Term
| A blow to the body that fractures certain ribs can lacerate the spleen. Fracture of which ribs poses the greatest danger? (specify side and number) |
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Definition
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Term
| What are the different kinds of axons that travel in the anterior and posterior vagal trunks? |
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Definition
| Visceral afferent (sensory) and parasympathetic preganglionic |
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Term
| Where along the course of the ribs does a fracture pose the greatest threat of lacerating the spleen? |
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Definition
| Posterior blow of left 9-11 ribs |
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Term
| A patient with a lacerated spleen complains of pain in the ipsilateral shoulder. What is likely to be irritated by blood leaking from the spleen? |
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Definition
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Term
| At surgery, the spleen must be mobilized to inspect it for lacerations. This is done by tearing the left layer of the lienorenal ligament and pulling forward the spleen and all the structures that run in the ligament. What are they? |
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Definition
| Tail of pancreas, splenic artery, and splenic vein |
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Term
| Congenital indirect inguinal hernias are more common in (1) because in this sex the possibility exists for (2) |
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Definition
1. Males
2. Patent processus vaginalis |
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Term
| Portal hypertension due to cirrhosis of the the liver can cause the following change(s) in the appearance of the anterior abdominal wall |
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Definition
| Dilated subcutaneous veins radiating from the umbilicus |
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Term
| Thrombosis of the inferior vena cava can cause the following change(s) in the appearance of the anterior abdominal wall |
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Definition
| dilated subcutaneous veins running from groin to axilla |
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Term
| Portal hypertension due to compression of the portal vein by a tumor of the neck of the pancreas can cause the following change(s) in the appearance of the anterior abdominal wall |
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Definition
| None (that is why it is so dangerous) |
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Term
| Cancer of the head of the pancreas often reveals itself by painless jaundice whereas cancer of the tail does not, because of the head of the pancreas lies (1) to the (2). |
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Definition
1. Anterior
2. Common bile duct |
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Term
| Associated with the jaundice is dilatation of the (1). This may be detectable by palpation if the fingers are placed on the anterior abdominal wall at the junction of the (2)with the (3), on the (4) side. |
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Definition
1. Gallbladder
2. Costal margin
3. Transpyloric plane
4. Right |
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Term
| Tumor of the body and tail of the pancreas is often inoperable because it frequently engulfs the (1) and the (2). |
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Definition
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Term
| Excluding peritoneum, identify the structures that form the boundaries of the epiploic foramen (of Winslow) 1. anteriorly, 2. superiorly, 3. posteriorly, 4. inferiorly |
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Definition
1. Portal vein
2. Duodenum
3. IVC
4. Transverse mesocolon |
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Term
[image]
- Be specific with C and D. Also define arrowheads
- Which letters correspond to arteries that directly anastomose with arteries of the Celiac trunk?
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Definition
A. Inferior pancreaticoduodenal artery
B. Middle colic artery
C. A jejunal artery
D. An ileal artery
E. Ileocolic artery
F. Right colic artery
Arrowheads: (Marginal artery) of Drummond |
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Term
| What branches of the SMA directly anastomose with branches of the celiac trunk? |
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Definition
Inferior pancreaticoduodenal artery and middle colic artery
(anastomose with superior pancreaticoduodenal artery and gastroepiploic arcade respectively) |
|
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Term
| What branches of the SMA directly anastomose with branches of the celiac trunk? |
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Definition
Inferior pancreaticoduodenal artery and middle colic artery
(anastomose with superior pancreaticoduodenal artery and gastroepiploic arcade respectively) |
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Term
| During surgery to repair an inguinal hernia, you put a surgical staple immediately medial to the deep inguinal ring. Damage to what structure will produce the most serious consequence? |
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Definition
| Inferior epigastric artery |
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Term
| After surgery to repair an inguinal hernia, the patient complains of numbness over the front of the scrotum and on the inside of the thigh adjacent to the scrotum. What has been injured? |
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Definition
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Term
| What areportions of the GI tract that have mesenteries along virtually their entire lengths? |
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Definition
| Stomach, jejunum, ileum, transverse colon, sigmoid colon. |
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Term
| Of those portions of the GI tract that do not have mesenteries along virtually their entire lengths, which are secondarily retroperitoneal? |
