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Anatomy Flashcards

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1
Q

Blood supply to SA/AV nodes

A

Right coronary artery (RCA infarct) = nodal dysfunction

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2
Q

Dominance in coronary circulation

A

R-dominant: RCA gives rise to PDA (70%)
L-dominant: LCX gives rise to PDA (20%)
Co-dominant: arises from both (10%)

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3
Q

LA can impinge on what 2 structures?

A

Enlargement of the left atrium can lead to…

  • dysphagia: compression of esophagus
  • hoarseness: compression of L recurrent laryngeal
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4
Q

Adrenal cortex anatomy (also, give stimulation and product of each region)

A

From the outside in: GFR
G: glomerulosa = stim. by renin-angiotensin system, secretes aldosterone
F: fasciculata = stim. by ACTH/CRH, secretes cortisol
R: reticularis = stim. by ACTH/CRH, secretes DHEA (androgen precursor), DHEA-S (marker for adrenal dysfunction), androstenedione (testosterone precursor)

Increased 17-OHP = congenital adrenal hyperplasia

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5
Q

Adrenal medulla derivative, cell type, innervation

A

neural crest derivative

  • chromaffin cells (neural crest), regulated by preganglionic sympathetics
  • secretes catecholamines (site of pheochromocytoma)
  • neuroblastoma comes from the adrenal medulla
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6
Q

Pituitary gland secretory products and embryonic derivative

A

Anterior: FLAT PiG (FSH, LG, ACTH, TSH, prolactin, GH), derived from oral ectoderm, alpha subunit of hormones is common

Posterior: vasopression and oxytocin (technically made in hypothalamus, then transported by neurophysins), derived from neuroectoderm

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7
Q

Pancreatic islet cells organization

A

Alpha cells: found on periphery of islet (secrete glucagon)
Beta: found in center of islet (secrete insulin)
Delta: found throughout islet (secrete somatostatin)

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8
Q

Retroperitoneal structures

A

SAD PUCKER: Suprarenal (adrenal) glands, Aorta/IVC, Duodenum, Ureters, Colon (asc/desc), Kidneys, Esophagus, Rectum (superior part)

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9
Q

GI ligaments to know

Falciform
Hepatoduodenal
Gastrohepatic
Gastrocolic
Gastrosplenic
Splenorenal
A

Falciform (liver to anterior wall): ligamentum teres hepatis (ventral mesentery)

Hepatoduodenal: portal triad, part of lesser omentum, compression = Pringle maneuver

Gastrohepatic: to lesser curvature of stomach, contains gastric arteries (separates lesser and greater sacs)

Gastrocolic: greater curvature to colon, contains gastroepiploics, part of greater omentum

Gastrosplenic: short gastrics, left gastroepiploics, greater omentum

Splenorenal: splenic artery and vein, tail of pancreas

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10
Q

Digestive tract facts

  • layers of wall/mucosa
  • wave speeds
A

4 layers in wall: mucosa, submucosa, muscularis, serosa
mucosa = epithelium, lamina propria, muscularis mucosa (site of myenteric plexus)

duodenum: 12/min > ileum: 8-9/min > stomach: 3 waves/min

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11
Q

GI tract histology notable features (esophagus, stomach, duodenum, ileum, colon)

A

Esophagus: non-keratinized stratified squamous

Stomach: gastric glands

Duodenum: villi/microvilli, Brunner glands (HCO3),

Ileum: Peyer’s patches,

Colon: no villi! abundant goblet cells

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12
Q

Abdominal aorta branch vertebral heights

A 
Celiac T12
SMA L1
Left renal L1
IMA L3
Bifurcation of aorta L4
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13
Q

Portosystemic anastomoses

A

Esophageal: L gastric vein –> esophageal vein (to azygos to SVC)

Umbilical: paraumbilical veins —> small superficial epigastrics

Rectal: superior rectal –> middle/inferior rectal

Tx: TIPS: portal vein to hepatic vein (bypasses liver entirely)

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14
Q

Pectinate line (endoderm meets ectoderm)

Give innervation, blood supply and drainage

A

Above: internal hemorrhoids (visceral innervation), adenocarcinoma
supplied by IMA, drained to portal vein
Below: external hemorrhoids (somatic = painful!), SCC
supplied by internal pudendal, drains to IVC
anal fissures: posterior due to poor perfusion

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15
Q

Liver anatomy (lobule structure, Zones, describe insults)

A

Apical = bile secretion, basolateral = sinusoids
Blood flow = portal vein (apical) to hepatic vein (basolateral)

Zone 1 (apical, periportal): affected first by viral hepatitis, ingested toxins
Zone 2 (intermediate): location of hepatic infection by yellow fever
Zone 3 (basolateral, centrilobular): affected first by ischemia, location of alcoholic hepatitis/toxic injury and p450 system
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16
Q

Femoral triangle (borders and contents)

A

Superior = inguinal ligament, lateral = sartorius, medial = adductor longus

NAVEL (lateral to medial): Nerve, Artery, Vein, Lymph

femoral sheath: includes artery, vein, lymph (not the nerve!)

