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Clinical Morphology > NBME review > Flashcards

NBME review Flashcards

1
Q

regions of spine with anterior curvature

A

cervical and lumbar (secondary=devs with sit/stand/walk)

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2
Q

regions of spine with posterior curvature

A

thoracic and sacral (primary=present at birth)

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3
Q

kyphosis

A

excessive thoracic curvature = hunchback

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4
Q

lordosis

A

excessive lumbar curvature = swayback

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5
Q

ligamentum flavum

A

extends between lamina of adjacent vertebrae

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6
Q

annulus fibrosis

A

outer part of vertebral disc = fibrous CT

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7
Q

nucleus pulposis

A

central part of vertebral disc = gel-like

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8
Q

herniated (“slipped”) disc

A
  • annulus fibrosis deteriorates -> nucleus pulposis bulges -> spinal nerve compression
  • most common in lumbar and cervical
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9
Q

what space is accessed during a lumbar puncture?

A

lumbar cistern/dural sac/ thecal sac

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10
Q

fibrous joint (synarthroses)

A
  • little or no movement

* ie sutures of skull

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11
Q

cartilagenous joint (amphiarthroses)

A
  • slight movement
  • fibrocartilagenous disks between articular surface
  • sternocostal joints, intervertebral joints, and symphysis pubis
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12
Q

intima

A

cells lining the surface of the synovial membrane that secrete synovial fluid

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13
Q

joint effusion caused by

A

irritation to the synovial membrane -> excess production of synovial fluid

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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

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15
Q

rotator cuff muscles

A
  • supraspinatus
  • infraspinatus
  • subscapularis
  • teres minor
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16
Q

movement of supraspinatus

A

initiate and assist ABDUCTING arm

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17
Q

movement of infraspinatus

A

ER, ABDUCTION, ADDUCTION

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18
Q

movement of subscapularis

A

IR

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19
Q

movement of teres minor

A

ER AND ADDUCTION

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20
Q

innervation of supraspinatus

A

suprascapular nerve

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21
Q

innervation of infraspinatus

A

suprascapular nerve

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22
Q

innervation of subscapularis

A

upper and lower subscapular nerve

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23
Q

innervation of teres minor

A

axillary nerve

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24
Q

muscle most often involved in rotator cuff injury

A

supraspinatus muscle

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25
Q

muscles of anterior compartment of arm function

A
  • flex arm and forearm

* supinate hand

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26
Q

innervation of anterior compartment of arm

A

musculucutaneous nerve

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27
Q

supply of anterior compartment of arm

A

branches of brachial artery

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28
Q

muscles of posterior compartment of arm function

A

extend the forearm

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29
Q

innervation of posterior compartment of arm

A

radial neve

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30
Q

supply of posterior compartment of arm

A

branches of deep brachial artery

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31
Q

annular ligament

A
  • stabilizes head of radius in relation to ulna

* easily injured in children

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32
Q

muscles of anterior compartment of forearm function

A
  • flex wrist and digits
  • pronate hand
  • flex thumb
  • adduct/abduct hand
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33
Q

innervation of anterior compartment of forearm

A

median nerve, EXCEPT flexor carpi ulnaris and ulnar have of flexor digitorum profundus (ulnar n)

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34
Q

supply of anterior compartment of forearm

A

branches of radial and ulnar arteries

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35
Q

muscles of posterior compartment of forearm function

A
  • extend wrist and digits
  • supinate hand
  • extend and abduct thumb
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36
Q

innervation of posterior compartment of forearm

A

radial nerve

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37
Q

supply of posterior compartment of forearm

A

branches of radial and ulnar arteries

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38
Q

superficial muscles of hand

A
  • 3 of thenar pad
  • 3 of hypothenar pad
  • lumbricals
  • adductor pollicis
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39
Q

innervation of superficial hand muscles

A

ulnar nerve EXCEPT lateral 2 lumbricals and 3 thenar muscles (median nerve)

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40
Q

deep muscles of hand

A
  • 3 palmar interossei

* 4 dorsal interossei

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41
Q

innervation of deep muscles of hand

A

ulnar nerve

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42
Q

supply of hand

A

branches of radial and ulnar arteries via superficial and deep palmar arches

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43
Q

merocrine secretion

A

product released by exocytosis (e.g. pancreas)

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44
Q

apocrine secretion

A

product release with a small portion of apical cytoplasm and membrane (e.g. mammary gland)

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45
Q

holocrine secretion

A

secretory product constitutes entire cell and its products (e.g. sebaceous gland)

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46
Q

tight junctions (zona occludens)

A
  • localized sealing of plasma membranes of adjacent cells

* important proteins: occludin, claudin, ZO proteins

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47
Q

desmosomes (macula adherens)

A
  • mechanical anchoring -> resist cell-cell separation
  • plaque of desmoplakin, plakoglobin, and plakophilin -> cytoplasmic keratin filaments on one side and adhesion molecules on the other
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48
Q

gap junctions

A
  • permit passage of small molecules

* membrane proteins call connexins form connexon

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49
Q

hemidesmosomes

A
  • asymmetrical cell junctions

* links cells to basal lamina by integrin proteins

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50
Q

proximal to distal limb development dependent on

A
  • FGF (fibroblast growth factor)

* mesoderm produce FGF -> ectoderm proliferation (AER) -> AER produces FGF -> prolif. of mesoderm (progress zone)

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51
Q

dorsal to ventral limb development dependent on

A
  • 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
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52
Q

anterior to posterior limb development depends on

A
  • 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
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53
Q

**intramembranous ossification

A
  • mesenchyme cells differentiate directly to osteoblasts -> lay down primary/woven bone -> remodeled to lamellar bone
  • flat bones of skull and bones of face
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54
Q

