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115 Cards in this Set
- Front
- Back
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A patient in the ER was stabbed from behind. The knife pierces his left kidney. What 2 layers of muscle were also penetrated?
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erector spinae and quadratus lumborum, if high enough, the diaphragm also (sits in front of the superior poles)
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A patient is stabbed anteriorly at the T12 level. The abdominal aorta is still intact, but a branch of it was hit. What muscle is most likely going to become ischemic?
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diaphragm. T12 is where the aorta exits the aortic hiatus of the diaphragm. it immediately gives off the inferior phrenic arteries to the diaphragm.
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A patient has atrophy of the psoas major muscle. What arcuate ligament would be directly affected?
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medial arcuate ligament
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A patient has atrophy of the quadratus lumborum muscle. What arcuate ligament would be directly affected?
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lateral arcuate ligament
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A patient is seen with a weakened suspensory ligament of the duodenum. What crura can we assume to be defective?
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Right crura makes the suspensory ligament of treitz
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An elderly patient in the ER has pain in the esophagus. A barium swallow shows an esophageal hiatal hernia. What crus/crura of the diaphragm is weakened in this patient?
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The right crus makes the esophageal hiatus. In a hiatal hernia, the esophageal hiatus is weakened
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As a surgeon performing a nephrectomy, you enter the body posteriorly. Why is this more favorable than entering anteriorly?
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The kidneys are retroperitoneal. If we enter posteriorly, we do not have to enter the peritoneal cavity and risk peritonitis.
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As a surgeon performing a nephrectomy, you enter the body posteriorly. After surgery the patient has lost sensation in the T12 dermatome and feels pain in his groin. What nerves could have been damaged? How were they damaged?
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subcostal (T12) was severed and ilioinguinal was irritated (cutaneous innervation for the groin)
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A patient in the ER is stabbed anteriorly at the L1 level and is rushed into shock trauma. As a vascular surgeon, you have already repaired the superior mesenteric artery and blood flow inferior to L1/L2 is restored. What other organ may become ischemic in this time?
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kidneys. renal arteries come off at L1/L2
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During abdominal surgery, you notice a peristalsing vessel passing over the common iliac bifurcation. If this was ligated accidentally why might we see edema in this patient?
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hydronecrosis of kidneys kills kidney as urine backs up. damaged kidney is unable to keep proteins out of the urine. low venous colloid pressure prevents water from entering vessels from tissue fluid. water collects in tissue fluid = edema
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A patient complains of pain in his lateral groin area that moves medially and downwards. He feels like his bowels are damaged? What is a quick differential diagnosis?
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Kidney stones. Pain is loin to groin. afferents run with bowels so bowels feel weird also
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A patient present to you with significant sympathetic nervous system deficits. Nerves are all intact but he has adrenal gland damage. Which cells of the adrenal gland are likely responsible for the weak sympathetic responses?
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Chromaffin cells secrete epinephrine/norepinephrine. these are the neurotransmiters for the sympathetic nervous system
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A patient in the ER has an Abdominal Aortic Aneurysm below the renal arteries and above the common iliacs. If we place a stent to repair the vessel, which gut anastomoses will we force?
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a stent in this AAA, to strengthen the artery wall, will block the Inferior mesenteric artery, forcing blood from the SMA to supply the hindgut. The marginal artery will be very important here (middle colic from SMA to Left colic from IMA).
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A patient is shot in the chest. The neck of his pancreas is severely damaged and dark blood is shooting out. What vessel is damaged?
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Portal vein forms right behind neck of pancreas. SMA also is there, but would not give us dark blood. dark blood = vein damage
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A patient in the ER has blood in feces and perineal pain. Bulges in the vessels are seen below the dentate/pectinate line. What is a likely diagnosis? Where might we see a blockage in venous drainage?
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external hemorrhoids. external and middle rectal plexus drains to internal iliac vein. there is likely a blockage there, forcing portal anastomoses
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A patient in the ER has ingested a direct toxin. What model of the liver will allow us to determine the cells most affected by this? What cells will be most affected?
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Liver acinus model, zone 1
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A patient in the ER has heart failure. What cells of the liver (zone) are at highest risk for death?
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Zone 3 is at highest risk for necrosis
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An alcoholic patient shows signs of fatty accumulation in the liver. What cells/zone of the liver will be the first affected?
