Thursday, 7 November 2013


*Afferent and efferent limbs of cough reflex- CN X - CN X
*Afferent and efferent limbs of gag reflex-CN IX - CN X
*Autonomic ganglia for CN III Ciliary
*Autonomic ganglia for CN IX Otic
*Autonomic ganglia for CN VII
PPG and submandibular
*Branch of CN V that carries parasympathetic to submandibular Lingual
*Branch of CN V that carries parasympathetics to parotid
Auriculotemporal (V3)
*Chief structures that traverse internal acoustic meatus
*Foramen where CN VII exits skull -Stylomastoid foramen
*Innervation of carotid sinus and carotid body-  CN IX(glasopharyngeal),CN X(vagus)
*Innervation of cricothyroid- External laryngeal nerve
*Innervation of digastric Anterior belly = CN V(trigeminal)
Posterior belly = CN VII (facial)
*Innervation of external surface of tympanic membrane- Auriculotemporal(V3),CN X
*Innervation of internal surface of tympanic membrane-CN IX
*Innervation of laryngeal muscles exclusive of cricothyroid
Recurrent laryngeal
*Innervation of levator veli palatini -CN X
*Innervation of omohyoid, sternohyoid and sternothyroid
Ansa cervicalis (C1-3 ventral rami)
*Innervation of tensor veli palatini-CN V3
*Major arterial supply to calvaria and supratentorial dura-Middle meningeal
*Major artery to internal structures of head- Maxillary
*Major artery to nasal cavity-Sphenopalatine
*Major cutaneous nerve of face-CN V
*Major nerve to TMJ (pain)-Auriculotemporal (V3)
*Major structures to pass through pharyngeal-wall superior to Auditory tube,levator veli palatini superiorconstrictor
*Most common site of nose bleed- Kiesselbach's plexus
*Muscle attached to disc of TMJ- Lateral pterygoid
*Muscle that depresses and abducts eye-Superior oblique
*Muscle that elevates and abducts eye-Inferior oblique
*Muscle that increases tension on vocal cords-Cricothyroid
*Muscle that opens auditory tube-Tensor veli palatini
*Muscle that protrudes tongue-Genioglossus
*Muscle that retracts mandible-Temporalis
*Muscles that are innervated by CN XI-Trapezius, SCM
*Nerve at risk when performing thyroidectomy-Lt & Rt recurrent laryngeal nerves
*Nerve injured when deviation of protruded tongue- Ipsilateral CN XII
*Nerve injured when tonsilar pillars sag and uvula deviates-CN X
*Nerve injury that causes hoarseness following thyroid surgery- Recurrent laryngeal
*Nerve potentially injured with tonsillectomy-CN IX
*Nerve that provides taste to anterior 2/3 of tongue- Chorda tympani
*Nerves of pharyngeal plexus- CN IX(abducence) (mucosa), CN X(vagus)(musculature), Sympathetics (vasomotor)
*Only muscle innervated by CN IX-Stylopharyngeus
*Only muscle to abduct vocal cords- Posterior cricoarytenoid
*Sensory ganglia for CN VII- Geniculate
*Sensory nerve to cornea- CN V1 (nasociliary)
*Sensory nerve to larynx inferior to vocal cords- Recurrent laryngeal
*Sensory nerve to larynx superior to vocal cords- Internal laryngeal
*Site of aspirated lodged fishbone- Piriform recess
*Site of cell bodies for nerve that carries taste to anterior 2/3 of tongue- Geniculate ganglion
*Site of postganglionic nerve cells that elicits constriction of pupil- Ciliary ganglion
*Site of postganglionic nerve cells that elicits dilation of pupil- Superior cervical ganglion
*Site of preganglionic nerve cells that elicits constriction of pupil - Edinger-Westphal
*Site of preganglionic nerve cells that elicits
dilation of pupil
Lateral horn, T1 - 2
*Specific nerve that elicits secretion from
submandibular gland
Chorda tympani
*Specific nerve that stimulates tear production
Greater petrosal CN VII
*Specific nerves that elicit secretion from the parotid gland
Tympanic branch of CN IX and lesser petrosal
*Spinal levels of sympathetic fibers to head
T1 - 2
*Structure that opens into inferior meatus of nasal cavity- Nasolacrimal duct
*Structure that opens into superior meatus of nasal cavity -Posterior ethmoid sinus
*Structures that course between anteriorand middle scalene
