ANATOMY COMPREHENSIVE EXAMS
→ superior laryngeal artery
1. Characteristic of the common carotid artery
• Within the carotid sheath, with the IJV and vagus nerve
to the level of the superior border of the thyroid
cartilage
• Terminal branches:
o internal carotid artery- no branches in the neck
o external carotid artery- has several branches
• RIGHT COMMON CAROTID ARTERY
o begins at the bifurcation of the brachiocephalic trunk,
other branch of this trunk is the right subclavian
artery
• LEFT COMMON CAROTID ARTERY
o Second branch of the arch of aorta
o arises posterior to the manubrium, slightly posterior
and to the left of the brachiocephalic trunk
o ascends anterior to the left subclavian artery and is at
first anterior to the trachea and then to its left
o has course of approximately 2 cm in the superior
mediastinum before entering the neck
o enters the neck by passing posterior to the left SC
joint
2. Describe the External Carotid Artery
• - supply most structures external to cranium
except orbit and part of the forehead and scalp
• - A branch from the bifurcation of the common
carotid artery
• - runs Posterosuperiorly to the region between
the neck of mandible and lobule of the auricle
• - embedded in the PAROTID GLAND
• - has 6 arteries arising from it: ASCENDING
PHARYNGEAL A., OCCIPITAL A., POSTERIOR
AURICULAR A., SUPERIOR THYROID A., LINGUAL
A., FACIAL A.
• - terminates by dividing into MAXILLARY ARTERY
&SUPERFICIAL TEMPORAL ARTERY
3. Describe superior thyroid arteries
• Most inferior of three anterior branches of
external carotid artery
• Runs antero-inferiorly deep to the infrahyoid
muscles to reach the thyroid gland
• Supply thyroid gland and gives off branches to the
infrahyoid muscles and SCM
• Gives rise to superior laryngeal artery - supplying
the larynx
4. During the course of performing a
thyroidectomy, the artery ligated is the superior
laryngeal artery
• External carotid a. → superior thyroid a.
• Courses with superior laryngeal nerve
through thyrohyoid membrane; supplies
supraglottic region
5. >>>>>
6. Describe external jugular vein
COURSE:
• Start: angle of mandible (union of: posterior
division of the retromandibular vein + posterior
auricular vein)
• Then: crosses SCM obliquely; deep to the
platysma; enters the anteroinferior part of the
lateral cervical region; pierces the investing layer
of deep cervical fascia; descends to the inferior
part of the lateral cervical region
• Termination:subclavian vein
PARTS IT DRAINS:
• scalp (most parts)
• face(side)
7. >>>>
8. Structures that has to be dissected away in order
to expose the common carotid artery on its
anterior side.
• Skin and Fascia
• Sternocleidomastoid muscle
• Sternohyoid mm
• Sternothyroid mm
• Superior belly of omohyoid
9. Describe the Superior Thyroid Artery (Source:
Moore)
• most inferior of the 3 anterior branches of the
external carotid artery
• runs antero-inferiorly deep to the infrahyoid
muscles to reach the thyroid gland
• gives off branches to the infrahyoid muscles and
SCM
 • gives rise to the superior laryngeal artery,
supplying the larynx
• accompanied by the external laryngeal nerve
Branches: (source: radiopaedia.org)
➢ Hyoid artery
➢ Sternocleidomastoid branches
➢ Superior laryngeal artey
➢ Cricothyroid branch
10. The blood supply of the upper lip
Artery:Superior Labial
Origin: Facial Artery near angle of mouth
Course: Runs medially in upper lip
Distribution: Upper lip and ala (side) and septum of
nose
11. >>>
12. Describe the posterior auricular artery.
• Arises from the posterior surface of the external
carotid artery just above the digastric posterior
belly.
• Ascends superficial to the styloid process and
deep to the parotid gland and ends between the
mastoid process and the external acoustic
meatus.
• Gives rise to stylomastoid, auricular, and occipital
branches.
13. The major erectile body in both the male and
female
Male- Penis
Female- Clitoris
*Both are analogous w/ each other
14. Describe the bulb of corpus spongiosum
- otherwise known as bulb of the penis, or bulb
of corpus cavernosus urethra (aka corpus
spongiosum);
- male urethra enters the bulb nearer to the
superior than to the inferior surface;
- the corpus spongiosum prevents the urethra
from pinching close during erection,
maintaining a viable channel for ejaculation
15. The part of the male reproductive tract which
carries only semen within the prostate gland
- Ejaculatory duct
16. Primary Sex organ:
Male- Testis; Female- Ovary
17. Site of sperm maturation.
Epididymis
18. Describe the correct order for the path of sperm
from the testes
Seminiferous tubules  Tubuli recti  Rete testis
 Ductuli efferentes  Ductus epididymis 
Ductus (vas) deferens  Ejaculatory duct 
Urethra (prostatic, membranous, cavernous)
19. What portions of the penis contains erectile
tissue that becomes engorge with blood?
- CORPORA CAVERNOSA & CORPUS
SPPONGIOSUM
20. The contractile layer of the scrotum
Dartos – contractile layer of the scrotum; very
vascular and contractile under cold or mechanical
stimuli
- also acts to regulate the temperature of the
testicles promoting spermatogenesis
-
21. Describe the exchange of gases between blood
and cells.
 Each respiratory bronchiole> 2-11 alveolar ducts > 5-6
During internal respiration, gas exchange occurs alveolar sacs each
between the blood in the tissue capillaries and
the body tissues. As oxygen is used by tissue cells O2 diffuses from
for their metabolic activities, oxygen leaves the the alveoli into
blood of the tissue capillaries and enters the the pulmonary
tissues and carbon dioxide enters the blood of the capillary blood
tissue capillaries from the tissues due to partial because the
pressure gradients. oxygen partial
pressure (PO2)
Oxygen: either transported by hemoglobin as in the alveoli is
oxyhemoglobin in the erythrocytes or transported greater than
in blood plasma. PO2 in the
• ↑ PO2in pulmonary capillaries; O2 pulmonary
combines with the hemoglobin. capillary blood.
• ↓ PO2 in tissue capillaries; O2 released
from the hemoglobin and diffuses into When O2 is
tissue cells. metabolized in
Carbon dioxide: carried by hemoglobin as the cells to
carbaminohemoglobin, dissolved in the plasma, form CO2,the
or as the bicarbonate ion. intracellular PCO2 rises causing CO2 to diffuse into the
• ↑ PCO2 in tissue capillaries; resulting in tissue capillaries. After blood flows to the lungs, the CO2
formation of carbaminohemoglobin diffuses out of the blood into the alveoli, because the
• ↓ PCO2 in pulmonary capillaries; CO2 PCO2 in the pulmonary capillary blood is greater than that
splits from hemoglobin and enters alveoli in the alveoli. Thus, the transport of O2by the blood
by diffusion. depends on both diffusion and the flow of blood.

