Anatomy Flashcards

1
Q

What does lymph contain?

A

Lymph is typically a clear fluid that contains proteins, foreign particles, and a few lymphocytes

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2
Q

What are lymph nodes?

A

Lymph nodes are encapsulated aggregates of lymphocytes that receive lymph from tissues, trap antigens, and help lymphocytes function in an immune response to an infection.

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3
Q

What is the structure of lymph nodes?

A

Numerous lymphatic vessels enter the lymph node all around the exterior (these are called afferent lymphatics). A small indentation called the hilum marks the place where a single efferent lymphatic vessel exits and where blood vessels enter and exit

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4
Q

What is the role of the lymph node?

A

The role of lymph nodes is to filter fluid within the tissue and fight off infection.

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5
Q

How many lymph nodes are there in the body?

A

There are about 500-700 lymph nodes spread throughout the body, found as clusters surrounding blood vessels

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6
Q

What is lymph?

A

Lymph is essentially “extra fluid” that is not taken up by capillary beds spread throughout the body.

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7
Q

How much extra fluid does the lymph carry away each day?

A

Although it sounds like a tiny amount of fluid, the volume of lymph carried away from tissues actually amounts to about 2-4 L every day.

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8
Q

How does the lymph collect fluid?

A

Starling forces govern the movement of fluid in capillary beds and are a delicate balance of hydrostatic (pressure-based) and oncotic (osmolality-based) forces. They cause a net movement of fluid from capillaries to the surrounding interstitial tissue, and overall this means that more blood volume is brought to the capillary bed by arterioles than is brought back by venules.

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9
Q

Where does the lymph collect the excess interstitial fluid?

A

Lymphatic vessels weaving between the capillaries, capturing the excess interstitial fluid that is left behind.

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10
Q

What is Lymphedema?

A

Lymphedema is characterized by the swelling of one or more limbs and sometimes the trunk or genitalia. It can be caused by genetic mutations, secondary infections, or the removal of lymph nodes to treat cancer.

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11
Q

How is lymph carried through the body?

A

Lymph is carried through the body in two different types of lymphatic vessels: initial lymphatics and collecting lymphatics.

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12
Q

Do skeletal muscles help move lymph?

A

Yes. The flow of lymph in these larger vessels is also helped by the contraction of skeletal muscle

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13
Q

Do collecting lymphatics have valves?

A

Yes, to prevent backflow.

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14
Q

Characteristics of lymph movement.

A

Lymphatic vessels have valves that prevent backflow, and some have a layer of smooth muscle that helps move lymph by peristalsis. Skeletal muscle contraction helps move lymph as well.

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15
Q

Where are the lymph nodes clustered?

A

Lymph Node Cluster Area of Body Drained

Cervical Head and neck
Hilar Lungs
Mediastinal Trachea and esophagus
Axillary Upper limb, breast, skin above umbilicus
Celiac Liver, stomach, spleen, pancreas, upper duodenum
Superior mesenteric Lower duodenum, jejunum, ileum, colon to splenic flexure
Inferior mesenteric Colon from splenic flexure to upper rectum
Internal iliac Lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), cervix, prostate
Para-aortic Testes, ovaries, kidneys, uterus
Superficial inguinal Anal canal (below pectinate line), skin below umbilicus (except popliteal area), scrotum, vulva
Popliteal Dorsolateral foot, posterior calf

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16
Q

All lymph leads back to two main ducts called the ?

A

The right lymphatic duct and the thoracic duct

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17
Q

Does the right lymphatic duct or the throacic duct handle more fluid?

A

The Thoracic Duct - handles all but the upper right quadrant of the body.

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18
Q

Where does the right lymphatic connect, and drain into?

A

The right subclavian vein.

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19
Q

Are lymph nodes big or small?

A

Lymph nodes are small, lymphocyte-packed structures that filter lymph and help fight infectious agents and kill malignant cells. They are arranged in clusters throughout the body.

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20
Q

What systems is lymph a part of?

A

The immune and circulatory systems.

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21
Q

What are the primary lymph organs?

A

red bone marrow and the thymus gland.

Primary lymphatic organs are where lymphocytes are formed and mature. They provide an environment for stem cells to divide and mature into B- and T- cells:

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22
Q

What are the secondary lymph organs?

A

The secondary lymphoid organs are the spleen and the lymph nodes. They act as sites for maintaining the mature naive lymphocytes and are also the site where lymphocyte binding to antigen and hence their activation occurs.

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23
Q

What are lymphatic capillaries made of?

A

Lymphatic capillaries are primarily made out of an endothelium layer that sits on a permeable basement membrane. The flap-like minivalves, located at gap-like junctions in the endothelium, are formed from the overlap of endothelial cells and are normally closed. They allow large particles to enter

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24
Q

What happens when antigens bind to antibodies?

A

Antibodies are produced by specialized white blood cells called B lymphocytes (or B cells). When an antigen binds to the B-cell surface, it stimulates the B cell to divide and mature into a group of identical cells called a clone. … Antibodies attack antigens by binding to them.

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25
Q

Where is the inguinal region?

A

The groin.

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26
Q

Where is the axilla?

A

The armpit is the underside of the shoulder joint, and is among the warmest areas of the body. The armpit is also called the axilla. Blood and lymph vessels serving the arm travel through the armpit.

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27
Q

If a patient has testicular cancer, what lymph nodes will be enlarged?

A

The para-aortic nodes drain the kidneys as well as the ovaries and uterus in women

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28
Q

Lymph is usually clear, but when is it milky white?

A

Lymph draining the small intestine contains fat and protein-rich macromolecules called chylomicrons, which imbue the lymph with a white, milky appearance.

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29
Q

What coronary artery is dominant in the vast majority of people?

A

Dominance is described according to the coronary artery that gives rise to the posterior descending artery. The right coronary artery is dominant in about 85% of the population. A smaller percentage of people have a dominant left coronary artery or have a co-dominant circulation.

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30
Q

What Is the Venous Drainage of the Heart?

A

There are four main veins draining the blood flow from the heart, all of which drain into the coronary sinus. They are the great, middle, small, and posterior cardiac veins. They coalesce at the back of the heart, forming the coronary sinus within the coronary sulcus. The coronary sinus empties directly into the right atrium

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31
Q

What are the main lymph nodes draining the heart?

A

The lymphatic channels of the heart drain into the tracheobronchial and brachiocephalic nodes.

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32
Q

How are blood vessels structured?

A

Blood vessels are composed of three main layers (or tunics): the tunica intima, the tunica media, and the tunica adventitia

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33
Q

Why is the tunica intima smooth?

A

The nonadherent surface allows red blood cells and platelets to pass by the inner lining of the blood vessels without sticking.

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34
Q

What are the components of the tunica intima structure?

A

The tunica intima is made up of an endothelial layer, a subendothelial layer, and a basement membrane.

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35
Q

What is the purpose of the vaso vasorum?

A

Vasa vasorum are the blood supply to the tunica adventitia and outermost parts of the tunica media in larger muscular arteries with thick tunica media.

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36
Q

How do arteries and veins differ in appearance?

A

Broadly speaking, there are two main types of vessels: arteries and veins. In general, arteries tend to be much more uniformly round than the irregularly shaped veins

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37
Q

What are the key differences between arteries and veins?

A

Arterial pressure is significantly higher than venous pressure.
Arteries have a very thick tunica media. So the arterial wall is much thicker than the venous wall.

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38
Q

Why are arterial walls much thicker the venous walls?

A

Arteries must contend with higher overall pressures, as well as significant pressure changes between systole (pump - contract) and diastole (relax).

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39
Q

What are elastic arteries?

A

Elastic arteries are the largest type of artery. Examples include the aorta, the pulmonary arteries, and the larger branches of the aorta (ie, brachiocephalic, subclavian, carotid, iliac). elastic arteries have a high density of elastin in the tunica media (elastin stained black). These arteries experience high pressure differences between systole and diastole. They expand quickly during systole and then contract back down during diastole.

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40
Q

What are muscular arteries?

A

Muscular arteries step down a size from elastic arteries. Examples include smaller branches off the aorta (ie, the coronary and renal arteries). The defining feature of the muscular arteries is the paucity of elastin in the tunica media. The muscular arteries have thick walls to contain the overall high pressures but don’t require a lot of elastin since they don’t deal with large pressure differences. They maintain perfusion to some pretty important organs (like the heart and kidneys). In hypotensive states, these muscular arteries can contract quite a lot to maintain perfusion

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41
Q

What is perfusion?

A

Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue.

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42
Q

What are the smallest types of arteries?

A

Arterioles are the smallest type of artery (Figure 7). Histologically, arterioles lack an external elastic lamina, and the internal elastic lamina is often incomplete. The arterioles don’t have to deal with pressure changes at all, and as such, they need the least amount of elastin.

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43
Q

What is the main histological difference between arteries and veins?

A

Arteries have thick tunic media that veins lack.

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44
Q

What happens when venous valves break down?

A

Venous valves prevent blood pooling in the lower extremities; when they break down, venous pooling worsens, causing deep vein thromboses (DVTs) and venous stasis dermatitis.

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45
Q

How can you distinguish a vein from a venule?

A

Veins are characterized by the presence of valves.

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46
Q

What is the function of the lymphatic system/

A

The lymphatic system is primarily responsible for maintaining peripheral fluid balance and transporting lymph to be sampled by the immune system.

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47
Q

How do the three types of capillaries differ?

A

The three types of capillaries differ in the continuity of the endothelium and basement membrane. Continuous capillaries have intact endothelial and basement membrane layers, fenestrated have discontinuous endothelial layers but intact basement membranes, and in sinusoidal capillaries both are discontinuous.

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48
Q

What distinguishes a lymphatic collecting vessel from a lymphatic capillary?

A

The presence of a smooth muscle layer that helps propel the lymph back to the heart.. Lymphatic vessels can be distinguished from veins by a thinner wall and larger lumen

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49
Q

Which of the three types of capillaries are least permeable?

A

Continuous capillaries are the least permeable of the different types of capillaries and can be found in muscles, connective tissue, the lungs, and the skin. They have continuous endothelium and basement membranes.

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50
Q

What are the characteristics of Fenestrated Capillaries?

A

The endothelial layer has intracellular pores called fenestrae, arrows), but the basement membrane is still continuous. These breaks in the endothelial cells allow the passage of larger molecules out of or into the capillary lumen.

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51
Q

Where are fenestrated capillaries found?

A

Classically they are found in the glomeruli of the kidney but also appear in the intestines, endocrine glands, and the pancreas.

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52
Q

What are the characteristics of sinusoid capillaries?

A

The endothelial layer and the basement membrane are both incomplete. Because both layers are incomplete, there is no selective filtration barrier, and large molecules, especially proteins, can pass through the sinusoids (small holes). These types of capillaries are found in the liver and spleen, organs whose primary roles rely on filtering out larger molecules.

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53
Q

When do coronary arteries get their blood - diastole or systole?

A

Diastole (Relax phase). All other arteries get their blood during systole (contractions)

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54
Q

From what vessel does the liver receive blood?

A

The hepatic portal vein that is coming from the digestive system.

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55
Q

What vein exits the liver heading to the heart?

A

The hepatic vein.

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56
Q

Do arteries have tributaries or branches? Which do veins have?

A

Arteries have branches, veins have tributaries.

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57
Q

How does the lumen appear differently in arteries and veins?

A

The lumen tends to flatten out in veins (less pressure).

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58
Q

In what type of vasculature is there the most resistance?

A

Mostly in small arteries and arterioles - 47% of the blood is found here.

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59
Q

How many places on the body can you take a pulse?

A
10 - radial and ulna pulses
cubital pulse
brachial
carotid
facias
femoral
dorsalis pedis 
posterior tibila
popliteal
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60
Q

What is atherosclerosis?

A

Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaque), which can restrict blood flow. The plaque can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body

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61
Q

List heart and circulatory problems.

A
atheroma
thrombus
embolus
arterial occlusion
fissured plague
ischemia and cerebral infarction
myocardial infarction
renal ischemia
intermittent claudication
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62
Q

What are sensory neurons?

A

Sensory neurons relay information about stimuli such as temperature, pressure, light, pain, and certain chemicals back to the brain. They are (in some cases literally) the eyes and ears of the nervous system, collecting information and keeping the CNS informed so it can formulate reactions.

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63
Q

How many kinds of sensory input are there?

A

Two: Visceral (from the viscera) and Somatic (skin, muscle, bones, joints)

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64
Q

What are the two pathways of the PNS?

A

sensory (afferent) and motor (efferent).

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65
Q

What’s the most basic distinction we make when talking about the nervous system?

A

The Central Nervous System (CNS) and the Peripheral Nervous System (PNS)

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66
Q

What makes up the Central Nervous System vs. the Periferal Nervous System?

A

The CNS is the brain and spinal chord. the PNS is everything else. (Starfleet Command Center vs. Exploratory Vessels and Research Stations scatted thruout the gallaxy. They send reports back to HQ. The officials at HQ issue orders.

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67
Q

Are motor neurons afferent or efferent?

A

Efferent. Motor neurons send signals in the opposite direction from sensory ones, transmitting commands from the brain to control the contraction of smooth, skeletal, and cardiac muscles

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68
Q

What is the difference between the Visceral and Somatic branches of the PNS?

A

The somatic motor division sends voluntary commands to skeletal muscles.

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69
Q

Are there any involuntary movements associated with the somatic motor division?

A

Yes. Reflexes.

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70
Q

Where does “integration” occur in the nervous system?

A

In the brainstem or posterior horn of the spinal cord, synaptic contact between sensory and motor neurons (integration) occurs. This can happen either directly, as in the case of monosynaptic reflexes, or via interneurons

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71
Q

What does ANS stand for in the nervous system?

A

autonomic nervous system (ANS). (Remember - this comes from the visceral and hence - all the workings of the ANS are Involuntary.

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72
Q

Which of the somatic or autonomic system involve voluntary movment?

A

The somatic, plus the exception of reflexes.

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73
Q

What nervous system regulates our survival?

A

The ANS. The medulla oblongata, part of the brain stem, is the CNS control center for visceral reflexes such as heart muscle contraction, vasomotor control, and respiratory rate and depth

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74
Q

What are the two branches of the ANS?

A

Sympathetic (fight or flight) and Parasympatheti (Rest and digest).

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75
Q

What do the sympathetic and parasympathetic nervous system regulate in our bodies?

A

Important body functions like breathing, heart rate, and digestion. If the sympathetic is involved - breathing and heart rate go, digestion goes down.

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76
Q

What are ganglia of the sympathetic nervous system, and where do they live?

A

Sympathetic nervous system pathways have a preganglionic (axons tend to be shorter) before the ganglion, and postganglionic (after the ganglion) neuron

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77
Q

How does the adrenaline rush work in the sympathetic nervous system?

A

Some sympathetic neurons start at the spinal cord and go directly out to the adrenal glands, allowing for the immediate release of the hormones epinephrine and norepinephrine. The messages are not first sent to HQ (CNS).

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78
Q

In the sympathetic nervous system, why are preganglion neurons generally shorter than postganglion?

A

The preganglionic neurons tend to have shorter axons than the postganglionic ones because the ganglia of the sympathetic nervous system are nestled close to the spine. This allows for quick signaling of many different parts of the body when the stress alarm has been sounded.

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79
Q

Does the sympathetic nervous system sometimes inhibit body functions?

A

Yes. Since the sympathetic nervous system’s job is to get the body into emergency mode, it inhibits functions it considers less important, like digestion.

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80
Q

What does the parasympathetic nervous system do?

A

It sends signals that slow the heartbeat and respiration rate and allow for digestion to take place.

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81
Q

Which system has longer axons? The sympathetic or parasympatheitc?

A

The parasympathetic -It not in such a hurry. It also communicates more directly - it doesn’t need to get the whole body riled up

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82
Q

in the parasympathetic nervous system, pre or post ganglionic nerves tend to be larger?

A

Preganglionic neurons tend to have larger axons than postganglionic ones.

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83
Q

What is the Enteric Nervous System?

A

It interfaces with the ANS, and regulates secretion, blood flow, and motility within the digestive tract.

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84
Q

Do afferent neurons in the Enteric (gut) nervous system go only to the gut?

A

No. In addition, afferent neurons send information from the ENS back to the CNS to keep “central command” informed of matters such as tension in the gut wall or the acidity of the stomach.

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85
Q

Where are the sensory nerve somas located?

A

The somas of sensory neurons are located in dorsal root ganglia. The somas of motor neurons are found in the ventral portion of the gray matter of the spinal cord.

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86
Q

How many type of glial cells are there?

A

6 - 4 in the CNS (astrocyte, Microglial, Ependymal, Olgodendrocytes) and 2 in the PNS (Satellite and Schwann Cells)

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87
Q

What glials make myelin?

A

Olgodendrocytes CNS, Schwann Cells PNS

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88
Q

What glial makes spinal fluid?

A

The Ependymal lines cavities in brain and spinal chord, and creates spinal fluid

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89
Q

What is the roll of Microglial of the CNS?

A

Defend and protect the immune system, acts as phagocyte

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90
Q

What is the most common glial cell types in the CNS?

A

Astrocytes - support, regulate ions - most abundant and versatile - star shaped, anchor neurons to blood supply, and govern exchange of materials between neurons and capillaries. Appear black when stained silver.

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91
Q

What do satellite glial cells do in the PNS?

A

Satellite Cells surround neuron cell bodies

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92
Q

What do Schwann glial cells do?

A

Insulate and help form myelin sheath

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93
Q

What does the myelin sheath cover?

A

Axons.

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94
Q

Interesting facts about neurons.

A

Longest living cells; can’t divide once become nerve cells - no mitosis (IS THIS TRUE ANYMORE?) ; 25% of food you eat each day goes to your brain.

