Ch21: Regional Anatomy — Exam Review（局部解剖学考试复习）

# Ch21: Regional Anatomy — Exam Review (100 Concepts + MCQ Bank + Past Papers)

Preparatory Mindset

This is the exam-focused capstone: Dr. Mavrych's "100 Must Important GA Conceptions" (the shelf notes your course uses), the 局解mc大全 bilingual MCQ bank (192 questions), and the past-paper scope (Test folder: abdomen, lower limbs, neck, scalp, thorax, upper limbs — image-based scanned exams). The final exam format (from the course deck) is short clinical vignettes testing: structure identification, nerve/vessel injury, hernias, spaces, and surgical relations.

Exam mindset: Master the mechanism → structure → sign triplets. The 100 concepts ARE the exam blueprint; the MCQ bank shows the exact question style (bilingual vignettes with options). Review this chapter the day before the exam.

Core Concepts — the 100 Conceptions by region (condensed)

A. Back & spine (concepts 1-3)

1. Lumbar puncture: needle enters the subarachnoid space at L3/L4 or L4/L5 (line through the iliac crests = L4); cord ends at L2 in adults (L3 in children), dural sac to S2; check for raised ICP first (cerebellar tonsil herniation risk)
2. Herniated IV disc: posterolateral herniation compresses the nerve root below (e.g., L4/L5 disc → L5 root); most common at L4/L5 & L5/S1; sciatica
3. Abnormal curvatures: kyphosis, lordosis, scoliosis (Caffey's: scoliosis imaging — Cobb angle)

B. Upper limb (concepts 4-12)

1. Upper limb fractures & nerves: surgical neck → axillary; midshaft → radial; supracondylar → median + brachial artery; medial epicondyle → ulnar (see Ch10 table)
2. (rotator cuff)
3. Abduction: supraspinatus 0-15° → deltoid 15-90° → scapular rotation >90°
4. Medial (golfer's) & lateral (tennis) epicondylitis: flexor vs extensor origins
5. Arterial anastomoses: scapular & elbow collaterals
6. Cubital fossa: R-T-B-M contents
7. Carpal tunnel syndrome: median nerve; Tinel/Phalen; thenar wasting
8. PIP = FDS, DIP = FDP
9. Lesion of UL nerves: Erb's (C5-6, waiter's tip), Klumpke's (C8-T1, claw + Horner)

C. Lower limb (concepts 13-20)

1. Avascular necrosis of femoral head: transcervical fracture → retinacular arteries (medial circumflex femoral) torn
2. Unhappy triad: MCL + medial meniscus + ACL (valgus blow)
3. Ankle joint injury: inversion → anterior talofibular; eversion → deltoid (rarely)
4. Injury of gluteal region: sciatic/superior gluteal (Trendelenburg)/inferior gluteal (weak extension)
5. Avulsion fractures: ASIS (sartorius), AIIS (rectus femoris), ischial tuberosity (hamstrings)
6. Femoral sheath & femoral hernia: canal = lymphatics; below & lateral to pubic tubercle; lacunar ligament strangulation; obturator nerve compression sign
7. Achilles rupture: Thompson's test
8. Fibular neck fracture → common peroneal → foot drop

D. Thorax (concepts 21-28)

1. Breast: 15-20 lobes, Cooper's ligaments, 75% → axillary nodes
2. Diaphragm: IVC T8, esophagus T10, aorta T12; phrenic C3-5
3. Cardiac hypertrophy: chamber silhouette changes
4. Auscultation of heart valves: aortic 2R, pulmonary 2L, tricuspid LSB, mitral apex
5. Blood supply of the heart: RCA (SA node, right marginal, posterior IV), LCA (LAD, circumflex)
6. Aspiration of foreign body: right main bronchus → right lung segments (10 right / 9 left)
7. Lung diseases: consolidation, collapse, effusion, cavitation
8. Open pneumothorax: sucking wound → seal; tension → needle decompression

