Dermatomes and corresponding Nerve supply !!

Dermatomes and corresponding Nerve supply !!

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LIVER ANATOMY 10 Q

Q1 ]The COUINAD’S SEGMENTAL NOMENCLATURE is based on position of …[AI 2004]
  • Hepatic veins & Portal veins
  • Hepatic vein & biliary ducts
  • Portal vein & Biliary ducts
  • Portal vein & Hepatic artery
 Q2] A surgeon excises a portion of liver to the left of the attachment of falciform ligament .The segments that have been resected are…[AI 2008]
  • Segment I & IVa
  • Segment I & IVB
  • Segment II & III
  • Segment I & II

 Q3] Right hepatic vein drains all except…[AIIMS MAY 2009]
  • Segment V
  • Segment III
  • Segment VI
  • Segment VII

 Q4] The right lobe of liver consists of ..[AIIMS 2004]
  • V , VI , VII , VIII Segments
  • IV , V , VI , VII , VIII Segments
  • I , II, V , VI , VII
  • III , IV , V, VI

 Q5] Aprroximately what % of total blood supply comes from hepatic artery….

  • < 10%
  • 25%
  • 50%
  • 75%

 Q6] False about Hepatic Duct… [ AIIMS MAY 2009]

  • Left hepatic duct formed in umblical fissure
  • Caudate lobe is drained only by left hepatic duct
  • Right anterior hepatic duct formed by V & VIII Segments
  • Left hepatic duct crosses IV segment

Q7] Most common variant of normal anatomy of hepatic artery….

  • division into right and left hepatic artery after giving off gastroduodenal artery
  • division into right and left hepatic artery before giving off gastroduodenal artery
  • replaced right hepatic artery ie origin of right hepatic artery from superior mesentric artery
  • replaced left hepatic artery ie origin of right hepatic artery from superior mesentric artery

Q8 ] which of the following is arranged in correct order of % of total cardiac output received…
  • kidney > liver > skeltal muscle > brain
  • liver > kidney > skeltal muscle > brain
  • skeltal muscle > brain > kidney > liver
  • liver > skeltal muscle > brain > kidney

Q9] True about common bile duct all except…[AI 2000]

  • Opens 10 cm distal to pylorus
  • lies anterior to IVC
  • Portal vein lies posterior to it
  • usually opens into duodenum separate from the main pancreatic duct

Q 10] which of following is false ….
  • Right anterior hepatic duct is formed from segments V & VIII
  • Right posterior hepatic duct is formed from segments V & VIII
  • left anterior hepatic duct drains segment III , IV
  • left posterior hepatic duct drains segment II

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Answers (Highlighted and star marked )

Q.1 The COUINAD’S SEGMENTAL NOMENCLATURE is based on position of …[AI 2004]
****Hepatic veins & Portal veins
Hepatic vein & biliary ducts
Portal vein & Biliary ducts
Portal vein & Hepatic artery
Q.2 A surgeon excises a portion of liver to the left of the attachment of falciform ligament .The segments that have been resected are…[AI 2008]
Segment I & IVa
Segment I & IVB
***Segment II & III
Segment I & II
Q.3 Right hepatic vein drains all except…[AIIMS MAY 2009]
Segment V
***Segment III
Segment VI
Segment VII
Q.4 The right lobe of liver consists of ..[AIIMS 2004]
***V , VI , VII , VIII Segments
IV , V , VI , VII , VIII Segments
I , II, V , VI , VII
III , IV , V, VI
Q.5 Aprroximately what % of total blood supply comes from hepatic artery….
< 10%
***25%
50%
75%
Q.6 False about Hepatic Duct… [ AIIMS MAY 2009]
Left hepatic duct formed in umblical fissure
***Caudate lobe is drained only by left hepatic duct
Right anterior hepatic duct formed by V & VIII Segments
Left hepatic duct crosses IV segment
Q.7 Most common variant of normal anatomy of hepatic artery….
Division into right and left hepatic artery after giving off gastroduodenal artery
Division into right and left hepatic artery before giving off gastroduodenal artery
***Replaced right hepatic artery ie origin of right hepatic artery from superior mesentric artery
Replaced left hepatic artery ie origin of right hepatic artery from superior mesentric artery
Q.8 whic of the following is arranged in correct order of % of total cardiac output received…
kidney > liver > skeltal muscle > brain
***liver > kidney > skeltal muscle > brain
skeltal muscle > brain > kidney > liver
liver > skeltal muscle > brain > kidney
Q.9 True about common bile duct all except…[AI 2000]
Opens 10 cm distal to pylorus
Lies anterior to IVC
Portal vein lies posterior to it
***Usually opens into duodenum separate from the main pancreatic duct
Q.10 which of following is false ….
Right anterior hepatic duct is formed from segments V & VIII
****Right posterior hepatic duct is formed from segments V & VIII
Left anterior hepatic duct drains segment III , IV
Left posterior hepatic duct drains segment II

LUMBAR TRIANGLE AND LUMBAR HERNIA

Q1] Which of the following statements is not true about lumbar hernia….

[a] Lumbar hernia is congenital in 20% cases and congenital lumbar hernia are usually bilateral.

[b] Herniation is more common through superior lumber triangle and more commonly occurs in left side as compared to right.

