MEDPRIME REVIEW CENTER BAGUIO CITY

Review Questions for Discussion on Anatomy

(Extremities, Back, Head and Neck, and Chest)
Dr. Vibar

A. GROUPINGS
1. Rotator cuff muscles tendons of it stabilize joint (Anterior,
superior and posterior)
* Weakest on inferior unprotected by muscle

SKELETAL SYSTEM
Total Bones in the body: 206
1. According to shape
A. Long with ends and shaft (Metacarpal, Humerus,
Phalanx)
B. Short Length and width are equal (Carpals and
Tarsals)
C. Flat Parietal bone of the skull and Ribs
D. Irregular Vertebrae, Hip Bone
2. According to location
A. Axial within the central axis with vertebral, thoracic
case, ribs,
sternum
B. Appendicular Upper and lower extremities, pelvis,
pectoral girdle
(Clavicle and Scapula)
3. According to germ layer
A. Mesoderm Supporting tissue (bones, muscles and
cartilages)
Mesenchyme/ stem cells gives rise to supporting
tissue
BONE FORMATION
A. Direct intramembranous
Mesenchyme Direct bone
B. Indirect intracartilagenous (Endochondral)
Mostly of bones except flat bones of skull
Skeletal muscle paraxial mesoderm
Cardiac muscle visceral/ sphlanchnic

Supraspinatus

JOINTS
1. Mobility
A. IMMOBILE (Synarthroses) Fibrous
- Sutures Sutures of the skull
- Syndesmosis Fibula/Tibia; Radius/Ulna
- Gomphosis Connection with tooth between mandible
and maxilla. B. SLIGHTLY MOVABLE (Amphiarthrosa
Cartilagenous
1. Primary synchondrosis Hyaline (Example: Costal
cartilages)
2. Secondary symphysis Fibrocartilage (Example:
Intervertabral
disks, pubis symphysis)
C. FREELY (Diarthroses) Synovial
Plane
Sternoclavicular joint,
acromioclavicular joint
Hinge/ Ginglymus
Elbow, knee and ankle joints
Pivot/ Trochoid
Atlantoaxial, radioulnar joints
Condyloid
Metacarpophalangeal joints
Ellipsoidal
Waist
Saddle
Carpometacarpal of thumb
Ball and Socket/
Hip joint, shoulder joint
Enarthroses
2. Medium
A. Fibrous
1. Collagenous most widely distributed
2. Elastic
3. Reticular lymphatic tissue, hematopoietic
B. Cartilagenous
1. Hyaline (most common)
2. Elastic
3. Fibroelastic
C. Sinovial joints
MUSCLES
* Rotator Cuff Muscles (SITS)
A. Supraspinatus (MC affected; inflammation of the
rotator cuff)
manifested by pain anterior and superior to the
shoulder joint during
abduction
B. Infraspinatus
C. Teres MINOR
D. Subscapularis

Infraspinatus
Teres Minor
Subscapularis
Deltoid muscle
Teres Major

Suprascapular
nerve
Suprascapular
nerve
Axillary nerve
Subscapular nerve
Axillary nerve
Subscapular nerve

Abductor
Lateral rotator
Lateral rotator
Medial rotator
Abductor
Medial rotator

Quadrangular Space
Bounded Above: Teres minor
Below: Teres major
Medial: Long head of the Triceps brachii
Lateral: Surgical neck of the humerus
Contents: Axillary nerve (Circumflex nerve) MC injured during
dislocation
Posterior circumflex humeral vessels
*Action of supination (Biceps brachii muscle) innervated by
Musculocutaneous
* Lumbricalis flexes the MCP joints innervated by the median
nerve (lateral part) and by the ulnar nerve (medial part)
* Extensor digitorum innervated by the radial nerve
Hypothenar muscles (Innervated by the ulnar nerve)
AFO
A: Abductor digiti minimi
F: Flexor digiti minimi
O. Opponens digiti minimi
Thenar muscles (innervated by the median nerve)
AFO
A: Abductor pollicis brevis
F: Flexor pollicis brevis
O: Opponens pollicis
*Palmar interossi ADduct fingers
* Dorsal interossi ABduct fingers both innervated by the ulnar
nerve
Anterior Arm: Musculocutaneous
Posterior Arm: Radial
Posterior Forearm: Radial
Anterior Forearm: Median (Thenar lateral), Ulnar (Hypothenar
medial)
* Abduct and adduct of fingers ulnar nerve
* Extension of fingers radial nerve
* Flexion of fingers ulnar nerve
Muscles of the Arms
Anterior: Flexor
Posterior: Extensor
- Musculocutaneous
- Radial
- Brachialis: main flexor
- Triceps brachii: main
extensor
- Biceps brachii: Supinator of forearm
of the
forearm
* Flexor Muscles of Forearm are all innervated by the Median
nerve EXCEPT Flexor carpalis and the flexor digitorum profundus
that is innervated by the ulnar nerve
*Medial epicondyle of humerus contains the common flexor
tendon origin of the pronator teres located at the humeral
head
*Extensor muscles of forearm innervated by the radial nerve
Superficial: Brachioradialis (Flexor) radial nerve
*Tennis elbow affectation of the lateral epicondylitis
* Golfers elbow affectation of the medial epicondylitis
BRACHIAL PLEXUS (C5, C6, C7, C8 and T1)
TERMINAL BRANCHES of the Plexus
Musculocutaneou
Lateral cord