E. Abdomen (concepts 29-53)

1. Anterior abdominal wall: Camper's/Scarpa's; rectus sheath (arcuate line)
2. Peritoneal structures: omenta, mesenteries, omental bursa, epiploic foramen
3. Foregut/midgut/hindgut: celiac/SMA/IMA territories
4. Posterior gastric ulcer: erodes the splenic artery (severe bleed); anterior ulcer → perforation
5. Congenital diaphragmatic hernia: Bochdalek (posterolateral, left)
6. Sliding hiatal hernia: GE junction above diaphragm → reflux
7. Meckel's diverticulum: rule of 2s (2 ft, 2 in, 2%, 2 tissues)
8. Features of the large intestine: teniae coli, haustra, epiploic appendices
9. Pain of appendicitis: umbilical → right iliac fossa; McBurney point; psoas/obturator signs
10. Volvulus: sigmoid (elderly) / cecal (young)
11. Hirschsprung's disease: aganglionosis → megacolon; Down syndrome; failure to pass meconium
12. Branches of abdominal aorta: celiac (T12/L1), SMA (L1), renal (L1-2), gonadal (L2), IMA (L3), common iliac (L4)
13. Mesenteric ischemia: SMA occlusion → pain out of proportion
14. AAA: infrarenal, >5.5 cm, rupture → shock
15. Biliary system: hepatic ducts → common hepatic → cystic → CBD → ampulla → 2nd duodenum (sphincter of Oddi)
16. Cholelithiasis: cholesterol/pigment; complications (colic, jaundice, pancreatitis, gallstone ileus)
17. Nerve supply of the liver: capsule = pain (stretch); parenchyma = no pain; sympathetic + vagus
18. Portal hypertension: 4 anastomoses; esophageal varices most dangerous; portacaval shunt
19. Pancreas: retroperitoneal; head in duodenal C-loop; portal vein behind neck; pancreatic head cancer → painless jaundice
20. Spleen: ribs 9-11; gastrosplenic & splenorenal ligaments; rupture → Kehr's sign
21. Kidney: retroperitoneal T12-L3; hilum AVU; left renal vein long (gonadal + suprarenal)
22. Nephrolithiasis: 3 narrowings; CT gold standard
23. Renal veins: left long; right short (→ IVC directly)
24. Varicocele: pampiniform plexus engorgement; left side more common (left renal vein) — wormlike scrotal mass
25. Hemorrhoids: internal above pectinate line (superior rectal/portal, painless bleed); external below (inferior rectal/systemic, painful)

F. Pelvis & perineum (concepts 54-67)

1. Deep perineal pouch: sphincter urethrae, deep transverse perineal, Cowper's glands (male)
2. Superficial perineal pouch: ischiocavernosus, bulbospongiosus, superficial transverse perineal, crura/bulb, Bartholin's glands (female)
3. Cystocele: bladder herniation through the anterior vaginal wall (pelvic floor weakness)
4. Ureter: crosses the pelvic brim anterior to iliac vessels; behind the uterine artery (female)
5. Nerve supply of pelvic viscera: autonomic (pelvic splanchnic S2-4 → bladder/rectum; sympathetic via hypogastric)
6. Paracentesis of urinary bladder: suprapubic, extraperitoneal
7. Prostate tumors: peripheral zone; DRE; spread to pelvic nodes & bone
8. Male urethra: prostatic (widest) → membranous (narrowest) → spongy (longest); membranous rupture → superficial pouch extravasation
9. Hydrocele & cryptorchism: patent processus vaginalis → hydrocele; undescended testis → malignancy risk
10. Cryptorchism: undescended testis; ↑ infertility & testicular cancer; orchidopexy
11. Lymphatic drainage of the pelvis: internal/external iliac → common iliac → lumbar
12. Lymphatic drainage from the testis: to lumbar (para-aortic) nodes (not inguinal!) — testicular cancer staging
13. Arterial supply of the uterus: uterine (internal iliac) + ovarian (aorta)
14. Parts of the uterine tube: infundibulum, ampulla (fertilization), isthmus, intramural

G. Head & neck (concepts 68-100)

69-73. Skull fractures & development

1. Foramina of the base: optic canal (II, ophthalmic a.), SOF (III/IV/V1/VI), rotundum (V2), ovale (V3), spinosum (middle meningeal), IAM (VII/VIII), jugular foramen (IX/X/XI, IJV), hypoglossal canal (XII), foramen magnum
2. Epidural hematoma: middle meningeal artery (pterion) → lens-shaped, lucid interval
3. Cavernous sinus infection: ICA + CN VI through; CN III/IV/V1/V2 lateral wall; danger triangle of face
4. Layers of the scalp: SCALP; dangerous area = loose areolar (emissary veins)
5. Innervation of face skin: V1/V2/V3 territories
6. Facial nerve (CN VII): motor face; taste ant 2/3 (chorda tympani); 5 branches
7. Communication of the facial vein: with the cavernous sinus (via ophthalmic) — danger triangle
8. Epistaxis: Little's area (Kiesselbach's plexus)
9. Sphenoiditis
10. Cheeks
11. Movements at the TMJ: temporalis (elevation/retraction), masseter (elevation), medial pterygoid (elevation), lateral pterygoid (protrusion)
12. Lesion of CN XII (hypoglossal): tongue deviates to the weak side (same side as lesion)
13. Lymph drainage from the head/neck
14. Blow-out fracture: orbital floor (inferior wall) — entrapment of inferior rectus → upgaze limitation
15. Muscles of the orbit: LR6 (abducts), SO4 (depresses the abducted eye), all others III
16. Oculomotor nerve palsy (CN III): "down & out" eye, ptosis, mydriasis, loss of accommodation — pupil blown with compression (posterior communicating aneurysm)
17. Trochlear nerve palsy (CN IV): weakness looking down & in; diplopia going downstairs
18. Abducens nerve palsy (CN VI): medial deviation (can't abduct); false-localizing sign (raised ICP)
19. Corneal reflex: CN V1 afferent → CN VII efferent (blink)
20. Horner syndrome: ptosis, miosis, anhidrosis (sympathetic; stellate ganglion, lung apex, carotid dissection)
21. Otitis media: middle ear infection; may spread to the mastoid (mastoiditis) or intracranial
22. Thyroid & parathyroid: isthmus rings 2-3; superior thyroid a. + external laryngeal n.; inferior thyroid a. + recurrent laryngeal n.; parathyroids (4) → hypocalcemia
23. Larynx: cartilages (thyroid, cricoid, arytenoid, epiglottis); intrinsic muscles by RLN (except cricothyroid = external laryngeal)
24. Cricothyrotomy: emergency airway through the cricothyroid membrane (below the thyroid cartilage, above the cricoid)
25. Retropharyngeal space: between buccopharyngeal & prevertebral fascia → infection to superior mediastinum
26. Carotid sheath: CCA/ICA, IJV, vagus
27. Axillary sheath: prevertebral fascia around axillary vessels & plexus
28. Posterior triangle of the neck: CN XI, cervical plexus, brachial plexus trunks, subclavian a.