22. DESCRIBE THE CONDUCTING PORTION OF THE

RESPIRATORY SYSTEM
- Function:warm, moisten, and filter the air
before it reaches the respiratory components
- Conducting portion:
o START: nose, nasopharynx, larynx,
trachea, bronchi, and bronchioles of
decreasing diameters, END: terminal
bronchioles
23. The structure which closes off the larynx
27. What is the artery located at the back of the leg?
- Epiglottis
Epiglottis closes off the larynx during swallowing.
Posterior tibial artery
• Direct branch of the popliteal artery, begins at the
24. Which one of the following best describes a
distal bor-der of the popliteus, as the popliteal
correct order of structures in the respiratory
artery passes deep to the tendinous arch of the
passageways?
soleus and simultaneously bifurcates into its
terminal branches.
Nose, pharynx, larynx, trachea, bronchi, and
• Close to its origin, the posterior tibial artery gives
bronchioles
rise to its largest branch, the fibular
artery, which runs lateral and parallel to it,
also within the deep subcompartment.
25. Describe the exchange of gases in the lungs • It supplies the posterior compartment and the
26. >>>>> foot
Pulmonary alveolus - basic structural unit of gas exchange
in the lung
 31. Boundaries of the perineum

- Anteriorly – pubic symphysis

- Posteriorly - sacruman dcoccyx
- Anterolaterally – ischio pubic ramus
- Posterolaterally - sacrotuberous ligament

32. A condensation of fibrous tissue in the female

located at the center of the posterior border of
the perineal membrane:

- Perineal Body

33. Blood supply to the major erectile body in both

male & female.

- Deep arteries of the penis/clitoris.

