NBME review Flashcards
1
Q
regions of spine with anterior curvature
A
cervical and lumbar (secondary=devs with sit/stand/walk)
2
Q
regions of spine with posterior curvature
A
thoracic and sacral (primary=present at birth)
3
Q
kyphosis
A
excessive thoracic curvature = hunchback
4
Q
lordosis
A
excessive lumbar curvature = swayback
5
Q
ligamentum flavum
A
extends between lamina of adjacent vertebrae
6
Q
annulus fibrosis
A
outer part of vertebral disc = fibrous CT
7
Q
nucleus pulposis
A
central part of vertebral disc = gel-like
8
Q
herniated (“slipped”) disc
A
- annulus fibrosis deteriorates -> nucleus pulposis bulges -> spinal nerve compression
- most common in lumbar and cervical
9
Q
what space is accessed during a lumbar puncture?
A
lumbar cistern/dural sac/ thecal sac
10
Q
fibrous joint (synarthroses)
A
- little or no movement
* ie sutures of skull
11
Q
cartilagenous joint (amphiarthroses)
A
- slight movement
- fibrocartilagenous disks between articular surface
- sternocostal joints, intervertebral joints, and symphysis pubis
12
Q
intima
A
cells lining the surface of the synovial membrane that secrete synovial fluid
13
Q
joint effusion caused by
A
irritation to the synovial membrane -> excess production of synovial fluid
14
Q
scapulothoracic “joint”
A
- ant surface of scapula and post./lat. thoracic wall
* allows elevation/depression, protraction/retraction, and upward/downward rotation of scapula
15
Q
rotator cuff muscles
A
- supraspinatus
- infraspinatus
- subscapularis
- teres minor
16
Q
movement of supraspinatus
A
initiate and assist ABDUCTING arm
17
Q
movement of infraspinatus
A
ER, ABDUCTION, ADDUCTION
18
Q
movement of subscapularis
A
IR
19
Q
movement of teres minor
A
ER AND ADDUCTION
20
Q
innervation of supraspinatus
A
suprascapular nerve
21
Q
innervation of infraspinatus
A
suprascapular nerve
22
Q
innervation of subscapularis
A
upper and lower subscapular nerve
23
Q
innervation of teres minor
A
axillary nerve
24
Q
muscle most often involved in rotator cuff injury
A
supraspinatus muscle
25
muscles of anterior compartment of arm function
* flex arm and forearm
| * supinate hand
26
innervation of anterior compartment of arm
musculucutaneous nerve
27
supply of anterior compartment of arm
branches of brachial artery
28
muscles of posterior compartment of arm function
extend the forearm
29
innervation of posterior compartment of arm
radial neve
30
supply of posterior compartment of arm
branches of deep brachial artery
31
annular ligament
* stabilizes head of radius in relation to ulna
| * easily injured in children
32
muscles of anterior compartment of forearm function
* flex wrist and digits
* pronate hand
* flex thumb
* adduct/abduct hand
33
innervation of anterior compartment of forearm
median nerve, EXCEPT flexor carpi ulnaris and ulnar have of flexor digitorum profundus (ulnar n)
34
supply of anterior compartment of forearm
branches of radial and ulnar arteries
35
muscles of posterior compartment of forearm function
* extend wrist and digits
* supinate hand
* extend and abduct thumb
36
innervation of posterior compartment of forearm
radial nerve
37
supply of posterior compartment of forearm
branches of radial and ulnar arteries
38
superficial muscles of hand
* 3 of thenar pad
* 3 of hypothenar pad
* lumbricals
* adductor pollicis
39
innervation of superficial hand muscles
ulnar nerve EXCEPT lateral 2 lumbricals and 3 thenar muscles (median nerve)
40
deep muscles of hand
* 3 palmar interossei
| * 4 dorsal interossei
41
innervation of deep muscles of hand
ulnar nerve
42
supply of hand
branches of radial and ulnar arteries via superficial and deep palmar arches
43
merocrine secretion
product released by exocytosis (e.g. pancreas)
44
apocrine secretion
product release with a small portion of apical cytoplasm and membrane (e.g. mammary gland)
45
holocrine secretion
secretory product constitutes entire cell and its products (e.g. sebaceous gland)
46
tight junctions (zona occludens)
* localized sealing of plasma membranes of adjacent cells
| * important proteins: occludin, claudin, ZO proteins
47
desmosomes (macula adherens)
* mechanical anchoring -> resist cell-cell separation
* plaque of desmoplakin, plakoglobin, and plakophilin -> cytoplasmic keratin filaments on one side and adhesion molecules on the other
48
gap junctions
* permit passage of small molecules
| * membrane proteins call connexins form connexon
49
hemidesmosomes
* asymmetrical cell junctions
| * links cells to basal lamina by integrin proteins
50
proximal to distal limb development dependent on
* FGF (fibroblast growth factor)
| * mesoderm produce FGF -> ectoderm proliferation (AER) -> AER produces FGF -> prolif. of mesoderm (progress zone)
51
dorsal to ventral limb development dependent on
* most important gene is Wnt-7a (signaling protein expressed by AER)
* Wnt-7a activates LMX-1 in mesoderm -> form dorsal structures
* ectoderm on ventral side has Engrailed1 that represses Wnt-7a
52
anterior to posterior limb development depends on
* Shh gene
* cells that produce Shh called ZPA (zone polarizing activity) are found at posterior base of limb buds
* Shh diffuses across limb bud to activate Hox genes that pattern thumb to little finger
53
**intramembranous ossification
* mesenchyme cells differentiate directly to osteoblasts -> lay down primary/woven bone -> remodeled to lamellar bone
* flat bones of skull and bones of face
54
**endochondral ossificatiuon
* long bones, vertebral column, pelvis, sternum, skull base
| * mesenchyme -> chondroblasts -> cartilage model -> osteoblasts
55
**reduction defects of limb
* meromelia - part of limb
* amelia - entire limb missing
* phocomelia - meromelia with hands or feet coming off shoulder/hip
* THALIDOMIDE -> disrupts AER and its production of FGF
56
