OBJECTIVES GLOSSARY - Define the following:

1. 2. 3. 4. 5. 6. 7.
8.

9. 10. 11. 12. 13. 14. 15. 16. 17.

20. 21.
22.

23. 24. 25. 26. 27.

29. 30. 31.

33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45.

Achalasia Agenesis Anastomosis Anhydrosis Ascites Atresia Borborygmi -centesis (Thoracocentesis, Pericardiocentesis, Amniocentesis) Cephalalgia Cholecystolithiasis Choledocholithiasis Cirrhosis Cyanosis Cyst Deglutition Dysphagia Dyspnea -ectomy (Appendectomy, Prostatectomy, Cholecystectomy, Tonsillectomy) Oedema Epistaxis Fistula Haemothorax Hernia Hypertrophy Hypoplasia Hypertension Hyperplasia -itis (Cholecystitis, Pancreatitis, Peritonitis, Pleuritis, Pericarditis) Ileus (dynamic versus adynamic) Infarction Intussussception Ischaemia Labyrinthine hydrops (Meniere disease) Pleural effusion Pneumothorax Quinsy Somatic Spondylolysis Spondylolisthesis Stenosis Valgus Varus Varicosity Visceral/splanchnic Volvulus

1. GENERAL EMBRYOLOGY 1.1 Ovulation, Fertilisation and Implantation 1. Describe the ovarian and menstrual cycles, explaining how they are linked. 2. Explain how the date for delivery is calculated from the last menstrual cycle. 3. Describe the clinical significance of the sperm count. 4. Describe the phases and results of fertilisation. 5. Discuss cleavage of the zygote and formation of the blastocyst. 6. Describe early implantation of the blastocyst. 1.2 Bilaminar Embryo, Gastrulation, Somites, and Folding of the Embryo 1. Describe implantation of the blastocyst. 2. Describe ectopic pregnancy including placenta previa. 3. Discuss the differentiation of the trophoblast, formation of lacunar networks and the establishment of a primordial uteroplacental circulation. 4. Trace development of the amniotic cavity, bilaminar embryo, umbilical vesicle, extraembryonic mesoderm, chorionic villi, and connecting stalk. 5. Describe the process of gastrulation and formation of the three germ layers. 6. Describe the development of the notochord and induction of the neural plate. 7. Describe the fate of the intraembryonic mesoderm, including the development of the somites and intraembryonic coelom. 8. Describe the formation of early embryonic blood vessels. 9. Describe the folding of the embryo. 10. Describe the development of sacrococcygeal teratomas. 11. Describe a hydatiform mole and its association with choriocarcinoma. 1.3 Placenta and Foetal Membranes 12. Describe the formation of the placenta. 13. Describe the foetomaternal junction. 14. Describe the placental circulation. 15. Describe how the amniotic fluid is produced and circulates. 16. Describe oligohydramnios and polyhydramnios and associated conditions. 17. Describe the development of the allantois and the foetal membranes. 18. Describe the cause of haemolytic disease (erythroblastosis foetalis) 1.4 Pharyngeal Arch Arteries; Foetal Circulation 1. Summarise the major events in the transformation of the pharyngeal arch system into the adult arterial pattern. 2. Discuss the relatively common aortic arch anomalies, especially patent ductus arteriosus and coarctation of the aorta. 3. Outline the embryologic basis of double aortic arch, right aortic arch, and retroesophageal subclavian artery. 4. Describe the foetal circulation and the changes that normally occur at birth. 5. Explain how coarctation of the aorta results in a difference between femoral and radial pulses and in notching of the ribs. 6. Describe the embryologic origin of coarctation of the aorta.

