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ANATOMY
UPPER LIMB
Shoulder
Hyperextension injury to neck and upper brachial plexus injury:
o Show where C5 and C6 nerve roots exit on skeleton (intervertebral foramina)
o Consequences of upper trunk brachial plexus injury
Shoulder anatomy attachments of shoulder muscles/rotator cuff and identification on prosection,
named nerves passing in this area. Movements produced by muscles
Muscles attached to the coracoid process innervation and function
Attachments to scapula
Course of subclavian artery, axillary artery and veins
Shoulder abduction muscles involved in initiation and top end of movement
Arm
Demonstration on cadaver of attachments of biceps and brachialis and brachioradialis
Muscle attachments to the head of humerus
Antecubital fossa: boundaries and contents
Know the innervation of muscles in upper limb and course of nerves
Supination and pronation muscles responsible and innervation,
Demonstrate reflexes of upper limb biceps, supinator, triceps and know the nerve roots
Sensory supply of upper limbs including anatomy of the cutaneous nerves of the upper limb
Sites of IV cannulation complications of cannulation, how to place a central line
Forearm and Hand
Hand and wrist. Including blood vessels, nerves. Movements of thumb and nerve supply to each
muscle that is moving thumb.
Anatomy of forearm. Flexors of wrist and hand, nerve supply. Radial and ulnar nerve areas of
likely damage. Ulnar paradox, radial nerve palsy.
LOWER LIMB
Hip
Bones of hip joint and pelvis, stabilising factors, why iliofemroal ligament strongest? Muscles of
walking and climbing stairs on cadaver.
Muscle attachments of hip and their actions
Muscles of abduction and adduction
Innervation and action of gluteals. Consequence of injury to nerve supply
Lateral cutaneous nerve of thigh and meralgia paresthetica
Attachments to ASIS, pubic rami
Thigh
Innervation and action of quadriceps and hamstrings
Function of fascia lata and ITB. What muscle inserts into ITB
Femoral triangle and Adductor canal.
Named cutaneous nerves of lower limb
Neurovascular course of the main arteries and nerves of the lower limb relate to angiogram
Muscles supplied by femoral nerve
Leg
Consequences of damage to common deep and superficial peroneal nerves and tibial nerve
Terminology of neuropraxia. How to test nerve function clinically
Anatomy of knee and ankle- asked ligaments and interpret an MRI scan of knee also
Popliteal fossa boundaries and contents
Lower leg anatomy + compartments + neurovascular + reflexes anatomy
What other injury, com peroneal, how to test (on pt)? Also about ankle lig.
Foot & Ankle
Medial malleolus, shown skeleton, Chap in room, hit side on whilst cycling, extensive question
about knee joint. Menisci, collaterals, blood supply, point on cadaver.
MRI of knee
Identigy EHL, EDL, talus, cuneiform and cuboid, tib post and ant
Movement at ankle if both tib post and tib ant contract together
Attachment origin and function of peroneus longus and brevis
Myotomes of foot
THORAX
Heart
o
Lung
o
o
o
Lung roots and surface markings (difference between right and left)
Blood supply of the lungs
Pathology of pulmonary embolism path of the thrombus to the pulmonary artery. Define
thrombus and embolus
Neurovascular
o Branches of arch of aorta, vagus and recurrent laryngeal nerves
o Course of the phrenic nerve
o Sympathetic chain pre-ganglionic and postganglionic outflow. What levels of cord does
it arise. Identify in thorax
o Path of vagus and ganglions
o Position of neurovascular bundle of rib, order.
o Anatomy and innervation of thoracic, mediastinal and diaphragmatic pleura
o Identify azygos vein and its tributaries (what drains into it)
Clinical
o Insertion of chest drain (safe triangle)
o How to insert subclavian line, show on cadaver, what would u do next (CXR)?
o Thoracic outlet syndrome and subclavian steal
TRUNK
Abdominal wall
o Identify layers of anterior abdominal wall,
Oesophagus
o Boundaries of posterior mediastinum
o Structure and blood supply of oesophagus
o Pathology of achalasia, Barretts.
o Portosystemic supply in varices
Stomach
o Surface anatomy
o Attachment of lesser and greater omentum
o Cells of stomach and function
Duodenum
o Relations of four parts of duodenum relevance of 1st part of duodenum Gastroduodenal
artery.