critical period of limb development
week 4-5
57
**duplication defects of limb
Shh involved in polydactyly -> If ZPA duplication -> mirroring of digits
58
**dysplasia defects of limb
ie abnormal fusion of digits (syndactyly) resulting from reduced apoptosis
59
caudal regression syndrome
(caudal dysplasia)
•impairs dev of lower half of body
•mechanism is abnormal gastrulation -> not enough caudal mesoderm
•genetic and environmental factors implicated
60
sirenomelia
* "mermaid syndrome"
* extreme rare form of caudal dysplasia
* fusion of lower limbs at midline
61
period of maximal sensitivity to teratogens
weeks 3-8 -> organogenesis
62
osteoblast
* derived from osteoprogenitor cells
| * cuboidal shaped, found on surface of bone
63
parathyroid hormone receptor
* expressed on osteoblasts
* stimulated by PTH -> induce RANKL and mCSF expression, inhibits OPG production
* PTH STIMULATES OSTEOCLASTOGENESIS
64
alkaline phosphatase
* cell surface enzyme found on osteoblasts
| * produce phosphate ions in bone matrix synth
65
IGF-1 receptor
* found on osteoblasts
| * binds IGF-1 from liver to stim growth of long bones
66
major component of osteoid matrix
type I collagen
67
osteoprotegerin (OPG)
* produced by osteoblast
| * decoy receptor for RANKL -> inhibits osteoclastogenesi
68
RANKL
* found on osteoblast
* ligand for RANK of osteoclast precursors
* receptor for OPG
69
osteocalcin
metabolic marker of bone formation found in osteoblast
70
primary/woven bone
initial ECM produced by osteoblast
71
secondary/lamellar bone
* remodeled woven bone
| * organized sheet of collagen
72
osteocyte
* osteoblasts that have become surrounded by bone matrix and stop producing osteoid
* release factors that stimulate bone remodeling/turnover in response to forces on bone
73
osteoclast
* large multinucleated cells on surface of bone
| * degrade bone matrix
74
osteoclast derived from
monocyte precursors originating in bone marrow
75
steps of osteoclastogenesis
monocyte -> macrophage -> binds M-CSF -> expresses RANK -> binds RANKL and becomes osteoclast precursor -> uncouples from osteoblast -> matures with sealing zone and ruffled border
76
M-CSF produced by
* macrophage colony-stimulating factor
| * osteoblasts
77
denosumab effect on osteoclastogenesis
* decreases osteoclastogenesis
| * antibody to RANKL (functions like OPG)
78
low plasma calcium causes secretion of
PTH -> acts on osteoblast receptors -> differentiation of osteoclasts -> increase bone turnover
79
high plasma calcium causes secretion of
calcitonin -> activation of osteoclast -> retract from bone surface -> decrease bone turnover
80
course of median nerve
* from lateral and medial cords
* runs with brachial artery in medial arm
* enters forearm anterior to elbow joint
* enters hand through carpal tunnel
81
course of ulnar nerve
* from medial cord
* runs with brachial artery in medial arm
* posses posterior to medial epicondyle
* medial aspect of forearm
82
course of axillary nerve
* from posterior cord
| * passes posterior to surgical neck of humerus
83
course of radial nerve
* from posterior cord
* posterior compartment of arm close to shaft of humerus
* enters forearm posterior to lateral epicondyle
84
posterior interosseous nerve
deep branch of radial nerve in the forearm
85
anterior interosseous nerve
deep branch of median nerve in forearm
86
sensory deficits with axillary nerve lesion
* ie dislocation glenohumeral join, fx surgical neck humerus
| * lateral shoulder and upper arm
87
sensory deficits with radial nerve lesion
* ie midshaft fx humerus
| * posterior arm/forearm and dorsum of hand
88
sensory deficits with median nerve lesion
* supraepicondylar fx of humerus or carpal tunnel syndrome
* palmar aspect of thumb
* palmar and dorsal aspect of index, middle, and half of ring finger
89
sensory deficits with lesion of anterior interosseous nerve
* ie fx of forearm
| * no sensory deficits
90
sensory deficits with lesion of ulnar nerve
* ie medial epicondyle fx, wrist fx or laceration
| * medial aspect of hand and most of 4th and 5th digits
91
sensory deficits with lesion of musculocutaneous nerve
lateral forearm
92
upper brachial plexus injury (Erb's Palsy)
* most commonly involves musculocutanous, axillary, suprascapular
* arm hangs by side, adducted, medially rotated, forearm extended and hand pronated
93
lower brachial plexus injury (Klumpke's Palsy)
* most commonly involved ulnar (maybe median)
| * "ulnar claw hand" (hyperextension of MP joints and flexion of IP joints)
94
iliofemoral ligament prevents
* hyperextension of hip joint
| * anterior part of joint capsule
95
pubofemoral ligement prevents
* excessive abduction and hyperextension of hip
| * anterior inferior part of joint capsule
96
ischiofemoral ligament prevents
* hyperextension of hip joint
| * posterior part of joint capsule
97
supply to the hip joint
* medial and later circumflex (around neck of femur)
| * medial provides majority
98
ACL prevents
anterior displacement of tibia on femur
99
PCL prevents
posterior displacement of tibia on femur
100
MCL and LCL function
help stabilize knee joint
101
medial and lateral meniscus function
* help stabilize knee join
| * shock absorption
102
unhappy triad of O'Donahue
MCL, ACL, and medial meniscus when injured together
| ^most commonly injured knee structures
103
ankle joint most stable when
dorsiflexed, comped with plantarflexed
104
ligaments in ankle
* deltoid on medial side
| * anterior talofibular, posterior talofibular, and calcaneofibular laterally
105
ankle sprain normally occurs via
excessive inversion on a plantarflexed weight-bearing foot
106
ankle ligament most at risk in ankle sprain
anterior talofibular
107
superficial abductors and extensors of femur (gluteal region)
* gluteus maximus (inferior glut n.)
