4. Anatomy III p82-93
Terms
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- Amniotic Fluid Abnormalities
- p. 82
- What is polyhydramnios?
- high amount of amniotic fluid (>1.5-2L)
- What is polyhydramnios clinically associated with?
- esophageal/duodenal atresis and anencephaly both of which impair the ability of the fetus to swallow amniotic fluid
- What is the condition leading to low amniotic fluid (<0.5L) called?
- Oligohydramnios
- What 2 conditions is oligohydramnios associated with?
- Bilateral renel agenesis or posterior urethral valves (in males) which results in the failure of the fetus to excrete urine into the amniotic fluid.
- What syndrome can oligohydramnios result in?
- Potter's Syndrome
- What does the term Potter's syndrom describe?
- Bilateral renal agenesis leading to oligohydramnios which results in fetal limb and facial deformaties and pulmonary hypoplasis
- What causes Potter's syndrome?
- Malformation of the ureteric bud
- What results when the poles of both kidneys fuse during development?
- Horseshoe kidney
- What arrests the ascend of the fused kidneys?
- The horseshoe kidneys get trapped under the inferior mesenteric artery.
- Landmark Dermatomes
- p. 82
- What dermatome is found at the posterior half of the skull?
- C2
- Where is the C3 dermatome?
- neck (high turtleneck shirt)
- Where is the C4 dermatome?
- lower neck (low-collar shirt)
- Where is the T4 dermatome?
- At the nipple
- Which dermatome can be found at the level of the xiphoid process?
- T7
- Which dermatome is important for early appendicitis pain refferl to the umbilicus?
- T10
- Where is the L1 dermatome?
- At the inguinal ligament
- What dermatome is found at the knee caps?
- L4
- Which dermatomes are associated with erection and sensation of penile and anal zones?
- S2, S3, S4 (S2, 3, 4 keeps the man begging for more)
- Gallbladder pain can be reffered to the right shoulder via which nerve?
- Phrenic nerve
- Which dermatome is found at the level of the belly butten?
- T10
- Rotator Cuff Muscles
- p. 82
- Which muscles form the rotator cuff?
- Supraspinatus, Infraspinatus, Teres minor, and Subscapularis (SItS)
- Which muscle helps the deltoid abduct the arm?
- Supraspinatus
- What function does the Infraspinatus muscle have?
- laterally rotates the arm at the shoulder joint
- What is the function of the Teres minor muscle?
- to adduct and laterally rotate the arm (Possible mistake in First Aid)
- Which muscle medically rotates and adducts the arm?
- Subscapularis
- Thenar-hypothenar Muscles
- p.83
- Name the thenar muscles.
- Opponens pollicis, Abductor pollicis brevis, Flexor pollicic brevis
- Name the hypothenar muscles.
- Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi
- What functions do the thenar and hypothenar muscles preform?
- oppose, abduct and flex (OAF)
- Unhappy triad/Knee injury
- p. 83
- What structures can be injured when a football player's cleated shoe is planted firmly in the turf and the knee is struck from the lateral side?
- medial collateral ligament (MCL), medial meniscus, and anterior cruciate ligament (ACL) (unhappy triad on the knee joint)
- What does a anterior drawer sign indicate?
- Tearing of the Anterior cruciate ligament (ACL)
- What does abnormal passive abduction indicate?
- A torn Medial collateral ligament (MCL)
- Recurrent Laryngeal nerve
- p.83
- The recurrent laryngeal nerve is a branch of which cranial nerve?
- CN X
- Which muscles does it supply?
- intrinsic muscles of the larynx except the cricothyroid muscle
- What structure does the right recurrent laryngeal nerve wrap around?
- right subclavian artery
- What structure does the left recurrent laryngeal nerve wrap around?
- arch of the aorta and the ligamentum arteriosum
- In what kind of surgery can this nerve be damaged in?
- thyroid surgery
- What happens when this nerve gets damaged?
- hoarseness
- Scalp and meninges: layers
- p. 83
- Name the layers of the scalp
- skin, connective tissue, aponeurosis, loose connective tissue, pericranium (SCALP)
- Name the meninges.
- Dura, arachnoid, and pia (DAP)
- What space is found between the dura and arachnoid?
- subdural space
- Between what meninges is the subarachnoid space located?
- between the arachnoid and the pia
- What is found in the subarachnoid space?
- CSF
- In which scalp layer are the emissary veins found?
- loose connective tissue
- Mastication Muscles
- p.84
- Which 3 muscles are responsible for closing the jaw?
