isurg

Vagus nerve course in thorax & abdomen? Thorax: Left vagus nerve SpoilerCrosses in front of the left subclavian artery. Enters the thorax between the left common carotid and subclavian arteries. Descends on the left side of the aortic arch. Travels behind the phrenic nerve. Courses behind the root of the left lung. Deviates medially and downwards to reach the esophagus and form the esophageal plexus with the right vagus nerve. Right vagus nerve SpoilerCrosses in front of the first part of the subclavian artery. Travels behind the innominate vessels. Reaches the thorax on the right side of the trachea. Inclines behind the hilum of the right lung. Courses medially towards the esophagus to form the esophageal plexus with the left vagus nerve. Abdomen: SpoilerThe oesophageal plexus, formed by the union of the right and left vagus nerves, The vagus nerve enters the abdomen through the oesophageal hiatus at the level of the tenth thoracic vertebra (T10). It divides into the anterior and posterior vagal trunks, which innervate the stomach, small intestine, liver, gallbladder, pancreas, and spleen. Nerves in oesophageal hiatus? SpoilerAnt & post vagal trunks. What do they supply? SpoilerStomach, duodenum, jejunum, ileum, cecum, ascending colon, medial 2/3 of transverse colon, spleen, pancreas, gall bladder Muscle dissected to see thyroid? SpoilerSternohyoid muscle

Rotators of the scapula, origin, insertion & nerve supply? Upward rotators: SpoilerTrapezius Serratus anterior Downward rotators: SpoilerRhomboids minor Rhomboids major Levator scapulae Muscle Origin Insertion Action Innervation SpoilerTrapezius SP C7-T12 Clavicle, scapula (acromion, SP) -Rotating scapula Cranial nerve XI Serratus anterior Ribs 1-9Scapula (ventral medial) - Preventing winging Long thoracic nerve Latissimus dorsi SP T6-S5, iliumHumerus (ITG)-Extending, adducting, internally rotating humerus Thoracodorsal nerve Rhomboid minor SP C7-T1 Scapula (medial spine) - Adducting scapula Dorsal scapular nerve Rhomboid major SP T2-T5 Scapula (medial border)- Adducting scapula Dorsal scapular nerve Levator scapulae Transverse process C1-C4 Scapula (superior medial) - Elevating, rotating scapula C3, C4 nerves Brachioradialis muscle demonstrate on yourself action SpoilerFlex forearm Nerve Supply (NS): !Radial nerve Show C5 reflex SpoilerBiceps reflex Name three muscles supplied by musculocutaneous nerve. Nerve root. Muscles (BBC): SpoilerBiceps brachii Brachialis Coracobrachialis Nerve root: SpoilerC5, C6, C7 External rotators of arm SpoilerSupraspinatus Infraspinatus Teres minor Axillary nerve cutaneous SpoilerSkin to the lower half of deltoid Axillary nerve muscle supply SpoilerDeltoid Teres minor Shoulder abductor muscles? SpoilerSupraspinatus (0-15) Deltoid (middle fibres) (15-90) Trapezius and serratus anterior (over 90): which will require upward rotation of the scapula with lateral rotation of the humerus.

What is the most common part of the duct that is involved in a stone? SpoilerMiddle 1/3 Why is this site most affected? SpoilerDue to looping of lingual nerve around duct, and thick mucus secretion and have to pour secretion in floor of mouth against gravity What are digastric triangle boundaries and their nerve supply? SpoilerSuperior: Inferior border of the mandible Anterior: Anterior belly of the di gastric muscle Posterior: Posterior belly of the digastric muscle Nerve supply SpoilerThe anterior belly of the digastric muscle is innervated by the mylohyoid nerve, which is a branch of the mandibular nerve The posterior belly of the digastric muscle is innervated by the digastric branch of the facial nerve. Names & actions of extrinsic muscles of the tongue SpoilerGenioglossus: protrusion of the tongue & depression of the tongue tip Hyoglossus: retraction of the tongue & depression of the lateral margins of the tongue Styloglossus: retraction of the tongue & elevation of the sides of the tongue Palatoglossus: Elevation of the posterior part of the tongue If you have injury of Hypoglossal, lingual or marginal mandibular what will the patient have? Marginal mandibular SpoilerDrippling of saliva from corner of affected side Poor speech articulation (slurred speech) Asymmetry on smiling or crying Hypoglossal SpoilerParalysis and atrophy in ipsilateral side Deviation to ipsilateral side on protrusion Poor speech articulation Lingual SpoilerLoss of general sensation from ant 2/3 of tongue and floor of mouth Loss of taste sensation from tongue only Boundaries of Posterior Triangle SpoilerBoundary Description Apex Sternocleidomastoid and the Trapezius muscles at the Occipital bone Anterior Posterior border of the Sternocleidomastoid Posterior Anterior border of the Trapezius Base Middle third of the clavicle [image: 1773944974415-596e7a43-c73e-42b3-bc28-fcbd5be83066-image.jpeg] Origin & Insertion of Omohyoid SpoilerOrigin - Insertion Inferior belly superior border of scapula near suprascapular notch - intermediate tendon Superior belly intermediate tendon - body of hyoid bone Study Notes Hypoglossal nerve SpoilerBecause the genioglossus muscle on the healthy side "pushes" the tongue, it will deviate toward the side of the injury when the patient sticks it out. Why lingual nerve injury causes loss of taste, even though it primarily carries general sensation? SpoilerWhile the Lingual nerve is a branch of the Mandibular nerve and carries general sensation (touch, pain, temperature), it also acts as a "highway" for taste fibers.The Chorda Tympani Connection. The reason a lingual nerve injury (specifically if it occurs after the two nerves join) causes loss of taste is due to the Chorda Tympani, a branch of the Facial nerve (CN VII). The Join: High up in the infratemporal fossa, the Chorda Tympani "hitches a ride" with the Lingual nerve. The Shared Path: From that point forward, they travel together as one physical cord. Omohyoid, remember that its two bellies are held together by an intermediate tendon. This tendon is actually tethered to the clavicle by a deep layer of fascia. This is why when the muscle contracts, it doesn't just pull the hyoid down; it also helps maintain the patency of the internal jugular vein!

[image: 1773779076152-bfaee33d-2c82-4c85-b447-584b7b78775c-image.jpeg]

[image: 1773749810414-faeb2c16-0673-4ec3-aea9-7f44aae36a70-image.jpeg]

[image: 1773745551198-399c1ec7-4356-478f-919c-abadf5f185c1-image.jpeg]

[image: 1773737846017-facenerv.png]

MRCS_Haematuria_OnePage.pdf

describe development of pancreas The pancreas develops from two endodermal buds of the foregut: Dorsal pancreatic bud → forms most of the pancreas: body, tail, and part of the head. Ventral pancreatic bud → forms the uncinate process and inferior/posterior part of the head. During development, the ventral bud rotates posteriorly with the bile duct around the duodenum and fuses with the dorsal bud. Duct formation: Main pancreatic duct (duct of Wirsung) = ventral duct + distal part of dorsal duct Accessory pancreatic duct (duct of Santorini) = proximal part of dorsal duct Opening into duodenum: Main duct joins the common bile duct → opens at the major duodenal papilla. Accessory duct may open at the minor duodenal papilla. [image: 1773989803488-d4d51eaf-1914-4bef-b547-4fce2a4566c9-image.jpeg]

[image: 1773646916929-cc9d7f80-65ed-4837-9da6-59a0f2c892fa-image.jpeg]

Parasagittal meningioma Tumour: Parasagittal meningioma Typical presentation Gradually progressive contralateral lower limb weakness Focal seizures in the leg UMN signs Why Compression of the Paracentral lobule (leg area of the Primary motor cortex). Exam clue Progressive leg weakness + seizures → parasagittal meningioma. Acoustic neuroma (vestibular schwannoma) Tumour: Vestibular schwannoma Typical presentation Unilateral hearing loss Tinnitus Balance problems Later: Facial numbness Facial weakness Why Compression of: Vestibulocochlear nerve (CN VIII) Facial nerve (CN VII) Exam clue Progressive unilateral deafness. Pituitary adenoma Tumour: Pituitary adenoma Typical presentation Bitemporal hemianopia Why Compression of the Optic chiasm. Other clues: Hormonal symptoms (galactorrhoea, acromegaly, Cushing's). Exam clue Loss of temporal visual fields. Cerebellopontine angle tumour Often a Vestibular schwannoma. Symptoms Hearing loss Facial numbness Ataxia Structures involved: Trigeminal nerve Facial nerve Vestibulocochlear nerve Exam clue Multiple cranial nerve deficits in the cerebellopontine angle. Frontal lobe tumour Commonly a Glioma. Typical presentation Personality change Disinhibition Poor judgement Sometimes urinary incontinence Structure affected: Frontal lobe Exam clue Behavioural change before neurological deficit. ✅ Very high-yield MRCS pattern Symptom Likely tumour Leg weakness Parasagittal meningioma Unilateral deafness Vestibular schwannoma Bitemporal hemianopia Pituitary adenoma Behaviour change Frontal lobe tumour Multiple cranial nerve palsies CPA tumour

[image: 1773462827029-1ccc8df2-b687-469f-8971-ab7821dc1a5e-image.jpeg]

checklist3.html