| * gluteus medius, gluteus minimus, and tensor fascia lata (superior glut n.)
108
deep external rotators of femur (gluteal region)
* piriformis (nerve to the...)
* obturator internus (nerve to the...)
* superior and inferior gamellus (nerve to the ^)
* quadratus femoris (nerve to the...)
109
anterior compartment of thigh function
extend leg at the knee
110
innervation of anterior compartment of thight
femoral nerve
111
supply of anterior compartment of thigh
femoral and deep femoral arteries
112
medial compartment of thigh function
adduct the thigh at the hip
113
innervation of medial compartment of thigh
obturator nerve
114
supply of medial compartment of thigh
deep femoral and obturator arteries
115
posterior compartment of thigh function
* flex leg at knee
| * extend thigh at hip
116
innervation of posterior compartment of thigh
sciatic nerve
117
supply of posterior compartment of thigh
deep femoral artery
118
anterior compartment of leg function
* dorsiflex foot
* invert foot
* extend toes
119
innervation of anterior compartment of leg
deep fibular nerve
120
supply of anterior compartment of leg
anterior tibial artery
121
lateral compartment of leg function
* plantarflex foot
| * evert foot
122
innervation of lateral compartment of leg
superficial fibular nerve
123
supply of lateral compartment of nerve
fibular artery
124
posterior compartment of leg function
* plantarflex foot
* invert foot
* flex toes
125
innervation of posterior compartment of leg
tibial nerve
126
supply of posterior compartment of leg
posterior tibial artery
127
major nerves of lumbar plexus
* lateral cutaneous nerve of thigh (L2, L3)
* femoral nerve (L2-L4)
* obturator nerve (L2-L4)
128
major nerves of sacral plexus
* superior gluteal (L4-S1)
* inferior gluteal (L5-S2)
* sciatic (L4-S3)
* posterior femoral cutaneous (S1-S3)
* named branches to small external rotators
129
sensory deficits with femoral nerve lesion
* anterior thigh
| * medial knee, leg, and foot
130
sensory deficits with obturator nerve lesion
medial thigh above knee
131
sensory deficits with superior gluteal nerve lesion
NONE
132
sensory deficits with tibial nerve lesion
* posterolateral leg
* lateral malleolus
* sole and lateral foot
133
sensory deficits with superficial fibular nerve lesion
* lateral leg
| * dorsum of foot
134
sensory deficits with deep fibular nerve lesion
•triangular area between 1st and 2nd toes
135
femoral artery is extension of
external iliac artery as it crosses under inguinal ligament
136
deep femoral artery branches
from posterolateral aspect of femoral artery in femoral triangle
137
3 main branches of deep femoral artery
* perforating branches -> medial and posterior thigh
* lateral femoral circumflex
* medial femoral circumflex
138
femoral artery moves to posterior compartment proximal to knee to become
popliteal artery
139
genicular arteries
branch off popliteal artery in posterior thigh to supply knee
140
popliteal artery divides at lower border of popliteal fossa to
anterior tibial and posterior tibial arteries
141
fibular (peroneal) artery comes from
posterior tibial artery
142
dorsalis pedis artery extension of
anterior tibial artery
143
inferior and superior gluteal arteries arise from
internal iliac artery
144
transverse tubule
finger-like projections formed by invaginations of sarcolemma
145
function of T-tubule
* in contact with SR
| * transmits depolarization from plasma membrane to deep in muscle cells
146
where is intracellular Ca2+ stored in muscle cells?
SR
| *important for regulation of muscle contraction
147
myofibrils composed of
thick (myosin) and thin (actin) filaments
148
desmin
* protein that connects myofibrils and is anchored in sarcolemma
* facilitates coordinated contraction
149
Z-line/disk
* define boundaries of sarcomere
| * has actin biding protein (alpha actinin)
150
I-band
* only thin filaments
| * width decreases in contraction
151
H-band
* in center of A-band
* only thick filaments
* width decreases in contraction
152
A-band
* overlapping thick and thin filaments
| * width constant in contraction
153
M-line
•middle of H-band
154
thin filament structure
f-actin forms complex with tropomyosin and troponin complex (I, T, and C)
155
troponin-t binds to
tropomyosin
156
troponin-i function
inhibits biding of myosin to actin
157
troponin-c binds to
Ca2+
158
thick filament structure
myosin that has 2 identical heavy chains and 2 pairs of light chains
159
heavy chains contain
biding site for actin and an ATPase domain
160
What happens when ATP binds to myosin head?
conformation change -> dissociation of myosin from actin filament
161
when ATP bound to myosin head is hydrolyzed..
thick filament hinge increases angle between head and tail, lining up head with new myosin binding site on actin filament
162
when is ADP released from myosin head
once it binds to actin
163
release of ADP causes
decrease in angle between head and tail of myosin -> thin filament slides toward center of sarcomere
164
rigor posistionof myosin
when no ATP is bound and it is tightly adhered to actin
165
depolarization of t-tubule sensed by
L-type Ca2+ channels in its membrane -> opens ryanodine sensitive Ca2+ channels in membrane of SR terminal cisternae
166
when calcium binds to troponin-c of actin filament
conformational changes that uncover myosin biding site allowing thick filament to bind
167
how is calcium returned to SR during relaxation of muscle?
