Gross Anatomy Exam 2 - weeks 6-9 Flashcards
1
Q
heWhat is the action of the pyramidalis?
A
Tenses the linea alba. Fun fact its absent in 20% of people.
2
Q
Where are the important places where the ribs articulate with the sternum?
A
2nd rib at angle of Louis/manubriosternal joint. 7th rib at xiphisternal joint.
3
Q
What is the venous drainage to the diaphragm?
A
Thoracic surface: pericardiacophrenic, musculophrenic (to internal thoracic), superior phrenic (to IVC or azygos). Abdominal surface: inferior phrenic (right to IVC, left anteriorly to IVC, posteriorly to left renal vein).
4
Q
What are the vestibular glands of the genitals?
A
Greater/Bartholin’s is in the superficial perianal pounch on either side of the vestibule of vagina, and they secrete mucus in arousal. Lesser/Shene’s are paraurethral glands on either side of vestibulr of vagina, open into vestibule near urethra and secrete mucus to moisten labia and vestibule.
5
Q
Where are the jejunum and ileum located?
A
Proximal 2/5 LUQ, distal 3/5 RUQ.
6
Q
Describe the venous and lymphatic drainage of the esophagus.
A
Left gastric vein (drains into portal venous system). Esophageal vein (drains into Azygos). The left gastric LNs drain into the celiac LNs.
7
Q
What are the parts of the stomach?
A
Cardia (T1 when supine), fundus, body, pylorus (antrum at ~L1 and canal) with sphincter.
8
Q
Where do the pancreatic ducts enter the duodenum?
A
Main via major duodenal papilla (joins common bile duct). Accessory via minor duodenal papilla. Common bile duct and main pancreatic duct each have a sphincter. The major duodenal papilla has a hepatopancreatic ampulla (of Vater) and a sphincter (of Oddi).
9
Q
What determines heart dominance?
A
The origin of the posterior interventricular artery. Right dominance (RCA) ~70%.
10
Q
What are the layers covering the testes?
A
Skin, Tunica Dartos, 3 spermatic layers, Tunica vaginalis (parietal and visceral), tunica albuginea.
11
Q
What is the reflected inguinal ligament?
A
Superior fibers of the external oblique aponeurosis and lacunar ligament fans upwards crossing the libea alba instead of inserting into the pubic tubercle.
12
Q
Descrine the broad ligament of the uterus.
A
2 peritoneal layers. It connects the lateral uterus to the lateral pelvic wall. Mesosalpinx (supports uterine tube), Mesovarium (attaches to ovary), Mesometrium (attaches to uterus).
13
Q
What are the innervations to the heart?
A
Vagus (parasympathetic), Sympathetic (presynaptic T1-T4 and postsynaptic cervical and superior thoracic ganglia), Visceral afferent fibers (travel with sympathetic fibers).
14
Q
List the anterior divisions of the internal iliac artery.
A
Obturator (20% from external iliac), Umbilical (gives off superior vesical_, Inferior vesical, Uterine, Vaginal, Internal pudendal, Inferior gluteal, Middle rectal.
15
Q
What are the infraperitoneal organs?
A
They are only partly covered by parietal peritoneum. The distal 2/3 of the rectum, urinary bladder.
16
Q
What is the insertion of rectus abdominis?
A
Costal cartilages 5-7.
17
Q
What is the origin of psoas major?
A
Transverse process of lumbar vertebrae, sides of T12-L5 bodies and IV discs,
18
Q
What are the boundaries of the inguinal canal?
A
Anterior wall - External oblique aponeurosis. Posterior wall - Transversalis fascia. Floor - Inguinal ligament. Roof - Conjoint tendon.
19
Q
What is the inguinal ligament of Poupart?
A
Fibrous, thickcned, folded margin of external oblique aponeurosis spanning from the ASIS to the pubic tubercle.
20
Q
What is the deep venous drainage to the abdominal wall and what do they drain into?
A
Superior epigastric (into internal thoracic). Inferior epigastric (into external thoracic). Paraumbilical (into hepatic portal vein - communicates with periumbilical).
21
Q
What is the thoracic duct?
A
The largest lymphatic channel in the body. originates from chyle cistern at L2 level - ascends to right of T5-L2 and thoracic aorta, left of azygous vein, posterior to esophagus, crosses to left at sternal angle, empties at left venous angle (union of left internal jugular and subclavian vein). It drains everything except the right upper quadrant (right lymphatic duct - right venous angle).
22
Q
What are the arteries of the penis?
A
Dosral, perianal, artery of bulb, deep arteries that supply corona cavernosa (have Helicine branches).
23
Q
What is the sympathetic, parasympathetic innervation, general venous and lymphatic drainage to the midgut?
A
T9-T12 splanchnic nerves and superior mesenteric ganglion, Vagus nerve, SMV, SM LNs.
24
Q
Describe the intercostal veins.
A
11 posteriorly on each side. 1st drains (usually) into BCV. 2-3rd form superior intercostal trunk, which branches into the azygous to the right and the BCV to the left. 4-11th drain into the azygous/hemiazygous system, which goes into the SVC. The anterior intercostal veins drain into the internal thoracic vein. The anterior and posterior intercostal veins anastomose as they approach the vertebral column.
25
Where do you auscultate the inferior lobe of the lung?
Anteriorly in the 6/7th intercostal space Posteriorly in the triangle of auscultation (trapezius, latissimus dorsi, medial border of scapula)
26
Describe the right vagus nerve.
Enters anterior to the right subclavian artery, travels between right BCV and trachea, posterior to right hilum. Gives off right recurrent laryngeal branch - hooks under subclavian artery and ascends between trachea and esophagus.
27
What is the innervation of the external obliques?
Anterior rami of T7-T12.
28
What are the renal blood supply segments?
Apical, anterosuperior, anterioinferior, posterior, inferior.
29
What are the structures in the posterior mediastinum?
Descending aorta Azygous (and hemiazygous and accessory hemiazygous veins) Thoracic duct Esophagus Sympathetic trunk/splanchnic nerves Intercostal arteries Vagus nerve plexus and trunks (DATES IV)
30
Describe the renal medulla.
Has columns and calyces. 2-3 minor calyces drain into a major one, 2-3 major calyces drain into the renal pelvis. The apex of the renal pyramid is a renal papilla - indents each minor calyx.
31
Where does the inferior epigastric artery branch from? What does it anastomose with?
The external iliac artery. The superior epigastrics.
32
What are the typical ribs and what do they have?
3-9. Head, neck, shaft, costal angle, transverse tubercle, articular facet, costal groove.
33
Describe the urogenital triangle.
