CCEB Part A 2023 questions and answer

CCEB Part A 2023 questions and answer Esophagus epitheium - Stratified squamous epithelium Middle cluneal nerve - S1-S3 PPR Superior cluneal nerve - L1-L3 PPR Inferior cluneal nerve - S1-S3 APR Medial or lateral PPR of C2-T6 supplies the intrinsic back muscles and skin? - Medial Medial or lateral PPR of T7-S3 supplies the intrinsic back muscles and skin? - Lateral Respiratory tract epithelium - Columnar pseudostratified epithelium Transitional epithelium - Ureter, urinary bladder, most of urethra Suboccipital triangle - Rectus capitis posterior major, obliquus capitus superior / inferior Carotid triangle - SCM, post belly of digastric, sup belly of omohyoid Posterior cervical triangle - SCM, trapezius, middle 1/3 of clavicle Inguinal triangle of Hesselbach - Rectus abdominis, inf epigastric vessels, inguinal ligament - Direct hernias Femoral triangle - Inguinal ligament, medial border of sartorius, adductor longus Guyon's canal - Ulnar n. and a. Surface markings - 2nd R intercostal space - aortic 2nd L intercostal space - pulmonary 4th L intercostal space - tricuspid 5th L intercostal space midsternal line - mitral Aorta bifurcates at [spinal level] - L4 Anterior tibial a. continues into foot as... - Dorsalis pedis artery Adrenal cortex hormones - Zona glomerulosa - mineralocorticoids (aldosterone) under renin Zona fasciculata - glucocorticoids (steroids) under ACTH Zona reticularis - sex hormones Blood supply for GI - Esophagus - proximal 1/2 duodenum (celiac trunk) Distal 1/2 duodenum - proximal 2/3 transverse colon (superior mesenteric a.) Distal 1/3 transverse colon - proximal 1/2 anal canal (inferior mesenteric a.) Retroperitoneal structures - Ascending/descending colon Pancreas Adrenals Rectum (lower 2/3) Kidneys Aorta IVC Duodenum (2nd - 4th parts) 3 layers of stomach smooth muscle - Outer longitudinal Inner circular Innermost oblique Longitudinal mucosal folds above pectineal line - Columns of Morgagni Pectineal line - Upper 1/2 - insensitive to pain Lower 1/2 - sensitive to pain Synarthrosis - Fibrous joint (immobile) Amphiarthrosis - Cartilaginous joint Diarthrosis - Synovial joint Synchondrosis - Primary cartilaginous - epiphyseal growth plate Symphysis - Secondary cartilaginous Hilton's law - The nerve which innervates a muscle that acts on the joint, will supply the joint Endomysium - Surrounds individual muscle fibers Perimysium - Surrounds fascicle Epimysium - Surrounds entire muscle Smooth muscle - No cross striation Spindle-shape Central nucleus Involuntary Skeletal muscle - Cross striations Elongated peripheral nucleus Voluntary Cardiac muscle - Cross striation Branches Intercalated disc Central nucleus TMJ joint type - Compound hinge and gliding joint Upper: protraction/retraction Lower: elevation/depression Elbow - Distal end of humerus Head of radius Trochlea of ulna Wrist joint - Distal radius Scaphoid Lunate 1st CMC joint - Trapezium + 1st MC Saddle Hip ligaments - Iliofemoral (Y) Pubofemoral Ischiofemoral Where do spermatozoa mature? - Epididymis Where is spermatozoa stored? - Ductus deferens What innervates the penis? - Pudendal n. (S2-4) Pelvic splanchnic nerve (S2-4) What does the uterus attach to? - Ovary - round ligament of ovary Labia majora - round ligament of uterus Broad ligament Where does the trachea begin? - C6 Where does the trachea end? - T4/5 What is the bifurcation of the trachea called? - Carina What innervates the lung pleura? - Parietal layer - intercostal and phrenic n. Visceral layer - CN X autonomic inn. What is another name for the suprapleural membrane? - Sibson's fascia 3 openings of the diaphragm - T8: IVC, phrenic n., pericardiacophrenic