Primary FRCA > Anatomy for Anaesthesia > Flashcards

Anatomy for Anaesthesia Flashcards

Understand applied anatomy relevant to anaesthesia, focusing on airway, nervous system, cardiovascular, and regional techniques. (223 cards)

Study These Flashcards
1
Q

Which structure passes through foramen rotundum?

A

Maxillary nerve (V2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which structures pass through foramen ovale?

A
  • Mandibular nerve (V3)
  • Accessory meningeal nerve
  • Lesser petrosal nerve
  • Emissary vein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which structures pass through foramen spinosum?

A
  • Middle meningeal artery & vein
  • Meningeal branch of mandibular nerve (CN V3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which structures pass through foramen lacerum?

A
  • Meningeal branch of ascending pharyngeal artery
  • Greater petrosal nerve
  • Traversed partially by internal carotid artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which structures pass through the auditory meatus?

A
  • Facial nerve
  • Vestibulocochlear nerve
  • Labyrinthine vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which structures pass through foramen magnum?

A
  • Medulla oblongata
  • Meninges
  • Spinal accessory nerves
  • Spinal arteries
  • Dural veins

Spinal accessory nerve ascends through foramen magnum, then comes out through the jugular foramen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which structures pass through the cavernous sinus?

A
  • Internal carotid artery
  • CN3, 4, V1 and V2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the innervation of the dura mater.

A

Supplied by meningeal branches of all three divisions of the trigeminal nerve and the first, second and third cervical nerves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a portal circulation?

A

Begins and ends with capillaries.

Examples: hepatic, adenohypophysis, placental, renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the determinants of intraocular pressure?

A
  • Internal:
    • Arterial and venous pressure
    • PaO2 and PaCO2
    • Aqueous humour production and drainage
    • Foreign bodies
  • Extrinsic:
    • Extraocular muscle tone (e.g. suxamethonium)
    • Prone positioning
    • Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which drugs can be used to reduce intraocular pressure?

A
  • Beta-blockers (e.g. timolol): reduce humour production
  • Prostaglandin analogues, cholinergics (e.g. pilocarpine): increase drainage
  • Ephedrine, alpha-2 agonists (e.g. brimonidine): both
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the pathway involved in the pupillary light reflex.

A
  • Afferent: Light is sensed by the OPTIC NERVE and transmitted via the OPTIC TRACT to the PRETECTAL NUCLEUS (midbrain). The signal then goes to the EDINGER-WESTPHAL nucleus (CN3).
  • Efferent: Parasympathetic fibres run from the EDINGER-WESTPHAL nucleus in CN3 and synapses in the CILIARY GANGLION - post-ganglionic parasympathetic fibres innervate the iris sphincter causing constriction.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What makes up the nasal septum?

A
  • Ethmoid bone
  • Vomer
  • Septal cartilage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outline the blood supply to the lateral nasal wall and septum.

A
  • Lateral nasal wall: sphenopalatine and anterior and posterior ethmoid arteries.
  • Septum: sphenopalatine and anterior and posterior ethmoid arteries AND superior labial and greater palatine arteries (Little’s area is a confluence of these supplies).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Outline the sensory innervation of the nasal cavity.

A
  • Anterior ethmoidal nerve (branch of V1)
  • Greater and lesser palatine nerves (branch of V2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Outline the nerve supply to the tongue.

A
  • Anterior 2/3 taste: Facial nerve
  • Anterior 2/3 touch: Trigeminal (V3 - Lingual)
  • Posterior 1/3 taste + touch: Glossopharyngeal
  • Motor: hypoglossal nerve for all except palatoglossus

Palatoglossus is innervated by the vagus nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the arrangement of the cricoid, arytenoid, cuneiform and corniculate cartilages.

A
  • Arytenoids sit on top of the cricoid cartilage.
  • Corniculate sit on top of the arytenoids and cuneiforms are found within the aryepiglottic fold.
  • The vocal ligaments extend anteriorly from the arytenoids to the anterior inner surface of the trachea.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the structure and attachments of the epiglottis.

A
  • Leaf-shaped cartilage with a stem and broad superior portion, covered by mucosa.
  • Inferior (stem): inner surface of the thyroid cartilage via thyroepiglottic ligament.
  • Anterior: hyoid via the hyoepiglottic ligament.
  • Anterosuperior: to tongue via the median and lateral glossoepiglottic folds, forming the valleculae.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What forms the vocal cords?

A

Thickening of the upper edge of the cricothyroid membrane connecting to the arytenoid cartilage posteriorly.

There is no submucosal covering, hence why it appears white.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the only tensor of the vocal cords?

A

Cricothyroid muscle

Supplied by the superior laryngeal nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the only abductor of the vocal cords?

A

Posterior cricoarytenoid muscle

All other intrinsic muscles are adductors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the functions of the superior laryngeal nerve?

A
  • Internal Branch: sensory innervation to mucous membrane of larynx above the cords (includes base of tongue and epiglottis)
  • External Branch: motor to cricothyroid

Originates from inferior ganglion of vagus nerve (C1 level).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the pharyngeal spaces of the neck.

A
  • Investing Layer: outermost of deep fascia layers.
  • Pretracheal: encloses trachea, oesophagus, thyroid and infrahyoid muscles.
  • Prevertebral: surrounds vertebral column and associated muscles.

Retropharyngeal space is between the pretracheal fascia and prevertebral fascia and can be a route for spread of infection or air.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Outline the triangles of the neck.

