Exam 2 Review Gross Anatomy

Front 1

The esophagus is posterior to what?

Back 1

Lt. Atrium

Front 2

The axillary lymph nodes are?

Back 2

Superficial

Front 3

The right lower lobe of the lung is located at what ribs?

Back 3

Ribs 6-8 and to Rib 10 posteriorly

Front 4

Cardiac hypertrophy would occlude what organ?

Back 4

Esophagus

Front 5

Tip of a pacemaker would go where?

Back 5

Right ventricle

Front 6

Hemothorax from broken ribs would result from blood from where?

Back 6

Intercostals bleed when a rib breaks

Front 7

What four areas is the esophagus constricted?

Back 7

The cricopharyngeal area, aortic arch, left bronchus, and diaphragm

Front 8

The sympathetic nervous system does what to bronchioles?

Back 8

Dilation

Front 9

What part of the electrical circuit of the heart does a pacemaker replace?

Back 9

SA node

Front 10

Aneurism of the aortic arch will impinge what?

Back 10

Phrenic nerve

Front 11

Flail chest is marked by what?

Back 11

Paradoxical breathing from a rib detached from the chest wall.

Front 12

Why is cardiac tamponade dangerous?

Back 12

Fluid buildup in pericardial sac slows heart down and reduces blood pressure.

Front 13

Where would you place a needle for thoracocentiesis?

Back 13

Superior boarder of rib.

Front 14

How does the vagus nerve affect the lungs?

Back 14

Constricts bronchioles

Front 15

What is the major function of the "bucket handle" motion of the ribs?

Back 15

To increase the transverse diameter of the chest cavity.

Front 16

What part of the lung is found in the 6th intercostal space?

Back 16

Inferior lung lobe

Front 17

During pregancy what vessel in the abdominal cavity can be compressed?

Back 17

IVC

Front 18

Stabbing through the sternum would penetrate what?

Back 18

The right ventricle of the heart

Front 19

What is a chylothorax? How can this happen?

Back 19

Where the thoracic duct leaks into the pleural space. From a left brachiocephalic vein injury.

Front 20

What would result from the trachea deviating left?

Back 20

Left brachiocephalic vein compression.

Front 21

Stabbing to the right of the manubrium would damage what?

Back 21

SVC

Front 22

Embolus to the brain would originate from where?

Back 22

Lt. Atrium or Lt. Ventricle. Cannot pass a capillary bed on its way there!

Front 23

Parietal pleura is innervated by

Back 23

Somatic afferent fibers

Front 24

The SA and AV nodes get their blood supply from what coronary artery?

Back 24

RCA

Front 25

Where does pain in the heart come from?

Back 25

Sympathetic trunks = visceral sensory afferents

Front 26

What occurs at the transthoracic plane?

Back 26

T4-T5
Bifurcation of trachea
Aortic arch
Azygous drains into SVC
Rib 2 articulates w/ sternum
S/Inf mediastinal division
Upper limit of pulmonary trunk

Front 27

Lower 1/3 of esophagus drains in to what lymph nodes?

Back 27

Posteromediastinal nodes
Lt. gastric nodes

Front 28

Right primary bronchus drains into?

Back 28

Inferior tracheobronchial nodes

Front 29

Placement of a central line can damage what vessel?

Back 29

Subclavian Artery

Front 30

Tumor of the thymus gland would compress what?

Back 30

Left brachiocephalic vein

Front 31

Dilation of the middle esophagus would compress what?

Back 31

Thoracic duct

Front 32

Paralysis of the diaphragm is marked by what?

Back 32

Paradoxical movement where the abdominal viscera are pushed to the paralyzed side.

Front 33

Danger in a radical masectomy?

Back 33

Injuring the long thoracic nerve or the thoracodorsal nerve.

Front 34

Thoracoentesis takes place where?

Back 34

Between the 9th and 10th rib (costodiaphragmatic space)

Front 35

Layers that a needle penetrates with thoracocentesis?

Back 35

Skin, superficial fascia, deep fascia, external intercostal, internal intercostal, innermost intercostal, endothoracic fascia, parietal pleura

Front 36

Where would you do an intercostal nerve block?

Back 36

At any level, numbing both the nerve in the costal groove in the superior space, and the collateral nerves inferiorly

(between internal and innermost intercostals)

Front 37

What occurs when air enters the pleural cavity?

Back 37

pneumothorax

Front 38

What is the term for a collapsed lung?

Back 38

Atelectasis

Front 39

What is the accumulation of fluid in the pleural cavity called?

Back 39

Hydrothorax (pleural effusion)

Front 40

What is the accumulation of blood in the pleural cavity called?

Back 40

Hemothorax

Front 41

Lateral breast lymphatic drainage?

Back 41

Nipple, areola, lobules, subareolar plexus, pectoral, lateral, subscapular, central, apical, subclavian lymphatic trunks

75% drains this way

Front 42

Medial breast lymphatic drainage?

Back 42

parasternal nodes to bronchomediastinal nodes to rt. or left drainage.
Also can travel to contralateral breast.

Front 43

Direction of external intercostal muscle fibers?

Back 43

Antero-inferiorly. Aid in inspiration.

Front 44

Innervation of intercostals, subcostales, and transversus thoracis?

Back 44

T1-T11

Front 45

Transversus thoracis attachments?

Back 45

Sternum, xiphoid, costal cartilage 4-7

Ribs 2-6

Front 46

What passes anterior to the hilus of each lung?

Back 46

Phrenic nerves

Front 47

What passes posterior to the hilus of each lung?

Back 47

Vagus nerves

Front 48

Where do you auscultate the middle lobe of the right lung?

Back 48

5th intercostal space

Front 49

What is posterior to the lower half of the manubrium?

Back 49

Aortic arch

Front 50

What are inferior to the sternal angle?

Back 50

Left ventricle and pulmonary trunk

Front 51

Where would a large object become lodged when aspirated?

Back 51

Right main bronchus

Front 52

Where would you find very small things that have been inhaled?

Back 52

Inferior lobe of right lung

Posterior basal segment

Front 53

Where would a left bronchogenic carcinoma manifest?