**endochondral ossificatiuon

A
  • long bones, vertebral column, pelvis, sternum, skull base

* mesenchyme -> chondroblasts -> cartilage model -> osteoblasts

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55
Q

**reduction defects of limb

A
  • 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
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56
Q

critical period of limb development

A

week 4-5

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57
Q

**duplication defects of limb

A

Shh involved in polydactyly -> If ZPA duplication -> mirroring of digits

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58
Q

**dysplasia defects of limb

A

ie abnormal fusion of digits (syndactyly) resulting from reduced apoptosis

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59
Q

caudal regression syndrome

A

(caudal dysplasia)
•impairs dev of lower half of body
•mechanism is abnormal gastrulation -> not enough caudal mesoderm
•genetic and environmental factors implicated

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60
Q

sirenomelia

A
  • “mermaid syndrome”
  • extreme rare form of caudal dysplasia
  • fusion of lower limbs at midline
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61
Q

period of maximal sensitivity to teratogens

A

weeks 3-8 -> organogenesis

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62
Q

osteoblast

A
  • derived from osteoprogenitor cells

* cuboidal shaped, found on surface of bone

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63
Q

parathyroid hormone receptor

A
  • expressed on osteoblasts
  • stimulated by PTH -> induce RANKL and mCSF expression, inhibits OPG production
  • PTH STIMULATES OSTEOCLASTOGENESIS
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64
Q

alkaline phosphatase

A
  • cell surface enzyme found on osteoblasts

* produce phosphate ions in bone matrix synth

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65
Q

IGF-1 receptor

A
  • found on osteoblasts

* binds IGF-1 from liver to stim growth of long bones

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66
Q

major component of osteoid matrix

A

type I collagen

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67
Q

osteoprotegerin (OPG)

A
  • produced by osteoblast

* decoy receptor for RANKL -> inhibits osteoclastogenesi

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68
Q

RANKL

A
  • found on osteoblast
  • ligand for RANK of osteoclast precursors
  • receptor for OPG
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69
Q

osteocalcin

A

metabolic marker of bone formation found in osteoblast

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70
Q

primary/woven bone

A

initial ECM produced by osteoblast

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71
Q

secondary/lamellar bone

A
  • remodeled woven bone

* organized sheet of collagen

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72
Q

osteocyte

A
  • 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
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73
Q

osteoclast

A
  • large multinucleated cells on surface of bone

* degrade bone matrix

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74
Q

osteoclast derived from

A

monocyte precursors originating in bone marrow

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75
Q

steps of osteoclastogenesis

A

monocyte -> macrophage -> binds M-CSF -> expresses RANK -> binds RANKL and becomes osteoclast precursor -> uncouples from osteoblast -> matures with sealing zone and ruffled border

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76
Q

M-CSF produced by

A
  • macrophage colony-stimulating factor

* osteoblasts

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77
Q

denosumab effect on osteoclastogenesis

A
  • decreases osteoclastogenesis

* antibody to RANKL (functions like OPG)

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78
Q

low plasma calcium causes secretion of

A

PTH -> acts on osteoblast receptors -> differentiation of osteoclasts -> increase bone turnover

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79
Q

high plasma calcium causes secretion of

A

calcitonin -> activation of osteoclast -> retract from bone surface -> decrease bone turnover

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80
Q

course of median nerve

A
  • from lateral and medial cords
  • runs with brachial artery in medial arm
  • enters forearm anterior to elbow joint
  • enters hand through carpal tunnel
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81
Q

course of ulnar nerve

A
  • from medial cord
  • runs with brachial artery in medial arm
  • posses posterior to medial epicondyle
  • medial aspect of forearm
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82
Q

course of axillary nerve

A
  • from posterior cord

* passes posterior to surgical neck of humerus

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83
Q

course of radial nerve

A
  • from posterior cord
  • posterior compartment of arm close to shaft of humerus
  • enters forearm posterior to lateral epicondyle
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84
Q

posterior interosseous nerve

A

deep branch of radial nerve in the forearm

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85
Q

anterior interosseous nerve

A

deep branch of median nerve in forearm

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86
Q

sensory deficits with axillary nerve lesion

A
  • ie dislocation glenohumeral join, fx surgical neck humerus

* lateral shoulder and upper arm

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87
Q

sensory deficits with radial nerve lesion

A
  • ie midshaft fx humerus

* posterior arm/forearm and dorsum of hand

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88
Q

sensory deficits with median nerve lesion

A
  • supraepicondylar fx of humerus or carpal tunnel syndrome
  • palmar aspect of thumb
  • palmar and dorsal aspect of index, middle, and half of ring finger
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89
Q

sensory deficits with lesion of anterior interosseous nerve

A
  • ie fx of forearm

* no sensory deficits

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90
Q

sensory deficits with lesion of ulnar nerve

A
  • ie medial epicondyle fx, wrist fx or laceration

* medial aspect of hand and most of 4th and 5th digits

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91
Q

sensory deficits with lesion of musculocutaneous nerve

A

lateral forearm

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92
Q

upper brachial plexus injury (Erb’s Palsy)

A
  • most commonly involves musculocutanous, axillary, suprascapular
  • arm hangs by side, adducted, medially rotated, forearm extended and hand pronated
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93
Q

lower brachial plexus injury (Klumpke’s Palsy)

A
  • most commonly involved ulnar (maybe median)

* “ulnar claw hand” (hyperextension of MP joints and flexion of IP joints)

