Block 6 Anatomy Wk 7 and 8 From Ta's W Expl

1. A patient complaining that swallowing is becoming difficult, would be termed what?

Esophageal cancer

Dysphagia

Aphagia

Odynophagia

dysphagia is difficulty, odynophagia is pain in swallowing

Explanation

dysphagia is difficulty, odynophagia is pain in swallowing

2. After denying that Justin Beiber is the greatest recording artist of all time, Ned hits me with a baseball bat and ruptures my spleen. Where was I likely hit?

Right posterior-axillary line, ribs 9-11

Left posterior-axillary line, ribs 9-11

Left flank

Right flank

fractured ribs can rupture the spleen

Explanation

fractured ribs can rupture the spleen

3. A patient comes to the emergency department complaining of a sharp pain to his right hypochondriac/epigastric area. The patient states that the sharp pain started earlier that day after he ate lunch at KFC, but that he has been experiencing intermittent pains in the same location for a few weeks. He also states that he is feeling pain over his right shoulder and into his back. The source of the patient's pain is most likely due to:

An inflamed appendix.

A ruptured appendix

An inflamed gallbladder

Peptic ulcer

Gallbladder can also send pain impulses via the right Phrenic nerve, resulting in pain in the C3-5 dermatome, hence the pain over the right shoulder.

Explanation

Gallbladder can also send pain impulses via the right Phrenic nerve, resulting in pain in the C3-5 dermatome, hence the pain over the right shoulder.

4. While presenting a case to your attending, your colleague says that his patient has a direct inguinal hernia. You know that this hernia must be:

Lateral to the inferior epigastric v.

Medial to the inferior epigastric a.

Protrude through the deep inguinal ring

Covered by internal spermatic fascia

Lateral to the pubic tubercle

direct inguinal hernia means it comes through Hesselbach’s triangle which is bounded by the lateral umbilical fold (inferior epigastric artery), linea semilunaris, and the inguinal ligament.

Explanation

direct inguinal hernia means it comes through Hesselbach’s triangle which is bounded by the lateral umbilical fold (inferior epigastric artery), linea semilunaris, and the inguinal ligament.

5. While studying in the anatomy lab for an upcoming practical exam, a nosey TA approaches you, points to a structure branching off the abdominal aorta at the level of T12, and asks you to name the 3 arteries that directly originate from it. You correctly respond by saying the following:

SMA, Splenic Artery, and the Superior Pancreaticoduodenal Artery

Left Gastric Artery, Splenic Artery, and the Proper Hepatic Artery

SMA, IMA, and Splenic Artery

Left Gastric Artery, Splenic Artery, and the Common Hepatic Artery

The artery that this TA is pointing to is the Celiac Trunk (the 3 divisions of the trunk are classic and important to remember for examination purposes). The Celiac trunk originates from the abdominal aorta at the level of T12 (the verterbral levels that the Celiac Trunk, the SMA, and the IMA originate are approximately T12, L1, and L3 respectively and are high yield relations). The Celiac trunk branches into the Left Gastric Artery, the Common Hepatic Artery (gives rise to the Gastroduodenal Artery which is at high risk for erosion during duodenal ulcers), and the Splenic Artery. Answer B is wrong because the Proper Hepatic Artery originates from the Common Hepatic Artery and not directly from the celiac trunk.

Explanation

The artery that this TA is pointing to is the Celiac Trunk (the 3 divisions of the trunk are classic and important to remember for examination purposes). The Celiac trunk originates from the abdominal aorta at the level of T12 (the verterbral levels that the Celiac Trunk, the SMA, and the IMA originate are approximately T12, L1, and L3 respectively and are high yield relations). The Celiac trunk branches into the Left Gastric Artery, the Common Hepatic Artery (gives rise to the Gastroduodenal Artery which is at high risk for erosion during duodenal ulcers), and the Splenic Artery. Answer B is wrong because the Proper Hepatic Artery originates from the Common Hepatic Artery and not directly from the celiac trunk.

6. Your 2-year old patient has had bouts of "tummy pain" and according to the mother, his diapers have had stool that looked like red currant jelly. Upon examination you find the two year old with his legs drawn up to his chest and a palpable sausage-like mass in the lower right abdomen. What is the likely cause of this child's condition?