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s
Axillary
Radial
Ulnar
Median

- Fall on the outreached hand

- Anterior displacement
- Smiths
- Fall on the back of the hand

Posterior cord
Posterior cord
Medial cord
Medial and lateral
cord
From C5 and C6

Long Thoracic
* Erb-Duchennes Syndrome
- Lesion at C5 and C6
- Proximal muscles in UE
- Waiters tip
- Altered sensation on
the lateral side of arm
*Klumpke
- C8 and T1
- Distal muscles of the
UE (Hand)
- Altered sensation on
the medial side of the arm
- APE hand, claw hand

Proximal row
Scaphoid/
Navicular
Lunate
Triquetral
Pisiform

Distal
row
Trapeziu
m
Trapezoi
d
Capitate
Hamate

* Long Thoracic Nerve Lesion

- Winged scapulae
- Anterior serratus muscle
- Abnormal: Weak protraction
- Median border/ vertebra is prominent
* Axillary nerve lesion
- Dislocation of shoulder and surgical neck
*Radial nerve lesion
- Spinal fracture and midshaft of humerus
- Wrist drop
*Median nerve lesion
- Proximal = Supracondylar fracture
= Hand of Benediction
- Distal = Carpal tunnel syndrome or lunate dislocation
= Ape Hand weakness of opposition of the
thumb
* Ulnar nerve lesion
- Proximal = medial epicondyle, weakness in flexion
- Distal = Fracture of hook of hamate; Claw hand
Cubital Fossa Contents to medial to lateral
A. Median Nerve
B. Brachial Artery
C. Biceps brachii
D. Radial Nerve
AXILLARY ARTERY
- From 1st rib to Teres major
* Tendon of the Pectoralis minor divides the artery into 3 parts
1. 1st part: Superior thoracic artery
2. 2nd part: Thoracoacromial artery and Lateral Thoracic
3. 3rd part: Subscapular, Anterior and Posterior Circumflex artery
Cephalic Vein (lateral) Drains to the axillary vein
Basilic (Lateral) Brachial vein
* Median antecubital vein connection of cephalic and basilica
vein
CLAVICLE
- 1st bone to begin ossification
- Last bone to complete ossification
* Medial 2/3 Convex
* Lateral 1/3 Flattened
- Fracture of the Clavicle
- Fall on shoulder or outstretched hand: Most commonly
fractured
bone
- Medial segment elevated by the pull of the SCM
- Lateral segment displaced downward by gravity and
pull of deltoid
and pectoralis major
- Cause brachial plexus injury/ lower trunk
- Haemorrhage from the subclavian artery or vein
* Fracture of the lower end of radius
- Posterior and superior displacement
- Dinner/ Silver fork deformity (Colles)

ANATOMICAL SNUFFBOX
- Lateral tendonds of EPB and Abd PL
- Medial tendon of EPL
- Floor Scaphoid and Lunate
* Radial artery; styloid process of radius; base of 1st
metacarpal bone can be palpated
CARPALS
*Most commonly fractured: Scaphoid
*Most commonly dislocated: Lunate Carpal Tunnel Syndrome
(median n.)

HUMERUS
* Surgical neck of the humerus: Axillary nerve
* Supracondylar ridge: Median nerve
* Radial/ Spiral groove: Radial nerve
* Medial epicondyle: Ulnar nerve
THIGH
A. Anterior: Flexor of the thigh and extensor of the leg
innervated by the Femoral nerve
- Quadriceps femoris
- Rectus femoris
- Vastus lateralis
- Vastus medialis
- Vastus intermedius
- Iliopsoas muscle
- Tensor Fascia lata: Medially rotate
- Sartorius: Laterally rotate
- Pectineus
B. Posterior: Extensor of the thigh, flexion of the leg innervated
by the sciatic Nerve
- Hamstring muscles
- Semitendinosus
- Semimembranosus
- Biceps femoris
- Adductor magnus (has dual innervation)
- Hamstring part (Sciatic nerve)
- Adductor part (Obturator nerve)
C. Medial: Adducts thigh innervated by the Obturator nerve
- Adductor longus
- Gracilis
Adductor Canal Transmission for structures
- Subsartorial canal, Hunters canal
- Fascial tunnel in the thigh running from the apex of the
femoral triangle to the Adductor hiatus in the tendons of
Adductor magnus
Muscle , vastus medialis, sartorius
- Contents: Femoral Artery and Vein
Saphenous Nerve
Nerve to vastus medialis
FEMORAL SHEATH
- Funnel shaped fascial tube formed by the prolongation of
iliopsoas and transversalis fascia of the abdomen
- Compartments
A. Lateral femoral artery
B. Intermediate femoral vein
C. Medial femoral canal
- Contents
NAVEL N: Femoral Nerve and its branches
A: Femoral Artery

