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Anatomy Flashcards

1
Q

Blood supply to SA/AV nodes

A

Right coronary artery (RCA infarct) = nodal dysfunction

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2
Q

Dominance in coronary circulation

A

R-dominant: RCA gives rise to PDA (70%)
L-dominant: LCX gives rise to PDA (20%)
Co-dominant: arises from both (10%)

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3
Q

LA can impinge on what 2 structures?

A

Enlargement of the left atrium can lead to…

  • dysphagia: compression of esophagus
  • hoarseness: compression of L recurrent laryngeal
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4
Q

Adrenal cortex anatomy (also, give stimulation and product of each region)

A

From the outside in: GFR
G: glomerulosa = stim. by renin-angiotensin system, secretes aldosterone
F: fasciculata = stim. by ACTH/CRH, secretes cortisol
R: reticularis = stim. by ACTH/CRH, secretes DHEA (androgen precursor), DHEA-S (marker for adrenal dysfunction), androstenedione (testosterone precursor)

Increased 17-OHP = congenital adrenal hyperplasia

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5
Q

Adrenal medulla derivative, cell type, innervation

A

neural crest derivative

  • chromaffin cells (neural crest), regulated by preganglionic sympathetics
  • secretes catecholamines (site of pheochromocytoma)
  • neuroblastoma comes from the adrenal medulla
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6
Q

Pituitary gland secretory products and embryonic derivative

A

Anterior: FLAT PiG (FSH, LG, ACTH, TSH, prolactin, GH), derived from oral ectoderm, alpha subunit of hormones is common

Posterior: vasopression and oxytocin (technically made in hypothalamus, then transported by neurophysins), derived from neuroectoderm

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7
Q

Pancreatic islet cells organization

A

Alpha cells: found on periphery of islet (secrete glucagon)
Beta: found in center of islet (secrete insulin)
Delta: found throughout islet (secrete somatostatin)

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8
Q

Retroperitoneal structures

A

SAD PUCKER: Suprarenal (adrenal) glands, Aorta/IVC, Duodenum, Ureters, Colon (asc/desc), Kidneys, Esophagus, Rectum (superior part)

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9
Q

GI ligaments to know

Falciform
Hepatoduodenal
Gastrohepatic
Gastrocolic
Gastrosplenic
Splenorenal
A

Falciform (liver to anterior wall): ligamentum teres hepatis (ventral mesentery)

Hepatoduodenal: portal triad, part of lesser omentum, compression = Pringle maneuver

Gastrohepatic: to lesser curvature of stomach, contains gastric arteries (separates lesser and greater sacs)

Gastrocolic: greater curvature to colon, contains gastroepiploics, part of greater omentum

Gastrosplenic: short gastrics, left gastroepiploics, greater omentum

Splenorenal: splenic artery and vein, tail of pancreas

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10
Q

Digestive tract facts

  • layers of wall/mucosa
  • wave speeds
A

4 layers in wall: mucosa, submucosa, muscularis, serosa
mucosa = epithelium, lamina propria, muscularis mucosa (site of myenteric plexus)

duodenum: 12/min > ileum: 8-9/min > stomach: 3 waves/min

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11
Q

GI tract histology notable features (esophagus, stomach, duodenum, ileum, colon)

A

Esophagus: non-keratinized stratified squamous

Stomach: gastric glands

Duodenum: villi/microvilli, Brunner glands (HCO3),

Ileum: Peyer’s patches,

Colon: no villi! abundant goblet cells

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12
Q

Abdominal aorta branch vertebral heights

A 
Celiac T12
SMA L1
Left renal L1
IMA L3
Bifurcation of aorta L4
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13
Q

Portosystemic anastomoses

A

Esophageal: L gastric vein –> esophageal vein (to azygos to SVC)

Umbilical: paraumbilical veins —> small superficial epigastrics

Rectal: superior rectal –> middle/inferior rectal

Tx: TIPS: portal vein to hepatic vein (bypasses liver entirely)

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14
Q

Pectinate line (endoderm meets ectoderm)

Give innervation, blood supply and drainage

A

Above: internal hemorrhoids (visceral innervation), adenocarcinoma
supplied by IMA, drained to portal vein
Below: external hemorrhoids (somatic = painful!), SCC
supplied by internal pudendal, drains to IVC
anal fissures: posterior due to poor perfusion

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15
Q

Liver anatomy (lobule structure, Zones, describe insults)

A

Apical = bile secretion, basolateral = sinusoids
Blood flow = portal vein (apical) to hepatic vein (basolateral)

Zone 1 (apical, periportal): affected first by viral hepatitis, ingested toxins
Zone 2 (intermediate): location of hepatic infection by yellow fever
Zone 3 (basolateral, centrilobular): affected first by ischemia, location of alcoholic hepatitis/toxic injury and p450 system
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16
Q

Femoral triangle (borders and contents)

A

Superior = inguinal ligament, lateral = sartorius, medial = adductor longus

NAVEL (lateral to medial): Nerve, Artery, Vein, Lymph

femoral sheath: includes artery, vein, lymph (not the nerve!)