Back 53

Could be anywhere, thorax, abdomen, pelvis because of drainage into thoracic duct.

Sentinel nodes are supraclavicular nodes!

Front 54

What is inferior to the manubrium?

Back 54

Right atrium

Front 55

Where would an embolus to the right pulmonary artery originate?

Back 55

Somewhere in the legs, femoral origin.

Front 56

Where do the first two posterior intercostal arteries branch from?

Back 56

The superior intercostal artery a branch of the costocervical trunk off of the subclavian

Front 57

What does the internal thoracic branch into at the costal margin?

Back 57

Musculophrenic and superior epigastric arteries

Front 58

Where do the left and middle thoracic wall drain?

Back 58

brachiocephalic veins

Front 59

What level does the azygous vein drain into the SVC?

Back 59

T4

Front 60

When someone has a sensory and motor deficit, what must be damaged?

Back 60

Some kind of SPINAL NERVE

Front 61

Structures lateral to the sternum on the right side from superior to inferior?

Back 61

Right brachiocephalic vein
SVC (2nd intercostal)
Right atrium (3-4 intercostal)
IVC

Front 62

What is the most common heart blockage?

Back 62

Left diagonal branch of the left anterior interventricular artery off the LCA

Front 63

A growth in the upper lobe of the right lung would block what?

Back 63

Venous and lymphatic drainage resulting in a swollen face, jaw, and arm

Front 64

What parts of the heart does the circumflex branch of the LCA supply?

Back 64

Left atrium and ventricle

Front 65

Innervation of the heart comes from where?

Back 65

T1-T4

Front 66

Where would the needle for a pericardiocentiesis procedure be placed?

Back 66

At the costal margin and xiphoid process possibly penetrating the rt. ventricle

Front 67

Level of aortic hiatus?

Back 67

T12

Aorta and thoracic duct, sometimes azygous and hemiazygous vein join

Front 68

Structures that enter at T8 through the diaphragm?

Back 68

IVC, right phrenic nerve, and right pericardiacophrenic artery

Front 69

From where do the pericardiacophrenic arteries branch?

Back 69

Internal thoracic artery near manubrium

Front 70

What structure of the diaphragm makes the esophageal hiatus?

Back 70

Right Crus

Front 71

What levels are the hilum of the lung?

Back 71

T5-T7

Front 72

What are the pulmonary arteries anterior to? Posterior to?

Back 72

Trachea and decending aorta.

SVC

Front 73

If the vagus nerve is compressed going through the esophageal hiatus what will occur?

Back 73

Loss of parasympathetic functions of foregut.

Front 74

What heart structure makes up the base of the heart?

Back 74

Left atrium

Front 75

What is the procedure where an incision is made to an intercostal space to access lungs and other structures?

Back 75

Thoracotomy

Front 76

Where is a chest tube placed?

Back 76

Lateral to the nipple, below axilla in the "safe triangle"

Front 77

What disorder of the heart is marked by relief when sitting forward?

Back 77

Pericarditis

Front 78

What disease is marked by hypertrophy of the left atrium and ventricle, increased pulmonary venous pressure, pulmonary edema?

Back 78

Mitral valve disease

Front 79

What is a key sign of aortic valve disease?

Back 79

Regurgitation and heart failure

Front 80

What is anterior to the esophagus?

Back 80

Left atrium

Front 81

Pain from the lungs would be referred to where?

Back 81

Body wall, by intercostal nerves.

Front 82

Where does the right bronchial artery branch from?

Back 82

The third intercostal.

The left are off of the aorta directly (x2)

Front 83

Flow of lymph from lungs?

Back 83

Bronchopulmonary, tracheobronchal, bronchomediastinal, right and left to ducts

Front 84

Auscultation at the right second intercostal would allow you to listen to?

Back 84

Aortic valve

Front 85

An enlarged left atrium would put pressure where?

Back 85

Indention of the esophagus

Front 86

If the area lateral to the sternum on the left side was stabbed, blood was present what can you assume was punctured?

Back 86

Right ventricle (4th intercostal space)

Front 87

Auscultation of the 5th intercostal space at the apex of the heart would allow you to listen to?

Back 87

Mitral valve

Front 88

Angina, heavyness in chest, sweating, arm pain, nausea, sharp pains in jaw would be symptoms of what?

Back 88

Coronary artery disease

Front 89

Name three congenital heart defects

Back 89

Atrial septal defect
Ventriculoseptal defect
Patent ductus arteriosus

Front 90

What is the sinus that allows ligation of two large vessels during surgery on the heart?

Back 90

Transverse pericardial sinus

Aortic arch and pulmonary trunk

Front 91

What is the reflection of the visceral pericardium covering? Parietal?

Back 91

Veins and arteries

Front 92

Tumor in lung extending into mediastinum can compress what nerve?

Back 92

Phrenic

Front 93

What is the risk with a central line?

Back 93

Getting air in lungs

Front 94

Where is a central line/dialysis line placed?

Back 94

Axillary to subclavian or internal jugular to SVC to right atrium

Front 95

How would one gain access to the IVC with a central line?

Back 95

Line dropped down SVC through right atrium into IVC

Front 96

What is coarctation of the aorta?

Back 96

When there is a constriction of the aorta distal to the left subclavian artery. Over time collaterals will be established.

Front 97

Lesion to vagus or laryngeal nerves is manifested by?

Back 97

Vocal cord paralysis
Hoarseness of voice
Enlarged lymph nodes

Front 98

A dissecting anuerysm of the aorta is a sign of this disease

Back 98

Marfan syndrome - defective fibrillin gene

Front 99

What is the position of the base of the heart and diaphragm while laying down? Standing up?

Back 99

Heart: T5-T8
Diaphragm: T9

Heart: T6-T9
Diaphragm: T9-T10

Front 100

Atherosclerosis is the thickening of what arterial layer?

Back 100

Tunica intima, foam cells develop.

Front 101

Structures in superior mediastinum?

Back 101

SVC, BCV, Arch of aorta, thoracic duct, trachea, esophagus, thymus, left recurrent laryngeal, vagus and phrenic nerves, cardiac plexus

Front 102

Structures in posterior mediastinum?