Meckel's diverticulitis

Acute appendicitis

Ileocecal intususception

Perianal abscess

Pyloric stenosis

This is the classical presentation when the distal ileum telescopes into the cecum. It’s most common in children less than 2 years old (80%) and rare in older children and adults.

Explanation

This is the classical presentation when the distal ileum telescopes into the cecum. It’s most common in children less than 2 years old (80%) and rare in older children and adults.

7. A 45 year-old obese male, with a 30 pack-year history of smoking, is referred to the gastroenterologist complaining of chronic heartburn. The esophageal endoscopy image below is the result of what process?

Neoplasia

Hyperplasia

Hypertrophy

Metaplasia

Pictured is typical of Barrett’s esophagus, in which normal (pink) non-keratinized squamous epithelium is replaced by columnar epithelium of the intestinal type (red). Chronic gastroesophageal reflux disease (GERD) leads to Barrett’s esophagus (metaplasia), which increases the risk of adenocarcinoma (neoplasia which is preceded by dysplasia). Obesity, smoking, and alcohol are risk factors.

Explanation

Pictured is typical of Barrett’s esophagus, in which normal (pink) non-keratinized squamous epithelium is replaced by columnar epithelium of the intestinal type (red). Chronic gastroesophageal reflux disease (GERD) leads to Barrett’s esophagus (metaplasia), which increases the risk of adenocarcinoma (neoplasia which is preceded by dysplasia). Obesity, smoking, and alcohol are risk factors.

8. A patient comes in with a history of recent blunt trauma to the abdomen. You diagnose him as having a rectus sheath hematoma. What blood vessel is most likely damaged?

Superior epigastric artery

Superficial epigastric artery

Inferior epigastric vein

External pudendal vein

Inferior Epigastric Artery branches from the External Iliac Artery

Explanation

Inferior Epigastric Artery branches from the External Iliac Artery

9. A patient's gastric ulcer perforated the posterior wall and eroded an artery. Which artery was most likely damaged?

Gstroduodenal

Splenic

Hepatic

Left gastric

Cystic

a rare and dangerous complication of gastric ulcer.

Explanation

a rare and dangerous complication of gastric ulcer.

10. Where does the transversus abdominis aponeurosis contribute to the posterior rectus sheath?

Superior to semilunar line

Inferior to semilunar line

Superior to arcuate line

Inferior to arcuate line

and inferior to the arcuate line, all aponeuroses form the anterior rectus sheath, so the posterior sheath is absent.

Explanation

and inferior to the arcuate line, all aponeuroses form the anterior rectus sheath, so the posterior sheath is absent.

11. The splenic artery is an end artery. Ligation leads to ischemia of what structures?

Spleen and pancreatic tail

Spleen and gastric antrum

Pancreatic tail and gastric antrum

Spleen and gastric fundus

Gastric body and pancreatic tail

http://upload.wikimedia.org/wikipedia/commons/3/3b/Gray533.pngshort gastric arteries (off distal portion of splenic artery) supply the gastric fundus. The tail of the pancreas is also found in in the splenorenal ligament in the hilum of the spleen. Its blood supply is from the splenic artery

Explanation

http://upload.wikimedia.org/wikipedia/commons/3/3b/Gray533.pngshort gastric arteries (off distal portion of splenic artery) supply the gastric fundus. The tail of the pancreas is also found in in the splenorenal ligament in the hilum of the spleen. Its blood supply is from the splenic artery

12. Upon abdominal exam you elicit a positive Murphy's Sign for cholecystitis under the right costal margin. Assuming the gallstone is large and full of bile acids that can erode a fistulous tract through the gall bladder wall, which of the following would be the most likely culprit for a gastric outlet obstruction?

Cholecystocolic fistula

Cholecystoduodenal fistula

Cholecystojejunal fistula

Pyloric stenosis

A cholecystocolic fistula allows for emptying of the gallstone into the transverse colon and rarely will cause a gallstone ileus. The cholecystojejunal fistula and the cholecystoduodenal fistula both enter the small intestine and may block the passage by the ileocecal valve. However the question asks for a likely culprit for gastric outlet obstruction (as seen in the endoscopy photo - pylorus with gallstone obstruction). This would most likely be a fistulous tract to the 1st part of the duodenum that would occlude the lumen and outflow of pylorus (Bouveret's Syndrome). Pyloric stenosis, although being the most common cause of GOO, is not described in the stem.

Explanation

A cholecystocolic fistula allows for emptying of the gallstone into the transverse colon and rarely will cause a gallstone ileus. The cholecystojejunal fistula and the cholecystoduodenal fistula both enter the small intestine and may block the passage by the ileocecal valve. However the question asks for a likely culprit for gastric outlet obstruction (as seen in the endoscopy photo - pylorus with gallstone obstruction). This would most likely be a fistulous tract to the 1st part of the duodenum that would occlude the lumen and outflow of pylorus (Bouveret's Syndrome). Pyloric stenosis, although being the most common cause of GOO, is not described in the stem.

13. The round ligament of the liver (AKA - Ligamentum Teres Hepatis) was embryologically derived from which of the following

The Left Umbilical Artery

The Right Umbilical Artery

The Urachus

The Left Umbilical Vein

The Right Umbilical Vein

The round ligament is derived from the umbilicalvein, and more importantly theleft umbilical vein. Note: the right umbilical vein tends to regress around the second month of development, whereas the left vein persists and becomes this ligament. Also, know these embryological origins well; Median Umbilical Fold - A remnant of the Urachus and the Medial Umbilical Folds - Remnants of the Umbilical Arteries

Explanation

The round ligament is derived from the umbilicalvein, and more importantly theleft umbilical vein. Note: the right umbilical vein tends to regress around the second month of development, whereas the left vein persists and becomes this ligament. Also, know these embryological origins well; Median Umbilical Fold - A remnant of the Urachus and the Medial Umbilical Folds - Remnants of the Umbilical Arteries

14. Your patient suffered a stab wound to his lower hypogastric region just lateral to the midline, what layers of the abdominal wall did the knife likely cross from first to last?

Skin, camper's fascia, scarpa's fascia, anterior rectal sheath, rectus abdominis, posterior rectal sheath, transversalis fascia, extraperitoneal fat, peritoneum

Skin, scarpa's fascia, camper's fascia, anterior rectal sheath, rectus abdominis, posterior rectal sheath, transversalis fascia, extraperitoneal fat, peritoneum

Skin, camper's fascia, scarpa's fascia,transversalis fascia, anterior rectal sheath, rectus abdominis, posterior rectal sheath, extraperitoneal fat, peritoneum

Skin, camper's fascia, scarpa's fascia, anterior rectal sheath, rectus abdominis, transversalis fascia, extraperitoneal fat, peritoneum

Skin, camper's fascia, scarpa's fascia, rectus abdominis, posterior rectal sheath, transversalis fascia, extraperitoneal fat, peritoneum

it’s below the arcuate line so no posterior rectus sheath.

Explanation

it’s below the arcuate line so no posterior rectus sheath.

15. Years after Ned and Matt Hasselbeck's altercation, Matt goes to see Ned about a direct inguinal hernia. What is the lateral border of Hesselbach's triangle?

Median umbilical fold

Medial umbilical fold

Lateral umbilical fold

Lateral border of rectus abdominis

http://upload.wikimedia.org/wikipedia/commons/a/a8/Inguinal_triangle.pngthe INGUINAL TRIANGLE is a region of the abdominal wall. It is also known by the eponym Hesselbach's triangle It is defined by the following structures • Medial border: Lateral margin of the rectus sheath, also called linea semilunaris • Superolateral border: Inferior epigastric vessels • Inferior border: Inguinal ligament, sometimes referred to as Poupart's ligament The inguinal triangle contains a depression referred to as the MEDIAL INGUINAL FOSSA, through which direct inguinal hernias protrude through the abdominal wall. The MEDIAL INGUINAL FOSSA is a depression located within the inguinal triangle on the peritoneal surface of the anterior abdominal wall between the ridges formed by the LATERAL UMBILICAL FOLD and the medial umbilical ligament, corresponding to the superficial inguinal ring.

Explanation

http://upload.wikimedia.org/wikipedia/commons/a/a8/Inguinal_triangle.pngthe INGUINAL TRIANGLE is a region of the abdominal wall. It is also known by the eponym Hesselbach's triangle It is defined by the following structures • Medial border: Lateral margin of the rectus sheath, also called linea semilunaris • Superolateral border: Inferior epigastric vessels • Inferior border: Inguinal ligament, sometimes referred to as Poupart's ligament The inguinal triangle contains a depression referred to as the MEDIAL INGUINAL FOSSA, through which direct inguinal hernias protrude through the abdominal wall. The MEDIAL INGUINAL FOSSA is a depression located within the inguinal triangle on the peritoneal surface of the anterior abdominal wall between the ridges formed by the LATERAL UMBILICAL FOLD and the medial umbilical ligament, corresponding to the superficial inguinal ring.

16. You were able to use ursodeoxycholic acid in time to dissolve the stone before it formed a fistula. It seemed to be beneficial over the first year after beginning treatment however one day the patient presented with pain in the epigastric area. On ultrasound you noticed an enlarged pancreas with a smaller stone in the Ampulla of Vater - obstructing the lumen of the pancreatic duct. Due to this obstruction the patient was experiencing acute pancreatitis. If the pancreas was to rupture into the abdominal cavity where would the enzymes be released.

Greater sac

Pouch of Douglas

Lesser sac

Morrison's Pouch

pancreas sits posteriorly to lesser sac

Explanation

pancreas sits posteriorly to lesser sac

17. What structure develops within the ventral mesogastrium?

Spleen

Liver

Kidney

Adrenal

Stomach

Pancreas

Duodenum

Spleen is derived from DORSAL mesogastrium

Explanation

Spleen is derived from DORSAL mesogastrium

18. Mac, the surgeon, and PC, the anatomist, are fighting about which 1/2 of the liver the caudate and quadrate lobes belong to. What would Mac argue?

Right because they’re right of the falciform ligament

Right because they’re right of the IVC

Left because they’re left of the falciform ligament

Left because they’re left of the IVC

http://upload.wikimedia.org/wikipedia/commons/a/a3/Gray1087-liver.pngSurgeons follow the branchings of the portal triad or hepatic veins to divide the liver into 8 segments. Instead of using the falciform ligament, surgeons draw an imaginary line between the IVC and gallbladder as the division between right and left halves.

Explanation

http://upload.wikimedia.org/wikipedia/commons/a/a3/Gray1087-liver.pngSurgeons follow the branchings of the portal triad or hepatic veins to divide the liver into 8 segments. Instead of using the falciform ligament, surgeons draw an imaginary line between the IVC and gallbladder as the division between right and left halves.

Block 6 Anatomy Wk 7 and 8 From Ta's W Expl

1. A patient complaining that swallowing is becoming difficult, would be termed what?

2.

What first name or nickname would you like us to use?

2. After denying that Justin Beiber is the greatest recording artist of all time, Ned hits me with a baseball bat and ruptures my spleen. Where was I likely hit?

4. While presenting a case to your attending, your colleague says that his patient has a direct inguinal hernia. You know that this hernia must be:

5. While studying in the anatomy lab for an upcoming practical exam, a nosey TA approaches you, points to a structure branching off the abdominal aorta at the level of T12, and asks you to name the 3 arteries that directly originate from it. You correctly respond by saying the following:

7. A 45 year-old obese male, with a 30 pack-year history of smoking, is referred to the gastroenterologist complaining of chronic heartburn. The esophageal endoscopy image below is the result of what process?

8. A patient comes in with a history of recent blunt trauma to the abdomen. You diagnose him as having a rectus sheath hematoma. What blood vessel is most likely damaged?

9. A patient's gastric ulcer perforated the posterior wall and eroded an artery. Which artery was most likely damaged?

10. Where does the transversus abdominis aponeurosis contribute to the posterior rectus sheath?

11. The splenic artery is an end artery. Ligation leads to ischemia of what structures?

13. The round ligament of the liver (AKA - Ligamentum Teres Hepatis) was embryologically derived from which of the following

14. Your patient suffered a stab wound to his lower hypogastric region just lateral to the midline, what layers of the abdominal wall did the knife likely cross from first to last?

15. Years after Ned and Matt Hasselbeck's altercation, Matt goes to see Ned about a direct inguinal hernia. What is the lateral border of Hesselbach's triangle?

17. What structure develops within the ventral mesogastrium?

18. Mac, the surgeon, and PC, the anatomist, are fighting about which 1/2 of the liver the caudate and quadrate lobes belong to. What would Mac argue?