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981 Cards in this Set

  • Front
  • Back
Autonomic pathwaysconsist of two motor neurons, a __ and a __
Autonomic pathwaysconsist of two motor neurons, a myelinated preganglionic
(presynaptic) neuron and an unmyelinated postganglionic (postsynaptic) neuron.
Because the linea albais relatively avascular, incisions may
not heal well and
Compression of the left testicular veinby a full sigmoid colon produces
varices of the pampiniform plexus on the left side- fertility may diminish.
In the female, palpable per vaginaare the
cervix and ostium of the uterus, the
The cavity of tunica vaginalisis a potential space that represents the detached
portion of the peritoneal cavity that surrounds the testis except at the mesorchium.
and the pelvic inlet more
The female pelvisis less massive, the subpubic angle is greater (almost 90°), and
The midrectum drains along the
middle rectal lymphatics.
from the
sacral promontory to a point a few millimeters below the superior mar-
ported by mesorchium) where?
in the scrotum.
The transverse midplane diameter,measured between the
ischial spines, is the
Correct Answer: B
Correct Answer: A
Explanation:
Explanation:
Explanation:
Explanation:
Explanation:
Explanation:
Explanation:
Explanation:
E. Spleen
The correct answer is E. The spleen follows the long axes of ribs 9 to 11 and lies mostly posterior to the stomach, above the colon, and partly anterior to the kidney. Therefore, it is the most likely organ of the group to be pierced by a sharp object penetrating just above rib 10 at the posterior axillary line. Note that the pleural cavity, and possibly the lower part of the inferior lobe of the lung, would be pierced before the spleen.
The left lobe of the liver (choice D) is positioned just beneath the diaphragm, just over and anterior to the stomach. The anterior positioning of this structure makes it an unlikely candidate for injury in this case. Even with deep penetration at the correct angle it would not be penetrated before the spleen.
Explanation:
E. Vesicouterine space
The correct answer is C. The posterior fornix is in contact with the floor of the rectouterine space. The rectouterine space is the lowest part of the peritoneal cavity in the female pelvis. The patient has introduced bacteria into the peritoneal cavity by the penetration of the sharp object, producing sepsis.
The vesicouterine space (choice E) is the region within the peritoneal cavity of the female pelvis between the urinary bladder and the uterus. This space is not related to the posterior fornix of the vagina.
E. Nerve cell body loss in the ipsilateral dorsal horn
The correct answer is B. The dorsal root ganglion (DRG) contains nerve cell bodies of primary sensory afferents (the neurons that actually detect the sensory input). The primary afferents that sense conscious proprioception, discriminative touch, and vibration have cell bodies in the DRG, send axons into the spinal cord via the dorsal roots, ascend in the ipsilateral dorsal columns (in this case in the fasciculus cuneatus), and synapse in the medulla (in this case in the nucleus cuneatus). Therefore, if the DRG were destroyed, axonal loss would be predicted in the ipsilateral dorsal columns.
Choice D is not correct because the cell bodies of lower motor neurons (which reside in the ventral horn) send axons out of the spinal cord via the ventral roots to eventually synapse on skeletal muscle and would therefore not be affected by this injury.
E. Between the parietal pleura and the visceral pleura
The correct answer is A. The pericardial space is located between the epicardium (also known as the visceral pericardium) and the parietal pericardium. A tear of a blood vessel immediately outside of the heart will cause bleeding into the pericardial space. This accumulation of blood in the pericardial space causes increased pressure on the heart, which restricts filling of the heart during diastole (cardiac tamponade). This reduced filling results in reduced cardiac output and reduced blood pressure.
E. Superficial perineal space
The correct answer is E. The bulb of the penis contains the urethra, and is found in the superficial perineal space. The superficial perineal space is found between the inferior fascia of the urogenital diaphragm (perineal membrane) and the superficial perineal fascia (Colles' fascia). The attachments of the superficial perineal fascia to the posterior edge of the urogenital membrane and to the ischiopubic rami prevent the urine from escaping posteriorly into the gluteal region or laterally into the thigh. The urine can escape anteriorly onto the anterior abdominal wall, where it will be deep to the superficial abdominal fascia (Scarpa's fascia).
The retroperitoneal space (choice D) is the region between the parietal peritoneum and the endoabdominal fascia. This space contains connective tissue, fat, and several organs, including the kidney and ureter.
E. passes through the deep inguinal ring
The correct answer is B. Direct inguinal hernias enter the inguinal canal by tearing through the posterior wall of that structure. The typical location for this type of hernia is through the inguinal triangle, bounded laterally by the inferior epigastric artery, medially by the lateral border of the rectus abdominis, and inferiorly by the inguinal ligament. Direct inguinal hernias pass medial to the inferior epigastric artery, whereas indirect inguinal hernias pass lateral to the inferior epigastric artery because the deep inguinal ring is lateral to the artery.
Indirect inguinal hernias pass through the deep inguinal ring (choice E), direct inguinal hernias do not. Both types of inguinal hernias pass through the superficial inguinal ring.
Correct Answer: E
E. Wall of the left atrium
The correct answer is B. The atrioventricular (AV) node is in the subendocardium of the interatrial septum. From the AV node, the Purkinje fibers of the atrioventricular bundle enter the interventricular septum to carry impulses to the ventricle. The function of the AV node is to retard the conduction of the cardiac impulses so that ventricular systole occurs after atrial systole.
The wall of the left atrium (choice E) does not contain any nodal cells.
Explanation:
E. Superior pancreaticoduodenal artery and inferior pancreaticoduodenal artery
The correct answer is E. The superior pancreaticoduodenal artery is a branch of the gastroduodenal artery, which is a branch of the common hepatic artery, itself a branch of the celiac trunk. The inferior pancreaticoduodenal artery is a branch of the superior mesenteric artery. Occlusion of the celiac trunk would allow blood from the superior mesenteric artery to reach the branches of the celiac trunk via the connections between the superior and inferior pancreaticoduodenal arteries.
The right colic and middle colic arteries (choice D) are both branches of the superior mesenteric artery.
E. Superior mesenteric vein-splenic vein
The correct answer is C. The splenic vein drains directly into the portal vein. The left renal vein drains directly into the inferior vena cava. Anastomosis of these veins would allow blood from the portal vein to drain retrograde though the splenic vein into the renal vein and then into the inferior vena cava.
The superior mesenteric vein (choice E) drains directly into the portal vein. The splenic vein also drains directly into the portal vein. Thus, neither vein is part of the caval venous system.
E. Superior pancreaticoduodenal-right gastroepiploic
The correct answer is D. The connection that specifically links the midgut (superior mesenteric artery territory) to foregut (celiac artery territory) is through the superior pancreaticoduodenal (from celiac artery) and inferior pancreaticoduodenal (from superior mesenteric artery) arteries.
Both the superior pancreaticoduodenal artery and the right gastroepiploic artery are branches of the gastroduodenal artery arising from the hepatic artery (choice E).
E. Right ventricle
The correct answer is A. The left atrium forms most of the posterior wall of the heart. The esophagus passes immediately posterior to the heart. Enlargement of the left atrium may compress the esophagus and cause dysphagia.
The right ventricle (choice E) forms most of the anterior wall of the heart and a small portion of the diaphragmatic surface of the heart. It is not related to the esophagus.
Correct Answer: A
E. Renal artery
The correct answer is B. The ureter leaves the renal pelvis and lies on the posterior abdominal wall as it descends to the pelvis. It crosses the pelvic brim at the level of the bifurcation of the common iliac artery. At this point it crosses anterior to the origin of the external iliac artery to enter the pelvis.
The origin of the renal artery (choice E) is from the abdominal aorta at about the level of the second lumbar vertebra. The renal arteries pass laterally to enter the renal pelvis. At this site, the ureter is posterior to the artery.
A bronchopulmonary segmentis defined by a?
Segmental bronchus and accom-
Correct Answer: A
Correct Answer: D
E. Short gastric
The correct answer is E. The splenic artery passes behind the stomach and gives off the short gastric artery and the left gastroepiploic artery immediately after passing the greater curvature. The left gastroepiploic artery has a strong anastomotic connection to another arterial supply while the short gastric does not, so the area supplied by branches of the short gastric arteries is more vulnerable to ischemia in this setting. If the block had occurred proximal to, instead of at the branch point, the short gastric vessels could be supplied by backflow from the left gastroepiploic artery.
