MRCEM > MRCEM > Flashcards

MRCEM Flashcards

(603 cards)

Study These Flashcards
1
Q

Attachments of Pectoralis Major (3)

A

Clavicular head - anterior surface mid clavicle
Sternocostal head - anterior surface of the sternum, superior six costal cartilages and aponeurosis of external oblique muscle
Distal attachment intertubular sulcus of the humerus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Actions of Pectoralis Major (3)

A

-Adducts and medially rotates the upper limb
-Draws the scapula anterioinferiorly
-Clavicular head flexes upper limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Nerve supply of Pectoralis Major

A

Lateral and medial pectoral nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Attachments of Pectoralis Minor

A

Originates from 3rd-5th ribs and inserts onto coracoid process of the scapula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Actions of Pectoralis Minor

A

Stabilises scapula by drawing it anterioinferiorly against the thoracic wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Nerve Supply to Pectoralis Minor

A

Medial Pectoral Nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where is Serratus Anterior located?

A

Lateral chest wall forming the medial border of the axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Attachments of Serratus Anterior

A

Arises from lateral aspects of ribs 1-8 and attaches to the costal (rib facing) surface of the medial border of the scapula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Action of Serratus Anterior

A

Rotates the scapula allowing the arm to be raised over 90 degrees
Also protects the scapula by holding it against the ribcage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Nerve Supply of Serratus Anterior

A

Long Thoracic Nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where is subclavius located?

A

Directly underneath the clavicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Attachments of Subclavius

A

Originates from junction of first rib and its costal cartilage. Inserts onto inferior surface of the middle third of the clavicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Action of Subclavius

A

Anchors and depresses clavicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nerve Supply of Subclavius

A

Nerve to subclavius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Attachments of Trapezius

A

Originates from skull, nuchal ligament and spinous processes of C7-T12
Attaches to clavicle, acromion and scapular spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Actions of Trapezius (4)

A

Abduction of the upper limb at the shoulder (rotates scapula)
Upper fibres elevate scapula
Middle fibres retract scapula
Lower fibres depress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Nerve Supply to Trapezius

A

Accessory Nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Blood Supply to Trapezius

A

Transverse Cervical Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Attachments of Latissimus Dorsi

A

Originates from spinous processes of T7-12, iliac crest, thoracolumbar fascia and inferior three ribs.
Converges into a tendon that attaches to the intertubercular sulcus of the humerus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Actions of Latissimus Dorsi

A

Extension, adduction and medial rotation of the upper limb at the shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nerve Supply of Latissimus Dorsi

A

Thoracodorsal Nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Blood Supply of Latissimus Dorsi

A

Thoracodorsal Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What type of joint is the sternoclavicular?

A

Saddle-type synovial joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name the three articulating surfaces of the sternoclavicular joint

