Anatomy

Question 1

what part of pancreas is intraperitoneal vs retroperitoneal

Answer 1

tail is intraperitoneal

Question 2

what part of duodenum is intraperitoneal vs retroperitoneal

Answer 2

1st part of duodenum is intraperitoneal

Question 3

contents of hepatoduodenal ligament

Answer 3

portal vein

common bile duct

proper hepatic artery

Question 4

if the abdomen continues to bleed after the pringle maneuver, then where is the suspected bleed

Answer 4

IVC or hepatic veins

the arteries/veins that go through the hepatoduodenal ligament are ruled out because this gets clamped in pringle maneuver.

these are: portal vein and proper hepatic artery

Question 5

interstitial cells of Cajal are responsible for

Answer 5

slow waves of the smooth muscle in the intestines

Question 6

During pregnancy, a physiologic increase in maternal insulin resistance occurs during the second and third trimesters, largely due to ____________

Answer 6

human placental lactogen (hPL), a peptide hormone secreted by the syncytiotrophoblast.

this allows more glucose to go to the fetus instead of the mother

Question 7

The S1 sound results from

Answer 7

the closure of the atrioventricular valves at the start of systole

Question 8

The S2 sound results from

Answer 8

the closing of the semilunar valves at the start of diastole.

Question 9

femoral nerve innervates what function

Answer 9

the muscles that do flexion of the hip and extension of the knee + sensory innvervatin of the skin on the anterior thigh and medial leg.

(iliacus, sartorius, quads)

injury: knee buckling and loss of patellar reflex

Question 10

inferior gluteal nerve does what function

Answer 10

extension and external rotation oft he thigh at the hip.

injury: difficulty standing from a seated position

Question 11

tradelenburg sign occurs from injury to what nerve

Answer 11

superior gluteal nerve

(innervates gluteus medius, gluteus minimus and tensor fasciae latae)

Question 12

auditory information goes to what thalamic nuclei?

Answer 12

medial geniculate body

Question 13

visual information goes to what thalamic nuclei?

Answer 13

lateral geniculate body

Question 14

an object in the nasal visual field of the left eye will be transmitted to what nucleus on what side?

Answer 14

the lateral geniculate nucleus/body on the same side

Question 15

how does blood get out of the portal circulation into systemic circulation?

Answer 15

hepatic vein drains blood from liver/portal circulation into systemic circulation

Question 16

what are the nerves involved in carotid sinus reflex

Answer 16

​​​​​​​The carotid sinus reflex has an afferent limb that arises from the baroreceptors in the sinus and travels to the vagal nucleus and medullary centers via the glossopharyngeal nerve (cranial nerve [CN] IX), whereas the efferent limb carries parasympathetic impulses to the sinoatrial (SA) and AV nodes via the vagus nerve (CN X).

Question 17

why do pregnant women get low hemoglobin and at what point during pregnancy does this happen

Answer 17

Pregnant patients have marked increases in blood plasma volume (by 30%-50%) by week 6 and red blood cell mass (by 20%-30%), which helps improve fetal nutrient delivery while also protecting against excessive blood loss during delivery. Because the expansion of blood plasma volume is greater than the increase in red blood cell mass, pregnant women typically have mildly decreased hemoglobin concentrations (ie, dilutional anemia).

Question 18

where are goblet cells found in the respiratory system

Answer 18

in the epithelium of the bronchi and larger bronchioles

vs club cells are found in terminal bronchioles

Question 19

T/F: aminotransferase levels are unchanged in healthy elderly individuals.

Answer 19

TRUE, this is the one parameter of age related liver changes that does not occur.

Elevations in liver enzymes should therefore raise suspicion for undiagnosed hepatic disease or hepatotoxin exposure. Small variations may be seen in bilirubin, alkaline phosphatase, and gamma-glutamyltransferase levels, but they are generally minimal.

Question 20

what is the signalling system for ang II at its receptors in arterioles

Answer 20

Angiotensin 2 acts on AT1 receptors found in the endothelium of arterioles throughout the circulation to achieve vasoconstriction. This signalling occurs via a Gq protein, to activate phospholipase C and subsequently increase intracellular calcium.

Question 21

what is the mechanism of edema in pregnant women (in terms of nml physiologic adaptations)

Answer 21

​​​​​​​Despite normal CVP (Central venous pressure), peripheral edema is common in pregnancy due to the increase in plasma volume resulting in decreased blood oncotic pressure; this change encourages leakage of intravascular fluid into dependent peripheral tissue (eg, lower extremities).

Question 22

what is the mechanism(s) of decreased SVR in pregnancy

Answer 22

increased release of peripheral vasodilators (NO, prostacyclin)

decreased sensitivity to vasoconstrictuors (NE and ang II)

Question 24

Platelets release what factors to increase their aggregation in the local environment.

Answer 24

thromboxane A2, serotonin, and ADP

they also release thromboplastin, which increases circulating amounts of both thrombin and fibrin.

Platelets release platelet-derived growth factor in order to direct cell movement during wound healing.

Platelets release a growth factor called transforming growth factor-beta, which promotes the deposition of extracellular matrix tissue into a healing wound.

Vascular endothelial growth factor is released by platelets in order to stimulate angiogenesis, or the regrowth of blood vessels.