The right gastroepiploic artery (choice D) is normally supplied by the gastroduodenal artery.
A large VSD is the principal factor in
tetralogy of Fallot.
A long mesorchiummay predispose to
testicular torsion with high potential for testicular ischemia and necrosis.
A patent urachus(rare) allows
reflux of urine through the umbilicus.
Correct Answer: B
Correct Answer: E
Correct Answer: E
E. Superior gluteal nerve
The correct answer is C. The pudendal nerve is a branch of the sacral plexus that exits from the greater sciatic foramen, and then enters the lesser sciatic foramen, to lie in the pudendal canal on the lateral wall of the ischioanal fossa. The inferior rectal nerve is a branch of the pudendal nerve, which crosses the ischioanal fossa to reach the anal canal, where it innervates the external anal sphincter and provides sensory innervation to the area.
The superior gluteal nerve (choice E) is a branch of the sacral plexus that exits through the greater sciatic foramen and innervates the gluteus medius, gluteus minimus, and tensor fascia latae muscles.
E. One half inch below the midpoint of the inguinal ligament
The correct answer is D. The inguinal canal lies entirely above the inguinal ligament. The deep inguinal ring is about one-half inch above the midpoint of the inguinal ligament. The superficial inguinal ring is superolateral to the pubic tubercle. Indirect inguinal hernias enter the inguinal canal through the deep inguinal ring.
The inguinal canal is entirely above the inguinal ligament. The thigh is below the inguinal ligament (choice E).
Correct Answer: A
Correct Answer: C
E. Posterior and superior mediastinum
The correct answer is E. The mediastinum is divided into four regions. The region above the manubriosternal junction (level of fourth thoracic vertebra) is the superior mediastinum. The region below the manubriosternal junction is divided into the anterior mediastinum (anterior to the pericardium), the middle mediastinum (within the pericardium), and the posterior mediastinum (posterior to the pericardium). The thoracic duct enters the thorax through the aortic hiatus of the diaphragm. At this point it lies in the posterior mediastinum, the region posterior to the pericardium. As it ascends through the thorax and passes the level of the fourth thoracic vertebra, it enters the superior mediastinum.
In addition to the thoracic duct, the posterior mediastinum (choices C and E) contains the descending aorta, azygos vein, hemiazygos vein and the esophagus.
A pudendal block can be effected by injecting an anesthetic into the vicinity of
the pudendal nerve in the pudendal canal close to the ischial spine.
E. Splenorenal ligament
The correct answer is D. The hepatoduodenal ligament is the portion of the lesser omentum that connects the liver to the first part of the duodenum. Within the hepatoduodenal ligament are found the proper hepatic artery and its branches, the common bile duct and its branches, and the portal vein. The cystic artery is usually a branch of the right hepatic artery, which is a branch of the proper hepatic artery.
The splenorenal ligament (choice E) is the mesentery that connects the spleen to the posterior abdominal wall. The splenic artery and splenic vein are within the splenorenal ligament.
The correct answer is B. The gastrohepatic ligament is the part of the lesser omentum that separates the greater peritoneal sac from the right portion of the lesser peritoneal sac. This portion of the lesser omentum has no significant blood vessels within it and may be incised for surgical access.
D. Splenorenal ligament
The correct answer is D. The splenorenal ligament is the portion of the dorsal mesentery between the posterior abdominal wall and the spleen. This mesentery transmits the splenic artery and vein from their retroperitoneal position in the proximal portion of their course to the peritoneal spleen.
The lesser omentum (choice C) is derived from the ventral mesentery. It is the mesentery between the lesser curvature of the stomach and the liver and between the first portion of the duodenum and the liver. It is not related to the spleen.
The correct answer is E. The stomach has a very rich anastomotic arterial supply and can tolerate occlusion of the gastroduodenal artery.
The left gastric artery, which supplies the proximal lesser curvature (choice D), arises directly from the celiac artery.
A ventricular septal defect produces
a serious right-to-left shunt with
in the right ventricle.
fusion of the
external oblique and internal oblique aponeuroses
Adrenal arteriesarise from the
inferior phrenic arteries, the aorta, and the renal
arteries
Correct Answer: E
Correct Answer: B
Correct Answer: C
Correct Answer: E
Correct Answer: C
Correct Answer: E
Correct Answer: E
An apical pulseis palpable at the point of maximal impulse (PMI) in which intercostal space? Just beneath what?
Fifth space, just beneath the nipple
Correct Answer: A
Correct Answer: A
Correct Answer: E
Anterior interventricular sulcus
Between left and right ventricles, marks the interventricular septum
Contains the anterior interventricular branch of the left coronary artery and the great cardiac vein
Aortic Auscultation
Right of sternum over second intercostal space
Correct Answer: C
Atrioventricular Function
Stimulated by atrial depolarization. It leads into the atrioventricular (A-V) bundle to synchronize ventricular depolarization
Atrioventricular Location
Atrioventricular near the interatrial septum
Atrioventricular Vasculature
Branch of right coronary artery near the posterior inter-ventricular branch
Autonomic pathwaysconsist of
two motor neurons
Correct Answer: A
nancy or constipation) results in
blood shunting through the anastomotic connections to the systemic venous system.
transverse perineal muscle extravasations of blood or urine will not pass into where?
extravasations of blood or urine will not pass into the anal triangle.
Correct Answer: B
of
all three aponeuroses and there is no posterior leaf.
Extraperitoneal Organ's ?
Rectum, anal canal, urinary bladder, cervix, prostate
gland, seminal vesicles
Peritoneal Organ's ?
Sigmoid colon, uterus, uterine tubes, ovaries, testes
Correct Answer: E
Correct Answer: D
Correct Answer: C
Correct Answer: D
Deep Perineal Space
Deep transverse perineal muscle, external urethral sphincter, urethra
Superficial Perineal Space
Crura of the clitoris, vestibular bulbs, superficial transverse perineal muscles, greater vestibular glands
Deep Perineal Space
Deep transverse perineal external urethral sphincter, bulbourethral glands, membranous urethra
Superficial Perineal Space
Testes, crura of penis, bulb of penis, penile urethra, superficial transverse perineal muscles
Coronary sulcus
Between atria and ventricles. nearly vertical behind sternum. marks the annulus fibrosus that supports the valves
Coronary sulcus (Contents)
Right side contains the right coronary artery, and small cardiac vein. Crossed by anterior cardiac veins
Left side contains circumflex branch of the left coronary artery and coronary sinus
T12 - ?
Nipple
Pubis
Correct Answer: B
Direct inguinal
Through the inguinal triangle bounded by inguinal ligament,
inguinal ring adjacentto the spermatic cord. Usually acquired
Correct Answer: D
Correct Answer: E
stone, what may develop?
pancreatitis may develop.
Correct Answer: B
E. Portal vein, hepatic artery, and hepatic vein
The correct answer is D. The free edge of the lesser omentum contains three important structures: the common bile duct, the hepatic artery, and the portal vein.
Neither the cystic duct (choices A, B, and C) nor the hepatic vein (choices B, C, and E) lies in the free edge of the lesser omentum.
Correct Answer: C
E. Short gastric
The correct answer is C. The arterial supply of the stomach is complex and is consequently a target on the USMLE. The right gastric artery supplies the distal lesser curvature.
The short gastric artery (choice E) supplies the proximal greater curvature above the splenic artery.
Explanation:
E. Right triangular ligament
The correct answer is A. While most of the liver is covered with peritoneum, there are several reflections of the peritoneum (commonly called "ligaments") on the posteroinferior surface of the liver. When the opposing layers of the reflections are separated, a "bare area" on the liver is produced. The largest bare area contains on one end the inferior vena cava and is bounded by a continuous irregular ring of ligament that is somewhat arbitrarily divided into sections called the anterior and posterior layers of the coronary ligaments. It is the anterior layer of the coronary ligament that would be felt in the maneuver described in the question stem.
The right triangular ligament (choice E) is the name given for the area where the anterior and posterior reflections of the coronary ligament merge on the inferior part of the posteroinferior surface of the liver.
Explanation:
E. Seminal vesicle
The correct answer is B. The deep perineal space is the region of the middle layer of the urogenital diaphragm. This layer of the diaphragm contains two skeletal muscles, the sphincter urethrae muscle and the deep transverse perineal muscle. Also found in this space is the bulbourethral gland (Cowper's gland). The membranous portion of the urethra is the portion of the urethra that passes through the urogenital diaphragm.