Back 102

Esophagus and plexus, thoracic aorta, azygous and hemiazygous, thoracic duct, vagus nerve, sympathetic trunks, splanchnic nerves, tracheobronchial lymph nodes

Front 103

An increase in laminin and collagen in the basal lamina of capillaries is indicative of what?

Back 103

Diabetes mellitus

Front 104

What is anosmia?

Back 104

Loss of sense of smell during head trauma. Olfactory nerve permanently severed.

Front 105

What is the fibrous pericardium attached to?

Back 105

Central tendon, sternopericardial ligament, tunica adventitica of vessels.

Innervated by phrenic nerve

Front 106

Structures unique to right atrium?

Back 106

Sinus venarum, crista terminalis, sulcus terminalis, coronary sinus opening, SVC and IVC openings

Front 107

How much thicker is the left ventricle than the right?

Back 107

2-3 times as thick

Front 108

Where is the deep cardiac plexus?

Back 108

Anterior surface of trachea.

The superficial is at the bifurcation of aortic arch

Front 109

Lymphatic drainage of the heart?

Back 109

Coronary arteries to either brachiocephalic nodes or tracheobronchial nodes

Front 110

Where do the right and left brachiocephalic veins unite?

Back 110

Costal cartilage 1

Front 111

What does the left brachiocephalic vein cross?

Back 111

Brachiocephalic artery and aorta, it is 2 times as long as the right

Front 112

What is anterior to the trachea and posterior to the left brachiocephalic vein?

Back 112

The brachiocephalic trunk, right recurrent laryngeal goes under it

Front 113

What is posterior to the left sternoclavicular joint?

Back 113

Left common carotid is bare here.

Front 114

What is the most posterior of the great vessels and ascends lateral to trachea?

Back 114

Left subclavian artery

Front 115

The left recurrent laryngeal wraps _______ to the ligamentum arteriosum?

Back 115

Lateral

Front 116

The vagus nerves are between what two vessels?

Back 116

Common carotids and internal jugulars

Front 117

What is the superior esophagus innervated by?

Back 117

recurrent laryingeals and middle cervical ganglion

Front 118

What is the inferior esophagus innervated by?

Back 118

Esophageal plexus

Front 119

Esophageal branches come from?

Back 119

inferior thyroid, 3rd intercostal, superior and inferior left bronchial a, right bronchial a, left gastric, short gastrics

Front 120

Chronic coughing, thick basement membrane of tracheal epithelium, increased goblet cells and increased mucous are signs of what?

Back 120

Smoking

Front 121

Three reasons why cilia would be immotile?

Back 121

Kartegeners, alcohol abuse, smoking

Front 122

How does someone have an asthma attack?

Back 122

Mast cells release histamine, smooth muscles of bronchioles are constricted and shut down.

Front 123

What disease is marked by a defective chloride channel and really salty sweat?

Back 123

Cystic fibrosis

Front 124

If you have no surfactant what will happen?

Back 124

You will have aveolar collapse and respiratory disress syndrome

Front 125

What is goodpasture syndrome?

Back 125

Antibodies made to type 4 collagen, BL in lungs and kidneys affected. Common in males 29 years of age.

Front 126

What is occuring when someone has permanent dilation of air spaces, no aveolar walls, thick blood vessels?

Back 126

Emphysema (COPD)

Front 127

What is inflammation of the lung?

Back 127

Pneumonia

Front 128

What is occuring when lung tissue is filled with red blood cells?

Back 128

Congestive heart failure. Macrophages are filled with hemosiderin (iron).

Front 129

What can occur with a cervical rib?

Back 129

arterial compression and embolism
T1 nerve compression
Subclavian vein compression

Front 130

From where does the azygous vein arise?

Back 130

L1-L2

Front 131

What intercostals does the azygous vein drain?

Back 131

2-4 from superior
5-11 posterior

Front 132

From where does the hemiazygous vein arise and where does it cross?

Back 132

T12
T9

Front 133

What intercostals does the hemiazygous vein drain?

Back 133

8 or 9 - 12 posterior

Front 134

Where does the accessory azygous vein cross and what intercostals does it drain?

Back 134

T8
4-8 left intercostals, also drains the left bronchial and superior intercostal (2-4)

Front 135

From where does the thoracic duct arise?

Back 135

Cisterna chyli at L2
Crosses at T5
Inbetween azygous and aorta

Front 136

Dilated veins around neck are a sign of what?

Back 136

Lung cancer

Front 137

A bullet penetrates the 4th intercostal space above nipple, what happens?

Back 137

Collapse of lung
Tension pneumothorax
Mediastinum shift
Rib fracture
Pleural effusion
Hemothorax

Front 138

Where is the best place for a chest tube?

Back 138

5th intercostal at midaxillary line
2nd intercostal at midclavicular line

Front 139

Chest pain radiating into left arm and neck is a sign of what?

Back 139

Myocardial infarction anteriorly
Decreased BP
Pulmonary vein pressure increases

Front 140

What vessels do NOT enlarge in a coactation of the aorta?

Back 140

Costocervical trunks

Front 141

What is an aortic dissection?

Back 141

Tear in the intima into the media of the vessel.
Marked by interscapular pain
Decreased kidney function
Acidosis
Ischema to legs

Front 142

Chest infection

Back 142

Opaque xray
Weight loss
Sputum with blood
Sweating
Fast breathing
Tuberculosis

Front 143

Discomfort swallowing, weight loss, bleeding in GI tract are signs of?

Back 143

Esophageal cancer

Front 144

Portacath insertion is where?

Back 144

Right anterior chest wall to internal jugular vein

Front 145

Healthy man collapses when running one day, autopsy shows an increased amount of lymphocytes and neutrophils in the tissue.

Back 145

Myocardial infarction caused by a 90% occluded artery in histology slide. No lumen is present in artery.

Front 146

Greater splanchnic nerves?

Back 146

T5-T9
Travel medially through crus of diaphragm to celiac ganglia

Front 147

Lesser splanchnic nerves?

Back 147

T10-T11

Travel medially through crus of diaphragm to aorticorenal ganglia

Front 148

Least splanchnic nerve?

