Exam 3 Flashcards
What does lateral and longitudinal folding cause blood islands to do?
- merge into one solid tube
* long: puts it at definitive position in Thorax
What does the Outflow tract become?
*pulmonary trunk and aorta
What do the conotruncal cushion grow out from?
*wall of primordial heart
What does the endocardial cushion grow out from?
*endocardial part of the heart
Where do the conotruncal cushion originate from?
*Neural Crest cells
What is the pathway for blood that will close?
*ostium primum
what forms from the atrioventricular canal?
*interatrium septum (fibrous skeleton of the heart)
What forms 2nd and closes off to cause misalignment of holes?
*septum seundum
What is the misaligned hole on the L side called?
*oval foramen and valve of oval foramen
What closes in fetal circulation after birth?
*ductus arteriosus, oval foramen, umbilical vein and ductus venosus, and umbilical artery
What becomes the aortic and pulmonary trunk?
- P: pulmonary channel
* A: aortic channel
What percent of babies have septal defects?
- 1% of babies (10% if include still born babies)
What percent of babies with heart problems have other developmental defects?
*30%
What are the signs and treatment of a septal defect in the membranous part of the ventricles?
- doesn’t seal up, surgery required
- baby cyanosis and sweat while suckling
- flow from L to R
How is a septal defect in the muscular part of the ventricles treated?
*seals up on its own
What are the signs of an atrial septal defect and how is it detected and treated?
- if doesn’t seal up, surgery required
- Doppler ultrasound to find hole
- shunt from R to L
- big defect causes blood to bypass pulmonary circuit (cyanotic, sweat while suckling)
- pulmonary side under more pressure (enlarged R side) if have this in adult
What are the alterations a tetralogy of fallot can cause?
- pulmonary stenosis
- overriding aorta
- interventricular septal defect
- hypertrophy
What accompanies tetralogy of fallot and how do you fix it?
- patent ductus arteriosus
* surgical fix
What is stenosis of valves?
*calcium of vales, hardening, narrow opening
What is insufficient of valves?
*doesn’t close right, blood comes back through
What is ductus arteriosus, signs and treatments?
- ductus art doesn’t close
- cyanosis sweat during suckling
- prostaglandins, surgical (can hit recurrent laryngeal nerve)
Where would hypertrophy in tetralogy of fallot occur?
- walls of RV
What part would be effected in the interventricular septal defect in tetralogy of fallot?
*membranous part
What are the muscles of the posterior abdominal wall?
*psoas, quadratus, iliacus, trans abdominis, internal and external oblique
What can a peritoneal infection do?
*travel to psoas major and go into thigh
Where is the pain felt in a psoas abscess?
*fever, pain in flank, pain walking
What is a psoas abscess caused by and how is it treated?
- staph aur
* antibiotics, surgically drained
What produces blood in the fetus?
*spleen
What stores and releases RBC?
*spleen
What is a lymphatic organ and what does that mean?
- spleen
* makes macrophages
What is the spleen derived from?
*mesoderm
What does the spleen do?
- splenic circulation (polysach. antigens recognize)
What are some reason why people don’t have a spleen?
- splenic agenesis, rupture in trauma, disease cured by removal of spleen (Hep c)
What is an overwhelming post splenectomy (OPSI) and how is it treated, and what are the signs?
- bacterial septic (blood infection)
- rec in 24-48 hours, 50-70% die
- intravenous antibiotics
- flu like symp, fever, headache, nausea
- vaccine, renew every 5 years
What gets 20% of the body’s blood supply?
*kidney
What does the kidney do and where is it located?
- removes waste
* T12-L3 vert
What is surrounded by a capsule (stretchy)?
*spleen
What is surrounded by para fat and a strong capsule of CT?
*kidney
What does the renal pyramid have in it?
*millions of nephrons
Where can you get constrictions of the ureters?
*superior part, kink over common iliac arteries, and by bladder
What is a kidney stone (renal calculi) composed of?
*oxalate, calcium, and cholesterol
Where is the pain in a kidney stone felt?
- pain when stretched
* pain in flank, groin, and lower back pain
How do you treat a kidney stone?
*lithotripsy (aim sound waves and tear them apart, epidural)
What is a stag horn calculi?
*kidney stone that remains in renal pelvis
Where do the kidneys develop?
*begin in pelvis ind evelopment
What has little anastomosis?
- segmental artery
Where is the bloodless zone?
*along lateral edge of the kidney
What is a simple renal cyst and how is it treated and detected?
- 1 or a few swollen nephrons
- needle aspirated (if pushing on something)
- ultrasound
What does the suprarenal gland not have?