The seminal vesicle (choice E) is in the pelvis, superior to both the pelvic diaphragm and the urogenital diaphragm. The seminal vesicle's duct joins the ductus deferens to form the ejaculatory duct, which enters the prostatic portion of the urethra.
Each uterine artery crosses immediately superior to a ureter in the
transverse
Extraperitoneal Organs?
Thoracic esophagus, rectum, kidneys, ureters,
and adrenal glands
Femoral
Passes inferior to the inguinal ligament through the femoral ring
Correct Answer: A
Correct Answer: D
Correct Answer: C
Correct Answer: D
Correct Answer: C
Correct Answer: C
Correct Answer: D
Correct Answer: B
Correct Answer: A
Correct Answer: B
Correct Answer: E
Correct Answer: B
Indirect inguinal
Through the deep inguinal ring and along the inguinal canal—
the superficial ring withinthe spermatic cord. Usually congenital
Kidney stones may lodge at these locations with pain referred, respectively, to what regions?
the subcostal, inguinal, and perineal regions.
Correct Answer: B
Metastatic carcinoma of the rectummay be widely disseminated within the
abdomen, pelvis, and inguinal region.
Minor calycesreceive one or two pyramids before fusing into
major calyces.
Mitral Auscultation
Apex of heart in fifth intercostal space in left midclavicular line
Movement of feces into the rectal ampulla generates
the urge to defecate.
E. Sinoatrial node
The correct answer is D. Individual cardiac muscle cells are joined together at the intercalated disks. These disks contain membrane specializations called gap junctions. Gap junctions allow for the electrical transmission of a membrane depolarization from one cell to the next. This electrical transmission accounts for the synchronous depolarization of cardiac muscle cells, which results in the synchronous contraction of these cells.
The sinoatrial node (choice E) is in the wall of the right atrium, near the entrance of the superior vena cava. The sinoatrial node is composed of specialized cardiac muscle cells that spontaneously depolarize at a rate faster than regular cardiac muscle cells and thus sets the pace at which the heart depolarizes and contracts. The sinoatrial node is therefore known as the pacemaker.
Normal uterine position is?
anteflexed (uterus bent forward on itself at the level
Correct Answer: C
Correct Answer: B
Correct Answer: E
Correct Answer: A
Correct Answer: E
Correct Answer: D
Correct Answer: E
Correct Answer: C
Correct Answer: D
Correct Answer: B
Correct Answer: E
Correct Answer: D
Correct Answer: A
Correct Answer: B
Correct Answer: A
Pathway
Aortic plexus to lumbar splanchnic nerves
L1-L2: pubic and inguinal regions, anterior scrotum or labia, anterior thigh
Pathway
Phrenic nerve
C3-C5: neck and shoulder
Intercostal nerves
T5-T10: thorax
Superior mesenteric plexus to lesser splanchnic nerve
T10-T11: umbilical region
Aorticorenal plexus to least splanchnic nerve
T12-L1: lumbar and ipsilateral inguinal regions
Pathway
Celiac plexus to greater splanchnic nerve
T5-T9: lower thorax,
epigastric region
Pathway
Hypogastric plexus to aortic plexus and then to lumbar splanchnic nerves
Referral Area
L1-L2: pubic and inguinal regions, anterior scrotum or labia, anterior thigh
Pathway
Pelvic plexus to pelvic splanchnic nerves
Referral Area
S3-S5: perineum and posterior thigh
Pathway
Gonadal nerves to aortic plexus and then to lesser and least splanchnic nerves
Referral Area
T10-T12: umbilical and pubic regions
Referral Area
C3-C5: neck and shoulder
Referral Area
T5-T10: thorax
Intercostal nerves
Pathway
Cervical and thoracic splanchnic nerves
Referral Area
T1-T4: upper thorax, postaxial brachium
Pathway
Intercostal nerves T1-T5
Referral Area
T1-T5: upper and midthorax
Pathway
Thoracic splanchnic nerves
Referral Area
T1-T5: thorax and epigastric region
Parasympathetic Effect
Cholinergic neurotransmission
Correct Answer: A
Parasympathetic Postsynaptic Pathway
Postganglionic cell bodies lie in numerous ganglia close to the target organ
Parasympathetic Presynaptic Pathway
Presynaptic cell bodies are located in the dorsal vagal nuclei of the brain, nuclei of the brain, synaptic axons form cranial nerve X, the vagus nerve
Parasympathetic - S3-S5: pelvic splanchnic nerves
Sympathetic - L1-L2: lumbar splanchnic nerves
Sympathetic - hypogastric plexus, pelvic plexus, cavernous plexus
referred along what nerve? On what dermatomes?
the greater splanchnic nerve to the fifth and sixth dermatomes
which include the epigastric region.
Correct Answer: A
Peritoneal (supported by mesentery) Organs?
Abdominal esophagus, stomach, superior
Pneumothorax -
loss of lungventilation
Anastomotic Connections
Azygos veins with left gastric and short gastric veins
Signs & Symptoms
Esophageal varices, intractable hematemesis
Superior rectal vein with middle and inferior rectal veins
Signs & Symptoms
Internal and external
Paraumbilical veins with superior and inferior epigastric veins
Signs & Symptoms
Caput medusae
Posterior interventricular sulcus
Delineates the interventricular septum, posteriorly
Posterior interventricular sulcus (Contents)
Contains the posterior interventricular branch of the right coronary artery and the middle cardiac vein
Correct Answer: E
E. Pubic tubercle
The correct answer is C. The pudendal nerve leaves the pelvis through the greater sciatic foramen, then wraps around the ischial spine and sacrospinous ligament to enter the lesser sciatic foramen and eventually reach the perineum. The ischial spine separates the greater sciatic foramen from the lesser sciatic foramen. Palpation of the ischial spine allows the physician to locate the pudendal nerve in order to perform a pudendal nerve block.
The pubic tubercle (choice E) is at the lateral end of the pubic crest. The medial attachment of the inguinal ligament is to the pubic tubercle.
Pulmonary Auscultation
Left of sternum over
Q: A pudendal nerve block is performed at what landmark?
A: Ischial spine
Q: At what level is a lumbar puncture performed?
A: Between L3-L4 or L4-L5
Q: Coronary artery occlusion usually occurs where?
A: Left anterior descending artery (LAD)
Q: Do the coronary arteries fill during systole or diastole?
A: Diastole
Q: Erection and sensation of the penis is in what dermatomes?
A: S2-S4
Q: How does the course of the left recurrent laryngeal nerve differ from that of the right?
A: The left wraps around the arch of the aorta and the ligamentum arteriosum while the right wraps around the subclavian artery.
Q: How is the appendix located?
A: 2/3 of the way from the umbilicus to the anterior superior iliac spine
Q: How many lobes are in the right and left lungs and what are their names?
A: --Right has three (superior,middle,inferior)
Q: Lumbar puncture is performed at what landmark?
A: Iliac crest
Q: Name five portal-systemic anastomoses.
A: 1.Left gastric-azygous vv.
Q: Name the 4 ligaments of the uterus.
A: --Suspensory ligament of ovaries
Q: Name the retroperitoneal structures (9).
A: 1.Duodenum(2nd-4th parts)
Q: Pain from the diaphragm is usually referred where?
A: Shoulder
Q: The area of the body that contains the appendix is known as what?
A: McBurney's point
Q: The inguinal ligament exists in what dermatome?
A: L1
Q: The male sexual response of ejaculation is mediated by what part of the nervous system?
A: Visceral and somatic nerves
Q: The male sexual response of emission is mediated by what part of the nervous system?
A: Sympathetic nervous system
Q: The male sexual response of erection is mediated by what part of the nervous system?
A: Parasympathetic nervous system
Q: The nipple exists in what dermatome?
A: T4
Q: The recurrent laryngeal nerve arises from what cranial nerve and supplies what muscles?
A: 1.CN X
Q: The SA and AV nodes are usually supplied by what artery?
A: Right Coronary Artery (RCA)
Q: The umbilicus exists in what dermatome?
A: T10
Q: The xiphoid process exists in what dermatome?
A: T7
Q: What are hernias?
A: Protrusions of peritoneum through an opening, usually sites of weakness.
