HYT-anatomy

RED ANATOMY

Foramina of Middle Cranial Fossa

Optic Canal	CN II, ophthalmic artery, central retinal vein
Superior Orbital Fissure	CN III, IV, VI, ophthalmic vein
Foramen Rotundum	CN V2 ( maxillary br.)
Foramen Ovale	CN V3 (mandibular br.)
Foramen Spinosum	middle meningeal artery
Foramen Lacerum	nothing

* all structures pass through sphenoid bone

Foramina of Posterior Cranial Fossa

Internal auditory meatus	CN VII, VIII
Jugular foramen	CN IX, X, XI, jugular vein
Hypoglossal canal	CN XII
Foramen magnum	spinal root of CN XI, brain stem , vertebral artery

* all structures pass through temporal & occipital bone

Passage of Cranial Nerves

CN I	Cribriform plate
CN II	Optic canal
CN III, IV, V1, VI	Superior orbital fissure
CN V2	Foramen rotundum
CN V3	Foramen ovale
CN VII, VIII	Internal auditory meatus
CN IX, X, XI	Jugular foramen

Mastication muscles

3 muscles to close jaw : masseter, temporalis, medial pterygoid
1 muscle to open jaw : lateral pterygoid
All are innervated by CN V3

3 Structures in Carotid sheath

V : internal jugular vein ( lateral )
A : common carotid artery ( medial )
N : vagus nerve ( posterior )

Diaphragm
Embryology	septum transversum pleutoperitoneal folds dorsal mesentery of esophagus body wall
Passage	At T 8	Inferior vena cava
	At T10	esophagus, vagus
	At T12	aorta, thoracic duct, azygous vein
Innervation	C3,4,5 : Referred pain to shoulder

8 Layers of Abdomianl wall	Spermatic cord
Skin
Fascia ( Camper's & Scarpa's )	Dartos muscle & Colles' fascia
Ext. Oblique muscles	Ext. spermatic fascia & superficial inguinal ring
Int. Oblique muscles	Cremaster muscle & conjoint tendon
Transeverse abdominalis	No contribution except to conjoint tendon
Transverse facisa	Internal spermatic fascia & deep inguinal ring
Extraperitoneal fat
Peritoneum	Tunica vaginalis testis & processus vaginalis

Inguinal Hernia
Direct Hernia	Protrude through inguinal ( Hasselbach's) triangle Bulge directly through abdominal wall medial to inf. epigastric artery Goes through the superficial inguinal ring only
Indirect Hernia	Due to failure of closure of processus vaginalis Enters deep inguinal ring lateral to inf. epigastric artery Goes through deep & superficial inguinal ring, and into scrotum
Hasselbach's triangle	Inguinal ligament Inferior epigastric artery Lateral border of rectus abdominalis

Clinical Landmarks
Ischial spine	Pudendal nerve block
McBurney's point	Appendix 2/3 of the way between umblicus & Superior iliac spine
Iliac crest	Lumbar pucture

Hand Muscle : Thenar - Hypothenar
Thenar	Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
Hypothenar	Opponens digiti minimi Abductor digiti minimi Flexor digiti minimi

Contents of femoral sheath

lateral to medial

femoral nerve, artery, vein, lymphatics

femoral nerve lies outside femoral sheath

femoral canal contains deep inguinal lymph node

Unhappy triad of Knee injury

Common for football injury ( by clipping from the side )
Injury of medial collateral ligament, medial meniscus, anterior cruciate ligament

Anterior Drawer sign : indicate tearing of ant. crucate ligament

Muscle name with Palate

Innervation by Vagus nerve , but tensor veli palatini --> CN V3

KLM sounds
Kuh- kuh-kuh	test palatal elevation	vagus nerve
La- la- la	test tongue	hypoglossal nerve
Mi- mi- mi	test lips	facial nerve