A

Anterior: SCM + mandible + midline
Posterior: SCM + clavicle + trapezius

Separated by sternocleidomastoid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Outline the course of the **carotid arteries**.
* Right common carotid arises from bifurcation of the **brachiocephalic trunk**. * Left common carotid arises directly from the **aortic arch**. * Ascend in the neck and split into internal and external carotids at the superior margin of the **thyroid cartilage** (C4). * The internal carotid enters the cranial cavity via the **carotid canal** in the **temporal bone**.
26
Outline the course of the **vertebral arteries**.
* Arise from the subclavian arteries, medial to the **anterior scalene**. * Ascend through the foramen transversarium in the transverse processes of the **cervical vertebrae**. * Enter the cranial cavity through the foramen magnum and converge to form the **basilar artery**.
27
What provides a blood supply to the **tonsils**?
From external carotid artery and its branches: * Tonsillar and ascending palatine arteries * Lesser palatine artery * Dorsal lingual artery * Ascending pharyngeal artery
28
Which **sensory nerves** innervate the posterior aspect of the head and scalp?
* Greater occipital nerve (C2) * Lesser occipital nerve (C2) * Greater auricular nerve (C2-3)
29
What comes together to form the **cervical plexus**?
* Ventral rami of C1–C4 * Superficial cervical plexus: sensory * Deep cervical plexus: motor ## Footnote C1 is motor only.
30
Describe the anatomy of the **thoracic duct**.
Arises from the **cisterna chyli** (between the aorta and right crus in front of L1 and L2), ascends via the **aortic hiatus**, and empties into the **brachiocephalic vein**. ## Footnote Drains the lower body and left half of upper body. Rest is drained by the right lymphatic duct.
31
Which groups of lymph nodes drain the **abdominal viscera**?
* **Pre-aortic nodes** drain into the intestinal lymph trunk, then into the cisterna chyli. * **Para-aortic node efferents** are the right and left lumbar trunks — these unite to drain into the cisterna chyli.
32
Which **spinal nerve roots** are the obturator and femoral nerves derived from?
Anterior rami of **L2-L4**
33
Describe the **L2** dermatome and myotome.
* **Dermatome**: anterior aspect of thigh * **Myotome**: hip flexion
34
At what **vertebral position** does the larynx lie in children compared to adults?
* Children: **C2/C3** * Adults: **C5/C6**
35
What makes up the **portal triad**?
* Hepatic artery * Portal vein * Branch of biliary tree
36
What is the only **laryngeal muscle** that is NOT innervated by the recurrent laryngeal nerve?
Cricothyroid muscle ## Footnote Innervated by the external laryngeal nerve (which is a branch of the superior laryngeal nerve, which is a branch of the vagus nerve).
37
Which nerve roots are responsible for **sympathetic innervation** to the heart?
T1-T4
38
Which **myotome** is responsible for great toe extension?
L5
39
What does the **ulnar nerve** innervate?
* Sensory: **medial 1.5 digits** * Motor: majority of **small muscles in the hand** except LOAF (median nerve)
40
Which structures pass through the **superior orbital fissure**?
* Oculomotor nerve * Trochlear nerve * Ophthalmic nerve (nasociliary, lacrimal, frontal) * Abducens nerve * Superior ophthalmic vein * Branch of inferior ophthalmic vein
41
Which nerve roots form the **ulnar nerve**?
Derived from **medial cord of the brachial plexus** which is comprised of nerve roots C8-T1
42
Which small muscles of the hand are innervated by the **median nerve**?
* Lumbricals 1+2 * Opponens Pollicis * Abductor Pollicis Brevis * Flexor Pollicis Brevis
43
What are the content of the **carotid sheath**?
* Carotid artery * Internal jugular vein * Vagus nerve
44
Describe the origin and course of the **internal jugular vein**.
* Originates as a continuation of the sigmoid sinus at the jugular foramen. * Exits the skull via the jugular foramen. * Descends through the neck within the carotid sheath. * Joins the subclavian vein to form the brachiocephalic vein.
45
What forms the lateral wall of the **orbit**?
**Zygoma** and the greater wing of **sphenoid**.
46
Describe the path of **CSF flow** through the brain.
* Lateral ventricles * Via the foramen of Monro into the third ventricle * Via the aqueduct of Sylvius to the fourth ventricle * From the fourth ventricle into the subarachnoid space via: * Foramen of Magendie (medially) * Foramina of Luschka (laterally) * Reabsorption into the dural venous sinuses
47
What are the borders and contents of the **femoral triangle**?
* **Superior:** inguinal ligament * **Lateral:** medial border of sartorius * **Medial:** lateral border of adductor longus * **Contains:** femoral nerve (in fascia iliaca), femoral artery and vein, the femoral canal (which contains lymphatics and loose connective tissue), and the lateral cutaneous nerve of the thigh.
48
Describe where the brachial plexus **exits** the neck.
It exits between the **anterior and middle scalenes**, before running in close proximity with the subclavian artery.
49
Where are the anterior rami of spinal nerves innervating the **abdominal wall** found?
Between the internal surface of the **internal oblique** and the external surface of **transversus abdominis** . ## Footnote This is where local anaesthetic is injected for a TAP block
50
Describe the borders of the **cubital fossa**.