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V: Femoral Vein
E: Empty space (allows vein and lymph vessels to
distend without
compromising adjacent
structures
L: Lymph nodes
Muscles of the Gluteal Region
* Superficial group Gluteus Maximus (Extensor of thigh)
Inferior gluteal nerve
* Intermediate group Gluteus medius and Gluteus minimus
(Abductor and medial rotator of thigh) Superior gluteal nerve
* Deep group Piriformis, Obturator internus, superior and
inferior Gemelli, Quadratus femoris (lateral rotator of thigh)
LUMBAR PLEXUS: know with branches and how it is related to
Psoas
- Formed by L1, L2, L3, and L4
- Branches:
1. Iliohypogastric (L1)
2. Ilioinguinal (L1)
3. Genitofemoral nerve (L1 and L2) Cremasteric reflex
4. Lateral femoral cutaneous (L2 and L3)
5. Femoral nerve (L2, L3 and L4)
6. Obturator nerve (L2, L3 and L4)
* All branches from the lateral side of the Psoas except:
- Genitofemoral nerve on Anterior
- Obturator nerve on Medial
LUMBOSACRAL PLEXUS
* To the lower limb that leave the pelvis through the Greater
Sciatic foramen
1. Sciatic (L4, L5, S1, S2, and S3) largest nerve in body
- Supplies no structures in gluteal region, skin
of the foot
and leg posterior thigh muscles
2. Superior Gluteal (L4, L5 and S1) injury to this
structure would
produce: Waddling gait, pelvis sag on
the side of unsupported limb (+)
Trendelenburg sign
3. Inferior Gluteal (L5, S1 and S2)
4. Nerve to the Quadratus femoris
5. Nerve to Obturator internus
6. Posterior cutaneous nerve of the thigh
HIP JOINT STABILITY
- Stability when a person stands on one leg with the foot
of the
opposite leg raised above the ground depends on 3
factors
- Head of the femur must be located normally within the
acetabulum
- Neck of femurmust be intact and must have a normal
angle with
shaft of femur
- Function of the Gluteus minimus and medius
Flexion
Anterior Compartment of
thigh
Extension
Posterior Compatment of
thigh and Glutues Maximus
Adduction
Medial Compartment of thigh
Abduction
Gluteus medius and minimus
Medial Rotation
Glutues medius and minimus
Lateral Rotation
Piriformis, etc
* Femoral nerve lesion
- May be damaged due to abscess of the psoas
- Inability to flex the thigh at the hip and extend the leg
at the knee
- * Diminished patellar tendon reflex
* Sciatic nerve lesion
- Susceptible to damage from an IM injection in the
lower medial
quadrant of the gluteus maximus
* Inferior gluteal nerve lsion
- Weakness in the ability to laterally rotate and extend
the thigh at hip joint (Example: climbing stairs or rising from a
chair)
* Saphenous nerve lesion
- Pain and paresthesia in skin of the medial aspect

- No motor loss
* Obturator nerve lesion
- Unable to adduct of thigh
- Paresthesia in skin of medial aspect of thigh
* Fracture of Femoral neck = Shortened and lateral rotation
* Medial Circumflex femoral supply of the hip joint
* Dislocation: Thigh shortened and medially rotated (Sciatic nerve
is compressed)
* Dorsiflex with foot and ankle joint function of the anterior
compartment
ANTERIOR LEG MUSCLES (Innervated by the Deep peroneal
nerve)
- Tibialis anterior
- Extensor digitorum longus
- Extensor hallucis longus
- Peroneus tertius
LATERAL LEG MUSCLES (innervated by the Superficial peroneal
nerve)
- Plantar flexion and eversion
- Peroneus longus
- Peroneus brevis
POSTERIOR LEG MUSCLES (innervated by the TIbial nerve)
- Plantar flexion and flexion of leg
- Superficial: Gastrocnemius, Plantaris, Soleus
- Deep: Popliteus, Flexor digitorum, Tibialis
* All PERONEAL muscles are for eversion
ACHILLES TENDON common attachment of the gastrocnemius
and soleus
*Popliteus Unlocks the knee
- Posterior compartment
- Supplied by the tibial nerve
POPLITEAL FOSSA
- Terminal of Sciatic nerve
- Tibial nerve
- Common peroneal nerve (MC injured nerve in the LE)
- Popliteal Artery and Vein
DEEP TENDON REFLEXES
C5
Biceps
brachii
C6
Brachioradial
is
C7
Triceps
L4
Patellar
S1
Achilles
tendon
*Adductor hiatus where the femoral artery becomes the
popliteal artery
* Vena Commitantes
- Tributaries are:
A. Anterior/ Posterior Tibial
B. Popliteal
C. Femoral
D. External Iliac
E. Internal Iliac
F. Common Iliac
* Saphenous vein
- Great saphenous vein Femoral vein
- Lesser saphenous vein Popliteal vein
*Dorsalis Pedis artery
Lateral: Tendon of external digitorum longus
Medial: Tendon of extensor hallucis longus
* Sciatic nerve divides into the (1) Tibial and (2) Common
Peroneal then the peroneal nerve then again is subdivided into
the (1) Deep and (2) Superficial
* Action of Dorsiflexion anterior compartment Deep peroneal
nerve