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95
Q

Neuron cell structure?

A

Dendrites, soma (main body); Axons (sends the message onward).

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96
Q

Shapes of neurons?

A

multipolar (very common - 99%)
bipolar (rare - retina, etc)
unipolar (some sensory receptors)
pyramidal ?

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97
Q

What are the three types of neuron communication?

A

afferant (head toward CNS with complaint, info)
efferent (head toward PNS with command)
interneurons, “associated” (in brain - communicates between neurons)

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98
Q

What is phagoytoses in Schwann nerve cells?

A

If damage occurs to a nerve, it can digest the axon.

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99
Q

Brain structures - also some in spinal cord

A
cranium
meningis
cerebral spinal fluid (CSF)
dura
arachnoid
pia
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100
Q

What’s the function of the dura?

A

The dura mater has several functions and layers. The dura mater is a membrane that envelops the arachnoid mater. It surrounds and supports the dural sinuses (also called dural venous sinuses, cerebral sinuses, or cranial sinuses) and carries blood from the brain toward the heart.

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101
Q

What’s the function of the pia mater?

A

Together with the other meningeal layers, the function of the pia mater is to protect the central nervous system by containing the cerebrospinal fluid, which cushions the brain and spine. The cranial pia mater covers the surface of the brain.

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102
Q

What roll does the arachnoid play in the brain?

A

Connected to the dura mater on the side closest to the CNS, this middle layer includes a network of fibers and collagen that are part of the suspension system that helps protect the brain and spinal cord from sudden impact.

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103
Q

What are the meningis?

A

The primary function of the meninges and of the cerebrospinal fluid is to protect the central nervous system. The pia mater is the meningeal envelope that firmly adheres to the surface of the brain and spinal cord.

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104
Q

What is the neural tube?

A

The neural tube is the embryonic structure that ultimately forms the brain and spinal cord. The neural tube is formed during a process called neurulation, which begins when the underlying dorsal mesoderm signals the ectodermal cells above it to elongate into columnar neural plate cells.

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105
Q

What are the parts of the primitive brain?

A

The archipallium or primitive (“reptilian”) brain, comprising the structures of the brain stem – medulla, pons, cerebellum, mesencephalon, the oldest basal nuclei – the globus pallidus and the olfactory bulbs.

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106
Q

What part of the brain is responsible for complex thinking?

A

The Frontal Lobe—Located under the forehead, the frontal lobe controls reasoning, planning, voluntary movement, and some aspects of speech. The prefrontal cortex is the part of the frontal lobe right behind the forehead.

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107
Q

In embrylogy, what develops from the neural tube and when does it begin?

A

5 weeks. The brain develops into three types (pro, mes, and thombacephalon), and then 5 (vesicles, tel, di, meta and myancephalon) , and finally the adult brain has four parts: cerebral hemisphere, diencephalon (interbrain), brain stem, cerebellum

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108
Q

What is the reflex arc?

A

A reflex arc is a neural pathway that controls a reflex. In vertebrates, most sensory neurons do not pass directly into the brain, but synapse in the spinal cord. This allows for faster reflex actions to occur by activating spinal motor neurons without the delay of routing signals through the brain. Sometimes message is generated and responded to on same side of body; sometimes not.

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109
Q

What is the muscle stretch reflex?

A

The stretch reflex (myotatic reflex) is a muscle contraction in response to stretching within the muscle. A spinal reflex is a fast response that involves an afferent signal into the spinal cord and an efferent signal out to the muscle.

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110
Q

What is Somatosensation?

A

Somatosensation is a collective term for the sensations of touch, temperature, body position, and pain recognized through neural receptors in the skin and certain internal organs. Thus, it includes processes such as” mechanoreception. thermoreception. proprioception.

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111
Q

How many spinal nerves are there?

A

31 pairs. Cervical 8, Throacic 12, Lumbar 5, Sacral 5, Coccyx 1

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112
Q

How many cranial nerves are there?

A

12 pairs.

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113
Q

What is a dorsal root ganglion?

A

A dorsal root ganglion (or spinal ganglion; also known as a posterior root ganglion) is a cluster of neurons (a ganglion) in a dorsal root of a spinal nerve. The cell bodies of sensory neurons known as first-order neurons are located in the dorsal root ganglia.

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114
Q

What does dorsal root gangla do?

A

The dorsal root ganglia contain cell bodies for sensory nerves that carry sensory information to the spinal cord.

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115
Q

What are the denticulate ligaments?

A

The denticulate ligaments are bilateral triangular lateral extensions of pia mater that anchor the spinal cord to the dura mater. They are formed by pia mater of the spinal cord coursing in-between the dorsal and ventral nerve roots bilaterally.

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116
Q

Function of Grey matter?

A

Grey matter contains most of the brain’s neuronal cell bodies. The grey matter includes regions of the brain involved in muscle control, and sensory perception such as seeing and hearing, memory, emotions, speech, decision making, and self-control.

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117
Q

Function of white matter?

A

Long thought to be passive tissue, white matter affects learning and brain functions, modulating the distribution of action potentials, acting as a relay and coordinating communication between different brain regions. White matter is named for its relatively light appearance resulting from the lipid content of myelin.

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118
Q

What is the function of the lateral grey horns?

A

The lateral column is only present in the thoracic region and upper lumbar segments.

The lateral grey column, or the lateral horn of spinal cord, is part of the sympathetic nervous system and receives input from brain stem, organs, and hypothalamus.

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119
Q

What is the function of the anterior horn?

A

One of the divisions of the grey matter of the spinal cord, the anterior horn contains cell bodies of alpha motor neurons, which innervate skeletal muscle to cause movement

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120
Q

Functions of the ventral horn?

A

The ventral horns contains the cell bodies of motor neurons that send axons via the ventral roots of the spinal nerves to terminate on striated muscles. … The ventral (and ventrolateral or anterolateral) columns carry both ascending information about pain and temperature, and descending motor information.

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121
Q

What is a cutaneous nerve?

A

A nerve that provides nerve supply to the skin.

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122
Q

What would happen if the anterior Ramus of a spinal nerve was damaged?

A

It will not affect other body functions such as sensation which is controlled by the dorsal roots of the spinal nerves. The ventral root generally controls the muscles and movements. If it is damaged, there will be weakness or paralysis in the muscles in the particular area of the body.

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123
Q

What are the effector organs?

A

Effector organs of the Autonomic pathway are: cardiac muscle, smooth muscle, glands, adipose tissue, kidney and other organs. … Cell body in the CNS, preganglionic neuron in the PNS, autonomic ganglion, postganglionic neuron to the effector organs.

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124
Q

What are the effector organs?

A

Effector organ a muscle or gland that contracts or secretes, respectively, in direct response to nerve impulses.

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125
Q

Cranial nerve mneumonic from C1 - C12?

A
Ooh, ooh, ooh to touch and feel very good velvet. Such heaven. O: olfactory nerve (CN I)
O: optic nerve (CN II)
O: oculomotor nerve (CN III)
T: trochlear nerve (CN IV)
T: trigeminal nerve(CN V)
A: abducens nerve (CN VI)
F: facial nerve (CN VII)
A: auditory (or vestibulocochlear) nerve (CN VIII)
G: glossopharyngeal nerve (CN IX)
V: vagus nerve (CN X)
S: spinal accessory nerve (CN XI)
H: hypoglossal nerve (CN XII)
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126
Q

Cranial nerve mnemonic for function?

A

Some say marry money but my brother says big brains matter more

S: sensory (olfactory nerve - CN I)
S: sensory (optic nerve - CN II)
M: motor (oculomotor nerve - CN III)
M: motor (trochlear nerve - CN IV)
B: both (trigeminal nerve - CN V)
M: motor (abducens nerve - CN VI)
B: both (facial nerve - CN VII)
S: sensory (vestibulocochlear nerve - CN VIII)
B: both (glossopharyngeal nerve CN IX)
B: both (vagus nerve - CN X)
M: motor (spinal accessory nerve - CN XI)
M: motor (hypoglossal nerve - CN XII)
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127
Q

Where does the spinal chord extend from?

A

The foramen magnum where it is continuous with the medulla to the level of the first or second lumbar vertebrae

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128
Q

What are the four plexis of the spinal chord?

A

Cervical, brachial, Lumbar, Sacral

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129
Q

What is a nerve plexus?

A

A nerve plexus is a plexus (branching network) of intersecting nerves. A nerve plexus is composed of afferent and efferent fibers that arise from the merging of the anterior rami of spinal nerves and blood vessels.

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130
Q

What is the spinal chord covered with?

A

Transparent Pia Mater.

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131
Q

What’s the dural root sleeve?

A

It actually consists of two nerve roots, a motor and sensory, inside a sleeve of dura. At a point just beyond the ganglion the two roots blend together and become a typical mixed peripheral nerve. At this same point the dural sleeve becomes adherent to the nerve and henceforth is called the epineurium.

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132
Q

What is the function of white matter in your spinal column?

A

White matter’s job is to conduct, process, and send nerve signals up and down the spinal cord.

The white matter of your brain and spinal cord is composed of bundles of axons. These axons are coated with myelin, a mixture of proteins and lipids, that helps conduct nerve signals and protect the axons.

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133
Q

What’s the posterior root ganglion?

A

A posterior root ganglion is a cluster of nerve cell bodies found immediately outside of the spinal column whose axons are normally responsible for transmitting sensory signals to the spinal cord.

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134
Q

What’s the function of the anterior gray horn in the spinal column?

A

one of the divisions of the grey matter of the spinal cord, the anterior horn contains cell bodies of alpha motor neurons, which innervate skeletal muscle to cause movement.

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135
Q

Where are the meninges located and what is their function?

A

The meninges are the dura mater, the arachnoid mater, and the pia mater. Cerebrospinal fluid is located in the subarachnoid space between the arachnoid mater and the pia mater. The primary function of the meninges is to protect the central nervous system.

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136
Q

What are the differences between the posterior and anterior grey horn matter?

A

The posterior horn is responsible for sensory processing. The anterior horn sends out motor signals to the skeletal muscles. … The fibers that cause contraction of skeletal muscles are the axons of these neurons.

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137
Q

What’s the difference between the anterior and posterior rootlets?

A

Anterior rootlets carry motor information out of the spinal cord (i.e. they contain efferent fibers) while the posterior rootlets carry sensory information into the spinal cord (i.e. they contain afferent fibers).

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138
Q

Are cranial nerves paired?

A

Yes. All cranial nerves are paired, which means that they occur on both the right and left sides of the body. The muscle, skin, or additional function supplied by a nerve on the same side of the body as the side it originates from, is referred to an ipsilateral function.

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139
Q

What’s a mixed nerve?

A

A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column.

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140
Q

Are all cranial nerves mixes?

A

Five cranial nerves have mixed sensory, motor and parasympathetic function. … The mixed cranial nerves are CN III Occulomotor, CN V Trigeminal, CN VII Facial, CN IX Glossopharyngeal and CN X Vagus.

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141
Q

What does each spinal nerve control?

A

The spinal nerves act as “telephone lines,” carrying messages back and forth between your body and spinal cord to control sensation and movement. Each spinal nerve has two roots (Fig. 8). The ventral (front) root carries motor impulses from the brain and the dorsal (back) root carries sensory impulses to the brain.

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142
Q

What’s a spinal ganglion?

A

A dorsal root ganglion (or spinal ganglion; also known as a posterior root ganglion) is a cluster of neurons (a ganglion) in a dorsal root of a spinal nerve. The cell bodies of sensory neurons known as first-order neurons are located in the dorsal root ganglia.

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143
Q

What is the function of the posterior ramus?

A

Because each spinal nerve carries both sensory and motor information, spinal nerves are referred to as “mixed nerves.” Posterior rami carry visceral motor, somatic motor, and sensory information to and from the skin and deep muscles of the back.

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144
Q

What are dorsal and ventral Rami?

A

The dorsal and ventral rami contain nerves that provide visceral motor, somatic motor, and sensory information, with the dorsal ramus feeding the dorsal trunk (skin and muscles of the back), and the ventral ramus feeding the ventral trunk and limbs through the ventrolateral surface.

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145
Q

Where is the vagus nerve and what does it do?

A

The vagus nerve runs from the brain through the face and thorax to the abdomen. It is a mixed nerve that contains parasympathetic fibres. The vagus nerve has two sensory ganglia (masses of nerve tissue that transmit sensory impulses): the superior and the inferior ganglia.

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146
Q

Are the Autonomous and Visceral Nervous Systems or Visceral Motor System the same thing?

A

Yes.

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147
Q

Describe the Autotomic Nervous System Features:

A
  • Autonomic sensory (chemoreceptors, mechano- (stretch) receptors
  • Motor neurons regulate visceral activities; can function independently of ANS
  • Preganglionic and postganglionic neurons
  • Acetylcholine or norepinephrine
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148
Q

Describe the Somatic Nervous System Features:

A

Somatic senses (pain, thermal, tactile, proprioreceptive)

Somatic motor neurons-skeletal muscle

Usually voluntary

Motor units

Acetylcholine

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149
Q

Which of these two systems, the Autonomic or Somatic, has ganglions?

A

The Autonomic.

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150
Q

Is the sympathetic system in the thoracolumbar or cranoisacral division?

A

Thorcolumbar. The parasympathetic is in the craniosacral division.

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151
Q

What are the different types of ganglia?

A

Sympathetic
Sympathetic trunk (paired)
Innervate organs above the diaphragm
Superior, middle, inferior cervical ganglia

Prevertebral (unpaired)
Below the diaphragm
Celiac, superior and inferior mesenteric ganglia

Parasympathetic
Preganglionic axons are longer than in sympathetic ganglia

Preganglionic neurons are myelinated, postganglionic neurons are not

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152
Q

What are the actions of neurotransmitters in ANS?

A

Acetylcholine (cholinergic neurons)
All preganglionic
Sympathetic postganglionic innervation of sweat glands
All parasympathetic postganglionic neurons
Nicotinic, muscarinic receptors

Norepinephrine (adrenergic)
α and β receptors
Can be excitatory or inhibitory

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153
Q

Functions of ANS?

A

“Fight or flight” (sympathetic)
More widespread and longer lasting
Norepinephrine and epinephrine can act as hormones as well as neurotransmitters

“Rest and digest” (parasympathetic)
Salivation, lacrimation, urination, digestion and defecation

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154
Q

Distinction between Control of Autonomic Functions?

A

Reflexes
Blood pressure
Digestion
Defecation and urination

Control within brain
Brain stem (cardiovascular, swallowing , digestion)
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155
Q

Embriologically, what does the nervous system look like?

A

The central nervous system (CNS) is formed in week 3 of development, during which time the neural plate develops

The neural plate, consisting of neuroectoderm, becomes the neural tube, which gives rise to the brain and spinal cord.

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156
Q

What is neurolation?

A

Neurulation is the transformation of the ectoderm overlying the notochord into a neural tube, which is flanked by 2 longitudinal formations, the neural crests

The rostral part of the neural tube becomes the adult brain.
The caudal part of the neural tube becomes the adult spinal cord.

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157
Q

Embiologically, where does the PNS come from?

A

Three sources:

  • Neural crest cells
  • Neural tube, which gives rise to all preganglionic autonomic nerves (sympathetic and parasympathetic) and all nerves (-motoneurons and -motoneurons) that innervate skeletal muscles
  • Mesoderm, which gives rise to the dura mater and to connective tissue investments of peripheral nerve fibers (endoneurium, perineurium, and epineurium)
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158
Q

Embriologically, what’s up with neural crest cells?

A

The neural crest cells differentiate from cells located along the lateral border of the neural plate, which is mediated by BMP-4 and BMP-7.

Neural crest cells undergo a prolific migration throughout the embryo (both the cranial region and trunk region) and ultimately differentiate into a wide array of adult cells and structures

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159
Q

Neural Crest cells coming from the Dorsal Neural Tube become…?

A

Neurons and glia of cranial ganglia, cartilage and bones, connective tissue, Sympathetic Adrenal Cells, Sensory neurons and glia, pigment

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160
Q

Cranial Neural Cells become..

A

Cranial neural crest cells differentiate into the following adult cells and structures:
Pharyngeal arch skeletal and connective tissue components
Bones of neurocranium; Pia and arachnoid
Parafollicular (C) cells of thyroid
Aorticopulmonary septum; Odontoblasts (dentin of teeth)
Sensory ganglia of cranial nerve (CN) V, CN VII, CN IX, and CN X
Ciliary (CN III), pterygopalatine (CN VII), submandibular (CN VII), and otic (CN IX) parasympathetic ganglia.

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161
Q

Are there different locations of neural crest cells?

A

Neural crest cells originating from different positions along the anterior-posterior axis develop into various tissues. These regions of neural crest can be divided into four main functional domains, which include the cranial neural crest, trunk neural crest, vagal and sacral neural crest, and cardiac neural crest.

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162
Q

Types of ganglia

A

Sympathetic and Parasympathetic - differences?
-sympathetic - above diaphragm paired; below diaphragm unpaired; preganglia shorter; deliver acetycholine (ganglia) - Norepinephrine to target
Parasympathetic - preganglia longer, post ganglia NOT myelinated - acetycholine x 2 usually.

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163
Q

What is a pseudogangion?

A

It looks like a ganglion, but only has nerve fibers and has no nerve cell bodies. Found in the teres minor muscle and radial nerve.

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164
Q

What is a plexus?

A

Ganglia often interconnect with other ganglia to form a complex system of ganglia known as a plexus.

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165
Q

What are the three types of ganglia?

A

Dorsal root (aka spinal ganglia) for sensory (afferent) neurons; cranial nerve; and Autonomic.

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166
Q

In the autonomic nervous system, what are pre and post ganglionic fibers?

A

Pre - from CNS to glanglia -

Post - from ganglia to effector organ

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167
Q

What is the basal ganglia?

