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🔖Gonadal drainage

🔹Venous drainage:

Left ovary/testis ➡️ left gonadal vein ➡️ left renal vein ➡️ IVC

Right over/testis ➡️ right gonadal vein ➡️ IVC

Left gonadal vein takes the Longest way.

Because the left spermatic vein enters the left renal vein at a 90 degree angle, flow is less laminar on the left than on right
➡️ left venous pressure > right venous pressure
➡️ varicocele more common on the left.

Source: #FirstAid #2017

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Foramina: Cranial Fossae📝 question #1
A 24-year-old man is brought to the emergency department 40 minutes after he was involved in a motor vehicle collision. He was the unrestrained driver. He is conscious. Physical examination shows numerous lacerations and ecchymoses over the face. His vision is normal. Ocular, facial, and lingual movements are intact. The gag reflex is present. Sensation to pinprick is absent over the right side of the face anterior to the right ear, extending down along the full extent of the mandible to the chin. Sensation also is absent over the right side of the tongue. X-rays of the skull show fractures of the orbit, zygomatic arch, and infratemporal fossa. The most likely cause of these findings is a fracture affecting which of the following locations?

A) Foramen lacerum
B) Foramen ovale
C) Foramen rotundum
D) Foramen spinosum
E) Jugular foramen

#anatomy #cranium #foramina

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The correct answer is B. 👆

Today's bonus: Clinical Correlate 🏥💉

Jugular foramen syndrome may be caused by a tumor pressing on CN IX, X, and XI. Patients present with hoarseness, dysphagia (CN IX and X), loss of sensation over the oropharynx and posterior third of the tongue (CN IX), and trapezius and sternocleidomastoid weakness (CN XI). The nearby CN XII may be involved, producing tongue deviation to the lesioned side.

#jugular #foramen #nerves

Medial Medullary Syndrome 📝 (A on the picture below)

🔸Due to occlusion of the Anterior Spinal Artery

Brain-stem lesion:
🔹Pyramid: contralateral spastic paresis
🔹Medial lemniscus: contralateral loss of tactile, vibration, conscious proprioception
🔹XII nucleus/fibers: ipsilateral flaccid paralysis of tongue with tongue deviation on protrusion to lesion side.

Figure III-5-17.
Source: Anatomy. Kaplan 2017.

#medulla #lesions #anatomy

Practice question #2

A child is in the nursery one day after birth. A nurse notices a urine-like discharge being expressed through the umbilical stump. What two structures in the embryo are connected by the structure that failed to obliterate during the embryologic development of this child?

A) Pulmonary artery - aorta
B) Bladder - yolk sac
C) Bladder - small bowel
D) Liver - umbilical vein
E) Kidney - large bowel

#embryology
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Pharyngeal apparatus📝

🔹Pharyngeal apparatus consists of the following:
▫️Pharyngeal arches (1,2,3,4 and 6) composed of mesoderm and neural crest
▫️Pharyngeal pouches (1,2,3,4) lined with endoderm
▫️Pharyngeal grooves or clefts (1,2,3, and 4) lined with ectoderm

🔹Components of the Pharyngeal arch (mesoderm -> muscles):
▫️1st: four muscles of mastication (masseter, temporalis, lateral and medial pterygoid), digastric (anterior belly), mylohyoid, tensor tympani, tensor veli palatini
▫️2nd: muscles of facial expression, figastric (posterior belly), stylohyoid, stapedius
▫️3rd: stylopharyngeus muscle
▫️4th: cricothyroid muscle, soft palate, pharynx (5 muscles)
▫️5th: intrinsic muscles of larynx (except cricothyroid muscle)

🔹Components of the Pharyngeal arch (neural crest -> skeletal/cartilage) - will be covered later.

🔹Adult derivatives of Pharyngeal pouches
▫️1st: epithelial lining of auditory tube and middle ear cavity
▫️2nd: epithelial lining of crypts of palatine tonsil
▫️3rd: Inferior parathyroid gland, thymus
▫️4th: superior parathyroid gland, C-cells of thyroid

🔹Pharyngeal groove/cleft 1 gives to the epithelial lining of external auditory meatus. All other grooves are obliterated.

Source: Anatomy. Kaplan 2017
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Explaination # 1 👆D) Remember that in viewing axial or transverse CT scans through the body, the right side of the patient is to your left and the left side to your right. In other words, the feet of the patient are toward you and the head away from you. The back of the patient is at the bottom of the image and the front of the patient toward the top. Directional terms are always in reference to the patient. The insert at the bottom right indicates the level of the section. Arrow 1 indicates the right brachiocephalic vein. The left brachiocephalic vein (choice B) is seen as the elongated structure immediately posterior to the manubrium of the sternum and to the left of the right brachiocephalic vein. Immediately posterior to the left brachiocephalic vein is the brachiocephalic artery (choice A, arrow 2). To the left of the latter are the left common carotid artery (choice C) and the left subclavian artery (arrow 3). The superior vena cava (choice E) is not seen at this level because the right and left brachiocephalic veins are still separate.

Explaination 👆. (B) Arrow 2 points to the gallbladder, which will be removed during the cholecystectomy
surgical removal of the gallbladder). Biliary colic may be due to impaction of a gallstone in the cystic duct, resulting in cholecystitis (inflammation of the gallbladder). Arrow 1 (choice A) points to the liver. Arrow 3 (choice C) points to the transverse colon. Arrow 4 (choice D) points to the spleen and arrow 5 (choice E) indicates the stomach, recognizable by its internal rugae.

Explaination B) 👆The metanephric diverticulum or ureteric bud gives rise to the ureter, renal pelvis, calices, and collecting tubules. The metanephric mass of intermediate mesoderm (choice C) gives rise to the nephrons in the kidney. The mesonephric and paramesonephric ducts (choices Aand D) play essential roles in the development of the male and female reproductive system, respectively. The pronephric duct (choice E) is derived from the transitory, nonfunctional first set of kidneys or pronephroi and does not contribute to the development of the ureter.