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287 Cards in this Set
- Front
- Back
What is the origin of the internal thoracic arteries? |
Subclavian artery
|
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what 2 areas or structures does the internal thoracic artery nourish?
|
intercoastal spaces anteriorly via small intercoastal branches and from the musculophrenic artery and the rectus abdominis via the superior epigastric artery
|
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what muscles hold the internal thoracic artery to the inside of the chest wall?
|
Transverse thoracic
|
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what is the sensory innervation to the pleura lining the thoracic cavity (coastal part)?
|
intercoastal nerves
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what is the sensory innervation to the pleura lining the mediastinum?
|
phrenic nerve
|
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what is the sensory innervation to the pleura lining the diaphragm?
|
phrenic (central part) and intercoastal nerves (peripheral)
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what is the sensory innervation to the pleura lining the costal and diaphragmatic surface of lungs?
|
visceral afferents
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what is the sensory innervation to the pleura lining the oblique fissures?
|
visceral afferents
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in general, by how many ribs higher does the inferior border of the lungs lie than the lowest extent of the parietal pleura?
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2
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in the mid axillary line, the mid-inspiration, the lungs cross the what rib while the lower border of the parietal pleura crosses which rib?
|
8th and 10th
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to drain fluid from the pleural cavity the drain tube is commonly placed in the 8th or 9th ICS, mid-axillary line. the drain enters what recess?
|
costodiaphragmatic recess
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what intercostal muscle layers does the intercostal neurovascular bundle travel between? |
the intermost intercostal and the internal intercostal muscles
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developmentally, each lung has how many broncho-pulmonary segments?
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10
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anatomically the superior lobe of the lung lies mostly ______, while the inferior lobe lies mostly ______.
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superior lies mostly anterior
inferior lies mostly posterior |
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what is the lingual?
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lower projection off the left upper lobe of lung
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lingual is synonymous with what part of the right lung?
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middle lobe
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the apex of each lung lies above the _____ and what rib to extend into the root of the neck.
|
clavicle and 1st rib
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what travels with the segmental bronchi through the middle of the broncho-pulmonary segment?
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segmental bronchi and artery |
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what is the result of sympathetic innervation to the lung? |
vasodilation of pulmonary and bronchial vessels, decreased mucus secretion and bronchodilation.
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lymphatic drainage of the lungs is collected by what set of lymph nodes?
|
pulmonary to hilar
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other than pulmonary vessels, what is the blood supply to the lungs and bronchi?
|
bronchial arteries
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the lung and viscera pleura are insensitive to somatic-type stimuli, expect for _______
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stretch or distension
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which primary bronchus is more likely to receive a foreign body and why?
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right main bronchus, it is wider and straighter continuation of trachea
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what is another name for the upper lobar bronchus and why?
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epiarterial, it lies above the right pulmonary artery
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at the hilum of the lung, what pulmonary structures generally lies most anterior? posterior? superior?
|
pulmonary veins
bronchus pulmonary artery |
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at what vertebral body level and sternal level does the trachea bifurcate?
|
at the sternal angle, 4th thoracic vertebral body level
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what is the upward pointing projection on the inside of the trachea at its bifurcation into primary bronchi?
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carina
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what nerve runs anterior to the root of the lung?
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phrenic nerve
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what nerve runs just posterior to the root of the lung?
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vagus nerve
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what component of the ANS is found on the lateral sides of vertebral bodies in thorax?
|
sympathetic chain and greater splanchnic nerve
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where is the needle placed to avoid the intercostals neurovascular bundle while removing fluid from costodiaphragmatic recess?
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through the middle of the space, using the superior border of the rib below as a guide
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in a unilateral sucking or open pneumothorax, what does the mediastinum and inflated lung do during inspiration?
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they deviate to the side opposite the opening in the thoracic wall
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in a unilateral tension pneumothorax, what does the mediastinum and inflated lung do upon expiration?
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they remained deviated to the side opposite the opening in the thoracic wall
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during inspiration describe the changes in shape and volume of the thoracic cavity.
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all volumes increase, thus pressure decrease within thoracic cavity. the ribcage elevates increasing the side to side diameter (bucket handle) and the AP diameter (pump handle), while the diaphragm contracts and drops, increasing superior-inferior diameter.
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what bony landmark divides the superior and inferior mediastina?
|
sternal angle
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the thymus is found in which division of the mediastinum?
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superior and anterior
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what is the primary "artery" found in the post mediastinum?
|
descending aorta
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the middle mediastinum is the "home" for what major structure/organ?
|
heart
|
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what structures border the thoracic duct in the post mediastinum?
