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Part II
Mesencephalon is Mid brain. Rhombencephalon is Hind brain.
Metencephalon is Pons.
Myelencephalon is Medulla oblongata.
Brainstem mean Mid brain, pons, medulla.
Sulcus mean surface depression.
Gyrus means surface elevation.
Cortex Grey matter cover surface of cerebral and cerebellar
hemispheres.
Rhomboid fossa is floor of 4th ventricle.
Calamus scriptorius is caudal end of rhomboid fossa (resembles
nib of a pen).
Locus ceruleus is bluish grey area in floor of 4th ventricle.
Restiform body is large lateral component of inferior cerebellar peduncle.
Juxtarestiform body is small medial component of Inferior cerebellar peduncle.
Brain and spinal cord are enclosed in meninges dura, arachnoid and pia.
Cranial dura has two layers, an outer endosteal and an inner meningeal layers.
Spinal dura is continuation of meningeal layer.
CSF is formed either by secretion or ultrafiltration from choroid plexus.
Blood vessels of brain run in subarachnoid space.
5. Cervical enlargment of spinal cord corresponds to C3 to T2 spinal segments; lumbar enlargment corresponds
to L1 to S3 spinal segments.
6. In spinal cord, grey matter is inside and presents anterior and posterior horns; white matter is outside and is
divided into posterior, lateral and anterior funiculi by emerging dorsal and ventral roQts of spinal nerves.
7. Grey matter is traversed by Central canal and white matter has ascending and descending tracts.
8. Posterior funiculus has fasciculus gracillis and cuneatus.
9. Anterior 2/3 of cross sectional area of Spinal cord is supplied by branches of anterior spinal arterior and the rest
by posterior spinal artery and pial plexus.
10. Cervical 8, Thoracic 12, Lumbar 5, Sacral 5, coccygeal 1.
11. Basal ganglia include caudate nucleus and lentiform nculeus.
12. Corpus striatum includes caudate nucleus and lentiform nucleus.
31. Blood supply toS.A.node of heart is derived from —Right coronary artery.
32. Cusps of Semilunar valve of Aorta are —One anterior and two posterior.
33. Cusps of semilunar valve of Pulmonary trunk are — one posterior and two anterior.
36. Circumflex branch of left coronary artery supplies mainly —Left atrium.
37. Apex of heart is situated at —Left fifth intercostal space.
38. Chief muscle of inspiration is —Diaphragm.
53. Inferior venacava enters right atrium at the level of — Sixth chondro-sternal joint.
54. Trachea bifurcates at the level of —Lower border of Fourth thoracic vertebra (in cadaver).
55. Level of beginning of arch of aorta is —T4-Vertebra.
61. Coeliac artery arises from abdominal aorta at the level of —T12.
62. Superior venacava develops from — Right common cardinal vein, Right anterior cardinal vein.
63. Coronary sinus develops from — Left horn of sinus venosus, Left common cardinal vein.
64. Left umblical vein ends into —Left branch of portal vein.
65. Muscles of back get motor innervation from —Dorsal primary rami.
66. Contents of lieno-renal ligament are —Splenic artery and tail of pancreas.
67. Space of Disse is — a space between hepatocytes and hepatic sinusoids
Erb’s Paralysis …Forcible widening of the angle between the head and the shoulder, upper trunk at Erb’s point
sustains injury resulting in Erb’s paralysis. This leads to Porter tip deformity.
Klumpke’s paralysis….Hyperabduction of arm results in damage to C8 Tl and sometimes Cl roots. Paralysis affects
intrinsic muscles of hand and flexors of wrist and fingers.
Injury to roots…. (Tearing away of 1st thoracic root) associated with cervical sympathetic paralysis—Horner’s
syndrome. This is characterized by constriction of pupil, ptosis, apparent enophthalmos, anhidrosis on affected side of
face and netk.
Sleep paralysis….Median and radial nerves suffer due to pressure effet while the patient is asleep under the influence
< alcohol.
Winging of scapula ….Due to paralysis of long thoracic nerve common in people carrying heavy weights on shoulder
for the nerve is exposed to injury in posterior triangle, (porter’s paralysis).
Ape hand is due to median nerve injury proximal to origin of its muscular and anterior interosseous branches.
Pointing index finger …lesion produced due to injury of median nerve just above the middle of forearm. There is on|
weakness in flexion of index finger as the nerve to that part of flexor digitorum superficialis is given at about the
middle forearm.
Ulnar claw hand is due to injury to ulnar nerve….Mild degree of clawing observed which leads to extension of 1 st
phalanges of 4th & 5th fingers and flexion of 2nd and 3rd phalanges. .