A

In the brain - a group of nuclei interconnected with cerebral cortex, thalamus, and brainstem. (motor control cognition, emotions, learning)

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168
Q

Where do sympathetic preganglionic nerves live?

A

Preganglionic cells of the sympathetic nervous system are located between the first thoracic segment and third lumbar segments of the spinal cord. Postganglionic cells have their cell bodies in the ganglia and send their axons to target organs or glands.

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169
Q

In the sympathetic nerve system, trace the travel route from spinal column to effector organ.

A

Arive from T1 - L2 regions’ lateral horn of grey, emerge via ventral root, enter their respective spinal nerve, enter white ramus - from there - four routes to synapse, up, down, entry level, or straight through (splanchnic).

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170
Q

Can a pregangionic fibre synapse with more than one posganglionic fibers?

A

Yes. 15 - 20.

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171
Q

When do neurons in the sympathetic system enter the gray ramu (less mylientated)?

A

When the fibres leave the sympathetic chain.

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172
Q

What is collateral ganglia?

A

Also called the preverterbral ganglia, the nervous receive input from the splanchnic nerves and innervate organs of the abdominal and pelvic ring. - including the ciliac ganglia, superior mesenteric ganglia, and inferior mesenteric gnaganglia.

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173
Q

What is a dorsal route ganglia?

A

Sensory nerve cell bodies - carrying info to spinal cord.

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174
Q

Difference between dorsal and ventral (anterior/motor) root?

A

The dorsal (posterior) or sensory root bears a dorsal root ganglion (DRG) containing the cell bodies of the sensory neurons. The ventral (anterior) or motor root consists of axons from the lower motor neurons in the ventral horn of the spinal cord.

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175
Q

____ are cells in the PNS which surround the cell bodies of neurons which are grouped in ganglia. They maintain the microenvironment and provide insulation.

A

Satellite cells.

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176
Q

What are the “nodes of Ranvier’?

A

Short unmyelinated regions between adjacent Schwann or oligodendrocytes.

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177
Q

In the CNS, _____ are cells which are phagocytic: they defend against pathogens and ingest cellular debris.

A

Microglia.

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178
Q

The RER and Golgi bodies in neurons, taken together, are called _____.

A

Nissi bodies. It’s function is to produce neurotransmitters

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179
Q

Where are Nissi bodies found?

A

in the soma.

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180
Q

The cell body and dendrites of a neuron contain _____ which allow them to respond to neurotransmitters.

A

chemically gated ion channels.

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181
Q

One of the main differences between an axon and a dendrite is that the axon contains
_____ ion channels, while the dendrite contains _____ ion channels.

A

voltage gated; chemically gated

? i wonder if this is true?

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182
Q

There is a secretory region at the distal end of each axon which releases _____.

A

neurotransmitters

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183
Q

A(n) _____ is a collection of neuronal cell bodies located inside of the CNS. nucleus

A

nucleus

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184
Q
  1. A(n) _____ is a group of neuronal cell bodies located in the PNS
A

ganglion

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185
Q

A(n) _____ is a collection of neuronal axons with a common origin and destination found
in the CNS.

A

tract

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186
Q

One of the differences between a nerve and a tract is that a(n) _____ does not carry its
own blood and lymphatic supply.

A

tract

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187
Q

A(n) _____ is a collection of neuronal axons, blood vessels, and connective tissues in the
PNS

A

nerve

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188
Q

In the PNS, a Schwann cell encloses the axon of a single neuron with an empty portion of
its _____.

A

plasma membrane

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189
Q

The _____ is the nucleus and cytoplasm of a Schwann cell which is wrapped around an
axon.

A

Neurilemme

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190
Q

A single Schwann cell is capable of interacting with the axons of how many neurons?

A

one vs. oligodendocytes in the CNS that can interact with many.

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191
Q

Neurons can be classified functionally as _____, _____ or _____.

A

sensory, motor, interneurons - OR, afferent, efferent, and association neurons

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192
Q

Action potentials in neurons are generated in the region called the _____.

A

trigger zone

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193
Q

Resting membrane potential in many nerve cells is roughly _____ millivolts.

A

-70

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194
Q

The major ions which contribute to the resting membrane potential are _____ and _____.

A

sodium (more on the outside), potassium (more on inside).

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195
Q

Only two types of cells can generate action potentials: _____ cells and _____.

A

muscle and nerve cells (neurons)

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196
Q

The speed of an action potential is greatest when it is traveling through an axon which is
_____.

A

myelinated

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197
Q

_____ are chemicals used for neuronal communication with the body and the brain.

A

Neurotransmitters

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198
Q

The _____ is the tube of ectoderm formed early in embryological development as the
embryonic tissue folds longitudinally.

A

embryonic neural tube

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199
Q

The three primary brain vesicles are formed during the _____ week after conception.

A

4th

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200
Q

Between the fifth week post-conception and birth, the prosencephalon (aka _____)
develops to produce the _____ and _____ of the adult brain

A

forebrain, cerebrum, diencephalon

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201
Q

Between the fifth week post-conception and birth, the mesencephalon develops to
produce the _____ of the adult brain.

A

midbrain

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202
Q

Between the fifth week post-conception and birth, the rhombencephalon (aka _____)
develops to produce the _____, _____ and _____ of the adult brain.

A

hindbrain, pons, medulla, cerebellum

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203
Q

In an adult, the _____ are a functional unit and are called the brain stem

A

midbrain, pons, and medulla oblongata

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204
Q

(True/False) The neural tube, initially hollow, remains filled with liquid in the adult.

A

true

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205
Q

The shape and size of the skull causes the embryonic neural tube to _____ during
development.

A

flex and fold

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206
Q

_____ form the gray matter of the CNS

A

Neuron bodies and unmyelinated axons

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207
Q

White matter is composed of _____.

A

myelinated neuronal axons

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208
Q

Gray matter is found in the cortex of the _____ and _____.

A

cortex, cerebellum

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209
Q

_____ surrounds the central core of gray matter in the CNS.

A

White matter

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210
Q

_____ are fluid-filled chambers within the brain.

A

ventricles

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211
Q

_____ is the fluid which surrounds, and fills the hollow areas in, the CNS.

A

cerebrospinal fluid

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212
Q

The left hemisphere contains Broca’s area, which is responsible for _____, _____ and
_____.

A

planning speech, thinking in words; writing

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213
Q

For historical reasons, the basal nuclei are also known as the _____, a name whose use is discouraged.

A

basal ganglia

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214
Q

The continuation of automatic behaviors necessary for survival (e.g., breathing) is
controlled by the _____.

A

brainstem

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215
Q

Ten of the twelve pairs of cranial nerves originate in the _____.

A

brain stem

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216
Q

The _____ are a set of three connective tissue membranes that surround the CNS.

A

meninges

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217
Q

The tough, fibrous, double-layered, outermost meninx is the _____.

A

dura mater

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218
Q

The _____ is the middle meninx.

A

arachnoid

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219
Q

The ____ is the innermost meninx: it clings tightly to the surface of the brain, even in the
sulci.

A

pia mater

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220
Q

The wide, cerebrospinal fluid containing space is between the _____ mater and the pia
mater and is called the _____ space.

A

arachnoid, subarachnoid

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221
Q

_____ fills the ventricles and surrounds the brain and spinal cord, acting as a shock
absorber, distributing nutritive materials, removing wastes, and providing a chemically
stable environment.

A

CSF

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222
Q

Impaired blood circulation to the brain due to a blocked or broken vessel is known as a(n)
_____, _____ or _____.

A

cerebrovascular accident; stroke;brain attack

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223
Q

(True/False) Most of the neuronal death due to a stroke occurs several minutes or even
hours after the stroke begins, allowing time for emergency treatment to have a major
effect.

A

true

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224
Q

An abnormal build up of beta-amyloid protein fragments in the regions surrounding
neurons, and of neurofibrillary tangles in the cytoplasm of pyramidal neurons and in that of
neurons whose axons connect with them, are the causes of neuronal death in _____.

A

Alzheimer’s

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225
Q

In the elderly, drug reactions, poor circulation, or disease, all of which may be curable, can
mimic the dementia caused by _____, which is not.

A

Alzheimer’s

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226
Q

In Huntington’s Disease, damage to the caudate nucleus, one of the basal nuclei, caused by an abnormal protein leads to _____ and eventually to death.

A

chorea (involuntary muscle spasms)

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227
Q

Loss of dopamine-producing neurons in the substantia nigra leads to tremor, muscular
rigidity, slow movement and postural instability in _____.

A

Parkinson’s

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228
Q

The _____ is formed of paired strips of cells arising from the ectoderm at the margin of the neural tube.

A

neural crest

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229
Q

The spinal cord itself is formed from the _____, and the dorsal root ganglia are formed
from the _____.

A

neural tube, neural crest

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230
Q

The spinal cord extends from the _____ to the _____; below L1 it branches to form the
_____.

A

skull, L1 vertebra, cauda equina

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231
Q

In addition to the vertebral column, the spinal cord is protected by the _____ and _____.

A

meninges, CSF

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232
Q

The butterfly-shaped central core of gray matter in the spinal cord can be divided into
three regions. The _____ contains the cell bodies of somatic motor neurons.

A

anterior horn

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233
Q

The butterfly-shaped central core of gray matter in the spinal cord can be divided into
three regions. The _____ contains the cell bodies of the autonomic motor neurons and is present only in the thoracic and upper lumbar (L1 and L2) regions.

A

lateral horn

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234
Q

The butterfly-shaped central core of gray matter in the spinal cord can be divided into
three regions. The _____ contains interneurons.

A

posterior horn

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235
Q

The axons of the neurons from the _____ and _____ horns emerge together as the
ventral roots.

A

lateral, anterior

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236
Q

The _____ are formed from the cell bodies of sensory neurons whose axons branch to
extend inward to the spinal cord and outward to the body.

A

dorsal root ganglia

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237
Q

_____ are white-matter columns consisting of the myelinated axons of neurons associated with the spinal cord.

A

funiculi

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238
Q

The neuronal cell bodies for the ascending pathways of the spinal cord itself are found in
the _____ or _____.

A

dorsal horn, dorsal root ganglia

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239
Q

Neurons in the _____ have axons which extend from the receptor to the spinal cord, or in
some cases all the way to the brain.

A

dorsal root ganglia

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240
Q

Neurons of the dorsal horn receive signals from those in the _____. Their own axons
extend to reach neurons in the brain stem, diencephalon, etc.

A

dorsal root ganglia

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241
Q

What do merkel cells do?

A

Let you feel light touch

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242
Q

What do Langerhaus cells effect?

A

immune system, found in the epidermis. Langerhans cells (LC) are tissue-resident dendritic cells of the skin, and contain organelles called Birbeck granules. They are present in all layers of the epidermis and are most prominent in the stratum spinosum.

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243
Q

Grey matter - where it is?

A

In the center of the spinal cord and on the outside of the brain - somas

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244
Q

White matter - where it is?

A

On the edges in the spinal column (surrounding the grey horns) and on the inside of the brain - full of axons traveling together (tracts). Deeper in the brain are the nuclei.

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245
Q

What are dermatomes

A

Dermatomes are areas of skin that are connected to a single spinal nerve. … Spinal nerves help to relay information from other parts of your body to your central nervous system. As such, each dermatome transmits sensory details from a particular area of skin back to your brain.

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246
Q

Dorsiflexion vs. Plantarflexion

A

Dorsiflexion is the backward bending and contracting of your hand or foot.

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247
Q

Eversion vs. Inversion of foot.

A

Eversion is the movement of the sole of the foot away from the median plane

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248
Q

thumb movements?

A

Faces laterally, moving forward (abduction). If moves laterally - flexion. Touching other digits - Opposition

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249
Q

Where do movement of forearm come from?

A

Radioulnar jt - pronation, supination.

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250
Q

What is carpal?

A

wrist

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251
Q

Occipital?

A

back of head

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252
Q

antebracial?

A

forearm

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253
Q

tarsal?

A

ancle

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254
Q

sural?

A

calf

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255
Q

Boundary between upper and lower limb?

A

upper gluteal

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256
Q

5 regions of anatomy

A

head area, thorax, abdomen, , upper limb, lower limb

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257
Q

Muscle movement is caused by?

A

Contractile cells

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258
Q

Three types of muscles?

A

Skeletal
Cardiac,
Smooth

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259
Q

Describe skeletal muscles?

A

voluntary, striated, two attachments - origin - (more fixed and proximal) insertion.
Enclosed by epimyseum, smaller bundles (perimysium, each muscle fiber (endomyseium

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260
Q

Lou Gehrig’s disease?

A

Fatal neuro disease, attacks neurons responsible for controlling voluntary muscles - brain unable to control voluntary movements

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261
Q

Describe cardiac muscles

A
  • Involuntary, striated, forms the myocardium (middle layer of heart)
  • Innervated by autonomic NS
  • Includes specialized myocardial fibers that form cardiac conduction system.
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262
Q

Describe smooth muscles?

A
  • Involuntary, nonstriated,
  • generally arranged in two layers - circular and longidudinal
  • Innervated by Auto NS regulating size of lumen
  • Peristaltic waves (rhythmic contractions) in GI tract, uterine tubes, ureters, and other organs
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263
Q

What is a Tendon?

A

fibrous bands of dense connective tissue that connect muscles to bones or cartilate

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264
Q

What are Ligaments

A

fibrous bands that connect bones to bones or cartilage or are folds of peritoneum serving to support visceral structures

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265
Q

What is Raphe?

A

Is the line of union of symmetrical structures by a fi brous or tendinous band such as the
pterygomandibular, pharyngeal, and scrotal raphes.

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266
Q

Retinaculum?

A

■ Is a fibrous band that holds a structure in place in the region of joints.

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267
Q

Bursae?

A

■ Are fluid-filled flattened sacs of synovial membrane that facilitate movement by minimizing
friction.

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268
Q

Synovial Tendon Sheaths?

A

■ Are synovial fl uid-fi lled tubular sacs around muscle tendons that facilitate movement by
reducing friction.

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269
Q

What is Fascia and how many kinds are there?

A

a fibrous sheet that envelopes the body under skin - may limit spread of pus and extravasated fluids such as urine and blood.
-Superficial, Deep

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270
Q

Superficial Fascia?

A

Is a loose connective tissue between the dermis and the deep (investing) fascia and
has a fatty superficial layer (fat, cutaneous vessels, nerves, lymphatics, and glands)
and a membranous deep layer.

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271
Q

Deep Fascia?

A

■ Is a sheet of fibrous tissue that invests the muscles and helps support them by serving
as an elastic sheath or stocking.
■ Provides origins or insertions for muscles, forms fibrous sheaths or retinacula for tendons, and forms potential pathways for infection or extravasation of fluids.

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272
Q

What is Hilton’s Law?

A

The nerve supplying a joint also supplies the muscles that move the joint and the skin covering the insertion of such muscles

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273
Q

What is a joint?

A

Union between two or more bones. Classified by structure: fibrous, cartilaginous, synovial

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274
Q

Features of Fibrous Joints

A
  • no joint cavity
  • joined by fibrous tissue
  • little or no movement

Sutures (betw flat bones of skull)
Syndremoses (inferior tibiofibular and tympanostrapedial syndesmoses

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275
Q

Features of Cartilaginous Joints?

A

-united by cartiage
-no joint cavity
Primary vs. Secondary Joints

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276
Q

Names 6 types of Synovial Joints

A
  • Plane (gliding) - (proximal tibiofibular, intertarsal…)
  • Hinge (elbow, ankle, .. )
  • Pivot (radioulnar, ..)
  • Condylar (allow flexion/extension - in wrist, knee….)
  • Saddle (carpometacarpal in thumb; between femur and patella)
  • Ball and Socket (shoulder, hip)
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277
Q

What is Osteoarthritis?

A

A noninflammatory degenerative joint disease characterized by
degeneration of the articular cartilage and osseous outgrowth at the margins. It
results from wear and tear of the joints; commonly affects the hands, fi ngers, hips, knees, feet, and
spine; and is accompanied by pain and stiffness

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278
Q

What is Rheumatoid arthritis?

A

An inflammatory disease
primarily of the joints. It is an autoimmune disease in which the immune system attacks the synovial
membranes and articular structures, leading to deformities and disability

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279
Q

What is gout?

A

Gout is a painful form of arthritis and is caused by too much uric acid in the blood. Uric acid crystals are
deposited in and around the joints,

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280
Q

What is the axial skeleton vs. the appendicular?

A

The axial skeleton (bones of the head, vertebral column, ribs, and sternum) and the appendicular skeleton (bones of the extremities).

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281
Q

What type of tissue are bones?

A

Are calcified connective tissue consisting of cells (osteocytes) embedded in a matrix of ground substance and collagen fibers, have a superficial thin layer of compact bone around a central mass of spongy bone, and contain internal soft tissue, the marrow, where blood cells are formed.

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282
Q

Function of bones?

A

Serve as a reservoir for calcium and phosphorus and act as biomechanical levers on which muscles act to produce the movements permitted by joints

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283
Q

How are bones classified?

A

Shape: long, short, fl at, irregular, and sesamoid bones and, according to their developmental history, into endochondral and membranous bones.

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284
Q

Long Bones

A
  • include humerus, radius, etc
  • develop by replacement of hyaline cartilage plate (endochondral ossificaiton)
  • have a shaft (diaphysis), two ends (epiphyses.
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285
Q

What is Diaphysis of long bones?

A

■ Forms the shaft (central region) and is composed of a thick tube of compact bone that encloses the marrow cavity.

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286
Q

What is Metaphysis of Long Bones?

A

Growth zone between diaphysis and epiphysis

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287
Q

What is Epiphyses in Long Bones

A

expanded articular ends, separated from the shaft by the epiphyseal plate during
bone growth and composed of a spongy bone surrounded by a thin layer of compact
bone.

