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Applied Anatomy SBA (single best answer) collection

[qwiz]
[q]

Anatomy of the inguinal canal

You are assisting with a primary open right inguinal hernia repair in a 27-year-old male. During the operation, the lead surgeon asks you to define the boundaries of the inguinal canal. Which of the following does not form part of the boundaries of the inguinal canal?

[c] Transversalis fascia and the conjoint tendon

[c] Inguinal ligament

[c*] Pectineal ligament

[c] Aponeuroses of the external and internal oblique fibres

[c] Arching fibres of the internal oblique and transversus abdominis muscles

[f] The boundaries of the inguinal canal are as follows:
Anteriorly: The aponeuroses of the external and internal oblique Posteriorly: The transversalis fascia, and medially, the conjoint tendon that is made up of the merging pubic attachments of the internal oblique and transversus abdominis aponeurosis Superiorly (the roof): Arching fibres of the internal oblique and transversus abdominis Inferiorly (the floor): The inguinal ligament which is the folded lower margin of the aponeurosis of the external oblique muscle

[f] The boundaries of the inguinal canal are as follows:
Anteriorly: The aponeuroses of the external and internal oblique Posteriorly: The transversalis fascia, and medially, the conjoint tendon that is made up of the merging pubic attachments of the internal oblique and transversus abdominis aponeurosis Superiorly (the roof): Arching fibres of the internal oblique and transversus abdominis Inferiorly (the floor): The inguinal ligament which is the folded lower margin of the aponeurosis of the external oblique muscle

[f] Nice job : Answer C is the correct option due to the fact that the pectineal ligament, also known as the ligament of Sir Astley Cooper, forms the inferior border of the femoral canal.

[f] The boundaries of the inguinal canal are as follows:
Anteriorly: The aponeuroses of the external and internal oblique Posteriorly: The transversalis fascia, and medially, the conjoint tendon that is made up of the merging pubic attachments of the internal oblique and transversus abdominis aponeurosis Superiorly (the roof): Arching fibres of the internal oblique and transversus abdominis Inferiorly (the floor): The inguinal ligament which is the folded lower margin of the aponeurosis of the external oblique muscle
[f] The boundaries of the inguinal canal are as follows:
Anteriorly: The aponeuroses of the external and internal oblique Posteriorly: The transversalis fascia, and medially, the conjoint tendon that is made up of the merging pubic attachments of the internal oblique and transversus abdominis aponeurosis Superiorly (the roof): Arching fibres of the internal oblique and transversus abdominis Inferiorly (the floor): The inguinal ligament which is the folded lower margin of the aponeurosis of the external oblique muscle

[q]

Anatomy of the spermatic cord

During a repair of a primary inguinal hernia, you are asked to name the nerve that is located within the spermatic cord. Which of the following is the nerve that is found within the spermatic cord?

[c] Ilioinguinal nerve

[c] Genitofemoral nerve

[c*] Genital branch of the genitofemoral nerve

[c] Iliohypogastric nerve

[c] Lateral femoral cutaneous nerve

[f] No

[f] No

[f] Nice job : Answer is C. The genital branch of the genitofemoral nerve forms part of the structures found within the spermatic cord and supplies the cremasteric muscle (motor) and anterior scrotal skin (sensory). Other structures include the vas deferens, the testicular artery, cremasteric and vas deferens, the pampiniform plexus, sympathetic nerve fibres and lymphatic vessels. The ilioinguinal nerve, which supplies sensation to the scrotum and medial aspect of the thigh, runs anteriorly to the spermatic cord. The iliohypogastric nerve and lateral femoral cutaneous nerve are not found within the spermatic cord. In addition to the genitofemoral nerve, ilioinguinal nerve, femoral nerve and obturator nerve, these nerves originate from the lumbar plexus (L1–L3 ventral primary rami and the superior branch of spinal nerve L4).

[f] No

[f] No

[q]

Midline laparotomy

You are asked to assist the lead surgeon with a midline laparotomy in theatre.The patient has small bowel obstruction confirmed by CT imaging. Before the start of the operation, you are asked what layers, from superficial to deep, would be cut through during a midline laparotomy incision. Which of the following is the most likely answer?

