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    A admin
    Anatomy

    spotter12.html

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    spotter13.html
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    Anatomy

    f71d6a4c-8cce-4463-9213-07b01447677b-image.png

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    1: "Adductor longus", 2: "Arterial branch of vastus medialis", 3: "Corona of glans penis", 4: "External oblique aponeurosis", 5: "Fascia lata (cut edge)", 6: "Femoral artery", 7: "Femoral nerve", 8: "Femoral vein", 9: "Grachis", 10: "Great saphenous vein", 11: "Iliopsoas", 12: "Ilioitibal tract", 13: "Inguinal ligament", 14: "Nerve to vastus medialis", 15: "Pectineus", 16: "Perforating branch of profunda femoris artery", 17: "Rectus femoris", 18: "Saphenous nerve", 19: "Sartorius", 20: "Subartorial fascia (thickened aponeurosis)", 21: "Spermatic cord", 22: "Superficial circumflex iliac vein", 23: "Superficial epigastric vein", 24: "Superficial external pudendal vein", 25: "Superficial inguinal ring", 26: "Tensor fasciae latae deep to fascia lata", 27: "Valvular bulge lie in vein", 28: "Vastus lateralis", 29: "Vastus medialis",
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    A admin
    Anatomy

    b63420d5-341c-4d53-8eb3-1b5b775e8faf-image.jpeg

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    A admin
    [image: 1779298315620-cubfossa.png]
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    Anatomy

    60271577-4b85-40bb-ae1e-488e6a016ae1-image.png

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    [image: 1779005944198-9db02420-bf6e-43f3-8a9b-c9bfaad919fb-image.jpeg]
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    Anatomy

    dae5828a-394c-4e70-9714-1a8a52fd2e1d-image.png

    Common carotid.

    External carotid.

    faa010b6-b1ad-4347-a986-d6f2cffe0a04-image.png

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    [image: 1778969321518-f423586a-8ceb-42d6-bcda-199c2d3f28af-image.jpeg]
  • A
    A admin
    Anatomy

    Identify the organ in the picture?
    3fcd1e6d-3846-42c4-b99b-e2b92acfa9dd-image.jpeg
    Thyroid gland

    Identify different parts?

    Left lobe
    Right lobes
    Isthmus
    Pyramidal lobe

    Blood supply and lymphatic drainage

    Category Details
    Arterial

    • Superior thyroid artery (1st branch of external carotid)
    • Inferior thyroid artery (from thyrocervical trunk from subclavian a. 1st part)
    • Thyroidea ima (in 10% of population -from brachiocephalic artery or aorta)
      Venous
    • Superior and middle thyroid veins - into the IJV
    • Inferior thyroid vein - into the brachiocephalic veins
      Lymphatic drainage
    • Pre-laryngeal
    • Pre-tracheal
    • Para-tracheal
    • Upper and lower deep cervical
    • Brachiocephalic lymph nodes.

    What is the Nerve supply?

    The 3 cervical ganglions (superior, middle and inferior) but mainly the middle.

    Embryology of thyroid?

    The thyroid gland develops from the foramen caecum (2/3 along the length of the tongue from the tip) → to pass forward and loop around and beneath (under) the hyoid bone.

    What is thyroglossal cyst?

    A fibrous cyst that forms from a persistent thyroglossal duct.

    What is the Supply of RLN?

    Supplies all intrinsic laryngeal muscles except cricothyroid muscle.
    Sensory innervation of the mucous membranes of the larynx below the vocal cords.

    What nerves could be damaged during thyroidectomy?

    Recurrent LN
    External LN
    Cervical sympathetic chain

    What is the clinical RLN injury:
    Unilateral RLN injury

    Diplophonia
    Hoarseness
    Dysphagia

    Bilateral RLN injury

    Aphonia, inability to speak or cough.
    Respiratory compromise

    ELN injury

    Abnormalities in pitch.
    Inability to sing with smooth change to each higher note (glissando or pitch glide)

    Sympathetic chain

    Horner's syndrome (ptosis, myosis, anhidrosis)

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    [image: 1778924612609-91ebc8a4-05ca-4196-a07c-8555852f7fc0-image.jpeg]
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    Anatomy