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Zone 3 cells are first to show fatty accumulation in alcoholics
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An alcoholic patient has progressed beyond fatty liver disease. Inflammation is seen. What granulocytes will we see elevated levels of in the liver?
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neutrophils create an inflammatory response in alcohol hepatitis
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An alcoholic patient has cirrhosis of the liver. Why will they have edema?
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Liver produces albumin to keep colloid pressure up in the veins of tissue fluid. low vein colloid pressure = edema
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A patient has cardiac cirrhosis. What will we see in this patient's liver cells?
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Centrilobular necrosis (zone 3). bad blood flow = zone 3 most likely to die of ischemia
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A patient in the ER has an abnormal accumulation of damaged RBCs in the liver. What cells may be dysfunctional?
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Kupffer cells phagocytize damaged RBCs along the sinusoids
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A patient has trouble emulsifying fats in the GI tract. What cells of the GI tract are most likely dysfunctional?
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Hepatocytes and the columnar epithelium of the GI tract. (90% of bile is reabsorbed). Hepatocytes only replenish 10%
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Theoretically, why might a patient with Clostridium Perfingens infection have trouble emulsifying fats?
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CP toxins attack tight junctions. tight junctions seal the bile canaliculi between hepatocytes. Bile will leak out of canaliculi and not make it to the larger ducts
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After a meal, a patient does not release bile from their gallbladder. Bile is being made properly. What cells may not be making their product correctly?
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enteroendocrine cells of duodenum secrete CCK to stimulate bile release
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After a meal, a patient does not release enzymes from their exocrine pancreas. What cells may not be making their product correctly?
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enteroendocrine cells of duodenum secrete CCK to stimulate pancreatic enzyme release
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A patient has overproduction of gastric acid in the stomach. What cells are defective?
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enteroendocrine cells of duodenum secrete GIP to inhibit gastric acid production
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After a fatty meal, a patient has sharp pains. A stone is found in the cystic duct. From what part of the GI tract did this irritated organ develop as a diverticulum?
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gallbladder is from the duodenum
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After ingesting food, the Myenteric plexus of the GI tract is not receiving a stimulus. What layer of the GI tract is damaged?
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Submucosal layer. it hold the Meissner's plexus that signals the myenteric
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In a patient with Hirschprung's Disease, which 2 GI tract layers are not fully developed?
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submucosal and muscularis externa are both missing their nerve plexii
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A patient presents to you with GERD. Which glands of the esophagus would we expect to hypertrophy or work harder?
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Esophageal cardiac glands secrete mucus with a neutral ph to protect the lower esophagus
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A patient presents in the ER with pyrosis and has difficulty breathing. What is your diagnosis?
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GERD to Barrett's Epithelium. pyrosis means heartburn
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A patient is having painful swallowing and it is seen that they have deficient esophageal gland proper. What layer of the esophagus is damaged?
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submucosa contains the esophageal gland proper (secretes acidic mucus to lubricate lumen of esophagus)
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A patient is diagnosed with GERD. What vertebral level is their dysfunction?
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T11 is the joining of the esophagus to the stomach cardia
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A patient has an ulcer forming due to difficulty secreting mucus in their stomach. What type of epithelium in the stomach is damaged? What region of the stomach is impaired?
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simple columnar, cardia. cardia is responsible for secreting mucus to protect stomach walls.
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A vegetarian patient presents with "burning soles of their feet". The cells responsible for these symptoms stain what color in H/E?
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parietal cells stain pink (eosin, acidophilic)
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A patient is seen to have a deficiency in carbonic anhydrase. Why would they have a difficult time digesting foods?
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Parietal cells use carbonic anhydrase to make H+ (and subsequently HCL). no HCL is being made now
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A vegetarian patient presents with "burning soles of their feet". Explain their symptoms.
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Dysfunctional parietal cells (upper gastric glands) are not making intrinsic factor so B12 is not absorbed = neurological deficits
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A vegetarian patient has neurological deficits and it is not Multiple sclerosis. The patient complains of burning soles of feet. Pathologists might notice damage to what part of gastric glands?
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parietal cells are in upper gastric glands
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In a patient, it is noticed that there is an absence of pepsin, but an abundance of pepsinogen. What cells might be damaged in the stomach? What specific enzyme may be dysfunctional?
