12/18/2017

ANATOMY important note for INDIAN medical mci screening entrance exam

By Live Dr - Wed Feb 11, 2:18 am

ANATOMY

Sesamoid bones (IN THE TENDONS OF )

Quadriceps femoris (Patella – largest sesamoid bone)

Peroneus longus

Tibialis anterior

Tibilais posterior

Lateral head of gastrocnemius

Psoas major

Gluteus maximus

Flexor hallucis brevis

*Peculiarities of sesamoid bones-

Ossify at birth

Devoid of periosteum

Absence of Haversian system

Spinal nerves

numbers

Cervical

8

Thoracic

12

Lumbar

5

Sacral

5

Coccygeal

1

Total

31

Relationship between VERTEBRAE and spinal cord segments

Cervical vertebrae

Add 1 to vertebral level

Thoracic 1-6

Add 2 to vertebral level

Thoracic 7-12

Add 3 to vertebral level

Lumbar 1

All sacral segments over

Below L1

Cauda equina

C7

Most prominent spinous process at the base of neck

T3

Level of the spine of scapula

T7

Level of lower angle of scapula

T12

Floating rib

L4

Level of iliac crests

S2

Level of posterior superior iliac spine

QUOTE CORNER

The first step in the acquisition of wisdom is silence, the second, listening, the third, memory, the fourth, practice, the fifth, teaching others.
Solomon Ibn Gabriol

ELEVENTH HOUR ANATOMY 1

STRUCTURE

LEVELS IN BODY

Xiphoid process

T9

Celiac trunk

T12 L1

Spleen

10th rib

Superior mesenteric artery

L1

Stomach pylorus

L1

Spinal cord ends adults

L1-L2

Spinal cord ends children

L3

Pancreas

L1L2

Inferior mesenteric artery

L3

Umbilicus

L3L4

Highest point of iliac crest

L4

Transtubercular plane

L5

ASIS

Sacral promontory

Pregnant nerves

Blood vessel contained

Sciatic nerve

Branch of inferior gluteal artery

Optic nerve

Central retinal artery

*Pregnant nerves- these are the nerves which carry a blood vessel in them.

*Nutrient artery to the tibia is the largest nutrient artery in the body

*Housemaid’s knee- Prepatellar bursitis

Clergyman’s knee- Infrapatellar bursitis

Layers of scalp

s-Skin

c-Connective tissue

a-Aponeurosis

l-Loose areolar tissue

p-Pericranium

CONDITION

DESCRIPTION

Dolicocephaly / Scaphcephaly

Closure of sagittal suture (anteroposterior widening)

Brachycephaly

Closure of coronal suture (transverse suture)

Trigonocephaly

Closure of metopic suture (Posterosuperior widening)

Oxycephaly/ Acrocephaly/ Terrencephaly

All sutures are closed

TRIVIAL TRUTH

Each square inch of human skin contains seventy-two feet of nerves

ELEVENTH HOUR ANATOMY 2

cranial nerve

type

function

Olfactory

Sensory

Perceives smell

Optic

Sensory

Vision

Occulomotor

Motor

Supplies levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, inferior oblique, supplies sphincter pupillae, and ciliary muscle with parasymapathetic fibres.

Trochlear

Motor

Supplies superior oblique

Trigeminal

Mixed

Supplies sensory fibres to the skin of the scalp, face, mouth, teeth, nasal cavity and paranasal sinuses.

Supplies motor fibres to the muscles of mastication, tensor veli palatini and tensor tympani.

Abducent

Motor

Supplies lateral rectus

Facial

Mixed

Supplies motor fibres to the muscles of face, scalp and auricle, buccinator, platysma, stapedius, stylohyoid and posterior belly of Digastric.

Gives sensory supply to anterior 2/3rd of tongue, floor of mouth and the palate.

Gives parasympathetic secretomotor fibres to the submandibular and sublingual salivary glands, lacrimal glands and the glands of the nose and palate.

Vestibulocochlear

Sensory

Position and movement of head.

Hearing

Glossopharyngeal nerve

Mixed

Supplies Stylopharyngeus muscle

Supplies parasympathetic secretomotor fibres to the parotid gland, sensory and taste fibres to the posterior third of tongue and pharynx.

Vagus

Mixed

Supplies constrictor muscles of pharynx and intrinsic muscles of larynx, involuntary muscles of trachea and bronchi, heart, alimentary tract from pharynx to splenic flexure of colon, liver and pancreas.

Afferent fibres form the above structures, taste from epiglottis and valleculae.

Spinal accessory

Motor

Supplies Sternocleidomastoid and trapezius.

Hypoglossal

Motor

Supplies muscles of tongue , except palatoglossus

CRANIAL FORAMEN WITH THE STRUCTURES PASSING THROUGH THEM

FORAMEN

STRUCTURES

Carotid canal

Internal carotid artery

Foramen rotundum

Maxillary nerve

QUOTE CORNER

Try not to become a man of success but a man of value.- Albert Einstein

ELEVENTH HOUR ANATOMY 3

CRANIAL FORAMEN CONTINUED…

FORAMEN

STRUCTURES

Foramen lacerum

Internal carotid artery, nerve of pterygoid canal

Jugular foramen

Inferior petrosal sinus, 9th , 10th , 11th cranial nerves, internal jugular vein

Stylomastoid foramen

Facial nerve

Foramen magnum

Medulla, tonsils of cerebellum, meninges.

Through subarachnoid space- spinal accessory nerve, vertebral artery, posterior spinal artery, anterior spinal artery.

Anterior part- ligament of dens, mebrana tectoria.

Optic canal

Optic nerve

Superior orbital fissure

Superior ophthalmic vein.

lacrimal, frontal, Trochlear, occulomotor, nasociliary, abducent nerves

Hypoglossal canal

Hypoglossal nerve

Internal acoustic meatus

Vestibulocochlear and facial nerves

Foramen spinosum

Middle meningial artery, nervus spinosus, posterior trunk of middle meningial artery.

Foramen ovale

Mandibular nerve, lesser petrosal nerve, accessory meningial artery, vein connecting cavernous sinus with the pterygoid plexus of veins.

Branches of external carotid artery

Anterior

Superior thyroid

Lingual

Facial

Posterior

Occipital

Posterior auricular

Medial

Ascending pharyngeal

Terminal

Maxillary

Superficial temporal.

TRIVIAL TRUTH

The longest muscle in the human body is the sartorius. Its name is a derivation of the adjective “sartorial,” a reference to what was the traditional cross-legged position of tailors (or “sartors”) at work.

ELEVENTH HOUR ANATOMY 4

Sensory innervation of tongue

region

general sensation

taste sensation

Anterior 2/3rd, (including circumvallate papillae for taste sensation)

Lingual nerve

Chorda tympani branch of facial nerve

Posterior 1/3rd ( except circumvallate papillae for taste sensation )

Glossopharyngeal nerve

Glossopharyngeal nerve

nerve

sensory ganglion

parasympathetic ganglion

Occulomotor

Ciliary

Trigeminal

Semilunar (gasserian)

Facial

Geniculate

Pterygopalatine, submandibular

Glossopharyngeal

Superior and inferior ganglion

Otic

Vagus

—————–//————–

In the wall of viscera

Carotid sheath contains

Carotid arteries

(within the sheath common carotid divides into external and internal carotids)

Internal jugular vein

Vagus nerve

Involuntary movements

site of lesion

Chorea

Atrophy of the striatum (Caudate nucleus / Putamen)

Athetosis

Diffuse hypermyelination of Pallidum / Thalamus

Hemiballismus

Hemorrhagic lesion of Subthalamus

Parkinson’s disease

Atrophy of Substantia nigra

Coarse tremors at rest

Red nucleus

Fine tremors at rest

Cerebellum

OCULAR MUSCLES

muscle

nerve supply

function

Superior rectus

Occulomotor nerve

Moves eyeball upwards and medially

Inferior rectus

Occulomotor nerve

Moves eyeball downwards and medially

QUOTE CORNER

You see, if you take pains and learn in order to get a reward, the work will seem hard; but when you work… if you love your work, you will find your reward in that.- Leo Nikolayevich Tolstoy

ELEVENTH HOUR ANATOMY 5

OCULAR MUSCLES CONTINUED…

muscle

nerve supply

function

Medial rectus

Occulomotor nerve

Moves eyeball medially

Lateral rectus

Abducent

moves eyeball laterally

Superior oblique

Trochlear

Moves eyeball downwards and laterally

Inferior oblique

Occulomotor nerve

Moves eyeball upwards and laterally

Orbicularis oculi

Facial nerve

Closes eyelids and dilates lacrimal sac

Levator palpebrae superioris

Occulomotor nerve and sympathetic supply

Raises upper lid

Sphincter pupillae

Parasympathetic supply by occulomotor nerve

Constricts pupil

Dilator pupillae

Sympathetic supply

Dilates pupil

Ciliary muscle

Parasympathetic supply by occulomotor nerve

Controls shape of eye, helps in accommodation.

LESION OF VISUAL PATHWAY

LOSS OF VISION

Optic nerve

Blindness in that eye

Crossing fibres of optic chiasma

Bitemporal hemianopia

Lateral parts of chiasma

Binasal hemianopia

Optic tract/ lateral geniculate body

Contralateral homonymous hemianopia

Meyer’s lop of optic radiation

Contralateral superior quadrantic anopia

Vascular lesion of occipital lobe

Contralateral homonymous hemianopia with macular sparing

BLOOD BRAIN BARRIER IS ABSENT AT

Pituitary

Area postrema

Organum vasculosum of lamina terminalis

Subfornical organ

Ventral part of median eminence of Hypothalamus

Anterior pituitary

Pineal gland

*Only cranial nerve to arise form the dorsal aspect of the brain stem

Trochlear nerve

*Facial vein communicates with the cavernous sinus through the superior and inferior ophthalmic veins

TRIVIAL THOUGHT

If you are right handed you tend to chew on the right hand side of your mouth and if you are left handed you tend to chew on the left hand side of your mouth.

ELEVENTH HOUR ANATOMY 6

Upper Quadrangular space

Superior boundary

Subscapularis in front, capsule of shoulder joint in middle and teres minor behind

Inferior boundary

Teres major

Medial boundary

Long head of triceps

Lateral boundary

Surgical neck of humerus

Contents

Axillary nerve

Posterior circumflex humeral vessels

UPPER TRIANGULAR SPACE

Medial boundary

Teres minor

Lateral boundary

Long head of triceps

Inferior boundary

Teres major

Contents

Circumflex scapular artery

Lower triangular space

Medial boundary

Long head of triceps

Lateral boundary

Medial border of humerus

Superior boundary

Teres major

Contents

Radial nerve and profunda brachii vessels

Anatomical snuff box / radial fossa

Called so because it is used to snort snuff.

Anterior boundary

Abductor pollicis longus and extensor pollicis brevis.

Posterior boundary

Extensor pollicis longus.

Floor

Scaphoid, trapezium, radial artery

Roof

Origin of cephalic vein, dorsal cutaneous branch of radial nerve

Significance

Tenderness is suggestive of scaphoid fracture

DE QUERVAIN’S STENOSING TENOSYNOVITIS

Stenosing tenosynovitis affecting common tendon sheath of extensor pollicis brevis and abductor pollicis longus

Localized pain over radial styloid process

Finkelstein’s test is positive

Local steroid injection / release of tendon sheath is done

Axial artery of upper limb

C7 intersegmental artery

Axial artery of Lower limb

L5 Intersegmental artery

QUOTE CORNER

Winning isn’t everything, but wanting to win is. – Vince Lombardi

ELEVENTH HOUR ANATOMY 7

infection of

spreads to

Thumb and index finger

Thenar space

Middle and ring fingers

Mid-palmar space

Little finger

Forearm space of Parona

*The second intercostal nerve is joined to the medial cutaneous nerve of the arm by a branch, called the intercostobrachial nerve, the second in costal nerve supplies the skin of the arm pit and the upper medial side of the arm.

In coronary artery insufficiency pain is referrered along this nerve to the medial side of the arm

FASCIAL COMPARTMENT

COMPARTMENT ARTERY

COMPARTMENT NERVE

Anterior fascial compartment of thigh

Femoral artery

Femoral nerve

Medial fascial compartment of thigh

Profunda femoris artery

Obturator nerve

Posterior fascial compartment of thigh

Branches of profunda femoris artery

Sciatic nerve

Anterior fascial compartment of leg

Anterior tibial artery

Deep peroneal nerve

Lateral fascial compartment of leg

Branches of peroneal artery

Superficial peroneal nerve

Posterior fascial compartment of leg

Posterior tibial artery

Tibial nerve

at the saphenous opening the great saphenous vein receives the following tributaries

Superficial circumflex iliac vein

Superficial epigastric vein

Superficial external pudendal vein

the adductor canal contains

Terminal part of femoral artery

Femoral vein

Saphenous nerve

Nerve to vastus medialis

Terminal part of obturator nerve

Deep lymph vessels

TRIVIAL TRUTH

Body-snatching was the secret disinterment of bodies in churchyards to sell them for dissection or anatomy lectures in medical schools. Those who practiced body-snatching or grave robbing were often called resurrectionists or resurrection-men.

ELEVENTH HOUR ANATOMY 8

Maintenance of arches of the foot

factor

medial longitudinal arch

lateral longitudinal arch

transverse arch

Shape of bones/ keystone

Rounded head of talus

Cuboid

Cuneiforms, metatarsals

Staples/ Inferior edges of bones are tied together by

Plantar ligaments, like plantar calcaneo-navicular ligament

Long and short plantar ligaments

Deep transverse ligaments, dorsal interossei

Tie beam/ Tying the ends of arch together

Plantar aponeurosis, medial part of flexor digitorum brevis, abductor hallucis, flexor hallucis longus, flexor hallucis brevis, medial part of flexor digitorum longus

Plantar aponeuroses, abductor digiti minimi, lateral part of flexor digitorum longus and brevis.

Peroneus longus tendon

Suspension bridge / Suspending the arch from above

Tibilais anterior and posterior, medial ligament of ankle joint

Peroneus longus and brevis

Peroneus longus tendon and peroneus brevis.

Bronchopulmonary segments

Anatomic, functional and surgical units of the lung.

It has a segmental bronchus, a segmental artery, lymph vessels and autonomic nerves.

Segmental vein lies in the connective tissue between adjacent bronchopulmonary segments.

There are 10 segments on each side.

RIGHT LUNG

LEFT LUNG

Superior lobe

apical, posterior, anterior

Superior lobe

apical, posterior, anterior

Middle lobe

medial , lateral

lingular lobe

superior lingular, inferior lingular

Inferior lobe

Superior, medial basal, lateral basal, posterior basal, anterior basal.

Inferior lobe

superior, medial basal, lateral basal, anterior basal, posterior basal

QUOTE CORNER

By three methods we may learn wisdom: first, by reflection, which is noblest; second, by imitation, which is easiest; and third, by experience, which is the most bitter.- Confucius

ELEVENTH HOUR ANATOMY 9

*Inferior vena cava is the largest vein in the body

*Artery of Adamkiewicz, also called Adamkiewicz artery/ major anterior segmental medullary artery / great anterior segmental medullary artery; is the largest anterior segmental medullary artery.

It typically arises from a left posterior intercostal artery, which branches from the aorta, and supplies the lower two thirds of the spinal cord via the anterior spinal artery.

When damaged or obstructed, it can result in anterior spinal artery syndrome, with loss of urinary and fecal continence and impaired motor function of the legs; sensory function is often preserved to a degree.

*Ranula-

Blue coloured mucous retention cyst in the floor of the mouth, due to obstruction to the ducts of mucous glands of Blandin and Nuhn in the floor of mouth.

*Stensons’ duct- Parotid gland

Wharton’s duct- Submandibular gland

*Node of Rouviere- Most superior of lateral group of retropharyngeal lymph nodes

Esophagus

10 inches / 25 cm long

Three sites of esophageal narrowing

At the beginning of esophagus behind the cricoid cartilage

Where the left bronchus an the arch of aorta cross the esophagus

Where the esophagus enters the stomach

Constrictions of esophagus

level

structure

15 cm

cricopharynx

25 cm

aortic arch

27 cm

left bronchus

40 cm

diaphragmatic entry

Cricopharynx is the narrowest region of gastrointestinal tract.

esophagus shows three indentation on radiographic study

from above downwards they are

Aortic arch

Left bronchus

Left atrium

TRIVIAL TRUTH

In the late 19th century, millions of human mummies were used as fuel for locomotives in Egypt where wood and coal was scarce, but mummies were plentiful.

ELEVENTH HOUR ANATOMY 10

Nasogastric intubation

Distances in adult from the nostril

To the cardiac orifice

44cm

Pylorus

60 cm

Blood supply of esophagus

Upper third

Inferior thyroid artery

Middle third

Branches from descending thoracic aorta

Lower third

Left gastric artery

Blood supply of the stomach

artery

arises form

supplies

Left gastric artery

Celiac artery

Lower third of esophagus, upper right part of the stomach

Right gastric artery

Hepatic artery

Lower right part of the stomach

Short gastric artery

Splenic artery

Fundus

Left gastroepiploic artery

Splenic artery

Upper part of greater curvature

Right gastroepiploic artery

Gastroduodenal branch of hepatic artery

Lower part of greater curvature

Esophageal hiatus transmits

Esophagus, anterior and posterior vagal trunks

Aortic hiatus transmits

Aorta, thoracic duct

Duodenum

1 foot

Jejunum

8 feet

Ileum

12 feet

*Liver is divided into right and left lobes by the attachment of the peritoneum of the falciform ligament

The right lobe is further divided into a quadrate lobe and caudate lobe, by gallbladder, fissure for the ligamentum teres, the inferior vena cava and the fissure for ligamentum venosum.

However quadrate and caudate lobes are functional parts of the left lobe of liver

Tributaries of left renal vein

Left gonadal vein

Left suprarenal vein

Left inferior phrenic vein

QUOTE CORNER

Aim for success, not perfection. Never give up your right to be wrong, because then you will lose the ability to learn new things and move forward with your life.- Anonymous.

ELEVENTH HOUR ANATOMY 11

Coverings of kidney

From inside out

Fibrous capsule

Perirenal fat

Renal fascia (Fascia of Gerota)

Pararenal fat

(Fascia of Zuckerlandl is the posterior layer of renal fascia)

The renal hilum transmits following structures from front to backwards

Renal vein

Two branches of the renal artery

Ureter

Third branch of the renal artery

Ureter

10 inches / 25 cm long

Has three constrictions in its course

Where the renal pelvis joins the Ureter

Where it crosses the pelvic brim

Where it enters the bladder wall

*Renal transplantation

Iliac fossa is the preferred site for transplanted kidney

Renal artery is anastomosed end to end to the internal iliac artery and renal vein is anastomosed end to side with the external iliac vein

RADIATION OF PAIN OF URINARY STONES

LOCATION OF STONE

RADIATION OF PAIN

Renal pelvis and Ureter

T11, T12, L1, L2

Flank, loin and groin

Lower part of Ureter

Femoral branch of genitofemoral nerve

L1, L2

Front of thigh

Testis or the tip of the penis

*Supernumerary renal arteries

A supernumerary artery may cross the pelviureteral junction and obstruct the outflow of urine, producing hydronephrosis

*Prostatic urethra is the widest and the most dilatable part portion of urethra

trivial truth

Over 2500 left handed people are killed each year from using products made for right handed people.

ELEVENTH HOUR ANATOMY 12

LOBES OF ProSTATE

Anterior lobe

Median / middle lobe (enlarged in BPH)

Posterior lobe (most common site of malignancy)

Right and left lateral lobes

Atonic bladder

Detrusor is relaxed and sphincter vesicae is tightly contracted, while sphincter urethrae is relaxed

The bladder becomes greatly distended, and finally overflows.

Patient may or may not be aware of passage

Seen in the stage of spinal shock

Automatic bladder

Bladder fills and empties reflexly

Seen after the patient has recovered from spinal shock

Autonomous bladder

Bladder wall is flaccid and has greatly increased capacity

It is distended and then overflows, leading to a continuous dribble.

Seen when the sacral segments of spinal cord are damaged

Superficial fascia is divided into

Camper’s fascia

Superficial fatty layer

Scarpa’s fascia

Deep membranous layer

Constituents of spermatic cord

Ductus deferens

Testicular and cremasteric arteries and artery of the ductus deferens

Pampiniform plexus of veins

Lymph vessels from testis

Plexus of sympathetic nerves around the artery to the ductus deferens

Remains of processus vaginalis

Coverings of the spermatic cord

External spermatic fascia

derived form external oblique aponeurosis

Cremasteric fascia

derived from internal oblique aponeurosis

Internal spermatic fascia

derived form fascia transversalis

QUOTE CORNER

The problem is never how to get new, innovative thoughts into your mind, but how to get old ones out. Every mind is a building filled with archaic furniture. Clean out a corner of your mind and creativity will instantly fill it. Dee Hock

ELEVENTH HOUR ANATOMY 13

Wishing you all great success in life.
Dr.Zakirhusain Shaikh

4 Comments

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