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94
Q

iliofemoral ligament prevents

A
  • hyperextension of hip joint

* anterior part of joint capsule

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95
Q

pubofemoral ligement prevents

A
  • excessive abduction and hyperextension of hip

* anterior inferior part of joint capsule

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96
Q

ischiofemoral ligament prevents

A
  • hyperextension of hip joint

* posterior part of joint capsule

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97
Q

supply to the hip joint

A
  • medial and later circumflex (around neck of femur)

* medial provides majority

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98
Q

ACL prevents

A

anterior displacement of tibia on femur

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99
Q

PCL prevents

A

posterior displacement of tibia on femur

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100
Q

MCL and LCL function

A

help stabilize knee joint

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101
Q

medial and lateral meniscus function

A
  • help stabilize knee join

* shock absorption

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102
Q

unhappy triad of O’Donahue

A

MCL, ACL, and medial meniscus when injured together

^most commonly injured knee structures

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103
Q

ankle joint most stable when

A

dorsiflexed, comped with plantarflexed

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104
Q

ligaments in ankle

A
  • deltoid on medial side

* anterior talofibular, posterior talofibular, and calcaneofibular laterally

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105
Q

ankle sprain normally occurs via

A

excessive inversion on a plantarflexed weight-bearing foot

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106
Q

ankle ligament most at risk in ankle sprain

A

anterior talofibular

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107
Q

superficial abductors and extensors of femur (gluteal region)

A
  • gluteus maximus (inferior glut n.)

* gluteus medius, gluteus minimus, and tensor fascia lata (superior glut n.)

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108
Q

deep external rotators of femur (gluteal region)

A
  • piriformis (nerve to the…)
  • obturator internus (nerve to the…)
  • superior and inferior gamellus (nerve to the ^)
  • quadratus femoris (nerve to the…)
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109
Q

anterior compartment of thigh function

A

extend leg at the knee

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110
Q

innervation of anterior compartment of thight

A

femoral nerve

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111
Q

supply of anterior compartment of thigh

A

femoral and deep femoral arteries

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112
Q

medial compartment of thigh function

A

adduct the thigh at the hip

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113
Q

innervation of medial compartment of thigh

A

obturator nerve

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114
Q

supply of medial compartment of thigh

A

deep femoral and obturator arteries

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115
Q

posterior compartment of thigh function

A
  • flex leg at knee

* extend thigh at hip

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116
Q

innervation of posterior compartment of thigh

A

sciatic nerve

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117
Q

supply of posterior compartment of thigh

A

deep femoral artery

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118
Q

anterior compartment of leg function

A
  • dorsiflex foot
  • invert foot
  • extend toes
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119
Q

innervation of anterior compartment of leg

A

deep fibular nerve

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120
Q

supply of anterior compartment of leg

A

anterior tibial artery

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121
Q

lateral compartment of leg function

A
  • plantarflex foot

* evert foot

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122
Q

innervation of lateral compartment of leg

A

superficial fibular nerve

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123
Q

supply of lateral compartment of nerve

A

fibular artery

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124
Q

posterior compartment of leg function

A
  • plantarflex foot
  • invert foot
  • flex toes
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125
Q

innervation of posterior compartment of leg

A

tibial nerve

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126
Q

supply of posterior compartment of leg

A

posterior tibial artery

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127
Q

major nerves of lumbar plexus

A
  • lateral cutaneous nerve of thigh (L2, L3)
  • femoral nerve (L2-L4)
  • obturator nerve (L2-L4)
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128
Q

major nerves of sacral plexus

A
  • superior gluteal (L4-S1)
  • inferior gluteal (L5-S2)
  • sciatic (L4-S3)
  • posterior femoral cutaneous (S1-S3)
  • named branches to small external rotators
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129
Q

sensory deficits with femoral nerve lesion

A
  • anterior thigh

* medial knee, leg, and foot

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130
Q

sensory deficits with obturator nerve lesion

A

medial thigh above knee

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131
Q

sensory deficits with superior gluteal nerve lesion

A

NONE

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132
Q

sensory deficits with tibial nerve lesion

A
  • posterolateral leg
  • lateral malleolus
  • sole and lateral foot
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133
Q

sensory deficits with superficial fibular nerve lesion

A
  • lateral leg

* dorsum of foot

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134
Q

sensory deficits with deep fibular nerve lesion

A

•triangular area between 1st and 2nd toes

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135
Q

femoral artery is extension of

A

external iliac artery as it crosses under inguinal ligament

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136
Q

deep femoral artery branches

A

from posterolateral aspect of femoral artery in femoral triangle

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137
Q

3 main branches of deep femoral artery

A
  • perforating branches -> medial and posterior thigh
  • lateral femoral circumflex
  • medial femoral circumflex
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138
Q

femoral artery moves to posterior compartment proximal to knee to become

A

popliteal artery

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139
Q

genicular arteries

A

branch off popliteal artery in posterior thigh to supply knee

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140
Q

popliteal artery divides at lower border of popliteal fossa to

A

anterior tibial and posterior tibial arteries

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141
Q

fibular (peroneal) artery comes from

A

posterior tibial artery

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142
Q

dorsalis pedis artery extension of

A

anterior tibial artery

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143
Q

inferior and superior gluteal arteries arise from

A

internal iliac artery

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144
Q

transverse tubule

A

finger-like projections formed by invaginations of sarcolemma

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145
Q

function of T-tubule

A
  • in contact with SR

* transmits depolarization from plasma membrane to deep in muscle cells

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146
Q

where is intracellular Ca2+ stored in muscle cells?