34. The vestibular bulbs/bulb of the corpus

spongiosum
• homologous structures
• VESTIBULAR BULBS
a. paired masses of elongated erectile tissue
(approx 3cm in length)
b. lie along the sides of vaginal orifice,
superior or deep to (not within) the labia
minora, immediately inferior to the
perineal membrane
28. The major artery that supplies the arm c. covered inferiorly and laterally by the
29. >>>> bulbospongiosus muscles extending along
- Brachial Artery their length
• BULB OF CORPUS SPONGIOSUM
30. Describe the subclavian artery o consists of erectile tissue
o enlarged posterior part-
- from brachiocephalic trunk (right) or arch of penetrated superiorly by the
aorta (left); urethra continuing from its
- in contact with the first rib passing posteriorly intermediate part
to the anterior scalene muscle; 35. >>>
- becomes the axillary artery after the first rib; 36. Drainage of Jejunum
- deep in the omoclavicular (subclavian)
triangle of the lateral cervical region, - drains into the SUPERIOR
posterosuperior to SC vein; MESSENTERIC VEIN and so is the
- arterial supply of the thoracic wall via the
internal thoracic and supreme intercostal Ileum
arteries; - lies anterior and to the right of SMA
- pressure point on middle thirds of the clavicle
– significant during upper limb hemorrhage in the root of the mesentery
- parts: medial, posterior and lateral
- ends posterior to the neck of
- branches: Vertebral, Internal thoracic,
Thyrocervical trunk, Costocervial trunk, Dorsal pancreas, where it UNITES with
scapular parts in relation to branches: medial
SPLENIC V. to form
– VIT; posterior – C; lateral D
HEPATIC PORTAL VEIN
37. >>>>
38. Lymphatic vessels within the bowel villi..
- specialized lymphatic vessels in
intestinal villi that absorb fat: Lacteals
- Lacteals drain into lymphatic vessels
between the layers of mesentery and
passes through 3 groups of lymph nodes
as given in figure.
o Lymphatic vessels from
terminal ileum drains to ileocolic
lymph nodes
39. Characteristic of the ileum.
• Last 3rd of small intestine; 3/5of total
length of small intestine (2.5-3.5
meters)
• Distal end of ileum: large intestine;
junction between ileum and cecum:
ileocecal valve (ileal ostium)
o Ileocecal valve: functional
sphincter formed by circular
muscle layers of ileum and
cecum; prevents reflux from
large intestine into the small
intestine
• Less prominent valves of Kerckring
(parallel running circular folds in
mucosa) compared to jejunum.
• Rich in lymphoid follicles
• Attached to posterior wall of abdomen
by mesentery; lies flexibly in
abdominal cavity
40. READ ON THESE STRUCTURES:
*all are parts of the large intestine*
• CECUM: first part; continuous with the
ascending colon; @iliac fossa (right lower
quadrant of the abdomen); entirely enveloped
by peritoneum; no mesentery; ileum enters it;
with ileocolic lips and frenula of the ileal
orifice (contracts, closing the valve to prevent
reflux from the cecum into the ileum), with
ileal papilla (passive flap valve, preventing
reflux from the cecum into the ileum);
ARTERIAL SUPPLY: ←ileocolic artery;
VENOUS DRAINAGE: →ileocolic vein;
LYMPH:→ileocolic lymph nodes
• DESCENDING COLON: occupies a calices, vessels and nerves.
secondarily retroperitoneal position
(between the left colic flexure and the left iliac
fossa); continuous with the sigmoid colon;
with paracolic gutter (the left one) on its
lateral aspect; ARTERIAL SUPPLY:
←sigmoid arteries; VENOUS DRAINAGE: →
inferior mesenteric vein → splenic vein →
hepatic portal vein→ liver; LYMPH:→
intermediate colic lymph node
• SIGMOID COLON: S-shaped loop; link:
descending colon and the rectum; from iliac
fossa to the third sacral (S3) vertebra; with
rectosigmoid junction (indicated by
termination of the teniae coli); mesentery:
sigmoid mesocolon; ARTERIAL SUPPLY:
←sigmoid arteries; VENOUS DRAINAGE: →
inferior mesenteric vein →splenic vein
→hepatic portal vein→liver; LYMPH:→
intermediate colic lymph node
• RECTUM: terminal part; primarily
retroperitoneal and subperitoneal;
continuous with the sigmoid colon at the level
of S3 vertebra
• TRANSVERSE COLON: third; longest; most
mobile; from right colic flexure →left colic
flexure (LCF- more superior, acute, and less
mobile than RCF, anterior to left kidney and
attaches to diaphragm throughphrenicocolic
ligament) ; ARTERIAL SUPPLY: ← middle
colic artery; VENOUS DRAINAGE: →superior
mesenteric vein; LYMPH:→middle colic
lymph nodes
41. Describe the space within the kidney
where pelvis, calices, vessels, and nerves
occupy
Renal Sinus
- The space within the kidney that
are occupied by the renal pelvis,
 - Is a fat-filled compartment located - contains the renal hilum (entrance
within the medial surface of the to this space)
kidney. - bordered by renal parenchyma
laterally
Contents: the ascending lumbarvein; it then traverses
the acute angle between the SMA anteriorly
Renal a. and v. and the aorta posteriorly.
Major and minor calices • Each renal vein drains into the IVC.
Adipose tissue
Lymphatic channels
Autonomic nerves
Fibrous tissue (variable amount) 43. Which part of the levatorani muscle is
thicker, narrow, and forms a sling that
42. Describe the renal vessels (Source: passes posterior to the anorectal
Moore) junction?

