High Yield Anatomy Supplement Flashcards
1
Q
What are the names for the junctions of the parietal bones with the frontal bone and occipital bone on the scalp?
A
Anterior - Bregma
Posterior - Lambda
2
Q
What are Galludet’s and Buck’s fascia?
A
Buck’s fascia - Deep Fascia of Penis - directly covers the corpus cavernosa / spongiosum
Galludet’s - Deep perineal fascia - covers the ischiocavernosus and bulbospongiosus muscles which lie overtop of Buck’s fascia
3
Q
What is Colle’s vs Darto’s fascia?
A
Both are superficial perineal fascia, which form a compartment between Galludet’s (Deep) and this superficial layer.
Darto’s is only present in males and is superficial perineal fascia which contains SMOOTH MUSCLE around the scrotum, involved in temperature regulation.
4
Q
What is Darto’s continuous with superiorly?
A
Scarpa’s fascia. Thus, a cut of the anterior chest wall can lead to bleeding which seeds downward and leads to swelling around penis and scrotum.
5
Q
What are the boundaries of the femoral triangle? What structures are contained within it?
A
Laterally - Sartorius muscle
Medially - Adductor longus muscle
Superiorly - Inguinal ligament
Includes nerve, artery, vein, and lymphatic (NAVL)
6
Q
What is the femoral sheath and what structures are contained within it?
A
Sheath made by transversalis fascia which surrounds the artery, vein, and lymphatics of the structures in the femoral triangle, but NOT the nerve
7
Q
What is the femoral canal and why is it clinically relevant?
A
Medial-most part of femoral sheath which contains the lymphatics
-> this is the site of femoral hernia, a type of hernia more common in females.
Weakness in the communication of the abdomen with the leg here.
8
Q
What are the boundaries of Hesselbach’s triangle?
A
This is the inguinal triangle, where direct inguinal hernias occur
Laterally - inferior epigastric vessels, arising from the external iliac artery before it becomes femoral artery under the inguinal ligament
Medially - Lateral border of rectus abdominis muscle
Inferiorly - Inguinal ligament
9
Q
What is the femoral ring?
A
The proximal opening of the femoral canal into the abdominal cavity -> contains lymphatics
10
Q
What two female structures are derived from the gubernaculum?
A
Remember, the gubernaculum is the structure responsible for pulling the gonads into their spot. Pulls the testes into the scrotum in males.
- Ovarian ligament - attaches to the inferior pole of the ovary, and latches to the uterine fundus (near junction of fallopian tubes with uterus)
- Round ligament - goes through the “round” inguinal canal. Extends from same spot on uterine fundus, all the way to the labia majora. So it’s almost like the ligament got pasted on there.
11
Q
What is the cardinal ligament and what is contained within it?
A
Ligament in the base of the broad ligament which holds the uterine artery and ureter. Ureter may be ligated during hysterectomy as uterine vessels are ligated (water goes under the bridge).
12
Q
What is the infundibulopelvic ligament? What happens if it gets twisted and how can this happen?
A
The other name for the suspensory ligament of the ovary which attaches to the superior pole. Contains the ovarian vessels.
Ovarian torsion - Can get twisted if there is an ovarian cyst or mass
-> will cause acute onset unilateral pelvic pain and edema / ischemia of ovary, with possible infarct
13
Q
What structures form the pelvic diaphragm?
A
- Levator ani, consists of: Pubococcygeus, iliococcygeus, puborectalis (maintains fecal continence)
- Coccygeus muscle
14
Q
How is cauda equina syndrome told apart from pudendal nerve injury? What typically causes each?
A
Cauda equina is generally much more painful, involves structures other than the S2-S4 dermatomes (e.g. there will be foot drop hyporeflexia), and bladder / fecal incontinence will happen much later than in pudendal nerve injury.
Cauda equina - Tumor or intervertebral disc hernation which impinges on cord below conus medullaris
Pudendal - stretch injury during childbirth
15
Q
What is the function of the superior laryngeal nerve? What does it pass thru?
A
It is a branch of the vagus nerve
Internal branch - pure sensory - it branches thru thyrohyoid membrane to supply sensory to the larynx and aryepiglotic folds above the vocal cords
External branch - smaller, pure motor - supplies the cricothyroid muscle only
16
Q
How does the cough reflex differ from the gag reflex?