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17
Q

Inguinal canal layers

A

Peritoneum, transversalis, transversus abdominus, internal oblique, external oblique, inguinal ligament, superficial inguinal ring

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18
Q

Hernias (diaphragmatic, indirect, direct, femoral)

A

Diaphragmatic: left-sided, hiatal is most common (sliding = upward displacement of GEJ, parasophageal = protrusion of fundus)
Indirect inguinal: processus vaginalis into scrotum, lateral to inferior epigastric (more common in infants!)
Direct inguinal: peritoneum bulges through Hesselbach triangle (older men)
Femoral: below inguinal triangle, lateral to pubic tubercle (more common in females, bowel incarceration)

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19
Q

Erythrocyte facts (life span, membrane protein)

A

life span: 120 days

membrane contains Cl-/HCO3- antiporter (export of HCO3 to allow for CO2 carrying)

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20
Q

Thrombocyte facts (life span, granules, receptors)

A

life span 8-10 days

Dense granules: ADP, Ca2+
Alpha granules: vWF, fibrinogen

vWF receptor: GpIb
fibrinogen receptor: GpIIb, IIIa

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21
Q

Neutrophil facts (granules contents, chemotactic factors)

A

Granules = ALP, collagenase, lysosome, lactoferrin (help with phagocytosis)

chemotactic factors: C5a, IL-8, kallikrein, CTB4

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22
Q

Macrophage facts (activation)

A

activated by IFN-y

septic shock mediator: responds to Lipid A, LPS, CD14

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23
Q

Eosinophil (give 5 causes of eosinophilia)

A

5 causes of increased eos:

neoplasia, asthma, allergies, chronic adrenal insufficiency, parasite

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24
Q

Basophil granules

A

Heparin and histamine

Mediate allergic reactions

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25
Q

Mast cell facts

A

local allergic reaction, bind Fc of IgE in allergic reactions
Type I hypersensitivity reactions
- cromolyn sodium = decreased histamine release (used to prevent asthma attacks)

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26
Q

Lymphocyte facts (receptors, site of maturation)

B cell
T cell
Plasma cell

A 
B cell (CD19/20, surface, 21, EBV receptor) - mature in bone marrow, stored in peripheral lymphoid tissue
T cell (CD3, then CD4/8) - matures in thymus (CD4+ = HIV target)
Plasma cell - clock-face chromatin, abundant RER, well-developed Golgi (multiple myeloma is a plasma cell cancer!)
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27
Q

Drawer test

A

ACL/PCL injury (abnormal anterior drawer = ACL injury)
ACL inserts on the anterior aspect of the tibia from the lateral femoral condyle
PCL inserts on posterior aspect of the tibia from the medial femoral condyle

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28
Q

McMurray test

A

click on external rotation = medial meniscus tear

click on internal rotation = lateral meniscus tear

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29
Q

Unhappy triad of knee injuries

A

ACL tear
MCL tear
medial/lateral meniscus

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30
Q

Baker cyst

A

popliteal fluid collection, related to chronic joint disease (knee arthritis or meniscal tear)

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31
Q

Most common rotator cuff injury

A

Supraspinatus

Test with empty can test

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32
Q

Pitching injury

A

Infraspinatus

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33
Q

Epicondylitis

A 
Medial = golfer's (repeated flexion)
Lateral = tennis (repeated extension)
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34
Q

Wrist bone syndromes (also, give bones of the wrist)

A

So Long To (Triq) Pinky, Here Comes The (Trapezoid) Thumb (Trapezium)

Scaphoid: avascular necrosis due to retrograde blood supply

Lunate: acute carpal tunnel syndrome

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35
Q

Carpal tunnel associations

A

Pregnancy, rheumatoid arthritis, hypothyroidism

36
Q

Guyon canal syndrome (give association)

A

Compression of ulnar nerve at the wrist

Often seen in cyclists

37
Q

Humerus surgical neck fracture

A

Axillary nerve injury
Decreased abduction of arm at shoulder
Decreased sensation over the deltoid

38
Q

Upper trunk of brachial plexus compression

A

Musculocutaneous nerve injury
Decreased forearm flexion at elbow, supination
Decreased sensation over lateral forearm

39
Q

Midshaft humerus fracture

A

Radial nerve injury (lies in spiral groove)
Leads to wrist drop (loss of extensors), decreased grip strength
Loss of sensation over posterior arm and dorsal hand