[c] Skin, subcutaneous fat, Scarpa’s fascia, external oblique, internal oblique, transversalis fascia, extraperitoneal fat and peritoneum

[c] Scarpa’s fascia, skin, linea alba, transversalis fascia, extraperitoneal fat, subcutaneous fat and peritoneum

[c] Skin, Scarpa’s fascia, linea alba, transversalis fascia, extraperitoneal fat, subcutaneous fat and peritoneum

[c] Linea alba, Scarpa’s fascia, skin, external oblique, internal oblique, transversalis fascia, extraperitoneal fat, subcutaneous fat and peritoneum

[c*] Skin, subcutaneous fat, Scarpa’s fascia, linea alba, transversalis fascia, extraperitoneal fat and peritoneum

[f] No

[f] No

[f] No

[f] No

[f] Nice job : Answer is E :Skin, subcutaneous fat, Scarpa’s fascia, linea alba, transversalis fascia, extraperitoneal fat and peritoneum
The layers encountered during a midline laparotomy are skin, subcutaneous fat, Scarpa’s fascia, linea alba, transversalis fascia, extraperitoneal fat and peritoneum. In the midline, the external and internal oblique muscles are absent. The linea alba is a fibrous aponeurotic
[/qwiz]


Below I will attach some learning resources to enhance your knowledge on above topics in applied anatomy.

An understanding of the inguinal canal + Anatomy + Surgery techniques
Anatomy tutorial on the layers of the abdominal wall

Montgomery tubercles – 蒙氏结节

Areolar glands or Glands of Montgomery are sebaceous glands in the areola surrounding the nipple. The glands make oily secretions (lipoid fluid) to keep the areola and the nipple lubricated and protected. Volatile compounds in these secretions may also serve as an olfactory stimulus for newborn appetite.

Montgomery-glands

The portions of the gland visible on the skin’s surface are called “Montgomery tubercles”. The round bumps are found in the areola, and on the nipple itself. They can become exposed and raised when the nipple is stimulated. The skin over the surface opening is lubricated and tends to be smoother than the rest of the areola. The tubercles become more pronounced during pregnancy.

The number of glands can vary greatly, usually averaging from four to 28 per breast.

蒙氏结节位于乳晕的外周部分,是蒙氏腺导管开口处隆突而成。蒙氏腺是能够分泌乳汁的大皮脂腺。孕妇自妊娠8周起,乳腺腺泡及乳腺小叶增生发育,使乳房逐渐增大。检查见乳房及其周围皮肤(乳晕)着色加深,乳晕周围出现蒙氏结节。

Cardiovascular System – Myocardial perfusion imaging

Cardiovascular System

Myocardial perfusion imaging

Imaging principle: To determine the state of coronary blood flow and the state of cardiomyocyte survival.
Normal cardiomyocytes selectively take up certain monovalent cationic compounds, which can be visualized by radionuclide labeling
Tracer uptake correlates positively with regional myocardial blood flow and correlates with cardiomyocyte function status
Normal myocardium develops, while ischemic or necrotic myocardium does not develop (defect) or image fades (sparse)
Nuclear Stress Myocardial Perfusion Imaging
Nuclear stress myocardial perfusion imaging (MPI) is a nuclear cardiology test that shows how well blood flows to the muscle of the heart (myocardium). This test is used to diagnose the presence or absence of coronary artery disease.

Here is a simple intro about MPI test.

Details

A radioactive tracer (called Myoview) is injected into the patient’s bloodstream and is taken up by the heart tissue. A single photon emission computed tomography (SPECT) camera detects the radiation released by the tracer to produce images of the heart. Two sets of images are taken, one after an injection at rest and another after an injection during a stress test – either exercise stress on a treadmill or drug-induced stress with persantine (dipyridamole) medication, which simulates exercise.

MPI tests can help your doctor:

• Find out if there are narrowings or blockages in your coronary (heart) arteries if you have chest discomfort.
• If you have heart damage from a heart attack if your heart is not working normally.
• Determine if you should undergo a coronary angiogram.
• Decide whether you would benefit from coronary stent or bypass surgery to treat your chest discomfort or help an abnormal pumping function go back to normal.
• If a heart procedure you had to improve blood flow (stent, bypass) is working.
• How well your heart can handle physical activity.

Explain 201TI myocardial perfusion imaging to distinguish myocardial infarction and myocardial ischemia.

201TI enters cardiomyocytes and is related to the activity of sodium pump. The uptake of 201TI by the myocardium is a marker of myocardial cell activity and cell membrane integrity. Therefore, 201TI is a common method for identifying viable myocardium and necrotic myocardium.
201TI MPI is a characteristic manifestation of the diagnosis of reversible myocardial ischemia from early perfusion defects to delayed imaging perfusion defects.
The perfusion defects in the early and delayed necrotic myocardium were fixed without change.

Occupational Environment and Health – Occupational Diseases

Occupational diseases

  1. Cause is clear
  2. Most of the causes can be quantitatively measured dose-response relationship
  3. In the same population, there are a certain number of people who are sick
  4. If the early detection and timely treatment, the prognosis is good
  5. Most occupational diseases currently have no specific treatment, and the later the treatment, the worse the curative effect.

 

Diagnosis and treatment of occupational diseases

Diagnosis of occupational disease diagnosis must collectively by the legal diagnostic facilities

Strong scientific policy, with the vital interests of the State and about patients!