A
Cough reflex - afferent is the internal branch of the superior laryngeal nerve (CNX), causes coughing due to URT irritation
Gag reflex - afferent is glossopharyngeal nerve (CNIX) due to touching pharynx / back of throat
17
Q
What arteries / structures do the superior and inferior laryngeal nerves relate to?
A
Superior laryngeal nerve - relates to superior thyroid artery, especially the external branch
Recurrent laryngeal nerve - relates to the inferior thyroid artery. Wraps around brachiocephalic artery on the right and arch of the aorta on the left #1747
18
Q
How can the internal branch of the superior laryngeal nerve be damaged?
A
Via sharp objects or damage upon attempted removal of sharp objects in the piriform recess -> nerve is very superficial underneath the mucosa on the lateral wall of this recess
19
Q
What will damage to the external branch of the superior laryngeal nerve do?
A
Causes monotonous voice -> cricothyroid muscle is responsible for raising voice pitch.
20
Q
What nerve roots give rise to the iliohypogastric nerve and how can it be damaged? What are the symptoms?
A
T12-L1
-> Damaged via abdominal surgery, especially appendectomy
Functions:
Motor - Abdominal wall muscles
Sensory - Suprapubic region + lateral gluteal region
Symptoms - burning / tingling radiating to inguinal / suprapubic regino
21
Q
What nerves control erection in males and where do they travel?
A
Cavernous nerves (S2-S4), autonomics from the inferior hypogastric plexus
- > travel in the prostatic venous plexus, can be damaged in prostate surgery and cause erectile dysfunction
- > # 11800
22
Q
What is the most distinctive way to tell femoral hernias apart from inguinal hernias, anatomically?
A
Femoral hernias lie INFERIOR to the inguinal ligament, and thus abdominal contents are protruding thru the femoral ring into the femoral canal (most medial portion of femoral sheath, a part of the femoral triangle)
Inguinal hernias lie ABOVE the inguinal ligament, and are either medial (direct) or lateral (indirect) to the inferior epigastric vessels, a branch of the external iliac before it becomes the femoral artery below the inguinal ligament
23
Q
What type of hernia is most prone to strangulation / incarceration?
A
Femoral hernia is most likely to have both, since herniations thru the femoral ring are not easily reducible by compression
Incarceration - lack of ability to reduce
Strangulation - loss of blood supply due to obstruction and prolonged strangulation
24
Q
What are the dependent segments of the lungs when the patient is in supine position?
A
Posterior segments of upper lobes
Superior segments of lower lobes
#2102
25
What do the superficial inguinal nodes drain, in general? What are the exceptions?
All skin below the umbilicus, the anal canal below the pectinate line, as well as scrotum / vulva
Exceptions - glans penis and popliteal node chain
26
Where do the glans penis / popliteal nodes drain?
They bypass the superficial inguinal nodes and drain directly into the deep inguinal nodes
27
Where are the deep inguinal nodes located and what drains into them?
Located in the femoral region, deep inside the femoral canal and then going inward (think NAVL with emphasis on that L).
All of the superficial inguinal nodes drain into them, as well as the lymph from the glans penis / popliteal nodes which drain directly into them
28
Why do we say that the veins of leg drain into superficial nodes and arteries into deep nodes?
Superficial inguinal nodes - follow the saphenous vein - medial leg including medial foot drains into superficial inguinal nodes, bypassing popliteal nodes
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Deep inguinal nodes - drainage follows the popliteal artery and its branches - drains the lateral leg, dorsolateral foot, and posterior calf. Popliteal lymph nodes will also be enlarged from infections of the lateral foot.
#11830
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29
What nodes drain the lymph to the lower rectum above the pectinate line?
Although there is some IMA contribution, much of it follows the middle rectal vein to drain into the internal iliac nodes. It is not entirely the IMA since your kneejerk reaction is that the primary artery supplying the rectum above the dentate line is the superior rectal artery, a branch of the IMA. Remember that the middle rectal artery is a branch of the internal iliac and also partially supplies the area above the dentate line.
