Anatomy

Question 1

The vertebral column is composed of 32-33 vertebrae (number cervical, thoracic, lumbar, sacral and coccygeal)…?

Answer 1

7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral and 3-4 coccygeal

Question 2

Each intervertebral disk is numbered by the vertebral body…?

Answer 2

ABOVE the disk.

Question 3

Each intervertebral disk is composed of…?

Answer 3

ANULUS FIBROSUS and NUCLEUS PULPOSUS

Question 4

The nucleus pulposus is the postnatal remnant of the…?

Answer 4

NOTOCHORD

Question 5

The vertebral bodies are strongly supported by two longitudinal ligaments, called…?

Answer 5

ANTERIOR LONGOTUDINAL LIGAMENT and POSTERIOR LONGITUDINAL LIGAMENT

Question 6

The anterior longitudinal ligament prevents (…?…) of the vertebrae and is often involved in “whiplash” accidents.

Answer 6

HYPEREXTENSION

Question 7

The posterior longitudinal ligament limits (…?…) of the vertebral column.

Answer 7

FLEXION

Question 8

Wich is the most common direction herniation of a nucleus pulposus due the posterior longitudinal ligament position and strengh?

Answer 8

POSTEROLATERAL

Question 9

In wich level does the herniation of the nucleus pulposus often occur?

Answer 9

LOWER CERVICAL (C5/C6 or C6/C7)
LOWER LUMBAR (L4/L5 or L5/S1)

Question 10

The herniated disk will usually compress the spinal nerve roots (…?…) the involved disk.

Answer 10

BELOW

Ex.: herniation of the C7 disk will compress the C8 nerve.

Question 11

The spinal cord terminates at wich level of the vertebral column?

Answer 11

L1 or L2

Question 12

The (…?…) are bilateral thickenings of pia mater that run continuously on the lateral sides of the midpoint of the cord.

Answer 12

DENTICULATE LIGAMENTS.

Question 13

The filum terminale is part of the (…?…) wich is composed of ventral and dorsal roots of lumbar and sacral nerves that extend below the inferior limit of the spinal cord.

Answer 13

CAUDA EQUINA

Question 14

The dura mater and dural sac terminate inferiorly at the…?

Answer 14

S2 vertebra

Question 15

The (…?…) is locatef between the inner walls of the vertebral canal and the dura mater. It contains fat and the internal vertebral venous plexus.

Answer 15

EPIDURAL SPACE

Question 16

The (…?…) is a pressurized space located between the arachnoid and pia mater layers. It contains (…?…), wich bathes the spinal cord and spinal nerve roots within the dural sac, and terminates at S2.

Answer 16

SUBARACNOID SPACE and CEREBROSPINAL FLUID (CSF)

Question 17

Inferior limit of the spinal cord in adult (conus medullaris)?

Answer 17

L1 or L2.

Question 18

Inferior limit of the dural sac and the subaracnoid space (CSF)?

Answer 18

S2 vertebra

Question 19

There are (…?…) pairs of spinal nerves attached to each of the segments of the spinal cord.

Answer 19

31 PAIRS
8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal.
The spinal nerves with the cranial nerves form part of the peripheral nervous system.

Question 20

Wich plexuses arises from the ventral rami?

Answer 20

BRACHIAL and LUMBOSACRAL plexuses

Question 40

The cervical nerves C1-C7 exit the intervertebral foramina…?

Answer 40

SUPERIOR to the pedicles of the same-numbered vertebrae.

Question 41

The C8 nerve exits the intervertebral foramen…?

Answer 41

INFERIOR to the C7 pedicle.

THIS IS THE TRANSITION POINT.

Question 42

All nerves beggining with T1 and bellow will exit the intervertebral foramina…?

Answer 42

INFERIOR to the pedicle of the same-numbered vertebrae.

Question 43

A lumbar puncture tap is typically performed at the (…?…) interspace level of the vertebral column.

Answer 43

L4-L5 interspace

Question 44

The autonomic nervous system (ANS) is concerned with the motor innervation of...?

Answer 44

SMOOTH MUSCLE CARDIAC MUSCLE GLANDS

Question 45

Anatomically and functionally, the ANS (1) (...?...) and (2) (...?...). In both divisions, 2 neurons form an autonomic pathway.