2. BACK 2.1 Superficial Back 1. Define a dermatome, a myotome and a spinal nerve. 2. List the major bony landmarks of the scapula and clavicle. 3. Describe the general difference in function between the superficial (extrinsic) and deep (intrinsic) muscles of the back. 4. Describe the general attachments, innervations, functions and blood supply of the five superficial muscles of the back. 5. Describe the cutaneous innervation of the back. 6. Describe the location of the nodes into which lymphatics of the skin of the back drain. 7. Describe the signs and symptoms of a lesion to the spinal accessory, dorsal scapular, long thoracic, thoracodorsal and axillary nerves. 8. List the borders of the triangle of auscultation and define its clinical significance. 2.2 Deep Back 1. Describe the general attachments, innervations, functions and blood supply of the erector spinae muscles. 2. Describe the general location, innervation and actions of transversospinalis muscles. 3. Explain how the intrinsic back muscles function unilaterally and bilaterally. 4. Describe the general extent of the thoracolumbar fascia and how it encloses the intrinsic muscles of the back. 5. Explain the functional loss resulting from nerve lesions to the intrinsic back muscles. 6. Describe the triangle of Petit and its clinical significance. 2.3 Vertebral Column and Spinal Cord 1. List the major features of typical cervical, thoracic and lumbar vertebrae. 2. List the major features of the sacrum and coccyx. 3. Describe the distinguishing features of the atlas and the axis. 4. Describe the joints between the atlas, axis and skull. 5. Describe the movements between the atlas, axis and skull. 6. Describe the function of the transverse and alar ligaments of the atlas. 7. Describe the five ligaments that support the vertebral column. 8. Describe the joints found between typical vertebrae. 9. Describe the movements between typical vertebrae. 10. Describe the normal curvatures of the vertebral column and their development. 11. Describe scoliosis, kyphosis and lordosis. 12. Describe the general anatomy of a cross section of the spinal cord. 13. Describe the difference between spinal gray matter and spinal white matter. 14. List the spinal cord segments where the dorsal (posterior) horn is found. 15. List the spinal cord segments where the lateral horn is found. 16. List the spinal cord segments where the ventral (anterior) horn is found. 17. Describe the functional modalities associated with ventral, dorsal and lateral horns. 18. Describe the extent, attachments and spaces of the spinal meninges. 19. Describe the extent and the contents of the dural sac (lumbar cistern). 20. Describe the extent and attachments of the filum terminale and denticulate ligaments.

21. Describe the changes in vertebral level of the conus medullaris from 8 weeks to 24 weeks to newborn to adult. 22. Describe between which vertebrae a lumbar puncture (spinal tap) should be performed in an infant and in an adult, and why. 23. List the structures the needle would pierce in a lumbar puncture. 24. Describe the blood supply of the spinal cord and its clinical significance. 25. Describe the location and function of the internal vertebral venous plexus (of Batson) and its role in the spread of infections and/or cancer. 26. Describe the nerve impingements, and their consequences, resulting from disc herniations in the cervical, thoracic and lumbar regions. 27. Describe the major anatomical features of the vertebral column, spinal cord, nerves and meninges in CT, MRI and Radiographic images. 28. Describe the anatomical landmarks used for lumbar and sacral epidural anaesthesia. 29. List the neurological signs and symptoms of spondylolysis and spondylolisthesis of the L5 vertebra. 30. Describe the structure of the intervertebral disc. 31. Describe the embryological origin of the vertebrae and intervertebral discs. 32. Describe locations of primary and secondary ossification centres of typical vertebrae. 33. Describe the formation of the neural plate and define the term neuroectoderm. 34. Describe the major steps in formation of the neural tube and neural crest. 35. List the derivatives of the neural tube. 36. List the nervous system derivatives of the neural crest cells. 37. Describe the three zones which form in the neural tube. 38. Explain how each of these zones contributes to formation of the spinal cord. 39. Outline the embryological origin of the cellular components of the spinal cord. 40. Describe the development of the meninges. 41. List common causes of neural tube defects. 42. Describe the basic anatomy, mechanisms and severity of spina bifida occulta, spina bifida with meningocoele, spina bifida with meningomyelocoele and spinal bifida with myeloschisis. 43. Describe the embryological origin of chordoma. 44. Outline the embryological bases for the development of brevicollis (Klippel-Feil), hemivertebra (with scoliosis) and rachischisis. 45. List the two most common locations of accessory ribs and their clinical significance. 46. Describe a lumbarised sacral, and a sacralised lumbar, vertebra. 47. Describe the anatomical location and mechanism of a Jefferson (burst) fracture. 48. Describe the anatomical location and mechanism of a Hangmans fracture. 2.4 Spinal Nerves and Somatic Plexus 1. Provide a general definition of spinal nerves and cranial nerves. 2. Define sensory/afferent, motor/efferent, somatic/parietal, visceral/splanchnic, ganglion and nucleus. 3. Explain the terms somatic afferent, visceral afferent, somatic efferent, and visceral efferent as they apply to nerve fibres found in spinal nerves. 4. List the targets of each of the nerve fibre types found in spinal nerves. 5. Compare and contrast visceral afferents versus somatic afferents.