30
What provides sensation to the external ear canal? Why is this relevant?
Mostly the auriculotemporal nerve (V3)
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However, posterior part of external canal receives innervation from Vagus nerve -> can cause vasovagal syncope if stimulated
#1814
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31
What do the epicardial vessels refer to? Are they what's being dilated in the coronary steal syndrome? What does coronary steal refer to?
Refers to the very large vessel branches on the surface of the heart, not the smaller coronary arteries and arterioles which branch into the myocardium
- > NO, these are not what's the problem in coronary steal
- > problem in coronary steal is dilation of all smaller vessels -> diversion of blood away from ischemic tissue
- > induces ischemia in myocardium downstream a stenosis which is reliant on collaterals, which are only well perfused due to relative vasoconstriction of other vessels
Generalized vasodilation inducible by dipyridamole / adenosine
32
What vessel is responsible for hemorrhage secondary to posterior duodenal ulcer? How about lesser curvature gastric ulcer?
Duodenal ulcer - gastroduodenal artery, a branch of the common hepatic
Lesser curvature - Left gastric artery
33
Where are the three lines and at what ribs can you insert the needle for thoracentesis?
Midclavicular line - between ribs 6 and 8 -> insert above 8th
Midaxillary line - between ribs 8 and 10 -> insert above 10th rib
Paravertebral line (posteriorly) - between ribs 10 and 12 -> insert above 12th rib
See #844 if confused
34
What is the underlying pathophysiology of direct inguinal hernia and who is it classic in?
Classic in older men due to repetitive connective tissue damage
Due to weakpoint in transversalis fascia "directly through the weakpoint"
35
What is the underlying pathophysiology of indirect inguinal hernia and who is it classic in?
Pathophysiology - patent processus vaginalis
```
Classically seen in male infants
#8669
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36
What condition can occur distal to the dentate line, posteriorly, related to constipation and high anal pressures?
Anal fissures - leads to severe bleeding
-> occurs posteriorly due to poor perfusion
Associated with low fiber diets and constipation
37
What is superior mesenteric artery syndrome and what causes it?
Diminished mesenteric fat -> decreased angle between superior mesenteric artery and 3rd part of duodenum
-> acute small bowel obstruction
Can also be caused by correction of scoliosis
38
What nerve is characteristically impinged in piriformis syndrome? What causes this?
Sciatic nerve -> can cause sciatica-like symptoms
Caused my hypertrophy or inflammation of the piriforms muscle, impinges sciatic nerve as it exit below it in the greater sciatic foramen (above sacrospinous ligament)
39
What is the pathogenesis of apple peel deformity in a neonate?
Jejunal / ileal ischemia -> necrosis and failure to properly develop a section of small intestine.
This results in an atretic blind pouch proximally, and distally the small bowel will wrap around a segment of the ileocolic artery. This results in something that looks like a "apple peel" or "Christmas tree" twirled around the central artery.
#319
40
What is a common site for the radial artery to get injured to cause "finger drop" with preservation of triceps / ECRL, but relative weakness of other extensors? What causes it?
Supinator canal -> anterior to the elbow, where the deep branch of the radial nerve dives in and then emerges as the posterior interosseous nerve
Due to repetitive pronation and supination (i.e. using a screwdriver)
41
Will hand sensation be affected in finger drop?
No -> the superficial branch of the radial nerve is what supplies the dorsal surface of the hand
42
What vessel serves as a good indicator of right atrial pressure?
Coronary sinus - since it communicates freely with the right atrium (junction of IVC and near the tricuspid valve orifice) -> will become dilated with increased right atrial pressures
-> #2124
43
Where will pain from phrenic nerve irritation refer to?
Shoulder area -> innervated by supraclavicular area (C3, C4)
| -> phrenic nerve distribution is C3/C4
44
What is the more medial of the two bones which articulates with the radius?
Lunate.
(Scaphoid is the other one, and is more lateral).
45
Where does the lymph of the vagina drain?
Lower 1/3 - derived from UG sinus -> superficial inguinal nodes
Upper 2/3 - derived from Mullerian ducts -> internal iliac nodes
46
Where are the leads for a biventricular pacemaker generally placed?
