ANATOMY (2023 REVIEWER)

MUSCULOSKELETAL

Brachial Plexus Injuries – 3

Cords Terminal Branches Motor
Anterior arm
• Biceps brachii
Musculocutaneous
Lateral • Brachialis
• Coracobrachialis
Anterior forearm EXCEPT 2 MUSCLES
Median Muscles of the hand
From anterior forearm
• Flexor carpi ulnaris
Median
Ulnar • Medial half of flexor digitorum
profundus
Muscles of the hand
• Deltoid
Axillary
• Teres minor
Posterior Posterior arm
Radial • Triceps brachii
Posterior forearm

Nerve Anatomical Landmark Presentation Notes

Axillary Surgical neck of humerus Abnormal abduction, flattening of deltoidRelated to humeral fractures (upper 1/3 of
C5, C6 arm; with posterior circumflex artery)
Radial Midshaft of humerus Drunk or on crutches with wrist drop Can present with decreased grip strength +
C5-T1 Lowest down in brachial plexus loss of sensation to posterior hand
Median Proximal: Supracondylar humerus Benediction sign when asked to flex fingers Thenar eminence atrophy
C6-C8, T1 fracture (proximal lesion)
Distal: Carpal tunnel syndrome Median claw when asked to extend fingers
(distal lesion)
Ulnar Proximal: Medial epicondyle Fall on outstretched hand Hypothenar eminence atrophy
C8, T1 Distal: Hook of Hamate OK gesture when asked to flex fingers
(proximal lesion)
Ulnar claw when asked to extend fingers
(distal lesion)

• Long thoracic nerve: Serratus anterior (winging of scapula)

• Important signs:
o Claw hand – ulnar
o Wrist drop – radial
o Hand of Benediction - medial

Cutaneous Innervation of the Hand – 1

• Median nerve
o Lateral side of palm
o Palmar side: lateral 3 ½ fingers
o Distal dorsal side: lateral 3 ½ fingers
• Ulnar nerve
o Medial side of palm and dorsum
o Palmar side: medial 1 ½ fingers
o Dorsal side: medial 1 ½ fingers
• Radial nerve
o Lateral side of dorsum
o Thenar eminence
o Proximal dorsal side: lateral 3 ½ fingers
Blood Supply of the Hand – 1
• Lateral: Radial artery
• Medial: Ulnar artery

Relationship of the Humerus with the Terminal Branches of the Brachial Plexus – 1

Part of the Humerus Nerve

Humeral shaft (Radial groove) Radial nerve
Cubital fossa Median nerve
Medial epicondyle and olecranon Ulnar nerve
Surgical neck Axillary nerve

Location Nerve (A-R-M) Artery

Surgical neck of humerus (Upper 1/3 of arm) Axillary nerve Posterior circumflex artery
Midshaft of humerus (Middle 1/3 of arm) Radial nerve Deep brachial artery (profunda brachii artery)
Distal humerus or cubital fossa (Lower 1/3 of arm) Median nerve Brachial artery

Innervation and Actions of the Muscles of the Thigh – 2

Compartment Innervation Exception Action
Anterior (Quadriceps femoris) Femoral nerve Psoas (anterior rami of lumbar n.) Flexes hip; extends knee
Medial Obturator nerve Hamstring part of adductor magnus Adducts thigh (closer to midline)
(sciatic n.)
Posterior Tibial branch of sciatic nerve Short head of biceps femoris Extends thigh at hip joint
(common fibular branch of sciatic n.)

Actions of the Muscle of the Leg – 1 Blood Vessels of the Foot – 1

• Anterior: dorsiflexion • From anterior tibial: dorsalis pedis + lateral tarsal = arcuate
• Posterior: plantar flexion and inversion • From posterior tibial: plantar arteries
• Lateral: plantar flexion and eversion

CIRCULATORY

Embryologic Structures of the Heart – 1

Before Birth After Birth
Umbilical vein (brings oxygenated blood to the baby) Ligamentum teres hepatis (inside falciform ligament)
Ductus venosus (bypasses liver; from portal vein to vena cava) Ligamentum venosum
Foramen ovale (defect between L and R atrium) Fossa ovalis
Ductus arteriosus (connection of pulmonary arteries to aorta to bypass Ligamentum arteriosum
pulmonary circulation)
Umbilical arteries (takes away deoxygenated blood from the baby) Medial umbilical ligament (in front of bladder)

