Mf2 Iv Blue Boxes

Front 1

Palpation of anterolateral abdominal wall (Guarding)

Back 1

Clinical sign of acute abdomen is guarding - involuntary tensing of ab muscles

Front 2

Injury to nerves of anterolateral abdominal wall

Back 2

If injury is in inguinal region can predispose to inguinal hernias

Front 3

Inguinal hernias: direct

Back 3

Through Hesselbach's triangle'
Exits ab w/ transversalis fascia
Passes thru canal to superficial ring lateral to spermatic cord

Front 4

Inguinal hernias: indirect

Back 4

Through deep inguinal ring
Through patent processus vaginalis and all 3 covers of spermatic cord
Can pass into scrotum because is inside spermatic cord

Front 5

Cremasteric reflex (sensory vs motor?)

Back 5

Stimulate ilioinguinal n. by stroking medial aspect of superior thigh
Elicits elevation of testis on same side by contraction of cremaster muscle via genital branch of genital femoral n.

Front 6

Cancer of testis and scrotum (which lymph nodes?)

Back 6

Testis - metastasize to retroperitoneal lumbar lymph nodes inferior to renal veins
Scrotum - to superficial inguinal lymph nodes

Front 7

Peritonitis and ascites

Back 7

Peritonitis - infection and inflammation of peritoneum due to gas, fecal matter, or bacteria entering cavity
Ascites - excess fluid in cavity

Front 8

Flow of ascitic fluid and pus

Back 8

Purulent material or fluid go into paracolic gutters to pelvic cavity where toxin absorption is slower

Front 9

Fluid in omental bursa (2)

Back 9

Perforation of posterior wall of stomach
Inflamed or injured pancreas -> fluid in bursa -> pancreatic pseudo-cyst

Front 10

Esophageal varices

Back 10

Portal hypertension -> reversal of venous flow into portocaval anastomosis into esophageal veins -> distension and hemorrahge

Front 11

Blockage of hepatopancreatic ampulla and pancreatitis

Back 11

Gallstones can block distal end of ampulla
-> bile backs up and enters pancreas -> pancreatitis
Can be compensated for by accessory pancreatic duct

Front 12

Cirrhosis of liver

Back 12

Replacement of hepatocytes w/ fat and fibrous tissue
-> portal hypertension and firm liver

Front 13

Gallstones (composition, 4 sites of impaction, clinical finding)

Back 13

Composed of cholesterol crystals
Sites of impaction: distal end of hepatopancreatic ampulla, infundibulum of gallbladder, hepatic or cystic (-> cholecystitis) ducts
If bile cannot leave gallbladder it can enter the blood and cause jaundice

Front 14

Pylorospasm

Back 14

Failure of smooth muscle fibers around pyloric canal to relax
Usually in infants 2-12 wks
Food does not pass to duodenum -> vomiting

Front 15

Congenital hypertrophic pyloric stenosis

Back 15

Elongated, overgrown pyloric canal
-> proximal part of stomach becoming dilated

Front 16

Gastric ulcers

Back 16

Open lesions of stomach mucosa
High gastric acid secretion -> reduces effectiveness of mucous lining -> vulnerable to h. pylori -> infection and erosion of mucous

Front 17

Vagotomy

Back 17

Secretion of parietal cell acid is controlled by vagus nerve, so sectioning vagus n. reduces production of acid

Front 18

Duodenal (peptic) ulcers

Back 18

Associated w/ chronic anxiety
High stomach acid overwhelms bicarb in duodenum
Can perforate wall of duodenum causing peritonitis and adhesion of gallbladder, liver, or pancreas
Can cause erosion of gastroduodenal a.

Front 19

Visceral referred pain

Back 19

Visceral pain radiates to dermatome level which receives visceral afferent fibers

Front 20

Appendicitis (cause: young v. old, pain)

Back 20

Cause: young people - hyperplasia of lymphatic follicles that occlude lumen; old people - fecalith (concretion forming around fecal matter)
Pain is initially vague then localized as parietal peritoneum is inlammed and irritated
Rupture -> infection of peritoneum

Front 21

Diverticulosis

Back 21

False diverticula are external evaginations of mucosa of colon (not evaginations of whole wall)
Usually in sigmoid colon where nutrient arteries perforate muscle coat
-> diverticulitis: infection and rupture and hemorrhage