```
Generally there are three:
1. Right atrium
2. Right ventricle
3. Left ventricle - via entering thru the coronary sinus and wrapping around the lateral venous tributaries
#7646
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47
Where does the coronary sinus sit?
```
The atrioventricular groove u fkboy
#7646
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48
How far does the bladder extend?
```
Far anteriorly, can be seen overtop of the pubic symphysis in its most anterior portion
#1737
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49
What are the two watershed areas of the intestines which are most susceptible to infarct?
1. Splenic flexture - junction of SMA / IMA
2. Rectosigmoid junction - junction of sigmoid artery and superior rectal artery of IMA
#413
50
What delivers the sympathetics vs parasympathetics of the face?
Sympathetics - travel on the artery plexuses to innervate their targets (i.e. for sweating of the face)
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Parasympathetics - travel with the nerves (i.e. facial nerve to lacrimal, sublingual, and submandibular glands)
#8329
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51
What nerve passes between the humeral and ulnar heads of the pronator teres?
Median nerve
52
What is Kehr sign?
Referred pain to the shoulder due to peritoneal inflammation.
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Left-sided Kehr sign is a classic symptom of splenic rupture -> referred pain to C3-C5 from irritation / bleeding on diaphragm.
#11753
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53
What lobes obstruct the right heart border and left hemidiaphragm (Silhouette sign)?
Right heart border - Right middle lobe. Note that the right atrium makes the right border of the heart. #1883
Left hemidiaphragm - Left lower lobe
54
What obscures the left heart border and right hemidiaphragm (silhouette sign)?
Left heart border - Lingula (LUL)
Right hemidiaphragm - Right lower lobe
55
What structure is most likely to be injured in a posterior dislocation of the tibia relative to the femur: tibial nerve, popliteal artery, or popliteal vein/
Popliteal artery, since it is the deepest structure #6516
56
How do you treat axillary hyperhidrosis?
T2 sympathetic ganglion sympathectomy
Targeting only the T1 / lower cervical ganglion (stellate ganglion) would fix the hands, but not the axilla (axilla recieves sympathetics from T2 level as well, not supplied by brachial plexus)
57
How can damage to the middle cerebral artery cause homonymous hemaniopsia?
MCA -> supplies optic radiations (Meyer's Loop in temporal lobe, dorsal optic radiation in parietal lobe)
-> large infarcts can damage this pathway
Anterior choroidal artery -> early branch of MCA -> supplies lateral geniculate nucleus
58
What structures drain into the superior nasal meatus (below superior turbinate)?
Posterior ethmoid sinus
59
What structures drain into the middle nasal meatus (below middle turbinate)?
Frontal sinus (above eyes), maxillary sinus (cheeks), anterior and middle ethmoid sinuses (insignificant)
60
What drains into the inferior inferior nasal meatus (below inferior turbinate)?
Nasolacrimal duct
61
What is the semilunar hiatus?
Opening of maxillary sinus. It is beneath the ethmoidal bulla and above the uncinate process above the inferior nasal concha, within the middle meatus.
-> this is the hiatus within which most things drain in the middle meatus
62
What does injury of the superficial vs deep peroneal nerve do?
Superficial - lateral leg compartment - loss of eversion and sensation to the dorsal foot (Except between 1st and 2nd toe)
Deep - anterior leg compartment - loss of dorsiflexion and sensation between 1st and 2nd toe
63
What is bronchopulmonary shunting?
The small decrease in PaO2 which occurs due to the 2/3 of the bronchial veins draining into the pulmonary vein
64
What is the arcuate line?
The point at which the posterior rectus sheath (behind the rectus abdominis, normally formed from the aponeurotic sheaths of the internal abdominal oblique and transversus abdominis) is eliminated, and becomes only anterior to rectus abdominis muscles.
65
What is posterior to the rectus abdominis muscle inferior to the arcuate line?
The transversalis fascia (only) and then layers of peritoneum posteriorly
66
Where do the superior and inferior epigastric arteries anastomose?
Within the substance of the rectus abdominis muscle -> vulnerable to hemorrhage in C-sections which must slice the muscle laterally
Remember that superior epigastric artery is a branch of the ITA (which also gives rise to the musculophrenic artery along the costal margin)
67
What arteries supply the lesser curvature of the stomach?