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17
Q

Inguinal canal layers

A

Peritoneum, transversalis, transversus abdominus, internal oblique, external oblique, inguinal ligament, superficial inguinal ring

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18
Q

Hernias (diaphragmatic, indirect, direct, femoral)

A

Diaphragmatic: left-sided, hiatal is most common (sliding = upward displacement of GEJ, parasophageal = protrusion of fundus)
Indirect inguinal: processus vaginalis into scrotum, lateral to inferior epigastric (more common in infants!)
Direct inguinal: peritoneum bulges through Hesselbach triangle (older men)
Femoral: below inguinal triangle, lateral to pubic tubercle (more common in females, bowel incarceration)

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19
Q

Erythrocyte facts (life span, membrane protein)

A

life span: 120 days

membrane contains Cl-/HCO3- antiporter (export of HCO3 to allow for CO2 carrying)

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20
Q

Thrombocyte facts (life span, granules, receptors)

A

life span 8-10 days

Dense granules: ADP, Ca2+
Alpha granules: vWF, fibrinogen

vWF receptor: GpIb
fibrinogen receptor: GpIIb, IIIa

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21
Q

Neutrophil facts (granules contents, chemotactic factors)

A

Granules = ALP, collagenase, lysosome, lactoferrin (help with phagocytosis)

chemotactic factors: C5a, IL-8, kallikrein, CTB4

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22
Q

Macrophage facts (activation)

A

activated by IFN-y

septic shock mediator: responds to Lipid A, LPS, CD14

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23
Q

Eosinophil (give 5 causes of eosinophilia)

A

5 causes of increased eos:

