Block 7 Anatomy Wk 10 11 From Ta's W Xpl

1. During a hysterectomy, the surgeon accidentally severed a vessel that crossed superior the ureter superiorly and caused massive blood loss. Which vessel did the surgeon cut?

Internal Pudendal artery

Uterine artery

Common iliac artery

External iliac artery

The ureter passes under the gonadal artery, over the external iliac artery, and under the uterine artery or vas deferens.

Explanation

The ureter passes under the gonadal artery, over the external iliac artery, and under the uterine artery or vas deferens.

2. A 35 year-old female presents for follow-up of high blood pressure. On exam, her blood pressure is 170/106 and there is an epigastric bruit. Ultrasound shows asymmetrically sized kidneys. Her renal arteriorgram is below. What is the likely diagnosis?

Malignant hypertension

Primary hypertension

Hypertension secondary to renal artery stenosis

Hypertension secondary to pheochromocytoma

This is a treatable cause of hypertension. As you will learn next semester in the cardiovascular block, there are generally 2 etiologies for renal artery stenosis-fibromuscular dysplasia (which was described) and atherosclerosis.

Explanation

This is a treatable cause of hypertension. As you will learn next semester in the cardiovascular block, there are generally 2 etiologies for renal artery stenosis-fibromuscular dysplasia (which was described) and atherosclerosis.

3. Mrs. Amazing is delivering a post-term baby. Your team decides that the babe is too large to be passed through the vaginal canal without medical intervention. Mrs. Amazing agrees to having a median episiotomy procedure. The vaginal delivery was carried out, but a complication did occur. As you predicted, a year later Mrs. Amazing comes to your office complaining that ever since you performed the median episiotomy, she has not been able to "hold it in". Which of the following was torn during birth following the median episiotomy?

Ischiocavernosus muscle.

Tensor Tympani muscle.

External Anal Sphincter muscle

Internal Anal Sphincter muscle

The External Anal Sphincter is a muscle that prevents defecation and is under voluntary control. This muscle is located posterior to the perineal body. A typical complication of a median episiotomy is a tear of the perineal body, which would lead to a weak pelvic diaphragm. However, in this case, the tear was even more extreme. She most likely still has function of her internal anal sphincter, because she is complaining of not being able to "hold it in". If the internal anal sphincter was damaged, she would probably complain of anal leakage in addition to having no voluntary defecation control. Most physicians prefer the mediolateral method.

Explanation

The External Anal Sphincter is a muscle that prevents defecation and is under voluntary control. This muscle is located posterior to the perineal body. A typical complication of a median episiotomy is a tear of the perineal body, which would lead to a weak pelvic diaphragm. However, in this case, the tear was even more extreme. She most likely still has function of her internal anal sphincter, because she is complaining of not being able to "hold it in". If the internal anal sphincter was damaged, she would probably complain of anal leakage in addition to having no voluntary defecation control. Most physicians prefer the mediolateral method.

4. In a posterior surgical approach, what layers would you have to go through to access the kidney?

Skin, Pararenal fat, Renal Fascia, Perirenal fat, Kidney Capsule

Skin, Perirenal fat, Kidney Capsule, Pararenal fat, Renal Fasica

Skin, Pararenal fat, Perirenal fat, Renal Fascia, Kidney Capsule

Skin, Perirenal fat, Renal Fascia, Pararenal fat, Kidney Capsule

Perirenal fat like perimeter

Explanation

Perirenal fat like perimeter

5. A patient comes to the clinic with an infection of his anal canal below the pectinate line. Lymph drainage of the this area goes directly to:

Para-aortic nodes

Deep inguinal nodes

Rectal nodes

Superficial inguinal nodes

Internal iliac nodes

Below the pectinate (dentate) line is ectoderm, has systemic blood supply, somatic innervation, and drains to the superficial inguinal nodes.

Explanation

Below the pectinate (dentate) line is ectoderm, has systemic blood supply, somatic innervation, and drains to the superficial inguinal nodes.

6. Mr. Santiago is a 70 y/o man who presents to your office with complaints of dysuria and nocturia. You perform a digital rectal exam and palpate a rubbery, diffusely enlarged prostate with obliteration of the median sulcus. What is the most likely prostatic lobe involved in this case?

Posterior lobe

Median lobe

Anterior lobe

Lateral lobe

Benign prostate hyperplasia often affects the median lobe which surrounds the urethra causing the urinary symptoms.