Left gastric - branch of celiac trunk
Right gastric - Branch of proper hepatic
These anastamose
68
What arteries supply the greater curvature of the stomach?
Left gastroepiploic (gastroomental) - branch of splenic artery
Right gastroepiploic (gastroomental) - branch of gastroduodenol, which is a branch of common hepatic
69
What does the splenic artery supply blood to on its way to the spleen?
1. Pancreas - body and tail, giving several branches
2. Short gastric arteries - gastric fundus - upper part of greater curvature
3. Left gastroepiploic
70
What is the only intrinsic muscle of the tongue not innervated by CN12? What is its function?
Palatoglossus - innervated by CN10
| -elevates posterior tongue during swallowing
71
What nerve innervates the mylohyoid muscle and what is its function? What other structure does it innervate?
V3 - trigeminal nerve, via mylohyoid nerve
-> functions to depress mandible and elevate hyoid bone
Also innervates the anterior belly of the digastric (posterior belly and stylohyoid is via CN7)
72
What is the function of genioglossus?
Protrudes tongue
| -> this one is basically the body of the tongue
73
What is the function of hyoglossus?
Depresses and retracts tongue
74
What is the function of styloglossus?
Retrudes tongue, and may curl sides since it attaches to sides.
75
What is the most common renal abnormality and what causes it?
Duplex collecting system -> due to splitting of ureteric bud before it induces metanephric blastema, or two separate ureteric buds interacting with the metanephric blastema
-> leads to bifid drainage or double ureter drainage system, respectively
76
What complications are associated with duplex collecting system?
Due to abnormal ureter drainage back into the bladder -> strongly associated with vesicoureteral reflex, increased risk of UTIs
77
What structure is contained in the falciform ligament? What does it divide?
Ligamentum teres hepatis (round ligament) -> remnant of umbilical vein
Divides the left lobe of the liver from the quadrate lobe anteriorly and the caudate lobe posteriorly
78
Where is pericardial pain referred to?
The shoulder - innervated by the phrenic nerve (C3-C5)
79
What part of the pancreas is peritoneal?
Only the tail.
Rest is retroperitoneal
80
What is the greater omentum? What region does it bound?
Omentum attaching to greater curvature of the stomach + first part of duodenum and inserting on transverse colon
Bounds the region of the lesser sac!
81
What is the lesser omentum and its two parts?
Omentum attached to lesser curvature of stomach and first part of duodenum and inserting on visceral /inferior surface of the liver.
Hepatoduodenal ligament - connects liver to first part of duodenum
-> contains the portal triad
Hepatogastric ligament - connects liver to lesser curvature of the stomach
-> contains gastric arteries
82
What is the falciform ligament derived from and what does it connect?
Derived from the VENTRAL MESENTERY
-> contains the round ligament, a derivative of the fetal umbilical vein
Connects the liver (between left and right lobes) to anterior abdominal wall (since it was a ventral mesentery).
83
What does it mean if the Pringle manuever fails to control bleeding around the liver?
Surgical pinching of hepatoduodenal ligament = Pringle manuever
The source of the bleeding is likely the IVC or hepatic veins
- > cutting input of blood into liver isn't helping
- > three structures occluded = proper hepatic artery, protal vein and common bile duct
84
What structure carries the gastroepiploic arteries?
Gastrocolic ligament, which connects the greater curvature of the stomach to the transverse colon
-> part of greater omentum
85
What ligament caries the short gastric arteries and left gastroepiploic vessels?
Gastrosplenic ligament, part of greater omentum
| -> ligament from spleen to greater curvature of the stomach
86
What ligament contains the tail of the pancreas? What else does it contain?
Splenorenal ligament
Also contains splenic artery and vein (distal portion of these vessels as they enter the spleen)
-> splenic artery arises from celiac trunk and go retroperitoneal to peritoneal, so this makes sense
87
When do you have a serosa vs an adventitia?
Serosa - intraperitoneal structures, which a discrete membrane of cells
Adventitia - retroperitoneal structures - also called fibrosa, just a loose connective tissue
88
What is muscularis externa vs muscularis mucosa?