A

SR

*important for regulation of muscle contraction

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147
Q

myofibrils composed of

A

thick (myosin) and thin (actin) filaments

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148
Q

desmin

A
  • protein that connects myofibrils and is anchored in sarcolemma
  • facilitates coordinated contraction
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149
Q

Z-line/disk

A
  • define boundaries of sarcomere

* has actin biding protein (alpha actinin)

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150
Q

I-band

A
  • only thin filaments

* width decreases in contraction

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151
Q

H-band

A
  • in center of A-band
  • only thick filaments
  • width decreases in contraction
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152
Q

A-band

A
  • overlapping thick and thin filaments

* width constant in contraction

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153
Q

M-line

A

•middle of H-band

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154
Q

thin filament structure

A

f-actin forms complex with tropomyosin and troponin complex (I, T, and C)

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155
Q

troponin-t binds to

A

tropomyosin

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156
Q

troponin-i function

A

inhibits biding of myosin to actin

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157
Q

troponin-c binds to

A

Ca2+

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158
Q

thick filament structure

A

myosin that has 2 identical heavy chains and 2 pairs of light chains

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159
Q

heavy chains contain

A

biding site for actin and an ATPase domain

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160
Q

What happens when ATP binds to myosin head?

A

conformation change -> dissociation of myosin from actin filament

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161
Q

when ATP bound to myosin head is hydrolyzed..

A

thick filament hinge increases angle between head and tail, lining up head with new myosin binding site on actin filament

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162
Q

when is ADP released from myosin head

A

once it binds to actin

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163
Q

release of ADP causes

A

decrease in angle between head and tail of myosin -> thin filament slides toward center of sarcomere

164
Q

rigor posistionof myosin

A

when no ATP is bound and it is tightly adhered to actin

165
Q

depolarization of t-tubule sensed by

A

L-type Ca2+ channels in its membrane -> opens ryanodine sensitive Ca2+ channels in membrane of SR terminal cisternae

166
Q

when calcium binds to troponin-c of actin filament

A

conformational changes that uncover myosin biding site allowing thick filament to bind

167
Q

how is calcium returned to SR during relaxation of muscle?

A

ATP-dependent pump

168
Q

septation of atria

A
  • 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
Q

atrial septal defects can occur if

A

septum secundum doesn’t grow enough, or foramen secundum is too large

170
Q

septation of atrioventricular canal

A

endocardial cushions on dorsal and ventral walls grow toward each other and fuse

171
Q

atrioventricular valves formed from

A

endocardial cushion tissue

172
Q

septation of ventricles

A
  • muscular: myoblasts on floor of ventricle grow toward fused endocardial cusions
  • membranous: forms from fused endocardial cushions and the aoritcopulmonary septum
173
Q

most common congenital cardiac defect

A

membranous ventricular septal defect

174
Q

septation of outflow tract

A
  • beginning in 5th week
  • neural crest cell migration into truncus arteriosus
  • conotruncal ridges spiral and fuse
175
Q

persistent truncus arteriosus

A

no septum forms in the outflow tract

176
Q

transposition of great vessels

A

aorticopulmonary septum doesn’t spiral

177
Q

tetralogy of fallot

A
  • 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
Q

innervation of diaphragm

A

phrenic nerve (C3, C4, C5 ventral rami)

179
Q

aortic hiatus

A
  • level of T12
  • within right and left crura of diaphragm
  • aorta, thoracic duct, azygos veins
180
Q

esophageal hiatus

A
  • level of T10
  • within muscular part of diaphragm
  • esophagus and vagus nerves
181
Q

caval opening

A
  • level of T8
  • located in central tendon of diaphragm
  • IVC and sometimes right phrenic nerve
182
Q

superior/inferior division of mediastinum

A

at sternal angle

183
Q

anterior mediastinum contains

A

CT, fat, remnants of thymus

184
Q

middle mediastinum contains

A

heart and roots of great vessels, and phrenic nerves

185
Q

posterior mediastinum contains

A

descending aorta, azygous vein, thoracic ducts, esophagus, trachea, vagus nerves

186
Q

pneumothorax

A

accumulation of air in pleural cavity -> lung collapse

187
Q

recesses in pleural cavity

A
  • costodiaphragmatic

* costomediastinal

188
Q

pleural effusion

A

accumulation of fluid in pleural space -> fixed with thoracentesis

189
Q

how to perform thoracentesis

A
  • 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
Q

innervation of costal parietal pleura

A

intercostal nerves

191
Q

innervation of mediastinal and diaphragmatic parietal pleura

A

phrenic nerves

192
Q

innervation of visceral pleura

A

autonomic nerves

193
Q

transverse pericardial sinus

A
  • posterior to ascending aorta and pulmonary trunk
  • anterior to SVC
  • can be used for ligature to stop blood circulation
194
Q

oblique sinus

A

located behind heart

195
Q

coronary flow occurs during

A
  • diastole

* R and L coronary arteries in aorta above aortic valve fill with blood when aortic valve closes

196
Q

cardiac skeleton important because

A

electrically separates atrial from ventricular musculature

197
Q

enlarged left atrium can compress

198
Q

margins of hear

A
  • right side: 3rd costal to 6th costal cartilage

* left side: 2nd intercostal space to midclavicular 5th intercostal space

199
Q

right coronary artery branches

A
  • PDA (PIV) 85% of the time
  • right marginal artery
  • sa nodal
  • av nodal
200
Q