- Masseter, temporalis, and medial pterygoid (M's munch)
- Which muscles opens the jaw?
- Lateral pterygoid
- Which nerve innervates the muscles that are responsible for jaw opening and closing?
- Trigeminal nerve V3
- Name the nerve that supplies the muscles of the tounge except palatoglossus.
- Hypoglossal nerve
- What nerve innervates the palatoglossus muscle?
- Vagus nerve
- The muscles with the root "palat" (except tensor veli palatini) are innervated by what nerve?
- vagus nereve
- What nerve innervates tensor veli palatini?
- mandibular branch of CN V
- Carotid Sheath
- p.84
- List the structures found in the carotid sheath (in the order from lateral, medial, posterior)
- Internal jugular vein, common carotid artery, and vagus nerve (VAN)
- Diaphragm Structures
- p.84
- What structure crosses the diaphragm at T8?
- IVC (I 8 10 EGG's AT 12)
- At what T level does the esophagus and vagus nerve cross the diaphragm?
- T10 (I 8 10 EGG's AT 12)
- What structure crosses the diaphragm at T12?
- aorta, thoracic duct, and azygous vein (I 8 10 EGG's AT 12)
- Name the innervation of the diaphragm
- C3, 4, and 5 (phrenic nerve)
- Where can the pain from the diaphragm be reffered to?
- shoulder
- Coronary artery anatomy
- p.85
- What artery supplies the SA and AV nodes?
- RCA right coronary artery
- The inferior portion of the left ventricle is supplied by what artery 80% of the time?
- RCA via the PD posterior descending artery
- In which artery does coronary artery occlusion most sommonly occur?
- LAD left anterior descending artery
- What artery supplies the anterior interventricular septum?
- LAD left anterior descending artery
- When do coronary arteries fill?
- during diastole
- What is the most posterior part of the heart?
- left atrium
- What can the enlargement of the left atrium cause?
- dysphagia
- Bronchopulmonary segments
- p 85
- What does each bronchopulmonary segment contain?
- 3º (segmental) bronchus and 2 arteries (bronchial and pulmonary) in the center
- What drains along the borders of the bronchopulmonary segments?
- veins and lymphatics
- What runs with the airways?
- arteries
- Lung Relations
- p. 85
- How many lobes does the right lung has?
- 3 lobes
- Which lung lobe has 2 lobes?
- left
- What is the homologue of the right middle lobe in the left lobe?
- lingula
- Which lung is the more common site for inhaled foregin body?
- right lung?
- Why is 1 lung a more common site for inhaled foregin body?
- Because of the lessvacute angle of the right main stem bronchus
- What is the relation of the pulmonary artery to the bronchus in each lung hilus?
- RALS - right lung anterior and left lung superior
- Femoral Triangle
- p.86
- What does the femoral sheath contain?
- femoral artery, femoral vein, and femoral canal (containing deep inguinal lymph node)
- Does the femoral nerve lie within the femoral sheath?
- no, it lies outside the sheath
- What do you call the entrance of abdominal contents through the femoral canal?
- femoral hernia
- What does the femoral triangle contain?
- femoral vein, aretery and nerve (VAN)
- Where does the femoral hernia protrude to?
- below and lateral to the pubic tubercle
- Abdominal Hernias
- p.86
- What are abdominal hernias?
- protrusions of peritoneum through an opening - usually sites of weakness
- What is the name of the hernia in which abdominal structures enter the thorax?
- diaphragmatic hernia
- What is the most common diaphragmatic hernia?
- hiatal hernia
- What happens in this type of hernia?
- the stomach herniates upward through the esophageal hiatus
- What can result from a defective development of pleuroperitoneal membrane in infants?
- diaphragmatic hernias
- From where does a direct hernia protrude?
- from the inguinal (Hesselbach's) triangle - bulges directly through the abdominal wall medial to the inferior epigastric artery
- Which inguinal ring does it go through?
- external inguinal ring only
- Who usually gets a direct hernia?
- older men
- What does the indirect hernia go through?
- the internal (deep) inguinal ring and external (superficial) inguinal ring and into the scrotum
- On which side of the inferior epigastric artery does the indirect hernia enter the internal inguinal ring?
- lateral to the inferior epigastric artery
- Who usually get an indirect hernia and why?
- infants, because of the failure of processus vaginalis to close
- Which structures make up Hesselbach's triangle?
- inferior epigastric artery, lateral border of rectus abdominis, and inguinal ligament
- Where does the inguinal canal start and end?
- begins at the deep inguinal ring and terminates at the superficial ring
- What does the inguinal canal transmit?
- the spermatic cord or the round ligament of the uterus and the genital branch of the genitofemoral nerve
- What structures make up the anterior wall of the inguinal canal?
- aponeuroses of the external oblique and internal oblique muscles
- What structures make up the posterior wall of the inguinal canal?
- aponeurosis of the transverse abdominal muscle and transversalis fascia
- What structures make up the superior wall of the inguinal canal?
- arching fibers of the internal oblique and transverse muscles
- What structures make up the inferior wall (floor) of the inguinal canal?
- inguinal and lacunar ligaments
- Arterial supply of stomach
- p. 87
- From where does the stomach receive its main blood supply?
- from the branches of the celiac trunk
- From where does the celiac trunk arise?
- from the front of the abdominal artery immediately below the aortic hiatus of the diaphragm
- What arteries does the celiac trunk divide into?
- left gastric, splenic, and common hepatic arteries
- What does the left gastric artery run along?
- lesser curvature of the stomach
- What artery does the left gastric artery anastomose with?
- the right gastric artery
- What does the splenic artery run along?
- runs along the superior boarder of the pancrease
- What arteries does the splenic artery give rise to?
- (dorsal pancreatic artery), short gastric arteries and left gastroepiploic artery
- What does the left gastroepiploic artery run along?
- the greater curvature of the stomach
- What does the common hepatic artery divide into?
- hepatic artery proper, right gastric artery, and gastroduodenal artery
- portal system anastamoses
- p. 88
- esophageal varices results at the anastamosis of which veins?
- left gastric vein (portal) and azygous (systemic)
- manifestation of portal hypertension at the anastamosis of the superior rectal with the middle/inferior rectal veins
- hemorrhoids
- caput medusae is at anastamosis of which veins
- paraumbilical (portal) and inferior epigastric (systemic)
- the two other sites of portal system anastamosis
- retroperitoneal vein (portal) with renal vein (systemic) and retroperitoneal vein with paravertebral vein (systemic)
- 3 manifestations seen in alcoholic cirrhosis
- esoph. Varices, hemorrhoids, caput medusae "Gut, butt and caput"
- lymph drainage
- p. 88
- drains right arm and right half of head
- right lymphatic duct
- what thoracic duct drains
- everything that right lymphatic duct does not
- pectinate line
- C2
- location of pectinate line
- where hindgut meets ectoderm
- innervation, hemorrhoid type, aterial supply and venous drainage above pectinate line
- visceral innervation, internal hemorrhoids, superior rectal artery, and rectal vein to inferior mesenteric vein to portal system
- innervation, hemorrhoid type, aterial supply and venous drainage below pectinate line
- somatic innervation, external hemorrhoids, inferior rectal artery, inferior rectal vein to internal pudendal vein to internal iliac vein to IVC
- retroperitoneal structures
- p. 88
- parts of duodenum that are retroperitoneal
- 2nd, 3rd and 4th parts
- parts of colon that are retroperitoneal
- descending and ascending colon
- 2 big organs that are retroperitoneal
- pancreas (except tail) and kidneys
- 2 major vessels that are retroperitoneal
- aorta and IVC
- digestive tract anatomy
- p. 89
- two big nerve plexuses in digestive tract and what they do
- Submucosal (Meissners) controls Secretions; Myeneteric (Auerbach's) controls Motility
- Layers of digestive tract from inside to out
- villi, lamina propria, muscularis mucosae, submucosa, serosa
- Gonadal venous drainage
- p. 89
- drainage of left ovary/testis
- left gonadal vein to left renal vein to IVC
- drainage of right ovary/testis
- right gonadal vein to IVC
- Enteric plexuses
- p. 89
- location of myenteric plexus
- b/w inner and outer layers of GI smooth muscle
- location of submucosal plexus
- b/w mucosa and inner layer of GI smooth muscle
- GI blood supply
- p. 89
- region and structures supplied by celiac artery
- foregut: stomach to duodenum, liver, gallbladder, pancreas
- hindgut is supplied by which artery
- inferior mesenteric artery
- superior mesenteric artery supplies ---
- midgut: duodenum to proximal 2/3 of transverse colon
- Kidney anatomy and glomerular structure
- p. 90
- grossly, the collecting system is made up of --
- papillae, medullary pyramids, renal pelvis and ureter
- which structures are in the renal medulla?
- proximal and distal straight tubules, loop of Henle, vasa recta
- location of macula densa
- part of DCT next to afferent arteriole
- Juxtaglomerular apparatus (JGA)
- p. 90
- two components of JGA
- JG cells (afferent arteriole) and macula densa (DCT, senses Na)
- three factors leading to renin secretion
- decreased renal blood pressure, decreased sodium in distal tubule, increased sympathetic tone
- what secretes erythropoeitin?
- JG cells
- Ureters: course
- p. 90
- two structures under which ureters pass
- uterine artery and ductus deferens "water under bridge"
- Ligaments of the uterus
- p. 91
- which ligament contains ovarian vessels?
- suspensatory ligament of uterus
- what does round ligament of uterus contain?
- nothing!
- which ligament contains uterine vessels?
- transverse cervical ligament
- what does broad ligament contain?
- round ligaments of uterus and ovaries and uterine tubules and vessels
- Autonomic innervation of male sexual response
- p. 91
- erection is mediated by ---- while emission is mediated by ----.
- Parasympathetics; Sympathetics "Point and Shoot"
- which nerves mediate ejaculation?
- visceral and somatic
- Clinically important landmarks
- p. 91
- McBurney's point
- site of appendix, 2/3 of way from umbilicus to ASIS
- significance of ischial spine
- site of pudendal nerve block
- site of lumbar puncture
- iliac crest
- Peripheral nerve layers
- p. 91
- what is covered by endoneurium?
- single nerve fiber
- what must be rejoined in microsurgery for lim reattachment?
- Perineurium: the Permeability barrier
- what surrounds the entire nerve?
- epineurium
- Corpuscles
- p. 91
- sites of meissner's corpuscles and their function
- dermis of palm, soles, and digits; involved in light discriminatory touch of hairless skin
- Sites of Pacinian corpuscles and their function
- deep skin at ligaments joint capsules, serous membranes and mesenteries; involved in Pressure, coase touch, vibration and tension
- Inner ear
- p. 92
- 3 components of bony labyrinth
- cochlea, vestibul and semicircular canals
- Site and composition of endolymph
- membranous labyrinth, high potassium (like ICF)
- site and composition of perilymph
- bony labyrinth, high sodium
- site of cochlear duct, utricle, saccule, and semicircular canals
- membranous labyrinth
- what frequency does base of cochlea pick up?
- high-frequency
- site and function of ampullae
- in semicircular canals, for angular acceleration
- site and function of maculae
- in utricle and saccule, for linear acceleration
- which frequency is lost first in hearing loss in elderly
- high-frequency
- site of endolymph production
- stria vascularis
- Collagen types
- p. 92
- most abundant protein in human body
- collagen
- collagen primarily found in basement membrane and basal lamina
- type IV. "under the floor"
- collagen type primarily found in cartilage
- type II. "carTWOlage"
- collagen type primarily found in bone
- type I. "bONE"
- Reticulin found in skin, blood vessels, uterus, fetal tissue, and granulation tissue
- type III.
- Collagen type X is found primarily in -----.
- epiphyseal plate
- Epidermis layers
- p. 92
- What are the layers of the epidermis from surface to base?
- stratum corneum, stratum lucidum (in thick skin), stratum granulosum, stratum spinosum, stratum basalis. "Californians Like Girls in String Bikinis"
- Epithelial cell junctions
- p. 93
- This type of junction is also called the zona occludens. (occludes diffusion across intracellular space)
- tight junction
- Forming a perimeter just below the tight junction, the zona adherens (intermediate junction) is composed of ------ and ------ filaments.
- e-cadherin & actin filaments
- Desmoplakin and ----- filaments are a part of the desmosome, also called the ----- ------.
- keratin. Macula adherens
- Structures that allow adjacent cells to communicate for electric and metabolic purposes.
- gap junction
- These structures connect cells to underlying extracellular matrix. Integrins are found in these structures.
- hemidesmosome
- Glomerular basement membrane
- p. 93
- The glomerular basement membrane is formed from fused endothelial and podocyte basement membranes and coated with ---- (pos / neg) charged ------ ------.
- heparan sulfate
- Responsible for filtering plasma according to ----- and ----.
- charge & size.
- In Nephrotic syndrome, Negative charge is lost. That's why plasma -----, which are negatively charged, are lost in the urine as a consequence.
- protein
- Principle antigen presenting cell of epidermis
- Langerhans cell
- Cilia structure
- p. 93
- what is the arrangement of microtubules?
- 9+2
- what is dynein?
- what happens in Kartagener's syndrome?
- Nissl bodies
- p. 93
- What are nissl bodies?
- RER in neurons, not found in axon or axon hillock
- What do nissl bodies synthesize?
- enzymes (i.e. ChAT) and peptide neurotransmitters