Muscularis mucosa - thin layer of smooth muscle which demarcates border between mucosa / submucosa
Muscularis externa - Also called muscularis propria, contains Auerbach's (myenteric) plexus, inner circular and outer longitudinal layers.
89
What is the difference between an erosion and an ulcer?
Erosion - loss of mucosa of the stomach, not into the submucosa (last layer of mucosa is muscularis mucosa)
Ulcer - Penetration into the submucosa or deeper
90
What are the sources of the three arteries of the suprarenal glands?
1. Superior suprarenal artery - from inferior phrenic
2. Middle suprarenal artery - from abdominal aorta above renal artery
3. Inferior suprarenal artery - from renal artery
91
What is the usual cause of superior mesenteric artery syndrome and what ar teh causes?
Compression of 3rd portion of the duodenum with subsequent bowel obstruction via a decreased angle between the superior mesenteric artery
-> occurs due to diminished mesenteric fat (low body weight / malnutrition)
92
What is the PANS innervation of lower GI? Including jejunum, ileum, cecum, ascending, transverse, descending, sigmoid colons, and rectum.
Vagus nerve: all elements before left colic flexure, via lower abdominal (inferior mesenteric) plexus
Pelvic splanchnic nerves from S2-S4: all elements after colic flexure (descending + sigmoid colon, rectum)
93
Where do the foregut, midgut, and hindgut arteries branch from? What is the separation point between midgut and hindgut?
Celiac - T12
SMA - L1
IMA - L3
Foregut/midgut - duodenum
Midgut/hindgut - distal transverse colon
94
What is the portosystemic shunt responsible for esophageal varices?
Left gastric vein, ALSO CALLED THE CORONARY VEIN because it supplies the cardia of the stomach (portal) to azygos vein (which drains inferior esophagus)
95
What anastamosis is responsible for caput medusae?
Paraumbilical vein (portal) to epigastric veins (raising from external iliac vein)
96
What vein does the inferior mesenteric vein drain into?
The SPLENIC vein! Which combines with the superior mesenteric vein to create the portal vein
97
What nerves supply sensory innervation to the anus below the pectinate line?
Inferior rectal nerves, the first branches of the pudendal nerve
98
What surface of the hepatocyte faces the bile canaliculi vs the sinusoids?
Apical surface - faces bile canaliculi
-> makes sense because you can view this as the liver's "glandular" secretions
Basolateral surface - faces the sinusoids
-> makes sense because the blood supply of glands typically faces the basolateral surface
99
What forms the conjoined tendon?
Transversus abdominis + internal oblique aponeuroses
| -> makes sense because external oblique aponeurosis is linea alba
100
What is the cremaster muscle derived from and what innervates it?
Internal oblique muscle
innervated by the genital branch of the genitofemoral nerve (L1)
101
What are the layers of the spermatic cord derived from?
ICE tie
Internal spermatic fascia - transversalis fascia
-> site of deep inguinal ring
Cremasteric muscle - internal oblique
External spermatic fascia - external oblique muscle
-> site of superficial inguinal ring
102
What are the pleuropericardial folds?
Two lateral folds forming ventrally from the wall of the pericardioperitoneal canals, which grow medially and hold the right or left phrenic nerve + cardinal veins.
They will fuse with eachother and separate the pericardial cavity from the pleural cavity.
Basically, these are the folds which separate the heart from the pleural cavity.
103
How does the pleural cavity become separated from the peritoneal cavity?
The pericardioperitoneal canals still allow communication between lungs + abdominal cavity.
They become sealed off via the pleuroperitoneal folds growing from the posterior wall and fusing with the septum transversum.
104
What will the septum transversum and the pleuroperitoneal folds become?
Septum transversum - central tendon of diaphragm
Pleuroperitoneal folds - muscular portion of diaphragm
105
What happens if there is a defect in the pleuroperitoneal membrane? Where does this usually occur?
Congenital diaphragmatic hernia
Usually occurs on the left side due to relative protect of the right hemidiaphgram by the liver
106
Who tends to get indirect inguinal hernias? Direct inguinal hernias? Femoral hernias?