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*
*
*

Action of Plantar Flexion posterior compartment Tibial nerve

Plantar flexion + Eversion lateral compartment
Peroneus muscle Eversion
Tibialis anterior and posterior Inversion

Common Peroneal/ Fibular Nerve lesions

- Frequently injured nerve of the lower extremity
- Pain and paresthesia lateral leg and entire dorsum
- Foot drop
- Steppage gait
Deep Peroneal/ Fibular Nerve lesions
- Foot drop
- Paresthesia in skin of webbed space between the 1st
and 2nd toe
Superficial Peroneal/ Fibular Nerve lesions
- Weakness in eversion of foot
Tibial Nerve lesions
- Cant stand on tiptoe
- Paresthesia on skin of posterior leg, sole and lateral
foot
KNEE JOINT
- Extracapsular Ligaments
- Ligamentum patellae
- Lateral and Medial collateral ligament
- Lateral: Forced Adduction of the tibia on the
femur
- Medial: Forced Abduction of tibia on the femur
- Oblique popliteal ligament
- Strength of the knee joint depends on the
1. Tone: brought about by the Quadriceps
2. Strength of the ligaments
- Intracapsular ligaments
A. Anterior cruciate ligament
- Prevents forward sliding of tibia on femur
- Posterior displacement of femur in tibia
- Lax during flexion
B. Posterior cruciate ligament
- Prevents backward sliding
- Anterior displacement of the femur on tibia
- Lax during extension
*UNHAPPY TRIAD OF ODONOGHUE
- ACL, Tibial collateral ligament and Medial Meniscus
(TERRIBLE TRIAD)
*Anterior Drawer sign: Forward sliding of the tibia on femur due
to rupture of the anterior cruciate ligament
*Posterior Drawer sign: Backward sliding of the tibia on femur
due to damage of the posterior cruciate ligament
LESION OF CORTICOSPINAL TRACT
* Above the level of decussation, manifest contralaterally
* Below the level of decussation, manifest ipsilaterally
SKULL
A. Paired bones
1. Cranial:
- Parietal
- Temporal

B. Unpaired bones
1. Cranial:
- Frontal
- Occipital
- Sphenoid
- Ethmoid

SKULL FRACTURE
Anterior cranial fossa anosmia, periorbital bruising (Raccoons
Eye) and CSF leakage through the nose (Rhinorrhea)
LAYERS OF THE SCALP
SCALP S: Skin
C: Connective tissue
A: Aponeurosis
L: Loose Connective tissue
P: Periosteum
Three Primary Brain
1. Forebrain / Prosencephalon
- Telencephalon - Cerebrum

- Diencephalon - Thalamus
2. Midbrain / Mesencephalon
- Mesencephalon - Midbrain
3. Hindbrain / Rhombencephalon
- Metencephalon Pons, Cerebellum
- Myeloncephalon - Medulla
*Neural tube forms the CNS which composes of the brain and
spinal cord
* Neural crest forms the PNS and ANS composed of the cranial,
spinal and autonomic ganglia and the plexuses
CEREBRUM
Brodmans area: Function of the cerebrum
Primarily motor area: Pre-central gyrus: Brodman area 4
Primary somasthetic area: Post-central gyrus; Brodman area 3, 1,
2
Primary visual area: Brodman area 17
Primary auditory area: Brodman area 41, 42
Brocas area: Brodman area 44, 45; motor aphasia (expression)
Wernickes area: Brodman area 22; sensory aphasia (receptive)
SENSORY AND MOTOR
Rule # 1 All areas are supplied by MCA except the LEG areas
(ACA)
Rule # 2 (+) occlusion of the right side presents at
contralateral side
(+) occlusion of the right ACA: loss of sensory and motor
left lower
extremity
CORTICOSPINAL TRACT
- Desce nding pathway (motor)
* The decussation is located at the lower medulla
Paralysis
Atrophy
Fasciculation
Clonus
Pathologic reflex
Muscle tone

UMN
Spastic
(-)
(-)
(+)
(+)
Increase

LMN
Flaccid
(+)
(+)
(-)
(-)
Decrease

VENTRICULAR SYSTEM
*Lateral ventricle (Cerebrum)
* 3rd ventricle (Thalamic)
* 4th ventricle (Pons, cerebellum and medulla)
Choroid plexus -----------------------> Lateral ventricle
----------------------> 3rd ventricle
Foramen of Monroe
-----------------------> 4th ventricle --------------------------------------------->
Subarachnoid
Aqueduct of Sylvius
Foramen of Magendie and
Luschka
space
Drains to the internal jugular vein <------- Arachnoid villi
<---------------l
* Aqueduct of Sylvius: narrowest site which is most prone to
blockages
CEREBROSPINAL FLUID
Appearance
Volume
Rate of
production
Pressure
Protein
Glucose
Chloride
Number of cells

Clear and colorless

130ml
0.5ml/min
60-150 mmH20
15-45 mg/100ml
50-85 mg/100ml
720-750 mg/100ml
0-3 lymphocytes

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MENINGITIS
Bacterial
Viral

WBC
>500-1000
(mostly PMN)
<500 (mostly
lymphocyte)