6. Compare and contrast visceral efferents versus somatic efferents. 7. Describe the formation and branches of a typical spinal nerve, including communicating branches to/from the sympathetic chain. 8. Explain the differences between dorsal/ventral roots and dorsal/ventral rami of typical spinal nerves, and list the sensory and motor fibres contained in each. 9. Describe a dorsal root ganglion and a typical afferent neuron. 10. Describe the anatomical sites of formation of somatic and visceral motor and sensory neurons from neuroblasts. 11. Describe the basic process of myelination and list the cell types responsible for myelination in the CNS versus the PNS. 12. Describe the distribution of a typical spinal nerve and its branches, including cutaneous branches. 13. Explain the relationship between dermatomes and the emergence/appearance of herpes zoster (shingles). 14. Explain how spinal nerves exit the vertebral canal in cervical, thoracic, lumbar, sacral and coccygeal regions 15. Describe a posterolateral herniation of the nucleus pulposus and predict the specific spinal nerve most likely to be injured/compressed by such a herniation in the cervical, thoracic and lumbar regions. 16. Describe the organisation and composition of a somatic nerve plexus. 17. List the nerve fibre types found in a typical nerve branch of a somatic plexus. 18. Explain the different consequences of an injury to a mixed spinal nerve versus an injury to a peripheral nerve branch of a somatic plexus. 3. PECTORAL REGION AND UPPER LIMB 3.1 Pectoral Region and Breast 1. List the general attachments, innervations, blood supply and actions of the muscles of the anterior chest wall. 2. Explain the effects of lesions to nerves innervating anterior chest wall muscles. 3. Describe the cutaneous innervation of the anterior chest wall. 4. Explain why blocking a single thoracic nerve will not result in any loss of sensation. 5. Describe the location, innervation, blood supply and lymphatic drainage of the mammary gland. 6. Explain the importance of the lymphatic drainage of a cancerous mammary gland. 7. Explain the symptoms and signs of peau dorange. 8. Describe polythelia and polymastia and their clinical significance. 9. Describe the milk line and explain its clinical significance. 10. Explain which clinical impairments could be caused by a cervical rib. 11. Describe the developmental anomalies in a child with Poland syndrome.

3.2. Axilla and Brachial Plexus 1. Describe the location of the axilla and what constitutes its medial, lateral, anterior and posterior boundaries (walls) and its apex. 2. Describe the apex of axilla and the cervicoaxillary sheath and explain how the contents of the axilla are continuous with structures in the neck the upper limb. 3. List the general attachments, innervations and actions of the muscles that contribute to the walls of the axilla. 4. Describe the functional loss of the muscles of the axillary walls resulting from lesions to the nerves innervating these muscles. 5. Define the extent of the axillary artery and axillary vein. 6. Describe the three parts of the axillary artery, their branches and distribution. 7. List the arteries involved in anastomosis around the scapula, and describe the importance of this anastomosis for collateral circulation. 8. Describe how blood may reach the upper limb if the 2nd part of the axillary artery is ligated. 9. Describe the clinical significance of the axillary sheath in local anaesthesia. 10. Describe the anatomical relationships that are important for successful insertion of a catheter for central venous access (infraclavicular subclavian venipuncture). 11. Describe the signs and symptoms of thoracic outlet syndrome. 12. Describe the lymphatic drainage of the walls of the axilla. 13. Describe the pattern of lymphatic drainage of the upper limb. 14. List the areas for examination in both males and females with enlarged axillary lymph nodes. 15. Describe the organisation of the brachial plexus from roots to terminal branches. 16. Define the terms pre-fixed and post-fixed brachial plexus. 17. List the fibre types that are present in the branches of the brachial plexus. 18. Describe the signs and symptoms of an upper brachial plexus lesion. 19. Describe the signs and symptoms of upper brachial plexus lesions when the C7 ventral ramus is involved. 20. Describe the signs and symptoms of a lower brachial plexus lesion. 21. Explain how a cervical rib may contribute to development of a lower brachial plexus lesion. 22. Describe the signs and symptoms of lesions of the medial, lateral and posterior cords of the brachial plexus. 23. Explain why lymphoedema may result from breast cancer surgery. 3.3 Shoulder and Arm 1. Describe the cutaneous innervation of the shoulder and arm. 2. List/identify the major anatomical features of the humerus. 3. Identify, name and correctly orient the bones forming the shoulder girdle and the shoulder joint. 4. Identify the bones of the shoulder girdle and shoulder joint in CT, MRI and X-ray images. 5. List the major ligaments that contribute to the stability of the glenohumeral joint. 6. Describe the location of subacromial and subscapular bursae at the shoulder joint.

7. List the attachments, innervations and actions of the muscles that act on the shoulder joint. 8. Describe the rotator cuff muscles and their function in maintaining the stability of the shoulder joint. 9. Explain the functional loss of the muscles of the shoulder and arm resulting from nerve lesions to these muscles. 10. Explain why the shoulder joint can be easily dislocated. 11. Describe shoulder dislocation injuries, particularly antero-inferior dislocations, and explain the nerve injuries that might accompany shoulder dislocations. 12. Describe the ligamentous injuries in acromioclavicular (shoulder) separation. 13. Describe the signs of acromioclavicular separation. 14. Describe the signs of calcific supraspinatus tendonitis. 15. Describe the compartments of the arm and the contents of each. 16. List the attachments, innervations, blood supply and actions of the muscles that act on the elbow joint. 17. Describe the origin and distributions of the nerves that course through the arm. 18. Describe the course of the brachial artery and its branches. 19. Describe the arterial anastomosis of the elbow. 20. Explain the potential clinical consequences of fractures at the surgical neck, midshaft, supracondylar, and medial epicondylar regions of the humerus. 21. Describe the cause and signs of Volkmanns ischaemic contracture. 22. Describe the bony and ligamentous anatomy of the elbow joint. 23. Describe the borders of the cubital fossa, its contents and their relationships. 24. Describe the superficial venous drainage of the arm. 25. Explain which nerves are at risk during intravenous access to the basilic or cephalic veins in the cubital fossa. 26. Identify the bones of the arm and elbow joint in CT, MRI and X-ray images. 27. Describe the motor and sensory deficits resulting from lesions of the median, musculocutaneous, radial, and ulnar nerves in the arm. 28. List the sites commonly used for venipuncture in the upper limb. 29. Describe the basic mechanism of radial head subluxation (nursemaids elbow) in small children. 3.4 Forearm and Hand 1. Describe the cutaneous innervation of the forearm and hand. 2. Explain how nerves with cutaneous distribution in the hand supply a digit. 3. Describe the superficial venous and lymphatic drainage of the forearm and hand. 4. Identify the bones of the forearm and hand in CT, MRI and X-ray images. 5. Describe the movements that occur at the radioulnar joints and at the wrist joint. 6. Describe the articulations between distal radius and the proximal row of carpals. 7. Describe the general arrangement of articulations between the distal row of carpal bones and the metacarpals. 8. List the general attachments, innervations, blood supply and actions of muscles in the flexor and extensor compartments of the forearm. 9. Describe the course of median, ulnar and radial nerves in the forearm and hand. 10. Describe the boundaries and contents of the anatomical snuff box.

11. Describe the course of the radial and ulnar arteries in the forearm and hand. 12. Describe the landmarks used when taking the radial pulse. 13. Describe the contribution, and clinical significance, of the superficial and deep palmar arterial arches in blood supply of the hand. 14. List the attachments, innervations, blood supply and actions of the intrinsic muscles of the hand. 15. Describe the movements of the thumb and of digits II-V. 16. Describe the tendon sheaths/bursae in the hand and fingers and their importance in the spread of infections. 17. Explain the anatomical mechanism of carpal tunnel syndrome . 18. Describe the signs and symptoms of carpal tunnel syndrome. 19. Explain the importance of the Allen Test. 20. List the steps in performing an Allen Test. 21. Describe tests for integrity of the median, ulnar and radial nerves in the forearm. 22. Describe tests for integrity of the median and ulnar nerves in the hand. 23. Recognise and describe mallet finger, Swan neck deformity and Boutonniere deformity on a radiograph. 24. Describe the signs and symptoms of lesions of the radial, median and ulnar nerves in the forearm. 25. Describe signs and symptoms of lesions of median and ulnar nerves at the wrist. 26. Describe the signs and symptoms of recurrent median nerve injury in the palm. 27. Explain why radial nerve injury at/above the elbow decreases grip strength. 28. Recognise and describe a Colles, Smith and Boxers fracture on a radiograph. 29. Describe the presentation of Dupuytrens contracture and trigger finger (stenosing tenosynovitis). 30. Describe the cause of ulnar claw-hand deformity. 31. List the commonly fractured and most commonly dislocated bones in the carpus. 32. List the most commonly fractured bone of the upper limb. 4. THORAX 4. 1 Thoracic Wall 1. Describe the dermatomes of the thoracic wall. 2. Describe the skeletal framework of the thoracic wall. 3. Describe the boundaries of the superior thoracic aperture (thoracic inlet) and the inferior thoracic aperture (thoracic outlet). 4. Describe the costovertebral, sternocostal and sternoclavicular joints. 5. List general attachments, innervations and actions of the intercostal muscles. 6. List the muscles that act in forced expiration. 7. List the accessory muscles of respiration. 8. List the layers of the thoracic wall from skin to the parietal pleura. 9. Describe the arterial supply, venous and lymphatic drainage of the thoracic wall.

Describe the course of the intercostal neurovascular bundle in relation to thoracocentesis, or in relation to administering local anaesthetic for a rib fracture. 11. Identify the major features of the thoracic wall in radiographic imagery. 4.2 Pleura and Lungs 1. Describe the location of parietal and visceral pleura and where they meet. 2. List the recesses formed by the pleural reflections. 3. Differentiate between the thoracic cavity and the pleural cavity. 4. Describe the relationship of the lungs to the pleural cavity. 5. Describe the surface projections (rib level) of the visceral and parietal pleura. 6. Explain the importance of the pleural recesses in thoracocentesis. 7. Differentiate between bucket-handle and pump-handle movement of the ribs during respiration. 8. Describe the blood supply and innervation of the parietal pleura. 9. List the identifying features of the right and left lungs. 10. List the surfaces and borders of the lungs. 11. Describe the surface projections (rib level) of the lobes and fissures of the lungs. 12. Differentiate between the root and hilum of the lung. 13. Describe the relationship of the structures in the root of each lung. 14. Describe the typical branching pattern of the bronchial tree. 15. Define a bronchopulmonary segment and understand its clinical importance. 16. Describe the arterial supply, venous and lymphatic drainage, and innervation of the lungs and the bronchial tree. 17. Identify the major anatomical features of the lungs in radiographic images. 18. Compare and contrast the mechanism underlying spontaneous and tension pneumothorax. 19. Explain how diaphragmatic pain may be referred to the shoulder as shoulder tip pain, and list the possible sites of the origin of the pain. 20. Explain the distribution of herpes zoster eruptions on the thoracic wall. 21. List the intercostal spaces where thoracocentesis can be safely performed at the midclavicular, midaxillary and paravertebral lines. 22. Explain why pleurisy (pleuritis) causes localised pain. 23. Describe the location of pleural effusion versus pulmonary oedema. 24. Explain why an aspirated foreign body would usually pass into the right bronchus. 25. List the germ layers contributing to the formation of the respiratory tract. 26. Describe the development of the larynx, trachea, bronchial tree and lungs. 27. Describe the stages of lung development. 28. Name the site of production, and the role of, surfactant. 29. Summarise the changes that occur in the respiratory system at birth. 30. Explain the embryological basis for laryngeal atresia, tracheal and esophageal stenosis and atresia, tracheoesophageal fistula, and respiratory distress syndrome. 31. Describe the parts of the diaphragm.
10.

32.

Describe the development of the diaphragm. 33. Explain the embryological mechanism for eventration and for all types of congenital diaphragmatic hernia. 34. Describe the division of the coelom into pleural, pericardial and peritoneal cavities. 4.3 Introduction to Autonomics 1. List the three target tissues of visceromotor (ANS) fibres. 2. Differentiate between a nucleus and a ganglion. 3. Define the terms preganglionic (presynaptic) and postganglionic (postsynaptic). 4. List the four cranial nerves that contain preganglionic parasympathetic fibres. 5. List the cord segments containing cell bodies of preganglionic sympathetic fibres. 6.List the cord segments containing cell bodies of preganglionic parasympathetic fibres. 7.Describe the course of a preganglionic parasympathetic fibre from its origin to a parasympathetic ganglion in the walls of thoracic viscera. 8. Describe the location and extent of the sympathetic trunk. 9.Describe the course of a preganglionic sympathetic fibre from its origin to its synapse in the sympathetic trunk or a preaortic ganglion. 10. Describe the pathways of sympathetic fibres innervating the body wall, thoracic viscera, and abdominopelvic viscera. 11. Describe the course of visceral sensory fibres traveling with sympathetic nerves, and the location of their cell bodies. 12. Describe the mechanism of referred pain. 4.4. Heart and Pericardium 1. Describe the location of the heart in the mediastinum. 2. List the pericardial coverings of the heart. 3. Describe the extent, and attachments, of the fibrous pericardium (pericardial sac). 4. Describe the arterial supply of the fibrous pericardium. 5. List the surfaces and margins of the heart and the chambers/structures that contribute to them. 6. Describe the anatomy of the heart chambers and their relationship to one another and to adjacent structures. 7. Describe the arterial supply and venous drainage of the heart. 8. Describe the pattern of venous blood flow from the upper limb to the right atrium. 9. Describe the innervation of the heart. 10. Describe the course of pain fibres from the heart to the CNS 11. Differentiate between the pathways used by visceral afferent fibres carrying pain versus physiologic sensation from the heart to the CNS.