Q: What are the boundaries of the inguinal (Hesselbach) triangle?
A: --Inferior epigastric artery
Q: What are the manifestations of portal hypertension?
A: --Esophageal varices
Q: What condition is usually associated with portal hypertension?
A: Alcoholic cirrhosis
Q: What defect may predispose an infant for a diaphragmatic hernia?
A: Defective development of the pleuroperitoneal membrane
Q: What gut regions and structures does the celiac artery supply?
A: 1.Foregut
Q: What gut regions and structures does the IMA supply?
A: 1.Hindgut
Q: What gut regions and structures does the SMA supply?
A: 1.Midgut
Q: What is a diaphragmatic hernia?
A: Abdominal retroperitoneal structures enter the thorax
Q: What is a hiatal hernia?
A: Stomach contents herniate upward through the esophageal hiatus of the diaphragm
Q: What is the arterial blood supply difference above and below the pectinate line?
A: --Superior rectal a. (Above)
Q: What is the course of a direct inguinal hernia?
A: Through weak abdominal wall, into the inguinal triangle, medial to the inferior epigastric artery, through the external inguinal ring only.
Q: What is the course of an indirect inguinal hernia?
A: Through the internal (deep) inguinal ring and the external (superficial) inguinal ring lateral to the inferior epigastric artery and into the scrotum
Q: What is the course of the ureters?
A: Pass under uterine artery and under the ductus deferens
Q: What is the function of Myenteric plexus? Submucosal plexus?
A: 1.Coordinates motility along entire gut wall
Q: What is the innervation difference above and below the pectinate line?
A: --Visceral innervation (Above)
Q: What is the innervation of the diaphram?
A: Phrenic nerve (C3,4,5)
Q: What is the Myenteric plexus also known as? Submucosal plexus?
A: 1. Auerbach's plexus
Q: What is the pectinate line of the rectum?
A: Where the hindgut meets ectoderm in the rectum
Q: What is the relationship of the two pulmonary arteries in the lung hilus?
A: Right anterior
Q: What is the usual pathology above the pectinate line of the rectum?
A: Internal hemorrhoids (not painful)
Q: What is the usual pathology below the pectinate line of the rectum?
A: External hemorrhoids (painful)
Q: What is the venous drainage difference above and below the pectinate line?
A: --Superior rectal v. to IMV to portal system (Above)
Q: What layers of the gut wall contribute to motility (4)?
A: --Muscularis mucosae
Q: What layers of the gut wall contribute to support (3)?
A: --Serosa
Q: What neurons do the GI enteric plexus contain?
A: Cell bodies of parasympathetic terminal effector neurons
Q: What part of the heart does the LAD supply?
A: anterior interventricular septum
Q: What structures do the broad ligament contain (4)?
A: --Round ligaments of the uterus
Q: What structures make up the bronchopulmonary segment?
A: --Tertiary bronchus
Q: What structures perforate the diaphragm at what vertebral levels?
A: --IVC at T8
Q: What usually provides the blood supply for the inferior left ventricle?
A: Posterior descending artery (PD) of the RCA
Q: Where is the Myenteric plexus located? Submucosal plexus?
A: 1.Between the inner and outer layers of smooth muscle in GI tract wall
Q: Which ligament contains the ovarian vessels?
A: Suspensory ligament of the ovary
Q: Which ligament contains the uterine vessels?
A: Transverse cervical (cardinal) ligament
Q: Which lung is the usual site of an inhaled foreign body?
A: Right lung
Q: Which lung provides a space for the heart to occupy?
A: Left lung (in the place of the middle lobe)
Q: Who usually gets a direct inguinal hernia? indirect hernia (and why)?
A: 1.Older men
Correct Answer: B
Correct Answer: D
Correct Answer: A
Correct Answer: E
Respiratory Musculature : Expiration
Internal intercostals proper, transverse thoracic, and abdominal muscles
Respiratory Musculature : Inspiration
External intercostals, interchondral portion of internal intercostals, and the diaphragm
Correct Answer: A
direction of the _____, and is larger in diameter than the _____.
trachea, left
Secondarily retroperitoneal (adherent) Organs?
Descending and inferior duodenum, pancreatic
Correct Answer: C
Correct Answer: A
Correct Answer: A
Correct Answer: A
Correct Answer: E
Correct Answer: A
Correct Answer: B
Correct Answer: A
Correct Answer: D
Correct Answer: E
Correct Answer: B
Correct Answer: E
Sinoatrial Function
Initiates contractile event with electrical depolarization spreading throughout atrial musculature
Sinoatrial Location
In myocardium between crista terminalis and opening of superior vena cava
Sinoatrial Vasculature
Nodal branch of the right coronary artery
Correct Answer: B
Sympathetic Effect
Adrenergic neurotransmission
increases heart rate, increases stroke volume, dilates coronary and pulmonary arteries
Sympathetic Postsynaptic Pathway
1. Fibers that synapse return to the spinal nerve via a gray ramus to mediate cutaneous piloerection, vasoconstriction, and sudomotor activity
Sympathetic Presynaptic Pathway
From spinal levels T1-L2 along the ventral root. Reach the chain of sympathetic ganglia via white rami communicantes
Correct Answer: A
Correct Answer: A
Correct Answer: B
Correct Answer: A
Correct Answer: B
A. First part of the duodenum
Correct Answer: A
directions. Describe them.
The external oblique muscle, internal oblique muscle, and transverse
abdominis muscle may be sequentially split and retracted so that extensive suturing is unnecessary to provide a strong repair (McBurney’s incision).
The anterior border of the left pleural cavity deviates laterally between fourth and sixth ribs to form the?
cardiac notch—a preferred route for needle
The atrioventricular bundlepasses through the
annulus fibrosus
The atrioventricular bundlepasses through the annulus fibrosus and descends along the posterior border of the
membranous part of the interventricular septum
The atrioventricular bundlepasses through the annulus fibrosus and descends along the posterior border of the membranous part of the interventricular septum to enter the muscular portion of the septum. It transmits
electrical activity
Correct Answer: B
Correct Answer: E
Correct Answer: D
The cremaster muscle of the spermatic cord is innervated by the
genital branch
of the genitofemoral nerve.
of the genitofemoral nerve. This provides the efferent limb for the?
cremaster
Correct Answer: C
ing through the
urogenital diaphragm
ing through the urogenital diaphragm and draining into the
prostatic or vesicle
The duodenal papillausually contains the
hepatopancreatic ampulla
the joining of
the common bile duct and the pancreatic duct.
Correct Answer: B
brief voluntary contraction necessary to
counter the passage of a peristaltic wave.
The external anal sphincter, innervated by the?
pudendal nerve
Correct Answer: A
urethral sphincteris formed by
muscle fascicles of the deep transverse perineal muscle that arch anterior to the urethra
muscle that arch anterior to the urethra but do not pass posterior because
the
Correct Answer: D
Correct Answer: E
Correct Answer: B
Correct Answer: C
Correct Answer: A
Correct Answer: C
Correct Answer: A
Correct Answer: E
Correct Answer: B
Correct Answer: D
Correct Answer: E
Correct Answer: B
Correct Answer: D
The hepatic portal veindirects venous return from where to where?
From the gastrointestinal tract to
The hepatic triangle, bounded by what 3 things? Contains what arteries?
Bounded by the cystic duct, gallbladder, and common hepatic duct, contains the cystic arteries and right hepatic artery with potential for extensive variation.
The inferior epigastric arterypasses into the rectus sheath at
the arcuate line.
This is a potential site for
Herniation into the rectus sheath.
Correct Answer: A
E. Third part of the duodenum
The correct answer is E. The inferior mesenteric artery arises from the anterior surface of the aorta at the level of the third lumbar vertebra. The third part of the duodenum crosses the midline at the level of the third lumbar vertebra and passes anterior to the aorta at the origin of the inferior mesenteric artery.
The second part of the duodenum (choice D) lies vertically to the right of the midline and extends from the level of the first lumbar vertebra to the level of the third lumbar vertebra.
erectile tissue.
the left adrenal vein usually drains inferiorly into the
left renal vein.
Correct Answer: B
Correct Answer: A
The levator ani muscleforms most of the
pelvic floor and its puborectalis por-
The lower rectum drains along the
inferior rectal lymphatics and then along both
The lymphatic drainage from the vaginais by three routes:
-the external and internal iliac nodes from the upper third of the vagina
Correct Answer: C
The male external urethral sphincteris formed by the
deep transverse perineal
muscle completely surrounding the membranous urethra.
