1. What dermatome overlies the umbilicus?
T10
1. What features demarcate the boundaries of the lesser or true pelvis?
Answe r: the pelvic Answer: pe lvic brim, sacrum, and coccyx.
1. What is the sternal angle of Louis, and why is it important?
1. What underlying bony feature does the point of the hip demarcate?
Answer: It is i s the articulation art iculation of the t he manubrium and and body of the sternum, and it marks the dividing point of the superior mediastinum from the inferior mediastin mediastinum. um. It It also overlies the tracheal bifurcation and aortic arch and is useful for counting intercostal spaces. (Second ribs articulate here.)
Answe r: The greater Answer: trochanter of the femur
Answe r: Spleen, Answer: Splee n, splenic sple nic 2. What abdominal viscera lie flexure of the transverse colon, in the left upper pancreaticc tail, stomach pancreati hypochondriac region? (variable), (vari able), and part of the left kidney.
2. What is primary site for lymphatic drainage from the breast?
Answer: Axillary lymph nodes (75% of all lymph).
2. When comparing the female to the male pubic arch, what difference is apparent?
Answer: The female pubic arch is larger and wider.
2. Which three bones fuse to form the coxal (hip) bone?
Answer: Ilium, ischium, and pubis. All come together in the acetabulum.
3. What are the layers of the abdominal wall?
-Skin; -Subcutaneous tissue (fatty Camper's fascia and membranous Scarpa's -Fascia in the lower abdomen); -External oblique; -Internal oblique; and -Transversus abdominis muscles; -Tranversalis fascia; -Extraperitoneal fascia (preperitoneal fat); -and peritoneum.
3. What important spaces are created by the sacrospinous ligament?
Answer: The greater and lesser sciatic foramina. They provide an avenue for structures to pass from the pelvis to the gluteal region and posterior thigh, and for the pudendal vessels and nerves to enter the pudendal canal and pass to the perineum.
3. Which hip joint ligament is the strongest?
Answer: The iliofemoral ligament, which forms an inverted "Y" ligament (of Bigelow) that limits hyperextension.
4. What is the major blood supply to the femoral head?
Answer: Primarily the retinacular arteries of the medial and Lateral femoral circumflex, and acetabular branch of the obturator artery, which runs in the ligament of the femoral head (less important In adults).
4. What muscles make up the pelvic diaphragm?
Answer: Levator ani and coccygeus.
Answer: Genital branch of the 4. What nerve is in the genitofemoral nerve. It spermatic cord, and what does innervates the cremaster it innervate? muscle?
5. What are the descriptive subdivisions of the uterus?
Answer: The body (fundus and isthmus) and cervix
5. What nerve innervates the major hip adductor muscles?
Answer: Superior gluteal nerve. Weakness of abductors (gluteus medius and minimus) on the weight bearing limb can lead to gluteal lurch during walking; this is known as a positive Trendelenburg sign.
5b. What is a indirect inguinal hernia?
Answer: A hernia that occurs lateral to the inferior epigastric vessels, passes through the deep inguinal ring and inguinal canal, and may appear at the superficial inguinal ring.
6. What is the access point of the lesser sac?
Answer: The epiploic foramen (Winslow), just posterior to the hepatoduodenal ligament and anterior to the IVC.
6. What is the inferior extent of the lung and parietal pleura in quiet respiration at the midaxillary line?
Lung extends to the eighth rib and the pleura to the tenth rib.
6. What nerves contribute to the formation of the lumbar plexus?
Answer: Ventral primary rami of L1-L4.
Answer: It is the lowest point in the female pelvis (where 6. Why is the rectouterine peritoneal fluids may collect), and pouch (of Douglas) important? access to drain these fluids is possible via the posterior vaginal fornix.
7. What are the descriptive subdivisions of the broad ligament?
Answer: Mesovarium (surrounds and suspends ovary), Mesopsalpinx (surrounds and suspends the uterine tubes), And mesometrium (surrounds and supports the uterus).
7. What are two components of the sciatic nerve?
Answer: Tibial and common fibular nerves.
7. Where does the hepatopancreatic ampulla terminate?
Answer: In the lumen of the second, or descending, part of the duodenum.