Indirect inguinal hernias - male infants (patent processus vaginalis)
Direct inguinal hernias - older men (weakness of transversalis fascia)
Femoral hernias - women
107
What is responsible for the bluish coolor of reticulocytes on Wright-Giemsa stain?
Residual ribosome RNA (rRNA)
108
How can adrenal insufficiency cause eosinophilia?
Cortisol is needed for the apoptosis of lymphocytes and eosinophils
109
What anticoagulant do mast cells and basophils possess?
Heparin!
110
Do dendritic cells have a phagocytic function?
```
Yes - they express Fc receptors on the surface
-> have a phagocytic function as well as being an antigen presenting cell (phagocytosis is how you utilize MHC class II)
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111
Describe the blood flow of the kidneys from renal artery to efferent arterioles.
Renal artery branches into interlobar arteries which travels between pyramids.
Interlobar arteries branch perpendicularly at the corticomedullary junction into arcuate arteries
Arcuate arteries branch perpendicularly again (parallel with interlobar arteries) into the cortex as interlobular arteries, where afferent arterioles come off.
Afferent arterioles supply the glomeruli and leave as efferent arterioles.
112
What are the two possible fates of the efferent arterioles and what determines this?
1. Outer 2/3 of efferent arterioles supply the peritubular capillaries of the renal cortex, before draining into the interlobular veins and ultimately renal veins
2. Inner 1/3 of glomeruli give off efferent arterioles which form vasa recta, which ultimately drain into arcuate veins.
113
Explain the lymph drainage above and below the dentate line?
Above - superior rectal vein to IMA, and middle rectal vein to internal iliac nodes
Below - all lymph goes to superficial inguinal nodes.
114
What drains the lymph from the superior and inferior portions of the bladder?
Superior - External iliac nodes
| Inferior - Internal iliac nodes
115
Where does the body of the uterus and cervix drain?
External iliac nodes, with the superior bladder
116
Where does the prostate, cervix, corpus cavernosum, and proximal vagina drain?
Internal iliac nodes
117
Does the medial or lateral foot and posterior calf drain into the popliteal nodes?
Lateral tract -> follows the arteries. Ultimately this system drains into the deep inguinal nodes.
Remember the saphenous vein is medial so it drains the medial leg and foot into the superficial system
118
Why is the pressure naturally higher in the left gonadal arteries than the right?
Left side - enters renal vein at 90 degree angle (vs right enters IVC at 0 degree angle)
-> flow is less laminar and more turbulent on the left -> increased pressure is required to generate the same flow
119
What lubricant glands open immediately next to the urethra in females and what are they analogous to in the male?
Paraurethral glands of Skene
Analogous to prostate gland
120
What is the labia minor derived from in females and what is it analogous to in males?
Urogenital folds -> analogous to the folding and closing of penile urethra (i.e. if this failed in males, would cause hypospadias)
121
What derives the vestibular bulbs vs greater vestibular glands in females?
Vestibular bulbs - genital tubercle (analogous to corpus spongiosum in males)
Greater vestibular glands (Bartholin glands) - derived from urogenital sinus (analogous to bulbourethral / Cowper glans in males)
122
What is the artery of Sampson and how does the round ligament of the uterus relate to it?
It is the anastamosis between the uterine artery and the ovarian vessels which runs parallel to the uterus
Round ligament (travelling from the uterine fundus to the labia major) travels overtop of it.
123
What type of epithelium is the peritoneum made of? Give one other area in the body where you would find this type of epithelium?
Simple squamous epithelium
| -> endothelium is also made of simple squamous
124
What type of epithelium covers the ovary? Fallopian tube?
Ovary - Simple cuboidal (germinal epithelium)
Fallopian tube - simple ciliated columnar
125
How does the contents of the seminal vesicle / vas deferens get into the urethra?
The two combine together to form the ejaculatory duct within the prostate, which drains into the prostatic urethra
126
What type of urethral injury will a pelvic fracture cause and what are the consequences?
Think Pelvic = Posterior
Injury can cause urine leakage into retropubic space
-> typically occurs at bulbomembranous junction (intersection between membranous urethra and bulb of penis / bulbous urethra)
127
What is the cause of an anterior urethral injury and where will the fluid leak?