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Definition
| Duodenum, Cecum, ascending and descending colon |
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Term
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Definition
1. It runs through the left edges of the cystic and caval fossae of the liver
2. It indicates the division between the territories of distribution of the left and right hepatic aa.
3. It indicates the division between the territories of distribution of the left and right branches of the portal v.
4. It indicates the division between the territories of drainage of the left and right hepatic bile ducts |
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Term
| Your patient has a few enlarged but painless superficial inguinal nodes. Define all from which spread of cancer to the superficial inguinal nodes would not be unusual. I haven't told you the sex of the patient, so check appropriate structures for both males and females |
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Definition
labium majus
scrotum
skin immediately inferior to the umbilicus
skin of big toe
skin of glans penis
skin over anterior thigh
subcutaneous tissue of buttock
subcutaneous tissue on medial aspect of lower leg |
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Term
| What is the shortest route of blood vessels to the stomach if the celiac artery develops an occlusion at its origin? |
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Definition
| Aorta-->SMA-->Middle Colic Artery-->Gastro-epiploic arcade (right and left)-->stomach |
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Term
| What is the shortest route of blood vessels to the liver if the celiac artery develops an occlusion at its origin? |
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Definition
| Aorta-->SMA-->inferior pancreaticoduodenal a.-->superior pancreaticoduodenal aa.-->gastroduodenal a.-->proper hepatic a. |
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Term
| P. W. is a 60 year old former smoker who experiences severe diffuse abdominal pain 15 - 30 minutes after eating a full meal. You suspect intestinal angina and order an angiogram to look for blockage in the major artery that feeds most of the small intestine. What is this artery? |
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Definition
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Term
| You find that the SMA is almost completely blocked for a length of 3 mm at a site about one centimeter from its origin, yet the small intestine is obviously still alive. What are all the existing anastomoses that may contribute to keeping the small intestine alive? |
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Definition
1. left colic with middle colic
2. left gastroepiploic with middle colic
3. right gastroepiploic with middle colic
4. superior pancreaticoduodenal with inferor pancreaticoduodenal |
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Term
| Where do the nodes commonly lie regarding carcinoma of the breast? Alongside what vessels do they lie? |
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Definition
| In the axilla alongside the lateral thoracic vessels |
|
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Term
| What percentage of breast lymph goes to the level 1 nodes? |
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Definition
|
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Term
| Where does lymph not going to level 1 nodes go to? |
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Definition
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Term
| What are the level 1 lymph nodes for breast cancer? |
|
Definition
| those lateral to the pectoralis minor muscle (i.e., the pectoral, subscapular, lateral, and a few central nodes) |
|
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Term
| What are the level 2 lymph nodes for breast cancer? |
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Definition
| those deep to the pectoralis minor (i.e., most of the central nodes) |
|
|
Term
| What are the level 3 lymph nodes for breast cancer? |
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Definition
| those medial to pectoralis minor (i.e., the apical axillary nodes) |
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Term
| Mary presents with a swelling in the floor of her armpit. Ultrasound shows it to a nonmalignant fluid-filled cyst. In what structure is this cyst most likely to be located (be specific)? |
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Definition
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Term
| M. H.-K. presents with diffuse poorly localized epigastric pain. You place your fingers along her right costal margin at the midclavicular line and ask that she take a deep breath. She begins her inspiration, but pain causes her to suddenly stop before completing it. What is likely to be inflamed? |
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Definition
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Term
| What spinal cord segments receive pain fibers from the gallbladder? |
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Definition
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Term
| Where is referred pain from the gallbladder most likely to be felt (specify side if pain not felt bilaterally)? |
|
Definition
| Right 7th-9th intercostal spaces |
|
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Term
| Cancer of the lower lobe of the left lung poses a greater risk to the patient than cancer of the lower lobe of the right lung because lymph from the lower lobe of the left lung: |
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Definition
| has a greater tendency to spread to the contralateral paratracheal lymph nodes than does lymph from the lower lobe of the right lung |
|
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Term
| List the alternate blood route in portal hypertension that leads to the development of esophageal varices |
|
Definition
Portal v.-->l. gastric v.-->esophageal vv.-->azygos v.
-->SVC-->r. atrium |
|
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Term
| List the alternate blood route in portal hypertension that leads to the development of caput medusae |
|
Definition
Portal v.-->paraumbilical vv.-->thoracoepigastric vv.
-->lateral thoracic v.-->axillary v.-->subclavian v.