Correct Answer: D
Correct Answer: B
Correct Answer: C
The papillary muscles
take up the slack in the chordae tendineae to maintain
Correct Answer: B
Correct Answer: C
Correct Answer: D
Correct Answer: E
Correct Answer: E
Correct Answer: A
Correct Answer: B
leaf is formed by fusion of the
internal oblique and transverse abdominis
Correct Answer: B
The rectal submucosal venous plexusforms anastomotic connections between
the middle rectal veins that drain directly into the internal iliac veins and the
The rectumis usually empty because feces are stored in the
sigmoid colon.
The renal fascia (the false capsule or Gerota’s fascia) is a discrete fascial layer that surrounds
each kidney.
The right adrenal vein usually drains medially into the
inferior vena
cava
Correct Answer: A
Correct Answer: A
Correct Answer: A
Correct Answer: C
glands, and upper ureters) is bounded by the
quadratus lumborum muscle,
The tail of the pancreascontains most of the
pancreatic islets (of Langerhans),
The testicular pampiniform plexusfunctions as a
countercurrent heat exchanger
that maintains testicular temperature a few degrees below core body temperature.
Correct Answer: B
Correct Answer: C
The upper rectum drains along the
superior rectal lymphatics.
The uretersnarrow at three points—
at the renal pelvis,
and at the bladder
Correct Answer: D
Correct Answer: A
Correct Answer: A
Correct Answer: D
E. Superior gluteal nerve
The correct answer is D. The pudendal nerve is often anesthetized to provide obstetric anesthesia (although epidural blocks are now more commonly used in preparation for delivery). The pudendal nerve arises from sacral segments 2, 3, and 4. It exits the pelvis by way of the greater sciatic foramen and then courses around the ischial spine (and sacrospinous ligament) to pass through the lesser sciatic foramen. It then runs through Alcock's canal to supply the muscles and skin of the perineal area.
The superior gluteal nerve (choice E) leaves the pelvis by passing through the greater sciatic foramen to supply the gluteus medius and minimus muscles.
Tricuspid Auscultation
Right of sternum in
Two to four minor calyces join to form
major calycesthat coalesce to form the renal
pelvis.
E. Varicosities of the spermatic vein
The correct answer is D. The processus vaginalis is an evagination of the parietal peritoneum of the abdomen that descends through the inguinal canal before the descent of the testis. Normally, the distal end of this evagination remains patent as the tunica vaginalis and the remainder of the processus vaginalis fuses and becomes fibrous. If a part of the processus vaginalis does not fuse (incomplete fusion), the resulting cystic structure is a hydrocele of the spermatic cord.
Varicosities of the spermatic cord (choice E) or the pampiniform plexus is termed a varicocele.
Pelvic plexus and pelvic splanchnic nerves (parasympathetic pathways) to spinal segments S2-S4
Pelvic splanchnic nerves (parasympathetic pathways) from S3-S5
Hypogastric nerve (sympathetic pathways) to spinal segments T12-L2
Urinary continenceof the partially full to full urinary bladder is a function of
the external urethral sphincter.
Ventricular coronary flow occurs during?
ventricular diastole when a pressure
differential occurs between the left ventricle and the aorta.
What 2 fat's support this capsule? Name and describe their locations?
Paranephric fat outside this capsule and perinephric fat inside this fascial layer support the kidney.
Correct Answer: A
Correct Answer: B
Correct Answer: B
Correct Answer: E
Correct Answer: A
When upright, excess fluid tends to collect in the?
costodiaphragmatic recess.
Right mainstem bronchus
Correct Answer: E
Correct Answer: D
Correct Answer: C
Correct Answer: B
Explanation:
Correct Answer: C
Correct Answer: C
Correct Answer: D
Correct Answer: B
Correct Answer: A
Correct Answer: D
Correct Answer: E
Correct Answer: A
Correct Answer: D
Correct Answer: E
Correct Answer: A
Correct Answer: B
Explanation:
The correct answer is E. Because the right main bronchus is wider and more vertical than the left, foreign objects are more likely to be aspirated into the right main bronchus. The superior segmental bronchus of the lower lobar bronchus is the only segmental bronchus that exits from the posterior wall of the lobar bronchi. Therefore, if a patient is supine at the time of aspiration, the object is most likely to enter the superior segmental bronchus of the lower lobe.
The medial segmental bronchus of the right middle lobe (choice C) arises from the anterior wall of the right middle lobar bronchus. Therefore, when the patient is supine, the effect of gravity will tend to prevent the object from entering this segmental bronchus.
Correct Answer: D
Correct Answer: C
Correct Answer: C
Correct Answer: D
Correct Answer: C
Correct Answer: C
• In the male, palpable per rectumare
posterior and lateral lobes of the prostate
Autonomic pathwaysconsist of two motor neurons, a __ and a __
Autonomic pathwaysconsist of two motor neurons, a myelinated preganglionic
Because the linea albais relatively avascular, incisions may
not heal well and
Compression of the left testicular veinby a full sigmoid colon produces
varices of the pampiniform plexus on the left side- fertility may diminish.
In the female, palpable per vaginaare the
cervix and ostium of the uterus, the
The cavity of tunica vaginalisis a potential space that represents the detached
portion of the peritoneal cavity that surrounds the testis except at the mesorchium.
and the pelvic inlet more
The female pelvisis less massive, the subpubic angle is greater (almost 90°), and
The midrectum drains along the
middle rectal lymphatics.
from the
sacral promontory to a point a few millimeters below the superior mar-
ported by mesorchium) where?
in the scrotum.
The transverse midplane diameter,measured between the
ischial spines, is the
Correct Answer: B
Correct Answer: A
Explanation:
Explanation:
Explanation:
Explanation:
Explanation:
Explanation:
Explanation:
Explanation:
E. Spleen
The correct answer is E. The spleen follows the long axes of ribs 9 to 11 and lies mostly posterior to the stomach, above the colon, and partly anterior to the kidney. Therefore, it is the most likely organ of the group to be pierced by a sharp object penetrating just above rib 10 at the posterior axillary line. Note that the pleural cavity, and possibly the lower part of the inferior lobe of the lung, would be pierced before the spleen.
Explanation:
E. Vesicouterine space
The correct answer is C. The posterior fornix is in contact with the floor of the rectouterine space. The rectouterine space is the lowest part of the peritoneal cavity in the female pelvis. The patient has introduced bacteria into the peritoneal cavity by the penetration of the sharp object, producing sepsis.
E. Nerve cell body loss in the ipsilateral dorsal horn
The correct answer is B. The dorsal root ganglion (DRG) contains nerve cell bodies of primary sensory afferents (the neurons that actually detect the sensory input). The primary afferents that sense conscious proprioception, discriminative touch, and vibration have cell bodies in the DRG, send axons into the spinal cord via the dorsal roots, ascend in the ipsilateral dorsal columns (in this case in the fasciculus cuneatus), and synapse in the medulla (in this case in the nucleus cuneatus). Therefore, if the DRG were destroyed, axonal loss would be predicted in the ipsilateral dorsal columns.
E. Between the parietal pleura and the visceral pleura
The correct answer is A. The pericardial space is located between the epicardium (also known as the visceral pericardium) and the parietal pericardium. A tear of a blood vessel immediately outside of the heart will cause bleeding into the pericardial space. This accumulation of blood in the pericardial space causes increased pressure on the heart, which restricts filling of the heart during diastole (cardiac tamponade). This reduced filling results in reduced cardiac output and reduced blood pressure.
E. Superficial perineal space
The correct answer is E. The bulb of the penis contains the urethra, and is found in the superficial perineal space. The superficial perineal space is found between the inferior fascia of the urogenital diaphragm (perineal membrane) and the superficial perineal fascia (Colles' fascia). The attachments of the superficial perineal fascia to the posterior edge of the urogenital membrane and to the ischiopubic rami prevent the urine from escaping posteriorly into the gluteal region or laterally into the thigh. The urine can escape anteriorly onto the anterior abdominal wall, where it will be deep to the superficial abdominal fascia (Scarpa's fascia).