Brachial plexus, subclavian artery
*Structures that open into middle meatus of nasal cavity- Frontal, maxillary, anterior and middle ethmoid
*Structures that pierce thyrohyoid membrane -Internal laryngeal nerve, superior laryngealartery
*Vertebral level of cricoid cartilage- CV6
*Vertebral level of hyoid bone - CV3
*Vertebral level of thyroid cartilage - CV4,5

At what level does the abdominal esophagus begin? End? - T10 - T11
Through what part of the diaphragm does the IVC pass through? - Central tendon (through cavel
Why isthe cavel opening called an opening?Why are the aortic hiatus and esophogeal hiatus called
hiatus? - The IVC passes through the central tendon of the diaphragm, a tendon NOTa muscle,
therefore termed opening - The aorta and esophagus pass through muscles
and are therefore termed hiatus
What spinal nerves supply the genitofemoral nerve? - L1- L2
Where does the sigmoid colon start? End? - Iliaccrest-S2,S3
What passes through the female inguinal canal? -
found ligament of uterus
- ilioinguinal n.
- genital branch of genitofemoral n.
- lymphatic vessels
Why are lymph vessels which travel through the inguinal canal important? - important due to
metastasis of cancer through these vessels
Name the second segment of the liver asif it was pinned on the practical test. - Segment II, left
lobe of liver
What are the KEYWORDS to remember and NOT confuse relating to the liver? - lobes
- parts
- divisions
- segments
How many functional PARTS of the liver are their. Describe the course of the superior
mesenteric artery? List them. - 3
- left
- right
- posterior
How many LOBES of liver are there? List them - 4
- left lobe
- right lobe
- cuadate lobe
- quadrate lobe
Which surface of the liver can all 4 lobes of the liver be seen? - visceral surface
How many DIVISIONS of the liver are there? List them - 4
- left lateral
- left medial
- right lateral
- right medial
How are the DIVISIONS of the liver divided? -based on hepatic vein drainage
What constitutes a liver segment? - an area of the liver which receives blood from a hepatic artery,
hepatic portal vein, and bile duct (portal triad)
What defines a part of the liver? - blood supply (both arterial and venous)
- bile drainage
List the hepatic veins - left hepatic v.
- intermediate hepatic v.
- right hepatic v.
Which DIVISIONS are drained by the lefthepatic v.
- left lateral division
- left medial division
Which DIVISIONS are drained by the right hepatic
v. - right lateral division
- right medial division
Which DIVISIONS are drained by the intermediate
hepatic v. - left medial division
- right medial division
Which SEGMENTS are drained by the right hepatic
v. - V
- VI
Which SEGMENTS are drained by the left hepatic
v. - II
- IV
Which SEGMENTS are drained by the intermediate
hepatic v. - IV
- V
Why isn't SEGMENT 1 not considered a part of the 4 DIVISIONS of the liver? - it drains directly into
the IVC
Where do the hepatic veins drain? - IVC
How are the components of the portal triad oriented topographically? What pneumonic can
help with this? - proper hepatic artery (left)
- common bile duct (right)
- hepatic portal vein (posterior)
- LARD PP (Left Artery Right Duct, PortalPosterior)
Which segment is the quadrate lobe? - S IV
Which segment is the caudate lobe? - S I
What bile ducts unite to make the common hepatic duct? - left hepatic duct
- right hepatic duct
What bile ducts unite to make the common bile duct (bile duct)? - common hepatic duct
- cystic duct
What are the parts of the bile duct? -
supraduodenal part (above 1st part of duodenum)
-retroduodenal part (behind 1st part of duodenum)
-pancreatic part
- intramural part
Are males or females more likely to get gallstones? - female
What are the 4 "F's" to remember for most likely group affected by gallstones? - Female
- Forties
- Fat (obese patients)
- Fertile (premenopausal)
What is mechanical (obstructive) jaundice?
