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Anatomy Flashcards

0
Q

Which veins shunt from the portal to the systemic system in caput medusae.

A

Para umbilical to superior/inferior epi gastric below the umbilicus and superior epi gastric and lateral thoracic above the umbilicus

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1
Q

Which veins shunt from the portal to the systemic system in esophageal varices?

A

Left gastric to esophageal

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2
Q

Which veins shunt from the portal to the systemic system in internal hemorrhoids?

A

Superior rectal to middle/inferior rectal veins

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3
Q

What is TIPS?

A

Transjugular intrahepatic portosystemic shunt between the portal and hepatic vein

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4
Q

Where is the CTZ zone located?

A

On the dorsal aspect of the medulla at the caudal end of the 4th ventricle (area postrema)

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5
Q

Where is the inferior thyroid artery?

A

Arises from subclavian.
Behind the carotid artery and jugular vein
Supplies the inferior pole of the thyroid gland

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6
Q

Where is the ansacervicalis?

A

Arises from C1-3 and innervates muscles in anterior neck

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7
Q

Where would penetrating trauma be to injure ansa cervicalis.

A

To the neck superior to cricoid cartilage

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8
Q

What nerve is injured with a positive Trendelenburg sign?

A

Superior gluteal

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9
Q

What would injury to the obturator nerve cause?

A

Loss of adduction

Loss of medial thigh sense

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10
Q

What would injury to the inferior gluteal nerve cause?

A

Glut max problems - can’t climb stairs or get up from a chair
Extension and external rotation

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11
Q

What is lost in an injury to the femoral nerve?

A

Loss of knee reflex and anterior thigh sensory

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12
Q

What courses through the cribiform plate?

A

CN I

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13
Q

What goes through the optic canal?

A

CN II
Ophthalmic artery
Central retinal vein

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14
Q

What goes through the superior orbital fissure?

A

CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers

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15
Q

What goes through foramen rotundum?

A

V2

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16
Q

What goes through foramen ovale?

A

V3

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17
Q

What goes through foramen spinosum?

A

Middle meningeal artery and vein

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18
Q

What are is the middle meningeal artery from?

A

Maxillary

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19
Q

What goes thru the internal acoustic meatus?

A

CN VII, VIII

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20
Q

What goes thru the jugular foramen?

A

CN IX, X, XI

Jugular vein

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21
Q

What goes thru the hypoglossal canal?

A

CN XII

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22
Q

What goes thru foramen magnum?

A

Spinal roots of CNXI, brain stem, vertebral arteries

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23
Q

What would injury to the middle frontal gyrus cause?

A

Deviation of eyes to the ipsilateral side (FEF lesion)

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24
Q

What is the area injured in Wernicke’s aphasia?

A

Superior temporal gyrus (Brodmann 22)

From injury to posterior branch of middle cerebral artery

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25
Q

At what level does the facial nerve arise in the brain stem?

A

Dorsolateral aspect of the pontomedullary jxn

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26
Q

Where does oculomotor nerve arise in the brainstem?

A

The level of superior colliculus (mesencephalon)

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27
Q

Where does the trochlear nerve arise?

A

At level of inferior colliculus (crosses before exiting brainstem)

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28
Q

What nerve courses with the inferior thyroid artery?

A

Recurrent laryngeal nerve

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29
Q

Where does the recurrent laryngeal branch loop on the right?

A

Below the subclavian

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30
Q

Where does the recurrent laryngeal nerve loop on the left?

A

Around the aortic arch

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31
Q

What does the recurrent laryngeal nerve supply?

A

All muscles of the larynx except cricothyroid

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32
Q

What does injury to the recurrent laryngeal nerve cause?

A 
Unilateral = hoarseness
Bilateral = respiratory difficulty
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33
Q

Which ribs overlie the spleen?

A

Ribs 9-11

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34
Q

Where do T cells become double positive?

A

In the cortex of the thymus

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35
Q

Where do T cells undergo negative selection?

A

In the medulla

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36
Q

What leads have Q waves with an anterior wall MI?

A

V1-V4

LAD

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37
Q

Where is the infarction if leads II, III, aVF have q waves?

A

Inferior wall

RCA

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38
Q

Where is the infarction if q waves are seen in leads V4-V6?

A

Anterolateral - lateral and posterior walls of left ventricle
LCX

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39
Q

Where is the infarction if you can see q waves in leads I and aVL?