Back 148

T12

Travel laterally through crus of diaphragm to the renal plexus

Front 149

How does a surgeon find the appendix?

Back 149

Traces the tinea coli to their intersection

Front 150

What is the ileopubic tract?

Back 150

A reflective band of transversus abdominis

Front 151

What is end stage liver disease marked by?

Back 151

Caput medusae

Front 152

The innervation of the foregut?

Back 152

T5-T9

Front 153

What does the vagus nerve innervate in the abdominal cavity?

Back 153

Foregut and midgut

Front 154

What is the hindgut innervated by?

Back 154

Pelvic splanchnics

Front 155

What is a portal-caval shunt?

Back 155

An anastamoses made between a vein in the portal area to a vein in the caval area. Splenic and renal connection is a common one

Front 156

What contributes to the posterior rectus sheath?

Back 156

1/2 of internal oblique aponeurosis + transversus abdominus aponeurosis

Front 157

What does not contribute to the rectus sheath?

Back 157

Transversalis fascia

Front 158

What dermatome is at the xiphoid process?

Back 158

T7

Front 159

What dermatome is at the rectus abodominis?

Back 159

T12

Front 160

What nerves would a surgeon have to be cautious of when doing a posterolateral kidney resection?

Back 160

Subcostal
Iliohypogastric
Ilioinguinal

Front 161

How would the pancreas receive blood if the gastroduodenal artery is ligated?

Back 161

Splenic artery

Front 162

What organs are in the epigastric region?

Back 162

Foregut

Front 163

What are the components of the superficial inguinal ring?

Back 163

Lateral crus
medial crus
intercrural fibers
lacunar ligament
Inguinal ligament
all formed by the external abdominal oblique

Front 164

What vessels are medial to the 2nd part of the duodenum?

Back 164

SMA
Abdominal aorta

Front 165

What is lateral to the 2nd part of the duodenum?

Back 165

Ascending colon

Front 166

What is superior to the 2nd part of the duodenum?

Back 166

Gallbladder

Front 167

What is posterior to the 2nd part of the duodenum?

Back 167

Right renal hilus

Front 168

A gunshot to the upper abdomen hits pancreas and there is blood, what is the vessel most likely damaged?

Back 168

SMA

Front 169

What is anterior to the 3rd part of the duodenum?

Back 169

SMA

Front 170

What is the 3rd part of the duodenum posterior to?

Back 170

Body of pancreas and transverse colon

Front 171

What layer forms the innermost layer of spermatic cord?

Back 171

Transversalis fascia

Front 172

Where is the most common place for gallstones to lodge?

Back 172

Ampulla of vater

Front 173

If a person has tingling around the umbilicus what dermatome is responsible?

Back 173

T10 intercostal

Front 174

Where is McBurney's point?

Back 174

1/3 of the way along the ASIS and umbilicus

Front 175

What veins are distended with caput medusae?

Back 175

Paraumbilical veins
Anastamose with superficial epigastrics that come off of the femoral just after the inguinal ligament

Front 176

What is urinary extravation?

Back 176

When urine flows into the potential space between scarpa's fascia and continuing layers

Front 177

What is referred pain?

Back 177

When somatics and viscerals synapse on the same 2nd order neuron (pain neuron) and the body cannot distinguish between the two

Front 178

What artery is posterior to the first part of the duodenum?

Back 178

Gastroduodenal

Front 179

What happens if the neck of the pancreas gets a tumor?

Back 179

The hepatic portal vein become occluded because it is directly posterior to it

Front 180

How would cancer of the pancreas metastasize to the liver?

Back 180

Through the portal system

Front 181

If the SMA had an aneurysm what would one expect?

Back 181

Compression of left renal vein posterior to it.

Front 182

What are the boundaries of the omental foramen?

Back 182

Roof - hepatoduodenal ligament
Floor - IVC

Front 183

What vessel is posterior to the 3rd part of the duodenum?

Back 183

Left renal vein

Front 184

A mass is found above the midpoint of the inguinal ligament in a young boy, what kind of hernia can be suspected?

Back 184

Indirect

Front 185

If the SMA is blocked what part of the gut can become ischemic because of no collateral circulation?

Back 185

Ileum or jejunum

Front 186

Mass found above and lateral to the pubic tubercle, what kind of hernia can be suspected?

Back 186

Direct

Front 187

A direct hernia compresses a nerve on external surface of spermatic cord that passes through the superficial ring, what nerve and what issue can be suspected?

Back 187

Ilioinguinal (cutaneous)

Loss of sensation from anterior scrotum

Front 188

Repair of a severely damaged spleen, what organ will you most likely encounter?

Back 188

Tail of pancreas lying over hilum.

Front 189

A carcinoma of the anal canal below the pectinate line will migrate into what lymph nodes?

Back 189

Superficial inguinal

Front 190

What spinal nerves might be injured during a cholecysectomy?

Back 190

T7 and T8

Front 191

What is a merkel diverticulum?

Back 191

A remaining vitelline duct

Front 192

What happens in achalasia, and is it congenital or acquired?

Back 192

No relaxation of lower esophageal sphincter and it is acquired

Front 193

Where is a spigelin hernia?

Back 193

On the linea semiluminaris between the muscles of the abdomen.

Front 194

Where would stomach cancer metastasize to?

Back 194

Celiac nodes

Front 195

What can you expect to see in an xray of a stomach?

Back 195

Air bubbles

Front 196

Where would blood collect in a rupture of an abdominal aortic aneurysm?

Back 196

Retrovesical space

Front 197

In order to enlarge the deep inguinal ring in surgery, where should an incision be made?

Back 197

Transversalis fascia

Front 198

Pain from cancer of the pancreas is referred to?

Back 198

T6-T9

Front 199

Woman has heartburn and epigastric pain, a portion of her stomach is in diaphragm. What gets compressed, what happens as a result of this compression?

Back 199

Vagus nerve

Decreased acid production

Front 200

Which of the parts of the pancreas is a tumor likely to be located?

Back 200

Head blocking the common bile duct

Pancreatic adenocarcinoma

Front 201

Repair of a hernial sac from an inguinal hernia cuts a thin white tube with little blood, what is it?

