USMLE STEP 1 REVIEW
DANIL HAMMOUDI.MD
SINOE
MEDICAL ASSOCIATION
biochem
Alkaptonuria and Ochronosis
Alkaptonuria is a rare disease in which the body does not have enough of an enzyme called homogentisic acid oxidase (HGAO). It is a genetic disease, meaning that it is inherited from a family member.
Because normal amounts of the HGAO enzyme are missing, homogentisic acid (HGA) is not used and builds up in the body. Some is eliminated in the urine, and the rest is deposited in body tissues where it is toxic. The result is ochronosis, a blue-black discoloration of connective tissue including bone, cartilage, and skin caused by deposits of ochre-colored pigment.
Patients with alkaptonuria are usually not aware of the disease until about age 40 when symptoms are present. Dark staining of the diapers sometimes can indicate the disease in infants, but usually no symptoms are present until much later in life.
Alkaptonuria and ochronosis affect many body systems, as described below.
- Skeletal (bones
and cartilage)--The knees, shoulders, and hips are most affected;
arthropathy (diseased joints) is common. Deposits of pigment cause
cartilage to become brittle and eventually to fragment (break apart).
- Cardiovascular (heart
and blood vessels)--The aortic and mitral heart valves are most affected.
Ochronotic granules can cause valves to calcify or harden. Pigment
deposits also can lead to the formation of atherosclerotic plaques (hard
spots in arteries) containing cholesterol and fat.
- Genitourinary
(genital and urinary systems and organs)--In men, the prostate is most
commonly affected. Pigment deposits can form stones in the prostate.
- Respiratory
(organs and structures involved in breathing)--Heavy pigment deposits in
the cartilage of the larynx (voice box), the trachea (windpipe), and the
bronchi (air passages to the lungs) are common.
- Ocular (eyes)--Vision
is not usually affected, but pigmentation in the white part of the eye is
evident in most patients by their early forties.
- Cutaneous
(skin)--Effects are most noticeable in areas where the body is exposed to
the sun and where sweat glands are located. Skin takes on a blue-black
speckled discoloration. Sweat can actually stain clothes brown.
- Other--The
teeth, central nervous system (brain and spinal cord), and endocrine
organs (which make hormones) also may be affected.
Arthropathy (joint disease characterized by swelling and enlarged bones) and discoloration of the skin cause the greatest disability.
Usually a physician can diagnose alkaptonuria based on symptoms of joint discomfort and skin discoloration. The diagnosis is confirmed by verifying family history of the disease, examining skin cells, and testing the urine. Urine left standing for several hours will turn brownish black if a patient has alkaptonuria.
Diets low in protein--especially in amino acids, phenylalanine (found in aspartame), and tyrosine--help reduce the levels of HGA, thereby lessening the amount of pigment deposited in body tissues. Symptoms of alkaptonuria (e.g., arthropathy, cardiovascular disease) are treated when possible. Unfortunately, the course of the disease remains unchanged, and no cure is available. However, patients tend to have a normal life span and die of causes comparable to those of the general population.
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Alkaptonuric ochronosis represents an autosomal
recessively transmitted inborn error of metabolism. It is the result of a
deficiency of the enzyme homogentisate 1,2-dioxygenase1
caused by mutations in the homogentisate 1,2-dioxygenase gene located to a
16-cM region of the 3q2 chromosome.2
The resulting elevation of serum homogentisic acid levels causes massive
excretion of homogentisic acid in the urine, which turns black on oxidation.3
Homogentisic acid deposition in connective tissue throughout the body causes
the tissue to become pigmented, a feature termed ochronosis by Virchow
in 1866.4
Deposition in the intervertebral disks and joint cartilage results in
ochronotic spondylopathy and arthropathy.3
In the eye, ochronotic pigmentation, histopathologically seen as amorphous
and curlicue deposits, occurs primarily in the conjunctiva and sclera in the
interpalpebral fissure.5
To our knowledge, the literature does not mention any effects on visual
function or corneal topography. In the case presented here, the enlarging
perilimbal ochronotic scleral lesions nasally and temporally were associated
with progressive peripheral corneal thinning and astigmatism in the axis of
the lesions. |
aka: alkaptonuria
- autosomal recessive
- excessive homogentisic
acid
- no homogentisic acid
oxidase
- part of phenylalanine
/ tyrosine pathway
- alkaptonuria:
brown/black urine
- ochronosis: brown/black
pigmentation of skin, mucous membranes
- pigment deposition in
articular cartilage of joints
- ==> chronic
arthritis (usually evident in 4th decade)
- narrowed, calcified
intervertebral disks
- renal calculi
- nephrocalcinosis
Ochronosis is one
of common side effect of long term high potency hydroquinone treatment
. Clinically there is slate gray to browish discoloration of the face.
Under microscope examination there is homogenous brownish material in the
dermis. This may be denatured collagen or other proteins. This condition is
rather difficult to treat with medication. The best treatment is now by doing
laser ablation with either Carbondioxide laser or Erbium :YAG
laser. Laser will remove skin down to the dermis follow by regeneration of new
healthy skin. There usually is post treatment hyperpigmentation which will
eventually fade away. This condition is one of the strong reason
why we should not use hydroquinone for long term treatment of melasma
It
is a hereditary enzyme deficiency of the homogentisic acid oxidase in the liver
and the kidneys. The gene is transmitted in a recessive autosomal mode. The
incidence of alkaptonuria is 1 per million with the highest prevalence in
Figure 1 : Biochemical disorder of alkaptonuria.
The
ochronotic pigment granules have a high affinity for fibrillary collagens which
are surrounded by abundant mucopolysaccharide ground substance. The most
outstanding example are the hyaline cartilages of the
joints. HGA is excreted in the urine (4-8 g/day). Upon oxidation of HGA the
excreted urine is discolored black (3). 
Ochronotic pigment
accumulation in the cartilage of the external ear.
It was Scribonius who described the first known case of
ochronosis in 1584. He mentioned a schoolboy which passed urine black as ink
(3). In 1902, Albrecht and Zdareck discovered the link with alkaptonuria.
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Radiograph of the spine and pelvis
demonstrating the waferlike calcifications of the intervertebral disks and
ankylosing of the spine and sacroiliac joints (open arrows). Advanced
degenerative arthritis is seen in the hips (closed arrow).
Ochronotic Pigment Deposits in the
Sclerae.
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Discussion
The clinical manifestations are caused by the accumulation of HGA in the tissues rich of fibrillary collagen. The binding by polymerisation and auto-oxidation of HGA is irreversible(16). Ochronotic arthropathy is caused by a deposition of the ochronotic pigment in the articular cartilage. This leads to a brittleness and fragmentation of the cartilage causing a non-specific synovitis. Also typical is the ochronotic spondylolysis in the lumbar spine. The stiffness of the back slowly progresses to a complete rigidity with flattening of the lumbar lordosis and dorsal hyperkyphosis resembling ankylosing spondylitis. In contrast to ankylosing spondylitis, syndesmophytes or an annular ossification with a bamboo pattern do not occur. There is a progressive desintegration and ossification of the nucleus pulposus, causing a diminished length sometimes more than 15 centimetres. There can also be a restriction of breathing because of affected costovertebral joints. Pain, stiffness, crepitation, flexion contractures and limitation of motion are the most common clinical features of the periferal ochronotic arthropathy. Deposition of calciumpyrophosphate cristals with attacks of pseudo-gout are associated with ochronotic arthropathy. The radiographic findings are not characteristic : a non-specific osteo-arthritis, chondrocalcinosis, peri-articular calcifications and osteochondromathosis.
The most important clinical signs of ochronosis are the pigmentations of the sclerae, auricles and the interphalyngeal and metatarsal joints. The otoscopic examination also demonstrates black cerumen. The earbones and the membranum tympanum have deposits of ochronotic pigments causing tinitus and diminished hearing.
The cardiovascular examination reveals an aortic murmur as a result of aortic stenosis and calcification. The deposits of ochronotic pigments in the valves could be an occasion for dystrophic calcification. Genito-urinary tract obstruction occurs in 60 % of ochronotic patients. Rectal examination reveals a nodular prostate in consequence of prostatic calcifications.
The corner stones of diagnosis are the examination of the urine (black color) and the histopathological examination with hematoxylin-eosin staining confirming the ochronotic pigments in the tissues.
There is no cure for ochronotic arthropathy. The enzyme deficiency is not to be treated yet (gentherapy in the future ?). Some physicians prescribe high doses of ascorbic acid to prevent the interaction of the ochronotic pigment with the tissues.(5) Unfortunately, the progress of the disease is not interrupted by this treatment. There only exists a symptomatic treatment : analgetics, NSAID, physical therapy, orthopaedic supports and intra-articular corticoid infiltration, especially in the knee. Finally, arthroplasty of the hip and knee is often necessary.
anatomy
if the urethra were damaged in
the bilb of the penis , urine could extravase into : superficial perineal space
the superficial perineal space and its
contents.
Definition: a potential space between the membranous layer of the subcutaneous tissue
and perineal membrane (= inferior fascia of the UG diaphragm)
Relationships:
· Superiorly: inferior fascia of the urogenital diaphragm
· Inferiorly: superficial perineal fascia (= continuation of superficial fascia of the abdomen)
Contents:
· Right and left corpus cavernosum (of penis/clitoris)
· Crus of each corpus cavernosum (of penis/clitoris)
· Bulb of penis/vestibule
· Superficial transverse perineal muscles
· Bulbospongiosus muscle
· Male: overlying the corpus spongiosum
· Female: beneath the labia majora
· Ischiocavernosus muscle
· Male: overlying the corpus cavernosum
· Female: beneath the labia majora
· Male only:
· Corpus spongiosum
· Penile urethra
· Female only:
· Greater vestibular glands
Blood vessels:
· Branches of the internal pudendal vessels (deep and dorsal arteries of penis/clitoris)
Lymphatics: superficial inguinal lymph nodes
Innervation:
· Branches of the pudendal nerves (dorsal nerve of penis/clitoris, posterior scrotal/labial nerves)
Male Urogenital Triangle
Make a midline incision beginning at the shaft or posterior portion of the penis and split the scrotum into right and left halves. Identify the superficial and posterior scrotal branches of the perineal nerve (terminal branches of the pudendal nerve) and the perineal and posterior scrotal vessels (branches from the internal pudendal vessels). Continue to reflect the skin flaps laterally. You are now in the superficial perineal space/pouch.
The contents of the superficial perineal pouch include three paired muscles and portions of the penis. Identify the ischiocavernosus muscle covering the crura of the penis, an extension of the corpus cavernosus originating from the ischial tuberosity. Identify the bulbospongiosus muscle covering the bulb of the penis, the first part of the corpus spongiosum. This muscle arises from the median raphe and the perineal body. Identify (if you can) the superficial transverse perineal muscle. This muscle runs from the ischial tuberosity to the perineal body. It is usually very small, so try looking for any fibers coursing transversely across the posterior boundary of the perineal membrane.
Between
the crus and the bulb of the penis you can see the perineal membrane,
the fascia of the UG diaphragm.
Q1. Ducts from Cowper’s gland open into the _________.
Remove the superficial fascia of the penis and observe the deep (Buck’s) fascia of the penis. Open the deep fascia on the dorsum of the shaft of the penis and identify the deep dorsal vein, the paired dorsal arteries, and the paired dorsal nerves.
Study the components of the shaft of the penis; the paired corpora cavernosa and the corpus spongiosum. Separate the erectile tissue and observe the glans penis (distal expansion of the corpus spongiosum) and the spongy or penile urethra. Make a cut longitudinally and observe the spongy urethra and its distal expansion, the navicular fossa.
Cut open the scrotum and expose the testis. Identify the epididymis and follow the course of the vas deferens from the scrotum to the superficial inguinal ring. Identify the tunica vaginalis covering the testis and epididymis. Open the testis and observe the thick tunica albuginea encasing the testis and the septa containing the seminiferous tubules. Try to locate the rete testis and efferent ducts. Distinguish the caput (head), corpus (body) and cauda (tail) portions of the epididymis. Finally, find the testicular artery and appreciate the venous (pampiniform) plexus.
Female Urogenital Triangle
Make an incision between the anus and the vagina, and then anteriorly around the right and left labia majora toward the pubic symphysis. Continue to reflect the skin flaps laterally. You are now in the superficial perineal space/pouch. Identify the superficial and posterior labial branches of the perineal nerve (terminal branches of the pudendal nerve) and the perineal and posterior labial vessels (branches from the internal pudendal vessels).
HINT: Identify the portions of the clitoris in the superficial pouch and look for the muscles associated with these tissues - the crura (alongside the ischialpubic ramus) and the bulb of the vestibule. (midline) (Grts. 3.59, 3.77; Net. PL. 356)
The contents of the superficial perineal pouch include the three-paired muscles, part of the clitoris, and the bulb of the vestibule. Identify the ischiocavernosus muscle covering the crura of the clitorus, an extension of the corpus cavernosus originating from the ischial tuberosity. Identify the bulbospongiosus muscle covering the bulb of the vestibule. This muscle arises from the median raphe and the perineal body. Attached posterior to the bulb of the vestibule are the greater vestibular (Bartholin’s) glands. (In most elderly, postmenopausal female cadavers, the accessory organs and glands are atrophic and not readily evident). Identify (if you can) the superficial transverse perineal muscle. This muscle runs from the ischial tuberosity to the perineal body. It is usually very small, so try looking for any fibers coursing transversely across the posterior boundary of the perineal membrane.
Between
the crus and the bulb of the vestibule you can see the perineal membrane,
the fascia of the UG diaphragm.
Identify the deep dorsal vein, the paired dorsal arteries and the paired dorsal nerves on the dorsum of the clitoris. Study the components of the erectile tissue of the clitoris, which consist of only two erectile bodies, the paired corpora cavernosa. The corpora cavernosa begin as the crura of the clitorus attached to the ischiopubic rami and end in the midline as the body of the clitoris and the glans.
ANS. 1. spongy (penile) urethra
urine could extravase into the anterior thigh if
the urethral ruptured occurred in the superficial peritoneal pouch.
Into the peritoneal
cavity =č ureter damage
Ischioanal fossa or
pudendal canal =č urethral rupture
THE PELVIS
The "pelvis" itself is where the trunk and lower limbs meet and is divided into a MAJOR or FALSE pelvis and a MINOR or TRUE pelvis.
- The PELVIC BRIM is the same as the SUPERIOR PELVIC APERTURE and the PELVIC INLET. It is the region bounded by the arcuate line and separates the true or minor pelvis from the false or major pelvis.
- The false pelvis contains structures that are part of the abdomen.
BOUNDARIES OF THE TRUE PELVIS
- Lateral wall: obturator internus muscle
- Posterior wall: sacrum, parts of the ilium, sacroiliac joint, piriformis muscle
- Anterior wall: pubic bones and parts of obturator internus muscle
- Floor: pelvic diaphragm
PELVIC DIAPHRAGM- the "funnel" Dr. Tucker placed in the hip bones.
Composed of:
(3) Levator ani muscles: puborectalis, pubococcygeus, and iliococcygeus
Coccygeus muscle
Its function include: supporting the abdominal and pelvic viscera, assisting the abdominal muscles in increasing abdominal pressure (for pushing hard during childbirth or even when on the toilet). The puborectalis forms the puborectal sling which is part of the external anal sphincter.
SACRAL PLEXUS = L4-S4
- - is found on the anterior surface of the piriformis muscle
- - part of L4 and L5 make up the Lumbosacral trunk
- - major branches include: sciatic n., pudendal n., and superior and inferior gluteal n.
- - the only new one is the PUDENDAL n. which exits the greater sciatic foramen, loops around the sacrospinous ligament, and enters the lesser sciatic foramen.
- - Pudendal n. innervates the anal canal muscles and external genitalia or the perineum.
UROGENITAL DIAPHRAGM = thin sheet of muscle that spans the pubic arch
- made of deep transverse perineal muscle and voluntary sphincter urethra muscle (you should know what this does)
-covering the UG diaphragm is the perineal membrane (deep fascia)
PELVIS BLOOD SUPPLY
URINARY BLADDER
- -Urine enters the bladder from the two ureters that come from the kidney and enter the bladder at an oblique angle. Why is this angle important?
- -Vesico- is the prefix meaning bladder.
- - Make sure you know the parts of the bladder in your syllabus.
- - The trigone is the smooth part of the bladder that is non-stretchable.
- - The urethra is different in males and females.
In females, it is short and ends at external urethral orifice in the vestibule of the vagina.
In males, it is much longer and divided into 3 parts: membranous, prostatic and spongy.