High-Yield Points

• Exams reward triplets: mechanism → structure → sign. For every concept above, be able to state all three (e.g., transcervical femoral neck fracture → retinacular arteries (medial circumflex femoral) → AVN of the femoral head).
• Nerve injury postures to recall cold: waiter's tip (Erb, C5-6), claw hand (ulnar; Klumpke C8-T1), wrist drop (radial), ape hand (median), foot drop (deep peroneal), Trendelenburg (superior gluteal), winged scapula (long thoracic), Horner (sympathetic T1).
• Arterial territories: foregut = celiac, midgut = SMA, hindgut = IMA; bleeding ulcer arteries — left gastric (lesser-curvature gastric), gastroduodenal (posterior duodenal), splenic (posterior gastric).
• Spaces that connect compartments: retropharyngeal & pretracheal (→ mediastinum), superficial/deep perineal pouch (urine extravasation), ischiorectal fossa (pudendal canal), femoral canal (hernia, lacunar ligament).
• The MCQ bank's favorite single facts: femoral canal = deep inguinal lymph node; safe IM quadrant = upper lateral; piriformis = gluteal landmark; indirect hernia lateral to inferior epigastric a. (deep ring) vs direct medial (Hesselbach triangle); IMA occlusion usually asymptomatic (marginal artery collaterals).

High-Yield MCQ Patterns (from 局解mc大全 — 192 questions)

1. Femoral canal contains → deep inguinal lymph node(s) (B)
2. Hernia in femoral triangle + weak hip adduction → obturator nerve (A)
3. Safe IM injection quadrant → upper lateral (E)
4. Landmark of the gluteal region → piriformis
5. Erb's palsy (C5-6) → waiter's tip
6. Intramuscular injection & sciatic nerve: avoid the medial/central buttock
7. Internal thoracic artery use → coronary bypass (LIMA)
8. IMA occlusion asymptomatic → collateral circulation (marginal artery)
9. Bleeding gastric ulcer (lesser curvature) → left gastric artery
10. Posterior gastric ulcer perforation → splenic artery / pancreas
11. Direct inguinal hernia after appendectomy → weak posterior wall (Hesselbach)
12. 15-year-old boy, left indirect hernia causing obstruction → patent processus vaginalis
13. Psoas tear in a footballer → femoral nerve injury (weak hip flexion/knee extension)
14. Needle in the 9th intercostal space midaxillary → costodiaphragmatic recess (pleural cavity)
15. Breast lymphatics 75% → axillary nodes
16. Thyroid tumor surgery → recurrent laryngeal nerve risk
17. Sternal puncture (4th/5th costal cartilage level) → cardiac tamponade risk (pericardium)
18. Tricuspid stenosis murmur → lower left sternal border
19. Pancreatic cancer with jaundice → Courvoisier (palpable non-tender gallbladder)

Past-Paper Scope (Test folder — image-based exams)

• Topics: Abdomen, Lower Limbs, Neck, Scalp, Thorax, Upper Limbs (docx+pdf, scanned images — identify structures & diagnose)
• How to prepare: for each region, be able to label the dissection photograph: muscles, vessels, nerves, and answer "what is at risk / what is this structure"
• Suggested drill: review the Illustrations galleries in each chapter as identification practice; know the mnemonic-listed structures cold

Topic Summary

The exam review condenses the course into the 100 Conceptions by region (back/spine → upper limb → lower limb → thorax → abdomen → pelvis/perineum → head & neck), the 192-question MCQ bank patterns (femoral canal, safe injection quadrant, hernias, bleeding ulcer arteries, nerve injuries), and the past-paper scope (structure identification in dissection images for abdomen/lower limbs/neck/scalp/thorax/upper limbs). Master the mechanism→structure→sign triplets, the arterial territories (celiac/SMA/IMA; left gastric vs gastroduodenal vs splenic), the spaces (retropharyngeal, pretracheal, superficial/deep perineal pouch, ischiorectal fossa), and the nerve injury postures (waiter's tip, claw, wrist drop, foot drop, Trendelenburg) — and you will be exam-ready.