CHON
High

Glucose
Low

Normal to
High

Normal

CRANIAL NERVES:
Purely Sensory: Cranial nerves 1, 2 ,8
Purely Motor: Cranial nerves 3, 4, 6, 11, 12
Mixed motor and sensory: Cranial nerves 5, 7, 9 and 10
* Midbrain: cranial nerve 3 and 4
* Pons: Cranial nerves 5, 6, 7, and 8
* Medulla: Cranial nerves 9, 10, 11, and 12
CRANIAL FOSSA
Foramen in cribriform plate of
ethmoid
Optic canal
Superior orbital fissure

Foramen Rotundum
Foramen Ovale
Jugular foramen
Hypoglossal canal
Interior Acoustic Meatus
Foramen magnum

REMEMBER:
Muscles of tongue
Mucous membrane of
tongue
Taste buds of the
tongue

Nerve Supply
CN XII except
Palatoglossus (CN 10)
Anterior 2/3 by CN V;
Posterior 1/3 by CN IX
Anterior 2/3 by CN
VII; Posterior 1/3 by
CN IX

Muscle

Action

Nerve Supply

CN II, Ophthalmic artery

CN III, IV, VI, ophthalmic
nerve of CN V and
Ophthalmic vein
Maxillary nerve of CN V
Mandibular nerve of CN V
CN IX, X, XI (Cranial part)
CN XII
CN VII and VIII
Medulla, meninges and
spinal part of CN XI

Medial rectus

Adduction

CN III

Superior
rectus

Upward and
medially

CN III

Inferior
rectus

Downward
and medially

CN III

Inferior
Oblique

Upward and
laterally

CN III

Superior
Oblique
Lateral rectus

Downward
and laterally
Abduction

CN IV

Eye after
injury
Abducted
and
Depressed
Abducted
and
Depressed
Abducted
and
Depressed
Abducted
and
Depressed
Extorted

CN VI

Adducted

Sensory

Skin of face, anterior 2/3 of

tongue (mucous membrane)
Motor
Muscles of mastication
Facial Nerve
Sensory
Anterior 2/3 of tongue (taste
buds)
Motor
Muscles of facial expression
Mandibular branch of CN V has 2 divisions
Anterior: Motor Mastication
Posterior: Sensory Skin of face
Parotid Gland Glossopharyngeal nerve
Bells palsy CN VII paralysis of muscles innervated by Facial
nerve
- Loss of tone of orbicularis oculi causes eversion of
eyelid causing it to be vulnerable to ulceration

Corneal blink reflex

Efferent: Facial Nerve closes the eye
Afferent: Ophthalmic branch of CN V
* Occulomotor Nerve: opens the eye
Trigeminal Neuralgia (Tic Douloureux) affectation of V2 and V3
- Pain on the area innervated by V2 and V3 of CN V
- Interruption of blood supply of the trigeminal ganglion
Muscles of the tongue
Palatoglossus
Stylogglossus
Hypoglossus
Genioglossus

Intrinsic Muscles of the tongue: REMEMBER: All are innervated by

CN XII except the Palatoglossus only

CN I

Opens Jaws Lateral Pterygoid

Trigeminal
Nerve

- Posterior this sulcus: Pharyngeal part of tongue

Foramen Cemun Remnant of the Thryoglossal duct

Elevate
Retract
Depress
Protrude

Sulcus Terminalis V shaped sulcus at the posterior part of the

tongue
- Anterior this sulcus: Oral part of tongue

A. Right Optic Nerve Blindness of the right eye Optic Neuritis

B. Optic Chiasm Bitemporal Hemianopsia Pituitary Adenoma
C. Right angle of Chiasm Right nasal Hemianopsia
Aneurysms
D. Right Optic Tract Left homozygous Hemianopsia Vascular
VERTEBRAL COLUMN
Kyphosis thoracic
Lordosis lumbar
Scoliosis Left or right deviation
Primary Curvature of the spine Thoracic and Sacral
- Complete concave on the ventral side
Secondary Curvature of the spine Cervical and Lumbar
- Convex on the ventral side
Cervical Vertebrae: (+) Transverse foramen where the
vertebral arteries pass
* The vertebral arteries do not PASS on the vertebral
foramina but rather the transverse foramen (only
located in the cervical vertebrae)
Atypical Cervical Vertebrae:
A. C1: Absent body (Atlas)
B. C2: Presence of Odontoid process (Axis)
C. C7: Presence of Vertebral prominence
Typical Cervical Vertebrae: C3-C6 with short bifid process
Vertebral artery is the 1st branch of the subclavian artery
Subclavian artery has 3 divisions depending on the major
anatomical landmark, the Scalenus anterior: S1 Vertebral,
Thyrocervical trunk, Internal thoracic
S2 Costocervical
S3 None
Thoracic Vertebrae: Heart shaped body
BTL:
B Bodies are where the ribs articulate
T Transverse process where the tubercle of the ribs
connect
L Long spinous processes

ANATOMY REVIEWER by Dr. vibar|-Encoded by KPCQ TO GOD BE THE GLORY FLY BATCH 2015!!

