Anatomy

Front 1

identify the paravertebral ganglia, if any, that satisfy each of the following statements
a) are connected to spinal nerve ventral rami by gray rami communicantes
b)are connected to spinal nerve ventral rami by white rami communicantes
c) are the source of preganglionic sympathetic axons to blood vessels of skeletal muscles
d)are the source of postganglionic sympathetic axons to sweat glands
e)are the source of postganglionic sympathetic axons to internal organs above the abdominal diaphragm
f)are the source of postganglionic sympathetic axons to internal organs below the abdominal diaphragm

Back 1

a)C1-Co (all)
b)T1-L2
c)none
d)all
e)C1-T5
f)none

Front 2

what kinds of autonomic axons are carried in the vagus?

Back 2

preganglionic parasympathetic

Front 3

what kinds of autonomic axons (if any) are carried in the greater splanchnic nerve?

Back 3

preganglionic sympathetic

Front 4

What kinds of autonomic axons are carried in a lumbar splanchnic nerve?

Back 4

preganglionic sympathetic

Front 5

What kinds of autonomic axons are carried in the pelvic splanchnic nerve?

Back 5

preganglionic parasympathetic

Front 6

In a person born with coarctation of the aorta just distal to the origin of the left subclavian artery, trace two possible routes by which arterial blood may pass from the aortic arch to the beginning of the femoral artery

Back 6

aortic arch-->left subclavian a-->internal thoracic a--> anterior intercostal-->posterior intercostal-->aorta-->common iliac-->external iliac--femoral

or aortic arch-->left subclavian-->internal thoracic-->superior epigastric-->inferior epigastric--> external iliac--> femoral artery

Front 7

Trace the blood supply to the AV node in a left coronary dominant heart

Back 7

left ventricle--> ascending aorta--> left coronary a-->circumflex coronary a-->posterior descending a -->AV node

Front 8

Provide an anatomical explanation for the following:
In making an incision into the left side of the fibrous pericardium so that you may gain access to the heart, you should pass the scalpel vertically not transversely

Back 8

A transverse incision is likely to cut the phrenic nerve, which is running vertically along the left edge of the fibrous pericardium.

Front 9

Provide an anatomical explanation for the following:
You place a stethescope over the right 5th intercostal space in the midaxillary line and yet fail to detect a pneumonia of middle lobe of right lung

Back 9

The middle lobe has no exposure in the right midaxillary line. it is essentially an anterior structure

Front 10

Provide an anatomical explanation for the following:
When clamping the thoracic aorta for the purpose of directing more blood to the brain, the clamp is placed as close to the abdominal diaphragm as is possible.

Back 10

to maximize your chances of preserving blood flow to the segmental artery that is the source of the artery of Adamkewicsz, and thus minimize spinal cord ischemia

Front 11

Your PA chest x ray of Ms. Jones, an inveterate smoker, shows a suspicious mass in the lower part of the left lung. CT pinpoints it to the anterior basal segment of the lower lobe. You order a mediastinoscopy.Why

Back 11

Because the lower lobe of the left lung drains to right as well as left paratrocheal lymph nodes. If the mediastinoscopy reveals tumor in the right nodes, the cancer is considered inoperable

Front 12

Your male patient comes in complaining of discomfort when he lifts objects. you suspect an inguinal hernia. Where would you palpate to feel its exit from the musculofascial abdominal wall into the subcutaneous space?

Your palpatation confirms your diagnosis. Statistically, what kind of hernia is this likely to be? How would your guess change if your patient were female?

You choose to do an external repair but cut the ilioinguinal nerve. What symptoms will this produce in your male patient?

Back 12

Immediately superolateral to the pubic tubercle

indirect inguinal

no change

numbness of skin on anterior scrotum and upper medial portion of thigh adjacent to scrotum

Front 13

If you want to injure a persons spleen, where should you hit him/her and why?

Now you feel bad and want to repair damage to the spleen. What do you incise to enable to mobilize the spleen?

aside from the splenic vessels, what other structure will accompany the spleen when you bring it toward your incision?

Back 13

back of lower ribcage on left, because you want to break ribs 9, 10,11 so they might tear spleen

left leaflet on lienorenal ligament

pancreas

Front 14

Name the first set(s) of lymph nodes to which the following structures drain and, if these nodes are readily palpable through the skin, state where you should attempt to feel for them.
a) mammary gland

Back 14

a)1.pectoral (anterior axillary=lateral thoracic), palpable along midaxillary line along side of thoracic wall in armpit, 2. parasternal=internal thoracic=internal mammary

Front 15

Name the first set(s) of lymph nodes to which the following structures drain and, if these nodes are readily palpable through the skin, state where you should attempt to feel for them.

b)ovary

Back 15

b)para-aortic nodes

Front 16

Name the first set(s) of lymph nodes to which the following structures drain and, if these nodes are readily palpable through the skin, state where you should attempt to feel for them.
c)testis

Back 16

para-aortic (same as ovary)

Front 17

Name the first set(s) of lymph nodes to which the following structures drain and, if these nodes are readily palpable through the skin, state where you should attempt to feel for them.

d)skin of the glans penis

Back 17

superficial inguinal- palpable immediately inferior to inguinal ligament

Front 18

Name the first set(s) of lymph nodes to which the following structures drain and, if these nodes are readily palpable through the skin, state where you should attempt to feel for them.

e)uterus

Back 18

1)internal iliac
2)para-aortic

Front 19

pierce membranous urethra when passing catheter through penis. Which regions where urine may spread?