A

-Sternal end of clavicle
-Manubrium of the sternum
-First costal cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Name the three ligaments in the sternoclavicular joint
-Sternoclavicular ligaments -Interclavicular ligament -Costoclavicular ligament
26
Movements at the sternoclavicular joint (5)
-Elevation -Depression -Protraction -Retraction -Rotation
27
Innervation and Blood Supply of Sternoclavicular Joint
Medial Supraclavicular Joint Internal thoracic artery and suprascapular artery
28
What type of joint is the acromioclavicular joint?
Plane type synovial joint
29
Name the two atypical features of the acromioclavicular joint
-Articular surfaces of the joint are lined with fibrocartilage -Joint cavity is partially divided by an articular disc (fibrocartilage)
30
Name the three ligaments that strengthen and stabilise the acromioclavicular joint
-Acromioclavicular ligament -Conoid ligament and trapeziod ligament (collectively known as the coracoclavicular ligament
31
Name the movements that occur at the acromioclavicular joint
Gliding in superior/inferior and anterior/posterior planes (passive movement)
32
Innervation and blood supply of acromioclavicular joint
Suprascapular and thoracoacromial arteries Suprascapular and lateral pectoral nerves
33
Attachments of Subscapularis
Originates from the subscapular fossa (anterior surface of the scapula) Attaches to lesser tubercle of the humerus
34
Actions of Subscapularis
Medial rotation of the arm
35
Innervation and Blood Supply of Subscapularis
Upper and lower scapular nerves Subscapular artery
36
Name the attachments of Teres Major
Originates from the posterior surface of the inferior angle of the scapula Attaches to the medial lip of the intertubercular groove of the humerus
37
Actions of Teres Major
Abduction, extension and medial rotation of the upper limb at the shoulder
38
Blood Supply and Innervation of Teres Major
Lower subscapular nerve Thoracodorsal artery and posterior circumflex humeral artery
39
Which artery is the source of the circumflex humeral arteries
Axillary artery
40
Name the roots, trunks, divisions, cords and nerves of the brachial plexus
Roots: Anterior Rami of C5-T1 Trunks: Superior, Middle and Inferior Divisons: Anterior and Posterior (3 of each) Cords: Lateral, posterior and medial Nerves (Major): Musculocutaneous, axillary median, radial and ulnar
41
Name the two types of injuries to affect the brachial plexus
-Erb's Palsy (C5/6) - stretching injury commonly during difficult vaginal delivery -Klumpke's Palsy (C8/T1) - rarer than Erb's Palsy and also associated with difficult vaginal delivery
42
Name the arterial supply to the breasts
-Internal thoracic artery -Lateral thoracic and thoracoacromial arteries -Lateral Mammary branches -Mammary branches (Veins correspond with the arteries and drain into the axillary and internal thoracic veins)
43
Where do the different areas of the breast drain into the lymphatic system
Skin: Axillary, inferior deep cervical and infraclavicular nodes Nipple and areola: subareolar lymphatic plexus Most of the drainage is to the axillary nodes Medial breast tissue also drains into the parasternal nodes
44
Deltoid Actions
Anterior fibres - flexion and medial rotation Posterior fibres - extension and lateral rotation Middle fibres - major abductor of the arm
45
Nerve supply of Deltoid
Axillary Nerve
46
Supraspinatus Actions
Abduction at shoulder - does the first 15 degrees and assists deltoid for the rest
47
Nerve Supply of Supraspinatus
Suprascapular nerve
48
Infraspinatus Actions
Laterally rotates the arm
49
Nerve Supply of Infraspinatus
Suprascapular nerve
50
Teres Minor Actions
Laterally rotates the arm
51
Nerve Supply of Teres Minor
Axillary Nerve
52
Which structure deepens the glenoid fossa?
Glenoid labrum
53
Name the ligaments that stabilise the shoulder and their location
Glenohumeral ligament - humerus to glenoid fossa Coracohumeral ligament - coracoid process to greater tubercle Transverse humeral ligament - between two tubercles of humerus Coracoacromial ligament - acromion to coracoid process (creating coracoacromial arch)
54
Name the muscles of the rotator cuff
Supraspinatus Infraspinatus Subscapularis Teres Minor
55
Which structures help stabilise the shoulder joint?
Biceps tendon Rotator Cuff Glenoid Labrum Ligaments
56
Actions of Biceps Brachii
Supination of the forearm Flexion of the arm at the elbow and the shoulder
57
Nerve Supply of Biceps Brachii
Musculocutaneous nerve (Bicep tendon reflex tests C6)
58
Actions of coracobrachialis
Flexion at the shoulder and weak adduction
59
Innervation of Coracobrachialis
Musculocutaneous nerve
60
Actions of Brachialis
Flexion at elbow
61
Nerve Supply of Brachialis
Musculocutaneous nerve (+contribution from radial nerve)
62
Origin and branches of Brachial Artery
Axillary Artery Profunda brachii, muscular, nutrient, ulnar collateral and terminal brances (radial and ulnar)
63
Anatomical Landmarks for palpation of the brachial artery
2-3cm medial to biceps tendon in the antecubital fossa
64
What is the name for paired veins that run alongside smaller arteries in the extremities?
Venae comitantes
65
Origin of median nerve
Medial and lateral roots of brachial plexus (C6-T1)
66
Anatomical Course Median Nerve
Axilla > lateral to brachial artery > crosses halfway to medial to brachial artery > anterior compartment of forearm > through carpal tunnel > terminates in hand
67
Functions of Median Nerve
Motor: flexor compartment of forearm, thenar muscles and lateral two lumbricals ( Sensory: Lateral aspect of palm and fingertips of lateral three and a half digits
68
Nerve roots and function of Musculocutaneous nerve
C5-7 terminal branch of lateral cord of brachial plexus Motor: anterior compartment of upper arm Sensory: lateral cutaneous nerve of forearm innervates lateral aspect of the forearm
69
Describe the course of the ulnar nerve
Brachial plexus > between axillary artery and nerve medial aspect of arm > posterior to elbow through ulnar tunnel > alongside ulna >medial to ulnar artery into hand
70
Territory of Intercostalbrachial nerve
Axilla and proximal medial arm
71
Territories of medical cutaneous nerves of the arm and forearm
Arm: medial arm Forearm: forearm and distal medial upper arm
72
Position of Infraclavicular nodes and region they drain
1st intercostal space Drain axilla, upper limb and anterior thoracic wall
73
Position of Supratrochlear nodes and region they drain
Superior to medial epicondyle of the humerus Drain 3rd-5th fingers and medial forearm
74
Actions and Innervation of Triceps
Extension of arm at elbow Radial nerve (Triceps tendon reflex tests C7)
75
Where does the radial nerve run in relation to the humerus and why is this relevant?
Radial groove of the humerus Can be damaged by shoulder dislocation or fracture of proximal humerus
76
Origin and Course of the Radial Nerve
Posterior cord of brachial plexus (C5-T1) Axilla > radial groove (wraps around humerus) > alongside brachial artery > cubital fossa > divides into two branches
77
Name the articulating surfaces of the elbow joint
Trochlear notch of ulna and trochlea of humerus Head of radius and capitulum of the humerus
78
Name the ligaments of the elbow
Radial and ulnar collateral ligaments Annular ligament (allows radius to rotate)
79
Muscles that move elbow
Extension: triceps brachii and anconeus Flexion: brachialis, biceps brachii and brachioradialis
80
Which structure can be damaged if the carrying angle of the elbow is pathologically increased?
Ulnar nerve
81
Which structure do the muscles of the anterior forearm arise from?
Medial humeral epicondyle
82
Action and Innervation of Flexor Carpi Ulnaris
Flexion and adduction of wrist Ulnar nerve
83
Action and Innervation of Palmaris Longus
Flexion of Wrist Median Nerve
84
Action and Innervation of Flexor Carpi Radialis
Flexion and abduction of wrist Median nerve
85
Action and Innervation of Pronator Teres
Pronation Median Nerve
86
Action and Innervation of Flexor Digitorum Superficialis
Flexes metacarpophalangeal joints and proximal interphalangeal joints at the four fingers Flexes at the wrist Median nerve (only muscle in intermediate compartment)
87
Action and Innervation of Flexor Digitorum Profundus
Flexes distal interphalangeal joints (only muscle that does this) Flexes metacarpophalangeal and wrist joints Medial half ulnar nerve Lateral half medial nerve
88
Action and Innervation of Flexor Pollicus Longus
Flexes interphalangeal joint and metacarpophalangeal joint of the thumb Median nerve
89
Action and Innervation of Pronator Quadratus
Pronates forearm Median nerve
90
Which arteries are formed from the ulnar artery
Anterior and posterior interosseous arteries
91
Which structures are formed by the anastomosis of the radial and ulnar arteries at the wrist?
Superficial and deep palmar arches
92
Location and territory of superficial and deep palmar (carpal) arches
Superficial: anterior to flexor tendons and deep to palmar aponeurosis. Digital arteries supplying 4 fingers Deep: deep to flexor tendons Contributes to supply of digits and wrist joints
93
Location of the Superficial Veins of the Upper Arm
Basilic - medial Cephalic -antero-lateral Median cubital - connects the two in the anticubital fossa
94
Name the three cutaneous nerves of the forearm and their supply territories
Lateral (musculocutaneous): lateral forearm Medial (medial cord): Anterior and posterior medial forearm Posterior (radial) - posterior forearm
95
Name the two branches the median nerve gives off in the forearm and their territory
Anteriorinterosseous nerve - deep muscles in anterior forearm Palmar cutaneous nerve - innervates the skin of the lateral palm (prior to carpal tunnel so palm is spared)
96
Name the three branches of the ulnar nerve in the forearm and the territories they supply
Muscular: Flexi Carpi Ulnaris and Flexor Digitorum Profundus Palmar Cutaneous: medial half of palm Dorsal Cutaneous: Dorsal surface of one and a half fingers and associated dorsal hand area
97
Which muscles act on the proximal and distal radioulnar joints?
Pronation: Pronator Quadratus and Pronator teres Supination: Supinator and Biceps Brachii
98
Action and Innervation of Brachioradialis
Flexion at the elbow Also contributes to supination at proximal radioulnar joint Radial Nerve
99
Action and Innervation of Extensor Carpi Radialis Longus and Brevis
Extends and abducts the wrist Radial Nerve
100
Action and Innervation of Extensor Digitorum Communis
Extension of digits at interphalangeal and metacarpophalangeal joints Radial Nerve
101
Action and Innervation of Extensor Digiti Minimi
Extends little finger and contributes to wrist extension Radial Nerve
102
Action and Innervation of Extensor Carpi Ulnaris
Extension and adduction of wrist Radial Nerve
103
Action and Innervation of Anconeus
Extends and stabilises elbow joint Abducts the ulna during pronation of forearm Radial Nerve
104
Action and Innervation of Supinator
Supinates the forearm Radial Nerve
105
Action and Innervation of Abductor Pollicis Longus
Abducts the thumb Radial nerve
106
Action and Innervation of Extensor Pollicis Longus
Extends all the joints of the thumb Radial Nerve
107
Action and Innervation of Extensor Pollicis Brevis
Extends at metacarpophalangeal and carpometacarpal joints of the thumb Radial Nerve
108
Action and Innervation of Extensor Indicis Proprius
Extends index finger Radial nerve
109
Name the structures that form the border of the anatomical snuffbox
Tendon of extensor pollicis longus (medial) Tendon of extensor pollicis brevis and abductor pollicis longus (lateral) Styloid process of the radius (proximal) Scaphoid and trapezium (floor) Skin (roof)
110
What is the extensor retinaculum and where does it attach
Fibrous band that holds the extensor tendons at the dorsum of the wrist Anterior border of the radius, styloid process of the ulna, triquetral and pisiform Keeps extensor tendons in aligment and prevents bowstringing during movements
111
Where is the palmar aponeurosis located and where does it attach?
Deep fascia in anterior palm Apex attaches to flexor retinaculum and palmaris longus tendon Base divides into four bands each sending a band to the skin and a deep band around the flexor tendons This fuses with the fibrous flexor sheath and deep transverse metacarpal ligaments
112
Which structures articulate at the wrist joint?
Distal end of radius Articular disc (ulnar does not articulate at this joint) Proximal row of carpal bones (not pisiform)
113
Name the four ligaments at the wrist joint
Palmar Radiocarpal Dorsal Radiocarpal Ulnar Collateral Radial Collateral
114
Name the muscles that flex the wrist
Flexor Carpi Ulnaris Flexor Carpi Radialis With assistance from flexor digitorum superficialis
115
Name the muscles that extend the wrist
Extensor Carpi Radialis Longus and Brevis Extensor Carpi Ulnaris Assistance from Extensor Digitorum
116
Name the muscles that adduct the wrist
Extensor Carpi Ulnaris Flexor Carpi Ulnaris
117
Name the muscles that abduct the wrist
Abductor Pollicis Longus Flexor Carpi Radialis Extensor Carpi Radialis Longus and Brevis
118
Where do the long flexor tendons attach?
FDS is split in two and attaches to the base of the middle phalanx FDP attaches to base of distal phalanx
119
What are the annular and cruciate pulleys
Annular - five areas where the fibrous flexor sheaths are reinforced by circular fibres Cruciate - 3 areas where the fibrous flexor sheathes are reinforced by cruciform fibres
120
Which structure does the long flexor tendon of the thumb arise from and what is it reinfored by?
Flexor Pollicis Longus 3 pulleys: annular 1 & 2 and oblique pulleys
121
Name the attachments of the Flexor Retinaculum
Pisiform Hook of the hamate Scaphoid Trapezium
122
Name the two slips of the flexor retinaculum and what they carry
Lateral Deep - tendon of flexor carpi radialis and its synovial sheath Medial Superficial - ulnar vessel and nerves
123
Which muscles groups arise from the Flexor Retinaculum
The muscles of the thenar and hypothenar eminences
124
Name the two layers that form the carpal tunnel and the structures they are formed of
Deep Carpal arch: laterally by scaphoid and trapezium tubercles and medially by hook of hamate and pisiform Flexor Retinaculum forms the roof
125
Name the contents of the Carpal Tunnel
Tendon of flexor pollicis longus (surrounded by its own synovial sheath) Four tendons of flexor digitorum profundus Four tendons of flexor digitorum superficialis (these eight tendons are encased together in a synovial sheath) Median Nerve
126
Actions and Innervation of Opponens Pollicis
Opposes the thumb (by medially rotating and flexing the metacarpal on the trapezium) Median nerve
127
Action and Innervation of Abductor Pollicis Brevis
Abducts the thumb Median nerve
128
Action and Innervation of Flexor Pollicis Brevis
Flexes the MCP joint of the thumb Median nerve. Deep head is innervated by ulnar nerve
129
Action and Innervation of Opponens Digiti Minimi
Opposition of the little finger by rotating the metacarpal Ulnar Nerve
130
Action and Innervation of Abductor Digiti Minimi
Abducts the little finger Ulnar Nerve
131
Action and Innervation Flexor Digiti Minimi Brevis
Flexes the MCP joint of the little finger Ulnar Nerve
132
Which structures are innervated by the recurrent branch of the ulnar nerve?
Thenar Muscles
133
Describe the nerve supply to the fingers and their location in the fingers
Median nerve - lateral branch - palmar aspect of thumb and radial side of index finger -Medial branch - proper palmar digital nerves ulnar side of index finger, both sides middle finger and radial side of ring finger Ulnar nerve -Proper digital nerves that supply ulnar side of ring finger and radial side of the little finger -Proper palmar digital nerves ulnar side of little finger Radial nerve -Dorsal thumb and proximal dorsal aspects of index and middle and radial side of ring finger.
134
Name the actions and innervation of the lumbricals
Flexion at MCP and extension at IP joints Lateral 2 median nerve and medial ulnar nerve