PDA (PIV) supplies

A
  • right atrium
  • right/left ventricle
  • 1/3 of septum
201
Q

right marginal arter supplies

A

right ventricle

202
Q

left coronary artery branches

A
  • LAD (AIV)
  • left marginal
  • circumflex
203
Q

LAD (AIV) supplies

A
  • right ventricle
  • left ventricle
  • 2/3 of septum
204
Q

left marginal artery supplies

A

left ventricle

205
Q

circumflex artery supples

A
  • posterior surface of left ventricle

* left atrium

206
Q

right main bronchus compared to left

A
  • shorter
  • wider
  • more vertical
  • thus more foreign bodies lodged on right side
207
Q

bronchopulmonary segments

A
  • divisions within lobes of lungs
  • artery and segmental bronchus at the center
  • veins at the periphery
208
Q

autonomic innervation of tracheobronchial tree

A
  • vagus nerves and T1-T4 of sympathetic trunk
  • visceral afferent from vagus
  • preganglionic parasymp and postganglionic symp from pulmonary plexus
209
Q

intercalated discs

A
  • in cardiac muscle

* desmosomes and gap junctions

210
Q

SA node

A
  • pacemaker

* electrical impulse from right atrium to left atrium and AV node

211
Q

AV nodes

A

conducts impulse from atria to ventricles

212
Q

bundle of His

A

conducts electrical impulse from AV node through cardiac skeleton and membranous IV septum

213
Q

Left and Right bundle branches

A

group of purkinje fibers along IV septum giving rise to the purkinje fibrers distributed in ventricles

214
Q

tunica intima

A
  • simple squamous
  • non-thrombogenic
  • release factors that regulate smooth muscle -> regulate vascular tone
215
Q

tunica media

A
  • concentric layers of smooth muscle
  • elastic fibers
  • type III collagen
  • proteoglycans
  • primarily regulates vascular tone, vessel diameter, and BP
216
Q

tunica adventitia

A
  • CT layer with fibroblasts, type I collagen, elastic fibers
  • vasa vasorum
  • sympathetic nerve fibers
217
Q

capillaries

A
  • 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
Q

continuous capillaries

A
  • found in muscle, nerve, CT
  • tight junctions resist leakage
  • pinocytosis
219
Q

fenestrated capillaries

A
  • found in GI and endocrine

* permanent channels along endothelial cells

220
Q

sinusoidal capillaries

A
  • found in bone marrow, liver, spleen

* large discontinuities between endothelial cells

221
Q

angiogenesis

A
  • formation of new capillaries from existing

* stimulation of endothelial cells by VEGF (vascular endothelial growth factor)

222
Q

mucosa of conducting respiratory system

A
  • ciliated pseudostratified columnar epithelium with goblet cells
  • as you approach respiratory portion, goblet cells decrease and changes to simple columnar and cuboidal
223
Q

submucosa of conducting respiratory system

A
  • smooth muscle cells that increase in # as diameter of tube decreases
  • hyaline cartilage that decreases as tube diameter decreases
  • seromucous glands
224
Q

bronchioles don’t have

A

goblet cells, seromucous glands, or cartilage

epithelium=cuboidal

225
Q

type I alveolar cells / pneumocytes

A
  • squamous, 97% alveolar surface
  • desmosomes and tight junctions
  • form gas permeable membrane
226
Q

type II alveolar cells / pneumocytes

A
  • cuboidal

* produce surfactant

227
Q

alveolar macrophage/ dust cell

A
  • derived from monocytes

* phagocytose carbon and dust from alveolar lumen

228
Q

blood-air barrier

A
  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
Q

anterior rectus sheath formed by

A
  • aponeurosis of external oblique

* part of aponeurosis of internal oblique

230
Q

posterior rectus sheath formed by

A
  • part of aponeurosis from internal oblique

* aponeurosis of transverse abdominus

231
Q

arcuate line

A

where the posterior rectus sheath ends and all that rectus abdominus rests on is transversalis fascia

232
Q

direct inguinal hernia

A

weakness in musculature of abdominal wall through hesselbach’s triangle

233
Q

indirect inguinal hernia

A

congenital defect in inguinal canal

234
Q

MDs don’t LIe

A

•direct hernia medial to inferior epigastric arteries
•indirect lateral
both above inguinal ligament

235
Q

femoral hernia

A

below inguinal ligament

236
Q

peritoneal epithelium

A

simple squamous (serous)

237
Q

pain from parietal peritoneum

A
  • shares sensory innervation with abdominal wall (T7-L1)

* sharp and localized

238
Q

pain from visceral peritoneum

A

•diffuse and dull referred pain

239
Q

pain from foregut organs refers to

A

epigastric

240
Q

pain from midgut organs refers to

241
Q

pain from hindgut organs refers to

A

pubic (hypogastric)

242
Q

epiploic foramen (of winslow)

A

entrance to lesser sac from greater sac

243
Q

foregut includes

A

esophagus, stomach, 1st half of duodenum and associated organs

244
Q

midgut includes

A

second half of duodenum, jejunum, ileum, ascending colon, and first 2/3 of transverse colon

245
Q

hindgut includes

A

last 1/3 of transverse colon, descending colon, sigmoid colon, and rectum

246
Q

anastamosis at foregut-midgut junction

A 
superior pancreaticoduodenal (celiac trunk) 
inferior pancreaticoduodenal (SMA)
247
Q

anastamosis at midgut-hingut junction

A 
middle colic (SMA)
left colic (IMA)
248
Q

anastamosis at rectum

A 
superior rectal (IMA) 
Middle and inferior rectal arteries (internal iliac)
249
Q

hepatoduodenal ligament contains

A

•proper hepatic artery
•portal vein
•common bile duct
(anterior to epiploic foramen)