Spinal Cord end at the level of L1 (in adults) and L3 (in newborns)
Conus medullaris: L1 because the tip of the spinal cord is the
conus medullaris
Vertebral level (Do not confuse with Dermatomal level)
C3-C4
Hyoid bone, Bifurcation of the common
carotid artery
C5
Thyroid cartilage
C6
Cricoid cartilage, start of trachea and
esophagus
T2
Sternal notch, Arch of the aorta
T4
Sternal angle, bifurcation of trachea
T5-T7
Pulmonary hilum
T8
Inferior Vena Cava hilum
T9
Xiphisternal joint
T10
Esophageal hiatus
T12
Aortic hiatus
T12-L1
Duodenum
T12
Celiac artery
L1
Superior Mesenteric artery, end of spinal cord
in adults, Upper pole of the right kidney
L2
Renal artery
L3
End of spinal cord in newborns, Umbilicus
L4
Iliac crest, Bifurcation of the aorta
S1
Sacral promontory
S2
End of dural sac and CSF
S3
Sigmoid colon
SPINAL CORD
Rule #1: All ascending tracts are SENSORY
All descending tracts are MOTOR
Rule #2: Lesions are Ipsilateral except for the Spinothalamic tract
ASCENDING TRACTS
Sensation: Lateral Spinothalamic tract: Pain and temperature
Anterior Spinothalamic tract: Touch and Pressure
Dorsal Column: Proprioception, 2pt Discrimination,
Vibratory sense
*Stereognosis ability to recognize objects with just touch
2 division of the dorsal column
Gracillis sensations on the lower extremities
Coneatus sensations on the upper extremities
DESCENDING TRACTS
Lateral Corticospinal tract when affected would yield upper
motor neuron loss
Anterior horn when affected would yield lower motor neuron
loss
A. Complete Cord Transection
Sensory loss: Complete loss
Contralateral sensory
Motor loss: Complete
loss
Proprioception, etc

Subacute combined degeneration: Decreased Vitamin B12

Wallenberg (PICA) Contralateral sensory loss (IX, X, XI)
Millard Gubler Pons
Claude and Weber Midbrain
* The loss of function is observed 1-2 segments lower the site of
affectation
Example: Sensory loss on the xiphoid process
(Dermatomal level of T7)
Spinal cord damage is at T5-T6
Lumbar Puncture Above or below 4th lumbar spine(an
imaginary line drawn between the highest point of both iliac
crests)
C5-C6 Most common site of IV disk herniation (Posterolateral
herniation)
Spino Bifida occulta (Common site: L5-S1) No clinical
manifestation
Retropharyngeal space: Reason why infections of the neck would
reach up to the mediastinum because of the presence of this
space
Carotid Sheath
- Common and Internal Carotid arteries
- Internal Jugular Veins
- Vagus Nerve
Platysma is innervated by Cranial nerve VII
Suprahyoid muscles
- Digastric
- Mylohyoid
- Stylohyoid
- Geniohyoid
Infrahyoid muscles (Innervated by the Ansa Cervicalis C1, C2, C3)
Deep: Thyrohyoid
Sternothyroid
Superficial: Omohyoid
Sternohyoid
Digastric (anterior belly) Nerve to the mylohyoid V3 from CN
V
(Posterior belly) from CN VII (also innervates the Stylohyoid)
Triangles of the Neck
Anterior Triangles: Digastric, Carotid, Muscular
Posterior Triangles: Occipital and Supraclavicular

B. Anterior Cord
Sensory loss:

1
4

5
6

but with intact

E

D. Central Cord
Sensory loss:
Motor loss: Upper >

Amyotrophic lateral sclerosis Pure Motor disease

- Degeneration of anterior horn cells and corticospinal
tract
- NOTE: NO SENSORY LOSS

Motor loss: Ipsilateral

C. Posterior Cord (Tabes dorsalis)

(Syringomyelia)
Sensory loss: Ipsilateral Proprioception,etc
Variable degree
But with intact Pain, temperature, touch
lower motor loss
Motor loss: None
E. Brown Sequards Hemisection
Sensory loss: Contralateral
Motor loss: Ipsilateral

1:
2:
3:
4:
5:
6:
7.
8:
9:

Mandible
Trapezius
Sternocleidomastoid Muscle
Posterior belly of the digastric
Anterior belly of the digastric
Superior belly of the omohyoid
Anterior Midline
Inferior belly of the omohyoid
Clavicle

9
A: Digastric
B: Occipital
C: Carotid
D: Muscular
E: Supraclavicular

THYROID GLAND
Blood supply: Superior thyroid artery External carotid artery
Inferior thyroid artery 1st part of the Subclavian artery

ANATOMY REVIEWER by Dr. vibar|-Encoded by KPCQ TO GOD BE THE GLORY FLY BATCH 2015!!