135
Name the actions and innervation of the dorsal interossei
Abduction of the digits Assists in flexion at MCP and extension at IP joints Ulnar nerve
136
Name the actions and innervation of the palmar interossei
Adduction of the digits Assists in flexion at MCP and extension at IP joints Ulnar nerve
137
Name the attachments of the Lumbricals
Originates from a tendon of the flexor digitorum profundus and inserts into the extensor hood
138
Name the attachments of the dorsal interossei
Originates from the lateral and medial surfaces of the metacarpals Attach into the extensor hood and proximal phalynx
139
Name the attachments of the palmar interossei
Originates from a medial or lateral surface of the metacarpal Attaches into the extensor hood and proximal phalynx
140
Where do the extensor tendons arising from the forearm attach?
Extensor hood of each finger
141
Where do the flexor tendons arising from the forearm attach
FDS - base of the middle phalynx FDP - distal phalanges FPL - base of distal phalynx of the thumb
142
Describe the dermatomes of the upper limb
C4 - superior shoulder C5 - lateral upper arm C6 - Lateral forearm and thumb C7 - Index and middle fingers C8 - Little finger and medial hand T1 - Medial forearm T2 - Distal medial upper arm T3 - Proximal medial upper arm and axilla
143
Name the common causes of axillary nerve injury
Fracture of humeral surgical neck Shoulder dislocation During shoulder surgery
144
Describe the dermatomes of the lower leg
L1 - Inguinal region and superior aspect of the medial thigh L2 - Middle/lateral anterior thigh L3 - Medial condyle of the femur running inferomedial across the thigh L4 - Medial malleolus L5 - Dorsum of the foot S1 - Lateral aspect of calcaneus S2 - Midpoint of popliteal fossa S3 - Horizontal gluteal crease S4/5 - Perianal region
145
Which artery do the cutaneous arteries of the anterior thigh arise from?
Femoral artery
146
Describe the path of the great saphenous vein
Formed by the dorsal arch of the foot and dorsal vein of the big toe Ascends up medial side of leg anteriorly to medial malleolus and posteriorly to medial condyle at the knee Drains into the femoral vein immediately inferior to inguinal ligament Receives tributaries from the superficial veins as it moves up the leg
147
Location and Drainage of Superficial Inguinal Nodes
Directly below inguinal ligament Penis, scrotum, perineum, buttock and abdominal wall
148
Location and drainage of Superficial Sub-Inguinal Nodes
Located on each side of the proximal section of the great saphenous vein Superficial lymphatic vessels of the lower leg
149
Location and drainage of Deep Sub-inguinal Nodes
Medial aspect of the femoral vein Deep lymphatic trunks of the thigh
150
Actions and innervation of Iliopsoas (Psoas Major and Iliacus)
Flexion of the thigh at the hip Psoas Major - L1-3 Iliacus - Femoral nerve
151
Actions and Innervation of Sartorius
Hip - flexion, abduction and lateral rotation Knee - flexion Femoral nerve
152
Actions and Innervation of Pectineus
Adduction and flexion at the hip Femoral nerve
153
Actions and Innervation of Quadriceps Femoris
Extension of the knee Stabilises patella Rectus femoris also flexes the hip Femoral nerve
154
Which structure is formed from the four muscles of Quadriceps femoris?
Quadriceps tendon
155
Name the four muscles that form Quadriceps Femoris
Vastus Lateralis Vastus Intermedius Vastus Medialis Rectus Femoris
156
Name the structures found in the femoral sheath
Femoral nerve Femoral artery Femoral vein Femoral canal - deep lymph nodes and vessels
157
Name the roots of the femoral nerve and the branches it then forms
L2-4 Superficial and deep branches are the source of cutaneous and muscular supply Also the source of the saphenous nerve
158
What type of bone is the patellar bone and which structure does it attach to?
Sesamoid bone Quadriceps tendon and patellar ligament
159
Which structures prevent lateral patellar draw?
Medial patellofemoral ligament and the medial facet of the trochlear groove of the femur
160
Actions and Innervation of Adductor Magnus
Adductor - adduction and flexion of the thigh: Obturator L2-4 Hamstring: adduction and extension: Tibial component of sciatic nerve (L4-S3)
161
Actions and Innervation of Adductor Longus
Adduction of the thigh Obturator nerve
162
Actions and Innervation of Adductor Brevis
Adduction of the thigh Obturator nerve
163
Actions and Innervation of Obturator Externus
Adduction and lateral rotation of the thigh Obturator nerve
164
Actions and Innervation of Gracilis
Adduction of the thigh and flexion of the knee Obturator nerve
165
Which test is used to test the adductor muscles of the thigh?
The adductor squeeze test
166
Which arteries supply the medial thigh ?
Profunda femoris artery supported by obturator artery
167
Territories supplied by obturator nerve
Motor: Medial compartment of the thigh Sensory: Cutaneous branches supply skin of medial thigh
168
Actions and Innervation of Gluteus Maximus
Main extensor of thigh Assists with lateral rotation Inferior Gluteal Nerve
169
Actions and Innervation of Gluteus Medius
Abduction and medial rotation of lower limb Stabilises pelvis Superior Gluteal Nerve
170
Actions and Innervation of Gluteus Minimus
Abduction and medial rotation of lower limb Stabilises pelvis Superior Gluteal Nerve
171
Actions and Innervation of Tensor Fascia Lata
Assists gluteus medius and minimus in abduction and medial rotation Superior Gluteal Nerve
172
Actions and Innervation of Piriformis
Lateral rotation and abduction Nerve to piriformis
173
Which muscles act as synergistic femoral lateral rotators and hip stabilisers
Piriformis Obturator Internus Quadratus Femoris
174
Describe the root and course of the sciatic nerve
L4-S3 (Lumbosacral plexus) Enters gluteal region via greater sciatic foramen Emerges inferiorly to the piriformis and descends inferolaterally Enters posterior thigh deep to long head of biceps femoris Terminates in the popliteal fossa by bifurcating into tibial and common fibular nerves
175
What are the landmarks for dividing gluteal region into quadrants
Vertical line from highest point on iliac crest Horizontal line half way between highest point on iliac crestand ischial tuberosity Sciatic nerve passes through lower medial quadrant
176
Which structure deepens the acetabulam?
Acetabular Labrum
177
Name the ligaments of the hip joint and their function
Ligamentum Teres - encloses branch of obturator artery Iliofemoral ligament - prevents hyperextension of the hip Pubofemoral ligament - prevents excessive abduction and extension Ischiofemoral - prevents hyperextension and holds femoral head in the acetabulam Transverse ligament - bridges acetabular notch and forms acetabulat foramen
178
Name the blood supply and innervation to the hip joint
Medial and Lateral Circumflex Femoral Arteries Sciatic, Femoral and Obturator nerves
179
Name the muscles that flex the hip
Iliopsoas Rectus Femoris Sartorius Pectineus
180
Name the muscles that extend the hip
Gluteus Maximus Semimembranous Semitendinous Biceps femoris (hamstring)
181
Names the muscles that abduct the hip
Gluteus Medius Gluteus Minimus Piriformis Tensor fascia latae
182
Name the muscles that adduct the hip
Adductors longus, brevis and magnus Pectineus Gracilis
183
Name the muscles that laterally rotate the hip
Biceps Femoris Gluteus Maximis Piriformis Assisted by obturators gemilli and quadratus femoris
184
Name the muscles that medially rotate the hip
Anterior fibres gluteus medius and minimus Tensor fascia latae
185
Name the muscles collectively known as the hamstrings, their actions and innervation
Biceps femoris -Flexion at the knee and contributes to extension at hip and lateral rotation at hip and knee (only when knee is flexed) -Long head tibial part of sciatic nerve and short head common fibular part of sciatic nerve Semitendinous -Flexion at the knee and extension at hip. Medial rotation at hip and knee -Tibial part of sciatic nerve Semimembranous -Flexion at knee, extension at hip. Medial rotation at hip and knee -Tibial part of sciatic nerve
186
Name the borders of the popliteal fossa
Semimembranous Biceps femoris Medial and lateral heads of gastrocnemius and plantaris Floor formed by posterior surface of knee joint capsule, popliteus muscle and posterior femur Roof is popliteal fascia and skin
187
Name the contents of the popliteal fossa medial to lateral
Popliteal artery Popliteal vein Tibial nerve Common fibular (peroneal) nerve
188
Actions and Innervation of Popliteus
Lateral rotation of knee - unlocks knee so flexion can occur Tibial Nerve
189
Name the two menisci of the knee and their functions
Medial and latral Deepens articular surface of tibia stabilising the joint Act as shock absorbers
190
Name the bursae of the knee and where they communicate
Suprapatellar - between quadriceps femoris and femur Prepatellar - between apex of patella and the skin Infrapatellar - deep lies between tibia and patella ligament and superficial lies between patella ligament and skin Semimembranous: between semimembranous and medial head of gastrocnemius
191
Name the ligaments of the knee and their roles
Patellar ligament - continuation of quadriceps tendon distal to patella Medial and lateral collateral ligaments - stabilise hing movement of the knee and prevent excessive medial and lateral movement Anterior cruciate - prevents anterior dislocation of the tibia onto the femur Posterior cruciate - prevents posterior dislocation of the tibia onto the femur Oblique Popliteal - prevents hyperextension and external rotation
192
Name the two openings in the knee capsule and the structures they are for
Anterior - suprapatellar bursa Posterior - popliteus
193
Describe the screw home mechanism in the knee and its function
During the last few degrees of extension the femoral condyle rotates medially on the tibial plateau which locks the knee Allows for prolonged weight bearing without the help of the muscles of the knee
194
Which bony projections do the anterior cruciate ligaments attach to and what is their function?
Tibial Spines To provide a secure anchor for the ACL to attach to
195
Actions and Innervation of Tibialis Anterior
Dorsiflexion and Inversion of foot Deep fibular nerve
196
Actions and Innervation of Extensor Digitorum Longus
Extension of lateral four toes and dorsiflexion of the foot Deep fibular nerve
197
Actions and Innervation of Extensor Hallucis Longus
Extension of the big toe and dorsiflexion of the foot Deep Fibular nerve
198
Actions and Innervation of Peroneus Tertius
Eversion and dorsiflexion of the foot Deep Fibular Nerve
199
Where does the patellar tendon attach?
Tibial tuberosity
200
Which artery is dorsalis pedis a continuation of?
Anterior tibial
201
Actions and Innervation of Peroneus longus
Eversion and planterflexion of the foot Superficial fibular (peroneal) nerve
202
Actions and Innervation of Peroneus Brevis
Eversion of the foot Superficial fibular (peroneal) nerve
203
Where do the Peroneus longus and brevis lie and where do they attach?
Longus - converges into a tendon which descends under the foot and attaches to the bones on the medial side (medial cuneiform and base of 1st metatarsal) Brevis - forms a tendon which travels posterior to lateral malleolus passes over calcaneus and cuboidal bones before attaching to tubercle on 5th metatarsal
204
Which tendons can be injured by inversion injuries of the ankle?
Peroneus (fibularis) longis and brevis
205
Actions and Innervation of Gastrocnemius
Plantarflexion of the foot and flexion at the knee joint Tibial nerve
206
Actions and Innervation of Soleus
Plantarflexion of the foot Tibial Nerve
207
Actions and Innervation of Plantaris
Contributes to plantarflexion of the foot and flexion at the knee Tibial Nerve
208
Actions and Innervation of Flexor Digitorum Longus
Flexion of the lateral four toes Tibial Nerve
209
Actions and Innervation of Flexor Hallucis Longus
Flexion of the big toe Tibial Nerve
210
Actions and Innervation of Tibialis Posterior
Inversion and Plantarflexion of the foot Also contributes to medial arch of the foot Tibial Nerve
211
Which arteries arise from the popliteal artery?
Anterior tibial artery Tibioperoneal trunk - which then divides into posterior tibial and fibular (peroneal) artery
212
Name the roots of the tibial nerve and the territories it supplies
L4-S3 Sensory - innervates skin of posterolateral leg, lateral foot and sole of foot Motor - posterior compartment of the leg and majority of the intrinsic foot muscles
213
Describe the course of the tibial nerve
Popliteal fossa > posterior to tibia > through tarsal tunnel and terminates immediately distal
214
Name the structures that lie in the layers of the soles of the foot
Plantar arteries and nerves lie between the 1st and 2nd layers Long flexor tendons lie within the 2nd layer Tendons of tibialis posterior and peroneus longus are part of the fourth
215
Where does tibialis posterior attach?
Plantar surfaces of the medial tarsal bones
216
Which bones form the ankle joint?
Tibia Fibula Talus
217
Name the ligaments of the ankle, their attachments and their function
Medial/Deltoid (4 ligaments together) - resists over-eversion of the foot. Fan out from the malleolus and attach to the talus, calcaneus and navicular bones Lateral resists over inversion of the foot and is comprised of three ligaments: -Anterior talofibular: lateral malleolus and talus -Posterior talofibular: lateral malleolus and talus -Calcaneofibular: lateral malleolus and calcaneus
218
How does the body of the talus affect joint stability?
The body of the talus fits snugly into the mortise formed by the bones of the leg. It is broad anteriorly and narrow posteriorly Therefore it is more stable in dorsiflexion than it is in plantar flexion
219
Which structures form the mortise of the ankle?
Medial malleolus Lateral malleolus Inferior transverse tibiofibular ligament
220
Name the tarsal bones from proximal to distal
Talus and Calcaneus Navicular Cuboid (lateral) 3x cuneiforms (lateral, middle and medial)
221
Name the joints between the tarsal bones
Subtalar - between calcaneus and talus Talonavicular - talus and navicular Calcaneocuboid - calcaneus and cuboid Navicular articulates with all the other tarsal bones Cuneiforms articulate with each other and the navicular
222
Name the location and function of the spring ligament
Anterio aspect of the sustentaculum tali to the plantar surface of the navicular bone Primary static stabiliser of the medial longitudinal arch
223
What is the role of the interosseus ligaments?
Connect non-articular surfaces of the bones
224
Which joints are involved in inversion and eversion of the foot and which bones make up these joints?
Subtalar: talus and calcaneus Midtarsal: talus + calcaneus and navicular and cuboid bones
225
Which muscles invert the foot?
Tibialis anterior Tibialis posterior
226
Which muscles evert the foot?
Peroneus longus and brevis Peroneus tertius
227
Name the bones that form the medial arch
Calcaneus Talus Navicular 3x cuneiforms 1st 3 metatarsal bones
228
Name the structures that support the medial arch
Muscles: tibialis anterior and posterior, fibularis longus, flexor digitorum longus, flexor hallucis and the intrinsic foot muscles Ligaments: plantar ligaments and medial ligament of the ankle joint Plantar aponeurosis
229
Name the bones of the lateral arch
Calcaneus Cuboid 4th and 5th metatarsal
230
Name the structures that support the lateral arch
Muscles: fibularis longus, flexor digitorum longus and intrinsic foot muscles Ligaments: Plantar ligaments Plantar aponeurosis
231
How would damage to the lateral femoral cutaneous nerve present?
Pain or paraesthesia to the outer thigh
232
How would damage to the common peroneal nerve present?
Foot drop Weakness in dorsiflexion and eversion Slapping gait
233
Name the two joints between the ribs and vertebrae
Costotransverse Costovertebral
234
Where do the ribs join anteriorly?
1-7: sternum 8-10: costal cartilage 11-12: don't have an attachment
235