➢ The renal arteries arise at the level of the IV • Puborectalis: the thicker, narrower, medial
disc between the L1 and L2 vertebrae
➢ The longer right renal artery passes
posteriorto the IVC.
➢ Each artery divides close to the hilum into
five segmental arteries that are end arteries

Segmental Arteries:
1. The superior (apical) segment is
supplied by the superior (apical)
segmental artery
2. The antero-superior segment supplied
by the anterosuperior segmental
3. The antero-inferior segment supplied by
antero-inferior segmental arteries part of the levatorani, consisting of muscle
4. The inferior segment is supplied by the fibers that are continuous between the
inferior segmental artery. posterior aspects of the bodies of the right
5. The posterior segmental artery, which
and left pubic bones. It forms a U-shaped
originates from a continuation of the
muscular sling (puborectal sling) that
posterior branch of the renal artery,
supplies the posterior segment of the passes posterior to the anorectal junction,
kidney. bounding the urogenital hiatus. This part
Renal Veins: plays a major role in maintaining fecal
• Renal veins drain each kidney and unite in a continence
variable fashion to form the right and left
renal veins
• Renal veins lie anterior to the right and left
renal arteries
• The longer left renal vein receives the left
suprarenal vein, the left gonadal (testicular
or ovarian) vein, and a communication with
44. What are the anterior lateral abdominal wall muscles?

- This layer is fused on either side with

the prevertebral fascia, and with it
45. Describe the layer of deep cervical fascia
completes the compartment containing
blends or continuous with the fibrous
the larynx and trachea, the thyroid
pericardium?
gland, and the pharynx and esophagus.
- It encloses the thyroid and is
- Pretracheal Fascia- extends medially in
responsible for its movement
front of the carotid vessels, and assists
during deglutition.
in forming the carotid sheath.
 46. What muscle divides the lateral cervical
region into two other triangles?
- For precise localization of structures, the
lateral cervical region is divided into a
large occipital triangle superiorly and a
small omoclavicular (subclavian) triangle
inferiorly by the inferior belly of the
omohyoid
47. Circumflexartery
- Circumflex arterty arises from LCA,
passes to the left in AV sulcus and runs
to posterior surface of the heart. Its
upplies the left atrium and left ventricle.
It anastomose with right coronary artery.
48. Describe the vein that merge with the
great cardiac vein to form the coronary
sinus:
- Oblique vein of the Left Atrium (of
Marshall)
o descends over the posterior wall of
the Left atrium and along with the
sphenoid, the maxilla, and the palatine bones, the
pterygopalatine fossa.
51. Describe the Transverse Facial Artery
- from the SUPERFICIAL TEMPORAL
ARTERY
- supplies: PAROTID GLAND & DUCT,
MASSETER, SKIN OF FACE
- Branches: SUPRAORBITAL A.,
SUPRATROCHLEAR A., MENTAL A.
52. Describe the transverse facial artery
- The retromandibular vein is a deep
vessel of the face formed by the
union of the superfi cial temporal
vein and the maxillary vein, the latter
draining the pterygoid venous
plexus. The retromandibular vein
runs posterior to the ramus of the
mandible within the substance of the
parotid gland, superficial to the
external carotid artery and deep to
Great Cardiac Vein defines the
beginning of the sinus
o Remnant of the embryonic left SVC,
which usually atrophies during the
fetal period, but occasionally persist
in adults, replacing or augmenting
right SVC.
49. Landmark of the cranium between the
intersection of sagittal& coronal suture
- Bregma.
50. What is the foramen rotundum
• aka round foramen
• posterior to the medial end of the superior orbital
fissure
• runs a horizontal course to an opening on the
anterior aspect of the root of the greater wing of
the sphenoid into a bony formation between the
the facial nerve. As it emerges from
the inferior pole of the parotid gland,
the retromandibular vein divides into
an anterior branch that unites with
the facial vein and a posterior branch
that joins the posterior auricular vein
inferior to the parotid gland to form
the external jugular vein. This vein
passes inferiorly and superficially in
the neck to empty into the subclavian
vein.
53. Describe levator labii superioris.
Levatorlabiisuperioris:one of the muscles
of facial expressions; broad, flat,
quadrangular extending between the lateral
side of the nose and the zygoma in the
infraorbital area
• Origin: Infra-orbital margin (maxilla)
• Insertion: Skin of upper lip
• Action: Part of dilators of mouth;
retract (elevate) and/or evert upper
lip; deepen nasolabial sulcus
(showing sadness)
• Nerve supply: CN VII
• Blood supply:Facial artery
 54. CN V/Trigeminal nerve;