Back 201

Vas deferens

Front 202

What are the boundaries for urine with a urethral rupture?

Back 202

Facia lata keeps it from going down the legs, colle's fascia keeps it from entering ischoanal fossa.

Front 203

If a surgeon made an incision in the right lower quadrant for an appendectomy, what would be the layers he would cut through?

Back 203

Skin, camper's fascia, scarpa's fascia, deep investing fascia, aponeurosis of ext oblique, internal oblique, transversus abdominis, transversalis fascia, extraperitoneal fat and fascia, parietal peritoneum

Front 204

An ulcer at the angular inciser of stomach forms a tumor at the angular notch, where is it likely to spread?

Back 204

Lesser curvature

Front 205

Traumatic rupture of diaphragm on left side would result in what?

Back 205

Seeing abdominal viscera in thoracic cavity on an xray

Front 206

What kind of issue begins in the umbilical region and spreds to the right iliac fossa?

Back 206

Appendicitis

Front 207

Distended abdomen, acute pain in lower left quadrant is a sign of?

Back 207

Twisting of sigmoid colon

Front 208

An ulcer in the first part of the duodenum would affect what structure?

Back 208

Gastroduodenal artery, immediately posterior to it

Front 209

Occluded IMA, if no collateral what risks ischemia?

Back 209

Sigmoid colon

Front 210

Enlarged veins common in portal hypertension?

Back 210

Superior rectal
Esophageal
Azygous
Superficial epigastric
Periumbilical
Middle and Inferior rectal veins

Front 211

Gallbladder pain tract?

Back 211

Celiac plexus to greater splanchnic

Front 212

Umbilical pain tract?

Back 212

T9-T11 to lesser splanchnic

Front 213

Ischemic decending colon from a thrombembolism, where did it originate?

Back 213

IMA

Front 214

Hemorrhoids enlarge from what two sources?

Back 214

IMA, Internal iliac, internal pudendal

Front 215

The 3rd part of the duodenum would become obstructed by what artery enlarging?

Back 215

SMA
"Nutcracker effect"

Front 216

Pain in epigastric region?

Back 216

Forgut issue, sometimes a duodenal ulcer

Front 217

Structure immediately posterior to epiploic foramen that can get damaged?

Back 217

IVC

Front 218

Numb anterior scrotum and adjacent thigh is from what nerve damage?

Back 218

Ilioinguinal

Front 219

tingling in lateral thigh from damage to what nerve during a hernia repair?

Back 219

Lateral femoral cutaneous

Front 220

What is the duct of Lushka?

Back 220

Same as duct of santorini, can be a leaking issue if the main pancreatic duct is ligated following a gallbladder removal.

Front 221

Where is a common site to find gallstones?

Back 221

Ileocecal region

Front 222

What does the ligament of Trietz suspend and where does it come from?

Back 222

The 4th part of the duodenum.

Comes from the Rt. Crus

Front 223

Where is pain from the Ureter felt?

Back 223

T11-L2

Front 224

What is posterior to the right common iliac artery?

Back 224

The right common iliac vein

Front 225

Where does fluid collect in the peritoneal cavity?

Back 225

Rectouterine pouch

Front 226

What two ribs overlie the kidneys?

Back 226

11 and 12

Front 227

A hernation has only transversalis facia and parietal peritoneum membrane, is it indirect or direct?

Back 227

Direct

Front 228

Where does acites come from?

Back 228

Retroperitoneal veins

Front 229

Where is the gallbladder located on the body wall?

Back 229

9th costal cartilage and semiluminaris line

Front 230

What is the cremasteric muscle made from and innervated by?

Back 230

Internal abdominal oblique muscle and genital branch of genitofemoral nerve

Front 231

Where does testicular/ovarian cancer metastasize?

Back 231

To lumbar nodes/ aortic nodes

Front 232

Where does scrotal cancer metastasize?

Back 232

Superficial inguinal lymph nodes

Front 233

What is hydrocele?

Back 233

Fluid accumulation between visceral and parietal layers of tunica vaginalis

Front 234

What is varicocele?

Back 234

Dilated veins of pampiniform plexus.

Front 235

What type of hernia is medial to the epigastric vessels?

Back 235

Direct

Front 236

What type of hernia is the result of a non-obliterated processus vaginalis?

Back 236

Indirect

Front 237

How do you palpate for an indirect hernia?

Back 237

Find femoral artery, move medial and superior.

These are medial to femoral and lateral to epigastric vessels

Front 238

What type of hernia presents below the inguinal ligament?

Back 238

Femoral hernia

Front 239

What is the median umbilical ligament a remnant of?

Back 239

The urachus which is a remnant of the allantois stalk in the embryo.

Front 240

Other types of hernias?

Back 240

Umbilical, incisional, spigelian

Front 241

14 year old boy presents with a bulge laterally and no bulge medially, what type of hernia is this?

Back 241

Indirect

Front 242

During surgery of an inguinal hernia what two nerves are at risk?

Back 242

Femoral branch of genitofemoral and ilioinguinal nerve

Front 243

Ulceration of posterior wall of the stomach can lead to what?

Back 243

Fluid filling the omental bursa.

Rupture of the splenic artery.

Front 244

Where would one palpate the liver?

Back 244

Right side below the costal margin

Front 245

What results from an incompetant cardiac sphincter that allows acid in the esophagus?

Back 245

GERD

Gastroesophageal reflux disorder

Front 246

What is special about the greater omentum?

Back 246

It is the "policeman" of the stomach and migrates to areas of inflammation

Front 247

What is Barrett esophagus?

Back 247

Where the epithelium in the esophagus changes from stratified squamous to simple columnar.

Secondary to GERD, smoking, drinking

Front 248

Dilation of esophageal veins from portal hypertension are called?

Back 248

Esophageal varices

If they rupture you DIE FAST from MASSIVE internal bleeding

Anastamoses between left gastric and azygous vein

Front 249

What is jaundice the result of?

Back 249

Bilirubin re-entering blood if the liver cannot reabsorb it.

Front 250

What is the result of pancreatic carcinoma?

