Anatomy- Exam 3 Clinical Flashcards (Week 5)

Front 1

A patient is stabbed anteriorly in the L1 vertebral level. In what transverse plane was he stabbed?

Back 1

transpyloric

Front 2

A patient is stabbed anteriorly in the L1 vertebral level. What blood vessel will be damaged?

Back 2

Abdominal aorta and superior mesenteric artery, maybe celiac trunk

Front 3

A patient is stabbed anteriorly in the L3 vertebral level. In what transverse plane was he stabbed?

Back 3

subcostal

Front 4

A patient is stabbed anteriorly in the L3 vertebral level. What blood vessel will be damaged?

Back 4

Inferior mesenteric artery

Front 5

A patient is stabbed anteriorly in the L4 vertebral level. In what transverse plane was he stabbed?

Back 5

Supracristal is at L4; Transumbilical is between L3/L4

Front 6

A patient is stabbed anteriorly in the L4 vertebral level. What blood vessel will be damaged?

Back 6

Bifurcation of the aorta

Front 7

A patient is stabbed anteriorly in the L5 vertebral level. In what transverse plane was he stabbed?

Back 7

Transtubercular

Front 8

A patient is stabbed anteriorly in the L5 vertebral level. What blood vessel will be damaged?

Back 8

Inferior vena cava

Front 9

An interventional cardiologist has entered a patient's femoral artery with a catheter. He is passing the catheter past the the L4 vertebral level. What blood vessel is he in?

Back 9

L4 = bifurcation of aorta. He just entered the abdominal aorta

Front 10

An interventional cardiologist has entered a patient's femoral vein with a catheter. He is passing the catheter past the the L5 vertebral level. What blood vessel is he in?

Back 10

L5 = inferior vena cava formation. He just entered the inferior vena cava

Front 11

A patient complains of abdominal pain in the right lower quadrant. What is a typical diagnosis?

Back 11

Appendicitis

Front 12

As a general surgeon, you are examining a patient with suspected appendicitis. Where will you palpate to find maximum tenderness?

Back 12

McBurney's Point

Front 13

A general surgeon is working above the subcostal plane and lateral to the left midclavicular plane. What area is he working in?

Back 13

Left hypochondrium

Front 14

A general surgeon is working below the transtubercular plane and lateral to the right midclavicular plane. What area is he working in?

Back 14

Right groin

Front 15

A patient is feeling pain in his shoulder. Breathing is also weakened. The EKG is normal and no heart trouble is seen, ruling out a heart attack. What is another possible explanation?

Back 15

Gallbladder inflammation. Irritates the nearby diaphragm (phrenic nerve is C3-C5)

Front 16

During a liposuction, a plastic surgeon will be entering which layer of fascia?

Back 16

Camper's fascia

Front 17

A patient has Caput Medusa. Why would a plastic surgeon refuse to perform a liposuction?

Back 17

With Caput Medusa, the paraumbilical veins are swollen with blood. Entering the abdominal fascia is too dangerous and the patient can bleed out.

Front 18

As a plastic surgeon, why would you be interested in a patient's alcohol consumption before a liposuction?

Back 18

Liver cirrhosis can block the portal vein system, forcing blood to the anastomoses in the para umbilical veins in the Camper's fascia. The patient could bleed to death during liposuction.

Front 19

A patient has very noticeable, distended veins in umbilical region of their abdominal wall. They do not have portal hypertension, drink no alcohol and have no blockage of portal veins. As a surgeon looking to remove an abdominal tumor, where should you look first?

Back 19

Along the inferior vena cava. Caput medusa can be caused by blockage of the portal veins or inferior vena cava. Since they do not have portal hypertension and drink no alcohol, the portal system is fine. A tumor near the vena cava is constricting blood flowand forcing paraumbilical, abdominal anastomoses

Front 20

A patient suffered severe damage to his scrotum and penis. He feels pain and high pressure in his abdomen. What is likely happening?

Back 20

Urinary extravasation. Urethra is damaged and urine flows into abdominal cavity

Front 21

A patient suffered severe damage to his scrotum and penis. He feels pain and high pressure in his abdomen. Between what 2 fascial layers is fluid accumulating?

Back 21

Scarpa fascia and external oblique facsia

Front 22

A patient suffered severe damage to his penis. He feels pain and high pressure in his abdomen. Why will we see no accumulation in his leg?

Back 22

Scarpa's Fascia is tight with the fascia lata. Fluid accumulates in the abdomen only

Front 23

A patient is complaining of abdominal pain in the T10 dermatome. Naturally, you suspect appendicitis. Why might a list of past surgeries be important during the history portion of the clinical exam?

Back 23

If they have already had the appendix removed, we can't assume appendicitis.

Front 24

A patient complaining of lower abdominal pain is suspected of having a hernia. What is the first area you will palpate?

Back 24

Inguinal triangle, medial to the lateral folds

Front 25

A patient is stabbed above the arcuate line of the abdomen. The blade of the knife stops just before the rectus abdominis muscle. What muscular fascia layers are damaged in this patient?