Answer 45

SYMPATHETIC (thoracolumbar) and PARASYMPATHETIC (craniosacral)

Question 46

Medular lesions at superior cervical ganglion, C3-C4, middle cervical ganglion, T1-T2 root result in ipsilateral Horner syndrome (interruption of sympathetic innervation), wich consists of:

Answer 46

PTOSIS, MIOSIS and ANHYDROSIS

Question 47

Two main mammary gland arterial supply?

Answer 47

INTERNAL THORACIC ARTERY (internal mammary) - a branch of the subclavian artery LATERAL THORACIC ARTERY - a branch of the axillary artery. Also, courses with the long thoracic nerve.

Question 48

Lymphatic drainage of the breast (mammary gland)?

Answer 48

LATERALLY (75%): drains from the nipple and the superior, lateral, and inferior quadrants to the axillary nodes. MEDIAL: most lymphnodes drains to the parasternal nodes. It is also through this medial route that cancer can spread to the opposite breast.

Question 49

A lesion of the (...?...) during dissection of axillary nodes after mastectomy (or after stab wounds) may cause winged scapula, a condition that lead the patient to the inability to anchor scapula to thoracic cage and...?

Answer 49

- LONG THORACIC NERVE | - CANNOT ABDUCT ARM ABOVE HORIZONTAL POSITION

Question 50

To separate the initical communication with foregut, the (...?...) forms to separate the esophagus from the trachea.

Answer 50

TRACHEOESOPHAGEAL SEPTUM

Question 51

A (...?...) is an abdnormal communication between the trachea and esophagus caused by a malformation of the tracheoesophageal septum.

Answer 51

TRACHEOESOPHAGEAL FISTULA

Question 52

A tracheoesophageal fistula is generally associated with...?

Answer 52

- ESOPHAGEAL ATRESIA and POLYHYDRAMNIOS - REGURGITATION of milk - GAGGING and CYANOSIS after feeding - ABDOMINAL DISTENTION after crying - REFLUX of gastric contents into lungs, causing PNEUMONITIS

Question 53

Pulmonary hypoplasia occurs when the lung development is stunted. This condition has 2 congenital causes:

Answer 53

CONGENITAL DIAPHRAGMATIC HERNIA and BILATERAL RENAL AGENESIS (this causes olygodramnios, wich increases the pressure on the fetal thorax and Potter's sequence)

Question 54

(...?...) with distal (...?...) is the most common tracheoesophageal anomalie

Answer 54

ESOPHAGEAL ATRESIA and TRACHEOESOPHAGEAL FISTULA

Question 55

Esophageal atresia with distal tracheoesophageal fistula cause polyhydramnio in utero, the clinical test to confirm this condition is...?

Answer 55

FAILURE to pass NASOGASTRIC tube into STOMACH.

Question 56

List the main types of tracheoesophageal anomalies.

Answer 56

- ESOPHAGEAL ATRESIA (EA) with DISTAL TRACHEOESOPHAGEAL FISTULA (TEF) - pure EA (atresia or stenosis) - pure TEF (H-type)

Question 57

The passage of instruments theough the intercostal space is done in the (...?...) part of the space to avoid the neurovascular structures (as during a thoracocentesis). An intercostal nerve block is done in the (...?...) portion of the intercostal space.

Answer 57

LOWER and UPPER

Question 58

The intercostal arteries are contributed anteriorly from branches of the (...?...) and posteriorly from branches of the (...?...)

Answer 58

INTERNAL THORACIC ARTERY and THORACIC AORTA

Question 59

Respiratory distress syndrome is caused by a deficiency of (...?...), a product of (...?...). This condition is associated with premature infants, infants of diabetic mothers, prolonged intrauterine asphyxia. (...?...) and (...?...) treatment increase the production of surfactant.

Answer 59

SURFACTANT and TYPE II PNEUMOCYTES. | THYROXINE and CORTISOL.

Question 60

Surfactant deficiency may lead to (...?...), whereby repeated gasping inhalations damage the alveolar lining. Histologically characterized by (...?...) and (...?...) fluid covering the alveoli.

Answer 60

HYALINE MEMBRANE DISEASE. | ATLECTASIS and EOSINOPHILIC.

Question 61

Pleurisy produces sharp pain upon respiration. Costal inflammation produces local dermatome pain of the chest wall via the intercostal nerves; whereby mediastinal irritation produces referred pain via the (...?...) nerve to the shoulder dermatomes of (...?...)