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288
Q

Describe features of Short Bones?

A

■ Include the carpal and tarsal bones and are approximately cuboid shaped.
■ Are composed of spongy bone and marrow surrounded by a thin outer layer of compact
bone.

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289
Q

Describe features of Flat Bones

A
  • Sternum, ribs, scapulae, vault of skull
  • Two layers - Compact bone enclosing spongy bone and marrow space
  • Articular surfaces covered with fibrocartilage and grow by replacement of connective tissue
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290
Q

Describe Irregular Bones?

A
  • Include bones of mixed shapes such as bones of the skull, vertebrae, and coxa.
  • Contain mostly spongy bone enveloped by a thin outer layer of compact bone.
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291
Q

Sesamoid Bones

A

■ Develop in certain tendons and reduce friction on the tendon, thus protecting it from
excessive wear.
■ Are commonly found where tendons cross the ends of long bones in the limbs, as in the
wrist and the knee (i.e., patella).

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292
Q

Osteoblast vs. Osteoclas?

A

Osteoblast synthesizes new bone and osteoclast functions in the resorption (break down bone matrix and release calcium and minerals) and remodeling of bone.

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293
Q

Osteomalacia ?

A

is a gradual softening of the bone due to failure of the bone to calcify because of lack of vitamin D or renal tubular dysfunction.

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294
Q

Osteopenia?

A

is a decreased calcification

of bone or a reduced bone mass due to an inadequate osteoid synthesis.

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295
Q

Osteoporosis?

A

is an age related disorder characterized by decreased bone mass and increased susceptibility to fractures. It occurs when bone resorption outpaces bone formation

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296
Q

Osteopetrosis?

A

is an abnormally dense bone, obliterating the marrow cavity, due to defective resportion of
immature bone.

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297
Q

Spinal nerves - are formed from what kind of roots?

A

Are formed from dorsal and ventral roots; each dorsal root has a ganglion that is within
the intervertebral foramen.

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298
Q

How are Spinal Nerves connected?

A

With the sympathetic chain ganglia by rami communicantes

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299
Q

Dorsal root ganglion?

A

Spinal nerves - generating somatic afferent and visceral afferent fibers.
-Dorsal root ganglia consist of cell bodies of the unipolar or pseudounipolar neurons and have no synapses

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300
Q

Anterior horn of the spinal cord controls?

A

Somatic efferent in the grey matter

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301
Q

Lateral horn of the spinal cord controls?

A

Visceral efferent in the grey matter. It is only present in the thoracic region and upper lumbar segments.

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302
Q

Difference between ventral and dorsal primary rami?

A

The ventral primary rami enter into the formation of plexuses (i.e., cervical, brachial, and lumbosacral); the dorsal primary rami innervate the skin and deep muscles of the back.

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303
Q

Skin is made of how many layers?

A

3

  • epidermis (stratified epithelium developed from ectoderm, avascular)
  • dermis, contains down growths from epidermis, develops from mesoderm– hypodermis (fatty layer)
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304
Q

Appendages of Skin?

A
  • sweat glands + mammary, sebaceous gland, hair - all develop from down growths in epidermis.
  • nails -
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305
Q

Is the GI tract innervated by the sympathetic or parasympathetic nervous system?

A

Both.

306
Q

Are blood vessels effected by the parasympathetic nervous system?

A

No. Same for muscles in hair follicles.

307
Q

Somatic efferent neurons leave the spinal cord through the _____root of spinal nerves

A

ventral

308
Q

Are sweat glands and sebaceous glands exocrine glands?

A

Yes. e.g sweat, salivary, mammary, ceruminous, lacrimal, sebaceous, prostate and mucous.

309
Q

Is the suprarenal gland a retoperitoneal organ?

A

Yes. And it is purely endocrine gland.

310
Q

What is a purely endocrine gland?

A

The pituitary gland, pineal gland, thyroid gland, parathyroid glands and the adrenal glands are purely endocrine glands. The pineal gland secretes the hormone melatonin which regulates sleep as well as is a very potent anti-oxidant.

311
Q

Number of bones in axial and appendicular skeletal sysmte?

A

80, 126. 206 total - varies during development

312
Q

Are the pelvic girdle and scapula bones in the axial or appendicular skeletal system?

A

Appendecular.

313
Q

How do red and yellow bone marrow differ?

A

Red bone marrow is involved in production of blood cells, while yellow marrow is important for fat storage. As you age, yellow bone marrow replaces red bone marrow.

314
Q

What is the function of yellow bone marrow?

A

Yellow bone marrow contains mesenchymal stem cells (marrow stromal cells), which produce cartilage, fat and bone. Yellow bone marrow also aids in the storage of fats in cells called adipocytes. This helps maintain the right environment and provides the sustenance that bones need to function.

315
Q

Where is red bone marrow found?

A

Primarily in flat bones, such as the ribs, sternum, and shoulder blades. It contains hematopoietic stem cells, which are the stem cells that form blood cells

316
Q

Where is yellow bone marrow found?

A

This type of bone marrow can be found in the medullary cavity in the shaft of long bones and is often surrounded by a layer of red bone marrow.

317
Q

What are haversian canals?

A

Minute tubes forming network in bone that contain blood vessels

318
Q

How can you remember what ligaments vs tendens do?

A

Ligaments for Like to LIke; Tendons for two types.

319
Q

Radius vs. Ulna?

A

Radius in longer, near the thumb. (Remember the word radius is longer). “Ulna is under.”

320
Q

Is the tibia or the fibula medial?

A

Tibia; fibula is lateral (see “la” in both words) (Tell a little fib) - fibula is much smaller. Tibia is larger, and sustains most of the structure (the bigger bone).

321
Q

Mneumonic for wrist bones? Some Lovers Try Positions That They can’t Handle.

A
Some – Scaphoid.
Lovers – Lunate.
Try – Triquetrum.
Positions – Pisiform.
That – Trapezium.
They – Trapezoid.
Can't – Capitate.
Handle – Hamate.
322
Q

Foot bones

A

tarsus, metatarsals, phalanges

323
Q

What is the nutrient artery and vein?

A

Enters in the middle of long bone.

324
Q

What is the epiphysis plate?

A

Growth plate - growing end, nutrient art gets pushed toward non-growing end.

325
Q

What are the 2 types of bone formation?

A

There are two types of bone ossification, intramembranous and endochondral. Each of these processes begins with a mesenchymal tissue precursor, but how it transforms into bone differs.

326
Q

What does plexus mean in anatomy?

A

A network or tangle of lymphatic vessels, nerves, or veins. For example, the brachial plexus is a network of nerves leading to the arm. In general, any interwoven entity made up of elements in a structure or system.

327
Q

Two types of bone?

A

Compact - a relatively solid mass of bone that provides strength

Spongy (trabecular or cancellous) - a less dense trabeculated network of bone spicules making up the substance of most bones and surrounding an inner marrow cavity

328
Q

What is the medullary cavity?

A

The central cavity of bone shafts where red bone marrow and/or yellow bone marrow (adipose tissue) is stored; hence, the medullary cavity is also known as the marrow cavity.

329
Q

4 Phases of Indirect fracture healing?

A
  • Fracture and inflammatory
  • Granulation/soft callus
  • Hard callus, woven bone creation
  • Remodelling, lammelar bone creation
330
Q

Bone remodeling cycle?

A

Osteoclasts - Osteoblasts - Osteocytes

331
Q

What are Osteocytes?

A

Osteocyte, a cell that lies within the substance of fully formed bone. It occupies a small chamber called a lacuna, which is contained in the calcified matrix of bone. Osteocytes derive from osteoblasts, or bone-forming cells, and are essentially osteoblasts surrounded by the products they secreted.

332
Q

What are Osteoclasts?

A

They break down bone - and get the minerals, etc from it - and use it throughout the body. They nibbles at and break down bone and is responsible for bone resorption.

333
Q

What are Osteoblasts?

A

Cells that form new bone. They also come from the bone marrow and are related to structural cells. They have only one nucleus. Osteoblasts work in teams to build bone. They produce new bone called “osteoid” which is made of bone collagen and other protein.dult stem cells traditionally found in the bone marrow

334
Q

What are mesenchymal cells?

A

Multipotent stromal cells that can differentiate into a variety of cell types, including osteoblasts (bone cells), chondrocytes (cartilage cells), myocytes (muscle cells) and adipocytes…

Traditionally found in the bone marrow

335
Q

Embryolically, how do bones develop?

A

Most bones first appear as condensations of mesenchymal cells which give rise to hyaline cartilage models that ossify viaendochondral ossification

336
Q

What are Sparpey’s fibers?

A

Periosteum attaches to underlying bone

337
Q

What is Endosteum?

A

Thin layer lining the medullary cavity.

338
Q

Where is the Metaphysis located?

A

Between the peiphysis (end) and diaphysis (shaft)

339
Q

What is the growth plate called?

A

Epiphyseal plate

340
Q

Four functions of bone?

A

Locomotion, stabliize posture, stabilitz joints, generate heat

341
Q

Characteristics of bone

A

Excitable, Contractile, Stretches, Elastic

342
Q

What is epimysium?

A

Fibrous connective tissue surrounding muscle belly. Made of groups of fasciculi. bounds by perimysium.

343
Q

What is a muscle belly?

A

the sum of all the muscle fibers in any given muscle. These muscle fibers are grouped into bundles of around 150 fibers called fasciculi. … The myofibrils are surrounded by sarcoplasm and together they constitute the contractile part of the muscle.

344
Q

What do Endomysium do?

A

Covers the muscle fiber - or muscle cells - (which has its own plasma membrane - sarcolemma)

345
Q

Muscle fiber contracts - pulls on endomyseiu, which in turn?

A

pulls on the next structure, and next - until it pulls on the tendon - which moves the bone.

346
Q

What’s Insertion in relation to bones?

A

Connecting muscle to bone are origins and insertions. Origin doesn’t move. Insertion does. When muscle contracts it moves from insertion to origin.

347
Q

Connective tissue sheets contribute to what?

A

Elasticity. They don’t like stretching. They recoil, resist stretching. Blood vessels and nerve fibers run through the connective tiisue.

348
Q

How do muscles attach to bones?

A

Direct (less common) - epimyacim, fusing with pericsteum or pericondrium. (fleshy connections) - not tough, not resilient. fibers destroyed when bone rubs up against the muscle.

Indirect (more common) - mediated through tendons and apineurosis
Why better?
Tendons conserve space - very small connections
Resilient - lots of collagen

349
Q

What are aponeurosis?

A

a sheet of pearly white fibrous tissue that takes the place of a tendon in flat muscles having a wide area of attachment.

350
Q

What is a myofibril?

A

Hundreds in a muscle cell. With calcium storage factory, striated.

351
Q

What’s the sarcomere structure?

A

https://www.youtube.com/watch?v=Nrf_g5m8fVM

352
Q

What is interventional radiology?

A

Interventional radiologists use diagnostic imaging tools (e.g., CT, ultrasound, MRI and fluoroscopy) to guide their procedures. Most interventional procedures avoid open and laparoscopic (keyhole) surgery and favor minimally invasive options

353
Q

What is an enthesis?

A

The enthesis (plural entheses) is the connective tissue between tendon or ligament and bone. There are two types of entheses: Fibrous entheses and fibrocartilaginous entheses.

354
Q

What is the function of the hyaline cartilage?

A

Present in the joints, the respiratory tract, and the immature skeleton - most common type of cartilage. High in collagen, a protein that is found not only in connective tissue but also in skin and bones, and helps hold the body together. … Articular cartilage functions as a shock absorber and also reduces friction between bones where they meet at joints.

355
Q

What is the cAMP signaling pathway and its relation to kinases?

A

A second messenger important in many biological processes. cAMP is a derivative of adenosine triphosphate (ATP) and used for intracellular signal transduction. Kinesis - is an amplifying protein with which it interacts

356
Q

What is the difference between cAMP and cGMP?

A

cAMP and cGMP are hydrophilic cyclic nucleotides important in cells as second messengers in cell communication. These molecules receive and pass signals from receptors to target molecules inside the cell. … The difference between cAMP and cGMP is that cAMP is a derivative of ATP while the cGMP is a derivative of GTP.

357
Q

Contrast dye is used in which radiological procedures?

A

Xray, Ct, Ultrasound,

358
Q

Make up of inside of Spinal Cord - cross section? !!!

A

The grey matter is divided into 3 regions: the posterior horn (receives sensory), anterior horn (innervate motor), and intermediate grey matter = lateral grey horn (receive from brain, organs, ONLY present in thoracic/lumbar. -. The white matter is divided into the posterior (afferent sensory), anterior (touch and pressure) , and lateral funiculi (pain + temperature).

359
Q

What are somites?

A

Somites are blocks of mesoderm that are located on either side of the neural tube in the developing vertebrate embryo. Somites are transient structures that will give rise to cells of the vertebrae and ribs, dermis of the dorsum, skeletal muscle of the body wall, back and limbs.

360
Q

What does the neural tube become?

A

The neural tube is the embryonic structure that ultimately forms the brain and spinal cord. It is formed in a process called neurulation

361
Q

What does the notocord become?

A

Vertebral column. The neural tube later becomes the baby=s spinal cord, spine, brain, and skull.

362
Q

What do the endoderm ectoderm and mesoderm form?

A

In general, ectoderm develops into parts of the skin, the brain and the nervous system. Mesoderm gives rise to bones, muscles, the heart and circulatory system, and internal sex organs. Endoderm turns into the inner lining of some systems, and some organs such as the liver and pancreas.

363
Q

What does the primitive node become?

A

The primitive node is an area through which migrating cells are channelled into a rodlike mass of mesenchymal cells called the notochord

364
Q

What does primitive streak gives rise to?

A

This thickening, the primitive streak, gives rise to the notochord and to the third basic layer, the mesoderm.

365
Q

How many somites do humans have?

A

In humans 42-44 somite pairs

366
Q

What causes neural tube defects?

A

Neural tube defects are considered a complex disorder because they are caused by a combination of multiple genes and multiple environmental factors. Known environmental factors include folic acid, maternal insulin dependent diabetes, and maternal use of certain anticonvulsant (antiseizure) medications.

367
Q

most common area for duo ulcers

A

duod first part

368
Q

inguinal ligament is formed by?

A

external oblique

369
Q

most common duo ulcers casued by?

A

h pylofi

370
Q

internal oblique and transversus abdom form together?

A

conjoint tendon

371
Q

Hesselbach’s triangle?

A

DIRECT inguinal hernia protrudes through a weakened area in the transversalis fascia

inguinal ligament pubic tuberus up to iliac
inferior

epigastric vessels form run up from ligament to rectus abdom (lower left to upper right)

deep ring is lateral to these vessels

upper left to right (vessels)
at bottom moving up from hip to umbilical - inguinal ligament
on later side rectus abdominus muscle

The inguinal triangle represents an area of potential weakness in the abdominal wall, through which herniation can occur. … By definition, a direct inguinal hernia occurs medially to the inferior epigastric vessels (through the inguinal triangle), and an indirect hernia occurs laterally to these vessels.

372
Q

free air under both hemidiaphragms?

A

perforated duo ulcer

373
Q

paraesopha hernia cause?

A

weak muscles around esop hiatus at diaphragm

374
Q

congenital diap hernia cause?

A

pleuroperitoneal fold absense

375
Q

INGUINAL CANAL -which muscle form anterior wall, roof, and posterior wall of inguina canal?

A

An anterior wall that is composed of the aponeurosis of the external oblique muscle and reinforced laterally by the internal oblique muscle. …

A posterior wall, also called the floor, is formed by the transversalis fascia, conjoint tendon, and deep inguinal ring.

376
Q

which muscle not present at inguinal canal at deep ring?

A

transversus abdominus

377
Q

route of spermatic cord, and what does it do?

A

suspends testis - begin at dep inguinal ring, thru canal, comes out thru superficial ring, end at scrotom.

formed by vas deferens

378
Q

interior epigastric artery is a branch of ?

A

EXTERNAL iliac

379
Q

internal spermatic fascia formed from?

A

transversalis fascia

380
Q

spermatic cord begins at?

A

deep inguinal ring

381
Q

ductus deferences begins at?

A

lower pole of testis

382
Q

How does ductus deferens begin?

A

continuity of duct of epididmus

383
Q

Charcot’s triad?

A

obstruction due to BILE STONE - classic picture jaundice, fever, abdominal pain

384
Q

Courvoisier law?

A

w/ jaundice, an ENLARGED gallbladder is unlikely to be due to gallstones; rather carcinoma of the pancreas or the lower biliary tree is more likely.

385
Q

Biliary colic due to obstruction of the cystic duct can be felt in the

A

epigastric region

386
Q

blood supply to duod?

A

celiac and MSA -

betw major duod papilla and 3rd part of duod

two (posterior/anterior) superior ancreaticodudenal art from celiac

anastomose w/
two (posterior/ant) inferior pancreaticoduodenal from SMA

387
Q

blood supply to appendix?

A

ileocolic art

388
Q

Terminal ileum?

A

most distal part of most distal segment of the small intestine and hosts many toxic substances, including bacteria, viruses, parasites, and digested food. Therefore, it is lined by a specialized lymphoid tissue of the immune system

389
Q

Main branches of superior rectal arteries?

A

3, 7, 11 oclock - dorsal lithotomy position

390
Q

superior rectal artery comes from?

A

IMA

391
Q

celiac plexus block to relieve pain affects?

A

afferent dorsal root

392
Q

blood supply to uterus, ovary, etc?

A

Ovary - ovarian branch of uterine artery

The uterine artery arises from the anterior division of the internal iliac artery. It crosses above the ureter on its course to the uterus (bridge over water). The uterine artery commonly anastomoses with the vaginal and ovarian artieries.