Explanation

Benign prostate hyperplasia often affects the median lobe which surrounds the urethra causing the urinary symptoms.

7. The patient above returns one week later with increased tenderness and discomfort and admits that he did not take his prescribed medications. The infection has now spread above the pectinate line. Blood supply of this area comes from:

Pudendal artery

Superior rectal artery

Inferior rectal artery

Vesicular artery

Superior rectal artery is a terminal branch of the IMA so it supplies the part of the rectum that is a hind gut derivative, which is above pectinate line.

Explanation

Superior rectal artery is a terminal branch of the IMA so it supplies the part of the rectum that is a hind gut derivative, which is above pectinate line.

8. You are doing rounds in the ER and a patient presents with priapism (painful erection lasting longer than 4 hours). He mentions it has been like this for the last 2 days so the urologist on call determines it is too late to give the standard injection of epinephrine. The blood must be removed as it has likely already clotted. Where would you want to insert the needle to aspirate the blood?

Corpus Spongiosum

Between Buck's fascia and Tunica Albuginea

Superficial Dorsal Vein of Penis

Corpus Cavernosum

Deep Dorsal Vein of Penis

during an erection, blood fills the sinuses of the corpora cavernosa.

Explanation

during an erection, blood fills the sinuses of the corpora cavernosa.

9. During a removal of an infected kidney, you ligated the left renal vein just proximal to its entry into the kidney hilum. Which structure(s) venous drainage were you attempting to preserve?

Kidney

Pancreas

Adrenal gland

Gonadal

A & B

A, B, & C

C & D

The left suprarenal and left gonadal veins drain into the left renal vein, whereas on the right, they drain directly into the IVC.

Explanation

The left suprarenal and left gonadal veins drain into the left renal vein, whereas on the right, they drain directly into the IVC.

10. David, a 25 year old healthy Caucasian male comes to your office because he has noticed that his right testicle appears to hang lower than his left testicle, particularly when it is cooler than usual in his apartment. He is worried that he might have testicular cancer and stated that the internet said that testicular cancer may make one testicle hang lower than the other testicle. After finding David's testicular examination to be unremarkable, you decide to test David's cremasteric reflex. You find that David's right testicle does not ascend after stroking the superior medial aspect of his right thigh; however, sensation over the right medial thigh was present. Which of the following is the most likely location of the nerve that is no longer able to provide efferent innervation to David's cremasteric muscle?

Lateral to the Psoas major muscle.

Deep to the Psoas major muscle (towards the posterior abdomen).

Medial to the Psoas major muscle.

Superficial and lying directly on top of the Psoas major muscle.

Medial to the Fibularis Longus muscle

http://upload.wikimedia.org/wikipedia/commons/7/7c/Gray823.pngThe efferent branch of the cremasteric reflex is the genital branch of the genitofemoral nerve. Carefully examine the slide titled "Lumbar plexus" from the lecture on the posterior abdomen (*these relationships are pretty high yield*).

Explanation

http://upload.wikimedia.org/wikipedia/commons/7/7c/Gray823.pngThe efferent branch of the cremasteric reflex is the genital branch of the genitofemoral nerve. Carefully examine the slide titled "Lumbar plexus" from the lecture on the posterior abdomen (*these relationships are pretty high yield*).

11. A 60 year-old man is in chronic renal failure and in need of a renal transplant. His nephew's HLA-DR allele matches his. Which kidney will likely be harvested from the nephew and why?

Left because of a longer renal artery

Left because of a longer renal vein

Right because of a longer renal artery

Right because of a longer renal vein

I find it easier to remember things longterm, if I know the reason behind it. The transplanted kidney is placed in the iliac fossa of the recipient and the donor renal vein and artery, and ureter are connected to the external iliac vein and artery, and bladder respectively. The External iliac vein is medial to the external iliac artery, therefore, a longer renal vein is desirable.

Explanation

I find it easier to remember things longterm, if I know the reason behind it. The transplanted kidney is placed in the iliac fossa of the recipient and the donor renal vein and artery, and ureter are connected to the external iliac vein and artery, and bladder respectively. The External iliac vein is medial to the external iliac artery, therefore, a longer renal vein is desirable.

12. A 60 year old man has his hernia repaired. The operation was uneventful. A couple of weeks later he complained of loss of sensation over the anterior part of his scrotum. Which nerve was most likely cut during the operation?