Pancreas
o Relations (which part is retroperitoneal)
o Blood supply
o Cells of pancreas (endo and exocrine function)
Colon
o Embryology of gut and appendix
o Anatomy of colon
o Pathology of colon and colon cancer
o Blood supply of intestine.
o What operation would you perform for a transverse colon tumour.
o Double contrast enema
Anatomy
1. Abdominal aorta: Name and point out branches that supply gut; which
branches come off posteriorly; what is an aneurysm; point it out on a pathology
section; what level does celiac trunk come off; what organs cross the midline;
2. Dissection of neck and thorax: Point out trachea; what nerve passes laterally
to trachea; point out hypoglossal nerve, what is subclavian steal syndrome; what
is thoracic outlet syndrome; branches of brachial plexus and levels; what vessel
plexus terminal branches goes around
3. Upper skeletal anatomy and simulated patient: Patient has fallen on shoulder
and head at same time with head/shoulder moving away from each other (upper
brachial C5/6 injury); what level, what nerve affected; point out arm
dermatomes; test radial nerve autonomous area; text flexion; what muscles
insert into coracoids; what two big muscles are involved in last part of shoulder
abduction (trapezius/serratus anterior), where do they insert and arise; what
nerves innervate them
1. Upper limb, prosection, live patient and skeleton all in one: Rapid fire 20 questions e.gwhere is the insertion of supraspinator, (demonstrate on skeleton), demonstrate pronation and
supination (live pt) point out long head of biceps (pro-section)
2. Unmanned prosection of mediastinum and thorax in saggital section. Lots of flags- just
had to identify the structures - was v hard !
3. Manned station- very easy, lower GI/ Hepatobillary -prosection of bowels- asked blood
supply, significance of water shed area and marginal artery of drummond. Also was given a
colonoscopy picture of bowel ca and asked to identify it. Then asked dukes classification.
Then hepatobillary anatomy on another prosection
Anatomy (specialty). Trunk and thorax. Dissection specimen of abdomen. Asked
to point out stomach, duodenum, and pancreas. The different parts of stomach,
blood supply. The arteries that bleed in duodenal ulcer. Parts of pancreas, blood
supply, function of pancreas (exocrine and endocrine). Blood supply to the colon.
Anatomy 2. Live model present. Asked to point out tibialis anterior tendon on
person. Point out Achilles tendon, Extensor Hallucis Longus, and digitorum.
Dorsalis pedis and posterior tibial pulse. Show what happens when tibialis
andterior and posterior contract together (inversion of the ankle). Point out
where peroneus longus attaches. Nerve supply of tibialis anterior, and peroneous
longus. Show me where you would test sensation of superficial and deep
peroneal, and sural nerve. Demonstrate ankle and knee jerk, and the nerve
roots.
Anatomy 3. Dry skeleton. Asked to point out the different parts of the humerus,
and sites where nerves can be damaged. Asked what lies around the radial nerve
in the radial groove (lateral and medial head of triceps). Origin and insertion of
rotator cuff muscle. The examiner pointed to the ASIS and asked me what that
point is called, and asked what attaches there (sartorius). Asked which nerve
gets compressed around there and what is the pathology called (meralgia
paraesthetica). Asked about origin and insertion of quadratus femoris.
2. Generic anatomy abdomen and pelvis. Didnt go too well. Int and ext
obliques, innervation of different parts of the abdomen (lots of questions
on this), identify ovary and fallopians, pouch of douglas. Then some
questions I didnt even understand.
Hip dry bones explain ligs and stability, what type of joint is it, what 3
factors stabilise it and in which order (congruency, ligaments, muscular
support). Contrast to the shoulder briefly.
Muscles wet specimen glute max type of muscle i.e. antigravity
extensor and hamstrings normal extensors, i.e. not antigravity. Glute
medius function in walking.
Knee wet specimen all ligs and menisci what do the menisci do?
