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Flashcards in Anatomy Deck (131):
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Which veins shunt from the portal to the systemic system in esophageal varices?

Left gastric to esophageal

1

Which veins shunt from the portal to the systemic system in caput medusae.

Para umbilical to superior/inferior epi gastric below the umbilicus and superior epi gastric and lateral thoracic above the umbilicus

2

Which veins shunt from the portal to the systemic system in internal hemorrhoids?

Superior rectal to middle/inferior rectal veins

3

What is TIPS?

Transjugular intrahepatic portosystemic shunt between the portal and hepatic vein

4

Where is the CTZ zone located?

On the dorsal aspect of the medulla at the caudal end of the 4th ventricle (area postrema)

5

Where is the inferior thyroid artery?

Arises from subclavian.
Behind the carotid artery and jugular vein
Supplies the inferior pole of the thyroid gland

6

Where is the ansacervicalis?

Arises from C1-3 and innervates muscles in anterior neck

7

Where would penetrating trauma be to injure ansa cervicalis.

To the neck superior to cricoid cartilage

8

What nerve is injured with a positive Trendelenburg sign?

Superior gluteal

9

What would injury to the obturator nerve cause?

Loss of adduction
Loss of medial thigh sense

10

What would injury to the inferior gluteal nerve cause?

Glut max problems - can't climb stairs or get up from a chair
Extension and external rotation

11

What is lost in an injury to the femoral nerve?

Loss of knee reflex and anterior thigh sensory

12

What courses through the cribiform plate?

CN I

13

What goes through the optic canal?

CN II
Ophthalmic artery
Central retinal vein

14

What goes through the superior orbital fissure?

CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers

15

What goes through foramen rotundum?

V2

16

What goes through foramen ovale?

V3

17

What goes through foramen spinosum?

Middle meningeal artery and vein

18

What are is the middle meningeal artery from?

Maxillary

19

What goes thru the internal acoustic meatus?

CN VII, VIII

20

What goes thru the jugular foramen?

CN IX, X, XI
Jugular vein

21

What goes thru the hypoglossal canal?

CN XII

22

What goes thru foramen magnum?

Spinal roots of CNXI, brain stem, vertebral arteries

23

What would injury to the middle frontal gyrus cause?

Deviation of eyes to the ipsilateral side (FEF lesion)

24

What is the area injured in Wernicke's aphasia?

Superior temporal gyrus (Brodmann 22)
From injury to posterior branch of middle cerebral artery

25

At what level does the facial nerve arise in the brain stem?

Dorsolateral aspect of the pontomedullary jxn

26

Where does oculomotor nerve arise in the brainstem?

The level of superior colliculus (mesencephalon)

27

Where does the trochlear nerve arise?

At level of inferior colliculus (crosses before exiting brainstem)

28

What nerve courses with the inferior thyroid artery?

Recurrent laryngeal nerve

29

Where does the recurrent laryngeal branch loop on the right?

Below the subclavian

30

Where does the recurrent laryngeal nerve loop on the left?

Around the aortic arch

31

What does the recurrent laryngeal nerve supply?

All muscles of the larynx except cricothyroid

32

What does injury to the recurrent laryngeal nerve cause?

Unilateral = hoarseness
Bilateral = respiratory difficulty

33

Which ribs overlie the spleen?

Ribs 9-11

34

Where do T cells become double positive?

In the cortex of the thymus

35

Where do T cells undergo negative selection?

In the medulla

36

What leads have Q waves with an anterior wall MI?

V1-V4
LAD

37

Where is the infarction if leads II, III, aVF have q waves?

Inferior wall
RCA

38

Where is the infarction if q waves are seen in leads V4-V6?

Anterolateral - lateral and posterior walls of left ventricle
LCX

39

Where is the infarction if you can see q waves in leads I and aVL?

Lateral wall of LV
LCX

40

Where is the infarction if q waves are in V1-V2

Anteroseptal
LAD

41

What structure does RCA provide?