ATP-dependent pump
168
septation of atria
* end of 4th week
* septum primum grows down from roof of common atrium leaving foramen primum
* cell death in septum primum -> foramen secundum
* septum secundum forms leaving foramen ovale
169
atrial septal defects can occur if
septum secundum doesn't grow enough, or foramen secundum is too large
170
septation of atrioventricular canal
endocardial cushions on dorsal and ventral walls grow toward each other and fuse
171
atrioventricular valves formed from
endocardial cushion tissue
172
septation of ventricles
* muscular: myoblasts on floor of ventricle grow toward fused endocardial cusions
* membranous: forms from fused endocardial cushions and the aoritcopulmonary septum
173
most common congenital cardiac defect
membranous ventricular septal defect
174
septation of outflow tract
* beginning in 5th week
* neural crest cell migration into truncus arteriosus
* conotruncal ridges spiral and fuse
175
persistent truncus arteriosus
no septum forms in the outflow tract
176
transposition of great vessels
aorticopulmonary septum doesn't spiral
177
tetralogy of fallot
* septum forms asymmetrically
* ventricular septal defect
* overriding aorta
* subpulmonary stenosis
* right ventricular hypertrophy
* caused by abnormal dev (displa1ement) of conus arteriosus from bulbus cordis
178
innervation of diaphragm
phrenic nerve (C3, C4, C5 ventral rami)
179
aortic hiatus
* level of T12
* within right and left crura of diaphragm
* aorta, thoracic duct, azygos veins
180
esophageal hiatus
* level of T10
* within muscular part of diaphragm
* esophagus and vagus nerves
181
caval opening
* level of T8
* located in central tendon of diaphragm
* IVC and sometimes right phrenic nerve
182
superior/inferior division of mediastinum
at sternal angle
183
anterior mediastinum contains
CT, fat, remnants of thymus
184
middle mediastinum contains
heart and roots of great vessels, and phrenic nerves
185
posterior mediastinum contains
descending aorta, azygous vein, thoracic ducts, esophagus, trachea, vagus nerves
186
pneumothorax
accumulation of air in pleural cavity -> lung collapse
187
recesses in pleural cavity
* costodiaphragmatic
| * costomediastinal
188
pleural effusion
accumulation of fluid in pleural space -> fixed with thoracentesis
189
how to perform thoracentesis
* patient supine or sitting upright
* 1-2 intercostal spaces below effusion, but no lower than 8th intercostal space (avoid damage to lung, liver, spleen, diaphragm)
190
innervation of costal parietal pleura
intercostal nerves
191
innervation of mediastinal and diaphragmatic parietal pleura
phrenic nerves
192
innervation of visceral pleura
autonomic nerves
193
transverse pericardial sinus
* posterior to ascending aorta and pulmonary trunk
* anterior to SVC
* can be used for ligature to stop blood circulation
194
oblique sinus
located behind heart
195
coronary flow occurs during
* diastole
| * R and L coronary arteries in aorta above aortic valve fill with blood when aortic valve closes
196
cardiac skeleton important because
electrically separates atrial from ventricular musculature
197
enlarged left atrium can compress
esophagus
198
margins of hear
* right side: 3rd costal to 6th costal cartilage
| * left side: 2nd intercostal space to midclavicular 5th intercostal space
199
right coronary artery branches
* PDA (PIV) 85% of the time
* right marginal artery
* sa nodal
* av nodal
200
PDA (PIV) supplies
* right atrium
* right/left ventricle
* 1/3 of septum
201
right marginal arter supplies
right ventricle
202
left coronary artery branches
* LAD (AIV)
* left marginal
* circumflex
203
LAD (AIV) supplies
* right ventricle
* left ventricle
* 2/3 of septum
204
left marginal artery supplies
left ventricle
205
circumflex artery supples
* posterior surface of left ventricle
| * left atrium
206
right main bronchus compared to left
* shorter
* wider
* more vertical
* thus more foreign bodies lodged on right side
207
bronchopulmonary segments
* divisions within lobes of lungs
* artery and segmental bronchus at the center
* veins at the periphery
208
autonomic innervation of tracheobronchial tree
* vagus nerves and T1-T4 of sympathetic trunk
* visceral afferent from vagus
* preganglionic parasymp and postganglionic symp from pulmonary plexus
209
intercalated discs
* in cardiac muscle
| * desmosomes and gap junctions
210
SA node
* pacemaker
| * electrical impulse from right atrium to left atrium and AV node
211
AV nodes
conducts impulse from atria to ventricles
212
bundle of His
conducts electrical impulse from AV node through cardiac skeleton and membranous IV septum
213
Left and Right bundle branches
group of purkinje fibers along IV septum giving rise to the purkinje fibrers distributed in ventricles
214
tunica intima
* simple squamous
* non-thrombogenic
* release factors that regulate smooth muscle -> regulate vascular tone
215
tunica media
* concentric layers of smooth muscle
* elastic fibers
* type III collagen
* proteoglycans
* primarily regulates vascular tone, vessel diameter, and BP
216
tunica adventitia
* CT layer with fibroblasts, type I collagen, elastic fibers
* vasa vasorum
* sympathetic nerve fibers
217
capillaries
* site of fluid, gas, and small molecule exchange between blood and tissues