* **Superior:** a line connecting the medial and lateral epicondyles * **Lateral:** medial border of brachioradialis * **Medial:** lateral border of pronator teres * **Floor:** proximally by brachialis, distally by supinator * **Roof:** a combination of skin and fascia, including the bicipital aponeurosis
51
What spinal level corresponds with the **cricothyroid membrane**?
C6
52
What are the structures of the **cubital fossa** in order of lateral to medial?
* Radial nerve * Biceps tendon * Brachial artery * Median nerve
53
Which nerve is a continuation of the **femoral nerve**?
Saphenous nerve
54
Which nerve innervates **latissimus dorsi**?
Thoracodorsal nerve
55
Which nerves make up the **brachial plexus**?
* Anterior primary rami of C5/6/7/8 * First thoracic spinal nerve (T1)
56
Which foramen does the **glossopharyngeal** nerve exit through?
Jugular foramen
57
Which nerve roots provide sympathetic innervation to the **bronchi**?
T2-T4 ## Footnote There are also parasympathetic fibres from the VAGUS that form a posterior pulmonary plexus.
58
Describe the functions of the recurrent **laryngeal nerve**.
* **Motor**: all intrinsic muscles of the larynx EXCEPT cricothyroid (innervated by external laryngeal nerve) * **Sensory**: larynx below the vocal cords
59
What are the five branches of the **facial nerve**?
* **Temporal:** extrinsic ear muscles, occipitofrontalis, and orbicularis oculi * **Zygomatic:** orbicularis oculi * **Buccal:** buccinator and lip muscles * **Mandibular:** muscles of the lower lip and chin * **Cervical:** platysma
60
What are some key features of the **first rib**?
* The first rib has a **scalene tubercle** for anterior scalene insertion, located between grooves for the subclavian vein (anterior) and subclavian artery (posterior). * The **phrenic nerve** lies on the anterior surface of the anterior scalene. * It articulates with the **T1 vertebra** and lacks a costal groove. * The **subclavius muscle** originates from its shaft and costal cartilage.
61
Describe the course of the **left phrenic nerve**.
* Passes inferiorly down the neck, crossing the left surface of the **arch of the aorta**. * Descends between the **left subclavian** and left common **carotid arteries**. * Pierces the diaphragm and carries sensory fibres from the **pleura**, **pericardium**, and a small part of the **peritoneum**.
62
What is the **function** of the superficial peroneal nerve? | (L4–S1)
* **Motor**: peroneus longus and brevis (eversion) * **Sensory**: anterolateral leg and dorsum of foot, excluding the web space between 1st and 2nd toes
63
What is the **function** of the deep peroneal nerve? | (L4-S1)
* **Motor**: anterior compartment of leg (tibialis anterior, extensor digitorum longus, peroneus tertius, extensor hallucis longus) * **Sensory**: webspace between 1st and 2nd toes
64
What is the **function** of the saphenous nerve? | (L3-4)
* Branch of **femoral nerve** * **Sensory**: medial side of leg and foot, extending to the proximal medial midfoot
65
What is the **function** of the sural nerve? | (S1-2)
Sensory innervation to lateral aspect of foot and little toe.
66
What does the **maxillary nerve** (branch of trigeminal) provide sensory innervation to?
Upper teeth
67
Describe the **functions** of the musculocutaneous nerve. | (C5-C7)
* **Motor:** biceps brachii, brachialis, and coracobrachialis. Enables flexion of the shoulder and elbow, and forearm supination * **Sensory:** lateral aspect of the forearm
68
What are the **functions** of the femoral nerve? | (L2-L4)
* **Motor:** quadriceps (knee extension) * **Sensory:** anterior thigh * **Reflex:** knee jerk
69
What are the afferent and efferents for the **gag reflex**?
* **Afferent:** glossopharyngeal nerve * **Efferent:** vagus nerve
70
Outline the muscles innervated by each of the spinal nerves that form the **brachial plexus**.
* **C5:** deltoids and biceps * **C6:** extensors of the wrists * **C7:** wrist extensors and triceps * **C8:** finger flexors of the hands * **T1:** small muscles of the hand
71
What does the **superior laryngeal nerve** do?
* Branch of the **vagus nerve** * **Motor (external branch):** cricothyroid * **Sensory (internal branch):** larynx above the cords
72
How **long** is the trachea and where does it **start**?
* **Length:** 15 cm * **Extent:** extends from the lower border of the cricoid cartilage at the level of C6 to the left bronchus, which angles at 45 degrees
73
Describe the blood supply to the **spinal cord**.
* The anterior and posterior spinal arteries arise from the **vertebral arteries** and supply the **anterior two thirds** and **posterior one third** of the spinal cord respectively. * The artery of **Adamkiewicz** provides additional blood to the anterior spinal artery and the distal cord.
74
What are the peripheral branches of the **sciatic nerve**?
* Tibial nerve * Common peroneal nerve
75
Which structures pass through the **jugular foramen**?
* Internal jugular vein from sigmoid sinus * Glossopharyngeal nerve (CN IX) * Vagus nerve (CN X) * Accessory nerve (CN XI)
76
What are the contents of the **anterior triangle** of the neck?
* **Artery:** common carotid * **Vein:** internal jugular * **Nerves:** facial, glossopharyngeal, accessory, and hypoglossal * **Lymphatics**
77
What are the levels of the different hiatus in the **diaphragm**?
* **T8**: Vena Cava * **T10**: Oesophagus * **T12**: Aorta
78
State the **three** peripheral attachments of the diaphragm.
1. Xiphoid process 2. Inferior 6 ribs/costal cartilage 3. Arcuate ligaments and lumbar vertebrae
79
Describe the structure of the **right and left crura** of the diaphragm.