Function: sensory (for face) + motor (for mm for mastication)

3 DIVISIONS: sensory innervation of face + anterosuperior part of scalp

• Ophthalmic nerve (CN V1)-main area of termination: eye; wholly sensory; branches:Frontal n- largest,
Nasociliary- intermediate, Lacrimal n
• Maxillary nerve (CN V2)-main area of termination: maxilla; wholly sensory; branches:zygomaticofacial n
+zygomaticotemporal n
• Sensory component of the mandibular nerve (CN V3)-main area of termination: mandible; inferior and largest
division; branches:Auriculotemoralbr; buccal br; mental br

55. Branches of Abdominal Aorta

56. Segments of the liver

Segmental Arteries:
• The superior (apical) segment is supplied by the superior (apical) segmental artery
• The antero-superior segment supplied by the anterosuperior segmental
• The antero-inferior segment supplied by antero-inferior segmental arteries
• The inferior segment is supplied by the inferior segmental artery.
• The posterior segmental artery, which originates from a continuation of the posterior branch of
the renal artery, supplies the posterior segment of the kidney.
Renal Veins:
• Renal veins drain each kidney and unite in a variable fashion to form the right and left renal veins
• Renal veins lie anterior to the right and left renal arteries
• The longer left renal vein receives the left suprarenal vein, the left gonadal (testicular or ovarian) vein,
and a communication with the ascending lumbarvein; it then traverses the acute angle between the
SMA anteriorly and the aorta posteriorly.
• Each renal vein drains into the IVC.
57. 7 to 9 Intercostal muscles

58. Structures at the root of the lung

Hilum of the lung
• A wedge-shaped area on the mediastinal surface of each lung through which the structures
forming the root of the lung pass to enter or exit the lung
• Medial to the hilum, the lung root is enclosed within the area of continuity between the
parietal and the visceral layers of pleura—the pleural sleeve (mesopneumonium).
• Inferior to the root of the lung, this continuity between parietal and visceral pleura forms the
pulmonary ligament, extending between the lung and the mediastinum, immediately anterior
to the esophagus. The pulmonary ligament consists of a double layer of pleura separated by
a small amount of connective tissue. When the root of the lung is severed and the lung is
removed, the pulmonary ligament appears to hang from the root.
• The branching structures of the root include the bronchi and pulmonary vessels.
Right hilum Left lung
59. Gluteus maximus muscle
- main extensor muscle of the hip
- largest and most superficial of the
three gluteal muscles and makes up a
large portion of the shape and
appearance of each side of the hips
- quadrilateral shape
- forms the prominence of the buttocks.
60. What forms the inguinal ligament?
- otherwise known as the Poupart
ligament; the inguinal ligament is
the thickened inferior margin of the
external oblique aponeurosis;
- a fibrous band that spans
between the ASIS and the pubic
tubercle
61. External rotators of the hip
62. >>>>
• superior gemellus, inferior
gemellus, obturator internus,
obturator externus, quadratus
femoris and piriformis
63. The normal angle of inclination
between the neck and the shaft of the
femur in adults and children
Normal angle of inclination of femur-
Adults – 125 degrees; Children- approx. 150
degrees
64. What is coxavarus(vara)?
65. >>>>>
- Angle <100 degree; results in shortening
of the limb on affected side
66. This ligament is a band of great strength 70. The major blood supply to the femoral head
which lies in front of the hip joint; it is comes from the extracapsular ring at the
intimately connected with the capsule, and base of the femoral neck.
serves to strengthen capsule.
Blood supply to FEMORAL HEAD:
• Iliofemoral ligament; ligamentum (1) Aorta → External Iliac A. → Femoral A. →
iliofemorale; Y-ligament; ligament of ProfundaFemoris A. → Lateral + Medial
Bigelow Circumflex A. V → Retinacular A (br. arising
• Said to be the body’s strongest ligament from MCFA are most abundant, bringing more
• Attachments: blood to the head and neck of the femur)
a. Above- lower part of the AIIS (2) Aorta → Internal Iliac A. → Obturator A. →
b. Below- divides into two bands: (1) Artery of the Ligamentum Teres
passes downward and is fixed to the
Extracapsular ring (@base of femoral neck):
lower part of the intertrochanteric
line, (2) directed downward and • Posteriorly- formed by large br. of MCFA
lateralward and is attached to the • Anteriorly- formed by smaller br. of LCFA
upper part of the intertrochanteric • + minor contributions- superior + inferior
line gluteal A.
• specifically prevents hyperextension of the • Ascending cervical br- give rise: Retinacular A
hip joint during standing by screwing the
+ Subsynovial Intraarticular Ring
femoral head into the acetabulum
Femoral neck fracture:

