GROSS ANATOMY SAMPLE QUESTIONS

STUDY GUIDE

Dear Medical Student make sure you answer all of these questions before you enter an examination
room.

PECTORAL REGION, BREAST

1. Surface anatomy:
a. Clavicle
b. Suprasternal notch (what vertebrae level?)
c. Sternal angle (vertebral level?)
d. 2nd costal cartilage
e. 4th intercostal space
f. Scapula- acromion, coracoid, spine of scapula
g. Axillary fold
h. Deltoid muscle
i. Pectoralis major muscle
j. Sternocleidomastoid muscle
k. Serratus anterior muscle
l. Latissimus dorsi muscle
m. Trapezius muscle
2. What are:
a. Median saggital plane
b. Prasaggital planes
c. Transverse planes
3. Is the breast entirely in the subcutaneous tissue?
4. Lymphatic drainage of the breast.
5. How is the breast attached to: a) pectoralis major muscle b) overlying skin
6. Which other muscles apart from pec major may the breast lie on? What are its surface
markings?
7. What is clavipectoral fascia? List the structures that pass through it.
8. Pec minor, whats its action, innervation and relation to the axillary artery?
9. When studying a muscle note:
a. Bony attachments – origin and insertion
b. Innervation? Spinal segments of the nerve)
c. Function (actions)
d. Blood supply
e. Its relations

INTERCOSTAL SPACE, INTERCOSTAL NERVE, RIBS, VERTEBRAE

1. Study again
a. Sternum
 b. Typical ribs, atypical ribs
c. First rib
d. Typical vertebrae
e. First thoracoc vertebra
2. How many
a. Thoracic vertebrae?
b. How many thoracic spinal nerves?
c. What is the relationship between them?
3. Intercostal space – how are they numbered? Blood supply? Nerve supply?
4. Note direction and extent of muscular fibres, a)external and b) internal c) innermost interscotal
muscles.
5. Where do intercostal neurovascular bundles lie in relation to intercostal muscles and the ribs?
6. List structures innervated by typical intercostal nerve. What part do Intercostal nerves play in a)
breathing b) sensation?
7. Where do you insert the needle in a drain for pneumothorax? Haemothorax? Where do you
insert the needle for minimum damage?
8. Draw a diagram of a typical thoracic spinal nerve and the manner of its branching.

Osteology

 Revise
o When studying bones, consider:
 Shape
 Processes and roughness (usually for muscular or ligamentous attachment)
 Cavities ( what occupies them or passes through them?)
 Positions, relations, blood supply, joints with other bones.
o Joints (classify them and give examples)
o Ribs ( head, neck, tubercle, shaft, costovertebral and triradiate ligaments)
o Vertebrae

THORACIC CAVITY, PLEURA, LUNGS, PERICARDIUM, SURFACE ANATOMY

1. What is the mediastinum? How is it divided?

2. What is pleural cavity? What does it contain? Does it extend into the neck?
3. What is a pneumothorax?
4. What are the surface markings of the pleural cavity, a) in the midclavicular line, b) inbthe
midaxillary line and c) midscapular line?
5. What’s the relationshipto the root of the lung of (a) the phrenic nerve and (b) the vagus nerve?
6. What are the relationships of the phrenic and vagus nerves to the left superior intercostal vein?
7. Draw a plan of the venous drainage of the thoracic wall.
8. What is pleura? What do visceral and parietal mean?
9. What is Sibson's fascia?
10. What are the surface markings of the horizontal and oblique fissure? How many lobes are in
each lung?
11. Bronchopulmonary segments. List them.
 12. Which main bronchus is more nearly a straight line continuation of the trachea? Why does this
matter?
13. What are the relationships of arteries, veins and bronchi at hilum?
14. Palpate the trachea
 Where is the bifurcation of the trachea? Surface marking? Vertebral level? What is
inferior to it?
15. Joints
 Costochondral and chondrosternal joints