*hilum
What does the suprarenal gland do?
*produce hormones
What do the hormones for the suprarenal gland do?
*regulate salt balance, glucose, androgens (esp during development)
What is the cortex and medulla derived from?
- C: mesoderm
* M: neural crest cells
Where does the medulla get sympathetic input from?
*T5-L1
What does the Medulla secrete?
*epinephrine and norepinephrine
What is a pheochromocytoma tumor and what are the signs and treatment and ways to detect it?
- adrenal constantly release EPI and norepinephrine
- rapid heart rate, forceful heart beat, high BP, shaking, tremor, sweating
- urine/blood test, imaging
- remove suprarenal gland
What can a high BP put you at risk for?
*heart attack, stroke, kidney failure
Where does the adrenal medulla pathway synapse?
- in adrenal medulla (with Chromaffin)
* has no post ganglionic fibers
What is chromaffin derived from and dump out?
- neural crest cell
* dump EPI and NPE in blood stream
Where is the superior and posterior mediastinum found?
- S: vertebrae T4 and T5
* P: T5-T12
What is in the venous angle?
*internal jugular and subclavian vein
Where are the greater/lesser/least splanchnic nerves found?
*G: T5-T10
Less: T10-T11
L: T10-T12
What do the greater/lesser/least splanchnic nerves supply input to?
*symp input to foregut and midgut
What dumps into azygous on the R side?
*posterior intercostal art
What delivers O2 arterial blood to lung tissues?
*bronchial artery
What do you have in embryo?
*2 aortas and 2 vena cavas
What predominates on the R and L side during embryo?
- vena cave predominates on R
* aorta predominates on L
What does the azygous vein supply blood to?
*superior Vena Cava
What happens in persistent L Vena Cava?
*connect common iliac to Renal on L side
What does the thoracic duct do?
*conveys most lymph of the body to the venous system
What kind of input is the Vagus nerve and what does it innervate?
- parasymp input
* abdominal structures
What is in the aortic arch?
*brachiocephalic trunk, L common carotid art, and L subclavian art
What is coarctation of aorta with collateral circulation and where does it typically occur?
- narrowing that causes obstruction to blood flow to inf part of body
- distal to ductus art and L subclavian art
What are the signs and treatment of coarctation of aorta with collateral circulation?
- babies: sweating during suckling, cyanosis
- adults: bruit, enlarged L side of heart
- balloon catherization, resection and anastomosis
What is Bruit and what can it lead to?
- swishing sound
* congestive heart failure
What are the causes of treatment of coarctation of aorta with collateral circulation?
- duct art tissue eptoptic
* not enough blood delivered during development
What is the origins of the Recurrent laryngeal nerve and what does it do?
- O: vagus nerve
* intrinsic muscle of larynx
What is the pharyngeal arch derived from and how many are there?
- 6
* derived from arch of eardrum, mandible
What happens to the 5th aortic arch?
*never develops
What is the Subclavian art derv from?
*4th arch
What happens to the 6th on the L side become part of?
*pulm artery and ductus arter
What happens to the 6th arch on the R side become?
- disappears
* causes R recurrent larynx. to hook around subclavian art
What closes off the obturator foramen?
*muscle and deep fascia
What separates the greater foramen from the lesser foramen?
*sacrospinous ligament
What structures pass through the greater sciatic foramen?
- superior/ inferior gluteal artery
- piriformis
- sciatic nerve
What does piriformis do?
*lateral rotator of femur
What does the pudendal nerve do?
- inn soft tissue
* leaves pelvis and goes in perineum
What structures pass through the lesser sciatic foramen?
- internal pudendal artery
- pudendal nerve
- obturator internus muscle
What is the pelvic inlet also called?
*pelvic brim
What is the conflict of the pelvic outlet?
*baby head has to fit through here
What do bipedal humans have to have?
*narrow pelvis
What is altricial?
*born immature
What are the boundaries of the pelvic outlet?
*inferior part of pubic symp, ischioppubic ramus, ischiotuberosity, sacrotuberous lig, inf tip of coccyx
What is the pelvic diaphragm?
- musculofascia sling (support for pelvic viscera)
* boundary between pelvis and perineum
What are the functions of the pelvic diaphragm?
*support pelvic viscera, maintain voluntary fecal content, guide baby head out
What is all the soft stuff beneath pelvis and between the thigh called?
*perineum
What are the muscles of the pelvic diaphragm?
*coccygeus Levator ani (iliococcygeus, pubococcygeus, puborectalis)
What is the obturator artery a branch of?
*internal iliac artery
What is the external anal sphincter?
*voluntary
What is the internal anal sphincter made of?