INTERNAL GENITALIA
MALE = DUCTUS DEFERENS, SEMINAL VESICLES, EJACULATORY DUCT, & PROSTATE GLAND
Sperm is made in the seminiferous tubules of the testis and stored in the epididymis. The DUCTUS DEFERENS is just a continuation of the epididymis and fuses with the DUCT OF THE SEMINAL VESICLE to form the EJACULATORY DUCT. The SEMINAL VESICLES provide nutrients so the sperm can survive its tough journey. The EJACULATORY DUCT empties into the prostatic urethra so the sperm can get out.
FEMALE = VAGINA, UTERUS, UTERINE TUBES, OVARIES
VAGINA- muscular tube lies posterior to bladder and anterior to the rectum.
It passes through both the UG and pelvic diaphragm.
UTERUS- know parts: cervix, isthmus, body, fundus
- uterine wall has 3 layers: perimetrium, myometrium, and endometrium
UTERINE TUBES = FALLOPIAN TUBE
- - parts: fimbriae, infundibulum, ampulla, isthmus, intra-uterine (intramural) part
- - ampulla is the normal site of fertilization
- - Because the uterine tube is open to the peritoneal cavity, infections in the vagina can spread into the peritoneum causing peritonitis.
BROAD LIGAMENT= folds of peritoneum (the rain pouch Dr. Tucker wore) that suspend the uterus and allow it to move.
- In places, the broad lig. has tough connective tissue that, because anatomists have to name everything, have names:
Ligamentum Teres (Round Lig.)- from near the fundus of the uterus through the inguinal canal to the labia majora
Ovarian Lig.- connects the ovary to the uterus
Suspensory Lig. - from the ovary to the lateral wall of the pelvis; is a conduit for ovarian vessels
Mesosalpinx- part of broad lig. between the uterine tube and ovary
Mesovarium- where the ovary itself attaches to the broad lig.
Mesometrium- part of the broad ligament attached to the body of the uterus
Are you tired yet? Keep it up, youíre doing great.
PERINEUM
The anal canal and external genitalia make up the PERINEUM. The perineum is diamond shaped with the superior triangle being the urogenital triangle and the inferior triangle being the anal triangle.
anterior point: pubic symphysis
posterior point: tip of coccyx
lateral points: ishial tuberosities
The PERINEAL BODY is the tendinous center of the perineum and the point of attachment for many muscles (levator ani, transverse perineal, bulbospongiosus). It can be stretched or even torn during childbirth.
ANAL TRIANGLE = ANAL CANAL, RECTUM, ISCHIOANAL FOSSA, AND PUDENDAL
CANAL
ANAL CANAL- blood and nerve supply differ on the two sides of the pectinate line
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Blood supply |
Venous Drainage |
Nerve Supply |
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Above the Pectinate Line |
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Superior rectal v. |
Pelvic splanchnic- muscular Inf. hypogastric- sensory |
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Below the Pectinate Line |
Middle and Inferior Rectal a. |
Inferior rectal v. |
Inf. rectal n from Pudendal n. |
· Know the difference between internal and external hemorrhoids.
Internal hemorrhoids- dilations of the superior rectal v. and are not painful because pain is not sensed above the pectinate line.
External hemorrhoids-dilations of the inferior rectal v. and are painful because pain is sensed below the pectinate line.
RECTUM- a continuation of the sigmoid colon and makes a right angle at the puborectalis sling (formed by what muscle?)
- - supplied by superior, middle, and inferior rectal arteries
ISHIOANAL FOSSA- filled with fat and connective tissue
- - supports and allows the anal canal to expand during defecation
- - is also a potential site for infection
- - carries the pudendal nerve, artery, and vein
MALE UROGENTIAL TRIANGLE
includes scrotum, penis, membranous urethra and superficial perineal muscles
PENIS : root, body, and glans
- made of corpus spongiosum (forms the glans and the bulb of the penis) and
corpus cavernosum (separates in the root to form two crura)
SUPERFICIAL PERINEAL MUSCLES= SUPERFICIAL TRANSVERSE PERINEAL M., BULBLOSPONGIOSUS M., ISCHIOCAVERNOSUS M.
- innervated by perineal n.
BULBOSPONGIOSUS M. - is assoc. with the bulb of the penis; when they contract urine, or semen is expelled from the urethra
In women, the bulbospongiousus m. acts as a vaginal sphincter.
ISHIOCAVERNOSUS M.- surrounds the crura and when it contracts, blood is forced from the crura into the body of the penis to help maintain erection
In women, the ishiocavernosus m. is involved in the erection of the clitoris.
FEMALE UROGENITAL TRIANGLE
VULVA = external female genitalia, includes: MONS PUBIS, LABIA MAJORA AND MINORA, VESTIBULE OF THE VAGINA, CLITORIS, BULB OF THE VESTIBULE, AND GREATER VESTIBULAR GLANDS
- note that the scrotum is homologous to the labia majora
- the labia minora cover the vestibule of the vagina
- the clitoris is made of two corpora cavernosa that from crura
QUIZ TIME!!!!!!!!
1. Where does the obturator internus muscle exit out of?
2. What are the walls of the true pelvis?
3. What are the muscles of pelvic diaphragm?
4. What is the course of the pudendal nerve?
5. Does the obturator nerve come from the sacral plexus?
6. Name the parts of the broad ligament.
7. What is the blood supply above the pectinate line?
8. What does the corpus spongiosum form?
Wow you really are smart! Ready for more?
VERTEBRAL COLUMN: 33 vertebrae
7 cervical, 12 thoracic, 5 lumbar, 5 (fused) sacral, 4 (fused) coccygeal
- the cervical and lumbar sections curve concave posteriorly
- excessive lumbar curvature is called lordosis
- the thoracic and sacrococcygeal parts curve concave anteriorly
- excessive thoracic curvature is called kyphosis
- make sure you can identify the body, arch, vertebral foramen, pedicle, lamina, transverse and spinal processes, and superior and inferior articular processes on a vertebrae
*** see your syllabus for distinguishing characteristics of each region***
- - Intervertebral discs are between adjacent vertebral bodies and made of an annulus fibrosus surrounding the nucleus pulposus. They act as shock absorbers and if they bulge posteriorly they can compress spinal nerves. This is a common source of lower back and leg pain.
- - A herniated disc is one where the annulus fibrosus weakens allowing the nucleus pulposus poke out and put pressure on a spinal nerve. This causes lots of lower back pain and is what clinicians call sciatica. ( Can you guess which nerve roots are pinched?)
- - ATLANTOOCCIPITAL JOINT = C1 and occipital bone ® nodding head yes
- - ATLANTOAXIAL JOINT = C1 and C2 ® shaking head no
BACK MUSCLES
EXTRINSIC- from vertebral column ® upper limb
- Superficial extrinsic back m.- help anchor the upper limb to the axial skeleton
include: traps, lats, rhomboids, and levator scapula
- Intermediate extrinsic back m.- accessory respiration m.
include: serratus posterior superior and inferior
INTRINSIC- completely assoc. with the vertebral column
- - Superficial intrinsic back m.- SPLENIUS- rotate, extend and laterally flex the neck
- - Intermed. intrinsic back m.- ERECTOR SPINAE- laterally flex and extend back
- - Deep intrinsic back m.- TRANSVERSOSPINAL M.- rotate and stabilize the vertebral column
THORACIC WALL
RIBS - 12 total:
1-7 (sometimes 8) = TRUE ribs- directly attach at the sternum
(usu. 8), 9 and 10 = FALSE ribs- attach to the rib superiorly, not directly to the sternum
11and 12 = FLOATING ribs- do not attach at all to the sternum
STERNUM
3 parts: manubrium, body, and xiphoid (CPR landmark)
- - superior part of manubrium = jugular notch
- - manubriosternal joint = joint between manubrium and body, forms the sternal angle (landmark for 2d rib)
BREASTS- read more in your assigned reading
- - mostly made of fat
- - mammary glands which make milk can really only be seen when milk is being made (guys have mammary glands too!)
- - The following arteries supply the breast: anterior intercostal branches of the internal thoracic a. (a branch of the subclavian a.), the lateral thoracic, thoracoacromial a, and posterior intercostal a.
- - Most of the lymphatic drainage of the breasts is to the axillary lymph
INTERCOSTAL SPACE
THORACIC WALL MUSCLES- all innervated by intercostal n
- External intercostal m.- elevates ribs
- Internal intercostal m.- depresses ribs
- Innermost intercostal m.-elevates ribs
- Between the internal and innermost m. are the intercostal vein, artery, and nerve. They run in or near the costal groove, or the inferior margin of the rib.
The intercostal nerves arise from the ventral rami of T1-T11
LUNGS
- - Surrounded by a double layer of membrane called the PLUERA SAC
- - inner layer of Pleura sac is the Visceral layer
- - outer layer of Pleura sac is the Parietal layer
- - The (potential) space between the two layers is called the Pleural cavity and if air fills this cavity (itís normally filled with pleural fluid) the lung will collapse.
- - Know the regions of the pleura: mediastinal and diaphragmatic pleura and the costodiaphragmatic recess
- -Know the parts of the lungs: apex, base, root, and hilum
- -The root is the bundle of stuff (primary bronchi, pulmonary vessels, connective tissue, nerves, and lymphatics) that enter and exit the lung at the hilum.
- - Left lung : oblique fissure ® superior and inferior lobes; cardiac notch
- - Right lung: horizontal and oblique fissure ® superior, middle, and inferior lobes
- -After entering the hilum, the primary bronchi branch sending a secondary bronchi to each lobe. The secondary bronchi branch into tertiary bronchi which supply a specific bronchopulmonary segment.
- - Note that the right primary bronchus is shorter, wider, and runs more vertical than the left. This is why objects often get stuck in the right bronchus or right lung.
- - Lungs receive parasympathetic innervation (by the VAGUS NERVE (cranial nerve X)), and sympathetic innervation.
The vagus n. sends fibers to the bronchoconstrictors and the sympathetic fibers innervate the bronchodilators.
PERICARDIUM AND HEART
PERICARDIUM = double walled fibrous sac around the heart
- - FIBROUS LAYER- outer layer, maintains structure
- - SEROUS LAYER- smooth, lubricated layer that allows for movement
- - Parietal and Visceral layer and Pericardial cavity
BLOOD FLOW THROUGH THE HEART
De-Oxygenated blood:
In the superior and inferior vena cava ® RT. Atrium ® RT. Ventricle ® out the Pulmonary Arteries to the Lung
Oxygenated blood:
From the lungs into the Pulmonary veins to the LFT. Atrium ® LFT. Ventricle ® out the aorta to the body
STRUCTURES OF THE HEART
RIGHT ATRIUM
- - Openings from the superior and inferior vena cava and the coronary sinus
- - (Interatrial septum) Fossa ovalis- remenant of the foramen ovale in the fetus
LEFT ATRIUM
- -4 pulmonary veins
VENTRICLES
- - trabeculae carnae, atrioventricular valves (cusps, papillary muscles, chordae tendinae), semilunar valves
- - The papillary muscles contract before the ventricles do. The papillary m. pull on the chordae tendinae to close the cusps and therefore close the valve to prevent blood from moving back into the atrium.
Right ventricle: Tricuspid and pulmonary valve
Left ventricle: Thicker because has to pump the blood against more ressistance (entire body vs. just to the lungs), bicuspid or mitral valve, and aortic valve
- When someone listens to your heartbeat, they are hearing the closing of valves.
Blood Supply of the Heart
- Blood needs to get to and from the heart itself. See pages 64 and 67 in your textbook.
- Right coronay artery- originates in the aorta, runs in the coronary groove and gives off the right marginal branch and the posterior interventricular a.
- - supplies the right atrium and right ventricle
- Left coronay artery- originates in the aorta, gives off the circumflex branch and the anterior interventrical a.
- - supplies the left atrium, left ventricle and interventricular septum
- Anterior Cardiac vein drains directly into the right atrium.
- All other cardiac veins drain into the coronary sinus of the right atrium.
- Great cardiac vein- travels with the anterior interventricular a.
- Middle cardiac vein- travels with the posterior interventricular a.
- Small cardiac vein- travels with the marginal branch
- -Look over your syllabus for clinical conditions
- - The heart is innervated by vagus nerve and sympathetic trunk via the cardiac plexus.
CONDUCTING SYSTEM
- The heart has its own specialized conducting system in which impulses are conducted to pacemaker regions.
- The two atria contract together before the two ventricles contract (together).
- SINOATRIAL NODE- pacemaker of the heart, located at the point where the superior vena cava enters the right atrium
- ATRIOVENTRICULAR NODE- located above the coronary sinus in the atrial septum
- ATRIOVENTRICULAR BUNDLE - Splits into right and left branches which end as Purkinje fibers, which cause ventricular contractions.
MEDIASTINUM
space between the two pleura sacs, does not include the lungs or pleura
Superior Mediastinum (from antr. to postr.)
- -Thymus
- - Brachiocephalic v, Superior Vena Cava, Aortic Arch
- - Vagus Nerve (Cranial n. X)- passes posterior to root of lung
- -Right vagus, left vagus, and recurrent laryngeal n.
- - Phrenic- passes anterior to root of lung, supplies the diaphragm
- -Trachea
- -Esophagus- connects the pharynx to the stomach
Anterior Mediastinum
connective tissue, fat, and lymph nodes
Middle Mediastinum
pericardium and heart
Posterior Mediastinum
- - Thoracic (Descending) aorta
- - Thoracic Duct- receives lymph from left side of head, neck, and thorax, the left upper limb and the rest of the body below the diaphragm
- - Azygous Vein- connects the superior and inferior vena cava
- - Esophagus
QUIZ TIME!!!!!!!
1. How many vertebrae do you have?
2. How does a cervical vertebrae differ from a
thoracic? From a Lumbar?
3. Which ribs are true? Which ones are false? Why?
4. What are some differences between the right and left lungs?
5. Do all arteries carry oxygenated blood?
6. What nerve innervates the diaphragm?
7. What is in the middle mediastinum? (No cheating, here!) Superior
mediastinum? Posterior?
ABDOMINAL CAVITY REVIEW
I. Surface anatomy: xiphoid process, costal margin, anterior superior iliac spine, pubic crest, pubic tubercle, pubic symphysis, umbilicus, linea alba.
II. Muscles:
- External Oblique runs downward and forwards forming aponeurosis anteriorly, which forms inguinal ligament and the superfical inguinal ring of the inguinal canal.
- Internal Oblique is deep to the E. O. and runs upward.
- Tranversus abdominis is deep to the I. O. and runs horizontal. It comes together with I. O. to form conjoint tendon.
- Rectus abdominis runs along the linea alba (six packs)
- Tranversalis Fascia is a fascia between the abdominal muscles and the peritoneum.
III. Inguinal Canal - An obligue passage 3-5 cm long, through the abdominal wall; spermatic cord (Male) and round ligament (female) travel from the abdomen to the perineum. It has an arch form by the I. O. and Transversus abdominus. The abdominal open is the deep ring and opening to the strotum is the superficial ring.
Boundaries; anterior- E. O. and I. O. muscles, posterior - conjoint tendon and transversalis fascia, roof - arching of the I. O. and T. A. muscles. floor - inguinal ligament.
IV. Spermatic Cord: consists of ductus deferens, testicular a.(a branch off of abdomial aorta), internal spermatic fascia, Pampiniform Plexus (Varicocele - pooling of blood due to defective valves) , cremasteric fascia, and external spermatic fascia.
V. Scrotum: mostly skin and fascia; Tunica Vaginalis - a perioneal sac surrounding the testes (parietal layer and visceral layer). Hydrocele - accumulation of fluid in the cavity of the tunica vaginalis. Tunica albuginea - a tough fibrous capsule around the testes.
VI. What is the difference between Direct and Indirect Inguinal Hernia? know this....
Peritoneal Cavity, Esophagus and Stomach.
Remember that the human body is a 3D structure. So the peritoneum is like a balloon with its wall against the abdominal wall. Then structures such as the stomach and small intestine push though the wall and wrap them self in the peritoneal wall (like a fist punching through a balloon). These structures are suspended by the mesentery.
- Know the different between peritoneal (very mobile), retroperitoneal (partial cover by the peritoneal and not very mobile), and intraperitoneal structures (things inside the peritoneal cavity).
- Know the different between greater sac and lesser sac (omental foramen - an opening between greater and lesser sac). Greater omentum descends from the stomach and wraps back up to the transvers colon. Lesser omentum is from the live to the stomach.
Abdominal Viscera
- Esophagus - enters through the esophageal hiatus of the diaphragm. The distal end is where the lower esophageal sphinster locates. The opening to the stomach is the cardiac orifice.
- Stomach: (no digestion occurs here). Parts : cardiac part, fundus (mostly air), body, pyloric part (with the pyloric sphincter) and antrum (the site of gastrin secretion).