Coronary Blood Supply – 2

Right Coronary Artery Left Coronary Artery
Right atrium Circumflex: left atrium
Right marginal: most of the RV and apex of heart LAD: anterior part of RV
Posterior interventricular: posterior part of LV Circumflex and left marginal: most of LV
Posterior interventricular: part of IV septum LAD: most of IV septum
SA node (60% of people) SA node (40% of people)
AV node (80% of people) AV node (20% of people)
Left anterior descending (LAD) = anterior interventricular

Cardiac Vein Accompanying Coronary Artery

Coronary sinus
Great cardiac vein
Middle cardiac vein
Small cardiac vein
Venous drainage of the heart:
Circumflex
LAD
Posterior interventricular
Right marginal
Right atrium (CAT – Coronary sinus, Anterior cardiac vein, Thebesian veins/smallest cardiac veins)
Coronary sinus (MOGS – Middle, Oblique, Great cardiac, Small cardiac veins)
Conducting System – 2
• SA node → AV node → Bundle of His → Left and right bundle branches → Purkinje fibers
(subendocardium layer)
• Moderator band/ septomarginal trabeculae: Right bundle branch

Valves of the Heart – 4

Valve Location Auscultation
Pulmonary Between pulmonary trunk and RV 2nd ICS left parasternal
Aortic Between aorta and LV 2nd ICS right parasternal
Mitral Between left atrium and ventricle 5th ICS left midclavicular
Tricuspid Between right atrium and ventricle 5th ICS left parasternal

Structures related to the Valves – 1

• Skeleton of the heart/fibrous rings/annulus – keeps valves open
• Papillary muscles – prevent prolapse of the valves (contracts when valves close)
• Chordae tendinae – strings from papillary muscles to cusps of the valves

RESPIRATORY

Paranasal Sinuses and Meatuses – 2

Sinus Drains to this meatus
1. Maxillary sinus Middle meatus
2. Frontal sinus Middle meatus
3. Sphenoidal sinus Spheno-ethmoidal recess
4. Ethmoid sinus
Anterior Middle meatus
Middle Middle meatus
Posterior Superior meatus
5. Nasolacrimal duct Inferior meatus

Laryngeal Cartilages – 1
Unpaired Paired
Thyroid cartilage Arytenoid
• Biggest cartilage in larynx; incomplete ring • Sits on top of cricoid
(shield-like)
Cricoid cartilage Corniculate
• Complete ring (signet ring) • Sits on top of arytenoid
Epiglottic cartilage Cuneiform
• Prevents food from entering larynx during • Floating; embedded in vestibular fold
deglutition

Intrinsic Muscles of the Larynx – 1

• All muscles EXCEPT cricothyroid – RECURRENT LARYNGEAL NERVE
• Cricothyroid – SUPERIOR LARYNGEAL NERVE

Trachea and Bronchi – 2

• Trachea
o 16-20 C-shaped cartilage rings
o From cricoid cartilage/C6
o Bifurcates at Sternal Angle of Louis
o Muscle: Trachealis (shortens trachea when trying to expectorate)
• Bronchi (right bronchi: easier for foreign body to lodge)
o Right main bronchus: shorter, wider, more vertical
o Left main bronchus: longer, narrow, more horizontal

Lobes and Fissures of the Lungs – 2

Right Lung Left Lung
Upper, middle, lower lobes Upper and lower lobe
Horizontal, oblique fissures Oblique fissure
With lingula and cardiac notch (accommodates heart)
Pleura – 1
• Pleura
o Visceral – lines the lungs
o Parietal – lines the chest wall
▪ Cervical/cupola (past thoracic inlet; cupola: small dome-shaped layer lining upper aspect of thoracic cage)
▪ Costal (covers area of the ribs)
▪ Mediastinal (covers area of the heart)
▪ Diaphragmatic (covers area of the diaphragm)
o Meets at the hilum
• Lines of pleural reflection (areas for thoracentesis)
o 8th rib MCL
o 10th rib MAL
o 12th rib MSL

Landmarks of the Chest – 1

• Sternal angle of Louis • Xiphosternal joint
o Arch of the aorta o Superior border of liver
o Bifurcation of the trachea o Inferior border of heart
o 2nd costal cartilage/ICS o Central tendon of the diaphragm
• Xiphoid process – T10

Neurovascular Structures of the Thorax – 1

• Thoracentesis: VAN (vein – artery – nerve)
o Nerve at the INFERIOR border of the rib → needle should be oriented SUPERIORLY