From the ischiopubic rami to prepuce of the clitoris. Skin, superficial perineal fascia, deep perineal / Colles fascia, superficial perineal pounch, perineal membrane, deep perineal pouch.
34
What is the transverse sinus of the pericardium?
Passage between the ascending aorta and the pulmonary trunk. A ligature is passed through this to clamp ascending aorta and pulmonary trunk during surgery.
35
Describe the structure of the liver.
Largest gland, major lymph producing organ, 9 functional lobes based on blood supply. Right and left lobes divided by falciform ligament (round ligament inferiorly). Interiorly and anteriorly there is the quadrate lobe, posteriorly the caudate lobe. There is the coronary ligament with the triangular ligaments laterally. The visceral surface has the ligamentum venosum. Inferiorly is the porta hepatis. The bare area is not covered by visceral peritoneum.
36
What spaces are made by the folding of the peritoneum in the female pelvic cavity?
Vesociuterine and retrouterine spaces.
37
What is the venous drainage of the stomach and where do the veins go?
Prepyloric veins -\> right gastric veins Gastric veins -\> hepatic portal vein Left gastro-omental and short gastric veins -\> splenic vein Right gastro-omental veins -\> SMV
38
What are the anterolateral abdominal wall muscles?
External and internal obliques, transversus abdominis.
39
What are cervical ribs?
0.5-2% of the population, can be uni or bilateral. They are associated in thoracic outlet syndrome - compression of neurovascular structures exiting/entering the superior thoracic aperture.
40
Describe the rectus sheath.
The aponeuroses of the anterolateral abdominal muscles. It contains the rectus abdominis muscles, superior and inferior epigastric vessels, T7-T12 anterior rami.
41
Where does spleen lymphatic drainage go?
To the celiac LNs.
42
Describe the external intercostal muscles.
"Hands in pockets" orientation. Exist posteriorly, then the membrane comes. Go from rib tubercles to the costochondral junction
43
Describe rib dislocation vs rib separation.
Dislocation is at the sternocostal joint or between the interchondral joints. Separation is at the costochondral joints and can displace superiorly and overlie rib above.
44
Describe pulmonary circulation - the pulmonary veins and arteries.
Pulmonary arteries turn into lobar arteries which turn into tertiary segmental arteries (and segmental branches) which supply a single bronchopulmonary segment. 2 pulmonary veins drain into a single lung, run independent of arteries and bronchi. They are intersegmental.
45
What is the anatomical location and auscultation site of the pulmonic valve?
Medial left 3rd costal cartilage. Auscultation site: Left parasternal 2nd intercostal space.
46
What is the sympathetic innervation to the liver?
The hepatic nerve plexus (part of the celiac plexus).
47
What is the innervation of the transversus abdominis?
Anterior rami of T6-L1.
48
What section of the mediastinum is the heart in?
The middle.
49
What is the action of the internal obliques?
Bilaterally - flexion of the trunk and compression of viscera. Unilaterally - Lateral flexion and ipsilateral trunk rotation.
50
What muscle aponeuroses are anterior to the rectus sheath above the arcuate line?
External oblique and 1/2 of internal oblique.
51
What is the fundus of the bladder?
The posterior surface.
52
Describe the paths of the phrenic nerves.
Anterior to the lung roots. Right descends along right side of SVC/IVC and pierces diaphragm near caval opening. Left descends lateral to left subclavian artery, course superficial to left atrium and ventricle, pierces diaphragm to left of pericardium.
53
Describe the thoracic aorta and its branches.
Begins left of T4 and descends posterior to esophagus. The most inferior part is dead center, esophagus displaced left. Anterior unpaired branches - to gut, pericardial, mediastinal Lateral paired branches - to viscera other than guts Posterolateral paired branches - 3-11th posterior intercostal arteries, subcostal arteries (1 each side) that supplies diaphragm
54
What are the ligaments connected to the ovary?
Mesovarium (attaches to lateral pelvic wall, part of broad ligament), Suspensory ligament (to lateral pelvic wall), Ovarian ligament (to the uterus).
55
Describe the pelvic diaphragm/floor.
Made up of the coccygeus and levator ani (puborectalis, pubococcygeal, iliococcygeus). Contains the pudendal nerve.
56
Describe the endopelvic fascia.
CT condensations that passively support the uterus. Uterosacral ligament (cervix to sacrum), Transerse Cervical / Cardinal ligament (cervix to lateral wall of pelvis), Pubocervical ligament (pubis to cervix).
57
What makes up the superior and inferior/diaphragmatic borders of the heart?
Superior: atria and auricles Inferior: RV (mainly) and LV
58
What are the anastomoses between the SMA and IMA?
The middle colic and left colic arteries. Form the marginal artery of Drummond.
59
What does the internal pudendal artery supply?
The main supply to the perineum, perianal muscles, external genitalia, erectile tissues.
60
Describe the thoracolumbar fascia.
Covers deep back muscles. Posterior sheath is thick, lumbar part of posterior sheath extends between the 12th rib and the iliac crest and attaches laterally to the internal obliques and transversus abdominis. Includes quadratus lumborum and psoas fascia.
61
Describe the internal intercostal muscles.
Anterior and then a membrane. Go from sternum to angle of ribs. The neurovascular bundle is deep to them.
62
What are the peritoneal recesses?
Paracolic gutters, subphrenic recess, subhepatic space, hepatorenal recess.
63
Describe the ilohypogastric nerve.
L1. Innervates abdominal muscles and skin of inguinal and pubic region.
64
What does rib 1 have that typical ribs do not?
A groove for the scalene tubercle and subclavian vessels. It also only has a single facet.
65
What is the insertion of the transversus abdominis?
Pubis via conjoint tendon, linea alba.
66
What innervates the suprarenal glands, kidneys, and ureters?
Suprarenal glands by the celiac plexus (no parasymp.), Kidneys by the renal plexus and the vagus nerve. Ureters by the renal, abdominal aortic, and superior/inferior hypogastric plexi. They also have pain/GVA axons that follow the sympathetic fibers to T11-L2.
67
What are the three parts of the muscular part of the diaphragm?
Sternal (2 muscular slips from xiphoid process), Costal (forms domes, interdigitates with transversus abdominis), Lumbar (arises from medial and lateral arcuate ligaments, forms right and left crura - right is bigger).
68
Describe the cysterna chyli.
Anterior to L2, marks beginning of the thoracic duct. Intestinal trunk - GI tract, liver, spleen, pancreas. Lumbar trunks - posterior abdominal wall, kidney, ureter, gonads, uterus, uterine tubes.
69
What is the innervation of the internal obliques?
Anterior rami of T6-L1.
70
Describe the aortic arch.