Name the accessory muscles of respiration
Pectoralis Major Pectoralis Minor Serratus anterior Scalene muscles
236
Name the three layers of muscle on the thoracic wall and the muscles they contain
Outer: External intercostals Intermediate: Internal intercostals Inner: Innermost intercostals, transversus, subcostals
237
Name the thoracic wall muscles involved in forced inspiration and the muscles involved forced in expiration
Inspiration: External intercostals, Expiration: Internal intercostals (forced), Innermost intercostals, transversus thoracis, subcostales
238
Which abdominal wall muscles assist in forced expiration
Rectus abdominis External oblique Internal oblique Transversus abdominis
239
Where is the neurovascular bundle of the ribs located and which structures are found in it?
Costal groove - undersurface of the rib Intercostal Vein Intercostal Artery Intercostal Nerve
240
Name the structures the diaphragm attaches to
Lumbar vertebrae and arcurate ligaments Costal cartilage of ribs 7-10 Ribs 11-12 Xiphoid process of sternum
241
Name the openings of the diaphragm, their vertebral levels and the structures that pass through them
Caval Hiatus (T8) - Inferior Vena Cava and terminal branches of right phrenic nerve Oesophageal Hiatus (T10) - Oesophagus, right and left vagal nerves and oesophageal branches of left gastric artery/vein Aortic Hiatus (T12) - Aorta, Thoracic Duct and Azygous Vein
242
Which nerve supplies the diaphragm?
Phrenic nerve
243
Name the structures that allow the trachea to perform it's primary functions
C shaped rings of cartilage supported by trachealis muscle Ciliated pseudostratified columnar epithelium with goblet cells Elastic walls
244
Name the boundaries for the trachea
Lower border of cricoid cartilage Bifurcates at level of sternal angle
245
Where is the thymus gland located and what happens to it after puberty?
Posterior to the manubrium of the sternum It decreases in size and is slowly replaced by fat
246
Name the two layers of the pericardium and their function
Fibrous: Prevents rapid overfilling of the hear Serous: Is made of two layers between which is serous fluid which minimises the friction generated by the heart as it contracts Also fixes the heart in the mediastinum and protects from infection
247
Name the innervation of the pericardium and the clinical relevance in pericarditis
Phrenic nerves (C3-5) GIven the cervical origin pericarditis can present with referred shoulder pain
248
Name the structures that make up the five surfaces of the heart
Anterior - Right ventricle Posterior - Left atrium Inferior - Left and right ventricles Right Pulmonary - Right atrium Left Pulmonary - Left atrium
249
Name the structures that make up the borders of the heart
Right Border - Right atrium Inferior Border - Left and Right Ventricles Left Border - Left ventricle Superior Border - Left and Right Atrium and the great vessels
250
Name the surface markings of the heart valves and their auscultation points
Mitral - Left of sternum fourth costal cartilage. Left intercostal space midclavicular Tricuspid - Right side of sternum 4th costal cartilage. Left 5th intercostal space parasternally Aortic - L side of sternum 3rd intercostal space. Right 2nd intercostal space Pulmonary valve - junction of sternum and left 3rd costal cartilage. Left 2nd intercostal space parasternally
251
Name the root of the aorta and the branches that arise from the aortic arch
Aortic orifice (base of left ventricle) Brachiocephalic trunk, left common carotid and left subclavian
252
Name the root of the Pulmonaries arteries and the vertebral level this occurs at
Pulmonary Trunk T5-6
253
Describe how heart conduction occurs
An action potential is created by the SA node This spreads across the atria causing it to contract When it reaches the AV node the signal is delayed It is then conducted into the bundle of his down the interventricular septum and into the left and right bundle branches The bundle of his and Purkinje fibres spread the wave impulses along the ventricles
254
Name the location of the SA and AV nodes
Upper wall of the right atrium (at the junction where the SVC enters) Atrioventricular septum
255
Name the origin of the coronary arteries and the two main arteries
Aortic sinuses Left and Right Coronary arteries
256
Name the branches of the coronary arteries and the territories they supply
Left -Left anterior descending: L+R ventricles and interventricular septum -Left marginal artery: Left ventricle -Left circumflex: Left atrium and ventricle Right -Right marginal artery: right ventricle and apex -Right coronary artery: right atrium and right ventricle -Posterior interventricular artery: right and left ventricles and interventricular septum
257
Which coronary artery supplies the SA and AV nodes?
Right coronary arteries
258
Describe the level of origin and ending of the oesophagus
Laryngopharynx (C6) Cardiac orifice of the stomach (T11)
259
Name the two oesophageal constrictions and their locations
Upper Oesophageal Sphincter- junction between pharynx and oesophagus Lower Oesophageal Sphincter - Gastro-oesophageal junction
260
Name the innervation of the oesophagus
Oesophageal plexus - combination of parasympathetic vagal trunks and sympathetic fibres from cervical and thoracic sympathetic trunks
261
Name the two layers of the pleura and their functions
Visceral pleura Parietal Pleura -Subdivided into mediastinal, cervical, costal and diaphragmatic Lubricate lungs and provide negative pressure space
262
Name the blood supply of the pleura
Parietal - phrenic and intercostal nerves Visceral - Pulmonary plexus
263
Name the two fissures found in the lungs and their location
Oblique fissure (both lungs) - from inferior border to posterior lung border in a superoposterior direction Horizontal (right) - from sternum at level of 4th rib to meet the oblique fissure
264
Name the function of the lung roots and the structures contained within
Suspends the lung from the mediastinum Bronchus, pulmonary artery, two pulmonary veins, bronchial vessels, pulmonary plexus and lymphatic vessels
265
Describe the lymphatic drainage of the lungs
Deep plexus drains the structures of the lung root Superficial plexus drains the lung parenchyma Both drain into the trachebronchial nodes which then drain into the right and left bronchomediastinal trunks
266
Describe the nerve supply of the lungs
Pulmonary Plexus which is made up of the following fibres -Parasympathetic- derived from vagus nerve: stimulate secretion from bronchial glands, contraction of bronchial smooth muscle and vasodilation of pulmonary vessels -Sympathetic - derived from sympathetic trunk: stimulate relaxation of bronchial smooth muscle and vasoconstriction of pulmonary vessels -Visceral afferent - conducts pain impulses to the sensory ganglion of vagus nerve
267
Name the attachments and extent of the external oblique, its functions and the ligament it forms
Originates from ribs 5-12 and inserts onto iliac crest and pubic tubercle Contralateral rotation of the torsa Inguinal ligament
268
Name the attachments and extent of the internal oblique and its functions
Originates from inguinal ligament, iliac crest and lumbodorsal fascia. Inserts onto ribs 10-12 Compression of abdomen and ipsilateral rotation of the torso
269
Name the attachments of the transversus abdominus and its functions
Originates from inguinal ligament, costal cartilages 7-12, iliac crest and thoracolumbar fascia. Inserts onto conjoint tendon, xiphoid process, linea alba and pubic crest Compression of the abdomen
270
Name the attachments of the Rectus Abdominis and its functions
Originates from the crest of the pubis bone and inserts onto the xiphoid process of the sternum and the costal cartilage of ribs 5-7 Compression of the abdominal contents and stabilisation of pelvis during walking and depression of the ribs
271
Describe the structures that form the rectus sheath
Formed by aponeuroses of the three flat muscles (encloses rectus abdominis and pyramidalis ) Anterior wall - aponeuroses of external oblique and half of interal oblique Posterior wall - aponeuroses of half of the internal oblique and transversus abdominis
272
Name the innervation of the anterior abdominal wall muscles
Thoracoabdominal nerves (T7-11), Subcostal nerve (T12) and branches of lumbar plexus (not external oblique)
273
Name the contents of the rectus sheath
Posterior intercostal nerves Superior epigastric artery Inferior epigastric artery
274
Name the boundaries of the inguinal canal
Anterior wall - aponeurosis of external oblique Posterior wall - transversalis fascia Roof - transversalis fascia, internal oblique and transversus abdominis Floor - inguinal ligament
275
Name the two rings (openings) of the inguinal canal and their origins
Deep (interal) - created by transversalis fascia Superficial (external) - formed by invagination of of the external oblique
276
Name the contents of the inguinal canal
Spermatic cord (male) Round ligament (female) Ilioinguinal nerve Genital branch of genitofemoral nerve
277
Name the components of the spermatic cord
3x fascia: external, cremaster and internal Vessels -Testicular artery -Cremasteric artery and vein -Artery to vas deferens -Pampiniform plexus of testicular veins Nerves -Genital branch of genitofemoral nerve -Autonomic nerves Vas deferens Processus vaginalis Lymph vessels
278
Describe the descent pathway of the testes
They are first located on the posterior abdominal wall and during development they descend down the abdomen, through the inguinal canal and into the scrotum They bring their neurovascular and lymphatic supply with them
279
Name the blood supply of the testes
Testicular artery (+cremasteric artery and artery of the vas deferens)
280
Name the venous drainage of the testes
Paired testicular veins that form the pampiniform plexus
281
Name the lymphatic drainage of the testes vs the scrotum
Testes - lumbar and para-aortic nodes Scrotum - superficial inguinal nodes
282
Describe the anatomical course of the vas deferens
-Arises from tail of epididymis -Travels through inguinal canal as part of spermatic cord -Moves down lateral pelvic wall -Passes between bladder and ureter and then travels down posterior of bladder -Inferior part of the ampulla joins duct from seminal vesicles to form ejaculatory duct
283
Name the innervation of the testes and epididymis
Testicular plexus Derived from aortic and renal plexi
284
Name the retroperitoneal structures
Adrenal glands Aorta and IVC Duodenum Pancreas Ureters Colon (ascending and descending) Kidneys Oesophagus Rectum
285
Name the two peritoneal layers, the differences between the two and their functions
Parietal - derived from somatic mesoderm and gets its nerve supply from same somatic supply as the abdominal wall (pain is well localised) Visceral - derived from splanchnic mesoderm and innervation is the same as the organs it covers (poorly localised) Supports viscera and provides pathway for blood vessels and lymph.
286
Name the three compartments of the abdominal cavity
Supracolic Infracolic Pelvic
287
Which structure separates the supracolic and infracolic compartments
Transverse mesocolon
288
Name the structures contained within the infracolic compartment and the structure separating the compartment into left and right
Small intestine, ascending and descending colon Mesentery of small intestine
289
Name the attachments of the mesentery of the small intestine and the function of its mechanoreceptors
Jejunum, ileum and posterior abdominal wall Nerve fibres that detect stimuli such as stretch and distension
290
Name the attachments of the abdominal wall
Sigmoid colon and posterior abdominal wall
291
Name the contents of the supracolic compartment
Stomach, liver and spleen
292
Name the four divisions of the stomach
Cardia - surrounds the superior opening Fundus - left and superior of the cardia Body Pylorus - connecting stomach to duodenum
293
Name the attachments of the greater omentum and its function
Greater curvature of the stomach, proximal duodenum, anterior surface of transverse colon Immune system (abdominal policeman)
294
Name the blood supply and innervation of the stomach
3 branches of coeliac trunk
295
Name the innervation of the stomach
Parasympathetic - anterior and posterior vagal nerves Sympathetic - T6-T9 - coeliac plexus
296
Name the four sections of the duodenum and the spinal levels they correspond to
D1 Superior L1 D2 Descending L1-L3 D3 Inferior L3 D4 Ascending L3-L2
297
Name the blood supply of the duodenum
Pancreaticoduodenal arteries
298
Name the arterial supply and innervation of the jejunum and the ileum
Superior mesenteric artery Sympathetic Lesser splanchnic nerves via celiac and superior mesenteric plexus (T9-10) Parasympathetic: Vagus
299
What is Meckel's diverticulum and why is it relevant?
Congenital abnormality of small intestine Can cause GI bleeding, intestinal obstruction, ulcers/perforation
300
Name the 7 common appendix tip locations
Pre-ileal Post-ileal Sub-ileal Pelvic Subcecal Paracecal Retrocecal
301
Name the blood supply and innervation of the colon
Superior and inferior mesenteric arteries (transition in transverse colon) Ascending and proximal 2/3 of transverse colon - superior mesenteric plexus Rest of the colon - inferior mesenteric plexus T10-L2
302
Name the surfaces of the liver
Diaphragmatic Visceral
303
Name the ligaments and recesses of the liver
Ligaments: falciform ligament, left and right triangular ligaments and coronary ligaments Recesses: Subphrenic spaces, subhepatic space and Morison's pouch
304
Name the four lobes of the liver
Left Right Caudate Quadrate
305
Which fissure runs between the caudate and quadrate lobes and which structures does it carry??
Porta hepatis All vessels, nerves and ducts entering or leaving the liver except the hepatic veins
306
Describe the microscopic structure of the liver
Hepatocytes are arranged into lobules Lobules are hexagonal shape and are drained by a central vein At the periphery of each lobule is the portal triad made up of: Arteriole (branch of hepatic artery) Venule (branche of hepatic portal vein) Bile duct Lymphatic vessels Vagus nerve fibres Sinusoids - mix arterial and portal blood
307
Described the blood supply of the liver
Hepatic artery - supplies non -parenchymal structures (branch of Coeliac trunk) Hepatic portal vein - dominant blood supply to liver parenchyma from small intestine to allow liver to perform its functions (e.g detoxification) Venous drainage is via hepatic veins into the inferior vena cava
308
Describe the lymphatic drainage of the liver
Anterior: Hepatic lymph nodes > coeliac lymph nodes > cisterna chyli Posterior: phrenic and posterior mediastinal nodes > right lymphatic and thoraric ducts
309
Describe the innervation of the gallbladder and bile ducts
Coeliac plexus and vagus nerve
310
Name the veins that the portal vein arises from and the five porto-systemic anastomoses
Superior mesenteric and splenic veins Oesophageal, Rectal, Retroperitoneal, Paraumbilical and with the IVC
311
Describe the arterial supply and venous/lymphatic drainage of the pancreas
Pancreatic branches of splenic artery Superior and inferior pancreaticduodenal arteries Venous: superior mesenteric branches of portal vein drains head of pancreas Pancreatic veins drain the rest of the pancreas into the splenic vein Lymphatic: pancreaticosplenal nodes and pyloric nodes > superior mesenteric and coeliac
312
Describe the innervation of the pancreas
Sympathetic, parasympathetic fibres from T6-10
313
Actions and Innervation of Quadratus Lumborum
Extension and lateral flexion of the vertebral column Fixes 12th rib during inspiration Anterior rami of T12-L4
314
Actions and Innervation of Psoas Major
Flexion of the thigh at the hip and lateral flexion of vertebral column Anterior rami of L1-L3
315
Actions and Innervation of Iliacus
Flexion and lateral rotation of the thigh at the hip joint Femoral nerve (L2-4)
316
Name the three types of branches of the abdominal aorta