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parietal cells or gastric enteroendocrine cells, carbonic anhydrase. Pepsinogen can only be converted to pepsin in the ACIDIC stomach lumen. parietal cells are responsible for secreting protons into the lumen. carbonic anhydrase in parietal cells is responsible for making H+ from carbonic acid. gastric enteroendocrine cells produce gastrin that stimulates acid production
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As a pathologist, you are looking at a section of stomach in H/E. You see long glands and short pits. You notice bright blue cells. What part of stomach are you seeing? What enzyme precursor do we see as a result of the blue cells?
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fundus or body, pepsinogen. chief cells are basophilic due to RER making pepsinogen
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In patients with chronic GERD, why might research want to limit the function of gastric enteroendocrine cells and up-regulate the function of esophageal cardia glands?
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limit gastrin release to limit the acid production. increase the mucus protection layer in lower esophagus
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A patient is having trouble regulating their pyloric sphincter. what specific layer of the GI tract is dysfunctional?
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middle circular layer of the stomach muscularis externa
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A patient presents with bacterial infections in his GI tract. What 3 specific cells of the small intestine may be dysfunctional?
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M Cells (phagocytes and APC), paneth cells (secrete antimicrobial lysozyme), plasma cells (make IgA)
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A patient has a build-up of lymph in their intestinal villi. What might be happening to cause this clog in the lacteal?
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triglycerides may not be broken down into glycerol. cannot enter the lacteal
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A patient is having difficulty digesting and absorbing nutrients in the GI tract. Pancreatic enzymes are not active, despite no damage to the cells of the pancreas. What part of the small intestine may be damaged in this patient?
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Brunner's glands in the duodenum submucosa secrete alkaline substance to optimize ph for pancreatic enzymes. damage to these glands leads to bad digestive enzyme function on the chyme
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Why might research in GERD lead to drugs that up-regulate enteroendocrine cells of the duodenum?
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the drug would promote Gastic Inhibitory Protein and secretin. both proteins shut off acid production in the stomach, decreasing damage to the esophagus
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A patient has a weakened immune system, due to GI abnormalities, due to dysfunctional microfold cells. A section in H/E is taken from each of the 3 parts of Small intestine to examine the extent of the damage. Why was it unnecessary to examine all 3 parts of small intestine?
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microfold cells are only in the ileum. microfold cells are found in peyer's patches. peyer's patches are only found in the ileum
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A patient presents with very heavily concentrated urine and it is noted that they have lost the ability to monitor the Glomerular filtration rate. What pole of the renal corpuscle is affected
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vascular pole contains the JG apparatus
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A patient with high blood pressure is taking ACE inhibitors. Where are these drugs inhibiting the conversion to angiotensin II?
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lung capillaries
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A patient has very low blood pressure and is unable to raise it using their internal regulatory systems. Paraventricular nucleus of the hypothalamus is working properly. What cells may be damaged in this pathway? What type of cells are they (epithelium, muscle?)
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JG cells, specialized smooth muscle. ADH and aldosterone are very important in regulating Blood pressure. in this patient ADH is probably fine, but aldosterone production is never started due to bad JG cells.
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A patient has damage to the paraventricular nucleus of the hypothalamus. What do we expect to see regarding his urine? What effects do we see on blood pressure
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Hypotonic, ADH is not present to allow water to enter blood from collecting duct. Lower blood pressure, water is being excreted out.
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A patient has total damage to the paraventricular nucleus of the hypothalamus. Will there be any reabsorption of water into blood in the collecting duct?
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Yes, even though ADH is gone, aldosterone allows for sodium to move out of collecting duct and water follows it out. Aldosterone also works in the distal tubules
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A patient has defective mesangial cells. What might we see in the basement membrane of the glomerulus?
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a build up of ions and proteins. mesangial cells function to phagocytize trapped particles and clean the basement membrane
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A patient's urine is examined. There are proteins seen in the urine that are about 30kDa large. Is this normal?
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No, even though it may get past the lamina densa, the proximal convoluted tubules are supposed to removal all small proteins
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A patient's urine is examined. There are proteins seen in the urine that are about 30kDa large. What part of the kidney nephron is damaged?
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proximal convoluted tubule is supposed to remove all small proteins from urine.