Cutaneous Innervation of the Face – 1

• Cranial nerve V (trigeminal n.) – just remember these pictures and where each nerve lands

Muscles of the Mouth – 1

Smiling Frowning Closing

Levator labii superioris alaeque nasi Depressor labii inferioris Orbicularis oris
Levator labii superioris Depressor anguli oris
Levator anguli oris Risorius
Zygomaticus minor Mentalis
Zygomaticus major

DIGESTIVE SYSTEM

Structure of the Oral Cavity – 1

• Opening of parotid duct – opposite of 2nd molar teeth
• Soft palate – closes during swallowing (to prevent food and liquids from entering nasopharynx)
• Palatine tonsils
o Anterior: palatoglossus
o Posterior: palatopharyngeus
Innervation of the Tongue – 2

Anterior 2/3 Posterior 1/3

Sensory Touch sensation Trigeminal (CN V3) Glossopharyngeal (CN IX)
Taste sensation Facial (CN VII) Glossopharyngeal (CN IX)
Motor Hypoglossal (CN XII)
Except palatoglossus – Vagus (CN X)

Uvula Deviation Tongue Deviation

Location Direction Location Direction
Central Ipsilateral Central Contralateral
Peripheral Contralateral Peripheral Ipsilateral
Note: Remember the rules for the peripheral lesion
Tongue – Towards the lesion
Uvula – Uway from the lesion

Anterolateral Abdominal Wall – 3

• Rectus abdominis – separated by linea alba
• External oblique – inferomedially (Hands on my pockEts)
• Internal oblique – superomedially (Hands on my tIts)
• Transversus abdominis – horizontal
• Transversalis fascia
• Inguinal canal
o Anterior wall – external oblique aponeurosis; external inguinal ring
o Posterior wall – transversalis fascia; internal inguinal ring
o Roof – arches of internal oblique and transversus abdominis
o Floor – inguinal ligament

Features of the GIT – 4

• Stomach
o Rugae (mucosal elevation of the stomach)
• Duodenum
o Retroperitoneal (partially covered by peritoneum)
o Major and minor duodenal papillae
o Circular folds of Kerckring (mucosal elevations)
• Jejunum
o Intraperitoneal (completely covered by peritoneum)
o Always superior in characteristics than ileum (except in arcades)
o Plicae circulares (mucosal elevations)
• Ileum
o Intraperitoneal; more arterial arcades
o Peyer’s patches
• Colon
o Only transverse colon is intraperitoneal
o Tenia coli - 3 longitudinal muscles; indicates that it is the LI
• Rectum
o Retroperitoneal
o Valves of Houston - horizontal mucosal elevations
• Anus (last 4 cm of GIT; anorectal line to columns)
o Columns of Morgagni
o Dentate/Pectinate line
▪ Above – internal hemorrhoids
▪ Below – external hemorrhoids
Blood Supply of the GIT – 3

Origin Blood Supply Areas of the Gut Supplied

Foregut Celiac trunk Distal 1/3 of esophagus to 2 nd part of duodenum
Midgut Superior mesenteric artery 3rd part of duodenum to proximal 2/3 of transverse colon
Hindgut Inferior mesenteric artery Distal 1/3 of transverse colon to proximal 1/3 of rectum

Clues:
Lesser curvature - shorter name (R and L gastric)
Greater curvature - longer name (R and L GO or gastroepiploic)

Remember:
Celiac trunk - distal third of esophagus up to proximal half of the 2nd part of the duodenum
SMA - distal half of 2nd part of duodenum up to proximal 2/3 of transverse colon
IMA - distal 1/3 of transverse colon to proximal third of the rectum
Middle 3rd of rectum - middle rectal
Distal 3rd and anus - inferior rectal

If SMA is ligated, what part would not have total ischemia? Duodenum (dual blood supply)
If IMA is transected, what would survive? Transverse colon (receives blood supply from SMA)
Relationship of GIT to Other Organs – 1
• Duodenum
o Pancreas
o Right kidney
o Liver
• Descending colon
o Stomach
o Spleen
o Left kidney

Lobes and Division of the Liver – 2

• Caudate lobe – Segment I
• Quadrate lobe – Segment IV
• Anatomical division – Falciform ligament
• Functional division – Cantlie’s line (fundus of gallbladder to IVC)

Biliary Tree – 1
• Triangle of Calot – for cystic artery
o Common hepatic duct
o Cystic duct
o Inferior border of liver