67. This ligament consist of strong
triangular band of fibers, which spring
from the ischium below and behind the
acetabulum and blends with the
circular fibers of the capsule
- ISCHIOCAPSULAR LIGAMENT or BAND/
LIGAMENT OF BERTIN
68. This consists of strong, flattened
fibers, which cross the acetabular
notch, and convert it into a foramen
through which the nutrient vessel enter
the joint
• → avascular necrosis of the femoral head
• “Fractures of the femoral neck interfere with
or completely interrupt the blood supply from
the root of the femoral neck to the femoral
head. The scant blood flow along the small
artery that accompanies the round ligament
may be insufficient to sustain the viability of
the femoral head, and ischemic necrosis
gradually takes place.”

• The Transverse Acetabular Ligament

(Ligamentum, Transversum acetabuli;
Transverse Ligament)

69. This ligament consists of a triangular,

somewhat flattened band implanted by
its apex into the anterosuperior part of
the fovea capitisfemoris

Ligamentumteresfemoris
• Base attached by two bands, one
into either side of the acetabular
notch, and between these bony
attachments it blends with the
transverse ligament.
 71. Describe the ulno-carpal joint a fall on the outstretched hand in a young
adult makes one suspicious of a fractured
Ulno-carpal joint scaphoid. (Source: SNELL)

• End of ulna separated from triquetral and
lunate by triangular fibrocartilage that acts
as shock absorber
• Abduction/adduction (radial/ulnar
deviation):
o 15 degrees abduction – lunate
makes contact with articular disk
o 45 degreed adduction – triquetrum
makes contact with articular disk
• Flexion/extension (170 degrees) through
lunate-capitate axis
• Circumduction
• Support: ulnar collateral ligament – ulnar
styloid to triquetrum, ulnar carpal ligament
– on palmar side
• Scaphoid fractures are classified according
to the severity of displacement--or how far
the pieces of bone have moved out of their
normal position:
o Non-displaced fracture. In this type
of fracture, the bone fragments line
up correctly.
o Displaced fracture. In this type of
fracture, the bone fragments have
moved out of their normal position.
There may be gaps between the
pieces of bone or fragments may
overlap each other.
76. This carpal bone is related to the
triangular cartilage

- Distally, the triangular cartilage inserts

into the Lunate via the ulnolunate
ligament, and into the Triquetrum via
ulnotriquetral ligament, the Hamate,
and the base of the 5th metacarpal.

- A fibrocartilaginous, triangular articular

disc of the distal radio-ulnar joint
(sometimes referred to by clinicians as
the “triangular ligament”) binds the ends
of the ulna and radius together, and is
the main uniting structure of the joint.
72. Displaced Scaphoid fractures
73. >>>>
74. >>>>
75. >>>>

