ANATOMY TOTAL

ANATOMYUPPER 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

Hearto Anatomy of heart and prosected myocardium heart compartments,

Lungo Lung roots and surface markings (difference between right and left)o Blood supply of the lungso 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 nerveso Course of the phrenic nerve o Sympathetic chain – pre-ganglionic and postganglionic outflow. What levels of cord does

it arise. Identify in thoraxo Path of vagus and ganglionso Position of neurovascular bundle of rib, order. o Anatomy and innervation of thoracic, mediastinal and diaphragmatic pleurao Identify azygos vein and it’s tributaries (what drains into it)

Clinicalo 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 mediastinumo Structure and blood supply of oesophaguso Pathology of achalasia, Barretts.o Portosystemic supply in varices

Stomacho Surface anatomyo Attachment of lesser and greater omentumo Cells of stomach and function

Duodenumo Relations of four parts of duodenum relevance of 1st part of duodenum – Gastroduodenal

artery. Pancreas

o Relations (which part is retroperitoneal)o Blood supplyo Cells of pancreas (endo and exocrine function)

Colono Embryology of gut and appendixo Anatomy of colono Pathology of colon and colon cancero Blood supply of intestine. o What operation would you perform for a transverse colon tumour.o Double contrast enemao Identify caecum, appendix, illeum

Appendixo Positions of appendixo Reason for appendix symptoms (central to RIF pain)

o Meckel’s diverticulum Bladder

o Type of epitheliumo Types of neoplasia and symptoms of neoplasia. o Blood supply, Muscle, Nerve supply, o Peritoneal relationship to bladder, Structures behind bladder, structures are penetrated

during an SPC insertion. o Causes of haematuria. Risk factors for UTIo Ureter, bony relations and blood supply

Livero liver anatomy, o Identify structure of the portal triad on prosection, porta hepatiso Gall bladder why it causes shoulder tip pain.o Foramen of winslow and Pringles manoeuvre

Aorta o Define aneurysm and what are its causes, pathology of aneurysms o AAA with thrombus, other complications and definitiono What level the aorta enters the abdomen? whats you surface markings for this entry

point?o Identify the branches of the aorta; what posterior branches of aorta do you know?;

Mesenteric vessels level of origin and named branches, gonadalao Aortogram identify the branches

o Small specimen of what looked like a fusiform aortic aneurysm , identify and describe?

IVCo Relations of IVC and tributaries

o Renal veins identify on prosection and describe anterior relations

Spleeno Blood supply of spleen

o Relation to thorax

o Structures at risk during splenectomy.

Kidneyo Blood supply

o Relations

Othero Structures that cross the midline in the abdomen.

o Which organs are retroperitoneal and which are on a mesentery

HEAD AND NECK Base of skull anatomy Thyroid

o Relations o Blood supply o Embryology o Approach to a thyroidectomy and complications of hoarsness after surgery

Parathyroid gland (blood supply, innervation), function,? causes? Identify thyroid cartilage, ansa cervicalis and omohyoid Surface marking for cricoidotomy and tracheostomy (layers to go through) Trigeminal nerve anatomy Blood supply of face (simple) Carotid body and sinuses- location and function Vessels and nerves of the neck, carotid triangle, IJV, carotid canal, subclavian artery,

hypoglossal nerve, facial artery, Salivary glands- where ducts open and what they produce Anatomy of larynx/vocal cords Name strap muscles and function, arytenoid, thyroid, cricoid cartilage **Parotid surface marking and structures running through

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.g- where 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.

1. Anatomy: Cadaver head and neack: level of larynx,vocal cords attachment , sensation in the larynx thyroid gland, blood supply, nerve relation, injury to ext laryngeal nerve, parafollicular cells strap muscles, nerve supply, action.

2. Anatomy & pathology: branches of aorta, anterior relations, surface anatomy, , identify celiac, sup mesenteric & inf mesenteric art in cadaver, aortogram, identify ileal, jejuna, external & internal iliac , femoral in aortogram, what are the branches of the external iliac

3. Anatomy: pt with motorbike injury: which nerve? Brachial plexuse which root? C5-6 which muscles supplied by? How can you test for…biceps, brachioradialis, pronator…? Musculocutaneous nerve, dermatomes, show me where is the deltoid, supinator biceps

Anatomy 2 (Generic) – Pt sustains thrown off motorbike and lands on shoulder, what part of brachial plexus is he likely to injure? Point to the C5 nerve root on a skeleton. Point on actor the dermatome of C5 and C6 (wanted to be very exact). How do you test for motor function for C5, C6 and C7? Demonstrate biceps and supinator reflex. What nerve supplies biceps? What other muscles does it supply? Does it have any sensory supply? (Lat cut nerve of forearm) Show me how

to test for shoulder abduction, elbow flexion and supination on actor. What muscle abducts shoulder after 30 degrees? What nerve supplies deltoid? What is the sensory supply for the axillary nerve? Which muscles rotate scapula? Which nerves supply serratus anterior and trapezius? Show on skeleton the attachments for serratus anterior and trapezius. Show on skeleton insertions of supraspinatus. What is this? (Coracoid process) What attaches here?

