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Quiz

  • 1: what are the boundaries and landmarks of the axilla and how are the positions of the axillary lymph nodes related to those landmarks? What is the drainage pattern of the axillary lymph node groups? What nerves and vessels are likely to be encountered during an operation on the axilla?
    • My answer: Boundaries of the axilla: a) Anterior: pec major, pec minor and associated fascia (anterior axillary fold) b) Lateral: intertubercular groove of humerus c) Medial: upper chest wall and serratus anterior d) Posterior: lat. dorsi and teres major (+ long head of triceps) e) Superior: cervicoaxillary canal (1st rib, upper border of scapula and corocoid process), clavicle f) Inferior: axillary fascia and skin over axilla.
      • Lateral group of lymph nodes (inferolateral limit of axilla), medial/pectoral group (against chest wall), posterior group (against posterior axillary fold) which all drain to central group (in the middle), which then drains to apical group (medially at the cervicoaxillary canal).
      • Might also be useful to cover the complex lymph drainage of the breast (see Ken Ashwell's lecture)
      • Vessel: axillary artery (cts with subclavian above and brachial below), with humeral circumflex branches (note that profunda brachii a. is below axillary level), associated lymphatic vessels.
      • Nerves: long thoracic nerve (to serratus ant.), pectoral nerve (to pectoralis major), all nerves of brachial plexus (from C5 to T1 spinal nerves, musculocutaneous nerve, axillary nerve, radial nerve, ulnar nerve, median nerve)
      • Associated lecture: AEB/Lectures/The lymphatic system
  • 2: where are the major lymph nod groups located in the body and what is the pattern of flow through the lymphatic system of the trunk?
    • Same lecture as above
    • The lymph nodes that are examined in clinical examination represent a relatively small proportion of the total lymph nodes (there are about 40 in the head, and hundreds in the thorax and more in the deep abdomen/pelvis. There are relatively few in the upper limb/lower limb)
    • You can describe all the ones in the head (buccal, submental, submandibular, preauricular, retroauricular, occipital, deep cervical, superficial cervical (ant/post triangles))
    • There are lymph nodes associated with the coeliac artery, SMA, IMA (preaortic), those lateral to the aorta (renal, suprarenal, etc), and those in the posterior abdominal wall. There are lymph nodes associated with the internal and external carotid arteries and the sacrum.
    • In the bowel, there are paracolic, intermediate and inferior mesenteric nodes (drain from out to in)
    • Thorax: deep pulmonary --> bronchopulmonary (hilar) --> tracheobronchial (ant and post) --> paratracheal --> bronchomediastinal --> mediastinal (to which the brachiocephalic nodes drain) --> subclavian trunks
    • Upper right quadrant drains to Rt lymphatic duct, which drains into either the Rt internal jugular v or Rt subclavian or their junction
    • Rest of the thorax/abdomen drains to the thoracic duct, which drains into the Lt internal jugular v or Lt subclavian or their junction
    • Thoracic duct begins at a collection of lymph vessels in the inferior thorax (diaphragm), which is dilated as the cisterna chyli in 20% of people
      • Movements of the diaphragm and thoracic/abdominal organs during respiration push lymph up the thoracic duct, which also has a small amount of smooth muscle
      • Pressure differentials in the brachicephalic vein
  • 3: Outline the structure of the limbic system. What is the role of the limbic system in memory and emotions? How does damage to components of the limbic system in primates affect their behaviour? Use a diagram
  • 4: toad heart prac (see your prac manual)
    • Which of the parts of the trace corresponds to the ventricles being contracted? (Looking at mechanical event)
    • Identify on the diagram point M: the QRS complex, which corresponds to ventricular depolarisation.
    • Which of the time periods labelled A and B best corresponds to absolute refractory period
      • A is during systole, so corresponds to your refractory period
  • 5:
    • the optic disc is located in which direction on the retina relative to the macula?
      • along the axis of the orbit (medial to the macula)
    • when using the right eye to fixate on a cross at a viewing distance of 30cm, where on the page should the blind spot fall?
      • should be lateral to your focus point. Work out the distance using the fact that you have similar triangles
    • a patient has a far point of 50cm. What is the most likely condition? Is this an optical or neural defect, can a lens correct it, and if so what lens is needed?
      • major cause of myopia is neural defect (eyeball too long for lens). Use biconcave lens
    • Assessing stereopsis. If the patient has their own prescription polarising sunglasses, can they wear these instead of the supplied glasses?
    • Should you assess monocular acuity with a Snellen chart before or after the Stereotest? Why?
  • 6: cns rat prac (rote learn this stuff AEB/Pracs/CNS pharmacology)
    • straub tail due to morphine
    • animal showing sedation, ataxia and hypotonia are symptoms of which of the drugs (a: hexobarbital)
    • u receptor in morphine causes analgesia
    • benzodiazapenes cause amnesia
    • amphetamine and cocaine; used for ADHD and narcolepsy
  • 7: histology - elastic artery (aorta). label everythin
    • histology - label the cells zoomed in of the grey matter of the spinal cord
  • 9: anatomy CXR (see this File:CXR2.png)
    • papillary muscles prevent mitral and tricuspid valve prolapse during systole
    • A = optic nerve (Lt)
    • B = occulomotor nerve (Rt)
    • C = Lt trigeminal nerve (sensory part)
    • Lesion of B = down and out eye, ptosis of upper eyelid, no pupillary reflex on that side
    • Cross section = open medulla
      • A = trigeminal nucleus, B = medial lemniscus, C = pyramid containing corticospinal tract
      • B carries discriminative touch, vibration and proprioception from trunk on Lt side of the body
  • 11, labelling, sagittal section (gross) through corpus callosum
    • A=fornix,
    • B = anterior cerebral a.
    • C = periaquiductal grey matter
    • tectum
    • supply of ACA
    • D = calcarine sulcus = primary visual cortex
A similar MRI image (from BrainStorm) shown in the quiz. However, the quiz one showed some arteries, including the anterior cerebral artery. Basically, learn this lecture: AEB/Lectures/Cerebral_blood_supply
  • MRI. A = anterior cerebral artery (supplying insula)
    • B = putamen
    • C = posterior limb of internal capsule
    • D = splenium of corpus