Back 25

external and internal obliques

Front 26

A patient is stabbed below the arcuate line of the abdomen. The blade of the knife stops just before the rectus abdominis muscle. What muscular fascia layers are damaged in this patient?

Back 26

external and internal obliques and aponeurosis of transverse abdominal muscle. Below the arcuate line, only transversalis fascia passes posterior to the rectus abdominis

Front 27

A patient with T10 abdominal pain later has pain more laterally and inferior as well. Why does this occur?

Back 27

Appendicitis is first seen as referred pain, but as it swells, it actually irritates the abdominal wall directly.

Front 28

A patient complains of lower abdominal pain. You palpate just superior of the medial aspect of the inguinal ligament. The patient is asked to cough and we feel an impulse. What is the likely diagnosis?

Back 28

Indirect inguinal hernia. Hernia is in the superficial ring

Front 29

A patient is complaining of abdominal pain. You find a mass medial to the inferior epigastric vessels. Do you expect this mass to enter the spermatic cord?

Back 29

No, direct hernias rarely enter the spermatic cord.

Front 30

A patient is complaining of abdominal pain. You find a mass medial to the inferior epigastric vessels. In the unlikely event that this hernia enters the spermatic cord, from where will it enter?

Back 30

Superficial ring

Front 31

Assume a patient had weakened internal oblique muscle. Which facsial layer of the spermatic cord would be directly affected?

Back 31

cremasteric fascia is derived from internal obliques

Front 32

Assume a patient had weakened external oblique muscle. Which facsial layer of the spermatic cord would be directly affected?

Back 32

external spermatic fascia is derived from aponeurosis of external obliques

Front 33

Assume a patient had weakened transversalis fascia. Which layer of the spermatic cord would be directly affected?

Back 33

internal spermatic cord is derived from transversalis fascia

Front 34

A teenage boy is going through puberty. It is discovered that his newly formed spermatic cord is missing the external spermatic fascia. What could have gone wrong during puberty?

Back 34

As the testes descend, they pass through the deep ring to obtain an internal fascia, the internal obliques create the cremasteric fascia. Then the spermatic cord passes through the superficial ring to obtain the external spermatic cord. This patients spermatic cord might not have passed through the superficial ring

Front 35

You stroke the patients superior medial thigh and notice no reflex. What spinal level may be damaged? What abdominal muscle is involved?

Back 35

Cremasteric reflex tests L1, cremasteric muscle is derived from abdominal internal oblique

Front 36

As a general surgeon, you perform an inguinal hernia repair. After surgery, you stroke the patients superior medial thigh and notice no reflex. There is no sensation in the scrotum. What nerves may you have damaged?

Back 36

Genitofemoral and ilioinguinal nerves

Front 37

As a general surgeon, you biopsy a patient's inguinal lymph nodes. A pathologist reports that malignant cells were found. Where did this cancer likely originate?

Back 37

Scrotal cancer

Front 38

As a general surgeon, you biopsy a patient's lumbar lymph nodes. A pathologist reports that malignant cells were found. Where did this cancer likely originate?

Back 38

Testicular cancer

Front 39

A patient has an increase in pressure in their scrotum. You shine a light on the scrotum and you note a translucent appearance. Where is this fluid accumulated?

Back 39

Fluid is in the remnant of the process vaginalis. This patient has a hydrocele. The process vaginalis become "obliterated" (closed off) after puberty. Fluid accumulates above where it is closed off

Front 40

A patient has pain when standing and reports a feeling of "bag of worms" in their scrotum. What result would we see in this patient's sperm count? Why?

Back 40

Low sperm count. The vericocele has dilated pampinoform veins that are unable to cool the cremasteric artery.

Front 41

A teenage boy, after puberty, had a teste that failed to descend. What strand of connective tissue failed to function?

Back 41

Gubernaculum testis

Front 42

Why might an indirect hernia be more dangerous in a patient?

Back 42

It is more prone to strangulation as it is more likely to enter the spermatic cord

Front 43

During general surgery, you find a hernia with only peritoneum covering it. Is this an indirect or direct hernia?

Back 43

Direct hernias have only a layer of peritoneum. Indirect hernias have peritoneum and the other layers of the spermatic cord

Front 44

During an indirect hernia repair, what are you likely removing from the inguinal canal?

Back 44

Fat or part of the small intestine that has entered the spermatic cord

Front 45

During abdominal surgery, you notice a nerve passing through psoas major. Where does this nerve ultimately go?

Back 45

Genitofemoral nerve goes along spermatic cord into testes.

Front 46

Why can direct inguinal and femoral hernias occur frequently?

Back 46

Femoral and inguinal triangles are both weak walls. Intestines and fat can easily migrate and protrude

Front 47

During an inguinal hernia repair, you accidentally cut the fascia of the spermatic cord. After surgery, the patient has no sensation in the testes and has lost the cremasteric reflex. What nerves were likely damaged? Between what layers of the spermatic cord are these nerves found?