vessels T10: esophagus, vagus n. T12: aorta, thoracic duct, azygos v. Medial arcuate ligament - Over psoas mm Lateral arcuate ligament - Over QL Median arcuate ligament - Connects L and R crura over aorta What is in the outer cortex of lymph nodes? - B cells organized into follicles (germinal centers w/ activated B cells) What is in the inner cortex of lymph nodes? - Mature T cells What does the spleen do? - Red pulp: destroys old RBCs White pulp: immune system What suspends the liver? - Coronary ligament - to undersurface of diaphragm What is the functional unit of the liver? - Sinusoids lined by hepatocytes and Kupffer cells What is the function of the thymus? - T cell maturation When does the thoracic duct begin (caudal)? - Cisterna chyli (L1) Where does the thoracic duct empty into? - L internal jugular and subclavian vein What type of epithelium is the epidermis? - Stratified keratinized squamous epithelium What do Merkel cells do? - Crude touch What do Meissner's corpuscles do? - Pressure What do Pacinian corpuscles do? - Vibration What do Ruffini corpuscles do? - Joint position sense What attaches the liver to the umbilicus? - Falciform ligament What type of sweat gland is most abundant? - Eccrine gland - thermoregulation What sweat gland secretes an oily mixture? - Apocrine What does the manubrium articulate with? - Clavicle 1st rib Part of 2nd rib Body of sternum Classification of ribs - Ribs 1-7: true Ribs 8-10: false Ribs 11-12: floating Which ribs only have 1 articular facet? - 1, 10-12 Where does the neurovascular bundle run between ribs? - Between internal and innermost muscles What is the apocrine gland called in the axilla with most lymph nodes? - Tail of Spence What ligament suspends the breast glandular tissue? - Suspensory ligament of Cooper What spinal level does the manubriosternal joint correspond to? - T4/5 What type of cell lines the esophagus? - Stratified non-keratinized squamous epithelium What layers of muscle line the esophagus? - Upper 1/3 - skeletal Middle 1/3 - mixed Lower 1/3 - smooth What type of cell is the ureter? - Transitional epithelium What is the pathway of the ureter? - Downwards on psoas -> over bifurcation of common iliac a. -> passes over ductus deferens / uterine artery Easiest spread of prostatic cancer - Lumbar vertebrae What type of joints are facet joints? - Planar synovial What motion do T/S facets allow? - Primary: rotation Secondary: flexion Where does 50% of cerivcal flexion/extension occur? - C0-C1 Where are the 2 regional enlargements of the spinal cord? - C6 (brachial plexus) Lumbosacral plexus What does the filum terminale interna do? - From conus medullaris to end of dural sac (S2) What does the filum terminale externa do? - Fuses filum terminale with dura and extends to coccyx Where is the interomediolateral horn located? - T1-L2 UMNL - Spasticity Incr reflexes w/ clonus No atrophy or fasciculations Babinski's sign LMNL - Flaccidity Decr or absent reflexes Atrophy and fasciculations Absent Babinski's sign What type of cell lines the BBB? - Astrocytes What type of cell makes CSF? - Ependymal cells Circle of Willis - Anterior communicating artery Anterior cerebral artery Internal carotid artery Posterior cerebral artery Posterior communicating artery Where do the olfactory nerves pass through? - Cribriform plate (ethmoid bone) Where is the optic chiasm? - Above pituitary fossa What Brodmann's area is the visual cortex? - Brodmann's area 17 CN III functions - Extra-ocular muscles of eye except SO and LR Parasympathetic fibers from Edinger-Westphal ncl in midbrain to ciliary ganglion What are the first order neurons for the cochlear system? - Organs of Corti in inner ear Where