Case 1
Question 2 – Greater sciatic foramen
What structures exit the pelvis through the greater sciatic foramen? (5.5 marks)
• Sciatic nerve
• Pudendal (re-enters pelvis via lesser sciatic foramen)
• Superior and inferior gluteal artery and vein
• Inferior gluteal nerve
• Posterior femoral cutaneous nerve
Question 3 – Uterine artery
List five (5) common or important uterine variants. (5 marks)
• Unicornuate utertus
• Bicornuate uterus
• Uterine didelphys
• Septate uterus
• Arcuate uterus
Case 2
Question 3 – Superficial lower limb veins
Name five (5) common or important variants of the superficial venous drainage of the lower limb (5 marks).
• Single LSV located within the saphenous compartment with no large parallel tributary
• Single LSV found in the saphenous compartment with a large subcutaneous tributary which pierces the superficial fascia to join the LSV at a variable level in the thigh
• LSV lies within the proximal saphenous compartment while a large subcutaneous tributary is found distally with no other substantial veins visible in the saphenous compartment. Once again, this tributary pierces the saphenous fascia at a variable level in the thigh to join the LSV.
• The LSV is found with the anterior accessory saphenous vein, which runs the lateral aspect of the thigh. Distally located in separate saphenous compartments, these two veins then join and lie within one saphenous compartment before entering the saphenofemoral junction
• Duplication of the LSV in the thigh region (rare)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024826/
Case 3
Question 3 – Lumbosacral segmentation
Name five (5) common or important variants of the superior mesenteric artery (5 marks)
• Arc of Riolan (SMA/IMA connection)
• Replaced common hepatic artery
• Replace left gastric artery
• Replaced splenic artery
• Common ceoliacomesenteric trunk
Case 4
Question 3 – Sacrum
Name five (5) common or important variants of the sacrum (5 marks)
• Angel-wing sacrum
• Accessory sacroiliac joint
• Sacral ribs
• Absence of dorsal wall of sacrum
• Midline cleft of S1
Case 5
Question 2 – Eosophagus
a. Name the structure A causing this depression. Name the 3 other sites of narrowing of the oesophagus? (2 marks)
• Cricopharyngeus muscle (C6)
• Aortic arch (T4)
• Left main bronchus (T5)
• Eosophageal hiatus (T10)
b. Describe the course of the oesophagus in the chest. (6 marks)
Origin
• Inferior border of cricoid cartilage or cricopharyngeus muscle at level of C6
• Continuous with laryngopharynx superiorly
Course
• Descends slightly left of midline, between trachea and vertebral column
• Enters thorax through superior thoracic aperture, descends through posterior mediastinum
• Courses slightly anteriorly following curvature of thoracic spine
• Passes anteriorly to the left near diaphragm to lie anterior to thoracic aorta
• Enters abdominal cavity via the oesophageal hiatus (an opening formed by the right crus of diaphragm) at level of T10
Termination
• Following short intra-abdominal course to the left, joins the cardiac orifice of stomach at level of T11
c. Describe the lymphatic drainage of the oesophagus in the chest. (4 marks)
• Upper third (skeletal muscle): deep cervical nodes
• Middle third (mixed skeletal/smooth muscle): posterior mediastinal nodes
• Lower third (smooth muscle): left gastric and coeliac nodes
Question 3 – Lung fissures & major bronchi
a. Name three (3) common or important variants of the lung fissures. (3 marks)
• azygos fissure (most common) – created when a laterally displaced azygos vein creates a deep pleural fissure into the apical segment of the right upper lobe during embryological development.
• superior or inferior (Twining’s line) accessory fissure
• left horizontal fissure
b. Name two (2) common or important variants of the major bronchi. (2 marks)
• Supernumerary superior segmental bronchus (most common)
• Tracheal bronchus (pig bronchus) – mostly on right side
Case 6
Question 2 – Larynx
e. Describe the innervation of the larynx. (4 marks)
Motor
• all intrinsic muscles: recurrent laryngeal nerve (branch of vagus)
– except cricothyroid (innervated by the external branch of superior laryngeal nerve)
Sensory
• Above vocal cord: internal branch of superior laryngeal nerve
• Below vocal cord: recurrent laryngeal nerve
Sympathetic: via superior and inferior laryngeal arteries from superior and middle sympathetic ganglia
Question 3 – Vertebral arteries
Name five (5) common or important variants of the vertebral arteries. (5 marks)
• asymmetry due to vertebral arterial hypoplasia, absence or termination into PICA of one of the vertebral arteries is very common
• variable dominance: left dominant (45%), right dominant (30%), co-dominant (25%)
• complete or partial vertebral artery duplication
• vertebral artery fenestration
• variable origin
– single left aberrant origin (86%)
– single right aberrant (12%)
– bilateral aberrant origin (3%)
– aortic arch origin of the left vertebral artery (5%)
– second branch of the subclavian artery
– external carotid artery (rare)
– common carotid artery (rare)
– internal carotid artery (rare)
Case 7
Question 3 – Brachial artery
Name five (5) common or important variants of glenoid labrum and labral biceps complex (5 marks)
• Buford complex – anterosuperior labrum is absent in the 1-3 o’clock position and the middle glenohumeral ligament is thickened (cord-like)
• sublabral foramen
• superior sublabral sulcus
• pseudo-SLAP lesion
• triangular/meniscoid/bumper type labrum
https://www.ajronline.org/doi/10.2214/AJR.14.12848
Case 8
Question 2
e. Name 4 structures embedded in the parotid gland (4 marks)
1. Facial nerve
2. External carotid artery
3. Maxillary artery
4. Superficial temporal artery
d. Describe the differences in secretions produced by the major salivary glands (3 marks)
• parotid glands: serous, watery
• submaxillary (mandibular) glands: mixed serous and mucous.
• sublingual glands: predominantly mucous
Question 3
List five (5) common or important variants of the ophthalmic artery. (5 marks)
• communicating branch between the ophthalmic and middle meningeal artery is present; most frequently passes through the superior orbital fissure (up to 50%)
• additional small foramen (or multiple foramina) lateral to the superior orbital fissure are present (foramen of Hyrtl or the meningo-orbital foramen)the connecting branch is known as sphenoidal artery or recurrent meningeal artery or orbital branch of the middle meningeal branch
• meningo-ophthalmic artery: regression of proximal ophthalmic artery and entire orbit is supplied by the middle meningeal artery
• Variable origin:
– arise from middle meningeal artery or vice versa
– arise from middle cerebral artery
– arise from posterior communicating artery
– cavernous origin of the ophthalmic artery is less common