393
Q

What does the Trigone do?

A

Smooth triangular region of the internal urinary bladder formed by the two ureteric orifices and the internal urethral orifice. The area is very sensitive to expansion and once stretched to a certain degree, the urinary bladder signals the brain of its need to empty.

394
Q

ERCP?

A

can see biliary and pancreatic ducts

395
Q

suspensory ligament of ovary

A

suspends ovarian vessels

396
Q

Is the Pancreas retroperitoneal… except the tail?

A

yes

397
Q

Trigone develops from?

A

mesonehric ducts in male and females

398
Q

urachal cyst develops from?

A

Allantois

A urachal cyst occurs when a pocket of air or fluid develops in the urachus. Before birth, the urachus is a primitive structure that connects the umbilical cord to the bladder in the developing baby. The urachus normally disappears before birth, but part of the urachus may remain in some people after they are born.

399
Q

paramesonephric duct forms the

A

Fallopian tubes

In the female, they will develop to form the fallopian tubes, uterus, cervix, and the upper one-third of the vagina.

Paramesonephric ducts (or Müllerian ducts) are paired ducts of the embryo that run down the lateral sides of the urogenital ridge and terminate at the sinus tubercle in the primitive urogenital sinus.

400
Q

. The lower part of the vagina develops from

A

urogenital sinus

401
Q

. first functional kidney in the embryo

A

mesonephros

402
Q

Meckel’s diverticulum may have

A

gastric mucosa

403
Q

WNT/β-catenin pathway

A

development of liver

404
Q

decreased mullerian inhibitory substance?

A

Remnants of Mullerian ducts in the male

405
Q

urorectal septum

A

divides cloaca

406
Q

fusion of urethral folds

A

forms male urethra

407
Q

oligohydramnios due to

A

failure of develop of kidneys

408
Q

failure of migrations of neural crest cells can cause what colon problem?

A

megacolon

409
Q

collecting ducts development

A

uretic buds

410
Q

fundic air bubble

A

erect chest xray

411
Q

rectouterine pouch?

A

Related to posterior fornix of vagina - pouch of Douglas?

412
Q

Dextrocardia?

A

PITx2 - Rare heart condition in which your heart points toward the right side of your chest instead of the left side.

413
Q

What becomes the permanent kidney

A

The metanephros remains as the permanent adult kidney. It develops from the uteric bud, an outgrowth of the mesonephric duct, and the metanephric mesoderm, derived from the caudal part of the nephrogenic ridge

414
Q

June 10 histology review here - re small intestine

A

x

415
Q

are mucosa and submucosa layers the same in duod, jejue, ileum?

A

No, but the muscularis and serosa are

416
Q

what are the four layers of folding in intestines about?

A
plicae circulares (valves of kerkring - evagination - cant flatten out like rugae of stomach
- mostly in the jujun

villi - evagination - have the lacteals

glands (crypts of lieberkuln

microviili on apical surface of the enterocytes - evagination

417
Q

are there two plexus - systems of microcirculation in small intestine? Yes

A

tip of villus

pericryptal capillary system

both drain into submucosal

418
Q

what is a lacteal?

A

blind capillary into villus - extends down to lymph nodes, to vessel just above muscular mucosa - nodes, drains to blood - to portal. Takes away EFFERENT

419
Q

Where are the nerve plexus in small intestine interesting?

A

Between two layers of muscularis - is this unusual??

420
Q

Where are peyer patches found

A

in Ileium and some in jeju.

421
Q

where are paneth cells found?

A

all 3 sections - duod, jeju, elium

422
Q

where are brunner glands found?

A

duod - neutralize stomach acid - “tuboloacinar”

423
Q

What features does duod have?

A

brunner, sphincter of Oddi, Paneths

424
Q

Where are Paneth cells found?

A

base of crypts of lieberkuln in all 3 parts of small intestine

425
Q

Where are chief cells found in stomach?

A

at base of gastric pits - pepsinogen

Gastric chief cells are generally located deep in the mucosal layer of the stomach lining. Chief cells release the zymogen (enzyme precursor) pepsinogen when stimulated by a variety of factors including cholinergic activity from the vagus nerve and acidic condition in the stomach.

426
Q

What do peyer patches due? in ILIUM

A

complicated, but has to do with IMMUNITY -

they form an important part of the immune system by monitoring intestinal bacteria populations and preventing the growth of pathogenic bacteria in the intestines

427
Q

What do paneth cells due and where are they found?

A

FIGHT BACTERIA in small intestine - all three sections

Paneth cells are the most highly secretory of the four lineages of epithelial cells that form the intestinal mucosa.

Their main function is to produce, package and export a variety of antimicrobial p

428
Q

What do Brunner’s cells do? FIRST duod section.

A

Secrete alkaline fluid composed of mucin, which exerts a physiologic anti-acid function by coating the duodenal epithelium, therefore protecting it from the acid chyme of the stomach.

429
Q

Islets of Langerhaus?

A

Pancreas - endocrine (hormone producing) - alpha, beta, and delta cells that produce glucagon, insulin, and somatostatin, respectively. A fourth type of islet cell, the F (or PP) cell, is located at the periphery of the islets and secretes pancreatic polypeptide

430
Q

How are parietal cells activated?

A

??

Histamine’s effect on the parietal cell is to activate adenylate cyclase, leading to elevation of intracellular cyclic AMP concentrations and activation of protein kinase A (PKA). …

Parietal cells are stimulated directly and indirectly by neural (acetylcholine), endocrine (gastrin), and paracrine (histamine) mechanisms. In a neural mechanism, depolarization of vagal postganglionic nerve fibers releases ACh which then binds to the muscarinic M3 receptor on parietal cells.

Somatostatin inhibits secretion of gastrin and histamine, and appears to have a direct inhibitory effect on the parietal cell.

431
Q

processus vaginalis? Related to indirect hernia?

A

In males, it precedes the testis in their descent down within the gubernaculum, and closes

(or vaginal process) is an embryonic developmental outpouching of the peritoneum. It is present from around the 12th week of gestation, and commences as a peritoneal outpouching.

432
Q

Remnants of gubernaculum? Females / males?

A

Females. … two
ovarian ligament and the round ligament of the uterus (ligamentum teres uteri) which respectively serve to support the ovaries and uterus in the pelvis.

Males

The upper part of the gubernaculum degenerates. The lower part persists as the gubernaculum testis (“scrotal ligament”). This ligament secures the testis to the most inferior portion of the scrotum, tethering it in place and limiting the degree to which the testis can move within the scrotum.

433
Q

What is the Gubernaculum?

A

Serves as a guide especially : a fibrous cord that connects the fetal testis with the bottom of the scrotum and by failing to elongate in proportion to the rest of the fetus causes the descent of the testis

434
Q

What is the inguinal ring?

A

: either of two openings in the fasciae of the abdominal muscles on each side of the body that are the inlet and outlet of the inguinal canal,

give passage to the spermatic cord in the male and the round ligament in the female, and are a frequent site of hernia formation : abdominal ring: a : deep inguinal ring.

435
Q

two veins forming hepatic portal?

A

Union of the splenic vein and the superior mesenteric vein, posterior to the neck of the pancreas, at the level of L2. As it ascends towards the liver, the portal vein passes posteriorly to the superior part of the duodenum and the bile duct.

436
Q

What vein drains the hindgut? and where does it connect into the venous system?

A

Inferior mesenteric vein.
Drains blood from the hindgut, including the proximal third of the rectum. The inferior mesenteric vein usually drains into the superior mesenteric vein, inferior to its union with the portal vein.

437
Q

how do muscles change above and below arcuate line?

A

above - external abdominal oblique, internal oblique and transverse abdominal -

below -
external
Internal and transverse merge

Transversalis fascia - is the inner most lining to the abdomen -

rectus sheath changes here too -

above - internal divides and goes on both sides (with external in front, trans behind)

below - all go in front -

438
Q

Stomach bed?

A

Structures upon which the stomach rests. These include the pancreas, spleen, left kidney, left suprarenal gland, transverse colon and its mesocolon, and the diaphragm.

439
Q

What fluids does the stomach and duod produce, including enzymes/hormones and from what cells to aid in digestion?

A

Parietal -

Hydrochlic acid
Intrinsic Factor B12

Chief - pepsin - via pepsixxx

gastrin, Gastrin is a linear peptide hormone produced by G cells of the duodenum and in the pyloric antrum of the stomach. It is secreted into the bloodstream.

CCK, I-cells in the lining of the duodenum and is also released by some neurons in the brain. It acts on two types of receptors found throughout the gut and central nervous system. The most recognised functions of this hormone are in digestion and appetite. Gallbladder?

Secretin

Produced by enteroendocrine cells, known as S cells, of the upper small intestine, secretin is released during the intestinal phase of a meal. Acid secreted from the stomach into the duodenum is the major stimulant of secretin although ingested fatty acids may also contribute to secretin release.

440
Q

Which hormone and enzyme is secreted by the stomach?

A

Gastrin Stimulates gastric acid secretion and proliferation of gastric epithelium

CCK - Cholecystokinin Stimulates secretion of pancreatic enzymes, and contraction and emptying of the gall bladder

Secretin Stimulates secretion of water and bicarbonate from the pancreas and bile ducts

Intrinsic Factor - enzyme?

441
Q

Difference between hormone and enzyme?

A

Enzymes are biological catalyst. They catalyze the biological reactions. Hormones are not catalyst. They simply initiate biochemical reactions.

442
Q

does the duod receive blood from celiac or SMA?

A

both.

443
Q

What secures the fourth part of the duod?

A

Ligament of Treitz - LANDMARK

attached to right cruz of diap.

444
Q

Landmarks of abdomen

A
1 Gastroesophageal junction. 
2 Gallbladder. ...
3 Duodenojejunal junction. ...
4 Sphincter of Oddi (hepatopancreatic ampulla) ...
5 Pylorus. ...
6 Ileocecal valve. ...
7 McBurney's point. ...
8 The ovaries.
445
Q

What are the plicae circularis?

A

Per TEXT _ in JEJUNUM

The inner wall of the small intestine is covered by numerous folds of mucous membrane called plicae circulares. The surface of these folds contains tiny projections called villi and microvilli, which further increase the total area for absorption.

446
Q

what are vasa recta?

A

Straight arteries

447
Q

Is the llium or jeju longer?

A

Ilium - which also is part of the false pelvis. PEYERS patches!

lymphatic tissue found throughout the ileum region of the small intestine. Also known as aggregated lymphoid nodules, they form an important part of the immune system by monitoring intestinal bacteria populations and preventing the growth of pathogenic bacteria in the intestines

448
Q

What do brunner’s glands do and where are they found?

A

First part of duod - produces barcobonate to neutralize stomach acid

449
Q

What do Paneth cells do in small intestine

A

Fight bacteria - produce antibacterial proteins and peptides, such as DEFENsin

450
Q

What are enterocytes in small intestine

A

cells that absorb nutrients

451
Q

Mecke’s diverticulum? Where is it? Why?

A

Meckel’s diverticulum is an outpouching or bulge in the lower part of the small intestine. The bulge is congenital (present at birth) and is a

leftover of the umbilical cord. Meckel’s diverticulum is the most common congenital defect of the gastrointestinal tract. rule of 2s

452
Q

When is megacolon often discovered?

A

when baby doesn’t first poop meconium - - but can be discovered in childhood - failure of Neural crest cells to migrate- lack of enteric ganglia - can also be acquired?

453
Q

Fissures and ligaments of liver?

A

FISSURES
lig teres, venosum, IVC
fossa gallbladder
Porta hepatis - between quadrate and caudate - where hepatic ducts, arteries, portal vein, nerves and vessels enter/leave

454
Q

Right shoulder or back pain?

A

gallbladder

Left? spleen

455
Q

Courvoisier’s Law?

A

In the presence of jaundice, an enlarged gallbladder is unlikely to be due to gallstones; rather carcinoma of the pancreas or the lower biliary tree is more likely.

456
Q

endocrine pancreas? 3 secretions?

A

islets of Langerhans -

insulin (lowers blood sugar by increasing glucose intake),

glucagon - raises blood sugar levels by convering glycogen to glucoes

somatostatin (suppresses both)

457
Q

Duct of Wirsung?

A

Main pancreatic duct -

458
Q

Pancreatic neck swelling (duct problem, cancer, etc) can affect what?

A

portal or IVC obstruction - because pancreas overlies both veins

459
Q

spleen has how many ligaments?

A

2 -

460
Q

What does spleen do?

A

Filter blood - graveyard of RBC 120 days - creates immune response - produces antibodies. Has sinosoid capillaries.

461
Q

Caudal end of the hindgut?

A

Joins the allantois (yolk sac) Develops cloaca.

462
Q

Does the cloaca divide?

A

Yes - by urorectal septum - rectum and anal cavity vs.urogential sinus (bladder) ventrally.

463
Q

Anorectal agenesis vs anal?

A

each can end as a blind sac - rectum - puborectalis muscle dead ends

anal - urorectabl semtum deadends

464
Q

SM artery? Where does it arise?

A

Behind neck of pancreas.

465
Q

Water runs under the bridge?

A

ureter crosses under uterine artery

In men, instead of the uterine arteries, the vas deferens cross the ureters anteriorly.

466
Q

Only part of suprarenal that develops from Neural crest cells?

A

medulla

467
Q

What does kidney develop from?

A

nephrogenic cord - pronephros, - degenerates

mesonephros - forms wolfian duct, ureters and male reproductive tract

metonephros - final kidney

468
Q

from what does the Ureteric bud develop?

A

metonephros - which forms the permanent kidney - which ascends

469
Q

how are the calyces of kidney formed?

A

uretic buds form ureter - which dilates to form renal pelvis, which forms calyces

470
Q

urogenital sinus formation?

A

from hindgut, urorectal septum divides rectum/anal from urogenital sinus.

471
Q

How is the urinary bladder developed?

A

from upper urogenital sinus which in continuous with allantois (degenerates in adults - uranchus - fibrous cord from bladder to umbilicus)-

472
Q

Trigone of bladder?

A

formed by incorporation of lower end of mesanophrenic ducts with posterior wall of urogenital sinus

473
Q

What bones do we sit on?

A

Ischael tuberosity from the ischium

474
Q

retrovesicle pouch, where is it? do both male and female have?

A

yes, both have - between rectum and bladder in males, and bladder and uterus in - females - retrouterine?

475
Q

ureter 3 constrictions?

A

at renal pelvis, pelvic brim, where connects with bladder

476
Q

What does the prostrate do?

A

The prostate secretes fluid that nourishes and protects sperm.

The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen

477
Q

What is lymph plexus in fore, mid, and hindgut (to upper rectum)?

A

Axillary Upper limb, breast, skin above umbilicus

Celiac Liver, stomach, spleen, pancreas, upper duodenum

Superior mesenteric Lower duodenum, jejunum, ileum, colon to splenic flexure

Inferior mesenteric Colon from splenic flexure to upper rectum

478
Q

What is lymph plexus for pelvic areas?

A

Internal iliac Lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), cervix, prostate

Para-aortic Testes, ovaries, kidneys, uterus

Superficial inguinal Anal canal (below pectinate line), skin below umbilicus (except popliteal area), scrotum, vulva

479
Q

Are blood vessels effected by the parasympathetic nervous system?

A

No, same with hair standing on end. goosebumps erector pili

480
Q

What did the round ligament of the liver used to be?

A

LEFT umbilical vein.

Umbilical artery forms the MEDIAL umbilical ligament. other remnants have the same word in them -

ductus venonsas - ligamentum venosus;

ductus aneriosos, ligament anteriosis

481
Q

Hirschsprung disease is missing which nerve ganglion?

A

Enteric POST ganglionic parasym neurons

482
Q

Too much NE being produced in suprarenal medulla - What type of nerve fibers are causing this?

A

PREganglionic sympathetic fibers

483
Q

fundus of gallbladder has ulcer posteriorly - what organ will be affected?

A

transverse colon

484
Q

tumor anterior to IVC just above the umbilicus - what organ compressed?

A

3rd duod

485
Q

excruciating pain from perforated ulcer, pain from peritoneal irritation by gastric juices in lesser sad - what sensory nerves convey this?

A

lower intercoastal sensory

486
Q

cremaster muscle - what nerve carries afferent?

A

Iliohypogastric

487
Q

knife would in abdomen - in SMA and vagus - what parts of colon affected?

A

ascending and transverse

488
Q

What surgery can bypass portal vein, and shunt blood from portal vein around liver? ??

A

splenchic to left renal vein

489
Q

During an appendectomy, which structure may be injured?

A

iliohypogastric nerve

490
Q

surgeon trying to distinguish jejunum from ileum ?

A

jejunum has fewer mesenteric arterial archades, longer vasa recta, plicae circularis are taller, less fat.

491
Q

medial umbilical fold ?

A

remnant of fetal artery

492
Q

What lymph nodes receive lymph from scrotum?

A

superficial inguinal. also penis, buttocks, and lower part of anal canal - lymph goes to external iliac and to lumbar

deep inguinal testis, upper vagina, and anal canal to external iliac

493
Q

Severe pain in abdomen - what nerve fibers?

A

greater splanchnic. (vagus not right because it contains sensory for reflexes, but not pain). lower intercostal carry pain from diap, abdominal wall, peritonium, but not GVA from GI tract

494
Q

chyptorchidism?

A

failure of testis to descend into scrotom

495
Q

hydrocele?

A

if middle portion of processes vaginales persists. if entire process persists, congenital indirect hernia

496
Q

what does secretin do and when/where is this done?

A

4 things - S cells in Duod.

S cells stimulated when fat enters Duod

stimulate LIVER to CREATE bile (which breaks down fat);

PANCREAS - Acinar to create HCO3-(bicarbonate)

STOMACH
Gcells - inhibit Gastrin production which inhibits parietal HCI production

Chief - make pepsinogen

497
Q

I cells - what do they do?