Answer 61

PHRENIC and C3-5

Question 62

Righ lung is divided into (...?...) lobes, separated by (...?...) fissures. Left lung is divided into (...?...) lobes. The horizontal fissure (right lung) follows the curvature of the (...?...) rib, the oblique fissure (both lungs) projects anteriorly at approximately the (...?...) intercostal space in the middleclavicular line.

Answer 62

- THREE and TWO. - TWO. - 4TH. - 5TH.

Question 63

About breath sounds: - superior lobes of the R and L lungs: (...?...) chest wall; (...?...) the 4th rib. - middle lobe of the R lung: (...?...) chest wall; (...?...) to the 4th rib and medially toward the sternum. - inferior lobes of the R and L lungs: (...?...) chest wall

Answer 63

- ANTERIOR and ABOVE - ANTERIOR and BELOW - POSTERIOR

Question 64

The enzyme that converts angiotensin I to angiotensin II is produced by (...?...).

Answer 64

The LUNG ENDOTHELIAL CELLS.

Question 65

Mesothelioma is a malignant tumor of the (...?...). | Causative agent is (...?...).

Answer 65

PLEURA and ASBESTOS DUST.

Question 66

Histologic features of TRACHEA: - epithelia: (...?...) - cartilage: (...?...) C shaped cartilaginous rings - glands: (...?...) - smooth muscle: (localization) - elastic fibers: (...?...)

Answer 66

- PSEUDOESTRATIFIED CILIATED COLUMNAR (PCC) cells, GOBLET cells - 16 to 20 - SEROMUCOUS glands - BETWEEN OPEN ENDS of C-shapped cartilage - PRESENT

Question 67

Histologic features of BRONCHI: - epithelia: (...?...) - cartilage: (...?...) - glands: (...?...) - smooth muscle: (...?...) - elastic fibers: (...?...)

Answer 67

- PCC to SIMPLE COLUMNAR cells - IRREGULAR PLATES - fewer SEROMUCOUS glands - PROMINENT - ABUNDANT

Question 68

Histologic features of BRONCHIOLES: - epithelia: (...?...) - cartilage: (...?...) - glands: (...?...) - smooth muscle: (...?...) - elastic fibers: (...?...)

Answer 68

- CILIATED, some GLOBET cells, CLARA cells in terminal bronchioles - NONE - NONE - HIGHEST PROPORTION of smooth muscle in the bronchial tree - ABUNDANT

Question 69

In (...?...), the secreted mucus is thick or viscous and the cilia have a difficult time moving it toward the pharynx. Patient with this disease have frequent infections of the respiratory system.

Answer 69

CYSTIC FIBROSIS

Question 70

Patients lacking DYNEIN having immotile cilia or (...?...) syndrome. This patients are subject to many infectious respiratory problems. Males also possess immotile sperm.

Answer 70

KARTAGENER

Question 71

(Histology of respiratory tract) The columnar and goblet cells are sensitive to irritation. The ciliated cells become taller, and there is an increase in the number of goblet cells and submucosal glands. Intensive irritation from smoking leads to a (...?...) where the ciliated epithelium becomes a squamous epithelium. This process is reversible.

Answer 71

SQUAMOUS METAPLASIA

Question 72

Bronchial metastatic tumors arise from (...?...) cells.

Answer 72

KULCHITSKY cells

Question 73

CYSTIC FIBROSIS that results in abnormally thick mucus is in part due to defective (...?...) by (...?...) cells

Answer 73

CHLORIDE TRANSPORT and CLARA

Question 74

Chronic obstructive pulmonary disease (COPD) affects the bronchioles and includes (disease 1) and (disease 2)

Answer 74

1) EMPHYSEMA | 2) ASTHMA

Question 75

EMPHYSEMA is caused by a loss of (...type of fibers...) and results in chronic airflow obstruction. Is it REVERSIBLE? (...?...) ASTHMA is a chronic process characterized by a reversible (narrowing?/enlargement?) of airways.

Answer 75

ELASTIC FIBERS and NO NARROWING.

Question 76

(...?...) cells, also called BRONCHIOLAR SECRETORY CELLS are nonciliated and secrete a serous solution similar to (...?...) The number of this cells increases in response to increased levels of polutants like cigarette smoke, and are most abundant in the terminal bronchioles. They are also involved with (...?...) ion transport into the lumens of the terminal bronchioles.

Answer 76

CLARA, and SURFACTANT, and CHLORIDE.