* single layer of endothelial cells and basement membrane
* pericytes = sphincter can be associated with outer wall
218
continuous capillaries
* found in muscle, nerve, CT
* tight junctions resist leakage
* pinocytosis
219
fenestrated capillaries
* found in GI and endocrine
| * permanent channels along endothelial cells
220
sinusoidal capillaries
* found in bone marrow, liver, spleen
| * large discontinuities between endothelial cells
221
angiogenesis
* formation of new capillaries from existing
| * stimulation of endothelial cells by VEGF (vascular endothelial growth factor)
222
mucosa of conducting respiratory system
* ciliated pseudostratified columnar epithelium with goblet cells
* as you approach respiratory portion, goblet cells decrease and changes to simple columnar and cuboidal
223
submucosa of conducting respiratory system
* smooth muscle cells that increase in # as diameter of tube decreases
* hyaline cartilage that decreases as tube diameter decreases
* seromucous glands
224
bronchioles don't have
goblet cells, seromucous glands, or cartilage
| epithelium=cuboidal
225
type I alveolar cells / pneumocytes
* squamous, 97% alveolar surface
* desmosomes and tight junctions
* form gas permeable membrane
226
type II alveolar cells / pneumocytes
* cuboidal
| * produce surfactant
227
alveolar macrophage/ dust cell
* derived from monocytes
| * phagocytose carbon and dust from alveolar lumen
228
blood-air barrier
1. surface and cytoplasm of type I alveolar cells
2. fused basal laminae of alveolar and capillary endothelial cells
3. cytoplasm of endothelial cells
229
anterior rectus sheath formed by
* aponeurosis of external oblique
| * part of aponeurosis of internal oblique
230
posterior rectus sheath formed by
* part of aponeurosis from internal oblique
| * aponeurosis of transverse abdominus
231
arcuate line
where the posterior rectus sheath ends and all that rectus abdominus rests on is transversalis fascia
232
direct inguinal hernia
weakness in musculature of abdominal wall through hesselbach's triangle
233
indirect inguinal hernia
congenital defect in inguinal canal
234
MDs don't LIe
•direct hernia medial to inferior epigastric arteries
•indirect lateral
both above inguinal ligament
235
femoral hernia
below inguinal ligament
236
peritoneal epithelium
simple squamous (serous)
237
pain from parietal peritoneum
* shares sensory innervation with abdominal wall (T7-L1)
| * sharp and localized
238
pain from visceral peritoneum
•diffuse and dull referred pain
239
pain from foregut organs refers to
epigastric
240
pain from midgut organs refers to
umbilical
241
pain from hindgut organs refers to
pubic (hypogastric)
242
epiploic foramen (of winslow)
entrance to lesser sac from greater sac
243
foregut includes
esophagus, stomach, 1st half of duodenum and associated organs
244
midgut includes
second half of duodenum, jejunum, ileum, ascending colon, and first 2/3 of transverse colon
245
hindgut includes
last 1/3 of transverse colon, descending colon, sigmoid colon, and rectum
246
anastamosis at foregut-midgut junction
```
superior pancreaticoduodenal (celiac trunk)
inferior pancreaticoduodenal (SMA)
```
247
anastamosis at midgut-hingut junction
```
middle colic (SMA)
left colic (IMA)
```
248
anastamosis at rectum
```
superior rectal (IMA)
Middle and inferior rectal arteries (internal iliac)
```
249
hepatoduodenal ligament contains
•proper hepatic artery
•portal vein
•common bile duct
(anterior to epiploic foramen)
250
rotation of stomach in embroylogic dev
90 degrees clockwise on longitudinal axis so left side faces anteriorly
251
spleen develops from
mesoderm in dorsal mesentery of stomach
252
midgut rotation
* 270 degrees around axis of SMA during herniation and upon return
* jejunum returns first to left side
* ileum returns to right side
* cecum returns last: RUQ then RLQ
253
hypertrophic pyloric stenosis
* projectile nonbilious vomiting
* sx usually begin 3-5 weeks after birth
* etiology unclear
254
annular pancreas
* vomiting (usually nonbilious) and abd distention
* sx begin in neonatal period with feeding
* ventral pancreatic bud has 2 lobs that form a ring around 2nd part of duodenum
255
meckel's diverticulum
* persistence of yolk stalk (vitelline duct)
* ectopic gastric mucosa may be present
* rule of 2s
256
volvulus
* vomiting, absence of stool, abd distention
* can obstruct SMA
* malrotation of midgut
257
duodenal atresia
* failed recanalization
* bilious vomit and abd distention
* double bubble sign
* associated with polyhydramnios
258
intussusception
* segment of intestine invaginates or telescopes into adjacent
* intermittent abd pain, vomiting, bloating, bloody stool
259
aganglionic megacolon (hirschsprung's disease)
* lack of ganglia in colon
* defect in RET gene (involved in neural crest cell migration)
* fecal retention and abdominal distention
260
esophagus histology
* thick nonkeratinized stratified squamous
* submucosal glands
* thoracic esophagus has adventitia, abdominal esophagus has serosa
261
stomach histology
* simple columnar epithlial lining consisting entirely of mucous-secreting cells
* gastric glands open into pits in mucosa
* 3 layers in muscularis: inner oblique, middle circular, outer longitudinal
262
mucous cells in gastric glands