True claw hand… a combined ulnar and median nerve lesions at elbow causes ‘true claw hand’.
Central sulcus (Fissure of Rolando) extends in a coronal plane and divides frontal lobe from parietal lobe.
Calcarine fissure is present only in medial aspect and bisects occipital lobe in a transverse plane.
Left cerebral hemisphere in most persons is concerned with verbal, calculating and analytic thinking as well as
interpretation speech, stereognosis and motor function of right hand.
Right cerebral hemisphere in most persons is concerned with Nonverbal, spatial, temporal and synthetic
function, appreciation, art and music and motor function of left hand.
Frontal lobe is mainly concerned with Motor, speech,cognition,Highest levels of affective behaviour.
Parietal lobe is mainly concerned with somatosensory processing, so damage to specific locations correlates
with paraesthesia at opposite side of body.
Occipital loije is mainly concerned with visual sensation, so lesions to occipital cortex leads to contralateral
homonymous anopia. Lesion to visual association areas leads to alexia or visual agnosia.
Damage to substantia nigra leads to Parkinsonism (Paralysis agitans), due to reduced dopamine production.
Trigeminal nerve emerges from pons laterally and abducens nerve emerges anteriorly at pontomedullary
junction.
About 20 olfactory nerves pass from nasal mucosa to olfactory bulbs via cribriform plate, so they are a
important source)
Meningitis.
Mitral cells is the second order neuron of first Cr. Nerve.
Optic nerve is actually a tract of brain, carrying meningeal sheaths complete with durameter,
arachnoidmater, subarachno
space and piamater. So intracranial pressure of C.S.F. is directly reflected in subarachnoid space of optic
nerve. High intracranial pressure causes papilloedema (Oedema at optic disc).
True equivalent of optic nerves are represented in retina by Bipolar cells.
Edinger-Westphal nucleus gives rise to parasympathetic component of oculomotor nerve.
This nucleus supplies ciliary muscles and sphincter of pupil via ciliary ganglia.
Largest of cranial nerves is trigeminal
Mesencephalic Nucleus of trigeminal receives fibers carrying proprioception i.e. Jaw Jerk reflex.
Most striking disorder of Trigeminal nerve fucntion is Tic douloureux.
Nervus intermedius of Wrisberg is small sensory component of facial N.
Represents nerve of the 4th and 6th branchial arches.
Torticollis is the spasm of sternomastoid and trapezius due to irritation of the Xlth Cr. nerve.
Blood supply of brain occurs by two vertebral arteries and two internal carotid arteries.
Ophthalmic artery
Posterior communicating artery
Anterior cerebral artery
Oculomotor Nerve emerges between posterior cerebral and superior cerebellar artery.
Circle of Willis which is formed by branches of Internal carotid and Basilar artery. It is complete in 90 %
individuals and I
tonsils.
First arch is called Mandibular arch.
Second arch is called Hyoid arch.
7. Cartilage of third arch forms greater cornu of hyoid and inferior part of body of hyoid bone.
8. Nerve of fourth arch is superior laryngeal nerve and nerve of sixth arch is recurrent laryngeal nerve.
9. Mdian (Pterigoid) canal transmits Vidian N. (Formed by Greater superficial petrosal nerve and deep petrosal
nerve).
10. Optic canal transmits optic nerve, ophthalmic artery and central vein of retina.
11. Superior orbital fissure transmits Illrd, IVth, ophthalmic division of Vth and Vlth cranial N. and ophthalmic
vein.
12. Inferior orbital fissure transmits Infraorbital branch of maxillary division of trigeminal nerve.
28. Axilla is a pyramidal space containing cords & branches of brachial plexus, axillary vessels, lymph nodes & fat.
29. Apex of axilla is bounded by 1 st rib, clavicle and scapula.
30. Anterior axillary fold is formed by pectoralis major.
31. Posterior axillary fold is formed by teres major and latissimus dorsi.
32. Mammary gland is located in superficial fascia. It extends from 2nd to 6th ribs; from parasternal region to
midaxillary line at 4 th costal cartilage level.
33. Structures passing through Quadrangular space are axillary nerve and posterior circumflex humeral vessels.
34. Nerve of flexor compatment is musculo cutaneous nerve (C5,C6,C7) and extensor compartment is radial nerve
(C5,C6,C7,C8,T1).
35. Anatomical snuff box is the space present on lateral aspect ofwrist and is bounded by abductor pollicis longus
and extensor pollicis brevis laterally (anteriorly) and extensor pollicis longus medially (Posteriorly).