R: **L1-L3** L: **L1-L2** ## Footnote Fuse medially to form the median arcuate ligament.
80
Describe the sensory innervation of the **nasal cavity**.
* **Vestibule:** infraorbital branch of the maxillary nerve (V2) * **Nasal cavity:** CN I, CN V1, and CN V2, including branches of the nasopalatine and lateral nasal nerves, superior dental nerves, sphenopalatine nerves, and greater palatine nerve
81
Describe the innervation of the **carotid body**.
Carotid sinus nerve (branch of glossopharyngeal nerve) ## Footnote Primarily responds to changes in pO2.
82
What are the boundaries of the **superior thoracic aperture**?
* **Posterior:** T1 vertebra * **Anterior:** manubrium * **Lateral:** first ribs and costal cartilages
83
Describe the structure and function of the **cervical plexus**.
* **Structure:** formed by the anterior rami of C1–C4; divides into superficial and deep branches. * **Motor:** neck muscles and diaphragm. * **Sensory:** lower border of the mandible to the second rib.
84
Describe the passage of the **recurrent laryngeal nerves**.
* **Right:** passes below and behind the subclavian artery, then ascends behind the common carotid. * **Left:** passes beneath the aorta around the ligamentum arteriosum.
85
How many **pairs of spinal roots** arise from the spinal cord?
31 pairs ## Footnote * 8 Cervical * 12 Thoracic * 5 Lumbar * 5 Sacral * 1 Coccygeal
86
Where does the spinal cord **end** in adults and newborns?
Adults: **L1/2** Neonates: **L3**
87
What landmarks are used to identify the **sacral hiatus** for caudal blocks?
The sacral hiatus is at the **apex of an equilateral triangle** completed by the **posterior superior iliac spines**.
88
Which **organs** receive the greatest blood flow per 100 g?
* Carotid Body: 2000 mL/min/100 g * Thyroid: 560 mL/min/100 g * Kidney: 420 mL/min/100 g * Heart: 87 mL/min/100 g
89
What is the sensory innervation of the **larynx** above and below the vocal cords?
* **Above:** internal branch of the superior laryngeal nerve * **Below:** recurrent laryngeal nerve * **Lingual surface of the epiglottis:** glossopharyngeal nerve
90
What is the **pharynx**?
Midline structure extending from the **skull base to C6**, composed of three paired and three unpaired muscles, with four layers and venous drainage into the internal jugular vein.
91
What is the **stellate ganglion**?
* Fusion of the **inferior cervical and first thoracic ganglia** (found in 80% of people). * Can be targeted with local anaesthesia for complex **regional pain syndromes**.
92
Which nerves provide sensory supply to the **foot**?
* Tibial nerve * Superficial peroneal nerve * Deep peroneal nerve * Sural nerve * Saphenous nerve
93
What are the contents of the **epidural space**?
* Fat * Epidural veins (Batson's plexus) * Arteries * Lymphatics * Spinal nerve roots ## Footnote Ends at L2 in adults.
94
Describe the sensory innervation of the **abdominal wall**.
* **Intercostal** nerves: T7-T11 * **Subcostal** nerve: T12 * **Iliohypogastric** nerve: L1 * **Ilioinguinal** nerve: L1
95
What are the borders of the **antecubital fossa**?
* **Superior**: line between medial and lateral epicondyles of humerus * **Medial**: lateral border of pronator teres * **Lateral**: medial border of brachioradialis
96
What are the contents of the **antecubital fossa**?
**MEDIAL to LATERAL**: * Median nerve * Brachial artery (bifurcates into radial and ulnar) * Biceps tendon and bicipital aponeurosis * Radial and posterior interosseous nerves
97
What passes through the **optic canal**?
Optic nerve and ophthalmic artery
98
What travels through the **foramen lacerum**?
**Internal carotid artery** passes over the superior surface of the foramen lacerum. ## Footnote Not technically through it.
99
Describe the anatomy of the **aortic root**.
* **RCA** from anterior aortic sinus * **LCA** from left posterior sinus
100
Describe the **venous drainage** of the heart.
* Great, medium, and small cardiac veins drain into the **coronary sinus**, which empties into the right atrium. * Thebesian veins (5% of drainage) **empty directly** into cardiac chambers.
101
What are the five anatomical levels of the **brachial plexus** in order?
1. Roots 2. Trunks 3. Divisions 4. Cords 5. Branches ## Footnote These levels are essential for understanding the organization of nerves supplying the upper limb.
102
At what **vertebral level** does the trachea start and end?
Start: **C6** End: **T4** Carina: **T5**
103
Describe the **sympathetic** and **parasympathetic** supply to the bronchial tree.
Sympathetic: **cardiac plexus (T2-4)** Parasympathetic: **vagus nerve**
104
What does the **circle of Willis** represent in the brain's vascular system?
A **circular network of arteries** that supplies blood to the brain. ## Footnote It provides collateral circulation, ensuring blood flow even if one part is blocked.
105
What are the **key structures** seen in a cross-section of the neck at **C6**?
* Cricoid cartilage * Carotid sheath * Scalene muscles * Brachial plexus * Cervical plexus * Sympathetic trunk
106
What are the different **regions** in a cross-section of the **spinal cord**?
* Dorsal horn * Ventral horn * Lateral horn * Central canal ## Footnote These regions are involved in sensory and motor functions, with the dorsal horn processing sensory information and the ventral horn containing motor neurons.
107
What **dermatomes** overlies the xiphoid process?
T6
108
What passes through the **caval hiatus** of the diaphragm?
* IVC * Right phrenic nerve | (T8)
109
What passes through the **oesophageal hiatus** of the diaphragm?