secrete mucous rich in bicarbonate
263
parietal cells in gastric glands
* produce HCl (pepsinogen -> pepsin)
| * produce intrinsic factor (absorption of vit B12)
264
chief cells in gastric glands
•secrete pepsinogen
265
enteroendocrine cells in gastric glands
* secrete serotonin (effect gut motility)
| * secrete gastrin (effect HCl secretion)
266
pepsin
proteolytic enzyme capable of digesting most proteins
267
small intestine histology
* luminal surface has plica circulares with villi
* mucosa simple columnar with tight junctions, goblet cells, paneth cells, enteroendocrine cells
* crypts of lieberkuhn
268
enterocytes of small intestine
absorptive and have microvilli (brush border)
269
paneth cells
lysozyme secreting (antibacterial)
270
cholecystokinin
* secreted by enteroendocrine cells in small intestine
| * stim secretion from pancreatic acinar cells and release bile from gallbladder
271
secretin
* secreted by enteroendocrine cells in small intestine
* released in response to gastric acid
* stim release of HCO3 from pancreas and liver
272
gastric inhibitory peptide
* secreted by enteroendocrine cells in small intestine
| * stim insulin secretion from pancreatic islets
273
glucagon like peptide
* secreted by enteroendocrine cells in small intestine
| * stim insulin secretion and inhibits glucagon secretion
274
brunners glands
* found only in mucosa of DUODENUM
| * secrete alkaline mucous
275
peyer's patches
* found in lamina propria of ILEUM
| * concentrated lymphocytes (AKA GALT)
276
histology of large intestine
* simple columnar with goblet cells
* crypts without villi
* teniae coli (longitudinal bands of longitudinal muscle
* epiploic appendages on the serosa
277
merocrine secretion of pancreatic proenzymes regulated by
* secretin and cholecystokinin from small intestine
| * stimulation by vagus nerve
278
alpha cells of pancreatic islet
produce glucagon -> increase blood glucose, gluconeogenesis, and glycogenolysis
279
beta cells of pancreatic islet
produce insulin -> decrease blood glucose, stim storage of glucose as glycogen
280
delta cells of pancreatic islet
produce somatostatin -> inhibit secretion of glucagon and insulin
281
blood flow in hepatic lobule
from periphery to center (zone I to zone III)
282
hepatocytes near zone I
* can rely on aerobic metabolism
| * more active in protein synth
283
hepatocytes near zone III
* get lower [O2] and nutrients
| * more involved in detoxification and glycogen metabolism
284
bile flow in liver
opposite to blood flow (zone III to zone I)
285
kupffer cells
* phagocytic cells found in sinusoids of liver
| * remove aged RBCs, bacteria and other debris
286
Ito cell
* in space of disse
| * stores vitamin A and other fat-soluble vits
287
broad ligament
* mesometrium
* mesovarium
* mesosalpinx
288
suspensory ligament of ovary
contains ovarian vessels
289
ovarian ligament
attaches it to uterus
290
round ligament of uterus
* continuous with ovarian ligament
| * enters deep inguinal ring
291
stress incontinence can be cause by damage to
* pubovesicle ligaments
* transverse cervical ligaments (cardinal)
* uterosacral ligaments
292
bladder prolapse involves
pubovesical ligaments
293
uterine prolapse involves
transverse cervical (cardinal) ligaments
294
layers of spermatic cord
* external spermatic fascia (ext oblique aponeurosis)
* cremasteric fascia/muscle (internal oblique)
* internal spermatic fascia (transversalis fascia)
295
parasympathetic innervation of pelvic organs
* preganglionic: pelvic splanchnic (S2-S4)
| * ganglia: located in wall of organ
296
sympathetic innervation of pelvic organs
* preganglionic: lesser and least splanchnic (T10-T12) and lumbar splanchnic (L1-L2)
* ganglia: pelvic ganglia
* postganglionic: hypogastric plexus (ovarian plexus to ovary and testicular plexus to testis/epididymis)
297
visceral afferents inferior to pelvic pain line
* structures that don't contact peritoneum + sigmoid colon and rectum
* follow parasympathetic fibers
298
visceral afferents superior to pelvic pain line
* structures in contact with peritoneum - sigmoid colon and rectum)
* follow sympathetics
299
mesonephric duct becomes
epididymis, vas deferens, and seminal vesicles
300
paramesonephric duct becomes
uterus, uterine tubes, and upper vagina
301
Wnt4 ->
maintain oocytes
302
SRY gene
produce testis determining factor (TDF)
303
MIS or AMH
•same thing anti-mullerian hormone/mullerian inhibiting substance
•produced by sertoli cells in respons to
TDF
304
in embryogenesis leydig cells produce
testosterone -> differentiation mesonephric duct
305
dihydrotestosterone
* 5-alpha reductase converts testosterone into this
| * cause dev of penis, scrotum, prostate
306
prostate and bulbourethral gland bud off
urethra
307
lower vagina forms from
sinovaginal bulbs (proliferaltion of endodermal tissue on posterior wall of urogenital sinus)
308
leydig cells
* found in space between seminiferous tubules
| * produces testosterone in response to LH
309
sertoli cells
* columnar epithelium found in seminiferous tubule
* secrete ABP in response to FSH
* also phagocytose residual germ cell cytoplasm and regulate release of mature spermatozoa
310
which spermatogenic cells are diploid
spermatogonia and primary spermatocytes
311
spermatogenesis sequence