A

respond to fat, peptones (protein) - release CCK

CCK hormone - travels to

Parietal - inhibits protein pump - HCI inhibited

LIVER - enhances secretin

GBLADDER - contracts - Bile released

Sphincter of ODDI - stimulated to relax - bile and bicarbonate can come out in duod

PANCREAS - release enzymes in acinar that help in duod to digest

498
Q

What do chief cells secrete and where are they?

A

stomach, lamina propria of mucosa, bottom of gastric pits which are deepest in pyloris-

secrete pepsinogen
rennin
lipase

lots of RER, super Golgi, zymogen granules

499
Q

Gastric muscularis externa’s job?

A

mix foods in stomach and empty into duod -influenced by what chyme contains

500
Q

What do mucous neck cells produce and where are they?

A

neck of gastric pit - soluable mucus - lubricates lining

501
Q

Glands in stomach?

A

parietal
chief
mucous neck
DNES Gcells

502
Q

Enteroendocrine G Cells - what do they do? Where are they?

A

enteroendocrine G cells -
In antrum of stomach

respond to partially digested proteins

secrete GASTRIN hormone (travels in blood)

-> parietal cells

2 kinds

open / closed

house variety of hormone containing granules (Gastrin, Ghrelin, glicentin, glucagon, serotonin, somatostatin, VIP, etc)

Open reach into lumen and can taste what is needed

Closed (closed off)

503
Q

how do pyloric and cardiac vs. fundic glands differ? ? Are we talking about the gastric pits?

A

COILED, and lack chief cells

504
Q

What’s in gastric juice and where does it come from?

A

HCI, mucus, pepsin, lipase, rennin,

Very Acidic

Acid level determines iif Pepsin created - which catalyses partial hydrolysis of proteins

505
Q

Regulation of gastric secretions?

A

Gastrin and histamine (released in stomach and Duod), and Ach (parasym) stimulate HCI

Somatostatin (pyloris and duod - Enteroendocrine cells- produce), inhibits Gastrin release - indirectly inhibits HCI

Urogastrone (HEGF) in inhibit HCI

506
Q

cephalic secretion % of gastric juices?

A

33% , gastric 66%

507
Q

What stimulates cephalic secretions?

A

sight of food, thought, smell, taste - occurs before food enters stomach

stimulates cerebral cortex -> hypothalmus -> to vagus

Stimulates stomach to start produce HCI, secrete pepsinogen

What inhibits? anything involving sympathetic nervous system - Greater splanchnic

508
Q

in stomach - can both sympathetic and parasym work at same time?

A

only one can dominate - there is dual innervation, but sympathetic controls and if it is acting, parasymp can not -

hence no gastric juices - digestion

509
Q

Does sympathetic nervous system (Greater splanchnic) act upon parietal and chief cells?

A

Not directly -

The parasympathetic does directly act upon them.

when sympathetic in action - parasympathetic can not influence.

510
Q

What stimulates gastric secretions? What is primary inhibitor? (SNS + somatostatin)

A
  1. Stretch (muscularis externa) - receptor here stimulates vagus - which triggers HCl production and pepsinogen secretion

two types - vagal/vagel or Enteric (short arc)

  1. partially digested proteins in antrum

Stimulate G cells to create Gastrin (hormone in blood) which does 2 things:

A. to Parietal,

Gastrin reacts on CCK2 receptor - which stimulates Calcium in the cell (via GQ pathway) to stimulate proton pump to release protons

HCI creation!

B. to Chief cells which have vesicles full of pepsinogen

Gastrin binds on CCK1 - raises calcium levels, stimulate vesicle to fuse with cell membrane, releasing pepsinogen

511
Q

Long reflex arc vs. short reflex arc in stretch of stomach?

A

Long arc - vagel (afferent) / vagel (efferent)

Enteric system, Submucosal Plexus, shortens the arc to message stomach to produce HCl and secrete pepsinogen -

Can also trigger Myenteric Plexus - for motility of stomach

512
Q

Why is HCl necessary to change pepsinoden into pepsin?

A

HCI affects PH level and only at 1.8-3.5 can pepsin be created.

513
Q

More proteins in stomach - what does this do ?

A

if PH is low - not a lot of proteins -

If lots of PROTEINS - PH goes up

514
Q

How do parietal cells make HCl?

A

Lots of mitochondria

water (H2O) and carbon dioxide (CO2) combine within the parietal cell cytoplasm to produce carbonic acid (H2CO3), catalysed by carbonic anhydrase. … The hydrogen ion that was formed is transported into the stomach lumen via the H+– K+ ATPase.

515
Q

What produces somatostatin?

A

D cells - ACh inhibits somatostatin

516
Q

Meckel’s remnant?

A

yolk sac

517
Q

where is quadrate lobe of liver?

A

medial, w/ portal hepatis,

518
Q

tumor in uncinate process of pancreas - what structure may it compromise?

A

SMA

519
Q

When do direct inguinal hernias develop?

A

after birth

520
Q

where does the genitofemoral nerve pass?

A

deep inguinal ring

521
Q

What nerve supplies the testis?

A

ilioinguinal

522
Q

Quadrate lobe of liver - where does it drain bile, where is it?

A

Bile to left hepatic duct, receives blood from left hepatic artery, lies between gallbladder foss and ligam teres hepatic (is the ROUND ligament of liver - remnant of left umbilical vein), medial to inferior segment, part of left lobe

523
Q

obstruction of IVC just proximal to entrance of renal vein - may result in dilation of which veins?

A

Left suprarenal

524
Q

Which muscle gives rise to washboard stomach?

A

linea semilunaris.

525
Q

What is linea circularis

A

arcuate line of rectus sheath - lower limit of posterior layer of rectus sheath

526
Q

faux inguinalis?

A

aponeuroses of internal oblique and trans abdominal (aka transversalis fascia)

527
Q

inadvertent laceration of dilated paraumbilical veins - what ligament likely severed?

A

lig. teres hepatis - round lig (remnant of left umb vein)

528
Q

retriperitoneal infection erodes artery running along superior border of pancreas?

A

splenic.

529
Q

where does gastroduodenal run in relation to pancreas?

A

it doesn’t - it is behind first part of duod. dorsal pancreatic artery runs behind neck of pancreas and divides into left and right to supply pancreas (comes from splenchic artery)

530
Q

tumor betw celiac trunk and SMA - what structure compress?

A

neck of pancreas

531
Q

internal oblique abdominus contributes to form what?

A

falx inguinal (conjoint tendon)

532
Q

laceration of SMA distal to origin of middle colic artery - which organ may become ischemic?

A

asc colon.

533
Q

kidney surgery, must remember what about the left renal vein?

A

It runs anterior to both aorta and left renal artery. Right renal is longer than left, and runs behind IVC

534
Q

islets of langhans - where and derived from what embriological type?

A

pancreas (insulin, glucagon, somastatin) - endoderm (popular Q)

535
Q

what structure may give rise to double ureters?

A

ureteric buds. ureteric bud gives rise to ureter, renal pelvis, calyces, and collecting tubules.

536
Q

What does the mesonephric duct give rise to?

A

epididymus duct, ductus defense, ejac duct, seminal vesicles

537
Q

What do seminal vesicle do?

A

The seminal vesicles (also known as the vesicular or seminal glands) are a pair of glands found in the male pelvis, which function to produce many of the constituent ingredients of semen. They ultimately provide around 70% of the total volume of semen

538
Q

Histology GI

A

from BRS

539
Q

What causes hypertrophic pyloric stenosis?

A

Olive - faulty migration of neural cells - sphnicter can’t relax - obstructs food, nonbilious vomiting

540
Q

Biliary atresia?

A

obliteration of ducts - jaundice, white/clay stools, dark urine - 100% mortality - liver transplant needed

Cause? not known. suggest chronic inflamation to ducts replaced by fibrotic tissue.
In some infants, the condition is most likely congenital, meaning present from birth. About one in 10 babies with biliary atresia have other congenital defects. Some research indicates that an early viral infection may be linked to biliary atresia

541
Q

Pancreatic divisum?

A

distal 2/3 of dorsal pan duct and ventral duct fail to anastomose - forms two separate duct systems.

542
Q

annular pancreas?

A

ring of pancreatic tissue around duod. causes obstruction. often bilious vomiting. hard to feed. DOUBLE BUBBLE often seen DOWN asso.

543
Q

diabetic mothers may affect what in baby’s pancreatic islets?

A

hyperplasia of pancreatic islets - increased birth weigh and serious episodes of hypoglycemia

544
Q

intestinal atresia/stenosis

A

failed recanalization and/or ischemic event (vascular accident) - various types; two blind bowel ends, apple peel, string of sausage

normal amniotic fluid, abdominal distention, later vomiting, failure to pass meconiu

545
Q

duplication of intestines?

A

abnormal recanalization - often by ileocecal valve - will feel/see abnormal mass, abd pain, vomiting chronic rectal bleeding, intussusception, perforation.

546
Q

Intussususception

A

current jelly stoods - telescoping, idiopathic cause - usually ileum - pain, vomiting, bloody stools, diarrhea

547
Q

superior mesenteric artery syndrome?

A

weight loss, 3rd duod compressed betw sma and aorta

548
Q

How are rectum and upper anal canal formed?

A

urorectal septum partitions into rectum and urogenital sinus

549
Q

failure of internal anal sphincter to relax?

A

likely megacolon (NCC migration failure). Also see distended abdomen, no meconium, gush of feces w/ rectal exam, loss of perstalsis on colon segment distal to where there is normal tissue.

550
Q

rectovesical fistula?

A

abnormal communication between rectum and urin bladder due to irregular formation of urorectal septum. (Meconium in urine)

551
Q

other probs with urorectal septum division?

A

rectourethral and rectovaginal fistulas

552
Q

Proctodeum?

A

Gives rise to lower anal canal - ectoderm

553
Q

rectal, anal connection problems? Various. Most common?

A

Most common - Anorectal agenesis - rectum ends in blind sac above pectinate line. - abnormal formation of urorectal septum

When rectal atresia: BOTH rectum and anal canal unconnected due to abnormal recanalization or compromised blood supply.

Imperforate anus - anal membrane fails to perforate

anal agenesis - anal canal below puborectal muscle - blind sac

554
Q

baby, umbilicus draining secretions, fecal material through umbilicus at times?

A

likely diag? ileal diverticulum (meckle’s)

remnant of vitelline duct persists

here fistula discharging contents onto surface of skin

555
Q

what kind of cells are kupffer, where are they found, and what are they derived from

A

macrophages liver- mesoderm

556
Q

WHAT gives rise to urogental ridge?

urinary system - BRS embriology

A

Intermediate mesoderm - between the paraxial and lateral plate mesoderm.

Includes the kidneys and gonads, and their respective duct systems, as well as the adrenal cortex. The intermediate mesoderm forms paired elevations called urogenital ridges.

557
Q

Wilm’s tumor?

A

kidney cancer - children

Solid cancerous tumor of the kidney that arises from immature kidney cells. For most children with Wilms tumor, no clear cause is known. Certain environmental factors (such as contact with toxic chemicals) may increase the risk of developing this disease, but more research is needed.

558
Q

How do kidneys form?

A

intermediate mesoderm, form three steps to a kidney. pronephros, 2nd Mesonephros (“middle kidney” WOLFIAN body becomes part of male repro system) - > Metanephros - final kidney

559
Q

How does metanephros develop into kidney? Where does the ureteric bud come from?

A

ureteric buds are formed from metanephros - buds grow out to pierce waiting mesenchymal tissue (metanephric blastema) which arises from cloaca.

buds grows longer like a flower stem with the kidney “cap” on top

560
Q

Does the ureteric buds form the entire kidney?

A

Ureteric buds: kidney’s collecting ducts, calyces and ureters.

Metanephric blastema (loops of Henle, variety of tubules - everything above collecting tubes of kidney

561
Q

Wolfian 2ndary kidney?

A

does it urinate? Yes - drains to cloaca/bladder. And is developing all sorts of structures. By wk 10 - metanephros is forming, expelling urine

562
Q

Renal unilateral agenesis?

A

1 Kidney doesn’t form - 2nd one has to work extra hard. - hypertrophy. relatively common

563
Q

Bilateral Renal Agenesis both kidneys?

A

Incompatible with life. Causes oligohydramnios - compression of feturs - POTTERS syndrome - usually stillborn, wrinkles, stunted limbs (not enough amnionic fluid)

564
Q

duplicated ureters, kidneys, weird rotations?

A

frequent, complete doubles, partial doubles, double kidneys where ureteric bud doubles, Horseshoe kidney ( ureteric buds connect with one another - create one kidney

Kidneys travel up, exchanging blood supplies and rotating as well. So a variety of abnormalities can arise

565
Q

What do HOX genes do? A variety of other genes involved - WT1, GDNF, HGF, etc. - in kidney development

A

establishes the “renogenic” region

566
Q

Polycistic kidney?

A

Autosomal recessive polycystic kidney disease (ARPKD) is a rare genetic disorder that affects 1 in 20,000 children. A fetus or baby with ARPKD has fluid-filled kidney cysts that may make the kidneys too big, or enlarged. ARPKD can cause a child to have poor kidney function, even in the womb

567
Q

What do the ureters connect to caudally?

A

They connect into the cloaca - which will become the urinary bladder - the kidneys rise up, the ureters grow long extending with them.

568
Q

Is cloaca endoderm?

A

yes, that is what the gut tube is from.

569
Q

What happens to the cloaca?

A

it is at the end of the caudal tube. It is pinched by the urorectal septum into two sacs - the bladder (anterior) and rectal area (posterior).

570
Q

How is the allantois involved?

A

it is connected to the bladder - into the yolk sac

571
Q

Where do the ureters connect the bladder?

A

posteriorly

572
Q

What is the urogenital sinus?

A

It has three parts -

upper - primitive bladder still attached to allontois (eventually it is blocked, fibroised, ligament urachus - become MEDIAN umbilical ligament - as adult from bladder to umbilicus

middle - pelvic, urethra

phallic - penile urethra in males

573
Q

What is the mesonephric duct?

A

Connects the primitive kidney, the mesonephros, to the cloaca and serves as the anlage for certain male reproductive organs

574
Q

Trigone?

A

triangular area in the inner bladder - where ureters connect

575
Q

What created the trigone of the bladder?

A

Mesonephric duct. Lined by endoderm - gut tube is endoderm, bladder is endoderm. The trigone is mesoderm - developed by fusion of ureters.

576
Q

Three kinds of Ectoderm, 1 Meso, 1 Endo

A

Ectoderm:
Surface CLEAN SOAP
Neural Tube NEASPOREN
Neural Crest SPAMS MOTEL

Meso - everything between skin and inside organs (skeletal muscles, bones)

Endo - organs/viscera

577
Q

Male vs female, how is it figured out? Y defines

A

XY - SRY gene (Sex Determining Y) - creates SRY protein - allows testis to be developed.

Testis produce TESTOSTERONE - signals to Wolfian duct to develop male parts - seminal vesicles, vas deferens, epedidymus

creates ANTI Mullerian hormone

Mullerian duct degenerates - so no female parts develop

578
Q

What does Anti-mullerian hormone do? and what secretes it?

A

degerates mullerian ducts -Testosterone.

579
Q

Do males and females have Wolfian ducts and Mullerian ducts?

A

Yes. Both start with them, but in females, Wolfian degenerates, and in males Mullerian degenerates.

580
Q

where do wolfian and mullerian ducts come from?

A

The wolffian ducts, which originate as excretory ducts of the primitive kidney, appear in the vicinity of the gonadal primordia of both sexes shortly after their formation. Wolffian ducts are progenitors of the upper male genital tract and give rise to the epididymis, vasa deferentia, and seminal vesicles

The paired Müllerian ducts (paramesonephric) originate in embryonal mesoderm lateral to each Wolffian duct (mesonephric duct) Both ducts grow in caudal and medial directions. The most cephalad portions of the ducts remain separate and form the fallopian tubes

581
Q

If there is no Y - what happens to the ovaries?

A

they develop. As there is no anti-mullerian hormone - because no testosterone - the mullerian duct develops

582
Q

For Wolfian duct to develop, what is needed?

A

Testosterone.

583
Q

What does the mullerian duct become?

A

fallopian tubes, uterus, cervix, and the upper one-third of the vagina.

584
Q

Where is the Mullerian duct located?

A

Paramesonephric ducts (or Müllerian ducts) are paired ducts of the embryo that run down the lateral sides of the urogenital ridge and terminate at the sinus tubercle in the primitive urogenital sinus.

585
Q

What does hormone DHT do in males? and where does it come from?

A

DHT comes from testostone - Develops the male external genitalia.

586
Q

What if there is no DHT?

A

Males inner structure develop, but as a chid - the baby appears to be a girl. At puberty, male testosterone will begin masculine characteristics will come forward.

587
Q

Three parts of urogenital sinus?

A

A vesical part that forms most of the urinary bladder and is continuous with the allantois

A pelvic part that becomes the urethra in the neck of the bladder; the prostatic part of the urethra in males and the entire urethra in females

A phallic part that grows toward the genital tubercle (primordium of the penis or clitoris

588
Q

urinary bladder - where does it come from?

A

from cloaca - urorectal septum, anteriorly urogential sinus.

Three parts -

top part - bladder forms (from vesical part), the allantois is progressively obliterated and forms the URACHUS, It becomes the MEDIAN umbilical ligament after birth which as an adult runs from bladder to umbilicus.

MALES: three regions: upper, pelvic, and phallic. The upper part gives rise to the urinary bladder and the pelvic (vesicle) part gives rise to the prostatic and membranous parts of the urethra. The phallic portion gives rise to the penile urethra.