Begins and ends at level of sternal angle, arches over the left hilum superiorly and posterolaterally to the left, then descends inferiorly beside T4-T12 vertebrae (thoracic aorta). Branches are brachiocephalic trunk, left common carotid artery, left subclavian artery. Variations - can have retroesophageal right subclavian artery (no brachiocephalic trunk), esophagus compressed. Can also have double arch of the aorta/vascular ring anomaly. Can cause stridor and dysphagia.
71
What are the layers of the anterolateral abdominal wall?
Camper's fascia, Scarpa's fascia, 3 muscles, transversalis fascia, extraperitoneal fat, parietal peritoneum.
72
Where do you auscrultate the middle lobe of the right lung?
Anteriorly in the 4th intercostal space
73
What muscles make up continence?
Puborectalis forms a sling around the anorectal junction, Pubococcygeus compression.
74
Describe the posterior abdominal wall veins.
Tributaries of IVC, begins L5 where the common iliac veins meet. Tributaries correspond to the paired visceral and parietal branches of the aorta.
75
What is the insertion of the internal obliques?
Pubic via conjoint tendon, ribs 10-12, linea alba.
76
What are the peritoneal folds?
Medial umbilical, medial umbilical (x2), lateral umbilical (x2).
77
Where do the lineae semilunaris go from/to and what does it mark?
From costal cartilage to pubic tubercles. It marks the lateral border of the rectus sheath.
78
What does the superior vesical artery supply?
The superior bladder and vas deferens.
79
What is the arterial supply to the ureters?
Descending branches by renal and gonadal arteries. Ascending branches by internal iliac arteries.
80
What is the arterial supply and venous drainage of the testicles?
Testicular arteries (arise from aorta at L2), cremasteric arteries and artery of vas deferens exist. The right pampiniform plexus drains into the IVC, left into left renal vein.
81
Roughly what vertebral levels are the kidneys at?
Approximately T12-L3.
82
Describe the left coronary artery.
Gives off Anterior IV Artery/LAD (supplies RV, LV, anterior 2/3 of IV septum, apex, anastomoses with post. IV branch of RCA at apex, gives off diagonal branch). Gives off Circumflex artery (supplies LA, LV, anastomoses with RCA at coronary sulcus), which gives off Left Marginal artery (supplies LV, anastomoses at IV branches).
83
What is the lymphatic drainage of the liver?
Superficial (associated with bare area) goes to the phrenic or posterior mediastinal LNs. Deep (associated with porta hepatis) go to hepatic or celiac LNs.
84
What is the insertion of psoas major?
Lesser trochanter of femur.
85
Where is pain referred to in the gallbladder?
The right shoulder - the gallbladder also gets GSA fibers of the right phrenic nerve.
86
Describe the path of the 3rd part of the duodenum.
Transverse/inferior/horizontal part. It crosses ~L3 posteriorly under SMA and anteriorly over IVC. It's the longest part of the duodenum.
87
What does the azygous vein drain?
Back, mediastinal, viscera, thoracoabdominal wall.
88
Where is the prostate?
At the neck of the bladder, where the IUS is.
89
What are the true, false, floating ribs?
True (1-7): vertebrosternal. False (8-10): vertebrochondral Floating (11-12): vertebral (terminate in posterior abdominal muscles).
90
Can the visceral pleura feel pain?
No
91
What is the innervation of psoas major?
Anterior rami of L1-L5.
92
Describe the femoral nerve.
L2-L4. Emerges from lateal border of psoas major. Innervates iliacus and anterior thigh.
93
What does the small cardiac vein run with?
The right marginal artery.
94
What is mesentery?
Connects organs to the posterior abdominal wall, double layer of parietal peritoneum.
95
Which kidney is lower?
The right kidney - left is also slightly under rib 11 and they're both under 12.
96
Describe the left vagus nerve.
Enters between the left common carotid and left subclavian artery, descends along left side of aortic arch - courses posterior to left hilum. Gives off left recurrent laryngeal branch - loops under aortic arch (lies posterior to ligamentum arteriosum), ascends between trachea and esophagus.
97
What are thoracoabdominal nerves?
When spinal nerves pass the costal cartilage they change their names. T7-L1 do this. T12 is subcostal under the 12th rib. L1 divides into the ilioinguinal and ilihypogastric.
98
What are the sites of ureter constriction?
The utereropelvic junction (L2), the utererovesical junction, and the point where it crosses anteriorly over the external iliac artery at the pelvic brim/inlet.
99
What is the origin of rectus abdominis?
Pubis.
100
What is tie insertion of iliacus?
Lesser trochanter of femur, major tendon of psoas.
101
Where is the arch of the azygous vein? How can it be compressed?
Loops superiorly over the right lung hilum before opening into the SVC. Can be compressed by enlarged right superior tracheobronchial or hilar nodes, or by tracheal or right lung tumours.
102
Where is the deep ring of the inguinal canal?
An opening in the posterior wall lateral to the inferior epigastric vessels.
103
What does the SVC drain?
All structures superior to the diaphragm except the heart.
104
At what level is the horizontal fissure of the right lung?
Along the 4th rib and costal cartilage
105
Describe the pericardium.
Fibrous (tough, hard, attached to central tendon of diaphragm and sternum), serous parietal layer, serous visceral layer/epicardium. In between serous layers there is a pericardial cavity with fluid secreted by the serous mesothelium. Has transverse sinus and oblique sinus. Supplied by pericardiocophrenic arteries (run with phrenic nerves), and innervated by vagus nerces and sympathetic trunk.
106
What does the iliolumbar artery supply?
The posterior abdominal and pelvic wall.
107
What are the branches of the pudendal nerve?`
Dorsal nerve of penis/clitoris, inferior rectal nerve (sensory to anal triangle, motor to lower 1/3 of anal canal), perineal nerve (sensory to posterior labia/scrotum, motor to perineal pouch contents).
108
What organs comprise the foregut?
Distal esophagus, stomach, spleen, pancreas, liver, gallbladder, 1st and 2nd part of duodenum.
109
Describe the brachiocephalic veins.
Right is short and runs vertically, left runs diagonally and overlies the three branches of the aortic arch. They join into the SVC posterior to the sternoclaviicular joint at the 1st right costal cartilage.
110
What is Hesselbach's triangle?
A weak area in the posterior inguinal canal between the medial and lateral peritoneal folds. Medial border - lateral wall of rectus abdominis Lateral border - inferior epigastric vessels Inferior border - inguinal ligament
111
What does the round ligament of the uterus do?
Holds the fundus forward. Goes through the inguinal canal, inserts into the subcutaneous labia majora.
112
Where does the superior epigastric artery branch from? What does it anastomose with?
Internal thoracic artery. The inferior epigastrics.
113
What is the action of the external obliques?