- Blood supply: Know this well... Celiac trunk comes off of the aorta. a, left gastric a. supplies esophagus and upper part of stomach (left of of lesser curvature). b, splenic a. gives off pancreatic branches, left gastroepiploic and short gastric a. (which supplies most of the greater curvature). c, Common hepatic - branches into hepatic a. proper and gastroduodenal artery. Hepatic artery proper gives off right gastric artery (supply the right side of lesser curvature) and branches into right and left hepatic arteries.
- What is Hiatus hernia? and Pyloric stenosis?
Small and Large Intestine
I. Duodenum (short but important structure); 1st part (upper duodenal cap) is free (peritoneal). 2nd (descending) recieved bile duct and pancreatic duct, which come together at the hepatonpancreatic ampulla, which opens at the major duodenal papilla. 3rd. (horizontal) - crosses anterior to the aorta. One other artery that cross in front of this part is the superior mesenteric a. 4th, ascending, connects with jejunum at the duodenojejunal flexure.
* Most (70-75 %) of ulcers occur at this structure.
II. Small intestine: jejunum (2/5) occupies the umbilical region and the ileum (3/5) occupies the hypogastric region. Blood supply by superior mesenteric a. and innervation is by the vagus and splanchnic nerves.
III. Large intestine: What are the differences between small instestine and large intestine? small intestine is usually very smooth. Large intestine has haustra, teniae coli, and appendices epiploicae.
- Cecum - is between small and large intestine. The open has a valve (iliocecal valve). What happens when feces plugged up the opening to the vermiform appendix?
- Ascending colon; retroperitoneal- not very mobile, blood supply right colic.
- Transverse colon - peritoneal - movable, supply by middle colic.
- Descending colon - retroperitoneal - not very mobile, supply by left colic.
- Sigmoid colon - look like and S. lies within the pelvis suspended from its wall by the sigmoid mesocolon. peritoneal - lots of movement.
- Innervation - parasympathetics by the vagus as far as the middle of the transverse colon. Distal to that done by the pelvis splanchnics (S2-S4). Sympathetic innervation via the thoracic splanchnic nerves and the collateral ganglia.
Abdominal Viscera
I. Liver
When you look at the liver in the text remember that the liver is flip up. Thus, you are looking at it posteriorly and upside-down. It has two surfaces (diaphragmic and visceral) and four lobes (right, left, quadrate (inferior to the caudate lobe), and caudate lobes.
- Ligaments: know the all, but major ones are falciform ligament and ligamentum teres.
- Function: protein synthesis, chemical modification, clotting factors, and important blood forming organ in fetus.
- Blood Supply: hepatic artery, proper , Make sure you know the Portal Vein system.
II. Gall Bladder: lies along the right edge of the quadrate lobe. The body drain into the cystic duct which combine with common hepatic duct to from bile duct. Bile duct joint with pancreatic duct to form hepatopancreatic ampulla which drains into the 2nd part of the duodenum.
- Function: to store bile for digesting fat.
- Blood supply: cystic a. and v.
III. The Pancreas: is an exocrine and endocrine gland consisting of a head, body, neck and tail. It is retroperitoneal which means it doesnít move that much. The pancreatic duct enters the duodenal papilla. Innervation is by sympathetic fibers parasympathetic fibers. Clinical conditions: pancreatitis and cancer of the pancreas.
IV. Spleen: is on the left side of the abdomen and posterior to the 9th and 10th costal margin. It is a lymphatic organ where antibody forms. There are two ligaments holding it up; gastrolienal which connects the spleen to the stomach and lienorenl which attaches the sleen to the posterior abdominal wall on the left side. Blood supply: Splenic a. from celiac trunk.
Anatomy Tables - Duodenum, Pancreas, Liver, & Gallbladder |
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Clinical Terms |
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Term |
Definition |
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a common method for reducing portal hypertension by diverting blood from the portal venous system to the systemic venous system by creating a communication between the portal vein and the IVC. This usually leads to hepatic encephalopathy as the toxins from the GI tract bypass the liver and its processing of them. |
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Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic and which is due to autodigestion of pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis or uremia. |
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A malignant growth of the pancreas. More than 90% are ductal adenocarcinomas with islet cell carcinomas making up the difference. Symptoms include abdominal pain, abdominal swelling, jaundice, weight loss and anorexia. |
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A concretion in the gall bladder or a bile duct, composed chiefly of cholesterol crystals. |
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Yellowing of the skin (and whites of eyes) by bilirubin, a bile pigment. Frequently because of a liver problem. (Latin, jaundice/jaune = yellow) |
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cholecystectomy |
The surgical removal of the gallbladder. This type of surgery may be performed with the traditional open incision or via a flexible fiberoptic scope (laparoscopic cholecystectomy). |
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Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. (Greek, kirrhos = yellow liver + -osis = condition) |
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Any increase in the portal vein pressure due to anatomic or functional obstruction (for example alcoholic cirrhosis) to blood flow in the portal venous system. Indicators of portal hypertension are: esophageal varices, hemorrhoids, enlarged veins on the anterior abdominal wall (caput Medusae) and ascites (fluid within the abdominal cavity). |
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An effusion and accumulation of serous fluid in the abdominal cavity. (Greek, askos = a bag) |
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Kocher manuever |
Reflecting the duodenum and pancreas medially by cutting through the fusion fascia along the right side of the descending part of the duodenum. This maneuver is used to gain access behind the pancreas. |
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duodenal stenosis |
Narrowing of the duodenum. May be congenital or the result of neoplastic growth. (Latin, stenosis = a narrowing) |
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duodenal atresia |
Congenital duodenal atresia (blind end) of the duodenum, caused by a failure of recanalization of the duodenal lumen during development. It should be noted that 70% of patients with duodenal atresia also have other malformations including Down's Syndrome, cardiac or GI defects. (Greek, atresia = without hole) |
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surgical establishment of a communication between the gall bladder and the jejunum. |
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itching caused by drug reaction, food allergy, liver disease, cancers, parasites, aging or dry skin. (Latin, prurio = an itching) |
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pigment found in bile. Mainly formed during heme catabolism- the breakdown of old red blood cells within the liver. (Latin, bilis = bile + ruber = red) |
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enlargement of the liver |
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diuretics |
agents that promote the excretion of urine through their effects on the function of the kidney |
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fiberoptic endoscopy for duodenal observation and cannulation of vater's ampulla in order to visualize the pancreatic and biliary duct system by retrograde (against the usual direction of flow) injection of contrast media |
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an anomaly that leads to a mass that resembles neoplastic tissue. (Greek, -oma = tumor) |
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varicose veins radiating from the umbilicus. Ordinarily seen as a sign of cirrhosis of the liver and caused by portal hypertension. (Latin, caput medusae = medusa head) |
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acute or chronic inflammation of the gall bladder |
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surgery to remove a diseased gallbladder through a fiberoptic scope that is inserted into a small incision near the navel. The patient is usually home 24 hours after the surgery. |
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vomiting of blood. (Greek, hema = blood + -emesis = vomiting) |
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Pringle maneuver |
manually stopping the inflow to the liver by compressing the portal vein and proper hepatic artery. This is utilized in cases when the liver is bleeding and the bleeding must be stopped immediately (such as in trauma or surgical exploration) |
· Greater omentum
· Gastrosplenic ligament
· Splenorenal ligament
· Gastrophrenic ligament
· Gastrocolic ligament
· Lesser omentum
·
Hepatogastric
ligament
·
Hepatoduodenal
ligament
·
Mesentery
proper
·
·
Ligaments
and folds of peritoneum
·
Falciform
ligament
·
Ligamentum
teres hepatis (obliterated umbilical vein)
·
Coronary
ligament
·
Left
triangular ligament
·
Right
triangular ligament
·
·
Peritoneal
cavity
·
Greater
peritoneal sac
·
Omental
(epiploic) foramen (of Winslow)
·
Lesser
peritoneal sac (omental bursa)
·
INTERNAL FEATURES OF THE ANTEROLATERAL ABDOMINAL WALL
·
Umbilical
folds
·
Median
- contains the remnant of the urachus
·
Medial
- contains the obliterated umbilical a.
·
Lateral
- contains the inferior epigastric vessels
·
Abdomen: Peritoneum and Foregut
PERITONEUM
Definitions
Peritoneum--Mesothelial (Simple squamous epitheliums), glistening, transparent serous membrane lining the abdominal walls and contents
Parietal part--lines the abdominal and pelvic walls; receives same blood and nerve supply as the region it lines
Visceral part--lines the organs; receives same blood and nerve supply as organs
Peritoneal Cavity--The potential space of capillary thinness between the parietal and visceral peritoneum; there are no organs in the peritoneal cavity, normally empty except for thin layer of fluid (peritoneal fluid) to keep surfaces moist, reduce friction, and supply leukocytes and antibodies; Subdivided into two sacs
Greater sac--entered by surgical incision of anterolateral abdominal wall; divided by transverse mesocolon into:
Supracolic compartment--contains the stomach, liver, and spleen
Infracolic compartment--contains the small intestine and ascending and descending colon; lies posterior to the greater omentum and is divided into right and left infracolic spaces by the mesentery of the small intestine
Lesser sac (omental bursa)--lies posterior to the stomach and adjoining structures and lesser omentum; permits free movement of the stomach on the structures posterior and inferior to it because wall slide smoothly.
Superior recess--limited superiorly by the diaphragm and the posterior layers of the coronary ligament of the liver
Inferior recess--between the superior part of the layers of the greater omentum; mostly sealed off potential space
Peritoneal Reflections--peritoneum reflected from one area to another
(example--body wall to organ, organ to organ). These reflections may be called omenta, mesenteries or ligaments.
Omentum--double-layered extension or fold of peritoneum that passes from the stomach and proximal part of the duodenum to adjacent organs in the abdominal cavity or to the abdominal wall
Mesentery--connection of viscera to body wall; double layered with thin layer of loose connective tissue between, in which vessels, nerves, lymphatics and fat run; length of mesentery determines the degree of mobility
Peritoneal ligament--double layer of peritoneum that connects an organ with another organ or to the abdominal wall
Intraperitoneal--surrounded by peritoneum--inside the peritoneum; organ that is almost completely covered by peritoneum, except for the small area where the mesentery is attached (example transverse colon, stomach, spleen)
Retroperitoneal (extraperitoneal)--Behind the peritoneum--an organ that is covered with peritoneum only on its anterior surface (examples: duodenum and pancreas [secondarily retroperitoneal], kidneys)
Embryology
Derivatives of the dorsal
mesogastrium
Greater omentum--prominent peritoneal fold that hangs down like an apron from the greater curvature of the stomach and the proximal part of the duodenum; folds back and attaches to the anterior surface of the transverse colon and its mesentery; quite mobile (with peristalsis)
Functions--prevents the visceral peritoneum from adhering to the parietal peritoneum lining the abdominal wall; protects other viscera by walling-off an inflamed organ (like appendix) [abdominal policeman]; cushions organs against injury and forms insulation against loss of body heat
Closed sac in the male
Open sac in the female
Gastrophrenic ligament--connects the stomach to the inferior surface of the diaphragm
Gastrosplenic (gastrolienal) ligament--connects the stomach to the spleen; reflects to the hilum of the spleen
Gastrocolic ligament--connects stomach to transverse colon; apron-like part of greater omentum
Splenorenal ligament
Derivatives of the ventral
mesogastrium
Lesser Omentum-helps former lesser sac, also called the omental bursa; cut off and isolated from the greater omentum due to the rotation of the stomach; opening into the lesser sac is called the epiploic foramen (aka omental foramen or foramen of Winslow; communication between greater and lesser sacs); connects the lesser curvature of the stomach and the proximal part of the duodenum to the liver
Hepatogastric (Gastrohepatic) ligament--membranous portion of lesser omentum connecting the liver to the stomach
Hepatoduodenal ligament--thickened free edge of the lesser omentum that conducts the portal triad (portal vein, hepatic artery, and bile duct)
Visceral peritoneum of the liver
Ligaments of the liver
falciform ligament--connects liver to the anterior abdominal wall
coronary ligament
triangular ligaments
Folds and Fossae (or recesses)--a recess (pouch) is formed by a peritoneal fold
Recto-uterine pouch (Pouch of
Utero-visceral pouch
Hepatorenal pouch (“Morrison’s
Pouch)
Paracolic
gutters--communication between the supracolic and infracolic compartments;
grooves between the lateral aspect of the ascending or descending colon and the
posterolateral abdominal wall; provide pathways for the flow of ascitic fluid
and the spread of infections
Anterior wall
folds--A peritoneal fold is a reflection of peritoneum that is raised from
the body wall by underlying blood vessels, ducts, and obliterated fetal vessels
Median--Urachus
Medial umbilical folds--Obliterated umbilical arteries
Lateral umbilical folds--Inferior epigastric arteries--remember their importance to defining inguinal hernia types
Blood Supply
Parietal peritoneum--from the abdominal wall
Visceral peritoneum--from vessels to the organs
Nerves
Parietal
Peritoneum Visceral
Peritoneum
T7-L1 T6-T12 thoracic splanchnics
Vasomotor from sympathetics Vasomotor from sympathetics
Pain: acute and localized Pain: Insensitive
FOREGUT
Parts
Arterial Supply
Celiac artery (“trunk”)--supplies the organs of the foregut and anastomoses with the superior mesenteric artery which supplies the midgut; first unpaired branch of the abdominal aorta, is usually the second branch overall; many variations in branches
Left gastric artery--to stomach and esophagus--to lesser curvature of stomach and esophageal branch
Splenic artery--to spleen, stomach, and pancreas--short gastric arteries, left gastroepiploic artery, pancreatic arteries
Common hepatic artery--to liver, gallbladder, stomach, duodenum--
Proper hepatic artery--left hepatic artery, right hepatic artery, cystic artery, right gastric artery
Gastroduodenal artery--superior pancreaticoduodenal artery, right gastroepiploic artery
Venous Drainage
Gastric and splenic veins to the
portal system
Innervation
Sympathetic--prevertebral [celiac] ganglia--causes vasoconstriction
Parasympathetic--vagus nerve--increases GI motility, secretion, absorption
Lymphatics--numerous, lymph nodes that surround each organ; all drain into the thoracic duct, cysterna chyli
Stomach
Orifices
Cardial-physiologic sphincter (not anatomical, no muscle band)
Pyloric --guarded by pylorus (pyloric sphincter), first sphincter in GI tract ”gatekeeper”; normally in tonic contraction and is closed except when emitting chyme; gastric peristalsis passes chyme into small intestine
Curvatures
Lesser--shorter, concave border; angular notch (incisure) is sharp indentation approximately 2/3 of the distance along the lesser curvature that indicates the junction of the body and the pyloric part; attachment of lesser omentum
Greater--attachment of greater omentum--longer, convex border
Parts
Cardia--part surround the cardial
orifice
Fundus--air bubble-looks black in radiographs; dilated superior part that relates to the left dome of diaphragm; limited by the plane of the cardial orifice; superior part reaches level of left 5th intercostal space; cardial notch is between esophagus and fundus; may be dilated by gas, fluid, food
Body--lies between the fundus and the pylori antrum
Pyloric (antrum, canal, pyloris)--funnel-shaped region; wide part (pyloric antrum) leads to pyloric canal (narrow part); pyloric sphincter controls discharge of the stomach contents through the pyloric orifice into duodenum
Relations
Anterior--adjacent to left lobe of liver, diaphragm, anterior abdominal wall
Posterior-- omental bursa and pancreas
Bed of stomach--posterior wall of omental bursa (diaphragm, spleen, kidney, suprarenal gland, pancreas, splenic artery and mesocolon
Muscle coats
Longitudinal
Circular
Oblique
Interior--
Gastric folds
(rugae, longitudinal ridges) form when gastric mucosa is contracted, most
marked in pyloric part
Gastric canal--forms temporarily during swallowing between gastric folds along lesser curvature; saliva and small amounts of food pass through to pyloric canal
Arteries--come off of three main branches of celiac trunk
Left gastric--branch off celiac trunk; runs in lesser omentum to the cardia and then courses along the lesser curvature to anastomose with the right gastric
Right gastric--arises from hepatic artery; runs to the left along the lesser curvature to anastomose with the left gastric
Gastroduodenal
Right Gastroepiploic (gastro-omental)--arises as one of two terminal branches of the gastroduodenal artery; runs to left along greater curvature and anastomoses with left gastroepiploic
Left gastroepiploic (gastro-omental)--arises from the splenic artery and courses along greater curvature to anastomose with the right gastroepiploic
Short gastric (4 or 5)--arise from distal end of splenic artery or its splenic branches and pass to the fundus of the stomach
Veins--parallel arteries in position and course and drain into portal system
Left and right gastricčPortal vein
Short gastric, left gastroepiploic and pancreaticčsplenic vein, which joins superior mesenteric veinčportal vein
right gastroepiploic and pancreaticčSuperior mesenteric vein
prepyloric--čright gastric vein; used to identify pylorus
Lymphatics--accompany arteries along greater and lesser curvatures and drain into gastric and gastro-omental lymph nodes located in the curvaturesčceliac lymph nodes
Nerves--
Parasympathetic--from anterior (derived from left vagus) and posterior (derived mainly from right vagus) vagal trunks
Sympathetic--from T6-T9 passes to celiac plexus through the greater splanchnic nerve
Applied Anatomy
Hiatal hernia--protrusion of stomach into the mediastinum through the esophageal hiatus; two types--sliding hiatus, cardial portion through diaphragm and paraesophageal hiatus, fundus part through with cardial portion undisturbed
Peptic ulcer--lesions of the stomach commonly associated with the presence of Heliobacter pylori; an ulcer is formed when the mucosa is inadequate to protect the mucosa from erosion by acid
Gastroscopy--use of flexible fiber endoscopes to examine the mucosa of stomach to observe gastric lesions and take biopsies
Gastrectomy--removal of all or part of the stomach in cases of stomach carcinoma or peptic ulcer disease
Vagotomy--section of the vagal trunks at the esophageal hiatus to reduce the production of acid
Duodenum--first, shortest, widest and most
fixed part of small intestine; C-shaped course around the head of the pancreas
from right to left;
4 Parts--First (proximal) two parts derived from embryological foregut and principally supplied by celiac artery (by definition are foregut), second (distal) two parts derived from embryological midgut and principally supplied by mesenteric artery (are midgut by definition)
Ampulla--first 2 cm of superior part--next to pylorus; is mobile and has different appearance than rest of duodenum
Part I (superior)--short (5 cm); lies anterolateral to the body of L1 vertebra--ascends from the pylorus and is overlapped by the liver and gallbladder; only has peritoneum anteriorly (except ampulla); proximal part has the hepatoduodenal ligament attached superiorly and the greater omentum attached inferiorly
Anterior: Liver, neck of the gall bladder
Posterior: Gastroduodenal artery, common bile duct, and portal vine
Inferior: pancreas
Part II (vertical or descending)--longer (7-10 cm); descends along the right sides of L1-L3; runs inferiorly, curving around head of pancreas; retroperitoneal
Anterior: Liver, transverse colon, jejunum, ileum, gallbladder
Posterior: Right kidney, ureter, renal blood vessels
Medial: Head of pancreas (pancreatic duct), common bile duct--enter posteromedial wall and untie to form the hepatopancreatic ampulla which opens on an eminences located posteromedially in the descending duodenum, the major duodenal papilla
Lateral: right kidney
Part III (horizontal or inferior) (6-8 cm); runs transversely to the left, passing over the IVC, aorta and L3 vertebra; it is crossed by the superior mesenteric artery (SMA) and vein and the root of the mesentery of the jejunum and ileum
Anterior: superior mesenteric vessels, root of mesentery, transverse colon and mesocolon
Posterior: right psoas muscle, IVC, aorta, sympathetic trunks
Inferior: Coils of jejunum and ileum
Part IV (Ascending) short (5 cm) begins left of L3 and rises to superior of L2; curves anteriorly at border of body of pancreas to join the jejunum at the duodenojejunal junction that takes the form of an acute angle, the duodenojejunal flexure which is supported by a suspensory muscle of the duodenum
Anterior: Root of mesentery and coils of jejunum
Posterior: Left psoas muscle
Suspensory ligament of the duodenum (“Ligament of Treitz”)
Interior Features
Plicae cicularis
Duodenal papilla--hill on side through which ducts open
Major papilla--combine pancreas and biliary tree ducts
Minor papilla--pancreatic duct only
Opening of main pancreatic duct (“Ampulla of Vater”)
Opening of accessory pancreatic duct
Arteries--the
duodenal arteries arise from the celiac trunk and the superior mesenteric
artery
Celiac trunk č gastroduodenal artery č superior pancreatico-duodenal arteries--supplies duodenum proximal to the entry of the bile duct into the second part of the duodenum
Superior mesenteric arteryčinferior pancreaticoduodenal artery--supplies duodenum distal to the entry of the bile duct
Both pancreaticoduodenal arteries lie in the curve between the duodenum and the head of the pancreas and supply both structures. Their anastomosis, near the level of entry of the bile duct is in effect an anastomosis of the celiac and superior mesenteric artery.
