Clinical Anatomy

Question 1

What is used as a reference point for accurately identifying rib number or intercostal space and where is it located

Answer 1

Sternal angle (2nd costal cartilage)

Question 2

Where do crushing injuries tend to break ribs

Answer 2

At the angle

Question 3

Where will Direct injuries to the rib fracture them

Answer 3

can be anywhere

Question 4

Which ribs are most commonly fractured and why?

Answer 4

Middle ribs because of exposed position

Question 5

When might you experience pain with a fractured rib

Answer 5

during respiration coughing or sneezing especially

Question 6

Where is the needle placed in a thoracentesis or local anesthesia to intercostal space and why?

Answer 6

over superior border of the rib (to avoid damage to vein artery and nerve in costal groove on inferior border)

Question 7

What will provide collateral circulation in the event of coarctation (narrowing) of the descending aorta

Answer 7

anastomoses between anterior and posterior intercostal arteries

Question 8

Why are penetrating/nonpenetrating wounds of the superior mediastinum dangerous and when are they common

Answer 8

Because of the number of large vessels there (high speed decelerating injuries)

Question 9

If a massive knife wound penetrated the back and posterior mediastinum what might be injured?
Thoracic duct
Arch of aorta
Inferior  vena cava
Left atrium of heart
Trachea

Answer 9

Thoracic duct

Question 10

What aspect of the lung is at risk with wounds to the neck and what does it lie behind?

Answer 10

apical extremity behind sternocleidomastoid

Question 11

What is a pneumothorax and what does it disrupt or change

Answer 11

Air into the pleural cavity

neutralizes the normally negative intrapleural pressure to atmospheric pressure

Question 12

What is Pericardiocentesis

Answer 12

Drainage of fluid from the pericardial sac to relieve pressure from around the heart

Question 13

If you had an accumulation of fluid in the pericardial sac exerting pressure on the heart what might it do?

Answer 13

restrict venous returen (cardiac tamponade

Question 14

Where would you insert the needle for a pericardiocentesis and why?

Answer 14

5th or 6th intercostal space close to sternum

it is the location of the cardiac notch so you wont hit lung

Question 15

What initiates the electrical impulse that drives the cardiac cycle

Answer 15

SA node

Question 16

What can modulate the SA node

Answer 16

parasympathetic and sympathetic input from cardiac plexus

Question 17

What was the embryonic structure and role of the fossa ovalis

Answer 17

foramen ovalis that shunted blood from right to left

Question 18

IF the foramen ovalis does not close what is it called

Answer 18

atrial septal defect

Question 19

If an atrial septal defect is large enough what can occur in the heart

Answer 19

movement of blood from left to right atrium and onto right ventricle, causing increased load and RIGHT SIDE ENLARGEMENT

Question 20

What is Right dominant heart and what is a left dominant heart

Answer 20

Right coronary artery has the posterior descending and supplies left ventricle and interventricular septum along with right

left coronary artery has the posterior descending and supplies right ventricle and interventricular septum along with left

Question 21

Which is more common Right or left dominant heart

Answer 21

Right dominant 50%

Left dominant 20%

Question 22

What section of the right ventricle is smooth

Answer 22

Conus arterious region

Question 23

Where do parietal and visceral plerua meet

Answer 23

root of lung

Question 24

How do you get visceral pain in thoracic and abdominal cavity

Answer 24

signal travels back reverse of the pathway that brought sympathetic supply to the organ (returns to same segment supplying preganglionic sympathetic for the organ)

Question 25

Where is heart pain referred to

Answer 25

1st to 5th intercostal spaces and medial aspect of upper limb

Question 26

Where is gall bladder pain referred to

Answer 26

7th to 9th intercostal spaces

Question 27

Where is appendix pain referred to

Answer 27

Umbilical region (T10-T11 level)

Question 28

What controls peristalsis of the gastrointestinal tract

Answer 28

parasympathetic fibers

Question 29

What stimulates acid secretion by parietal cells in the stomach

Answer 29

vagal parasympathetic fibers

Question 30

What may be done to reduce excess acid formation with peptic ulcers

Answer 30

transection of vagal trunks

Question 31

``` What is the major fiber component of the greater splanchnic nerve Pregang sym postgang sym pregang para postgang para brachiomotor ```

Answer 31

Pregang sym (sensory fibers also travel in the greater splanchnic nerve)

Question 32

``` Transection of the vagus in the upper thoraax would least affect which of the following organs esophagus heart stomach gall bladder kidney ```

Answer 32

Heart Parasympathetic cardiac fibers from vagus arise in the cervical region and travel toward the cardiac plexus independent of vagus proper

Question 33

``` What is the most likely location of referred pain from the appendix Right shoulder Umbilical region inferior border of scapula anterior neck inguinal region ```

Answer 33

Umbilical region

Question 34

What would rupture of the male urethra lead to and why is this so

Answer 34

accumulation of urine between layers in the abdominal wall due to continuity of superficial membranous fascia with superficial fascia of the perineum

Question 35

What would the cremaster reflex test the integrity of

Answer 35

genitofemoral and ilioinguinal nerves

Question 36

Is the cremaster reflex more active in younger or older males

Answer 36

Younger

Question 37

What is a hydrocele

Answer 37

Accumulation of fluid in the tunica vaginalis or patent processus vaginalis

Question 38

What is a varicocele

Answer 38

pampinifiorm plexus of veins is dilated and tortuous

Question 39

What is cut/ligated in a vasectomy

Answer 39

ductus deferens bilaterally

Question 40

where is the incision made in a vassectomy

Answer 40

superior wall of the scrotum

Question 41

What is the name for protrusion of the abdominal visceral through either inguinal ring

Answer 41

inguinal hernia

Question 42

A hernia that follows the normal rout of the testis before birth is what

Answer 42

indirect inguinal hernia

Question 43

A hernia that protuedes directly through the abdominal wall in the ingunal triangle and through the superficial ring is what

Answer 43

Direct inginal hernia

Question 44

Where would an indirect hernia occur relative to the inferior epigastric vessels

Answer 44

Lateral

Question 45

Where would an direct hernia occur relative to the inferior epigastric vessels

Answer 45

Medial

Question 46

Which type of inguinal hernia is more common in adult males

Answer 46

direct

Question 47

Which type of inguinal hernia is more common in young males

Answer 47

indirect

Question 48

Why are inguinal hernias more common in males than females and which ones are rarest in females

Answer 48

Because they have fewer and smaller structures passing through abdominal wall Direct inguinal hernias are more rare

Question 49

What forms the anterior wall of the rectus sheath at the umbilicus - superficial membranous fascia and external oblique aponeurosis - External oblique and internal oblique aponeurosis - Internal oblique and transversus abdominus aponeuroses - transversus abdominis aponeurosis and transversalis fascia - transversalis fascia and peritoneum

Answer 49

External oblique and internal oblique aponeurosis

Question 50

``` The cremaster muscle is derived from which of these exeternal oblique internal oblique superficial membranous fascia tranversus abdominis transversalis fascia ```

Answer 50

internal oblique external oblique: external spermatic fascia Transversalis fascia: internal spermatic fascia Superfical membranous fascia: dartos and fascia of scrotum

Question 51

What is a hiatal hernia

Answer 51

protrusion of part of the stomach through the esophageal haitus of the diaphragm

Question 52

What can cause a hiatal hernia

Answer 52

Weakening of musculature around haitus in midle aged individuals

Question 53

In a common hiatal hernia what specifically slides through the hiatus and when

Answer 53

cardia and parts of fundus of stomach | especially when idividual lies down or bends over

Question 54

What is appendicitis and what causes it

Answer 54

acute inflammation of appendix from obstruction of the lumen of the organ

Question 55

What is the is the pain progression of appendicitis

Answer 55

dull pain in paraumbilical region to serious pain in posterior abdominal wall due to irritation of the sensitive parietal peritoneum

Question 56

What may result from a ruptured appendix

Answer 56

Peritonitis (infection of the peritoneum)

Question 57

What are the two common locations for gallstones to lodge

Answer 57

distal end of hepatopancreatic ampula (ampula of Vater) | junction of gallbladder neck and cystic duct

Question 58

What could result from blockage of the hepatopancreatic ampulla (from a gallstone)

Answer 58

Pancreatitis

Question 59

What are 2 things that could cause pancreatitis

Answer 59

blockage of the hepatopancreatic ampulla (from a gallstone) blockage of pancreatic duct (from swelling of pancreatic head)

Question 60

If you obstruct the ampulla of vater (hepatopancreatic) what can happen

Answer 60

Reflux of bile into pancreatic duct

Question 61

If you fracture the lower ribs on the left side what may result

Answer 61

rupture of the spleen

Question 62

What are 2 ways to rupture the spleen

Answer 62

fracture of lower ribs on left blunt trauma causing sudden increase in intraabdominal pressure

Question 63

What is the benefit of the greater omentum when one organ is inflamed

Answer 63

it is higly mobile and can wrap itself around and inflamed organ thereby protecting other viscera from infection

Question 64

``` what specific part of the intestine would receive a gallstone that passed through the common bile duct 1st part of the jejunum ascending (4th) part of duodenum horizontal (3rd) part of duodenum descending (2nd) part of duodenum superior (1st) part of duodenum ```

Answer 64

Descending (2nd) part of duodenum

Question 65

``` The posterior boundary of the omental (epiploic) foramen is formed by what duodenum inferior vena cava lesser omentum stomach transverse colon ```

Answer 65

Inferior vena cava Anteriorly: hepatoduodenal ligament Superiorly: caudate lobe of liver Inferiorly: 1st part of duodenum

Question 66

In resection of parts of the gastrointestinal tract why must the vessels in peritoneal structrures be identified?

Answer 66

to retain blood supply to the portions not removed

Question 67

if the superior mesenteric artery is occluded slowly over many months what happens to the involved bowl

Answer 67

it is nourished by blood of the inferior mesenteric artery by way of marginal artery

Question 68

What is the major pathway for a venous emoli from the lower extremity, pelvis and perineum and where would it go

Answer 68

Inferior vena cava to right heart and the lungs

Question 69

What is Nutcraker syndrome also called and what is it commonly caused by

Answer 69

renal vein entrapment syndromee compression of left renal vein between superior mesenteric artery and the abdominal aorta

Question 70

What are symptoms of nutcracker syndrome

Answer 70

Blood in urie and abdominal left flank pain

Question 71

What would the clinical manifestations of portal hypertesion include

Answer 71

Varicosities of rectal veins (hemorrhoids) Esophageal varices varicosities of cutaneous veins around the umbilicus (caput medusae)

Question 72

What clinical manifestation of portal hypertension is often most severe and possibly fatal

Answer 72

bleeding from esophageal varices

Question 73

``` Occlusion of the ileocolic artery could result in ischemia of which of the following organs descending colon pacnreas transverse colon rectum appendix ```

Answer 73

appendix ileocolic supplies appendix ileum and seum pancreas: grecieves from branches of celiac and proximal superior mesenteric transverse colon: middle colic from SMA Colon/rectom: branches from IMA

Question 74

``` Which of the following is a tributary of the hepatic portal venous system common iliac vein suprarenal vein superior rectal vein renal vein inferior phrenic vein ```

Answer 74

superior rectal vein crosses over the common iliac vessels to become the inferior mesenteric vein all others drain into inferior vena cava