Get Through

MRCS:AnatomyVivas

MRcs
Simon Overstall MB&s
Plastic Surgery Registrar
Thc Altred Hosphal
Helbourne. Australia

n. ft6y41
Socrrrvy
Mrotclt'tE
PRESSr,.u.r
O 2006 R<iyal Sociery of Medicine Press Ltd

Reprinted 2008

Publishcd by thc Royal Srcicty of Medicinc Prcss [,rd

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Contents

lntroduction

PracticeViva Quesdons 3
J
1. Upperlimb
2. Lower limb 15
3. Headand neck 25
4. Thorax 35
5. Abdomenand Pelvis 4l
)J
6. Back

PracticeViva Answers 57
1. Upperlimb 59
2. Lower limb 69
3. Headaad neck 79
4. Thorax 9l
5. AMomen and Pelvis 97
5. Back 1ll

Furtherreading 113
@ :,,'-:

Maay tbanls to Dr Norman Eisenberg and Dr Cbris Briggs * the

Urfivcrsity of Melbourne for the use of the Anatomdia imagcs. Also
*anls o Dr Gerry Ahrn and tf,e 'Dartoe Contractors' of Meradr
Uaiversity for the rse of cheir anetornical imaps. Tlracl<s to Dixori:
Woon ard Natalie Zantuck forproofreading.
A speial thanke to Frrya for all of her $rppcrt during &e writing of
6is book.
 t
o
lntroduction A
c
o

.\narom1,is one of the toughestsubiectsfor medicalstudentsand s.urgical

irainees.[t requiresa gooJ memory for derail and the ability to think in
rhreedimensidns.Thcrc is {unfortunatel,v)no shortcut to learning-thesub-
ic'cr.Read through the books and then consolidatcyour knowledge using
Jirr.ct.d cadaveis,plastic or computer models,or time spcnt in the oper-
.rrinsthearre,Ask questionswhcncver assisting, in theatre.Most surgeons
, r. onll' too kcen to show off thcir hard-earncdknowlcdge of anatomy'
Horr;e"er, anatomy is more than jusr rote learning. oi tables'
L:ndcrsrandthe basiciayout of thc bodl', the concept of fasciaand com-
rrarrmcnls, and visualiz.ethe three-dimensional modcl in your mind's eye'
tfh.r.
r feu'simplerulcsthat m:rvhelp you dedueemanl' surpriseviva
"r.
q' ugsrrons.
Some people 6nd mnemonics a uscful way to learn anatomy' My
.rdvicc $.ould tre to usc mnemonics only in coniunction rvith an under-
tundine ancla mental picturc of the region.lr is vcry easyto rcmember
rh.' rnnirn,rni.,bur to i rrget o'hat the dirtl rhyme or acronym actualh'
stendsfor. I har.eincludei t.-rm..f rhe cleanermnemonicsfor thosc of
vou rtho hrve not heardthem before.
This k rk is designedto be usedas a self-restingtool in preparationfor
rht anatoml' viva v6ce.The list of topics discussedherc is based91 previ-
ous viva questionsrcmembcredby candidatcssitting.the-MRCScxarn
,,,j.. th" p"rt fe*, years.By no meansis the list cxhaustivc.Certain ropir^s
cr()DuD in rhe e*ams time'and rime again. I havc rried to representthc
pr"fut.'n.. of thesc popular qucstion; in this book' For instancc, the
;L6;.; i, mu.h ni.* p*rprirt region for viva questionsthan rhe blck'
"
Thc best tinr€ to usc th;s 6ook is in thc weeks running up to the exam,
aher having read through a good anatomy textbook and atlas. closc
j'ourself thc questions in the front of this
i",,. r.*rf].i,rts and theri ask
Look. Bener still, find ,.r,n.uni clscto ask you the qucstions' Prctendy'rr
are in thc exam and try to verbalizethc answersin full for.crrchquestion
il.forc .-h"cking the anr*crs. You'lt be surprisedat how diflicult it is ttr
Irccururelvand-conciselyexphin c topic yor.rthought you kncw r.+'cll. lt is
nruch betier to practiscrhis techniqucnrrw bcfore the cxam. [)'rr't rv.rr1'
itj rrru can't recite all the answers as lisred in this book. Thesc are
de{i{:ncdas model ans\vers.Yor are unlikely ro fail for missing s.me .f
' finer dctails.
the
(io and
This book is useful for identifying g:rps in your knowledge'
rcaclthe relevanrch:rpter in the trixtfook if you don't feel you answered
l particular question wcll enorrgh.
"l'here:rreiix sectirr'sin the-MRCS viva vocc.Thescarc divided int<r
three sep;rrateexams:
. Applied SurgicalAnatomy/OpcrariveSurflery
. Carc
Applied Phvsiologl'/(-ritical
' A'ppliedSuigical Pathology/Principlesof Surgery.
 Eachexam lastsfor 20 minutes,divided into trvo 1O-minuresegments.
These
t During, the anatomy section thc examiners will often-use props'
e
c .uy U. B"n*, CT scans, MRI scans, specimcn FX)ts,live models' pho-
rographsor cadavers'
o There are rwo examlncrs for each section; one surgeon.1ld 3n
whilst the
3
.*o*lnr, ,rf the basic sciences.One will ask thc' questions
;;;;;;*. the ctntlidate and then they swap around' You rvill usually
*i;;;askedquestionson three or morc separatett-rpics'
be
il p;;[uuty t . askeda varietv'ofquesrionsrangirrg.indifficulty'
progre$s
The examinerswill'usually start with easierquesdonsand then
yuu .nr*., them rvell. However, don't read ttxr much
*-nra.t.t depth if
mean
1"r".,t i* luti becausevou are askedseverale'1syqucstionsd<>esn't
previous one badly'
'-r,ouanswercd the
There arc somegeneraltips that are useful for an,vviva voce:
r Always ask to have the quesdon repeatedor rephrasedif you didn't
hear or didn't understandthe first rime.
. ;;;; ti',int f'r a few secondsbefore shouting out the answer' This
wili givc "nJ you a chanceto organizeyour.thougits'
o Trv to Dresentyourunr*.r'in a clcar, logicil way' If prrssible'brcak
ot
uuu, .n.*.t up into headingsor topics,c.g' What are the branches
'The aiillary artcry is.divided into three parts
itt. r*itt.t)' anery? 'Ihe
first
,i.*Ji"g i, it e relati'nship to tire pecroralisminor muscle.
;; h;;;;. branch, thc secondpait has two branchesand the rhird
concise
il'"nr*.,h;; i'hr*. bt"n.h... They arc as follows"" A snappy'
like this will nrakcir clear ro the exlminer that yo' know;our
his box :tnd move on to rhe nex! question' A l,ng-

L
;;f,-it.;ii-d;k
in a random
winied list of the branchesthat have to tre draggeclout
order will annoy the examinersand lead to lorvcr scores'
. ;l;y; ilk ilt,i.*"tin... inthc cye.You will often be handeda bone
(but often
ii, tirl". other proP ro lead the que{iont' lt is a bad idea
l'ook at'
it""*"tf * *,i-Ui. ,t. answerwhilst staringat the obiect'
use the prop only to demonstrate ccrtaln
nnif tp..t to, the examiners;
points in your answer'
. F,*p..t the unexpected' There will alwa.vsbe a qucstion ytl l^<l'l:
nraKe an
know the answer to. lf this happcns it is reasonat:leto
inf.rrn,..l guess.However, if you'iealll' don't knor'vthen,stly"t: Tllf
you wlll
cxamincrJwillnlove(,n to lnother topic thopefully onc that
kno*l an,l vou'll havc :lll()thcrchanceto,pick up poinrs' r. r ,,t
. itur rh. bad oncs behind you. l)on't dwcll-on thc.question''ou drdn
i.;;';t;;;*"t"U uaty. T,y not to gtt ttxr flustercd'When thatquestion
ii;;C;htd y;" should'move.,n to"t'e"trate on thc nr'xt subiett' '
"ni
. riitt.n shorvna cadaveror wet specimen,take your timc to orietrtlte
y<lur
v'ourself.Find a point t,f refercnic that ,vourecogn-izt.and.work,
from'rhis. For exantple' when show-n thc lrrachtal plcx.us'
wav round
'v; ttttp. ,t., is formed by the conlluence'f rhe branches
f.^;L ?,,tift.
and lateral cords rhit form the mcdirn ncrve' You
i;;';1;. ;;.Ji"l
,ir,ruld,t.n he ebte r,i ,nlutk your way back from this
dcducethe rest,
landmark and

. fl..-,"i.i.. ,,r'ithyour,nswers. Av'icl lo'g-t'afflc ii -v,u can :rnswcrrhe

ouesti.n in a ti.rv.t.",l r"ni.n."r. This *,"illimprcsrrhc exarniners
and
I
lLl.rrul"ru more timc to gain ptlirrts in the nt'xt qtrL*sti(rn'
 !
t
ti
t
a

3
oc
o
5
o
:
!

PracticeViva Questions
 !

B
l. Upper limb I
3
D
o
1.1 Draw the b'raciid plexus and labd the branches.
Fa

o
zs
1.2 Vhich musclesdo tlre branchesof tbe poeterior cord of the :-
brachial plexus supply? c
,!!
o
1.3 Which muscledocs the long thoracic nerve supply and how j
would you teet it? r

1.4 How many branchesarigefrom the divisiong of the brachial

I plexus?

.t
 6, 4",b1,'/* -fr&.tr&*
"o
!l

.nJrtbh+*te<'ff-
o ,)"Wi
5
ll
o f ujo
o l=+
a.
o
t

!
c
!
o
I

r ?y'{""i

btu"J7;a&;/- u*.1"J e\z',ailPb' !

eiiJ'u*
'!Ywld^

Reproducedwith pcrmissionof I)artos (irutractors (sca78-548@bigpond'com'au)'

1,5 '
U h'+"- t'" r
a Idcntify this bone.
b Identify the bony points A to G.
c Which musclesattach at points H to K?

1.6 Dcscribc thc arrangemcnt of thc musclcs in thc flexor

compartmcnt of thc forearm.

1.,7 What is thc nervc supply to the forearm flexor compartmcnt

musclcs?
1.3 What are the actions of the flexor digitorum profundus and ?
flexor digitorum superficialis muscles?How would you test ;
C
dreat? l|
o

1.9 What is the motor nerve supply to the hand? r

o3
' Pt P 1 o
1 r. 0 What do the lumbricals do? i k.r !
g
/rf",J- tPf o
t!
1 . 1I do?
Whatdo theinrerossei -
c
lt
.. !
1 . 1 2 How many corilBartments are there is the extensor retinaculum o
and what runs through each one?
3
F

(lontractors (sca78'5486:bigpond'cotn'iru!'
Reproduced with permission of l)artos

1.13
a What is the yellow shadedregion on the dorsunr of the hancl
known as?
'ifhich tendons are
h What are the boundariesof this region?
labclledA trt C?
c What are the contetrtsof this anatonlical region? g : .
' ' t
1.14 Which musclcsmake up the shoulder rotator cuff?
.o 1.15 What arc the boundariesof the axilla? >\
l)

1.16 What are the contentsof the axilla?

o
J
t, 1.17 Namc the branchesof the axillary artery'
o
o
1.18 What is the clavipectoral fascia and which structures pierce it?
o
5

7.19 What is the quadrangular space and which sfirctures Pass

c
!
through it?
E
o

I 1.20 Which ncrvcs can be damaged by a fracnrre of the humerus?

q
 !
3
6
q
6
o
s
F
oc
o
o

o
r 5
b,/ ,
l e -
C
!
!
o

*r'(,1
-.,V C

ta^j*.

wirh permissionof Dartosc,ontractors(sca78548@bigpond.com.au).

Reproduced

t.2t
a IdentifythemuscleslabelledA to C.
labelledD to L'
b Identifytheotherstructures
of the cubitalfossa?
1.22 Whataretheboundaries

fossa?
ofthecubital
r.z3 whatarethecontents
f: l:f fffi
^u[;* retvo -
 Which of thc carpal boncs provide attachment for the flexor !
retinaculum and which structurespass through the carpal tunncli 0
a

o
\l'hich structures are cut through during an open carpal tunnel I
rclcaseand which structuresmav tre damaeed durine this t
procedure? o
o
o
t
5

-
?
.lt
t!
=
3
tt

1.27 Which dermatomcis this?

?
0
lt
o
o

D
oE
o
0
o
5

!
c
!
a
=
3
e

Reproduced with permission of Dartos contractors (sca78548@bigpond.com.au).

1.28
I
a tdentify the muscleslabelledA to J.
b IdentifythetendonslabelledK to M'
c What iappets to the tendonsat the pointsmarkedX?
1.29 What prcventsthe flexor tcndons from bow stringing? Dcscribe
the ariangement of thesc stnrdurcs. t,

o
1 . 3 0 Wherc does tlre musculocutancousncrvc arise from?
p
o
1 . 3 1 Which musdes does it suPPIY? fi.6,c o

L.32 Docs this ncrrc havc a scnsorycomPoncnt? o

c
!
t
o

af
 !
T
2. Lower limb n
B
t

h{ F
oc
1.1 How many compartmertsare there in rhe leg? \Y,:,,
M"l
a
+.
'

f"it"
o
5

o
I

i.
r
{o

f. h.
t' 0
- !

- i
tr-N
)eY,
! (rt

fl,'A t*t*,

Reproducedwith permissionof Dartos C,oaractors(sca78548@bigpond.com.au).

,,'
a Whatarethestrucnues labelledA to K?
labelled
b ldentifythearteries L to N.
c Namethe super6cialstructureslabelled0 and P?
d Which nervesrun next to the structureslabelledO and P?
e lfhich nervesrun next to the arterieslabelledL and N?

2.3 Which muscleslie in the anterior compartmentof the legi

JrJfi"
2.4 ir ,n" ffi-
whathappens of the
anteriorcompartment
regisdamiged? *A.lZ;o-27.\l.L.rf .l-orti,

2.5 What arethe boundariesof the femoraltriangle?

 r0 2.6 What are the contents of the femoral triangle?
I

2.7 What is the femoral sheath?

s
P 2.8 What is the femoral canal?
o
o
2.9 What is the femoral ring and what are its boundariesi What is
its significance to the surgeon?
|rJ

2.lO Where would you palpate the foot pulses?

{o

, I
, I

a
L
What investigationis this?
b Idcntift chcvesscls1;rhcllcdA tt:r.f.
 | . 1 2 Describethe vascularsupply to the leg. !
o
I
: . 1 3 Dessibe the path of the long saphenousvein. .t
o
J
: . 1 4 Vhich nerveruns in dose proximity to the long saphenousvein? D
What is the relevanceof this to the vasculaxsurgeon? o
o
2 . 1 5 Where doesthis newe arise? s.
0
I
5
F
2 . 1 6 What doesthis nerve supply?
{o
2 . 1 7 \Whatis the subsartorial (Hunteds) caaal?
3
F
2 . 1 8 What are its boundaries?