neoplasia, asthma, allergies, chronic adrenal insufficiency, parasite

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24
Q

Basophil granules

A

Heparin and histamine

Mediate allergic reactions

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25
Mast cell facts
local allergic reaction, bind Fc of IgE in allergic reactions Type I hypersensitivity reactions - cromolyn sodium = decreased histamine release (used to prevent asthma attacks)
26
Lymphocyte facts (receptors, site of maturation) B cell T cell Plasma cell
``` B cell (CD19/20, surface, 21, EBV receptor) - mature in bone marrow, stored in peripheral lymphoid tissue T cell (CD3, then CD4/8) - matures in thymus (CD4+ = HIV target) Plasma cell - clock-face chromatin, abundant RER, well-developed Golgi (multiple myeloma is a plasma cell cancer!) ```
27
Drawer test
ACL/PCL injury (abnormal anterior drawer = ACL injury) ACL inserts on the anterior aspect of the tibia from the lateral femoral condyle PCL inserts on posterior aspect of the tibia from the medial femoral condyle
28
McMurray test
click on external rotation = medial meniscus tear | click on internal rotation = lateral meniscus tear
29
Unhappy triad of knee injuries
ACL tear MCL tear medial/lateral meniscus
30
Baker cyst
popliteal fluid collection, related to chronic joint disease (knee arthritis or meniscal tear)
31
Most common rotator cuff injury
Supraspinatus Test with empty can test
32
Pitching injury
Infraspinatus
33
Epicondylitis
``` Medial = golfer's (repeated flexion) Lateral = tennis (repeated extension) ```
34
Wrist bone syndromes (also, give bones of the wrist)
So Long To (Triq) Pinky, Here Comes The (Trapezoid) Thumb (Trapezium) Scaphoid: avascular necrosis due to retrograde blood supply Lunate: acute carpal tunnel syndrome
35
Carpal tunnel associations
Pregnancy, rheumatoid arthritis, hypothyroidism
36
Guyon canal syndrome (give association)
Compression of ulnar nerve at the wrist Often seen in cyclists
37
Humerus surgical neck fracture
Axillary nerve injury Decreased abduction of arm at shoulder Decreased sensation over the deltoid
38
Upper trunk of brachial plexus compression
Musculocutaneous nerve injury Decreased forearm flexion at elbow, supination Decreased sensation over lateral forearm
39
Midshaft humerus fracture
Radial nerve injury (lies in spiral groove) Leads to wrist drop (loss of extensors), decreased grip strength Loss of sensation over posterior arm and dorsal hand
40
Supracondylar fracture of humerus
Median nerve injury Loss of wrist flexion, 2nd/3rd finger flexion (ape hand, Pope's blessing) Loss of sensation over thenar eminence Tinel sign - tingling on percussion
41
Fracture of medial epicondyle of humerus
Ulnar nerve injury Loss of wrist flexion, flexion of ulnar fingers, interossei Loss of sensation over ulnar hand
42
Superficial laceration of palm
recurrent branch of median nerve Loss of thenar muscle group: opposition, abduction, flexion of thumb No loss of sensation
43
Tear of upper trunk (lateral pull during dystocia)
Erb's Palsy (tear of C5-C6 nerve roots) | Waiter's tip: arm adducted (deltoid), internally rotated (infraspinatus), extended (biceps)
44
Tear of lower trunk (upward pull during dystocia)
Klumpke's palsy (tear of C8-T1 nerve roots) | Total claw hand: loss of lumbricals, interossei, thenar and hypothenar eminence
45
Compression of lower trunk and subclavian vessels (extra cervical rib, Pancoast tumor)
Thoracic outlet syndrome | Same muscle deficits as Klumpke's, but also ischemia, pain and edema due to vascular compression
46
Winged scapula
lesion of long thoracic nerve (axillary node resection) | Loss of serratus anterior
47
Pope's blessing (first two extended, last two flexed)
If present during extension/rest: distal ulnar lesion (ulnar clawing) If present during flexion: proximal median lesion
48
Okay sign (first two flexed, last two extended)
If present during extension/rest: distal median lesion (median clawing) If present during flexion: proximal ulnar lesion
49
Thenar eminence muscles
Opponens pollicus, Abducens pollicus longus, Flexor pollicus longus Innervated by median nerve
50
Hypothenar eminence muscles
Opponens digiti minimu, Abductor digiti minimi, Flexor digiti minimi Innervated by ulnar nerve
51
Interossei function and innervation
``` Dorsal = abduction Palmar = adduction ``` DAB, PAD Innervated by ulnar nerve
52
Pelvic surgery nerve injury (motor and sensory deficits)
Obturator (L2-L4) decreased thigh sensation decreased adduction
53
Pelvic fracture nerve injury (motor and sensory deficits)
Femoral (L2-L4) | decreased thigh flexion, leg extension
54
Trauma/compression of lateral leg | Fibular neck fracture
Common peroneal nerve injury (L4-S2) Foot drop, steppage gait Loss of eversion and dorsiflexion PED = peroneal everts and dorsiflexes
55
Knee trauma Baker cyst Tarsal tunnel syndrome
Tibial nerve injury (L4-S3) Loss of sole of feet Inability to curl toes TIP: tibial inverts and plantarflexes
56
IM injection nerve injury
``` Superior gluteal (L4-S1) trendelenburg gait Lesion is on the side on which the patient stands (opposite to the hip that drops) ```
57
Posterior hip dislocation
Inferior gluteal (L5-S2) difficulty climbing stairs, rising from seated position Loss of hip extension
58
Nerve block during birth
Pudendal nerve Innervates perineum Found near ischial spine
59
Lumbosacral radiculopathy