Back 47

Internal spermatic cord and cremasteric fascia

Front 48

A patient has an ischemic appendix. What major artery could be blocked?

Back 48

Superior mesenteric artery supplies midgut

Front 49

A patient has an ischemic Descending colon. What major artery could be blocked?

Back 49

Inferior mesenteric artery supplies the hindgut

Front 50

A patient has a sore throat and an eroded esophagus. He also feels heartburn regularly. What is a likely diagnosis?

Back 50

GERD/Gastric reflux

Front 51

A patient who smokes has chronic acid reflux. Over time he has a difficult time breathing and is producing too much mucous. What is a likely diagnosis?

Back 51

GERD that became Barrett's Epithelium

Front 52

An alcoholic patient has portal hypertension. What are 2 important anastomoses you want to check?

Back 52

Esophageal and paraumbilical veins

Front 53

A non-drinker patient is found to have esophageal varices. Assuming he does not have hepatitis C, what may be causing this?

Back 53

Cancer blocking the portal vein

Front 54

Cancer of the pancreatic head could lead to ischemia of what gut region? Why?

Back 54

Midgut. Superior mesenteric artery is wedged between duodenum and pancreatic head. it supplies the midgut

Front 55

Your patient has sclerus icterus and you notice a yellowing of the skin. The patient does not have gallstones. What might you diagnose?

Back 55

Pancreatic cancer. The head of the pancreas can impinge on the bile duct. Bile retention = jaundice

Front 56

A patient has sclerus icterus and yellowing of the skin. Pancreatic cancer is not seen. What might be causing this?

Back 56

Gallstones

Front 57

A patient is severely injured in his back. Ribs 9-11 are broken. Internal bleeding is observed. Explain why this specific internal bleeding VERY bad?

Back 57

The spleen is damaged. A lot of gastrointestinal blood must go through the spleen, so if it is damaged, we are losing all blood to the GI tract

Front 58

A patient complains of back pain. You palpate a mass near the anterior mid axillary line. The patient does not have any cancers. What might you infer about this patients drinking habits?

Back 58

Alcoholic. Spleen is enlarged due to portal hypertension. Likely caused by cirrhosis, likely caused by alcoholism.

Front 59

During thoracocentesis, a clumsy med student punctures extremely far in. The needle passes through the anterior visceral plura. Assuming the lungs are totally damaged, what other structure, in the abdominal cavity, was hit?

Back 59

Superior pole of kidney and Liver are both possible

Front 60

As an OB/GYN, you are examining a fetus in the uterus. You see the ligamentum teres as what structure in the fetus?

Back 60

Left umbilical vein, bypassing liver filtration

Front 61

A female patient complains of severe epigastric pain that is worse after meals. Her skin has a yellow tint to it. What is a quick differential diagnosis?

Back 61

Gallstones

Front 62

A patient is stabbed near the lesser curvature of his stomach. What gastric anastomoses will be damaged?

Back 62

Left/right gastric arteries

Front 63

A patient is stabbed in the greater curvature of his stomach. What gastric anastomoses is damaged?

Back 63

Right/Left Epiploic arteries

Front 64

A patient is stabbed near the head of the pancreas. The duodenum and superior mesenteric artery are intact, but the anastomoses between them are gone. Which artery was damaged?

Back 64

anterior Pancreaticoduodenal arteries

Front 65

A patient has damage to the T6 spinal cord segment. Which gut region might be affected?

Back 65

Foregut

Front 66

You are examining a piece of colon with some blood vessels intact. There are elaborate arcades and short vasa recta. What part of the colon are you examining?

Back 66

Ileum

Front 67

You are examining a piece of colon with some blood vessels intact. There are simple arcades and long vasa recta. What part of the colon are you examining?

Back 67

jejunum

Front 68

You are examining a piece of colon. There are Anti-mesenteric peyer's patches visible. What part of the colon are you examining?

Back 68

Ileum

Front 69

A patient is stabbed in the abdomen. The anastomoses between the Mid gut and hind gut is lost. What artery is cut?

Back 69

Marginal artery

Front 70

A patient with atherosclerosis has a blockage of the superior mesentery artery. What artery is keeping the midgut from becoming ischemic?

Back 70

Marginal artery anastomoses the SMA and IMA

Front 71

During surgery, you notice a ligament connecting the liver and duodenum. Why is it important that you do not cut this?

Back 71

It contains the portal triad- heaptic artery, portal vein and bile duct

Front 72

A patient has a stomach ulcer. After going untreated for a week, he is seen to also have pancreatitis. Why did this form?

Back 72

Stomach acid leaked into the epiploic foramen of winslow and irritated the pancreas.

Front 73

A patient has fluid accumulation in the peritoneal cavity. What is the diagnosis?

Back 73

Ascites

Front 74

A patient needs drugs delivered to the circulation quickly. What type of injection would you give? Why is this site a prime place for injection?

Back 74

Intraperitoneal injection. peritoneum is very vascular and easy to penetrate