FEMALES: In females, the pelvic part of the UG sinus gives rise to the sinovaginal bulbs, structures that will eventually form the inferior two thirds of the vagina.

The female urogenital sinus also gives rise to the urethra and vestibule of the vagina.

589
Q

Bladder exstrophy?

A

Ventral wall problem -

congenital abnormality that occurs when the skin over the lower abdominal wall (bottom part of the tummy) does not form properly. The bladder is open and exposed on the outside of the abdomen. In epispadias, the urethra does not form properly. Exstrophy means ‘turned inside out’.

not just by abnormal bladder development, but by a congenital malformation of the ventral wall of abdomen (between umbilicus and pubic symphysis).
There may also be other anomolies associated with failure of closure of abdominal wall and bladder (epispadias, pubic bone anomolies)

590
Q

urachal/allantois abnormalities?

A

incomplete closure of the allantois canal. One distinguishes 4 types of anomalies: Urachal cyst: Such cyst is found somewhere along the allantois canal.

There are four types of congenital urachal anomalies: patent urachus, umbilical-urachal sinus, vesicourachal diverticulum, and urachal cyst A patent urachus is purely congenital and accounts for about 50% of all cases of congenital anomalies

Patent urachus repair is surgery to fix a bladder defect. In an open (or patent) urachus, there is an opening between the bladder and the belly button (navel). The urachus is a tube between the bladder and the belly button that is present before birth.

591
Q

Bladder abnormalities?

A

hourglass, septums, duplications

592
Q

Where do the mesonephric ducts connect?

A

They are absorbed in the trigone of the bladder. ureters connect there as well but are not absorbed

The internal urethral spincter is also present

593
Q

Does inside of bladder eventually become one type of cell?

A

yes, it becomes endodermal epithelium.

594
Q

What happens to the mesonephrinic ducts?

A

In males - turn into ductus deferens and ejaculatory ducts

in females, most regresses except for part that was absorbed in the trigone.

595
Q

How is the male urethra formed?

A

folds?

urogenital sinus, vesicourethral canal gives rise to bladder and upper part of prostatic urethra (proximal to ejac ducts)

all endoderm

muscles, lamina propria, serous - mesoderm

596
Q

What develops from pelvic part of urogenital sinus in males?

A

prostatic urethra and membranous urethra

597
Q

how is the male urethra formed?

A

The epithelium of the glandular part of the penile urethra (terminal or navicular fossa) develops by canalization of an ectodermal cord of cells that extends into the glans from its tip

598
Q

how is the female urethra created?

A

The endodermal vesicourethral canal of the urogenital sinus gives rise to the bladder (vesical) and the entire urethra

The connective tissue and smooth muscle come from the adjacent splanchnic mesenchyme

599
Q

How do the adrenal glands develop?

A

The suprarenal gland develops from two components:
A mesodermal portion, which forms the cortex
An ectodermal portion, which forms the medulla

600
Q

How are chromaffin cells formed in the adrenal medulla?

A

While the fetal cortex is being formed, cells originating in the sympathetic system (neural crest cells) invade its medial aspect, where they are arranged in cords and clusters

These cells give rise to the medulla of the suprarenal gland.

They stain yellow-brown with chrome salts and hence are called chromaffin cells

601
Q

active labor - epidural - visceral sensory pain to what spinal cord level?

A

S3

602
Q

newborn Male, external urethral orifice on ventral surface of penis?

A

Hypospadias 1/300. If on dorsal side - very rare - epispadias 1/120,00

603
Q

prostatic nerve damaged during prostate surgery - what will see?

A

erectile dysfunction - parasympathetic

604
Q

female hernia (mother of four) of urinary bladder into anterior aspect of vagina through a tear in pubocervical fascia - which separates bladder from vagina?

A

cystocele often painful when pee. often occurs postmenopausal.

fascia often torn in childbirth.

605
Q

measuring a pregnant woman’s diagonal conjugate - where measuring?

A

sacral promonotory (first sacral vertebra).to inferior edge of pubic synphisis

he obstetrical conjugate is the distance between the sacral promontory and the inner pubic arch; it should measure 11.5 cm or more. The diagonal conjugate is the distance from the undersurface of the pubic arch to sacral promontory; it is 2 cm longer than the obstetrical conjugate.

606
Q

variocele vs hydrocele in scrotom?

A

Bag of worms - usually left side - veins abnormally dilated -

Hydrocele - serous fluid w/in spermatic chord - due to remnant of tunica vaginalis - no pain, water balloon - drain with needle - light through scrotum will see clear fluid.

Varicoceles are believed to be caused by defective valves in the veins within the scrotum, just above the testicles. Normally, these valves regulate the flow of blood to and from the testicles. When normal flow doesn’t occur, the blood backs up, causing the veins to dilate (enlarge).

607
Q

obdurator hernia, where will you see it?

A

small bowel obstruction, sharp pain medial thigh. usually elderly females - over 70 esp if lost weight

608
Q

lymph glands receiving from all of perineum and external genitalia except clitoris?

A

superficial inguinal.

609
Q

failure of ureteric buds at 5th week will result in ?

A

ureter among others not being formed correctly.

610
Q

accident - severing sacral at t12 - L1?

A

Loss of voluntary control of excretion.

611
Q

Stillborn delivered with agenesis of kidneys - oligo or poly hydramnios?

A

Oligo - lack amniotic, because he wasn’t peeing.

612
Q

which ligament is females correspond to the gubernaculum testis?

A

round ligament of uterus

613
Q

in pelvis, torn sacrospinous ligament also often means what muscle is torn?

A

coccygeus

614
Q

young female, no period, with short closed vagina, no upper vagina, cervix uterus? what went wrong?

A

atresia of Paramesonephrenic ducts. These form uterine tubes, uterus, cervix and superiod third of vagina. if absent - no organs. lower 2/3 of vagina develops from sinovaginal bulbes .

These two canalize to form a single complete vaginal canal. . can still develop ovaries as from from indifferent embryonic gonads if there is hormonal stimuli to puberty.

Not mesonephrenic ducts in females - they are suppressed.

615
Q

Episiotomy during labor? what cut??? what tears?

A

perineal body.

616
Q

placing catheter up male penis - what’s the order?

A

navicular foss, spongy urethra, membranous urethra, prostatic urethra, intramural urethra.

617
Q

pudendal nerve block during delivery- what structure not affected by local anesthetic?

A

rectum - not affected by sensory nerves - visceral nerve fibers from hypogastric plexuses.

618
Q

development of primitive gonads induced by invasion of genital ridges by primordial germ cells. Where do these primordial cells migrate from?

A

yolk sac endoderm.

619
Q

from where does the urinary system develop?

A

intermediate mesoderm.

620
Q

during micturation, parasymp glands cause contractions of what nerves? the detrusor or the internal urethral sphinter?

A

Detrusor - internal urethral spincter only in males. relaxation by parasym allows urine to flow into the urethra, not contract.

In males, the internal sphincter muscle of urethra functions to prevent reflux of seminal fluids into the male bladder during ejaculation. Females do have a more elaborate external sphincter muscle than males as it is made up of three parts: the sphincter urethrae, urethrovaginal muscle, and the compressor urethrae.

621
Q

fracture of the lateral wall of true pelvis endanger which structure?

A

ductis deferens

622
Q

muscle most often torn in childbirth?

A

Pubococcygeus (major component of levator ani) - 2nd muscle, not the one with the anal cavity, but the one next to it

623
Q

boy with urine dripping from abnormal opening on underside of penis - what structures most likely didn’t fuse normally?

A

urethral folds. “hypospadius”

in females they do not fuse and form the labia minora. The folds remain open and form the vestibule.

624
Q

familial dysautonomia

A

?rare genetic disorder - effects neural crest cell migration - > could affect internal urethral spincter -

Familial dysautonomia is a genetic disorder that affects the development and survival of certain nerve cells. The disorder disturbs cells in the autonomic nervous system, which controls involuntary actions such as digestion, breathing, production of tears, and the regulation of blood pressure and body temperature.

625
Q

ligation of uterine artery - near junction of uterus and vagina - what structure at risk?

A

ureter - bridge under the water.

626
Q

constipated, what muscle strained heavily when attempts to pass her stool?

A

relaxation of puborectalis (sling) around anorectal junction straightens angle, and all other muscles in area contract - raising pelvic floor.

re external anal sphincter - that needs to relax to pass the stool.

627
Q

prostate feeds which lymph?

A

internal iliac

628
Q

reciprocal induction involves what?

A

Ureteric buds and kidneys -

Mesenchyme and epithelium

complicated gene sequencing - can cause numerous abnormalities - Abnormalities in these inductive events may cause inhibition of ureteric bud growth and renal agenesis or, conversely, duplication or overproliferation of structures

A reciprocal induction drives the mesenchyme to form an epithelium that gives rise to the renal tubules. A rather large set of signaling molecules are necessary for normal kidney morphogenesis.

Mesenchyme in blastema expresses WT1 (makes tissue competent to respond to signaling from epithelium of ureteric bud), and also produces glial-derived neurotrophic factor (GDNF) and hepatocyte growth factor (HGF )

Ureteric bud expresses GDNF receptor (RET) and HGF receptor (MET) and responds by secreting BMP7 and FGF2, which stimulates proliferation and then differentiation of mesenchyme

629
Q

Where does external pudendal artery come from?

A

The superficial external pudendal artery arises from the medial side of the femoral artery. It supplies the male scrotum and the female labia majora.

630
Q

Vas deferens?

A

vas deferens - transports mature sperm in urethra from epididymus to ejac duct via the scrotom, inguinal canal, join with seminal vesicles - ART - usually superior vesicle - Ly: ext/int iliac
N: Sym Pelvic plexus

loops over inferior epigastric art.

631
Q

Seminal vesicles?

A

seminal vesicles - produce sugar rich fluid - semen (nutritious and motil aid) up to 80% of ejaculate

Betw bladder and rectum

ART: inferior vesical, middle rectal
Ly: inferior hypogastric -

632
Q

Ejac ducts

A

ejac ducts- union of seminal vesicle and ampulla of vas defense - runs to near end of prostate
contains semen and sperm

Art/Ly/N - same as seminal

633
Q

prostate?

A

prostate - 3 zones
central (surrounds ejac ducts),

transitional - grows as men age BPH, Benign Prostate Hyperplasia 20% cancer

periferal (gland zone) - 70% cancer here (on the outer edge of most of prostate, except for fibrous connecting

Glands produce ~ 30% of ejaculate, milky white, liquifies semen

ART: inf vesicle and middle rectal V: prostatic plexus
LY: INTERNAL ILIAC
N: Inf hypogastric plexus (T10-L1)

634
Q

seminal colliculus?

A

Landmark in prostate - distal to the entrance of the ejaculatory ducts (that are now combined duct of vas deferens and seminal vesicle)

635
Q

Hypogastric nerve?

A

Transitions between the superior hypogastric plexus and the inferior hypogastric plexus. The hypogastric nerve enters the sympathetic chain at T10-L2.

636
Q

Hypogastric nerve?

A

Transitions between the superior hypogastric plexus and the inferior hypogastric plexus. The hypogastric nerve enters the sympathetic chain at T10-L2.

The upper part, the superior hypogastric plexus, is located anterior to the L5 vertebral body and the sacral promontory, whereas the inferior hypogastric plexus lies within the bilateral presacral tissues on either side of the rectum at S2, S3, and S4 levels.

637
Q

How common is prostate cancer?

A

most common other than skin cancer. 1 in 6 white men 1:5 Black. 95% adenocarcinoma

638
Q

How common is prostate cancer?

A

most common other than skin cancer. 1 in 6 white men 1:5 Black. 95% adenocarcinoma

symptoms? mostly non-symptomatic - can see urinary complaints or retention, back pain, hematuria

Biopsy estab diagnosis, false neg results often bec cancer can be in one part and not others - so various biopsies frequent

639
Q

Gleason scale?

A

Ranges from 1-5 and describes how much the cancer from a biopsy looks like healthy tissue (lower score) or abnormal tissue (higher score). Most cancers score a grade of 3 or higher.

640
Q

Pathway of spread of prostate cancer?

A

via veins or lymph - (internal iliac vein)

often spreads early to bone, lymph,

641
Q

why is screening for prostate cancer controversial?

A

too many false positives - or those men who want to be screened should be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.

Digital also OK - looking for roughness - should be smooth if no cancer

642
Q

bulbourethral glands?

A

sexual arousal mucous - below prostate. lubricates, flushes high acid of urine and other foreign matter

In the membranous urethra

643
Q

urethra -

A

prostatic, membranous, spongy

narrowest area? at the tip.

644
Q

urethral trauma - two kinds -

posterior, anterior

A

Posterior - in prostatic and membranous - car accidents, pelvic fractures,

Anterior distal to membraneous
- straddle - can appear years later w/ urethral stricture

645
Q

In MALES _ What section of the urethra is the urethral spincter located?

A

membraneous. Is it same for females?

646
Q

What arteries supply the Vagina? N? Lymph?

A

vaginal art (anterior iliac branch)

Nerve - autonomic

Lower vagina - pudendal, Pain fibers are from sacral nerve root? ??

Ly: ext iliac upper 1/3 vag, mid 1/3 common and internal iliac
Lower 1/3 inguinal

647
Q

main vaginal bacteria for vaginosis?

A

Gardnerella vaginalis 95%

population - reproductive age

Signs
Odor, more discharge, irritation some times, hysuria rare

Whiff test - 70% accuracy - looking for clue cells, PH higher than 4.5 indicates infection

tment/ antibiotics

648
Q

cervix - external, internal os, what part dilates to give birth

A

internal

arteries - at 3 and 9
Nerve - parasym, many pain nerves run with

Lymph - complex - obturator, common iliace, etc. US ME LIES mneumonic

Upper - superficial and aortic

M - external iliac

L - Internal iliac, external iliac, sacral

649
Q

is cervical cancer common?

A

Yes - 1/3 most common in women - not in US due to mass screening/early intervention

85% squamous cell carc.
most near ext os where cells change from stratified squ to simple epit

HPV virus causes most

screening - PAP only - 21 - 29 age / PAP + HPV 3-5 year
30 - 65 every 5

clinical sign - abnormal bleeding, esp after sex

can invade bladder and rectum directly

triad of edema, pain the hydronephrosis suggest pelvic wall involved

common metastisis? lymph, liver, lung bone

tment: early surgery, later radiation, chem

650
Q

most common reason to do hysterectomy?

A

leiomyomas - pelvic cycts, pain and bleeding

651
Q

uterus, three parts

A

cervix, isthmus, body (90 degrees from vagina)

652
Q

where is rectouterine pouch?

A

pouch of douglass - up and between uterus and rectum

653
Q

endometriosis?

A

Often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis

654
Q

Most common female genital cancer?

A

endometrial , US 2/8% will be diagnosed. 75% postmenopausal - most common symptom, bleeding. harder to detect in non-postmenopausal women.

655
Q

Ligaments of uterus?

A

broad - wide with cardinal ligament a part, connect ovary to tube and back to uterus

ovarian and suspensory ligament of ovary

round (artery of sampson within),

rectourterine - uterus to sacrum),

656
Q

What arteries supply uterus?

A

uterine which anastomisizes w ovarian along uterine tube

LY: lateral aortic, pelvic, and iliac nodes that surround the iliac vessels.
N: sympathetic nervous system (by way of the hypogastric and ovarian plexuses) and the parasympathetic nervous system (by way of the pelvic splanchnic nerves from the second through fourth sacral nerves).

657
Q

arteries in female reprod system?

A

at uterus - ovarian, utereine,(anast+) LOWER _ vaginal, middle rectal, internal pudendal

658
Q

Polycistic ovarian syndrome?

A

12 or more follicles in at least 1 ovary -

Women with polycystic ovarian syndrome (PCOS) have abnormalities in the metabolism of androgens and estrogen and in the control of androgen production.

The major features of PCOS include menstrual dysfunction, anovulation, and signs of hyperandrogenism

 Other signs and symptoms of PCOS may include the following:
Hirsutism 
Infertility 
Obesity and metabolic syndrome 
Diabetes 
Obstructive sleep apnea
659
Q

Ovarian cancer?

A

most common cause of cancer death from gynecologic tumors in US.

660
Q

Venous drainage of ovary vein?

A

Left - to left renal vein, right to IVC

661
Q

common way women hurt the pudendal nerve?

A

spinning, childbirth

662
Q

Pudendal Nerve Entrapment?

A
Pudendal neuralgia (also known as Pudendal Canal Syndrome, Alcock Canal Syndrome, and Pudendal Nerve Entrapment, PNE) is a form of nerve pain (neuropathy, neuritis) where the symptoms are perceived to be in the pelvis / pelvic/perineal region (genitals, perianal) 
The pelvic pain is worsened by sitting and lying, and can include prickling, stabbing, burning, numbness, and the sense of a foreign object in the urethra, penis or vagina, and rectum. 
In addition to pain, sexual dysfunction, impotence, fecal and urinary incontinence can be a problem
663
Q

Where does pudendal nerve start?

A

S2 - 4 runs posterior and in the bottom, all the way to the penis - dividing off into various branches -

Can do nerve block -

Obstetric Neuropathy - pelvic nerve injury can occur due to damage caused by the presenting part of the baby or the delivery forceps - may affect the pudendal, obturator (inner thigh) and sciatic nerves (leg below the knee)

Pudendal Neuropathy - sacral nerve (S2, S3, S4) invasion by rectal and metastatic bone tumours can cause pain, numbness and weakness in the areas supplied by the pudendal and sciatic nerves

Pudendal Neuralgia – most common presentation - injury to the pudendal nerve in the pelvis can be caused by excessive cycling on a narrow saddle,, horse riding, chronic constipation, previous pelvic surgery, pelvic fractures and direct blunt trauma (straddle injury)

664
Q

What nerve is blocked during childbirth?