A

Lateral wall of LV

LCX

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40
Q

Where is the infarction if q waves are in V1-V2

A

Anteroseptal

LAD

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41
Q

What structure does RCA provide?

A

SA and AV nodes
Papillary muscles
Posterior 1/3 of the inter ventricular septum and posterior walls of the ventricles
Right ventricle

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42
Q

What does the LCX provide?

A

Supplies lateral and posterior walls of the left ventricle

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43
Q

What does the LAD supply?

A

The anterior 2/3 of the septum
Anterior papillary muscle
Anterior surface of the left ventricle

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44
Q

Where is the left atrium?

A

Posterior

Base of the heart

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45
Q

What can enlargement of the left atrium cause?

A

Dysphagia and hoarseness due to compression of the left recurrent laryngeal nerve

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46
Q

Where are gastric glands located?

A

Laminate propria

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47
Q

Which areas of the colon are most susceptible to ischemia?

A 
Splenic flexors (watershed area from SMA and IMA)
Sigmoid colon (btween IMA and hypo gastric arteries
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48
Q

What is contraindicated in a patient suspects of toxic mega colon?

A

Colonoscopy and barium enema - perforation

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53
Q

What does the falciform ligament do?

A

Connects the liver to the anterior abdominal wall

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54
Q

Which ligament connects the greater and lesser sacs?

A

Hepatoduodenal

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55
Q

Which ligament holds the gastric arteries?

A

Gastrohepatic

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56
Q

Which ligament separates the greater and lesser sacs on the right? The left?

A

Gastrohepatic

Gastrosplenic

57
Q

What are the layers of the gut wall?

A

Mucosa = laminate propria, muscularis mucosa, epithelium
Submucosa = regulates BF, secretions, absorptions, meissner’s
Muscularis externa = inner circular, myenteric nerve plexus (auerbach’s), outer longitudinal
Serosa

58
Q

What is the histo of the duodenum?

A

Villi, microvilli,
brunner’s glands (secrete alkaline fluid)
Crypts of lieberkuhn (have gi stem cells)
Tubular glands in submucosl layer

59
Q

What is the histo of the jejunum?

A

Heavy lymphocytic infiltrate in the laminate propria
Plicae circularis
Crypts of lieberkuhn

60
Q

What is the histo of the ileum?

A

Peyer’s patches (laminate propria, submucosa)
Crypts
Most goblet cells in small intestine

61
Q

What is the histo of the Colon?

A

No villi
Crypts
Lots of goblet cells

62
Q

Ulcers in the lesser curvature of the stomach cause bleeding from what artery?

A

Left gastric

63
Q

Obstruction of the splenic artery causes ischemia thru which bvs?

A

Short gastric because left gastroepiploic has good anastomoses

64
Q

Which part of the duodenum is close to the head of the pancreas?

A

2nd part

Contains ampulla

65
Q

Which part of the duodenum is close to the aorta, IVC, and SMA?

A

The 3rd part (transverse)

May get caught between aorta and SMA

66
Q

Where do internal hemorrhoids drain?

A

Superior rectal vein –> inferior mesenteric vein –> portal
To deep nodes

67
Q

Where do external hemorrhoids drain?

A

Inferior rectal vein –> internal pudendal vein –> internal iliac vein –> IVC
To superficial inguinal nodes

68
Q

What is the centrilobular portion influenced by?

A

Ischemia
Toxins (alcohol)
Contains the p450 system and is furthest away from the portal triad

69
Q

What are the features of an indirect inguinal hernia?

A

Lateral to the inferior epigastric vessels
Goes into the scrotum
Occurs due to failure of processes vaginalis to close
Covered by all 3 spermatic layers
Goes through transversalis

70
Q

What are the features of a direct inguinal hernia?

A

Medial to the inferior epigastric arteries
Lateral to rectus abdominis
Covered by external spermatic fascia
Older men

71
Q

Where is a femoral hernia?

A

Below the inguinal ligament
Lateral to pubic tubercle
More common in women and right side

72
Q

Where are the G cells?

A

In the Antrum of the stomach

73
Q

Where are the I cells in the GI tract?

A

Duodenum
Jejunum
Secrete CCK - delay gastric emptying, gall bladder contraction, relax sphincter of Oddi

74
Q

Where are the S cells?

A

Duodenum

Secretin - cause pancreatic bicarbonate secretion and bile secretion

75
Q

Where are the D cells?

A

Pancreatic islets
GI mucosa
Somatostatin

76
Q

Where are the K cells in the GI tract?