Front 22

Accessory renal vessels

Back 22

As embryological kidneys ascend their blood supply/drainage progressively shifts superiorly
When inferior vessels do not degenerate -> accessory renal arteries and veins

Front 23

Congenital anomalies of kidneys and ureter (3)

Back 23

Bifid renal pelvis + ureter - due to division of metanephric diverticulum
Horseshoe kidney - fusing of inferior poles to form one kidney at L3-L5 below IMA
Ectopic pelvic kidney - failure of ascension, so lies anterior to sacrum

Front 24

Renal and ureteric calculi

Back 24

Salts of inorganic and organic acids that start in calices of kidneys and pass from kidney to renal pelvis to ureter
Pain goes from loin (lumbar) to groin (inguinal) as stone descends (inferoanteriorly)

Front 25

Referred pain from diaphragm (2)

Back 25

Irritation of diaphragmatic pleura or peritoneum -> shoulder region (C3-C5)
Irritation of peripheral regions -> inferior intercostal nervers, more localized to skin over costal margins of anterior ab wall

Front 26

Congenital diaphragmatic hernia

Back 26

Herniation of abdominal contents into thoracic cavity (usually on left due to liver) due to posterolateral defects in diaphragm

Front 27

Psoas abscess

Back 27

TB infection can spread through blood to vertebrae and into psoas sheath to produce abscess
-> psoas fascia thickens and pus goes into pelvic brim -> superior part of thigh

Front 28

Pulsations of aorta and abdominal aortic aneurysm

Back 28

Tumor in pancreas or stomach can transmit pulsations of aorta and can be mistaken for aneurysm
Aneurysm usually results from congenital or acquired weakness in ab wall
Acute rupture -> severe pain in abdomen or back -> high mortality

Front 29

Pelvic fractures (4 common sites)

Back 29

Pubic rami, acetabula, sacroiliac joints, alae of ilium

Front 30

Iatrogenic injury to ureters during ligation of uterine artery

Back 30

Ureter passes immediately inferior to uterine artery near lateral part of fornix of vagina
Can be transected during hysterectomy

Front 31

Hypertrophy of prostate

Back 31

Enlargement of middle lobe projects into urinary bladder

Front 32

Digital examination through vagina (what can be palpated?)

Back 32

Pulsations of uterine arteries through lateral fornices
Cervix, ischial spines, sacral promontory can be palapted

Front 33

Lifetime changes in normal anatomy of uterus

Back 33

Large at birth
Grows during puberty
Expands greatly during pregnancy then returns to normal size
Post menopause involutes and regresses

Front 34

Anesthesia for childbirth (3 types)

Back 34

Spinal: L3-L4
Pudendal: S2-S4 dermatomes
Caudal: S2-S4

Front 35

Spinal block

Back 35

Needle into subarachnoid space at L3-L4
Complete anesthesia inferior to waist
No sensation of uterine contractions

Front 36

Pudendal nerve block

Back 36

Local anesthesia over S2-S4 dermatomes
Inject at sacrospinous ligament near attachment to ischial spine
Can feel uterine contractions
Needle is close to fetal head so hard to readmin

Front 37

Caudal nerve block

Back 37

Needle into sacral canal to block S2-4
Sensation of uterine contractions
No sequel spinal headache

Front 38

Disruptions of perineal body

Back 38

In females, final support of pelvic viscera
Injury can lead to prolapse of bladder or uterus

Front 39

Episiotomy

Back 39

Incision of perineum and inferoposterior vaginal wall udring pregnancy to enlarge vaginal orifice
Median - incises perineal body, associated w/ increased risk of severe laceration and pelvic prolapse
Mediolateral - lower future risks

Front 40

Rupture of urethra in males and extravasation of urine (2 types)

Back 40

Fractures of pelvic girdle can cause rupture of intermediate urethra -> extravasation of blood + urine into deep perineal pouch
Forceful blow to perineum -> rupture of spongy urethra -> extravasation of urine into bulb of penis and superficial perineal space

Front 41

Hemorrhoids (internal vs external, which are painful?)

Back 41

Internal - prolapses of rectal mucosa containing normally dilated veins of internal venous plexus, not painful because above pectinate line
External - thromboses in veins of external venous plexus, painful because below pectinate line and so somatic

Front 42

Urethral catheterization

Back 42

Intermediate urethra is unprotected and vulnerable to rupture

Front 43

Ilioinguinal nerve block

Back 43

Abolish sensation from anterior perineum