Back 250

Obstructive jaundice

Front 251

What predisposes someone to carcinoma of stomach?

Back 251

Chronic gastritis, pernicious anemia, polyps

Front 252

Splenic rupture can result from?

Back 252

Fracturing ribs 9-11

Front 253

When will the spleen be enlarged?

Back 253

Liver failure, sickle cell, infections, leukemia, lymphoma

Extends past the midaxillary line!

Front 254

Who is more likely to contract gallstones?

Back 254

Females 40 years and up

Front 255

What is Hartmann's pouch?

Back 255

out-pouching of the wall of the gallbladder at the junction of the neck of the gallbladder and the cystic duct.

Very common place to get an obstruction

Front 256

Symptoms of gallstones?

Back 256

Spasms after eating, jaundice, referred pain to right shoulder from gallbladder irritating diaphragm, severe epigastric (right quadrant) pain

Front 257

What are cholesterol stones called?

Back 257

Cholelithiasis

20% men over 75 years
35% of women over 75 years

Front 258

What are brown pigment gallstones almost always associated with?

Back 258

Bacterial cholangitis

Front 259

What artery provides the anastamoses between the SMA and IMA?

Back 259

Marginal

Front 260

Congenital megacolon, without any enteric nervous system. More common in males.

Back 260

Hirschsprung's disease

Neural crest cells fail to migrate

Front 261

Sites of portal-caval anastamoses

Back 261

Esophageal veins

Paraumbilical veins

Veins of anal canals

Retroperitoneal veins

Front 262

What is the recto-anal watershed?

Back 262

Division of rectal drainage by pectinate line. Endoderm changes to ectoderm.

Front 263

Upper and middle rectum drainage

Back 263

Upper: Inferior mesenteric nodes

Middle: Internal iliac nodes

Front 264

Referred pain localizes when....

Back 264

Organ irritates body wall

Front 265

Yellowing of the sclerae of the eyes.

Back 265

Scleral Icterus

Front 266

What is marked by intermittent, colicky abdominal pain, vomiting, constipation, dehydration, ischemia?

Back 266

Bowel obstruction

Front 267

Where does diverticular disease usually affect people?

Back 267

Decending and sigmoidal colon.

Front 268

What is an Ostomy?

Back 268

A bag connecting somethign to teh outside wall

Front 269

What is annular pancreas?

Back 269

When the ventral bud that rotates is split.

Front 270

What is Cirrhosis?

Back 270

Hepatic fibrosis from liver damage. Increased portal vein pressure
Decreased blood proteins.
Decreased clotting factors.
Edema, jaundice, splenomegaly
Neurological damage

Front 271

What is atrophic gastritis?

Back 271

When you lack intrinsic factor and cannot absorb B12 in the gut.

Neurological problems that mimic MS

Front 272

How is the mucosa different in the fundic stomach vs. the pyloric?

Back 272

Fundic: Short pits, long glands

Pyloric: long pits, short glands

Front 273

What types of cells are found in the fundic stomach?

Back 273

Mucous neck cells, chief cells, parietal cells, enteroendocrine cells, undifferentiated cells

Front 274

What do you need B12 for?

Back 274

RBC production

Nerve impulses

Front 275

Phases of alcoholic liver disease?

Back 275

Fatty liver

Alcoholic hepatitis

Cirrhosis

Front 276

Which stage of liver disease is reversible?

Back 276

Fatty liver

Front 277

What stage of liver disease shows Zone 3 necrosis and an increase in neutrophils?

Back 277

Hepatitis

Front 278

What type of disorder is marked by zone 3 hypoxia in the liver while zones 1 and 2 look normal?

Back 278

Cardiac cirrhosis

Front 279

Two types of hiatal hernias?

Back 279

Sliding: esophagus pushed through diaphragm

Paraesophageal: stomah or bowel pushed through diaphragm

Front 280

Kidney stones reflect pain where?

Back 280

T11-L2 from "loin to groin"

Uric acid crystals and bowel pain.

Front 281

BPH

Back 281

Benign Prostatic Hypertrophy

Affects Transitional zone (In central zone) where there is a massive enlargement and often a collapsed urethra

Front 282

Prostatic Carcinoma

Back 282

Affects Peripheral zone

Radical prostectomy

Front 283

Prostatic adrenocarcinoma

Back 283

Metastasizes into vertebral column via Batson's plexus = no valves

Front 284

Hystersalpingogram

Back 284

Injections of uterus and tubes with a radiopaque dye.

Dye should fill tubes and leaks into peritoneal cavity via oviduct.

Front 285

What procedure uses an intravaginal scope to view abdominal cavities?

Back 285

Culdoscopy - through posterior fornix of vagina

Front 286

Why does prolapse occur?

Back 286

Weak pelvic diaphragm muscles, particularly levator ani

Front 287

What disorder is characterized by the neck of the bladder slipping through pelvic diaphragm causing the urethral sphincter to fail?

Back 287

Stress incontinence. Intra-abdominal pressure no longer helps keep urethral sphincter closed.

Front 288

What are the nerves involved in erection?

Back 288

Cavernous nerves

Front 289

Factors contributing to erectile dysfunction?

Back 289

Diabetes
Hypertension
Smoking
Low serum testosterone

Front 290

How does viagra work?

Back 290

Enhances relaxing effect of NO by inhibiting phosphodiesterase that degrades cyclic GMP. NO relaxes helicine arteries to allow blood to fill in penis.

Front 291

In order to repair a tumor in the labia majora what nerve must be blocked?

Back 291

Pudendal nerve

Front 292

Reconstructive surgery of the uterus risks damaging what structure?

Back 292

Ureter

Front 293

After removal of the rectum, what nerves might be damaged that lead to erectile dysfunction?

Back 293

Pelvic splanchnic parasympathetic nerves, S2-S4.

Front 294

What is the landmark for a pudendal block?

Back 294

Ischial spine

Front 295

Damage to what nerve leads to incontinence?

Back 295

Pudendal

Front 296

Where do external genatalia have lymph drainage?

Back 296

Superficial and deep inguinal lymph nodes

Front 297

The ureter passes lateral to what female organ?