8. What are the three major branches of the celiac artery (trunk), and what do they supply?
Answer: Left gastric, common hepatic, and splenic. They supply the spleen and the foregut derivatives of t he GI tract. Esophagus (distal end) Stomach Duodenum (proximal end) Liver, gallbladder, pancreas
8. What powerful flexor of the thigh at the hip attaches to the lesser trochanter?
Answer: Iliopsoas muscle.
8. What structures may be involved in stress incontinence?
Answer: Stress incontinence may result from a loss of functional integrity of the pubovesical ligaments, vesicocervical fascia, levator ani, and / or urethral sphincter.
9. Identify several easy ways to differentiate the jejunum from the ileum.
Answer: The jejunum compared to the ileum is larger in diameter; its mesentery contains less fat; its arterial arcades are fewer; and it has a longer vasa recta.
9. Uterine prolapse may occur with the loss of support of which important structures?
Answer: The transverse cervical (cardinal) and uterosacral ligaments, and the levator ani muscle,
9. What nerve innervates the anterior compartment of the thigh?
Answer: Femoral nerve (L2L4). The muscles are largely extensors of the leg at the knee.
10. What are the hamstrings muscles?
10. What structures are supplied by the superior mesenteric artery?
Answer: Semitendinosus, semimembranosus, and the long head of the biceps femoris. They extend the thigh at the hip and flex the leg at the knee. They are supplied by the tibial nerve and attach to the ischial tuberosity.
Answer: Midgut derivatives of the GI tract. Distal portion of duodenum to the left colic flexure.
10. Which branches of the internal iliac artery arise from the posterior division?
Answer: iliolumbar, lateral sacral, and superior gluteal arteries
11. How does the urinary bladder empty itself?
Answer: Appropriate central nervous system reflexes initiate voiding via stimulation of pelvic splanchnic nerves to the bladder;this causes contraction of the detrusor smooth muscle of the bladder wall. Voluntary relaxation of external sphincter urethrae muscle tone occurs in conjunction with the detrusor contraction, but it is mediated by the somatic nervous system. In males, sympathetic relaxation of the internal sphincter (females lack internal sphincter) also occurs with detrusor contraction.
11. Where is McBurney's point?
Answer: One third of the way along a line connecting the anterior superior iliac spine to the umbilicus. It is a good landmark for locating an inflamed appendix (point of tenderness).
Answer: To avoid injury to the 11. Why are gluteal large sciatic nerve, which runs intramuscular injections given through the lower half of the in the upper outer quadrant? gluteal region.
12. What are the descriptive subdivisions of the male urethra?
12. What is the pes anserinus?
Answer: Prostatic, membranous, and spongy (penile).
Answer: An attachment arrangement of tendons of the semitendinosus gracilis, and sartorius muscles to the medial tibial condyle (looks like a goose's foot).
12. What portions of the large bowel are retroperitoneal?
Answer: Ascending colon, descending colon, and rectum *.
13. How does one test for an ACL injury?
Answer: Anterior drawer sign, where the tibia moves anterioly in relation to the femur. The ACL normally prevents hyperextension of the knee and is injured more than the posterior cruciate ligament.
13. Where do sperm and seminal fluids empty into the urethra?
Answer: Into the prostatic urethra via the ejaculatory ducts.
13. Where is the bare area of the liver?
Answer: The portion that is pressed against the diaphragm and is not covered with visceral peritoneum. It will have a dull appearance rather than glistening appearance.
14. What are the four important sites of portocaval anastomoses?
Answer: Esophageal, paraumbilical, rectal, and retroperitoneal.
14. What is the innervation of the external anal sphincter?
Answer: Inferior anal (rectal) nerves from the pudendal nerve (S2-S4).
14. What is the unhappy triad?
Answer: Injury to the ACL, tibial collateral ligament, and medial meniscus.
15. Trace bile from the liver to the gallbladder and then duodenum, naming every duct traversed in correct order. 15. What is the arterial blood supply to the muscles of the anterior compartment of the leg?
15. Which rectal veins are involved in portocaval anastomoses?
16. What is the parasympathetic innervation of the pelvic viscera?
16. What nerve innervates the following muscles?
Gastrocnemius Fibularis longus Tibialis anterior Plantaris Flexor hallucis longus Flexor digitorum brevis Soleus Abductor digiti mi nimi Plantar and dorsal interossei
Answer: Right and left hepatic ducts to the common hepatic duct to the cystic duct to the gallbladder. From the gallbladder to the cystic duct to the common bile duct to the hepatopancreatic ampulla (of Vater) to the second part of the duodenum.
Answer: anterior tibial artery.
Answer: The inferior and middle rectal veins (tributaries of the internal iliac vein - caval system) anastomose with the superior rectal vein from the inferior mesenteric vein, a tributary of the portal venous system. Answer: Parasympathetic preganglionic fibers arise from S2-S4 via pelvic splanchnic nerves that course to the inferior hypogastric plexus (pelvic), synapse there, and then innervate pelvic viscera (smooth muscle and glands). Gastrocnemius - Tibial Fibularis longus - Superficial fibular Tibialis anterior - Deep fibular Plantaris - Tibial Flexor hallucis longus - Tibial Flexor digitorum brevis - Medial plantar (from tibial) Soleus - Tibial Abductor digiti minimi - Lateral planta r (from tibial) Plantar and dorsal interossei - Lateral plantar (from tibial)
16. Where does the lymphatic duct begin?
Answer: In the abdomen at the cisterna chyli, which is the dilated beginning of the duct that receives lymph from the lumbar and interstitial lymphatic glands.
17. Footdrop may indicate an injury to which nerve?
Answer: Deep fibular nerve ( if weakened eversion is also present, then it is the common fibular nerve).
17. Identify three common anatomical sites where a renal calculus (stone) may become lodged and obstruct urine flow.
1. Ureteropelvic junction 2. Pelvic brim - Crossing the bifurcation of common iliac a or beginning of external iliac a 3. Ureterovesicular junction: Passage through the wall of the urinary bladder
17. Lymphatic spread of cancer cells from a malignant ovarian tumor may involve the aortic (lumbar) lymph nodes directly. Why?
Answer: The lymphatic vessels of the ovary follow the ovarian artery directly back to the abdominal aorta and infiltrate aortic nodes in this region.
18. How is the joint between the talus and tibia classified?
Answer: Talocrural joint, a uniaxial synovial hinge (ginglymus) joint.
18. Into which veins do the gonadal veins empty?
Answer: The right vein empties into the IVC and the left vein empties into the left renal vein.
Answer: The pubic symphysis 18. What the boundaries of the anteriorly, the ischial diamond-shaped perineum? tuberosity laterally, and the coccyx posteriorly.
19. How are thoracic splanchnic nerves distributed to the abdominal GI tract?
Answer: They distribute to the foregut and midgut derivatives of the GI tract by synapsing in the celiac and superior mesenteric ganglia and sending postganglionic fibers to the viscera on the vessels of the celiac and SMA.
19. What are the two bony arches of the foot?
Answer: the longitudinal and transverse arches.
19. Why is the central tendon of the perineum important?
Answer: It anchors the perineum because it provides for attachment of many skeletal muscles of the perineum as well as fascial layers.
20. What is the common cause of erectile dysfunction?
Answer: Loss of functionality i n the nerves that relax the smooth muscle tone of the corpus cavernosum, which impedes blood flow into cavernous erectile tissue. Current medications facilitate smooth muscle relaxation and increase blood flow.
20. What is the spring ligament, and why is it important?
Answer: Plantar calcaneonavicular ligament, which supports the head of the talus and medial longitudinal arch of the foot. It is fairly elastic, hence its name.
20. Where do the pain afferents from the abdominal viscera terminate in the central nervous system?
Answer: Afferents axons conveying pain pass via thoracicand lumbar splanchnic nerves to the dorsal root ganglia (site of the afferent neurons) and into the spinal cord between the T5 and L2 levels, where they synapse in the dorsal horn (gray matter).
21. What is the female homologue of the male corpus spongiosum penis?
21. Which nerves of the lumbar plexus arise from L2L4 ventral rami, and what do they innervate?
Answer: The bulb of the vestibule.
Answer: Femoral nerve, which innervates the anterior compartment muscles of the thigh (largely knee extensors), and obturator, which innervates medial compartment muscles of the thigh (la rgely hip a dductors).
1) Il iohypogastric (L1/T12-L1) 2) Ilio inguinal (L1/T12-L1) 3) Genitofemoral (L1-2) 4) Lateral femora l cutaneous (L2-3) 5) Femoral nerve (L2- 4) 6) Obturator nerve (L2- 4)
21. Which tarsal bone is fractured most often?
Answer: Calcaneus. Most are intraarticular fractures in which the talus is driven down on the calcaneus, as in a fall from a great height, with a landing on the heel.
22. In the lower limb, what are the two deep tendon reflexes?
Answer: The patellar tendon reflex (L3-L4) and the calcaneal tendon reflex (S1-S2).
22. What is the parasympathetic innervation to the GI tract?
Answer: Foregut and midgut derivatives are innervated by the vagus nerve; the hindgut is innervated by the pelvic splanchnic nerves (S2-S4).
23. What is the blood supply to the sole of the foot?
Answer: Medial and lateral plantar arteries derived from the posterior tibial artery.
25. What dermatomes are associated with each of the following regions? Inguinal region Knee Second toe Posterior leg and thigh
L1 L4 L5 S1-S2
32. What is the axis around which the gut tube rotates during development?
Esophageal tributaries anastomoses with those tributaries to azygos system > SVC
Answer: The superior mesenteric artery (SMA).
ESOPHAGEAL VARICOSE VEINS
Complication:
Esophageal tributaries anastomoses with those tributaries to azygos system > SVC Complication: ?
Esophageal varices
Indirect vs Direct Inguinal Hernia Leaves lateral to the inferior epigastric vessels Enters through the deep inguinal ring Mainly congenital Most common (75%)
Indirect
Hernial sac by persistent processus vaginalis and the covering of the spermatic cord Lies within the cord, covered by processus vaginalis
Indirect vs Direct Inguinal Hernia Leaves medial to inferior epigastric vessels Protrudes through the inguinal (Hesselbach's) triangle Always acquired, but seems like genetic factors predispose Hernial sac by fascia transversalis & peritoneum Lies outside of the processus vaginalis, parallel to spermatic cord and its coverings.
Direct Inguinal Hernia
Paraumbilical veins anastomoses with subcutaneous veins of anterior abdominal wall > SVC & IVC Complication: ?
CAPUT MEDUSAE
stopped at slide 119..... will continue later
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Superior rectal vein anastomoses with middle and inferior rectal veins to the IVC Complication: ?
Internal HEMORRHOIDS
SA node to AV node to common AV bundle (of His) to Trace the conduction pathway right and left bundle branches through the heart. and subendocardial Purkinje system. Veins of Retzius - anastomose of small colic veins with veins in the posterior abdominal wall Complication: ?
SILENT VARICES
What are semilunar valves?
The pulmonary and aortic valves. Each has three semilunar cusps or leaflets. (They share a common embryologic origin.)
What are the hallmarks of tetralogy of Fallot?
Pulmonary stenosis or narrowing of the right ventricular outflow, transposed aorta, right ventricular hypertrophy and VSD.
What does the fourth pair of aortic arches become in the adult?
Answer: On the right side, the right subclavian artery; on the left side, the aortic arch.
What is the most common congenital heart defect?
Answer: VSD (ventricular septal defect), which usually occurs in the membranous portion of the ventricular septum.
What is thoracic outlet syndrome?
Compression of one or more of the structures passing out of the thoracic outlet. The subclavian artery or vein or lower portion of the brachial plexus is often involved.
What structure of the embryonic foregut region gives rise to the lung buds?
Laryngotracheal diverticulum.
What types of nerve fibers travel in the thoracic cardiac nerves?
Postganglionic sympathetic fibers (to the heart) and visceral afferents from the heart.
What veins drain the posterior thoracic wall?
Drainage is largely by tributaries of the azygos system of veins (intercostal veins).
Which coronary artery supplies the SA node?
Right coronary artery, usually its SA nodal branch
Why do most lung abscesses occur in the right lung?
The right main bronchus is wider, shorter, and more vertical than the left bronchus, and aspirated infective agents can gain easier access to the right lung.
Why is angina pectoris an example of referred pain?
Visceral afferents from the ischemic heart are conveyed to the upper thoracic spinal cord levels, which also receive somatic afferents from the T1T4 dermatomes. Both groups of afferents converge in the dorsal horn of the spinal cord, and angina may be perceived as localized to the somatic distribution (T1-T4) rather than identified with the heart.
Why is the azygos system of veins important clinically?
Answer: It has important connections with tributaries of the inferior vena cava and portal system, which normally drains most of the venous blood from below the diaphragm back to the heart. If this drainage is compromised, the connections with the azygos system provide alternative routes of venous return to the heart.