Fracture of the scaphoid bone

• is common in young adults; unless
treated effectively, the fragments will not
unite, and permanent weakness and pain
of the wrist will result, with the
subsequent development of
osteoarthritis. The fracture line usually
goes through the narrowest part of the
bone, which, because of its location, is
bathed in synovial fluid. The blood
vessels to the scaphoid enter its proximal
and distal ends, although the blood
supply is occasionally confined to its
distal end. If the latter occurs, a fracture 77. Developmentally, it is a sesamoid bone
deprives the proximal fragment of its (embedded in flexor carpi ulnaris
arterial supply, and this fragment tendon)
undergoes avascular necrosis. Deep
tenderness in the anatomic snuffbox after
Pisiform
- Sesamoid bone found medially on the
proximal row of carpal bones and
articulates with triquetral
- It is formed w/in the tendon of the flexor
carpi ulnaris
78. Describe the main support to the radio-
carpal joint
- ulnocarpal and radioulnar ligaments –
two sets of ligaments that provide the
main support for the wrist.
79. A patient complains of pain on the
lateral aspect of the wrist aggravated
by adduction of the wrist with flexion of
the thumb
80. >>>>
- deQuervain Tenosynovitis
- test: Finkelstein test – flexion of
thumb and ulnar wrist deviation
causes pain at first dorsal
compartment
- trivia: this condition was named
after Fritz de Quervain, Swiss
Surgeon, 1895
81. A 21 year old male patient fell from a
bike hitting his right shoulder and right
side of his face on the hard pavement.
He felt a sudden numbness and
tingling sensation on his right arm
82. >>>
83. >>>
84. >>>
- Brachial plexus injury
85. Define the Brachial Plexus:
86. >>>
- A major nerve network supplying the
upper limb which begins in the neck
and extends into the axilla
- Formed by the union of the anterior
rami of the last four cervical (C5-C8)
and first Thoracic (T1) nerves which
constitute its roots
87. Clavipectoral fascia
88. >>>
- Deep to the pectoralis major; another
layer of deep fascia suspended from the
clavicle & investing the pectoralis minor
muscle.
89. Define the third part of the axillary
artery
- from the lateral border of pectoralis minor
to the inferior border of teres major
has three branches:
a. subscapular artery s the largest
branch of the axillary artery
b. Opposite the origin of this artery,
the anterior circumflex humeral
and posterior circumflex humeral
arteries arise, sometimes by
means of a common trunk.
90. Manifestation of Low Radial Nerve
Palsy
- Wrist drop
 91. Describe the blood supply of the shaft
of the femur
• The femoral arteries receive blood through
the external iliac artery. That proximal
section of the femoral artery, known
specifically as the common femoral artery
(CFA), leaves the femoral triangle through
an apex beneath the sartorius muscle.
• It then divides into a deep and superficial
femoral. The deep vessel is more
commonly known as the Profunda which
provides blood to the thigh. The other
branch is the superficial femoral artery or
SFA. The SFA connects to the popliteal
artery at the opening of adductor magnus
or hunter's canal towards the end of the
femur.
92. Read on the scarpa’s triangle
Femoral triangle (Scarpa’s triangle)
• A subfascial formation, triangular
landmark
• Appears as a triangular depression
inferior to the inguinal ligament
when the thigh is flexed, abducted,
and laterally rotated.
• Bounded:
o Superiorly: inguinal ligament
(thickened inferior margin of
external oblique aponeurosis);
forms base of femoral triangle
o Medially: lateral border of
adductor longus
o Laterally: medial border of
sartorius muscle
It also has a floor and a roof
o Roof: fascia lata
o Base: pectineus, iliopsoas, and
adductor longus muscles
• Contents (contained within fascial
compartment known as femoral
sheath):
o Femoral nerve: innervates
anterior compartment of
thigh; provides sensory
branches for the leg and
foot
o Femoral artery:
responsible for majority of
the arterial supply to the
lower limb
o Femoral vein: great
saphenous vein drains into
the femoral vein within the
triangle
o Femoral canal: structure
which contains deep lymph
nodes and vessels
93. DEFINE THE HUNTER’S CANAL
• aka Adductor Canal/ Subsartorial Canal/
Canal of Guyton
• aponeurotic tunnel
• middle third of thigh
Course:
• Femoral Triangle (apex) → Adductor
hiatus (opening of adductor magnus)
• between: anterior + medial compartment
of thigh
Boundaries:
• Anterolaterally- Vastus medialis
• Posterior- Adductor longus + magnus
• Covered by: strong aponeurosis (from
Vastus medialis→ Adductor longus +
magnus)
• Medially + roof- Sartorius
Contents:
• Femoral A(→ inf. foramen)
• Femoral V(→ inf. foramen)
• br of Femoral N (saphenous n + n to
vastus medialis; → ant. foramen)
 94. The common nerve supply to the adductor muscle group of the thigh

- The adductor muscle group of the thigh is also called medial compartment of the thigh. There are five
muscles in this group: gracilis, obturator externus, adductor brevis, adductor longus, and adductor
magnus.