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aorta, vertebral bodies, esophagus
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what is the name for the thin membrane which lines the inside of the fibrous pericardium?
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parietal layer of serous pericardium
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what is the procedure called when pericardial sac is tapped with a needle for removal of fluid?
|
pericardiocenthesis
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where on the ant chest wall is the aortic valve best heard? the mitral valve?
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2nd ICS, right of sternum
apex of heart, 5th ICS near left MCL |
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where on the anterior chest wall is the apex of the heart projected?
|
5th ICS near left MCL
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what valve is heard best at about its anatomic position as projected onto the anterior chest wall?
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tricuspid valve
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what is the name of the external depression on the heart which divides the atria from ventricles?
|
coronary sulcus
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auricles are part of which heart chamber?
|
atria
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the pulm trunk carries blood from which chamber of the heart?
|
RV
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what is the name of the AV valve that sits bw the RA and RV?
|
tricuspid
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the "rough" muscular part of the atria walls are termed the ________ muscles
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pectinate
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what is the function of the papillary/chordae tendenae complexes?
|
prevent AV valve cusps from regurgitating into atria upon ventricular contractions
|
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How many pulm veins usually enter the LA?
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4
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what is the usual origin for the left subclavian artery? the right subclavian artery?
|
aortic arch
brachiocephalic trunk |
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the azygos vein arches over the root of the lung to enter what vessel?
|
SVC
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in general the venous drainage from the heart is collected in what structure before being empited into the RA?
|
coronary sinus
|
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in a left dominant coronary artery distribution pattern, which parts of the heart are supplied by branches of the left coronary artery?
|
both interventricular sulci and the posterior surface of the LV
|
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the coronary arteries arise from the aortic sinuses of ______
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valsalva
|
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the impulse wave from the AV node is transmitted to the ventricles by what bundle?
|
AV bundle of His
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which nerve supplies parasympathetic innervation to the thoracic viscera?
|
CN X (vagus)
|
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what affect does sympathetic innervation have on the heart?
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increased heart rate and force of contracility, dilation of coronary arteries
|
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what affect does sympathetic innervation have on the lungs?
|
bronchodilation, decreased mucus secretion, vasodilation of pulmonary vessels
|
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where is the cardiac skeleton located?
|
at the level of coronary sulcus
|
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what is the cardiac skeleton made of in the human?
|
semi-rigid, dense connective tissue
|
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name 3 functions of the cardiac skeleton
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attachment for valves, attachment of cardiac muscles and insulation of ventricles from electrical impulses
|
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what is the feature of the RA that represents a right to left shunt in fetal life?
|
foramen ovale
|
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in fetal life, most of the blood from the pulmonary trunk is shunted to the aorta via the _______
|
ductus arterosum
|
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what does the ductus arterosum become in an adult?
|
ligamentum arterosum
|
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what chamber of the heart helps form the left heart border on PA plain film radiograph?
|
mostly LV. the LA appendage also forms tiny part of it
|
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The absence of what feature of the cardiac silhouette indicates the presence of enlarged lymph nodes or masses in the mediastinum?
|
the aorto-pulmonary window or wedge is missing with enlarged lymph nodes on the left. the right side shows widened mediastinum in the same region
|
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what is the superior extent of the pleural cavity?
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about 1 inch above the clavicle/1st rib
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what is then name of the peritoneal lined space bw the body wall and the diaphragm?
|
costodiaphragmatic recess
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a PA chest x-ray should exhibit how many pairs of ribs?
|
at least 8
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the anterior aspect of each rib is located ___________ to the posterior aspect of the rib
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below/inferior
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in a normal CXR what radiopaque structure can be seen in the substance of the lung?
|
pulmonary vessels
|
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what forms the majority of right heart border?
left heart border? |
right: RA and SVC
left: LV and pulm trunk and aorta |
|
what is the aortic knob?
|
arch of the aorta on left mediastinal border
|
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what part of the heart lies most anterior in thorax?
posterior? |
RV
LA and LV |
|
what structure normally makes an impression on the esophagus?
|
aorta-superiorly
|
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on inspiration what is the position of the diaphragm?
|
descends
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pneumonia of which lobe of the lung obsures the right heart border on PA view?
|
right middle lobe
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how would free air in abdominal cavity show up on plain film x-ray?
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as a radiolucent (dark) region inferior to the diaphragm
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how do you describe a PA CXR of person with severe emphysema?
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barrel shaped long and rounded, but low hemi-diaphragm domes
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fluid accumulating in the pleura space is referred to as...