* Oesophagus * Vagus nerves * Left gastric vessel | (T10)
110
What passes through the **aortic hiatus** of the diaphragm?
* Aorta * Azygos vein * Thoracic duct | (T12)
111
List key **posterior anatomical landmarks** for determining vertebral levels.
* Inferior angle of scapula: T7 * Lower rib margin: T10 * Intercristal (Tuffier's) line at iliac crests: L3/4 * PSIS: S2
112
What is the **femoral sheath** and its contents?
Continuation of **extraperitoneal fascia**. Contains **femoral artery**, **vein**, and **inguinal lymph nodes**.
113
What is the **function** of the **cricothyroid muscle**?
Tenses and elongates vocal cords, **raising pitch** by increasing distance between thyroid and arytenoid cartilages.
114
What is the **larynx** and its **functions**?
Sphincter of the respiratory tract. * Protects tracheobronchial tree from foreign bodies * Phonation * Coughing
115
What are the upper and lower borders of the **larynx**?
Upper: **base of tongue** Lower: **cricoid cartilage**
116
Which **cartilages** make up the larynx?
Unpaired: * Thyroid * Cricoid * Epiglottic Paired: * Arytenoid * Corniculate * Cuneiform
117
Which nerves contribute to the **lumbar plexus** and where is it formed?
* L1-4 (variable contribution from T12) * Formed within the **psoas** muscle
118
What are the terminal nerves of the **lumbar plexus**?
* Iliohypogastric (T12, L1) * Ilioinguinal (T12, L1) * Genitofemoral (L1-2) * Lateral cutaneous nerve of thigh (L2-3) * Obturator nerve (L2-4) * Femoral nerve (L2-4)
119
What are the **functions** of the ilioinguinal and iliohypogastric nerves?
* **Ilioinguinal**: sensation to superomedial thigh and genitals. * **Iliohypogastric**: sensation to suprapubic skin and posterolateral gluteal region.
120
What are the boundaries of the **nasal cavity**?
* **Floor:** hard palate * **Roof:** sphenoid and ethmoid * **Medial:** septum * **Lateral:** medial orbit, ethmoid air cells, and maxillary sinus
121
What is the **blood supply** to the nasal cavity?
The nasal cavity receives its blood supply primarily from branches of the **maxillary artery**, particularly the **sphenopalatine artery**. ## Footnote These arteries are crucial for providing oxygenated blood to the nasal tissues.
122
What is the **nerve supply** of the nasal cavity?
The nasal cavity is primarily supplied by branches of the **trigeminal nerve**: the **ophthalmic nerve** provides anterior sensation, while the **maxillary nerve** supplies the posterior region. ## Footnote These branches are essential for sensory innervation of the nasal mucosa.
123
What are the boundaries of the **orbit**?
* **Roof:** frontal bone and lesser wing of sphenoid * **Medial:** ethmoid, lacrimal, maxillary, and lesser wing of sphenoid * **Floor:** sphenoid and maxillary * **Lateral:** zygoma and greater wing of sphenoid
124
What passes through the **inferior orbital fissure**?
* Maxillary nerve branches (zygomatic and infraorbital) * Infraorbital artery * Inferior ophthalmic vein
125
Which nerves contribute to the **sacral plexus**?
L4-5 and S1-4
126
What are the **main nerves** that arise from the sacral plexus?
* Superior gluteal nerve (glute med + min) * Inferior gluteal nerve (glute max) * Sciatic nerve (becomes tibial and common peroneal) * Posterior cutaneous nerve of thigh
127
What are the **functions** of the **sciatic nerve**?
* **Motor**: muscles in back of thigh (hamstrings) * **Sensory**: skin of posterior thigh, lower leg, and foot * **Reflex**: ankle jerk
128
Which nerve is responsible for the left arm pain experienced during a **myocardial infarction**?
The **intercostobrachial nerve**, which originates from the T2 spinal nerve. ## Footnote This nerve provides sensory innervation to the skin of the upper medial arm and can refer pain during cardiac events.
129
What are the components of the **laryngeal reflex**?
* **Afferent:** superior laryngeal nerve (branch of the vagus nerve) * **Efferent:** vagus nerve * **Effector:** intrinsic laryngeal muscles (especially the adductors)
130
Which **blood vessel** supplies the branches that perfuse the tracheal mucosa?
Inferior thyroid artery ## Footnote Venous drainage is via the inferior thyroid venous plexus.
131
Which nerve roots contribute to the **long thoracic nerve**?
C5-7
132
Which nerves are responsible for **controlling defecation**?
Pelvic splanchnic nerves (S2-S4)
133
List the structures in the **bronchial tree** from largest to smallest.
1. Trachea 2. Main bronchus 3. Lobar bronchus 4. Segmental bronchus 5. Terminal bronchiole 6. Respiratory bronchiole 7. Alveolus
134
What are the **parasympathetic ganglia** in the head and neck?
* Ciliary * Pterygopalatine * Submandibular * Otic
135
What does the **recurrent laryngeal nerve** supply?
Supplies all intrinsic laryngeal muscles except **cricothyroid**, which is supplied by the external branch of the superior laryngeal nerve.
136
Describe blood flow to the **liver**.
The liver receives ~25% of cardiac output at rest. Most (~70%) comes from the **hepatic portal vein** (formed by the splenic and superior mesenteric veins). ## Footnote The **hepatic artery** supplies most of the oxygen to the liver.
137
Which nerve supplies the **AV node**?
Left vagus nerve ## Footnote Also supplied by the right coronary artery.
138
Why does partial **recurrent laryngeal nerve** palsy cause greater adduction of the affected vocal cord than complete palsy?
Vocal cord abductors have **greater resting tone** than adductors. **Complete** damage affects both equally, resulting in a neutral position, while **partial** damage leads to unopposed adduction.