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The urine of a diabetic patient is being examined. There are high levels of glucose and proteins over 69kDa. Why is there a high level of glucose?
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Diabetics have high blood-glucose levels. This high amount of glucose is all moved into the urinary space in the glomerulus. Diabetics have too much glucose in their urine that all of it cannot be reabsorbed into the blood in the proximal tubules. much glucose is subsequently seen in urine.
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The urine of a diabetic patient is being examined. There are high levels of glucose and proteins over 69kDa. What cells are proliferating to cause the high protein levels?
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Diabetes causes mesangial cells to thicken the basement membrane (type 4 collagen/lamina densa) and this damages the filtration barrier in the glomerulus.
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A patient has recently suffered from a viral infection. High levels of albumin are found in his urine. What is the diagnosis? Describe the pathogenesis of this disease.
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Immune glomerularnephritis. Antibody-antigen complexes are trapped in the glomerular basement membrane. immune system attacks the membrane.
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A patient has recently suffered from a viral infection. High levels of albumin are found in his urine. What is the diagnosis? How can diabetes theoretically prevent this disease pathway? Why wouldn't diabetes help this disease in practice?
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Immune glomerularnephritis (post-streptococcal maybe). Antibody-antigen complexes are trapped in the glomerular basement membrane. immune system attacks the membrane. diabetes causes increased mesangial cell proliferation so the mesangial cells would be able to clear the basement membrane and phagocytize the complexes before they were attacked. in practice however, the mesangial cells actually also create more ECM and thicken the basement membrane and damage the filtration barrier
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A patient with severe hypertension has high levels of albumin in the urine. What is the diagnosis? What causes mesangial cells to thicken the basement membrane?
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Non-immune glomerularnephritis. mesangial cells thicken the basement membrane in response to the endothelial damage associated with hypertension
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A patient is diagnosed with Goodpasture's syndrome. Even though both are auto-immune disorders with similar urinalysis results, why is this diagnosis different from immune glomerularnephritis?
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immune Glomerularnephritis refers to the body's immune system attacking the trapped particles in the basement membrane. Goodpasture refers to the body's immune system actually attacking type 4 collagen of the lamina densa.
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A 29 year old male in the ER is having severely labored breathing and there are high levels of albumin in his urine. What is your diagnosis? Explain.
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Goodpasture syndrome. Auto-immune disease is attacking the collagen 4 in alveolar septae and in the lamina densa of the glomerular filtration barrier. 29 year old males are most likely
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A patient is seen to have multiple proteins in the urine under 69kDa in size. What is the epithelium of the damaged area of the nephron?
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proximal convoluted tubules are simple cuboidal/columnar with brush border
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As a pathologist, you see many basal striations in the sections of proximal convoluted tubules. Describe these findings.
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Basal striations indicate mitocondria which indicates active ion transport. proximal tubules are busy pumping ions, that sneak through the lamina rarae, out of urine back into blood
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Why might we expect edema in a patient with severe diabetes or hypertension leading to glomerularnephritis?
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These lead to high levels of albumin in urine (damage to lamina densa). lower albumin in the blood = lower colloid pressure = tissue fluid does not return into veins easily = edema
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A patient is diagnosed with diabetes insipidus. What part of the nephron is most vulnerable to this disease?
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collecting ducts. ADH is not produced and collecting ducts cannot function properly and concentrate urine. patients have hypotonic urine
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A patient has been drinking copious amounts of water. Why do we see clear urine?
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High water intake inhibits ADH release. urine ions and proteins are extremely diluted.
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A patient's urine has an abnormal pH. What part of the nephron is likely damaged?
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Distal tubule secretes H+ and ammonia to adjust pH.
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Why might a patient medicated for hypertension have hypotonic urine?
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ACE inhibitors block renin-angiotensin pathway. aldosterone is not able to allow for sodium reabsorption into blood, water does not follow it into blood. water stays in urine.
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A patient has a very low glomerular filtration rate. What cells are likely dysfunctional? How are these dysfunctional cells supposed to work to speed up GFR?
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Macula densa usually monitors the [NaCl] in the distal tube fluid and decides if more aldosterone is needed (to absorb more Na in the distal tube). if more is needed (GFR is too slow), it stimulates renin release by JG cells (smooth muscle)
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An alcoholic patient has severe liver cirrhosis and failure. We see hypotonic urine and a fluctating blood pressure. How was the renin-angiotensin pathway affected in this patient?
