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86 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Pulmonary embolism
1. Most common cause= |
DVT
DVT starts from = |
lower limb or pelvis
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RPA
location of: = |
Posterior to Ascending Aorta and SVC
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LPA
location of: = |
Anterior to Descending Thoracic Aorta
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Pulmonary embolism
2. Risk Factors |
patient’s age
minimal physical exercise bed rest after a major operative gynecological procedure Postoperative |
Pulmonary embolism
Summary: Two days ago, a 65-year-old woman underwent a total abdominal hysterectomy due to endometrial cancer. She developed acute onset dyspnea with pleuritic chest pain. She has tachypnea and tachycardia and appears anxious. Rales (crackles) are not present by pulmonary examination Most likely diagnosis: Pulmonary embolism Most likely location of the primary disease: Deep vein thrombosis (DVT) of the pelvis or lower limb |
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Pulmonary embolism
location of: 3. RPA= LPA= |
Posterior to Ascending Aorta and SVC
Anterior to Descending Thoracic Aorta |
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identify the
right pulmonary artery locations? |
Posterior to the ascending aorta and the SVC
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how many pulmonary veins entering the left atrium?
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4
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A 44-year-old woman who has a DVT of the lower extremity suddenly
gasps and collapses. She is found to be hypotensive. Resuscitative measures are attempted without success. Which of the following is the most likely diagnosis? |
B. Saddle embolus
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A saddle embolus or straddling embolism is a thrombus that straddles a dividing blood vessel. Saddle emboli are often lethal because they prevent the entry of blood into the lung and cause acute anoxia. These emboli typically originate in the veins of the lower extremities and are carried by venous blood to the vena cava and then through the right atrium and ventricle into the pulmonary artery. A massive thromboembolus may occlude the pulmonary artery or its main branches and cause sudden death.
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Acute Pancreatitis
Anatomical location |
Retroperitoneal
posterior to the stomach lesser peritoneal sac (omental bursa) |
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Acute Pancreatitis:
S/S = key sign is = Most common cause = |
Pain radiates to back
alcohol and then gall stone |
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Acute Pancreatitis
3. Diagnosis-enzyme |
Serum amylase
1st to check S. Lipase |
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Acute Pancreatitis
4. Complications = 3ct |
chronic pancreatic.....
diabetes...... And pseudocyst |
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the second portion of the
duodenum and the head of the pancreas. You note an artery and vein passing anteriorly to the uncinate process of the pancreas and the third portion of the duodenum. Which vessels are these? |
SMA and SMV
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Acute Pancreatitis
As you proceed to elevate the duodenum and pancreas, you note two veins posterior to the neck of the pancreas uniting to form a large vein that passes superiorly. Which large vein has been formed? |
Portal vein
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Acute Pancreatitis
As you continue, you also note a large, tortuous artery passing to the left along the superior border of the pancreas. This is likely to be which of the following? |
Splenic artery
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Small Bowel Mesentric Angina
Mesenteric ischemia-Risk Factors = 4ct |
a. Age
b. Hypertension c. Diabetes d. Hypocholesterolemia Hx |
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Small Bowel Mesentric Angina
most commonly involved = |
SMA-Superior mesenteric artery-
Nm Branches = & organs fed = (i-iv ct) |
a. Branches of SMA
i. Inferior pancreaticduodenal ii. Right colic artery..... ascending colon iii. Middle colon A..... transverse mesocolon iv. ileocolic |
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Small Bowel Mesentric Angina
1. During a surgical procedure, you have elevated the transverse colon and note an artery in the transverse mesocolon. What is this vessel? |
B. Middle colic artery
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Small Bowel Mesentric Angina
2. During surgery you note a retroperitoneal artery crossing the right side of the posterior abdominal wall and supplying the ascending colon. Which vessel is this? |
Right colic artery
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3. A 44-year-old accountant develops a bleeding ulcer around tax time.