Question 77

Alveolar cell types: 1) (...?...) is involved in gas exchange. 2) (...?...) produce and secrete surfactant.

Answer 77

TYPE I PNEUMOCYTE and TYPE II PNEUMOCYTE.

Question 78

(...?...) induces the fetal synthesis of surfactant. High insulin levels in diabetic mothers antagonize the effects of it. Infants of diabetic mothers have a (...?...) incidence of RESPIRATORY DISTRESS SYNDROME.

Answer 78

CORTICOSTEROIDS and HIGHER.

Question 79

There are openings in the wall of most alveoli that form the pores of (...?...)

Answer 79

KOHN

Question 80

Alveoli have ⬆️ tendency to collapse on expiration as ⬇️ is the radius. This is the law of (...?...)

Answer 80

LAPLACE

Question 81

Pulmonary surfactant is a complex mix of (...?...), the most important of wich is (...?...). Remember Choline, you know french people has weird costumes, so one day CHOLINE was doing a mix salad of LETTUCE, but the main ingredient in this salad was made of DI PALMITO y PHOSPHATIDYL. CHOLINE made LESS salad than she needed, so her ALVEOLI COLLAPSED and she died.

Answer 81

LECITHINS and DIPALMITOYLPHOSPHATIDYLCHOLINE (DPPC)

Question 82

(...?...) cells migrate into the developing heart and play an important role in cardiac development.

Answer 82

NEURAL CREST

Question 83

The primitive heart tube forms (...?...) dilatations and a cranial outflow tract, the (...?...)

Answer 83

FOUR and TRUNCUS ARTERIOSUS

Question 84

``` Embryonic dilatation: Truncus arteriosus (neural crest) ``` Adult structure: (...?...)

Answer 84

AORTA, PULMONARY TRUNK and SEMILUNAR VALVES

Question 85

Embryonic dilatation: Bulbus cordis Adult structure: (...?...)

Answer 85

SMOOTH part of RIGHT VENTRICLE (conus arteriosus) SMOOTH part of LEFT VENTRICLE (aortic vetibule)

Question 86

Embryonic dilatation: Primitive ventricle Adult structure: (...?...)

Answer 86

TRABECULATED part of RIGHT VENTRICLE TRABECULATED part of LEFT VENTRICLE

Question 87

Embryonic dilatation: Primitive atrium Adult structure: (...?...)

Answer 87

TRABECULATED part of RA (pectinate muscles) | TRABECULATED part of LA (pectinate muscles)

Question 88

``` Embryonic dilatation: Sinus venosus (the only dilatation that does not become subdivided by a septum) ``` Adult structure: (...?...)

Answer 88

Right - SMOOTH part of RA (sinus venarum) | Left - CORONARY SINUS and OBLIQUE VEIN of th LA.

Question 89

List the three major venous systems that flow into the sinus venosus end of the heart tube:

Answer 89

1) VITELINE (omphalomesentheric) veins (drain deoxygenated blood from the yolk sac; they will coalesce and form the veins of the liver and part of the IVC) 2) UMBILICAL VEIN (carries oxygenated blood from the placenta) 3) CARDINAL VEINS (carry deoxygenated blood from the body of the embryo, they will coalesce and contribute to some of the major veins of the body (brachiocephalic, SVC, IVC, azygos, renal)

Question 90

During fetal circulation, oxygenated blood flood from the placenta of the fetus throught the umbilical vein. List the vascular shunts that develops in the fetal circulation to bypass blood flow around the liver and lungs.

Answer 90

DUCTUS VENOSUS (oxygenated blood bypass the sinusoids of the liver into the IVC and to de RA) FORAME OVALE (oxygenated blood bypass the pulmonary circulation, into the LA then LV) DUCTUS ARTERIOSUS (shunts deoxygenated blood from the pulmonary trunk to the aorta to bypass the pulmonaru circulation)

Question 91

Umbilical vein becomes (...?...) R and L umbilical arteries (...?...) Ductus venosus becomes (...?...) Forame ovale becomes (...?...) Ductus arteriosus (...?...)

Answer 91

LIGAMENTUM TERES OF LIVER MEDIAL UMBILICAL LIGAMENT LIGAMENTUM VENOSUM FOSSA OVALIS LIGAMENTUM ARTERIOSUM

Question 92

List the pressure gradients in the fetal and postnatal circulation:

Answer 92

Fetal : R -> L Postnatal: L-> R