Veins--follow arteries and drain into the portal vein, either directly or through the superior mesenteric and splenic veins
Lymphatics--follow the arteries; anterior vessels drain into pancreaticoduodenal lymph nodes and pylori lymph nodes; posterior vessels drain into superior mesenteric lymph nodes; efferent vessels drain into celiac lymph nodes
Innervation--From vagus and sympathetic nerves through the celiac and superior mesenteric plexuses on the pancreaticoduodenal arteries
Duodenal recesses
Inferior
Paraduodenal--large and lie to left of ascending part of duodenum; may strangulate a loop of intestine (paraduodenal hernia)
Retroduodenal
Applied Anatomy
Ulcers--normally in the posterior wall of the superior part of the duodenum; close relation also makes it possible to effect liver and gallbladder
Atresia
Stenosis
Liver--RUQ (mainly) and LUQ, largest gland in
the body; protected by rib cage a little under sternum; stores glycogen and
secretes bile
Surface projections
Surfaces--diaphragmatic
and visceral; diaphragmatic separated from diaphragm by subphrenic recesses
which are separated into right and left by falciform ligament
Anterior: anterior abdominal wall
Posterior: diaphragm, inferior vena cava, “bare area”
Inferior (visceral): right kidney, colon, stomach, duodenum, right suprarenal gland, lesser omentum
Lobes--are demarcated by 4 furrows which make an H-shape; independent right and left lobes, each with own bloody supply and biliary drainage and demarcated from one another by grooves formed by gallbladder (inferiorly) and the IVC (superiorly)
Right--attachment of falciform ligament
Left--includes caudate lobe and much of quadrate lobe
Quadrate--between gallbladder and falciform ligament (posterior surface)
Caudate--between inferior vena cava and ligamentum venosum (posterior)
Portal triad--portal vein, hepatic duct, hepatic artery proper are enclosed in thick free edge of the lesser omentum, specifically the hepatoduodenal ligament
Peritoneal “Ligaments”
Coronary
Falciform
Triangular
Arteries--30% of total hepatic blood supply
Common hepatic artery--from the celiac trunk to the origin of the gastroduodenal artery
Proper hepatic artery--from the origin of the gastroduodenal artery to its bifurcation into right and left branches
Right and Left hepatic arteries--supply right and left lobes; carries well-oxygenated blood from aorta (right supplies middle part of bile duct)
Veins--70% of total hepatic blood supply
Portal vein--carries poorly oxygenated but nutrient-rich blood from the GI tract to the sinusoids of the liver
Hepatic veins--intersegmental in their distribution and function, draining parts of adjacent segments; formed by the union of the central veins of the liver; open into the IVC, just inferior to diaphragm
Gallbladder--repository for cholesterol which is necessary to digest fat; bile salts emulsify to be carried through blood; bile is made in the liver and constantly dribbles down bile duct; it then flows retrogradely into gallbladder to sit until fatty meal is eaten; lies in gallbladder fossa on the visceral surface of the liver, which is at the junction of the right and left lobes of the liver
Surface projection--tip of 9th costal cartilage on the right side; first part of duodenum is usually stained with bile; capacity of up 50 mL of bile.
Parts
Fundus--wide end, projects from the inferior border of the liver and is usually located at the tip of the 9th costal cartilage in the MCL
Body--contacts the visceral surface of the liver, the transverse colon, and the superior part of the duodenum
Neck--narrow, tapered and directed toward the porta hepatis; mucosa of neck spirals into a fold, the spiral valve;
Cystic duct--connects the neck of gallbladder to the common hepatic duct; passes between the layers of the lesser omentum, usually parallel to the common hepatic duct, which it joins to form the bile duct
Arteries
Cystic artery--supplies gallbladder, cystic duct and proximal part of the bile duct; commonly arises from right hepatic artery in the angle between the common hepatic duct and the cystic duct
Hepatic artery
Veins--cystic veins--drain directly into the liver via the bed of the gallbladder and the portal system
Biliary Tree
Bile Passages--Common hepatic duct and cystic duct unite to form the common bile duct, which empties into the Sphincter of Oddi
Bile Ducts--right and left hepatic ducts drain right and left lobes of liver, respectively; they then unite to form the common hepatic duct, which is joined on the right side by the cystic duct to form the bile duct, which conveys bile to the duodenum
Bile Duct--forms in the free edge of the lesser omentum by the union of the cystic duct and common hepatic duct; descends posterior to first part of duodenum and lies in a groove on the posterior surface of the head of the pancreas; comes in contact with main pancreatic duct on left side of descending duodenum and unite to form the hepatopancreatic ampulla (ampulla of Vater), with the dilation within the major duodenal papilla; circular muscle around distal end of duct is thickened to form the sphincter of the bile duct which when contracted doesn’t allow bile to enter duodenum and backs up into the cystic duct to the gallbladder where it is concentrated and stored
Applied anatomy of liver and
gallbladder
Jaundice
Gallstones
Variations in gall bladder anatomy
Pancreas--an
elongated, accessory digestive gland
Surface projection
Parts
Head--expanded part of the gland; nestled in C-curve of duodenum, firmly attached to medial aspect of descending and horizontal part of the duodenum; rests posteriorly on IVC, right renal artery and vein, left renal vein
uncinate process--a projection from the inferior part of the head, extends medially to the left, posterior to the SMA
Bile duct--lies in a groove on the posterosuperior surface of the head or is embedded in its substance
Neck--short and overlies superior mesenteric vessels, which form a groove in its posterior aspect; anterior surface is adjacent to the pylorus of stomach
Body--lies to left of SMV and SMA, passing over aorta and L2, posterior to the omental bursa; anterior surface lies in floor of omental bursa and forms part of stomach bed; posterior surface devoid of peritoneum and contacts aorta, SMA, left suprarenal gland, left kidney and renal vessels
Tail--continues to spleen; lies anterior to left kidney, closely related to hilum of spleen and left colic flexure; relatively mobile and passes through layers of splenorenal ligament with the splenic vessels
Relations
Anterior: transverse mesocolon; small gut, stomach
Posterior: splenic vein, aorta, IVC, bile duct
Right: duodenum
Left: spleen
Ducts--possibly two entries into duodenum
Main pancreatic duct--mainly dorsal; beings in tail and runs through parenchyma to the head where it turns inferiorly and is closely related to the bile duct; unites with bile duct to form short hepatopancreatic ampulla which opens into the descending part of the duodenum at the major duodenal papilla. Sphincters (sphincter of pancreatic duct, sphincter of bile duct and hepatopancreatic sphincter of Oddi) are smooth muscles sphincters that control the flow of bile and pancreatic juice into the duodenum
Accessory pancreatic duct--drains uncinate process and inferior part of head and opens into duodenum at minor duodenal papilla; usually communicates with main pancreatic duct
Arteries
Splenic--form several arcades with pancreatic branches of gastroduodenal and superior mesenteric arteries--supply body and tail
Superior pancreaticoduodenal--branches of gastroduodenal--supply head
Anterior and posterior inferior pancreaticoduodenal--branches of SMA supply head
Veins--corresponding pancreatic veins are tributaries of splenic and superior mesenteric part os the portal vein, but most drain into splenic vein
Spleen--mobile,
largest lymphatic organ; usually purplish color; located intraperitoneally in
LUQ; completely surrounded by peritoneum except at hilum where veins and arteries
enter and leave; varies considerably in size, weight and shape but usually size
of clenched fist
Surface
projections--separated from ribs by diaphragm and costodiaphragmatic recess
Upper border--related to the 9th rib
Lower border--related to the 11th
rib
Relations
Posteriorly: left part of diaphragm
Anteriorly: Stomach
Medially--Kidney and tail of pancreas (left boundary of omental bursa)
Inferiorly--left colic flexure
“Ligament” contents and
relationships
Lienorenal ligament--splenic artery and tail of pancreas
Gastrolienal (gastrosplenic) ligament--connects spleen to greater curvature of stomach--short gastric artery and stomach
Phrenicocolic ligament--diaphragm
Arteries--Splenic artery, follows tortuous course along superior border of pancreas; between layers of splenorenal ligament divides into five or more branches that enter the hilum
Veins--Splenic vein, formed by several tributaries that emerge from the hilum; joined by IMV and runs posterior to the body and tail of the pancreas throughout most of its course ; joins with SMV to form portal vein
|
For the following questions, indicate the letter that corresponds to the SINGLE MOST APPROPRIATE ANSWER. 1.
Dr. Nussbaum used a laparoscopic procedure to remove the gallbladder of a
53-year-old 2.
During vaginal delivery, an episiotomy is performed by incising the perineal
body to 3.
A 57-year-old woman has a tumor involving the labia majora and minora.
Surgery is 4.
A 67-year-old man is jaundiced and has severe abdominal pain. He is diagnosed
with 5.
During an emergency hysterectomy in a 45-year-old woman, the surgeon exposes
a 6.
A 26-year-old woman complains of abdominal pain in the umbilical region. A
problem 7.
A 12-year-old boy is undergoing liver transplant surgery. During the
procedure the 8.
A 63-year-old man had a tumor adjacent to the celiac ganglion and plexus.
This tumor 9.
A 63-year-old woman has an ulcer in the posterior wall of the first part of
the duodenum. 10.
An aortic aneurysm in the aortic hiatus of the diaphragm could directly
compress the 11.
A 55-year-old man has cancer of the stomach requiring a total gastrectomy.
Which group 12.
During the examination of a 45-year-old woman, a large pelvic mass is
discovered. 13.
The T8 spinal nerve is compressed by a tumor in the intervertebral foramen.
This 14.
A 23-year-old motorcycle accident victim was rushed to the operating room,
where a 15.
In a patient with severe portal venous obstruction secondary to cirrhosis of
the liver, 16.
A 45-year-old man arrived at the emergency room with a severe pain on his
right side. 17.
A 37-year-old male was diagnosed with testicular cancer. Cells in a tumor
arising in the 18.
A fourth-year medical student assists the surgeon in a direct inguinal hernia
repair of a 19.
Hemorrhoids bother a 23-year-old woman who is seven months pregnant. These
have 20.
The urologist palpated the patient's spermatic cord while performing a
vasectomy. He 21.
A 46-year-old man is having an inguinal hernia repaired. During the procedure
the 22.
During abdominal surgery, the surgeon examined several structures that are
primarily 23.
A 22-year-old man is shot in a bar fight. The bullet passes through the
midline of the 24.
In preparation for removal of an inflamed gallbladder, the surgeon
laparoscopically 25.
A 52-year-old man complains of pain in the epigastric region. This is most
likely 26.
A patient with a massive carcinoma of the stomach had most of his stomach
removed 27.
A 68-year-old woman has a recently diagnosed occlusion of her inferior
mesenteric artery 28.
In discussing the problems linked with alcoholism to a patient who has begun
drinking 29.
A 56-year-old man is having surgery to repair a direct inguinal hernia. The
surgeon is 30.
A 63-year-old man has his rectum removed after a diagnosis of rectal cancer.
Following 31.
A 67-year-old woman is having reconstructive surgery to correct prolapse of
the uterus. 32.
A 36-year-old man is passing blood in his urine. A pyelogram reveals an
abnormality in 33.
An obese, 45-year-old woman has severe upper abdominal pain after eating a
meal at a 34.
A 42-year-old man is brought to the emergency department with a severe
laceration of 35.
During repair of an inguinal hernia, the inferior epigastric artery was cut
as it passed 36.
A 47-year-old man is diagnosed with a hiatal hernia. During the surgical
repair of this 37.
As part of a weight therapy program, a 35-year-old man underwent resection of
38.
A 47-year-old man with abdominal pain has an abdominal CT scan. It reveals an
39.
After birth, the vessel(s) that bring blood from the placenta to the heart of
the embryo 40.
While exploring the posterior abdominal wall you recall that all of the
following relations 41.
An infant arrives in the emergency department with symptoms of
gastrointestinal 42.
Each of the following structures is involved in the development of the
diaphragm 43.
Ligaments derived from the ventral mesentery include all of the following
EXCEPT the 44.
An infant is born with a rare defect at the umbilicus which expresses urine.
It is probably 45.
An infant in your care is diagnosed with a malformation of the GI tract. MRI
and barium 46.