40
Q

Supracondylar fracture of humerus

A

Median nerve injury
Loss of wrist flexion, 2nd/3rd finger flexion (ape hand, Pope’s blessing)
Loss of sensation over thenar eminence
Tinel sign - tingling on percussion

41
Q

Fracture of medial epicondyle of humerus

A

Ulnar nerve injury
Loss of wrist flexion, flexion of ulnar fingers, interossei
Loss of sensation over ulnar hand

42
Q

Superficial laceration of palm

A

recurrent branch of median nerve
Loss of thenar muscle group: opposition, abduction, flexion of thumb
No loss of sensation

43
Q

Tear of upper trunk (lateral pull during dystocia)

A

Erb’s Palsy (tear of C5-C6 nerve roots)

Waiter’s tip: arm adducted (deltoid), internally rotated (infraspinatus), extended (biceps)

44
Q

Tear of lower trunk (upward pull during dystocia)

A

Klumpke’s palsy (tear of C8-T1 nerve roots)

Total claw hand: loss of lumbricals, interossei, thenar and hypothenar eminence

45
Q

Compression of lower trunk and subclavian vessels (extra cervical rib, Pancoast tumor)

A

Thoracic outlet syndrome

Same muscle deficits as Klumpke’s, but also ischemia, pain and edema due to vascular compression

46
Q

Winged scapula

A

lesion of long thoracic nerve (axillary node resection)

Loss of serratus anterior

47
Q

Pope’s blessing (first two extended, last two flexed)

A

If present during extension/rest: distal ulnar lesion (ulnar clawing)
If present during flexion: proximal median lesion

48
Q

Okay sign (first two flexed, last two extended)

A

If present during extension/rest: distal median lesion (median clawing)
If present during flexion: proximal ulnar lesion

49
Q

Thenar eminence muscles

A

Opponens pollicus, Abducens pollicus longus, Flexor pollicus longus

Innervated by median nerve

50
Q

Hypothenar eminence muscles

A

Opponens digiti minimu, Abductor digiti minimi, Flexor digiti minimi

Innervated by ulnar nerve

51
Q

Interossei function and innervation

A 
Dorsal = abduction
Palmar = adduction

DAB, PAD

Innervated by ulnar nerve

52
Q

Pelvic surgery nerve injury (motor and sensory deficits)

A

Obturator (L2-L4)
decreased thigh sensation
decreased adduction

53
Q

Pelvic fracture nerve injury (motor and sensory deficits)

A

Femoral (L2-L4)

decreased thigh flexion, leg extension

54
Q

Trauma/compression of lateral leg

Fibular neck fracture

A

Common peroneal nerve injury (L4-S2)
Foot drop, steppage gait
Loss of eversion and dorsiflexion

PED = peroneal everts and dorsiflexes

55
Q

Knee trauma
Baker cyst
Tarsal tunnel syndrome

A

Tibial nerve injury (L4-S3)
Loss of sole of feet
Inability to curl toes

TIP: tibial inverts and plantarflexes

56
Q

IM injection nerve injury

A 
Superior gluteal (L4-S1)
trendelenburg gait
Lesion is on the side on which the patient stands (opposite to the hip that drops)
57
Q

Posterior hip dislocation

A

Inferior gluteal (L5-S2)
difficulty climbing stairs, rising from seated position
Loss of hip extension

58
Q

Nerve block during birth

A

Pudendal nerve
Innervates perineum
Found near ischial spine

59
Q

Lumbosacral radiculopathy

A

Nerve is inferior to the disc (L4 nerve is damaged in L3-L4 herniation)

L3-L4: decreased patellar reflex
L4-L5: decreased dorsiflexion, no heel-walking
L5-S1: decreased plantarflexion, difficulty in toe-walking, decreased Achilles reflex

60
Q

Proteins involved in muscle conduction to contraction

A

Nerve: presynaptic Ca channels, NT release
Muscle cell: DHP receptor (voltage-gated), ryanodine (sarcoplasmic reticulum), troponin C (moves tropomysoin out of the myosin-binding groove)

61
Q

Myosin cycle in muscle contraction

A

After opening of binding groove by troponin C…

  • myosin binds to actin filament
  • myosin releases ADP and Pi in the power stroke
  • new ATP binds and causes detachment of myosin from actin
  • hydrolysis of ATP cocks myosin into high-energy position for next cycle
62
Q

Skeletal muscle microscopic structure

A

Z-line - borders of the sarcomere (center of light actin chain)
M-line - middle of the sarcomere (center of heavy myosin chain)
A-band - Myosin heavy chain, Always same length!
H-band - distance between light chains (myosin only)
I-band - distance between heavy chains (actin only)

During contraction, H-band and I-band contract, and Z-lines and M-lines move closer together

63
Q

Type 1 vs. Type 2 muscle fibers

A

Type 1: slow twitch, reddish color due to increased myoglobin concentration and increased mitochondria for sustained contraction (1 slow red ox)