139
What is the normal range for **portal venous pressure**?
5-10 mm Hg
140
Which **aortic sinuses** do the right and left coronary arteries arise from?
R: Anterior L: Posterior
141
Which **parts of the heart** does the right coronary artery supply?
* RA * RV * SA node * AV node (in 90%)
142
Describe the blood supply to the **kidneys**.
* **Renal blood flow:** approximately 1/5 of cardiac output * **Flow distribution:** * ~500 mL/min to each kidney * ~500 mL/100 g to the cortex * ~1/5 (~100 mL/100 g) to the outer medulla * ~1/5 (~20 mL/100 g) to the inner medulla
143
What is **left dominance** in coronary circulation?
In 15% of the population, the posterior interventricular branch is from the **left circumflex artery** instead of the right.
144
What tethers the c**onus medullaris** to the coccyx?
Filum terminale ## Footnote Spinal cord ends at L1/2 in adults and L2/3 in neonates.
145
Describe the anatomy of the **liver**.
* **Morphological**: right, left, caudate, and quadrate lobes * **Functional**: 8 lobes, each with a branch of hepatic artery, portal vein, hepatic vein, and biliary drainage.
146
Describe the formation of the **placenta**.
The **chorion** (cytotrophoblasts and syncytiotrophoblasts) invades the **decidua** (uterine lining). It penetrates uterine spiral arteries, filling **intervillous spaces** with maternal blood. **Chorionic villi** project into these spaces, forming the interface between mother and baby.
147
Describe the components of the **dorsal column-medial lemniscal** pathway.
* **1st order**: sensory receptor to gracile or cuneate nucleus in medulla * **2nd order**: medulla to contralateral thalamus * **3rd order**: thalamus to somatosensory cortex
148
What is the **difference** between the gracile and cuneate fasciculus?
**Gracile**: lower body (more medial) **Cuneate**: upper body (more lateral)
149
What are the **two** types of lower motor neurone?
**Alpha**: extrafusal fibres, voluntary movement **Gamma**: intrafusal fibres, proprioception
150
What is the relative **thickness** of the **left ventricle** compared to the **right ventricle**?
1:3
151
What are the lobes and segments of the **liver**?
**Lobes**: left, right, caudate, quadrate **Segments**: 8 segments (based on portal vein, hepatic artery and bile duct supply) ## Footnote Histological unit is the lobule, the functional unit is the acinus.
152
What **terminal nerves** provide a sensory supply to the foot?
* Posterior tibial nerve (medial and lateral plantar branches, and medial calcaneal branch) * Sural nerve * Superficial peroneal nerve * Deep peroneal nerve * Saphenous nerve ## Footnote Saphenous originates from femoral nerve, all others are from sciatic.
153
Which nerve roots contribute to the **sciatic nerve**?
The sciatic nerve is formed from the **L4**, **L5**, **S1**, **S2**, and **S3** nerve roots. ## Footnote It is the largest nerve in the body and innervates the lower limb.
154
How to block the five nerves in an **ankle block**?
* **Posterior tibial nerve**: behind medial malleolus * **Sural nerve**: between lateral malleolus and Achilles tendon * **Superficial peroneal nerve**: between lateral malleolus and extensor hallucis longus tendon * **Deep peroneal nerve**: immediately lateral to EHL tendon * **Saphenous nerve**: between medial malleolus and anterior tibial tendon
155
What do the **superficial** and **deep branches** of the **radial nerve** innervate?
* **Superficial**: sensory to dorsum of hand * **Deep**: motor supply to posterior compartment of forearm
156
What is the course of the radial nerve in the **antecubital fossa**?
The radial nerve enters the **antecubital fossa** anterior to the lateral condyle of the humerus, travels lateral to the **biceps tendon**, and passes under the **brachioradialis** before dividing into superficial and deep branches. ## Footnote This nerve is crucial for the motor and sensory innervation of the arm and hand.
157
Which nerve comes directly off the **superior trunk** of the brachial plexus?
Suprascapular nerve
158
Which **section** of the brachial plexus does the **clavicle** overlie?
Divisions
159
What is the target of an **interscalene block**?
Roots of brachial plexus from C5-C7 ## Footnote This means that the ulnar nerve region is NOT covered.
160
How to perform an **interscalene block**?
* Obtain consent * Use ultrasound guidance * Inject 20 mL Levobupivacaine ## Footnote Indication: shoulder surgery (e.g., rotator cuff repair, arthroplasty)
161
Which **foramina** do the main blood vessels supplying the **circle of Willis** pass?
* **Internal carotid artery:** carotid canal * **Vertebral arteries:** foramen magnum
162
What are the two biggest branches of the **right coronary artery**?
1. Posterior Descending Artery (posterior 1/3 of septum) 2. Right Marginal Artery (right ventricle)
163
Describe the variability in the blood supply to the **SA and AV node** amongst individuals.
* SA Node: RCA (60%), Left Circumflex (40%) * AV Node: RCA (90%), Left Circumflex (10%)
164
What structures are transmitted through the **inferior hiatus** of the diaphragm?
* Aorta * Thoracic Duct * Azygous Vein ## Footnote The inferior hiatus is located at the T12 vertebral level.
165
What is the level of the **middle hiatus** in the diaphragm and what structures pass through it?
The middle hiatus is located at the **T10** vertebral level. It transmits the **oesophagus**, **vagus nerves**, and **left gastric vessels**.
166