E. passes through the deep inguinal ring
The correct answer is B. Direct inguinal hernias enter the inguinal canal by tearing through the posterior wall of that structure. The typical location for this type of hernia is through the inguinal triangle, bounded laterally by the inferior epigastric artery, medially by the lateral border of the rectus abdominis, and inferiorly by the inguinal ligament. Direct inguinal hernias pass medial to the inferior epigastric artery, whereas indirect inguinal hernias pass lateral to the inferior epigastric artery because the deep inguinal ring is lateral to the artery.
Correct Answer: E
E. Wall of the left atrium
The correct answer is B. The atrioventricular (AV) node is in the subendocardium of the interatrial septum. From the AV node, the Purkinje fibers of the atrioventricular bundle enter the interventricular septum to carry impulses to the ventricle. The function of the AV node is to retard the conduction of the cardiac impulses so that ventricular systole occurs after atrial systole.
Explanation:
E. Superior pancreaticoduodenal artery and inferior pancreaticoduodenal artery
The correct answer is E. The superior pancreaticoduodenal artery is a branch of the gastroduodenal artery, which is a branch of the common hepatic artery, itself a branch of the celiac trunk. The inferior pancreaticoduodenal artery is a branch of the superior mesenteric artery. Occlusion of the celiac trunk would allow blood from the superior mesenteric artery to reach the branches of the celiac trunk via the connections between the superior and inferior pancreaticoduodenal arteries.
E. Superior mesenteric vein-splenic vein
The correct answer is C. The splenic vein drains directly into the portal vein. The left renal vein drains directly into the inferior vena cava. Anastomosis of these veins would allow blood from the portal vein to drain retrograde though the splenic vein into the renal vein and then into the inferior vena cava.
E. Superior pancreaticoduodenal-right gastroepiploic
The correct answer is D. The connection that specifically links the midgut (superior mesenteric artery territory) to foregut (celiac artery territory) is through the superior pancreaticoduodenal (from celiac artery) and inferior pancreaticoduodenal (from superior mesenteric artery) arteries.
E. Right ventricle
The correct answer is A. The left atrium forms most of the posterior wall of the heart. The esophagus passes immediately posterior to the heart. Enlargement of the left atrium may compress the esophagus and cause dysphagia.
Correct Answer: A
E. Renal artery
The correct answer is B. The ureter leaves the renal pelvis and lies on the posterior abdominal wall as it descends to the pelvis. It crosses the pelvic brim at the level of the bifurcation of the common iliac artery. At this point it crosses anterior to the origin of the external iliac artery to enter the pelvis.
A bronchopulmonary segmentis defined by a?
Segmental bronchus and accom-
Correct Answer: A
Correct Answer: D
E. Short gastric
The correct answer is E. The splenic artery passes behind the stomach and gives off the short gastric artery and the left gastroepiploic artery immediately after passing the greater curvature. The left gastroepiploic artery has a strong anastomotic connection to another arterial supply while the short gastric does not, so the area supplied by branches of the short gastric arteries is more vulnerable to ischemia in this setting. If the block had occurred proximal to, instead of at the branch point, the short gastric vessels could be supplied by backflow from the left gastroepiploic artery.
A large VSD is the principal factor in
tetralogy of Fallot.
A long mesorchiummay predispose to
testicular torsion with high potential for testicular ischemia and necrosis.
A patent urachus(rare) allows
reflux of urine through the umbilicus.
Correct Answer: B
Correct Answer: E
Correct Answer: E
E. Superior gluteal nerve
The correct answer is C. The pudendal nerve is a branch of the sacral plexus that exits from the greater sciatic foramen, and then enters the lesser sciatic foramen, to lie in the pudendal canal on the lateral wall of the ischioanal fossa. The inferior rectal nerve is a branch of the pudendal nerve, which crosses the ischioanal fossa to reach the anal canal, where it innervates the external anal sphincter and provides sensory innervation to the area.
E. One half inch below the midpoint of the inguinal ligament
The correct answer is D. The inguinal canal lies entirely above the inguinal ligament. The deep inguinal ring is about one-half inch above the midpoint of the inguinal ligament. The superficial inguinal ring is superolateral to the pubic tubercle. Indirect inguinal hernias enter the inguinal canal through the deep inguinal ring.
Correct Answer: A
Correct Answer: C
E. Posterior and superior mediastinum
The correct answer is E. The mediastinum is divided into four regions. The region above the manubriosternal junction (level of fourth thoracic vertebra) is the superior mediastinum. The region below the manubriosternal junction is divided into the anterior mediastinum (anterior to the pericardium), the middle mediastinum (within the pericardium), and the posterior mediastinum (posterior to the pericardium). The thoracic duct enters the thorax through the aortic hiatus of the diaphragm. At this point it lies in the posterior mediastinum, the region posterior to the pericardium. As it ascends through the thorax and passes the level of the fourth thoracic vertebra, it enters the superior mediastinum.
A pudendal block can be effected by injecting an anesthetic into the vicinity of
the pudendal nerve in the pudendal canal close to the ischial spine.
E. Splenorenal ligament
The correct answer is D. The hepatoduodenal ligament is the portion of the lesser omentum that connects the liver to the first part of the duodenum. Within the hepatoduodenal ligament are found the proper hepatic artery and its branches, the common bile duct and its branches, and the portal vein. The cystic artery is usually a branch of the right hepatic artery, which is a branch of the proper hepatic artery.
The correct answer is B. The gastrohepatic ligament is the part of the lesser omentum that separates the greater peritoneal sac from the right portion of the lesser peritoneal sac. This portion of the lesser omentum has no significant blood vessels within it and may be incised for surgical access.
D. Splenorenal ligament
The correct answer is D. The splenorenal ligament is the portion of the dorsal mesentery between the posterior abdominal wall and the spleen. This mesentery transmits the splenic artery and vein from their retroperitoneal position in the proximal portion of their course to the peritoneal spleen.
The correct answer is E. The stomach has a very rich anastomotic arterial supply and can tolerate occlusion of the gastroduodenal artery.
A ventricular septal defect produces
a serious right-to-left shunt with
fusion of the
external oblique and internal oblique aponeuroses
Adrenal arteriesarise from the
inferior phrenic arteries, the aorta, and the renal
Correct Answer: E
Correct Answer: B
Correct Answer: C
Correct Answer: E
Correct Answer: C
Correct Answer: E
Correct Answer: E
An apical pulseis palpable at the point of maximal impulse (PMI) in which intercostal space? Just beneath what?
Fifth space, just beneath the nipple
Correct Answer: A
Correct Answer: A
Correct Answer: E
Anterior interventricular sulcus
Between left and right ventricles, marks the interventricular septum
Contains the anterior interventricular branch of the left coronary artery and the great cardiac vein
Aortic Auscultation
Right of sternum over second intercostal space
Correct Answer: C
Atrioventricular Function
Stimulated by atrial depolarization. It leads into the atrioventricular (A-V) bundle to synchronize ventricular depolarization
Atrioventricular Location
Atrioventricular near the interatrial septum
Atrioventricular Vasculature
Branch of right coronary artery near the posterior inter-ventricular branch
Autonomic pathwaysconsist of
two motor neurons
Correct Answer: A
nancy or constipation) results in
blood shunting through the anastomotic connections to the systemic venous system.
transverse perineal muscle extravasations of blood or urine will not pass into where?
extravasations of blood or urine will not pass into the anal triangle.
Correct Answer: B
of
all three aponeuroses and there is no posterior leaf.
Extraperitoneal Organ's ?
Rectum, anal canal, urinary bladder, cervix, prostate
Peritoneal Organ's ?
Sigmoid colon, uterus, uterine tubes, ovaries, testes
Correct Answer: E
Correct Answer: D
Correct Answer: C
Correct Answer: D
Deep Perineal Space
Deep transverse perineal muscle, external urethral sphincter, urethra
Superficial Perineal Space
Crura of the clitoris, vestibular bulbs, superficial transverse perineal muscles, greater vestibular glands
Deep Perineal Space
Deep transverse perineal external urethral sphincter, bulbourethral glands, membranous urethra
Superficial Perineal Space
Testes, crura of penis, bulb of penis, penile urethra, superficial transverse perineal muscles
Coronary sulcus
Between atria and ventricles. nearly vertical behind sternum. marks the annulus fibrosus that supports the valves
Coronary sulcus (Contents)
Right side contains the right coronary artery, and small cardiac vein. Crossed by anterior cardiac veins
T12 - ?
Nipple
Correct Answer: B
Direct inguinal
Through the inguinal triangle bounded by inguinal ligament,
Correct Answer: D
Correct Answer: E
stone, what may develop?
pancreatitis may develop.
Correct Answer: B
E. Portal vein, hepatic artery, and hepatic vein
The correct answer is D. The free edge of the lesser omentum contains three important structures: the common bile duct, the hepatic artery, and the portal vein.
Correct Answer: C
E. Short gastric
The correct answer is C. The arterial supply of the stomach is complex and is consequently a target on the USMLE. The right gastric artery supplies the distal lesser curvature.
Explanation:
E. Right triangular ligament
The correct answer is A. While most of the liver is covered with peritoneum, there are several reflections of the peritoneum (commonly called "ligaments") on the posteroinferior surface of the liver. When the opposing layers of the reflections are separated, a "bare area" on the liver is produced. The largest bare area contains on one end the inferior vena cava and is bounded by a continuous irregular ring of ligament that is somewhat arbitrarily divided into sections called the anterior and posterior layers of the coronary ligaments. It is the anterior layer of the coronary ligament that would be felt in the maneuver described in the question stem.
Explanation:
E. Seminal vesicle
The correct answer is B. The deep perineal space is the region of the middle layer of the urogenital diaphragm. This layer of the diaphragm contains two skeletal muscles, the sphincter urethrae muscle and the deep transverse perineal muscle. Also found in this space is the bulbourethral gland (Cowper's gland). The membranous portion of the urethra is the portion of the urethra that passes through the urogenital diaphragm.
Each uterine artery crosses immediately superior to a ureter in the
transverse
Extraperitoneal Organs?
Thoracic esophagus, rectum, kidneys, ureters,
Femoral
Passes inferior to the inguinal ligament through the femoral ring
Correct Answer: A
Correct Answer: D
Correct Answer: C
Correct Answer: D
Correct Answer: C
Correct Answer: C
Correct Answer: D
Correct Answer: B
Correct Answer: A
Correct Answer: B
Correct Answer: E
Correct Answer: B
Indirect inguinal
Through the deep inguinal ring and along the inguinal canal—
Kidney stones may lodge at these locations with pain referred, respectively, to what regions?
the subcostal, inguinal, and perineal regions.
Correct Answer: B
Metastatic carcinoma of the rectummay be widely disseminated within the
abdomen, pelvis, and inguinal region.
Minor calycesreceive one or two pyramids before fusing into
major calyces.
Mitral Auscultation
Apex of heart in fifth intercostal space in left midclavicular line
Movement of feces into the rectal ampulla generates
the urge to defecate.
E. Sinoatrial node
The correct answer is D. Individual cardiac muscle cells are joined together at the intercalated disks. These disks contain membrane specializations called gap junctions. Gap junctions allow for the electrical transmission of a membrane depolarization from one cell to the next. This electrical transmission accounts for the synchronous depolarization of cardiac muscle cells, which results in the synchronous contraction of these cells.
Normal uterine position is?
anteflexed (uterus bent forward on itself at the level
Correct Answer: C
Correct Answer: B
Correct Answer: E
Correct Answer: A
Correct Answer: E
Correct Answer: D
Correct Answer: E
Correct Answer: C
Correct Answer: D
Correct Answer: B
Correct Answer: E
Correct Answer: D
Correct Answer: A
Correct Answer: B
Correct Answer: A
Pathway
Aortic plexus to lumbar splanchnic nerves
L1-L2: pubic and inguinal regions, anterior scrotum or labia, anterior thigh
Pathway
Phrenic nerve
C3-C5: neck and shoulder
Intercostal nerves
T5-T10: thorax
Superior mesenteric plexus to lesser splanchnic nerve
T10-T11: umbilical region
Aorticorenal plexus to least splanchnic nerve
T12-L1: lumbar and ipsilateral inguinal regions
Pathway
Celiac plexus to greater splanchnic nerve
T5-T9: lower thorax,
Pathway
Hypogastric plexus to aortic plexus and then to lumbar splanchnic nerves
Referral Area
L1-L2: pubic and inguinal regions, anterior scrotum or labia, anterior thigh
Pathway
Pelvic plexus to pelvic splanchnic nerves
Referral Area
S3-S5: perineum and posterior thigh
Pathway
Gonadal nerves to aortic plexus and then to lesser and least splanchnic nerves
Referral Area
T10-T12: umbilical and pubic regions
Referral Area
C3-C5: neck and shoulder
Referral Area
T5-T10: thorax
Pathway
Cervical and thoracic splanchnic nerves
Referral Area
T1-T4: upper thorax, postaxial brachium
Pathway
Intercostal nerves T1-T5
Referral Area
T1-T5: upper and midthorax
Pathway
Thoracic splanchnic nerves
Referral Area
T1-T5: thorax and epigastric region
Parasympathetic Effect
Cholinergic neurotransmission
Correct Answer: A
Parasympathetic Postsynaptic Pathway
Postganglionic cell bodies lie in numerous ganglia close to the target organ
Parasympathetic Presynaptic Pathway
Presynaptic cell bodies are located in the dorsal vagal nuclei of the brain, nuclei of the brain, synaptic axons form cranial nerve X, the vagus nerve
Parasympathetic - S3-S5: pelvic splanchnic nerves
Sympathetic - L1-L2: lumbar splanchnic nerves
Sympathetic - hypogastric plexus, pelvic plexus, cavernous plexus
referred along what nerve? On what dermatomes?
the greater splanchnic nerve to the fifth and sixth dermatomes
Correct Answer: A
Peritoneal (supported by mesentery) Organs?
Abdominal esophagus, stomach, superior
Pneumothorax -
loss of lungventilation
Anastomotic Connections
Azygos veins with left gastric and short gastric veins
Signs & Symptoms
Esophageal varices, intractable hematemesis
Superior rectal vein with middle and inferior rectal veins
Signs & Symptoms
Internal and external
Paraumbilical veins with superior and inferior epigastric veins
Signs & Symptoms
Caput medusae
Posterior interventricular sulcus
Delineates the interventricular septum, posteriorly
Posterior interventricular sulcus (Contents)
Contains the posterior interventricular branch of the right coronary artery and the middle cardiac vein
Correct Answer: E
E. Pubic tubercle
The correct answer is C. The pudendal nerve leaves the pelvis through the greater sciatic foramen, then wraps around the ischial spine and sacrospinous ligament to enter the lesser sciatic foramen and eventually reach the perineum. The ischial spine separates the greater sciatic foramen from the lesser sciatic foramen. Palpation of the ischial spine allows the physician to locate the pudendal nerve in order to perform a pudendal nerve block.
Pulmonary Auscultation
Left of sternum over
Q: A pudendal nerve block is performed at what landmark?
A: Ischial spine
Q: At what level is a lumbar puncture performed?
A: Between L3-L4 or L4-L5
Q: Coronary artery occlusion usually occurs where?
A: Left anterior descending artery (LAD)
Q: Do the coronary arteries fill during systole or diastole?
A: Diastole
Q: Erection and sensation of the penis is in what dermatomes?
A: S2-S4
Q: How does the course of the left recurrent laryngeal nerve differ from that of the right?
A: The left wraps around the arch of the aorta and the ligamentum arteriosum while the right wraps around the subclavian artery.
Q: How is the appendix located?
A: 2/3 of the way from the umbilicus to the anterior superior iliac spine
Q: How many lobes are in the right and left lungs and what are their names?
A: --Right has three (superior,middle,inferior)
Q: Lumbar puncture is performed at what landmark?
A: Iliac crest
Q: Name five portal-systemic anastomoses.
A: 1.Left gastric-azygous vv.
Q: Name the 4 ligaments of the uterus.
A: --Suspensory ligament of ovaries
Q: Name the retroperitoneal structures (9).
A: 1.Duodenum(2nd-4th parts)
Q: Pain from the diaphragm is usually referred where?
A: Shoulder
Q: The area of the body that contains the appendix is known as what?
A: McBurney's point
Q: The inguinal ligament exists in what dermatome?
A: L1
Q: The male sexual response of ejaculation is mediated by what part of the nervous system?
A: Visceral and somatic nerves
Q: The male sexual response of emission is mediated by what part of the nervous system?
A: Sympathetic nervous system
Q: The male sexual response of erection is mediated by what part of the nervous system?
A: Parasympathetic nervous system
Q: The nipple exists in what dermatome?
A: T4
Q: The recurrent laryngeal nerve arises from what cranial nerve and supplies what muscles?
A: 1.CN X
Q: The SA and AV nodes are usually supplied by what artery?
A: Right Coronary Artery (RCA)
Q: The umbilicus exists in what dermatome?
A: T10
Q: The xiphoid process exists in what dermatome?
A: T7
Q: What are hernias?
A: Protrusions of peritoneum through an opening, usually sites of weakness.
Q: What are the boundaries of the inguinal (Hesselbach) triangle?
A: --Inferior epigastric artery
Q: What are the manifestations of portal hypertension?
A: --Esophageal varices
Q: What condition is usually associated with portal hypertension?
A: Alcoholic cirrhosis
Q: What defect may predispose an infant for a diaphragmatic hernia?
A: Defective development of the pleuroperitoneal membrane
Q: What gut regions and structures does the celiac artery supply?
A: 1.Foregut
Q: What gut regions and structures does the IMA supply?
A: 1.Hindgut
Q: What gut regions and structures does the SMA supply?
A: 1.Midgut
Q: What is a diaphragmatic hernia?
A: Abdominal retroperitoneal structures enter the thorax
Q: What is a hiatal hernia?
A: Stomach contents herniate upward through the esophageal hiatus of the diaphragm
Q: What is the arterial blood supply difference above and below the pectinate line?
A: --Superior rectal a. (Above)
Q: What is the course of a direct inguinal hernia?
A: Through weak abdominal wall, into the inguinal triangle, medial to the inferior epigastric artery, through the external inguinal ring only.
Q: What is the course of an indirect inguinal hernia?
A: Through the internal (deep) inguinal ring and the external (superficial) inguinal ring lateral to the inferior epigastric artery and into the scrotum
Q: What is the course of the ureters?
A: Pass under uterine artery and under the ductus deferens
Q: What is the function of Myenteric plexus? Submucosal plexus?
A: 1.Coordinates motility along entire gut wall
Q: What is the innervation difference above and below the pectinate line?
A: --Visceral innervation (Above)
Q: What is the innervation of the diaphram?
A: Phrenic nerve (C3,4,5)
Q: What is the Myenteric plexus also known as? Submucosal plexus?
A: 1. Auerbach's plexus
Q: What is the pectinate line of the rectum?
A: Where the hindgut meets ectoderm in the rectum
Q: What is the relationship of the two pulmonary arteries in the lung hilus?
A: Right anterior
Q: What is the usual pathology above the pectinate line of the rectum?
A: Internal hemorrhoids (not painful)
Q: What is the usual pathology below the pectinate line of the rectum?
A: External hemorrhoids (painful)
Q: What is the venous drainage difference above and below the pectinate line?
A: --Superior rectal v. to IMV to portal system (Above)
Q: What layers of the gut wall contribute to motility (4)?
A: --Muscularis mucosae
Q: What layers of the gut wall contribute to support (3)?
A: --Serosa
Q: What neurons do the GI enteric plexus contain?
A: Cell bodies of parasympathetic terminal effector neurons
Q: What part of the heart does the LAD supply?
A: anterior interventricular septum
Q: What structures do the broad ligament contain (4)?
A: --Round ligaments of the uterus
Q: What structures make up the bronchopulmonary segment?
A: --Tertiary bronchus
Q: What structures perforate the diaphragm at what vertebral levels?
A: --IVC at T8
Q: What usually provides the blood supply for the inferior left ventricle?
A: Posterior descending artery (PD) of the RCA
Q: Where is the Myenteric plexus located? Submucosal plexus?
A: 1.Between the inner and outer layers of smooth muscle in GI tract wall
Q: Which ligament contains the ovarian vessels?
A: Suspensory ligament of the ovary
Q: Which ligament contains the uterine vessels?
A: Transverse cervical (cardinal) ligament
Q: Which lung is the usual site of an inhaled foreign body?
A: Right lung
Q: Which lung provides a space for the heart to occupy?
A: Left lung (in the place of the middle lobe)
Q: Who usually gets a direct inguinal hernia? indirect hernia (and why)?
A: 1.Older men
Correct Answer: B
Correct Answer: D
Correct Answer: A
Correct Answer: E
Respiratory Musculature : Expiration
Internal intercostals proper, transverse thoracic, and abdominal muscles
Respiratory Musculature : Inspiration
External intercostals, interchondral portion of internal intercostals, and the diaphragm
Correct Answer: A
direction of the _____, and is larger in diameter than the _____.
trachea, left
Secondarily retroperitoneal (adherent) Organs?
Descending and inferior duodenum, pancreatic
Correct Answer: C
Correct Answer: A
Correct Answer: A
Correct Answer: A
Correct Answer: E
Correct Answer: A
Correct Answer: B
Correct Answer: A
Correct Answer: D
Correct Answer: E
Correct Answer: B
Correct Answer: E
Sinoatrial Function
Initiates contractile event with electrical depolarization spreading throughout atrial musculature
Sinoatrial Location
In myocardium between crista terminalis and opening of superior vena cava
Sinoatrial Vasculature
Nodal branch of the right coronary artery
Correct Answer: B
Sympathetic Effect
Adrenergic neurotransmission
Sympathetic Postsynaptic Pathway
1. Fibers that synapse return to the spinal nerve via a gray ramus to mediate cutaneous piloerection, vasoconstriction, and sudomotor activity
Sympathetic Presynaptic Pathway
From spinal levels T1-L2 along the ventral root. Reach the chain of sympathetic ganglia via white rami communicantes
Correct Answer: A
Correct Answer: A
Correct Answer: B
Correct Answer: A
Correct Answer: B
A. First part of the duodenum
Correct Answer: A
directions. Describe them.
The external oblique muscle, internal oblique muscle, and transverse
The anterior border of the left pleural cavity deviates laterally between fourth and sixth ribs to form the?
cardiac notch—a preferred route for needle
The atrioventricular bundlepasses through the
annulus fibrosus
The atrioventricular bundlepasses through the annulus fibrosus and descends along the posterior border of the
membranous part of the interventricular septum
The atrioventricular bundlepasses through the annulus fibrosus and descends along the posterior border of the membranous part of the interventricular septum to enter the muscular portion of the septum. It transmits
electrical activity
Correct Answer: B
Correct Answer: E
Correct Answer: D
The cremaster muscle of the spermatic cord is innervated by the
genital branch
of the genitofemoral nerve. This provides the efferent limb for the?
cremaster
Correct Answer: C
ing through the
urogenital diaphragm
ing through the urogenital diaphragm and draining into the
prostatic or vesicle
The duodenal papillausually contains the
hepatopancreatic ampulla
the joining of
the common bile duct and the pancreatic duct.
Correct Answer: B
brief voluntary contraction necessary to
counter the passage of a peristaltic wave.
The external anal sphincter, innervated by the?
pudendal nerve
Correct Answer: A
urethral sphincteris formed by
muscle fascicles of the deep transverse perineal muscle that arch anterior to the urethra
muscle that arch anterior to the urethra but do not pass posterior because
the
Correct Answer: D
Correct Answer: E
Correct Answer: B
Correct Answer: C
Correct Answer: A
Correct Answer: C
Correct Answer: A
Correct Answer: E
Correct Answer: B
Correct Answer: D
Correct Answer: E
Correct Answer: B
Correct Answer: D
The hepatic portal veindirects venous return from where to where?
From the gastrointestinal tract to
The hepatic triangle, bounded by what 3 things? Contains what arteries?
Bounded by the cystic duct, gallbladder, and common hepatic duct, contains the cystic arteries and right hepatic artery with potential for extensive variation.
The inferior epigastric arterypasses into the rectus sheath at
the arcuate line.
This is a potential site for
Herniation into the rectus sheath.
Correct Answer: A
E. Third part of the duodenum
The correct answer is E. The inferior mesenteric artery arises from the anterior surface of the aorta at the level of the third lumbar vertebra. The third part of the duodenum crosses the midline at the level of the third lumbar vertebra and passes anterior to the aorta at the origin of the inferior mesenteric artery.
erectile tissue.
the left adrenal vein usually drains inferiorly into the
left renal vein.