[c] Lumbar hernia tend to increase in size and should be repaired whenever found.

[d] Howship -Romberg sign is positive in lumbar hernias.

[e] In erect posture presence of reducible and often tympanitic mass in flank usually makes the diagonosis.

ANS [D] Howship -romberg sign : pain abdomen extends down the medial aspect of thigh with abduction, extension or internal rotation of thigh. This is most specific clinical finding of a OBTURATOR HERNIA

SEE THE FIGURE BELOW

Image

Ref CSDT pg no 794 / 11 ed.

ROTATOR CUFF : ANATOMY , PATHOLOGY ,ORTHOPEDICS

Q1] Rotator cuff/ musculotendinous cuff of shoulder is a fibrous sheath formed by four flattened tendons which blend with capsule of shoulder joint and enforces it. Which of the following statements is false about rotator cuff….

A] All four muscle arise from scapula and are inserted into tuberosity of humerous.

B] All four muscle do external rotation of arm.

C] Rotaror cuff gives strength to capsule of shoulder joint all around except inferiorly.

D] Rotator interval is space between supraspinatous and subscapularis.

ANS [B] SEE THE TABLE BELOW

Image

Q2] Which part of rotator cuff is  in greatest tension during overhead abduction and hence is most commonly affected tendon in rotator cuff tendinitis/tear…

A] SUPRASPINATUS

B] INFRASPINATUS

C] TERES MINOR

D] SUBSCAPULARIS

ANS [A] SEE FIGURE BELOW

Image

Q3] All of following specificaly indicate complete rotator cuff tear in a patient presenting with shoulder pain except….

A] Neer impingement sign positive

B] JOBES test positive

C] Contrast flooding subacromial bursa when injected into glenohumeral joint during arthrography.

D] Hyperintense signals on T2 MRI that extends throughout tendon.

E] Diffusely hypoechoic tendon on USG.

ANS: [A] , [B], [E]

[A] = NEER IMPINGEMENT SIGN IS +VE in any cause of anterosuperior impingement as in subacromial bursitis or partial tendon tear.

[B] JOBES TEST can be +ve in partial tears also.

[E] normally tendon is echoic structure whereas fluid is hypoechoic so diffusely hypoechoic tendon denotes tendinitis and not tear.

NOTE : ON T2 WATER IS HYPERINTENSE IE WHITE SO TENDON TEAR APPEAR AS HYPERINTENSE SIGNAL.

SEE FIGURE BELOW:

Image

NOTE POINTS: 1] LIFT OFF TEST IS DONE TO ASCESS ISOLATED SUBSCAPULARIS TEAR= “FORGOTTEN TENDON” [AI 2010]

2] SHOULDER JOINT CAPSULE HAS 2 OPENINGS ONE FOR LONG HEAD OF BICEPS AND BY OTHER IT COMMUNICATES WITH SUBSCAPULAR BURSA.

3] THOUGH JOINT CAPSULE IS LEAST REINFORCED INFERIORLY ,MOST COMMON TYPE OF SHOULDER DISLOCATION IS ANTERIOR OF SUBCORACOID TYPE.

4]In subacromial bursitis pressure over deltoid below acromian in adducted arm produces pain but this pain dissapears when same test is repeated in abducted position . This sign is clled as DAWBARNS SIGN.

References [1]. CODT 3ed page 191. [2] BDC vol 1 page 79 4th ed [3] campbells orthopedics 11th ed page 2607 [4] @medscape

Hyoid bone

Hyoid bone is present at level of base of mandible & C3  vertebra . It is kept suspended at this level by muscle and ligament attachment.

DEVELOPMENT : SEE FIGURE BELOW

Image

OSSIFICATION: It ossifies from 6 centres [ 2 primary centre for each greater cornu + 2 secondary centre for each  lesser cornu + 2 secondary for body].

MUSCLE ATTACHMENT :

[A] BODY ;1.anterior surface = geniohyoid + myelohyoid+ hyoglossus(also from greater cornu)

2. upper border = genioglossi & thyrohyoid membrane.

3. lower border =  3 strap muscle = sternohyoid , thyrohyoid( some  par extend to greater cornu) ,omohyoid ( note that sternothyroid is also a strap muscle but as the name suggests it is not attached to hyoid)

[B] GREATER CORNU = Thyrohyoid memb (also on body) +digastric pulley + stylohyoid muscle+ thyrohyoid muscle ( also on body)

so hyoglossus originates from body + greater cornua  (q)

[C] LESSER CORNU = stylohyoid ligament ( note that stylohyoid muscle originate from greater cornua)

note: Middle constrictor originate from lesser cornua + greater cornua.

NERVE SUPPLY OF STRAP MUSCLE :see the figure below

Image

1. superior belly of omohyoid= by superior root ie descending branch of hypoglossal nerve fibres of which are derived from C1 ventral ramus.

2. sternohyoid + sternothyroid+ inferior belly of omohyoid = ANSA CERVICALIS.

3 NOTE THAT thyrohyoid is  not supplied by ansa cevicalis , it alongwith geniohyoid is supplied by C1 through hypoglossal nerve.

Note : hyoid fracture is most likely to occur in THROTTLING > STRANGULATION> HANGING.

REF: bdc 3rd ed page 30, Langman embryology 10ed page 261

diagram : sujeet kumar