Mnemonics... Contents of the Spermatic Cord

The contents of the Spermatic Cord can be easily remember with the Rule of 3's.

3 arteries: Testicular Artery, Cremasteric Artery, Artery to Vas
3 veins: Pampiniform plexus, Cremasteric Vein, Vein of Vas
3 nerves: genital branch of genitofemoral nerve, sympathetics, ilioinguinal nerve (technically runs outside the spermatic cord.
3 fascias: External Spermatic Fascia, Cremasteric fascia, Internal Spermatic fascia
3 others: Vas Deferens, Lymphatics, Tunica Vaginalis

Credit to instantanatomy.net

For your information... Suture materials

Absorbable

Vicryl - Polyglactin 

Monocryl - Poliglecaprone

PDS - Polydioxanone

Catgut - Fibres from intestinal walls of animals

Non-absorbable

Ethilon - Nylon

Silk - Silk

Prolene - polypropylene

Question of the Day... Klumpke's Paralysis

This question was taken from the Coventry Oct 2012 Exam.

Question:
What are the roots involved in an inferior brachial plexus lesion?

Answer:
C8 and T1

What is the result of injury to the nerve roots of C8 and T1?
Paralysis of the intrinsic muscles of the hands and flexors of the wrist leads to the classic "claw hand". Metocarpophalangeal joints are extended and interphalangeal joints are flexed due to unopposed reciprocal muscles.

It also results in paraesthesia over C8/T1 dermatome distribution

What other signs may be seen in Klumpke's paralysis?
Klumpke's paralysis is commonly associated with Horner's syndrome as traumatic injury to the lower nerve roots of the brachial plexus can also result in disruption to the sympathetic chain.

What is the most common cause of Klumpke's paralysis?

• Childbirth - pulling on arm during delivery
• Forceful, sudden extension of the arm above the head (like a monkey swinging on a tree!)

For your Information... How does CLO test work?

The CLO test is a rapid test for the diagnosis of Helicobacter Pylori, which secretes the enzyme "Urease".

The CLO test takes advantage of this chemical reaction to test for the presence of Helicobacter Pylori. The biopsy specimen from an OGD is placed into medium containing urea and indicator phenol red. When the Urea is hydrolysed by the H. Pylori in the specimen into NH₃, the pH is raised and the indicator changes from yellow to RED.

The CLO test works by detecting when the medium becomes ALKALINE due to the ammonia.

This is in stark contrast to the Urease Breath Test, which detects the CO₂ (via C¹³ labelled urea) produced from the reaction.

Question of the Day... Erb's Palsy

This question was taken from the Coventry Oct 2012 exam.

Question:
What is the position seen in Erb's Palsy?

Answer:

"Waiter's tip" position

What is Erb's palsy?

Erb's palsy is a lower motor neuron lesion that common occurs when the head and shoulders are forced apart, stretching and tearing the upper roots of the brachial plexus.

Which roots are affected in Erb's Palsy?

C5 and C6

Why does the patient present with the "Waiter's tip"?

Paralysis of the deltoid prevents the arm from being raised.

Paralysis of the biceps brachii and brachialis (flex and supinate elbow) means that the arm is limp and the forearm is pronated.

For your information... Chvostek's and Trousseau's Sign

This question was taken from the Sheffield Feb 2014 exam.

Both Chvostek's and Trousseau's sign are clinical signs elicited in patient's who have Hypocalcaemia

Chvostek's Sign
There are 2 variations to this sign but the most common practiced variation is where the practitioner uses either a finger or a hammer to tap at the angle of the jaw. In a patient with hypocalcaemia, this results in ipsilateral contraction of some or all of the muscles innervated by the facial nerve.

The technique described above involves using a finger to tap on Point A

Trousseau's sign

A blood pressure cuff is inflated to above systolic blood pressure and sustained for 3 mins. The subsequent lack of blood flow will induce spams of the muscles of the hands and forearms.

• Flex
• Wrist and Metocarpophalangeal joints
• Extend
• Distal and Proximal Interphalangeal joints
• Adduct
• Fingers

Mnemonics... Glasgow Criteria

There is a simple mnemonic to remember the Glasgow Scoring system as prognosis for Acute pancreatitis. Just remember to do the scoring within 48hrs of the onset of symptoms. 3 or more requires admission to HD or ITU.

Mnemonic Letter	Criteria	Positive when:
P	Arterial PaO2	<60 mmHg <8 kPa
A	Age	>55 yrs
N	Neutrophils (WBC count)	<15x109/L
C	Calcium	<2 mmol/l
R	Raised Urea	>16 mmol/l
E	Enzymes (LDH and AST)	LDH >600 iu/l AST >200 iu/l
A	Albumin	<32g/l
S	Sugar (Serum glucose)	>10mmol/l

For your information... Layers of the Abdominal Wall

Here are the layers of the anterior abdominal wall from superficial to deep:

• Skin
• Fascia
• Camper's - superficial fatty layer
• Scarpa's - deep fibrous layer
• Muscle
• Rectus abdominis
• External Oblique
• Internal Oblique
• Transversus abdominis
• Transversalis Fascia
• Peritoneum

The only change from this is below the Arcuate Line when the Internal Oblique and Transversus Abdominis aponeuroses merge and pass superficial to the Rectus muscles. This means that the Rectus Abdominis rests directly on the Transversalis fascia below the Arcuate line.

Mnemonics... Branches of the Facial Nerve

The facial nerve can be divided into 2 parts:

• Intracranial
• Extracranial

Intracranial branches:

1. Greater petrosal nerve
2. Nerve to stapedius
3. Chorda Tympani

Extracranial branches:

1. Temporal
2. Zygomatic
3. Buccal
4. Marginal Mandibular
5. Cervical

There is a simple mnemonic that will help you to remember the extracranial branches of the facial nerve:

The Zebra Bit My Cock

Rollover the image for answers:

Very easy to remember, and fun!

Mnemonics... Branches of the External Carotid Artery

This mnemonic will help you to remember the branches of the external carotid artery.

The Common Carotid Artery arises from the Right Brachiocephalic Trunk on the Right and the directly from the Arch of Aorta on the Left. It then bifurcates into the External and Internal Carotid arteries at the level of C4.

There are 8 branches of the external carotid artery. From proximal to distal the Mnemonic is:

Some Anatomists Like Fornication, Others Prefer S & M

S - Superior Thyroid Artery
A - Ascending Pharyngeal Artery
L - Lingual Artery
F - Facial Artery
O - Occipital Artery
P - Posterior Auricular Artery
S - Superficial Temporal Artery
M - Maxillary Artery

There are others of course, but this is the one I used!