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pleural effusion
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in contrast to pneumonia, how do large effusions affect the organs of the thorax?
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pneumonias occupy the lung space with little or no displacement, effusions push the lungs and mediastinum to the opposite side- space occupying
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on a pneumonthorax the visceral pleura of the partially deflated lung is seen as a thin ________
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white line
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name 4 reasons for mediastinal widening that are caused by disease states
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pulm HTN
lung cancer aorta rupture enlarged mediastinal lymph nodes cardiomegaly |
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cardiomegaly due to mitral valve regurgitation is due mainly to enlargment of what?
|
LA
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cardiomegaly due to aortic valve regurgitation is due mainly to enlargment of what?
|
LV
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what view is best on aortagram to clearly visulize the 3 chief supra-aortic branches off the aortic arch?
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lateral view
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what is the vertical midline feature on the abdominal wall that intersects the umbilicus?
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linea alba
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in the quadrant system, what is the landmark for the 2 perpendicular lines?
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umbilicus
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in the quadrant system, where is the appendix located? the liver? the stomach?
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lower right
upper right upper left |
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what is the bony component of the abdominal wall inferiorly?
|
the pelvis (ilium, pubis, sacrum)
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how many lumbar vertebrae are there?
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5
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which ribs supports the posterior abdominal wall posteriorly?
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11 & 12
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what is the name of the thick fatty layer on the abdominal wall?
|
Camper's fascia
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what is the clinical significance of Scarpa's fascia?
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forms the wall for a potential space bw the superficial fascia of the skin and the underlying abdominal wall
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how do the lateral abdominal muscles compare to the intercostal muscles?
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they are 3 in number, innervated mostly by thoracic nerves, helps control pressure in body cavity
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what are the collective functions of the abdominal muscles?
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protection, flex trunk, helps control intra-abdominal pressure
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what is the makeup of the anterior rectus sheath above the arcuate line?
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in general the anterior rectus sheath is composed of the aponeuroses of the external oblique and the internal oblique above the arcuate line, and all 3 aponeuroses below the arcuate line. the posterior rectus sheath above the arcuate line is composed of the aponeuroses of the transversus abdominis and the internal oblique, and below the arcuate line only transverses fascia
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how do the lateral abdominal muscles differ in innervation from the anterior abdominal muscles?
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the 3 lateral abdominal muscles are innervated by T7-L1, the rectus abdmoinis is supplied by T7-T12
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how do the nerves and vessels reach the rectus abdominis?
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they run bw the 2 inner lateral muscle layers and pierce the rectus sheath laterally
|
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what makes up the inguinal ligament?
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the thickened lower margin of the external oblique aponeurosis
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what forms the anterior wall of the inguinal canal?
|
external oblique aponeurosis
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what runs thru the inguinal canal in the male? the female?
|
spermatic cord
round ligament |
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what muscle layer gives rise to the cremasteric fascia?
|
internal oblique, rarely transverses abdominis too
|
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what is the name given to the testicular vein in the spermatic cord?
|
pampiniform plexus
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what is the name of the sperm duct?
|
vas deferens, or ductus deferens
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what is the name of the peritoneal sack located in the scrotum, anterior to the testes?
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tunica vaginalis
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what is the thick coat of the testes called?
|
tunica albugenia
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what structure is responsible for storing sperm, once produced by the testes?
|
epididymus
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in performing a vasectomy, what layers are incised to reach the vas deferens?
|
skin, colles fascia, dartos muscle, external spermatic fascia, cremasteric fascia/muscle, internal spermatic fascia, extraperitoneal fat
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what is the relationship of the hernia neck of an indirect hernia to the inferior epigastric vessels?
|
the neck of the indirect hernia lies lateral to the inferior epigastric vessels
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what is the most common age groups for occurrence of indirect inguinal hernias? direct inguinal hernias?
|
indirect: young males: mostly newborns and toddlers <1yo
direct: middle aged to old males, with weak abdominal muscles |
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what is the difference bw hematocele vs hydrocele?
|
the tunica vaginalis contains blood in a hematocele, but peritoneal like fluid in a hydrocele
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on which side is a variocele most common?
|
left
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a patent processes vaginalis is a ready made path for which type of inguinal hernia?
|
indirect
|
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what is the initial lymphatic drainage of the testes and why is it different from that of the scrotum?
|
testies lymphatics follow testciular vessels toward the para-aortic (lumbar)
scrotal lymphatics follow external pudendal vessels toward the superficial inguinal lymph nodes. difference due to the fact that testes develop high on the posterior abdominal wall and descend into the scrotum, unlike scrotum that develops from anterior abdominal wall. Generally, lymphatics follow the vessels that supply the organ or region |
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what is the name of the peritoneum lining the GI tract organs?
|
Visceral peritoneum
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how does the peritoneum compare to the pleura?
|
it is the same, except for location
|
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name 3 functions of the mesenteries.