Bilaterally - flexion of the trunk and compression of viscera. Unilaterally - Lateral flexion and contralateral trunk rotation?
114
How is the bladder attached to the umbilicus?
The apex is attached by the median umbilical ligament (urachus remnant).
115
What do the renal arteries branch into? What do the veins drain into?
The segmental arteries, then the interlobar arteries, then the arcuate arteries. The arcuate veins drain into the interlobar veins then into the segmental veins then the renal veins then the IVC.
116
Describe the right atrium.
Gets deoxygenated blood from the SVC, IVC, coronary sinus, anterior cardiac veins. Has smooth segment (sinus venarum), rough segment (pectinate muscle), crista terminalis, fossa ovalis, auricle (space for increased blood flow).
117
Describe the left ventricle.
Rough segment (trabeculae carnae), smooth segment (aortic vestibule), mitral/bicuspid valve (chordae tendinae, anterior and posterior papillary valves), a thicker wall.
118
What is the sympathetic, parasympathetic innervation, general venous and lymphatic drainage to the foregut?
T5-T9 spanchnic nerves and celiac plexus, Vagus nerve, Hepatic portal vein, Celiac LNs.
119
Where do the adrenal glands derive from embryologically?
Cortex from the mesoderm, medulla from the neural crest cells.
120
What does the uterine artery supply? Describe its course briefly.
Just in women, the uterus, fallopian tubes, ovaries, vagina. Ascends along the lateral border of hte uterus, anastomoses with ovarian artery at origin of tubes, crosses superiorly over the ureter.
121
What is the insertion of the pyramidalis?
Linea alba.
122
How much of continence is provided by the internal anal sphincter?
80%.
123
What is the most superior structure in the right hilum?
Eparterial bronchus.
124
Describe the greater omentum.
4 layered visceral peritoneal structure, connects transverse colon to greater curvature of the stomach. It can move within the peritoneal cavity, is the abdominal policeman.
125
Describe the right coronary artery.
Descends in interventricular groove. Supplies RA. Gives off SA nodal branch (supplies PT, SA node), Right marginal branch (supplies RN, apex, anastomoses at IV branches), Posterior Interventricular branch (supplies RV, LV, posterior 1/3 of IV septum. Anastomoses with LAD. Gives off AV node.)
126
Describe the ilioinguinal nerve.
L1. Innervates the abdominal muscles and skin of inguinal and pubic region.
127
What is the blood supply and lymphatic drainage of the duodenum?
Pancreaticoduodenal arteries, drainage to hepatic portal vein. Lymphatic drainage to celiac and SM LNs.
128
What is the innervation of rectus abdominis?
Anterior rami of T6-T12.
129
Where do the celiac trunk, SMA, and IMA come from the abdominal aorta?
T12, L1, L3.
130
What is the name of the position you are in for a gynecological exam?
Lithotomy.
131
What is the subcostal nerve?
The anterior rami of T12. It supplies the external oblique and skin of anterior abdominal wall.
132
What are the layers of the spermatic cord and what are they derived from?
External spermatic fascia (investing fascia of ext. oblique), Cremaster fascia (investing fibers of int. oblique) Internal spermatic fascia (transversalis fascia).
133
What are the specific arterial supplies to the different parts of the stomach?
Right and left gastric arteries to lesser curvature, right and left gastro-omental arteries to greater curvature, short/posterior gastric arteries to fundus.
134
What does the great cardiac vein run with?
The anterior interventricular artery/LAD.
135
What is the arterial supply and venous drainage to the adrenal glands?
Superiorly from the inferior phrenic arteries, middle from the aorta, inferior from the renal arteries. The right suprarenal vein drains into the IVC, the left into the inferior phrenic vein (which goes into the left renal vein).
136
What does the superior gluteal artery supply? Describe its course briefly.
It is the major blood supply to the muscle and skin of the gluteal region. It travels between the lumbosacral trunk and S1 ventral rami before exiting via the GSF and entering the gluteal region superior to the piriformis.
137
What are the contents of the superficial perineal pouch?
Erectile tissues, 3 muscles of external genitalia, Bartholin's/great vestibular glands in females.
138
What is the anatomical location and auscultation site of the tricuspid valve?
Medial aspect of right 5th costal cartilage. Auscultation site: Left parasternal 5th intercostal space
139
Describe the esophageal hiatus of the diaphragm.
T10. Muscular sphincter. Esophagus, esophageal vessels, and vagus nerve trunks pass through.
140
Describe the structure of the large intestine.
Cecum, ascending colon, transverse colon, descending colon, sigmoid colon (to rectum). Right colic (hepatic) flexure and left colic (splenic) flexure. Teniae coli are 3 distinct bands of smooth muscle that run longitudinally - contract to form the Haustra (end at rectosigmoid junction). Haustra internally are called semilunar folds/plicae semilunaris. There are omental/epiploic appendices (small fatty projections). Iliocecal valve are 2 semilunar flaps around a slit-like origin.
141
What is the coccygeal plexus?
Made of S4, S5, coccygeal nerves. Provides skin sensation in the anal region.
142
What is the origin of the internal obliques?
Thoracolumbar fascia, anterior iliac crest, inguinal ligament.
143
Describe the left atrium.
Gets oxygenated blood from 4 pulmonary veins. Has larger smooth wall portion and smaller muscular portion than that of right atrium, auricle (rough/pectinate muscle), semilunar depression (floor of fossa ovalis).
144
What is pectus carinatum?
Pigeon chest - due to CT disorders. Can cause scoliosis, links to congenital heart disease.
145
Which side of the diaphragmatic dome is higher?
The right because of the liver.
146
What organs comprise the midgut?
2nd, 3rd, 4th part of duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal 2/3 of transverse colon.
147
What are the superior mediastinal structures?
Arch of Azygous Phrenic nerve Vagus nerve Thoracic Duct Left recurrent laryngeal nerve Brachiocephalic veins (and SVC) Aortic Arch (and its 3 branches) Thymus Trachea Lymph nodes Esophagus (A PVT Left BATTLE)
148
What does the lateral sacral artery supply?
The skin and muscle posterior to the sacrum. It travels alonf the posterior pelvic wall.
149
What does the pelvic brim/inlet divide the pelvis into?
Above it is the false/greater pelvis (in the abdominal cavity) and below it is the true/lesser pelvis.
150
Describe the caval opening of the diaphragm.
Most anterior, T8. IVC, liver lymph vessels, right phrenic nerve pass through.
151
What are the arteries and veins and lymphatic drainage of the scrotum?
Anterior/posterior scrotal branches of arteries and veins. Drains into superficial inguinal lymph nodes.
152
What is the sympathetic innervation of the spleen?