-->brachiocephalic v.-->SVC-->r. atrium |
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Term
| Trace two substantially different routes by which arterial blood can reach most of the small intestine in the case where there is a blockage of the SMA at its origin |
|
Definition
Celiac trunk-->Common hepatic-->Gastroduodenal-->
Superior anterior and posterior pancreaticoduodenal a.-->
Inferior anterior and posterior pancreaticoduodenal a. --> SMA
Celiac trunk-->splenic a.-->right gastroepiploic-->
middle colic-->SMA |
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Term
| A 45 yo premenopausal woman is scheduled to undergo uterine artery embolization to treat uterine fibroids. You are obligated to inform her that the procedure may induce menopause. What is the anatomic reason for this? |
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Definition
| In older women a majority of the arterial blood for the ovaries may be supplied by the ovarian branch of the uterine artery. |
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Term
| What blood vessels supply the left ventricle in a left coronary dominant heart? |
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Definition
| Left main coronary, diagonal, LAD, obtuse marginal, circumflex coronary, PDA |
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Term
| What blood vessels supplies the interventricular septum in a right coronary dominant heart? |
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Definition
| Left main coronary, LAD, right coronary, PDA |
|
|
Term
| What blood vessels supplies the right atrium in a right coronary dominant heart? |
|
Definition
|
|
Term
| What blood vessels supplies the right ventricle in a right coronary dominant heart |
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Definition
| Right coronary, acute marginal, LAD, PDA |
|
|
Term
| Name the first groups of lymph nodes to which the mammary gland drains |
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Definition
| Axillary and internal mammary |
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Term
| Name the first groups of lymph nodes to which the testes drains |
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Definition
|
|
Term
| Name the first groups of lymph nodes to which the ovaries drain |
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Definition
|
|
Term
| Name the first groups of lymph nodes to which the uterus drains |
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Definition
|
|
Term
| Name the first groups of lymph nodes to which the transverse colon drains |
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Definition
|
|
Term
| Name the first groups of lymph nodes to which the vulva drains |
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Definition
|
|
Term
| Name the first groups of lymph nodes to which the skin of the hallux drains |
|
Definition
|
|
Term
| Name the first groups of lymph nodes to which the skin of the pollex drains |
|
Definition
|
|
Term
| Name the first groups of lymph nodes to which the skin of the glans penis drains |
|
Definition
|
|
Term
| What lymph nodes do NOT drain into the part of the thoracic duct that lies in the abdomen and thorax |
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Definition
| Axillary and internal mammary |
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|
Term
| What effect does the parasympathetic nervous system have on heart rate? |
|
Definition
|
|
Term
| What effect does the parasympathetic nervous system have on the pyloric sphinctor |
|
Definition
|
|
Term
| What effect does the parasympathetic nervous system have on the urinary bladder |
|
Definition
| Relaxes (S2-S4 pelvic splanchnic nerves) |
|
|
Term
| What effect does the parasympathetic nervous system have on the vasculature of the corpus cavernosum |
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Definition
| Dilates (S2-S4 pelvic splanchnic nerves) |
|
|
Term
| What effect does the parasympathetic nervous system have on the sphincter urethrovaginalis |
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Definition
| None (this is a voluntary muscle) |
|
|
Term
| What effect does the parasympathetic nervous system have on tear production |
|
Definition
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|
Term
| What effect does the parasympathetic nervous system have on saliva production |
|
Definition
|
|
Term
| What is the relationship between the ureter and the psoas major? |
|
Definition
|
|
Term
| What is the relationship between the ureter and the iliac arteries? |
|
Definition
| Ureter crosses the bifurcation of the common iliac arteries |
|
|
Term
| What is the relationship between the ureter and the infundibulopelvic ligament? |
|
Definition
| Ureter crosses about 1cm superiomedial to it |
|
|
Term
| What is the infundibulopelvic ligament? |
|
Definition
| Fold of peritoneum that is raised by the ovarian vessels, nerves, and lymphatics as they pass to and from the ovary. It can be seen as a indentation of the broad ligament of the uterus just lateral to the fimbrae of the fallopian tube |
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Term
| What is the relationship between the ureter and the lateral fornix of the vagina (lateral wall of cervix) |
|
Definition
|
|
Term
| What is the relationship between the ureter and the uterine artery? |
|
Definition
|
|
Term
| Where should you attempt to palpate the gallbladder to see if it is painful? |
|
Definition
| At the intersection of the linea semilunaris and the costal margin on the right side |
|
|
Term
| How would pancreatic cancer cause nonpainful jaundice? |
|
Definition
| Head of the pancreas lies anterior to the common bile duct. If it grows due to cancer, it can occlude the common bile duct and cause jaundice |
|
|
Term
| Where should you look for blood-borne metastases to cancer of the head of the pancreas on CT? |
|
Definition
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|
Term
| A patient that underwent resection of the rectum for treatment of cancer is impotent following surgery. Why? |
|
Definition
| Because the pelvic plexus has been damaged and therefore no parasympathetic innervation to corpus cavernosus. |
|
|
Term
| What gives rise to the Artery of Adamkiewitz? |
|
Definition
| T10-T11 intercostal arteries, subcostal artery, or upper lumbrical arteries |
|
|
Term
| Why is it acceptable to treat internal hemorrhoids, but not external hemorrhoids, by rubber band ligation |
|
Definition
| Anal canal above pectinate line (where internal hemorrhoids develop) is only sensitive to visceral pain. Below this, the anal canal is sensitive to somatic pain. |
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