spermatogonia -> primary spermatocyte -> meiosis I -> secondary spermatocyte -> meiosis II -> spermatid -> spermiogenesis -> spermatozoa
312
histology of epididymis
* pseudostratified columnar with long branched stereocilia
* principle cells with stereocilia
* basal cells that are precursors for principle cells
313
histology of vas deferens
* pseudostratified columnar with stereocilia
| * thick muscular layer
314
zones of prostate gland
* transition zone around urethra
* central zone around ejaculatory ducts
* peripheral zone
315
corpora amylacea
concretions often found in prostate gland that can be site of calcium deposition
316
benign prostate hyperplasia most often involves
cells and stroma of central and transitional zones
317
prostate cancer most often involves
peripheral zone
318
ovarian surface epithelium
(OSE)
•simple squamous-to-low-cuboidal
•important stem cell that repairs damage caused by ovulation
319
ovarian cycle
* follicular phase
* ovulatory phase
* luteal phase
320
steps of folliculogenesis
primordial follicle -> primary (unilayered) follicle -> secondary (multilayered) follicle ->antral follicle -> graffian (preovulatory) follicle
321
corpus luteum
* granulosa lutein cells (from granulosa) -> progesterone/estrogen in response to FSH and LH
* theca lutein cells (from theca interna) -> androstenedion and progesterone in response to LH
322
estradiol
made from androstenedione (from theca lutein) by aromatase within granulosa lutein
323
corpus albicans
luteolysis of corpus luteum occurs if hCG does not stimulate it to continue producing hormones
324
what stimulates thickening of endometrium during proliferative phase?
estrogen produced by maturing ovarian follicles
325
secretory phase controlled by
progesterone and estrogen produced by corpus luteum
326
what initiates ischemic phase
regression of corpus luteum
327
foramina of anterior cranial fossa
cribriform plate
328
foramina of middle cranial fossa
```
C/O canals, ROS foramen, and 1 fissure
•carotid canal
•optic canal
•foramen rotundum
•foramen ovale
•foramen spinosum
•superior orbital fissure
```
329
foramina of posterior cranial fossa
```
HIJ + magnum
•hypoglossal canal
•internal acoustic meatus
•jugular foramen
•forament magnum
```
330
what runs through superior orbital fissure
CN III, IV, V1, and VI
331
what runs through foramen rotundum
maxillary nerve
332
what runs through foramen ovale
mandibular nerve
333
what runs through carotid canal
internal carotid artery and internal carotid nervous plexus (sympathetic)
334
what runs through internal acoustic meatus
CN VII and VIII
335
what runs through jugular foramen
CN IX, X, and XI
| and sigmoid sinus
336
what runs through foramen magnum
* vertebral arteries
* spinal contribution to CN XI
* anterior and posterior spinal arteries
337
epidural hematoma
* middle meningeal artery
* usually fx of temporal bone
* brief LOC -> lucid interval -> HA, AMS, weakness
* convex hyperdensity on CT (lemon)
338
subdural hematoma
* bridging veins
* elderly and alcoholics susceptible
* HA and AMS w/o other clinical findings
* concave hyperdensity of CT (banana)
339
subarachnoid hemorrhage
* stroke with bleeding into subarachnoid space
* sudden onset severe headache, n/v, neck/back pain, dizzy, sz
* LP would show blood
340
innervation of extraocular muscles
LR6, SO4, ATR3
341
test superior rectus
look lateral and up
342
test inferior rectus
look lateral and down
343
test inferior oblique
look medial and up
344
test superior oblique
look medial and down
345
nasal septum formed by
vomer and perpendicular plate of ethmoid bone
346
sphenoid sinus drains into
spehnoethmoidal recess
347
ethmoid sinus drains into
superior and middle meatuses
348
frontal sinus drains into
middle meatus
349
maxillary sinus drains into
middle meatus
350
nasolacrimal duct drains into
inferior meatus
351
epistaxis often involves
septal branch of superior labial artery from facial artery
352
vestibule of larynx
* supraglotic
| * above vestibular folds
353
ventricle of larynx
* glottic
| * between vestibular and vocal folds
354
infraglottic region of larynx
* subglottic
| * below vocal folds
355
only laryngeal muscles that abduct (open) vocal folds
posterior cricoarytenoids
356
position of rima glottidis in quiet respiration
open/ abducted vocal folds
357
position of rima glottidis in swallowing
•closed/ adducted vocal folds
| +epiglottis swings down to close laryngeal vesibule
358
position of rima glottidis in phonation (speech)
closed/ abducted vocal folds
359
superior laryngeal branch of vagus nerve
* motor to cricothyroid
| * sensory to mucosa above vocal folds
360
recurrent laryngeal branch of vagus nerve
* motor to all muscles except cricothyroid
| * sensory to mucosa below vocal folds
361
only cranial nerves arising from cerebrum
CN I and II (all others from brainstem)
362
cranial nerves that transmit parasympathetic information
CN III, VII, IX, and X
363
branches of opthalmic nerve (V1)
* frontal nerve gives a branch to lacrimal gland and then exits supraorbital foramen and becomes supraorbital nerve
* smaller branches give sensation to cornea and conjunctiva
364
supraorbital nerve sensory to
* branch of V1
| * sensation to scalp, forehead and nose
365
branches of maxillary nerve (V2)