What is the level of the **superior hiatus** in the diaphragm and what structures are transmitted through it?
The superior hiatus is located at the **T8** vertebral level. It transmits the **inferior vena cava** and the **terminal branch of the right phrenic nerve**.
167
What is the **function** of the azygos vein?
Drains **posterior thoracic** and **abdominal walls**, **mediastinal structures** on the right, providing a collateral pathway between the superior and inferior vena cava.
168
What are the **peripheral attachments** of the diaphragm?
* Xiphisternum * Costal cartilages of ribs 7 to 12 * L1 to L3 vertebrae (medial and lateral arcuate ligaments)
169
List **muscles** other than the diaphragm that are involved in **inspiration**.
* External intercostals * Scalene * Sternocleidomastoid * Pectoralis minor * Serratus anterior
170
What are the three **chambers** of the eye?
* **anterior** chamber * **posterior** chamber * **vitreous** chamber ## Footnote The anterior and posterior chambers are separated by the iris.
171
What are the three layers of the **globe**?
1. Sclera (outer) 2. Choroid (middle) 3. Retina (inner) ## Footnote The cornea is the anterior, transparent continuation of the sclera and the conjunctiva is the mucous membrane overlying it.
172
Describe the circulation of **aqueous humour**.
* **Production**: Ciliary bodies actively transport Na⁺ into the posterior chamber (80%) + ultrafiltration of plasma (20%) * **Enters** anterior chamber through pupil * **Drainage**: Trabecular meshwork into Canal of Schlemm (into episcleral veins)
173
What is the **main vein** that joins the **femoral vein** near the groin?
Great saphenous vein
174
What muscles make up the floor of the **femoral triangle**?
* Adductor Longus * Pectineus * Iliopsoas
175
Which muscles are innervated by the **femoral nerve**?
* Quadriceps femoris * Pectineus * Iliacus * Sartorius
176
Which nerves are blocked in a **fascia iliaca block**?
Femoral nerve and Lateral cutaneous nerve of the thigh
177
Which **muscles** elevate and depress the **hyoid**?
Elevate: * Geniohyoid * Digastric * Mylohyoid * Stylohyoid * Genioglossus * Hyoglossus Depress: * Sternohyoid * Sternothyroid * Omohyoid
178
Which nerve roots are found in the **cauda equina**?
**L2/3 to the coccygeal nerve**, continuing inferiorly to reach **foramina**.
179
What key landmarks are used to determine **vertebral level**?
* **C7**: Vertebra prominens * **T3**: Spinous process of scapula * **T7**: Inferior angle of scapula * **L4**: Iliac crests (Tuffier's line)
180
Which nerves are blocked in a **3-in-1 block**?
* Femoral nerve * Lateral cutaneous nerve of the thigh * Obturator nerve ## Footnote Historically used for hip and knee surgery but largely superseded by femoral nerve blocks/adductor canal block.
181
For which operations could a **lumbar plexus** block be used?
Surgery at or above the knee (e.g. hip arthroplasty, total knee arthroplasty, ACL repair). ## Footnote Sciatic nerve must be blocked if surgery involves below the knee.
182
List some specific **complications** of a lumbar plexus block.
* Epidural spread of local anaesthetic * Intrathecal injection * Retroperitoneal haematoma * Renal injury
183
What is the **sacral hiatus**?
Failure of fusion of the **5th laminar arch of the sacrum**, resulting in a defect called the sacral hiatus.
184
How is the sacral hiatus identified by **surface anatomy**?
**Sacral cornu** (articular processes) are at the vertex of an inverted equilateral triangle where the top two points are the **right and left PSIS**. ## Footnote A blue 22 g cannula/needle is used to puncture the sacro-coccygeal membrane.
185
Describe the **venous drainage** of the spinal cord.
Anterior, lateral, and posterior venous plexuses **unite to drain** into azygos, vertebral, lumbar, and sacral veins.
186
Name the **extra-pyramidal tracts**.
* Rubrospinal * Tectospinal * Vestibulospinal * Olivospinal * Reticulospinal
187
What are the boundaries of the **epidural space**?
* **Superior**: foramen magnum * **Inferior**: sacrococcygeal membrane * **Anterior**: posterior longitudinal ligament, vertebral body, intervertebral discs * **Posterior**: ligamentum flavum * **Lateral**: pedicles, intervertebral foraminae
188
How to perform a **wrist block** for the median and ulnar nerves using a **landmark technique**?
* **Median Nerve**: Between FCR and PL tendons * **Ulnar Nerve**: Between ulnar styloid process and FCU ## Footnote 4-6 mL for each nerve.
189
What are the layers of a **peripheral sensory nerve**?
* **Epineurium**: around nerve * **Perineurium**: around fascicle * **Endoneurium**: around nerve fiber * **Schwann cell**: myelin
190
Which spinal nerves transmit **nociceptive signals** during the first and second stage of labour?
First stage: **T10 to L1** Second stage: **S1 to S4**
191
At what vertebral level does the **dural sac** end in adults?
S1/2
192
What is the upper limit of normal for **CSF opening** pressure?
20 cm H2O
193
At what vertebral level is the **carina**?
T4/T5
194
Which structures are near the **internal jugular vein**?
* **Anterior**: internal carotid, vagus * **Posterior**: sympathetic chain, dome of pleura * **Medial**: carotid arteries, cranial nerves 9-12, deep cervical lymph nodes
195
Which **main veins** drain into the internal jugular vein?
* Inferior petrosal vein * Common facial vein * Lingual vein * Superior and middle thyroid veins * Pharyngeal venous plexus
196
What is the **piriform fossa**?
Recess beside the **laryngeal inlet** between the aryepiglottic fold and lateral pharyngeal wall. ## Footnote Common site for foreign body lodging.