Anatomy 3 (Generic) – Point to prosection of torso where the pulmonary trunk is. Does the ascending aorta have any branches? What are they? How many coronary arteries are there? What is that? (Azygos vein) Where does it go? What does it drain? Shown cut section of heart – what is that? (Papillary muscle and chordae tendinae) What is the function of the chordae tendinae? Which valve is that? (tricuspid) Prosection of torso – What is that? (sympathetic chain ganglia) What happens to sympathetic postgangionic fibers, how does it exit? (no idea! Was looking for something specific I couldn’t get!) Find me the spleen. What is the blood supply? How does it travel? What else does it supply? What is that? (duodenum, falciform ligament, ligamentum teres, fundus of gall bladder) How many parts does the duodenum have? What are they called? There is an artery that runs behind the duodenum, what is it? Why is it important? Where does the pancreatic duct enter? And what joins the major pancreatic duct? Why is there a major and accessory pancreatic duct? What are the surface markings for the gallbladder?

ANATOMYPosterior cranial fossa. Which nerves go through which holes. Venous sinuses. Anatomy of acoustic neuroma

ANATOMYFairly straight forward thorax and abdomen just like stuff covered in course.

ANATOMYLower leg, muscles of thigh, femoral triangle, compartments of lower leg.

1. Generic anatomy – root of the neck, thyroid and embryology, upper trunk of brachial plexus, identification of SCM, scalenes, rec laryngeal. Implication of C5,C6 nerve root injury. Not difficult at all. Having chosen H&N I thought that this was my speciality choice.

2. Generic anatomy – abdomen and pelvis. Didn’t 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 didn’t even understand.

Specialist anatomy – easiest station of the day on parotid anatomy – surface markings on a patient then base of skull – pointed to stylomastoid foramen and asked me to state what exits here. A bit on the facial nerve. A bit on parotid tumours and duct of Stensen. Causes of neck lumps in various areas.

Station 20 – Speciality Choice 1 anatomy

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.

Station 21 – Generic Anatomy – Head/Neck/Thorax (Mostly head and neck)

Oesophagus – muscular structure – identify on wet specimen. Tracheal level for bifurcation at which Tx level. Identify common carotid and divisions into internal and external Identify nerve crossing it. Identify submandibular salivary gland. Where does it open into? What type of saliva exist

(serous mucoid and mixed type). What type of saliva produced in submandibular gland? Identify parotid gland. Where opens into? Identify facial artery.

Station 22 Generic Anatomy – Abdo

Identify ext/int oblique by orientation of fibres. What Tx level is umbilicus. What level innervates it and what levels above innervate abdo? Origin/insertion of ext oblique and innervation. Why does appendicitis pain start centrally and the localise to RIF and which nerves and root

levels are responsible for this? Idenfiy fallopian tubes and ovary and pouch of douglas. What branch of SMA supplies the appendix? Identify the appendix/caecum/terminal ileum/ascending colon. What remnant should you consent for when consenting for appendicetomy? (Mekels

diverticulum).

Anatomy/Path:

1) Neuro case: (i) skull-stylomastoid foramen and internal auditory meatus-point 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)

1) Anatomy and pathology (Specialist) Prosection10y/o boy falls from tree, presents in A&E. Shown plain radigraph of supracondylar fracture.

What would you assess first? How would you do this?

Asked to articulate a humerus, radius and ulna. Asked to point out the articular surfaces.

Show me the nerves and vessels you have mentioned (anterior interosseous nerve, median nerve, brachial artery and radial artery.

2) Anatomy-SkeletonWhat is the rotator cuff? What muscles form it? Point to their origins and insertions.

Show me the pubic tubercle. How is related to a femoral hernia?

What is this (pointing to the greater tuberosity)? What attaches here? What other attachments are there on the proximal femur? Show me their origins and insertions

3) Anatomy-Surface anatomy. Man has crush injury to lower leg after horse lands on him. You are assessing him in A&E

Point to tibialis anterior, EHL, EDL.

What inserts at the base of the fifth MT?

Asked the patient to show me the action of TA, EHL, Peroneals and the combined action of PT and TA.

What is the innervation of these muscles? What is the sensory distribution of the sup. peroneal, deep peroneal, tibial nerve, sural and saphenous nerve?

What are the compartments of the leg and what are their contents, blood supply and innervation?

Station 9 – anatomy specialty #1 neurosciencesVery easy station. I was shown a sagittal mri and asked to identify structures like corpus callosum, cerebellum.. I was given a diagram and asked to draw the csf circulation, then had a few questions on where is csf produced, where is it absorbed. Shown a skull and asked to identify stylomastoid foramen and superior orbital fissure. What is the position of the eyeball in horner syndrome, what does the patient do to compensate Station 10 – anatomy genericAgain extremely easy station. There were a heart, lung and liver and I was asked questions like show me the left ventricle, what goes in and out of it. What are the

structures seen in the hilum, what are the boundaries of the H area in the liver. Moved into a chest cadaver. Where is the diaphragm, the phrenic nerve, what goes through the central orifice in the diaphragm Station 11 – anatomy specialty #2 head and neckSlightly more demanding station on cadaveric prosection. Examiner pointed at the thyroid, recurrent laryngeal nerve, strap muscles. What is the innervation of strap muscles, what are the roots of ansa cervicalis, what is the function of strap muscles. What are the cells where medullary thyroid ca originates from.

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 you’d 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. What’s 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 Erb’s 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?

1. Brachial plexus injury in a patient with ?hyperextension in RTA. Point to the site of the injury on a skeleton (I pointed around C5-C6, he seemed happy with that). Point to C5 and C6 dermatomes on the patient. How would you test for this reflex? Show me how to test for deltoid? What nerve supplies and where is the sensory loss? Supraspinatus. Movements of shoulder, which muscles, what angle (first 30 supraspinatus, the deltoid, then trapezius and serratus anterior). Origin, insertion and nerve supply to serratus anterior. Point to the coracoid process on the skeleton and patient. What attaches here?

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 didn’t 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 view (both normal and told so) indentify different bits.

8.    Anatomy: Abdomen describe the different layers of the abdominal wall. Find caecum, appendix, ascending colon fallopian tubes and ovaries on cadaver. Can’t remember other questions. V pleasant helpful examiner.

9.    Anatomy: scenario women had fallen off horse and hit back, I can’t remember all the injuries but you were supposed to be assessing her lower limb. Again examiner was v pleasant. Asked to indentify rectus femoris, vastus lateralis on cadaver. Asked to define femoral triangle/ canal. What runs through. Asked what nerves supply the different compartments of the leg. Significance of distribution of parastheisa (L5) and what else I’d like to assess other than her leg.

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 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

Oesophagus anatomy and venous anastomosis at its lower end.

Carotid artery anatomy and branches.

Hypoglossal nerve and its injury.

Carina and its level

Cranial foramina and cavernous sinus anatomy and thrombosis.

Femoral triangle and adductor canal  

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 3rd 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.

Anatomy – cervical spine – shown a C2 and asked to name it and why it is C2, asked questions about parts and then general questions about bony anatomy of cervical spine – also hyoid bone and cricoid, also asked about ligaments around odontoid peg.

Anatomy – Upper limb – given a radiograph of a young boys elbow showing a supracondylar fracture – asked about assessing the limb and then asked to demonstrate brachial artery, median nerve, ulnar nerve , radial nerve. Then asked about the previous nerves in terms of nerve injury and respective loss of function etc.

Anatomy – Abdomen – torso – asked to show external oblique, internal oblique, show the appendix, caecum and terminal ileum and ascending colon. Asked to demonstrate fallopian tube and ovary. Asked about positions of appendix, asked about appendicitis and why pain localizes from central to RIF, asked why hip extension makes pain worse.

1.Anatomy- Thorax

Scenario regarding stab wound to thorax- asked to point out structures in heart- RA, 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.

Anatomy – cervical spine – shown a C2 and asked to name it and why it is C2, asked questions about parts and then general questions about bony anatomy of cervical spine – also hyoid bone and cricoid, also asked about ligaments around odontoid peg.

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.

Anatomy – Upper limb – given a radiograph of a young boys elbow showing a supracondylar fracture – asked about assessing the limb and then asked to demonstrate brachial artery, median nerve, ulnar nerve , radial nerve. Then asked about the previous nerves in terms of nerve injury and respective loss of function etc.

Anatomy – Abdomen – torso – asked to show external oblique, internal oblique, show the appendix, caecum and terminal ileum and ascending colon. Asked to demonstrate fallopian tube and ovary. Asked about positions of appendix, asked about appendicitis and why pain localizes from central to RIF, asked why hip extension makes pain worse.

1.Anatomy- Thorax

Scenario regarding stab wound to thorax- asked to point out structures in heart- RA, 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 3rd 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.

2. 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

3. 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.