The gastroenterologist visualizes the ulcer in the proximal duodenum. A radiologist has been called to cannulate and embolize the artery supplying the ulcer. Which of the following arteries does the radiologist need to cannulate? |
Celiac artery
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Coronary Artery Circulation
Myocardial infarction ◆ Anatomical structures likely affected: |
Right coronary artery
left anterior descending artery |
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Anatomical structures likely affected:
RCA |
SA node
AV node posterior 1/3 Interventricular septum |
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Anatomical structures
RCA branches |
a. SA nodal branch
b. Right margincal branch c. Posterior interventricular |
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Anatomical structures likely affected:
LCA= |
Anterior right/Left ventricles
Anterior 2/3 Interventricular septuim |
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Anatomical structures
LCA branches |
a. Circumflex
b. Left marginal c. Left anterior descending artery is the most commonly occluded of the coronary arteries = |
LAD
c. Left anterior descending |
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As a cardiologist, you are concerned about blockage of the artery to the SA node in a patient.
This artery typically arises from which of the following? |
RCA
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In a balanced coronary artery pattern, the blood supply to the majority of the
interventricular septum is derived from which of the following? |
Anterior interventricular artery
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As a cardiologist, you are concerned about blockage of the artery to
the AV node in a patient. This artery typically arises from which of the following? |
RCA
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Pneumothorax
to remove fluid from the pleural cavity of your patient (thoracentesis). insert the needle over the top of a rib, into an intercostal space inferior to lower border of the lung @ MAL at the end of a normal expiration. highest RIB level W/o injuring the lung? |
8th intercostal space
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Pneumothorax
While performing this thoracentesis procedure, lowest level of the pleural cavity at the end of expiration will lie at #___ RIB in the MAL? |
10th
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Pneumothorax
While performing this procedure, the lower lung border will lie at the level of which rib in the MCL? |
6th
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gall stones(cholelithiasis)
Histology of Gall Bladder |
gallbladder fossa lies between the right and quadrate lobes of
the liver. ❖ The cystic artery is usually a branch of the right hepatic artery. ❖ The hepatic ducts are the most anterior structures at the porta hepatis. ❖ The bile ducts lie to the right within the hepatoduodenal ligament |
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gall stones(cholelithiasis)
Blood supply of Gal Bladder |
Cystic Duct ---->
Cystic Artery(Branch of Hepatic Artery) |
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gall stones(cholelithiasis)
Risk Factors |
fat
forty fertile |
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gall stones(cholelithiasis)
Which of the following is the correct landmark for locating the normal position of the gallbladder during a physical examination? |
junction of
-R linea semilunaris w/ -subcostal margin |
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During a surgical procedure in which you will remove the gallbladder,
you will expect its blood supply, the cystic artery, to arise from which of the following arteries? |
A. Right hepatic artery
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During the surgical procedure in the above question, your index finger
is placed into the epiploic foramen. Which of the following structures would be inferior to your finger? |
B. First part of the duodenum
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Suprarenal gland tumor
Right Adrenal Anatomical relationship: |
Right Adrenal gland
IVC Liver diaphragm |
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Suprarenal gland tumor
Anatomical relationship: |
b. Left Adrenal gland
(Stomach Pancreas Diaphragm Spleen |
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As a surgeon about to remove the right adrenal gland, you examine the
blood supply of the right adrenal gland and observe which of the following? |
Its central vein drains into the IVC
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After removal of a large portion of the stomach in a patient who has
cancer, you are now examining the lymph nodes that receive lymph from the stomach. Which of the following structures receives lymph directly from the stomach? |
Celiac nodes
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In a patient who has testicular cancer that has metastasized (spread) to
the lymph nodes, which of the following would you expect to be involved first? |
Lumbar (aortic) nodes
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❖ The right suprarenal gland is closely related to the IVC, into which
its vein will open. ❖ The left suprarenal vein drains into the left renal vein. ❖ Multiple arteries to the suprarenal glands arise from the inferior phrenic artery, aorta, and renal artery. ❖ Lymph from the gonads drains to upper lumbar nodes. ❖ Lymph above the pectinate line of the anal canal drains to the iliac nodes, whereas lymph below the pectinate line drains to inguinal nodes. |
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Recurrent Tonsillitis
Vessel involved with intraoperative bleeding: |
External palatine vein
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Recurrent Tonsillitis
Loss of taste sensation |
Compression of glossopharyngeal nerve (CN IX)
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Recurrent Tonsillitis