250
Q

rotation of stomach in embroylogic dev

A

90 degrees clockwise on longitudinal axis so left side faces anteriorly

251
Q

spleen develops from

A

mesoderm in dorsal mesentery of stomach

252
Q

midgut rotation

A
  • 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
Q

hypertrophic pyloric stenosis

A
  • projectile nonbilious vomiting
  • sx usually begin 3-5 weeks after birth
  • etiology unclear
254
Q

annular pancreas

A
  • 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
Q

meckel’s diverticulum

A
  • persistence of yolk stalk (vitelline duct)
  • ectopic gastric mucosa may be present
  • rule of 2s
256
Q

volvulus

A
  • vomiting, absence of stool, abd distention
  • can obstruct SMA
  • malrotation of midgut
257
Q

duodenal atresia

A
  • failed recanalization
  • bilious vomit and abd distention
  • double bubble sign
  • associated with polyhydramnios
258
Q

intussusception

A
  • segment of intestine invaginates or telescopes into adjacent
  • intermittent abd pain, vomiting, bloating, bloody stool
259
Q

aganglionic megacolon (hirschsprung’s disease)

A
  • lack of ganglia in colon
  • defect in RET gene (involved in neural crest cell migration)
  • fecal retention and abdominal distention
260
Q

esophagus histology

A
  • thick nonkeratinized stratified squamous
  • submucosal glands
  • thoracic esophagus has adventitia, abdominal esophagus has serosa
261
Q

stomach histology

A
  • 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
Q

mucous cells in gastric glands

A

secrete mucous rich in bicarbonate

263
Q

parietal cells in gastric glands

A
  • produce HCl (pepsinogen -> pepsin)

* produce intrinsic factor (absorption of vit B12)

264
Q

chief cells in gastric glands

A

•secrete pepsinogen

265
Q

enteroendocrine cells in gastric glands

A
  • secrete serotonin (effect gut motility)

* secrete gastrin (effect HCl secretion)

266
Q

pepsin

A

proteolytic enzyme capable of digesting most proteins

267
Q

small intestine histology

A
  • luminal surface has plica circulares with villi
  • mucosa simple columnar with tight junctions, goblet cells, paneth cells, enteroendocrine cells
  • crypts of lieberkuhn
268
Q

enterocytes of small intestine

A

absorptive and have microvilli (brush border)

269
Q

paneth cells

A

lysozyme secreting (antibacterial)

270
Q

cholecystokinin

A
  • secreted by enteroendocrine cells in small intestine

* stim secretion from pancreatic acinar cells and release bile from gallbladder

271
Q

secretin

A
  • secreted by enteroendocrine cells in small intestine
  • released in response to gastric acid
  • stim release of HCO3 from pancreas and liver
272
Q

gastric inhibitory peptide

A
  • secreted by enteroendocrine cells in small intestine

* stim insulin secretion from pancreatic islets

273
Q

glucagon like peptide

A
  • secreted by enteroendocrine cells in small intestine

* stim insulin secretion and inhibits glucagon secretion

274
Q

brunners glands

A
  • found only in mucosa of DUODENUM

* secrete alkaline mucous

275
Q

peyer’s patches

A
  • found in lamina propria of ILEUM

* concentrated lymphocytes (AKA GALT)

276
Q

histology of large intestine

A
  • simple columnar with goblet cells
  • crypts without villi
  • teniae coli (longitudinal bands of longitudinal muscle
  • epiploic appendages on the serosa
277
Q

merocrine secretion of pancreatic proenzymes regulated by

A
  • secretin and cholecystokinin from small intestine

* stimulation by vagus nerve

278
Q

alpha cells of pancreatic islet

A

produce glucagon -> increase blood glucose, gluconeogenesis, and glycogenolysis

279
Q

beta cells of pancreatic islet

A

produce insulin -> decrease blood glucose, stim storage of glucose as glycogen

280
Q

delta cells of pancreatic islet

A

produce somatostatin -> inhibit secretion of glucagon and insulin

281
Q

blood flow in hepatic lobule

A

from periphery to center (zone I to zone III)

282
Q

hepatocytes near zone I

A
  • can rely on aerobic metabolism

* more active in protein synth

283
Q

hepatocytes near zone III

A
  • get lower [O2] and nutrients

* more involved in detoxification and glycogen metabolism

284
Q

bile flow in liver

A

opposite to blood flow (zone III to zone I)

285
Q

kupffer cells

A
  • phagocytic cells found in sinusoids of liver

* remove aged RBCs, bacteria and other debris

286
Q

Ito cell

A
  • in space of disse

* stores vitamin A and other fat-soluble vits

287
Q

broad ligament

A
  • mesometrium
  • mesovarium
  • mesosalpinx
288
Q

suspensory ligament of ovary

A

contains ovarian vessels

289
Q

ovarian ligament

A

attaches it to uterus

290
Q

round ligament of uterus

A
  • continuous with ovarian ligament

* enters deep inguinal ring

291
Q

stress incontinence can be cause by damage to

A
  • pubovesicle ligaments
  • transverse cervical ligaments (cardinal)
  • uterosacral ligaments
292
Q

bladder prolapse involves

A

pubovesical ligaments

293
Q

uterine prolapse involves

A

transverse cervical (cardinal) ligaments

294
Q

layers of spermatic cord

A
  • external spermatic fascia (ext oblique aponeurosis)
  • cremasteric fascia/muscle (internal oblique)
  • internal spermatic fascia (transversalis fascia)
295
Q

parasympathetic innervation of pelvic organs

A
  • preganglionic: pelvic splanchnic (S2-S4)

* ganglia: located in wall of organ

296
Q

sympathetic innervation of pelvic organs

A
  • 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
Q

visceral afferents inferior to pelvic pain line

A
  • structures that don’t contact peritoneum + sigmoid colon and rectum
  • follow parasympathetic fibers
298
Q

visceral afferents superior to pelvic pain line

A
  • structures in contact with peritoneum - sigmoid colon and rectum)
  • follow sympathetics
299
Q

mesonephric duct becomes

A

epididymis, vas deferens, and seminal vesicles

300
Q

paramesonephric duct becomes

A

uterus, uterine tubes, and upper vagina

301
Q

Wnt4 ->

A

maintain oocytes

302
Q

SRY gene

A

produce testis determining factor (TDF)