SA and AV nodes
Papillary muscles
Posterior 1/3 of the inter ventricular septum and posterior walls of the ventricles
Right ventricle

42

What does the LCX provide?

Supplies lateral and posterior walls of the left ventricle

43

What does the LAD supply?

The anterior 2/3 of the septum
Anterior papillary muscle
Anterior surface of the left ventricle

44

Where is the left atrium?

Posterior
Base of the heart

45

What can enlargement of the left atrium cause?

Dysphagia and hoarseness due to compression of the left recurrent laryngeal nerve

46

Where are gastric glands located?

Laminate propria

47

Which areas of the colon are most susceptible to ischemia?

Splenic flexors (watershed area from SMA and IMA)
Sigmoid colon (btween IMA and hypo gastric arteries

48

What is contraindicated in a patient suspects of toxic mega colon?

Colonoscopy and barium enema - perforation

53

What does the falciform ligament do?

Connects the liver to the anterior abdominal wall

54

Which ligament connects the greater and lesser sacs?

Hepatoduodenal

55

Which ligament holds the gastric arteries?

Gastrohepatic

56

Which ligament separates the greater and lesser sacs on the right? The left?

Gastrohepatic
Gastrosplenic

57

What are the layers of the gut wall?

Mucosa = laminate propria, muscularis mucosa, epithelium
Submucosa = regulates BF, secretions, absorptions, meissner's
Muscularis externa = inner circular, myenteric nerve plexus (auerbach's), outer longitudinal
Serosa

58

What is the histo of the duodenum?

Villi, microvilli,
brunner's glands (secrete alkaline fluid)
Crypts of lieberkuhn (have gi stem cells)
Tubular glands in submucosl layer

59

What is the histo of the jejunum?

Heavy lymphocytic infiltrate in the laminate propria
Plicae circularis
Crypts of lieberkuhn

60

What is the histo of the ileum?

Peyer's patches (laminate propria, submucosa)
Crypts
Most goblet cells in small intestine

61

What is the histo of the Colon?

No villi
Crypts
Lots of goblet cells

62

Ulcers in the lesser curvature of the stomach cause bleeding from what artery?

Left gastric

63

Obstruction of the splenic artery causes ischemia thru which bvs?

Short gastric because left gastroepiploic has good anastomoses

64

Which part of the duodenum is close to the head of the pancreas?

2nd part
Contains ampulla

65

Which part of the duodenum is close to the aorta, IVC, and SMA?

The 3rd part (transverse)
May get caught between aorta and SMA

66

Where do internal hemorrhoids drain?

Superior rectal vein --> inferior mesenteric vein --> portal
To deep nodes

67

Where do external hemorrhoids drain?

Inferior rectal vein --> internal pudendal vein --> internal iliac vein --> IVC
To superficial inguinal nodes

68

What is the centrilobular portion influenced by?

Ischemia
Toxins (alcohol)
Contains the p450 system and is furthest away from the portal triad

69

What are the features of an indirect inguinal hernia?

Lateral to the inferior epigastric vessels
Goes into the scrotum
Occurs due to failure of processes vaginalis to close
Covered by all 3 spermatic layers
Goes through transversalis

70

What are the features of a direct inguinal hernia?

Medial to the inferior epigastric arteries
Lateral to rectus abdominis
Covered by external spermatic fascia
Older men

71

Where is a femoral hernia?

Below the inguinal ligament
Lateral to pubic tubercle
More common in women and right side

72

Where are the G cells?

In the Antrum of the stomach

73

Where are the I cells in the GI tract?

Duodenum
Jejunum
Secrete CCK - delay gastric emptying, gall bladder contraction, relax sphincter of Oddi

74

Where are the S cells?

Duodenum
Secretin - cause pancreatic bicarbonate secretion and bile secretion

75

Where are the D cells?

Pancreatic islets
GI mucosa
Somatostatin

76

Where are the K cells in the GI tract?

Duodenum
Jejunum
Glucose dependent insulinotropic peptide - increases insulin release and decreases gastric acid secretion
Causes oral glucose to be used more rapidly than IV glucose

77

Where is VIP secreted from?