- inner circular layer
* involuntary sphincter
What does the internal sphincter respond to?
*pressure by opening
What is the pectinate lilne?
*anal columns with anal sinus
What is inferior and superior to the pectinate line?
- I: somatic innervation
* S: visceral innervation
What is the spot of the clocal membrane in embryo?
*pectinate line
Which hemorrhoids are painful?
*external
What is internal hemorrhoid associated with?
*age, lining of GI track weaken (can’t hold veins in place)
What wraps around the anal canal and you kink it to control the anal sphincter?
*puborectalis
What is the urinary bladder covered with?
*perineum
What is the wall of the bladder made up of?
*detrusor muscle
Where does the trigone develop from?
*distal part of ureter in embryo
What prevents urine from going back up?
*ureteric orifices
What does the neck of the detrusor muscle function as?
*an internal urethral sphincter
What is the function of the internal urethra sphincter in men and women?
- F: argue if still there
* M: contracts during orgasm, prevents semen from going into bladder
What holds the ovarian artery and vain in place?
*suspensory ligament of ovary
What do the ovaries do?
*produce hormones that regulate uterine cycle and early pregnancy
Where does fertilization happen?
*distal part of uterine tube
What is an eptopic pregnancy and what is it due to?
*can occur in uterine tube, due to scar from STI (chlamydia, gonorrhea)
What are the signs of chlamydia and detection and treatment?
- 20% no symptoms
- pain in lower abdomen, heavy mens bleeding, foul smelling vaginal discharge, fever, painful urination/sexual intercourse
- sample of fluid near cervix
- antibiotics
What is in the lumen of the uterine tube?
*ciliated epithelium, secretory cells
What do the ciliated epithelium and secretory cells do?
- C: propel egg toward uterus
* S: provide nutrition to egg and sperm
What is the function of the uterus?
- smooth involuntary
* development of fetus, expel fetus
How long is the urethra in women?
*2.5-4 cm long
Where does the embryo implant?
*myometrium
What is the endometrium?
*lining of lumen, shed every month
What is scraped during a pap smear and prone to cervical cancer?
*external os
Why does more menstrual cycles make you more likely to get cervical cancer?
*inverts ever month into acidic environment, causes inflammation
What is the Prostate?
*fibromuscular gland (has CT and smooth muscle)
increase in size over age (makes more tissue)
What is BPH (benign prostate hyperplasis), signs/treatment?
- close off urethra, cant drain bladder
- frequent urination, sudden urge to urinate
- drugs to relax muscle, transurethral resection of prostate
What adds the nutrient part to sperm during ejaculation?
*seminal and prostate gland
What is the ductus deferens?
*muscular tube (smooth muscle, moves ejaculate)
Where is sperm produced and stored?
- S: epididymis
* P: testis
What adds the lubricating part of ejaculate?
*bulbourethral gland
What turns 90 degrees and you can puncture while inserting the catheter?
*spongy urethra
What does the spongy urethra contain?
*urethral glands in wall (omit lubricating fluid)
What kind of fibers are in the superior hypogastric plexus?
*symp fibers, has both pre and postganglion fibers
What does the erectile tissue have?
*symp and parasymp innervation
What do the pelvic splanchnic nerves innervate, and what kind of innervation?
*erectile tissue (parasymp)
what kind of fibers does the inferior hypogastric plexus have?
*symp and parasymp
What inn the pudendal nerve?
*anti rami S2-S4, motor and sen functions
Where do the motor and sensory functions of the pudendal nerve go?
- M: inn pelvic diaphragm
* S: perineum and external genital
What does the phallus become?
*penis or clit
What can an undescended testis lead to?
*infertilization and cancer
What is the remnant of vaginal process?
*tunica vaginalis
What is the remnant of the gubernaculum?
*ligament of ovary, round ligament of uterus , scrotal ligament
Where is an indirect (congenital) inguinal hernia found and where is the pulse felt?
- lateral to inferior epigastric vessels
* pulse felt deep over inguinal ring
Where is a direct (acquired) inguinal hernia found and where is the pulse felt?
- medial to inferior epigastric vessels
* more superficial
Who gets more femoral hernias?
*females
What muscles help with erection?
- ischiocavernosus
* bulbospongiosus
What is in the bulb?
*corpus spongiosum
What is the perineal body and what can happen there?
- fibromuscular
- can tear during child birth
- lead to prolapsed uterus, bladder
What is an episiotomy and what can it lead to?
- enlargement of birth canal by cutting muscle
* weakness
What passes obliquely through the tunica albuginea?
*veins that when squeezed become erect
What is a tumescence?