The greater splanchnic and lesser splanchnic nerves.
153
What are the anastomoses within the artieres branching from the celiac trunk?
The left and right gastric arteries, also the right and left gastro-omental arteries.
154
Where do the cystic veins drain into?
The cystic veins (gallbladder) drain into the hepatic portal vein.
155
What is the erectile tissue of the genitals?
Crus of penis/clitoris extends into the corpus cavernosum and blub of penis extends into the corpus spongiosum. Corpus spongiosum terminates at the glans penis, the spongy urethra travels through the corpus spongiosum. Crura covered by ischiocavernosus muscle, bulb covered by bulbospongiosus muscle.
156
What is the arterial supply to the diaphragm?
Thoracic surface: pericardiacophrenic, musculophrenic (from internal thoracic), superior phrenic (from thoracic aorta) Abdominal surface: inferior phrenic (from thoracic aorta).
157
What does the inferior gluteal artery supply? Describe its course briefly.
The gluteal region. It comes out between the S2 and S3 ventral rami and emerges inferior to the piriformis.
158
What is a nephron?
The urinary excretory unit. They are formed up until birth.
159
What are the posterior divisions of the internal iliac artery?
Iliolumbar, Lateral Sacral, and Superior gluteal arteries.
160
What is the innervation of quadratus lumborum?
Anterior rami of T12-L4.
161
What is the origin of the pyramidalis?
Pubic crest.
162
Where is the gallbladder located? How do all the ducts go?
Anterior under the right lobe of the liver. The right and left hepatic duct form the common hepatic duct. The cystic duct joins it at the gallbladder spinal fold and they become the common bile duct.
163
Describe the thymus.
In adults, replaced by fatty tissue. Anterior to SVC and left BCV. Blood supply by the anterior intercostal and internal thoracic arteries. Veins drain into BCV, internal thoracic, inferior thyroid veins.
164
What are the small apertures of the diaphragm?
Sternocostal triangle (lymphatic and superior epigastric vessels), Right and Left Crural (greater and lesser splanchnic nerves)
165
What's the venous drainage of the anal canal?
Above the pectinate line: superior rectal vein (into portal venous system). Below the pectinate line: middle rectal vein (into internal iliac veins), inferior rectal veins (into internal pudendal veins, which drain into the internal iliac veins).
166
What does rib 2 have that typical ribs do not?
A serratus anterior tuberosity.
167
What are the contents of the inguinal canal?
Ilioinguinal nerve, blood and lymph vessels, genital branch of genitofemoral nerve, round ligament of uterus or spermatic cord.
168
What is endothoracic fascia?
The glue holding the parietal pleura to the thoracic wall. It is made of LCT, and above the 1st rib-C7 transverse process it is thickened to cover the lung apex (Sibson's fascia).
169
What is the Lacunar ligament?
Deeper external oblique aponeurotic fibers pass posteriorly to attach laterally to pubic tubercle.
170
What is the anatomical location and auscultation site of the mitral/bicuspid valve?
Medial left 3rd intercostal space. Auscultation site: Left midclavicular 5th intercostal space.
171
What is the superficial venous drainage to the abdominal wall and what do they drain into?
Superficial epigastric (into great saphenous). Thoracoepigastric (into lateral thoracic). Periumbilical - communicates with thoracoepigastric and paraumbilical.
172
What is the origin of transversus abdominis?
Iliac crest, inguinal ligament, thoracolumbar fascia, costall cartilages 7-12.
173
What are the pleural recesses?
Areas of the pleural reflections not occupied by lung during deep inspiration. Costomediastinal (left\>right due to cardiac notch) and costodiaphragmatic (more pronounced around rib 8-10).
174
Describe the the degrees of perianal tears.
Primary- vagina, Secondary - perianal muscles, Tertiary - anal sphincter, Quaternary - rectum.
175
Describe the innermost intercostal/oblique muscles.
Same fiber direction as internal intercostals. Exist in lateral compartment only. Neurovascular bundle superficial to them.
176
Describe the differences between the jejunum and the ileum.
Jejunum is wider diameter, deeper red (needs more blood), not twisted, thick/heavy wall, less mesenteric fat, fewer Peyer's patches, larger taller circular folds (plicae circularis), longer vasa recta, greater density of vascularity. Few large arterial arcades (many short ones in ileum).
177
What innervates the costal parietal pleura?
1-12th intercostal nerves.
178
What makes up the right and left borders of the heart?
Right: RA, SVC, IVC Left: LV (mainly) and left auricle
179
In the mediastinum, what's the general orientation of arteries to veins.
Arteries generally more anterior and right.
180
What is the venous drainage of the pancreas?
Most drain to splenic vein, some to SMV, all drain to hepatic portal vein.
181
What's the structure of the cecum?
No mesentery except in appendix. Rectum internally has folds. 3 transverse folds. Anal canal bends 90 degrees posteriorly at penvic diaphragm - anorectal flexure. Divided into upper and lower by pectinate line. There are anal columns (series of longitudinal ridges with superior rectal vessels) with valves at inferior ends. Anal sinuses (small recesses) inferior to valves.
182
Describe the ejaculatory duct.
Seminal gland and vas deferens combine into it and join into the prostatic urethra.
183
Describe the Lumbar Plexus.
L1-L5. Posterior rami supply back muscles, anterior are lumbar plexus - supplies skin, part of lower limb, muscles of inferior most trunk. Iliohypogastric n. (L1), Ilioinguinal n. (L1), Femoral n. (L2-L4), Lateral cutaneous nerve of thigh (L2-L3), Genitofemoral n. (L1-L2), Obturator n. (L2-L4).
184
What is the internal and external os?
External is the opening into the vagina, internal/isthmus is the opening of the cervix into the uterus.
185
Describe heart conduction.
SA node is the pacemaker -\> AV node (through AV bundle and right and left bundle branches) -\> papillary muscles/ventricular walls on each side of IVS.
186
What are the layers of the thoracic wall from superficial to deep?
Skin, superficial fascia, intercostal muscles, endothoracic fascia, parietal pleura (cervical, costal, mediastinal, diaphragmatic), pleural space/cavity. The visceral pleura is not part of the thoracic wall.
187
External anal sphincter is extension of levator ani.
Ischioanal fascia is lots of fat, pudendal/Alcock's canal. Base is skin of the perineum, medial wall is levator ani and anal canal, lateral wall is obturator internus.
188
Where do the coronary arteries arise from?
Arise from right and left aortic sinuses - are the first to get ox. blood.
189
Describe the path of the esophagus. Where is it prone to constrict?