Pancreas – 1
• Head – lesions here can jaundice (CBD gets obstructed)
• Major pancreatic duct of Wirsung
• Accessory pancreatic duct of Santorini

GENITOURINARY

Constrictions of the Ureter – 1

• At the ureteropelvic junction (becomes smaller)
• Brim of the pelvic inlet/cross the common iliac (high pressure)
• Upon entering the bladder wall (diagonal orientation to prevent reflux)

Important Landmarks
Runs OVER (ANTERIOR TO) the inferior pole of the kidney
Runs UNDER (POSTERIOR TO) the testicular or ovarian vessels
Runs OVER (ANTERIOR TO) the external iliac vessels
Runs UNDER (POSTERIOR TO) the uterine artery (“water under the bridge”)

Parts of the Male Urethra – 1

• Intramural/preprostatic – internal urethral sphincter (smooth muscle)
• Prostatic – urethral crest: seminal colliculus (empty secretions from testis and glands; semen empties to prostatic urethra)
• Intermediate/membranous – narrowest; external urethral sphincter (with voluntary and involuntary control)
• Spongy – longest and widest

Lobes of the Prostate – 1

• Transition zone – surrounds the urethra; dribbling/weak stream in BPH
• Inferoposterior lobe – palpable during DRE

Male-Female Homologous Structures – 1

Female Male
Labia majora Scrotum
Clitoris Penis
Bartholin’s gland Cowper’s gland
Round ligament of uterus Gubernaculum
Hymen Seminal colliculus
Ligaments of the Female Reproductive System – 1
• Broad ligament
o Mesovarium
o Mesosalpinx
o Mesometrium
• Suspensory ligament of the ovary/infundibulopelvic ligament – pelvic wall to ovary
• Round ligament of the ovary/ovarian ligament – ovary to uterus
• Round ligament of the uterus – uterus to labia majora
• Uterosacral ligament – uterus to sacrum
• Cardinal/Mackenrodts ligament – cervix to pelvic wall
o Uterine artery ("Water under the bridge")

Spaces in Relation to Female Reproductive System – 1

• Vesicouterine pouch – between bladder and uterus
• Cul-de-sac/Rectouterine pouch/Pouch of Douglas – between rectum and uterus
o Most inferior portion of peritoneal cavity

Blood Supply of the Female Reproductive System – 2

• UTERINE ARTERY – from internal pudendal artery
• OVARIAN ARTERY – from abdominal aorta

Contents of the Spermatic Cord – 1

• Pampiniform plexus
• Ductus deferens
• Cremasteric artery
• Testicular artery
• Artery of the ductus deferens
• Genital branch of the genitofemoral nerve
• Sympathetic nerve fibers
• Lymphatic vessels
• NOT INCLUDED: Epididymis

NEUROANATOMY

CSF Flow Anatomy – 1

Choroid plexus → Lateral ventricles → Foramen of Monroe → Third ventricle → Aqueduct of Sylvius → Fourth
ventricle → Central canal/Foramen of Luschka and Magendie → Subarachnoid space → Arachnoid sinus/villi
NOTE: Luschka – 2 lateral; Magendie – 1 medial; central canal to spinal cord
Blood Supply of the Cerebral Cortex – 1
• Middle cerebral artery
o Posterior part of frontal lobe
o Lateral part of parietal lobe
o Medial portions of temporal lobe
• Anterior cerebral artery
o Anterior portion of frontal lobe
o Medial part of parietal lobe
• Posterior cerebral artery
o Occipital lobe
o Inferolateral portion of temporal lobe

Meningeal Spaces – 2
• Epidural – hematoma from middle meningeal artery
• DURA MATER
• Subdural
• ARACHNOID MATER
• Subarachnoid space – absorption of CSF
• PIA MATER

Structures Passing through the Cranium – 1

• Anterior cranial fossa – CN I (1)
• Middle cranial fossa – CN II, III, IV, V, VI (2-6)
• Posterior cranial fossa – CN VII, VIII, IX, X, XI, XII (7-12)

Cranial Nerve Cranial Opening Mnemonic (Version 1) Mnemonic (Version 2)

I Cribriform plate Climb
II Optic canal On
III Superior orbital fissure Sea
IV Superior orbital fissure Snail Cristy – I
V Superior orbital fissure (V1) So RO(S)(I) Often – II
Foramen rotundum (V2) Stays – III, IV, V1, VI
Foramen ovale (V3) FRying – V2
VI Superior orbital fissure (S) FOr – V3
VII Internal acoustic meatus (I) I AM – VII, VIII
VIII Internal acoustic meatus Is James – IX, X, XI
IX Jugular foramen Jolly Howard - XII
X Jugular foramen Jolly
XI Jugular foramen Jolly
XII Hypoglossal canal Happy