 Revise the movements possible at these joints

ANTERIOR MEDIUSTINUM, PERICARDIAL CAVITY, HEART, CORONARY VESSEL

1. Describe the pericardium.

2. What is tamponade?
3. Heart border
4. Apex beat?
5. Surface markings of heart valve.
6. How do coronary arteries arise from the aorta? Would most blood enter them during systole or
diastole?
7. Venous drainage – name all cardiac veins. Do they all drain into the coronary sinus?
8. Motor and sensory innervation of the heart? Where is pain from the heart referred to?
9. Is pericardium innervated? How?
10. List in their correct relationship the structures that lie in the plane of vertebral body T4

CHAMBERS AND CONDUCTING SYSTEM OF THE HEART

1. Which chamber has the thickest wall? Will this always have been so in utero, birth,
adulthood)?
2. Is the ventricular septum all muscular?
3. What can you see on atrial septum? How do these features relate to cardiac development?
To prenatal blood flow?
4. List, in order, the chambers, valves and vessels, starting with the venae cave, that a blood
cell would pass through until it reaches the descending aorta (a) in adults (b) in the fetus.
5. Which is the most anterior chamber ? The most posterior chamber?
6. What are the papillary muscles? Chordae tendineae? What are their functions?
7. Note the smooth and rough walled parts of atria. What’s the embryonic explanation for
this?
8. What’s the position of SA node and AV node?
9. Atrial conduction pathways
10. Purkinje fibres, bundle of his (location)
11. Right and left bundle branches, moderator band ( location and functions)
12. What are the main branches of the coronary arteries supplying the parts of the conducting
system?
 13. What is the fibrous skeleton? Why does it matter?

CONGENITAL ANOMALIES

1. ASD, VSD, Tretralogy of Fallot, Transposition of great vessels??

SUPERIOR MEDIASTINUM, POSTERIOR MEDIASTINUM, ROOT OF NECK

2. Which palpable structures can be used as guides to the position of the mediastinum?
3. Aorta- ascending, arch, descending. Discuss the position, surface marks and vertebral levels of
each.
4. What’s the relationship of arch of aorta with bifurcation of the trachea?
5. Describe and compare the courses of right and left recurrent laryngeal nerves. Explain the
difference.
6. Where does phrenic nerve originate from? Why should cervical nerves supply the
thoraco/abdominal boundary?
7. Phernic nerve – motor – to what? Sensory – to what?
8. The thyroid gland can enlarge down into thorax (retrosternal goitre). What effect may this have
on brachiocephalic veins?
9. Discuss the posterior relations of the heart.
10. What connection exist between the sympathetic trunk and spinal nerves (a) between T1 and L2,
(b) in the cervical, lower lumbar and sacral regions
11. Thoracic duct – course? Termination? Valves? Functions
12. At what sites is the oesophagus narrowed? By what? How far is each constriction from the
incisors teeth? What use is this information?
13. Oesophagus- arterial supply? Venous drainage (this is important why???) Nerve supply?
14. 3 large (and several small) structures pass though or behind the diaphragm. What? Where?
What vertebral level?
15. What is a tracheo-oesophageal fistula? How does it arise?
16. Subclavian artery: parts and branches.
17. Revise osteology of first rib. What structures pass in close relation to its neck?
18. Where is the vagus nerve? What is its origin? What is its function?