Thyroidea Ima Artery supplies the isthmus

Venous drainage: Superior and Middlve thyroid vein Internal
jugular vein
Inferior thyroid vein Braciocephalic
Histology: Parafollicular cells: Calcitonin
Follicular Cells: T3 and T4
Chief Cells: PTH
Oxyphil cells: Supporting cells in the Parathyroid
3 unpaired cartilage (Epiglottis, Thyroid, Cricoid)
3 paired cartilage (Arytenoid, Cuneiform, Corniculate)
CN XI Trapezius elevate
While SCM Lateral rotate and abduct
Superior Laryngeal Nerve
A. Internal thyrohyoid
* Sensory ABOVE the vocal cords
B. External cricothyroid
Inferior/ Recurrent Laryngeal Nerve
A. Right RLN Right Subclavian artery
B. Left RLN Arch of the Aorta
* Sensory BELOW the vocal cords
Abduct the Vocal Cords: Posterior Cricothyroid (PAB)
Adduct the Vocal Cords: Lateral Cricothyroid (LAD)
Cricothyroid: tensor
Thyroarytenoid: relaxor
Cervical Plexus:
Important nerves: ANSA CERVICALIS: C1, C2 and C3
PHERENIC NERVE: C3, C4 and C5
STERNUM
1. Manubrium
* Sternal angle of Louie is at T4 (REMEMBER C6 is where the
trachea and esophagus starts and the Trachea ends at T4 and the
esophagus ends at T10)
T4 is also important as the landmark where the arch of the aorta
arises from the ascending aorta; also where the azygous vein
joins the SVC
2. Body
3. Xyphoid process (VL: T9; DL: T7)
Ribs
- True Ribs: 1st to 7th
- False Ribs: 8th to 12th
* 8th, 9th and 10th False ribs proper
* 11th and 12th Floating ribs
Rib 1 Most curved and presence of prominent tubercle as the
attachment of the Scalenus Anterior
Rib 2 Thinner and less curved, Tuberosity of the Scalenus
anterior
Rib 10 Articulate with T10
Rib 11 and 12 No neck and tubercle
*Weakest part of the rib anterior to the angle of the rib

Thoracic Outlet
Posterior: T1
Lateral: Medial border of the 1st rib
Anterior: Manubrium sterni
Thoracic Outlet Syndrome
- Pressure of the lower trunk of the plexus producing pain down
the medial forearm, wasting of the medial muscles (pressure on
the Ulnar nerve)
Division of the MEDIASTINUM
T4-T5 to the Sternal Angle

- Anything above the drawn line would be the Superior

Mediastinum
- Anything below would be the Inferior Mediastinum
- The landmark here is the heart, anything anterior the
heart is the ANTERIOR mediastinum and anything
behind the heart will be the POSTERIOR mediastinum
* Important structures on each division
SUPERIOR: Thymus gland and the Arch of the Aorta
ANTERIOR: Thymus gland
MIDDLE: Heart, Pericardium, Root of the Great vessels and
Ascending Aorta
POSTERIOR: Descending Aorta, Azygous Vein
HEART
Layer of the Pericardium
A. Fibrous
B. Serous
1. Parietal
2. Visceral (also known as the Epicardium layer of the
Heart)
Pericardial fluid (Normal amount is up to 30ml)
Most Anterior chamber of the heart: Right Ventricle
Most Posterior chamber of the heart: Left Atrium
Base of the heart is the Left Atrium
Apex of the heart is the Left Ventricle (5th ICS LMCL)
Sternocostal Surface: Right Ventricle
Diaphragmatic Surface: Left and Right Ventricle
Pulmonary Surface: Left Ventricle
ANATOMICAL LOCATIONS (not Auscultation sites)
Tricuspid Valve: Behind the right half of sternum (4th ICS)
Mitral Valve: Behind left half of sternum (4 th ICS)
Pulmonary Valve: Behind medial 3rd left costal cartilage (T6-T7)
Aortic Valve: 3rd ICS
Blood Supply
Right Coronary Artery
A. Marginal Supplies the RV and RA
B. Posterior Interventricular Supplies the RA
Left Coronary Artery
A. Anterior Interventricular Supplies the interventricular
septum and RV
B. Circumflex Supplies the LA and LV
Coronary Sinus is composed of the:
A. Great Cardiac Vein
B. Small Cardiac Vein
C. Middle Cardiac Vein
The Right Atrium receives 5 holes from 5 Veins:
A. Superior Vena Cava
B. Inferior Vena Cava
C. Coronary Sinus
D. Anterior Cardiac Vein
E. Venae Cordis Minimal
I, avL, V1-V4
II, III, avF
V2-V4
V1-V3
V4-V6

Large anterior wall

Inferior wall
Anteroapical wall
Anteroseptal wall
Posterolateral wall

Proximal LAD
Distal LAD
Distal LAD
Distal LAD
Circumflex Artery

FATE OF THE PRIMITIVE HEART

Primitive Atrium Left Atrium
Sinus venosus Right Atrium (right horn); Coronary Sinus (left
horn)
Primitive Ventricle Left Ventricle
Bulbus Cordis Right Ventricle
Truncus Arteriosus Root of the aorta and Pulmonary Trunk
Remnants of the fetal circulation Adult heart

ANATOMY REVIEWER by Dr. vibar|-Encoded by KPCQ TO GOD BE THE GLORY FLY BATCH 2015!!