2.19 What runs through it?

l"!4k1,
*JyA,

r h-j

a.h.!.
l*{*
t'$ttr9*t

Drl
f l r .

m. W++tt5qf
issionof DartosContractors(sca78548@bigpond.com.au).

tk h'a it
'Which
a ioint is this and which sideof the body is it from?
b Name oointsA to D.
What attachesto points E to J?
!
2.21 What do the cnrciateligamentsdo? How would you test them?

a
6 2.22 Which of rhe cruciatesis rhc srrongerl pU a\re{i,"!.ts
o

3 (a.",/' /*t)
og
t
e
o
-t 5'^Y'tlrit^-t
t,
F n):.1 ,otLlrr,l
;
I lyox. 6r;lir
3
r !s^i tarJir''1tts

with permission
Reproduced (sc478548@bigFond'com'au}'
o{ DanosContractors

2.23 L ,
,"J,J ,t4 t{ u|rt tfbi^
a whichb.neisthis?
b Name the area highlighted in yellow.
c What attaches to Points A to C?
d What attaches to Point Dl
 !
I
a
a
||
7
og
o
g,
o
t
5

P
F
o
,j,lu, {o

3
,

a Namethe bonyprominence labelledA.

b Whichstructures passbehind(posterior to) thislandmark?
c Namethe structurepalpableat point B.
d \flhich muscles
conrribureto this suucture?
,-.htJ-nv. e Whatarethenervesupplies to thesemuscles? i
f Whichbonescanbe palpatedat pointsC to l.
,.],

',-f .y'l' t*i^

-?gL N
- P'ifi
. r 4 -
- irro^a L4aaWj ti
+ffn
-f '' h''"J!" '{€g
-{r! L fa*'J*
'+
!
T
a,
o

tl
o
5'
P

{o

(;ontrrct()r's1sce7li54ti(l'brgpotttl.coltr..ttt).
l(cp(rluced rr,ith pernrissionof l)irrtos

2.25
rr Which bonc is this and rvhich sitlc is it frorn?
b Narne ttie prrrtslirbcllcdA to K'

2.26 Describcthe blood suPPlyto thc head of thc fcmur'

"\' rif' f ts u {-'r'

2.27 What is the significanccof this?

thigh'
2.21J Narnc thc musclcsin thc antcrior compartnrerrtof thc
 A Ut''^r6 p1u
What is the newe to de nedial compartsnenrof rhe thigb?
!
3
B,
a
o

J
o
t
C
5
o
t
s
I i'2fr,f t,
I

t
o

3
u

( - ? ^' {

..j A€,J
(E*r*)

Rcproducedwith permissionof Dartos(krntractors(sca78.548@bigpond,com.au),

tt K".- ( )
a ldentify'rhcstructureslabelledA to H.
b t!flhardoesstrucrureF dividc into? - .

2.31 What are the boundariesof rhe poplirealfossa?

2.32 lVhich sfiucturesare in the popliteal fossa?

 Fl 7t-fz'{ F3:,ar'

!
3
a
o
J
D
o -----;-.I
o
e
0
I
fi*tP'
o
}J
F
''-lrt*'^"
o
; 5{" Y}''ll"tt

3
q
(e
- ob(":i{a'r"n't I
irJ;2e".,1!vt

QtJt'lt*1V
j

Reproducedwith permissionof Dartoscontractors(sca78548@bigpond,com.au|.

2.33
a This is the posteriorasPectof the glutealregion' Which sideis
it fromJ
tr Identify rhe musclestabelledA to G. ',
c !(/hich'nerve exitsthepelvisabovemuscleA? o' ., i. . **,n*
- 6 q "'^''
d Whichmuscles doesthisnervesupply? , 4'( ,
muscles do? tb&utfh ol hiF it-
c What do these
i i.,* *.,uld d".ig" i"Jttg 1.t'g tnanifestiiselfI 'h^Lu^by &;t
e tdcntify the ncrves H
latrelled to K.
f f- A *h ldentifythe arteries labelledL andlvl'
\i Fromwhicharterydo thcsctwo vessels originare?
dutt fJt"*"n do theset*.t
/ ,
clxitrhe wlvk? 4 s' f
; ilt;;h-;iri.t "ti"fi.t
* vJfi'}t t Wtti.tt'ttunyprominenccis markedby N' and whichnlusclt's
i n s e rht e r e ? A v " i ^ i - r ^ s , '/,igot*irs6+'t(q ,6.f,'
".t; ,6
2.34 Whichsrructures are cur throughduringthe posteriorapproach
to thc hiP ioint?
2.35 Which nervesare at risk in this approach?
!
il
&
2.36 Describethe mggJ*e_layers 9_!!s ColEql._t-h.e
foot. Which other
structuresrun in theselavers? o

!l
2.37 Which cutaneoussensorynervesuppliessensationto the oumide
*
o
of the thigh? n o
t L. L . n v .
0
t l t
2.38 Which dermatome is this? {,,2 9l
6

2.39 What are the surface markings of this ncrve (as uscd to perform {
o
anerveblock)? ,{,
l-L^ b. o*}ioJ € *rrS
t
t
2.40 What is the sensory nerve supply to the first web space of the
foot?
i y. n,
2.4t What are the nerve roots of the sciatic nerve? L ,, . 5,, t ,j
,5
2.42 What are the terminal branches of the sciatic n rur? ( t -^u
\ c.f .nv.
2.43 How would you test the sensarionand motor function of the L5
nerve rootl
)os*n q ,fr"t LHL
( r# "( v;yF4
 !

3. Head and neck D

a

g
.o
3 . 1 Describe
thearrangement
of thea..p r"rJ, k:rltr""u. o

6'
5.2 What are the boundaries of the posterior triangle of rhe neck? t
!",
' 3.3 Describe/demons'ate the actions of the sternocleidomastoid
and o
t|
trapezius? a
!l

3.4 o.
Which structures are found in the posterior triangle of the neck? J
o
r
3.5 What would be the effect of cutting the spinal accessory nerve?

3.6 List the layers you would cut through during a tracheostomy
tube insertion.
Fvyill*

11**

fu'le-j
c
lo{*'' "

-r,/
a Name the foramina labelledA to C. Which structurespass
through them?
b Name the boncslabclledU roZ.

3,8 How many boncs docs thc sphcnoidarticulate wirh and what
are they?
 r !
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i <
i ! r
i o
*"^',^f
f. :,,'.i:*{' fi
.t u/! t., r*t | ?
l o
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i {..,t,,:l
i l
ft*{ otr
I t t
i\?-/*> j c
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l c
t 5
l r D
;ttr;,,-lL,'l f *
'ia r.nl.l
stl"na5fi,d ffirg
l -
f, :....:.,..f.-nrlnl^+
, rv+i*-tz/
I
, i
-';Ast t , u
fic,tf d^t
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':i c.'llr' ;:rtt*b;?+:.':-'
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1.9
a Name thesc foramina. lVhat structurespassthroug,hthcm?
b ldentify poinrs H to K.

3 . 1 0 What is the path of the facial ncrve? What are its branches and
which structures do thcy supply?

l.t t How would you quickly tcst thc motor function of thc divisions
of the facial nervc?

r.t2 What is thc scnsory ncrvc supply to thc ear?

 blr'tfuo

'ldr LW
ttl*

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Idcntify the different parts of the ear labelled A to L.

3 . 1 { Describethe arraagementof the vcnousdrainageof the brain. !
Ia
i. l5 What are thc cavernousrinuses,what passesthrouglr them and a
o
whar is their clinicd relevaace?
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. z ^ * @r.Ltnl- , E.ba { oftt!.

a ldentify the vesselslabelled A to F.
b Name this anastomosis of vessels.

\.17 What are the surfacc markings of the cervical vertebrae levels?
! l
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A I
o l

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oc tl l-t- oore
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3.18 Surfacemark the following parts of the larynx:
r Hyoid bone
. Thyroid canilage
. Cricoid cartilage
r Firsrtrachealring
. Thyroid membrane
. Laryngealprominence
o Cricothyroidligament

3.19 What are the branchesof the externalcarotid artery?

3.2O What are the branchesof the internalcarotid artery?

3.21 Vhich cervicalvenebrallcvel correspondsto the bifurcation of

the common carotid arterv? (rr

3,22 What are thc branchesof the maxillary anery?

3.23 How many cranial nervesarc therc and what are thcir names?

3.24 What are the divisions of thc fifth cranial ncrvc?

-1.2.5 What do they supply sensationto?

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nerve on this facc.
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3.27
A to E.
labelled
a Namethesutures
b Namethe red shadedarca -. F'? f " '! :' ' :'
c lVhat run, behindir; - .
d What is the clinicalsignificanceof this?
e tdentifythe partsof the mandiblelabelledG to K.

3.28 What are the surfacemarkingsof thc parotid gland?

3.29 What are the surfacemarkingsof the parotid {Stenson's)

duct?

3.30 What arc the layc'rsof the scalp?

3.31 What is the blood supplyto the scalp?

3.32 Whereis the standardincisionmadefor accessto the

submandibulargland?Why is it madehere?
3.33 In what anatomical triangle does the submandibulargland !
lie? T
..: f}
ll
a\
1.34 Vhat nervesmay be damqgeddudng a submandibulat gland
excision? T
I
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j.35 Vhich vessclsarc usually errcuntered during the approach to o
I
rhe eub,mandibulargland? td"* vyua,t o
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3.36 l+ ' t' j t t t. ' ; r
h - '
a Namethe srrucrureslabelledA ro N. f' ''- . :
b Identify the structureslabelledO to S. What do rhey
communicate with?
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s.\f 3.37 What structuresrun through the superiororbital 6ssure?

3.38 Describethe arrangementof the extraocularmuscles,their

actions and nervesupply.

3.39
a ldentify the structureslabelledA to L.
- ( V- f
b lVhich'venebrallevelis this cross-section?

3.40 Which vertebralleveldoesthe isthmusof the-thyroidgland

corrcspondto? t+ V

3.41 Describethe relationshipof the thyroid gland to the layersof

the cervicalfascia.

3.42 Describethe blood supplyto the thyroid gland.

3.43 Which structuresare at risk of damageduring ligation of these

vesselsduring a thyroidcctomy?What are the consequenccs of
this?

3.44 Describcthc vcnousdrainageof thc thyroidgland.

 !

4 . T h o r a x - : . . ' :. ,-' r, ,, ;r
t't
o

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Ehat movementsdo the ribs make during respiration? o
t
o
t
I

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o
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x

What are the surface markings of rhe hean? tndicate the cardiac
borders on this chcsr.

{.1 What are the landmarks for inserting a chest drain?

1..{ Which layers would you go through whcn inscrting a chesr

drainl

-{.5 ln which of theseplanesdo the intcrcostal vcssclsrun?

{.(r Whar is the blood supply ro rhc ocsophagus?

l.i What constrictions occur in the ocsophagus?

l.\ What are the surfacc markings of the rrachealcarina?

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4.9 ( --iJ,qa4},afu b{6voA-t

a Wfratinvestigation
i1 thi3.l. :- U U . Uz .h{Av ,1,*,
arelabelledA to E?-
b What strucrures

4.10 Which of the main bronchi (right or left) would an inhaled

foreignobiectprefereotiallyenterand why?
pt.\.,*." L v' T Y / s
4.ll How manylobesdo the lungshavei
- u * tf l t
t

4,12 How many bronchopulmonarysegmentsdoeseachlung have?

36
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1.13 Name the differentpartsof the sternumlabelledA to E.

1.14 Whichthoracicvcrtebraclcvelsdo the diffcrcntpansof thc

stcrnumcorrespondto?

4.15 What is the morornervesupplyto the diaphragmiWhichspinal

levelsdoesthG ncrvearisefrom? { I
,rri

4.16 Whichncrvessupplysensadon ro rhc diaphragm?

Whichspinal
lcvelsdo thesenervesarisefrom? I

1.17 What is theclinicalrclcvancc

of this scnsorysupplyto the
diaphragm?
 !
4.18 What is thc blood supplyto the diaphragm?
T
a
a 4.19 What are the boundariesof the breast?
o
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oC t d{'
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4.21 What is the nervcsupplyto the brcastand'thenipple?
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4'27 r t nf.^- t '( -t' ,L-9-

{t Ul ' r
a rVhichsideis thislungfrom? *tJ'J
b Iflhich structurescausethe irnpressionson the lung labelled D
to F'?
c Which nervesrun in the positions lahelled G and H?
d \0hat are thc stnrctureslabelled A to C?

4.23 What are thc surfacemarkings of the lung fissurcs?

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-+.14 Namethe structureslabelledA to P.

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Rtpr<xlrrcedrvith pcrmission of [)artos (}rntracror:; isclT{1.j48(trbigfxrnd.conr.rul.

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Which bone is this?
Nan-rcpoints A to F).
t)

c V'hat attachesto point F'? G>IJ

,1 Wh:rt lrticul;rrcswirh point (,?

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a Whichboneis this?
b Identifythe bonypointsA to D., I
Whatattaches to pointD? '' i;
d Which srructurescausethe groovesE and F?
'"
\ e W h i c h s t r u c t u r e r u n s i n p o s iG ? nG
rio " 6"'.
( t ) f Which structuresrun aboveand belxg-PoinrS? ,i
c\ , {,
c WhichboneaniculatesFithpoinrA?- :
h Whichmuscleattaches at pointH?
ult r.n.nftt

h = t1 i f>./ r'-

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i.r pJ
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,
a Which vertebral levcl is this CT scan?
h Idenrify the structureslabelled A ro O'

4.28 Which structureswould a ncedlc passthrough during subclavian

vcin cannulation?

4,2() Which structuresarc at risk during subclavianvcin cannulation?

 !

5. Abdomen and pelvis a

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Vhich abdominaland pelvic srructuresare intrapcritonealand
which are retroperitoneal?
fi
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i 1 Which characteristics
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Which characteristics
will help distinguishbetweenlargebowel g
and smallbowcl? D
I
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E
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:.1 What are the surfaccmarkingsof theseopenings?

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5.6 a.--..:rj li,. :

il What is this iuvestigation?

l't klcntifv the structureslabclledA to F.
c Which structurefornts the faint lirremrrkcd (i? ,i
, ,J,-
)
tt \Vhrlt causestl-rccup-sh:tpedirttplessionlatrelleclI t r
).' Describethe courseof the urc*crs.What are their relations? !
il
n
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i.8 Wrat is the blood supply of the ureters? .t
o
a
i.9 Vhat causesthe consrictions of the ureter as seenon the )
intravenousurogram? p$ oE
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5.10
a What organis shown by A.
b ldentify the structureslabelledB to F. v
c What organis relatedto positionG?
d whati, it" u.r"i oiJ.i.,?ttgucrurss3sbeltl'-? h.d G 4a
t n: "t .e Therefore, which side is this-organfrom?
I
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f At what vertebral levelsdoes this organ lie and what are its
Ifascial
a s c r alayers?
llayerst
n&r
/t,. ^ ,1
g What are the posterior relations of this organ? \ 7 /t I

43
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5.11
a What is this investig,ation?
labelled A to L.
b ldentity'the vcsserls

5.12 Describe the course of the abdominal aorta.

5 . 1 3 Name the branches and describe the level at which they arise.

s.t4 What is the transpyloric plane and what sructures lie at this
levcl?

5.1.t What layers would a surgcon cut through during a midlinc

laparotomy incisionl
 ; it' \[,'hatsuucturesmakeup thc rectussheath?Is this the samefor
!
the enrirelength? T
a
A
o
: i- \Vhat is the epiploicforamen(of Winslow)?
r
oc
' o
": \{4rat are the boundariesof the epiploicforamen?
e
o
t
5
' "19 A fingercan be insenedinto thc epiploicforamenand squcczed !t
againsta thumb antcriorly.What is this procedurecalled?
a
9
3
r-10 What structuresare squcezed? o
t
D
)
g

,i.21 What is this procedureusedfor? ?{

5

i.l2 In the supineperson,what part of the abdomenis the most

dependent?

\.2-l What clinical significance

doesrhis have?

5.24 What is rheinguinalcanal?

i.25 What arethc boundaries

of rheinguinalcanal?

5.26 What runsthroughthc inguinalcanal?

5.27 What is rhemid-inguinalpoint?

t.28 What is thc midpointof the inguinalligament?

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s.29
a What is this investigation?
b Name thc parts labellcdA to.|.

.r.30 Where does thc common bile duct entcr the bowel?

,^/s.lt Which anatomical structure controls the sccrction of bile?

s.32 What are the layers of the spermatic cord and scrotum and
which layers of thc aMominal wall do thcy dcrivc from?

5.33 Vhar are the contents of the spermatic cord?

5.34 What is the fate of thc right and left testicularveins?

5.3,5 What is thc clinical relevanceof this?