is the primary auditory cortex? - Superior temporal gyrus (Brodmann's area 22) Where are the blood pressure receptors linked to CN IX? - Internal carotid artery: - Carotid body (chemoreceptors) - Carotid sinus (baroreceptors) How far down does vagus parasympathetic innervation reach? - As far as transverse colon Internal capsule limbs - Anterior limb: thalamocortical fibers Genu: corticobulbar fibers Posterior limb: corticospinal tract VPL thalamus input - From neck and below VPM thalamus input - From head Cerebellum lobes - Anterior - spinocerebellum Posterior - cerebrocerebellum Flocculonodular - vestibulocerebellum Cerebellum nuclei - Fastigial - spine Globose - proximal joints Emboliform - middle joints Dentate - distal joints What type of junction is the BBB? - Tight junctions What molecules require carrier-mediated transport across the BBB? - Glucose Amino acids What substances readily cross the BBB? - Lipid-soluble substances What is the main blood supply to the cortex? - Middle cerebral aa. PICA syndrome - Ipsilateral Horner's syndrome Ipsilateral loss of light touch and position sense Contralateral loss of pain and temperature Where is CSF produced? - Choroid plexus in lateral ventricles Where does CSF collect? - Cisterna When does the anterior fontanelle close? - 18mos When does the posterior fontanelle close? - First 2-3 mos What comes out of the superior orbital fissure? - CN III, IV, V1, VI What comes out of the foramen retundum? - CN V2 What comes out of the foramen ovale? - CN V3 What comes through the foramen lacerum? - Internal carotid artery What comes through the internal auditory meatus? - CN VII, VIII What comes through the jugular foramen? - CN IX, X, XI What comes out of the hypoglossal foramen? - CN XII UMNL affecting CN - Able to raise eyebrow on affected side LMNL affecting CN - Unable to raise eyebrow on affected side Phrenic nerve - C3-C5 Brachial plexus nerve roots - C5-T1 APR Brachial plexus trunks - Upper: C5-C6 Middle: C7 Lower: C8-T1 Brachial plexus cords - Posterior cord: all posterior divisions (C5-T1) Lateral cord: anterior division of upper and middle trunks (C5-C7) Medial cord: anterior division of lower trunk (C8-T1) Posterior cord divides into... - Axillary nerve (C5-6) Radial nerve (C5-T1) Musculocutaneous nerve comes from... - Lateral cord Dorsal scapular nerve - C5 Levator scapulae, rhomboids Long thoracic nerve - C5-C7 Serratus anterior Suprascapular nerve - C5-C6 Supraspinatus, infraspinatus Thoracodorsal nerve - C6-8 Latissimus dorsi Upper and lower subscapular nerves - Subscapularis Erb-Duchenne palsy - Damage to C5-6 nerve roots Waiter tip appearance: elbow extended, forearm pronated, fingers flexed Klumpke palsy - Damage to C8-T1 nerve roots Claw hand Lateral femoral cutaneous n. - L2-3 Genitofemoral n. - L1-2 Femoral n. - L2-4 Obturator n. - L2-4 Superior gluteal n. - L4-S1 Inferior gluteal n. - L5-S2 Sciatic n. - L4-S3 Superficial peroneal nerve - Peroneus longus / brevis Skin on dorsum of foot except web space between 1st and 2nd Deep peroneal n. - TA, EHL, EDL, peroneus tertius Skin on web space between 1st and 2nd Parasympathetic nerves - CN III, VII, IX, X S2-S4 Myenteric plexus of Auerbach - Between inner circular and outer longitudinal smooth mm Meissner's plexus - Submucosal Regulates secretion of intestinal glands Nociception from esophagus to splenic flexure - Sympathetic fibers Nociception from splenic flexure to rectum; bladder to prostate - Parasympathetic fibers Hering-Breuer reflex - Inflation of lungs causes diaphragm to relax Afferent (vagus n.) Efferent (phrenic n.) What connects cardiac muscle - Intercalated discs with gap junctions What is syncytium? - Synchron