    Muscles of rotator cuff, origin & insertion
    Check Neck and Shoulder station

    Identify acromion, coracoid process
    ‱ Acromion: 2
    ‱ Coracoid process: 3

    1e21dbfc-4d0a-4fd6-9440-c6b8f54ce8d8-image.jpeg

    96b38a03-db50-41b6-8a3f-7c3c3e815ec1-image.jpeg

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    [image: 1778922029210-975d2572-6a94-4958-99b5-c4fb61ed41a7-image.jpeg]
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    Anatomy

    97380512-1712-4e22-97be-47ce208224f4-image.jpeg

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    [image: 1778253457060-cf71d448-7cbc-48e9-be0e-77c47b932fc4-image.jpeg]
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    Anatomy

    fa72859a-87ae-4585-97ea-11b5dc0f3832-image.jpeg

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    [image: 1778246409589-88af0987-99c1-4a09-899d-b65bf3c9669e-image.jpeg]
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    Anatomy

    fbbc15c0-06d8-411a-9813-3d037e97847a-image.jpeg

    18 Tendoachilles

    19 Inability for planta flexion

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    Anatomy

    eb8f34c4-c553-473e-bb43-2343b956c737-image.png

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    Blood supply of pancreas?ArterialVenous<ul><li>Superior pancreaticoduodenal artery (from gastroduodenal artery) supply head</li><li>Inferior pancreaticoduodenal artery (from SMA) supply head & uncinate process</li><li>Pancreatic branches (from splenic artery) supply tail & body</li></ul><ul><li>Superior pancreaticoduodenal vein</li><li>Inferior pancreaticoduodenal vein</li><li>Veins drain to splenic vein</li></ul> Course of splenic arteryArise from celiac, pass above pancreas, behind stomach (separated from it by lesser sac), lienorenal ligament then ends by terminal branch in splenic hilum. Describe ductal drainage system of pancreas?Main pancreatic duct (of Wirsung):drains head, body and tail $\rightarrow$ opens into major duodenal papilla.Accessory pancreatic duct (of Santorini):drains the uncinate process $\rightarrow$ opens into minor duodenal papilla. Vessel presents behind body of pancreas?Splenic vein Space between stomach and pancreas?Lesser sac Vessel present behind neck?Portal vein Peritoneal relations of the duodenum?The first part of the duodenum lies within the peritoneum, but its other parts are retroperitoneal. Vessels present in front and behind the third part of duodenum?In frontSuperior mesenteric artery & veinBehindIVCAortaRight gonadal vein Hepatic artery runs in which part of peritoneum?Lesser omentum
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    Anatomy

    RTA NECK & SHOULDER INJURYStemPatient involved in an RTA.
    Neck and shoulder injury.What injury do you suspect?
    Brachial plexus injury

    Mechanism of injury?Traction injury

    Common trunk to be injured?Upper trunk

    C5 nerve will exit in between which 2 vertebra?Between C4 and C5

    Where do they exit from? – point at the vertebra (you will be given a vertebra in the exam)Intervertebral Foramen

    C5 and C6 cutaneous supply on human body?C5: lateral armC6: lateral forearm and thumb

    Describe Erb’s & Klumpke palsy?Erb’sKlumpke’s

    ERBS: Damage to the upper nerve roots (C5, C6) Motor affection(waiter’s tip deformity)
    Paralysis of arm abductors (supraspinatus + deltoid)
    arm adduction
    Paralysis of arm external rotators (infraspinatus + teres minor)
    arm internal rotation
    Paralysis of forearm flexors and supinators (biceps, brachialis, brachioradialis) $\rightarrow$ forearm extension and pronation
    Sensory affection loss of sensation of radial side of arm and forearm
    KLUMPKE / Injury to lower trunk (C8, T1) (claw hand deformity)
    Paralysis of all intrinsic muscles of the hand
    Paralysis of wrist flexors (except flexor carpi radialis)
    Hyperextension of MCP joints with flexion of IP joints
    Sensory: loss of sensation over ulnar border of forearm and hand

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    Rotators of the scapula, origin, insertion & nerve supply? Upward rotators -Trapezius -Serratus anterior Downward rotators -Rhomboids minor -Rhomboids major Levator scapulae Muscle Origin Insertion Action Innervation Trapezius SP C7-T12 Clavicle, scapula (acromion, SP) Rotating scapula Cranial nerve XI Serratus anterior Ribs 1-9 Scapula (ventral medial) Preventing winging Long thoracic nerve Latissimus dorsi SP T6-S5, ilium Humerus (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 & NS: Action: Flex forearm Nerve Supply (NS): Radial nerve Show C5 reflex Biceps reflex Name three muscles supplied by musculocutaneous nerve. Nerve root. Muscles: BBC Biceps brachii Brachialis Coracobrachialis Nerve root: C5, C6, C7 External rotators of arm Supraspinatus Infraspinatus Teres minor Axillary nerve cutaneous Skin to the lower half of deltoid Axillary nerve muscle supply Deltoid Teres minor Shoulder abductor muscles? Supraspinatus (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.
  • A
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    Anatomy

    1. Name the tarsal bones

    2. Articulation
      The talus articulates:

    with tibia and fibula

    with navicular bone

    with calcaneus

    The navicular articulates:

    with the three cuneiforms

    with talus

    The cuboid articulates:

    with calcaneus

    with lateral two metatarsals

    The cuneiforms articulate:

    with medial three metatarsals

    with navicular bone

    The calcaneus articulates:

    with talus

    with cuboid

    Peroneus brevis

    Avascular necrosis

    -Posterior tibial artery supplies the body of the talus via:
    Artery of tarsal canal (supplies most of talar body, dominant blood supply)
    Deltoid branch supplies the medial portion of talar body
    -Anterior tibial artery supplies head and neck of talus
    -Peroneal artery supplies head and neck of talus via artery of tarsal sinus

    In case of displaced talar neck fracture, which could lead to disruption of artery of tarsal canal, most of talar body will lose its blood supply (except medial portion which is supplied by the deltoid branch) and that will lead eventually to AVN

    Anterior tibial artery


    Loss of plantar flexion


    Medial longitudinal arch
    ‱ Calcaneus, Talus, Navicular‱ 3 cuneiforms‱ 3 medial metatarsals
    Lateral longitudinal arch
    ‱ Calcaneus‱ Cuboid‱ 2 lateral metatarsals
    Transverse arch
    ‱ Cuboid, 3 cuneiforms‱ Bases of metatarsals


    Mnemonic: Tom Has Very Nice Dogs & Pigs
    Tibialis anterior
    Extensor Hallucis longus
    Anterior tibial vessels,
    Anterior tibial nerve
    Digitorum longus (Extensor)
    Peroneus tertius

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    Structures behind medial malleolus? Mnemonic: Tom Does Very Nice Hats Tibialis posterior tendon Flexor Digitorum longus posterior tibial Vessels posterior tibial Nerve Hallucis longus (Flexor) Identify structure number 12 on the XR:Sustentaculum tali [image: 1774873069532-c5fb34b2-5f30-497e-a458-327738cfc48b-image.jpeg] What is the component of ankle joint? Tibia Fibula Talus What is the type of this joint?Synovial hinge joint [image: 1774872996205-e65126fc-f271-4426-94f8-c444d7a0cc53-image.jpeg] Movements of this joint? Plantarflexion Dorsiflexion At which movement is it more stable? Why? Ankle joint is most stable in dorsiflexion, because the talus is wider anteriorly and narrower posteriorly. (Note: In dorsiflexion, the wider anterior part of the talar trochlea wedges tightly into the mortise formed by the tibia and fibula.) Components of subtalar joint? Talus and calcaneus What are the movements at the joint? Inversion and eversion of foot Identify the Deltoid ligament, calcaneofibular ligament, posterior talofibular ligament: SpoilerDeltoid ligament (6) Calcaneofibular ligament (3) Posterior talofibular ligament (19) Demonstrate pulses of the foot?The dorsalis pedis pulse is found between the first two metatarsal bones. The posterior tibial pulse is found 2cm-3cm below and behind the medial malleolus. What does the midtarsal joint do?The midtarsal joint, consisting of the talonavicular and the calcaneocuboid joints, is presumed to be responsible for the foot being both flexible and rigid during different parts of the stance phase of gait.
  • A
    A admin
    Anatomy

    Parotid Gland

    Superior: Zygomatic arch
    Anterior: Anterior border of masseter
    Posterior: Line down from Mastoid process
    Inferior: Angle of mandible

    The middle 1/3 of a line drawn between intertragic notch to the corner of the mouth.

    In vestibule of mouth against 2nd upper molar teeth.

    Infection (parotitis, mumps)
    Obstructed duct (calculus or external compression)
    Neoplasm (pleomorphic adenoma, Warthin's tumour)
    Deep parotid lymph nodes

    Pleomorphic adenoma

    Mucoepidermoid carcinoma

    Exit through the stylomastoid foramen.

    Branches in the face: "The Zebra Bothered My Cat"
    Temporal branch
    Zygomatic branch
    Buccal branch
    Marginal mandibular branch
    Cervical branch

    f56f0e55-4b6e-4097-84ef-ad6de0e3cf40-image.jpeg

    Within facial canal:
    Nerve to stapedius
    Chorda tympani
    Greater petrosal nerve (preganglionic to lacrimal)
    After leaving skull (motor):
    Nerve to stylohyoid
    Nerve to posterior belly of digastric
    Posterior auricular nerve (occipital belly of occipitofrontalis muscle)

    50ebff86-c34a-4c60-89a4-0a2a910f4b5b-image.jpeg


    Stylohyoid muscle

    As it crosses the inferior border of the mandible.
    Adjacent to the anterior border of the masseter.

    No ischemia, as there is rich anastomosis with the contralateral vessels.

    (Note: This refers to the highly vascular nature of the face and the extensive communication between the left and right facial arteries, as well as branches from the ophthalmic and maxillary arteries.)

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    History

    You are a core surgical trainee in the outpatient clinic. A 52-year-old man is referred by his GP with recurrent upper abdominal pain and weight loss. He has a background of heavy alcohol use.

    Site of pain (epigastric, radiating to back)
    Onset and duration (acute vs chronic, recurrent episodes)
    Character of pain (deep, boring, constant)
    Radiation (especially straight through to the back)
    Severity and impact on daily activities
    Timing and relation to meals (worse after eating)
    Relieving/exacerbating factors (leaning forward, alcohol, food)
    Associated nausea and vomiting
    Weight loss and anorexia
    Steatorrhoea (pale, greasy, foul-smelling stools)
    Symptoms of diabetes mellitus (polyuria, polydipsia)
    History of alcohol intake (quantity, duration)
    Previous episodes of acute pancreatitis
    Gallstone history or biliary symptoms (jaundice, colic)
    Drug history (e.g. steroids, azathioprine)
    Family history of pancreatic disease or malignancy

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    History

    Stem (Candidate Instructions)
    You are a surgical trainee in the outpatient clinic.
    Your next patient is John Smith, a 60-year-old man who has been referred by his GP with bleeding per rectum and unintentional weight loss.

    Take a focused history from the patient
    You do not need to perform an examination
    At the end, summarise your findings and outline your initial concerns to the examiner
    You have 6 minutes.

    Role Player (Patient Script)

    60-year-old male
    3-month history of intermittent rectal bleeding
    Blood is dark red, mixed with stool, sometimes on paper
    Associated change in bowel habit → looser stools, increased frequency
    Unintentional weight loss (~6–8 kg over 3 months)
    Occasional abdominal discomfort, no severe pain
    No PR bleeding previously
    If asked:
    No melaena
    No haematemesis
    Some fatigue
    No known haemorrhoids
    No inflammatory bowel disease history
    PMH: Hypertension
    Drugs: Amlodipine
    FH: Father had bowel cancer at 70
    SH: Ex-smoker, moderate alcohol

    16-Mark Scheme (Examiner Checklist)

    1. Introduction & Communication (2 marks)
      Introduces self, confirms patient identity, gains consent
      Open questioning style, allows patient to describe symptoms
    2. Presenting Complaint Exploration (4 marks)
      Bleeding history:
      Onset and duration
      Colour (fresh vs dark), relation to stool
      Quantity/frequency
      Mixed vs separate from stool
      Red flag features:
      Change in bowel habit
      Weight loss
      Tenesmus or urgency
    3. Associated Symptoms (3 marks)
      Abdominal pain or discomfort
      Symptoms of anaemia (fatigue, dizziness)
      Melaena / upper GI symptoms
      Mucus in stool / features suggestive of IBD
    4. Bowel History (2 marks)
      Baseline bowel habit vs current
      Stool consistency (loose, hard, alternating)
      Frequency and urgency
    5. Past Medical & Drug History (2 marks)
      GI conditions (polyps, IBD, haemorrhoids)
      Medication review (anticoagulants, antiplatelets, NSAIDs)
    6. Family History (1 mark)
      Colorectal cancer or polyps
    7. Social History (1 mark)
      Smoking and alcohol
      Functional impact / performance status
    8. Ideas, Concerns, Expectations (ICE) (1 mark)
      Elicits patient concern (e.g., cancer worry)

    Examiner questions
    Differentials

    Malignancy
    Hemorrhoids

    Management

    Blood, examination.
    High suspicion of colorectal malignancy
    Needs urgent investigation (e.g., 2-week wait referral, colonoscopy)

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  • A
    A admin
    Mocks

    Identify the organ in the picture?
    22703feb-f62a-477f-911a-aa32265abee4-image.jpeg

    Thyroid gland

    Identify different parts?

    Left lobe
    Right lobes
    Isthmus
    Pyramidal lobe

    Blood Supply and Lymphatic Drainage

    Arterial
    ‱ Superior thyroid artery (1st branch of external carotid)
    ‱ Inferior thyroid artery (from thyrocervical trunk from subclavian a. 1st part)
    ‱ Thyroidea ima (in 10% of population - from brachiocephalic artery or aorta)
    Venous
    ‱ Superior and middle thyroid veins - into the IJV
    ‱ Inferior thyroid vein - into the brachiocephalic veins
    Lymphatic drainage
    ‱ Pre-laryngeal
    ‱ Pre-tracheal
    ‱ Para-tracheal
    ‱ Upper and lower deep cervical
    ‱ Brachiocephalic lymph nodes

    What is the Nerve supply?

    The 3 cervical ganglions (superior, middle and inferior) but mainly the middle.

    Embryology of thyroid?

    The thyroid gland develops from the foramen caecum (2/3 along the length of the tongue from the tip) - to pass forward and loop around and beneath (under) the hyoid bone.

    What is thyroglossal cyst?

    A fibrous cyst that forms from a persistent thyroglossal duct.

    What is the Supply of RLN (Recurrent Laryngeal Nerve)?

    Supplies all intrinsic laryngeal muscles except cricothyroid muscle.
    Sensory innervation of the mucous membranes of the larynx below the vocal cords.

    What nerves could be damaged during thyroidectomy

    Recurrent LN
    External LN
    Cervical sympathetic chain

    What is the clinical RLN injury

    Unilateral RLN injury
    Dysphagia
    Diplophonia
    Hoarseness
    Bilateral RLN injury
    Aphonia, inability to speak or cough.
    Respiratory compromise
    ELN injury
    Abnormalities in pitch.Inability to sing with smooth change to each higher note (glissando or pitch glide)
    Sympathetic chain
    Horners syndrome

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    A admin
    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
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    Mocks

    On diagram identify

    Fundus
    Body
    Pylorus antrum
    Pyloric canal

    Blood supply of stomach

    9eebd5c5-bf52-4c54-88bf-a3edd580eb3a-image.jpeg

    On diagram identify

    Head of Pancreas
    Neck of Pancreas
    Tail

    Blood supply of pancreas?
    Arterial

    Superior pancreaticoduodenal artery (from gastroduodenal artery) supply head
    Inferior pancreaticoduodenal artery (from SMA) supply head & uncinate process
    Pancreatic branches (from splenic artery) supply tail & body

    Venous

    Superior pancreaticoduodenal vein
    Veins drain to splenic vein
    Inferior pancreaticoduodenal vein

    Course of splenic artery

    Arise from celiac, pass above pancreas, behind stomach (separated from it by lesser sac), lienorenal ligament then ends by terminal branch in splenic hilum.

    Describe ductal drainage system of pancreas?

    Main pancreatic duct (of Wirsung): drains head, body and tail - opens into major duodenal papilla.
    Accessory pancreatic duct (of Santorini): drains the uncinate process - opens into minor duodenal papilla.

    Vessel presents behind body of pancreas?

    Splenic vein

    Space between stomach and pancreas?

    Lesser sac

    Vessel present behind neck?

    Portal vein

    Peritoneal relations of the duodenum?

    The first part of the duodenum lies within the peritoneum, but its other parts are retroperitoneal.

    Vessels present in front and behind the third part of duodenum?

    In front: Superior mesenteric artery & vein
    Behind: IVCAortaRight gonadal vein

    Hepatic artery runs in which part of peritoneum?

    Lesser omentum

    Clinical Correlation Tip
    The fact that the portal vein forms behind the neck of the pancreas (by the union of the splenic and superior mesenteric veins) is a major "must-know" for surgical anatomy. If a tumor grows in the neck of the pancreas, it can quickly involve this major vein.

    Superior Mesenteric Artery (SMA) Syndrome is a rare but serious gastrointestinal condition. To understand it, you have to look at the specific "nutcracker" anatomy of the third part of the duodenum.
    Normally, there is a cushion of mesenteric fat that keeps the angle between the Aorta and the SMA wide enough so the duodenum can pass through freely.
    In SMA Syndrome, that mesenteric fat pad disappears or the angle narrows significantly. This causes the SMA to compress the duodenum against the aorta, creating a physical blockage.
    The "Prone Relief" Sign: Patients often find that lying on their stomach (prone) or in the left lateral decubitus position relieves the pain, as gravity pulls the SMA forward, opening the trap.
    Imaging: A CT scan or a "Barium Swallow" will show a dilated first and second part of the duodenum, with a sharp cutoff where the SMA crosses the third part.
    Management:
    Medical: The first goal is weight gain to restore the fat pad (often via a feeding tube placed past the obstruction).
    Surgical: If medical management fails, a Duodenojejunostomy is performed, where a new path is created to bypass the compression.

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  • A
    A admin
    Mocks

    Stem: Patient involved in an RTA (Road Traffic Accident). Neck and shoulder injury.

    What injury do you suspect?

    Brachial plexus injury

    Mechanism of injury?

    Traction injury

    Common trunk to be injured?

    Upper trunk

    C5 nerve will exit in between which 2 vertebra

    Between C4 and C5

    Where do they exit from? - point at the vertebra (you will be given a vertebra in the exam)

    Intervertebral Foramen

    C5 and C6 cutaneous supply on human body?

    C5: lateral arm
    C6: lateral forearm and thumb

    Describe sensory deficit in Erb’s & Klumpke palsy?

    Erbs (waiters tip) - loss of radial side of arm and forearm
    !Klumpke's (claw hand) - loss of sensation over ulnar border of forearm and hand

    Identify Rotator cuff muscle? Origin? Insertion? Nerve supply?

    Muscle -Origin - Insertion - Action - Innervation - Subscapularis - Ventral scapula (subscapular fossa) Humerus (LT - Lesser Tuberosity) - Internally rotating arm; - Providing anterior stability Upper and lower subscapular nerves
    Supraspinatus - Superior scapula (supraspinatus fossa) Humerus (greater tuberosity) - Abducting; Providing stability; - Externally rotating arm Suprascapular nerve
    Infraspinatus Dorsal scapula (infraspinatus fossa) Humerus (greater tuberosity) - Providing stability; - Externally rotating arm- Suprascapular nerve
    Teres minor Scapula (dorsolateral) Humerus (greater tuberosity) - Providing stability; Externally rotating arm - Axillary nerve

    What is the Deltoid muscle origin and insertion?

    Origin: lateral clavicle and scapula Insertion: deltoid tuberosity of humerus

    How to test it on actor? (Likely referring to a clinical exam/OSCE scenario)

    Inability to abduct the shoulder > 15 degrees
    Loss of sensation over the badge area

    What are the flexors of the elbow and their Nerve supply (Value)? -Name of the nerve in the forearm

    Muscle Origin Insertion Action Innervation
    Brachialis Anterior humerus Ulnar tuberosity (anterior) - Flexing forearm - Radial (C5-T1) + Musculocutaneous (C5-C7)
    Biceps brachii Coracoid (short head); Supraglenoid (long head) Radial tuberosity Relations to bicipital tendon: Medially: Median n. and brachial a. Lateral: Radial nerve - Supination, flexion - Musculocutaneous (C5-C7)
    Pronator teres Medial epicondyle and coronoid Mid-lateral radius - Pronating, flexing forearm - Median nerve C5-T1

    Name of the sensory nerve in the forearm

    Lateral cutaneous nerve of forearm

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    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.
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    Mocks

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    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!