5.-16 What is the lumbarplexusand which muscleis it rclatcdto? !
E
at
5.37 Whichnervesarisefrom thc lumbarplexus? a
a

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5.38
Y
:r Whar is this investigationand what levelis it?
b Narne the srructureslabcllcd A to P. I
.;..19 Describcthc blood supply to the stomach.
I
.5.40 Describcthe venousdrainage of thc stomach.

-;.41 Where are the sitesof portosystemicanastomoses?

II
5.42 Dcscribc.theorigin, path and branchesof the superior
mesentcrlc artcry. Ii
i
-5.4.3 Dcscribethe blood supply to thc colon.
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5.44 What is this investigation?Namethe partsof the bowel labelled
AtoI.

5.45 Which partsof the colon are retroperitoneal?

5.46 What is Calot's triangle?What forms the boundaricsand what

are the contelts?
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|vc I anaJslt-,
5.47
a What_organis this and from which angleis rhe phorograph
taken?
b Name the differenrlobeslabelledA ro D.
c Whar are rheorher srrucrureslabelledF.to Ki
Itk - 7.y'^9 A
!
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s.48 f-q,v,,t t^yta.u 4.'{}" 4lee^

a What is this organ?
b Which sideof the body is it from?
c What adiacentorganshaveleft the impressionsshown b,r'A
to D?
d Is this organnormallypalpable? lf not. how muchbiggermust
it be beforeit is palpable? .
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5.49 6.
a Is this a maleor fe#le pelvis?
b Namethe structureslabilledA to M.
c Namethe aperturelabelledN._pd,"J,.
i&
i.50 Describerhedifferentpans of rhe urethrain rhe male.

i.5l which part of the urcthrais responsible

for conrrotof the flow
-(w"+"1/6^^aw
of urine? 4>t' spt,r*k<
"roleii
.;.-52 Whichis rhc mostdilatablcpart of the urethra?
P6r,t,l'"
5.53 Which is rhe leastdilatablepart of the urethra? yn4*i;t
ra2v-1t-$
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5.54
'h:r,r4v. a tWhichbone is this?
't -
b ldentiflpointsAtoN]
. i.r"r". it'. rhree bones labelled X to Z that forrn this trone?
d Whcre do these three brrnes nrcet?
e What anachesbenvecn points A and H? .
() ru
f What is representedby thc blue shading at points and t
g Which muscleorig,inatcsfrom pointJ? nt\'.U 5-'f
A t .
of I'f J ''
4 ' l - ' -
5.55 Describc thc peritoncal relations of the rectum'
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5.56
a This is a seriesof photographstaken during a cystoscopy.Is it
Irom a maleor temale?
Identify the strucrureslabelledA ro J.
L What sructure(s)opensinto point H? What is its (rh_eir)
funcrion? c1^6-J'+2-
d What strucrure(s) opensinto pnint I?
 !
6. Back ;t
a
c- 6 a
|t
T-az J
- t - - >
3 ' Pa " r 1 I
5-s- oc
6.1 How many spinal nerves are there? e _ i
o
0

o
t-
6.2 What landmarksare usedwhen performinga lumbar puncrurc?
I
F
t
6..1 Which layersdoesthe tumbar punctureneedlepassthrough? a
-

6.4 Describethe anaromyof the sympathericchain.

{rr-rL, _ v w;42

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Rcprtxluced
with permissi,nof l)artosc'nrrlct'rs (scr78.i4g(rrbigprnd.c'm.ru)
(r.5 njf'ul (z\,,;Gl lnrtlto ( (t-+)
;lWhich region of the spine is rhis vertelrrrrfrom?
n Which-ckrracreristicshelp you identify its position?
c lclentifyrhe parrs lebellcdA ro |.
 itt':. V
i.

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f

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Rcproducedwith permissionof
6'6 t'grio{ HPc't 4 Ih-oto-" Vttebtq
a Whichpanbf the spineis this vertebrafrom?
b What characteristicshelp you identify it?
c ldentify pointsA to F.
 a
l. Upperlimb tl
e,
o

t
l. I Answer u
to
ROOTS TRUNKS DIVISIONS CORDS Branches
t-
c
DS !
!
SC LP t!
^( Supmg€pulry
3
It

c6
NS LS
c7 TD
Mont f SIERq
US

c8

T1 MCNF
MCNA
MP
Lmg th@ic

drawing the basicpaftern of $e brachialplexus usinga

lractile
simplifiedline diagramlike the one above.This shouldtake lb
seconds.Then fill in the branches.
Ihree bronchesfrom the roo6:
r Dorsal scapularnerve
. Long thoracic nerve
r Nerye to subclavius
One bronchfrom the upper trunk
o Suprascapuhrnerye
fhree brondres from the loterolcord:
r Lateral pectoral nerve
. Lateral root of median nerve
r Musculocutaneousnerye
Fivebronchesfrom the pos-teriorcord:
t Upper subscapular nerve
e Thoracodorsalnerve
o Lower subscapular nerve
. Axillary nerve
. Radialnerve
The spines are small and bifid (except C1 and C7
which are single) and the articular facets are relatively
 Fivebronches
from the mediolcord:
a o Medialpectoral nerve
tl
r Medialcutaneousnerveof arm
rG r Medialcutaneousnerveofforearm
. Medialroot of mediannerve
tl r Ulnar nerve

{o 1 . 2 Answer
d The posteriorcord of the brachialplexussuppliesthe musclesthat
:' form the posteriorborder of the axilla"deltoidand posterior
c musclesof tlre arm and forearm.
!
!
o
The bronchesore the:
. Upper subscapular nerve- subscapularis
ET . Thoracodorsalnerve- latissimusdorsi
. Lower subscapular 66trfs- su65capularis
and_leresmaior
r Axillarynerye- deltoid,teres mlnor
. Radialnary€- triccps,all the cxtcnsor murclrs of thc forgarm

t.3 Answer
The serraus anterior muscleis suppliedby the long thoracicnerve
(of Bell)(C567 Bellsin heaven).
To test this muscle,ask the patientto facea wall and pushboth
handsforward againstit. Weaknessof the serratusanterior muscle
will causecharacteristicwintint of the scapulaon that side,

1.4 Answer
None, as all the branchesexit the brachialplexus before or after the
divisions.

t.5 Answer
a This is a right humerus(with the humeralheadpointinginwards
the capitulumand trochleapointingforwards).
b A Greatertubercle
B Lessertubercle
C Intertubercular(bicipial)groove
D Medialepicondyle
E Lateral epicondyle
F Trochlea
G Caoitulum
c H Pectoralismajor
I Latissimus dorsi
J Teres major
Rememben
Ladybetweentwo majors.
K Deltoid
 f, Arr*er ,J, !
D
The brearm ffexor muscles are alglged in two layers.
F'
ne s+erlUa |oyer has five musclesarranged like five fingers o
ndiating out from the cornmon flexor orlgin of the medial
epicordy'e of the humerus (they all cross the elbow joint). From !,

bterd to medialthe musclesare: pT g

. Fronator teres Io
r Flexor carpi radialis F cF
"' il
o Flexordigitorumsuperficidis FD9
:-
r Palnnris longus DI c
r Flexor carpi ulnaris ccu !
!
o
The deep loyerlrasthree musclesand they all originate in the forearm =
(none crossesthe elbow ioint): 3
r
.- r Flo<or pollicis longus f: PL
,n o Flexor digitorum profundus pllc
r Pronator quadratus PA

1.7 Answer Nt
The forearm compartment flexor musclesare all rupplied by the
n1gllangry" €xcept for the flexor carpi ulnarlsand the ulnar half of
dre flexor dlgitorum prorfrrndusmuscles,which are suppliedby the.
ulnar nerve. Feu r Luvip (-
lJ Answer
The flexor digitorum prgfundus(FDP) tendon inserts into rhe base
of the disal phalanx of the finger. !t can be tested by asking tlre-
patient to flex the distal interphahngealjoint ofthat finger. DIF
The flexor digitorum rygglgi{is (FDS)tendon inserts into the
bapeof the middle phalanxof tfie finger. Flexionat tlre proximal flf
interphalurgeal ioint can be by the contraction of both tlre FDS and
6s FDP. Therefore, ro tcrt dre function of the FDS muscle atone,
the patiem! FDP must be inaciyated by holdingthe other fingers
ow stralght and askingthe patient to flex the unrestrained finger.
. Remember:
Sup"rf"gE:d,o-t" -p to
"{ry-plgfulus
passing
through.

1,9 Answer n^"e NJ ,nl?

All of the Intrinsic musclesof the hand are suppliedby the ulnar
nerye except for the lateral two lumbricals,opponenspollicis,
abductor pollicis brevis and fle:<orpollicis brevis (LOAF muscles),
which are suppliedby the mediannerve.

l.l0 Answer
There are four lumbricalsin eachhand.They aaach proximally to
the FDP pq1!on, cross the radial side of the corresponding u&3)
meacarpal phalangealjoint (MCPJ)and insen int rhe e-r€nso7 yw {\tniyn'a<-
expansionof that digir They flex $e MCPJand extend the
interphalangealioins. {^u{
ht1-
Wyo*"'ffi
 l.l I Answer
!
TD
There are four dorsal inrerossei (between the bones).Eachanaches
proximally to adjacentsides of the two metacarpalsit lies between
o
(i,e. the fourth dorsal interosselataches to thc fourth and f1ftfi
metacarpals)and insens distally onro the baseof the proxlmal
!l
D phalanx.The Dorsal InterosseiABduct the fingers.The litde finger
2
Io . hasa separateabducor (aMuctor digitl minimi).
' There are three_palmar interossei which atach proximally to the
a palmar aspectofthe second,fourth and fifth metacarpalsand insert
:' distallyinto the baseof the proximalphalanxof the corresponding
!
c digit. The PalmarinterosseiADuct the fingers,
T RemernbeF pAD .natoag.
=
3
r Ll2 Answer
There are six companments. From radial to ulnar:
'
{\ L F' : t. L Extensor pollicis brevis and abductor pollicis longus
2. Extensor carpi radialis longusand extensor carpiradialis brevis
,- tr J. txrensor pollicislongus
4. Extensorindicispropriusand extensordigitorumcommunis
5. Extensordigiti minimi
. 6. Extensor carpi ulnaris

l, | 3 Answer
This area is known as the anatomicalsnufi box.
b The anatomicalsnuff box is bounded on ttre raail side by the
abductor pollicis longus(A) and exrensor pollicis brevis (B)
tendons. On the ulnar side is the exrensor pollicis longus (C)
tendon. The floor is the scaphoidand trapezium bonei.
The contenB ofthe anatomicalsnuffbox are the radial artery,
radial nerve and extensor carpi radialislongusand brevis tendons.

l.l4 Answer
The rotator cuff is made up of four muscles:
r Supraspinatus
r lnfraspinatus
r Teresminor
r Subscapularis
RemembenSITS.
These four musclesblend their tendinous insertironsinto the articular
capsuleof the glenohumeralioinc This arrangementholds the
humerus dghtly in position, givinggreater stability to the shoulder
joinq but still allowing a lalge rangeof movement.
l.l5 Answer !
The axilh is a pyramidd, intermuscularspacewith the following *
tg
boundaries: o
fi
- r Apoc cervicoaxilhry cand (the convergence of chvicle' scaPula
and first nb) ?
t
- o Anterion Pectoralis rnaior and minor muscles
t
\ o Base:axillary hscia ?
\. Poaterior subscapuhris, teres nraior, latissimus dorsi muscles
(superior to inferior) ro
-- o Hedial: upper three ribs, intercosal spacesand sgl3gls anterior :-
. muscle
c
!
!
\ r Laterat: intert rbercuhr groove of humerug short head of biceps, o
coracobrachialistendon
3
t:
l.l6 Answer
The contents of the axilla are:
o Axillary artery and its branches
. Axillary vein and its tributaries
. Axillary lymph nodes:
Level | (bdow pectoralis minor)
Level 2 (behind pectoralis minor)
Level 3 (above pectordis minor)
r Brachbl plocus - cords and brandtes
r Fat

l.l7 Answer
The axiflaryartery is dividedin@thlee+artsi -
. h;g.tpan is m6dd to dre pecoriisinor andhas6ilbran.n,
,{f,
$gPeriorthoracicarterY
. Secoid part is behind the pectoralisminor and haiG.
-T-ora.*.tomid '"J branches:
tnrnk f A
Lateraldroracicartery L1
. Third part is la@ralto thil pectoralis minor and has6E€;brandres:
Subscapularanery
Anterior circumflo< humeral artery
Posterior circum{lex hurreral artery

l.l8 Answer

The clavipectoralfasciais a thin layer of fibrous tissuethat surrounds

the pecroralisminor muscle.lt ataches superiorly to dre clavicleand
inferiorly to the axillary fascia lt is thus the susPensoryligamentof
the axilla below the pectoralis minor.
Four structures pierce the chvipectoral fascia:
r Two stllrctures Fssing in:
Cephalicvein
Lymphaic vessels
r Two stru€ulres pa$ing oue.
Lateral pectoral newe
Thoracoacromial trunk
 l.l9 Answer
!

The guadrangufgspaceis formed:

d
. Laterallyby the humerus
o . Mediallyby the long head of triceps
. Supe4gdy by the teretmlnor
D
. Infgigfly by ttre te13g rngier
I
{o Passingthrough this spaceis the axlllary_-n-e1rye
and the posterior
circumflex humeralarteqr

c
1t
1.20 Answer
.g
o The nervesthat can be damagedare the:
. Axillary neF e as it passescloseto the n_ec(of the humerus in the
quadrangularspace
v
o Radialnerve .u;it winds a_rgundthe shaftof the humerusat the
luricrio-nbetween ttre proximal two-drirds and distal one-drird
. Ulnl!: nerye as it passesbehindthe mg*dlalegicondyle
o Mediannerve in a supracondylarfracture

1.2| Answer
a A Bicepsbrachii
B Brachloradialis
C Pronator teres
b D Ceohalicvein
E Basilicvein
F Mediancubitalvein
G Radialartery
H Brachial arrery
I Cephalicvein
J Lateral cutaneousnerve offorearm (termination of
musculocubneousnerve)
K Medialcutan@usnerve of forearm (branchof medlalcord of
brachialplexus)
L Bicepstendon

1.22 Answer
The cubitalfossais a trianglhr intermuscularspacebounded:
r Superiorbr the interepitrochler line
r.. Mediall)cthe pronator teres
\ Laterally:the brachioradialis
,2. Floon the brachialis
\. R6.?t the iiieiEda of the forearm ^

1,23 Answer
From lateralto medialthe contents of the cubitalfossaare the:
o Bicepslendon
o BrachialArtery (with venaecomiantes)
r MedianNerve
Remernben
TAN.
i.21 Answer !
D
a Prorirnolro>v
!i
A S<aphoid n
o
B Lr.nate 3
C Triquetrum t
D Pisiform D
t
Disul row:.
E Hamate
t
r!
F Capiate a
G Trapezoid -
H Trapezium
c
E
b X marks the hook of the hamate-
€
a
c Y marks the proximal interphahngealioint of $e index finger'
:
g
25 Answer
The fle:ggr retinaculumattachesto the:
r Hook of the harnte and lateral ridge of the trapezium disully
o Pisiformand the tlbercle of tlre scaphoidproximally
The contene of the carpal tunnel are:
o Four flexor digitorum superficialistenlons
. Four flexor digitorum profundustendons # I .
. Mediannerve
r Flexor pollicis longustendon b-1 trl=\-
r Flexor carpi radialis@ndon s^)(d$o,.-r-

-26 Answer
During open carpal tunnel decompressionthe following layersare
cut:
r Skin
o Subcutaneousht
r Palmarfascia
..#
. (Eharis 6-revismuscle,occasionally)
. Fb*or retinaculum
It is imponant to divide dre entire length of the flexor retinaculum.
At rirk ofdamage in open carpaltunnel releaseare the:
r Palmarcutaneousbranch of the mediannerve (sensadonto the
thenar eminence)
o Recurrent branch ofthe mediannerve (motor branch rc the
thenar muscles)
. Ulnar nerve as it passesthrough the flexor retinaculum(with an
incisiontoo ulnar)
r l'ledian nerve
r Suoerficialpalmararch
. Fl;;;6-i6-s through the carpaltunnel
pa-ssing

1.27 Answer
This is the C6 dermatome.
 1.28 Answer
!
T a A Flexor carpl radlalls
B Palmarislongus
o
C Flcxor cerpl ulnarlr
D Flexor pollicislongus
i' E Brachioradialis
D
F Flexor digitorum superficialis
t
(D G Abducor pollicisbrevis
a H Flexor pollicis brevis
I Flexor digiti minimi
c
1t J Abductor digiti minimi
! b K Flexorpollicislongus
o
L Flexor digirorum profundusto litde finger
M Flexor digitorum superficialisto ring finger
c At point X the flexor digitorum superficialis(FDS)tendon splits
to insert into the middle phalanges.
The flexor digitorum
profundustendon passesthrough this split in the FDSto insert
into the baseofthe disal phalanges.

1.29 Answer
To prevent t}te flexor tendons from bow stringingthere are a series
of fascialcoveringsthat anchor the tendon to the bony skeleton
whilst still allowingthe tendons to glide smoothly.
At the wrist there is the flexor retlmculum and on dre fingers the
pulleys.There are the annular (Al-5) and the cruciate pulleys
(cr-3):
. A I pulley is over the metacarpalphalangealjoint
. ,{3 pulley is over the proximal interphalangealjoint
. A5 pulley is over the distal interphdangealioint
,--u' . A2 pulley is over the proximal phalanx(qgstrmpg.tant pulley)
o A4 pulley is over the middle phalanx(seconrimost impffit
pulley)
o C I pully lies between A2 and A3
o C2 pulley lies between A3 and A4 >\
o C3 pully lies between iA4 and A5
From proximal to distal the pulleysare: A I , A2, C I, 43, C2, A4, C3,
A5.

1,30 Answer
The musculocutaneousnerve is the continuation of the l*.i!r|c!trd .
of the brachialolexus.

1.3| Answer
The musculocutaneousnerve suppliesthe:
o Bicepsbrachii
r Erachialis
. Corocobrachialis1
RememberThe musculocutaneousnerye is the BBC nerve.
I

Jl Answer -: !
I
!l
I Yes, it does. Hence the name musculocrtoneous. After givingoff ia
I morcr branchesit crossesthe lateral border of the bicepstendon
o
I and continues as the lateral cutaneousnerve of the forearm. This
I suppliessensationto the radialhalfof the volar forearm and also !|
some of the dorsalsurface.
6
I I
II o

| *r'tr c
o

-. Tk";q3 A- ^J ' r't

I
l 'vLaih -.L;,r-L f<a4tga4zt - t, Lr3 f( ,: /]K
|
T-tcJ'-<- S S-2, tz-+.-es- LS Ltt
|
A,-uf k{€ n=:.}g< C+!4
I
I
4-
I _ , o-7odr*'aa c"r..*1^1, +. 4e"-
n kL<.- y(tt,:L<- .ft",..r.= Jr fr
I
_<.Ve-n *,-a+t L3 L,f
I ^
@ €rLew: F^-r i <,n cs-A
|
S Erluo<.: Q-xtzv&iT't a+_k
I '
Il , *'- 7r>"-[7-1- p<rlk'- ,1 ir't t ^-.-- -€i '*-L
'
+ ft\t - n^,"n-<-t^-<'<n? {A LL
|
5-crxr'tr?*
i H-y Fte.->> t -L: -vr<z- <toL* 4U+'/h"l<I
I
I
| TnkL- -^.,u*u,*'l 4- LL'
Y*
"
L
A:p<>'t--^
46
r t-
-rc+a-ry t<Srr'A " k
I;
,- # %Y+ x^*"F **^^i
|I *,
*FFY-?A ?L:{. luk
t<L ndo -P{*xr 4 ,-, X Ls-t
rM< , J-sys I - ?[e"]er- kls &. -91 5z-
 .!

2. Lower limb D
e,
1'l
o

I
D
al t
Answer 5
{o
There are four compartmentsin rhe leg: -
I

r Anterior P
o Lateral
o
r Superficialposterior t
r Deep posterior o

L2 Answer
3
EI

a A Tibla
B Fibula
C Soleus
D Ga$rocnaemius
E Planaris tendon
F lnterosseusmembraneu/
G Flexor hallucislongus
H Tibialisposterior
I Flexor digitorum longus
J Tibialisanrerior
K Peroneuslonlus
b L Anterior abiJ anery /
M Peronealanery
N Posterior ti6i"l lftery,/
c O Long saphenousvein
P Short saphenousvein
d The saphenousnerye runs *,.{ long saphenousvein (O)
whilst the sural nerve runs with {"ttre sholn.ipf,"i.r, vein (p).
e The deep peroneal nerye runs in the anerio'r
*rnp""**a
dre tibial artery (L). The tibhl nerve .n,l'n *" a""p"iai,
-anterior
posterior companmenr witi the posterior tibial anery (N). .

L3 Answer
The folloving muscleslie in the
c Tibialisanterior "nr".iorfrp"rtrnenr
o Exrensor digitiorum longus
. ExtensorhallucislonguJ
. reroneus tertius

L4 Answer
The patient wlll be left with a foot drop.
 f t t \
.! 2.5 Answer Yet*or4 ' ux
l e Medially:the medial border of the adductor longus
ti r Lateralbcthe medial border ofthe sartorius
o r SuperiorV:the inguinalligament
o Roof the fascia lata
D
. Floon iliacus,psoastendon, pectineusand adducror longus

I
o Ancwer b^hl7
t,F
A
t

P From lateral to medial:fumoral nerve, femoral artery, femoral vein

and lymph nodes,
5
t Remember:NAW: Nerve, Anery, Vein, Y fronts.
=
3
r 2.7 Answer
The femoral sheathis a continuation of the extraperitonealfascia-
formed anteriorly by the tranwersalis fasciaand posteriorly by the
ileopsoasfascia lt is a fascialtube that extends for 3 cm below the
inguinalligarnentand surrounds the femoral artery, femoral vein and
femoral canalconaining dre tymphatjcvessds.lt does not contain
the femord nerve,

2.8 Anrwer
.The femoral canalis the most medial of the cornpanmens of dte
femoral sheath. k conains faf tyrnphatic vesselsand Cloquet's node.
Superiorlythe fcmorrl canrl opens Into drc femoral rlng,

2.9 Anrwer
Th" fg*otd_{rrais the superior mouth of the femoral canal.lts
boundariesare:
r Anterion inguinalligament
o Posterion superior ramus of the pubis covered in 6e pectineal
ligament(of Asdey Cooper)
o Medialbnlacunar ligament
. Lateral: fasciaaround the femoral vein
It is where a femorel hernia would occur.

2.lO Answer
The dorsalispedis pgJsgis palpatedon tlre dorsum of the foot iust
lateral to dte octensor hallucislmgus tendon over the cuneiform
bones.
The posterior tibial pulse is palpablehalfrraybeween dre
posterior border of the medial malleolusand the tendo-Achilles.

2,, I Answer
This is a digital subtraction angiogram (DSA) of the left leg.
b A Common femoral artery
B Superficialfemoral artery
C Profundafemoris artery
D Poplitealarrery
 E Anterior dbial artery (Note the perpendicularcourse as it .g
grercesthe interosseousmembrane) c
F Tibioperonealrunk
G Peronealanery
;'
o
H Posterior tibial artery
I Dorsalispedisartery !l

J Lateral plantar artery

{(l
: 7 Answer Yo-s,-.b-r ,-(4 ( Aa) d
N
The external iliac artery changesits name to the femoral artery after
passingunder the inguinalligamenrThe femoral(or common
femoral) artery givesoff a deep branch calledthe profunda femoris {o
that suppliesall the drigh muscles.The continuation o{ the femoral
anery is known by vascularsurgeonsas *re superficialfemoral
c,
artery. Thls vesselthen becomesthe popliteal artery after passlng
through the adductor hiatus ofthe adductor magnustendon. ln the
poplitealfossa,it givesoff fivgACercular-branches (superior medial,
superiorlaeral, inferior medial,inferior lateraland middle).The
poplllgel 3rtery ends by dividinginto the arEe!Sl!ibb|{r9q/
(smaller)and tibioperoneal trunk (laryer). The anterior tibial artery
piercesthe interosseousmembraneand then runs in the anterior
compar$nent of the leg supplyingall the musclesof this
compartrnenLThis artery becomesthe dgqgalifpc![J artery after
crossingthe ankle joint.
The tibioperoneal trunk dividesinto the peroneal anery (larger
branch) rhat runs close to the fibula and the posterior tibial artery
that runs in tlre posterior companment close to the tibial nerve. At
the ankle,the po_Sgrigt_lbial_artery runs behind the medial malleolus
and then dividesinto the medialand lateral plantar arteries, The
lateral plantar artery anastomoseswith the dorsalispedis artery at
tie plantar arch.

2.l3 Answer Lsv

The long saphenous vein starts in the foot atthe confluenceofthe
dorsal venous arch and the dorsal vein ofthe great toe, lt passesiust
anterior to the medial malleolusto climb up dre calf,just posterior
to the palpableborder of the tjbia- lt passesa hand'sbreadth behind
the medial border of the patella,continues up tlre medial aspectof
the thigh and then pierces the hscia lata to drain into the femoral
vein at tie saphenofemoraljrlnction (approximately2 cm below and
lateralto the pubictubercle).
There are numerous perforatingveins connectingthe deep and
superficialvenous systems.fu a rough guide,these perforators are: I
cm below, I cm aboveand l0 cm abovethe medialmalleolus,one in
the middle of the calf and one iust below the knee. In realiry,the
position of the perforators is quite variable(hencethe need for
Doppler markingprior to varicosevein surgery).
.g 7.14 Answer
L9V
t The Ep[gnggr n6rye runs close to the lo-ngsaphenous vein below
rf thc knsc. lt mry bc drmagcd durlng rtripplnt of th. Infcrlor part of
thc long rephenour veln whcn rcetlnS vrrlco3! v6lns,
ll
2. | 5 Answer
I

3
T
The saphenousnerve is a branch ofthe femoralrnrue and passes
through the subsartorialcanalwith the femoral vessels.
P
2,15 Answer
o
t
6 The saphenousnerve suppliessensationto the mgdid3lpg:t of the
ca[3odlgel-
3
lr
2.17 Answer
The subsartq{al (adductor or Hunter's) canalis an intermuscular
tulnel beneath the middle third of dre sartorius muilE. ltiids at
the adductor hiatus,an openingin the adductor m.gnus tendon.

2. l8 Answer
r Lateral:vastusmedialis
r Posterion adductor longusand adductor magnus
r Anterion sarcorlus

2 . 1 9 Answer
{
The contenrs of the subsartorialenalare rhe femoral ve$els as they
palsfromthc anteaollifiiifri6-ffi6il'c thc poptiGi-iessets:
r Supcrffclal
fcmoralanery(anterlor)
r Femoralvein (posterior)
Saphenousnerve (NoterThis nerve does not exit through the
adductor hiatus but perforates beoreen the gracilisand sartorius
to run with the long saphenousvein)
r Nerve to vastusmedialis(Note:Again,this nerve does not exit
through t}re adductor hiatus)

2.20 Answer
a Thisls the left kneeloinr
Note:the medial condy'e or plateauof dre tibia is larger tJranthe
lateral side. The lateral femoral condyle hasa grearer prominence on
the side of dre patellagroove to preyenr dre patellabeing dislocaed
laterallywith every contractironof tie quadriceps- $is muscle has a
lateralpull.
b A Lateralcondyle of femur
B Medialcondyle of femur
c Intercondylarfossa
D Patellagroove
c From anterior to posterior the following structures attach into
!
$e tibial plateau: !l
E Anterior horn of medial meniscus o
6
F Anterlor cruciate ligament t
G Anterior horn of latenl meniscus s
H Posterior horn of lateral meniscus ll
I Posterior horn of medial meniscus !
J Posterior cruciate ligament
n
{o
Answer
z
N

The cruciate lisamentsat@hlhg_fibia to thgQmur and are named o

accordingto their position of origin on the(ibi4 {
o
The anterior cruciote ligomentabches t" O"'fi-t";Q part of the
intercondylar area of the ribia, iust behind the mddi4lneniscus. lt
t
runs superiorly and posteriorlyto ettach into *d@
cogdyl{inrercondyla ur. lt preyp-ftsthe tibia from
beingdisplacedanteriorlyfrom the femur and prflvenc V
hyperextenslon
--'The:anteriorof the knee.
cruciate ligamentis tested by assessingthe arnount
of anterlor movement of dre dbia reladve to ctrefemui with tlre knee
flcxcd to 900 (anarlor drawer tcst).
The poxerior auciate ligamentattaches to the@kjr aspect of
the intercondylar area of the ribia. lt runs superioit/ind anteriorly
to actachinto the4fEil@condyley'intercondylarnotch of the femur. lt
Pr!y_e"[sthe tibia displacedposteriorly from the femur and
prevents hyperflexion ofrfie knee.
The posterior cruciatc ligamentis tegd by assessingthe atrlounr
of posterior movenrent of the tibia relative to the femur with the
knee flexed to 90' (posterior drawer test).

Answer
The posterior cruciate ligamenris stronger than the anterior.

Answer
a This is tJremedialaspectof the left tibia.
b This is the pes-?nFFiFirlffdm-rhqtatin for goose's foot).
c From anterior to posterion
A tlrtorius
B Gracilis
C Semitendinosus
Remernber:
SayGrace before Tea
d The tibial (or medial) collateral ligamenr

Answer
a This is the medial malleolus.
b Passingposterior to the medial malleoluq under the flexor
rednaculumare (from anteiior to posterior):
r Tibialis posterior tendon
 . FlexorDigitorumlongustendon
!
D
. Posrerior ribial Anery
. Venaecgmitantcsof tha po*erlor dbial ancrl
F
i r Tlblal Nbrve
o Flexor Hallucislongustendon
?
t
Remcmber:
Tom, Dlck And Very lthughty Harry."
=
o
t c This is the tendo calcaneusor Achilles endon.
o d The three musclesof the superficialposterior compartment of
P the leg insert into the calcaneusvia the Achillestendon. They are
tne:
5
{ . Gastrocnaemius(medialand lateral heads)
o . Soleus
I

r Plantaris
3
F e All the superficialposterior compartrnentmusclesare6upplied by
the tibial nerve.
f The bones that can be palpatedalongthe medialborder ofthe
foot are:
C Distal phalanxof great toe
D Proximal phalanxofgreat toe
E First metaarsal
F Medhl cuneiform
G Navicular
H Talus
I Calcaneus

2.25 Answer
a This is the posterior aspectof a right femur.
b A Head of femur
B Neck of femur
C Grearer trochanor
D Lesserrochantcr
E Intertrochanteric crest
F Adductor tubercle
G Medialcondyle
H Lateralcondyle
I Intercondylarfossa
J Lineaaspera
K Glutealwberosity

2.25 Answer
*=
The femoral head receivesa smallamount of blood from the anery
wi$ll :!:_]!ro!grn_feres, but this is usuallyinadequatealone.
.s/ The majority of the blood supplycornesfrom rhe 9g1p14ag1g!if
rh e[gn4 rilg that lies around the baseof dre femoral neck. This
anastomosisreceivesbranchesfrom the mglial and lateral f
c|!S!!ex'f ellgBlarreriesandasmallerl6il-ributio-nTomthe
sgpgliql3sgfinferior ghrte^l eteries. Srnallvesselsfrom this
anastomosis passthroughthe medullaof the femoralneck to supply
the femoral head. .
 L77 Answer .0
lntracapsularfiactgles of the lgskglghe femur disrupt the ll
inrraosseous blood supplyro the fcmoral head.The blood supply
through the ligarnentumteres is usuallyinadequate,thus leadingto o
avascularnecrosisof the headof the femur.
||
l"2t Answer b

The anterior thigh musclesare the hip flexors and *re knee
{
o
5
extensors.They are the: N
t Peqnius
r lliopsoas o
. Tei-sor fascialata to
r Sartorius =
. Quadricepsfemoris -X 3
q
Rectusfemoris
Vastuslateralis
Vastusintermedialis
Vastusmedialis

L29 Answer
The medial(or adductor)comparrmenrof the ttrighis suppliedby
the obturarcr nerve.

L30 Answer
a A Bicepsfemoris
B Lateralheadofgastrocnaemius
C Medial head of gastrocnaemius
D Semimembranosis
E Semitendonosrs
F Common peronealnerve
G Tibialnerve
H Sural nerve
b The common peroneal newe (F) dividesinto the superficialand
deep peroneal nerves.

2.3 | Answer
The rcpliteal fo6 is a diamond-shapedintermuscularregion on the
' posterior aspectof the knee. The boundariesare:
o Superomedially: semimembranosis and semitendinosis+muscles
. Inferomediallp medial headof gastrocnaem]iJ-muscle
o Superolaterally: bicepsfemorismuscle
r Inferolaterally:lateral head of gasrocnaemiusand planta!_s
muscles 1
o Floon the capsuleof the knee
loint, popliteusmuscleand femur
r Roof: popliteal fascia
 2.12 Answer
!
!l
a Th".otlgntsg th"!g1>.!ts
l {r" ^r"(from deepto superficial):
r Poplitealartery
o o Poolitealvein
r Tibialnerve
D
. Common peronealnerve
t
u
{o The ooolitealfossaalsocontains:
. r F a t
, t t -

d - t LYmPhnodes
t,
J . Termination of the short saphenousvein as it enters the popliteal
o
t vein
o
4 . Suralnerve
f' PoPliteusbursa
.6 . The fiveJenic,ul4l,branchesof the popliteal artery

2.33 Answer
a This is the rlght glutcal rcgion.
Note:Whenever shown a photograph or specimenof the gluteal
region use therlrlfoqrlliS.FCfSlg rs a landmarkto orientate yourself.
b A Pirlformis ?
B SuperiorgemellusS
C Obturator internus {
D InfeiibFg*T-e'llus 1
E Gluteusmedius
F Gluteusmaximus
G Quadratus femoris Q
The superior rluteal nerye exfu the pelvisabove the piriformis (A).
d ThesupE;G;AuEilGnve suppliesfu d gteqtEt [t 5E €!G"l
m.ilrjqus.
e They are abductorsofthe hlp.ioinc
f The patient would havea Ttrldglglblrt_gk.
-s H Sciaticnerve .'-\
PuieiElnerve -> nt'1e+ {t;.ptwb
svs/ |
,qid ffix) 5uPenor tluteal neNe /
I o K lnferior gluteal nerve /
t . #
n L tnrenor gweat anery
M Superior glweal artery
i The superior and inferior sluteal arteries are branchesof the
. - inrernatffi
..-
I The supe-ror and inferior glutealarteries exit the pelvistlplgh
the greater sciaticforamen.
K N of the fumur.Thisis the insertion
of the glgs andqtdmys,piriforqris,supeliorand
inferior andobturatorinternus.
: 34 Answer
!
!
T're followingstructuresare cut throuth duringthe posterior D

arproachto the hip joint:

r Skin o
. Sub<utaneousfat
-- . Glutealfuscia
B

\. GluteustgllDr,Js
. Short eIlglnal_Ietalor muscles ? {o
. Hip joint capsule
P
i.35 Answer o
The nervesat risk are the sciaticnerve and superiorglutealnerve.
{o
I
i.34 Answer tr
Deep m the plantar fasciarhere are four mgsclelayers.From
superficialto deep they are the:
-.. Abductor hallucis,abductordigitiminimiand flexor digitorum
\ r
Quadratusphntae and four lumbricals(andtendonsof tlte flexor
digitorum longusand flexor hallucislongus)
(' Flexor hallucisbrevis,adductorhallucisand flexor digiriminimi
\r Thlegglan_cr interosseiand four dorsal interossei(and the . 3|
tendonsof tie cibialisposterior and peroneuslongus) q D
ThemedialandlareralplanarrGF* andmedialandlateralplanrer
/ged* run betweenthe first andlecondlayersof muscles.The
deggblglat h is betweenthe third andfourth layers.

2.37 Answer
Thelqlcrelcqtaneous 0efv-e-et!9?!g!rsuppliessenlAlleqto che
oursideof rhethigh.

2.38 Answer
Thisisthe L2 andL3 dermarome-

7,39 Answer
l-2 cm medialandinferiorro theanteriorsuperioriliacspineasthe
nervepasses
belowthe inguinalligamenr

2.10 Answer
Thesensory
nervesupplyis the deepperoneal
newe.
2.41 Answer
Thenerverootsof the sciaticnerveareL4,5,S| ,2,3.

2,12 Answer
The terminalbranches
of the sciaticnerveare the tibialnerveand
the common peroneal nerve.
 2.43 Answer
!
a
D
|l
r L5 sensation:dorsum of the foot
tt r L5 motor: test extensor hallucislongus(lift up big toe)
I
3
5
a
{t
it
P

5
t
*
3
t
 .0
D
3. Head and neck {t
^
o

tl

:t
I. 1 Answer to
The deep fasciaof the neck hasfour layers: il
. The irug$ilSlEyerof deep cervicalhscia - this is the most
superficiallayer and surrounds the entire neck lt is deep to the I
o
platysmamuscle.lt splits to enclosetJresternocleidomastoid !
a
musclesanteriorly and the trapeziusmusclesposteriorly. t,
I
. The plgfgEglgl-bltr g
of deep cervicalhscb lies posteriorly and
a
surrounds dre vertebral column and the associatedmuscles o
(scalenemuscles,longuscolli, etc). F
. The ore-tracheallayer of deep cervicalhscia lies anteriorly and
surrounds the trachea,oesophagusud thyroid gland.
. The E{elllbbg3th is another anterior (but paired) sheathof deep
cervicalhscia that lies on either side of the pre-trachealfascia.lt,
surrounds tfre carotid al!9ry medialV,internal iugular vein
laterally and vagusl9!!g in beween. lt also containsth- ans4
cervicaffsand some lymph nodes. c.r< sgt-g ck;u- p-rrL

3.2 Answer
The posterior triangle ofthe neck is bordered b1':
r Anteriorly: posterior border of the sternocleidomastoidmuscle
. Posteriorly: anterior border of tie trapeziusmuscle
o Inferiorly:middlethird of the clavicle
o Roof investinghyer of deep cervicalhscia
o Floor: pre-venebral fasciaover the top of the following muscles:
,Splenius cagitis
72 Leuacorscapulae
\- Scalenusanterior
\ Scalenus medius
\ Scalenusposterior

3.3 Answer
The $f44ejdorngsloid turns ttre head to the side opposite the
muscle.To test the left sternocleidomastoidask the padent to turn
his/her headto the righc
TheJ4pgjls.elevares *re scapula-To rest the muscle,ask the
patient to shrug his/her shoulders.
!
3.4 Answer
D
l'i The contents of the posterior triangle of dre neck are:
t
6' Neryes
o

$
D LlElrygrse
I
e
t .r. Bffi plexus(superior, middle and inferior trd-nks)
o
a Artenes
P r Third part of the subclavianartery
I
o
tt
a. . Transversecerrical arterv) .l both branchesofthe thyrocervical
D . 5roffi'" I rrunk a bnnch of rhe first part of
I
g

i r Occipital aftery - ar the apex of dre posterior rlangle

r
yuinr -
r Externaljugularvein
Lymphnodes

3.5 Anrwer
pe.S" !o Su rpj4 .f.".tofylette would result in paralysisof the
ipsitareraltrapeziusand sternocleidomaqtoidmuscles.

3.6 Answer
Durlng trachcosromy,
r .SklD ts ellgrvbt-laycnl arc tavcrsed:
. Subcutaneous-fu!
. flgcysrna
o lnvesdnglayer of deep cervicalhscia
r Strap.muscles(sternohyoldand stemothyroid) - these
are usually
pulled asiderather rhan cut
o Pre-trachealfascia
r Thyroid istlrmus(ligatedand dtvided)
r Trachea

3.7 Answer
A Supraorbitalforamen - supraorbidalnerye, anery and vein
B Infraorbitalforamen - infraorbial nerue,artery and vetn
C Menal foramen - mental nerve, an€ry and veln
U Sphenoid
V Mandible
\N Zygoma
X Frontal bone
Y Nasalbone
Z Maxilla
 Anrwer
!

The sphenoidarciculates
with3gbt other bones: D

r Teqgoral
' Pallilal o
. Frontal
I
. Volnrer
. ocgBal
' Z)rgg0atic {
r Palatine
. Ethmoidal
I
o
1.9 Answer
a A Foramenovale Mandibulardivislonof the trigeminal
nerye
o
B Carodd canal Internalcarotidanery r
Syrnpatheticplexus
C Jugularforamen Internal jugularvein (formed by the
inferinr petrosal and sigmoid
sinuses)
Glossopharyngeal nerve
Vagusnerve
Accessorynerve
D Stylomastoidforamen Facialnerve
Stylomastoidanery
E Foramenmagnum Medullaand surroundingmeninges
Spinalroots of accessorynerve
Anterior and posteriorspinaland
venebral arteries
F Foramenspinosum Middlemeningeal vessels
G Foramenlacerum Internalcarotidartery (passesinto
foramenlacerumfrom carotid
canal)
b H Occipial condyle
I Externalocciphalprotuberance
J Styloid process
K Vomer

3.l0 Answer
The facialnerve (or seventhcranialnerve) emelggsfrom the
junction of the pons and medulla.lt traversesthe posterior cranial
fossa,runs within its own canalin the temporal bone and then exits
the skull at the stylomastoidforamen.
Within the facialcanalthe hcial nfre tives off the:
o Greater petrosal nerve.These are parasympatheticfibres that
then hitch a ride wilh th9 1rygill-a1y_divi-sion
of the trigeminal
nerve-tN V2- to irppi/in" Li.*ii lana
. Nerye to stapedius
. Clerlaiymgani. These are specialqensoryand parasympathetic
fibres drat hirch a lift with the lingualnerve - a Urinitr of tfre
mandibulardivisionof the trigeminalnerve (CN V3) to provide
 taste to the anterior two-thirds of the tongue and innervationto
!
the submandibular and sublingualsalivaryglands
!l
o r Auricular branch suppliessenlation to a small area of skin around
o the external aud'rtorymeatus
s After leavingthe skull the fucial nerrregivesofi the?ostehor
auricular nei-ve(which suppliesthe ociipital belly Sl6ttip-itofrontalis)
!,
D
f that suppliei the srylohyoidmuscleand the Posterior
{o "6tTEEi'.f, DarodilEEff,Within the gland' the
belly of dilastric then enters th€i:t
a n;fid4ffi-6to five brqnche-s:temporal, zygomatic,buccal'
!,, minaluutarand ceilical. the-Jbranches supplydre musclesof facial
I expression.
o
al
o- RemembenThe function of the hcial nerve from the mnemonic:face'
tl
f
o, ear, taste, tear.
:o
r 3.ll Answer
. Temporal: raise Your eYebrows
. Zygomatic:close your eyesti8htly
r Buccal:blow your cheeksout
r Mandibular:show me your bocom teeth
o Cervical:tense the skin on your necldchin (platysma)

3,l2 Answer
Four nervescontributesensationto the ean
e Greacau-rigularnerve (branch of the cervical plexus)(x
r Auriculotemporal branch of the nguLi-bularnerve V3
o Auricular branch of the vagusnerve X
. Branchesof the facial nervdbranches from tie tympanic plexus)vlt

3.l3 Answer
A Helix
B Andhelix
C Supcriorcrus
D lnferior crura
E Triangularfossa
F Scapha
G Concha
H Tragus
I Inrcnraglc notch
J Antitragus
K Lobule
L Externalacoustic meatus

3,l4 Answer
€\ vx. The network of cerebralveinsdrain into the venoussinuses- These
\' are channelsbetween the dura and the periosteum that contain no
valves.
t S!.rPeriorsagital sinus- this lies in the superior fulx cerebri and
runs from the crista gali anteriorly to the internal occipital
protuberance ffi-rry (confluenceof sinulE5)--
 . -
bleclgr satitlal sinus this lies in the inferior border of the falx !
c-"r"Uri ana joins the great cerebral veiill6GE-comethe stEi$t t}
srnus
r S_tnrjght-9i49$- dtit is formed by the confluenceof the inferior o
sagittalslnusand tlre great cerebral vein and runs
inferioposteriody to the internal occipital protuberance
(confluenceof sinuses)
r Transvele sinuses- these (right and leQ passlaterallyfrom the {o
internaloccipitalprotuberance(confluenceof sinuses)to become
the sigmoidsinuses
. qt4olC sinuses- these curve mediallyand t}en exit through the
jugular foramina to become the internal jugular veins o
. -
_Oig!P!!4 sinus this runs superiody from the epidural plexus of p
veins to the confluenceof sinuses
o Cavernoussinuses* these lie on either side of the sellaturcica- o
These sinusesdrain the and middle f ' /
cg3Ealv€ns into the r!! g
. Sqpggr_pgggGf sinuses- these run from the cavernoussinuses
to the iulglcn of the transverseand sigmoidsinuses
. .].dgf!g11pSSgs4lsinuses--6Ese runlfom It;cavernous sinuses
to empty direcdy into the interqq!_igg4elveins
. BasilaisinusEF these connE6TeliErioipetrosal sinuseswith
thlGpiiural plexus of veins
The emissaryveins connect the intra- and extra-cranialveins.

3.15 Answer
Th" g.Ilg,r,DjlU;CJ are paired venoussinuses,about 2 cm long on
either side of the sellaturcica and lateral to tJresphenoidair sinuses,
immediatelyposterior to the optic chiasm.Draining into tlrese
sinusesare the superior and inferior ophthalmicveins,the superficial
middle cerebral vein and the sphenoparietalsinuses.The cavernous
sinusescommunicatewith eachother via the intercavernoussinuses
and drain into the inferior and superior petrosal sinuses.
The cavernoussinuscontainsthe internalcarotidartery, 3 ,4,9 1, z r (
occulomotor nerve,troclear nerve, ophthalmicand maxillarydivisions
of the trigeminalnerve,abducensnerve and sympatheticplexus.
A. ttfecdgE-9Iy[9llrlglihe-Ace may spread through the facial
tr veinsand ophthalmicveins(valveless) into the cavernoussinuses
causingthrombosis. This conditjon manifesusas a swollen, painful,
r",tg!: goiEE ted ipsilateraleye, progressiveloss oflGion6d the
developmentof third, fourth, fifth and sixth cranialnerve palsies.The
condition may quickly spreadto the contra.lateralsinus.

3.16 Answer
a A Internal carotid artery
B Anterior communicatinganery
C Anterior cerebral artery
D Middle cerebral artery
E Basilarartery
b This is the circle of Willis.
 3.17 Answer
!
-- Hard palate
',,, Cl
D
a
fi C2 = Angle of mandible
o = Hyoid bone
' -C3
C4 = SuPeriorthYroidnotch
t
D --C5 = ThYroid canilage
= Cricoid cartilage
e ' ,86
{o c7 = UpPer racheal rings
a
t., 3.18 Answer
3
o
B.
l
t
a
J
n
a
r

3.19 Answer 5 lt ,,(u ,fr n

From inferior to 5!99rior the branchesof the external carotid
arGry are:
r Ascendint pharyngeat
r Superior thYroid
I Lingual
o Facial
r Occipital
r Posterior auricular
r SuperficialtemPoral
r Maxillary

3.20 Answer
The internal carodd artery has no branchesin the neck but after
passingthrough the cavernoussinusdivides into the anerior and
middlJ cerebial anery and also givesoff the smallerPosterior
communicatingaften/.
lll Answer
!

The conrmon carotid artery bifurcates into the internal and external D

carqid arteries at the level of C4. 6

o
l.22 Answ€r
3 P
The mar<illaryartery is divided into three parts by its relation to the I
hteral pceryloid muscle. 0
to
I Frst Port(inferior to laeral pterygold) hasfive branches: a
. Deep auricularartery !d
r Anterior tympanicartet7 - E
o
r Middle meningealartery V'- tl
a
r Accessoermeningealartery !,
I
r lnfericr alveolarartery e
I
L o
*cond port (behlndlateral pterygoid) hasfour branches: a
. Deep temporal artery
-
. Prerygoid artery
r l.lassetericarcerlr
e Buccalartery

3 Thitd port (superior ro lateral pterygoid)has six branches:

r Posterior superior alveolarartery
r InfraorbitalarGry
r Descendingpdatlne artery
. Artery ofpterygoid canal
r Pharyngealartery
r Sphenopalatineartery

3.23 Answer
There are l2 cranialnerves:
r Olfactory
' OPtic
r Oculomotor
r Trochlea
r Trrgeminal
r Abducens
r Facial
r Vestibulocochlear
o Glossopharyngeal
o Vagus
o Accessory
' HyPotlossal

3.74 Answer rrt

54c
The fifdr cranialor trigerninalnerve suppliessensationto the face
and mo,tor supplyto the musclesof masticatioifTherEli6TrrEE
-F-
divisioris:
r OPhthalmic 5
r MaxillarT
r Mandibular
 3.25 Answer
!
H
a
The ophthohnkdivisionsupplies seQsationto the forehead' upper
eyelid$, eye, anterior nose and nasalmucosa
It '
o The maxillorydivisionsuppliessensationto the cheek lower eyelid'
? lateral nose, uPPerte€6, up-perlip and maxillarysinuses'
T
The mandibutor divisbasuppliessensadonto the skin over dte
D
= mandible,lower teeth and liP,temPoral skin and lower oral cavity'
3
o
5 t.26 Answer
.H

I
o
e
D
I
a
3
o
a
F

3.27 Answer
A Coronalsuture
B Squamous suture
C Lamboidsuture
D Zygornaticofacial suture
E Sagittal suture ( - F-'f -s
D Thisii the Pefign. lt is the iunctionof the frontal,Parietal'
temporalandsphenoidbones.
c Th.fiona! blglS! of gg rn'd9!e4elq&elemery runsbehindit'
d The ptifr6iTT w6kSint oFGt slutt andmaybe flacturedby a
blowto the temporalregion,eg' from a cricketball'A fi'acture
maylaceratethe middlemeningeal aneql leadingto an extradural
haematoma-
G Angle
H Ramus
I Coronoidprocess
J Head
K Body
3.26 Answer
!
The parotid glandsare paired salivaryglandslying over the ramus and ll

angleof the mandible.They are roughly C{elggbr in shape.

The edge of the parotid runs from the o
in a line
"l_tg_e-4;
to just overlap the
posterior border of the m:6setermuscle.From here, it )
ru
toy?rdr th. .nglu_6l6u-m ble, which ir wpgs-arour J

Pornrrcruns up, ovellbe_trlas@.Ld to

ry€c,err and curves forward around the inferior part of the auricle of I
tie ear. !,
o
3.29 Answer t,
o
I
The paroti-dducr runs in the middle third of a line drawn ft-om the I
c
ingeruragicnotch tg the midd ilrnr6, lg Can be rolled Over t
the massetermuscleand emptiessalivainto the mouth at *e papilta o
F
opposite the second maxillary rnolar tooth.

3.30 Answer
The,layelr p|lbeJcalp are (from superficialro deep):
f ' Skin
d o Connecdvedssue(containingvesselsand nerves)
A . Aponeurosisof occipitalis/frontalismuscles(galea)
l- . Looseconnective(areolar)tissue
' Pericranium
P
Rernernben
SCALP.

3.3 1 Answer
The scaloreceivesblood from t}e:
o Supraorbitaland supratrochleararteries arygigrly
r Occipital artery posteriorly
o Superficialtemporal and pogqg:j_o1gunfqLarafteries laterally

3.32 Answer
The standardincisionfor submandilularglandsurgeryis 3 cm below
the angleof the mandible.ThEffiffifuTamagifltie marginal
mandibularbranchof the hcial nerve.

3.33 Answer
The submandibuhrglandliesin the digastricor submandibular
triangle.

3.34 Answer
The nqnrry/
.following -areat risk durinS,rU*"1q!j!"1"f gbld Gry
r Lintual nerve l') . .
' Nerve to mylohyoidY3 L\r-1.Y\^u d (!l/d
r Hypoglossalnerve lXfi
o Marginalmandibularnerve
V(i
!
3,35 Answer
tl Th. fu:4_l.tgZ_e4:Cin run overor throughthe glandandare
u:y!!-!etrcd duringsubmandibuhrglandsurgery.
o

T
3.36 Answer
D a A Middleconcha
tB
?
o
Pitritary gland
Tranwersesinus
U Falxcerebri
!d
I E Tongue
o . - F lnferior concha
ll
o.
t, G Ethmoidsinus
c / ' n Superiorconcha
o
I Epigloais
F l Oesophagus
K Mandible
L Trachea
M Frontalsinus
N Hyoid bone
b o Sgperior:meatus- lies between the superior and midd,!5
conchaeand communicateswith the ethmoidalsinuseCT
P Middfemqatus- lies betweenthe middleand inferiopn
conchaeand communicatcswith the fronal sinus?h8ugh
the frontonasal ducts and also the maxillary and
ethmoidalsinuscs
Q Inferior meatus- lies below the inferior condra and ^
communlcate with the eye via dre nasolacrimalductl9
R splggedtDgldaLrcqess - lies above the superior conchaand
communicateswith the sphenoidsinus(._p
S Egstachian(auditory) tube - link the middle ear to the
nasoPnarmx

1.37 Anrwer ( O(.

The superiororbital fissureis a slklike foramenallowing
communicationbetween the middle cranialfossaand the orbit
From superior to lnferior the structures passingthrough this
.' foramen are:
r Lacrimalnerve V (
- r FrOnAlnerVe ilt
.1
-- .r Superiorophthalmicvein{'
lv --t c Trochlearnerve iV
/4, !-. Superiordivisionof the oculomotor nerve irt
z L. Nasociliarynerve V1
_ ltfi.
'4. lnferior divisionof oculomotor nerve tfl
d, Abducensnerve U{
1. Inferiorophthalmicveinf
: 3E Answer
.0
There are sevenextraocular muscles:on€ eyelid elevator, four recci t,
musclesand rwo obliquemuscles.
The levour pohebroesuperiorisoriginatesfrom the sphenoid,jusr o
aboverhe tendinousring and inseru into the lAlsal plateof rhe s
uppereyelid.lt elevatesthe upper eyelid.ltsQua_|nerve supplyis the
tl

- oculomotor nerveand synlpslhedcfibres.

The -+---
,
superiorrectus,itfupl-ctui rtellatrrcctusand lotlrol rectus to
musclesoriginatefrom thC tendinousring (on rhe sphenoid)inT
attachinto the scleraofthe eye in posirionscorrespondingro cheir P
name.Eachmusclepullsthe eye in the directioncorrespondingro is I
o
name,i.e.the medialrectuspullsrhe eye mediallyand the lateral Fr
rectuspullsthe eye laterally.However,the superiorand inferior p
r€cti do not pull the eye directlyup or down; they move slightly
diagonally so that they slightlyadductrhe eye,i.e.the superiorrectus o
pullsthe9ye!p 1g-.11gqg!!y, -his andtheinferiorreqlss;ruiEtt,AF r
down and medrEl
.IyJtis diagonalmoveiffit is c6ileired by the
obfiFe muscleswhich also havea diagonalpull buEih-6eEteral
dirEEiio-nEbduccion).
All of the recti are suppliedby the oculomotor neryeapan from
the lateralrectus,which is suppliedby rhe abducensnerye (abducens
abductsthe eye). %g Lr1.6 { e,rw-.i Yyt) e{ Z
The yPeriggliltggg originatis iust ibove the tendinous ring and
paSses obliquelyforwards.andmedially,passingthrougha pulley
(trochlear) and then attachinginto the scleraposterioirlyundei the
superior rectus. lts action is therefore to pull the eye inferiorlv and
lapmfly (down and out). The superior oblique is suppjiAfE IFe
roc-h-reariGFG. --
The inferiorobligue,originates from tie anterior medial orbial
flogr and inserts into the posterior lateral sclera.lr pulls the eye
latsrally(up and out). The inferior obliqueis supptied
:uPgg! ",nd
Dylne occulomotor nerve.

3.39 Answer
a A Trapelus
B Sternocleidomastoid
C Internaljugularvein
D Carotid anery
E Platysma
F Invesringlayerof deepcervicalfascia
G Upper pole of rhyroid gland
H Spinalcord
I Vagusnerve
j Vertebral artery
K Larynx
L Pharynx(compressed)
b This cross-secdonis at the C4lC5 level.
Note:the carotid arterT has not yet bifurcared(C4) and the vocal
cords are just visiblein the arytenoidscartilage.
'! 3.40 Answer
tl of the thyroid glandis at the level of the C7 vertebra.
The is-thm-us
o
3.4 | Answer
s
The chyroidglandlieswithin its own coveringof connectivetissue-
tl

tt'e tnv?6ladffilThis is within the pre-trachealfascia,which

{o surroundsthe larynx and pharynxas well. The pre'trachealand pre-
vercebralfuscialie within the investinglayerof deep cervicalfascia"
:j

E 3.42 Answer
o
!l

Ir
The rbLgl|3leld is suppliedbilaterallyby the superiorand inferior
2
CL thyroid arteries.fhe superi.otJhwid-srleryis a branch of the external
carotid artery and suppliesthe upper pole. Thejqfuior thyloid-glery
r is a branchof the thyrocervicaltrunk and suppliesthe lower pole.
of the population have a thyroidea_.1!4aLery, a
Th19e per-c,,eJlt
midlineartery from the brachiocephalic trunk that suppliesthe
isthmusof the gland,

3,43 Answer
The recurrentlaryngeol neryeruns close (usuallyposterior) to the
inferloi thyrold artery and is at risk of damageduringligationof this
vessel.This nerve suppliesall the musclesof the larynx except for
the cricothyroidmuscle.Damageto this nerve leadsto paralysisof
the ipsilateralvocal cord. Bilateralparalysiscan lead to fttal occlusion
of the airway.
The exter!-o_lloryngeol neruervns close to the superior thyroid
artery and is at risk of damageduring ligationof this vessel.This
nervesuppliesrhe cricothyroid muscleand damageto it will manifest
itselfas a lossof timbre of the voice (monotone speech).

3.44 Answer
The thUoid-Clandis usuallydl3ilgd bilaterally by three veins:
. Superiorthyroid vein
r Middlethyroidvein
r Inferior thyroid vein
The superiorand middleveinsempty into the inrernaliugularvein on
that side.The inferior vein emptiesinto the brachiocephalic
vein.
 !
3
n
4. Thorax o

t
D
,rsy4,n*.-fiti. 'ft'z- t;b; l^iy
t
k"f'r ta
Answer
During inspiration,conraclion of the intercostel musclescauses.the^
t
mkjdlCof the ribs to(@ upwards (bo:kerlandlg-qovement)' This {
increasesthe transver]l diameter o{ the chese Movement of the ribs !
c
at the cSg?yglebrdjeints also allows the anterior ends of the ribs D
x
to@rfl*ards (pqu-bar'4e lloverngnt), thus increasing the + Af
antiloposterior diameter of the chest
#
1.2 Anryer

2
f . / o-
_:/,L

, a,c
?b-4

r_.C.

| . Lower border of the third costal cartilage at the @edp of the 3d a-<.
sternum /--\ tfr c . ( ' ,
1 Lower border of the sixth cosal canilage at dre(iglpof dte srcmum
- ,r7
3. Fjfttr bgg4ostal spacein the mid'clavicularline E{t
4. Secondintercostal sgace,2 cm to the l-eftof the sternum 7' 1 J Lt'i
Draw a slightly curved line between these four points'

4.3 Answer
A chest drain is usuallyinsened into the founh intercostal spacein
the anterior axillary line, iust superior to the fifth rib (this avoids
damagingthe intercostal vesselsthat run in the upper part of the
intercostal space,iust inferior to the corresponding rib).
!
4.4 Answer ! c?
ll The drain passesthrough the:
n
. Skin
o r Subcutaneousfat
3 r Deep Fascia
t,
?-/. Serratusanterior muscle #
a ,. Externalintercostal muscle
{
o !
-. Internalintercostalmuscle
d e Innermostintercostalmuscle
I . Endothoracicfascia f
{5 u
!., o Parieal pleura
o
i 4.5 Answer
Theintercostal
neurovascular bundlerunsin the planebetweenthe
X qg4pCgllstd andthe illcrmosrjnreraa$aLnuscles in the
order(fromsuperiorto inferior):vein,anery,nerve.

4.6 Answer 61e,4

ryf{1 4 *r^r*
o Superior part- inferior thyroid arteries
r Middle part - oesophagealbranchesof the descendingaora
. Lower pan - left gastric art€ry and inferior phrenic artery

4.7 Answer
The following scructurescausea conE4istion in the oesophagus
(from superiorto inferior):
. Upper oesophageal sphincter
r Arch of aorta pressesagainstthe left lareral surfaceof the
oesophagus
o Left main bronchus
r Diaphratmatic hiatus

4,8 Answer
>{<
The {gshea b.fgtsares inro the leA_errslflshtlnai!_brqnchi just below
the levelof the manubrio-sternal junction.
7
4.9 Answer
a This is a contrast bronchogram.
b A Left main bronchus
B Rightmain bronchus
. C Intermediatebronchus
D Trachea
.E Rightupper lobe bronchus

4. l0 Answer
Th"@66roiihr])is largerin diameter andformslessof an
a$!E_glq_rh"_!139brr-Ean thi left"For this reasona foreS-6ody
willtendto falldownthe rightside.
 4 I Answer
!
Thc rigin krnghasthree lobes: upper, middle and lower. The left tung !l
lEs rwo kcbes:upper and lower.
't
o
r 12 Amwer AP^ L!
3 T
s
Th9 nShtlung has l0 segmens (three in the upper lobe, two in the
middle lobe and five in the lower lobe). The tit t nChas nine or l0 3

segments,too (four or five in the upper lobeEd-five in the lower 3

o
lob€). n
I
.{
1.13 Answer
o
A Jugularnotch !l
x
B Manubrium
Sternalangle(of Louis)
D Body
E Xiphoid process

1.l4 Answer

1
T2
ilarubdm
fr3-Tr)
slemum
T3
T4
T5
Eody ofstlmum
(TrrD) T6
T7
XIphU.rnun
T8
rn) T9
T10
T11
12
Sternalnotch= DiscbetweenT2 andT3
Manubrium = T3 to T4
Sternalangle{of Louis)= Discbeoryeen
T4 andT5
Bodyof sternum= T5 ro Tg
Xiphisternum = T9

4.l5 Answer
andleft.phrenicneryesare the rnororsupptyto the
l,T:qn.
draphragmandarisefrom the C3, C4, C5 spinalb;eJs:
Rernember:
C345keepsthe diaphragm alive.
 4. 16 Angwer
!
t The phrenicnerve providesseniarionto the Genral,partof the
r|' diaphngm,whilst rJrcintcrcortll nerver T5.Tl I and subcostalTl2
providesensationro rhe.pcrlpheralpan.
ll
D 1.47 Answer
6
{o lrritadon of the central pan of the d,gphxagn',e.g.from a bleeding
spleniclaceration,will be felt as referred pain in the dermatome of
i the phrenicnerve roots - C3,4,5,i.e.the shoulder.lrritation to the
peripheralpans of the diaphragmis felt more locally.
u
o
ll
x 4.18 Answer
The diaphra8mis suppliedby the followinga-neries:
o Superior and inferior phrenic arteries from the aorta
r Musculophrenicbranchesof the inernal mammar/ art€ry
. A small contribution from the intercostal arteries to the
peripheral parts of the diaphragm

4.19 Answer
The baseof the breast is circular and extends from the lateral
border of the $emum to the mid-axillaryline,from the secondrib
down to the sixth rib.

4.20
Ly-T' Answer
The breast receivesb_lqgd-fromfour sources:
t -4f-th ) r Mediallyfrom branchesof the intemal mammaryartery t n A rF9*
,o) . Laterallyfrom branchesof the lareralthoracic artery
L+- q-3*bs . Deeply through pedo4lors from the pectoralis maior muscle
L. TA x'Arr(

O'+*t'V1 (thoracoacromialtrunk) ft a*,tt-."t

r Inferiorly/laterallyfrom branchesof tfie intercostal angries
{-
4 . 7 1 Answer

Ell.t,gn from the_!Lq$:Oql nipple is carried by the fourth, fifth

and sixth intercostal nerves.
-
| 4.22 Ans-wer rn
a This is S" *"dlqigpg!gl$" !S!_!gng.Ctheflat diaphragmatic
!35efacesdownwhilstthe riinner, sl4gl 3llgMl_bgrder faces
forwards.)
D Aorta
o.;(.-2
------t E Diaphragm
F Heart
C-v-+' G Phrenic nerve (anteriorly)
,--OL H Vagusnerve (poseriorly)
ftp^ d A Left main bronchus
I Pulmonaryanery
C Pulmonaryvein
 obl,7c - {z v+ 64c
ltr**
!

@lC!t! have an olfggg;fissure that extends from the spinous T

pro€essof the T2 vertebra posteriorly to the sixth cosal cartilage F
o
anteriorly. ft" dd3lqg also has ho.i.omal firsrte tiat r
dre fourth rib. " s
P

4,74 Answer t

A Right auricle
to
B Ascendingaorta
a
I
C Brachiocephalictrunk
D Arch of aorta Jo
E Left anterior descendingcoronary anery (anterior ll
x
interventricular anery)
F Right coronary anery
G Marginalartery
H Pulmonarytrunk
I Left pulmonary artery
J Rightventricle
K Left ventricle
L Left carotid artery
M Left subclaviananery
N Superior vena cara
O Left mainbronchus
P Inferior vena ca\ra

4.25 Answer
a This is the superior aspectof a rypical rib from the right side (this
happensto be the eighth rib).
Note: The upper surfaceis blunt whereas the inferior border has a
sharp edge,lateral to the costalgroove. The neurovascularbundle
runs behindthis sharpedge.
A Head
B Neck
C Tubercle
D Shaft
E Angle
The costal cartilageattachesto this point.
d This is the tubercle of the rib and has a fug1&Llnlllxdon wit}r
tft" tqn!yg-"_plo$!Lof the correspondingvene-6[Eg. if this is
the fou th iF! transverse
process of the T4 vertebra.

Ansirer
a This is a right first rib. (Note how flat, how small and how tightly
curved it is. The superior surfacehasthe grooves.)
b A Head
B Neck
C Tubercle
D Scaleneubercle
 The scalenetubercle(D) providesartachmentfor the scalenus
!
a anteriormuscle.
E Subclavian vein
o F Subclavian anerT
s The Tl nerve root runs in direct contaff with thethafl of the rib
-
t} with the fibres of the C8 nerve root runningaboveit. These
nerveroocsmergeto form the inferior trunk of the brachial
to plexus. >.
The C8 nerve root runs abovethe negK- of the first rib and the Tl
l nerveroot runs below the neck.Both structuresthen passabove
the shaftof rhe first rib (G).
, This is cheheadof the first rib and hasa fucetfor articularionwith
il
x the T I vertebra.
h The scalenusmediusmuscleattachesto the first rib at point H.

4,27 Answer
a This CT scanis at the levelof the pulmonaryaneries.lt is
thereforeat the T5 vertebrallevel.
b A Ascendingaorta
B Rightpulmonaryarcery
C Descending aorta
D BodyofT5 venebra
E Suoeriorvenacava
F Rightmainbronchus
G Left mainbronchus
H Oesophagus
I Azygousvein
J Left scapula
K Left lower lobe pulmonaryarcery
L Left pulmonaryvein
M Rightpulmonaryvein
N Srernum
O Left internalmammaryartery

4.28 Answer
During subclavianvein cannulationthe needlepassesthroughthe:
r Skin
r Subcutaneous fut
r Deep fuscia
r Clavicularheadof pectoralismaior
. Clavipecroralfqs-qia
.. Subclavius
r Subclavianvein wall

4.29 Answer
At risk of damageare the:
r Subclavian arrery
r Phrenicnerve
. Apex of lunt
r Thoracicduct (on left side)
 .o

5. Abdomen and pelvis

!
6
!i
o

l|
D
:'
5. I Answer ?
o
lntroperttoneal: x
r Stomach vl

o First part ofthe duodenum It

r Jejunum e
o
r lleum 3
o
. Transversecolon I
t,
r Sigmoidcolon I
r Tail of pancreas o
!
' APPendix o
o Caecum 3
r Liver
r Gallbladder
r Uterus
r Ovaries
Retroperitoneol:
e Kidneys
r Ureters
r Adrenal glands
r Ascendingand descending colon (includingsplenicand hepadc
flexures)
. Most of the pancreas(except the tip of the tail which lies within
tIe splenicperitoneum)
r second,third and fourth parts of duodenum
r Inferlor venacava
. Aorta
o Lymph nodes around the aorta
o Bladder
t Vagina

5.2 Answer
The iejunum is a dgf,er red in colour. has a lilggry4!-bfe_]umen.a
ftjskeru@it is morejrqrlar, has longer vasa-recta,fewer .-= arcades,
lcsf_&sjn the mesenteryand deeper plicaecirculares.
e "t.f*rui.e. 6{6e '+sJ
5.3 Answer
The large bowel has saqcul_ations/haur#ljq.t,apggldices epiploicae,
tenia coli, a larger calibre lumen and a thicker wall.
W-a
5.4 Answer
There are trcelard;cmois in rhe diaphr4gm:
 At the levelof T8 is the covolopeningwhichallowspassage of the
!
c inferiorvenacava,the riShtPhrenicnerveand lymphaticvessels
J . At the level of T l0 is !h€ oesophdgedl hiotuswhich allows Passag€
r! of the oesophagus,yStu!-o€rve, leftJ3sttlg v-essels and lynpbatics
A , ' At the level of T l2 is the oortichiotuswhich allows passageof the
!l aorta,azytousvein and thoracicducr This is actuallyan aPerture
D posterior io the diaphragmrather than a true hole within it
{o
Answer
T8 = Xiphisternaljunction
D
I Tl0 = Seventhcosul cartllage
q
1 12 = Justabovethe transpyloricplane
o
Answer
l,
I
a This is a rctrogradepyclogram.
!
o
Note:.Thecontrast cathecersinserted through the urethra and
bladderand inrc the ureters.This is not an intravenousurogram
where the contrast is givenvia a vein and then filtered by the
lcidneys.
The appearance of the kidneysand uretersis similarin both
investigations.
b A Lefcureter
B Rightureter
C Left renalpelvis
D Rlghtpelvl-uretericiunctlon
E Calyx
F Bladder
c This line is the psoasshadowand is causedby the psoasmajor
muscle,
d The rernl papillaeprgiect into the minor calycescausingthis
characteristic shape.The minor calycesunite to form wo or
three maior calyceswhlch then empty into the renalpelvis.

Answer
The ureters start at the renal pelvis- the most posterior ofthe renal
hilum structures (vein, artery, pelvis,from anterior to po$erior).
They are reroperitoneal for their entire courseand there is an equal
fengthof ureter in the abdomenand in the pelvis.The abdominal
ureterdescendsalmost vertically downwards, anterior to the Psoas
major muscle,iust overlappingthe transverseprocessesof the
lumbar vertebrae. Qgh_qlelgr is crossedalrte]dorlyby the gonadal
artery and vein. The genitofemoral nerve passesbehind9\e ureter
(which explainsthe referred pain to the testes with ureteric calculi).
At the pelvic brim the ureters passanterior to the external iliac
artery (ureter, artery, vein from anterior to posterior), The left
ureterhas the apex of the sigmoid mesocolonas its anterior relation
at the pelvic brim, The pfulc ylglet then descendsposteroinferiorly
on the lateral pelvic wall, anterior co the branchesof the internal iliac
arteries,then curvesanteromediallyto enter the posterolateral
surfaceof the bladder.Justbefere enteringthqbladder the ureter is
 crossd aneriorfy by the rrasdeferensin t]re male or the uterine
!
artery in-dre bmale. ;r
6

53 Answer ,r1.,,,.: ,)-,,{.1.., ,l iq*{ar,F. o

. fuperion urereric branchesof the renal arteries
o D
Lliddle: branchesof the gonadalarreries
. lnferioc branchesof the common and external iliac aneries t
I
o Pelvic branchesof the internal iliac and vesicalarteries to
t

5.9 Answer !t

Pelvic-uretericiunction v
o.
Ureter changesdirection as it crossesthe pelvic brim 0
Crossing of rhe gonadalamery 3
o
3
r Ob Iique inramu ra-l-co-[F56-ofdre vesicuIo-u rete ric unction
i 3
e
5.10 Answer
E
a This is a kidney. I

b B Left renal vein

C Left renal anery
D Aorta
E Inferior vena cava
F Left ureter
The left suprarenal(adrenal)gland.
d From anterior to posterior:
r Renalvein
o Renalartery (or arteries)
r Renalpelvisand ureter
e The renal anen/ is passingin front of tlre renal vein. This is
therefore the posterior aspecrof the left kidney.
f The kidneyslie in t}e paravertebralgrooves at the levelsof T I 2 to
L3. The hilum is ar rhe ranspyloric plane(the left,is slighdyhigher).
They are retroperitoneal structures.Eachkidney is surrounded by
a relal capsuleof fibrous,gissue,which is within th" p":lfplng_hs
Th;sEiifihEn'Sii66-d6i by the renal frscia (Gero'ta-bhscia).
'
The posterior relations of the kidnellre (l6lifrlsd6f,-
r Diaphragm(superiorly)
r Quadratus lumborum (inferiorly)
o Psoasmajor (medially)
o TransversesaMominis (laterally)
FN).r -
f,fzff*:- -r
,/ j_-.a+4- ,
5.1| Answer
a This is an abdominal aortotram.
/.-- V llP*i -t
'- .{
o A Abdominal aorta
2 B Rightcommon iliacanery
+' b#')
t'(
-L ',1
I i
--l---L-F
I C Left common iliacartery
7D Lek renal artery (
\ E Rightrenalanery
7F Splenicaruery
\G Common hepaticartery
H Superior mesentericartery
 I Gastroduodenalaftery
!
tl . ) Left hepatic arrery
" K Righrhepaticartery
o L Inferior mesentericartery

!, 5. l2 Answer
q The abdominalaona stafts in the midlineas it passestirough the
{
o diaphragmar the levelof Tl 2 ( | inch abovethe transpyloricplane).lt
o runs in the retroperitoneum,in front of the lumbarvertebraethen
tl
bifurcatesslightlyto the left of rhe midlinear the levelof L4 (the
a, supracresblplane)into the common iliacarteries.
4
o
o 5. l3 Answer
I
ll The rnidlinebronchesare the:
!
. r Coeliacaxis- Ll upper
! r Superiormesentericartery - Ll lower
o
. Inferior mesentericartery - L3
The poiredbronches are the:
. lnferiorphrenicaneries- Tl2
o Suprarenalarteries- Ll (sometimestiese arisefrom the renal
artenes)
r Renalarteries- betweenLl and L2
. Gonadalaneries- L2
. Four pairedlumbarafteries- Ll, 2, 3 and4

5. l4 Answer
The rranspyloricplaneis the line halfwaybetweenthe suprasternal
notch and the superior pubic symphesis.
At this levelthere is the:
o Terminationof the spinalcord
. Aorta givesoff the superior mesentericanery
o Lateralborder of the rectusaMominis musclecrossesthe costal
margin
o Duodenojeiunaljunction
r Ll vertebra
o Neck of the pancreas
o Hila of the kidneys
. Formationof the oortal vein

5. l5 Answer
o )Ktn
. Subcutaneous far
. Scarpa'sfascia
. Lineaalba
o Transversalisfascia
o ExrraperitonealFat
r Peritoneum
: 6 Answer
!
Tre aDcneuroses ofthree musclesmakeup the rectusshearh:
externaloblique,internalobliqueand [ransversusabdominis. n'
a
The reglusshearhhasan anterior layerand a posterior layer.The
superiorthree-quartersare differentfrom the inferior quarter.The
I
arcuareline demarcatesthe boundarybetweenthe two regionsand
iies 3 cm below tlre umbilicus.
Superiorly,the anferiofJayeris madeup ofthe aponeurosisofthe to
externalobliquemuscleand halfof cheinternalobliquemuscle.The
- p_osteriorlayeris madeup of the aponeurosisof the other halfof the !r
internalobliqueand the transversusabdominismuscles. tt
Inferiorly,all rhree musclelayerspassanteriorly.There is no
posterior layerof sheath.The recrusabdominismuscleis in direcr
o
conractwirh the transversalis fascla. I
D
5
S.l7 Answer o
.o
This is an openingberweenthe greatersac(the main perironeal
e.
cavity)and the lessersac (omentalbursa).

5.18 Answer
r Anterior: the free edgeof the lesseromentum containingthe
portal triad
r ,Posterior:the inferior venacavacoveredin perrroneum
r Superior:caudateprocessofthe liver
r Infgrior:the firsr part of rhe duodenumcoveredin perironeum

5.l9 Answer
This is Pringle'smanoeuvre.

5.20 Answer
The portal criad is compressedbetween tfre finger and thumb as it
runs through the free edgeof the lesseromentum: portal vein
posteriorly,common bile duct on the righr and hepaticartery on tJre
lefc

5.2 | Answer
This manoeuvrecan be usedremporarilyto stopthe inflow of blood
to the liver, eg to control the haemorrhagefrom a liver laceration.

5.22 Answer
The hepatorenalspace(Mpryisorr'spouch) is rhe mosr dependent
areawhen supine.This is conrinuouswith the right paracolicgutter
and lies betweenthe right kidneyand the liver.

5,23 Answer
This is the mosr likelysicefor.a collectionof blood or pus to pool,
leadingto the formation of an abscess.
 .o 5.24 Answer
The inguinalcanalis a cleft-likespace,entirelybetweenthe layersof
the abdominalwall. lt is approximarely2 cm wide and runs above
o
and parallelto rhe inguinalligament.lt extendsfrom the deep ring
(openingin the transversalis hscia) to the superficialring (openingin
D
D rhc cxternelobliquc),
o
{o 5.25 Answer du ,,,'.
i'.,,.,,.
q . A,nterior:externalobliqueaponeurosis, reinforcedlaterallyby
incernaloblique
q
. Posterior:transversalisfascia,reinforcedmediallyby the conjoint
0
[enoon
o . lnferior:the in-rollededgeof externaloblique(i.e.the inguinal
ll ligament)
CI . Superior:the lower edgeof internalobliqueand transversus
!
o abdominis
6'
5.25 Answer
Runningrhroughrhe inguinalcanalis the:
r lliointuinal
nerve
o Spermaticcord (males)
o Roundligament(females) .

5,21 Answer
The mid-inguinal
point is halfway berweenthe anterior superioriliac
spineand the pubicsymphysis. This correspondsto the femoral
artery pulse.