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Liver is responsible for making angiotensinogen. Cirrhotic liver with failure is not making angiotensinogen. renin has nothing to convert into angiotensin I. no aldosterone is made. water remains in distal tubes and collecting duct (ADH will bring a lot out though). damage to renin-angiotensin pathway = inability for body to regulate BP
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A hypertensive patient on ACE inhibitors might suffer from dehydration as a side effect. How would diabetes insipidus make this worse?
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on ACE inhibitors we are preventing aldosterone from bringing water back into the blood. diabetes insipidus means the patient doesn't have any ADH and water is not able to re-enter the blood at any point after distal tubes. severe dehydration.
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A pregnant patient is about to give birth. Three fingers are never able to enter side-by-side in the vaginal. What protein is dysfunctional? What is the narrowest distance the baby must clear?
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If three fingers cannot enter the vagina, the ischial tuberosities are not far enough apart. without relaxin, the interspinous distance (between ischial spine) is 10cm. with relaxin, the obstetric conjugate is the narrowest fixed distance
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A pregnant patient is giving birth. You palpate the sacral promontory and find the pubic symphysis. What have you estimated? What distance will indicate a likely successful birth?
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we use this diagonal conjugate to estimate the obstetric conjuate. diag = 13cm. ob= 11.5cm
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A patient presents with fecal incontinence. Examination of the puborectalis muscle shows that it is too relaxed. Describe the angle of the perineal flexure in this condition.
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It will be greater than 80 degrees. and below 180
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During a colonscopy, you pass a camera from the rectum into the sigmoid colon. At what vertebral level is the camera?
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S3= rectum/colon
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A patient has damage to the anal pectin epithelium. Will he experience referred pain? What epithelium is damaged?
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No, below the pectinate line sensory neurons are somatic. Stratified squamous non-keratinized.
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A patient has damage to the anal canal epithelium below the White Line of Hilton. What type epithelium is damaged?
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skin/stratified squamous keratinized
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In a patient, lymph collected below the pectinate line will be found in which lymph nodes?
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superficial inguinal
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In a patient, lymph collected above the pectinate line will be found in which lymph nodes?
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internal iliac
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A patient has bulging anal veins above the pectinate line. What is the diagnosis?
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internal hemorrhoids
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A patient with Benign Prostate Hyperplasia will have dysuria. Why will he also have difficulty ejaculating?
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Ejaculatory duct joins the urethra in the prostatic urethra that is compressed during BPH
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A patient complains of lumbar back pain and a mass is felt during palpation through the rectum. Radical prostectomy sparring the fibrous capsule is performed. Can he still get erections?
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Yes
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A female trying to get pregnant is seen to have defective fimbriae. Can she get pregnant?
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No, fimbriae must scoop egg out of the peritoneal space and bring it into the fallopian tubes to be fertilized.
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A patient has ischemia of an ovary. What structure was likely damaged?
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suspensory ligament of the ovary contains all blood vessels to ovaries (not in mesovarium)
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During surgery in a female, you notice the ureter passing underneath a blood vessel. What is the layer surrounding this artery?
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cardinal ligament surrounds uterine artery
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A patient has damage to her uterine artery. What artery will anastomose in this patient and prevent ischemia of the uterus?
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ovarian artery
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An infertile patient is being examined by an OB/GYN. A hysterosalpingogram is performed and the dye does not enter the fallopian tubes. Why is this patient infertile?
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likely there is mucus blocking the fallopian tubes
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A patient with a vaginal infection is being examined by an OB/GYN. A hysterosalpingogram is performed and the dye is seen to enter the peritoneal cavity. Based on this data, what serious condition are women more likely to experience than men?
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the infection can enter the peritoneal cavity = peritonititis. women have vulnerable area between fimbriae and ovary where there is an opening in the peritoneal cavity. men don't have this
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A patient has a rash on her vagina below her hymen. Will she see referred pain?
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no, below the hymen = somatic pain
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A patient has an abscess in her Pouch of Douglas. How will you biopsy this abscess?
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Culdoscopy, enter posterior fornix of vagina into pouch
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A woman's levator ani muscles and pelvic diaphragm is weaker after childbirth. What artery is going to be strained in this condition?