Parasympathetic ganglia in sphincters, gallbladder, small intestine

Increases intestinal water and electrolyte secretion
Increases relaxation of sphincters

78

What secretes bicarbonate in the GI tract?

Mucosal cells of stomach, duodenum, salivary glands, brunner's glands, pancreas

79

Where are the peyer's patches?

In laminate propria and submucosa of ileum

80

What artery bleeds from a ruptured ulcer in the posterior wall of the duodenum?

Gastroduodenal artery

81

Where does perforation of the duodenum often occur?

In the anterior part of the duodenum,

82

Where are ulcers in the stomach most often located?

In the lesser curvature of the stomach at the junction of the

83

Where is zenker's diverticulum

Between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor
Due to cricopharyngeal muscle dysfunction

84

What is the in the mucosal layer of the gut wall?

Epithelium for absorption
Laminate propria for support
Muscularis mucosa for motility

85

What is in the submucosa layer of the gut wall?

Meissner's plexus - regulates blood flow, secretions, absorption

86

What is in the muscularis externa?

Auerbach's - myenteric plexus for contractility
Inner circular
Outer longitudinal

87

What is the most common location for diverticulum?

Sigmoid colon

88

Where do volvulus occur?

Cecum (young adult)
Sigmoid colon (elderly)

89

Where are angiodysplasia located?

In the cecum, terminal ileum and ascending colon

90

Where does the recurrent laryngeal nerve loop on the right?

Below the right subclavian at the jxn of brachiocephalic artery

91

Where does the recurrent laryngeal nerve on left?

Under the aortic arch

92

What lymph nodes does the distal 1/3 of the vagina, vulva, scrotum drain to?

Superficial inguinal

93

What lymph nodes does the proximal 2/3 of vagina/uterus?

Obturator, external iliac and hypo gastric nodes

94

What lymph nodes do the glans penis and clitoris drain to?

Deep inguinal nodes

95

Where do the superficial and deep inguinal nodes drain?

External iliac nodes to the common iliac nodes

96

What ligament holds the ovarian vessels?

Suspensory ligament of the ovaries

97

What ligament holds the uterine vessels?

Cardinal ligament

98

What is contained in the broad ligament?

Uterus
Fallopian tubes
Ovaries

99

What nerve mediates ejaculation?

Hypo gastric nerve

100

What nerve mediates erection?

Pudendal nerve

101

Where are the Sertoli cells? What do they do?

In seminiferous tubules
Secrete inhibit, Mif, androgen-binding protein to maintain local levels of testosterone
Form blood-testis barrier

102

What cell makes hCG?

Synctiotrohphoblast

103

What is the outermost layer of the spermatic cord?

External spermatic fascia (from external oblique)

104

Originates from proximal tubule cells
Polygonal clear cells
Most common in men 50-70 yo
Ass. With gene deletion in ch.3
Invades renal vein - can present with varicocele
Resistant to chemo and radiation

RCC

105

Palpable flank mass with hematuria in a 2-4 yo
HTN
Small blue cells
Associate with beckwith Weismann and WAGR complex

Wilms tumor

106

Associated with exposure to phenacetin, rubbers, aniline dyes, cyclophosphamide, leather, textiles, plastics
Papillary growth with pleomorphism
Flat growth = high grade from p53 mutations
Presents with painless hematuria

Transitional cell carcinoma
Can be in calyces, pelvis, ureters, or bladder

107

Arises from urachal remnant at the dome of bladder

Adenocarcinoma

108

Lipidized astrocytes
Reticulin deposits
Chronic inflammatory infiltrate

Pleomorphic xanthoastrocytoma

109

Located As cystic and solid mass in Posterior fossa
GFAP positive
Rosenthal fibers -Eosinophilic corkscrew

Pilocytic astrocytoma

110

Midline cerebellum tumor of blue cells
Increased MYC
Homer wright rosettes
Radio sensitive
Associated with Turcot's
Drop mets to spinal cord