Knee actor demonstrate ACL test (any)
Knee MRI ACL rupture
Ankle mvts where do they occur, ligaments of the ankle joint.
for
Anatomy/Path:
1) Neuro case: (i) skull-stylomastoid foramen and internal auditory meatuspoint out and describe what goes through it; clinical symptoms if lesion
within the petrous temporal bone; (ii) shown an MRI-sagittal section of
brain. Asked to point to various structures and name them and identify a
lesion ?acoustic neuroma (iii)) piece of paper with words describing the
CNS structures of CSF prod and drainage-asked to draw arrows showing
the pathway of the CSF prod and drainage; then asked to define the basal
cisterns. (1 examiner)
2) Generic case: (i) wet specimen of head and neck and upper limb (ie head
neck and upper torso) asked to: point to /define branches of aorta; thyroid
lobes and vessels (arts and veins); and larynx and its innervation and
muscles; upper trunk of the brachial plexus; describe clinical signs of an
upper and also a lower brachial plexus injury. (1 examiner)
3) Abdominal case: (i) Shown a wet specimen of dissected abdomen- asked
to point out caecum, ascending colon, appendix; describe 4 different types
of appendix (eg retrocaecal appendix etc); why does appendix abdo pain
begin as central pain and then become localized? And why does hip
extension exacerbate RIF pain? Then asked to point out the uterus and the
ovaries and point out the pouch of Douglas. (1 examiner)
4) Path case: just given an A4 sheet (no picture) describing a man with an
undescended testicle (RIF mass). Asked what the diagnosis might be. Then
on the other side of the sheet the diagnosis is given to you as teratoma.
Then asked questions about teratoma. Eg blood tests and clinical
management and then also asked what other types of testicular cancer
are common. (1 examiner)
Anatomy 1 (Generic):
Trauma patient who has fallen onto shoulder forcing it down. Entered station to find
examiner with patient and skeleton A range of questions of upper brachial plexus injuries
including motor and sensory supply. Questions on the MSK nerve (demonstrate on patient
how youd test motor, sensory etc). Then moved onto skeleton show me where rotator
muscles attach/insert. Which muscles rotate the scapula show attachments/nerve supply.
Anatomy 2 (Generic):
Open thorax and neck. Whats this left vagus/arch of aorta + branches. What does
recurrent laryngeal supply. Show me upper trunk of brachial plexus. What is the
arterial/venous supply of the thyroid gland. What would happen if you remove the thyroid
gland. Where are the parathyroids what do they do? What nerves are in danger when you
do a thyroidectomy? What position would a patient with an Erbs palsy have their arm?
Anatomy 3 (Neuroscience):
Shown angiogram what are the various branches. What would happen if I occluded the
ICA? Where else does the brain get its arterial blood supply? Where do these arteries run?
What part of the central nervous system do they supply? What are the branches of the ICA
before it bifurcates?
2. Femoral triangle. What lies in the femoral sheath, apparently the femoral
branch of the genitofemoral nerve is found there as well as the usual
structures (he said no one got that!). Rectus femoris, what are its actions at
the hip and knee joint. Gluteus medius, its nerve supply. What is the iliotibial
tract, which two muscles insert there. What is its action (locks knee in
extension). Point to the biceps femoris, how many heads, what is the nerve
supply to ?each head. Point to the common peroneal nerve. What SENSORY
loss will you get if that is damaged.
3. Lung hilum, point to the structures. How many segments in each lung/lobe.
Surface anatomy of pleura and lung fissures. Phrenic nerve and vagus nerve
in relation to hilum. A bizarre question on how you would indentify the surface
anatomy of the spinous process of T5, 6 and 7 on a patient lying supine ( I
said angle of Louis as T4/5 but he didnt accept that, and then I said you feel
for the spine of C7 which is prominent (and I think he agreed which does not
make any sense!) Pulmonary embolism, tell me how it gets to there from the
knee. What happens after treatment of an PE?
7. Anatomy: head and Neck: Given C1 and C2 asked to talk through them.
Asked to talk about where vertebral arteries neared cervical spine. Surface
anatomy on pt: Hyoid bone, Cricoid cartilage, cervical levels of each. Where a
brachial plexus block would go. Plain film cervical spine x-rays- lateral and peg
4. Anatomy - what is epithelial the lining of the urogenital tract? where is the
bladder in relation to the peritoneum? What lies posterior to the bladder?
Innervation of the bladder? How do you treat an over active bladder? Side
effects of the these drugs? What is the blood supply to the bladder?
6. Anatomy - ENT - structures off the aortic arch, where are the recurrent
laryngeal nerves, anatomy of the thyroid?, blood supply to the thyroid?
venous drainage of the thyroid, What nerves can be damaged during a
thyroidectomy? layers of tissue you cut through for a tracheostomy.
7. Anatomy - skeletal, ulnar, radius, humerus - boney landmarks, pelvis
boney landmarks, attachments of the external rotators, the insertion of
the thigh adductors, anatomy of the adductor canal.
