Zuha Iftikhar (G14)
Compiled by:
Rukhsar Uns (G14)
Reference Books:
- Snell’s Clinical Anatomy By Regions 10th Edition
- BD Chaurasia Human Anatomy 8th Edition
ABDOMEN AND PELVIS
RENAL MODULE
Chapter 6: Abdomen Part I – Anterolateral Abdominal Wall
Posterior Abdominal Wall
(LO: R-A-001 – Describe the boundaries, muscles and clinical anatomy of the posterior abdominal wall.)
- Skip the male reproductive anatomy and begin directly from Posterior Abdominal Wall.
- Memorize the vertebral levels, ribs and muscles forming the posterior abdominal wall.
- Study Table 6.2 thoroughly.
- Since the muscles have been studied previously, revise them with emphasis on their relations and attachments.
Quadratus Lumborum and Psoas Fascia
(LO: R-A-001 – Describe the fascial layers and clinical correlations of the posterior abdominal wall.)
- Quadratus lumborum is an important muscle for MCQs.
- Know the structures formed by the fascial layers:
- Anterior layer → Medial arcuate ligament
- Middle layer → Lateral arcuate ligament
- Posterior layer → Iliolumbar ligament(Repeated MCQ)
- The clinical note on Psoas Abscess in Tuberculosis is very important.
- Understand how tuberculosis of vertebrae spreads through the psoas sheath (Clinical MCQ).
- Skip embryological notes in this section.
Abdominal Aorta and Inferior Vena Cava
(LO: R-A-001 – Describe the major abdominal vessels and their clinical importance.)
- Memorize the tributaries of the inferior vena cava (Important MCQ).
Study the clinical notes:
- Abdominal aorta trauma
- Occlusion of abdominal aorta
- Inferior vena cava trauma
- Inferior vena cava compression (Clinical Correlations)
Chapter 7: Abdomen Part II – Urinary Tract
Kidney
(LO R-A-002 Describe the anatomy, relations, blood supply, lymphatic drainage and clinical correlates of the kidneys)
- Study the location, extent and external features of the kidneys completely.
- Memorize the parts of the kidney, including:
- Upper and lower poles
- Medial and lateral border
- Anterior and Posterior surfaces (Basic Anatomy)
- The hilum and renal sinus are very important. Memorize the arrangement of structures at the hilum from anterior to posterior:
- Renal vein
- Renal artery
- Renal pelvis/ureter
- Posterior segmental artery (Repeated MCQ)
- Coverings of the kidney are extremely important and repeatedly tested:
- Fibrous capsule
- Perirenal fat
- Renal fascia
- Pararenal fat (Very Important MCQ)
- Study the internal structure of the kidney in sequence:
- Renal pyramids
- Renal papillae
- Minor calyces
- Major calyces
- Renal pelvis
- Ureter
- Renal columns
- Medullary rays (Repeated MCQ)
- Relations of both kidneys (anterior and posterior) are very important. Memorize The relations of the right and left kidneys separately (High Yield MCQ and Viva).
- The blood supply of the kidney is very important. Prepare a flowchart of the arterial supply:
- Renal artery
- Segmental arteries
- Interlobar arteries
- Arcuate arteries
- Interlobular arteries
- Afferent arterioles (Repeated MCQ)
- Lymphatic drainage and nerve supply should be studied.
Clinical notes:
- Renal mobility (Nephroptosis) (Important MCQ)
- Role of perirenal fat and renal fascia in support of kidney
- Kidney trauma (remember ribs protecting the kidney)
- Kidney tumors
- Renal vein involvement and varicocele (Clinical Correlation)
- Renal pain is an important topic:
- Pain usually originates from the renal pelvis
- Spinal segments: T11–L2 (especially T12 via subcostal nerve)
- Pain radiates from flank to anterior abdominal wall and groin
(Repeated MCQ)
- A commonly tested MCQ is that a transplanted kidney is placed in the iliac fossa (Repeated MCQ).
Ureter
(LO R-A-003: Describe the anatomy, relations, blood supply and clinical correlates of the ureter.)
- Study the extent of the ureter from the renal pelvis to the urinary bladder.
- The three constrictions of the ureter are extremely important and repeatedly tested:
- Pelvi-ureteric junction (PUJ)
- Crossing over the pelvic brim near the sacroiliac joint
- Ureterovesical junction (UVJ) (Very Important MCQ)
- Memorize the relations of the right and left ureters separately.
- Blood supply, lymphatic drainage and nerve supply are important.
Clinical notes:
- Ureteric stones (Very Important MCQ)
- Common sites of stone impaction are the three constrictions.
- Pain classically radiates from loin to groin.
- Pain fibers travel through T11–L2 spinal segments. (Repeated MCQ)
Read traumatic injuries of the ureter once.
Chapter 9: Pelvis and Perineum
Urinary Bladder
(LO R-A-004: Describe the anatomy, blood supply, nerve supply and clinical correlates of the urinary bladder.)
- Study the male urinary bladder thoroughly; female differences may be read for comparison.
- Memorize the parts, surfaces and relations of the bladder.
- Blood supply and nerve supply are important and frequently tested.
- Understand the support and anatomy of the bladder neck.
Clinical notes:
- Stress incontinence
- Urinary retention
- Bladder distension
- Suprapubic aspiration
- Cystoscopy (Important Clinical MCQ)
- Bladder injuries are very important:
- Intraperitoneal rupture
- Extraperitoneal rupture (Repeated MCQ and Viva)
- Palpation of the distended bladder should be read once.
Male Urethra
(LO R-A-008)
- Study the parts of the male urethra and their extent.
- Memorize the important constrictions and dilatations.
- Relations and passage through pelvic structures are important.
- Clinical correlations should be read once for understanding.
Ureteric Calculi
- A repeated MCQ is the common sites of ureteric stone impaction, which correspond to the three ureteric constrictions.
- Remember the typical radiation of pain from loin to groin.
- Correlate the pain pathway with spinal segments T11–L2.
High-Yield MCQs of the Renal Module:
- Arrangement of structures at the renal hilum.
- Coverings of the kidney.
- Relations of right and left kidneys.
- Branches of the renal artery.
- Kidney transplant in the iliac fossa.
- Three constrictions of the ureter.
- Sites of ureteric stone impaction.
- Intraperitoneal vs extraperitoneal rupture of bladder.
- Bladder injuries and urinary retention.
Note: Regarding the remaining Learning Objectives R-A-005 – 007, these are not important you can cover them by giving a read from Medicnetic or Medico Express