197
What passes through the **greater palatine foramen**?
* Anterior palatine nerve * Descending palatine vessels
198
Why are **sensory neurones** preferentially targeted by local anaesthetics?
Due to **use dependence** and their **smaller** size.
199
What is the order of **intercostal structures**?
* Vein (superior) * Artery * Nerve (inferior)
200
Between which muscle layers are the **intercostal nerves** and **vessels** found?
Between **internal** and **innermost** intercostal.
201
What is the **optimal site** for blocking an intercostal nerve?
Angle of the rib ## Footnote This is the point at which the rib curves forward and downward.
202
What are the afferent and efferent limbs of the **gag reflex**?
**Afferent**: Glossopharyngeal **Efferent**: Vagus
203
At what vertebral level is the **stellate ganglion**?
C7-T1
204
What are the nuclei of the **vagus nerve**?
* Dorsal nucleus * Nucleus ambiguus * Nucleus tractus solitarius
205
At what **level** does the common carotid bifurcate?
C4 Upper border of thyroid cartilage
206
What are the **branches** of the vagus nerve?
* **Cranial**: meningeal, auricular * **Neck**: superior laryngeal, recurrent laryngeal * **Thorax**: inferior cardiac, anterior and posterior bronchial, esophageal * **Abdomen**: gastric, celiac, hepatic
207
At what **vertebral level** is the epiglottis, vocal cords and cricoid?
* Epiglottis: **C2** * Vocal Cords: **C4** * Cricoid: **C6**
208
Describe the **length** and **margins** of the **trachea**.
* Length: **10 cm** * Extends from **C6** (cricoid cartilage) to **T4/5** (carina) * Composed of **15-20 U-shaped rings**
209
What is the name of the **trigeminal nerve ganglion**?
Gasserian ganglion ## Footnote Located in the Meckel cave (CSF-filled space within dura over temporal bone)
210
Name the **intrinsic muscles** of the larynx.
* Posterior cricoarytenoid (only abductor) * Lateral cricoarytenoid * Interarytenoid (oblique + transverse) * Vocalis * Thyroarytenoid * Cricothyroid
211
Why is partial **recurrent laryngeal nerve** injury more likely to cause **airway obstruction** than complete injury?
**Partial**: abductor fibers (*posterior cricoarytenoid*) lost, adductors still work → vocal cord pulled medially → glottic opening narrowed → airway obstruction. **Complete**: both abductor and adductor fibers lost → cord fixed in paramedian position → passive airway opening usually adequate.
212
What are the branches of the **superior laryngeal nerve**?
* **Internal**: sensory to vocal cords and above * **External**: motor to cricothyroid muscle
213
What are the different types of **peripheral nerve injury**?
* Neuropraxia (pressure without loss of continuity) * Axonotmesis (neural tube intact but axons are disrupted, likely to recover) * Neurotmesis (neural tube severed, permanent)
214
What are the two main types of **brachial plexus injury**?
* **Erb's Palsy** (C5-6): waiter's tip position - shoulder adducted and internally rotated, elbow extended, forearm pronated. * **Klumpke's Palsy** (C8-T1): paralysis of hand muscles, weak finger flexion, sensory loss over inner forearm and medial hand.
215
Describe the features of **ulnar nerve injury**.
* **Motor**: weak intrinsic hand muscles, clawing of 4th-5th fingers, weak wrist flexion (if elbow lesion) * **Sensory**: medial 1.5 fingers, dorsal and palmar hand * **Clinical**: Froment's sign
216
Where do the anterior and posterior **spinal arteries** arise from?
**Anterior**: vertebral arteries **Posterior**: posterior inferior cerebellar arteries ## Footnote There are 3 anterior and 3 posterior spinal veins (drain into the epidural venous plexus).
217
What level of block is usually needed when delivering an epidural for a **Caesarean section**?
T4-5
218
What is the **difference** between the white and grey rami communiantes?
**White**: myelinated and formed by preganglionic sympathetic neurones leaving the spinal cord **Grey**: postganglionic fibres join the spinal nerves through the grey rami
219
Which **nerves** are commonly missed with the following types of block? * Interscalene * Supraclavicular * Infraclavicular * Axillary
* **Interscalene**: C8 and T1 * **Supraclavicular**: usually none * **Infraclavicular**: usually none * **Axillary**: musculocutaneous needs separate injection, axillary nerve not covered
220
What is the course of the **vagus nerve**?
The vagus nerve originates in the **medulla** and travels through the neck, thorax, and abdomen, branching to various organs. ## Footnote It plays a crucial role in autonomic control of the heart, lungs, and digestive tract.
221
What are the **clinical features** of vagus nerve transection at the jugular foramen?
* Hoarse voice (vocal cord paralysis) * Weak cough * Reduced bowel motility * Loss of vagal reflexes (gag, cough)
222
What are the causes of **recurrent laryngeal nerve damage**?
* Thyroid or parathyroid surgery * Malignancy in the neck * Cardiothoracic surgery * Aortic aneurysm * Trauma ## Footnote Recurrent laryngeal nerve damage can lead to voice changes and breathing difficulties.
223
What is the **Bell-Magendie Law**?
A principle stating that **anterior** spinal nerve roots are responsible for **motor** function, while **posterior** nerve roots are responsible for **sensory** function. ## Footnote This law is fundamental in understanding the organization of the spinal cord and its functions.
Primary FRCA
flashcards
Decks in class (17)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions