Case 1
Question 2 – Greater sciatic foramen
e. Describe the blood supply to the femoral head. (3 marks)
• Medial femoral circumflex artery – fom deep femoral artery
• Lateral femoral circumflex artery – from deep femoral artery
• Artery to ligamentum teres – branch from obturator artery of MFCA
• Ascending cervical branches giving rise to retinacular arteries
Question 3 – Sciatic nerve
List five common or important variants of the sciatic nerve? (5 marks)
Variations in the common peroneal and tibial branches:
• Common peroneal nerve piercing piriformis muscle and tibial nerve exiting below
• Common peroneal nerve travelling above piriformis muscle and tibial nerve below
• Common peroneal nerve travelling above piriformis muscle and tibial nerve piercing piriformis muscle
• Both common peroneal nerve and tibial nerve travelling below piriformis muscle separately
• Sciatic nerve courses over the piriformis muscle
• Sciatic nerve pierces piriformis muscle
Case 2
Question 2: Spine
b. List the contents of a typical intervertebral (exit) foramen at the level of the mid lumbar spine. (6 marks)
• Spinal nerve roots
• Dorsal root ganglion
• Spinal artery of the segmental artery
• Communicating veins between internal and external plexuses
• Recurrent meningeal nerves
• Transformainal ligaments
c. Which spinal nerve exits between the C2 and C3 vertebrae? (1 mark)
C3
d. Which spinal nerve exits between the C7 and T1 vertebrae? (1 mark)
C8
e. Which spinal nerve exits between the T6 and T7 vertebrae? (1 mark)
T6
f. Which spinal nerve exits between the L5 and S1 vertebrae? (1 mark)
S1
Question 3 – Spinal cord arterial supply
List five (5) common or important variants of the arterial supply to the spinal cord. (5 marks)
• Artery of Adamkiewicz arises on the right side
• Variable origin of artery of Adamkiewicz
– arising from lumbar arteries at level of L1 – L2
– intercostal arteries T5 – T8
• Duplicate anterior spinal arteries
• Single-origin anterior spinal artery from unilateral vertebral artery
• Single or duplicate anterior spinal arteries arising off vascular arcade between vertebral arteries
Case 3
Question 2 – Azygos vein
d. Describe the course of the azygos vein (5 marks)
• Arises at the level of the renal vein (L1 0 L2) as either branch of IVC or confluence of right ascending lumbar and right subcostal vein
• Ascends to the right of the vertebral column entering thoracic cavity via aortic hiatus at T12
• Continues in posterior mediastinum on the anterolateral surface of T12 to T5
• At the level of T4, it arches anteriorly over the hilum of the right lung
• Terminates as it drains into SVC at the upper limit of the pericardium
e. Describe the tributaries of the azygos vein (3 marks)
• Receives all but the first intercostal vein on the right.
– Second, third and fourth intercostal vein drain via the right superior intercostal vein.
• Hemiazygos and accessory azygos vein drain into azygos vein at mid thorcacic level.
• Right bronchial veins drain into azygos vein near its termination
Question 3 – Coronary artery
Name five (5) common or important variants of the coronary arteries. (5 marks)
• Left dominant variant, large left circumflex supplies posterior interventricular artery
• Left coronary artery supplying SA nodal branch (40%)
• LCx supplying AV node
• Coronary artery arising from non-coronary sinus
• Co-dominance of the arteries
• Ramus intermedius – an additional artery arising at the bifurcation of the left main artery
Case 4
Question 3 – Urinary bladder
d. Describe the blood supply to the urinary bladder. (6 marks)
• Upper bladder is supply by superior vesical artery
– branch of anterior division internal iliac artery
• Lower bladder
– Males: inferior vesical artery (branch of anterior division ILA)
– Females: vaginal artery instead of inferior vesical artery (branch of anterior division ILA). Also receives contributions from the uterine artery.
This answer needs improvement.
Question 3 – Male gonads
List five (5) common or important variants of the male gonads and their development. (5 marks)
• Bell clapper deformity – high attachment of tunica vaginalis on spermatic cord
• Arrest of testicular descent
• Polyorchidism
• Testicular appendage
• Both testes in one scrotal sac
Case 5
Question 2 – Liver segments
b. Name the boundaries of the epiploic foramen (of Winslow). (4 marks)
• Anterior: Hepatoduodenal ligament, containing the hepatic triad (common hepatic artery, vein and common bile duct)
• Posterior: Peritoneum overlying IVC
• Medial: Gastrosplenic ligament and splenorenal ligament
• Superior: Caudate lobe of the liver
• Inferior: Peritoneum overlying the commencement of duodenum and hepatic artery
c. Which liver segments are located between the right and middle hepatic veins? (1 mark)
5 & 8
d. Which liver segments does the left hepatic vein drain? (2 marks)
• 2, 3 and occasionally segment 4
f. Which hepatic vein(s) drain segment 1? (1 mark)
• The veins of the caudate lobe are highly inconsistent, varying in number from one to five. When present, they drain the segment I of the liver that corresponds to the caudate lobe. The veins of the caudate lobe terminate by draining directly into the inferior vena cava.
g. What structures define the horizontal plane that divides the superior and inferior liver segments? (1 mark)
Portal vein
Question 3 – Lung fissures & major bronchi
Name five (5) common or important variants of the suprarenal arteries. (5 marks)
• Absent middle suprarenal
• Variable number of superior suprarenal arteries.
• Variable origin of the middle suprarenal artery:
– inferior phrenic artery
– coeliac trunk
– superior mesenteric artery
– renal artery
– lumbar artery
– gonadal artery
• Variable origin of the inferior adrenal artery include:
– terminal branch of renal artery
– from a supplementary renal artery
– off aorta or as a common trunk with middle adrenal artery (12%)
– gonadal artery
– coeliac trunk
Case 6
Question 2 – Middle cerebral artery
d. Describe the four parts of the middle cerebral artery (excluding branches). (4 marks)
• M1: sphenoidal or horizontal segment
– originates at the terminal bifurcation of the internal carotid artery
– courses laterally parallel to the sphenoid ridge
– terminates either: at the genu adjacent to the limen insulae, where it makes a right-angle turn at the main bifurcation
• M2: insular segment
– originates at the genu/limen insulae or the main bifurcation
courses posterosuperiorly in the insular cleft
– terminates at the circular sulcus of insula, where it makes a right angle to hairpin turn
• M3: opercular segment
– originates at the circular sulcus of the insula
– courses laterally along the frontoparietal operculum
– terminates at the external surface of the Sylvian fissure
• M4: cortical segment
– originates at the external/top surface of the Sylvian fissure
– courses superiorly on the lateral convexity
– terminates at their final cortical territory
Question 3 – Corpus callosum
Name five (5) common or important variants of the corpus callosum. (5 marks)
• cavum septum pellucidum
• callosal isthmus
• callosal vascular indentation
• callosal septal and periseptal pseudolesions
• subcallosal pseudomass
Case 7
Question 2 – Paediatric elbow
a. List the average age at which each of the secondary ossification centres appear in order. (6 marks)
C: capitellum – Age 1
R: radial head – Age 3
I: internal/medial epicondyle – Age 5
T: trochlea – Age 7
O: olecranonon – Age 9
E: external/lateral epicondyle – Age 11
Question 3 – Brachial artery
Name five common or important variants of the arterial supply of the hand. (5 marks)
• Brachioradial artery – high origin from brachial artery (~9%)
• High origin from axillary artery
• Cubital crossover – anastomosis between brachioradial artery and normal brachial artery in cubital fossa
• Contribution of radial or brachioradial artery to formation of the superficial palmar arch
• Persistent median artery
Case 8
Question 2
b. Describe the arterial blood supply to the thyroid gland. (4 marks)
• Superior thyroid artery – first branch of the external carotid artery.
• Inferior thyroid artery – arises from the thyrocervical trunk (a branch of the subclavian artery).
• Thyroid ima artery – anatomical variant – arises from the brachiocephalic trunk and supplies the anterior surface and isthmus of the thyroid gland.
Question 3
a. Name three common or important variants of the thyroid gland (excluding vascular variants). (3 marks)
• Ectopic thyroid tissue
• Pyramidal lobe extending to base of tongue
• Thyroglossal cyst or fistula
b. Name two common or important variants of the parathyroid glands (excluding vascular variants). (2 marks)
• Supernumerary glands (15%)
• Ectopic parathyroid gland – most commonly inferior to inferior pole