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support, fat storage, transmits vessels, nerves and lymphatics
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what is the name of the mesentery that drapes off the greater curvature of the stomach?
|
greater omentum
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what is it referred to as the "Policeman of the abdomen"?
|
it adheres to inflamed tissue and tends to separate it from the rest of the peritoneal cavity
|
|
in what quadrant is the liver located?
|
upper right
|
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what are the 3 parts of the small intestine?
|
duodenum, jejunum, ileum
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what part of the GI tract "frames" the small intestine?
|
large intestine (colon)
|
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in what quadrant of the abdomen would you find the appendix?
|
lower right
|
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what is the name of the mesentery to the sigmoid colon? the small intestine?
|
sigmoid mesocolon
mesentery proper |
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what is the location of the spleen?
|
left side, posterior to the mid axillary line, oriented along the long axis of the 10th rib
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what is the name of the colic flexure where the transverse colon turns into the descending colon?
|
left colic flexure or splenic flexure
|
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what is the characteristic shape of the stomach?
|
J shape
|
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what part of the stomach usually contains swallowed air?
|
fundus
|
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what is the name of the mucosal folds in the stomach?
|
rugae
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what is the name of the sphincter that lies bw the stomach and the duodenum?
|
pyloric
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how is the 1st part of duodenum likes the last part of the stomach?
|
it has smooth mucosa
|
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what empties into the 2nd part of the duodenum?
|
major duodenal papillae
|
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what is the characteristic shape of the duodenum?
|
C shape
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what lies nestled in the curve of the duodenum?
|
head of pancreas
|
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what is the name of the mucosal folds in the small intestine?
|
plicae circularae
|
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name 5 ways the ileum differs from the jejunum?
|
ileum is smaller in size, has fewer and lower plica, is less vascular, has more encroaching mesenteric fat, has shorter vasa recti, more complicated arcades, have Peyer patches, possible Meckel's diverticulum
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what is name of the part of the large intestine that connects to the ileum and the appendix?
|
cecum
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what is McBurney's Point?
|
surface projection onto anterior abdominal wall of the location where the appendix originates from the cecum
|
|
what characteristics distinguish the large intestine from the small intestine?
|
the presence of tenia coli, plica semilunares, haustra, and epiploic appendages
|
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what arterial trunks supplies the foregut?
midgut? hindgut? |
Celiac
SMA IMA |
|
what are the 3 branches off the celiac artery?
|
left gastric, splenic, common hepatic
|
|
name the arteries that collectively supply the jejunum and ileum?
|
intestinal
|
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what is the origin of the middle colic artery and what general region does it supply?
|
SMA, transverse colon
|
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why are the vessels to the gut smaller than they initially appear on visual inspection?
|
they are "coated" with an autonomic nerve plexus
|
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which unpaired artery gives rise to the left colic artery and sigmoidal arteries?
|
IMA
|
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what is the functional significance of the marginal artery?
|
provides for a continuous anastomotic supply of blood to the colon in the event that a major colic branches are compressed, temporarily or permanently
|
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what 3 veins converge to form the portal vein?
|
Splenic and SMV, plus IMV
|
|
where is the portal vein formed?
|
behind the neck of the pancreas
|
|
what is the function of the portal vein?
|
bring nutrient rich, still moderately oxygenated blood to the liver for processing from the GI tract
|
|
what is portal hypertension?
|
restriction of blood flow thru the portal vein
|
|
what are some symptoms of chronic portal HTN?
|
splenomegaly, hemorrhoids, esophageal varices, caput medusa
|
|
how can sx of chronic portal HTN be alleviated?
|
surgically routing portal to the IVC thru fusion of these vessels or other adjacent porta/caval vessels (left renal and splenic veins)
also an interventional procedure called TIPS- trans intrahepatic portal shunt |
|
how many lobes does the liver have?
|
2-4: right and left (caudate and quadrate part of right anatomic, but part of left functional lobe)
|
|
what separates the liver into anatomic lobes?
|
falciform ligament and left sagittal fissure
|
|
what lies in the right hepatic fossa?
|
Gallbladder and IVC
|
|
what is the round ligament of the liver?
|
the remnant of the umbilical vein
|
|
what is the porta hepatis?
|
hilum of liver (transverse hepatic fissure)- contains components of hepatic artery, hepatic ducts and portal vein
|
|
what are the 2 sources of blood to the liver?
|
portal vein (70%) and hepatic artery (30%)
|
|
what separates the liver into functional lobes?
|
physically- the middle hepatic vein
by definition- right and left branching of the hepatic arteries, portal veins, and hepatic ducts |
|
what is the function of the gallbladder?
|
stores, concentrates and releases bile
|
|
what is the name of the duct that transmits bile to and from the gallbladder?
|
cystic duct
|
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what is the special connective tissue formation in the duct that prevents over distension and collapse of the duct to the gallbladder?
|
spiral valve (of Heister)
|
|
what is the route of bile once produced until it reaches the duodenum?
|
liver, hepatic ducts, common hepatic duct, cystic duct, gallbladder, cystic duct, common bile duct, ampula of Vater, major duodenal papillae, duodenum
|
|
what is the function of the pancreas?
|
endocrine- sugar metabolism: glucagon and insulin
exocrine- digestion: bicarb, lipases, amylases, proteases |
|
where is the head of the pancreas located? the tail?
|
nestled in the C shaped crook of the duodenum
at the hilum of the spleen |
|
what is the relationship of the main pancreatic duct and common bile duct?
|
they empty into a common site- ampula of Vater
|
|
where is the spleen located?
|
posterior to the mid-axillary line, left side, along the 10th rib
|
|
why is it commonly injured in MVAs?
|
it is on a pedicle made from the greater omentum and is relatively mobile. it therefore can become a projectile within the peritoneal cavity during a severe MVA and crashes against the inside of the rib cage. It is often bruised or lacerated
|
|
what other organ is also at risk in MVA that injures the spleen?
|
tail of pancreas as well as the splenic vessels
|
|
what does the muscular component of the diaphragm attach to "centrally"?
|
central tendon of the diaphragm
|
|
what passes thru the diaphragm at the level of 10th thoracic vertebral body? what other structure accompanies it?
|
esophagus
vagus nerve |
|
why are they accessory/aberrant arteries common?
|
during its ascent out of the pelvis, the kidneys lose and re-establish their arterial supply and thus may have multiple branches rather than just one renal artery to each kidney
|
|
what is the effect on diaphragm function if the right phrenic nerve is damaged?
|
right hemidiaphragm is paralyzed- expansion of lung on affected side more difficult
|
|
what are the 2 muscles in the posterior abdomen that forms the chief flexor of the thigh?
|
iliacus and psoas
|
|
where do the kidneys originate during development?
|
in the pelvis
|
|
what is the order of structures at the hilum of the kidney?
|
vein, artery, ureter/renal pelvis
|
|
what are the major structures in the kidney medulla?
|
renal pyramids
|
|
into what structure does renal papillae empty urine?
|
minor calyx
|
|
what is the name of the fatty "encasement" that surrounds the kidney?
|
perirenal fat
|
|
how can accessory/aberrant renal arteries lead to hydronephrosis?
|
accessory arteries to the inferior pole of the kidney can compress the ureter, thus restricting urine flow and eventually dilation of the collecting system within the kidney with backed up urine
|
|
what are end arteries and give 4 examples.
|
arteries that do not anastomose with other arteries
ex. vasa recti, segmental renal arteries, segmental hepatic arteries, segmental pulmonary arteries, appendicular artery (named vas recti) |
|
what is the shape of the left suprarenal gland?
|
crescent
|
|
where is the hilum of the suprarenal gland?
|
where the suprarenal vein exits the gland
|
|
name 4 different paired arteries off the abdominal aorta from superior to inferior
|
inferior phrenic, renal, testicular/ovarian, lumbar, common iliac
|
|
at what lumbar vertebral level does the aorta bifurcate?
|
L4
|
|
into what venous structure does most of the veins of the retroperitoneum drain on the right vs the left side?
|
right- IVC
left- left renal vein |
|
what does the left renal vein pass over to reach the IVC? what does it pass under?
|
aorta
SMA |
|
what nerves of the lumbar plexus are involved in cremaster reflex?
|
the cremaster reflex tests the integrity of L1-L2 spinal cord level. By stroking the skin over the femoral triangle, the cremaster muscle reflexly contracts, raising the testicle. the nerve involved is mostly genitofemoral nerve, but some sensory from ilioinguinal nerve
|
|
what are the 2 lumbar plexus nerves that innervate the thigh?
|
femoral and obturator
|
|
what nerve gives parasympathetic innervation to most of the GI tract?
|
vagus
|
|
what is the result of parasympathetic innervation to the gut?
|
increased peristalsis, increased secretion of digestive juices, sphincter control
|
|
what are visceral afferents and what is the characterisitc of the pain associated with them compared to somatic afferents?
|
sensory nerves of the GI tract. visceral afferents that carry pain perception are thru stretch receptors. it is perceived as dull, achy, poorly localized pains over general areas either referred to the midline or over the affected solid organs
|
|
in the gut, what does increased sympathetic tone result in the GI tract?
|
vasoconstriction of the vessels of the gut
|
|
in the abdominal cavity, the GI tract drains into which set of lymph nodes?
|
preaortic or intestinal nodes
|
|
the retroperitoneum and LE drains into which set of lymph nodes?
|
para-aortic or lumbar nodes
|
|
in general, they lymphatic drainage of the abdomen and its contents follows the path of what other system?
|
blood vessels
|
|
into which lymph nodes does the testes/ovaries drain?
|
para-aortic/lumbar nodes
|
|
into which lymph nodes does the scrotum initially drain into?
|
superficial inguinal nodes
|
|
what is the key characteristic of the lumen of the esophagus following barium swallow?
|
monotonously smooth
|
|
when the patient is lying on their back, what part of stomach is most posterior and thus fills with barium after partial barium swallow?
|
fundus
|
|
what internal structures are obvious on partial emptying of stomach?
|
rugae
|
|
what characteristic shape does the first part of duodenum exhibit on barium filling?
|
arrow head or x-mas tree
|
|
where is the anatomical location of the duodeno-jejunal junction?
|
posterior to the stomach
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what is the characteristic appearance of the lumen of the jejunum on barium swallow study?
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feathery
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the ileum is mostly located in the lower abdomen and loops fall into what?
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the pelvic cavity
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on barium enema of the large intestine what are the bulges/segments of the gut called?
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haustra
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bc of motility of the sigmoid colon, it is often ______ on itself and rectum on barium study
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superimposed
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to study the lining of the large intestine, a small amount of barium is used to coast the gut lining when placed under what?
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pressurized gas
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the normal liver appears as a ________ mass in the URQ on CT
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homogeneous
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the pancrease appears as a lightly ________ elongated tissue that stretches across the left posterior and middle abdominal wall on CT
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lobulated
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what is considered the radiologist's friend bc it provides a dark outline to most soft tissue organs on CT?
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fat
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what can be seen on the posterior abdominal cavity wall on the LUQ on CT?
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the spleen
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the kidneys lie in the post abdominal region in a ___________ position, surrounded by radiolucent ______________ on CT
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retroperitoneal
perirenal fat |
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on excretory or retrograde cystogram, the contents of the bile duct and pancreatic duct can be seen emptying into the what?
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duodenum
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on US gallstones appear as _______ objects surrounded by _________ bile
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white (hyperchoic)
dark (anechoic) |
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on SMA arteriorgram, the intestinal branches are mostly found ______ of the midline
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left
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what is the demarcation bw the false and true pelvis?
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the pelvic brim, following along the superior margin of the pubic symphysis of the pubis arcuate line of the ilium, ala of the sacrum and sacral promontory
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what are the 3 bones that make up the hip bone?
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ilium, ischium, pubis
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what is the structure where the 2 hip bones unite anteriorly?
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pubic symphysis
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what part of the sacrum unites with the hip bones posteriorly?
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the ala of the sacrum articulate with the ilium and are held in place by strong sacroiliac ligaments. there is actually a joint which is reasonably nonmotile, the sacroiliac joint
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what ligaments and bony prominences are involved in the formation of the greater and lesser sciatic foramina?
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the sacrotuberous and sacrospinous ligaments that connect the ishial tuberosity and ischial spine to the sacrum. the space bw the sacrotuberous and sacropspinous ligaments is the lesser sciatic foramen
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in the anatomical position what 2 bony features of the pelvis lie on the same vertical plane?
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the anterior part of the pubic symphysis and the ASIS
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Who has the widest subpubic angle?
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females
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who has the smallest pelvic inlet and outlet?
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males
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who has shallowest true pelvis?
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females
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What is the pouch of Douglas and what is its clinical significance?
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The rectouterine space or peritoneal space between the uterus and anterior rectum. Clinically it is an important area adjacent to the posterior fornix of the vagina. The thin vaginal wall is all that separates the peritoneal cavity from the outer environment. It can easily be punctured thus transmitting infection to the peritoneal cavity.
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What is the sacral plexus?
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The sacral plexus is composed of ventral primary rami of segments S1 to S5 and the lumbosacral trunk from L4-5. These nerves combine to form the major nerves that leave the pelvis to supply the lower limb.
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What are the major nerves derived from the sacral plexus?
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Sciatic, superior and inferior gluteal, pudendal, posterior femoral cutaneous, and pelvic splanchnics.
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What are the two sources for sympathetic nerves in the pelvis?
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Sacral sympathetic trunk (or chain) and the hypogastric plexus.
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What is the origin of the parasympathetic innervation to the pelvic viscera?
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Pelvis splanchnics from S2-S4.
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What are the chief arteries off the internal iliac artery?
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Superior and inferior gluteal arteries, umbilical supplying superior vesicular branches, obturator, middle rectals, internal pudendals, uterine and vaginal branches
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What arteries in the pelvis are unique to females?
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Uterine and vaginal branches off the internal iliac, and ovarian from the lumbar aorta.
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What is the origin for the common variation of the obturator artery?
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It may arise off the inferior epigastric branch from the external iliac and pass over the pelvic brim to the obturator canal (20% occurrence).
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On a rectal exam, what can be palpated anteriorly in the female?
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cervix of uterus
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What is the muscular sheet found at the pelvic outlet? What are its components?
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Pelvic diaphragm
levator ani and coccygeus muscles. |
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What is the name of the medial part of the levator ani that keeps the “kink” in the anus?
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Puborectal sling.
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What is the path for the ureters? Where are the three constrictions or narrowed areas in the ureters?
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They pass down the posterior abdominal wall, over the pelvic brim, along the posterior wall of the pelvis and then anterior to the enter posterior wall of the bladder.
Three constrictions are 1) at the renal pelvis, 2) where they cross the external iliac artery and pass over the pelvic brim, and 3) as they pass through the bladder wall. These areas are where large calculi, ‘kidney stones’, often are stopped and then cause increased pain. Small stones may pass with little or no pain. |
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As the ureters approach the uterus, what structure crosses immediately over them?
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Uterine artery
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What is the smooth area in the bladder where the ureters pierce the bladder wall?
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Trigone, outlined by the inlets of the ureters and inferiorly by the outlet of the bladder
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What is the name of the smooth muscle found in the urinary bladder wall?
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Detrusor muscle
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What is the ring of smooth muscle called at the neck of the urinary bladder?
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Internal sphincter
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What is its innervation of the internal sphincter?
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It is closed tonically by the sympathetics and stimulated to open by the parasympathetics (by inhibition of sympathetics).
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On rectal exam what can be palpated anteriorly in the male.
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Prostate and seminal vesicles
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Where is the membranous urethra located in both sexes?
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Within the urogenital diaphragm
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What is the pathway for sperm after passing through the superficial inguinal ring?
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In the vas deferens the sperm pass through the inguinal canal, then through the deep inguinal ring, over the pelvic brim, along the lateral aspect of the bladder, join the duct of the seminal vesicle to form the ejaculatory duct, passes through the prostate gland, and enter the prostatic urethra on the posterior aspect along the colliculus seminalis
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Into what do the ejaculatory ducts empty?
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Prostatic urethra, along the side of the colliculus seminalis
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What nerve group functions during ejaculation?
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Parasympathetics, cause contraction of urethral muscles. Sympathetics, cause movement of sperm down the vas and secretion of glands (emission)
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How does the prostate empty into the urethra compared to the ejaculatory ducts?
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Numerous small ducts open into the prostatic urethra
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What is the name for the longest part of the urethra in males?
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Spongy urethra (since it enclosed by the corpus spongiosum
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The female urethra opens into what space?
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vestibule
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What arteries supply the rectum?
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Superior rectal from inferior mesenteric, middle rectal form internal iliac, and inferior rectal from internal pudendal artery
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What are the boundaries of the perineum?
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It is a diamond formed by the pubic symphysis, pubic rami, ishial rami, ishial tubosities, sacrotuberous ligaments, and coccyx
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What are its two subdivisions, and in general what is found in each?
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Anal triangle; anal canal, external anal sphincter, and ishiorectal fossa. Urogenital triangle; UG diaphragm, scrotum/labia, penis/clitoris, vestibule
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What are the boundaries of the ischiorectal fossae? With what is it normally filled?
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Perineal body anteriorly, laterally obturator internus muscle, levator ani. They are filled with fat.
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What is the UG diaphragm and how does it differ from the pelvic diaphragm
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It stretches between the inferior pubic rami. It lies superficial to the pelvic diaphragm and contains the external sphincter of the urethra.
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What pierces the UG diaphragm in the female? The male?
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Female – urethra and vagina
Male - urethra |
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What is found in the deep perineal space?
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The urogenital diaphragm
|
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What is the superficial perineal space? And what is found there?
|
It is the area superficial to the UG diaphragm. It contains the structures associated with the penis and scrotum, or structures of the vestibule, clitoris, and labia, plus all the associated nerves and vessels.
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What is the difference between the external and internal urethral sphincter?
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The external sphincter is under voluntary control while the internal sphincter is controlled by autonomic nerves.
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What is the chief nerve supply to the perineum?
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Pudendal nerve and its branches.
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What is the origin of the inferior rectal nerves & vessels?
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Pudendal nerve and internal pudendal artery and veins.
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What are the names of the nerves and arteries on the dorsum of the body of the penis? What is the function of the nerves found here?
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Deep dorsal vein, dorsal arteries, and dorsal nerves
Sensory to the surface |
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The crura and bulb of the penis make up what basic part of the penis?
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Root of the penis
|
|
What is the muscle layer that lies over the bulb of the penis? What is its function?
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Bulbospongiosus, compresses the bulb and assists erection
|
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How does the path of the urethra differ between the sexes?
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The male urethra consists of prostatic and spongy components that are not found in the female. The membranous component is common in both.
|
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The bulb of the penis is continuous with what structure in the shaft of the penis?
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Corpora spongiosum
|
|
What is the mechanism of erection?
|
Upon stimulation the smooth muscle in the trabeculae and arteries of the corpora relax because of parasympathetic stimulation (via pelvic splanchnics). The arteries straighten and enlarge allowing increased blood flow into the cavernous spaces. The bulbospongiosus and ishiocavernosus muscles compress the venous drainage at the periphery of the corpora and impede outflow of blood. As a result the corpora become enlarged and rigid and erection occurs.
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How do the drainage patterns for the superficial veins of the perineum differ from that of the deep dorsal vein?
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The perineum is drained via the internal pudendal veins back toward the lesser sciatic foramen while the deep dorsal vein drains through a defect in the UG diaphragm directly into a plexus of veins surrounding the prostate gland
|
|
What is the name of the end of the uterine tube that drapes over the ovary?
|
Fimbrae, which sweep over the surface of the ovary and pick up ovulated oocytes
|
|
What is the origin of the ovarian arteries?
|
They pass into the pelvis over the pelvic brim. They originate as paired arteries off the aorta
|
|
What is the peritoneal sheet that attaches the uterus to the lateral pelvic wall?
|
Broad ligament of the uterus
|
|
What is the ligamentous structure within broad ligament that contains the ovarian vessels?
|
Suspensory ligament of the ovary
|
|
What ligament supports the cervix/uterus within the broad ligament?
|
Transverse cervical or ‘cardinal’ ligament
|
|
What is the usual orientation of the uterus in relationship to the bladder?
|
Anteflexed anteriorly over the bladder
|
|
At what uterine anatomic landmark does the uterine artery approach the uterus
|
It approaches at the uterine cervix from both sides and then its branches go superiorly and inferiorly to supply the uterus
|
|
What are the vaginal spaces around the end of the cervix?
|
Anterior, lateral, and posterior fornices (fornix is singular).
|
|
The crura of the clitoris make up what structure in the body?
|
Corpora cavernosa
|
|
What is the skeletal muscle that lays over the crura of the clitoris? What is its function?
|
Ishiocavernosus muscle. Its function is to help maintain erection in the clitoris.
|
|
What is the nerve supply to the female perineum?
|
Perineal branches of the pudendal nerve
|
|
What is the surgical procedure called that prevents the UG diaphragm from ripping during childbirth?
|
Episiotomy
It is done to enlarge the vaginal orifice and prevent a jagged tear in the perineum. This heals more quickly and can prevent damage to important structures such as the perineal body that have consequences later in life in support of pelvic viscera |
|
In the pudendal nerve block, what bony feature does the clinician use as a guide to anesthetize the pudendal nerve?
|
ischial spine
|
|
To where do the lymphatics for the cervix drain?
|
They pass along the uterine vessels to the internal iliac nodes and then superior along the aorta
|
|
To where do the lymphatics for the scrotum/labia drain initially?
|
They drain to the superficial inguinal nodes
|
|
To where do the lymphatics of the ovary/testes drain?
|
The lymphatics follow the ovarian and testicular blood vessels and ascend to the lumbar lymph nodes
|