36. Axillary nerve passes through quadrangular space curving around the surgical neck of humerus.
37. Radial nerve in the spiral groove is covered posteriorly by lateral head of triceps brachii muscle.
38. Radial bursa is the synovial sheath covering flexor pollicis longus and extends upto its insertion.
39. Myelin of peripheral nerves is produced by “Schwann cells” and of central nervous system is by
oligodendrocytes.
40. Spinal nucleus of trigeminal nerve is in continuation below with substantia gelatinosa of Rolando.
41. Facial colliculus is an elevation in the floor of IVth ventricle produced by the fibres of facial nerve as they are
turning round the nucleus of abducent nerve.
42. Temporal lobe is closely associated with memory (short term memory).
43. Cerebellum is connected to medulla by inferior; to pons by middle; and to mid brain by suprior cerebellar
peduncles.
44. The trigeminal is the only nerve having primary sensory neurons within the brainstem-(Mesencephalic nucleus
of trigeminal nerve in mid brain).
45. Eye of the hand—median nerve as it is sensory to the most part of the palm of hand.
46. Lumbar puncture can be done to obtain CSF by passing a needle between laminae or spines of L3 & L4
vertebrae as the spinal cord ends at the lower border of LI or upper border of L2 vertebra.
47. Cerebello medullary cistern is selected for cisternal puncture.
48. Usually cerebral haemorrhage is due to rupture of Charcot’s artery (one of lateral striate branch of middle
cerebral artery).
49. Macular area in occupital lobe is supplied by both middle and posterior cerebral arteries. In states of blockage
of middle cerebral artery, posterior cerebral artery takes over the supply thus “Sparing the macular area”.
50. Rupture of middle meningeal artery leads to extradural haematoma.
51. Rupture of cerebral veins leads to subdural haemotoma.
52. Subarachnoid space is continuous along the optic nerve as far as lamina cribrosa. Increased intracranial tension
due to excess of fluid in the space produces papilloedema.
61. Basilic vein pierces deep fascia at the level of — Insertion of Coracobrachialis.
62. ‘Holden’s line is — The line along which the membranous layer of superficial fascia is attached to deep fascia
of thigh.
63. Nerve winding around the neck of fibula is — Common peroneal N.
64. Main extensor of thigh is — Gluteus maximus.
74. Anastomoses between gastric and duodenal arteries are scanty, giving rise to a ‘white line’ at pyloroduodenal
junction.
75. Ligament of Treitz is a surgical landmark of duodenojejunal flexure. It extends from duodenojejunal flexure to
right cms of diaphragm.
76. Radiographically, jejunum is characterised by its valvulae conniventes, which are spaced regularly, giving rise to
a concertina effect.
77. Radiographically, ileum is recognised as characterless part, lying mainly in hypogastrium. An individual can lead
a normal life even after resection of upto one third of small gut. An individual can survive even with one and
half feet of small gut. Main function of colon is conservation of fluid, shortest part of colon is ascending colon.
78. Appendicular artery arises from ileocolic artery, whereas the accessary appendicular artery (if present) arises
from posterior caecal artery.
79. Most common position on appendix is retrocaecal (65-70% cases).
80. Because the appendix develops from midgut; which is innervated by lesser splanchnic nerve (T10-T11), initial
colicky pain visceral pain) is referred to periumbilical region (T10-T11)
Most common age group for appendicitis is teenagers and young adults, because at this age the lumen of appendix
is very narrow.
Ampulla is the widest portion of rectum, lying just above the pelvic floor. It is usually empty because faeces are
stored in sigmoid colon.
The cardinal features of large gut (i.e taeniae, appendices epiploicae and sacculations) are absent in
rectum.Houston’s valves are semicircular rectal folds present at inner wall of rectum. They are three in number.
because of mesenteric attachment, liver moves with diaphragm during respiration.
Anatomically right and left lobe are separated by a line passing along falciform ligament. The line of division of
surgical lobes passes from gall bladder fossa to inferior venacava. Liver has been divided into eight segments, which
has got importance in segementectomy of liver, jixamural portion in the narrowest portion of CBD.
Mucosal fold in cystic duct is called ‘Valves of Heister’, which maintains the patency of cystic duct. G3 can undergo
distension upto 50 times.
Posteromedial wall of neck of Gall bladder is dilated, and is known as Hartmann’s pouch.
Calot’s triangle is formed by common hepatic duct on the left, liver above and cystic duct on the right side. In 90%
cases, 3 sac artery lies in Calot’s triangle. Failure of complete rotation of ventral bud leads to annular pancreas.
