Anatomy

Front 1

name all the kinds of axons (sympathetic, parasympathetic, preganglionic, postganglionic, visceral sensory, somatic sensory, somatic motor, etc) found in white rami communicantes

Back 1

preganglionic sympathetic
visceral sensory

Front 2

name all the kinds of axons (sympathetic, parasympathetic, preganglionic, postganglionic, visceral sensory, somatic sensory, somatic motor, etc) found in pelvic splanchnic nerves

Back 2

preganglionic parasympathetic visceral sensory

Front 3

name all the kinds of axons (sympathetic, parasympathetic, preganglionic, postganglionic, visceral sensory, somatic sensory, somatic motor, etc) found in celiac ganglion

Back 3

preganglionic sympathetic, preganglionic parasympathetic, postganglionic sympathetic, visceral sensory

Front 4

which ventral rami and which dorsal rami are connected directly to white rami communicantes?

Back 4

T1-L2 ventral rami, no dorsal rami

Front 5

What spinal cord segments innervate the gall bladder and how is this related to the location of referred pain from cholecystitis?

Back 5

T7-T9, referred pain felt along right 7th-9th ICS

Front 6

What spinal cord segments innervate the heart and how is this related to referred pain from cardiac ischemia?

Back 6

T1-T5 referred pain typically felt over left anterior ICS 1-5 and along medial aspect of arm, which is innervated by T1

Front 7

state the effect of sympathetic and parasympathetic on:
a) heart rate
b)bronchial diameter
c)sweating in palms
d)gastric emptying
e)urination

Back 7

a)s:increases p:decreases
b)s:increases p:decreases
c)s:increases p:none
d)s:delays p:promotes
e)s:delays p:promotes

Front 8

why order PET scan of mediastinum if you suspect cancer of lower lobe of left lung as opposed to lower lobe of right lung?

Back 8

lower lobe of left lung sends lymph to both left and right paratrocheal nodes, whereas the lower lobe of the right lung drains only to the ipsilateral side. if cancer of the left lower lobe is in right paratroch. nodes, the cancer is considered inoperable. Pet scan can show cancer in mediastinal nodes

Front 9

what is the artery of Adamkewics? why is it important?

Back 9

a large spinal branch of either intercostal aa10-11, the subcostal a, or lumbar arteries 1-2, that adds substantially to the arterial supply of the lower spinal cord. This is important in any situation that requires cross clamping of the thoracic aorta.

Front 10

which lobes of the right lung can be heard by stethescope placed:
a)paravertebrally
b)midaxillary line
c)midclavicular line

Back 10

a)upper, lower
b)upper, lower
c)upper, middle

Front 11

A blow to the body that fractures certain ribs can lacerate the spleen. Which ribs, and where along their courses, pose the greatest danger?

Back 11

left 9-11 ribs posteriorly

Front 12

during surgery you want to mobilize the spleen and bring it forward into view. What structure is holding the spleen to the posterior abdominal wall and must be torn to do this?
other than blood vessels, what structure is most at risk when tearing this?

Back 12

lienorenal ligament

pancreas at risk when tearing lienorenal ligament

Front 13

When performing prostate surgery, one must be very careful not to damage the nerves adjacent to its lateral surface. Why?

Back 13

these pelvic plexus nerves are responsible for penile erection

Front 14

trace from portal vein to right atrium the routes that:
a) pose the greatest risk of life to the patient

Back 14

portal v--> left gastric v-->esophgeal veous plexus--> hemiazygos --> azygous-->svc-->right atrium.

or


portal v--> left gastric v-->esophgeal veous plexus--> azygous-->svc-->right atrium.

Front 15

trace from portal vein to right atrium the routes that:
b)results in the only visible signs on the external body surface

Back 15

portal vein-->paraumbilical v-->thoracoepigastric v--> lateral thoracic-->svc-->rt. atrium

or
portal v-->paraumbilical-->thoracoepigastric-->superficial epigastric-->IVC-->rt. atrium

Front 16

structure posterior to upper half of left kidney (outside gerota's fascia)

Back 16

diaphragm

Front 17

structure anterior to the hilum of the right kidney (outside gerota's fascia)

Back 17

duodenum

Front 18

structure anterior to the hilum of the left kidney (outside gerota's fascia)