*erection
What happens during the parasympathetic input of an erection?
- arousal/tumescence phase
* causes smooth muscle of helicine arteries to relax and blood flows in
What happens during the sympathetic inputs of an erection?
- ejaculation/ orgasm phase
* vasocontrict, detumescence (blood flows out)
What does the anterior compartment of the arm do?
*arm extension and forearm flexion
What does the biceps brachii do?
*supination
What does the brachialis do?
- main forearm flexor
* inn by musculocutaneous nerve
What does the coracobrachialis do?
- arm adductor
* weak arm extensor
What does the forearm do?
*flexion, extension, abduction, adduction of wrist
How many muscles are in your forearm?
*19
What does the flexor carpi radialis do?
*flex wrist/wrist abduction
What does the palmaris longus do?
*tenses palmar aponeurosis
What do 2-60% or people not have?
*palmaris longus
What does the flexor carpi ulnaris do?
*adduct wrist
What does the first layer of the forearm do and what does it attach to?
- pronators and flexor
* attach to medial epicondyle (common flexor tendon)
What is the distal attachment for the flexor digitorum superficialis and what does it do?
- middle phalanges
* flexes metacarpophalangeal and proximal interphalanges
What is the distal attachment for the flexor digitorum profundus and what does it do?
- distal phalanges
* flexes metacarpophalangeal and proximal/distal interphalanges
What does the flexor pollicis longus do?
*flexes thumb
What does the pronator quadratus do?
- primary pronator
* fibers going 90 degrees
What innervates the anterior forearm?
*median nerve
What does the ulnar nerve innervate?
*medial half of flexor digitorum profundus and ulnaris
What innervates the Thenar muscle?
*median nerve
What can cause an injury at the median nerve?
*cubital fossa, supracondylar fracture
What are the symptoms of a median nerve injury?
- thenar wasting (ape hand)
- diminished opposability
- lose of pronation
- numb/tingling in lateral 3.5 digits
What causes injury to the ulnar nerve?
*fracture of medial epicondyle
What are the signs of ulnar nerve injury?
- wasting of hypothenar (claw hand)
- digits 3,4,5 hyperextension at metacarp joints, flexed at proximal/ distal interph. joint
- middle digit has sensory deficit
- lose function in adduction/abduction of digits
What does the posterior compartment of the forearm do, what is it innervated by and what are its origins?
- extend wrist and digits, abduction/extension of thumb, supination
- origins of common extensor tendon (on lateral epicondyle)
- all inn by radial nerve
What is the extensor digiti minimi attached to?
*5th digit
What is the extensor carpi radialis longus attached to?
*2nd metacarp
What is the extensor carpi radialis brevis attached to?
*3rd metacarpal (more deep)
What can cause damage to the radial nerve and what are the signs?
- broken humerus
- wrist drop (can’t extend wrist)
- if at proximal wrist (diff extending elbow)
What is a reflex?
*rapid involuntary response to a stimulus
What is clonus?
- most hyperactive a reflex can be
* reflex keeps working indefinitely
What does a hypoactive and hyperactive reflex indicate?
- O: peripheral problem
* E: Central problem
What does a Golgi tendon detect?
*tension of tendon
What does a muscle spindle detect?
*movement of muscle fibers
How can a legion be determined?
*by reflexes in CNS and PNS (can find location)
What kind of reflexes are there?
*deep tendon, cranial nerve, cutaneous stimulation
How do you score reflexes?
*0-absent, 1-hypoactive, 2-normal, 3-hyperactive without clonus, 4- hyperactive with clonus
What is a doctor looking for when they are checking your reflex?
*symmetry
What spinal segments are affected in a quadriceps, triceps, biceps, calcaneal, and plantar reflex?
*Q: L3,4
*C:S1
*P: L5,S1
*T: C6,7
B:C5,6
What are the normal response to a plantar reflex check?
- babies: spread toes apart
* adults: curl toes
What is a Babinski sign and what does it indicate?
- CNS legion
* separate toes during plantar reflex test
What is bifurcation of the brachial artery and how common is it?
- divides at middle of arm
* 3%
What can high bifurcation cause?
- ulnar art run superficial (mistaken as vein)
* chemical drug can accidently be put into it
What is a chemical endartitis?
- put drugs in brachial artery
* damage art, inflammation of capillary distal to site of injection (causes blood clott, circulation shut down)
What runs on superficial side of serratus anterior?
*long thoracic nerve
How can the long thoracic nerve get injured?
*stabbing injury
What does a damage to the long thoracic nerve cause?
- winged scapula
* can’t hold scapula against rib cage, pops out