Type 2: fast twitch, white fibers from decreased mitochondria, increased anaerobic glycolysis (weight-training = increased fast-twitch muscle)

64
Q

Smooth muscle contraction

A

mediated by calcium, regulated by calmodulin
L-type voltage gated channel allows Ca influx, increases myosin-light-chain kinase activity (MLCK), increased myosin-P + actin, contraction via cross-bridging

65
Q

Smooth muscle relaxation

A

mediated by NO

Increases intracellular guanylate cyclase, increased cGMP, increased myosin-light-chain phosphorylase (MLCP)

66
Q

Endochondral bone formation

A

Axial/appendicular skeleton
Chondrocytes make cartilaginous model, which is later replaced by osteoclasts/blasts to remodel into lamellar bone
Woven bone is formed later after fractures and in Paget disease

67
Q

Membranous ossification

A

Bones of calvarium/skull, facial bones

Woven bone formed without cartilage first, later remodeled to lamellar bone

68
Q

Effect of PTH on bone

A

low levels = anabolic effects (building bone)

high levels = catabolic effects (osteitis fibrosa cystica)

69
Q

Estrogen effects on bone

A

Induces apoptosis in bone-resorbing osteoclasts

Decreased estrogen leads to excess remodeling/resorption –> osteoporosis

70
Q

Ureter course

A

The ureters pass under the uterine artery (or under the vas deferens) prior to entering the bladder

71
Q

Venous drainage of the gonads

A

Left gonadal veins drain into the L renal vein at a 90 degree angle, thus have less laminar flow, therefore increased risk of varicocele on the left (dilation of pampiniform plexus)
Right gonadal vein drains directly into the IVC

72
Q

Lymphatic drainage of the gonads

A

ovaries/testes –> paraaortic
Distal vagina/scrotum –> superficial inguinal
Proximal vagina –> obturator/hypogastric nodes

73
Q

Infundibulopelvic ligament

A

Suspensory ligament
ovaries –> lateral pelvic wall
contains ovarian vessels!
When operating, there is risk of ligating the ureter

74
Q

Cardinal ligament

A

cervix –> pelvic side wall

contains uterine vessels

75
Q

Round ligament

A

Uterine fundus –> labia majora
contains artery of Sampson
(remnant of gubernaculum)

76
Q

Broad ligament

A

uterus/ovaries –> side pelvic wall

77
Q

Ovarian ligament

A

ovary –> uterus

remnant of gubernaculum

78
Q

Histology of female repro tract

stratified squamous, simple columnar, simple cuboidal

A

Stratified squamous: vagina, ectocervix
Simple columnar: endocervix, uterus (glands are tubular in follicular phase, coiled in luteal phase), fallopian tube (ciliated)
Simple cuboidal: outer surface of ovary

79
Q

SEVEN-UP

A 
Seminiferous tubules
Epididymis
Vas deferens
Ejaculatory duct
(nothing)
Urethra
Penis
80
Q

Urethra segments

A

Posterior: membranous (pelvis fractures), bulbar (blunt force)
Anterior: penile (perineal straddle - leads to urine Buck’s fascia)

81
Q

Erection mechanisms (nerves: pelvic, hypogastric, pudendal)

A

NO –> increased cGMP –> smooth muscle relaxation –> vasodilation

Norepinephrine –> increased [Ca]i –> smooth muscle contraction –> vasconstriction

Emission: sympathetic
Ejaculation: visceral/somatic

82
Q

Sertoli cell functions

A
  • located in tubule wall
  • secrete inhibin B (responds to FSH) = decreased FSH
  • forms blood-sperm barrier (tight junctions)
  • temperature sensitive (increased temp = decreased inhibin, decreased sperm)
83
Q

Leydig cell functions

A

increased LH = increased testosterone

unaffected by temperature

84
Q

Conducting zone of lungs

A

no gas exchange!
anatomic dead space
Cartilage/goblet cells - until the end of bronchi
Pseudostratified ciliated columnar cells - until end of terminal bronchioles (therefore, mucociliary clearance happens until end of terminal bronchioles)

85
Q

Respiratory zone

A

lung parenchyma: respiratory bronchioles, alveolar ducts, alveoli

Mostly cuboidal until alveoli, then simple squamous

86
Q

Pneumocytes (Type I, Type II, Clara)

A

Type I: line alveoli, squamous, gas diffusion
Type II: pulmonary surfactant, cuboidal/clustered
- precursors to Type I and other Type II
- proliferate during lung damage

Clara cells: non-ciliated, secretory granules
- secrete part of surfactant, degrade toxins

87
Q

Bifurcations to know: (all at 4!)

A

Common carotid: C4
Trachea: T4
Abdominal aorta: L4

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