Muscle name with ~Glossus

Innervation of hypoglossal nerve, but palatoglossus --> vagal nerve

Cervical rib

An embriological defect ; can compress subcalvian artery and inferior trunk of branchial plexus (C8, T1), resulting in thoracic outlet syndrome

Atrophy of the thenar and hypothenar eminences
Atrophy of the interosseous muscle
Sensory deficits on the medial side of the forearm and hand
Disappearance of the radial pulse upon moving the head toward the opposite side

Medial nerve injury
Motor deficit	no loss of power in any of arm muscle loss of forearm pronation, wrist, and finger flexion several thumb movement, thenar atrophy
Sensory deficit	loss of sense in lateral palm, over thumb, radial 2 finger

Ulnar nerve injury
Motor deficit	impaired wrist flexion & adduction impaired adduction of thumb & ulnar 2 fingers

Radial nerve injury
Motor deficit	triceps brachi ( triceps reflex ) brachioradialis ( brachioradialis reflex ) extensor carpi radialis longus
Sensory deficit	posterior brachial cutaneous dorsal antebrachial cutaneous

Axillary nerve injury
Motor deficit	loss of deltoid action

Musculocutaneous nerve injury

Motor deficit

loss of function of coracobrachialis, biceps & brachialis muscle ( biceps reflex )

affect flextion at the shoulder (coracobrachialis & biceps brachii)
flexion at elbow (brachialis , biceps brachii )
supination of forearm ( biceps brachii )

Sensory deficit

below elbow, continue as lateral cutaneous nerve of forearm
no distribution to hand

Erb- Duchenne palsy
Cause	Traction or tear of the superior trunk of the brachial plexus (C5 & C6 roots) ; follows falling down on shoulder or trauma during delivery
Findings	limb hangs by side ( paralysis of abductors ) medially rotated ( paralysis of lateral rotators ) forearm is pronated ( loss of biceps )

Nerve injury in lower limbs
Common peroneal nerve	loss of dorsiflexion ( foot drop )
Tibial nerve	loss of plantar flexion
Femoral nerve	loss of knee jerk
Obturator nerve	loss of hip adduction

Pectinate line
Above the line	internal hekmorrhoid ( not painful ), adenocarcinoma visceral innervation, blood supply, and lymphatic drainage
Below the line	external hemorrhoid ( painful ), squamous cell ca, Somatic innervation, blood supply & lymphatic drainage

Portal - systemic anastomosis
Esophageal varices	left gastric --- azygous
Hemorrhoid	superior --- middle / inferior rectal
Caput medusae	paraumbilical --- inferior epigastric

Recurrent laryngeal nerve
Supplies all intrinsic muscles of the larynx except the cricothyroid muscle.
Left recurrent laryngeal nerve	wraps around the aortic arch and the ligamentum arteriosum
Right recurrent laryngeal nerve	wraps around right subclavian artery.
Damages results in hoarseness as a complication of thyroid surgery.

Lung relations

Right lung has three lobes. Left has two lobes and Lingula ( homologue of right middle lobe ).
Right lung more common site are for inhaled foreign body owing to less acute angle of right main stem bronchus

Relation of pulmonary artery to the bronchus at each lung hilus : RALS ( Right-Anteior, Left-Superior )

Bronchial & Pulmonary artery run with airways in the center, veins and lymphatics drain along the border

Course of ureter

pass under artery & under ductus deferens

Autonomic innervation of penis
Erection	by parasympathetic nervous system ( Point )
Emission	by sympathetic innervation ( Shoot )
Ejaculation	by somatic & visceral nerves

Ligaments of the uterus

pubocervical, transverse cervical ( cardinal ), sacrocervical ligaments, round ligament of uterus, round ligament of ovary
round ligament of uterus : homologous to gubernaculum testis; run from labia majora to uterus
round ligament of ovary : run from uterus to ovary
broad ligament contains the round ligaments of the uterus, the round ligaments of the ovary, the uterine tubes, the epoophoron and multiple lymphatic vessels & nerve fibers

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