The former location of the membrane separating the endodermal and ectodermal
portions 47.
An infant has a 46,XY karyotype but exhibits a
normal female phenotype (ovaries, 48.
Both mesonephric ducts sprout two ureteric buds which bifurcate but fail to
penetrate the 49.
An infant is born with female external genitalia and undescended testes
within the 50. Decreased amniotic fluid volume in the absence of causative factors
(such as the rupture 1.
The trachea 2.
Sebaceous glands 3.
The osmolarity of (provisional) urine is not appreciably altered once it 4.
A recent article in the New England Journal of Medicine documented the use of
an inhibitor of 5.
Which statement is correct? 6.
Products in provisional urine that are reabsorbed by cortical nephrons enter
the 7.
In normal tissue, which of the following cell types would you expect to have
the fewest 8.
Which of the following cell types lack a basal lamina or external lamina? 9.
Which type(s) of muscle has/have one synapse on each cell? 10.
A mutant mouse lacks the enzyme that phosphorylates acid hydrolases on
mannose residues at 11.
Under normal conditions, lamellar bodies or their products may appear in
which of the 12.
Which region of the human respiratory tract would have small plates of
hyaline cartilage and 13.
The biochemical composition of surfactant within alveoli most closely
resembles 14.
The thinnest regions of a Type I pneumocyte measure 15.
The total number of renal lobules is identical to the number of 16.
Within the juxtaglomerular apparatus renin is secreted by the 17.
The formation of hypertonic urine in humans is possible because 18.
Which of the following regions would be most intensely stained by antibodies
specific for a 19.
A sagittal (longitudinal) section through the epiglottis was compared to several
cross sections cut 20.
Regarding the nasal cavity, which of the following is correct? 21.
Human olfactory epithelium includes 22.
The Langerhans cells of skin 23.
Cells derived from a serous gland of a mutant mouse were grown in culture. The
secretory 24.
Alport's syndrome results from defective glomerular filtration caused by an
inherited defect in II.
IN THE FOLLOWING SECTION, NOTE THAT THE CORRECT ANSWER IS THE 25.
Regarding the vasa rectae, the following statements are true EXCEPT they 26.
In which compartment would you LEAST expect to find the protein laminin? 27.
The following structures are derived from matrix cells of the hair follicle
EXCEPT 28.
Each of the different segments of bronchioles includes all of the following
components EXCEPT 29.
Regarding the renal corpuscle, all of the following statements are correct
EXCEPT 30.
Which of the following is/are LEAST likely to be a component of the blood/air
barrier? 31.
The following cell types typically may have more than one nucleus EXCEPT 32.
All of the following statements are true for the pulmonary arteries EXCEPT
they 33.
Within the integument, both the stratum basale and stratum spinosum are found
in all of the 34.
One hour prior to sacrifice, a radioactive DNA precursor was injected into a
young mouse. III.
A SET OF LETTERED HEADINGS IS FOLLOWED BY A LIST OF WORDS OR PHRASES. FOR
EACH NUMBERED WORD OR PHRASE INDICATE THE CORRESPONDING LETTER. 35.
Originate in cell derived from neural crest 36.
Lack a unit membrane 37.
Product interacts with intermediate filaments 38.
Product forms intercellular moisture barrier. 39.
Minimal in cells below level of stratum spinosum. A.
Apocrine sweat glands I. FOR THE FOLLOWING QUESTIONS, INDICATE THE LETTER THAT CORRESPONDS TO THE SINGLE MOST APPROPRIATE ANSWER. 1.
Which of the following cell types is/are capable of division? 2.
Which hematocrit and reticulocyte count combination is most likely for a 3.
Which of the following produce(s) mature circulating membrane-bounded
elements that are 4.
Which statement below is true? 5.
Secondary (specific) granules first appear in which stage of granulocyte 6.
The appearance of multiple nucleoli in a proerythroblast is indicative of 7.
An electron micrograph of a small blood vessel in cross section shows several
types of 8.
"Anchoring filaments" 9.
Which of the following substances is not present in normal lymph? 10.
In the formation of an atherosclerotic plaque, platelet derived growth factor
(PDGF) 11.
Which of the following are enclosed by a connective tissue capsule and have
both 12.
The predominant cell type in the lymph node paracortex and in internodular
areas of lymphoid 13.
In an individual born with agammaglobulinemia (i.e., the inability to mount
antibody 14.
A twenty-nine year old female presents with a thymoma (a malignant tumor of
the thymus 15.
Which of the following functions in an autocrine mode during the maturation
of T-helper precursor cells to committed T-helper cells? 16.
Proteolytic cleavage of an intact protein antigen into several antigenic
peptides occurs 17.
A 5-year-old patient presents with recurrent viral infections. Subsequent
tests reveal normal 18.
Platelets 19.
Which of the following are properties of mature red blood cells? They Use
the following experimental model to answer the next three questions (20-22). 20.
Based on the data given in the graph on the left, which conclusions are
justified? 21.
CFU-NM are unlikely to be affected by the (715 GCSFR mutation because 22.
Using the information in both the graph and table, which step in the
differentiation of 23.
Which of the following responses to a foreign body is most closely associated
with neutrophils? 24.
The destruction of lymphocytes within the thymus occurs by 25.
In order for cytotoxic T-lymphocytes to eliminate virus-infected cells, which
combination of Major Histocompatibility Complex (MHC) factors is required for
cytotoxic T-cell activation and subsequent target cell killing? II. IN THE FOLLOWING SECTION, NOTE THAT THE CORRECT ANSWER IS THE STATEMENT THAT IS LEAST LIKELY. 26.
Which of the following is NOT a characteristic of pluripotential hemopoietic
stem cells? 27.
Cell proliferation is a property of the following cells associated with the
adult circulatory 28.
All of the following statements regarding leukocyte granules are correct
EXCEPT 29.
Characteristics of white blood cells include the following EXCEPT they 30.
Which of the following is LEAST likely to be present in the light region of III. MATCH THE NUMBERED QUESTIONS BELOW WITH THE LETTERED OPTIONS A-E. EACH ANSWER MAY BE USED ONCE, MORE THAN ONCE OR NOT AT ALL. Match
the lettered options below with the numbered descriptive phrases related to
the 31.
Continuous with the tunica intima of blood vessels 32.
Thick in the ventricle and thinner in the atrium Match each numbered description with the appropriate lettered vessel below. A.
Lymph capillary 33.
Vessel may have associated pericytes 34.
Has muscular adventitia that is thick Match
the lettered options below with the numbered descriptive phrases related to
the A.
Lymph node only 35.
Nodules in cortex 36.
Subcapsular sinuses present 37.
Medulla present 38.
Supportive stromal cells derived from endoderm III. DIAGRAMS Use the SEM image from a lymphoid organ below to answer questions 39-40. 39.
What structure is marked by X's? 40.
What structure is shown at Y? I.
FOR THE FOLLOWING QUESTIONS, INDICATE THE LETTER THAT 1.
Parenchymal cells of which of the following can be regarded as modified
sympathetic 2.
The primary secretory product from which of the following pancreatic cells is
rich in 3.
A cross section from near the tip of the tongue would include 4.
The mediastinum testis originates from the Large
amounts of colloidal material are characteristically found in the 6.
The histologist determined that a section was NOT from the esophagus because
of the presence of 7.
Spermatozoa first acquire motility in the 8.
The seminal vesicle 9.
The portal tract (portal canal, portal triad) may include one or more
branches of 10.
Lipid storage droplets characteristically are observed in the cytoplasm of 11.
Analysis of sections of developing teeth reveals that 12.
Which of the following secretes a slightly acidic fluid that is rich in acid
phosphatase? 13.
Which of the following indicates a correct order of structures encountered from
the center 14.
Interstitial cells of Leydig have cell surface receptors that make them
physiologically 15.
Centroacinar cells 16.
In the male, recombination of genetic material occurs in 17.
The blood/testis barrier is formed by 18.
The exocrine secretory product of the liver is important in 19.
Which of the following is/are true regarding the developing true placenta? It
20.
Pinealocytes 21.
Fenestrated capillaries are associated with 22.
Galactorrhea (milky secretion from the breast) is often associated with the
most common 23.
Concerning the mammary gland, select the appropriately matched items. 24.
Which of the following is/are lined with an epithelium that includes ciliated
cells? 25.
Which cells undergo morphological change into decidual cells? 26.
Which hormone is secreted into capillaries of the median eminence? 27.
A mouse was injected with 3H-thymidine and sacrificed one hour later.
Sections of mouse small intestine that were prepared for autoradiography
revealed labeled cells 28.
The primary oocyte is arrested in meiosis at 29.
In the digestive system, the muscularis mucosae 30.
The neurohypophysis 31.
In a normal 23-year-old woman, how would the secretory activity of
endometrial glands 32.
To analyze the function of parietal cells, a mouse was sacrificed a short
time after feeding. Biopsies of stomach mucosa analyzed by light and electron
microscopy and measurements of the stomach contents obtained before and after
feeding showed that following feeding the 33.
During absorption of nutrients from the lumen of the small intestine, 34.
The pyloric region of the stomach may be distinguished from the cardiac
region because, in the pylorus 35.
The colon may be distinguished from the jejunum, because, in the colon 36.
Secretion by parathyroid chief cells is directly regulated by a hormone from 37.
Amenorrhea (no menstrual cycle) is frequently observed in women who have a
specific II.
IN THE FOLLOWING SECTION, NOTE THAT THE CORRECT ANSWER IS 38.
Which of the following statements regarding hypothalamic neurons is NOT
correct? 39.
Testosterone directly affects all of the following EXCEPT 40.
Which "ovarian precursor®later structure" relationship is NOT
correct? 41.
In the small intestine, the pairs of cells LEAST likely to lie adjacent to
one another are 42.
The cervix includes all of the following EXCEPT 43.
All of the following are true of the prostate gland EXCEPT it 44.
All of the following are characteristic functions of Sertoli cells EXCEPT 45.
Cells of the adrenal cortex have all of the following EXCEPT 46.
Morphological characteristics of the small intestine include the following
EXCEPT 47.
The following statements describe the histological appearance of the anal
canal EXCEPT III. A SET OF LETTERED HEADINGS IS FOLLOWED BY A LIST OF WORDS OR PHRASES. FOR EACH NUMBERED WORD OR PHRASE, INDICATE THE CORRESPONDING LETTER. A
( if the item is associated with A only. A.
Cytotrophoblasts 48.
Derived from the inner cell mass 49.
The outermost layer of a primary villus 50.
Is in contact with maternal tissue IV. A SET OF LETTERED HEADINGS IS FOLLOWED BY A LIST OF WORDS OR PHRASES. FOR EACH NUMBERED WORD OR PHRASE, INDICATE THE CORRESPONDING LETTER. Match the numbered descriptions regarding cells of the stomach mucosa with the lettered specific cell types, A-E. A.
Parietal cells 51.
Somatostatin secreted by these cells inhibits HCl formation. 52. A major function of these cells requires the intracellular enzyme carbonic anhydrase. A V. GREATER, LESSER or the SAME For the following questions indicate which is greater, A or B, or if they are approximately the same, C. A
= A is greater than B 53.
A. The number of corpora albicantia produced by an ovary during reproductive
life. 54.
A. The number of mitoses in endometrial glands of the uterus during the
follicular 55.
A. The number of lactiferous duct openings in the nipple of a non-pregnant,
post- 56.
A. The amount of mucosal infolding at the ampulla of the uterine tube. VI.
DIAGRAM - SELECT THE LABELED REGION IN THE DIAGRAM THAT Select the letter (A-D) in the diagram of principal cells of the thyroid gland with each function below. Choose E if no appropriate match is shown. 57.
Iodide pump 58.
Site of cleavage of active hormone from thyroglobulin 59.
Storage of T3 and T4 E - not shown in diagram Match the labeled structures in the diagram to identify each description below 60.
Blood with the greatest concentration of ingested nutrients is found here. 61.
Following secretion, secretory IgA (sIgA) is transported by this structure. 62.
A cell found within region B is most likely to be a Use the diagrams below representing various accessory glands of the digestive system to answer the following questions. 63.
Which structure is LEAST likely to be found in the parotid gland? 64.
The exocrine pancreas would consist primarily of which combination of
structures? For the following questions, indicate the letter that corresponds to the SINGLE MOST APPROPRIATE ANSWER. 40.
In a fight a man was hit hard just below his orbit. He has some loss of
sensation to his 41.
Drooping of the upper eyelid and constriction of the pupil could result from
damage to all 42.
Thrombosis (blood clot) of the cavernous sinus usually results from
infections in the orbit, nasal sinuses or superior part of the face. All of
the following structures are 43.
An autonomic pathway from the CNS to the lacrimal gland includes all of the
following structures EXCEPT the 44 . The orbicularis oculi is an important muscle of
facial expression. All of the following statements pertain to it EXCEPT that
it 45.
45-year-old man lost consciousness after receiving a severe blow to the head.
He was brought to the emergency department and diagnosed with an epidural
hematoma. This was probably caused by the rupture of the 46.
During your neurology rotation, you are asked a series of questions about the
sixth cranial nerve. You did well because you knew that the sixth cranial
nerve 47.
A cut just anterior to the ear could sever an artery and a nerve. Which of
the following combinations may have been severed? 48.
All of the following statements regarding components of the autonomic nervous
system in the orbit are correct EXCEPT that 49
A tumor compresses the facial nerve as it exits the cranium. This nerve 50.
47-year-old woman visits your office and complains that she has double vision
(diplopia). During an examination of her eyes, you ask her to look in various
directions to test the integrity of the eye muscles. Select from the options
below the location of the pupil (the direction you would ask her to look) if
you were interested in testing for a functional right superior rectus muscle.
51.
A 53-year-old man has lost vision in his right eye. An MRI reveals a tumor,
confined to the optic canal, compressing the optic nerve. What other
structure(s) is (are) also most 52.
Your patient presents with an advanced stage of squamous cell carcinoma of
the mid-line area of the lower lip. Which of the following groups of lymph
nodes will most likely be 53.
Responding to a domestic violence call, the police officer found a man
bleeding profusely from a wound just above the hairline caused by being hit
by a broken bottle. Which layer 54.
A 20-year-old college baseball player was rushed to the emergency department
after being struck on the lateral side of his head during practice. This blow
resulted in damage 55. A 32-year-old male received a gunshot wound to the face (in the
drawing below) as the result of a drive-by shooting. In the emergency
department, the resident on duty considered structures to avoid during the
removal of the bullet, which was lodged in the mandible. All of the following
structures are likely to be located along the path of the bullet EXCEPT 46.
Pain associated with an infection limited to the middle ear cavity results
from impulses carried 47.
All of the following structures are usually supplied by branches of the
maxillary artery EXCEPT the 48.
An otolaryngologist examined the tympanic membrane of a patient with a middle
ear infection. She recalled that the tympanic membrane 49.
While removing a schwannoma of the vagus nerve, as it exits the skull at the
jugular foramen, the superior cervical ganglion was inadvertently destroyed.
This could result in 50.
All of the following statements concerning the middle ear cavity are correct
EXCEPT that it 51.
A 27-year-old man was struck on the side of his head with a hockey stick,
fracturing the ramus 52.
A bullet that passes through the posterior belly of the digastric muscle
would damage all of the 53.
An oral surgeon corrected the malocclusion of a patient by repositioning the
articular disk of the 54.
"Shingles" is a painful skin disorder that results from a viral
infection in the cell bodies of 55.
A thyroidectomy is performed to remove a tumor. During the procedure, the
surgeon remembered that all of the following statements regarding the thyroid
gland are correct EXCEPT that 56.
A 35-year-old woman complained to her physician that her left hand felt
colder than her right. 57.
Following an injection of a local anesthetic agent around the mandibular
division of the 58.
During exploratory surgery of the posterior triangle of the neck, a surgeon
is aware that all of the 59.
An aneurysm at the bifurcation of the common carotid artery could compress
and damage 60.
An oral surgeon, while correcting an uneven temporomandibular joint, is
especially careful to 61.
In preparation for a thyroidectomy, a resident recalls that all of the
following statements about 62.
While preparing for surgery in the infratemporal fossa, you remind yourself
that the chorda 63.
During resection of the trigeminal ganglion for relief from trigeminal
neuralgia the motor root of 64.
The otic vesicle develops into all the following structures EXCEPT the 65.
Select the lettered part of the figure below that best indicates the
structures that gives rise to the For the following questions, indicate the letter that corresponds to the SINGLE MOST APPROPRIATE ANSWER. 1.
A 9-year-old boy was hospitalized with inflamed palatine tonsils. During
removal of the 2.
A patient with a severe pharyngeal infection would initially have 3.