5. Anatomy - Bladder. Sagittal dissection of pelvis. What is this? Urinary bladder.
What is the peritoneal relationship of the bladder? Mostly retroperitoneal. Superior
surface and superior posterior surface are covered by peritoneum. What is the
blood supply? Superior and inferior vesical arteries. What muscle is within the
bladder? detrusor muscle. What is the nerve supply? Parasympathetic from
S2,3,4. pelvic splanchnic nerve. What is posterior to the bladder? seminal vesicle,
rectum, ureters. How does the ureter enter the urinary bladder? It enters at an
angle. Why? to prevent reflux. What lines the bladder epithelium? transitional cell
epithelium. What are the common types of cancer? TCC and SCC. what are the
causes? TCC - dye,rubber industry, smoking. SCC - smoking, schistosomiasis,
recurrent stones, cyclophosphamide.
6. Anatomy - Case of acute appendicitis. Dissection specimen of the abdomen.
Questions around abdominal wall and abdominal viscera. Asked to identify
external oblique muscle, internal oblique muscle. what are the attachments of
external oblique muscle? what is its nerve supply? show me the deep ingunal ring.
Which muscle lies directly in front of the deep inguinal ring? IOM. show me the
ovaries. what is this? fallopian tube. show me the caecum, ileum, appendix,
ascending colon. what are the positions which appendix can lie in? retrocaecal,
retroileal, retrocolic, pelvic. What is the blood supply of appendix? appendicular
artery. Where is it from? ileocolic branch of SMA. Why is appendicitis pain central
initially? visceral innervation. Why is it localised to right iliac fossa after that?
irritation of parietal peritoneum.
7. Anatomy - Case of injury to the thigh and leg. Dissection of the lower limbs. Show
me the femoral vein. What lies medial to the femoral vein. Femoral canal. What is
enclosed within the femoral sheath? femoral vein, artery, canal, lymphatics. what
muscle is this? rectus femoris. what are its action? flex hip and extend knee. loss
of toe and ankle dorsiflexion, loss of sensation around the left aspect of the leg.
what is injured? common peroneal nerve. Show me the common peroneal nerve.
what does it supply? anterior and lateral compartments of the leg. What muscle is
this? gluteus medius. What nerve supply? superior gluteal nerve. What is the
function of gluteus medius on walking? I said it helps tilting the pelvis up.
examiner was looking for a specific word/term which i couldnt get.
ANATOMY
Point to the thyroid. Name the part of the thyroid gland. Point to the hyoid and the
muscles associated with it. What function do these muscles have. Identify the
recurrent laryngeal nerve. what does it supply and what happens if transected.
Arterial supply of the thyroid. Components of the larynx.
Rotator cuff muscles. Roots values of upper limb reflexes. Hip muscles, lateral
cutaneous nerve, meralgia paraesthetica, radial nerve palsy.
Abdominal aorta, branches supplying the colon, AAA specimen, risk factors
> Anatomy
> 1. Neck dissection. Triangles of neck. Course of accessory nerve.
Extrinsic tongue muscles and their innervation. Platysma muscle and its
innervation. Course of L recurrent laryngeal nerve. What's at risk with
submandibular gland dissection
>
> 2. Surface anatomy of leg. Actions of various muscles. Insertion of
peroneus tertius. Compartment syndrome and contents of each
compartment in leg.
>
> 3. Thorax-abdo. Idnetify papillary muscles and chordae tendinae in
heart. Describe course of splenic artery and relations of the pancreas.
Then pointed at nerve bundles lateral to thoracic/lumbar vertrebral
bodies, ?sympathetic trunk - wasn't sure. Apparently she was getting at
grey rami?
Anatomy
> 1. Neck dissection. Triangles of neck. Course of accessory nerve.
Extrinsic tongue muscles and their innervation. Platysma muscle and its
innervation. Course of L recurrent laryngeal nerve. What's at risk with
2. Anatomy
Lower limb. Posterior aspect of leg. Pointed at thing s and asked to anem- sciatic nerve.
Asked- what boney prominences does it pass through.
Name hamstring muscles and point them out.
Boundaries of popliteal fossa and its contents.
Causes of a lump in the popliteal fossa
3. Anatomy
Neuroanatomy- very hard.
Head with one quarter removed and dissected.