Goes pharynx-\>stomach. Is posterior to the left atrium, exits through esophageal hiatus at around the T10 level along with the anterior and posterior vagal trunks. Prone to constrict at level of left og left primary bronchus, at level of aortic arch, at esophageal hiatus.
190
How do ribs 10-12 differ from typical ribs?
One facet on the head. 11 and 12 have no transverse tubercle.
191
What are the anterior abdominal wall muscles?
Rectus abdominis and pyramidalis.
192
What does the middle rectal artery anastomose with?
The superior and inferior rectal arteries.
193
Where is the obturator nerve in relation to psoas major?
Emerges from the medial border.
194
Describe the subcostal muscles.
Orientation similar to innermost intercostals, span the intercostal spaces.
195
What is the origin of iliacus?
Superior 1/3 of the iliac fossa.
196
Describe the perinephric and paranephric fat.
Perinephric is contained within the renal fascia and is continuous with the renal sinus. Paranephric is external to the posterior renal fascia and is associated with the lumbar region.
197
Where do the posterior intercostal arteries originate from?
1-2nd from the subclavian - costocervical trunk. 3-11th from the thoracic/descending aorta.
198
What is the afferent innervation of the anal canal?
Superior - visceral innervation (lumbar splanchnic nerves). Inferior - somatic innervation.
199
What is the lymphatic drainage of the large intestine and cecum?
Descending, sigmoid colon, proximal rectum -\> IM LNs. Distal rectum above pectinate line -\> internal iliac LNs. Distal rectum below pectinate line -\> superficial inguinal LNs.
200
What is the action of iliacus?
Flexes thigh, stabilizes hip, acts to flex trunk while sitting.
201
What is the lymphatic drainage of the pancreas?
Celiac and superior mesenteric plexus.
202
What is the general arterial supply to the pelvic cavity?
The internal iliac artery, but abdominal arteries enter the pelvic cavity (superior rectal (IMA), gonadal (aorta), median sacral (aorta).
203
Where is the base of the heart?
Mainly the LA, some RA. T5-T8 level, overlays esophagus and thoracic aorta. Receives pulmonary veins on LA part, SVC/IVC on RA part.
204
Describe the medial umbilical peritoneal folds.
Remnant of the embryological umbilical arteries. Underneath it is the medial umbilical ligaments.
205
What does the middle cardiac vein run with?
The posterior interventricular artery.
206
How can you get a xiphoid process fracture?
Poor CPR or contact sports. Can have dislocation of xiphisternal joint, compromised diaphragm, broken pieces can injure the heart/liver.
207
What is the insertion of the external obliques?
The pubic tubercle, anterior ilac crest, linea alba.
208
Describe the renal fascia.
The anterior and posterior fuse laterally. The anterior is posterior to the parietal peritoneum, the posterior is posterior to the perirenal fat and anterior to the pararenal fat.
209
Where is the apex of the heart?
Inferolateral part of LV, lies along midclavicular line at the left 5th intercostal level.
210
At what level are the oblique fissures of the lungs?
T2-6
211
What muscle aponeuroses are anterior to the rectus sheath below the arcuate line?
All 3 anteriolateral muscle aponeuroses.
212
What is pectus excavatum?
Sunken chest - due to intrauterine chest pressure, can compress lung. Appears at puberty.
213
What organ does the obturator nerve course through? Also what are its nerve roots?
L2-4. It travels with the obturator artery and vein through the obturator canal and courses near the ovary.
214
What forms the marginal artery of Drummond?
Middle colic arteries from SMA and left colic arteries from IMA.
215
What is the Canal of Nuck?
In women, incomplete obliteration of processus vaginalis. Can form small abnormal pounch in the peritoneum in the inguinal canal anterior to the round ligament of the uterus - travels into labia majora. Can result in cyst, hydrocele, indirect inguinal hernia. Analogous to patent processus vaginalis in males.
216
What innervates the cremasteric muscles?
The GSE fibers of the genitofemoral nerve.
217
What is the conjoint tendon made of?
The medial fibers of the internal oblique aponeurosis and the deeper fibers of the transversus abdominis aponeurosis.
218
What are the retroperitoneal organs?
Only partially wrapped in visceral peritoneum. Suprarenal glands, Aorta and IVC, Duodenum (2nd, 3rd, 4th parts), Pancreas (all but tail), Ureters, Colon (ascending and descending), Kidneys, Esophagus, Rectum (proximal 2/3). The secondary retroperitoneal organs are the Duodenum, Pancreas, Colon.
219
What are the layers of the scrotum?
Skin, Dartos muscle (continuous with Scarpa's fascia), 3 spermatic layers.
220
What is the venous drainage of the liver?
The hepatic portal vein (union of SMV and splenic vein). Hepatic veins drain into the IVC.
221
What are the types of hysterectomies?
Radical (everything), Total (uterus + cervix), Partial (just uterus).
222
What is the peritoneal cavity?
A potential space between the parietal and visceral peritoneum.
223
What is the insertion of quadratus lumborum?
Internal lip of iliac crest.
224
What are the dimensions that the thoracic wall moves in in response to changes in intrathoracic volume and pressure?
Anteroposterior - primarily involves 2-6th ribs (convexity/concavity at costotransvere joints allow for rotational movement) Lateral - primary involves 7-10th ribs (flat costotransverse joints allow for gliding movements) Superior/inferior - primarily involves diaphragmatic dome
225
What is the origin of quadratus lumborum?
Medial 1/2 of rib 12 inferior border, tips of lumbar transverse process.
226
What does the vaginal artery supply?
Just in women, the inferior bladder and the vagina. Usually branches from the uterine artery.
227
What is the action of quadratus lumborum?
Extends and lateralluy flexes vertebral column, fixes rib 12 on inspiration.
228
What is the cutaneous innervation to the scrotum?
Anteriorly - ilionguinal nerve (L1) Posteriorly - pudendal nerve (S2-S4)
229
What is the innervation of iliacus?
Femoral nerve (L2-L4).
230
What is the action of psias major?
Flex thigh at hip, balance trunk, flex vertebral column laterally, acts to flex trunk while sitting.
231
Where do the anterior intercostal arteries originate from?
1-6th from the internal thoracic/mammary arteries. 7-9th from the musculophrenic arteries (also branches of the internal thoracic arteries). The superior epigastric arteries also branch from the internal thoracic arteries, and anastomose with the posterior epigastrics arounf the umbilicus.
232
What are the innervations to the diaphragm?
Phrenic nerve (C3-C5). GSA: central is phrenic nerve, peripheral is inter/subcostal.
233
What is the anatomical location and auscultation site of the aortic valve?
Medial left 3rd intercostal space. Auscultation site: Right parasternal 2nd intercostal space.
234
Describe the arcuate ligaments.