Medulloblastoma

111

Perivascular pseudorosettes
Rod-shaped blepharoplasts found near nucleus
Found in 4th ventricle

Ependymoma

112

Foamy cells
High vascularity
Cerebellum
Can secrete EPO

Hemangioblastoma

113

Cystic spaces with brown fluid and cholesterol
Calcification
Keratin pearls lined by stratified squamous
May cause bitemporal hemianopsia

Craniopharyngioma

114

Precocious puberty
Impaired upward gaze
Obstructive hydrocephalus

Germinoma in dorsal midbrain

115

Stains for GFAP
Serpentine necrosis
Pseudopalisading pleomorphic tumor cells
Central areas of necrosis and hemorrhage
May cross midline
Infiltrative
Mutations in PDGF, p53, EGFR

Glioblastoma multiforme

116

Spindle cells with whorled pattern
Psammoma bodies
Near parasagittal brain and surfaces
From arachnoid villi cells
May have dural attachment
Due to loss of Merlin in ch.22

Meningioma

117

Chicken-wire capillary pattern
Round nuclei with clear cytoplasm
Calcification
GFAP positive
Due to loss of heterozygosity
Only in white matter
Most often in frontal lobes

Oligodendroglioma

118

S100 positive
Present with facial numbness/weakness, tinnitus, hearing loss
Regular, oval nuclei with areas of dense, loose growth

Schwannoma

119

Grows in epiphysis of long bones
Soap bubble or double bubble on X-ray
Spindle cells with multinucleated cells (grow in synctium)
Large red/brown cystic degeneration
20-40 yo

Giant cell osteoclastoma

120

Bony stalk near growth plate of long bones
Mature bone with cartilaginous cap
From metaphysis

Osteochondroma

121

In metaphysis of long bones
Codman's triangle
Makes new bone - mixed lytic/blastic lesion in X-ray
Mutations in RB
Rf: Paget's disease! Radiation, bone infarcts

Osteosarcoma

122

In boys under 15
Arises in diaphysis
Anaplastic blue cell tumor
Responsive to chemo
Onion skin appearing in bone
Associated with t(11;22) translocation
Homer wright rosettes, necrosis/hemorrhage
May have systemic systems: fever, increased ESR, anemia, increased WBCs

Ewing sarcoma

123

Usually located in pelvis, spine, scapula, humerus, tibia or femur
Expansive glistening mass within medullary cavity

Chondrosarcoma

124

Pink pearly nodules with telangectasias
Palisading nuclei
Upper lip

BCC

125

S100 positive
Driven by activating mutation in BRAF kinase
Nodular form is the worst

Melanoma

126

Psammoma bodies
Orphan-Annie nuclei, nuclear grooves
Most common type

Papillary thyroid carcinoma

127

Uniform cells in capsule that are invading
Spreads hematogenous lay

Follicular carcinoma of thyroid

128

Sheets of cells in amyloid stroma
Associated with RET mutation
Can present with hypocalcemia
From para follicular cells (neuroectoderm)

Medullary carcinoid of the thyroid
(MEN2)

129

Where do the ureters course?

On top of psoas
Under the uterine artery and ductus deferens
Crosses over external iliac artery and vein
Medial to gonadal veins and lateral to the internal iliac

130

What is the blood supply to the ureter?

Upper = renal artery
Distal = branches of aorta, iliac, gonadal

171

Where is the SVC in relation to the other vessels?

The SVC is to the right of the aorta
The aorta is in the middle of the SVC and pulmonary trunk

172

What are the retroperitoneal structures?

SADPUCKER

Supra renal gland
Aorta and IVC
Duodenum (2nd and 3rd parts)
Pancreas
Ureters
Colon
Kidneys
Esophagus (lower 2/3)
Rectum
Bladder

173

What ligament holds the portal triad?

Hepatoduodenal ligament

174

What ligament holds the derivative of the umbilical vein?

Ligamentum teres hepatis in the falciform ligament