Single ventral gut arteries Paired visceral arteries Paired wall arteries
317
Name the tributaries of the inferior vena cava and the structures they drain
Common Iliac - drain lower limbs and gluteal region Lumbar veins - posterior abdominal wall Renal veins - drain the kidneys, left adrenal gland and left testis/ovary Right suprarenal vein - right adrenal gland Inferior phrenic vein - diaphragm Hepatic veins - Liver
318
Name the branches of the lumbar plexus and the structures they supply
Iliohypogastric (L1) - internal oblique, transversus abdominus and skin of posterolateral/pubic regions Ilioinguinal (L1) - internal oblique, transversus abdominus and skin of superior anteriomedial thigh (in men skin of penis and anterior scrotum and females skin of mons pubis and labia majora) Genitofemoral (L1-2) - cremasteric muscle and anterior scrotum (males) or mons pubis/labia majora (females) Femoral branch innervates skin on upper anterior thigh Lateral cutaneous nerve (L2-3) - anterior and lateral thigh down to knee (sensory) Obturator (L2-4): muscles of medial thigh and innervates skin over medial thigh Femoral (L2-4) - Muscles of anterior thigh and innervates skin on anterior thigh and medial leg
319
Name the structures drained by the pre-aortic and para-aortic nodes
Pre-aortic: GI tract, spleen, gallbladder, liver, pancreas Para-aortic: kidneys, ovaries, testes and other pelvic organs
320
Name the vertebral level of the kidneys
T12-L3
321
Name the layers covering the kidneys (deep to superficial)
Renal capsule Perirenal fat Renal fascia Pararenal fat
322
Describe the structure of the kidneys
Cortex Medulla is divided up into renal pyramids At the head of each pyramid is the renal papilla which is associated with a minor calyx (collects urine) Several minor calyxes merge to form major calyxes Through these urine passes int the renal pelvis and then drains into the ureter Renin is secreted by juxtaglomerular cells found in the arterioles at the surface of the glomeruli
323
Describe the blood supply to the kidneys
Renal arteries - which divide into anterior and posterior divisions Five segmental arteries are formed from these (end arteries with no overlap - can lead to infarction if damaged)
324
Describe the innervation of the kidneys
T10-L1 via thoracolumbar splanchnic Parasympathetic: Vagus nerve and Intermesenteric plexus Pain travels via the coeliac plexus to the sympathetic trunk (by use of splanchnic nerves)
325
Where do the ureters enter the bladder?
Ureteric meatus in the trigone (fundus)
326
Describe the innervation of the bladder
Sympathetic: hypogastric nerve (T12-L2) - relaxes detrusor muscle promoting urinary retention Parasympathetic: Pelvic nerve (S2-4) - causes contraction of the detrusor muscle promoting micturation Somatic: Pudendal nerve (S2-4) - innervates the external urethral sphincter (gives voluntary control over micturation
327
Name the functions of the pelvic floor
Support of abdominopelvic viscera Resistance to increasesin intra-pelvic/abdominal pressure Urinary and faecal continence
328
Describe the innervation of the rectum and anus
Rectum Sympathetic: lumbar splanchnic nerves and superior + inferior hypogastric plexuses Parasympathetic: S2-4 via pelvic splanchnic nerves and inferior hypogastric Sensory fibres follow parasympathetic fibres Anus Above pectinate line: inferior hypogastric plexus Below pectinate line: somatic innervation via inferior rectal nerves
329
Describe the lymphatic drainage of the rectum and anus
Pararectal lymph nodes Internal iliac node (lower part of rectum and anus) Superficial inguinal lymph nodes (anus below pectinate line)
330
Describe the division of the rectum into separate parts and its relevance
Pectinate line Divides the anal canal into two which has different arterial supply, venous drainage, innervation and lymphatic drainage
331
Describe the location of the rectovesical fascia in men and women
Men: rectovesical pouch sits between the rectum and bladder Females: rectouterine pouch (of Douglas) between rectum and uterus and vesicouterine pouch between uterus and bladder
332
Describe the innervation of the anal skin
Inferior rectal nerve (branch of the pudendal nerve S2-4)
333
Describe the lymphatic drainage of the prostate
External and internal iliac nodes Sacral nodes
334
Describe the blood supply of the uterus
Uterine artery (runs in broad ligament) - anastomis with ovarian artery Venous drainage is by plexus that drains into the uterine veins
335
Describe the innervation of the uterus and fallopian tubes
Sympathetic: Uterovaginal plexus (anterior and intermediate parts of the inferior hypogastric plexus) Parasympathetic: Pelvic splanchnic nerves Cervix: inferior nerve fibres of the uterovaginal plexus Fallopian tubes: ovarian and uterine plexuses. Sensory fibres from T11-L1
336
Name the structures that make up the fallopian tubes (lateral to medial)
Fimbrae Infundibulum Ampull Isthmus
337
Describe the blood supply to the ovaries and the lymphatic drainage
Ovarian arteries - direct branches of the aorta Para-aortic nodes
338
Describe the innervation of the ovaries
Sympathetic and parasympathetic innervation is from the ovarian and uterine plexuses
339
Describe the divisions of the male urethra
Prostatic - widest part Membranous - surrounded by external sphincter and narrowest part of the urethral Penile Urethra is 15-20cm in length
340
Describe the anatomy of the penis
Divisions: root, body and glans Erectile tissues: -Left and right crura which then form the corpora cavernosa -Bulb forms the corpus spungiosum (male urethra runs through this) 4 muscles: -Bulbospongiosus x2 - empties spongy urethra of residual semen and urine -Ischiocavernosus x2 - contracts to force blood from the cavernous space in the crura into the corpora cavernosa (helps maintain erection)
341
Describe the blood supply and innervation of the penis
Dorsal arteries of the penis Deep arteries of the penis Bulbourethral artery Venous drainage is the deep dorsal vein of the penis Nerve supply is S2-4 spinal cord segments and spinal ganglia Sensory and sympathetic innervation is supplied by the dorsal nerve of the penis Parasympathetic supply is from the peri-prostatic nerve plexus
342
Describe the innervation and lymph drainage of the scrotum
Anterior and anterolateral aspect - anterior scrotal nerves (genital branch of genitofemoral nerve and ilioinguinal nerve) Posterior - posterior scrotal nerves (perineal branches of the pudendal nerve and posterior femoral cutaneous nerve) Superficial inguinal nodes
343
Name the ligaments that support the sacroiliac joint (and the pelvis itself) and their location
Interosseous sacroiliac ligament - posterior and superior to the joint between the ilium and the sacrum Posterior sacroiliac (sacrotuberous): covers the interosseous ligament Anterior (sacrospinous) - thickening of the anterior joint capsule Ileolumbar ligament - L5 vertebrae to wing of the pelvis and iliac crest
344
Name the five ligaments that support the sacrococcygeal symphysis
Anterior sacrococcygeal Deep posterior sacrococcygeal Superficial posterior sacrococcygeal Lateral sacrococcygeal Interarticular ligaments
345
Name the spinal nerves that form the sacral plexus and the branches
Anterior rami of S1-S4 spinal roots Superior gluteal nerve, Inferior gluteal nerve, Sciatic nerve, Posterior femoral cutaneous nerve, Pudendal nerve,
346
Name the postvertebral extensor muscles of the neck
Erector Spinae Multifidus Trapezius, suboccipital muscles and splenius capitus
347
Name the prevertebral flexor muscles of the neck
Longus capitis Longus colli Rectus capitis anterior Rectus capitis lateralis
348
What is the function of the prevertebral fascia
Structural support Encloses neurovascular structures Limits the spread of infection or disease
349
Which fascia encloses the thyroid gland?
Pretracheal
350
Which muscles lie in the deep cervical fascia
Trapezius and sternomastoid
351
Name the layers of the deep cervical fascia (superficial to deep) and their role in the infection
Investing layer Pretracheal layer Prevertebral layer Carotid sheath Limit the spread of infection (infections have defined spread: retropharyngeal spread and visceral spread)
352
Name the tissue spaces of the neck and how infection can spread between them
Pre-vertebral Retropharyngeal Parapharyngeal Submandibular Infection spreads through the fascial planes
353
Attachments, Innervation and Actions of Sternocleidomastoid
Manubrium of sternum Medial third of clavicle Mastoid process of temporal bone and superior nuchal line of occipital bone Accessory nerve Lateral flexion and rotation of neck extension of the neck at atlanto-occipital joints (when acting bilaterally)
354
Name the actions of the suprahyoids and the infrahyoids
Suprahyoids - elevate the hyoid bone (involved in swallowing) Infrahyoids - depress the larynx
355
Which structure does the isthmus of the thyroid gland attach to ?
Tracheal rings
356
Describe the blood supply and lymphatic drainage of the thyroid gland
Superior thyroid artery (branch of external carotid) Inferior thyroid artery (branch of thyrocervical trunk which is branch of subclavian) Venous drainage is via plexus of superior, middle and inferior thyroid veins Lymphatic drainage is to the paratracheal and deep cervical nodes
357
Which nerves run in close proximity to the thyroid and can be damage during surgery
Left and right recurrent laryngeal nerve
358
Name the three components of the cervical sympathetic trunk
Superior, middle and inferior ganglia
359
Describe the somatic branches of the cervical sympathetic trunk
Primarily grey rami communication - postganglionic fibres that join the 8 cervical nerves to supply sympathetic fibres to the somatic structures (skin,muscle etc.)
360
Describe the two main types of branches of the cervical sympathetic trunk
Visceral: cardiac nerves, pharyngeal branches, laryngeal branches and vascular nerves that supply head/neck and thoracic viscera Vascular: travels alongside the vasculature of the neck and innervates smooth muscle
361
Describe the features of Horner's syndrome and the anatomical basis
Partial Ptosis (eyelid drooping Miosis (constriction of pupil) Anhidrosis (decreased sweating) Stretching or damage to the sympathetic fibres
362
Name the attachments, innervation and actions of the anterior scalene
Transverse process of C3-6 and scalene tubercle (inner border of 1st Rib) Anterior rami of C5-6 Elevation of the 1st rib Ipsilateral contraction causes ipsilateral lateral flexion of the neck Bilateral contraction caused anterior flexion of the neck
363
Name the structures that pass anteriorly to the anterior scalene
Subclavian vein Phrenic nerve (also intimate with the median of the lung and the vagus nerve)
364
Which nerve wraps around the right subclavian artery?
Right recurrent laryngeal nerve
365
Name the functions of the facial nerve
Motor: muscles of facial expression, posterior belly of digastric, stylohyoid and stapedius muscles Sensory - small area around concha of external ear Special sensory - taste to anterior 2/3 of the tongue Parasympathetic: supplies many of the glands of the face (Submandibular, Sublingual, nasal, palantine, pharyngeal and lacrimal glands)
365
Where does the jugulo-omohyoid lymph node drain and where is it located
Located near the intersection of the internal jugular vein and the intermediate tendon of the omo-hyoid muscle Primarily drains the tongue
366
Name the position, innervation and actions of Orbicularis Oculi
Positioned over frontal and zygomatic bones Actions Palpebral part - gently closes the eyelids Lacrimal part - drainage of tears Orbital part - tightly closes the eyes Temporal and zygomatic branches of the facial nerve
367
Actions and innervation of orbicularis oris
Closes the lips Buccal branches of the facial nerve
368
Describe how the orbicularis oris is associated with buccinator and the function of its slip
They blend together Incisive slip is a small muscle that intermingles with the orbicularis oris and helps pull the lip upwards and outward The mentalis slip wrinkles the chin and pushes the lower lip forward
369
Describe the origin, actions and innervation of the buccinator muscle
Originates from the maxilla and mandible Pulls the cheek inwards against the teeth Buccal branches of the facial nerve
370
Where is modiolus located and what is it's function
Located at the angle of the mouth (convergence of 3 muscles) Dynamic lip movements, oral competence and facial expressions
371
Name where the facial nerve emerges into the face, the five branches it bifurcates into within the parotid and the territories supplied
Stylomastoid Foramen Temporal: frontalis, orbicularis oculi and corrugator supercilii Zygmomatic: orbicularis oculi Buccal: orbicularis oris, buccinator and zygomaticus Marginal mandibular: depressor labii inferioris, depressor anguli oris and mentalis Cervical: platysma
372
Name the divisions of the trigeminal nerve
Ophthalmic Maxillary Mandibular
373
Name the five branches of the ophthalmic nerve and the territories they supply
Lacrimal nerve: lacrimal gland, lateral upper eyelid and conjunctiva. Stimulates lacrimal gland secretion Frontal nerve -Supraorbital: forehead and scalp -Supratrochlear: medial forehead, glabella and upper medial eyelid Nasociliary: cornea, conjunctiva, iris, skin/mucous membrane medial aspect of nose, frontal and ethmoid sinuses and eyelids Infratrochlear: medial upper and lower eyelids, medial conjunctiva, skin of the nose above the medial canthus and lacrimal caruncle and lacrimal sac
374
Name the branches of the maxillary nerves and the territories they supply
Infraorbital : lower eyelid, medial side of the cheek and upper lip Zygomaticofacial: malar eminence (prominent part of the cheekbone) Zygomaticotemporal: skin of the temple
375
Name the branches of the mandibular nerve and the territories they supply
Buccal: skin of cheek, lining of the cheek and buccal gingiva of the mandibular teeth Mental: skin and mucosa of the lower lip and chin Auriculotemporal nerve: skin over posterior temple, around the ear, tragus, anterior ear and ear canal
376
Describe the course of the facial artery
Arises from the external carotid Along posterior surface of submandibular gland Passes over body of the mandible Then has a torturous course towards the angle of the moth and terminates in the nasolabial fold
377
Name the origin and surface markings of the superficial temporal artery
Arises from the external carotid Anterior to the ear
378
Describe the drainage of the facial vein
Drains into the ophthalmic vein via the angular vein which then drains into the cavernous sinus
379
Describe the lymphatic drainage of the face
Preauricular- drain forehead, lateral eyelids, conjunctiva and cheek Submandibular - drain nasal cavity, mid face skin, cheeks, lips and anterior parts of mouth and tongue Submental: drain central portion of lower lip, floor of the mouth, tip of the tongue and associated teeth
380
Describe the arterial supply and venous drainage of the scalp
Three branches of the external carotid: superficial temporal, posterior auricular and occipital Ophthalmic artery Superficial venous drainage - follows arterial supply Deep via pterygoid venous plexus Connects to the veins of the skull via emissary veins (this forms a connection between the scalp and dural venous sinuses)
381
Describe the territories of occipital, auriculotemporal and zygomaticotemporal nerves
Occipital: skin posterior to ear and occipital region Zygomaticotemporal: supplies the temple Auriculotemporal nerve: skin anterosuperior to the auricle
382
Describe the attachments, innervation and actions of occipitofrontalis
Occipital belly originates from occipital bone and frontal belly originates from epicranial aponeurosis Frontal belly inserts into skin of eyebrows Occipital belly inserts into epicranial aponeurosis Facial nerve Facial expressions, raising eyebrows/wrinkling forehead (frontal belly) and pulling scalp backwards (occipital belly)
383
Name the bones that make up the zygomatic arch
Temporal process of the zygomatic bone and zygomatic process of the temporal bone
384
Which nerves run through the temporal fossa
Deep temporal nerve Zygomaticotemporal nerve Auriculotempoeral nerve Temporal branches of the facial nerve
385
Name the attachments, innervation and actions of the temporalis muscle
Originates from temporal bone and insert via tendon to the coronoid process of the mandible Mandibular elevation, retrusion and mastication Mandibular branch of trigeminal nerve
386
Name the attachments, innervation and actions of the masseter
Maxillary process of zygomatic bone and zygomatic arch of temporal bone Both ends attach to ramus of mandible Elevation of the mandible Mandibular nerve
387
Name the structures that pass through the parotid gland
Facial Nerve External Carotid Retromandibular vein
388
Describe the innervation of the parotid gland
Sensory - auriculotemporal nerve (gland) and great auricular nerve (fascia) Parasympathetic - Glossopharyngeal nerve and otic ganglion via auriculotemporal nerve Sympathetic - superior cervical ganglion (vasoconstricts)
389
What is the clinical relevance of the parotid capsule
The capsule is tough and fibrous which restricts swelling of the gland - causes pain in parotitis
390
Describe the anatomical course of the parotid duct
Transverses the masseter muscle It then pierces the buccinator It opens out into the oral cavity near the second upper molar
391
Name the contents of the infratemporal fossa
Medial and Lateral Pterygoids Mandibular nerve Auriculotemporal, buccal, lingual and inferior alvelolar nerves Chorda tympani and otic ganglion Maxillary artery Pterygoid venous plexus Maxillary vein and middle meningeal vein
392
Name the functions of the medial and lateral pterygoids
Medial - opens the mouth Lateral - protraction of the mandible and depression of the chin
393
Name the origin of the maxillary artery and the structures its branches supply
External carotid Local bone, ear, tympanum, nose and palate
394
Describe the drainage pattern of the pterygoid venous plexus
Drains from venoules of the infratemporal fossa Palate, nasal cavity, paranasal sinus, nasopharynx and auditory tube Drains into maxillary vein which then drains into retromandibular vein
395
Describe the clinical importance of the pterygoid venous plexus
Can be injured during dental anaesthetics Connected to deep facial veins, cavernous sinus and inferior ophthalmic veins
396
Describe the course of the mandibular nerve
Motor root runs along the trigeminal cave joining the sensory root It then exits via the foramen ovale and then enters the infratemporal fossa where it then divides into anterior and posterior branches
397
Describe the territories supplied by the branches of the maxillary nerve
Auriculotemporal: anterior auricle, lateral temple, anterior external meatus and anterior tympanic membrane Inferior alveolar nerve: mylohyoid and anterior digastric muscles, mandibular teeth, lower lip and chin Lingual nerve: anterior 2/3 tongue (including taste via chorda tympani), submandibular and sublingual glands
398
Name the emergence point of the glossopharyngeal nerve and the territories it supplies
Jugular foramen Sensory: oropharynx, carotid body and sinus, posterior 1/3 of tongue, middle ear cavity and eustachian tube Special sensory: taste sensation to posterior 1/3 of tongue Parasympathetic: parotid gland Motor: stylopharyngeus muscle of the pharynx
399
Name the emergence and territories supplied by the vagus nerve
Jugular Foramen Sensory: skin of external acoustic meatus and surfaces of laryngopharynx and larynx. Visceral sensation to heart and abdominal viscera Special sensory: taste sensation to epiglottis and root of tongue Motor: majority of pharynx, soft palate and larynx Parasympathetic: smooth muscle of trachea, bronchi, gastrointestinal tract and regulates heart rhythm
400
Name the emergence point and territories supplied by the accessory nerve
Jugular foramen Spinal - Sternocleidomastoid Trapezius Cranial part combines with vagus nerve to form nucleus ambiguus - controls muscles of the larynx, pharynx, soft palate
401
Name the emergence point of the hypoglossal nerve and the territories it supplies
Hypoglossal canal Muscles of the tongue (except palatoglossus
402
Name the emergence point of the maxillary nerve and the territories it supplies
Foromen rotundum Sensory: lower eyelid, conjunctiva, inferior posterior nasal cavity, cheeks, maxillary sinus, lateral nose, upper lip, teeth, gingiva and superior palate Parasympathetic: lacrimal gland, mucous glands of nasal mucosa
403
Name the location of the pterygopalatine plexus and the structures it supplies
Pterygopalatine fossa Nose and palate (sensory, secretomotor and sympathetic)
404
Describe the blood supply and innervation of the external nose
Maxillary and ophthalmic arteries + branches of facial artery External nasal nerve (branch of trigeminal nerve) supplies dorsum, nasal alae and nasal vestibule Lateral aspects Infrorbital nerve (branch of maxillary nerve
405
Name the conchae and meatuses of the nose
Inferior, medial and superior conchae Inferior, middle, superior and spheno-ethmoidal recess
406
Where does the nasolacrimal duct drain
Inferior meatus
407
What are the ostia of the nose and what is their function
Small openings that connect the paranasal sinuses to the nose allowing for mucous drainage and air ventilation
408
Name the blood supply and innervation of the lateral wall and septum
Lateral: -Sphenopalatine, anterior and posterior ethmoidal arteries and facial artery Septum -Anterior and posterior ethmoidal arteries, sphenopalatine artery, greater palatine artery and superior labial artery Nasopalatine and nasocilliary nerve
409
What is the significance of sinus development at age 6-7?
Frontal and sphenoid sinuses become identifiable on CT and MRI
410
Name the innervation of the mucous membrane of the mouth and gingivae
Mandibular nerve - lower gingivae, cheek and anterior 23 tongue Maxillary nerve - upper gingivae, hard palate and nasal mucosa
411
Describe the layout of permanent dentition and when they appear
Central incisor Lateral incisor Canine 1st/2nd premolar/bicuspid 1st/2nd molar Third molar/wisdom tooth Between age 6-13 except wisdom teeth - by age 21
412
Describe the structure of the tooth and their innervation
Crown and root Crown is covered by enamel Root is covered by cementum A layer of dentine lies below Underneath this is the pulp cavity filled with dental pulp Maxillary teeth - anterior, middle and posterior superior alveolar nerve Mandibular teeth - inferior alveolar nerve
413
Describe the blood supply and lymph drainage of the hard palate
Greater palatine arteries as well as lesser and ascending palatine arteries Submandibular and upper deep cervical lymph nodes
414
Describe the structure of the tongue
Anterior 2/3 -Apex and body which terminates at sulcus terminalis -Made up of vallate, filiform and fungiform papillae Posterior 1/3 -No papillae but does have lingual tonsils
415
Describe the lymphatic drainage and innervation of the tongue
Anterior - marginal and central nodes > submandibular, jugulo-omohyoid and deep cervical Posterior - dorsal > join with marginal vessles to jugulo-omohyoid and jugulodigastric Motor - hypoglossal (except palatoglossus) and pharngeal plexus Sensory - lingual nerve and glossopharyngeal nerve Taste - facial (via lingual), glossopharyngeal and vagus nerve
416
Name the key structures found on the floor of the mouth
Submandibular duct Hypoglossal nerve Lingual artery and nerve Glossopharyngeal nerve Sublingual
417
Describe how the muscles of the pharynx are arranged, their lymph node drainage and innervation
Into two groups longitudinal and constrictor 3x constrictor muscles and 3x longitudinal muscles Deep cervical lymph nodes Motor: vagus, glossopharyngeal and sympathetic fibres Sensory: maxillary, glossopharyngeal and laryngeal
418
Describe the vascular supply and lymph drainage of the tonsils
Facial artery Venous drainage is external palatine vein Lymphatic drainage - jugulodigastric tonsils and upper deep cervical nodes
419
Describe the innervation of the laryngopharynx and gag reflex
Pharyngeal plexus (motor) Pterygopalatine ganglion (secretomotor) Maxillary nerve (sensory) gag reflex - glossopharyngeal and vagus nerves
420
Name the laryngeal cartilages
Thyroid cartilage - forms Adam's apple Cricoid cartilage - marks the inferior border of the larynx as it forms the trachea Epiglottis Arytenoid cartilage - sit on the cricoid cartilage Corniculate cartilage - articulates with the arytenoid cartilage Cuneiform cartilage - located within the aryepiglottic folds
421
Name the functions and innervation of the intrinsic muscles of the larynx
Alter the size and shape of the inlet and move the vocal cords (phonation, sphincteric, coughing and breath holding whilst straining) Recurrent laryngeal nerve
422
Describe the innervation of the eyelids and the location of the meibomian glands
Within the tarsal plates with openings along the inner eyelids Upper eyelids - ophthalmic nerve Lower eyelids - maxillary nerve
423
Name the innervation of the conjunctiva
Ophthalmic division of trigeminal nerve
424
Describe the structure of the lacrimal system
Lacrimal gland - superolateral aspect of orbit Excretory lacrimal duct Lacrimal sac (collects tears from the eye) Lacrimal lake Nasolacrimal duct
425
Name the actions and innervation of the muscles of eye movements
Superior Rectus -Elevation -Contributes to adduction and lateral rotation -Oculomotor Inferior Rectus -Depression -Contributes to adduction and lateral rotation -Oculomotor Medial Rectus -Adduction -Oculomotor Lateral Rectus -Abduction -Abducens Superior Oblique -Depression, abducts and medially rotates -Trochlear nerve Inferior Oblique -Elevates, abducts and laterally rotates the eye -Oculomotor
426
Name the factors that contribute to eye stability
Bony orbit Extraocular muscles Vestibulo-ochlear reflex Suspensory ligaments and orbital fat
427
Where does the optic nerve emerge and which blood vessels supply it
Sphenoidal optic canal Anterior cerebral, ophthalmic and central retinal arteries
428
Name the structures supplied by the ophthalmic artery
Eye Orbital muscles Lacrimal glands
429
Describe the venous and lymphatic drainage of the eye
Superior and inferior ophthalmic veins (superior communicates with cavernous sinus) Deep cervical nodes via pre-auricular and parotid groups
430
Describe the innervation of the sclera and cornea including pathway for corneal reflex
Sclera - long and short ciliary nerves ophthalmic division of trigeminal ganglion
431
Describe the function of the choroid and ciliary body
Connective tissue and blood vessels - supplies outer layers of retina Ciliary muscle and processes - change the shape of the lens and contributes to aqueous humor formation
432
Describe the blood supply to the retina
Central retinal artery supplies inner 2/3 Outer 1/3 is choroidal capillaries
433
Describe the clinical effect of 3rd, 4th and 6th nerve palsies
3rd - eye turned outward and downward causing double vision 4th - double vision, head tilt (cant look down), difference in eye height 6th - lack of abduction, double vision, inward turned eye
434
Name the nerves that supply the external ear
Greater auricular (auricle) Lesser Occipital (auricle) Auriculotemporal (auricle and external auditory meatus) Branches of facial and vagus nerve (auricle and external auditory meatus)
435
Name the main functions of the inner ear and the structures associated with them
Hearing - cochlea Kinetic balance - semicircular canals Static balance - saccule and utricle
436
Name the three ligaments that stabilise the TMJ
Lateral ligament Sphenomandibular ligament Stylomandibular ligament
437
Name the movements at the TMJ and the muscles responsible
Protrusion - lateral pterygoid Retraction - temporalis Elevation - temporalis, masseter and medial pterygoid Depression - mainly gravity but digastric, geniohyoid and mylohyoid muscles assist when there is resistance
438
Name the two components of the vertebral disc
Nucleus pulposus Annulus fibrosus
439
Name the attachments of the anterior and posterior longitudinal ligaments
Anterior - occipital bone, anterior tubercle of C1 and then extends caudally to anterior sacrum Posterior - lies within the vertebral canal - attaches to intervertebral discs and vertebral bodies from C2 to sacrum. Extends cranially as the tectorial membrane.
440
Name the ligaments of the vertebral arches and their functions
Ligamenta flava - resists separation of the laminae and aid extension Interspinous - connects spinous processes Supraspinous - prevents separation of spinous processes during flexion and resists hyperflexion Nuchal ligament - supports the head (muscles of the posterior neck and shoulder attach here) Intertransverse - limits lateral flexion
441
Name the ligament that supports the dens
Cruciform ligament
442
Which muscle predominantly flexes the spine
Rectus abdominis
443
Name the innervation of erector spinae
Segmental posterior spinal root rami
444
Name the 3 layers of spinal meninges
Dura Arachnoid Pia
445
Describe the location of the cerebellar lobes related to the sulci
Frontal - anterior to central sulcus and above lateral sulcus Parietal - posterior to central sulcus and above lateral sulcus Temporal - below lateral sulcus Occipital - below parietal-occipital sulcus
446
Name the location and function of the basal ganglia
Lateral forebrain Supraspinal control of skeletal muscle movements
447
Name the three components of cerebral white matter
Commissural fibres Association fibres Projection fibres (form internal capsule)
448
Name the location and function of Broca's area
Left frontal lobe Speech production and articulation
449
Name the location and function of Wernicke's area
Temporal lobe (usually left) Language comprehension
450
Name the components of the visual axis and their function
Retinal bipolar cells - relay visual signals from photoreceptors to the ganglion cells Ganglion cells - output neurons of the retina Optic nerve - converts light to electrical signals Optic chiasm - where fibres from both optic nerves cross Optic tract - carries signals from optic chiasm to brain Optic radiation - carries signals from lateral geniculate nucleus (relay centre) to primary visual cortex Visual cortex - processes visual information
451
Name the blood supply of the optic tract, chiasm and nerves
Optic tract - posterior communicating artery and anterior choroidal artery Optic chiasm - anterior cerebral artery and branches of superior hypophyseal artery Optic nerve - Ophthalmic artery
452
Describe the arrangement of the ventricles
Lateral ventricles - one in each hemisphere (horns project into frontal, occipital and temporal lobes) Third - between left and right thalamus (connects to lateral ventricles via foramen of munro) Fourth - lies within the brainstem (CSF drains into the spinal cord and subarachnoid cisterns from here)
453
Name the location and function of the thalamus
Around the third ventricle Relay nuclei - transmit sensory and motor information to cerebral cortex Reticular nucleus - regulator for other nuclei Mediodorsal nuclei - emotional memory, motivation (connects to prefrontal cortex) Other nuclei - motor control, arousal and sensory integration
454
Where does the internal carotid enter the brain ?
Carotid canal
455
Which artery connects the anterior cerebral arteries across the midline
Anterior communication artery
456
Why does macular sparing occur in posterior cerebral thromboembolic disease?
Blood supply from both the posterior and middle cerebral arteries Represented in both lobes
457
Name the blood supply of the midbrain and the structure found within the midbrain which relates to Parkinson's disease
Posterior cerebral and superior cerebellar arteries Substantia nigra
458
Name the blood supply of the pons and the nuclei found within it
Pontine branches of basilar artery Motor part of trigeminal nerve, abducens and vestibulocochlear nerves
459
Name the blood supply of the medulla
Posterior inferior cerebellar arteries and branches of basilar and vertebral arteries
460
Name the features of medial medullary syndrome
Contralateral hemiparesis Hemisensory loss Ipsilateral hypoglossal palsy
461
Name the features of lateral medullary syndrome
Vertigo Ataxia Sensory loss on one side of face and body Dysphagia
462
Other than in the brain where else does CSF drain ?
Through the cribiform plate of the ethmoid bone into the nasal tissues
463
Name the blood supply of the cerebellum
Posterior inferior cerebellar Anterior inferior cerebellar Superior cerebellar
464
Name the two enlargements of the spinal cord and their spinal levels
Cervical C3-T1 (for brachial plexus) Lumbar T9-L1 (lumbosacral plexus)
465
Describe the features of hemisection of the spinal cord
Loss of voluntary movement and fine sensation on the same side and loss of pain and temperature on the contralateral side
466
Describe the features of central cord syndrome
Cervical spinal cord injury - most commonly by hyperextension Greater weakness in the arms than the legs Sensory loss below injury level
467
Describe the features of anterior spinal artery syndrome
Abrupt onset of pain Bilateral motor weakness Loss of pain, temperature and light touch sensation with preserved touch, vibration and position sense
468
Name the blood supply of the spinal cord and the territories supplied
Anterior spinal artery - anterior 2/3 2x posterior - posterior 1/3 including dorsal sensory column
469
Describe how homeostasis works
Negative feedback loops via receptors, comparators and effectors based on a set point (a narrow range of values where normal function works)
470
Describe how positive feedback loops work
These systems amplify the starting signal Usually found in processes that need to be pushed to completion It is an unstable process
471
Why are oscillations found in homeostasis
Allows for small fluctuations rather than one set value Are necessary for some homeostatic functions (for example insulin release) They are based on a lag time in feedback
472
What is the difference between osmolality vs osmolarity?
Osmolality - number of solute particles per kilogram of solvent Osmolarity - number of solute particles per litre of solvent (can change via temperature)
473
Name the differences between intracellular and extracellular fluid
Intracellular -fluid inside cells -High concentration of potassium, magnesium and phosphate Extracellular -Fluid outside cells eg plama and interstitial fluid -High concentration of sodium, chloride and bicarbonate
474
Describe the function of Na-K ATPase
Moves ions against the concentration gradient (3 sodium out for 2 potassium in) Acts as a docking station for proteins Cell signalling pathways
475
How does the donnan equilibrium affect chloride ions?
the distribution of diffusible ions (chloride) is unequal due to non-diffusible ions (proteins) Chloride ions move to the side with impermeable anions This creates an uneven distribution of permeable ions leading to an electrical potential difference
476
Describe how oncotic pressure works
The force exerted by large molecules that pulls water into the blood capillaries
477
Name the key structures of the cell and their function
Mitochondria - generating energy Nucleus - control centre (contains the DNA) Endoplasmic reticulum - protein and lipid synthesis Golgi apparatus - modifies, sorts and packages proteins and lipids for secretion and lipids Lysosome - acts as cells digestive system
478
Describe the structure of the cell membrane
Bilayer of phospholipid molecules which have a head molecule (hydrophillic), a phosphate molecule, a-glycerol and two fatty acid chains (hydrophobic) Channel proteins and carrier proteins Cholesterol
479
What are G-protein coupled receptors?
Receptors found in a wide variety of tissues that respond to extracellular tissues and trigger intracellular signalling cascades
480
What is the difference between voltage gated ion channels and ligand gated ion channels ?
Voltage gated - open via electrical signals Ligand - open via binding of a specific chemical messenger (ligand)
481
Describe the difference between laminar flow and turbulent flow
Smooth streamlined flow where the fluid in the center moves faster than the edges Irregular chaotic flow occurs at high speed or when there is a sudden change in the vessel's shape
482
Describe the function of platelets, fibrin and thrombins role in coagulation
Thrombin (Factor IIa) converts fibrinogen into fibrin which creates a dense network of fibrin fibres Platelets then form a platelet plug
483
Describe the role of 5HT and thromboxane A2 in haemostasis
Released from platelets and causes other platelets to aggregate Vasoconstriction Initiates coagulation cascade Platelet activation and aggregation Vasoconstriction Amplifies platelet response (positive feedback loop)
484
Describe how action potentials are generated and how repolarisation occurs
Depolarisation - voltage gated ion channels open and the positive charge of the sodium ions turns the potential in the cell to positive If the threshold potential is reached then an action potential is generated As long as the threshold is reached then the response is the same irrespective of the strength of the stimulus (all or nothing approach) Once the cell has been depolarised the voltage gated ion channels close and potassium ions move down their gradient out of the cell which makes the membrane potential more negative
485
Describe how absolute refractory and relative refractory periods work
Absolute - once the sodium channel opens after an AP they enter an inactive state and cannot be reopened Relative - during this phase an action potential can be released but requires a stronger stimuli than usual
486
Describe how saltatory conduction works
The electrical impulse travels along the myelinated nerve between nodes of ranvier (where ion channels are exposed) The insulating acts as an insulator It allows faster transmission and energy conservation
487
Describe how synaptic transmission works
Action potentials depolarise the synaptic terminal opening the voltage gated calcium channels Calcium influxes into the terminal and the synaptic vesicles fuse with the cell membrane The neurotransmitter is released into the synaptic cleft They then cross to the post synaptic membane and bind to post-synaptic receptors (either ligand gated ion channels or G protein coupled receptors) Neurotransmitters are then inactivated or removed by one of the following: re-uptake, breakdown or diffusion
488
Describe the role of cholinesterase, MAO and COMT in synaptic transmission
Breaks down acetylcholinesterase Breaks down neurotransmitters such as serotonin and dopamine Breaks down neurotransmitters such as dopamine and norepinephrine
489
Describe the structure of skeletal muscles
Fibres are cylindrical and multi-nucleated They are arranged in bundles covered in connective tissue called perimysium Within each cell is a myofibril which causes muscle contraction. They are arranged in repeating units called sarcomeres and contain thick and thin fibres
490
What is the sarcolemma and sarcoplasmic reticulum
Tubular sheath which envelops the skeletal muscle fibres Specialised endoplasmic reticulum which regulates the flow of calcium ions
491
Describe how skeletal muscle contraction works
Action potentials at the NMJ travels along the sarcolemma and down the transverse tubule to depolarise the cell membrane Depolarisation of the sarcolemma opens voltage gated calcium channels The calcium influx activates ryanodine receptors which allows calcium to flow from the sarcoplasmic reticulum into the cytoplasm The calcium binds to troponin C which reveals a binding site on actin for the myosin head This results in ATP hydrolysis which provides energy for the contraction
492
What is the difference between temporal summation and spatial summation?
Temporal summation - when a single neuron fires repeatedly Spatial summation - when multiple neurons fire at the same time
493
What is a motor unit ?
A single motor neuron and all the skeletal fibres it innervates
494
What is motor unit recruitment?
Activating additional motor units within a muscle to increase the force of contraction
495
Describe the differences of cardiac muscle compared to skeletal muscle
Branching fibres Centrally located nucleus T tubules lie in register with the z band not the AI junction Intercalated discs Gap junctions
496
What is electrical coupling in cardiac muscle ?
When an action potential in one muscle cell triggers coordinated contraction in neighbouring cells - achieved via gap junctions in intercalated discs
497
How does calcium release work in cardiac muscle?
A small amount of calcium release triggers a much bigger release of calcium from the sarcoplasmic reticulum
498
What is the relationship between length and tension in cardiac muscle
The greater the stretch the stronger the contraction
499
Name the lung volumes and their definition
Tidal Volume - volume that enters and leaves with each breath (0.5L) Vital Capacity - volume that can be exhaled after maximum inspiration (inspiratory reserve volume + tidal volume + expiratory reserve volume 4.5L) Residual Volume - volume remaining after maximum expiration (1.5L) Functional Residual Capacity - volume remaining after quiet expiration (3L)
500
What is the difference between anatomical and alveolar dead space?
Anatomical - volume of air that never reaches the alveoli Alveolar - volume of air that reaches the alveoli but never participates in respiration
501
Role of Type 1 and Type 2 Alveolar pneumocytes
Type 1 - facilitates gas exchange Type 2 - secretes surfactant
502
Describe lung compliance and the difference between static and dynamic compliance
Measure of how easily lungs stretch and expand Measured when there is no air flow Continuous measurement during rhythmic breathing -incorporates airway resistance
503
Name the partial pressures of oxygen and nitrogen in air
Oxygen 21% Nitrogen 78%
504
What is Henry's Law
The determinant of the quantity of gas dissolved in a fluid
505
Name the partial pressures of oxygen and carbon dioxide in inspired, alveolar and expired air
159, 104 ,104 mmHg 0.3, 40, 40 mmHg
506
Describe the factors that shift the oxygen-haemoglobin dissociation curve
Left - pH increase, decreased 2,3 DPG levels, decreased temperature, faetal haemaglobin Right - pH decrease, increased 2,3 DPG levels, increased temperature Anaemia causes the curve to shift right and downwards
507
Describe the relationship between CO2, carbonic acid and bicarbonate
Carbon dioxide and water form carbonic acid - this then dissociates into hydrogen ion and bicarbonate ion Reversible equilibrium that helps maintain pH balance
508
Describe how chloride ions effect haemoglobin
Chloride ions move into the red blood cells as bicarbonate ions move out - facilitates carbon dioxide transport and prevents build up of negative charge
509
Describe how respiration is controlled
Respiratory control centre in the pons and medulla -Dorsal - inspiration -Pontine - controls rate and depth of breathing -Ventral - controls inspiration and expiration (important when increased respiration is important) Voluntary respiration is via the motor cortex in the cerebrum via the cortical motor neurons
510
Describe how rising CO2 effects respiration
Central chemoreceptors detect changes in arterial CO2 This leads to an increase in ventilation Once the CO2 drops ventilation decreases Increasing pCO2 also decreases the pH of the CSF which stimulates the respiratory centre to increase ventilation
511
Describe how peripheral chemoreceptors work in respiration
Located in carotid arch and aortic body Detect large changes in pO2
512
Describe how stretch, irritant and J receptors in the lungs work
Found in smooth muscle Send signals via the vagus nerve to the brain Irritant receptors -role in irritant cough and airway restriction J receptors - stimulated by pulmonary congestion or oedema - cause rapid shallow breathing, bradycardia and hypotension
513
Name the normal adult values for total blood volume, cardiac output and stroke volume
TBV - 5000ml CO - HR x SV SV - 70ml (difference between end diastolic value and end systolic volume)
514
How is mean arterial pressure calculated?
Diastolic BP + 1/3 (systolic BP - diastolic BP)
515
What is the normal central venous pressure?
8-12mmHg
516
Describe the cardiac cycle
SA node activates atrial myocytes The annulus fibrosus electrically insulates the atria from the ventricles AV node then fires and Bundle of His and Purkinje fibres then carry the depolarisation wave
517
What are the pressures found in the areas of the heart during systole and diastole ?
RA: 0-4 RV: 25 systolic, 4 diastolic Pulmonary artery: 25 systolic, 10 diastolic LA: 8-10 LV; 120 systolic, 10 diastolic
518
What is the resting potential of the myocyte and the trigger point
-90mV -70mV
519
How do Fast Na channels and calcium channels affect the action potential
Fast Na channels open and close rapidly to facilitate fast depolarisation Ca channels allow calcium to enter the cell causing large amounts of calcium to be released
520
How does the pacemaker potential work?
It is the slow depolarisation of the hearts pacemaker cells after an action potential The inward current of sodium ions allows the membrane potential to rise automatically to towards the threshold point
521
How do chronotropes effect potassium channels ?
Activation of inward rectifier potassium channels slows the rate at which the cell reaches the threshold slowing the heart rate Activation of potassium channels involved in repolarisation can decrease the action potential duration and increases the heart rate
522
Describe how excitation-contraction coupling works
Action potential reaches the muscle fibre and propagatesacross the sarcolemma (muscle cell membrane) DHRPs in the T-tubule membrane detect the change in the membranes electrical potential They open ryanodine receptors on the sarcoplasmic reticulum which causes the rapid release of calcium into the cell The released calcium ions bind to regulatory proteins which allows the myosin heads to bind to actin causing the muscle contraction Once the action potential ends the sarcoplasmic reticulum pumps calcium ions back into the SR via Ca-ATPase causing the muscle to relax Ca-ATPase and sodium/calcium channels in the cell membrane help maintain the levels of calcium in the cell
523
How does the treppe effect work?
Muscle contraction force increases with each successive stimulus after a period of rest because not all released calcium ions have been pumped into the SR before the neck stimulus arrives
524
How does noradrenaline affect calcium handling?
It increases calcium influx by stimulating L type calcium channels through beta-adrenergic receptors
525
How do digoxin and hypoxia affect calcium handling
Digoxin increases sodium levels which causes an influx of calcium into the heart Hypoxia impairs calcium ATP levels and calcium leak from the SR - causes a weaker force of contraction
526
Describe how the frank-starling law works
the heart pumps more blood with each contraction in response to an increase in the volume of blood filling the ventricles before contraction up to a limit
527
How do calcium channel blockers affect vasoconstriction?
They prevent vasoconstriction by blocking the entry of calcium into the smooth muscle cells which is necessary for muscle constriction
528
Name the vasoactive substances released from the endothelium and whether they vasodilate or vasoconstrict
Vasodilate -Nitric oxide -Prostacyclin -Endothelium-derived hyperpolarising factor Vasoconstriction -Endothelin -Angiotensin II Stimulated by hormone, mechanical and chemical signals
529
How do hydrophilic and lipophilic substance cross the capillary
Hydrophilic substances - primarily through pores and fenestrations Lipophilic substances - exchange via diffusion
530
Name the functions of tight junctions, glycocalyx and pores in the capillaries