Embryologic Division of the CNS – 2

Motor and Sensory Tracts – 2

Motor
• Corticospinal tract
o Primary motor cortex, Premotor area, Primary Somatosensory cortex → Posterior limb of internal capsule → Crus cerebri of midbrain →
Basis pontis of pons → Medullary pyramids of medulla → Ventral horn of spinal cord
• Rubrospinal tract – flexors of the limbs
o Decorticate (flexed) – above red nucleus; Decerebrate (extended) – below red nucleus

Sensory
• Anterolateral/Spinothalamic – crude touch, pain, temperature in the limbs
o First order: Doral root ganglion
o Second order: Lissauer’s tract of spinal cord → Anterolateral tract of spinal cord
o Third order: Ventral posterolateral nucleus of thalamus → Primary somatosensory cortex
• Dorsal Column Medial Lemniscal Pathway – vibration, light touch, pressure, two-point discrimination, proprioception in the limbs
o First order: Doral root ganglion → Dorsal column of spinal cord
o Second order: Cuneate and gracile nuclei of medulla
o Third order: Ventral posterolateral nucleus of thalamus → Primary somatosensory cortex
• Trigeminothalamic tract – sensation in the face

Brodmann’s Areas – 1
• 4 – Primary motor (Memory tip: FOUR for MOTOR)
• 3, 1, 2 – Primary Somatosensory
• 8 – Frontal eye field
• 44 – Broca’s
• 22 – Wernicke’s

HISTOLOGY

Note: These were the main points during our exam (may not be the same as yours)

Bone and Cartilage – 4

• Bone resorption – osteoclast
• Bone formation – osteoblast
• Hyaline and elastic cartilage – collagen type II
• Fibrocartilage – collagen type I

Muscles – 2
Heart and Blood Vessels – 4
• Vasa vasorum – blood vessels of blood vessels; located in tunica adventitia
• Subendocardium – Purkinje fibers

Blood and Immunology – 2

• Life span of RBC - 4 months/120 days
• Eosinophils - parasites, allergies
• IgG – most abundant
• IgM – first to be produced; biggest (pentamer)
• IgE – allergies

Respiratory System – 6
• Alveolar macrophage/dust cells – heart failure cells
• Type 1 pneumocyte – alveolar wall cells
• Type 2 pneumocyte – surfactant in alveoli; can differentiate
• Clara cells – surfactant in the airways
Gastrointestinal Tract – 4
• Submucosa – Meissner’s Plexus
• Muscularis externa – Myenteric/Auerbach Plexus
• Cells of the stomach
o Parietal cell – HCl
o Chief cells – pepsinogen
o Enterochromaffin cells – serotonin
o G cells – gastrin
• Brunner’s gland – duodenum

EC cells Serotonin I cells CCK

ECL cells Histamine G cells Gastrin
S cells Secretin N cells Neurotensin
K cells GIP D cells Somatostatin
L cells GLP-1 M cells Motilin

Accessory Organs of Digestion – 2

• Structures of liver lobule

Zone I Affected 1st by viral hepatitis

BEST oxygenated (most resistance to hypoxia) – near the portal vein
Zone II Yellow fever
Zone III Affected 1st by ischemia
Most sensitive to metabolic toxins
Site of alcoholic hepatitis
(+) high amounts of CYP450 enzyme system

Kidney, Ureter, Bladder – 2

• Glomerulus
o Endothelium – fenestrated, negatively charged
o Basement membrane
o Podocyte – with foot processes
• Urothelium/Transitional epithelium – unique to ureter and bladder

Female Reproductive System – 1

• Primordial follicle – arrested at 1st meiotic prophase
• Unilaminar Primary Follicle – simple cuboidal; undergo mitosis
• Multilayered Primary Follicle – stratified cuboidal (granulosa); with zona pellucida
• Secondary/Antral Follicle – with theca externa and interna
• Graafian/Preovulatory Follicle – dominant

Male Reproductive System – 3

• Spermatogonia – round nuclei
• Spermatocytes
o Primary – undergo 1st meiotic division
o Secondary – undergo 2nd meiotic division
• Spermatids – elongated nuclei
• Interstitial cells of Leydig – testosterone
• Sertoli cells – blood-testes barrier