ANTERIOR ABDOMINAL WALL, SURFACE ANATOMY, INGUINAL REGION, SPERMATIC CORD, TESTIS

1. What is the relationship of the femoral pulse to the midinguinal point? What is the midinguinal
point? What is the midpoint of the inguinal ligament?
2. Locate the nine regions of the abdominal wall recognised for descriptive purposes.
3. What is a dermatome? What are the spinal segmental levels for the skin around the
4. umbilicus, over the epigastrium, over the hypogastrium and over superficial inguinal ring?
5. 6 How many tendinous intersections are there in the rectus abdominis muscle? Where are
6. they situated?
7. What is the nerve supply of the rectus abdominis? Does it enter the muscle from the medial or
from the lateral side? Of what relevance is this to abdominal incisions?
 8. Understand the rectus sheath above and below the arcuate line. What separates the internal
epigastric artery from peritoneum (a) below the arcuate line, and (b) above the arcuate line?
9. What are the deep and superficial inguinal rings?
10. What are the surface markings of the deep and superficial inguinal rings?
11. How does the position of the deep inguinal ring relate to that of the femoral artery?
12. What is the lacunar ligament? pectineal ligament? femoral canal? femoral sheath? Femoral
ring? What may run on the lacunar ligament?
13. What constitutes the conjoint tendon?
14. What are the differences between direct and indirect inguinal hernias? between inguinal and
femoral hernias?
15. Why may a congenital inguinal hernia develop?
16. In the inguinal canal, what forms (a) the anterior wall; (b) the posterior wall; (c) the roof;
17. What nerves and vessels pass under the inguinal ligament? What are the contents of the
inguinal canal (a) in the male? and (b) in the female?
18. What are the constituents of the spermatic cord?
19. What is the cremasteric reflex, its afferent and efferent components and the spinal segments
20. Which blood vessels supply and drain the abdominal wall?
21. To which areas to the lymphatic vessels of the abdominal skin drain? Which areas drain to
axillary nodes? Which areas drain to inguinal nodes?
22. To which nodes do the lymphatics of the abdominal muscles drain?
23. Does the genital branch of the genitofemoral nerve pass through the deep inguinal ring? Does it
pass through the superficial inguinal ring? What is its function?
24. Does the ilioinguinal nerve pass through the deep inguinal ring? Does it pass through the
superficial inguinal ring? What is its function?
25. What is the relationship of the inferior epigastric artery to the deep inguinal ring?
26. What is the innervation, and its spinal segmental value, of the scrotal skin?
27. The testicular coverings are similar to the layers of the anterior abdominal wall. What
corresponds to peritoneum?
28. What is the lymph drainage of the testis? of the scrotum? of the penis?

ABDOMINAL VISCERA

General arrangement and disposition of abdominal viscera

1. What is a mesentery? What is the root of the mesentery? What is an omentum?

2. From which embryological structure does the falciform ligament develop?
3. What is the ligamentum teres? What did it convey?
4. Which embryological structures are represented in the median and medial umbilical ligaments?
Some textbooks use American terminology and call the medial umbilical ligament the lateral
umbilical ligament. Be aware of this but do not be anxious about it.
5. What is McBurney's point. What use is it?
6. To which costal cartilage is the gall bladder related?
7. What are the greater and lesser omenta? From which embryological structures do they
develop?
 8. What are the greater and lesser sacs?
9. What are the supra- and infra- colic compartments?
10. What is a paracolic gutter? How far superiorly would fluid in the right paracolic gutter extend in
the supine position? Would it extend as far on the left?
11. What is a subphrenic recess?
12. What are the relationships of the portal vein, hepatic artery and common bile duct in the free
margin of the lesser omentum?
13. What is Pringle's manoeuvre?
14. How could you enter the lesser sac without incising the lesser omentum? Where would you
make an incision to expose the posterior surface of the stomach?.

Stomach and blood supply, lesser omentum, spleen, duodenum, superior mesenteric vessels, small
bowel