5.28 Answer
The midpointof the inguinalligamentis halfwaybetweenthe anterior
superioriliacspineand the pubicrubercle.This correspordsto rhe
deepinguinalring.The mid-inguinalpoint is thereforemedialto the
midpolntof the inguinalligament

5,79 Answer
a This is an endoscopicrerograde cholangiopancreatogram
(ERCP).
b A Ampullaof Vater
B Pancreatic duct
C Common bile duct
D Fundusof gallbladder
E Body of gallbladder
F Neck of gallbladder
G Cyscicduct
H Commonhepadcduct
I Left hepaticduct
J Righthepaticduct
! i I Answer '!
--e
ccmmon bile duct enrers rhe posteromedial wall of the second !l

p a - c f t h e d u o d e n u m a t t h e a m p u l l ao f V a t e r .
o

5 I I Answer
D
The sphincterof Oddi regulates the flow of bile and is under neural
t
and hormonalcontrol.
to
5
5.32 Answer
!
fu rhe testesdescendthrough*re inguinalcanalwith the vas e,
deferensand neurovascular sffuctures,they take a contributionfrom 4
o
tie abdominalwall layers,which becomehscialcoverings.
(!
- The laygSsof the scroum and cord are: I
. Skinfrom abdominalskin
. Daruosmusclefrom abdominalCamper'sfascia
6
. Darrosfasciafrom abdominalScaroa'sfascia
. fi EEiGe.niiiil f.r. i f ro mGiie r-niG bIique muscIe
o Cremastermusclefrom" internalobliquemuscle
o Inrernalsper4qlg,.,fucia from transversalis fascia
-gfialis
. TufilE of the testes (and-Eli-reriGlprocessus varinalis
of iile ?oFd)E11 rhe abdominalperii6nzum--
Note:The tralsversusabdominismuscledoes not contriblte
to the cord or scrotum. lbxir

5.33 Answer
The contentsof the spermaticcord are:
) . Thiee arteries:testcular,cremastericand anery ofthe vas
oelerens
r r Three nerves:sympathetic, parasympatheticand genitofemoral
nenve
.l . Three other structures:v-asdeferens,pampaniformplelgs of veins
and lymphadcvessels

5.34 Answer
The testicularveinsare formed by the mergingpampaniformplexus
of veini whiih ierve an irnpoftanr role ii-th'eriroreiulation oi rhe
testes.The lefgleslicqlarveip drainsino the left renalvein.The right
testicularvein drains direcdy into the inferior vena cava.

5.35 Answer
Becauseof the more oblique entry 9.f-qh-9 righg_19_qljqulAlt'-ein
into
the inferior ven" .a"", ir is l;ia li[;ly ;o llloi bact<flowof blood.
Varicocoelesare rhere{oremore common on the left side.

5.35 Answer
f
The |,umbarplexqg is formed by the 4nterioruami of *,f,L| to L5
spinalnerves.The plexuslieswithin rhe psoasmajor muscle.
 I 5,37 Answer
!
:tl \ /
The nervesof the lumbarplexusare diyidedaccordingto how they
exit the psoasmajormuscle:
o
< Loterol
D
,f . lliohypotastricnerve (Ll)
. llioinguinal
nerve(Ll)
I . Lateralcutaneousnerve of thigh (L2, L3)
t
T
. Femoralnerve (L2, [3, L4)
!t
f
Anterior
ET . Genitofemoral
nerve(Ll, L2)
e
.gt Medio/
6 . Obturator nerve (L2, L3, L4)
tl e Lumbosacraltrunk (L4,L5)
t
o.
! 5.38 Answer
a
3 a This is a Q] scanof the abdomenat lhe levelof L | - the
transpyloricplane.
b A Rightkidney
B Left kidney
C Liver
D Stomach
E Spleen
F Body of Ll vertebra
G Pancreas
H Aona
I Left renal vein
J lnferior venacava
K Superiormesentericvein
L Rightrectusabdominismuscle
M Secondpart of duodenum
N Right psoasmajor muscle
O Rightquadratuslumborum muscle
P Superiormesentericartery

)a 5.39 Answer
The stomachis a foregut srructureand is thereforesuppliedby
branchesof the coeliactrunk. The lessercurve of the stomachis
suppliedby the right and left tastric arteries. The greater curve of
the stomach is suppliedby dre right and left gastroepiploicarteries.
The fundusis suppliedby the shon gasric arteries.
The coeli?g_trunkdivides into three branches:hg>afic,spl_e.dc and
left_gastricarteries. The splenicarcery givesoff the short gastric and
the left gastroepiploicarteries. The hepaticartery givesoff the ritht
gastricand the gastroduodenal arteries.The gastroduodenal artery
dividesinto the superiorpancreaticoduodenal and right
gascroepiploic aneries,
 :.40 Answer
!
The veinsof the stomachcorrgspondto,the.arcerres: It
r Lessercurve of the stomacriisdrainedby the right and o
reftgastric F'
v e i ns o
r Greater curve of the stomachis drainedby the right
and left s
gasrroepiploic veins t,

r Fundusis drainedby the shon gastricveins

o
. gastricand left gastroepiploicveinsdrain into the splenic {o
:::J, I
r gastroepiploicveinsdrain into the superior mesentericvein !.
light
. Rightgastricvein drainsdirectly into the pora.l vein_
the portal r
vein is formed by the confluenceof the superior mesenrcricand a
splenicveins o
3
o
Note:The inferior mesentericvein drainsinto the splenicvein. 3
!r
:
o.
5.4| Answer !
r!
The portosystemicanastomoses
occur at the: 3
I
. Oesophagus
r Umbilicus
r Rectum
r Retroperitoneum

5.42 Answer
The superior *"r"n,ufi.'j.,ery providesthe blood supply
to the
embryologicalmidgutstructures.
It arisesfrom the abslgqinalaorta ar the transpyloricplane(Ll)
behindthe body ofthe pancreas.lr then passesanierior io th"'*
uncinateprocessof the pancreasand rhird part of the duodenum,
i.e.
the p,ancreas and duodenumare w1:p_ped around the superior
mesentericartery and vein.
, r:ft The branchesof the superior mesentericaftery are the:
r Inferior pancreaticoduodenal
o Middlecolic
r Rightcolic
r Severaliejunaland ilealaneries
o lleocolic

5.43 Answer
The colon is a midgutsrructurefrom the ileocaecaljuncdon
rc the
splenicflexure and is suppliedby-the slprcrior
mesenteriear_terpThe
remainingpordon of the colon (from the splenic
flexure ." *u
is a hiJr{gutsrruclure and is therefore suppliedby the
inferior "nurf
mesentericarcery.

,1,,.fi The superiorrnesenteric

orcerygivesthe followingbranchesto the
colon:
r lleocolic
r Rightcolic
. Middlecolic
 The inferiormesentericonerTgivesthe following branchesto the
Y colon:
H
& r Lcft colic
6
o r Severalsigmoidarteries
o Superiorrectal
It
These namedarteries do not direcdy enter the colon but
P anastomosewith eachother to form the marginalartery (of
to Drummond) that runs alongsidethe colon, providing a collateral
circulation.
!n
t 5.14 Answer
CI
o This is a doublecontrastenema(bariumand air).
o A Caecum
l} B Appendix
e C Ascendingcolon
!
o D Transversecolon
I
E Descendingcolon
F Sigmoidcolon
G Rectum
H Hepatic flexure
I Splenicflexure

5,45 Answer
Theascending
colon,descending
colon,hepatic
andsplenic
flexufts,
and rectum are all retroperitoneal.

5.{6 Answer
/ .
Calo!'s-rdangleis formedby the cptic ductlaterally,the common
hepaticd_qc.t
mediallyandthe eCSqof the-liyersuperiorly.lt contains
the righthepaticar.tery,cystic.aqtery
andrhe rightbrandtof the
ponalvein. ! .) it e)
5.47 Answer
a This is the inferior surfaceof tlre liver. The anterior surfaceis
towards the top of the plcture.
b A Right lob€
B Left lobe
C Quadrate lobe
D Caudatelobe
E Gallbladder
F Inferior vena cava
G Falciformligament
H Ligamentumteres
I Common bile duct
J Portal vein
K Hepatic artery
5.48 Answer
!
p
a This is the inferior surfaceof the spleen.
b The spleenlieson the left sideof the upperabdomen.
o
Note:This is a rick ouestionto catchout those candidates who think
this organis a kidney- easilycionein the stressof the exam situation ll
when handeda shrivelledqr,q)ecjmen! D

c A Left kidney(renalimpression) {o
B Splenicflexureof colon (colonicimpression) 5

C Fundus/greater curve of stomach(gastricimpression) p

D Tail of pancreas ET

Note:The superior/anteriorsurfaceusuallyhass_el'graj
n!ffbes ro o
I
helpyou identifythe gascricarea. o
t,
d The spleenis 19t 19r.44fy p_alpable.lt must be ar leasrdoubleits
normal sizebefore its border is palpableunder rhe costalmargin, !
o
5.49 Answer I

a This is a femalepelvis.
b A Symphysis pubis
B Bladder
C Uterus
D Rectum
E Urechra
F Vagina
G Cervix of uterus
H Rectouterinepouch (of Douglas)
I Anal canal
J Sigmoidcolon
K Body of L5 vertebra
L Body of Sl vertebra
M Caudaequina
c This is the pelvicinler

5.50 Answer
The urethra star6 at the bladder neck as the pre-prosaiic urethra,'
descendi.through t}e prostateglandas Oe prosatil uiethra iili
e4ltsrrhe pro:lare gland to become the qgnbrangus urethra, which
then entersthe bulb of the penisto becomethe sponry urethra.The
spongyurethra passesthrough the penis to end as the external
urethral meatus.

5.5 I Answer
The qeFbrylsglJJrerira is surrounded by the qxternalurerhral
sphincter.This musclerelsles duringthe voidingof urine.

5.52 Answer
The prostaricurethra is the m9-stditilUte parr of rhe urerhra.
 5.53 Answer
J The membranousurethra is the leastdilatablepart of the urethra.
e
5,54 Answer
!l a This is the righthip bone (or innominate bone).
I
b A Anterior superioriliacsPine
{o B lliaccrest
C Anterior inferior iliacspine
l.
D Obturator foramen
E Greater sciaticnotch
F lschialspine
G lschialtuberosity
o H Pubictubercle
c) I Lessersciaticnorch
CL J lliacfossa
T K Arcuate line
L Superiorramusof pubis
M lnferiorramusof oubis
N lliactuberosity
c X lschium
Y Pubis
Z llium
d The ilium, ischiumand pubismeet in the aceglb-ulum (meaning
vinegarcup) to form the Hgpcede-g-symbol.
e The inguinalligamentattachesbetweenthe anterior superioriliac
spine(A) and the pubictubercle(H).
f O and P are the articularsurfacesof the hip bone.
Q-is the.articularsurhce for the sacroiliacioint. This area is
covered with hyalinecarcilage.lt is a synovialioint (the strongest
in the body).
P is the articularsurfacefor the pubicsymphysis, This areais
covered by a thln layer of hyallnecardlagethat attachesto the
oppositesidethrough a thick fibrocartilaginous disc.This is a
secondarycartilaginous joint.
g The iliacusoriginatesfrom the hollow of the iliacfossa,passes
beneaththe inguinalligamentand insertsinto the psoastendon.

5,55 Answer
o Superior third of the rectum has peritoneum anteriorly and
laterally
. Midd-lelhird of the rectum has peritoneum Qllgnorly only
. Lower rhird of the rectum has no peritoneum

5.55 Answer
a This cystoscopyis from a male patient.
b A Externalurethralorifice
B Penileurethramucosa
C Intrabulbarfossa
D Openingto membranousurethra
E Membranousurethra mucosa
 F Verumnrn (serninal colliculus)
G Lhedrrelcrest !
H Opening of prosatic urricle !,
a
I Prostatic sinus i'
o
J Internal urethral orifice
fne po-$a$g{Ble,is a sr4e!!_t!1g!_sry[!grac, a vestigial
5
P
suucrure thar is the homologue of the uterus. On
either side of
in thephotograph)
isdresrit_rike
ofeninj"ilhi-'
t
o
:I !f::*l ducts.
e,acutatory {o
The prosatic ducts open into the prostatic sinuses I
on either side
or tne ureutral cresl F
g
g
o
3
o
t
D
I
4
!
t
T
5
 !
6. Back Jo
a
o

tl
D
6.1 Answer 5
t
There are 3 | pairsof spinalnerves: o
t
r Eight cervical I
r Twelve thoracic ip
l|
r Fivelumbar n
F
r Five sacral
. One coccygeal

5.2 Answer
A line drawn betweenthe iliaccrests (supracrestalplane)
will
intersecrthe vertebralco.lumna.rthe levelof L4. A
iumbir punc&re
needleshouldbe insertedinro rhe spacebeGn rhe L4
and L5
Yertebrae.

6.3 Answer i.t"^ b"l ,*,Jt^f,

'
The needlewill passthrough rhe:
r Skin
o Subcutaneous 6t
. Deep hscia
r Supraspinousligament
. Interspinousligament
r Ugamentumflavum
. Dura mater
r Arachnoidmater
Note:There are no musclesin the midline.

5.4 Answer f7-y^lt AL cLt;t"

The cell bodiesof the sympatheticnerve cellslie
within the lateral
norn ot grey marter of the spinalcord from the level
of Tl to L2.
Pregandionicfihres passfrom these ceil bodres
ttirough the anterior
roots of the.spinalcord ro enter the anterior rami
oi-the spinal
nervesofTl ro L2,
From here tbsre_]fib-rcspQ!$tclcb wlip rami .ornmunicanru.^
to enter the sympatheticchain,wtte.e th"y,y"ap
gan_glionicfibre.s.The^sesynapsesoccur at the level of the
nerve root
or .ne pregangrionic fibres and may ascendor descenda revel.some
fibres pass rhrough thu
V.grrhgtg._l1rln *ittout slnapsingto form
splanchnicnerves.
The pgst-sanglignic_.fb6sthen rerurn to the anterior
rami via the
grey rami communicanresfor distribution to
the targer organs.
.c The sympatheticchain receivesylh!!g-El1i!914!0glgmtes from
T the T I to L2 levelsonly but the chain e:ctendsup and down the
entire lengthof the spinalcolumn.
o There are three cervicaltandia: superior,middleand inferior.
Usuallythe inferior cervicalganglionis fused with the first droraclc
P ganglionto form the larger stellate gantlion, whidl lies just above dt€
I
neckofthe first rib.
{t Note:The whke rami communicanlescontain unmyelinatedfibres
g
whereasthe;fggj communicantesconain myelinatedfibres.
I
E 6.5 Answer
t
- This is a Srpleakgrd(olyeuebra (C3 to C7 are typical ceruical
vertebrae.This happensto be the C3 venebra.)
Characteristicsof the cervical veftebrae are:
r Large,triangular vercdt6 foramen
. Smalltransverseprocessescontaininga foramen
e Smalland wide body
. Shon and bifid (C3 to C5) spinousprocess
A Spinousprocess
B Posterior tubercle oftransverse process
C Anterior tuberde oftransverse process
D Superior articular process
E Transverseforamen
F Venebral foramen
G Body

5.5 Answer
a This is the inferior aspectof a thoracic venebra (this is T6).
b Characteristicsof the thoraclc vertebrae are:
li\ r Smaller,circularvenebral foramen
14 . ttEn-shapfE body
! Long tranwerse processesthat angleposteriorly
a with the ribs
@foranlculatlon
a Long spinous processthat slopes inferiorly
c A Boq/
B Pedicle
Transverseprocess (slopingposteriorly)
D Spinousprocess (slopinginfuriorly)
E Lamlna
t Inferior articular process
Further rcading
n

o
Abrahams et al. McMinn's Colour Atlas of Human Anatomy,4th edn.
o
McMinn. Inst's Anatomy: Regiorwl and Applied, 9th edn. g

Moore. Clinically Orientated Anatomy, 5th edn. 0q

Ovcrstall- S, G, M9LF!-K. er Through Intercollegiate MRCS

9y49\
l"* 111{ 2: MCQsandEMes.London:R-oyat
Press,
Society;aM;ti.i;;
2005.
www.anatomedia.com

il3