1. Bleeding V. & A. 2. Loss of taste posterior 1/3 tongue (N is =) |
a. Palatine vein
b. Tonsilar branch of facial artery CN IX |
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Recurrent Tonsillitis
3. Location of palatine tonsil= |
palotoglossal arch/palatopharyngeal arch
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Recurrent Tonsillitis
4. Pharyngeal tonsil/adenoid location = |
floor or posterior wall of mesopharynx
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During a procedure to remove a palatine tonsil, the operating field was
suddenly filled with bright red blood. Which artery was inadvertently damaged? |
Tonsillar branch of facial
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A patient has a mild chronic cough, but has clear lungs and no evidence
of bronchitis. Her physician believes that the symptoms are due to postnasal drip brought on by allergy. Which nerve is responsible for the afferent limb of the cough reflex? |
CN IX
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Which structure passes through the gap between the superior and middle
constrictor muscles? |
Glossopharyngeal nerve
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❖ The three pharyngeal constrictor muscles are stacked like ice-cream
cones. Structures pass into the pharynx through gaps between the muscles. ❖ The tonsillar ring (Waldeyer) is a discontinuous mass of lymphoid tissue located where the body opens to the environment, exposing the immune system to pathogens. ❖ At the base of the palatine tonsil, the tonsillar branch of the facial artery, and the glossopharyngeal nerve (CN IX) can be identified. ❖ The gag reflex is evoked by mechanical stimulation of the oropharynx. The ______ limb of the reflex is mediated by the glossopharyngeal nerve (CN IX), and _____ limb is mediated by vagus nerve (CN X). |
afferent
efferent |
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Menstural/Ovarian cycle
Hormones ? & Levels ? a. Proliferative= b. Luteal= |
high estrogen
high progesterone |
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Menstural/Ovarian cycle
Hormones ? & Levels ? c. Menstruation= d. Middle level of cycle = |
low level of estrogen/low level progesterone
high level of LH |
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Amenorrhea types & description
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a. Primary-never had
b. Secondary-had but then stops |
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Anorexia nervosa affects what part of brain.
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hypothalamus
everything decreases |
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Peptic ulcer disease
Organs likely affected: |
duodenum
Stomach |
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Peptic ulcer disease
Blood supply of stomach = 4ct |
-celiac artery .....
a. Left gastric b. Splenic c. Common hepatic |
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Peptic ulcer disease
__________ artery-at risk of ulcer perforation |
Gastroduodenal
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Peptic ulcer disease
S/S 4ct |
Mid abdominal pain right after eating-
gastric ulcer, chronic pancreatic, mesenteric ischemia, choleliathisis |
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Peptic ulcer disease
Treatment includes a = |
histamine-blocking agent,
proton pump inhibitor, antibiotic therapy. + |
The
bacterium Helicobacter pylori has been implicated in most cases of peptic ulcer disease. If an ulcer occurs in the duodenum, the posterior wall of the ampulla of the duodenum (duodenal cap) is the usual site. The gastroduodenal artery lies posterior to the duodenum at this point and is at risk in the event of ulcer perforation. |
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Gastric contents exiting a posterior perforation of the stomach wall will
accumulate in which of the following? |
omental bursa
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Ligation of the common hepatic artery will eliminate the gastric blood
supply through which of the following arteries? |
Right gastro-omental
right gastric arteries |
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surgical incision through the fundus of the stomach would require
you to clamp which of the following? |
Short gastric arteries
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Peptic ulcer disease
❖ stomach vertebral Levels = gastroesophageal junction pylorus, which lie at vertebral levels ❖ The stomach is supplied by all three branches of the celiac artery. ❖ The short gastric and left gastro-omental arteries lie within the gastrosplenic ligament and are at risk in a splenectomy |
T-11
L-1 |
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Benign Prostatic Hyperplasia
Anatomical basis for the symptomatology: |
Compression of the
bladder neck or prostatic urethra |
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Benign Prostatic Hyperplasia
1.Histology of Prostate 2.Transitional epithelium means what |
–cancer
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Benign Prostatic Hyperplasia
1. A 66-year-old man complains of difficulty voiding and is noted to have probable BPH. Which of the following prostatic lobes is likely to be responsible for these symptoms |
Middle lobe
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Benign Prostatic Hyperplasia
48-year-old man is undergoing cystoscopic examination. As the cystoscope is placed into the urethra through the penile portion, which of the following tissues surrounds the urethra? |
Corpus spongiosum
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police detective takes a scraping of some stains to be examined for
alkaline phosphatase to assess whether these might be ejaculate. What is the source of alkaline phosphatase in the semen? |
Seminal vesicles
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❖ The posterior and lateral lobes of the prostate are palpable by DRE.