Median (forms aortic hiatus, unites crura in front of aorta), Medial (x2, thickening of psoas major fascia between lumbar vertebral bodies and tip of L1 transverse process), Lateral (x2, thickening of quadratus lumborum fascia, more midclavicular, tip of 12th rib).
235
Describe the 4th part of the duodenum.
Ascending, mostly retroperitoneal, ascends back to ~L2, terminates at duodenojejunal flexure. Supported by suspensory ligament of Treitz.
236
What do the renal fascia do in a perinephric abscess?
Acts to block the spread of infection.
237
What muscle does the genitofemoral nerve pierce?
Psoas major.
238
What is the name of the "hilum" of the testes, where the neurovascular structures enter and leave the testes?
Rete testis/mediastinum. It's on the posterior surface.
239
Where is the visceral pleura continuous with the parietal pleura?
At the hilum.
240
What level is the xiphoid process at?
T10.
241
Where is the superficial ring of the inguinal canal?
An opening in the anterior wall superolateral to the pubic tubercle.
242
Describe the psoas fascia.
Fuses laterally with the quadratus lumborum fascia, continuous with iliac fascia. Thickened superiorly to form medial arcuate ligaments.
243
What is the origin of the external obliques?
Ribs 5-12.
244
Where does the linea alba go from/to?
Xiphoid process to pubic symphysis.
245
Describe the lesser omentum.
Double layered structure of visceral peritoneum that connects the transverse colon to the lesser curvature of the stomach. It is divided into the thin membranous hepatogastric ligament and the thick hepatoduodenal ligament, the free edge of which contains the portal triad.
246
Describe the perineal membrane.
Strong fascia perforated by urethra and vagina, provides attachment for superficial external genitalia.
247
Describe the musculotendinous bands of the diaphragm.
Arise from the anterior surfaces of L1-L3, IV discs, and anterior longitudinal ligaments.
248
Describe the right ventricle.
Rough segment (trabeculae carnae), smooth segment (conus arteriosus/infundibulum), tricuspid valve (chordae tendinae, anterior/posterior/septal papillary muscles), septomarginal trabeculae/moderator band (runs from base of anterior papillary muscle to IV septum, carries right branch of AV node).
249
What is the pelvic floor/diaphragm responsible for?
Supports viscera, resists increases in intraabdominal pressure, controls anal opening, vagina, urethra, raises floor on contraction.
250
What is the action of the transversus abdominis?
Maintains posture and supports abdominal viscera.
251
What is the arcuate line?
Where the transversus abdominis aponeurotic fibers no longer travel posterior to rectus abdominis. It's ~1/3 from the umbilicus to the pubic symphysis.
252
What does the superficial epigastric artery branch from? Is it deep to the rectus sheath?
The femoral artery (distal to the inguinal ligament). It is superficial to the rectus sheath.
253
What does the external iliac artery give off before it exits the pelvis posteriorly to the inguinal ligament and turns into the femoral artery?
The inferior epigastric artery (anterior abdominal wall) and deep circumflex iliac artery.
254
What are lumbar ribs?
AKA 13th ribs - less than 1% of the population. Can be uni or bilateral. They articulate with the ventral surface of the lumbar transverse processes. They're rarely associated with any issues.
255
Describe the perineum.
A diamond shaped area that is divided into the urogenital and anal triangle.
256
What is the left side equivalent of the azygous vein?
1st posterior intercostal veins (drains into BCV) Left superior intercostal veins (drain 2-4th IC spaces, into left BCV) Accessory hemiazygous veins (drain 5-8th IC spaces, sometimes left brachial veins, cross right at T7/T8 to drain into azygous) Hemiazygous veins (drain 9-12th IC spaves, crosses right at T9 to drain into azygous)
257
What are the anastomoses between the SMA and celiac trunk?
The superior anterior/posterior pancreaticoduodenal arteries and the inferior anterior/posterior pancreaticoduodenal arteries.
258
What innervates the peripheral parts of the diaphragm?
6-12th intercostal nerves.
259
What is the lymph drainage of the pelvic region?
Superior bladder - External Iliac LNs. Inferior bladder and prostate - Internal iliac LNs. Glans penis/clitoris - Deep inguinal LNs. Ovary, uterine tube, fundus of uterus - Lumbar/Aortic LNs.
260
Describe the anal triangle.
From the ischial spines to the coccyx.
261
Describe the anterior quadratus lumborum fascia.
Attaches to the 12th rib, lumbar transverse processes, and iliac crest. It is continuous with the aponeurotic origin of transversus abdominis, adheres inferiorly to iliolumbar ligaments, thickens superiorly to form lateral arcuate ligaments.
262
Where do the bronchial arteries arise from?
Right - thoracic aorta or 3rd posterior intercostal artery Left - thoracid aorta
263
Where do the bronchial veins drain into?
Right - azygous vein Left - accessory hemiazygous vein
264
What is the pulmonary ligament?
Not a true ligament - a loose fold of mediastinal pleura inferior to the hilum. Provides space for the expansion of hilum structures.
265
What are the contents of the spermatic cord?
Artery to ductus (vas) deferens, Ductus deference, Lymph vessels, Testicular artery, Cremasteric artery and vein, Obliterated processus vaginalis remnant, Pampiniform plexus, Genital branch of genitofemoral nerve.
266
What is the location and function of the epididymis?
Posterior surface and superior pole of the testes. It stores sperm until maturation occurs, the tail is continuous with the vas deferens.
267
Where do you auscultate the superior lobe of the lung?
2nd intercostal space
268
Where is the lymphatic drainage to the suprarenal glands, kidneys, ureters?
Suprarenal and renal LNs and the LNs of the proximal ureters follow veins and drain to the lumbar/para-aortic LNs. The distal ureters drain to the common/external iliac LNs.
269
Around what level is the horseshoe kidney?
L3, IMA blocks ascent.
270
What provides autonomic innervation to the pelvis?
Sacral sympathetics (continuation of lumbar sympathetic trunks, produce vasomotion/contraction of internal genitals in orgasm, inhibit defecation). Hypogastric plexi (sympathetic nerve fibers from lower lumbar splanchnics and GVAs. Superior descends into pelvis and divides into left and right hypogastrics). Pelvic splanchnic nerves (join the left and right hypogastrics and sacral splanchnics to form inferior hypogastric plexus, supplies distal transverse, descending, sigmoid colon, rectum, all viscera of pelvis and perineum, increases bladder contraction, rectum peristalsis, erection).
271
What arteries are deep to the rectus abdominis?
The superior and inferior epigastric arteries.
272
Describe the peritoneal cavity.
