Anatomy Flashcards
(131 cards)
0
Q
Which veins shunt from the portal to the systemic system in caput medusae.
A
Para umbilical to superior/inferior epi gastric below the umbilicus and superior epi gastric and lateral thoracic above the umbilicus
1
Q
Which veins shunt from the portal to the systemic system in esophageal varices?
A
Left gastric to esophageal
2
Q
Which veins shunt from the portal to the systemic system in internal hemorrhoids?
A
Superior rectal to middle/inferior rectal veins
3
Q
What is TIPS?
A
Transjugular intrahepatic portosystemic shunt between the portal and hepatic vein
4
Q
Where is the CTZ zone located?
A
On the dorsal aspect of the medulla at the caudal end of the 4th ventricle (area postrema)
5
Q
Where is the inferior thyroid artery?
A
Arises from subclavian.
Behind the carotid artery and jugular vein
Supplies the inferior pole of the thyroid gland
6
Q
Where is the ansacervicalis?
A
Arises from C1-3 and innervates muscles in anterior neck
7
Q
Where would penetrating trauma be to injure ansa cervicalis.
A
To the neck superior to cricoid cartilage
8
Q
What nerve is injured with a positive Trendelenburg sign?
A
Superior gluteal
9
Q
What would injury to the obturator nerve cause?
A
Loss of adduction
Loss of medial thigh sense
10
Q
What would injury to the inferior gluteal nerve cause?
A
Glut max problems - can’t climb stairs or get up from a chair
Extension and external rotation
11
Q
What is lost in an injury to the femoral nerve?
A
Loss of knee reflex and anterior thigh sensory
12
Q
What courses through the cribiform plate?
A
CN I
13
Q
What goes through the optic canal?
A
CN II
Ophthalmic artery
Central retinal vein
14
Q
What goes through the superior orbital fissure?
A
CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers
15
Q
What goes through foramen rotundum?
A
V2
16
Q
What goes through foramen ovale?
A
V3
17
Q
What goes through foramen spinosum?
A
Middle meningeal artery and vein
18
Q
What are is the middle meningeal artery from?
A
Maxillary
19
Q
What goes thru the internal acoustic meatus?
A
CN VII, VIII
20
Q
What goes thru the jugular foramen?
A
CN IX, X, XI
Jugular vein
21
Q
What goes thru the hypoglossal canal?
A
CN XII
22
Q
What goes thru foramen magnum?
A
Spinal roots of CNXI, brain stem, vertebral arteries
23
Q
What would injury to the middle frontal gyrus cause?
A
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