Nerve is inferior to the disc (L4 nerve is damaged in L3-L4 herniation) L3-L4: decreased patellar reflex L4-L5: decreased dorsiflexion, no heel-walking L5-S1: decreased plantarflexion, difficulty in toe-walking, decreased Achilles reflex
60
Proteins involved in muscle conduction to contraction
Nerve: presynaptic Ca channels, NT release Muscle cell: DHP receptor (voltage-gated), ryanodine (sarcoplasmic reticulum), troponin C (moves tropomysoin out of the myosin-binding groove)
61
Myosin cycle in muscle contraction
After opening of binding groove by troponin C... - myosin binds to actin filament - myosin releases ADP and Pi in the power stroke - new ATP binds and causes detachment of myosin from actin - hydrolysis of ATP cocks myosin into high-energy position for next cycle
62
Skeletal muscle microscopic structure
Z-line - borders of the sarcomere (center of light actin chain) M-line - middle of the sarcomere (center of heavy myosin chain) A-band - Myosin heavy chain, Always same length! H-band - distance between light chains (myosin only) I-band - distance between heavy chains (actin only) During contraction, H-band and I-band contract, and Z-lines and M-lines move closer together
63
Type 1 vs. Type 2 muscle fibers
Type 1: slow twitch, reddish color due to increased myoglobin concentration and increased mitochondria for sustained contraction (1 slow red ox) Type 2: fast twitch, white fibers from decreased mitochondria, increased anaerobic glycolysis (weight-training = increased fast-twitch muscle)
64
Smooth muscle contraction
mediated by calcium, regulated by calmodulin L-type voltage gated channel allows Ca influx, increases myosin-light-chain kinase activity (MLCK), increased myosin-P + actin, contraction via cross-bridging
65
Smooth muscle relaxation
mediated by NO | Increases intracellular guanylate cyclase, increased cGMP, increased myosin-light-chain phosphorylase (MLCP)
66
Endochondral bone formation
Axial/appendicular skeleton Chondrocytes make cartilaginous model, which is later replaced by osteoclasts/blasts to remodel into lamellar bone Woven bone is formed later after fractures and in Paget disease
67
Membranous ossification
Bones of calvarium/skull, facial bones | Woven bone formed without cartilage first, later remodeled to lamellar bone
68
Effect of PTH on bone
low levels = anabolic effects (building bone) | high levels = catabolic effects (osteitis fibrosa cystica)
69
Estrogen effects on bone
Induces apoptosis in bone-resorbing osteoclasts Decreased estrogen leads to excess remodeling/resorption --> osteoporosis
70
Ureter course
The ureters pass under the uterine artery (or under the vas deferens) prior to entering the bladder
71
Venous drainage of the gonads
Left gonadal veins drain into the L renal vein at a 90 degree angle, thus have less laminar flow, therefore increased risk of varicocele on the left (dilation of pampiniform plexus) Right gonadal vein drains directly into the IVC
72
Lymphatic drainage of the gonads
ovaries/testes --> paraaortic Distal vagina/scrotum --> superficial inguinal Proximal vagina --> obturator/hypogastric nodes
73
Infundibulopelvic ligament
Suspensory ligament ovaries --> lateral pelvic wall contains *ovarian* vessels! When operating, there is risk of ligating the ureter
74
Cardinal ligament
cervix --> pelvic side wall | contains *uterine* vessels
75
Round ligament
Uterine fundus --> labia majora contains artery of Sampson (remnant of gubernaculum)
76
Broad ligament
uterus/ovaries --> side pelvic wall
77
Ovarian ligament
ovary --> uterus | remnant of gubernaculum
78
Histology of female repro tract | stratified squamous, simple columnar, simple cuboidal
Stratified squamous: vagina, ectocervix Simple columnar: endocervix, uterus (glands are tubular in follicular phase, coiled in luteal phase), fallopian tube (ciliated) Simple cuboidal: outer surface of ovary
79
SEVEN-UP
``` Seminiferous tubules Epididymis Vas deferens Ejaculatory duct (nothing) Urethra Penis ```
80
Urethra segments
Posterior: membranous (pelvis fractures), bulbar (blunt force) Anterior: penile (perineal straddle - leads to urine Buck's fascia)
81
Erection mechanisms (nerves: pelvic, hypogastric, pudendal)
NO --> increased cGMP --> smooth muscle relaxation --> vasodilation Norepinephrine --> increased [Ca]i --> smooth muscle contraction --> vasconstriction Emission: sympathetic Ejaculation: visceral/somatic
82
Sertoli cell functions
- located in tubule wall - secrete inhibin B (responds to FSH) = decreased FSH - forms blood-sperm barrier (tight junctions) - temperature sensitive (increased temp = decreased inhibin, decreased sperm)
83
Leydig cell functions
increased LH = increased testosterone unaffected by temperature
84
Conducting zone of lungs
no gas exchange! anatomic dead space Cartilage/goblet cells - until the end of bronchi Pseudostratified ciliated columnar cells - until end of terminal bronchioles (therefore, mucociliary clearance happens until end of terminal bronchioles)
85
Respiratory zone
lung parenchyma: respiratory bronchioles, alveolar ducts, alveoli Mostly cuboidal until alveoli, then simple squamous
86
Pneumocytes (Type I, Type II, Clara)
Type I: line alveoli, squamous, gas diffusion Type II: pulmonary surfactant, cuboidal/clustered - precursors to Type I and other Type II - proliferate during lung damage Clara cells: non-ciliated, secretory granules - secrete part of surfactant, degrade toxins
87
Bifurcations to know: (all at 4!)
Common carotid: C4 Trachea: T4 Abdominal aorta: L4

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