Back 18

pancreas

Front 19

structure immediately posterior to IVC at the level of T12

Back 19

right suprarenal gland

Front 20

in the male, anterior to the rectum, 1 fingerslength superior to the anus

Back 20

prostate

Front 21

structure in the female, anterior to the rectum, 1 fingerslength superior to the anus

Back 21

vagina or post cul-de-sac

Front 22

structure in the free edge of the hepatoduodenal ligament

Back 22

common bile duct

Front 23

structure contacting the inferior pole of the spleen

Back 23

left colic flexure

Front 24

structure encircling the male urethra immediately inferior to the prostate gland

Back 24

sphincter urethrae

Front 25

structure passing transversely in the root of the broad ligament

Back 25

uterine a.

Front 26

structure passing from posterior to anterior- one fingersbreadth lateral to the junction of the uterine cervix and vagina

Back 26

ureter

Front 27

during removal of what organ would you clamp and eventually cut through the structures of the infundibulopelvic ligament?

Back 27

ovary

Front 28

if you clamp a structure parallel to the ligament, but 1 fingersbreadth posteromedial to it, what have you injured?

Back 28

ureter

Front 29

anatomical explanation for the fact that cancer of the head of the pancreas often reveals itself by painless jaundice, whereas cancer of the tail does not?

Back 29

common bile duct is embedded in posterior surface of pancreatic head and may be compressed by tumor

Front 30

associated with jaundice is dilation of a structure that can be palpated. what structure is this and where should you place your fingers in order to feel it?

Back 30

gall bladder, on right side at junction of any two transpyloric plane, costal margin, and linea semilunaris

Front 31

tumors of the body and tail of the pancreas are often inoperable because it engulfs neighboring arteries. name two most likely to be surrounded by such a tumor.

If you do attempt surgery, once you have entered the peritoneal cavity, what should you do to see the body of the pancreas?

Back 31

splenic, SMA

incise gastrocolic ligament transversely

Front 32

in making an incision into the left side of the fibrous pericardium so that you may gain access to the heart, you should pass the scalpel vertically not transversely. Why

Back 32

the phrenic nerve runs vertically along the left side of the pericardium. A vertical incision minimizes chance of inadvertently cutting phrenic

Front 33

You are treating a patient who had eating disorder, is willing to eat more, but every attempt to do so is followed by vomiting of bile stained food. you advise the patient to adopt a prone position after eating, and this solves the problem. why?

Back 33

patient's third part of duodenum was being compressed by SMA. In prone position, the artery falls away from the duodenum and allows food to pass

Front 34

You suspect that a female patient has been bleeding into peritoneal cavity. what might you do to determine if you suspicion is correct?

Back 34

culocentesis- insert needle through posterior fornix of vagina into posterior cul de sac

Front 35

Cancer of the stomach may spread via three routes: veins that drain to stomach, lymphatic vessels that drain to stomach, or by passing along structures that directly connect the stomach to other organs. a) to which structure will cancer spread if it follows venous route? b)to which major lymph nodes will such cancer spread? c)to which major organ will such cancer spread if it moves inferiorly along a connecting structure?

Back 35

a)liver
b)celiac
c)transverse colon

Front 36

name and describe the easiest way to temporarily occlude all blood supply to the liver.

if after performing this maneuver you observe continued bleeding, give explanation for how this is possible.

Back 36

Pringle maneuver
clamp across hepatoduodenal ligament.

if still bleeding: a hepatic vein has been torn and blood is flowing backward from IVC into it.

Front 37

give up on catheter attempt and next day notice that scrotum and penis are swollen with fluid. What happened? if nothing is done, where will fluid spread?

Back 37

torn urethra immediately below perineal membrane. urine has filled perineal cleft and sprad to scrotum and penis. If nothing done: can spread into anterior abdominal wall between scarpas fascia and EAO fascia but is stopped from spreading to lower limb by attachment of Colle's fascia by perineal membran and ischiopubic rami and scarpa's to iliac crest and fascia later

Front 38

potential cancer on glans penis. give names and locations of nodes you should look at or palpate for signs of metastasis.

Back 38

superficial inguinal nodes, lie parallel to and below inguinal ligament

Front 39

What is Cantlie's line and what is its significance?

Back 39

a line through the cystic and caval fossae of the liver. indicates division between physiological left and right lobes of liver (and location of middle hepatic vein)