Back 297

Cervix

Front 298

What is medial to the ovarian vessels in the suspensory ligament?

Back 298

Ureter passes over pelvic brim medial to these vessels

Front 299

Where does cervical cancer metastasize to?

Back 299

Internal iliac nodes - uterine artery comes from internal iliac artery

Front 300

Sign of BPH?

Back 300

Urinating at night

Front 301

Lymphatic drainage from scrotum?

Back 301

Superficial inguinal lymph nodes

Front 302

Numb posterior scrotum?

Back 302

Pudendal nerve

Front 303

Glans penis, clitoris, labia minora, lower vaginal lymphatic drainage?

Back 303

Deep inguinal lymph nodes

Front 304

Scrotum, labia majora, superficial penis/clitoris lymphatic drainage?

Back 304

Superficial inguinal lymph nodes

Front 305

Removal of prostate (radical prosectomy) may damage what nerves?

Back 305

Cavernous nerves from inferior hypogastric plexus from pelvic splanchnics

Front 306

Anal senosry area

Back 306

Pudendal nerve

Front 307

Ligation of what ligament cuts blood to ovary?

Back 307

Suspensory ovarian ligament

Front 308

Uterine vessels are in?

Back 308

Transverse cardinal ligament

Front 309

Other support to uterus besides cardinal ligament?

Back 309

Uterosacral ligament

Front 310

Somatic nerves innervate what pelvic muscles?

Back 310

Levator ani
Sphincter urethrae
Deep transverse perenial
Bulbospongiousus

Front 311

Detrusor muscle of the bladder is innervated by?

Back 311

Parasympathetic NS

Front 312

What is the blood supply to the prostate?

Back 312

Inferior vesicle
Internal pudendal
Middle rectal

Front 313

What does the prostate secrete?

Back 313

Citric acid, fibrinolysin, serine protease

Front 314

What is prostate specific antigen normally secreted by?

Back 314

The liver, small amounts by prostate

Front 315

What nerves cause ejaculation?

Back 315

Sacral splanchnics L1, L2

Front 316

What part of the pituitary makes FSH?

Back 316

Anterior pituitary

Front 317

What type of cell makes gonadotropes?

Back 317

Basophils

Front 318

What does estrogen stimulate?

Back 318

Proliferative phase of menstrual cycle

Front 319

What cells produce estrogen?

Back 319

Granulosa cells convert androgens to estrogen in the follicle

Front 320

What is the secretory phase of the uterus stimulated by?

Back 320

Directly: Progesterone

Indirectly: LH surge

Front 321

What are the three parts of the broad ligament?

Back 321

Mesovarium
Mesosalpinx
Mesometrium

Front 322

After the LH surge, when does ovulation occur?

Back 322

12-24 hours

Front 323

Where does fertilization occur?

Back 323

In the ampulla

Front 324

What does a pregnancy test test for? What cells make it?

Back 324

HCG

Chorionic trophoblasts in the placenta

Front 325

Where is the bladder in relation to the uterus?

Back 325

Anterior and inferior

Front 326

How does the mucosa of the cervix change as you go towards the vagina?

Back 326

Simple columnar to stratified squamous non-keratinized epithelium

Front 327

What are vaginal fornices?

Back 327

Continual recesses of the vagina around the cervix

Front 328

What chemical is found in the lamina rarae (externa and interna) of the glomerular basement membrane?

Back 328

Heparin sulfate

Front 329

What is a physical barrier of the lamina densa of the glomerular basement membrane?

Back 329

Type IV collagen

Front 330

What cleans the glomerular basement membrane?

Back 330

Mesangial cells

Front 331

What blocks Na+ from leaving the loop of Henle?

Back 331

Furosemide, diuretic that keeps water from being reabsorbed

Front 332

If a biopsy was taken 3cm below the 12th rib what would it pierce?

Back 332

Quadratus lumborum and latissiumus dorsi

Front 333

If a biopsy of the superior pole of the kidney above the 12th rib was taken what would it pierce?

Back 333

Diaphragm

Front 334

What features does the Proximal convoluted tubule have?

Back 334

Brush boarders, acidophilic, more seen in cross section, fuzzy or collapsed lumens.

Front 335

What does the macula densa do?

Back 335

It is a specialized DCT that facilitates the release of renin from JCG cells. Detects the amount of sodium in urine.

Front 336

How much protein is excreted from the kidney each day?

Back 336

100-150 mg

Front 337

Where does ADH act on the kidney?

Back 337

Acts at the collecting ducts

Front 338

From what vertebral level do the renal arteries arise?

Back 338

L1/L2 disc

Front 339

Where does the superior mesenteric artery arise?

Back 339

L1

Front 340

What lies just above the origins of the renal arteries?

Back 340

transpyloric plane

Front 341

What is the adrenal gland innervated by?

Back 341

Greater splanchnic nerve

Front 342

What cells release epinephrine and norepinephrine in the adrenal gland?

Back 342

Chromaffin cells

Front 343

The transumbilical plane is at what vertebral level?

Back 343

L3-L4

Front 344

Where does the IMA arise?

Back 344

Subcostal plane at L3

Front 345

If a catheter were threaded through the femoral artery what route would it take?

Back 345

Underneath ureter at bifurcation of common iliac.

enters aorta at supracristal plane L4

Front 346

How do juxtaglomerular cells respond to blood pressure?

Back 346

They have stretch receptors

Front 347

What does renin do?

Back 347

Converts angiotensinogen made by liver to angiotensin I

Angiotensin I is converted to angiotensin II by ACE in lungs

Front 348

What does angoitensin II do?

Back 348

Powerful vasoconstricto.

Binds to zona glomerula to make it release aldosterone, which increases sodium reapsorption from collecting duct and DCT to reabsorb more water.

Front 349

Where does the ureter cross the pelvic brim?

Back 349

At the bifurcation of the common iliac arteries.

Front 350

From where does the uterine artery arise?

Back 350

Anterior trunk of internal iliac artery

Front 351

Where do the uterine artery and ureter cross?

Back 351

2cm above the ischial spine

Front 352

Where do pain afferents from the fundus and body of the uterus travel?