Common causes? - Jaundice caused by blockage of hepatopancreatic ampulla
- blockage of hepatopancreatic ampulla by gallstone
-compression of bile duct by tumor in head of pancreas
What are common symptoms of mechanical jaundice?
- pain in abdominal region
- white feces (due to lack of biliruben in feces)
- yellowing of skin and sclera of eyes (due to
elevated bilirubin in bloodstream)
Where is the fundus of the gallbladder located according to surface anatomy? - Right MCL
- 10th costal cartilage
Where is the bare area of the liver located? - between the layers of the coronary ligament
What are the layers of the coronary ligament? - hepatophrenic ligament (ant. layer)
- hepatorenal ligament (post. layer)
What are the adjacent structures relatedto the bare area of the liver? - right kidney
- right suprarenal gland
- diaphragm
Name the 4 portal systemic anastomoses 1.
esophophogeal vv. draining into azygos vein
(systemic) or left gastric (portal)
2. rectal vv. between the inferior and middle vv.
draining into the IVC (systemic) and the superior
rectal v. (continues as superior mesentaric v.)
3. paraumbilical vv. of anterior abdominal wall
(portal) anastomsing with superficial epigastric vv.
4.colic vv. (portal) with retroperiotoneal vv.
What may develop during portal hypertension when the paraumbilical anastomoses are dilated?
- caput medusae (varicose veins radiating outward from the umbilicus)
What may develop during portal hypertension when the esophageal anastmoses are dilated?
 -esophageal varices (dilated submucosalvv. in the lower third of the esophagus)
- patients have a strong tendency to develop bleeding which is often severe and may be fatal
What are the common causes of portal hypertension?
- cirrhosis due to:
- alcohol abuse
- hepatitis
Is the pancreas an exocrine gland or an endocrine gland? - both
What are the functions of the pancreas? -
Exocrine: secrete digestive juices (pancreatic juice) into the duodenum through the major
duodenal papilla (main pancreatic duct) or minor duodenal papilla (accessory pancreatic duct)
- Endocrine: release of hormones directly into the bloodstream (insulin) (glucagon) for regulation of
blood glucose
What is the eponym for the main pancreatic duct?
Accesory pancreatic duct? - duct of Wirsung
- duct of Santorini
Is the pancreas intraperitoneal or retroperitoneal?
- both
- head, neck and body of pancreas are
secondarily retroperitoneal
- tail of pancreas is intraperitoneal
Within what ligament is the tail of pancreas located? - splenorenal (lienorenal) ligament
How many sphincters are located in the area of the hepatopancreatic ampulla? What are there
functions? - 3
- sphincter of pancreatic duct (prevents reflux of
bile into pancreatic duct)
- sphincter of bile duct (controls flow of bile)
- sphincter of hepatopancreatic ampulla (prevents
contents of duodenum from entering the the
What is the eponym for the hepatopancreatic sphincter? - sphincter of Oddi
Is the spleen intraperitoneal or retroperitoneal? - intraperitoneal
Where is the spleen not surrounded by peritoneum? - its hilum
What ribs are associated with the spleen? - left ribs 9 to 11
Is damage of the spleen life-threatening? Can a person live without the spleen? - yes to both
- damage to the spleen usually results in massive
bleeding which can be fatal if left untreated
- if spleen cannot be repaired it can be safely removed without extreme issue to the patient
What are the consequences of a splenectomy to the patient? - increased vulnerability to certain diseases such as pneumonia, meningitis, and

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