action:** lateral flexion, flexion and rotation of the head on the neck, raise sternum (secondary muscle of respiration).

Answer 77

**upper half:** anteriorly: platysma muscle, external jugular vein Medial: anterior scalene muscle, common carotid artery, internal jugular vein, carotid sheath **lower half:** anteriorly: platysma posteriorly: anterior scalene muscle, common carotid artery, internal jugular vein, carotid sheath

Answer 78

* absent mastoid insertion (occipital insertion only) * absent clavicular or sternal head * fusion with trapezius muscle * additional clavicular head * separate muscle bellies for sternomastoid and cleidomastoid * separate muscle bellies for cleidooccipital and sternocleidomastoid

Answer 79

The primary blood supply to the face and neck

Answer 80

**Origin:** at the common carotid bifurcation level C4 **Course:** * Through the carotid sheath * Divided from the internal carotid artery by styloglossus and stylopharangeus * Exiting to pass through the parotid gland **Termination:** bifurcation in the maxillary and superficial temporal artery Distinguishable from ICA due to the many branches of the ECA

Answer 81

* Superior thyroid artery * Asecnding laryngeal * Lingual * Facial * Occipital * Posterior auricular * Maxillary * Superficial temporal

Answer 82

* Anterior – sternocleidomastoid * Posterior – internal carotid artery * Medial – larynx * Lateral – sternocleidomastoid

Answer 83

* Branch height **Trunks:** * Lingofacial trucnk * Thryolingual * Thyrolingualfacial * Occipital and posterior auricular have common trunk

Answer 84

There are 4 paired jugular veins which provide drainage of deoxygenated blood from the face, head and brain: * Internal jugular veins * External jugular veins * Posterior external jugular veins * Anterior jugular veins

Answer 85

**Origin:** Formed by the union of the inferior petrosal and sigmoid dural venous sinuses at the jugular foramen. **Course:** Descending in the carotid sheath, anterior to the internal carotid and vagus nerve, enters the thorax posterior to the two heads of the sternocleidomastoid **Drains to:** unites with the subclavian vein to form the brachiocephalic vein

Answer 86

**Tributaries:** (medical school lets fun people in) * Middle thyroid v * Superior thyroid v * Lingual v * Facial v * Pharyngeal v * Inferior petrosal sinus

Answer 87

**Origin:** Retromendibular and posterior auricular veins unite to form the external jugular vein at the angle of the mandible **Course:** Descends deep to the platysma but superficial to SCM, pierces the cervical fascia posterior to the head of the clavicle **Drains to:** subclavian veins

Answer 88

* Anterior jugular vein * Posterior external jugular vein * Suprascapular vein * Transverse cervical vein

Answer 89

**Origin:** Arise in the region of the hyoid bone confluence of multiple submandibular vessels **Course:** Descending medial to the anterior boarder of the sternocleidomastoid **Drains to:** passes deep to SCM to drain into the external jugular vein **Tributaries:** Small submandibular, laryngeal and thyroid veins **Variant:** may drain directly to the subclavian veins

Answer 90

Origin: Confluence of superficial veins of the posterosuperior neck and scalp Course: Supeficial course over the posterior triangle Drains to: External jugular vein

Answer 91

Submental and submandibular nodes * Below mylohyoid muscle and above the lower margin of the hyoid bone (or the carotid bifurcation) * anterior to the posterior border of the submandibular glands * level Ia: submental nodes, i.e. between the anterior bellies of the digastric muscles * level Ib: submandibular nodes between the anterior and posterior bellies of digastric muscles

Answer 92

Superior Internal jugular (deep cervical) chain * base of the skull to the inferior border of hyoid bone (or the carotid bifurcation) * anterior to the posterior border of sternocleidomastoid (SCM) muscle * posterior to the posterior border of the level I glands

Answer 93

Middle Internal jugular (deep cervical) chain * lower margin of hyoid to lower margin of cricoid cartilage (or the intermediate tendon of Omohyoid) * anterior to the posterior border of SCM * Posterior to the anterior boarder of SCM

Answer 94

Inferior Internal jugular (deep cervical) chain * lower margin of cricoid cartilage to level of the clavicle * anterior and medial to an oblique line drawn through the posterior edge of SCM and the posterolateral edge of the anterior scalene muscle * Posterior to the anterior border of SCM

Answer 95

Posterior triangle (spinal accessory) nodes, posterior to posterior edges of SCM and scalenus anterior * level Va: superior half, posterior to levels II and III * level Vb: inferior half, posterior to level IV

Answer 96

prelaryngeal / pretracheal / Delphian node * from the inferior margin of hyoid bone to the manubrium * anterior to levels III and IV

Answer 97

* superior mediastinal nodes * between CCAs, below superior aspect of manubrium to level of the brachiocephalic vein

Answer 98

The thyroid gland is an endocrine gland located in the pre-tracheal fascia of the neck **Function:** endocrine control of metabolism **Location:** Pre-tracheal fascia anterior to the thyroid, cricoid and first 3 tracheal cartilages

Answer 99

* Butterfly shaped with a lobe bilaterally joined by a central isthmus * Each lobe may be divided into an upper and lower pole * Parathyroid glands lie with each pole and are sometime intracapsular

Answer 100

**Arterial supply:** * Superior thyroid artery (from the ECA) * Inferior thyroid artery (from the thyrocervical trunk) **Venous drainage:** * Superior, middle and inferior thyroid veins (internal jugular, internal jugular and brachiocephalic vein) **Innervation:** * Superior, middle and inferior cervical ganglia **Lymphatics:** * Level 6 cervical nodes

Answer 101

* Anterior – strap muscle * Posterior – thyroid and cricoid cartilage, trachea * Posterior medial – trachea-oesophageal groove with the parathyroid glands and the recurrent laryngeal nerves * Posterior lateral – carotid space

Answer 102

* Pyramidal lobe * Lobar hemigenesis * Thyroglassal duct cyst * Ectopic thyroid tissue – lingual thyroid * Zuckerkandl’s tubercle * Thyroidea Ima artery

Answer 103

Single long bone of the arm Location: between the shoulder and the elbow

Answer 104

* Proximal: Rounded head covered with articular cartilage, greater and lesser tubercles, intertubercular groove * Mid: Surgical neck inferior to the tubercles, deltoid tuberosity, spiral groove from radial nerve * Distal: condyle of the humerus which consists of: capitulum, trochlear, medial and lateral epicondyles, radial fossa, olecranon fossa, coronoid fossa

Answer 105

* Proximal: the head of the humerus articulates with the glenoid of the scapula * Distal: capitulum with the radial head, trochlear with the trochlear notch of the ulnar

Answer 106

* Superior, middle, inferior and spiral glenohumeral ligaments * Radial and ulnar collateral ligaments

Answer 107

* Anterior: brachialis, bicep brachii, coracobrachialis * Posterior: Profunda brachii, radial nerve, triceps brachii * Lateral: deltoid * Medial: brachial plexus, brachial artery, supratrochlear nodes

Answer 108

Blood supply: * Anterior and posterior humeral circumflex arteries and veins * Perforators from profunda brachii Lymphatics: * Supratrochlear and axillary nodes Innervation: * Radial nerve

Answer 109

* Supracondylar process * Olecranon foramen

Answer 110

The elbow joint is a complex synovial joint between the arm and the forearm Has a joint capsule Synovial

Answer 111

Combination hinge pivot joint: Internal and external rotation of the arm Flexion and extension of the arm

Answer 112

* Proximal head of the radius the capitulum of the humerus * Trochlea notch of the ulnar with the trochlear of the humerus * Proximal radial head the proximal radial notch of the ulnar

Answer 113

* Brachioradialis * Biceps brachii * Triceps brachii

Answer 114

* Annular ligament * Proximal radial and ulnar collateral ligament complexes * Oblique cord- thickening of the supinator

Answer 115

* Coronoid and radial fossa fat pads anteriorly * Olecranon fat pad posteriorly

Answer 116

Blood supply: * Anastomotic arcade formed from branches of the radial, ulnar and brachial arteries Nerves: * Median, radial, ulnar and musculocutaneous nerves

Answer 117

* Anterior: biceps brachii tendon, brachialis muscle, median nerve, brachial artery * Posteriorly: Olecranon bursae, triceps brachii tendon * Laterally: Common extensor tendon, supinator muscle * Medially: ulnar nerve

Answer 118

* Variation in carry angle between males and females, females have larger angles usually * Synovial folds * Capitellar and olecranon pseudofacets * Accessory ossicles: os supratrochlear dorsale, patella cubiti

Answer 119

The shoulder joint also known as the gleno-humeral joint is a ball and socket synovial joint between the humerus and the glenoid.

Answer 120

* Most mobile joint in the body * Flex/extension, int. ext. rotation, ab and adduction

Answer 121

Head of the humerus with the glenoid fossa of the scapula. The glenoid labrum adds depth to the glenoid fossa.

Answer 122

* Attached to the margin of the glenoid fossa to the anatomical neck of the humerus, the long head of the biceps travels through it. * It is re-enforced by the rotator cuff except inferiorly where it is at its weakest

Answer 123

* Subacrominal – subdeltoid bursa * Subscapular bursa (communicates with the joint by the foramen of Weitbrecht)

Answer 124

* Superior, middle and inferior glenohumeral ligaments * Coracohumeral ligaments * Transverse humeral ligament

Answer 125

* abduction * produced by the deltoid assisted by the supraspinatus * adduction * produced by the short scapular muscles (except supraspinatus) when the deltoid relaxes. Assisted by the pectoralis major and latissimus dorsi * flexion * clavicular head of the pectoralis major and the anterior fibers of the deltoid, assisted by the coracobrachialis and biceps * extension * latissimus dorsi, posterior fibers of the deltoid and the long head of the triceps * rotation * lateral rotation: infraspinatus and teres minor * medial rotation: subscapularis and teres major

Answer 126

Arterial supply: * Anterior and posterior humeral circumflex and subscapular arteries Innervation: * Axillary (C5-C6), suprascapular, subscapular, musculocutaneous nerves Lymphatics: * Axillary

Answer 127

* Buford complex – cord like middle glenohumeral ligament * Os acrominale * Capsule attached to labrum * Long head of biceps insertion – glenoid, glenoid and labrum, labrum only

Answer 128

The biceps brachii muscle (also known simply as biceps) is a two-headed muscle in the anterior compartment of the arm that flexes at the elbow and supinates the forearm.

Answer 129

* Origin: * Short head: coracoid process of the scapula * Long head: supraglenoid tubercle of the scapula * Insertion: * Radial tuberosity of the proximal radius

Answer 130

musculocutaneous nerve

Answer 131

* arm abduction, arm adduction and ventral flexion * supination * flexion of the supinated forearm

Answer 132

* Duplicated long head of biceps tendon: can mimic longitudinal tear * Bifid/bifurcated insertion: anatomic variant that arises from persistent division between the short head and long head of the distal biceps brachii tendon

Answer 133

A plexus of nerves innervating the arm and part of the upper thorax Location: in the neck extending into the axilla, posterior to the clavicle Supply: motor and sensory to upper limb and upper thorax

Answer 134

Roots – C5 to T1 Trunks – upper C5-6, middle C7, lower C8-T1 Divisions – anterior and posterior Cords – named to their relation to the axillary artery – medial, lateral, posterior Branches: * Axillary (C5-6) * Musculocutaneous (C5-7) * Radial (all) * Medial (all) * Ulnar (C7, 8 T1)

Answer 135

Emerges between the middle and anterior scalenes Course intimately related to the axiallary artery

Answer 136

* ~50% Pre-fixed – C4 contribution or Post-fixed – T2 contribution * Variation in branching patterns

Answer 137

Venous drainage of the upper limb is a vascular system for the return of deoxygenated blood from the capillary beds of the upper limb to the heart via the superior vena cava.

Answer 138

The deep veins are located under the deep fascia. They are typically paired and lie on either side of an artery from which they take their name (venae comitantes).

Answer 139

* Deep venous palmar arch - receives the palmar metacarpal veins, drains to the radial veins * Radial veins - Receives the deep venous palmar arch, run with the the radial artery, drains into the brachial veins * Ulnar veins – Receives the surficial venous palmar arch, runs with the ulnar artery, drains into the brachial veins * Brachial veins – Origin at the union of the radial and ulnar veins, course following the brachial artery, ending at the inferior border of teres major, at this point the brachial veins join the basilic vein to form the axiliary vein * Axillary veins – the axillary vein continues with the axillary artery and is joined by the cephalic vein, subscapular vein, circumflex humeral vein, lateral thoracic vein and thoraco-acromial vein. It terminates at the lateral margin of the first rib where it becomes the subclavian vein.

Answer 140

* Superficial venous palmer arch: accompanies the superficial palmer arch, drains the commo palmer digital veins, drains into the ulnar vein * Dorsal venous network: formed from the dorsal metacarpal veins drains into the basilic and cephalic veins * Cephalic – origin the dorsal venous plexus, runs up the superficial space of the lateral aspect of the arm, drains to the median cubital and axially vein * Basilic – origin the dorsal venous network, up the superficial tissue of the medial aspect of the arm, also receives the median cubital vein, drains to the brachial veins mid arm

Answer 141

The ribs are the main structural element of the thorax. **Function:** Protection, respiration

Answer 142

There are 12 ribs which are separated by intercostal spaces. The first 7 ribs increase in length the lower five decrease in length. The 1^st, 11^th and 12^th ribs are considered atypical ribs.

Answer 143

True ribs – First 7 attached to the sternum directly by their own costal cartilage False ribs – 8^th to 10^th, converge anteriorly via the costal cartilage to the 7^th costal cartilage thus have indirect connection to the sternum. Floating ribs – the 11^th and 12^th have no anterior direct or indirect sternal attachment The first rib is the most superior of the twelve ribs. It is an atypical rib because of number differentiating features and is an important landmark for the borders of the superior thoracic aperture.

Answer 144

* Compared to a typical rib the first rib is short and thick. * It has a singular articular facet of the costovertebral joint. * The first rib has a head, neck and shaft but lacks a discrete angle. * Groove for the subclavian artery – laterally * Groove for the subclavian vein – anterior to the scalene turbicle * Transverse tubercle – Posterior and lateral to the neck it bears a facet for the transverse process of T1 * Scalene tubercle – anterior between the grooves for the subclavian artery and vein.

Answer 145

* Costovertebral joint * Costotransverse joint * Costochondral joint

Answer 146

* Anterior and middle scalene * Intercostal muscles * Subclavius muscle * Serratus anterior * Costoclavicular ligaments

Answer 147

**Blood supply:** Arterial: internal thoracic and superior intercostal arteries, venous: intercostal veins **Innervation:** first intercostal nerve

Answer 148

* Anterior: Sympathetic trunk over the neck, superior intercostal artery, ventral T1 nerve root * Superior: lower trunk of the brachial plexus, subclavian artery and vein, clavicle * Inferior: Intercostal vessels and nerves, parietal pleura * Medial: contents of the superior thoracic aperture * Lateral: Axillary artery and vein, divisions and cords of the brachial plexus

Answer 149

* First cervical rib * Bifid (forked) rib * Hypoplastic rib

Answer 150

**Layers:** adventitia, media and intima **Origin:** T4 plane continuation of the ascending aorta **Course:** posterior and to the left in the superior mediastinum **Termination:** continuation as the descending aorta pass the level T4 **Branches:** brachiocephalic trunk, Left common carotid artery, left subclavian artery

Answer 151

**Superior:** Large vessels of the superior mediastinum **Inferior:** recurrent laryngeal (which one), ligament arteriosum, the bifurcation of the pulmonary trunk **Anterior:** thymus or thymic reminant, fat **Posterior:** trachea, oesophagus, thoric duct crosses from right to left **Lateral:** right superior vena cava, terminination of the azygos, right upper lobe left: left upper lobe lung

Answer 152

* Double arch * Bovine arch common origin of the left common carotid and brachiocephalic trunk * Left common carotid from the brachiocephalic trunk **Branches directly from the aorta:** * Thyroid Ima * Vertebral artery (most commonly the left) * Right subclavian and right common carotid **Right sided arch:** * Type 1 - mirror * Type 2 – absent left subclavian * Type 3 – isolated left subclavian

Answer 153

The thoracic duct is the main lymphatic channel for the return of chyle to the venous system.

Answer 154

* Origin: continuation from the cistern chyli * Course in the retroperitneum posterior to the great vessels ascending, entering the thoracic cavity via the aortic hiatus at T12, continues to ascend in the posterior mediastinum on the right hand side initially, swapping sides at the level T4, continuing superiorly through the thoracic inlet, anterior to the subclavian artery, anterior to the anterior scalene, draining in the convergence of the left subclavian and internal jugular.

Answer 155

* Anterior: oesophagus, left atrium, carina * Posterior: vertebral column, symphathetic chain of ganglion * Left lateral: descending aorta, left lung and pleura * Right lateral: azygos vein, right lung and pleura

Answer 156

* Variant anatomy in 40% of the population * Duplication * Aberrant termination * Multiple terminal channels Continues on the right to terminate in the right internal jugular vein

Answer 157

The trachea is the primary trunk of the conductive airways **Function:** transmission of gas between the larynx and the main bronchi **Location:** Visceral space of the neck and posterior mediastinum

Answer 158

Made up of posteriorly incomplete cartilage rings with interspaced annular ligaments Enveloped by the trachealis muscle which is particularly prominent posteriorly Lined with ciliated epithelium Divided into: cervical and thoracic trachea **Origin:** continuation of the airway distal to the cricoid cartilage (C6) **Termination:** birfucates at the carina level L4

Answer 159

**Arterial supply:** * Inferior thyroid arteries * Bronchial arteries **Venous drainage:** * Inferior thyroid veins * Azygos system **Lymphatics:** * Drainage into deep cervical, peri and para-tracheal nodes of the mediastinum **Innervation:** * Vagus and sympathetic trunk

Answer 160

* Posterior: oesophagus and recurrent laryngeal nerve * Anterior: Thyroid strap muscle, jugular notch, manubrium, great vessels of the superior mediastinum * Lateral: Sternocleidomastoid, brachiocephalic veins and arteries * Superior: larynx * Inferior: Sub-carinal lymph nodes, main bronchi

Answer 161

* Trachea oesophageal fistula * Tracheal atresia * Pig bronchus * Lunate trachea * Tracheal diverticulum

Answer 162

Branching tree of airways beginning at the carina. The lumen diameter decreases with each branching. Airways down to the level of the bronchioles contain c-shaped rings of hyaline cartilage to maintain the patency of the lumen. **Function:** transmission of gas between the trachea and the respiratory airways of the lungs

Answer 163

**Right side:** * Right main bronchus * Bronchus intermedius * Right Upper lobe bronchus * Right middle lobe bronchus * Right lower lobe bronchus **Left side:** * Left main bronchus * Left upper lobe bronchus * Left lower lobe bronchus **Further branches:** * Segmental bronchi * 20 to 25 generations of bronchioles * Terminal bronchioles

Answer 164

**Arterial supply:** * Bronchial arteries * Branches of the descending aorta **Venous drainage:** * Bronchial veins draining into the azygos system **Lymphatic drainage:** * Hilar nodes

Answer 165

* Bronchial cyst * Pig bronchus * Oesophageal branch * Azygos bronchus * Cardiac bronchus

Answer 166

The superior thoracic aperture is the superior opening into the thorax **Function:** Allow the passage of a large number of structure into and out of the thorax **Location:** Encircled by the first rib, the T1 vertebrae and the manubrium

Answer 167

* Lung apices * Trachea * Oesophagus * Thymus * Sometimes the thyroid

Answer 168

* Brachiocephalic veins * Internal thoracic arteries * Brachiocephalic truck * The left common carotid artery * The left subclavian artery **Lymphatics:** * Cervical lymph nodes * Thoracic duct

Answer 169

* Vagus nerves * Phrenic nerves * Ascending laryngeal nerves * The sympathethetic chain of ganglion

Answer 170

* Part of sternocleidomastoid * Sternohyoid * Sternothyroid

Answer 171

* Right common carotid and subclavian can pass through * Thyroid IMA artery can pass through * Thyroid can extend through * Cervical ribs

Answer 172

The biliary tree is the system of biliary vessels of the liver and abdomen Location: Intrahepatic and within the free edge of the lesser omentum

Answer 173

Dividable into intrahepatic and extrahepatic ducts Each liver segment has its own biliary drainage duct, where biliary canaliculi unite to form segmental ducts. There ducts join to form: * Right posterior duct * Right anterior duct * Right hepatic duct * Left hepatic duct

Answer 174

The right and left hepatic duct unite to form the common hepatic duct, segment I drains directly here also. The common hepatic duct then leaves the liver parenchyma. The common hepatic duct is joint by the cystic duct of the gallbladder arfter ~2-3cm, they unite to form the common bile duct. The common bile duct runs in the free edge of the lesser omentum, behind the head of the pancreas to join with the main pancreatic duct forming the ampulla of Vater draining into the D2 via the sphincter of oddi.

Answer 175

Blood supply: * Right and left hepatic artery * Cystic artery * Branches of the common hepatic artery * Posterior pancreaticoduodenal artery branches * Gastroduodenal artery Venous: * Into the portal system Lymphatics: * Porta hepatis nodes * Coeliac nodes Innervation: * Coeliac plexus

Answer 176

At the porta hepatis: The common hepatic duct lies in front and is to the right of the hepatic artery, the portal vein is between the two

Answer 177

Cystic duct: * Duplication * Low insertion * High insertion * Cystic artery posterior to the right hepatic duct Common hepatic duct: * Triple confluence * Aberrant hepatic duct * Non-union of the left and right hepatic ducts CBD: * May pass behind through or around the pancreatic head * Variable location of the ampulla * CBD may drain separately from the main pancreatic duct * Pancreatic divisum

Answer 178

The extra hepatic biliary tree is the system responsible for the drainage and storage of bile from the liver to the D2 segment of the duodenum.

Answer 179

The left and right intrahepatic ducts join to form the common hepatic duct which leaves the liver parenchyma at the porta hepatis anterior to the hepatic artery and to the right of the portal vein. The common hepatic duct joins the cystic duct to form the common bile duct. The common bile duct initially travels in the free edge of the lesser omentum, then courses posterior to the duodenum and the pancreas joining the main pancreatic duct to form the ampulla of Vater. The ampulla of Vater drains into D2 via the major duodenal papillae

Answer 180

Arteries: * Cystic * Right hepatic * Posterior superior pancreaticoduodenal artery Venous: * Drains to portal vein Lymphatics: * Porta hepatis * Coeliac

Answer 181

Cystic duct: * Low insertion * Medial insertion * Parallel course * Cystic artery anterior to the cystic duct Common hepatic duct: * Triple confluence * Aberrant hepatic duct * Non-union of the right and left hepatic ducts Common bile duct: * Partially covered posteriorly * Completely covered * Completely uncovered * Lateral to pancreatic head

Answer 182

* The duodenum is the first part of the small intestine * Location: between the pylorus of the stomach and the jejunum, in the anterior pararenal space * Function: Alkalinisation of chym, mixing of bile with chyme, sensing of chyme to produce gastrointestinal reflexes

Answer 183

C-shape of small bowel lies at the level L1-3 Encompasses the head of the pancreas in the duodenal sweep Length 20-30 cm in length

Answer 184

* D1 from the pylorus of the stomach courses to the right, features duodenum bulb * D2 from the D1 segment descending approximately 3-4cm, features major and minor duodenal papilla * D3 from D2 turn to the left around the pancreatic head course * D4 from D3 continues to course to the left however also ascends to the ligament of Treitz, after the small bowel continues as the jejunum

Answer 185

* SMA and SMV are anterior to the D3 segment * Inferior vena cava and the abdominal aorta are posterior to the D3 and D2 * D1, D2, D3 form a c shaped around the pancreatic head

Answer 186

Arterial: * Duodenal cap – right gastric and right gastroepiploic arteries * Superior and inferior, posterior and anterior pancreaticoduodenal arteries Venous drainage: * Duodenal cap – prepyloric vein into the portal vein * Superior and inferior, anterior and posterior pancreaticoduodenal veins draining into the superior mesenteric vein Lymphatics: * Coeliac and superior mesenteric nodes Innervation: * Vagus and superior mesenteric plexus

Answer 187

* Duodenal papilla inserts into different segments * Duodenal duplication * Duodenal diverticulum

Answer 188

The kidneys are paired retropenritoneal organs. Function: production of urine, water and electrolyte homeostatsis, hormone production Location: Perirenal space, long axis parallel to psoas, lies on quadratus lumborum

Answer 189

* 9-14cm long, left usually larger than the right * Bean shaped * Fibrous capsule * Divided in the superior, mid and inferior poles * The parenchyma consists of cortex and medulla. * The renal sinus consists of the renal pelvis, calyces, vessels, nerves, lymphatics and fat * The renal cortex lie peripheral * The medulla consists of 10-14 hilum facing pyramids, separated by renal columns * Each pyramid drains into minor calyces via a papilla, which inturn 3-4 join to form the major calyces, of which 2-3 join to drain into the renal pelvis

Answer 190

* Arterial: right and left renal arteries from the abdominal aorta level L1 * Venous: Right and left renal veins into the inferior vena cava * Innervation: Renal plexus * Lymphatics: Peri-renal and para-aortic

Answer 191

* Anterior: Hepatic flexure, liver * Posterior: Diaphragm, quadratus lumborium * Superior: right adrenal gland, liver * Inferior: Right ureter * Medial: duodenum, inferior vena cava

Answer 192

* Anterior: Splenic flexure, stomach, lesser sac * Posterior: quadratus lumborum * Superior: Spleen * Inferior: Left ureter * Medially: Jejunum and pancreas

Answer 193

Horseshoe, agenesis, cross fused renal ectopia, pancake, pelvic kidney, colomn of bertin, dromedary hump, accessory renal arteries, duplex collecting system, retrocaval ureter

Answer 194

Main pancreatic duct (Wirsung) – runs the length of the pancreas terminates at the ampulla of Vater, formed by the fusion of the dorsal and ventral ducts. Accessory pancreatic duct (Santorini) – Variant, usually connects to the main duct, runs in the head of the pancreas drains to the minor duodenal papilla. Ruminant of the dorsal duct. Smaller ducts – clusters of exocrine pancreastic cells for acini which are connected to: intercalated ducts Intralobular ducts join to the main pancreatic duct in a herringbone pattern

Answer 195

* Pancreatic divisum – most common variant, failure of fusion of the dorsal and ventral ducts. As a result the majority of pancreastic secretions are drained via the minor papilla, believed to increase the risk of pancreatitis. Types; * 1 no connection * 2 Absent ventral duct * 3 Inadequate connection * Santorrinicele – cystic dilation of the of the dorsal duct in the setting of pancreatic divisum * Meandering main pancreatic duct – maybe z-type or loop type * Ansa pancreatica – loop like connection between the main and accessory ducts * Anomalous pancreaticobiliary junction – union of the pancreatic duct and the common bile duct outside of the duodenal wall

Answer 196

The liver can be divided into 8 functionally independent segments using the Couinaud classification system.

Answer 197

Each segment has its own dual blood inflow, lymphatic and biliary drainage Each segment is a wedge pointed at the porta hepatis The segement are divided in to a superior and inferior group by a horizontal plane drawn at the level of the bifurcation of the portal vein. The segments are divided right to left by vertical planes following the hepatic veins.

Answer 198

Segment 1 – caudate lobe special in this system as is can receive supply from the left and right portal system, location – around the vena cava, divided into medial caudate process and lateral papillary process. Drains directly into the IVC Segment 2 and 3 – to the left of the left hepatic vein, superior and inferior to the portal vein bifurcation Segement 4 – between the left and middle hepatic veins, divided into A for part above the bifurcation of the portal vein and B for below 5 and 6 – Both inferior to the portal bifurcation, 5 between the middle and the right hepatic veins, 6 to the right of the right hepatic vein 7 and 8 - both above the portal vein bifurcation, 7 to the right of the right hepatic vein, 8 between the right and middle hepatic veins

Answer 199

* Right or left supply to the caudate * Hepatic vein duplication * Reidels lobe * Beavertail liver

Answer 200

The spleen is an unpaired haematological organ of the abdomen Function: Immune, red cell production and maturation Location: left hypochondrium

Answer 201

* Wedge shaped * ~12.5cm in length * Enclosed by a thin capsule * Tissues consists of inner red pulp and outer white pulp * Has a upper and lower pole * Has a visceral and diaphragmatic surface * Covered by peritoneum except the hilum which has the: * Gastrosplenic ligament * Splenorenal ligament

Answer 202

Arterial: Splenic artery (coeliac trunk) Venous: splenic vein into portal Lymphatics: Splenic hilar, retropancreatic, coeliac Innervation: Coeliac plexus (vagal trunks)

Answer 203

Diaphragmatic surface – dome of the left hemidiaphragm Visceral surface – tail of the pancreas, left kidney, adrenal gland, stomach

Answer 204

* 10% accessory spleen * Wondering spleen * Polysplenia * Aspenia * Splenogonal fusion * Retrorenal spleen

Answer 205

Muscular organ between the oesophagus and duodenum. Location: upper abdomen Function: storage and digestion of food

Answer 206

* Divided into: * Cardia – receives the oesophagus * Fundus – superolateral dome * Body – main region * Pyloris – lower section exit point

Answer 207

* Lower oesophageal sphincter * Pylorus

Answer 208

Arterial supply: * Right gastric common hepatic * Left gastric from the coeliac trunk * Right gastroepiploic from the superior gastroduodenal * Left gastroepiploic from the splenic * Short gastric from splenic and terminal left gastroepiploic Venous drainage: * Right and left gastric veins to the portal vein * Right gastroepiploic to the superior mesenteric vein * Left gastroepiploic veins and short veins to the splenic Lymphatics: * Coeliac and para-aortic nodes Innervation: * Gastric plexus (coeliac and vagus)

Answer 209

* Anterior: left lobe of the liver, anterior abdominal wall * Posterior: lesser sac and stomach bed * Medial: abdominal aorta, coeliac trunk and nodes

Answer 210

* Situs inversus * Hypertonic or hypotonic stomach * Pyloric stenosis * Congenital hiatus hernia

Answer 211

Has three to four horizontal tendinous intersections that divide the muscle into segments. Origin: Pubic symphysis, tubercle and crest Insertion: Xiphisternum and the 5-7 th costal cartilages

Answer 212

* The linear alba divides the recti into right and left * Laterally the rectus sheath fuses to form the linea semilunaris * Above the arcute line the IO splits to form the rectus sheath * Below the arcute line the transversalis fascia passes anterior to the rectus abdominus

Answer 213

Arterial supply: * Superior and inferior epigastric arties Venous drainage: * Superior and inferior epigastric veins Innervation: * Anterior rami of T6 to L1 spinal nerve Lymphatics: * Above the umbilicus to the axillary nodes * Below the umbilicus to the inguinal nodes

Answer 214

* Anterior: Rectus sheath, Camper’s fascia, Scarper’s fascia * Posterior: pre-peritneal fat, peritoneum * Lateral: hiatus semilunaris * Medial: Linea alba * Superior: xiphoid process and the 5 th to 8 th costal cartilages * Inferior: Pubic symphysis

Answer 215

Variation in the number of segments Pyramidalis

Answer 216

The kidneys are retroperitoneal organs involved in the filtration of blood, production of urine, water and electrolyte balance and the production of hormones

Answer 217

Typically a single renal artery from the aorta at the level L1 inferior to the origin of the superior mesenteric artery, however there is commonly additional accessory arteries.

Answer 218

the right renal artery passes posterior to the IVC and the right renal vein, the left renal artery courses posterior to the left renal vein

Answer 219

* Dorsal and ventral rami * The dorsal and ventral rami divide into segmental branches within the renal hilum these branches are: * Apical * Anterior superior * Posterior superior * Inferior * Posterior * These segmental branches divide to form the: * Arcute * Interlobar * Interlobular * Inferior adrenal artery * Ureteric artery * Capsular artery

Answer 220

The inferior mesenteric artery is the primary arterial supply for the hindgut

Answer 221

* Origin: 3 rd unpaired/anterior branch of the abdominal aorta at the level L3 * Course: Obliquely descends in the retroperitoneum, initially anterior to the aorta then to the left. * Termination: continues as the superior rectal artery

Answer 222

* Left colic * Two to four sigmoid arteris * Superior rectal artery

Answer 223

Bowel from the splenic flexure to the upper 2/3 of the rectum

Answer 224

* Anterior: D3 * Posterior: abdominal aorta, left psoas, left common iliac artery * Lateral (left): Inferior mesenteric vein

Answer 225

* Doubled IMA * Absent IMA * Common trunks * Absent left colic branch * Arc of Riolan (SMA/IMA connection)

Answer 226

Also known as the coeliac axis is the primary abdominal arterial supply to the foregut. Location: first unpaired branch of the abdominal aorta (T12)

Answer 227

* Origin: anterior branch of the abdominal aorta at the level of T12, just under to the medial arcuate ligament * Course: Very short course before under the median arcuate ligament * Termination: trifurcation into its three branches: * Common hepatic – (right gastric, properhepatic, gastroduedenal) * Splenic * Left gastric arteries

Answer 228

* Gut from the distal oesophagus to the D2 * Liver * Gallbladder * Spleen * Pancreas

Answer 229

* Classical branching is seen in 70% * Branches may arise independently from the aorta * Coeliacomesenteric trunk * Other branches may arise from the trunk including: * Dorsal pancreatic artery * Right hepatic artery * Inferior phrenic artery

Answer 230

* The inferior vena cava is the primary blood return pathway from the abdomen and lower limbs back to the heart * Function: return of de-oxygenated blood from the abdomen and lower limb to the heart * Location: Retroperitoneum and short course in the posterior mediastinum

Answer 231

* Has valves * Origin: Formed as the confluence of the common iliac veins at the level L5 * Course: Ascending in the great vessel space, passes through the posterior aspect of the liver, through the caval hiatus of the diaphragm at the level T8 short course in the posterior mediastinum * Termination: right atrium

Answer 232

* Common iliac veins (L5) * Lumbar veins (L1-L5) * Right gonadal veins L2 * Bilateral renal veins L1 * Right adrenal veins L1 * Right and left inferior phrenic veins T8 * Right, middle and left hepatic veins T8

Answer 233

* Anterior: Right common iliac artery, right gonadal vessels, D3, common bile duct, portal vein, head of the pancreas, D1, epiploic foramen, liver * Posterior: Lower lumbar vertebrae and discs, anterior longitudinal ligament, Right psoas belly, sympathetic trunk * Lateral left: abdominal aorta, caudate lobe of the liver, right crus * Lateral right: right kidney, right ureter, D2

Answer 234

* Duplication * Agenesis * Circumcaval ureter * Circumaortic vena cava * High union * Double inferior vena cava * Left sided vena cava * IVC webs * Portocaval shunt

Answer 235

* Origin: L1 confluence of the splenic and superior mesenteric veins * Course: runs in the free edge of the lesser omentum enter the porta hepatic as a posterior structure * Termination: bifurcated to form right and left braches, the level of bifurcation in used to define the boundaries of the liver segments

Answer 236

* Portal trifurcation * Absent right portal vein * Portal vein duplication * Left renal veins drains into the portal system * Absent SMV, all branches converge to for the portal vein * Abernathy malformation portosystemic shunt

Answer 237

The retroperitoneum is a space in the abdominal cavity Location: between the posterior parietal peritoneum and the muscle of the back

Answer 238

Dividable into 4 spaces by the pararenal fascia * Anterior pararenal space –anterior to the kidneys, extends from the diaphragm to the pelvis * Perirenal space – around the kidney, from the bare area of the liver and subphrenic space, continuous with the mediastinum through the diaphragmatic hiatuses, inferiorly it is closed below the kidneys * Posterior pararenal space – posterior to the kidneys, extends from the inferior phrenic fascia opens into the pelvis * Great vessel space - the space around the abdominal aorta and inferior vena cava, only named in some sources

Answer 239

Duodenum, pancreas, ascending and descending colon, roots of the small bowel mesentery and transverse mesocolon.

Answer 240

kidneys, adrenal glands, the proximal collecting system, perirenal fat, renal vessels

Answer 241

small space containing olny fat, lymphatics, blood vessels, no major organs

Answer 242

Abdominal aorta and inferior vena cava

Answer 243

thinner of the two courses from the lateral origin at the lateral parietal peritoneum to cross anterior to the great vessels of the abdomen. Also known as Gerota’s fascia.

Answer 244

thicker of the two origin is the psoas fascia coursing laterally to become the laterconal fascia continuing on as the lateral parietal peritoneum. Also known as Zuckerkandl’s fascia.

Answer 245

Inverted triangle in shape Formed by the fusion of 5 sacral vertebrae Concave anterior

Answer 246

* Sacral prominence * Superior articular processes with associated facets * Sacral body * Alar wings laterally * Median sacral crest * Sacral canal (triangular in shape) * Termination of the sacral canal is at the sacral hiatus * First four nerve roots exit via the paired anterior and posterior foramen * The fifth sacral nerves exit via the sacral hiatus

Answer 247

* Superiorly with the L5 vertebrae via the sacral prominence and the body of L5 and via the superior articular facets with the inferior articular facets of the L5 vertebrae * Laterally the sacrum articulates with the ilium via the sacroiliac joints (mixed fibrous/synovial joints) * Sacrococcygeal – inferiorly the sacrum articulates with the first coccygeal segment

Answer 248

* Lumbosacral * Iliolumbar * Sacroiliac ligaments * Sacrospinous * Sacrotuberous * Sacrococcygeal ligaments

Answer 249

**Blood supply:** * Iliolumbar arteries (Posterior division of the internal iliac arteries) * Lateral sacral arteries (post. Div. int. iliac) * Median sacral artery from the aorta **Venous drainage:** * Via the internal and external vertebral plexuses to the median and lateral sacral veins **Lymphatics:** * Perirectal and internal iliac nodes

Answer 250

* Lumboralisation of the S1 * Sacralisation of the L5 * Sacral agenesis

Answer 251

The lavatory ani also known as the muscular pelvic diaphragm is the musculotendinous sheet that forms the majority of the pelvis floor. **Function:** supports the pelvic viscera and aided in urinary and faecal continence

Answer 252

**Pubococcygeus:** * From the inner surface of the pubis merging medially to form the perineal body **Iliococcygeus:** * From the inner tip of the coccyx to the ischial spine. **Puborectalis:** * From the body of the pubis forming a sling around the rectum * Coccygeus is not formally part of lavatory ani however it is an important element of the pelvic floor. It is between the sacrospinous ligament/ischial spine and the lateral border of the coccyx and sacrum.

Answer 253

**Arterial supply:** * Inferior gluteal artery **Venous drainage:** * Inferior gluteal veins **Innervation:** * Pudendal nerve (internal surface) * Branches of S3,4 (external surface)

Answer 254

The internal iliac artery is the primary blood supply to the pelvis, pelvic viscera, external genitals, perineum, buttocks and medial thigh

Answer 255

**Origin:** The bifurcation of the common iliac artery at the level of the pelvic brim **Course:** Posteromedial toward the greater sciatic foramen. **Termination:** Divides into the anterior and posterior division just prior to the greater sciatic foramen

Answer 256

Rule of 3’s: 3 bladder, 3 muscular, 3 female ISO POG MUV * Superior vesicular * Inferior vesicular * Obliterated umbilical * Inferior gluteal * Obturator * Internal pudendal * Middle rectal * Uterine * Vaginal

Answer 257

* Persistent sciatic artery * Obturator artery origin from the external iliac

Answer 258

**Origin:** The internal iliac artery divides into anterior and posterior divisions at the superior border of the greater sciatic foramen **Course:** Posterior towards the great sciatic foramen

Answer 259

Iliolumbar artery – with lumbar and ilial branches – ilium, iliacus, L5/S1 foramen Lateral sacral artery – with superior and inferior branches – supplies the sacrum and piriformis Superior gluteal artery – superficial and deep braches – supplies the gluteal muscles

Answer 260

* Persistent sciatic artery * Superior and inferior branches of the lateral sacral origin directly from the posterior division of the internal iliac artery * Superior gluteal may arise directly from the internal iliac

Answer 261

the ovarian and uterine arteries unite and form an anastomotic network, venous drainage uterine veins into the internal iliac veins

Answer 262

* Uterus fundus – pre and para-aortic lymph nodes due to the anastomotic network * Uterus body and cervical – predominantly to the internal and external iliac chains however there is some drainage to the superficial inguinal nodes via the round ligament

Answer 263

The anal canal is the section of the gastrointestinal tract between the rectum and the anal verge. **Function:** * Control of defecation

Answer 264

* Approximately 4cm in length **Origin:** anorectal angle (the right angle turn at lavator ani) **Termination:** The anal verge * Dentate line – separates the anal canal into an upper and lower part. These parts differ in structure and neurovascular supply. The dentate line is formed by the anal columns (of Morgani), which are a series of anal sinuses that drain the anal glands. It is located at approximately the middle of the anal canal. * Above the dentate line the epithelium is a mucous membrane and below the dentate line the epithelium is a stratified squamous cells. * Anal sphincters – divided into internal and external. Internal is a continuation of the inner rectal muscle, thickened muscular ring, composed of visceral muscle. External skeletal muscle with deep, superficial and subcutaneous parts * The anal margin is the 5cm of skin around the anal verse

Answer 265

* Laterally – inchioanal fossa * Anterior – bulbospongiosus, perineal body, vagina * Posterior – tip of the coccyx

Answer 266

**Blood supply:** * Above the dentate line: superior and middle rectal arteries. (Superior from the inferior mesenteric, middle rectal from the internal iliac artery) and median sacral artery. * Below the dentate line: inferior rectal artery a branch of the internal pudendal artery **Venous drainage:** * Above the dentate line: superior rectal vein to the inferior mesenteric vein (portal system) * Below the dentate line: inferior and middle rectal veins to the internal iliac veins **Lymphatic drainage:** * Above the dentate line: internal iliac nodes * Below the dentate line: superficial inguinal nodes **Innervation:** * Above the dentate line: inferior hypogastric plexus * Below the dentate line: Inferior rectal branches of the pudendal nerve (S2-4)

Answer 267

Imperforate anus

Answer 268

The uterus is a primary reproductive organ of females **Function:** Gestation of an embryo to birth **Location:** Extraperitoneal pelvis, peritoneum drapes over the fundal uterus

Answer 269

Inverted pear shaped, most of the bulk is myotrium -\> smooth muscle Typically 7.5cm in length, can grow to 40 in length during pregnancy **Consists of:** * Body * Isthmus between the body and the cervix * Cervix at the base * Rounded fundus superiorly above the plane of the insertion of the fallopian tubes * Cornu laterally * Endometrial cavity internally which is lined with endometrial tissue

Answer 270

* Pubocervical * Uterosacral * Transverse cervical * Broad ligament * Round ligament * Suspensory ligament of the ovaries * Ovarian ligament

Answer 271

**Blood supply:** Uterine arteries, branches of the anterior division of the internal iliac arteries **Venous drainage:** Uterine veins into the internal iliac veins **Lymphatics:** * Fundus: para-aortic nodes * Body/cervix: internal and external iliac nodes, superficial inguinal nodes via the round ligament **Innervation:** Inferior Hypogastric plexus, uterovaginal and ovarian plexus

Answer 272

* Posterior: Rectum and pouch of Douglas * Anterior: Urinary bladder, uterovesical pouch * Lateral: the adexal spaces, multiple vessels, the ovaries, broad ligament * Superior: the intraabdoinal cavity * Inferior: vagina

Answer 273

* Bicornate * Arcuate * Septated * Unicornated * Agenisis * Anteverted * Retroverted * Uterus didephys

Answer 274

T2 to T8 are considered typical thoracic vertebrae.

Answer 275

T2 to T8 are considered typical thoracic vertebrae.

Answer 276

T2 to T8 are considered typical thoracic vertebrae.

Answer 277

Relative to cervical and lumbar vertebrae, thoracic vertebrae have: * medium-sized, heart shaped vertebral bodies * medium-sized vertebral canal * prominent transverse processes with costal facets * long spinous processes angulating downwards

Answer 278

**Anterior components of thoracic vertebrae:** * body * pedicle * superior and inferior costal demifacets **Posterior components of typical thoracic vertebrae:** * downward angled spinous processes * transverse processes with transverse costal facets * Superior and inferior articular facets * lamina * intervertebral foramen

Answer 279

**Ribs** **Each vertebra contains three points of articulation with ribs.** * The superior demifacet of a thoracic vertebra articulates with the corresponding rib (costovertebral joint). * This rib articulates again with the costal facet on the transverse process (costotransverse joint). * The inferior demifacet articulates with the rib below. **Intervertebral:** **Facet (zygapophyseal) Joints** * The superior articular process arises from the upper border of pedicle. An oval facet faces posterolaterally. * The inferior articular process arises from the lower border of the pedicle. The facets face anteromedially. **Intervertebral discs** * Similar to other vertebrae, discs are interposed between hyaline cartilage on the centrum of the vertebral bodies. The disc height is slightly less than cervical vertebrae.

Answer 280

The atlanto-occipital articulation is comprised of a pair of condyloid synovial joints that connect the occiput to the first cervical vertebra (atlas/C1).

Answer 281

* Concave surface on the lateral mass articulates with the convex surface of the occipital condyle. * The joint is reinforced by fibrous capsules which support each joint.

Answer 282

* anterior atlanto-occipital membrane – continuation of the anterior longitudinal ligament, between the anterior arch and the anterior foramen magnum. * posterior atlanto-occipital membrane – continuation of the posterior atlantoaxial membrane, connects the posterior aspect of the posterior edge of the foramen magnum.

Answer 283

**Arterial supply:** Vertebral arteries **Venous drainage:** Internal and external, posterior and anterior vertebral plexi **Innervation:** The joint capsule is innervated by the C1 nerve.

Answer 284

* Variable degree of communication between the atlanto-occipital joint and the cavity between the dens (odontoid peg) and transverse ligament * Third occipital condyle (condylus tertius) which may articulate with the anterior arch of the atlas, or the dens * Paracondylar process * Occipital condyle hypoplasia * Division of the superior articular facet of the atlas

Answer 285

The calcaneus is the largest of the tarsal bones and is colloquially refered to as the heel bone. Function: Inversion and eversion, transfer of force between the leg and the heel pad. Location: below the talus

Answer 286

* Irregular box shaped bone Features: * Calcaneal tuberosity (heel) – posterior projection with: * Lateral process * Medial process * Posteriorly – superior, middle (attachment for the Achilles) and inferior facet * Sustentaculum tali – antero-medial process inferior to which is a groove from the flexor halluces longus * Dorsal surface – location of the anterior, middle and posterior talocalcaneal facets, the tarsal sinus runs between the middle and posterior facets. * Anterior process - anterior projection the anterior surface of which has the facet for the cuboid

Answer 287

* Talus via the anterior, middle and posterior articular facets * Cuboid via the facet for the cuboid on the anterior surface * Shares a joint space with the talonavicular joint forming the talocalcaneonavicular joint

Answer 288

* Superior: talocalcaneal joint, talus, sinus tarsi * Inferior: fad pad, long and short plantar ligaments * Anterior: calcaneocuboidal joint, cuboid bone * Posterior: Achilles tendon * Medial: Tendon of flexor hallucis longus, deltoid ligament of the ankle, tibial nerve, posterior tibial artery * Lateral: Tendons of peroneus longus and brevis

Answer 289

* Medial and lateral calcaneal arteries from the posterior tibial and fibular arteries * Artery of the tarsal sinus Innervation: * Tibial, sural and deep fibular nerves

Answer 290

* Talocalcaneal coalition * Calcaneonavicular coalition * Os calcaneus secundaris

Answer 291

Long bone of the thigh Function: transfer force between the hip and leg

Answer 292

Proximal portion: * Head globular hemisphere covered in synovial cartilage except for the central fovea (attachment of ligamentum terres) * Neck thinner process through which a large majority of the blood supply to the head flows * Greater trochanter – large irregular lateral attachment site * Lesser trochanter – conical posteromedial attachment site * Intertrocanteric line anteriorly * Intertrocanteric crest posteriorly Shaft: * Long * Linea aspera – posterior ridge that serves as the attachment for multiple muscle and the intermuscular septa, 3 ridges superiorly becomes two ridges inferiorly that diverge to for the triangular popliteal surface Distal: * Flared head with two rounded synovial line condyles * Synovial surface anteriorly for articulation with the patella * Bilateral epicondyles superior to each condyle

Answer 293

Femoroacetabular – femoral head with the acetabulum, synovial ball and socket with fibrous capsule Patellofemoral – between the patella groove and the articular surface of the patella Tibiofemoral – between the medial and lateral condyles and the medial and lateral tibial plateau

Answer 294

Arterial: * Artery of ligamentum terres * Anterior and posterior humeral circumflex * Perforating braches from profunda femoris * Popliteal and genicular arteries distally Venous: * Anterior and posterior femoral circumflex veins to the greater saphenous veins * Popliteal and deep femoral veins to the common iliac veins Innervation: * Femoral and tibial nerves

Answer 295

* Coxa valgus/varus * Hip dysplasia * Os acetabula

Answer 296

The patella is the largest sesamoid bone in the human body. It lies within the quadriceps tendon / patellar ligament and forms part of the knee joint.

Answer 297

Articular surface is covered in hyaline cartilage. It articulates with the trochlear groove of the femur (anterior distal surface between the medial and lateral condyles).

Answer 298

* The patella is triangular in shape with a superior base and inferior apex. * The posterior surface is smooth, composed of articular cartilage, and is divided into medial and lateral facets, which are sub divided into superior, middle and inferior portions. * The lateral facet is the largest (this counters the tendency for the quadriceps to pull the patella laterally). * The anterior surface is rough, for attachment of tendons and ligaments.

Answer 299

Ligaments: * Patellar ligament – from the apex of the patella to the tibial tuberosity * Medial and lateral patellar retinaculum * Medial and lateral patellofemoral ligament (MPFL and LPFL). Muscles: * Quadriceps tendon superiorly (really the same thing as the patellar ligament).

Answer 300

* superior: common tendon of quadratus femoris, suprapatellar bursa * inferior: patellar tendon, infrapatellar bursa, infrapatellar fat pad * lateral: lateral patellar retinaculum * medial: medial patellar retinaculum * posterior: knee joint, femur * anterior: prepatellar bursa

Answer 301

Blood supply: * Anastomotic rings formed from the branches of the superior and inferior geniculate arteries Innervation: * branches of nerves to vastus medialis and vastus lateralis

Answer 302

* bipartite patella * multipartite patella * absent patella * variation in shape (see: Wiberg classification) * dorsal defect of the patella (may occasionally be symptomatic)

Answer 303

The knee joint is a modified hinge joint between the thigh and the leg Movements: Flexion and extension

Answer 304

Type: Synovial joint with a capsule (largest synovial joint in the body) Articulations: * Femoral condyles with tibial plateaus * Patella with the patella groove of the femur

Answer 305

* Medial collateral ligament * Lateral collateral ligament * Anterior cruciate ligament * Posterior cruciate ligament * Meniscofemoral ligaments * Anteriolateral and posterolateral ligaments

Answer 306

* Medial – larger, c-shaped, attached to the MCL laterally * Lateral – smaller, almost a complete circle

Answer 307

* Pre-patella bursa * Supra-patella bursa * Deep and superficial Infrapatella bursa * Semimembranous bursa

Answer 308

* Hoffa’s deep to the patella tendon * Suprapatella fat pad

Answer 309

Arterial supply: * Superior and inferior, medial and lateral, Genicular branches of the popliteal artery * Descending genicular from the femoral * Descending branch of the lateral circumflex * Circumflex fibular Venous: into the popliteal and femoral veins Innervation: Femoral and genicular branches from the tibial and fibular nerves

Answer 310

* Patella – dorsal patella defect, bipartite, absent * Baker’s cyst * Discoid meniscus * Flabella

Answer 311

The hamstrings are the muscles of the posterior compartment of the thigh and include the: * lateral: biceps femoris * medial: semimembranosus and semitendinosus Function: flex knee and extend hip

Answer 312

Apart from the short head of biceps femoris, the muscles share two common features: * span both the hip and knee joints * originate from the ischial tuberosity The short head of the biceps femoris originates from the linear aspera

Answer 313

2 heads (long and short) Origin is the Ischial tuberosity (long) and linea aspera (short) Insertion is the fibular head Innervation: tibial nerve Artery: Inferior gluteal and popliteal artery

Answer 314

Origin Ischial Tubersotirty Accompanies semimembranoiss however forms tendon 2/3 down thigh Inserts on the medial superior tibial condyle, pes anserisus posterior to the gracillis Innervation: tibial nerve Artery: Inferior gluteal and popliteal artery

Answer 315

Origin Ischial tuberositiy Inserts on the medial tibial condyle and posterior joint capsule Innervation: tibial nerve Artery: Inferior gluteal and popliteal artery

Answer 316

* Sartorius * Gracilis * Semitendinoisis

Answer 317

* origin: above the lateral and medial femoral condyle * insertion: calcaneal (Achilles) tendon into mid-posterior calcaneus

Answer 318

* arterial supply: sural arteries * innervation: tibial nerve (sciatic nerve nerve roots S1 and S2)

Answer 319

antagonist: tibialis anterior action: plantar flexes foot and flexes knee

Answer 320

* superficial to soleus * forms the inferior borders of the popliteal fossa

Answer 321

Arterial supply of the foot is the vascular system that supplies oxygenated blood to the foot Gross anatomy: The arterial supply of the foot can be divided into plantar and dorsal components:

Answer 322

Origin: posterior tibial branch Supplies: the medial side of the foot and the first toe Termination: the 1 st medial plantar digital artery

Answer 323

Origin: Posterior tibial artery Course: Cross the foot toward the base of the 5 th metatarsal Supplies: lateral intrinsic muscle of the foot Termination: As the Plantar arch

Answer 324

Connects the dorsalis pedis with the lateral plantar artery Lies deep to the plantar aponeurosis Branches: Plantar metatarsal arteries Termination: connects with dorsalis pedis in the first metatarsal interspace

Answer 325

Dorsalis pedis Origin: Continuation of the anterior tibial artery Course: Runs lateral to the extensor halluces longus tendon Termination: continues as the first metatarsal artery Branches: * First dorsal metatarsal artery * Medial tarsal arteries * Lateral tarsal arteries * Arcuate artery * Dorsal metatarsal arteries

Answer 326

Large artery of the popliteal fossa Supplies: Primary supply for the leg below the knee

Answer 327

Origin: A continuation of the superficial femoral artery as it passes out of the adductor hiatus Course: * Through the popliteal fossa where it is the deepest structure * Through the fibrous arch of soleus Termination: Bifurcation into the anterior tibial and the tibioperoneal trunk

Answer 328

Medial and lateral, superior and inferior genicular arteries Middle genicular artery

Answer 329

Popliteal artery is the most deep structure in the popliteal fossa Deep to the popliteal vein

Answer 330

* Trifurcation * Peroneal from the anterior tibial * High origin of the anterior tibial * High origin of the posterior tibial * Very long tibioperoneal trunk * Hypoplastic infrapopliteal vessels * Popliteal artery entrapment

Answer 331

The long and short saphenous veins are superficial veins of the lower limb Function: return oxygenated blood from the lower limb to the iliac veins Gross anatomy: Both have valves Origin: continuation of the medial marginal vein of the foot Termination: Pierces the deep facia of the femoral triangle draining into the spahenofemoral junction. 99% have a valve within 2mm of the SFJ

Answer 332

It passes anterior to the medial malleolus, ascending in the saphenous space between the saphenous fascia superficially and the deep fascia, it is closely related to the saphenous nerve(s) below the knee.

Answer 333

* Small saphenous vein * Unnamed superficial veins of the leg * Medial marginal vein of the foot * Superficial epigastric * Superficial circumflex iliac * Superficial external iliac * Superficial external pudendal * Multiple deep perforators to the deep system

Answer 334

Origin: Confluence of the lateral aspect of the venous network of the dorsum of the foot Termination: Pierces the deep fascia of the popliteal fossa to drain into the popliteal vein

Answer 335

Posterior to the lateral malleolus, ascending in the subcutaneous tissues of the lateral leg

Answer 336

* Multiple unnamed superficial branches * Great saphenous vein * Multiple perforators to the deep venous system

Answer 337

Course closely associated with the sural nerve

Answer 338

* Vein of Giacomini * Duplication * Absence * Fenestration

High Yield Flashcards

(363 cards)