Question 25

von Willebrand factor function

Answer 25

stabilizes platelets by forming a bridge between platelets and collagen.

Question 26

Haptoglobin function

Answer 26

binds circulating hemoglobin and reduces renal excretion of free hemoglobin, preventing tubular injury.

Question 27

Vitamin K is a cofactor to what enzyme

Answer 27

gamma glutamyl carboxylase (converts coagulation factors in all pathways of coagulation cascade to active form)

Question 28

what are the levels (by the spine levels) of the main arteries coming of the aorta

Answer 28

• celiac trunk at T12
• renal arteries originate from the lateral surface of the aorta at the level of the L2 (2 kidneys, level 2)
• SMA at L1
• IMA at L3
• bifurcation into common iliac aa. at L4 (bi-FOUR-cates)

Question 29

type II pneumocytes function

Answer 29

secretion of surfactant and division to replace type I pneumocytes

mn: II is 2 surfaces rubbing up against eachother and the two cells that come from division

Question 30

uvular deviation is d/t damage to what CN

Answer 30

vagus

Question 31

What does vWF bind?

Answer 31

collagen and plts (by plt glycoprotein GP1B) to initiate clotting

and factor 8 to protect it (In the absence of vWF, factor VIII is rapidly degraded in the circulation via proteolytic inactivation)

Question 32

what gets expressed upon binding with vWF

Answer 32

serotonin, calcium

and ADP (triggers adhesion), thrmoboxane A2 –> facilitates expression of GPIIB/IIA (binds fibrin to make mesh)

thromboxane A2 is inhibited by PGI2 and NO

Question 33

Androgens in the ovary are produced bycells, which are primarily stimulated by . The androgens diffuse to the cells, which are stimulated by ___________ to convert the androgens to estrogens.

Answer 33

Androgens in the ovary are produced by theca cells, which are primarily stimulated by luteinizing hormone (LH). The androgens diffuse to the granulosa cells, which are stimulated by follicle-stimulating hormone (FSH) to convert the androgens to estrogens.

Question 34

Magnocellular neurosecretory cells

what are they

Answer 34

cells in the hypothalamus synthesize and carry oxytocin and vasopressin to the posterior pituitary gland, where they are stored.

Question 35

Continuous stimulation of the pituitary gonadotropic cells by gonadotropin-releasing hormone would cause accelerated or deccelerated pubertal development

Answer 35

deccelerated

due to suppression of follicle-stimulating hormone/luteinizing hormone release from pituitary gonadotropic cells.

pulsatile stimulation –> nml pubertal dev.

Question 36

this is a stain of brain tissue. what are the circuled cells

Answer 36

microglia

cells with elongated, hyperchromatic nuclei (circled in blue) are microglia. Microglia are the resident phagocytes of the central nervous system (CNS), and they migrate to areas of tissue damage to help clear away dead and dying cells. They also release cytokines that stimulate the immune system to respond to the area of injury.

derived from mesoderm (vs neuronal glial cells, which derive from neuroectoderm

Question 37

derivatives of Neural crest cells (neuroectoderm)

Answer 37

dentine of teeth, skull bones, facial cartilage

leptomeninges (arachnoid and pia), PNS

melanocytes

Adrenal Medulla, enterochromaffin cells

aorticopulmonary septum

Question 38

what are the derivatives of mesoderm

Answer 38

everything that makes you MOVE

1. peritoneal linings (allows sliding motion)
2. Bones, muscle, connective tissue up to tracheal cartilage (not including cartilage of the face), dermis
3. blood & lymphatics (always moving) + spleen (but not the thymus
4. adrenal cortex (salt, sweet, sex)
5. kidneys, wall of GI tract (gotta go!)
6. proximal vagina (+uterus and fallopian tubes), ovaries, testes
7. dura Mater

a/w VACTERL defects

Question 39

T/F: in the pancreas, epinephrine binding to alpha receptors has greater effect than binding to beta receptors

Answer 39

binding at alpha causes decreased insulin secretion, binding at beta causes increased insulin secretion

alpha effect dominates with epinephrine

Question 40

Lesions to the lateral geniculate nucleus, would cause ___________ defects.

Lesions to the medial geniculate nucleus would cause difficulties in _____________

Answer 40

Lesions to the lateral geniculate nucleus, part of the thalamic visual pathway, would cause visual field defects.

Lesions to the medial geniculate nucleus, part of the thalamic auditory pathway, would cause difficulties in sound localization.

Question 41

hemineglect and anosognosia (unawareness of one’s condition) occur due to damage of what cortex?

Answer 41

nondominant (usually right) parietal cortex

Question 42

pt w/ left-dominant circulation, what artery supplies the AV node?

Answer 42

left circumflex artery.

The right coronary artery gives rise to the AV nodal artery in patients with right-dominant or codominant circulation.

Question 43

T/F: cardiac ventricle compliance increase is a normal physiologic aging process

Answer 43

FALSE lungs have increased compliance, not the heart (and NOT the chest wall) –> this produces the floppy balloon effect

the opposite happens with the heart –> it stiffens and undergoes cardiomyocyte hypertrophy (to make up for decrease in number of cardiomyocytes)