* infraorbital nerve
| * superior alveolar nerve
366
superior alveolar nerve sensory to
* branch of V2
| * sensation to upper teeth/palate, some sinuses, and nasal mucosa
367
infraorbital nerve sensory to
* branch of V2
| * sensation to cheeks, lower eyelids, and upper lip
368
branches of mandibular nerve (V3)
sensory:
•buccal - inside mouth and cheek
•ariculotemportal - skin around external ear
•lingual - anterior 2/3 of tongue
•inferior alveolar - lower teeth -> mental nerve - lower lip/face
motor:
•supply temporalis, masseter, medial/lateral pterygoids
369
innervation of parotid gland
* Parasympathetic
* preganglionic - lesser petrosal of glossopharyngeal
* otic ganglion
* postganglionic - ariculotemporal branch of V3
370
travel of facial nerve in skull
internal acoustic meatus -> petrous part of temporal bone -> out stylomastoid foramen
371
innervation and function of stapedius muscle
* branch of facial nerve
| * attaches to stapes and dampens sound received from TM
372
temporal branches of facial nerve innervate
frontalis, orbicularis oculi, and corrugator supercili
373
zygomatic branches of facial nerve innervate
orbicularis oculi
374
buccal branches of facial nerve innervate
orbicularis oris, buccinator, zygomaticus
375
marginal mandibular branches of facial nerve innervate
mentalis
376
cervical branch of facial nerve innervates
platysma
377
chorda tympani nerve
* branch of facial nerve
* taste from anterior 2/3 of tongue
* also parasympathetic to sublingual and submandibular salivary glands
378
glossopharyngeal nerve
* CN IX
* sensory to posterior 1/3 tongue, palate, and oropharynx
* afferent of gag reflex
* motor to pharynx
* taste from posterior 1/3 of tongue
379
vagus nerve
* CN X
* sensory external ear, larynx, esophagus
* motor muscles of pharynx, larynx, palate, and esophagus
* efferent of gag reflex
380
double layer of epithelium on ciliary body
* inner: pigmented
| * outer: secrete aqueous humor
381
flow of aqueous humor
posterior chamber -> through pupil -> anterior chamber -> drains at trabecular meshwork of limbus
382
acute/ closed angle glaucoma
•flow aqueous humor obstructed by iris tissue
383
chronic/ open angle glaucoma
drainage of aqeuous humor from trabecular meshwork is impaired
384
when ciliary muscle relaxes
* tension on zonular fibers -> flat lens
| * distance vision
385
when ciliary muscle contacts
* laxity to zonular fibers 0 -> round lens
| * close vision
386
oxytocin
* made by paraventricular nuclei of hypothalamus
* stored posterior pituitary
* uterine contraction and lactation
387
ADH
* =antidurietic hormone = vasopressin
* made by supraoptic nuclei of hypothalamus
* stored posterior pituitary
* decrease urine production/constric arterioles -> increase BP
388
growth hormone
* anterior pituitary acidophils
| * bone and soft tissue growth
389
prolactin
* anterior pituitary acidophils
| * initiation/maintenance of lactation
390
TSH
* anterior pituitary basophils
| * stimulate thyroid to make T3 and T4
391
FSH
* anterior pituitary basophils
| * stimulate follicle development
392
LH
* anterior pituitary basophils
| * stimulate testosterone production -> spermatogenesis
393
ACTH
* =adrenocorticotrophic hormone
* anterior pituitary basophils
* cause cortisol and androgen release -> regulation of metabolism and immune responses, secondary sex characteristic
394
parafollicular cells
* =c cells
* found in interstitium around thyroid follicles
* produce calcitonin -> lowers blood calcium by acting on osteoclasts (decrease bone turnover) and kidney/gut (increase calcium excretion)
395
thyroglobulin synthesis (exocrine phase)
1. TSH stimulates follicular cell
2. iodide uptake via ATP dependent pump
3. diffusion of iodide through cell
4. synthesis of thyroglobulin and exocytosis into colloid
5. oxidation of iodide by thyroid peroxidase
6. transfer of iodine to tyrosyl residues of thyroglobulin
7. storage of iodothyroglobulin in colloid
396
thyroid hormone synthesis and release (endocrine phase)
1. TSH stimulates follicular cell
2. colloid droplet containing iodothyroglobulin endocytosis
3. fusion of droplet with lysosome and degradation to T3 and T4
4. release of T3 and T4 into bloodstream and interaction with binding proteins
397
Thyroid hormon
* =T3 and T4
* increase basal metabolic rate in adults
* influence growth and neurological development in fetus
398
foregut sympathetic innervation
* T5-T9
* pre: greater splanchnic
* post: celiac plexus
399
foregut parasympathetic innervation
vagus
400
midgut sympathetic innervation
* T5-T9 pre: greater splanchnic
* T10-T11: lesser splanchnic
* post: superior mesenteric plexus
401
midgut parasympathetic innervation
vagus
402
hindgut sympathetic innervation
* L1-L2
* pre: lumbar -> post: inferior mesenteric plexus
* pre: sacral splanchnic -> post: hypogastric plexus via pelvic ganglia
403
hindgut parasympathetic innervation
pelvic splanchnic nerves (S2-S4)
404
valgus stress ->
medial collateral ligament
405
varus stress ->
lateral collateral ligament
406
lachman's test
•for ACL
407
SAD PUCKER
```
Retroperitoneal structures:
S suprarenal glands
A aorta/ivc
D duodenum (2-4 parts)
P pancreas (except tail)
U ureters
C colon (ascending and descending)
K kidneys
E esophagus (thoracic portion)
R rectum
```