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uterine artery is held in the cardinal ligament. with weakened pelvic diaphragm, the ligament is under major strain. artery is in it
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After childbirth, a woman is having trouble holding in her urine during exercising . Explain why this occurs.
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stress incontinence. Pelvic diaphragm is weak after childbirth. allows for bladder to prolapse. Bladder neck is no longer using abdominal pressure as a physiological sphincter.
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During surgery you notice a nerve passing medially to psoas major and through the obturator canal. What area is cutaneously innervated by this nerve?
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obturator nerve innervates the upper medial thigh
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A patient with an enlarged prostate complains of lower back pain. How did the cancer metastasize?
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From the prostatic plexus to Batson's plexus
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A patient has fluid accumulation in the superficial perineal pouch. What layers is the fluid between?
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Collies fascia and perineal membrane
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A patient has fluid accumulation in the superficial perineal pouch. Why does this fluid not enter the anal triangle of perineum?
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Collies fascia is tight with central tendon/perineal body
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A female patient is suffering from Bartholinitis. This inflammation occurs between what fascial layers?
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superficial perineal pouch, between collies fascia and perineal membrane
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A patient suffers damage to the pudendal nerve. What affect will we see on erection?
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No effect on erection, but penis will be insensitive
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Assume a patient has no acetylcholine (or nitric oxide). Why would there be no erection?
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Erection is controlled by parasympathetics, that use ACH
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After taking Viagara, a patient has an erection for 7 hours. Why will we see ischemia?
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bulbospongiosum and ischiocavernous muscles are contracted to prevent venous return from penis. no new blood is entering the penis via helicine arteries
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A patient is unable to get an erection. All nerves are intact. What artery is likely damaged?
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Helicine artery allows blood to swell penis
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A patient regularly has semen in his bladder after ejaculation. What nerve is damaged? What muscle is damaged?
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sympathetic L1-L2. internal urethral sphincter
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A patient is going through a dangerously painful childbirth. You perform an episiotomy to easy the birth. What are we trying to be sure we do not cut?
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Central tendon, all muscles in perineum attach to it
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A patient has penile insensitivity. This may be caused by entrapment of a major nerve in a fascial specialization of what muscle?
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obturator internus = Alcock' canal that holds pudendal nerve
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A patient has suffered damage to Onuf's nucleus. The affected muscle is found in what perineal space?
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external urethral sphincter Deep perineal space
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During painful childbirth, an OB/GYN may administer a pudendal nerve block. What bony landmark are you looking for to find the nerve?
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ischial spine lies right behind the pudendal nerve
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A man suffers from penile insensitivity due to a poorly designed bicycle seat. Will we see urinary incontinence?
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Yes, external urethral sphincter is controlled by deep perineal nerve of the pudendal nerve
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A patient suffers from diverticulitis in the colon. What part of the colon is most likely affected and why?
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Sigmoid colon/descending colon. high intralumenal pressure causes diverticulum to form and can become inflammed. sigmoid colon is the narrowest part of colon and it has the highest pressure of the colon.
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Assume a patient has a calmodulin deficiency in their kidneys. Why would GFR be poorly regulated?
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calmodulin = smooth muscle. JG cells are smooth muscle. Macula densa regulates GFR by stimulating JG cells to release renin. without calmodulin, JG cells are irresponsive
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Assume a patient has a calmodulin deficiency in their kidneys. Why would we see hypotonic urine?
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calmodulin is needed for smooth muscle cells to function. JG cells are smooth muscle. no renin is being released in this patient = no aldosterone = less water reabsorbed into blood - more water in urine
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A patient recently suffered from a viral infection. We now see high levels of albumin in the urine. Diagnosis?
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post-streptococcal immune glomerular nephritis
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A patient has high levels of stomach acid being produced. What 3 types of cells may be dysfuntional?
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hyperfunction of gastric enteroendocrine cells (secrete gastrin). hyperfunction of parietal cells (elaborate HCL). Hypofunction of duodenal enteroendocrine glands (usually release GIP and secretin to slow acid production)
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The esophagus is having a difficult time moving food down the tract. In what layer are the dysfunctional glands found?
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Submucosa holds esophageal glands proper (esophageal cardia glands are in mucosa)
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