A fluid filled space between the parietal and visceral peritoneum, no structures in it. Made of greater sac (from diaphragm to pelvis, in females opens out through uterine tubes) and lesser sac/Omental bursa (hidden) which communicate via the omental foramen.
273
Describe the transverse thoracic muscles.
Fiber direction opposite to innermost intercostals. Span the 2-6th intercostal spaces.
274
What are the paired visceral branches of the abdominal aorta?
They branch laterally. Middle suprarenal (L1), Renal (L1), Gonadal (L2).
275
What is the deep lymphatic drainage to the abdominal wall?
Accompanies deep veins. External iliac -\> common iliac -\> lumbar -\> cysterna chyli -\> thoracic duct.
276
How is pain felt in the parietal and visceral peritoneum?
Parietal - localized, visceral - generalized.
277
What are the paired parietal branches of the abdominal aorta?
Branch posterolaterally and supply muscles. Inferior phrenic (T12), Lumbar (L1-L4), Subcostal (visible at L2 but is actually from the thoracic aorta).
278
Describe the venous drainage of the heart.
Small, middle, great cardiac veins drain into the coronary sinus and tributaries. Tiny anterior cardiac veins drain into right atrium. There are also thebesian veins.
279
What is the sympathetic, parasympathetic innervation, general venous and lymphatic drainage to the hindgut?
Lumbar splanchnic nerves L1-L2 and inferior mesenteric ganglion, Vagus nerve, IMV, IM LNs.
280
What is the innervation of the pyramidalis?
Anterior rami T12.
281
What organs comprise the hindgut?
Distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum and anal canal above pectinate line.
282
What is the action of the rectus abdominis?
Flexion of trunk and compression of viscera.
283
What ligament is the tail of the pancreas found in? Where is the pancreas found?
The splenorenal ligament. Head is right of SMA, Uncinate process posterior to SMA, neck behind pylorus, body left of SMA.
284
What makes up the posterior and lateral wall of the pelvic wall?
Posterior wall: piriformis Lateral wall: obturator internus
285
Describe the sacral plexus.
Made up of the lumbosacral trunk (L4, L5), and the S1-S4 ventral rami. It travels down the posterior pelvic wall anterior to the piriformis. Consists of the pudendal nerve (S2-S4), pelvic splanchnic nerves (S2-S4), and to the lower limb - superior (L5-S1) and inferior gluteal nerves (L5-S2), sciatic nerve (L4-S3), posterior femoral cutaneous nerve, nerve to piriformis, nerve to quadratus femoris, nerve to obturator internus.
286
Where is the minor duodenal papilla?
~2cm above the major duodenal papilla.
287
What is the superficial lymphatic drainage to the abdominal wall?
Above umbilicus - axillary LNs. Below umbilicus - superfiical inguinal LNs.
288
What is the path of sperm?
Seminiferous tubules -\> straight tubules -\> rete testes/mediastinum -\> efferent ductules -\> head of epididymis.
289
Describe the omental foramen borders
AKA the epiploic foramen and the foramen of winslow. Anterior - hepatoduodenal ligament Posterior - IVC, right crus of diaphragm Superior - caudate lobe of liver Inferior - 1st part of duodenum
290
What part of the bladder do the ureters go into?
The fundus.
291
What does the inferior vesical artery supply?
Just in men, the inferior bladder, prostate, and seminal vesicles.
292
What does the coronary sinus run with?
The circumflex artery.
293
What are the adrenal/suprarenal glands attached to? What is their texture?
To the crura, course/rough.
294
What innervates the mediastinal pleura?
The phrenic nerve (anterior rami C3-C5). It also innervates the pericardium (pain referred to root of the shoulder) and central diaphragm.
295
Where does the trachea divide into the primary bronchi?
At the sternal angle (last bit of cartilage is called the carina).
296
What is the oblique sinus of the pericardium?
Posterior to heart, reflection of the pericardium surrounding the pulmonary veins, IVC, esophagus.
297
Where are the lung nerves derived from?
The pulmonary plexus (parasympathetic X finers, sympathetic fibers from shympathetic chain, visceral afferent fibers from X).
298
What is the Pringle maneuver?
Clamping the hepatoduodenal ligament in surgery (contains portal triad).
299
What is the Pectineal ligament?
Most lateral lacunar ligament fibers continue along pecten pubis medial to the femoral canal.
300
What is under the lateral umbilical peritoneal folds?
The inferior epigastric vessels.
301
Describe the cremasteric reflex.
Stroke skin of superior medial thigh - ipsilateral teste retracts. GSA - femoral branch of genitofemoral nerve + ilionguinal nerve. GSE - genital branch of genitofemoral nerve
302
Describe the positioning of the spleen and the splenic vessels.
LUQ midaxillary. Behind stomach, anterior/medial to left dome of diaphragm and ribs 9-11, superior to kidney and tail of pancreas, laterally is left colic flexure. Splenic artery courses above pancreas, vein courses behind it.
303
Describe the median umbilical peritoneal fold.
Remnant of the embryological urachus, goes from the umbilicus to the urinary bladder. Underneath it is the median umbilical ligament.
304
what is the Sampling Reflex/RAIR?
Rectal-anal inhibitory reflex. The rectum distends and the IAS relaxes, and the EAS contracts and allows for sampling of rectal contents. It is lost in Hirschprung Disease.
305
What is the perineal body the attachment point for?
The levator ani and muscles of the perineum.
306
What structures can a sternal fracture damage?
Superior mediastinal ones.
307
Describe the aortic aperture of the diaphragm.
Most posterior, T12. Posterior to median arcuate ligament. Aorta, thoracic duct, sometimes Azygos and hemiazygos veins pass through.
308
What is damage at or above the sacral promontory most likely to cause?
Sympathetic damage, e.g. "firing blanks".
309
Describe lung lymphatic drainage.
Deep LNs -\> pulmonary LNs -\> Hilar/Bronchopulmonary (superficial straight here) -\> Tracheobronchial/Carinal -\> Paratracheal -\> Bronchomediastinal lymph trunk -\> Thoracic duct (L) and Right lymphatic duct -\> Venous system via R and L venous angles. Sometimes left lower lobe drains into the right superior tracheobronchial nodes.
310
What are the anastomoses of the heart?
Right marginal branch and left marginal branchat IV branches. Posterior interventricular artery and LAD. Circumflex artery with RCA at coronary sulcus.
311
Where do you auscultate the apex of the lung?
Superior to the medial 1/3 of the clavicle
312
Describe the deep perineal pouch.
Space between the pelvic diaphragm and perineal membrane. Contains part of the urethra, nerves and vessels, external urethral sphincter, in males the bulbourethral glands and deep transverse perineal muscles.
313
What is the most superior structure in the left hilum?
Pulmonary artery.