A

Duodenum
Jejunum
Glucose dependent insulinotropic peptide - increases insulin release and decreases gastric acid secretion
Causes oral glucose to be used more rapidly than IV glucose

77
Q

Where is VIP secreted from?

A

Parasympathetic ganglia in sphincters, gallbladder, small intestine

Increases intestinal water and electrolyte secretion
Increases relaxation of sphincters

78
Q

What secretes bicarbonate in the GI tract?

A

Mucosal cells of stomach, duodenum, salivary glands, brunner’s glands, pancreas

79
Q

Where are the peyer’s patches?

A

In laminate propria and submucosa of ileum

80
Q

What artery bleeds from a ruptured ulcer in the posterior wall of the duodenum?

A

Gastroduodenal artery

81
Q

Where does perforation of the duodenum often occur?

A

In the anterior part of the duodenum,

82
Q

Where are ulcers in the stomach most often located?

A

In the lesser curvature of the stomach at the junction of the

83
Q

Where is zenker’s diverticulum

A

Between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor
Due to cricopharyngeal muscle dysfunction

84
Q

What is the in the mucosal layer of the gut wall?

A

Epithelium for absorption
Laminate propria for support
Muscularis mucosa for motility

85
Q

What is in the submucosa layer of the gut wall?

A

Meissner’s plexus - regulates blood flow, secretions, absorption

86
Q

What is in the muscularis externa?

A

Auerbach’s - myenteric plexus for contractility
Inner circular
Outer longitudinal

87
Q

What is the most common location for diverticulum?

A

Sigmoid colon

88
Q

Where do volvulus occur?

A 
Cecum (young adult)
Sigmoid colon (elderly)
89
Q

Where are angiodysplasia located?

A

In the cecum, terminal ileum and ascending colon

90
Q

Where does the recurrent laryngeal nerve loop on the right?

A

Below the right subclavian at the jxn of brachiocephalic artery

91
Q

Where does the recurrent laryngeal nerve on left?

A

Under the aortic arch

92
Q

What lymph nodes does the distal 1/3 of the vagina, vulva, scrotum drain to?

A

Superficial inguinal

93
Q

What lymph nodes does the proximal 2/3 of vagina/uterus?

A

Obturator, external iliac and hypo gastric nodes

94
Q

What lymph nodes do the glans penis and clitoris drain to?

A

Deep inguinal nodes

95
Q

Where do the superficial and deep inguinal nodes drain?

A

External iliac nodes to the common iliac nodes

96
Q

What ligament holds the ovarian vessels?

A

Suspensory ligament of the ovaries

97
Q

What ligament holds the uterine vessels?

A

Cardinal ligament

98
Q

What is contained in the broad ligament?

A

Uterus
Fallopian tubes
Ovaries

99
Q

What nerve mediates ejaculation?

A

Hypo gastric nerve

100
Q

What nerve mediates erection?

A

Pudendal nerve

101
Q

Where are the Sertoli cells? What do they do?

A

In seminiferous tubules
Secrete inhibit, Mif, androgen-binding protein to maintain local levels of testosterone
Form blood-testis barrier

102
Q

What cell makes hCG?

A

Synctiotrohphoblast

103
Q

What is the outermost layer of the spermatic cord?

A

External spermatic fascia (from external oblique)

104
Q 
Originates from proximal tubule cells 
Polygonal clear cells 
Most common in men 50-70 yo 
Ass. With gene deletion in ch.3 
Invades renal vein - can present with varicocele 
Resistant to chemo and radiation
A

RCC

105
Q

Palpable flank mass with hematuria in a 2-4 yo
HTN
Small blue cells
Associate with beckwith Weismann and WAGR complex

A

Wilms tumor

106
Q

Associated with exposure to phenacetin, rubbers, aniline dyes, cyclophosphamide, leather, textiles, plastics
Papillary growth with pleomorphism
Flat growth = high grade from p53 mutations
Presents with painless hematuria

A

Transitional cell carcinoma

Can be in calyces, pelvis, ureters, or bladder

107
Q

Arises from urachal remnant at the dome of bladder

A

Adenocarcinoma

108
Q

Lipidized astrocytes
Reticulin deposits
Chronic inflammatory infiltrate

A

Pleomorphic xanthoastrocytoma

109
Q

Located As cystic and solid mass in Posterior fossa
GFAP positive
Rosenthal fibers -Eosinophilic corkscrew