Asked to name- tentorium cereblli, straight sinus, confluence of sinuses, optic nerve,
opthalmic canal and sella turcica
Questions- About oculumotor nerve, where does it emerge from brainstem. Signs of 3 rd
nerve palsy. Where is pupil dilated? Which muscle innervated by 3rd nerve- had to name
each individual muscle!
Asked about meaning false-localizing sign
Given scenario of intracranial lesion. Signs of raised ICP.
Location of lenticulate nucleus!!! Had no idea! Very hard station- lots of similar feedback
from other trainees though.
4. Anatomy
Brachial plexus. Scenarior RTC with injury to NV bundle right shoulder. Model there and
skeleton.
Asked about possible injury- from pattern said upper brachial plexus. Asked roots
involved, and to point out associated dermatomes.
Lots of questions re brachial plexus and nerve, their roots, muscles supplied etc.
Insertion of trapezius.
Pretty hard.
Anatomy
Examination of the brachial plexus - healthy volunteer. I
was asked to point out where the nerve roots exited on
a model skeleton. I then had to examine the
dermotomes and myotomes of the upper limb. I was
then asked to test the function of the
musculocultaneous, radial, axillary, median and ulnar
nerve individually. I got asked some anatomy here as
well - what attached to the coracoid process
Anatomy of the lower limb station - prosection of the
leg - looked at the course of the sciatic nerve, was
asked about the origin, the route it took and its
branches - i had to identify these. Got asked about
pathology which may lead to weakness in the sciatic
nerve.
9. intracerebral anatomy - got asked to identify the
extra occular muscles, the ICA, the falx cerebri and
tentorial membrane. Was asked about false localizing
signs.
1.Anatomy- Thorax
Scenario regarding stab wound to thorax- asked to point out structures in heartRA, atrial appendage, pulmonary artery, anatomy of hilum of lung, base of liver
(H), attachment of diagram and structures passing through at each level
2. Anatomy- Parotid
Parotid, surface anatomy of gland and duct, questions regarding causes of
swelling, commonest benign and malignant tumours
3. Anatomy- Shoulder
Osteology of scapular, humerus and clavicle, asked to side and point out
structures. Insertion and origin of rotator cuff and pectoral muscles plus nerve
supply on wet specimen. Talk through movements of shoulder and which
muscles. MRI of shoulder, asked to point out triceps tendon.
Stn 4 : anatomy about spine. Parts of vertebrae. Ligaments. Attachments. What level
spinal cord terminate in the adult and child! What runs in the epidural space, subdural
space. Stern examiner. Was not giving any hints at all.
Stn 5: anatomy of cricothyroid vocal fold. Muscles and nerve attachments, thyroid
anatomy, what is the muscles. Where does the vocal ligaments attached onto. Function
of infra hyoid muscles. It's nerve supply.
Stn 6 : anatomy of lower limb, patient injured in rta. Closed injuries. Show surface
anatomy of ant compartment muscles and tendons. Nerve supply to skin. Exact surface
dermatomal map. Where is S1 nerve dermatome. Where is the arteries. Exact medial
lateral locations. What is the main worry -compartment syndrome.
1.Anatomy- Thorax
Scenario regarding stab wound to thorax- asked to point out structures in heartRA, atrial appendage, pulmonary artery, anatomy of hilum of lung, base of liver
(H), attachment of diagram and structures passing through at each level
2. Anatomy- Parotid
Parotid, surface anatomy of gland and duct, questions regarding causes of
swelling, commonest benign and malignant tumours
3. Anatomy- Shoulder
Osteology of scapular, humerus and clavicle, asked to side and point out
structures. Insertion and origin of rotator cuff and pectoral muscles plus nerve
supply on wet specimen. Talk through movements of shoulder and which
muscles. MRI of shoulder, asked to point out triceps tendon.
2. Anatomy
Lower limb. Posterior aspect of leg. Pointed at thing s and asked to anem- sciatic nerve.
Asked- what boney prominences does it pass through.
Name hamstring muscles and point them out.
Boundaries of popliteal fossa and its contents.
Causes of a lump in the popliteal fossa
3. Anatomy
Neuroanatomy- very hard.
Head with one quarter removed and dissected.
Asked to name- tentorium cereblli, straight sinus, confluence of sinuses, optic nerve,
opthalmic canal and sella turcica
Questions- About oculumotor nerve, where does it emerge from brainstem. Signs of 3 rd
nerve palsy. Where is pupil dilated? Which muscle innervated by 3rd nerve- had to name