Seal the gap between endothelial cells - allow water and small molecules but block large molecules (proteins) Maintains vascular homeostasis by controlling permeability, prevents the adhesion of blood cells and regulating blood flow Facilitates the exchange of substances, regulate moisture movement
531
How do interstitial oncotic pressure and capillary hydrostatic pressure work
The osmotic pressure exerted by proteins within the interstitial fluid which pulls water from the capillaries into the surrounding tissue The pressure of blood pushing on the capillary walls forcing fluid and small solutes out into the interstitial tissue
532
How does the myogenic response work?
Smooth muscle in the wall of the arterioles respond directly to changes in pressure
533
How do potassium, carbon dioxide and adenosine affect hyperaemia ?
Potassium acts as a vasodilator increasing blood flow to tissues CO2 - is a vasodilator which directly effects the smooth muscle Adenosine - binds to adenosine receptors triggering vasodilation
534
What is the function of arteriovenous anastomoses
Thermoregulation Blood flow regulation Myocardial stretch and cardiac output
535
Name the main components of the blood brain barrier
Endothelial cells Pericytes Astrocytes
536
How do CO2 and potassium effect cerebral autoregulation
Increased CO2 causes vasodilation which decreases the effectiveness of cerebral autoregulation Potassium helps regulate the diameter of the cerebral blood vessels
537
How do skeletal muscle beds lower total peripheral resistance during exercise?
They cause widespread vasodilation driven by metabolic demand
538
Name the structures of the stomach wall
Serosa Myenteric plexus - beween the longitudinal and circular smooth muscle layers - regulates GI motility Circular and longitudinal muscle layers Submucosal plexus - regulates mucosal secretion Muscularis mucosae (smooth muscle) Lamina propria Mucosal layer
539
Describe the production, composition and function of saliva
Produced in salivary glands (parotid, submandibular, sublingual glands) Controlled by the autonomic nervous system Mostly water with electrolytes and enzymes Digestion, chewing and protects teeth
540
Describe the phases of swallowing
Voluntary phase - food bolus is produced and is moved to the pharynx by the tongue Pharyngeal phase - pressure receptors are activated and it signals the swallowing centre in the brainstem which: -Inhibits respiration -Raises the larynx -Closes the glottis -Opens the upper oesophageal sphincter Oesophageal phase - larynx lowers and the cricopharyngeus muscle constricts preventing reflux. Bolus is moved down the oesophagus by peristalsis
541
What is the function of chief cells and parietal cells
Chief cells produce pepsinogen for protein digestion Parietal cells - secrete hydrochloric acid and intrinsic factor (for absorption of B12)
542
How does the proton pump work ?
It exchanges hydrogen ions for potassium ions to pump hydrogen ions into the stomach
543
Describe how the mucosal barrier of the stomach works
Mucus-bicarbonate layer Epithelial cells Prostaglandins, blood flow and cell renewal
544
Describe the phases of gastric secretion
Cephalic -Parietal cells release acid and other cells release histamine and gastrin -Triggers: Food anticipation, sight/smell of food Gastric -Distension, chemical signals and negative feedback -Triggers: food entering stomach and presence of proteins and amino acids Intestinal -Stimuation (distension and amino acids) and inhibition (presence of fats and acids in the intestine) -Partially digested food (Chyme) enters the small intestine
545
Name the factors that affect gastric emptying
Volume Composition (fats and solids empty slower than liquids, proteins and carbohydrates) Energy density Osmolality Medications, surgery and diseases
546
How does the addition of water, bicarbonate and bile effect duodenal chyme
The addition of water and bicarbonate neutralizes the acid The water in addition to bile helps dilute and mix with chyme to prepare it for digestions
547
What is the function of the sodium pump in the small intestine ?
It pumps three sodium out of the cell and two potassium in This creates a low concentration of sodium in the cell which is necessary for absorbing nutrients such as glucose and amino acid via secondary active transport systems
548
How is carbohydrate digestion handled in the small intestine
Pancreatic amylase breaks down the starches into smaller sugars Enzymes on the intestinal wall (brush border) break them down further These are then absorbed into the bloodstream via transporter proteins
549
Name the functions of proteases and carboxypeptidases
Breaks down proteins and peptides Removes amino acids one by one from the carboxyl end of the protein
550
How is iron absorbed ?
Through special cells called enterocytes in the duodenum and upper jejunum Ascorbate (vitamin C) forms complexes with iron which enhances iron absorption
551
How is fat digestion handled in the small intestine ?
Emulsification by bile Further breakdown by lipases Bile salts combine with the fatty acids to form micelles which transport the fatty acids Fat soluble vitamins are absorbed in a similar way and once in the cell they are formed into chylomicrons
552
Describe the function and origins of CCK and secretin
Released by the small intestine - stimulates digestion of fats and protein Produced in the small intestine and stimulates the pancreas and liver to release bicarbonate to neutralise stomach acid
553
Name the main constituents of bile
Water Bile salts (dual structure makes them amphilic) Cholesterol Phospholipids Bilirubin
554
Name the stimulants to bile formation and secretion
Bile salts, secretin, glucagon and gastrin Vagus nerve and CCK
555
556
What is the role of bacteria in the large intestine
Digestion Vitamin synthesis Bile + bilirubin handling
557
How does renal autoregulation work ?
Myogenic response - blood vessels restrict in response to increased pressure Tubuloglomerular feedback - adjusts flow based on salt concentration Protects the glomeruli from high blood pressure, maintains stable function and ensures consistent waste removal
558
What is the filtration fraction?
The proportion of renal plasma flow that is filtered GFR/renal plasma flow About 20% in healthy adults
559
Name the components of the glomerular filtration barrier
Glomerular endothelial cells Glomerular basement membrane Podocytes Allows small molecules to pass whilst keeping the larger molecules in the blood
560
Name the factors affecting GFR
Balance of hydrostatic pressure and colloid osmotic pressure Autoregulation Capillary membrane Renal blood flow Age, blood pressure, chronic conditions etc.
561
How do vasoactive substances affect GFR?
Vasodilating substances increase GFR Vasoconstrictive substances decrease GFR
562
How is creatinine clearance calculated?
creatinine concentration in urine x volume of urine in ml/min divided by creatinine concentration in serum
563
Describe the paracellular and transcellular tubular transport
Passive movement of solutes and water between renal tubular cells through tight junctions Movement of substances through the kidneys tubular cells from the lumen to the blood
564
What is the difference between primary and secondary active transport
Primary uses energy to move substances against their concentration or electrochemical gradient Secondary uses energy stored in an existing electrochemical gradient
565
What is maximum tubular transport?
The maximum rate at which a substance can be reabsorbed or secreted by the renal tubules For example glucose has a maximum of 375mg/min
566
What is the difference between glucose splay and saturation?
Gradual transition from complete glucose reabsorption to excretion in the urine (200mg/dl) The point at which all glucose transporter proteins in the kidneys are working at maximum capacity (350mg/dl)
567
Name the functions of the proximal tubule function
Reabsorbs Nutrients: glucose, amino acids, vitamins Electrolytes: sodium, chloride and potassium Water Bicarbonate Secretes byproducts and medications Sodium is actively transported out of the cells creating a gradient for glucose and amino acids
568
Describe the functions of the loop of henle
Descending limb (thin) -Water reabsorption Ascending limb (thick) -Impermeable to water -Salt removal -Creates concentration gradient Counter-current multiplier -Creates a high osmotic gradient allowing for concentration of urine and prevention of excess water loss Diuretics effect the thick limb inhibiting the Na-K-CL cotransporter preventing them being reabsorbed
569
Describe the function of the distal collecting system
Distal convoluted tube Final site of sodium, calcium and magnesium Permeability to water is regulated by hormones Target for angiotensin II and aldosterone Collecting duct -Receives fluid from several DCTs -Permeability to water changes depending on bodys hydration status -Contains intercalated cells which are responsible for acid base balance -Urea is essential for concentrating urine
570
How does tubular flow affect potassium excretion?
Increased tubular flow increases potassium excretion Diuretics that increase urine flow can increase potassium excretion
571
How do PTH and activated vitamin D affect calcium handling in the kidneys
PTH signals the kidneys to increase the reabsorption of calcium from the urine It also stimulates the kidneys to turn vitamin D into its active form The activated vitamin D can then increases absorption of dietary calcium and phosphate in the intestines
572
How is plasma osmolality regulalated?
Osmoreceptors in the hypothalamus sense changes in osmolality If too high they stimulate the thirst mechanism The posterior pituitary releases ADH which increases the number of aquaporin channels in the collecting ducts allowing more reabsorption ofwater This can also be stimulated by the RAAS system if BP is too low Angiotensin II promotes sodium and water reabsorption and stimulates ADH release If osmolality is too low then the hypothalamus and pituitary gland reduce the release of ADH
573
Describe the effect of ADH on blood vessels and its metabolism
ADH increases vascular tone by increasing vasoconstriction It is metabolised in the liver and kidneys
574
How does ACE generate Angiotensin II and what is the function of Angiotensin II
ACE converts a precursor into Angiotensin II Increases BP, increases salt and water retention via aldosterone (produced in adrenal cortex) Promotes cardiac and vascular remodelling (can lead to fibrosis) Reduces blood vessel relaxation Triggers thirst and release of ADH and corticotropin-releasing hormone
575
What are the effects of aldosterone and ANP
Regulates blood pressure and electrolyte balance by increasing sodium and water reabsorption and increasing potassium excretion Increases sodium and water excretion by increasing GFR and inhibiting sodium reabsorption
576
Describe how anion gap is calculated
(Sodium + Potassium) - (Chloride + Bicarbonate)
577
How does urinary acidification work?
The kidneys secrete hydrogen ions and reabsorb bicarbonate
578
Which factors affect hydrogen secretion/excretion
Diet Hormones such as aldosterone Urine pH Potassium and phosphate intake Fluid flow rate Active transport CKD, diuretics
579
What is the normal intracellular potassium concentration
150-160mmol/L
580
How is potassium handled in the kidneys?
Freely filtered at the glomerulus Reabsorbed in proximal tubule and thick ascending loop of henle Fine tuning occurs in the distal sections Aldosterone increases potassium excretion Acidosis causes retained potassium Sodium causes secretion of potassium
581
Where is calcium transported in the kidneys
The proximal tubule reabsorbs 60-70% of filtered calcium Thick limb of the loop of henle, the distal convoluted tubule and collecting duct also contribute
582
Name the two parts of the pituitary glands and their functions
Anterior -Glandular tissue -Secretes hormones: growth hormone, prolactin, TSH, ACTH, FSH and LH -Regulated by hormonal signals from hypothalamus Posterior -Neural tissue -Oxytocin and ADH -Regulated by neural signals from the hypothalamus
583
What are the roles of hypothalamic releasing hormones: CRH, TRH and dopamine?
Regulates the release of anterior pituitary hormones -CRH: stimulates ACTH release -TRH : stimulates release of TSH -Dopamine: inhibits release of prolactin
584
What is the basis of diabetes insipidus and SIADH?
DI - caused by problems with ADH SIADH - innappropriate release of ADH
585
How is the adrenal cortex regulated?
Glucocorticoids and androgens are regulated by ACTH which is released from the pituitary gland by corticotropin releasing hormone This is a negative feedback loop by cortisol Mineralcorticoids are regulated by the RAAS system -Kidneys release renin which converts angiotensin I to angiotensin II which acts on the adrenal cortex to release aldosterone This helps increase sodium reabsorption and potassium excretion increasing BP
586
What are the effects of glucocorticoids
Increased blood glucose Fat breakdown Muscle breakdown Inhibited glucose uptake Reduced inflammation and immune suppression Reduce bone formation and increasing calcium excretion
587
Describe the pathophysiology of Cushing's Syndrome
Prolonged exposure to high levels of cortisol either from exogenous (medications) or endogenous (over production) Promotes gluconeogenesis Causes insulin resistance and dyslipidaemia Increases visceral fat accumulation Causes muscle breakdown and bone loss Increased blood pressure
588
What is the function of the adrenal medulla?
Secretes catacholamines - adrenaline and noradrenaline Produces small amounts of dopamine Modified sympathetic ganglion
589
How are adrenaline and noradrenaline degraded?
Enzyme breakdown (MAO and COMT) Re-uptake (noradrenaline transporter)
590
What are the functions of alpha and beta cells in the pancreas
Alpha - produces glucagon Beta - produces insulin
591
Name the stimulants of insulin production
Glucose Specific amino acids and fatty acids Incretin hormones (GLP-1 and GIP) Glucagon Parasympathetic nervous system
592
How do insulin receptors work?
Insulin receptors bind insulin and other growth factors This initiates a signalling cascade which then regulates glucose uptake
593
Name the effect of insulin on glycogen, glycolysis,
-Promotes glycogen synthesis (glycoysis and prevents glycogen breakdown) -Inhibits lypolysis -Enhances protein synthesis
594
Name the stimulants of glucagon
Low blood glucose Stress Autonomic activation via sympathetic nervous system
595
Name the effects of glucagon on the hepatic handling of glucose, glycogen, urea, fat and ketones
Increases hepatic glucose production - promotes glycogenolysis and gluconeogenesis Promotes fat and amino acid breakdown - promotes the creation of ketones Stimulates urea production
596
What are the normal values of TSH and T4
0.4-4.0 9-25
597
Why are thyroid hormone binding proteins important ?
They deliver thyroid hormones to their target tissues and regulate the amount of free thyroid hormone available to cells
598
Where is T4 converted to T3?
Primarily liver and other peripheral tissues
599
Describe the key functions of the thyroid hormones
Increases basal metabolism rate stimulating metabolism of carbohydrates and fats Stimulates bone growth in children Increases heart rate, contractility and cardiac output Promotes heat production Affects mood, memory and speed of nerve activity Increases oxygenation
600
Name the functions of calcium
Bone mineralisation Nerve transmission Neuromuscular excitability Muscle contraction Vascular tone Coagulation Hormone secretion and control
601
Describe the differences between ionised, complexed and bound calcium
Ionised - free form of calcium Complexed - temporarily bound to phosphate, citrate or bicarbonate (part of serum calcium) Bound - attached to proteins (acts as a reserve)
602
MRCEM
flashcards
Decks in class (1)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions