Anatomy Last Minute Revision

ANATOMY LAST MINUTE REVISION

Qworld Last minute Revision : Tanmay Mehta

GENERAL ANATOMY: Types of Joints : Schindylesis

vomar -sphenoidal rostrum junction

Syndesmosis

Inferior tibiofibular First costochondral joint

Synchondrosis

Epiphysis-diaphysis

Symphysis

Manibrosternal

Saddle

Carpo metacarpal joint of thumb (first CMc joint)

Ellipsoid

Wrist

Types of epiphyses: Atavistic epiphysis

Os trigonum Coracoid process of scapula

Pressure

Head of femur

Traction

Tubercle of humerus Trochanter of femur Mastoid process

Other Important points : In interpharyngeal joint capsule is absent on = dorsal side Hyaluronic acid = is responsible for viscocity of synovial fluid

2


UPPER LIMB: Muscles & Boes of Upper limb: Greater tubersosity of humerus is lost

Abduction and LR affected

Osssification in fetus starts in

5th IU life

NOT attached to scapula

p.major

NOT attached to greater tuberosity of humerus

Subscapularis

First bone to osiify in membrane

Clavicle

NOT paa thro carpal tunnel

Ulnar n.

NOT form proximal row of carpal bone

Capitate

Shoulder

Glenohumaeral joint permits F/E/Ab/Ad/IR/ER

# Sx neck humerus results in

Flat shoulder

Ossification centre of medial epicondyle appear in

5th year

Midpalmar space is

Medial to septum attaching palmar aponeurosis to 3rd metacarpal bone

Tendon frequently absent in hand

Palmaris longus

NOT cause retraction of shoulder

Serratus ant

NOT bound quarilateral space

Deltoid

Serratus ant

NOT orginate from lower 8 ribs

NOT flex forearm

Anconeus

NOT extend middle distal phalnx of index finger

Extensor carpi radialis longus

Muscles attached to hook of hamate

Flexor retinaculum

Tip of coracoid process of scpula give rise to

Short head of biceps

Rupture of supraspinatus

Difficulty in inititation of abduction

Lower border of scapula corresponds to

D-7

Hinge joint

Elbow

3


Lumbrical action

Flexion of MP joint Extension of IP joint

Medial wall of axilla formed by

Serratus anterior

NOT form boundry to sup entrance to axilla

Coracoid m

Coracobrachialis assist in

Flexion of arm

Adduction of hand at wrist by

Extensor carpi ulnaris

Lateral border of cubital fossa

Brachioradial fossa

NOT attached to pisiform

FDS

3rd head of corachobrachialis c/d

Struther's ligament

Tubercles of montgomery in

Breast

Nerves of Upper limb : Klumpkee's paralysis

Lower brachial plexus

Brachialis is supplied by

Radial & musculocutaneos nerve

Brachial plexus

Radial n. arise from post cord

Axillary n palsy

Deltoid & teres minor

Winging scapula

Serratus anterior

Boxer's m.

Serratus anterior

Relation of musculocutaneus n with axillary artery in axilla LATERAL Unable to oppsose thumb following incised wound infront Median n. of wrist Medial collateral ligament of elbow joint closely related to

Ulnar n

Axillary n arise from

Post cord

Root value of ulnar

(c-7) , C- 8 T-1

Carpal tunnel syndrome - compression of

Median n

Medial cord NOT give rise to

n.to supraspinatus

Root value of axillary

C- 5,6

Root value of raidal

C -5 to T-1

Root value of musculocutaneus

C- 5,6,7 4


Wrist drop

Radial n

Musician's n

Ulnar n

Eye of hand

Median n

1st and 2nd lumbricals

Median n

Labourer n

Median n

Deep br of ulnar NOT supply

1st lumbrical 2nd lumbrical

Fine movements of hand

Ulnar n

Nerve NOT related to humerus

Musculocutaneus

Hypothenar m.

Ulnar n

NOT a br of post cord

Ulnar

Median n palsy at carpal tunnel

Loss of sensation over theaner eminence

Injury to ulnar n at wrist

Paralysis of adduction of thumb

Serratus ant

Long thoracic n

Brachialis

Musculocut n

Post interosseus is br of

Radial n

Pronator teres

Median n

Median n supplies

Abductor pollicis brevis (ABPB)

C-8 , T-1 NOT suplly

Extensor indices

Nail of bed of thumb

Median n

MCP joint are flexed in paralysis of

Radial n

NOT a sensory n

Long thoracic n

Intercostobrachial n is a br of

2nd intercostobrachial n

Ulnar n palsy at wrist spares

Opponens pollicis

Structurl LEAST likely to compressed in flexion and abduction of shoulder

Suprascapular n

Lunate dislocation

Median n 5


Erb's point

C-5,6

Theaner eminence

Median n

Radial n injury in lower part of spiral groove

Paralysis of anconeus

Pronator quadratus has same innervation as

Flexor pollicis longus (median n)

After musculocut n complete injury , flexion of elbow by

Ulnar head of pronator teres

Finger by which all m in hand tested

Middle

Lymphatic drainage of upper limb : LN first involved in ca breast

Pectoral gr

Ca breast of upper outer quadrant mostly spreads to

Pectoral LN

Gr of axillary LN along lateral thoracic a

Anterior set

Blood supply of upper limb : Deep palmar arch

Formed by deep br of ulnar a

Axillary a of U.L. is derived from

7th cervical intersegmental

Artery NOT taking part in scapular anastomosis

Ant circumflex humeral

NOT supply breast

Thoracodorsal br of subscapular a

a.supply of latissimus dorsi

Subscapular a

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LOWER LIMB Bones & Joints of lower limb : Fabella

Sesamoid bone

Fabella occurs in

Gastronemious lateral head

Patella completely ossifies by

14 years

Distal femoral epiphysis seen at age of

34 weeks

Ossifiaction of lower end of femur seen at

36 week

Ossification centre in calcaneus and talus appear in

3rd and 6th month

Due to bony support most stable position of ankle joint

Dorsiflexion

Abduction and adduction of frefoot occurs at

Midtarsal joint

Inversion and eversion occurs at

Subtalar and midtarsal joint

Spring ligament

Planter calcaneonavicular ligament

NOT provide stability to akle joint

Calcaneo navicular /spring ligament

Key stone of medial longitudinal arch of foot

Talus

NOT form deltoid ligament

Tibiofibular

Ligamnet forming medial boundry of femoral canal

Lacunar

ACL

Prevent forward displacement of tibial condyle

Ligament of bigelow in

Hip joint

Strongest ligament in body

Iliofemoral ligament

Medial meniscus is attached at

Three points

Extension of hip is restricted by

Ileofemoral ligament

Housemaid' s knee

Prepatellaar bursa

Oblique popliteal ligament is cont of

Semimembranosus

Fascia cribrosa is related to

Femoral canal

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Qworld Last minute Revision : Tanmay Mehta Muscles of lower limb : Peroneus brevis is inserted into

Base of 5th metatarsal

NOT insert into planter aspect of foot

Peroneus tertius

Ischail tuberosity gives attach ment to

Adductor magnus

Sartorius origin

Ant sup iliac spine

Extends knee with hip in flexion

Rectus femoris

Expansion of semimembraous tendon

Oblique popliteal ligament

Invertor inserted on all tarsal bone except talus

Tibialis posterior

In walking hip bone of suspended leg is raised by

Obturator externus ( ACTING ON SUPPORTED SIDE OF BODY)

When foot is off the ground action of gluteus medius

Abduction

Biceps femoris

Attached to head of fibula

Tredenlenburg sign +

g.medius and minimus palsy

Action of quadratus femoris

LR

Medial longitudinal arch of foot NOT formed by

Cuboid

Extensor of knee

Quadriceps

Wt of body in sitting posture supported by

Ischial tuberosity

Spontaneus pelvic diasthesis seen in

Extended lithotomy

Popliteal m forms

FLOOR of politeal fossa

Flexor of hip

Psoas

NOT a LR of hip

Psoas

NOT forms floor of femoral triangle

Adductor brevis

Action of popliteus

Rotate Femur Laterally On Tibia (FLOT)

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Qworld Last minute Revision : Tanmay Mehta Nerves of Lowerlimb : Posterior division of obturator nerve innervates

Knee joint

Knee jerk

L-2,3,4 (primarily L-3)

By pniching sartorius m

Cremesteric reflex elicited

MC cause of neuralgic pain in foot

Compression of communication b/w medial and lateral planter n

NOT a content of femoral sheath

Femoral nerve

NOT a content of subartorius canal

Nerve to vastus intermedius

Femoral nerve

NOT supply tensor fascia lata

g.maximus

Inf gluteal n

Popliteal m

Tibial n

Pain b/w great toe and 2nd toe

L-5

Venesction of GSV - pain on medial aspect of great toe

Saphenous n

Largest br of lumbar plexus

Femoral n

Adductor hallucis

Deep br of lateral planter n

Tarsal tunnel syndrome

Post tibial n

MC used donor n in grafting

Sural n

Foot drop

Deep peroneal n

Pain from hip joint is reffered to

Knee joint

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Qworld Last minute Revision : Tanmay Mehta Blood supply of lower limb : Longest vein in human body

Long saphenous vein

Number of perforaters of GSV in LEG

4

Femoral vein lies

MEDIAL to femoral a

Abnormal obturator a. is abr of

Inferior epigastric a

Pass out thro greater sciatic notch and reenter pelvis thro lesser sciatic notch

Internal pudendal a

Superficial femoral artery becomes popliteal artery

At hiatus in adductor magnus

Subsartorial canal

1. Femoral artery and vein 2. Saphenous nerve 3. Posterior division of obturator nerve

i.v. infusion is avoided in

Long saphenous vein

Lateral circumflex femoral a is a br of

Profunda femoris a

NOT supply head of femur in children

Nutrient a

Heel and lateral part of foot

Popliteal LN

Glans penis

DIN

Saphenous opening is situated

Below and lateral to pubic tubercle

GSV can be exposed anterior to medial malleolus at

2.5 cm

Sacral canal volume

25-35 cc

Short saphenous veinn is continuation of

Lateral marginal vein

Major blood supply to posterior femoral muscles is provided by

Perforating branches of deep femoral a

In adult a' supply of head of femur from

Br from medial and lateral circumflex femoral a

Femoral canal

Medial most compartment of femoral sheath

Peroneal a is a br of

Post tibial a

A found in adductor canal

Femoral

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Qworld Last minute Revision : Tanmay Mehta Negative Points lower limb : Medial cord NOT give rise to

n.to supraspinatus

Deep br of ulnar NOT supply

1st lumbrical 2nd lumbrical

Nerve NOT related to humerus

Musculocutaneus

NOT a br of post cord

Ulnar

C-8 , T-1 NOT suplly

Extensor indices

NOT a sensory n

Long thoracic n

Structurl LEAST likely to compressed in flexion and abduction of shoulder

Suprascapular n

NOT attached to scapula

p.major

NOT attached to greater tuberosity of humerus

Subscapularis

NOT paa thro carpal tunnel

Ulnar n.

NOT form proximal row of carpal bone

Capitate

NOT cause retraction of shoulder

Serratus ant

NOT bound quarilateral space

Deltoid

Serratus ant

NOT orginate from lower 8 ribs

NOT flex forearm

Anconeus

NOT extend middle distal phalnx of index finger

Extensor carpi radialis longus

NOT form boundry to sup entrance to axilla

Coracoid m

NOT attached to pisiform

FDS

Artery NOT taking part in scapular anastomosis

Ant circumflex humeral

NOT supply breast

Thoracodorsal br of subscapular a

NOT provide stability to akle joint

Calcaneo navicular /spring ligament

NOT form deltoid ligament

Tibiofibular

NOT insert into planter aspect of foot

Peroneus tertius

Medial longitudinal arch of foot NOT formed by

Cuboid

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NOT a LR of hip

Psoas

NOT forms floor of femoral triangle

Adductor brevis

NOT a content of femoral sheath

Femoral nerve

NOT a content of subartorius canal

Nerve to vastus intermedius

Femoral nerve

NOT supply tensor fascia lata

Osssification in fetus starts in

5th IU life

Ossification centre of medial epicondyle appear in

5th year

Patella completely ossifies by

14 years

Distal femoral epiphysis seen at age of

34 weeks

Ossifiaction of lower end of femur seen at

36 week

Ossification centre in calcaneus and talus appear in

3rd and 6th month

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THORAX & BACK Important points of thorax & back : SA node is located

Sub epicardially

Thoracic duct is also called

Pecquet duct

Blood supply of thorax and back : Internal thoracic vein are tributaries of

= brachiocephalic vein

Lt sup intercostal vein drains into

Lt brachocephalic vein

Bronchial vein of right side open into

Azygos vein

Arch of aorta lies in

Superior mediastinum

MC variation in arch of aorta

Lt CCA arise from brachiocephalic trunk

Parietal pleura is

Sensitive to pain

Arch of aorta

Closely related to parietal pleura

Base of heart is Related to

Descending aorta

Base of heart formed by

Both atria ( LA>RA)

Inferior surface of heart fromed by

RV & LV

Boundries of koch's triangle

1. Tendon of todaro 2. Septal leaflet of tricusspid valve 3. Orfice of coronary sinus

Part of heart lying infront of esophagus

LA

Anterior interventricular artery is a br of

LCA

Posterior interventricular artery is a br of

RCA

SA node is supplied by

RCA

AV node

RCA

Apex of heart

LCA

Post 1/3 septum

RCA

Bundle of his

Dual blood suplly

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SVC ,IVC , coronary sinus open into

RA

Coronary sulcus is occupied by

Coronary sinus

Oblique sinus of pericardium lies

Behind LA

Great , small and middle cardiac vein

drain into coronary sinus

Coronary sinus opens into

RA

middle cardiac vein is located at

Post IV sulcus

Lung : Anatomical division of right midddle lobe of llung

Medial and lateral

Lung abcess secondary to aspiration

Posterior upper & Apical lower lobe

FB aspiration is MC enters

Right main bronchus

If FB accidentally enters nose it goes

Apical segment of right lower lobe

Most dependent part of lung in supine position

Lower apical

Right main bronchus

More vertical and broder

FB aspiration is MC in

Rt middle and Inf apical lobe

MC site of lung abcess

Post segment of rt upper lobe

Intralobar sequestration of lung MC in

Post basal segment of lower lobe

Bronchial artey supplies upto

Respiratory bronchiole

Apex of left lung

Subclavian artery forms a groove

Structure arching over hilum of right lung

Azygos vein

Numerical values of thorax & back: Length of trachea

10-12 cm

Length of adult trachea

14-15 cm

Diameter of adult trachea

1.2-1.6 cm

Length of esophagus

25 cm

At mid axillary line parietal pleura extends up to level of

10 th rib 14


Lower border of costodiaphragmatic recess is at level of

6 th rib

True ribs

7th rib

At cross section of T-4

Arch of aorta

Carina is at level of

T-4

Esophagus opening

T-10

IVC opening

T-8

Negative points of thorax & back : Bronchopulmonary segment do not conatain =Independent pulmoanary VEIN Vein not draining into coronary sinus= Anterior cardiac vein Aorta =NOT pierce diaphragm Costo sternal joint = is NOT direct articulation of ribs 8th rib NOT directly articulate with sternum Thoracic duct is NOT situated b/w neck of first rib and apex of lung Scalenus posterior NOT inserted on first rib Internal mammary artery NOT supply esophagus Pectoralis major is NOT cut in posterolateral thoracotomy Anteromedial basal is NOT a part of left lower lobe of lung Nerves of thorax & back : Sympathetic inervation of heart

T-2 to T-6

In angina pain to left arm by incraesed activity in AFFERENT fibers in

Thoracic splanchnic n.

Autonomic supply to SA node

Symathetic excitatory

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ABDOMEN Nerve supply Abdomen : Parasympathetic division innervates

Detrusor

Motor nerve supply to detrusor

S-2,3,4

First event in micturition reflex

Relaxation of perineal muscels

Nerve supply of bladder

1. Sympathetic postganglionic : L-1,2 ganglia 2. Parasympathetic preganglionic : arise from S2,3,4 and synapse with postganglionic neurons in inferior hypogastric plexus 3. Aff sensory f. via pelvic splanchnic and sympathetic n.

Parasympathetic outflow from sacral plexus

Nerve erigentes

Abdominal part of sympathetic trunk

Grey rami communicantes are given off to lumbar spinal nerves

Relation of sympathetic trunk to IVC

Left

Spleen

Nerve supply from celiac plexus

Umbilicus

T-10

Parasympathetic supply to rectum and anal canal

S-2,3,4

External pile pain is carried by

Pudendal nerve

Sensory nerves of cervix pass through

S-2,3,4

Pelvic splanchnic nerve formed by

Anterior rami of S-2,3,4

Cremasteric reflex

L-1

Afferents of Cremasteric reflex

Genitofemoral nerve

Cremaster muscle(efferent limb of Cremasteric reflex)

Genital branch of Genitofemoral nerve

Rectus abdominis innervated by

Lower six intercostal nerves

After herniotomy loss of sensation over scrotum and root Ilioinguinal n.

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of penis N supply of pyramidalis

Subcostal n.

Numerical Values of Abdomen : Length of spermatozoa

5o microns

Capacity of stomach in new born

30 ml

Length of CBD

8 cm

Length of inguinal canal

3.75 cm

Length of female urethra

4 cm ( 40 mm)

Length of maleadult urethra

20 cm

Length of female adult cervical canal

2.5 cm

Normal portal venous pressure

6-12 mm hg

Kidney has

5 segments

Transpyloric plane pass through

L-1,2

Superior mesenteric artery

L-1

Celiac axis

T-12 ,L-1

Iliac crest highest point

L-4

Relations of Abdomen : Vas in males and ROUND ligament in females

Penetrates inguinal ring

DIR contains

ROUND ligament in females

Conjoint tendon

Lower fibers of IO and TA

Facia extension of lacunar ligament along pectineal line Cooper's ligament >75% strength of intact abdominal wall in the

Aponeurosis

DIR is a defect in

Facia tranversalis

SIR is an opening in

aponeurois of EOA

SIR transmits

Ilioinguinal nerve

Hasselbach's triangle

Inguinal triangle

Hasselbach's triangle

1. Lateral border of RA

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2. Inguinal ligament 3. Inf epigastric a. Common structure in femoral traingle and Hasselbach's Inguinal ligament triangle Neurovascular bundle in anterior abdominal wall is situated b/w

IO & TA

Inferior hypogastric plexus located

b/w layers of anterior abdominal wall

Rectus abdominis innervated by

Lower six intercostal nerves

Flexor of lumbar vertebrae

Rectus abdominis

Rectus abdominis inserted into

Xiphoid process

Muscles posterior to kidney

1. Psoas major 2. Quadratus lumborum 3. Transverse adbdominis

nerves posterior to kidney

1. Ilioinguinal nerve 2. Subcostal nerve 3. Iliohypogastric nerve

Perineal body

1. Levator ani 2. External anl sphincter 3. Bulbocavernous

Diaphragm : Root value of phrenic n

c-3,4,5

Irritation of diaphragm radiates to

C-3,4

Deelopment of diaphragm is from

1. Septum transversum 2. Pleuroperitoneal membrane

MC diaphragmatic hernia

Hiatus hernia

Foramen of bochdelk

Posterolateral gap in diaphragm

Esophagus enters through

Muscular part of diaphragm

During abd surgery under LA sudden pain d/t

Parietal peritoneum

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Qworld Last minute Revision : Tanmay Mehta Blood supply of Abdomen : Internal Iliac Ant Trunk

1. Superior Vesical Artery Artery to Ductus Deferans  2. Inferior Vesical Artery 3. Middle Rectal Artery 4. Uterine Artery Azygos A. of Vagina  Helicine Arteries  Vaginal Artery  Obturator Artery  Iliac branc  Vesical branch  Pubic branch   Anterior branch Post branch  Acetabular branch  Internal Pudental Artery  Muscular branches  Inferior Rectal A  Perineal Artery  A. of bulb of Penis  Uretheral Artery  Deep A. of Peni  Dorsal A. of penis  Inferior Gluteal Artery 

Post Trunk

1. Ilio Lumbar 2. Lateral Sacral A 3. Sup Gluteal Artery

External Iliac

1.

Inferior Epigastric Cremasteric Artery Pubic Branch (  AOA) Muscular  Cutaneous  2. Deep Circumflex ioliac Artery 

Uterine artery is abranch of

Int iliac a.-Ant Trunk

Superior rectal artery arise from

Inferior mesenteric a.

Middle Rectal Artery a br of

Internal Iliac - Ant Trunk

Internal Pudental Artery is a br of

Internal Iliac - Ant Trunk

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Post Trunk Int iliac a branch is

Sup Gluteal Artery

Deep Circumflex ioliac Artery is a br of

External Iliac

Jejunum

Superior mesenteric a.

Superior mesenteric a. suplleis

1. 2. 3. 4.

Inferori mesenteric artery

1. Transverse colon 2. Descending colon 3. Sigmoid colon

Inferori mesenteric artery

Takes part in formation of marginal artery

Appendicular artery is abranch of

Ilioclolic a.

Rt teticular vein drains into

IVC

Lt teticular vein drains into

Left renal vein

Rt adrenal vein drains into

IVC

Renal collar by splitting int two limbs and encirclling aorta by

Left renal vein

Tributaries of left renal vein

1. Lt goandal 2. Lt suprarenal 3. Inferior phrenic

left renal vein

Crosses Infront of aorta below SMA

Suprarenal gland

1. Aorta 2. Renal artery 3. Inferior phrenic artery

Inferior messenteric vein drains into

Splenic vein

Blood vessel related to paraduodenal fossa

Inferior messenteric vein

Venous drainage of liver into IVC via

Hepatic veins

End arterial supply

Liver Spleen Kidney

Dual supply

Lung

Jejunum Appendix Ascendinf colon Transverse colon

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Coeliac

 



Left Gastric Common hepatic Right Gastric Gastroduodenal a. Right Gastro Epiploic b. Sup pancreatico duodenal (Ant, Post) c. Supraduodenal Artery of Wilke d. Right Hepatic(Accessory Right hepatic form SMA) I. Cystic I. Supf - Inferior Surface II. Deep - Superior Surface e) Left Hepatic(Accessory Left hepatic form LGA) Splenic A  Pancreatic branches(A.Pancreatica Major, A.Caudae Pancreatic)  Short Gastric A  Posterior Gastric A  Left Gastro Epiploic A  Splenic Branches

Smallest branch of celiac axis

Left gastric

Splenic aretry arise from

Celiac a.

Left gastro epiploc artery is a br of

Splenic aretry

Cystic a arise from

Right Hepatic a.

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Qworld Last minute Revision : Tanmay Mehta Lymphatic drainage Abdomen : Ovary

Paraaortic LN

Testis

Pre and para aortic LN

Anal canal

inguinal

Umbillicus

Axillary + inguinal

Stomach area suplied by short gastric arteries and left gastroepiploic artery

Pancreatico splenic LN

Fundus of stomach

Pancreatico splenic LN

Uterus cornu and fundus

1. SIN 2. Pre and para aortic LN

Glanspenis

DIN

Isthmus of uterine tube Inferior part of anal canal Big toe

SIN

prostatic part membranous part

1. int iliac nodes 2. some to ext iliac nodes

spongy part( penile urethra)

1. deep ing nodes 2. some to ext iliac nodes

Lymphatics of vulva

Traverses labia from medial to lateral side

Important Points : Abdomen Tail of pancreas

Has maximum nuber of iscelets of langerhans

Appendix

Has tenia coli

Shortest part of colon

Ascending colon

Principal factor causing ruputure of graffian follicle

Necrobiosis of overlying tissue

Pouch of duglas

b/w uterus and rectum

Fascia of denonvilliers

b/w rectal ampula & prostate and seminal vesicals

Buck's fascia is related to

Penis`

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Superficial penile fascia

Contain dartos Conatin loose connective tissue Contains superficial dorsal vein

Camper fascia

Superficial FATTY fasica b/w umb and pubis

Fascia of gerota

Renal fascia

Prostate

Surrounds neck of bladder Median lobe -hypertrophies in old age - b/w urethra and ejaculatory ducts Posterior lobe- carcinoma

Trigone of bladder

1. 2. 3. 4.

Cave of Ritzeus

Infront of bladder

Structure in intersigmoid recess

Lt ureter

Ureter

Crossed anteriorly by gonadal artery

MC site of surgical ureterovaginal fistula

Below uterine artery in mackenrod's ligament

Ureter crosses

1. Ifurcation of common iliac 2. Uterina a. 3. Sigmoid mesoclon

Bile duct opens into

2nd part of duodenum

Structure in free border of lesser omentum ( A to P)

1. CBD 2. Hepatic artery 3. Portal vein

Bondry of lesser sac

lower margin of greater omentum (Inferiorly)

Location of omental bursa

Left subhepatic

Urethra in female

Is shorter than male

Least dilatable part of urethra

Membranous

No folds in mucus membrane Borderes by interureteric crrest Mesodermal in origin Overlies median lobe of prostate

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Bulbourethral glands open in

Penile urethra

COWPER'S glands open in

Penile urethra

Ejaculatory duct opens into

Prostatic urethra

Pliceman of abdomen

greater momentum

Attchment of mesentery of SI

Lt Transverse process of L-2 to Rt sacroiliac joint

Appendix epeploacea

In alimaentary canal along with mesentry

MC type of inversion of testis

Anterior

Contents of sacral canal

1. Filum terminale 2. Dura 3. Vertebral venous plexus

Pudendal canal

1. Pudendal n. 2. Internal pudendal artery and vein

Acessary spleen occur at

1. Tail of pancraes 2. Hilum of spleen and its mesentry 3. Omentum and mesentry of small bowel

Max support to uterus

Mackenrodt's ligament

Caudate lobe of liver situated

b/e IVC and ligament venosum

Caudate lobe of liver

Anterior to rt inf phrenic a.

Negative Points Abdomen : Inferior epigastric

is not a branch of = internal iliac

Ovarian artery is not a branch of = internal iliac Allantois NOT normally shrink in umbillical cord Bowel NOT strangulated in = rectouterine pouch In hydrocele aspiration needle NOT pass through = tunica albugenia Rectus sheath NOT contain = genitofemoral n. Latissimus dorsi is NOT posterior to kidney

24


Pancreatic bed NOT include splenic artery Obturator internus NOT form perineal body Conjoint tendon is NOT continuous with inguinal ligament Rectus sheath NOT deficient anterosuperiorly Ovary is NOT a content of broad ligament First lumbar vein is NOT a tributary of lt renal vein Rt suprarenal gland is NOT present in trans pyloric plane Superficial penile facsia is NOT innervated by ilioinguinal nerve Inguinal canal is NOT bounded posteriorly by = lacunar ligament Anal continence is NOT contributed by = valves of Houston SMA does NOT suplly suprarenal gland Lung has NO endarterial supply Acessary spleen NOT occur at ovary and testis Nerve to oburator internus is NOT a content of pudendal canal Ureter is NOT related to posteriro surface of bladder Large mucosal folds NOT seein in ileum Anal canal is NOT completely lined by stratified squamus epithelium Ureter NOTcrosses IMA Lumbar vertebra NOT permit rotation Upper part of Vagina is covered with peritoneum Meckle's diverticulum arise from ANTImesenteric border of ileum

25


HEAD & NECK Bones of head & neck : Skull consisits of

22 bones

Cranio facial angle

130⁰

Pterion corresponds to

Ant pole of insula MMA Lateral cerebral sulcus

Increased thickness of skull bones

= thalassemia

Ciliary ganglion is located

At apex of orbit b/w optic n. and LR

Optic foramen is located b/w

= Lesser wing and body of sphenoid

Optic nerve pass through

Optic foramen

Foramina in greater wing of sphenoid

Rotundum Ovale Spionosum

Weakest wall of orbit

= medial wall

Structure passing through infraorbital fissure

Zygomatic nerve

Structure passing through supraorbital fissure

1. 3,4,6 C.N. 2. Ѵ-1 C.N.(ophthalmic division of rigeminal) 3. Ophthalmic vein

Nasolacrimal duct is directed

Downwards , Laterally , Backwards

Lacrimal duct opens at

= inferior meatus

Narrowest part of middle ear

= mesotympanum

Inner ear is in

= petrous part of temporal bone

Arcuate eminence of petrous part of temporal bone is due to

= superior semicircular canal

Roof of olfactory region is formed by

Cribriform plate of ethemoid

Incisior foramen in mouth is

Foramen of scarpa

26


Mandibular nerve passes through

Foramen ovale

MMA passes through

Foramen spinosum

Chassaignae's tubercle lies at level of

Erb's point

Chassaignae's tubercle is

= at level of cricoid cartilage

Chassaignae's tubercle

Carotid tubercle on C-6 vertebra

Trachea begins at

= lower border of cricoids

Esophagus starts at

= lower end of cricoids

Esophagus is narrowest at

Its beginning

Cartilage with signet ring shape

=cricoids

Laryngeal cartilage above glottis

= epiglottis

Narrowest part of GIT(alimentary canal)

= cricopharynx

Larynx extends from

c-3 to c-6

Isthmus of thyroid gland is across

2nd to 4th tracheal rings

Thyroglossal cyst moves with deglutition because

Attached to hyoid bone

Superior malleolar ligament connects

Head of malleus to roof of epitympanum

Transverse ligamaent of atlas is apart of

Cruciate ligament

Ligament in TM joint

1. Lateral temporomandbular ( not tympano mandibular) 2. Sphenomandibular 3. Stylomandibular

number of ossification centers for hyoid bone

6

Mastoid process antrum begins to deveop in

6th month

Posterior fontonalle ossified at age of

6 month

Vertebra with most prominent spine

c-7

Vertebra prominence

C-7


6th month

27

Qworld Last minute Revision : Tanmay Mehta Nerves of head & neck : Smallest cranial nerve

Olfactory

Structure in lateral wall of cavernous sinus ( not whole trigeminal nerve is in lateral wall)

1. Occulomotor 2. Trochlear 3. Ophtalmic nerve( br of trigeminal nerve)

Structure related to cavernous sinus

1. Occulomotor 2. Trochlear 3. Ophtalmic nerve( br of trigeminal nerve) 4. Mandibular br of trigeminal nerve 5. Abducens nerve 6. ICA

Direct content of cavernous sinus

Abducens nerve

Internal carotid nerve is a branch of

Internal sympathetic chain

SR supplied by

Superior division of third n.

Occulomotor nerve

MR , SR,IR, IO, sphincterdilator pupillae , LPS

3rd n. palsy

Mydriasis Ptosis Outward deviation of eye Difficulaty in accomodation Diplopia Superior gaze palsy

Normal eye sight + absent DLR & IDLR

Occulomotor nerve palsy

Cranial nerve MC ccopressed by intracranial aneurysm

Occulomotor

Largest ganglion in neck

Superior ganglion

Horner's syndrome is due to pressure on

Stellate ganglion

Horner's syndrome

Ptosis Miosis Anhydrosis

Direct content of cavernous sinus

Abducens nerve

Dorello's canal transmits in tip of temporal bone en route to cavernous sinus

Abducens nerve

28


Abducent

LR

Trochlear

SO ( inferior and lateral movement)

Inability to look downwards and laterallay

Trochlear n palsy

Cranial nerve with longest intracranial course

Trochlear

Cranial nerve which decussate within brain

Trochlear

Nerve passing through meckle's cave

Tirgeminal n.

Sensory nerve supply of middle ear

9th C.N. glossopharyngeal n.

Main nerve supply of tonsil

= glossopharyngeal n.

Throat pain radiating to ear following tonsillectomy is due to


Pain in post 1/3 rd tongue following tonsillectomy is due to


post 1/3 rd tongue

glossopharyngeal n.

Pharyngotympanic tube is supplied by

glossopharyngeal n.

Only pharyngeal m. suplied by glossopharyngeal n.

Stylopharyngeus

Tympanic plexus formed by

Tympanic br of glossopharyngeal n.

Branches of glossopharyngeal n.

1. Tympanic 2. Tonsillar 3. Pharyngeal plexus

Ant 2/3 rd tongue taste sensation

Chorda tympani

Chorda tympani supllies

1. Ant 2/3 tongue 2. Muscles of facial expression 3. Secretomotor fibers to submandibular glands

Nerve seen in tympanic cavity

Chorda tympani

Alderman's nerve

Br of auricula branch of vagus nerve

Nerve of laterjet of vagus is seen in

Stomach

Sensory supply of trachea

Vagus

Lacrimal gland is supplied by

Sphenopalatine ganglion

29


Sphenopalatine ganglion is formed by

Greater superficial petrosal n

Facial nerve supplies

1. Lacrimal gland 2. Nasal gland 3. Submandibular gland

Facial nerve NOT supplies

Parotid gland

Facial nerve lies in

Substance of parotid gland

Lesser superficial petrosal n. supplies

Parotid

Greater superficial petrosal n.

FIRST Branch of Facial n.

Nerve of pterygoid canal

= Sympathetic + Greater superficial petrosal n

Secretomotor fibers to parotid gland pass through

Otic ganglion

Parasympathetic supply to parotid

Otic ganglion

Secetomotor fibers to parotid is via

Auriculotemporal nerve

Skin over angle of mandible + parotid area

Auriculotemporal nerve

Skin at angle of jaw supplied by

= greater auricular nerve

Tip of nose by

Ophthalmic n.

Recurrent layrengeal n is closely related to

= inferior thyroid artery

Sensory nerve supply of trachea

Recurrent layrengeal n

Nerve supply of mucosa of larynx

internal laryngeal nerve

Damage to internal laryngeal nerve

= anesthesia of larynx

Damage to external layrengeal nerve

= loss of timber of voice

Cricothyroid is supplied by

external layrengeal nerve

Muscles of mastication 1. Masseter 2. Temporalis 3. Lateral and medial pterygoids

Mandibular nerve

Facial expresion muscles Orbicularis oris occuli Buccinator

Facial n.

Stepedius m

Facial n.

Tensor tympani ( toynbee's muscle)

Mandibular nerve 30


Posterior belly of digastric

Facial n.

Anterior belly of digastric

Trigeminal nerve

Mandibular nerve passes through

Foramen ovale

Nerve supplying submandibular gland

Facial nerve

Palatoglossus

Vagus

Muscles of tongue are supplied by (except palatoglossus)

Hypoglossal nerve ( 12 C.N.)

Styloglossus Genioglossus hypoglossus Geniohyoid Thyrohyoid

Hypoglossal nerve

Palsy of right genioglossus(safety muscle of tongue)

Deviation of tongue to right

All palatal muscles (except tensor veli palati)

Cranial aceessary nerve

Soft palate

Cranial aceessary nerve

Superficial cut in post triangle of neck leads to

Shrugging inability

Ansa cervicalis supplies

1. Sternohyoid 2. Sternothyroid 3. Omohyoid

Cervical plexus

1. Mylohyoid 2. Scalenus medius 3. Capitis longus

Blood supply of head & neck : Choroid fissure of eye permits entry of

= hyaloid artery

Cilioretinal artery is a br of

= choroidal artery

Left subclavian a is a br of

= arch of aorta

Branches of subclavian artery

1. Vertebral 2. Thyrocervical trunk 3. Internal thoracic

Foramen transeverserium transmits

= vertebral artery

Intervertebral foramen transmits

Spinal arteries

Anterior spinal artery is abranch of

= vertebral artery

31


Branchial sinus passes b/w

Two carotids

Level of branching of CCA

= upper border of thyroid cartilage

Nuber of branches of ICA in neck

None

Ophthalmic artery is a branch of

Intracerebral part of ICA

Supraorbital & supratrochlear arteries are branches of

Ophthalmic artery

Facial artery

brach of ECA Main blood supply of tonsil Suplly both lips Conveys postganglionic sympathetic fibers to submandibular gland

Main blood supply of tonsil

Facial artery

Artery palpable at ant border of masseter

Facial a.

MMA is abranch of

= maxillary artery

Cisterna of lateral sulcus contain

Middle meningeal artery

MMA passes through

Foramen spinosum

Ascending pharyngeal a is a branch of

ECA

Inferior thyroid artery arise from

= thyrocervical trunk of 1st part of subclavian artery

Blood supply of cervical esophagus

= inferior thyroid a.

Recurrent layrengeal n is closely related to

= inferior thyroid artery

Inferior thyroid artery is ligated

= as far as possible

Middle thyroid vein drains into

= IJV

Circularis iridis major is located at

= root of iris

Dangerous area of face is

Area drained by angular faical vein

Direct communication of cavernous sinus

Inferior petrosal Pterygoid venous plexus Orbit veins

TOC of subgaleal hematoma

= conservative

32

Qworld Last minute Revision : Tanmay Mehta Lymphatic drainage of head & neck : Tonsil

Jugulodiagastric nodes

Tip of tongue

Submental LN

Waldeyer lymphatic chain

1. Palatine tonsil 2. Pharyngeal tonsil 3. Tubal tonsil

LN in cervical group

100

Relations of head & neck: Structure inferior to sphenopetrosal synchondrosis

Cartilagenous part of auditary tube

Structures passing b/w upper border of sup constrictor and = levator palatii muscle base of skull Cartilagenous E tube Posterior chamber of eye refers to space

= posterior to iris ( not posterior to lens)

Lamina cribrosa is a modfication of

= sclera

Carotid sheath contains

Carotid a. IJV Vagus

Vocal ligament

Is continuous with cricothyroid membrane

Muscles of head & neck : Most important muscles of expiration

= abdominal wall m.

toynbee's muscle

Tensor tympani

Posterior boundry of carotid triangle

= SCM

Only pharyngeal m. suplied by glossopharyngeal n.

Stylopharyngeus

Opening of jaw ( depressor of mandible)

Lateral pterygoid m.

I/L deviation of tongue is due to unaltered action of

Genioglossus

Palsy of right genioglossus

Deviation of tongue to right

safety muscle of tongue

Genioglossus

Subcutaneus muscle extending from clavicle to mandible

Platysma 33


Abductor of vocal cord

Psterior cricoarytenoid

Elevator of larynx

1. Thyrohuoid 2. Stylohyoid 3. Digastric

Depressor of larynx

Sternohyoid

Negative points head & neck : Pterion NOT corresponds to = transverse sinus Foramina NOT in greater wing of sphenoid = optic canal NOT Direct communication of cavernous sinus = sigmoid and straight sinus Posterior auricular nerve is NOT a content of tympanic cavity Cough receptors are NOT seen in = soft palate Prevertebral fascia is NOT posterior to = scalenus anterior Middle constrictor muscle is NOT a derivative of 2nd arch Not formes by Waldeyer lymphatic chain = post auricular nodes Facial nerve NOT supplies =Parotid gland NOT Branches of subclavian artery = subscapular artery Ansa cervicalis NOT supplies = thyrohyoid Alar ligament is NOT seen in TM joint Lamina pappeocyces is NOT found in lateral wall of nose

34


BRAIN Fibers of brain: Pyramidal fibers are

= projection fibers

Fibers passing through genu of internal capsule

= corticonuclear

Fibers passing through crus cerebri

= corticonuclear & corticospinal

Inferoir cerebellor peduncle has

= vestibulo/olivo/spino cerebellar fibers

Middle cerebellor peduncle has

Pontocerebellar f.

Content of interpeduncular fossa

1. Mammilary bodies 2. Occulomotor nerve 3. Posterior perforated substance 4. Tuber cinerum

Fibers passing through posterior column

= FASCICULUS GRACILLIS

Fibers of acoustic radiation arise in

=Medial geniculate body

Central canal of spinal cord is central in region of

= lumbar

In postnatal period greatest growth in grey matter of CNS Is of

= dendrtic tree

Spectru of colour highest visualise due to central cones

= red green

CSF: CSF partly absorbed by lymphatics around

= 1,2,7,8 C.N.

Total volume of CSF

= 150 ml

Rhoboid fossa forms the floor of

4th ventricle

Cerebral aqueduct of sylvius connects

3rd to 4th ventricle

BBB is destroyed by

Inflamation ,radiation and tumour

Tectal breaking seen in

Arnold chiari malformation

Portal circulation seen in

Hypophysisi cereberi

Myelin sheath in CNS is synthesized by

Oligodendroglia

BBB is formed by

Astrocytes

35


Cranial nerves Origin: Facial

Pons

Glossopharyngeal Vagus Hypoglossal

Medulla

Nuclei of brain: Basal ganglia

Caudate nucleus Putamen Lentiform nucleus Amygdaloid nucleus

Cerebellum

Dentate nucleus

Purkinje cells of cerebellum end in

Cerebellar nuclei

Nucleus common to 9, 10 ,11 C.N.

Nucleus ambiguous

9,10,7 (Nine ,Ten , Seven)cranial nerve end in

Nucleus tractus solitaries

Number of nuclei of trigeminal nerve in CNS

4

Nucleus in floor of 4th ventricle

Abducens Dorsal vagal Hypoglossal

GVE (general visceral efferent) column

Dorsal nucleus of vagus

Light reflex

Pretectal nucleus

Efferent form cochlear nucleus to

Superior olivary nucleus

Mammilothalamic tract ends in

Anerior thalamic nucleus

Thalamic nuclei not projecting to neocortex

reticular nuclei

Mastoid antrum is related to

Cochlea nucleus in thalamus

Spinal cord : Spinal nerve pair

= 31

Spinal cord ends at in adult

L-1 lower border

In newborn S cord ends at

L-3

Subarachnoid space ends at

S-2

36

Qworld Last minute Revision : Tanmay Mehta Negative Points of Brain : Pupilary reflex pathway NOT includes = LGB Geniculate body is NOT a part of epithalamus Ant inf cerebellar artery does NOT supply medulla Facial nucleus is NOT found in floor of 4th ventricle Pontocerebellar f. is NOT seen in inf cerebellar peduncle Trochlear & Ophthalmic nerve is NOT seen in interpeduncular fossa Thalamus is NOT included in basal ganglia Anterior spinocerebellar tract NOT enter via inferior cerebellar peduncle Thalamic nuclei NOT projecting to neocortex=reticular nuclei Blood supply of brain : Cisterna of lateral sulcus contain

Middle meningeal artery

MMA passes through

Foramen spinosum

Middle meningeal artery is a branch of

Maxillary artery

Complete sulcus

Calcarine sulcus

Example of limiting sulcus

Central sulcus

Unpaired artery in brain

Basilar artery

Artery supplyinf occipital cortex

MCA+PCA

Branch of basilar artery

PCA

Greater vein of galen is formed by

= internal cerebral veins

vein of galen drains into

= straight sinus

Superior cerebral vein drains into

= superior sagital sinus

37

Qworld Last minute Revision : Tanmay Mehta Auditary pathway : Auditary transmission via = lateral laminiscus Efferent form cochlear nucleus to =Superior olivary nucleus Fibers of acoustic radiation arise in =Medial geniculate body Auditary pathway is via = medial geniculate body Optic tract is related to = lateral geniculate body Auditary pathway is via = medial geniculate body

38


EMBRYOLOGY Pharyngeal arches and pouches : Tonsils

2nd pouch

Thymus

3rd pouch

Superior parathyroid gland

4th puch

Inferior parathyroid gland

3rd pouch

parathyroid glands

3rd and 4th puches

Parafollicular cells / C- cells of thyroid

Ultimobarachial body > 3rd pouch

Malleus ,incus Mandible Sphenomandibular ligament Anterior malleolar ligament

1st arch

Stapes Stylohyoid ligament Smaller cornu of hyoid

2nd arch

Greater cornu of hyoid

3rd arch cartilage

Foot plate of stapes develops from

Otic capsule

Negative points embryology : Gall bladder = is NOT derivative of mesoderm Scelra of eye = NOT derived from ectoderm Posterior malleeolar ligament = not derived from 1st arch Retinal vascular endothelium is not derived from ectoderm Odontoblast is NOT endodermal origin Dilator pupillae is NOT mesodermal origin Petrous temporal bone is NOT present at birth Bone marrow is NOT ectodermal in origin 3rd part of duodenum is NOT derived from foregut

39

Qworld Last minute Revision : Tanmay Mehta Important points of embryology : Persisitent left SVC drais into = coronary sinus Shotgun periniumis = congenital condition in female Double barr body = xxx (KFS) Number of barr bodie in superfemale= 2 Patent foramen ovale =nonfusion of ostium primum with secundum Premature closue of f. ovale results in = RVH Membranous atrioventricular part of IV septum is b/w = RA & LV Cleft lip = nonfusion of maxillary with medial nasal process Midline cleft lip = nonfusion of two medial nasal process Incomplete closure of ectodermal cleft cause = coloboma of iris and retina Exomphalos = ds involving abdominal wall Nonascent of kidney due to = faulty blood vessels During formation of vertebra = ARTERY is intersegmental in position Gastrulation= process by which 3 germ layers form Meiosis in males occurs in = seminiferous tubules In testis haploi number of chromosome present in = spermatids Female child at birth oocyte ina stage of = prophase 1st meiotic Numerical values of embryology : Umbillical vesical attians full develpoment in

4 week in fetus

Reduction of phsiological hernia at

10th week

Testes descends into scrotum during

End of 8th month

Ossifiacation centers of all carpal bone found by

12 th year

Formation of primary ovary takes place by

8th week in fetus

Umbillical cord ( right umb vein disappears first , left is left with two arteris)

2 artery and 1 vein

Length of umbillical cord

50 cm

Length of mature human spermatozoa

50-60 microns

40


Melanoblast appear in basal layer of epidermis during

3rd month of IU life

Notochord develops in

3rd week

Malleus stapes incus present at

Birth

Optic vesicals appears at

30 day IU life

Anterior neuropore closes on

24 days


6th month

Development of septal defects in fetal heart occurs at

5-8 weeks

All generation of bronchus fully present by

16th week of IU life

Embryology of reproductive system : Uterus

Mullerian duct

Epoophoron,

Wolfian duct

appendix of testis

paramesonephric duct

Clitoris

Genital tubercle

Scrotum

Genital swelling in male

Embryology of teeth: First teeth to appear in infant

Lower central incisior

Cusp of carabelli is seen

1st upper molar

Stenson's duct opens at

2nd Upper molar tooth

Root of teeh does NOT contain

Enamel

Nerve in close relation to lower third molar

Lingual n.

Origin of tissues and organs : Sphincter and dilatoe papillae

Neuroectoderm

Skin , appendages of skin , brain

Ectoderm

Liver parenchyma

Endoderm

Precartilagenous analogue to bone

Mesenchyme

41


Melanoblast

neural crest cells

Somatic afferent column

Alar lamina of neural crest

Embryonic disc

Inner cell mass

Somites

Paraaxial mesoderm

Primodial germ cells

Endoderm of Yolk sac ( recently ectoderm )

Germ cells in ovary

Yolk sac

Oogonia

Yolk sac

Corona radiata of ovum

Follicular cells

Urachus fistula

Persiistent allantois

Urorectal septum separates cloaca into

Rectum and urogenital sinus

Collecting tubule of kidney

Ureteric bud

PCT

Metanephric tubules

Lesser omentum

Ventral mesogastrium

Ventral mesogastrium derivatives

1. Lesser omentum 2. Falciform ligament 3. Coronary ligament

Duodenum

Foregut & midgut

Right subclavian artery

Right 4th aortic arch

Falciform ligament contains

=Ligamentum teres

Ligamentum teres

= umbillical vein

Ligamaentum aretriosus

= ductus arteriosus

42


HISTOLOGY Lymph capillaries = have discontinuous basement memebrane JG cells are = smooth muscle cells of afferent arteriole Good collateral circulation in = skin Toughest layer of esophagus= muscularis Normqal process of repalcing old epitheilum with new one called= apoptosis DERMIS HAVE LYMPHATICS Functional unit of kidney = nephron Largest organelle in eukaryotes = ER Nissel's substance = ribonucleoprotein Location of important structures : Ducts of balini found in

Kidney

Haversion system

Cortical bone

Brunner's gland

Duodenum

Space of disse

Liver

Intercalated disc

Cardiac muscle

Cartilage: Commenest cartilage to ossify

Fibroelastic

Elastic cartilage

Auditary tube

No cartilage in

Bronchiole

Cells: Gitter cells

Microglia

stellate cells of von kupfer

Sinusoids of LIVER

Hasal corpuscles

Thymus

Holfbauer cells

In placenta in early pregnancy

Pseudounipolar neuron

Spinal dorsal root ganglion

43

Qworld Last minute Revision : Tanmay Mehta Glands: Holocrine secretion

Sebaceous gland

Epithelium: Calyx ,Pelvis ,Ureter, bladder , urethra

Transitional

Cornea

Stratified squamus nonkeratinnized

Tonsil

Stratified squamus nonkeratinnized

Ansa nephroni

Cuboidal and squamus

Parietal peritoneum

Simple squamus

Olfactory epithelium

Pseudostratified

Negative points of histology : Sinusoids = are not found in skeletal muscles Brain , internal ear, eye= have NO LYMPHATICS

44

Anatomy Last Minute Revision

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