Portal vein is formed by union of superior mesenteric vein and splenic vein behind the neck of pancreas at the level
of L2 vertebra.
Numerous prostatic ducts open on posterior wall of prostatic Urethra on either side of Urethral crest (Crista
Urethralis).
Adrenal medulla is composed of chromaffin cells, which secrete noradrenaline and adrenaline.
Arterial supply of adrenals is from three arteries :
Superior suprarenal artery —Arises from inferior phrenic artery.
Buck’s fascia is the deep fascia of penis which surrounds all three corpus, but does not extend into glans.
Prostate gland has two parts. Outer zone is called Prostatic Gland Proper which is the site of Carcinoma. Inner
occupied by Submucosal Glands and this zone is called Adenomatous zone (site for benign enlargement).
An enlarged Prostate is covered by three capsule :
Prostatic sheath of pelvic fascia—Outer most.
True capsule : Also called surgical capsule. It is the Compressed outer Zone of prostate gland itself.
Ovarian Ligament is attached between the medial pole of ovary and Uterine cornu.
Vaginal fluid is acidic (four in taste), due to fermentation of glycogen by Doderlein’s bacilli in vaginal cells.
Lower Third of vagina is pain sensitive, whereas upper two third is pain insensitive.
In Uterus Duplex, there are two uteri but single vagina.
Umbilicus corresponds to T10 spinal segment. Deep fascia is absent over anterior abdominal wall.
Space between the external oblique aponeurosis and membranous layer of superficial fascia near inguinal region is
called “superficial inguinal pouch”.
Reflected part of inguinal ligament and pectinate ligament are other extensions of inguinal ligament.
Superficial inguinal ring is an opening in the external oblique aponeurosis located just above and lateral to crest of
pubis.
Deep inguinal ring is a gap in transversalis fascia present about 1.25 cm above mid inguinal point.
Space between hip bone and inguinal ligament is pelvifemoral space. Through this vessels, nerves and two muscles
pass from abdomen to thigh.
Inguinal canal is a musculo aponeurotic tunnel extending from deep inguinal ring to superficial inguinal ring. It is
about 4 cm long.
Rectus sheath : An aponeurotic sheath which envelopes the rectus abdominis muscle. It prevents bow stringing of
the muscle.
Umbilicus — T|{)
Bare area of liver is triangular area bounded by superior and inferior layer of coronary ligament base by groove
for inferior venacava. It is a site of portocaval anastomosis.
Anatomical lobes of liver—Right and left lobes; right lobe includes quadrate and caudate lobes. Division is by
attachment of falciform fold, fissure for ligamentum teres and fissure for ligamentum venosum. Pancreas is
retroperitoneal organ. Male Urethra has total length 18 to 20 cm.
Gastric canal is a radiological entity extending from cardiac orifice to angular incisure.
Nerve of Laterjet is the continuation of anterior vagus nerve ia the lesser omentum 10 to 15 mm away from
lesser curvature
Defective arterio-venous anastomosis in the gastro duodenal mucosa may lead to mucosal ischemia and
ulceration.
Sphincter vesicae is supplied by S2, S3 and S4 (Parasympathetic) nerves.
Interval between external oblique aponeurosis and deep layer of superficial fascia is “superficial inguinal
pouch”. It is often occupied by testis in children (in retracted state).
Fascia covering under surface of diaphragm extends through its oesophageal opening and penetrates into
submucosa of oesophgus as “phreno oesophageal ligament”.
Factor holding the duodenojejunal flexure is “ligament of Treitz”.
Tonic contraction of physiological gastro-oesophageal sphincter prevents the regurgitation of stomach
contents into the oesophgus.
Duodenojejunal flexure is separated from stomach by greater omentum and transverse mesocolon.
“Payer’s patches” of ileum lie along its antimesenteic border.
Muscle coat in some parts of wall of appendix may be absent. In these areas mucous membrane of appendix
and peritoneinj are in contact with each other. In such case infection when present in mucous coat may spread
to the peritoneum.
Suprarenals and kidneys are enclosed in renal fascia. However suprarenals lie in a separate compartment.
Lowest region of urinary bladder is its neck.
Round ligament of uterus and ligament of ovary are derivatives of gubernaculum ovary.
Ovarian or testicular arteries (gonadal arteries) are branches directly from aorta but right gonadal vein drains
to inferior venacava and left gonadal vein drains to left renal vein.
One of the sites of portocaval anastomosis is in anorectal wall it is between superio rectal vein, (portal system)
and inferior,middle rectal veins (systemic veins).
Neck of henial sac is medial to inferior epigastric artery in direct inguinal hernia and it is lateral to artery in
indirect (oblique inguinal hernia.)
Iliopubic tract (thickened lower part of fascia transversalis) when well developed can be used for hernial repair.
Tenderness in renal angle indicates kidney pathology.
Diaphagmatic irritation causes referred pain in shoulder tip. This is due to same spinal segmental involvement
—phrenic and supra clavicular nerves have the same root value C3,4.
In sliding hiatal hernia, there is upward slide of gastro-oesophagial junction through the lax oesophageal
hiatus. The clampii action of the crura of the diaphragm is lost, hence there is acid regurgitation.
In para-oesophageal hiatal hernia gastro-oesophagial junction is normal and only part of fundus of stomach
enters through the oesophageal hiatus and there is no acid regurgitation.
Carcinoma head of pancreas speedily involves the bile duct and may cause jaundice or may press on portal vein and
cause ascites or obstruct pylorus.
Blood less zone of Brodel is not blood less in kidney – Hence radial or intersegmental incisions are preferred during
surgery on kidney.
Safe position to divide the ureter is 2 cm below the bifurcation of common iliac artery as the inferior vesical artery
supplies the lower part.
Pubococcygeus supports vagina, urethra and anus, Injury to pubococcygeus and pelvic fascia results in cystocele.
Prostatic tumors may spread to vertebrae as the prostatic venous plexus drains to inferior venacava through sacral
veins and vertebral venous plexus.
Removal of metastatic lymph nodes from the lateral pelvic wall may cause damage to obturator nerve (as it runs in
the extra peritoneal tissue of lateral pelvic wall) resulting in weakness of adduction of thigh on the affected side.
Abscess in the rectouterine pouch can be drained through posterior vaginal wall at posterior fornix.
In mediolateral episiotomy levator ani muscle is usually spared as that muscle supports pelvic floor.
All muscles of anterior group of thigh are innervated by femoral Nerve (L2,3,4)
Locking of knee occurs by Medial Rotation of lower and of femur on tibia during terminal stages of extension, when
feet are supporting the body weight.
1. Popliteus muscle pierces capsular ligament of knee posteriorly to become an intracapsular structure.
2. Main role of menisci of knee joint is rotational movement.
3. Nerve roots involved in knee jerk reflex is L2,3,4.
4. Extensor of knee is Quadriceps muscles.
5. Flexor of knee is Hamstring muscles.
15. Blood islands of Pander is mesenchymal congregations on the wall of yolk sac giving raise to blood cells and
blood vessels.
16. Liver is the largest gland of the body
17. Blood How through kidney 1700 L/day out of whic 170L of glomerular filtrate is formed and only about 1.5 L
wine is formed.
18. Fold ofDouglasor linea semicircularis or arcuate line is related to internal oblique muscle in abdomen.
19. Corpora amylaceae are Prostatic concretions.
25. Cells of Paneth are cells present at the bottom of crypt of small intestine.
26. Henle’s loop is Part of nephron.
27. Leydig cells are interstitial cells present in stroma between semiinferous tubules of testis
28. Sertoli cells are supporting cells in semiinferous tubule.
29. Herring bodies are Neurosecretory material seen in pars nervosa of pituitary.
30. CanalofSchlemmis Canal present at the sclero corneal angle in scleral furrow.
31. Betz cells are large pyramidal cells located in inner pyramidal layer of cerebral cortex.
32. Outer and Inner bands of Ballarger are Horizontally running fibres located in 4th and 5th lamina of cerebral
cortex.
33. Node of Ranvier is Region on the nerve fibres between two internodes.
34. Nissl granules are Chromatic bodies (granules) in the cytoplasm of neurones.
35. Region at the junction of 3 hepatic lobules presents portal triad, which includes a portal venous radicle, branch
of hepatic artery and biliary canaliculus.
36. Lung : Lining epithelium of alveoli shows the following cells :
37. Type I alveolor cells — Squamous cells.
38. Type II alveolar cells — Irregular cuboidal cells (Surfactant cells)
Remnants
Kerking’s centre is ossification centre appearing in posterior margin of foramen magnum in occipital bones.
Haversian canal is longitudinal channel containing blood vessel located in compact bone.
Volkmann’s canal is transverse channels running from periosteum to endosteum of bone, inter connect
Haversian canals and contain blood vessles.
Whitnall’s tubercle is tubercle on orbital surface of zygomatic bone.
Bones located add leverage to tendons and differ from regular bones in not having a periosteum.
Pancreatic islets are more abundant in the tail of the pancreas and contain a cells which secrete glucogen; P cells
which secrete insulin; y cells secrete somatostatin which inhibits secretory activity of beta or more a alpha cells.
GEP (Gastro Entero Pancreatic) endocrine system belongs to APUD cell series and has scattered solitary hormone
producing cells in gastrointestinal mucosa and pancreas.
Lamina propria of the intestine is the chief site for production of the secretory immunoglobulin (IgA). Secreted IgA
coats the mucosal surface and prevents the attachment of the antigen to the intestinal cells. IgA is important for
local immunological process through out the body.
Epithelium covering the Payer’s patches has “M” cells which help in immune responses.
Lining of terminal bronchioles is simple columnar or cuboidal epthelium with or without cilia but without mucous
glands or goblet cells in the wall.
Interalveolar septum in between the alveoli is composed of lining cells of adjacent alveoli and structures interposed
between them (capillaries).
Striated ducts of the salivary glands modify the composition of alveolar secretions.
3 cells of the islets comprise 60-90% of all the islets cells. They are in the central part, a cells are located in peripheral
part.
Terminal bronchioles are the finer divisions of conducting part of respiratory system which are 0.5 mm or less in
diameter.
Sertoli cells of the testis produce steroids, secrete fluids including androgen binding protein, inhibin in adult and
Mullerian inhibiting hormone in the fetus and estrogens.
One type of entero endocrine cell may become numerous and produce carcinoid tumour, characterised by excessive
secretion of serotonin.
Premature infants suffer with respiratory distress syndrome due to lack of type II pneumocytes in lungs.
Talus is the key stone of the arch. It receives body weight and transmits it to the arches below.
Body to the axis (C2) bears a strong process getting vertically upwards from its superior surface. This process is
“odontoid process” which is the detached centrum of atlas.
Bodies of 5th to 8th thoracic vertebrae on left side show flattening due to pressure of thoracic aorta.
Failure of fusion of two arch centres posteriorly results in “spina bifida” occurs commonly in lumbar region. If the
deformity is not associated with neurological abnormality it is “spina bifida occulta”.
When the defect involves one or several arches, spinal cord with meninges may prolapse (meningomyelocele).
Fractures of spine most commonly involve T12 LI and L2 — cause is usually flexion compression type of injury.
Disc prolapse or prolapsed intervertebral disc is protrusion of nucleus pulposus posteriorly into vertebral canal
through posterior part of annulus fibrosus either due to trauma or degenerative changes in the annulus. Most
common sites are L4L5 or L5/ SI.
Plane of greatest pelvic dimensions is at the level of pelvis where the cavity is most spacious. It’s antero posterior
diameters taken from a point between 2nd & 3rd sacral vertebrae and middle of symphysis. Children under 9 years
and males have anthropoid type of pelvis (dolichopelvic).
Abrupt pronation during tennis play causes sprain or partial tear of radial collateral ligament. This is
manifested as pain tenderness over lateral epicondyle.
Tennis elbow is a condition which has either sprain of lateral ligament of elbow joint or tear of some fibers of
extensor radialis brevis or an inflammation of its bursa.
Lumbar triangle of Petit is triangular area bounded by Latissimus dorsi, iliac crest and external oblique.
arcuate ligament is a poorly defined arch in front of aorta connecting the medial tendinous Median margins of
crura of diaphragm.
Medial arcuate ligament is the tendinous arch in fascia covering the psoas major muscle.
Lateral arcuate ligament is the tendinous arch in anterior layer of thoraco-lumbar fascia covering Quadratus
lumborum muscle.
Biceps brachii is a flexor of elbow and a powerful supinator of forearm when the arm is semiflexed.
Brachioradialis is flexor of elbow when the forearm is in mid prone position.
Lumbrical muscle tendon in hand turns round the lateral sides of fingers, but in foot they turn round the
medial sides of to reach the dorsal digital expansions.
Motor supply to skeletal muscles is through spinal or cranial nerves, but to cardiac and smooth muscles it is
through autonomic nerves.
All the muscles of mastication are supplied by mandibular division of trigeminal nerve (V Cranial).
All anterior crural muscles are supplied by deep peroneal nerve..
Posterior crural muscles are all supplied by tibial nerve.
A muscle which initiates and maintains a movement is a prime mover.
A muscle which can initiate and maintain an opposite movement of the prime mover is antogonist.
A muscle which can eliminate the additional unwanted movements produced by a prime move at a joint other
than the desired joint is called a synergic muscle.
Muscles of head can be grouped into muscles of facial expression and muscles of mastication.
Trumpeter’s muscle is buccinator.
In quiet inspiration, the thoraco-abdominal diaphragm is the sole muscle concerned with movements.
Triangle of auscultation—a space bounded by trapezius, latissimus dorsi and medial border of scapula. Deep
to this triangle, cardiac orifice of stomach lies (on left side). (1) In oesophageal obstruction s splash of
swallowed liquied can be ausculated in the region of left side. (2) Apex of lower lobe of both lungs is located
beneath this area of corresponding sides.
Superior laryngeal artery which is in close relation with internal laryngeal nerve is a branch of superior thyroid
artery.
Axillary artery is the continuation of subclavian artery at the outer border of 1st rib.
Arteria princeps pollicis is a branch of radial artery. It turns medially into palm and supplied nutrient artery to 1
st metacarpal bone.
Coronary sinus opens into right atrium and guarded by a valve; tributatries are great cardiac vein, small
cardiac vein,middle cardiac vein, posterior vein of left ventricle and oblique vein of left atrium.
Superior vena cava drains upper limbs, head, neck and thorax into posterior part of right atrium.
Veins draining the face:Angular, Facial maxillary, Middle temporal
Tributaries of Internal Jugular vein are :Veins of tongue, Veins of pharynx, Veins of thyroid, Veins of face
(through facial vein), Inferior petrosal sinus
Right coronary artery supplies conducing system of heart as far as proximal parts of the right and left bundle
branch.
SA node is supplied by right coronary artery (artery to SA node or nodal artery).
AV node is supplied by right coronary artery (branch of large posterior septal artery, a branch of posterior
interventricular branch of right coronary artery).
Posterior interventricular artery is a branch of right coronary given at the crux of heart.
Anterior interventricular artery is a branch of left coronary artery.
“Circle of willis” is formed by posterior cerebral, middle cerebral, anterior cerebral, posterior communicating
arteries and is located in inter peduncular fossa of base of brain.
1st part of superior vesical artery is the proximal patent section of umbilical artery.
Superiorand middle thyroid veins open into internal jugular vein and Inferior thyroid veins into brachiocephalic
of corresponding sides.
Shadow of left profile of aortic arch in X-ray photographs is called “aortic knuckle”.
In wounds of Palmar arches, ligature of vessels proximal to wrist may be inefffective as there is anastomoses
between radial and ulnar arteries through their palmar and dorsal carpal branches and other branches.
There is constant anastomosis between branches of last sigmoidal and superior rectal arteries “Critical point
of Sudack” is non anastomatic area on sigmoid colon when the above anastomosis is absent.
Facial vein has communications with cavernous venous sinus, hence infective thrombosis of facial vein may
extend to the intracranial venous sinuses.
In thrombosis of superior bulb of internal jugular vein IX, X, & XI nerves are involved.
Cannulation of basilic vein is more liable to be successful than cephalic as the basilic vein continues as axillary
vein without angulation.
Axillary vein thrombosis in prolonged abduction (Eg. Painting a ceiling) may be due to the groove produced by
subclavius muscle on the 1st part of vein where there is a valve in the wall.
Obstruction of portal vein may produce opening of sites of portocaval anastomoses which are at:
Lower end of oesophagus — leads to oesophageal varices. (Communication between left gastric & azygos
system of veins).
This is the only long bone that lies horizontally in the body
The largest cerebellar efferent bundle is the superior cerebellar peduncle. This is formed by fibres from the globose,
emboliform and dentate nuclei.
According to Wolff’s law, the bone formation is directly proportional to stress and strain
Motor point is the site where the motor nerve enters the muscle
Blood brain barrier is constituted by capillary endothelium (with fenestrations), basement membrane of endothelium
end feet of astrocytes covering the capillary walls.
It is osseofibrous tunnel between concave palmar suface of carpal bones and deep surface of flexor retinaculum of
wrist Contents
3.Median Nerve
The choroid plexus of the fourth ventricle is supplied by the posterior inferior cerebellar artery
Unpaired artery in the brain is basilar artery
Arch of aorta begins opposite 2nd costal cartilage
Triangle of Koch is bounded by tricuspid leaflet, orifice of coronary sinus & tendon of todaro
Diaphragm is at lowest level in prone position
Structure affected first when accessory cervical rib is stretched is medial cord of brachial plexus
However when the arm is abducted pressure over the same point causes no pain, because bursa disappears
under acromion is called Dawbarn’s sign.
End Arteries
Artereis which do not anastomose with their adjacent one are called end arteries. e.g.
Branches
—Ant.interventricular branch.
— Circumflex branch.
Distribution
Note : Branches of both Rt. & Lt. coronary arteries supply interatrial and interventricular septa.
ABDOMEN
IMPORTANT RELATIONS
B.Retroduodenal part
C. Infraduodenal part
1. Anteriorly : a groove in the upper and lateral parts of the posterior surface of the head of the pancreas.
1.The upper pole of each kidney is related to the corresponding suprarenal gland. The lower poles lie about one inch
to the iliac crests.
2.The medial border of each kidney is related to (i) the suprarenal gland, above the hilus; and (ii) to the ureter below
hilus.
3. Posterior relations .
The posterior surfaeces of both kidneys are related to : (1) the diaphragm; (2) the medial and lateral arcuate
ligaments; (3) the psoas major; (4) the quadratus lumborum; (5) the transversus abdominis; (6) the subcostal vessels;
and (7) the subcostal, iliohypogastric and ilioinguinal nerves. In addition, the right kidney is related to 12th rib, and
the left kidney to 1 lth and 12th ribs.
1.Right suparental gland; (2) liver; (3) second part of duodenum; (4) hepatic flexure of colon and (5) small intestine.
Out of these the hepatic and intestinal surfaces are covered by peritoneum.
2.The lateral border of the right kidney is related to the right lobe of the liver and to the hepatic flexure of the colon.
1.Anterior relations :
1.left suprarenal gland; (2) spleen; (3) stomach; (4) pancreas; (5) splenic vessels; (6) splenic flexure and descending
colon; and (7) jejunum. Out of these the gastric, splenic and jejunal surfaces are covered by perotoneum.
2.The lateral border of the left kidney is related in the spleen and to the descending colon.
B.The anterior surface is devoid of peritoneum, except for a small part inferiorly. It is related to : (1) the inferior vena
cava medially; (2) the liver, laterally; and (3) occasionally to the duodenum, inferiorly.
D.Anterior border. A little below the apex it presents the hilum where the suprarenal vein emerges.
E.Medial border. It is related to : (1) the right coeliac ganglion; and (2) the right inferior phrenic artery.
Relations of Left Suprarenal Gland A.Anterior surface. From above downwards it is related to : (1) the cardiac end of
the stomach; (2) the splenic artery; and (3) the pancreas. The upper end may be related to the posterior extremity of
the spleen. Near the lower end there is the hilum through which the left suprarenal vein emerges. Only the gastric
impression is covered by peritoneum (of the lesser sac):
B.Posterior surface. It is related to : (1) the kidney, laterally; and (2) the left crus of the diaphragm, medially.
C.Medial border. It is related to : (1) the left coeliac ganglion; (2) the left inferior phrenic artery; and (3) the left gastric
artery.
THORAX
Contents
a. Muscles attached to sternum (sternothyroid and sternohyoid)
b. Remnants of thymus gland
c. Vessels
1. Arch of aorta
2. Origin of brachiocephalic, left common carotid, and left subclavian arteries
3. Left and right branchiocephalic veins
4. Superior vena cava
d. Trachea
e. Esophagus
f. Nerves and plexuses
1. Vagus—right and left
2. Left recurrent laryngeal
3. Phrenic—right and left
4. Cardiac plexus (superficial)
g. Lymphatics
1. Brachiocephalic and tracheobronchial nodes
2. Thoracic duct
Inferior mediastinum—has three subdivisions that extend downward from lower border of superior mediastinum to
diaphragm
1. Anterior mediastinum
a. Location—posterior to body of sternum and attached costal cartilages, anterior to heart and pericardium
b. Contents
1. Fat
2. Remnants of thymus gland
3. Anterior mediastinal lymph nodes
2. Middle mediastinum
a. Location—between anterior mediastinum and posterior mediastinum
b. Contents
1. Heart and pericardium
2. Beginning or termination of great vessels
3. Pulmonary arteries and veins
4. Phrenic nerves
5. Bifurcation of trachea
6. Tracheobronchial lymph nodes
7. Cardiac plexus (deep)
Posterior mediastinum
a. Location—posterior to heart and pericardium, anterior to vertebrae T5-T12
b. Contents
1. Esophagus
2. Descending aorta and origins of posterior intercostal arteries
3. Azygos system of veins and termination of posterior intercostal veins
4. Nerves
a. Vagus nerves
b. Splanchnic nerves
5. Lymphatics
a. Thoracic duct
b. Posterior mediastinal nodes
c. Tracheobronchial nodes
d. Bronchomediastinal trunk
Locking muscles—Popliteus.
Casser’s perforated muscle—Coracobrachialis