It is undertaken by the medical and health institutions approved by the health administrative department of the people’s government at or above the provincial level;

A collective diagnosis is conducted by more than three licensed physicians who have obtained occupational disease diagnosis qualifications.

 

Occupational disease diagnosis should integrate three factors

(1) Career history: important prerequisites

  • Work type
  • Length of service
  • Types of exposure to harmful factors
  • Time
  • Quantity
  • Contact method
  • Use of protective measures Other diseases of the same type of work
  • Exclude non-occupational contacts similar to occupational diseases

(2) Labor health survey in the production environment

  • Process flow
  • Method of operation
  • Environmental sanitation
  • Protective measures and effects, etc.
  • Level of harmful factors in the workshop

(3) Clinical manifestations and auxiliary examination results, etc.

  • Whether the symptoms and signs meet the characteristics of an occupational disease
  • Pay special attention to early typical symptoms and signs

GCE A/L Information and Communication Technology – 2015

2015 වර්ෂයේ රජය විසින් පැවැත්වූ උසස් පෙළ තොරතුරු හා සන්නිවේදන තාක්ෂණය (සිංහල මාධ්‍යය) විෂයට අදාළ සම්පූර්ණ ප්‍රශ්න පත්‍රයයි. Here is the 2015 GCE A/L Information and Communication Technology Full paper (Sinhalese Medium). To download follow this link. Please share with your friends!

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GCE A/L Science for Technology 2015 Full Paper

2015 වර්ෂයේ උසස් පෙළ තාක්ෂණවේදය සඳහා විද්‍යාව විෂයට අදාළ සම්පූර්ණ ප්‍රශ්න පත්‍රයයි. Here is the GCE A/L Science for Technology 2015 Full Paper. To download follow this link. Please share with your friends!

GCE A/L 2017 Biology

2017 වර්ෂයේ රජය මඟින් පැවැත්වූ උසස් පෙළ විභාගයේ ජීව විද්‍යාව බහුවරණ ප්‍රශ්න පත්‍රයයි. This is the 2017 GCE A/L Biology MCQ paper. Download complete question paper via following link.

ප්‍රශ්න සියල්ලටම පිළිතුරු සපයන්න.

01. පහත දී ඇති සංයෝග වලින් කවරක් තනි නියුක්ලියෝටයිඩයකින් පමණක් සෑදී තිබේද?
1. NAD 2. ATP 3. FAD 4. m-RNA 5. DNA

02. ජීවියෙකුගේ සුවිශේෂි වාසස්ථානයේ වෙනස්වීම් වලට අනුකූලව ඇති වූ අනුවර්තනයක් ලෙස සැලකිය නොහැක්කේ.
1. සමහර කඩොලාන ශාකවල ජලාබුජතාවයි.
2. ශුෂ්ක ශාකවල පත්‍ර පහුරු බවට විකරණය වීමයි.
3. කාන්තාර වල වෙසෙන ඔටුවාට පුළුල්ව විහිඳුණු පාද තිබීමයි.
4. උණුසුම් පරිසර වලදී වැඩිපුර දහඩිය දැමීමයි.
5. කෘමීන් පෙන්වන වේශාන්තරණයයි.

03. DNA අණුවක ඇඩිනීන් මෙන් හතර ගුණයක් සයිටෝසීන් පවතී නම්, නයිට්‍රජනීය භෂ්ම 12000 ක් DNA අණුවක පවතින ගුවැනීන් භෂ්ම සංඛ්‍යාව කොපමණද?
1. 2400 කි. 2. 3000කි. 3. 4000 කි. 4. 4800 කි.
5. 9600 කි.

04. DNA හා ප්‍රෝටීන් යන දෙවර්ගයම,
1. ඉහළ උෂ්ණත්ව වලදී අප්‍රතිවර්ත්‍ය ලෙස ගුණාහානිකරණය සිදුවේ.
2. ශාඛනය නොවූ රේඛීය බහු අවයවික වේ.
3. ඇතැම් වෛරස වල ප්‍රවේණික ද්‍රව්‍ය ලෙස ක්‍රියා කරයි.
4. ස්වයං ප්‍රතිචලිත වියහැකි අණු වේ.
5. බැක්ටීරියා වර්ණ දේහයේ අඩංගු වේ.

05. ක්ෂුද්‍ර දේහ සම්බන්ධව පහත දී ඇති ප්‍රකාශවලින් අසත්‍ය ප්‍රකාශය තෝරන්න.
1. මේවා ඔක්සිකාරක එන්සයිම අඩංගු පටලමය ආශයිකා වේ.
2. මේවා සමහරක් පෙරොක්සයිඩ් වල විෂ හරණ කරයි.
3. පෙරොක්සිසෝම ශාක ප්‍රභාසංශ්ලේෂණයේ දී වැදගත් වේ.
4. පෙරොක්සිසෝම ශාක සත්ත්ව සෛල දෙකහිම ඇත.
5. මේවා අන්තඃ ප්ලාස්මීය ජාලිකා වලින් නිපදවයි.