A

Pilocytic astrocytoma

110
Q 
Midline cerebellum tumor of blue cells 
Increased MYC
Homer wright rosettes 
Radio sensitive
Associated with Turcot's 
Drop mets to spinal cord
A

Medulloblastoma

111
Q

Perivascular pseudorosettes
Rod-shaped blepharoplasts found near nucleus
Found in 4th ventricle

A

Ependymoma

112
Q

Foamy cells
High vascularity
Cerebellum
Can secrete EPO

A

Hemangioblastoma

113
Q

Cystic spaces with brown fluid and cholesterol
Calcification
Keratin pearls lined by stratified squamous
May cause bitemporal hemianopsia

A

Craniopharyngioma

114
Q

Precocious puberty
Impaired upward gaze
Obstructive hydrocephalus

A

Germinoma in dorsal midbrain

115
Q

Stains for GFAP
Serpentine necrosis
Pseudopalisading pleomorphic tumor cells
Central areas of necrosis and hemorrhage
May cross midline
Infiltrative
Mutations in PDGF, p53, EGFR

A

Glioblastoma multiforme

116
Q 
Spindle cells with whorled pattern
Psammoma bodies
Near parasagittal brain and surfaces
From arachnoid villi cells
May have dural attachment 
Due to loss of Merlin in ch.22
A

Meningioma

117
Q 
Chicken-wire capillary pattern 
Round nuclei with clear cytoplasm
Calcification
GFAP positive 
Due to loss of heterozygosity 
Only in white matter
Most often in frontal lobes
A

Oligodendroglioma

118
Q

S100 positive
Present with facial numbness/weakness, tinnitus, hearing loss
Regular, oval nuclei with areas of dense, loose growth

A

Schwannoma

119
Q 
Grows in epiphysis of long bones
Soap bubble or double bubble on X-ray
Spindle cells with multinucleated cells (grow in synctium)
Large red/brown cystic degeneration 
20-40 yo
A

Giant cell osteoclastoma

120
Q

Bony stalk near growth plate of long bones
Mature bone with cartilaginous cap
From metaphysis

A

Osteochondroma

121
Q

In metaphysis of long bones
Codman’s triangle
Makes new bone - mixed lytic/blastic lesion in X-ray
Mutations in RB
Rf: Paget’s disease! Radiation, bone infarcts

A

Osteosarcoma

122
Q 
In boys under 15
Arises in diaphysis 
Anaplastic blue cell tumor 
Responsive to chemo 
Onion skin appearing in bone 
Associated with t(11;22) translocation 
Homer wright rosettes, necrosis/hemorrhage
May have systemic systems: fever, increased ESR, anemia, increased WBCs
A

Ewing sarcoma

123
Q

Usually located in pelvis, spine, scapula, humerus, tibia or femur
Expansive glistening mass within medullary cavity

A

Chondrosarcoma

124
Q

Pink pearly nodules with telangectasias
Palisading nuclei
Upper lip

A

BCC

125
Q

S100 positive
Driven by activating mutation in BRAF kinase
Nodular form is the worst

A

Melanoma

126
Q

Psammoma bodies
Orphan-Annie nuclei, nuclear grooves
Most common type

A

Papillary thyroid carcinoma

127
Q

Uniform cells in capsule that are invading

Spreads hematogenous lay

A

Follicular carcinoma of thyroid

128
Q

Sheets of cells in amyloid stroma
Associated with RET mutation
Can present with hypocalcemia
From para follicular cells (neuroectoderm)

A

Medullary carcinoid of the thyroid

MEN2

129
Q

Where do the ureters course?

A

On top of psoas
Under the uterine artery and ductus deferens
Crosses over external iliac artery and vein
Medial to gonadal veins and lateral to the internal iliac

130
Q

What is the blood supply to the ureter?

A 
Upper = renal artery 
Distal = branches of aorta, iliac, gonadal
171
Q

Where is the SVC in relation to the other vessels?

A

The SVC is to the right of the aorta

The aorta is in the middle of the SVC and pulmonary trunk

172
Q

What are the retroperitoneal structures?

A

SADPUCKER

Supra renal gland
Aorta and IVC 
Duodenum (2nd and 3rd parts) 
Pancreas
Ureters
Colon
Kidneys
Esophagus (lower 2/3)
Rectum 
Bladder
173
Q

What ligament holds the portal triad?

A

Hepatoduodenal ligament

174
Q

What ligament holds the derivative of the umbilical vein?

A

Ligamentum teres hepatis in the falciform ligament

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