10

12. Explain why the pain of a myocardial infarction maybe referred to the upper limb. 13. Explain how cardiac pain differs from intercostal pain. 14. Describe the surface projections of the heart and the heart valves. 15. Identify the auscultation sites for heart valve sounds and explain why these sites differ from the anatomic location of the valves. 16. Describe the path of blood flow through the heart. 17. Identify the parts of myocardium affected by occlusion of any of the coronary arteries. 18. Differentiate between the systemic and the pulmonary circulation. 19. Identify the major anatomical features of the heart and great vessels in radiographic images, CT and MRI. 20. Describe the clinical significance of the transverse pericardial sinus. 21. Describe the importance of the aortic sinuses for continuous myocardial perfusion. 22. Define cardiac tamponade. 23. Describe pericardiocentesis for the alleviation of cardiac tamponade. 24. Describe anatomical explanations for the three cardinal signs of cardiac tamponade. 25. Explain why a paraxiphoid approach is used to alleviate cardiac tamponade and list the structures that the needle will pierce. 26. Explain why swallowing a sharp object might pierce the heart and into which chamber it could enter. 27. Describe the formation of the transverse pericardial sinus. 28. List the subdivisions of the tubular heart. 29. Describe the partitioning of the atrioventricular canal. 30. Describe the partitioning of the bulbus cordis and truncus arteriosus by the aorticopulmonary septum. 31. Describe the fate of the sinus venosus. 32. Describe the formation of the right and left atria. 33. Describe the development of the interatrial septum. 34. Describe the partitioning of the common ventricle. 35. Describe the development of the heart valves. 36. List the cardiac structures derived from the neural crest cells. 37. Explain the fate of vitelline, umbilical and cardinal vessels. 38. Describe the foetal circulation and discuss the changes that occur at birth. 39. Describe the two types of ventricular septal defect. 40. Describe the four types of atrial septal defects. 41. List the most common heart defects in Down syndrome. 42. Describe the difference between dextrocardia and situs inversus. 43. Describe the development underlying ectopia cordis, persistent truncus arteriosus, transposition of the great arteries, tetralogy of Fallot, patent ductus arteriosus. 44. List left-to-right shunts in congenital heart defects and explain why they are generally acyanotic.

11

45. List right-to-left shunts in congenital heart defects and explain why they are generally cyanotic. 4.5 Mediastinum 1. Describe the subdivisions of the mediastinum and their boundaries. 2. List the structures found in the superior, anterior, middle and posterior mediastinum and their relationships to one another. 3. Describe the relationships of the esophagus, trachea and thoracic duct in the superior mediastinum. 4. Describe the typical branches of the aortic arch in the superior mediastinum. 5. Describe the relationship of phrenic nerves to the aortic arch and root of the lung. 6. Describe the relationship of the vagus nerves to aortic arch, root of lung, esophagus. 7. Describe the course of the right and left recurrent laryngeal nerves in the thorax. 8. List the structures that are found at the plane of Ludwig. 9. Describe the four normal constrictions of the esophagus. 10. Describe the arterial supply, innervation, venous and lymphatic drainage of the thoracic and abdominal portions of the esophagus. 11. Describe the azygos system of veins and their typical pattern of drainage. 12. Describe the origin of the greater, lesser and least splanchnic nerves. 13. Identify, in images, the major structures found in the mediastinum. 14. List the normal openings in the diaphragm and their approximate vertebral level. 5. ABDOMEN 5.1 Anterior Abdominal Wall 1. Describe the bony boundaries of the anterolateral abdominal wall. 2. Describe the division of the anterolateral abdominal wall into four clinical quadrants and nine anatomical regions. 3. Describe the location of major abdominal organs and vessels in the four quadrants and in the nine regions of the abdomen. 4. Describe the blood supply, lymphatic drainage and cutaneous innervation of the abdominal wall. 5. List the layers of the superficial fascia and describe their locations. 6. List the general attachment, blood supply, innervation, and function of the muscles of the anterolateral abdominal wall. 7. Explain how venous blood may reach the right atrium when the IVC is obstructed. 8. Describe how the aponeuroses of the anterolateral wall muscles contribute to the anterior and posterior layers of the rectus sheath. 9. Describe the inguinal ligament and its attachment sites. 10.Explain the surgical significance of the intersection of the right semilunar line and the costal margin. 11.Explain the surgical significance of "McBurneys point". 12.Explain the surgical approach through the layers of the abdominal wall to an inflamed appendix and the surgical significance of the muscle fibre orientation.