Acute appendicitis: clinical manifestations, classification, surgical treatment, complications

Explain the clinical manifestations of acute appendicitis

  • Abdominal pain: the first symptom, initially localized to the periumbilical region, persistent aggravation, gradually shifts and fixed in the right lower abdomen
  • Gastrointestinal symptoms: nausea, vomiting, increased frequency of bowel movements
  • Systemic reactions: fever, lack or loss of appetite, oliguria, thirst, toxic symptoms.
  • Signs:
    1. Rebound tenderness, pain on percussion, rigidity, and guarding, McBurney point tenderness: Most specific finding
    2. RLQ tenderness but nonspecific
    3. Left lower quadrant (LLQ) tenderness
    4. Rovsing sign (RLQ pain with palpation of the LLQ): Suggests peritoneal irritation
    5. Dunphy sign (sharp pain in the RLQ elicited by a voluntary cough): Suggests localized peritonitis
    6. Psoas sign (RLQ pain with extension of the right hip or with flexion of the right hip against resistance): Suggests that an inflamed appendix is located along the course of the right psoas muscle
  • Laboratory tests: WBC is elevated and urine is normal.
  • Other checks: X-ray, B-ultrasound

 

Pathological classification of acute appendicitis

  • acute simple appendicitis
  • acute purulent appendicitis
  • gangrene or perforating appendicitis
  • periappendicular abscess

 

What should be differentiated from acute appendicitis disease?

  • Gastric duodenal ulcer perforation
  • Right ureteral stones
  • Gynecological diseases: ectopic pregnancy, ovarian follicular or Corpus luteum cyst rupture, acute salpingitis and acute pelvic inflammatory disease
  • Acute mesenteric lymphadenitis

 * Acute salpingitis is infection of the fallopian tubes.

** Ruptured corpus luteal cysts are one of the commonest causes of spontaneous haemoperitoneum in a woman of reproductive age.

 

Briefly describe the complications after surgical resection of acute appendicitis

  • Incision infection
  • Peritonitis, abdominal abscess
  • Bleeding
  • Fecal fistula = one between the colon and the external surface of the body, discharging feces.
  • Appendiceal stump inflammation = Stump appendicitis refers to inflammation of the residual appendiceal tissue post appendectomy.
  • Adhesive intestinal obstruction

Hyperthyroidism – Classification, Indications & Surgical Treatment

Classification of hyperthyroidism, indications, Surgical operation indications and contraindications.

Hyperthyroidism symptoms

Hyperthyroidism symptoms

Classification

  • Primary hyperthyroidism
  • Secondary hyperthyroidism
  • Hyperfunctioning thyroid adenoma

Indications:

  1. Nodular hyperthyroidism, although drugs or iodine can eliminate or alleviate the symptoms of hyperthyroidism, but the nodules still exist, and may be secondary to hyperthyroidism or cancer.
  2. Diffuse hyperthyroidism, after systemic drug treatment, no significant improvement, or relapse after stopping the drug.
  3. Retrosternal goiter with hyperthyroidism, or compression symptoms caused by thyroid enlargement.
  4. Within 6 months of pregnancy, there is hyperthyroidism, which is adversely affects both situation mutually.
  5. Suspected of malignant. (primary condition has a localized nodule or a scanning find outs a cold nodule)
  6. Hyperfunctioning thyroid adenoma

Surgical operation indications:

  1. Secondary hyperthyroidism, hyperfunctioning thyroid adenoma
  2. Moderate or above primary hyperthyroidism
  3. Hyperthyroidism with thyroid compression symptoms or retrosternal goiter, or suspected cancer
  4. Medical treatment of side effects such as allergies or myelosuppression
  5. Long-term drug treatment relapse after drug withdrawal or relapse after 131I treatment
  6. Those with the above indications in the early and middle stages of pregnancy should also consider surgery

Contraindications:

  1. Teen hyperthyroidism
  2. Mild primary hyperthyroidism
  3. Exophthalmos is severe and hyperthyroidism is mild.
  4. The patient has severe organ dysfunction such as heart and lung, and the drug is not improved, and surgery is not allowed.

 

The role and usage of iodine as a preoperative preparation for hyperthyroidism.

  1. Inhibits proteolytic enzymes, thereby reducing the decomposition of thyroglobulin, which gradually inhibits the release of thyroxine, and does not cause sudden changes in the circulatory system after surgery.
  2. Iodine can reduce the blood flow of the thyroid and reduce the congestion of the gland, with the time glands get shrunken and harden.

Use of iodine: compound potassium iodide solution, 3 times a day, 3 drops per day on the first day, then add 1 drop each time to 16 drops each time, then maintain this dose.