A

To relieve pain associated with the second (pushing) stage of labor, an injection called a pudendal block can be given through the vaginal wall and into the pudendal nerve in the pelvis, numbing the area between the vagina and anus (perineum). Pudendal blocks do not relieve the pain of contractions.

665
Q

femoral hernia?

A

in groin, inner thigh -

A femoral hernia usually occurs when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh. It pushes through a weak spot in the surrounding muscle wall (abdominal wall) into an area called the femoral canal.

666
Q

h pylori

A

The primary colonisation of H. pylori usually occurs during early childhood and decreases with age, but following an episode of acute gastritis, the infection can last a lifetime (3). Although other microorganisms reside in the human stomach, only H. pylori can survive over long periods of time.

667
Q

Greater vestibular glands?

A

secrete mucous in vaginal vestibule - superficial perenial pouch

The Bartholin’s glands (also called Bartholin glands or greater vestibular glands) are two pea sized compound alveolar glands located slightly posterior and to the left and right of the opening of the vagina. They secrete mucus to lubricate the vagina and are homologous to bulbourethral glands in males.

668
Q

urogenital folds?

A

from the cloacal folds;

male spongy urethra and ventral aspect of the penis; i

female - labia minora.

669
Q

Femoral hernia landmarks?

A

The femoral canal lies just below the inguinal ligament and lateral to the pubic tubercle. Consequently, a femoral hernia will pass below and lateral to the pubic tubercle, whereas an inguinal hernia will be seen above and medial to it. The key landmark for the femoral canal is the femoral vein.

670
Q

Meromelia?

A

birth defect, missing part of limb - thalidomide, preg nausea drug in 50s -

671
Q

Gartner’s cyst?

A

is a benign vaginal cyst that originates from the Gartner’s duct, which is a vestigial remnant of the mesonephric duct (wolffian duct) in females.

672
Q

crematerier reflex?

A

L1, L2 spinal segment

673
Q

Omphalocele?

A

trisomy 18

674
Q

femoral ring?

A

inguinal ligament

The femoral ring is the base of the femoral canal. It is directed upward and is oval in form, its long diameter being directed transversely and measuring about 1.25 cm. Part of the intestine can sometimes pass through the femoral ring into the femoral canal causing a femoral hernia

. Its boundaries are: anteriorly: inguinal ligament. medially: lacunar ligament.

he lateral compartment contains the femoral artery, the intermediate compartment contains the femoral vein, and the medial and smallest compartment is called the femoral canal. The femoral canal contains efferent lymphatic vessels and a lymph node embedded in a small amount of areolar tissue.

675
Q

vasectomy?

A

derivative of mesonephric ducts - scrotom, cut vas deferens

676
Q

persistent processes vaginalis?

A

indirect hernia - The processus vaginalis (or vaginal process) is an embryonic developmental outpouching of the peritoneum. It is present from around the 12th week of gestation, and commences as a peritoneal outpouching. n males, it precedes the testis in their descent down within the gubernaculum, and closes.

677
Q

Testicular lymphatics

A

Lumbar lymph

678
Q

Bicornuate uterus?

A

A bicornuate uterus is a type of congenital uterine malformation or müllerian duct anomalies in which the uterus appears to be heart-shaped. Bicornuate uteri have two conjoined cavities whereas a typical uterus has only one cavity.

679
Q

volvulus?

A

sigmoid colon

680
Q

Double bubble sign

A

duod atresia

681
Q

Congenital diaphragmatic hernia

A

Left pleuro-peritoneal membrane

682
Q

Non-bilious projectile vomiting

A

Hypertrophic pyloric stenosis

683
Q

Intussusception

A

ileum, iliocolic junction

684
Q

Gastroduodenal artery often eroded by?

A

duod ulcer

685
Q

Murphy’s sign?

A

gallbladder, Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.

686
Q

What muscle relaxes during urination?

A

During micturition, parasympathetic stimulation causes the detrusor muscle to contract and the internal urethral sphincter to relax. The external urethral sphincter (sphincter urethrae) is under somatic control and is consciously relaxed during micturition

687
Q

In male development, the mesonephric duct develops into all genitourinary internal structures except for what?

A

PROSTATE _ Develops into male internal structures (except prostate)—Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens(SEED).

Female remnant is Gartner duct

688
Q

Rank these 3 androgens in order, from most to least potent: androstenedione, dihydrotestosterone (DHT), and testosterone.

A

dht-. testosterone -> androstenedione

Testosterone:

Differentiation of epididymis, vas deferens, seminal vesicles (internal genitalia, except prostate)

Growth spurt: penis, seminal vesicles, sperm, muscle, RBCs

Deepening of voice

Closing of epiphyseal plates (viaestrogen converted from testosterone)

Libido

DHT:

Early—differentiation of penis, scrotum, prostate

Late—prostate growth, balding, sebaceous gland activity

689
Q

What disorder is associated with ambiguous genitalia at birth and inability to convert testosterone to dihydrotestosterone?

A

absence of Sertoli cells or lack of Müllerian inhibitory factor develop both male and female internal genitalia and male external genitalia (streak gonads)

5α-reductasedeficiency—inability to convert testosterone intoDHT male internal genitalia, ambiguous external genitaliauntil puberty (when testosterone levels cause masculinization)

In the testes:

Leydig Leads to male (internal and external) sexual differentiation.

Sertoli Shuts down female (internal) sexual differentiation.

690
Q

What ligament connect cervix to side of pelvis?

A

The Cardinal (or transverse cervical) ligament attaches the Cervix to the side wall of the pelvis

691
Q

What effect does progesterone have on uterine smooth muscle?

A

relaxes

692
Q

IN males, what duct remains?

A

Mesonephric duct remains, while the paramesonephric duct degenerates (except the appendix testis)

693
Q

In males, what cells secrete testosterone?

A

Leydig cells, located in the interstitium -

Leydig cells, also known as interstitial cells of Leydig, are found adjacent to the seminiferous tubules in the testicle. They produce testosterone in the presence of luteinizing hormone (LH).

, secrete testosterone in the presence of LH (Leydies [ladies] dig testosterone)

694
Q

What hormones do Sertoli and Leydig cells respond to?

A

Sertoli cells: FSH; Leydig cells: LH

Where are seminiferous tubules located?
testes
Seminiferous tubules are located within the testes, and are the specific location of meiosis, and the subsequent creation of male gametes, namely spermatozoa. The epithelium of the tubule consists of a type of sustentacular cells known as Sertoli cells, which are tall, columnar type cells that line the tubule.

695
Q

What 3 structures are contained within the broad ligament of the uterus?

A

The round ligaments of the uterus, the fallopian tubes, the ovaries

696
Q

What ligament connects the uterine horn to the labia majora?

A

round ligament

697
Q

What 4 structures are derived from the mesonephric duct? SEED

A

seminal vescicle, epididymus, ejac duct, van defenens

698
Q

Hypospadias is associated with what 4 conditions?

A

Inguinal hernia, chordee (upward or downward bending of penis), cryptorchidism, and 5α-reductase deficiency

699
Q

To which lymph nodes does fluid from the distal vagina/vulva/scrotum/distal anus drain?

A

superficial

700
Q

What nerve cells innervate erection, emission, ejaculation?

A

Parasympathetic (pelvic splanchnic nerves); Sympathetic (hypogastric nerve); visceral and Somatic (pudendal nerve), respectively (Point, Squeeze, and Shoot)

701
Q

What is the function of dihydrotestosterone (DHT) in male sexual differentiation?

A

It promotes development of the undifferentiated gonads into the male external genitalia and prostate

702
Q

Estrogen causes the urogenital sinus to form which two structures in the female embryo?

A

The greater vestibular glands (of Bartholin) and the urethral/paraurethral glands (of Skene)

703
Q

What forms the blood-testis barrier, and what is its purpose?

A

Tight junctions between Sertoli cells; it isolates gametes from the immune system, preventing an autoimmune attack

704
Q

A newborn is found to have a heart-lung fistula and holoprosencephaly (one hemisphere in brain). What substance was his mother likely abusing during pregnancy?

A

Alcohol (these defects are found in the most severe form of fetal alcohol syndrome)

705
Q

An 8.-month-old child presents with abdominal pain and bloody stool. what might child have?

A

meckle’s diverticulum.

706
Q

Is epispadias or hypospadias more common?

A

HYPO _ In Epispadias. you hit your EYE when you PEE

707
Q

What germ layer gives rise to the upper vagina? The lower vagina?

A

Mesoderm; endoderm (derived from urogenital sinus)

708
Q

cause of epispadias?

A

Epispadias results from faulty positioning of the genital tubercle
A genital tubercle or phallic tubercle is a body of tissue present in the development of the reproductive system. It forms in the ventral, caudal region of mammalian embryos of both sexes, and eventually develops into a primordial phallus

709
Q

What is the role of nitric oxide (NO) in the physiology of penile erection?

A

What is the role of nitric oxide (NO) in the physiology of penile erection?
Nitric oxide causes smooth muscle relaxation and vasodilation through cGMP production to increase blood flow to the penis

710
Q

What part of the urethra is prone to injury in perineal straddle injuries?

A

The bulbar/spongy urethra (anterior urethra)

711
Q

The umbilical vein drains into the IVC via which structure(s)?

A

Liver or ductus venosus

712
Q

Urachus?

A

Allantois forms from hindgut and extends into urogenital sinus. Allantois becomes the urachus, a duct between fetalbladder and umbilicus. Failure of urachus to involute can lead to anomalies that may increase risk of infection and/or malignancy (eg, adenocarcinoma) if not treated.

Obliterated urachus is represented by the median umbilical ligament after birth, which is covered by median umbilical fold of the peritoneum

713
Q

Patent urachus?

A

Total failure of urachus to obliterate urine discharge from umbilicus.

Urachal cyst

Partial failure of urachus to obliterate; fluid-filled cavity lined with uroepithelium, between umbilicus andbladder. Cyst can become infected and present as painful mass below umbilicus.

Vesicourachaldiverticulum

Slight failure of urachus to obliterate outpouching of bladder.

714
Q

What causes free air under diaphragm?

A

The most common cause is a perforated abdominal organ, generally from a perforated peptic ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or abdominal trauma. A perforated appendix seldom causes a pneumoperitoneum. … This was achieved by insufflating the abdomen with carbon dioxide.

715
Q

What causes peritoneal irritation?

A

Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen and covers and supports most of your abdominal organs. Peritonitis is usually caused by infection from bacteria or fungi

716
Q

are plicae Circularis found in ileum?

A

NO. no feathers

717
Q

What is feathery appearance in Jejunum?

A

plicae circulares -
: the numerous permanent crescentic folds of mucous membrane found in the small intestine especially in the lower part of the duodenum and the jejunum

718
Q

Differences between jeju, ileum?

A

jeju feathery bec have plcae circulares

ILIUM has peyer’s patches, paler, thinner, no plicae circulares so smoother in appearance

719
Q

Origin of SMA?

A

NECK of Pancreas

720
Q

uncinate of pancreas?

A

head and neck

721
Q

Langerhaus - where mostly in pancreas?

A

tail -

722
Q

most pancreatic cancer?

A

Head and neck

723
Q

Pringle manuever?

A

pinch portal triad

724
Q

Where is epiploic froman of winslow?

A

Anterior to IVC

725
Q

urethral stricture? more common males

A

A stricture restricts the flow of urine from the bladder and can cause a variety of medical problems in the urinary tract, including inflammation or infection

726
Q

May-Thurner / DVThrombosis?

A

When the left iliac vein is compressed by the right iliac artery, which increases the risk of deep vein thrombosis (DVT) in the left extremity. DVT is a blood clot that may partially or completely block blood flow through the vein.

727
Q

Valves of Kerkring?

A

Plicae circular folds in small intestines

728
Q

four folding in small intestines SMI?

A

plicae circulares

intestinal villi (growing out of cirulares)

intestinal glands CRYPTS
(grooves between vilii)

microvilli (on the surface of all of this ) 3rd level wave? - with striated border

on apical surface of lining ENTEROCYTES

729
Q

SMI lining of epithelium?

A

simple columnar with goblet cells beside enterocytes,

Lamina propria forms core of villi, smooth muscle, vessels, lymph, nerve -

MOVES in rhythm

730
Q

Muscular externa 2 parts

A

inner circular smooth, and outer longitudianl smooth

731
Q

What cells are found throughout the stomach?

A

mucous neck

732
Q

Where are chief cells found?

A

Fundus only ????

733
Q

Where are secretin and CCK produced?

A

SMALL intestine - by G cells -

secretin - bicarb in pancreas and biliary tract

CCK - stim pancreatic enzymes and contraction of Gallb.

734
Q

periodontal ligament?

A

fiber bundles -

735
Q

Transeptal fibers of the gingivae?

A

extend from one tooth to the next.

736
Q

Glands of von ebner’s role?

A

taste bud enhancing - deliver saliva to furrow surrounding each papillae

737
Q

gastric pits in stomach?

A

deepest in pyloris,

738
Q

Muscle that mixes in stomach?

A

musularis externa - two layers, myenteric plexus between - creates the movement

two roles, mixing and pushing into duod

739
Q

parietal cells (oxyntic)

A

upper half of gland, secrete HCI and gastric Intrinsic factor (Vb12)

unique tubulovesicular system with canaliculi and microvilli - enlarge when HCI secreted - microvilli become longer-

740
Q
  • Chief (zymogenic) cells - NOT in cardiac and pyloric glands
A

lower half of gland

secrete pepsinogen and precursors of rennin and lipase

741
Q

Mucous neck cells

A

in neck, produce mucous, may be able to divide

742
Q

G cells (DNES) diffuse neuroendocrine system cells

A

open and closed - open can taste lumen

at least 12 kinds - believed each one secretes only one hormone

743
Q

Regenerative cells -

A

in neck area - replacing cells

744
Q

regulation of gastric secretions?

A

Gastrin, histamine (by G cells) w/ ACH (parasymp) stimulate HCI

Somatostatin - G cells - inhibit gastrin ->in directly inhibit HCI

Urogastrone (HEGF) and gastric inhibitory peptide and prostaglandins (from small intestine) Directly inhibit HCI

745
Q

muscle that climbs stairs

A

Psoas. Absess from/on kidneys can affect.

746
Q

Three arteries in pelvis not from internal iliac artery?

A
Ovarian (aorta up by SMA)
Super rectal (IMA!)  supplies rectum, upper anal
median sacral (
747
Q

aorta in the abdomen?

A

T12 - L4

748
Q

What happens at L4?

A

aorta divides into common iliac arteries - the “terminal branches” of the aorta and median sacral artery

also height of iliac crest

749
Q

4 unpaired branches of aorta ?

A

celiac, SMA, IMA, median sacral

750
Q

3 arteries supplying suprarenals?

A
superior suprarenal (inferior phrenic branch)
middle supradrenal (direct from aorta)
inferior suprarenal (renal)
751
Q

posterior blood supply in abdomen (posterior arteries of aorta)

A

inferior phrenic (paired0
4 lumbar pairs
median sacral

752
Q

SRY, Sertoli, Leydig?

A

functions?

753
Q

SRY, Sertoli, Leydig?

A

functions?

SRY - creates testosterone
sertoli - ?

Leydig - creates testosteron

Leydig Leads to male (internal and external) sexual differentiation.

Sertoli Shuts down female (internal) sexual differentiation.

754
Q

greater vestibular gland

A

female - superior perenial pouch, males deep pound

755
Q

subcardial vein? embryo - cardial vein?

A

gartner’s cyst,

A Gartner’s duct cyst (sometimes incorrectly referred to as vaginal inclusion cyst) is a benign vaginal cyst that originates from the Gartner’s duct, which is a vestigial remnant of the mesonephric duct (wolffian duct) in females.

femoral ring,

crematerier relfex - testing L1, l2 - efferent, afferant -

most common trachael esoph fistula - trachea communicates with stomach, and blind sac for esoph,

persistant processes vaginales (indirect hernia)

testis - lumbar lymph notes

ductus anteriorosus - prostiglandin E????

turner syndrome 45xo problems? weblike neck
Wide or weblike neck.
Low-set ears.
Broad chest with widely spaced nipples.
High, narrow roof of the mouth (palate)
Arms that turn outward at the elbows.
Fingernails and toenails that are narrow and turned upward.

duojejunal junction/ liga of treitz, bleeding upper or lower GI bleed

left should pain - spleen and myocardial ischemia

intussupction - often into cecum

medial umbilical ligament - can be attached to what artery? or vein?

femoral canal - psoas and iliacus muscle right there - be careful when fixing because of abnormal obdurator art! - when cutting through the lacunar ligament.

murphy’s sign - gbladder inflamed -
boas sign - scapula

rolling vs sliding hiatal hernia

femoral hernia -

756
Q

signs of liver disease

A

spider angioma, can’t draw star of david, Petechiae, scratch marks; clubbing/Terry’s nails,

female escutcheon in a male - pubic hair shape

hand tremors, pale hands, Duputryen’s contracture (fingers can’t bend right - Schamroth’s window - (fingers - nails can’t touch)

757
Q

caudate vs quadrate?

A

Quad is nestled between gall bladder and round - caudate is behind toward the spine

758
Q

what stimulate bile secretion?

A

vagul stim and CCK stim

759
Q

cystic duct?

A

spiral valves of heister

760
Q

what produces CCK?

A

I cells in duod when fatty food comes into the duod. CCK causes contractions of the gallbladder, releasing bile to digest fats

761
Q

Secretin in the fireman because?

A

it sends message to pancreas and bile ducts to release bicarb - to put out the fire in the duod/acid

762
Q

review continues June 17, anatomy

A

more vericel - 3 reaons

large intestine can compress, right goes direct to IVC, compression by left renal vein