303
Q

MIS or AMH

A

•same thing anti-mullerian hormone/mullerian inhibiting substance
•produced by sertoli cells in respons to
TDF

304
Q

in embryogenesis leydig cells produce

A

testosterone -> differentiation mesonephric duct

305
Q

dihydrotestosterone

A
  • 5-alpha reductase converts testosterone into this

* cause dev of penis, scrotum, prostate

306
Q

prostate and bulbourethral gland bud off

307
Q

lower vagina forms from

A

sinovaginal bulbs (proliferaltion of endodermal tissue on posterior wall of urogenital sinus)

308
Q

leydig cells

A
  • found in space between seminiferous tubules

* produces testosterone in response to LH

309
Q

sertoli cells

A
  • 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
Q

which spermatogenic cells are diploid

A

spermatogonia and primary spermatocytes

311
Q

spermatogenesis sequence

A

spermatogonia -> primary spermatocyte -> meiosis I -> secondary spermatocyte -> meiosis II -> spermatid -> spermiogenesis -> spermatozoa

312
Q

histology of epididymis

A
  • pseudostratified columnar with long branched stereocilia
  • principle cells with stereocilia
  • basal cells that are precursors for principle cells
313
Q

histology of vas deferens

A
  • pseudostratified columnar with stereocilia

* thick muscular layer

314
Q

zones of prostate gland

A
  • transition zone around urethra
  • central zone around ejaculatory ducts
  • peripheral zone
315
Q

corpora amylacea

A

concretions often found in prostate gland that can be site of calcium deposition

316
Q

benign prostate hyperplasia most often involves

A

cells and stroma of central and transitional zones

317
Q

prostate cancer most often involves

A

peripheral zone

318
Q

ovarian surface epithelium

A

(OSE)
•simple squamous-to-low-cuboidal
•important stem cell that repairs damage caused by ovulation

319
Q

ovarian cycle

A
  • follicular phase
  • ovulatory phase
  • luteal phase
320
Q

steps of folliculogenesis

A

primordial follicle -> primary (unilayered) follicle -> secondary (multilayered) follicle ->antral follicle -> graffian (preovulatory) follicle

321
Q

corpus luteum

A
  • 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
Q

estradiol

A

made from androstenedione (from theca lutein) by aromatase within granulosa lutein

323
Q

corpus albicans

A

luteolysis of corpus luteum occurs if hCG does not stimulate it to continue producing hormones

324
Q

what stimulates thickening of endometrium during proliferative phase?

A

estrogen produced by maturing ovarian follicles

325
Q

secretory phase controlled by

A

progesterone and estrogen produced by corpus luteum

326
Q

what initiates ischemic phase

A

regression of corpus luteum

327
Q

foramina of anterior cranial fossa

A

cribriform plate

328
Q

foramina of middle cranial fossa

A 
C/O canals, ROS foramen, and 1 fissure
•carotid canal
•optic canal
•foramen rotundum
•foramen ovale
•foramen spinosum
•superior orbital fissure
329
Q

foramina of posterior cranial fossa

A 
HIJ + magnum
•hypoglossal canal
•internal acoustic meatus
•jugular foramen
•forament magnum
330
Q

what runs through superior orbital fissure

A

CN III, IV, V1, and VI

331
Q

what runs through foramen rotundum

A

maxillary nerve

332
Q

what runs through foramen ovale

A

mandibular nerve

333
Q

what runs through carotid canal

A

internal carotid artery and internal carotid nervous plexus (sympathetic)

334
Q

what runs through internal acoustic meatus

A

CN VII and VIII

335
Q

what runs through jugular foramen

A

CN IX, X, and XI

and sigmoid sinus

336
Q

what runs through foramen magnum

A
  • vertebral arteries
  • spinal contribution to CN XI
  • anterior and posterior spinal arteries
337
Q

epidural hematoma

A
  • middle meningeal artery
  • usually fx of temporal bone
  • brief LOC -> lucid interval -> HA, AMS, weakness
  • convex hyperdensity on CT (lemon)
338
Q

subdural hematoma

A
  • bridging veins
  • elderly and alcoholics susceptible
  • HA and AMS w/o other clinical findings
  • concave hyperdensity of CT (banana)
339
Q

subarachnoid hemorrhage

A
  • stroke with bleeding into subarachnoid space
  • sudden onset severe headache, n/v, neck/back pain, dizzy, sz
  • LP would show blood
340
Q

innervation of extraocular muscles

A

LR6, SO4, ATR3

341
Q

test superior rectus

A

look lateral and up

342
Q

test inferior rectus

A

look lateral and down

343
Q

test inferior oblique

A

look medial and up

344
Q

test superior oblique

A

look medial and down

345
Q

nasal septum formed by

A

vomer and perpendicular plate of ethmoid bone

346
Q

sphenoid sinus drains into

A

spehnoethmoidal recess

347
Q

ethmoid sinus drains into

A

superior and middle meatuses

348
Q

frontal sinus drains into

A

middle meatus

349
Q

maxillary sinus drains into

A

middle meatus

350
Q

nasolacrimal duct drains into

A

inferior meatus

351
Q

epistaxis often involves

A

septal branch of superior labial artery from facial artery

352
Q

vestibule of larynx

A
  • supraglotic

* above vestibular folds

353
Q

ventricle of larynx

A
  • glottic

* between vestibular and vocal folds

354
Q

infraglottic region of larynx

A
  • subglottic

* below vocal folds

355
Q

only laryngeal muscles that abduct (open) vocal folds

A

posterior cricoarytenoids

356
Q

position of rima glottidis in quiet respiration

A

open/ abducted vocal folds

357
Q

position of rima glottidis in swallowing

A

•closed/ adducted vocal folds

+epiglottis swings down to close laryngeal vesibule

358
Q

position of rima glottidis in phonation (speech)