All the adductor muscles are innervated by the Obturator nerve.

Recall:

Anterior compartment – Femoral n.

Medial compartment – Obturator n.
Posterior compartment – Sciatic n.

95. Describe the Gracilis Muscle (Source: Moore)

• a long, strap-like muscle and is the most medial muscle of the thigh
• the most superficial of the adductor group and the weakest member
• the only one of the group to cross the knee joint as well as the hip joint
• The gracilis joins with two other two-joint muscles from the other two compartments (the sartoriusand
semitendinosus muscles). They have a common tendinous insertion, the pes anserinus(L., goose’s
foot),
• Proximal Attachment: Body and inferior ramus of pubis
• Distal Attachment: Superior part of medial surface of tibia.(pes anserinus)
• Innervation: Obturator nerve (L2, L3)
• Action: Adducts thigh; flexes leg; helps rotate leg medially

96. Enumerate the muscles located in the thenar compartment

 97. Define the muscles located in the hypothenar compartment.
98. >>>
99. >>>

Abductor DigitiMinimi

- most superficial of the three muscles forming

thehypothenar eminence

Flexor DigitiMinimi Brevis

- variable in size; it lies lateral to the abductor

digitiminimi.

OpponensDigitiMinimi

- quadrangular muscle that lies deep to the

- abductor and flexor muscles of the 5th finger
 increases the size of the nine structures or
their coverings that pass through it
100. Describe what happens anatomically o affects the median nerve hence paresthesia
in De Quervain’s disease (tingling), hypoesthesia (diminished
sensation) or anesthesia (absence of
- De Quervain's disease is a sensation) may occur in the lateral three
painful inflammation of tendons in the thumb and a half digits
that extend to the wrist. The swollen o includes symptoms affecting at least 2 of the
tendons and their coverings rub against the first 3 digits, but not the palm of dorsum of
narrow tunnel through which they pass. the hand
That causes pain at the base of the thumb
and into the lower arm.
107. The Central Compartment of the
101. The MUSCLES that act exclusively at
the carpometacarpal joint hand contains:
- Flexor tendons and their sheaths
- abductorpollicis longus (APL);
- The short muscle Lumbricals
o possibly extensor digitorum,
extensor indicis, extensor - Superficial Palmar Arterial Arch
digitiminimi, extensor pollicis brevis
- Digital Vessels and Nerves
and longus
*not certain of this answer; table 6.11,
pp751-752 will indicate that the only
muscle acting (exclusively) at
carpometacarpal joint is APL; however, Q101 108. What are the actions of opponens
is looking for muscle(s) so the extensors may pollicis muscle
be included

102. Muscles that makes up the

hypothenar eminence
- Abductor digiti minimi,
- Flexor digiti minimi brevis,
- Opponens digiti minimi

103. Bones at the proximal carpal row-

Scaphoid, Lunate, Triquetrum, Pisiform
(MNEMONIC: Sweet Lovers Try Positions)

104. Nerve that passes through the carpal

tunnel beneath the flexor retinaculum
- Median nerve

opponens trapezium lateral median opposes

105. A patient presents numbness of the pollicis & border of thumb
second and third digits especially upon (thenar flexor 1st to
waking up in the morning muscle) retinaculum metacarpal other
106. >>>> digits

• CARPAL TUNNEL SYNDROME

o results from any lesion that significantly
reduces the size of carpal tunnel or
109. Describe the lumbricals
Lumbrical muscles: Four short hand
muscles, each associated with a finger,
located in the metacarpus deep to the
palmar fascia; very crucial to finger
movement, linking the extensor tendons to
the flexor tendons. Denervation basis for
ulnar claw and hand of benediction.
• Origin: tendon of the flexor
digitorumprofundus
110. WHAT ARE FIBROUS SLIPS, COVERED BY SYNOVIAL MEMBRANE TRANSMIT BLOOD VESSELS TO
THE FLEXOR TENDONS
• Insertion: pass dorsally and
laterally around each finger, inserts
into extensor hood
• Action: flex at the MCP joint, and
extend at the interphalangeal (IP)
joints of each finger
• Innervation: medial two lumbricals
(of the littler and ring fingers) →
ulnar nerve; lateral two lumbricals
(of the index and middle fingers) →
median nerve