HBA 531 THE BODY. Trunk Examination September 30, What is the effect of the parasympathetic nervous system on: (2.5)

Transcription

1 HBA 531 THE BODY Trunk Examination September 30, 2013 Name: 1. What is the effect of the parasympathetic nervous system on: (2.5) a) Heart rate b) Male reproductive function c) Pylorus d) Internal anal sphincter e) Sphincter urethrovaginalis 2. List the types of injury, insult or pathological process that elicit somatic pain: (4.5) Circle the items in the list above that elicit visceral pain In what two ways does somatic and visceral pain differ? What is referred pain? Where is the referred pain from cholecystitis (inflammation of the gallbladder) felt? 3. What spinal nerves should be anesthetized to eliminate the pain of: (1.5) a) The first stage of labor (associated with uterine contractions) b) Stretching of the cervix c) Stretching of the vaginal opening 4. During surgery to repair an inguinal hernia, you put a surgical staple immediately medial to the deep inguinal ring. What is the worst consequence you might anticipate? (1) After the patient recovers from the surgery, he complains of numbness over the front of his scrotum and on the inside of his upper thigh. What might have happened? 1

2 5. Describe where on the front of the chest a stethoscope should be placed in order to hear sounds from the following: (3) a) Upper lobe of the right lung b) Middle lobe of the right lung c) Apical segment of left lung d) Aortic valve e) Mitral valve f) Tricuspid valve 6. After a skateboarding accident, a14 year old boy is taken to the emergency room with obvious signs of trauma to his right lower rib cage. He is rushed to surgery where a deep laceration of the liver is discovered. The surgeon must first control bleeding. What is the easiest way to temporarily occlude all blood supply to the liver? (1) After performing this maneuver, the surgeon observes continued bleeding. What is the anatomical explanation for how this is possible? 7. What is the primary reason that lumbar punctures are performed either between the 3 rd and 4 th or between the 4 th or 5 th lumbar vertebrae? (2.5) How is the correct position to perform a lumbar puncture identified? If the purpose of the lumbar puncture is to perform an epidural block, list in order the structures the needle will pass through to enter this space: 2

3 8. List the types of neurons in the following: (2.5) a) White ramus communicans b) Cervical sympathetic cardiac nerve c) Anterior vagal trunk d) Greater occipital nerve e) Pelvic splanchnic nerves 9. While performing a routine physical on a 44 year old man, a doctor notices that the patient appears jaundiced and he finds that he can palpate a bulge just below the patient s right rib cage in approximately the midclavicular line. The patient, however, reports that the bulge is not tender. The doctor orders an abdominal CT scan for the patient. What does he expect to find? (1.5) Explain the anatomical basis for the doctor s initial observations. 10. After having been obese for most of her life, a young woman decides to go on a severe calorie restricted diet and is proud to have lost 60 pound in only two months. However, she begins to experience abdominal cramps and vomiting whenever she eats solid food, although these symptoms abate if she lies prone after eating. Explain in reference to anatomy how these symptoms are related to her weight loss. (1) 11. An emergency room physician needs to place a needle through the right anterior second intercostal space to treat a case of tension pneumothorax. Identify and explain which of the following three potential needle entry sites is a good choice and why the others are not: (1.5) a) At the medial end of the intercostal space, close to the sternum b) At about the midclavicular line close to lower border of the second rib c) At about the midclavicular line close to the upper border of the third rib 12. What anatomical feature determines whether a heart is right coronary dominant or left coronary dominant? (1) What difference does this make in regard to blood supply to the heart chambers? 3

4 13. Match the following list of portions of the gut tube with their correct distinguishing characteristics: (3.5) duodenum jejunum ileum ascending colon transverse colon descending colon sigmoid colon A. Retroperitoneal B. Mesenteric C. Appendices epiploicae D. Encroaching mesenteric fat E. Long vasa recta F. Taenia coli G. Haustrae 14. Trace one arterial anastomosis that provides an alternative route of blood flow to the descending thoracic aorta in the case of coarctation of the aorta. (2) Ascending aorta Descending aorta 15. A new resident tries to pass a catheter through a patient s penis into his urinary bladder and accidently ruptures his urethra just inferior to the perineal membrane. Identify where the urine will accumulate (between what layers) in the following regions: (2) a) Penile shaft b) Scrotum c) Perineum d) Anterior lower abdomen 16. An accident victim has lost a great deal of blood. As an emergency procedure, you choose to open the chest and clamp the thoracic aorta at T9 to direct more of the cardiac output to the brain. What risk do you run by depriving the aorta distal to the clamp of blood for 10 minutes, and what is the anatomical basis of this concern? (2) What structure lies immediately to the right of the thoracic aorta at T9 that could be torn by careless placement of the clamp? 17. Explain with reference to anatomy why venereal diseases, such as gonorrhea, have the potential to spread to the abdominal cavity in females but not in males. (1) 4

5 18. State the nerve(s) and the spinal segments involved in performing the following functions: (3) a) Carry sensation from the glans of clitoris b) Provide motor supply to the external anal sphincter c) Carry sensation of a full urinary bladder d) Provide motor supply to the diaphragm e) Carry sensation from the mediastinal pleura f) Carry sensation from the left lung 19. State the surface anatomy of the following: (2) a) lower limit of right pleural cavity b) spleen c) superficial inguinal ring 20. Name the group(s) of lymph nodes to which each of the following structures drain: (4) a) breast b) skin of the glans penis c) kidney d) ovary e) uterus f) jejunum 21. When a person experiences a slipped disc, what has happened anatomically? (2) Why is the radiating pain accompanying a slipped disc typically only on one side? 5

6 22. Listed below are sites of arterial anastomoses. For each case, name the arteries that actually participate in the anastomosis, and then name the immediate parent artery of each participant. (4) Participating Arteries Parent Arteries a) wall of the rectum b) gastrocolic ligament c) uterine tube d) head of pancreas 23. Name the structures with the following relationships: (4) a) Anterior to the hilum of the right kidney (outside of Gerota s fascia) b) Anterior to the hilum of the left kidney (outside of Gerota s fascia) c) Along the anterior edge of psoas major where it arises from lumbar vertebrae d) Anterior to the uncinate process of the pancreas e) On the posterior surface of the sacrospinous ligament f) Inferior to the lateral arcuate ligament of the diaphragm g) Runs vertically 1-2 cm medial to the infundibulopelvic ligament h) Branches from the aorta behind the third part of the duodenum 24. Symptoms of poor venous return such as edema (swelling), pain, varicose veins, and skin ulcers, are substantially more common for the left lower limb than the right. Identify a site of venous compression that likely contributes to this asymmetry. (0.75) 25. Explain with reference to anatomy where an inhaled foreign object is likely to go if: (2) a) a person is sitting in a chair b) a person is lying supine 6

7 26. Portal hypertension refers to a situation where venous flow through the liver is retarded. Trace one clinically significant route by which such blood can return to the heart, and state the symptoms (or signs) that may result if this route is used. (3) 27. Identify the types of cell bodies found in the following locations: (4) a) Intermediolateral column of the spinal cord at the level of T2 b) Dorsal root ganglion of C5 c) Dorsal root ganglion on T7 d) Sympathetic chain ganglion at the level of T4 e) Sympathetic chain ganglion at the level of L5 f) Ventral horn of the spinal cord at the level of T3 g) Celiac ganglion h) Ganglia in left inferior hypogastric plexus 28. Below are three axial CT scans from a patient who has been administered both intravascular and oral contrast. The levels of the sections are indicated on the image at the right. Identify indicated structures. (2.25) A: B: C: D: E: F: G: H: I: 7

8 29. Below are numbered sections from an axial MRA. In the upper left is a sagittal section provided information about the level of each axial section. Identify the labeled structures, stating side (l. or r.) where appropriate. (5) A: B: C: D: E: F: G: H: I: J: K: L: M: N: O: P: Q: R: S: T: 8