A

closed/ abducted vocal folds

359
Q

superior laryngeal branch of vagus nerve

A
  • motor to cricothyroid

* sensory to mucosa above vocal folds

360
Q

recurrent laryngeal branch of vagus nerve

A
  • motor to all muscles except cricothyroid

* sensory to mucosa below vocal folds

361
Q

only cranial nerves arising from cerebrum

A

CN I and II (all others from brainstem)

362
Q

cranial nerves that transmit parasympathetic information

A

CN III, VII, IX, and X

363
Q

branches of opthalmic nerve (V1)

A
  • 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
Q

supraorbital nerve sensory to

A
  • branch of V1

* sensation to scalp, forehead and nose

365
Q

branches of maxillary nerve (V2)

A
  • infraorbital nerve

* superior alveolar nerve

366
Q

superior alveolar nerve sensory to

A
  • branch of V2

* sensation to upper teeth/palate, some sinuses, and nasal mucosa

367
Q

infraorbital nerve sensory to

A
  • branch of V2

* sensation to cheeks, lower eyelids, and upper lip

368
Q

branches of mandibular nerve (V3)

A

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
Q

innervation of parotid gland

A
  • Parasympathetic
  • preganglionic - lesser petrosal of glossopharyngeal
  • otic ganglion
  • postganglionic - ariculotemporal branch of V3
370
Q

travel of facial nerve in skull

A

internal acoustic meatus -> petrous part of temporal bone -> out stylomastoid foramen

371
Q

innervation and function of stapedius muscle

A
  • branch of facial nerve

* attaches to stapes and dampens sound received from TM

372
Q

temporal branches of facial nerve innervate

A

frontalis, orbicularis oculi, and corrugator supercili

373
Q

zygomatic branches of facial nerve innervate

A

orbicularis oculi

374
Q

buccal branches of facial nerve innervate

A

orbicularis oris, buccinator, zygomaticus

375
Q

marginal mandibular branches of facial nerve innervate

376
Q

cervical branch of facial nerve innervates

377
Q

chorda tympani nerve

A
  • branch of facial nerve
  • taste from anterior 2/3 of tongue
  • also parasympathetic to sublingual and submandibular salivary glands
378
Q

glossopharyngeal nerve

A
  • 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
Q

vagus nerve

A
  • CN X
  • sensory external ear, larynx, esophagus
  • motor muscles of pharynx, larynx, palate, and esophagus
  • efferent of gag reflex
380
Q

double layer of epithelium on ciliary body

A
  • inner: pigmented

* outer: secrete aqueous humor

381
Q

flow of aqueous humor

A

posterior chamber -> through pupil -> anterior chamber -> drains at trabecular meshwork of limbus

382
Q

acute/ closed angle glaucoma

A

•flow aqueous humor obstructed by iris tissue

383
Q

chronic/ open angle glaucoma

A

drainage of aqeuous humor from trabecular meshwork is impaired

384
Q

when ciliary muscle relaxes

A
  • tension on zonular fibers -> flat lens

* distance vision

385
Q

when ciliary muscle contacts

A
  • laxity to zonular fibers 0 -> round lens

* close vision

386
Q

oxytocin

A
  • made by paraventricular nuclei of hypothalamus
  • stored posterior pituitary
  • uterine contraction and lactation
387
Q

ADH

A
  • =antidurietic hormone = vasopressin
  • made by supraoptic nuclei of hypothalamus
  • stored posterior pituitary
  • decrease urine production/constric arterioles -> increase BP
388
Q

growth hormone

A
  • anterior pituitary acidophils

* bone and soft tissue growth

389
Q

prolactin

A
  • anterior pituitary acidophils

* initiation/maintenance of lactation

390
Q

TSH

A
  • anterior pituitary basophils

* stimulate thyroid to make T3 and T4

391
Q

FSH

A
  • anterior pituitary basophils

* stimulate follicle development

392
Q

LH

A
  • anterior pituitary basophils

* stimulate testosterone production -> spermatogenesis

393
Q

ACTH

A
  • =adrenocorticotrophic hormone
  • anterior pituitary basophils
  • cause cortisol and androgen release -> regulation of metabolism and immune responses, secondary sex characteristic
394
Q

parafollicular cells

A
  • =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
Q

thyroglobulin synthesis (exocrine phase)

A
  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
Q

thyroid hormone synthesis and release (endocrine phase)

A
  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
Q

Thyroid hormon

A
  • =T3 and T4
  • increase basal metabolic rate in adults
  • influence growth and neurological development in fetus
398
Q

foregut sympathetic innervation

A
  • T5-T9
  • pre: greater splanchnic
  • post: celiac plexus
399
Q

foregut parasympathetic innervation

400
Q

midgut sympathetic innervation

A
  • T5-T9 pre: greater splanchnic
  • T10-T11: lesser splanchnic
  • post: superior mesenteric plexus
401
Q

midgut parasympathetic innervation

402
Q

hindgut sympathetic innervation

A
  • L1-L2
  • pre: lumbar -> post: inferior mesenteric plexus
  • pre: sacral splanchnic -> post: hypogastric plexus via pelvic ganglia
403
Q

hindgut parasympathetic innervation

A

pelvic splanchnic nerves (S2-S4)

404
Q

valgus stress ->

A

medial collateral ligament

405
Q

varus stress ->

A

lateral collateral ligament

406
Q

lachman’s test

A

•for ACL

407
Q

SAD PUCKER

A 
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

Clinical Morphology (25 decks)

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