12

13.Describe the anatomy of the superficial and deep inguinal rings. 14.Describe the process of testicular descent into the scrotal sac. 15.Describe the structure and contents of the spermatic cord. 16.Describe the boundaries of the inguinal triangle (of Hesselbach) and its clinical significance. 17.Explain the difference between a direct and an indirect inguinal hernia. 18.Describe the fate of the processus vaginalis and its role in indirect inguinal hernias. 19.Explain why pain from an inguinal hernia occurs at the site of the hernia. 20.Define cryptorchidism and explain the problems associated with the condition. 21.Explain the advantage of performing vertical surgical incisions on the midline. 22.Compare and contrast the location of an epigastric versus an umbilical hernia. 23. Describe the cremasteric reflex arc following stimulation of the anterior scrotal sac. 24.Explain why a blow to the testis is felt around the umbilicus. 25.Explain why the initial pain of appendicitis is felt around the umbilicus. 26.List the dermatomes which overlie the xiphoid process, umbilicus and pubis. 27.Describe the dermatomes for pain distribution from various abdominal viscera and explain how the pain is referred to the abdominal wall. 28.Describe the development and clinical picture of gastroschisis. 5.2 Peritoneal Cavity 1. Describe the parietal and visceral peritoneum. 2. Describe the extent of the peritoneal cavity, the greater and lesser sacs, and the omental (epiploic) foramen (of Winslow). 3. Describe the location of the paracolic gutters, the vesicouterine pouch, rectouterine pouch (of Douglas) and hepatorenal pouch (of Morrison) in the peritoneal cavity. 4. Describe the following peritoneal mesenteries and the abdominal organs they enclose/suspend: the mesentery, transverse mesocolon and sigmoid mesocolon. 5. Describe the following peritoneal ligaments and the abdominal organs they enclose/suspend: falciform, round ligament of the liver (ligamentum teres hepatis), coronary, triangular, median, medial and lateral umbilical, greater omentum, gastrocolic, gastrosplenic, splenorenal ligaments, lesser omentum (hepatoduodenal and hepatogastric ligaments) and suspensory ligament of the duodenum (Treitz). 6. Describe the difference between intraperitoneal and retroperitoneal abdominal organs. 7. Explain where free air in the peritoneal cavity can accumulate. 5.3 Gastrointestinal Tract 1. Describe the stomach and identify its parts and curvatures. 2. Describe the relationship of the stomach to the spleen, pancreas, liver, and colon. 3. Describe the blood supply and the venous and lymphatic drainage of the stomach. 4. Describe the location of the duodenum and its relationship to surrounding organs. 5. Describe the blood supply and the venous and lymphatic drainage of the duodenum. 6. Describe the location of the jejunum and ileum. 7. Describe blood supply and venous and lymphatic drainage of the jejunum and ileum. 8. Describe the location of the large intestine and its relationship to surrounding organs.

13

9. Describe the blood supply and the venous and lymphatic drainage of the large bowel. 10. Describe the sympathetic, parasympathetic and sensory innervation of the foregut, midgut and hind gut. 11. Describe the anastamotic communications between vessels of the foregut and midgut and between vessels of the midgut and hindgut. 12. Explain why surgical resection of the ascending or descending colon should be done in the lateral paracolic gutters. 13. Compare and contrast where stomach contents from a perforation of the posterior, versus the anterior, stomach wall will initially accumulate. 14. List vessels which may be eroded in ulceration of the posterior wall of the stomach. 15. Determine the large artery at risk for injury/haemorrhage by a perforated ulcer in the posterior wall of the duodenal cap (1st part of dudenum). 16. Determine the lymph nodes that may drain tumours in various parts of the small and large intestine. 17. Explain which parts of the GI tract may become involved in volvulus. 18. Explain how the hind gut receives its blood supply after repair of an abdominal aortic aneurysm since the inferior mesenteric artery is usually sacrificed in the procedure. 19. Describe the development of an ileal (Meckel) diverticulum. 20. List the structures in the hepatoduodenal ligament that will be gripped during a Pringle manoeuver. 21. Describe the mechanism for development of megacolon (Hirchsprungs disease). 22. Describe the importance of the ligamentum venosum in the foetal circulation. 23. Describe the derivatives of the embryonic foregut, midgut and hindgut. 24. Explain the development of an omphalocoele. 25. Compare and contrast the development and clinical picture of congenital hypertrophic pyloric stenosis versus duodenal stenosis. 26. Describe the development and clinical picture of duodenal atresia. 27. Describe the nerve pathways for pain in a patient with gastroesophageal reflux disease (Barretts esophagus) 5.4 Liver, Pancreas, Spleen 1. Describe the location of the liver and its relationship to surrounding structures. 2. Describe the four anatomical lobes of the liver. 3. Describe the functional (physiological) lobes of the liver. 4. List the structures entering/leaving the liver at the porta hepatis. 5. List the branches of the coeliac trunk and their area of supply. 6. Describe the arterial supply of the liver, gall bladder and cystic duct. 7. Describe the bare area of the liver. 8. Describe the location of the gall bladder and its relationship to the liver. 9. Describe the anatomy of the biliary tree. 10. Describe the blood supply, venous and lymphatic drainage of liver and gall bladder. 11. List the three common sites where gall stones can be impacted (lodged) and explain the effects of each on bile flow. 12. Explain how the pain from an inflamed gallbladder can refer to the shoulder. 13. Explain the pathway taken by an endoscope from the mouth to the biliary tree during Endoscopic Retrograde CholangioPancreatography (ERCP) to remove a gallstone.

14

14. List the borders of the triangle of Calot and state the importance of this triangle when performing laparoscopic surgery for gallbladder disease. 15. Describe the location of the pancreas and its relationship to surrounding structures. 16. Describe the blood supply and the venous and lymphatic drainage of the pancreas. 17. Describe how pancreatic enzymes flow to the duodenum. 18. Describe the location of the spleen and its relationship to surrounding structures. 19. Describe the blood supply and the venous and lymphatic drainage of the spleen. 20. List the areas of portocaval anastomosis and describe how these areas may decompress (alleviate) portal hypertension. 21. Explain how portal hypertension can create varicosities and where these can occur. 22. Explain which caval vein can be anastomosed with the splenic vein to create a portocaval shunt to decompress portal hypertension. 23. Identify, in radiological images, the liver, pancreas and spleen, their blood supply and adjacent abdominal structures. 24. Describe the rotation of the foregut and midgut during development. 25. Describe how jaundice can occur with respect to drainage through the extrahepatic biliary system. 26. Describe the contents of a liver segment and its importance in surgery of the liver. 27. Describe the embryologic mechanism responsible for an anular pancreas.

5.5 Posterior Abdominal Wall 1. Describe the boundaries of the posterior abdominal wall. 2. Describe the attachment, and the peritoneal lining, of the diaphragm. 3. Describe the innervation and blood supply of the diaphragm. 4. List the innervations, blood supply, general attachments and actions of the muscles of the posterior abdominal wall. 5. Describe the origin of the lumbar plexus and list its branches and their distribution. 6. Describe the abdominal aorta and its parietal and visceral branches. 7. List the approximate vertebral levels of the visceral branches of the abdominal aorta and its bifurcation into the common iliac arteries. 8. Describe the inferior vena cava and its tributaries, and list the vertebral level where it begins from the common iliac veins. 9. Describe the cisterna chili, and the course and termination of the thoracic duct. 10. Describe the location of the kidneys and their relationship with surrounding organs and ribs 11 and 12. 11. Describe the relationship of the kidneys to the diaphragm, psoas major, quadratus lumborum and transversus abdominis aponeurosis. 12. Describe the kidneys in relation to the renal fascia, perirenal and pararenal fat. 13. Describe the anatomy of the cortex and medulla of the kidney. 14. Describe the flow of urine from the renal papillae to the ureter and urinary bladder. 15. Identify the structures in the hilum of the kidney and their relationship to one another. 16. Identify the course, relationships, blood supply and innervation of the ureters.

15

Describe the blood supply, innervation, venous and lymph drainage of the kidneys. Describe the development, location, blood supply, innervation, venous and lymph drainage of the suprarenal glands. 19. Describe the location and the nerve fibre types in the superior hypogastric plexus. 20. Identify, in radiological images, the structures in the posterior abdominal wall. 21. List the constrictions of the ureters and explain their relationship to kidney stones. 22. Describe the development of the kidney from the metanephric diverticulum and the metanephric mass of mesoderm. 23. Explain the distribution of pain from kidney stones that are impacted in the ureter. 24. Describe the layers of the body wall that would be cut when harvesting a donor kidney using a posterior approach. 25. Describe the development of a discoid (pancake), and a horseshoe, kidney. 26. Describe the development of a bifid or double ureter. 27. Describe the embryologic mechanism responsible for renal agenesis. 28. Describe the psoas sign and explain why it can be positive during appendicitis (psoas sign is not always positive depending on the location of the appendix). 29. Describe how a kidney may have more than one renal artery and how an accessory renal artery may cause hydronephrosis. 30. Describe the development of adrenal hyperplasia. 31. Describe the development of cystic kidney disease.
17. 18.

16