❖ The middle lobe may press on the bladder neck in BPH. ❖ The sphincter urethrae muscle extends superiorly to cover the anterior surface of the prostate. ❖ The bulbourethral glands lie adjacent to the membranous urethra, but their ducts open into the proximal spongy urethra. |
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Menopause
Estrogen/Progesterone Levels are low during menopause a. Because of |
atrophy of ovaries due to _____
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apoptosis
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Menopause
3. Turner’s Syndrome a. Low levels of |
estrogen/progesterone
because of ___________ |
atrophy
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Menopause
3. Turner’s Syndrome Hormone levels will be = |
Low estrogen
Low progesterone because of = |
atrophy
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Klinefelter Syndrome
Chromosomal type = Causes what in testis = |
XXY
Testicular atrophy so the levels of testosterone will be = |
very LOW
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Menopause
b. Levels of GnRH, LH, FSH will be = |
HIGH
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Androgen Insensitivity Syndrome
1. Karyotype = |
46XY
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Androgen Insensitivity Syndrome
2. Pathophysiology |
defective androgen receptor
causes atrophy of mesonephric duct mesonephric duct structures developed from = |
a. Mesonephric duct
b. Paramesonephric duct |
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Perinephric Abcess
◆ Anatomical structure involved: |
Kidney
anatomically related Structures |
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Perinephric Abcess
1. Most common organism cause of UTI?= |
E. COLI
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Perinephric Abcess
2. Between renal fascia you have paranephric fat=paranephric abcess a. UTI ascending infection goes into b. Infection in paranephric fat= |
kidney causing pyelonephritis
paranephric abscess |
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Perinephric Abcess
3. Treatment: |
a. Drainage
b. Followed by Antibiotics |
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1. During the removal of a patient’s kidney, you would observe which of
the following as being most anterior within the renal sinus? |
Renal vein
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2. You wish to examine the hilum of the right kidney during surgery. Which
of the following structures must be elevated and reflected to do so? |
Duodenum
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3. To elevate the kidney within the renal fascia and the perirenal fat, the
renal fascia must be reflected or incised from the fascia of which of the following muscles? |
Psoas muscle
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Perinephric Abcess
❖ The hilum of the left kidney lies at the level of = ❖ In the renal sinus, the renal vessels lie anterior to the _____ _____ with the _____ ______ being the most anterior. |
L-1
renal pelvis renal vein ❖ The left renal vein receives the = 3ct |
inferior phrenic,
suprarenal, gonadal vessels. |
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Ludwig's angina is a bilateral infection of the
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submandibular space ...
2 compartments in mouth floor sublingual space & submylohyoid (aka submaxillary space) |
-infection begins in mouth floor
-characteristically aggressive, -rapidly spreading -"woody" or brawny cellulitis involving -submandibular space. -rapidly spreading cellulitis w/o -lymphatic involvement -generally without abscess formation. Both the submylohyoid and sublingual spaces are involved. The infection is bilateral. |
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submandibular space ...
2 compartments in mouth floor sublingual space & submylohyoid (aka submaxillary space) Nm Dz = |
Ludwig's angina
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