Back 352

L1, L2 (peritoneum)

Front 353

Where do pain afferents from the cervix and vagina travel?

Back 353

S2-S4 (parasympathetic)

Front 354

Pain afferents travel from ureter to?

Back 354

T11-L2

Front 355

If the uterine artery were ligated at its origin what organs would be compromised?

Back 355

Cervix and vagina

Front 356

Where do the pain afferents from the distal vagina travel?

Back 356

S2-S4 PUDENDAL

Front 357

What nerve and artery pass towards the urogential triangle in the lateral wall of the ischioanal fossa?

Back 357

The pudendal nerve (perineal nerves)

The internal pudendal artery

Front 358

A specialization of what fascia forms the alcock's canal?

Back 358

Obturator internus

Front 359

If an abscess occurs in the ischioanal fossa, how far anteriorly may the abscess spread?

Back 359

Can spread to the anterior recess and posteriorly through the deep postanal space to the opposite side.

Front 360

What would be inferior and superior to this anteriorly spreading abscess?

Back 360

Inferior would be perineal membrane and superiorly would be the levator ani.

Front 361

What are the layers and the derivatives of the spermatic cord?

Back 361

External : External oblique
Cremasteric: Internal oblique
Internal: Transversalis fascia

Front 362

Two type of hemorrhoids?

Back 362

Internal AKA piles, can become prolapsed

External - covered by skin, very painful

Front 363

Pain from a damaged right testis would travel where?

Back 363

T7

Front 364

What does the tunica vaginalis form from?

Back 364

Processus vaginalis a layer of peritoneum.

Front 365

What level do the testicular/ovarian arteries arise?

Back 365

L2

Front 366

Where does the left renal vein drain?

Back 366

IVC

Front 367

What lays in the posterior wall of the omental bursa?

Back 367

The pancreas

Front 368

During development the portion of the stomach that will become the posterior wall is facing what direction?

Back 368

Anatomical right

Front 369

What cells are responsible for the formation of HCL in the gastric lumen?

Back 369

Parietal cells

Front 370

Where are parietal cells located?

Back 370

Fundus of stomach

Front 371

What three things make up the hepatoduodenal ligament?

Back 371

Hepatic artery proper
Common bile duct
Hepatic portal vein

Front 372

What are the branches of the celiac artery?

Back 372

Common hepatic, splenic, and left gastric

Front 373

What is the blood supply to the stomach?

Back 373

Right and left gastrics, right and left gastro-epiploic (gastro-omental), and short gastric (fundus)

Front 374

Sympathetic innervation to stomach?

Back 374

T6-T9, celiac, greater splanchnic

Front 375

What level is the pyloric sphincter of the stomach?

Back 375

L1

Front 376

Pain afferents from the gallbladder, bile duct, and duodenum travel?

Back 376

T6-T9

Front 377

If the ampulla of Vater is blocked what will occur?

Back 377

Pancreatic enzymes will back up into the pancreas, possibly digest tissue and backwash into the blood.

Front 378

Where do the gallbladder, head of pancreas and liver develop from?

Back 378

Diverticulum of the duodenum

Front 379

Where does the cystic artery branch from?

Back 379

Right hepatic artery

Front 380

The accessory pancreatic duct is also known as what? What is it a remnant of?

Back 380

Duct of santorini.

Remnant of embryonic dorsal bud of pancreas.

The ventral bud gives rise to the duct of wirsung and the man dorsal duct joins with the ventral head.

Front 381

What form the walls of the bile canaliculi in the liver?

Back 381

Hepatocytes

Front 382

What type of epithelium lines the gallbladder?

Back 382

Simple columnar

Front 383

What does the gallbladder lack that gives away its identity?

Back 383

No submucosa, no glands.

Front 384

What are the sinuses called in the epithelium of the gallbladder?

Back 384

Rokitansky-Aschoff sinuses

Front 385

What lobe of the liver is immediately medial to the gallbladder?

Back 385

Quadrate lobe

Front 386

How will the trachea of a smoker appear?

Back 386

Thick basement membrane, goblet cells.

Front 387

What cells secrete lipoprotein and keep the walls of the bronchioles from sticking together?

Back 387

Clara cells - secrete CC16

Front 388

Why are there no clara cells in the trachea and bronchii?

Back 388

Those structures have cartilage to keep them from sticking together.

Front 389

What is the sinus venosus?

Back 389

Remnant of the in-growth of vessels into the right atrium. Demarcated by the crista terminalis, it is the smooth area.

Front 390

What are the bronchial segments of the right lung?

Back 390

APALMSMALM

Front 391

From what structure does the hepatoduodenal ligament derive?

Back 391

Ventral mesentery

Front 392

What is the name for the muscular structure at the end of the ampulla of Vater?

Back 392

Sphincter of Oddie

Front 393

What does the obliterated left umbilical vein become?

Back 393

Round ligament (ligamentum teres of liver)

Front 394

What pain afferent levels are from the kidneys?

Back 394

T10-L1

Front 395

What pain afferent levels are from the small bowel?

Back 395

T8-T10

Front 396

What pain afferent levels are from the transverse colon?

Back 396

T11

Front 397

What pain afferents are from the decending colon?

Back 397

T12-L1

Front 398

What pain afferents are from the sigmoid colon to rectum?

Back 398

L2,L3
S2
S4

Front 399

What arteries serve as the anastamoses around the head of the pancreas?

Back 399

Superior pancreaticoduodenal to anterior and posterior superior to anterior and posterior inferior to inferior pancreaticoduodenal to SMA

Front 400

What is the tract of bile from the liver to the duodenum?

Back 400

bile canaliculi --> intrahepatic bile ductures --> interolbar bile ductules --> r/l hepatic ducts --> common hepatic --> cystic --> bile duct

Front 401

What vessels lie in the splenorenal ligament?

Back 401

The splenic artery and vein. The tail of the pancreas is also in this ligament

Front 402

What vessels lie in the gastrosplenal ligament?

Back 402

The short gastric arteries and veins.

Front 403

What vessels lie in the lesser omentum?

Back 403

Left gastric artery and vein.