A fracture originating in the mastoid process that passes through the
stylomastoid foramen may 4.
Injury to the right hypoglossal nerve as it exits the brain stem can result
in 5.
During surgery to remove the structure marked "1" in the diagram
below, a surgeon encountered 6.
During an examination of the area shown in the diagram below, the structure
marked "2" is 7.
After passing through the pterygopalatine fossa, the maxillary nerve sends
branches innervating 8.
A child with a cleft palate was seen by an otolaryngologist. In planning a
surgical procedure to 9.
At a crayfish boil, Keith ate too fast and a small piece of crayfish shell
got caught in the piriform recess. This is an area 10.
Cancerous cells from a tumor of the vestibular fold of the larynx may
directly metastasize to the 11.
A periodontist made incisions in the mucous membrane medial to the mandibular
teeth. He 12. A 85-year-old hypertensive man was brought to the
emergency department with a major, 13.
The pterygopalatine ganglion receives input from 14.
Dr. Cotton used a laryngoscope to examine the vocal cords of a patient
complaining of a 15.
Following an injection of a local anesthetic agent around the mandibular
division of the 16.
A 30-year-old man broke his nose during a boxing match, damaging some of the
nerve supply to 17.
In a patient with an aneurysm of the aortic arch, compression of the left
recurrent laryngeal nerve 18.
While preparing for surgery in the oral cavity, you remind yourself that the
chorda tympani nerve 19.
A 22-year-old army recruit reported to sickbay as a consequence of severely
impacted 20.
A 2-year-old was playing outside with rocks and decided to put one up her
nose. This affected 21.
A patient has symptoms limited to loss of taste from the tongue and decreased
salivary gland 22.
When swallowing a piece of beef tenderloin, the size of the laryngeal inlet,
vestibule and rima 23.
A 72-year-old man had a calculus in his submandibular duct. While removing
the calculus, the 24.
A patient came to your office with a complaint of "food going down the
wrong way". An 25.
A 53-year-old, overweight woman was having difficulty sleeping and snored
quite loudly. To 26.
A woman with a large schwannoma compressing the nerve of the pterygoid canal
would have all For the following questions, indicate the letter that corresponds to the SINGLE MOST APPROPRIATE ANSWER. 1.
An undescended testis is surgically removed from a 24-year-old male. Histological
2.
The stage of oocyte development in the female germ line with the same
chromosome 3.
A 10 week-old male embryo is spontaneously aborted. When examined, it is
found that 4.
The germ cells of an 8-week male embryo are at which of the following stages
of 5
The germ cells of a 12 year-old prepubertal boy are at which of the following
stages of 6.
In a ZIFT procedure, a polar body is removed from an oocyte for chromosome
analysis 7.
Administration of an antiprogesterone compound such as RU-486 is most likely
to result 8.
The embryonal stem (ES) cell is totipotent. It may become incorporated into
virtually 9.
A conceptus is characterized by swollen stem villi and the complete absence
of an Karyotype
Origin of Chromosomes 10.
While Angleman and Prader-Willi syndromes result from disturbances of the
same gene, 11.
A tertiary stem villus is distinguished from both primary and secondary stem
villi by the 12.
During the first week of development of the embryo, a number of events occur.
Which of 13.
From your understanding of the process of gastrulation and of the
nomenclature 14.
The vertebral body at the T-1 level differentiates from (is derived from) 15.
A newborn is diagnosed with a syndrome affecting the development of dorsal
root 16.
Development of the erector spinae muscles of a newborn is abnormal. Which of
the 17.
A newborn has a tuft of hair at the L5 vertebral level. 18.
It is thought that as many as 75% of all human neural tube defects (ntds)
could be 19.
Behavioral testing of a newborn suggests that spinal motor neurons have not
developed Precursor
Location 20.
A developmental abnormality that affects the normal differentiation of the
paraxial 21.
The brain and the spinal cord in the developing human are formed by the 22.
A caudal malformation resulting from abnormal gastrulation characterized by a
tracheal- 23.
As a first-year medical student and during your first physical examination of
a patient 24.
A toddler tripped and fell backwards against the edge of the fireplace. He
sustained a 25.
Eighty-year-old Mrs. Smith has pain in her back and hip which radiates down
into her 26.
A 17-year-old man was accidentally shot at close range with shotgun pellets
while 27.
During surgery to remove a bone tumor (sarcoma) that invaded the left side of
several 28.
During a midline "lumbar tap" to remove a sample of cerebrospinal
fluid, the needle used 29.
You have been introduced to one concept in anatomy which states that
"many muscles, in 30.
At a tennis tournament in 1993, Monica Seles was stabbed in the back just
medial to the 31.
During a physical examination of the vertebral column, your patient complains
of pain as 32.
In addition to the information in the question above, the physician also knew
that 33.
A lesion of the lateral pectoral nerve would cause a partial loss of function
of the 34.
Destroying a ventral primary ramus of a typical spinal nerve would damage 35.
A crushing injury, which has severely damaged the coracoid process of the
scapula, 36.
A 40-year-old woman was diagnosed with breast cancer. The tumor is located in
the 37.
During surgery of the anterior chest wall, you are required to resect (cut
off a part of) the 38.
Unable to release his right hand from the reins, Christopher Reeve was hurled
head- 39.
Pat Day was thrown from his mount at 40.
The Hunchback of Notre Dame suffered numerous maladies. His most apparent For the following questions, indicate the letter that corresponds to the SINGLE MOST APPROPRIATE ANSWER. 1.
A 12-year-old little league baseball player received a direct hit to his
manubrium from a 2.
During surgery to remove a large mass from the esophagus, the intern recalled
that all 3.
Although you are a first year medical student and a novice at using the
stethoscope, you 4.
Which of the following sets of structures are found in the right ventricle? 5.
An intern at the 6.
A tumor located in the bronchomediastinal lymph nodes immediately superior to
the 7.
A knife penetrating the anterior chest wall in the area at the tip of the
arrow below would 8.
A knife-wound to the anterior chest would usually NOT cause a collapsed lung
if it was 9.
In an anterior-posterior X-ray of the chest, the right ventricle would often
be located in 10.
Following a particularly intense workout at the gym, a 25-year-old man
experienced pain 11.
A 54-year-old woman with severe angina experienced pain radiating down the
medial 12.
As you pass a chest tube through the sixth intercostal space of a patient
suffering from a 13.
A knife piercing the 4th intercostal space two inches lateral to the spinous
processes 14.
An individual with a gunshot wound to the chest is diagnosed as having a
damaged left 15.
During a procedure to drain blood from the pericardial sac in a patient
suffering from 16.
The blood flow in the limbs can be increased by surgically sectioning the 17.
A 72-year-old woman has undergone "preventive" angioplasty of her
right coronary 18.
During a 4th year elective in pulmonary disease, you become involved in a
discussion 19.
A 63-year-old man having failed his stress test,
underwent an arteriogram to ascertain the 20.
Surgery in the posterior mediastinum has severely damaged the left greater
splanchnic 21.
An arteriogram of the coronary arteries in a 52-year-old man revealed several
sites of 22.
While skiing out west, a 48-year-old man fell and his ski pole pierced his
thoracic cavity 23.
A 34-year-old man had his left vagus nerve severed as a result of a traumatic
injury to
A. heart. 24.
An MRI of the thorax of a 4-year-old child indicates a mass approximately the
size of a 25.
While reviewing anatomy in preparation for thoracic surgery, you spend some
time 26.
During surgery to remove bony overgrowths from the anterior midline surface
of the CASE STUDY: Questions 27-30 An 84-year-old woman with a history of chronic congestive heart failure complains of being short of breath. Her breathing is rapid and labored. 27.
The movement of the ribs during inspiration involves all of the following
EXCEPT 28.
During your physical exam of the patient's thorax, you note a percussive
dullness and 29.
After withdrawal of 855 ml of fluid, the signs of respiratory distress are
still present. In 30.
Radiographic examination confirmed the foreign body in an airway and showed 31.
The normal adult arterial pattern develops as a result of the formation and
selective 32.
In the adult, the right and left recurrent laryngeal nerves pursue different
paths in the neck 33.
An isolated membranous ventricular septal defect (VSD) could result from
abnormal 34.
The first blood cells in the human embryo are formed in the 35.
A large oblique vein was last observed by U.C. medical students in a cadaver
in 1997. 36.
A persistent communication between the right and left atria is an atrial
septal defect 37.
The vitelline system of veins gives rise to all of the following structures
EXCEPT the 38.
As soon as a newborn takes her first breath, all of the following changes
occur in the 39.
A number of malformations can arise during the various steps of
cardiogenesis. A 40.
All of the following events occur during the first five days of heart
formation: Choose
the letter which corresponds to the correct chronological sequence of the
events. For the following questions, indicate the letter that corresponds to the SINGLE MOST APPROPRIATE ANSWER. 1.
A patient in the emergency room has a penetrating knife wound in the apex of
the femoral 2.
A 48-year-old man visited your office with symptoms that had developed over a
year and that 3.
During surgery to section the flexor retinaculum for carpal tunnel syndrome,
the surgeon must be 4.
In the upper extremity, a pulse may be palpated in all of the following
locations EXCEPT the 5.
A hunter recently returned from a two-week trip into the 6.
A waitress for the past 15 years complains of foot pain after a day's work.
You suspect that she 7.
A 16-year-old female had a fracture of the surgical neck of the humerus as
the result of a 8.
A 16-year-old soccer striker was tripped and fell to the turf on his right
shoulder. On 9.
During surgery to repair a bloody wound in the area of the "anatomical
snuff box," the 10.
A 40-year-old woman has varicosed veins in her left leg which cause her a
considerable amount 11.
A phlebotomist was examining the patient's arms to determine the best site to
draw blood from 12.
As you're running down the street trying to catch a bus, you suddenly twist
your right ankle 13.
During surgical removal of a tumor of the upper forearm, the supinator muscle
was cut, injuring 14.
While playing tackle with his 16-year-old son, the father received a blow on
the lateral side of 15.
All of the following muscles are primarily used in rising from a sitting
position EXCEPT the 16.
A 26-year-old male was stabbed in the upper part of the arm during an
altercation in a barroom.
18.
Dr. McDonough examined the hand of a prize-fighter who had difficulty flexing
the 19.
Jose Canseco complained of severe pain in the hypothenar eminence of his left
hand following 20.
As a required exercise, you have to palpate the pulse of different arteries
of the lower limb. The 21.
Footdrop can be caused by damage to the 22.
Dr. Stern examined the fingers of Red's ace, Denny Neagle. Dr. Stern was
aware that Neagle 23.
A 17-year-old long jumper hyperextended her wrist during
her second jump in a track meet. 24.
Tingling, painful, or itching sensations on the lateral surface of the thigh
may occur in an 25.
A patient with subcutaneous hemorrhages in both cubital areas, secondary to
unsuccessful 26.
A 45-year-old female secretary visited her doctor with symptoms of pain in
her right hand that 27.
A 45-year-old man comes into the emergency department with a stab wound that
severed the 28.
As the result of a motor vehicle accident, a 65-year-old male had a
laceration that severed the 29.
A child falls on a spike, injuring midline structures in the popliteal fossa.
Which of the 30.
The goalie of a 31.
A 30-year-old man went to see his physician because he had problems when
walking. During 32.
An x-ray was taken in a 56-year-old female, revealing a cervical rib (extra
rib in the lower 33.
A 60-year-old woman is diagnosed with varicosed veins in both of her legs. As
a first-year 34.
To prepare for your first day of your orthopedic rotation, you decide to
review the anatomy of 35.
In assessing the functions of the small muscles of the hand, the physical
therapist asks the patient 36.
During the repair of a femoral hernia that has extended into the superficial
fascia of the anterior 37.
A 47-year0old man sustained an injury to his left lower limb. You observe
that his foot is 38.
While drawing blood from the median cubital vein, the underlying
neurovascular structures are 39.
A radiologist wished to catheterize the femoral artery in order to perform an
arteriogram to 40.
A patient has loss of sensation of the skin between the big and second toes.
He could also 41.
The lateral plate mesoderm gives rise to all of the following limb components
EXCEPT For all the following questions, indicate the letter that corresponds to the SINGLE MOST APPROPRIATE ANSWER. 1.
Which of the following properties is associated with nociceptors? 2.
Which of the following reflexes has the SHORTEST response delay or latency? 3.
Synaptic integration depends upon the temporal and spatial summation of EPSPs
and 4.
A structure found at ALL rostro-caudal levels of the brainstem (midbrain,
pons, medulla) is the 5.
An ophthalmologist examined the retina of a elderly
patient who had lost considerable 6.
A tumor of the dorsal horn of the spinal cord at the mid-thoracic level would
MOST 7.
A visual field examination of only the right eye of a 71-year-old patient
revealed a loss of QUESTION
8 8.
This patient probably has a very small (lacunar) infarct in the 9.
Neuropathic pain is a pathological condition that can occur following
peripheral nerve 10.
A 30-year-old man complains of double vision when he looks straight ahead. It
seems 11.
In the dorsal column-medial lemniscus pathway (DCML), the receptive fields of
the 12.
Following cataract surgery, the ophthalmologist examined the lens of his
84-year-old 13.
In normal daylight 14.
All the following statements concerning second messengers in neurons are
correct 15.
Astrogliosis is associated with all of the following EXCEPT 16.
All the following statements concerning the neuromuscular junction (NMJ) are
correct (Questions #17 and 18) A well-known politician was shot in the back during a youth rally. During examination in the emergency department, it was found that the bullet was lodged in the right dorsal column of the spinal cord at the level of the eighth thoracic vertebra. The patient could not feel anything below this level. 17.
The term that best describes this type of nerve injury is 18.
You would expect to find transneuronal degeneration in the 19.
A swimmer jumps from a 10 foot diving board, feet first into the water.
During his 20.
Consequences of hypoxia - ischemia in the CNS include all the following
EXCEPT 21.
Visual acuity 22.
Which of the following properties is NOT CORRECT about the generator
potential? 23.
A tumor in the fourth ventricle (medulloblastoma) that obstructs all of the
fourth 24.
In normal daylight 25.
While driving, you decide to check the speed limit. You look to the side of
the road for a 26.
Which of the following would increase the velocity and efficiency of action
potential 27.
The left lateral geniculate nucleus 28.
In the year 2010, a neurosurgeon used a fiberoptic system to endoscopically
examine the 29.
While a person learns to spin while figure skating there is a change in
firing rate of the 30.
When gated Ca2+ channels open in a cell that was at rest 31.
The cells lining the brain ventricles have all the following characteristics
EXCEPT that 32.
The observation that the uptake of the anticonvulsant drug phenytoin across
the blood- CLUSTER CASE: Audrey is a 45-year-old woman who was brought to her local hospital's emergency room by her husband because of several days of progressive weakness and numbness in her arms and legs. Her symptoms had begun with tingling in her toes, which she assumed to be her feet "falling asleep." However, this feeling did not disappear, and she began to feel numb, first in her toes on both feet, then ascending to her calves and knees. Two days later, Audrey began to feel numb in her fingertips and had difficulty lifting her legs. When she finally was unable to climb the stairs of her house because of leg weakness, had difficulty gripping the banister and shortness of breath, her husband urged her to go to the emergency room. The neurologist who examined Audrey in the emergency room noticed that she was short of breath while sitting in bed. He asked the respiratory therapist to measure her vital capacity, and the value for this was far lower than was expected for her age and weight. Her neurologic examination showed that her arms and legs were very weak, so that she had difficulty lifting them against gravity. She was unable to feel a pin or a vibrating tuning fork at all on her legs and below her elbows, but was able to feel the pin on her upper chest. The neurologist could not elicit any reflexes from her ankles or knees. He subsequently advised the emergency room staff that Audrey needed to have a spinal tap, and be admitted to the intensive care unit immediately. 33.
34.
35.
A light is shone in one eye of a person as indicated in the drawing above,
while the other *
A. 36.
The visual field loss indicated by the drawing above could result from a
hemorrhage of 37.
In examining an unconscious patient which you suspect has a compression of
the rostral 38.
A newborn had a deficient meningeal covering around the spinal cord due to 39.
Both presbyopia and hyperopia For all the following questions, indicate the letter that corresponds to the SINGLE MOST APPROPRIATE ANSWER. 1.
Corticospinal fibers can be injured in a lesion of the 2.
In an examination for resting muscle tone, a physician slowly moves the limb
of a patient in order to detect resistance to passive movement resulting from
3.
Two-year-old children should be able to copy a 4.
Symptoms of unilateral cerebellar lesions include ipsilateral 5.
As a medical student who has just arrived on the pediatric neurology service,
you review head 6.
Fibers in the internal capsule include axons that descend from the cerebral
cortex to synapse 7.
An 18-year-old male was brought to the emergency department following a motor
vehicle 8.
After a viral infection, a 24-month-old girl is hospitalized with idiopathic
thrombocytopenia 9.
A lesion of the entire right inferior colliculus will MOST LIKELY result in 10.
Which of the following develops first in the infant? 11.
An ischemic infarct limited to the right inferior cerebellar peduncle would
lead to central 12.
All the following statements about sound transduction in the cochlea are
correct EXCEPT that 13.
The figure above shows the circuitry of the DIRECT and INDIRECT pathways of
the motor 14.
Cooperative play begins at age (in years) of 15.
A stroke (lacunar or small infarct) in the left posterior limb of the
internal capsule would result in 16.
During testing for the biceps jerk reflex, your goal is to cause an increase
in the 17.
A stroke that resulted in right-sided weakness (hemiparesis) which is more
marked in the arm than in the leg suggests that the site of the occlusion is
MOST LIKELY in the 18.
A 48-year-old male was examined by you, his physician with generalized
complaints about 19.
The stereocilia on a hair cell near the base of the cochlea 20.
A patient presents with a wide-based, ataxic gait during his attempts at
walking. He also is 21.
An 8-year-old boy was admitted to the Children's Hospital Psychiatric unit
because of threatening to run away and kill himself. His mother reported
changes in his behavior over the 22.
While in the hospital, the above patient,
uncharacteristically defecated in his pants. He also 23.
The initial sign of puberty in females is 24.
After an injury to the inferior temporal area, a patient would MOST LIKELY
have a(an) 25.
An eight-year-old boy's normal development is MOST LIKELY to be characterized
by (Questions # 26 and 27): For
each of the definitions listed blow, select the defense mechanism being
described. 26.
Distortion of external reality. 27.
An idea or feeling is kept out of consciousness. 28.
A 56-year-old mechanic joined your HMO. He has a history of a stroke of the
left internal 29.
In an unconscious patient in the emergency department, you lightly touch the
cornea of one 30.
The central pattern generator that sends signals to lower motor neurons for
stepping (walking) 31.
The dorsal root ganglia are to the cuneate nuclei as the spiral ganglia are
to the 32.
You perform the Rinne test on a 35-year-old male and determine that the
patient hears better 33.
All of the following statements concerning the cerebellum are correct EXCEPT
that 34.
A 62-year-old male had a hypertensive stroke. Three days later, when asked
where he lived, he 35.
Among adolescents which of the following is true? (Questions #36-37): A patient suffered a stroke in the area shown by the hatching below. The patient died three months after the stroke. 36.
Symptoms from the above lesion include 37.
Following the death of this patient, sections taken from the CNS and stained
for myelin would 38.
A patient presents with involuntary rapid, flick-like movements of the limbs.
Family history 39.
The imaging technique used to produce the image labeled "A" above 40.
During manual muscle testing you determine that your patient has weakness of
the triceps 41.
A 72-year-old man with prostate cancer has had increasingly severe back pain
for two months 42.
A patient was admitted to the Emergency Department of University Hospital
with a constellation 43.
Fibrillation potentials 44.
During a soccer game a 17-year-old male was knocked to the ground, striking
his head. He was Assuming
a single lesion is responsible for these neurologic deficits, which of the
following fiber combinations / structures have MOST LIKELY been affected by
this lesion? 45.
Output (efferent projections) from the GP/m and/or SNpr go DIRECTLY to all
the following For all the following questions, indicate the letter that corresponds to the SINGLE MOST APPROPRIATE ANSWER. 1.
All of the following are correct statements concerning the EEG EXCEPT that 2.
The conscious perception of emotional states (feelings) is mediated by
connections from the 3.
A 63-year-old hypertensive, diabetic male had a gradual onset of symptoms
that included "tingling" of the right side of his face and right
limbs and difficulty in walking. On neurological 4.
Narcolepsy can be described as having all of the following clinical
characteristics EXCEPT for 5.
A patient with the pathology observed in the Image "Q" in the Image
Collection Page could 6.
MR imaging revealed that a patient with focal onset seizures has an
arteriovenous malformation that is inoperable. Consequently, this patient's
epilepsy must be managed pharmacologically. An antiepileptic drug that
inhibits the enzyme that metabolizes GABA is 7.
A defect in development of the diencephalon could result in abnormal
morphology of all of the 8.
Individuals with deficits in the nigrostriatal dopaminergic system 9.
A 60-year-old man had a cardiorespiratory arrest. After resuscitation his EEG
showed persistent 10.
A 50-year-old Gross Anatomy course director at the U.C. College of Medicine
has a history of 11.
Sexual dimorphism in the central nervous system has been described for all
the following structures EXCEPT the 12.
A form of nonassociative learning that enables a novel stimulus to alert us
to potentially 13.
The nucleus solitarius receives sensory input from neurons associated with
all of the following EXCEPT 14.
A possible role for the calcium ion in the induction of LTP (long-term
potentiation) includes all 15.
Which of the following is an example of an appetitive behavior? 16.
Characteristics of non-fluent aphasia include 17.
A 42-year-old woman is incontinent. After a thorough neurological
examination, it is concluded 18.
A 28-year-old man is brought to you by his family. Two months ago he had a
head injury (went 19.
A patient with impairment of episodic and semantic memory systems would MOST
LIKELY 20.
A 64-year-old woman had a hemorrhage that was restricted to the thalamus. The
resultant "thalamic syndrome" would include all of the following
EXCEPT (Questions
#21 and 22): 21.
The structures affected by the tumor include the 22.
As a consequence of the damage shown in the drawing above, one would expect
axonal 23.
Following a head injury resulting from a motor vehicle accident, a
16-year-old was tested This
patient probably had an injury of the 24.
The amygdala has projections to all of the following structures EXCEPT the 25.
A patient with body neglect and tactile agnosia MOST LIKELY has a lesion of
the (Questions
#26-27): 26.
Structures DIRECTLY affected by this lesion include 27.
Enduring (long term) symptoms expected from this lesion include 28.
All the following are correct statements concerning the effects of an injury
of the peripheral nervous system EXCEPT 29.
An 18-year-old boy does not appear to have undergone puberty and has been
diagnosed with 30.
A 33-year-old woman with a history of multiple chronic stressors presents
with a three-month 31.
A patient with a history of chronic alcoholism and diagnosed with severe
memory impairment 32.
All of the following statements regarding REM sleep are correct EXCEPT that
it 33.
A 55-year-old woman in a psychiatric ward received antipsychotic drug
treatment for her bizarre 34.
After two episodes of "muscle weakness", a 24-year-old woman was
seen by a neurologist. This
patient probably suffered an injury to 35. A 58-year-old woman consulted her physician with the complaint of a right-sided headache that has been increasing in frequency and intensity, "numbness" over her right cheekbone and right forehead, blurred vision, and paralysis of her right eye. A neurological examination revealed ptosis of the right upper eyelid, loss of pupillary reflexes in the right eye, and a total right eye ophthalmoplegia (paralysis of eye muscles). Also, a visual field deficit was detected and is shown below: In
addition, there was loss of sensation over the right side of her face, except
for the mandibular 36.
Inhibition of the hypothalamo-pituitary adrenal axis occurs via 37.
Cells in layer V of the cerebral cortex 38.
A woman was found lying in the street. On admission into the Emergency
Department she had Of the following, the MOST LIKELY cause of her clinical signs is
A. an obstruction of the cortical branches of the left middle cerebral
artery. 39.
All of the following are correct statements about Cajal-Retzius cells EXCEPT
that 40.
Groups of neurons that are considered a part of the reticular formation are
involved in all of the 41.
The increased susceptibility to major depression in women may be because 42.
A 63-year-old man, shivering on a hot August day, was brought to the
emergency department. 43.
An event such as diving into an ice-cold mountain lake after a hot five hour
hike produces 44.
A 5-year-old girl presents with normal intelligence and sudden onset of
seizures. An MRI 45.
The hippocampal formation has projections to all of the following structures
EXCEPT to the (Questions #46-48): 46.
The scan labeled "A" in the above figure is of a normal patient. In
the scan labeled "B", the patient had sustained a right cerebral
hemorrhage, indicated by the white area (arrow). This cerebrovascular
accident MOST LIKELY resulted in 47.
The blood vessel(s) MOST LIKELY responsible for this hemorrhage is (are) the 48.
The imaging technique used to produce the scan labeled "A" 49.
The Kluver-Bucy syndrome is typically associated with lesions of the 50.
A 70-year-old retired accountant comes to see you complaining of difficulty
talking and . FOR THE FOLLOWING QUESTIONS, INDICATE THE LETTER THAT CORRESPONDS TO THE SINGLE MOST APPROPRIATE ANSWER. 1.
The nuclear envelope 2.
Which of the following typical somatic cells would have the highest DNA
content? A cell 3.
The best method to localize the intracellular site of a specific enzyme would
be 4.
What type of epithelium has the following characteristics? The number of
cells at the luminal surface is fewer than the number of cells that contact
the basement membrane, but all cells contact the basement membrane. 5.
Which component makes the least contribution to the sheet-like structure of a
basal lamina? 6.
The cytoplasmic surface of the zonula adherens is most closely associated
with 7.
Using a standard light microscope, careful observation of a histological
section stained with H and E could reveal 8.
Which type of stratified epithelium is characterized by large cells at the
luminal surface that partially protrude from the free surface and may be
binucleate? 9.
After staining with H and E, some cells in a tissue had extensive regions of
cytoplasm that appeared blue. A major activity of these cells would be 10.
Immunocytochemical localization of keratin in a biopsy of a tumor indicates
the tumor originated from 11.
Rickets is a childhood bone disease that is characterized by a low level of
mineralization during bone deposition. Compared to a section of bone from a
normal child, a section of bone from a child with rickets would reveal 12.
Cytochalasins inhibit cytokinesis, but not anaphase separation or movement of
chromosomes 13.
The coordinated movement of cilia within the respiratory tract requires
electrical coupling of ciliated epithelial cells. This coupling is achieved
via 14.
Which of the following contributes to the negative charge on the outer
surface of red blood cell plasma membranes? 15.
The movement of Na+ and K + ions across the plasma membrane by
sodium/potassium ATPase is an example of 16.
The dissociation of low density lipoprotein (LDL) from its receptor occurs in
17.
Laboratory analysis showed that all serum proteins, derived from a particular
patient, terminated in galactose. This observation suggests a specific
glycosyltransferase is lacking that is normally located in the 18.
What protein feature is "monitored" by chaperone proteins? 19.
Dolichol phosphate 20.
The proteolytic conversion of proinsulin to insulin involves enzymatic recognition
of 21.
Which of the following is associated with the role of mitochondria in
apoptosis? 22.
Cross-linked lysine residues contribute resistance to elongation of which
structures? 23.
Lysosomal enzymes 24.
In electron micrographs, regular spacing of heavily-stained bands is seen in 25.
Both bone and dense irregular connective tissue of the dermis contain
substantial amounts of 26.
Which statement regarding peripheral nerve is correct? 27.
The major cytoskeletal component of the mitotic apparatus 28.
Dynein and myosin have in common the property that they 29.
The transverse tubular (TT) system in skeletal muscle 30.
During normal contraction of striated muscle, the 31.
Which of the following statements is correct regarding mitochondria? 32.
The resilient property of elastic fibers results mainly from which of the
following properties? 33.
In large axons, microtubules 34.
NGF (nerve growth factor), BDNF (brain derived neurotrophic factor), and
neurotrophin 3 35.
Stimulation of sympathetic nerves would mobilize lipids from adipose tissues
in the 36.
To determine whether a tumor originated from white fat or brown fat, the most
definitive method would examine 37.
Strips of a simple columnar epithelium were grown in tissue culture and their
apical and basolateral plasma membranes were isolated separately. Biochemical
analysis revealed that the glucose transporter, normally restricted to the
apical membrane, was found in both membrane fractions. Electron microscopy
confirmed the hypothesis that these cultured cells had poorly developed 38.
The major cytoskeletal element that interacts with hemidesmosomes is II. IN THE FOLLOWING SECTION, NOTE THAT THE CORRECT ANSWER IS THE STATEMENT THAT IS LEAST LIKELY. 39.
Characteristics of kinetochores would include all of the following EXCEPT
they 40.
The nucleolus has all of the following characteristics EXCEPT it 41
The smooth endoplasmic reticulum is involved in all of the following EXCEPT 42.
The signal recognition particle is required for synthesis of all of the
following EXCEPT 43.
The intracellular trafficking of a ligand (e.g., IgA) from the basolateral
surface to the apical 44.
Bone and fibrocartilage have in common all of the following EXCEPT 45.
The following are characteristic of all three types of cartilage EXCEPT 46.
Woven bone is found in all of the following EXCEPT 47.
All of the following matches (associations) are true EXCEPT 48.
All of the following statements regarding connective tissue are true EXCEPT 49.
All of the following statements concerning skeletal muscle are true EXCEPT 50.
All of the following are transmembrane proteins EXCEPT 51.
The following statements regarding dendrites are true EXCEPT dendrites 52.
The following statements about osteoclasts are true EXCEPT they III. DIAGRAMS 53.
During normal functioning of the cell surface specializations above, the
cytoskeletal elements (arrows) 54.
During normal functioning of the structure above, the cytoskeletal elements USE THE INDIVIDUAL DIAGRAMS A, B, AND C AND THE (D AND E) COMBINATIONS OF DIAGRAMS TO BEST MATCH THE PHRASES BELOW. 55.
Cells joined by gap junctions. 56.
Each cell directly innervated. 57.
Actin to myosin ratio much greater than six to one. 58.
Fascia adherentes present. Use the diagram of bone below to identify the region indicated. 59.
Identify the site of oldest bone. 60. The diagrams below show three axons (1, 2, and 3) in cross-section. The graphs underneath depict the conductance of action potentials by the axons. Which graph (A - E) shows the most correct representation of the action potential conduction? DO
NOT PRINT EXTRA QUESTIONS 22. Which of the following events is associated with the role of mitochondria in apoptosis? The role of mitochondria in apoptosis includes which of the following? Mitochondrial constituents are associated with which of the following events of the apoptotic cascade B.
Formation by Bax/Bcl-2 heterodimers Immunocytochemistry shows that a specific integrin (6(4, unlike other integrins, is concentrated at epidermal hemi-desmosomes, consistent with biochemical analysis that this integrin interacts with The
basal plasma membranes of epithelial cells adjacent to connective tissue
would be most closely associated with The
zonula adherens is primarily associated with which cytoskeletal element? The
macula adherens is primarily associated with which cytoskeletal element? After
staining a section with a basic dye (stain), you observed the basal cytoplasm
of a group of After
treating tissue with DNA and staining with a basic dye, which of the cellular
components Microvilli
on intestinal absorptive cells contain a core of The
following statements regarding the wide variety of mitochondrial proteins are
true EXCEPT: Pancreatic
acinar cells synthesize and secrete large quantities of digestive enzymes. In
H&E The
secretory products of which cells below, commonly found in connective tissue,
cause FOR THE FOLLOWING QUESTIONS, INDICATE THE LETTER THAT CORRESPONDS TO THE BEST OR MOST LIKELY ANSWER. 1. A cell that has abundant cytoplasmic basophilia also,
characteristically, would have A. virtually no mitochondria. B. abundant peroxisomes. C. an absence of secretory granules. * D. a large nucleolus. E. extensive development of smooth endoplasmic reticulum. 2. DNA and octamers of histones form unit structures that
are visible by transmission electron microscopy. These structures are referred to as A. nucleolar chromatin. B. heterochromatin. C. nuclear pore subunits. * D. nucleosomes. E. euchromatin. 3. An epithelium is composed of a continuous layer of
cuboidal cells resting upon a basement membrane and a layer of tall cells resting on top of the cuboidal
layer. This epithelium would be classified as A. stratified squamous non-keratinized. * B. stratified columnar. C. pseudostratified columnar. D. transitional. E. stratified cuboidal. 4. You are somewhat of a novice in histology and want to
confirm that a tissue is developing muscle. Which of the following reagents would provide
definitive identification? A. Actin antibody * B. Desmin antibody C. Keratin antibody D. Vimentin antibody E. Collagen antibody 2 5. A radioactively labeled compound was injected into a
few cells in a simple columnar epithelium. Thirty minutes later, the epithelium was prepared for
autoradiography. Subsequent analysis revealed that most of the epithelial cells were labeled. These
results were most likely due to the presence of A. cadherins. * B. connexons. C. laminin. D. integrins. E. fibronectin. 6. To understand the relationships among organelles in
cultured secretory cells, you investigate the movement of gold particles from one compartment to another. You
introduce electron-dense, 5nm gold particles specifically into the space between
the inner and outer membranes of the nuclear envelope. Gold particles are inert, cannot traverse unit
membranes, and do not interact with cellular components, but rather serve as a marker for
the movement of cisternal contents. A few hours after successful introduction of the gold
particles, you fix and prepare the cultured cells for thin-section analysis in the transmission electron
microscope. You would expect to find gold particles in the * A. Golgi apparatus. B. nuclear matrix. C. mitochondrial cristae. D. mitochondrial matrix. E. centrioles. 7. Peroxisomes A. are surrounded by two unit
membranes. B. synthesize catalase. C. are the main organelle
associated with I-cell disease. * D. internalize newly
synthesized enzymes from the cytosol. E. store ATP as a major outcome of enzymatic activity. 8. Which of the following conditions would cause
depletion of white fat? A. High levels of epinephrine B. Active firing of sympathetic nerves in fat tissue C. High levels of insulin * D. A and B E. A, B, and C 3 9. In H and E-stained sections of the exocrine pancreas,
acinar cells have apical eosinophilia and basal basophilia. This light microscopy observation is
consistent with which of the following electron microscopy observations or known cell activities? A. Abundant RER in the apical region B. Metabolically inactive cells C. Mitochondria concentrated along infolded basal membrane * D. Secretory products awaiting regulated secretion E. Abundant SER in the basal region 10. The signal recognition particle (SRP) is composed of A. six heterologous proteins. B. six homologous proteins. * C. six heterologous proteins and a piece of 7S RNA. D. six homologous proteins and a
piece of 7S RNA. E. none of the above. 11. During normal embryogenesis, approximately 50% of
spinal cord motor neurons die because they A. are not innervated by
pre-synaptic neurons. B. fail to extend axons into the
ventral root. C. innervate inappropriate
target organs. * D. receive an inadequate
supply of trophic factor(s) from the target organs. E. express antigens recognized by the immune system as
foreign. 12. As a gastroenterologist, you are specifically interested
in understanding how bacterial toxins change the permeability of the simple columnar epithelium
lining the intestine and contribute to gastrointestinal disease. One of your research goals is to determine
whether a specific toxin changes the morphology of the zonula occludens. For these
studies, the research tool that would be most informative is A. the periodic acid Schiff method. B. scanning electron microscopy. * C. freeze-fracture electron microscopy. D. autoradiography. E. hematoxylin and eosin staining. 4 13. Cessation of protein synthesis in an epithelium would
have the greatest effect on the formation of A. collagen type I. * B. laminin. C. collagen type II. D. fibronectin. E. collagen type III. 14. Portions of the sequence of two related proteins are
compared below using the single letter code for amino acids. Protein 1 gas gpm gpr gpp gpp gkn gdd
gea gkp grp ger gpp gpq gar glp gta glp gmk ghr Protein 2 gdp glf gli gpk gdp gnr ghp
gpp gvl vtpplplk gpp gdp gfp gry get gdv gpp gpp If these selected sequences are representative, what is
protein 2? A. A mutant form of protein 1 B. Collagen type I C. Collagen type II * D. Collagen type IV E. s-laminin 15. Fat cells in a section of human tissue showed
positive labeling with antibodies specific for “uncoupling protein”. The most likely explanation is
that the A. labeling is artifactual and nonspecific. * B. labeled cells are brown fat cells. C. patient is diabetic, with chronically low insulin
levels. D. positive cells are a unilocular fat tumor. E. positive cells are undifferentiated progenitor cells. 16. A DNA content of 4N and diploid chromosome number
would indicate that cells were in a stage of the cell cycle immediately prior to the start of A. the first division of meiosis only. B. mitosis only. C. the second division of meiosis only. * D. either meiosis or mitosis. E. S phase. 5 17. A karyotype from a person with Klinefelter’s syndrome
that showed two X and one Y chromosome is an example of A. translocation. B. double minutes. C. triploidy. * D. trisomy. E. euploidy. 18. The two diagrams below depict skeletal muscle in two
different stages of contraction. The number of thick filament crossbridges in contact with
thin filaments * A. is higher in 1 than in 2. B. is higher in 2 than in 1. C. is the same in both micrographs. D. is zero in both micrographs. E. cannot be determined by inspection of the micrographs. 1 2 6 19. Which of the following features contribute directly
to the tensile strength of collagen fibers? A. Intermolecular cross-linking of lysine residues B. Ordered polymerization C. Glycosylation of hydroxyproline and hydroxylysine
residues * D. A and B E. A, B, and C 20. A patient with Hurler’s syndrome had abnormal bone
structure due to a lysosomal deficiency of iduronidase, the enzyme that breaks down GAGs. Other lysosomal
enzymes were normal in this patient. Exposure of the patient’s cultured cells to the enzyme
iduronidase restored enzyme activity within lysosomes. These data indicate that the patient’s
cells A. lack mannose phosphorylating enzyme. B. have defective lysosomal
membrane channel proteins. C. lack a mannose 6-phosphate
receptor in the Golgi apparatus. * D. synthesize defective
iduronidase. E. lack receptors for lysosomal enzyme in the plasma
membrane. 7 21. Application of a fluorescent-labeled keratin antibody
to cultured epithelial cells (shown below) revealed filamentous structures that end at dark
unlabeled regions at the lateral surfaces of the cells. These unlabeled areas (arrows) at the end of the
filaments indicate the presence of A. zonula occludens. B. gap junctions. C. zonula adherens. * D. macula adherens. E. glycocalyx. 22. Compared to other regions of cartilage, the capsular
matrix is enriched in A. calcium salts. B. collagen type I. C. collagen type II. D. elastin. * E. proteoglycans. 8 23. The type of muscle depicted in the electron
micrograph below A. is most abundant in the forearm. B. arises by cell fusion during development. * C. contracts at low velocity and low energy expenditure. D. occurs as single cells joined together by intercalated
discs. E. undergoes hypertrophy, but not hyperplasia. 24. The resilience of elastic fibers primarily results
from which of the following properties? A. Substantial á-helical
structure * B. Random coil polypeptide structure C. Extensive glycosylation D. Cross-linking of individual polypeptides E. Microfibrils 9 One strategy for identifying basal (external) lamina
components that might attract regenerating axons was to generate antibodies against whole basal lamina and
test whether the components recognized by the antibodies were restricted to the neuromuscular
junction. The two panels in the figure below show the same histological section containing several skeletal
muscle fibers (X) cut in cross-section. The section was double-labeled with Antibody A (panel a) and
Antibody B (panel b). In both cases, positive labeling is represented by bright areas, over a black background. 25. The pattern of labeling by Antibody A is consistent
with reactivity toward which of the following components? A. Collagen type IV * B. s-laminin C. Fibronectin D. A and B E. A, B, and C 26. The pattern of labeling by Antibody B is consistent
with reactivity toward which of the following components? * A. Entactin B. Agrin C. Fibronectin D. A and B E. A, B, and C 27. Exposure of a simple columnar epithelium to a
compound that disrupts actin polymerization would affect mainly A. gap junctions. * B. zonula adherens. C. macula adherens. D. hemidesmosomes. E. zonula occludens. C =
capillary X =
skeletal muscle fiber X X X X X 10 28. In electron micrographs, regular spacing of
electron-light and electron-dense bands is observed in A. microtubules. B. elastic fibers. C. laminin. * D. collagen type I fibrils. E. collagen type IV. 29. Which of the following statements is/are true? The
thin filaments in skeletal muscle differ from purified F-actin filaments in that 1. thin filaments are all approximately the same length
whereas F-actin can polymerize to a much greater length. 2. thin filaments interact with
myosin whereas purified F-actin does not. 3. thin filament-myosin interactions are sensitive to Ca++ levels
whereas F-actin- myosin interactions are not. A. 1 only B. 2 only C. 1 and 2 only * D. 1 and 3 only E. 1, 2 and 3 30. Which of the following contributes to the
electronegativity of the red blood cell plasma membrane? A. Phosphatidyl choline B. Phosphatidyl ethanolamine * C. Phosphatidyl serine D. Sphingomyelin E. None of the above. 11 The figure below shows a section of bone, examined by
fluorescence microscopy, from an adult patient who received two doses of tetracycline separated by a 12-day
interval. 31. Which statement regarding the pairs of bright
fluorescent lines indicated by single arrows is correct? * A. Collagen laid down here is likely to be highly aligned. B. The lines are portions of Haversian canals cut in
longitudinal section. C. Resorption is occurring more rapidly than deposition. D. In these regions, cartilage is being converted to
bone. E. These indicate sites of bone inflammation. 32. The discontinuity in the pair of fluorescent lines
indicated by the double arrow most likely results from A. presence of a blood vessel. * B. osteoclast action. C. fresh deposition of osteoid. D. incomplete mineralization. E. a stress fracture. 33. An investigator adds Protein X (a 60,000 MW anionic
protein) to mouse L cells. The L cells internalize 50 picograms/cell of Protein X in one hour. When the
investigator increased the concentration of Protein X ten-fold, the cells still internalized 50
picograms /cell/hour. The most likely mode of entry of Protein X into the cells is A. fluid phase pinocytosis. B. non-specific, adsorptive pinocytosis. C. passive diffusion. D. phagocytosis. * E. specific, adsorptive pinocytosis. bone marrow bone 12 34. Injury to two adjacent Schwann cells of a myelinated
nerve results in an unmyelinated segment of axon, as indicated below: Brief stimulation of this cell body induces an action
potential. Which graph below best represents the movement of the action potential along the axon? time distance time distance distance time distance time time distance E D C B A 13 35. Assume that you are studying the synthesis of
glycophorin. Put these items in the order in which they would participate, starting with the earliest. 1 =
dolichol phosphate; 2 = galactosyl transferase; 3 = signal recognition particle; and 4 =
sialosyltransferase. A. 3, 2, 4, 1 B. 3, 1, 4, 2 C. 1, 3, 2, 4 * D. 3, 1, 2, 4 E. 1, 3, 4, 2 36. After freely diffusing into cells, ammonium chloride
(NH4Cl) dissociates into ammonia and chloride ions. The ammonia next diffuses into acidic
intracellular compartments where it is protonated (becoming NH4 + ).
This results in alkalinization of these compartments. Which structure would be most affected by this treatment? A. Cis-Golgi apparatus * B. Late endosomes C. Medial-Golgi apparatus D. Plasma membrane derived coated vesicles E. Rough endoplasmic reticulum 37. Ultrastructural analysis of liver cells obtained from
an individual suffering from a disease of unknown origin showed the proliferation of round,
membrane bounded structures of homogeneous appearance and medium electron opacity. Biochemical
analysis of the contents of the structures showed that they were acid phosphatase
negative and glycosyl transferase negative, but were capable of removing hydrogen atoms from
organic substrates. The structures are most probably A. endosomes. B. Golgi apparatus. C. mitochondria. * D. peroxisomes. E. lipid droplets. 38. In skeletal muscle, the sarcoplasmic reticulum
responds to depolarization of the sarcolemma by A. releasing acetylcholine. B. sequestering Ca++ . C. hydrolyzing ATP. * D. releasing Ca++ . E. releasing Na+ . 14 To investigate the mechanisms of axoplasmic transport,
investigators expressed a naturally-fluorescent version of one of the neurofilament subunit proteins in cultured
sympathetic neurons. These fluorescent neurofilament proteins assembled into filaments and the
movement of these filaments along the axon was examined in real time by fluorescence microscopy. The
graph below shows the movement of one labeled filament. (s, seconds) 39. Which of the following conclusions is justified by
the results of this analysis? A. The velocity varies, but is always within the accepted
range for fast axonal transport. B. The velocity varies, but is always within the accepted
range for slow axonal transport. * C. The average velocity is characteristic of slow
axonal transport, although it includes bursts of movement at much more rapid rates. D. The average velocity is characteristic of fast axonal
transport, although it includes movements at much slower rates. 40. Apoptotic cell death is characterized by A. inactivation of caspase 8. B. sequestration of cytochrome C in the mitochondrial
intermembrane space * C. specific endonuclease products. D. Bcl-2/Bcl-2 dimer formation. 15 The graph below shows the results of a chip-array
analysis of the effect of estrogen on cultured mammary epithelial cells. 41. Which conclusions are justified by these results? A. Estrogen does not decrease the transcription of any
genes. B. Estrogen has pronounced effects on translation of some
target genes. * C. Transcription of the majority of genes is unaffected
by estrogen. D. The stability of some proteins is enhanced more than
10-fold by estrogen. E. None of the above. control Estrogen-treated 16 II. IN THE FOLLOWING SECTION, NOTE THAT THE CORRECT
ANSWER IS THE STATEMENT THAT IS LEAST LIKELY. 42. A deficit in the gene encoding N-acetylglucosamine
phosphotransferase would result in all of the following EXCEPT A. I-cell disease. B. lysosomes without enzymes. * C. addition of mannose-6-phosphate on lysosomal
enzymes. D. exocytosis of lysosomal enzymes. E. alteration of a function in the cis-Golgi apparataus. 43. All of the following are found within both calcified
cartilage and bone EXCEPT A. hydroxyapatite crystals. B. glycosaminoglycans. C. lacunae. * D. collagen type I. E. cells derived from mesenchyme. 44. The following statements are true for mitochondria
EXCEPT they A. divide by fission. B. have F0/F1 (ATP
synthase) complexes associated with the inner membrane. * C. contain DNA that encodes
for all their proteins. D. contain enzymes for Kreb’s
cycle (TCA cycle) mostly in the matrix. E. have an outer membrane that
is permeable to many small molecules. 45. All the following statements regarding nerve growth
factor (NGF) are true EXCEPT it A. promotes survival of sensory neurons. B. promotes extension of neurites from sensory neurons. C. is produced by target tissues. D. binds to trk receptors. * E. promotes division of sensory ganglion cells. 17 46. All of the following interactions play a key role in
the assembly of basal laminae EXCEPT A. entactin - collagen type IV. B. laminin - entactin. C. collagen type IV- collagen type IV. D. laminin - laminin. * E. hylauronic acid - collagen type IV. 47. Clathrin is directly involved in all of the following
EXCEPT A. endocytosis of exogenous proteins that enter cells via
receptor-mediated endocytosis. * B. transfer of ligands from late endosomes to
lysosomes. C. movement of newly synthesized lysosomal enzymes from
the trans-Golgi region to primary lysosomes. D. movement of newly synthesized enzymes from the
trans-Golgi region to secretory granules in pancreatic acinar cells. 48. All of the following are true of the RER-associated
chaperone proteins EXCEPT they A. are integral RER proteins. B. reduce and re-oxidize S-S
groups on nascent proteins. C. function by reading the secondary and tertiary
structure of nascent proteins. * D. add the high mannose
oligosaccharide tree onto N-linked glycoproteins. E. are synthesized in the RER. 18 III. MATCH THE NUMBERED OPTIONS BELOW WITH THE LETTERED
OPTIONS A-E. EACH ANSWER MAY BE USED ONCE, MORE THAN ONCE OR NOT
AT ALL. Match the organelle (A-E) with the numbered choices. A. Lysosome B. Smooth endoplasmic reticulum C. Rough endoplasmic reticulum D. Mitochondrial inner membrane E. Plasma membrane 49. Signal peptidase C 50. Band III dimers E Match the surface modifications/specializations (A-E)
with the numbered descriptions or functions. A. Stereocilia B. Microvilli C. Cilia D. Both stereocilia and microvilli E. Both microvilli and cilia 51. In the light microscope, these structures are
numerous, have a thick glycocalyx, and appear as an apical striated (brush) border on cells in a simple columnar
epithelium. B 52. Basal bodies provide an anchoring function in these
structures. C 19 Match the numbered descriptions related to cell division
with the lettered stages (A-E) of the mitotic and/or meiotic cell cycle. A. S-phase B. Prophase C. Metaphase D. Telophase E. Interphase 53. Nuclear envelope breakdown occurs late in this stage. B 54. Stage usually used for analysis of chromosome
banding, number and morphology. C A B C D E Type I Collagen Type I Collagen Type II Collagen Type II Collagen Type IV collagen Type II Collagen Fibronectin Glycoproteins Type III Collagen Laminin Fibronectin Proteoglycans Proteoglycans Fibronectin
Proteoglycans For each tissue listed in questions 54 & 55 below,
select the letter from the chart above that best represents the composition of the tissue. 55. Fibrocartilage A 56. Elastic cartilage C 20 Match the type(s) of muscle with the characteristics
given below. A. Smooth muscle B. Cardiac muscle C. Skeletal muscle D. Cardiac and skeletal muscle E. Smooth and cardiac muscle 57. T tubules D 58. Neuromuscular junction on each cell C |