Illiohypogastric nerve

Perineal nerve

Ilioinguinal nerve

Pudendal nerve

Genitofemoral nerve

ilioinguinal nerve, like the iliohypogastric nerve, arises from L1, emerges lateral to psoas major muscle, pierces transversus abdominus travelling between it and the internal oblique. But unlike the iliohypogastric nerve, it traverses inguinal canal (not entering deep inguinal ring, but exiting superficial ring) provides sensory innervation to mons pubis and labium majus or anterior scrotum.

Explanation

ilioinguinal nerve, like the iliohypogastric nerve, arises from L1, emerges lateral to psoas major muscle, pierces transversus abdominus travelling between it and the internal oblique. But unlike the iliohypogastric nerve, it traverses inguinal canal (not entering deep inguinal ring, but exiting superficial ring) provides sensory innervation to mons pubis and labium majus or anterior scrotum.

13. Paula gets a cyst in her greater vestibular gland. It becomes inflamed and forms an abscess. What are the likely findings on pelvic exam?

Swollen, red, and hot superomedial to the vaginal orifice

Swollen, red and tender beneath the vaginal wall posterolaterally

No vaginal changes seen

Red, hot, and tender around the cervix

Uterine prolapse

an abcess is tender, swollen, red, and hot. The Greater vestibular (Bartholin) glands are located posterolaterally to the vaginal orifice.

Explanation

an abcess is tender, swollen, red, and hot. The Greater vestibular (Bartholin) glands are located posterolaterally to the vaginal orifice.

14. This is the male equivalent of the uterine artery in the (under, under, over, under) mnemonic that denotes the path of travel of the ureter as it goes into the bladder?

Vas deferens

Testicular artery

Superior vesicle artery

Inferior vesicle artery

Middle rectal artery

Pampiniform plexus

Not to be confused with embryological homologs

Explanation

Not to be confused with embryological homologs

15. A female patient comes in with her second pregnancy and you diagnose uterine prolapse. The patient must have not been doing her kegels. By not doing this recommended exercise which structure was not strong enough that might have prevented the prolapse?

Cardinal Ligament

Bulbospongiosus

Pubococcygeus

Ischiocavernosus

Superficial Transverse Perineal Muscle

Kegel exercises strengthen both levator ani and perineal muscles. Uterine prolapse is more likely in women when the transverse cervical (cardinal) and uterosacral ligaments and levator ani (especially pubococcygeus) muscles are weakened because they normally support the uterus.

Explanation

Kegel exercises strengthen both levator ani and perineal muscles. Uterine prolapse is more likely in women when the transverse cervical (cardinal) and uterosacral ligaments and levator ani (especially pubococcygeus) muscles are weakened because they normally support the uterus.

16. Mrs. Chandler is 25 year old female considering becoming pregnant. She comes to your office for a consultation to check her conjugate and to determine the narrowest part of her pelvis. Which conjugate is the shortest of the three?

Obstetric

Diagonal

True

A and B

A and C

B and C

Diagonal conjugate (diameter) is measured by inserting your fingers (at the inferior border of pubic symphysis) and touching the sacral promontory to calculate (from the superior border of pubic symphysis) the obstetric (true) conjugate. The transverse diameters increase during pregnancy due to relaxin, but the obstetric conjugate remains unaffected. This measurement will help predict cephalopelvic disproportion during vaginal delivery that may require intervention.

Explanation

Diagonal conjugate (diameter) is measured by inserting your fingers (at the inferior border of pubic symphysis) and touching the sacral promontory to calculate (from the superior border of pubic symphysis) the obstetric (true) conjugate. The transverse diameters increase during pregnancy due to relaxin, but the obstetric conjugate remains unaffected. This measurement will help predict cephalopelvic disproportion during vaginal delivery that may require intervention.

17. This artery is often used for grafting purposes, if a patient's LAD artery in the heart is dysfunctional after an MI. The artery used has two terminal branches; the medial one anastomoses with another artery in the abdomen that comes from the femoral artery.

What is Internal Mammary

What is Musculophrenic

What is Superior epigastric

What is Inferior epigastric

What is Superficial femoral

What is Subcostal

The internal mammary (thoracic) artery is used whenever possible in coronary artery bypass grafts because of positive outcomes. It’s terminal branches are musculophrenic and superior epigastric arteries.

Explanation

The internal mammary (thoracic) artery is used whenever possible in coronary artery bypass grafts because of positive outcomes. It’s terminal branches are musculophrenic and superior epigastric arteries.