Perineal straddle injury
Fluid leaks between Galludet's (deep perineal) and Colle's (superficial perineal) fascia, which is the "superficial perineal space"
Remember than Galludet's is one layer superficial to the deep fascia of Buck which invests the ischiocavernosus / bulbospongiosus muscles.
128
What nerve carries sympathetics and parasympathetics to control male erection / ejaculation?
Cavernous nerve
PANS - contribution is via pelvic splanchnics to this nerve
-> M3 receptors cause NO release and smooth muscle relaxation via cGMP
SANS - Lumbar splanchnics converge in inferior hypogastric plexus to contribute
-> norepinephrine causes smooth muscle contraction / vasoconstriction to destroy erection
129
What populates the mucosa of the trachea and how is it different than a bronchus?
1. Tall, pseudostratified columnar epithelium with goblet cells
2. Lamina propria connective tissue with blood vessels (to warm the air)
Difference from bronchus - no muscularis mucosae, since the cartilage is so strong in the trachea, but discontinuous in the bronchi. Also, the epithelium transitions to simple ciliated columnar in the bronchi.
130
How far inferiorly in the conducting zone do cartilage, submucosal glands, and goblet cells extend?
Cartilage - stops being present in the bronchioles
Submucosal glands - stop being present in bronchioles (only present in trachea / bronchi)
Goblet cells - stop being present in bronchioles (surfactant / cleansing function done by club cells)
131
How far down the respiratory tree do the epithelial cells remain ciliated?
Respiratory bronchioles
-> the first respiratory zone epithelium. The cells which are participating in gas exchange (becoming squamous cells) will not have cilia, only the cuboidal cells which are intermixed with club cells which are basically analogous to terminal bronchioles will have cilia.
You can think of respiratory bronchioles as half terminal bronchioles and half alveoli.
132
How does the pulmonary artery relate to the bronchus at each lung hilum?
Think RALS
Right - Anterior
Left - Superior
Right pulmonary artery is anterior to the right mainstem bronchus
Left pulmonary artery is superior to the left mainstem bronchus
133
Where does a peanut tend to go if you aspirate it while standing vs supine?
Standing - Basal segments of right lower lobe
Supine - Posterior segment of right upper lobe
134
What does the horizontal fissure divide?
Right upper lobe from right middle lobe
-> remember this because both lungs have an oblique fissue, and there is no middle lobe on the left side
135
What structures perforate the diaphragm at T8 vs T10 vs T12?
T8 - IVC (since liver is sorta in the middle), and right phrenic nerve
T10 - esophagus, vagus nerve (think CN X = T X), since branches go anterior and posterior to esophagus / stomach
T12 - Aorta, thoracic duct, azygous vein (think red, white, and blue)
136
At what spinal level do the common carotid, trachea, and abdominal aorta bifurcate?
"Bifourcate"
Common carotid - bifurcate at C4
Trachea - bifurcate at T4
Aorta - bifurcate at L4
137
Where do you place the needle for thoracentesis in midclavicular line, midaxillary line, and paravertebral line?
Lung tissue extends: 6, 8, 10
Pleura extends: 8, 10, 12
Midclavicular line: Above 7th or 8th rib, above 8th optimal
Midaxillary line: Above 9th or 10th rib, above 10th optimal
Paravertebral line: Above 11th or 12th rib, above 12th optimal
138
What is the ANS route to the pupillary dilator muscle + superior tarsal muscle? (SANS only)
Nucleus: Intermediolateral cell column T1-2
Preganglionic axon: WCR, ascends sympathetic trunk
Ganglion: Superior cervical ganglion (SCG)
Postganglionic axon: follows blood vessels and then long ciliary nerves, pierce sclera, perichoroidal space
139
What is the ANS route to the ciliary body + sphincter pupillae? (PANS only)
Nucleus: Edinger-Westphal (midbrain)
Preganglionic axon: CN3
Ganglion: Ciliary ganglion
Postganglionic axon: short ciliary nerves, pierce sclera and travel to muscles through perichoroidal space
140
How does CN2 enter the orbit and what travels with it?
Optic canal, accompanied by ophthalmic artery (branch of internal carotid artery)