1. Identify the difference parts of the stomach: cardia, fundus, body, antrum and pylorus.
2. Is the oblique layer of muscle found in all parts of the stomach?
3. Compare the mucosa of the fundus, body and pyloric regions with respect to histological cel]
types and their function.
4. Examine closely the vascular supply and learn the lymphatic drainage of the stomach.
5. How do the sphincters of the cardiac and pyloric regions of the stomach differ?
6. Note the manner in which the oesophagus pierces the diaphragm and enters the stomach.
Which crus is most intimately related to it?
7. At what vertebral level is the pylorus normally found? Is it always at the transpyloric plane?
8. What is a hiatus hernia?
9. How does the vagus nerve enter the abdomen? Which branches of the vagus supply the anterior
and posterior surfaces of the stomach? Follow the course of the vagus nerve in relation to the
lesser omentum, liver and stomach.What are the nerves of Latarjet?
10. Define the boundaries of the lesser sac.
11. Identify the lienorenal and gastrosplenic ligaments. What do they contain?
12. To which ribs is the spleen related? Can a normal spleen be palpated? What are the
13. dimensions of the spleen? How far anteriorly does it normally extend?
14. At what vertebral level does the coeliac trunk arise? List its branches and the organs it supplies.
15. What is the length of the small intestine in the living? Determine the extent of the ileum and
jejunum. Compare the wall thicknesses of stomach, duodenum, jejunum and ileum. How does
this relate to function?
16. Compare the mucosal surfaces of duodenum, jejunum and ileum.
17. What is the origin and course of the preganglionic sympathetic fibres of the coeliac ganglion?
How do these enter the abdomen?
18. Which of the abdominal viscera are supplied by the vagus nerve?
19. Define the course of the superior mesenteric vein and list the regions of gut it drains.
20. At approximately what vertebral levels do the superior and inferior mesenteric arteries arise
from the abdominal aorta? How much gut would become ischaemic if the trunk of the superior
mesenteric artery were occluded?
21. Define the blood supply of the appendix and note its relation to the terminal ileum.
 22. Identify the plicae circulares.
23. What is Meckel's diverticulum? Why might this cause problems? Which other embryological
remnants might lead to a discharging umbilicus in a newborn baby? Large bowel, pancreas
24. What are taeniae coli? Where do they all join? What are appendices epiploicae?
25. What is the marginal artery (of Drummond)? Why is it important?
26. Where does the sigmoid colon begin and end?
27. How might you distinguish at operation between large and small bowel?
28. What are the arteries of (a) foregut, (b) midgut, (c) hindgut?
29. What is the accessory pancreatic duct? To which region would pancreatic pain such as that
which occurs in acute pancreatitis be referred?
30. List the parts of the pancreas.
31. What is the arterial supply of the pancreas?
32. Note the relationship of the tail of the pancreas to the splenic artery, the spleen, the lienorenal
ligament.

Liver, biliary system, diaphragm

1. What are the surface markings of the liver.

2. Identify the lobes of the liver.
3. Identify the coronary ligament of the liver.
4. Identify the triangular ligaments of the liver.
5. Identify the ligamentum teres and the ligamentum venosum. What embryological structures do
these represent and what is their functional significance? What is the blood supply of the liver?
6. Where is the portal vein formed?
7. What is the significance of portosystemic anastomoses? What is a Caput Medusae?
8. What are the relationships between right and left hepatic ducts, branches of the hepatic artery,
cystic duct and cystic artery?
9. What is the surface marking of the fundus of the gall bladder?
10. How long is the common bile duct? How is it formed?
11. Note the intimate relationship between the common bile duct, the head of the pancreas and the
duodenum. Why may cancer of the head of the pancreas cause jaundicere
12. Why is the right shoulder a site of referred pain from the gall bladder?
13. List the attachments of the diaphragm.
14. What is the nerve supply of the diaphragm?
15. Study the abdominal relations of the diaphragm.
16. Revise the thoracic relations of the diaphragm.
17. List the structures that pass through the diaphragm.
18. At what vertebral levels do these structures pass through the diaphragm?
19. Does the aorta pass through the diaphragm?
20. At what vertebral level does the abdominal aorta divide?
21. What and where is the cisterna chyli.
22. What is meant by subphrenic and subhepatic spaces? How do they relate to the liver? What is
the hepatorenal recess (Morison's pouch)? What does this communicate with?
23. Understand the nature and significance of the segmental blood supply of the liver. This is similar
to the bronchopulmonary segments of the lung.
24. Tributaries of hepatic veins are found in the portal triad.
25. The caudate process of the liver drains bile to the right hepatic duct.
26. The cystic artery usually passes anterior to the common hepatic duct.
27. In the free edge of the lesser omentum,the portal vein lies posteriorly.
28. Most of the islets of Langerhans lie in the tail of the pancreas.
29. The caudate lobe lies anterior to the first part of the duodenum.
30. The duodenum may be damaged in a right hemicolectomy.
31. The blood supply to the gall bladder is from the branches of the coeliac artery.
32. An artery lies to the right of the common bile duct in the free edge of the lesser omentum.
33. After truncal vagotomy the pylorus functions normally.
34. Digital pressure on the hepatic artery in the free edge of the lesser omentum will stop bleeding
from the injured liver. (Pringle's manoeuvre)
35. Cells associated with gastric glands of the stomach include:
a. parietal cells.
b. goblet cells.
c. chief cells.
d. Paneth cells.
e. chromaffin cells.