Umbilical vein Ligamentum teres

Umbilical Arteries Medial umbilical ligaments
Urachus Median umbilical ligament
Ductus Arteriosus Ligamentum arteriosum
Ductus venosus Ligamentum venosum

Posterior BPS, Right

Inferior Lingular
BPS, Left

Patent Ductus Arteriosus

- From maternal rubella infection during pregnancy
- Connection between the Aorta and Pulmonary Artery
- Aortic blood is shunted into the pulmonary artery due to failure
of ligamentum arteriosum to involute

Lymph drainage of the lungs

A. Superficial/ Subpleural lies deep in the visceral pleura and
drains lymph from the surface to the hilum of the lung
B. Deep Plexus lies within the lungs

DEVELOPMENT OF THE VENOUS SYSTEM

A. Umbilical or Allantoic or Placental Veins: involutes
after birth
B. Vitelline or Omphalomesenteric Veins: Becomes the
Portal system
C. Cardinal Veins: Becomes the Caval system
Pharyngela arches
1st pair: Maxillary
2nd pair: Stapedial
3rd pair: Proximal: Common Carotid artery; Distal: Internal Carotid
Artery
4th pair: Left: Arch of Aorta; Right: Proximal part of Subclavian
artery
5th pair: None
6th pair: Left Proximal: Left Pulmonary Artery; Left Distal: Ductus
Arteriosus
Right Proximal: Right Pulmonary Artery; Right Distal:
None
PLEURA
1. Parietal
2. Visceral
Pleural Reflection
8th MCL
10th MAL
12th Vertebral column

Lung Reflection
6th MCL
8th MAL
10th Vertebral column

Right Lung 3 lobes

Superior lobe
Inferior lobe
Apical
Superior
Posterior
Anterior
basal
Anterior
Medial basal
Middle lobe
Lateral basal
Lateral
Posterior basal
Medial
Left Lung 2 lobes
Superior lobe
Inferior lobe
Apico-posterior
Superior
Anterior
Anterior basal
Superior/ Inferior Lingular Medial basal
Lateral basal
Posterior basal
3 Differences of each lobe
1. Right lung has 3 lobes while left has 2 lobes
2. Right lung has a horizontal and oblique fissure, the
left only has the oblique fissure
3. Right lung has eparterial and hyparterial bronchus
while the left
only has hyparterial bronchus
* Each lung has its apex 2.5cm above the clavicle
Bronchi
Main Right: Wider, Shorter and more vertical
For Foreign body Aspiration
Most common BPS affected
Position
Posterobasal BPS,
Standing or sitting
Right
Superior BPS, Right
Supine

Lying on right side

Lying on left side

Pulmonary Bronchopulmonary Trachebronchi Parasternal

Bronchomediastinal
Intercostal arteries from:
Posterior: descending Thoracic aorta
Anterior: Internal Thoracic, Musculophrenic
Thoracentesis: Above the rib at the 5th ICS because VAN is located
below the rib
Histology

Lining
Epitheliu
m
Cartilag
e
Glands

Bronchu
s

Bronchio
le

Terminal
Bronchio
le

PSCCE
with GC

PSCCE
with GC

(+)

(-)

Simple
columna
r
(-)

(+)

(-)

(-)

Respirat
ory
Bronchio
le
Simple
cuboidal

Alveolar

(-)

Simple
squamo
s
(-)

(-)

(-)

AORTA
A. Ascending aorta
- Right and left Coronaries
B. Arch of Aorta
- Brachiocephalic
- Left common carotid
- Left subclavian
C. Descending aorta
- Bronchial
- Mediastinal
- Esophageal
- Posterior intercostal
- Pericardial
- Subcostal
D. Abdominal aorta
Aortic Arch Anomalies
Coarctation of the Aorta rib notching
- Ductus arteriosus
A. Pre (Before) Bad prognosis (Children)
B. Post (After) Good prognosis (Adults) due to development of
collaterals (anterior intercostal with the posterior intercostal)
BREAST
* Retraction of nipple is due to the lactiferous ducts
* Dimpling of skin is due to shortening of Coopers ligaments
* Most common site of Breast malignancy is the UPPER LATERAL
part
INJURIES RELATED AFTER RADICAL MASTECTOMY
Winging of the scapula
Long Thoracic nerve
Difficulty on horizontal
Thoracodorsal nerve
extension of upper
extremities
Loss of sensation on the
Intercostal nerve
upper inner aspect of arm
Difficulty in lifting her child,
Medial Pectoral nerve
flapping her arms and doing
arm wrestling
Blood Supply
1. Internal Thoracic

ANATOMY REVIEWER by Dr. vibar|-Encoded by KPCQ TO GOD BE THE GLORY FLY BATCH 2015!!

2. Lateral Thoracic
3. Posterior Intercostal
Lymphatic Drainage
1. Lateral Quadrant
2. Medial Quadrant
Axillary Lymph nodes
Anterior Level I Pectoral
Posterior Level I Scapular
Lateral Level I Humeral
Central LN Level II

Apical LN Level III

* Lateral and Central: Axillary lymph nodes
* Medial: Parasternal lymph nodes and opposite breast
* Inferior: Sub-diaphragmatic inferior phrenic lymph nodes
Stages of Breast Cancer
0 CIS
1 - <=2cm
2 - <=5cm ,1-3 LN
3 - <=5cm, >4LN
4 Distant Metastasis

ANATOMY REVIEWER by Dr. vibar|-Encoded by KPCQ TO GOD BE THE GLORY FLY BATCH 2015!!