Back 19

scrotum: between tunica dartos and external spermatic fascia

shaft of penis: between subcutaneous tissue and Buck's fascia
Anterior abdominal wall: Scarpa's fascia and fascia of external abdominal oblique
lateral abdominal wall: Scarpa's fascia and fascia of external abdominal oblique

Front 20

A chronic alcoholic is brought to the ER unconscious. His family reports that he vomited a substantial volume of blood then collapsed supine on the floor. Give anatomical explanation for why hematemesis can occur in chronic alcoholics

Back 20

Cirrhosis disrupts the architecture of the hepatic sinusoids and retards blood flow through them. This causes portal hypertension and the need for portal venous blood to get to the caval system some other way. One way is through left gastric v. anastamosis with esophageal vv draining to azygos system. These esophageal vv. can rupture, leading to hematemesis

Front 21

If patient aspirates blood while lying supine, into which lung is the blood most likely to pass and into which two segments of this lung?

Back 21

right lung
posterior segment of upper lobe, superior segment of lower lobe

Front 22

cut pulmonary ligament to move lung (cut inferiorly to superiorly), if carry incision too far, what is the first structure you will damage?

Back 22

inferior pulmonary vein

Front 23

a patient complains of leaking feces. You wonder if the problem is with the skeletal muscles that are largely responsible for fecal continence. Which are these?

Back 23

external anal sphincter
puborectalis

Front 24

to stimulate pudendal nerve without breaking the skin, how could you place a stimulating electrode near the nerve?

Back 24

put electrode on a finger and insert in rectum (or vagina) feel for ischial spine through wall of rectum, then move electrode posteromedially until it is near beginning of sacrospinous ligament

Front 25

A patient presents with vague epigastric pain and jaundice. At first you expect gall bladder disease. Where do you expect referred pain to be felt?

Back 25

Along right intercostal spaces 7-9, or radiating around right side of chest deep to inferior angle of scapula

Front 26

where to palpate gall bladder to see if it is painful?

Back 26

on right side, just below costal margin where it intersects transpyloric plane, or midclavicular line, or linea semilunaris

Front 27

How does pancreatic cancer account for jaundice?

Back 27

cancer of the head of the pancreas often compresses the common bile duct, which lies embedded in its posterior surface

Front 28

Where on CT do you look for blood borne metastases of pancreatic cancer?

Back 28

liver

Front 29

to remove tumor with a 1in. margin of pancreatic tissue, you need to remove most of the duodenum. Why?

Back 29

because you must tie off the pancreaticoduodenal arteries to remove the head of the pancreas and this deprives duodenum of blood, so it must be taken too.

Front 30

you manage to preserve the pylorus and suture what remains of part 1 of the duodenum to the jejunum(when removing pancreatic cancer). Can you cut vagal trunks?

Back 30

No, because vagus relaxes pyloric sphincter. If you cut vagal trunks, patient can't empty stomach.

Front 31

give explanation:
a)inferior mesenteric artery was tied of but descending colon did not die

Back 31

a) the marginal artery of drummond, or her arc of Rislan, took on supply of the descending colon

Front 32

give explanation:
right hepatic artery was tied off but quadrate lobe did not die

Back 32

quadrate lobe of liver fed by left hepatic artery

Front 33

give explanation:
left hepatic artery was tied off but the left lobe of her liver did not die.

Back 33

portal v. provides 50% or more of O2 to liver

Front 34

describe anatomy of:
a)aortic bifurcation
b)apex of the left lung
c)left brachiocephalic vein
d)best site to hear mitral valve

Back 34

a)just to left of umbilicus
b)l fb superior to medial third of left clavicle
c)deep to upper half of manubrium
d)1 handsbreadth to the left of midsternal line at level of xiphisternal joint (or in 5th ic space)

Front 35

spinal cord segment responsible for:
a) producing a decrease in the air pressure within the right lung

Back 35

C3,4,5

Front 36

spinal cord segment responsible for:
b)the substernal crushing pain when your heart has insufficient arterial blood

Back 36

T1-T5

Front 37

spinal cord segment responsible for:
d)causing dull diffuse pain when your appendix is inflamed

Back 37

T10

Front 38

spinal cord segment responsible for:
e)responsible for elevation of the testis when the inside of the thigh is scratched

Back 38

L1/2

Front 39

spinal cord segment responsible for:
f)dilation of the deep artery of the clitoris

Back 39

S3, 4

Front 40

spinal cord segment responsible for:
g)increasing the blood pressure in the corpus cavernosum above that in the aorta

Back 40

S2,3,4

Front 41

spinal cord segment responsible for:
h) the pain of a pimple in the skin 4cm superolateral to external occipital protuberance

Back 41

C2

Front 42

spinal cord segment responsible for:
i)letting you know your bladder is full

Back 42

S3,4

Front 43

structures:
in the free edge of the hepatoduodenal ligament

Back 43

common bile duct

Front 44

structures:
passing transversely through the concavity of the aortic arch:

Back 44

right pulmonary artery, left mainstem bronchus, left recurrent laryngeal nerve

Front 45

structure:
1cm lateral to the lateral vaginal fornix, postero-inferior to the uterine artery

Back 45

ureter

Front 46

structure:
crossing common iliac bifurcation 1cm posteromedial to the infundibulopelvic ligament

Back 46

ureter

Front 47

structure:
anterior to the uncinate process of the pancreas

Back 47

superior mes. vein

Front 48

structure:
anterior to the origin of the inferior mesenteric artery

Back 48

duodenum

Front 49

structure anterior to the inferior pole of the right kidney (gerota's fascia intervening)

Back 49

right flexure of colon