‘A 31 yoa-td rmato presents oto omergency room wih igh fade eve and alodomial pain for th past2 days, She also comeiahs of malas and has vorited Several mos since ast ight. he past medical story benign. The vl signs Inctso a temperature of 20°C (OU, « puso of 2OMIn, aespratay ate of Bim. and 9 blood preesure of 20789 mn Hg, On physi examination, severe ‘ostovertabra angle tendemess fs noted, Ses admited tthe medal Noor and ood is rawn. The abort est reveals leukocyss th predominant noutephis and erased Crest protein ad ferrin vel Sho sispected to hve a reopeetoneal ergan infection Which of ts folowing best ecibs the Invowed xg? 8 produces hydrohlrc aid Cts composed of bus and parenctyma ‘isthe most common ste of Mckat' etic eae}‘A 31 yoa-td rmato presents oto omergency room wih igh fade eve and alodomial pain for th past2 days, She also comeiahs of malas and has vorited Several mos since ast ight. he past medical story benign. The vl signs Inctso a temperature of 20°C (OU, « puso of 2OMIn, aespratay ate of 28%ne. ad 9 blood presse of 20789 mm Hg, On psi examination, severe ‘ostovertabra angle tendemess fs noted, Ses admited tthe medal Noor and ood is rawn. The abort est reveals leukocyss th predominant noutephis and erased Crest protein ad ferrin vel Sho sispected to hve a reopeetoneal ergan infection Which of ts folowing best ecibs the Invowed xg? 8 produces hysrochlrc aid ox Cis composed of bus and parenctyma 538 ‘1s the most commen ste of Mckat' venta ox Resul B bsctto ttExplanation: CComect answer C: This pation asa ravepertoncalinfcton whan abscess. ‘The most kal diagnos i acto Pyoionphis, which ross om the becttl invasion of he ronal parenchyma. Feotures suggestive of his ‘lagnris re gh-srce fever shaosna sin, mane, ana soetvereba langle endomess. Lukocyoss wth predominant noutophit, and neseasea Coactne proton and fort lvos neato an ilormatory proces ‘The kehoy are retopartoncal organs thal are composed of tbls and parenchyma, Tsother ans cheicerinvive characteristics of ‘nvapetncal pans Retopemoneal organs af stucures that fe behind the nd are undercover of petenca fs. The Kidney, eters, uprarens ‘lands, pancreas, mest oe duodenum, escenng lon, descending con fd esophagus ar the retoportonel organs. er street ro presentinthe etvopertonea space are the art and feter vena cava wth ‘hal branches and Vbuatis the esta cyl, mph nodes, mph vessos, and novos, ung to sympatnatc Muns. Inrepetonca ana tetiopertoneal organs Major Major secondary eal} jor peony Related Videos: ®yeloneps dey con ane eros Abscoss: ett. © hionoo9y 410009 First Aid References: Fst Ad forth USMLE Stop 12018, 20h 0589, rt forte IESE Sop OOHRS Fst Ad forthe USMLE Stop 12017, 271 570a Intropertoneal and retropertonal organs jor Major secondary ajo primary Intapertonesl —__rtropertoneal organs ost retpsctonea! ‘rgans(suspended themesemaryaung organs never ad 9 bbyamesonlen) development) raeceaiey + somaen “+ Duden, 2%and2° + Kidneys User and as + Ackenal lands galbisddor + Heod.nock, andbedy + Ureters + Spicen cot pancress aorta * Duoderum. t+ Ascending colon + fror vena pat + Descending colon oe + Tat + Upper cium + Lower rctum pancreas + soalcana deg + Appendix + Semoid colon ‘Option A: The guloaoris th oxgan that stoves and concertttes Bt. The ‘albiadder fpr ofthe hepatobiliary system ands losey associated wit ‘he ver The gabladder isnot arevopertoneal rear ‘Option B: The stomach produces hyechon acd The stomach an Inrapooncal expan and covered by panel ayer, pon De The eu ost nN haha Macks etc The eal}at + Descending colon cna + Talot + Upper rectum + Lower rectum + eg teu + append okn + Stomota colon : * Spleen pancieas : ‘Option A: The gatladoris th oxgan that stoves and concerites be. The ‘bader pr ofthe hepatbllry ystom and is lossy associated wit ‘elven. The galacce isnot a etropertones organ ‘Option B: The stomach produces hyrechone ace, The stomach an Inrapetoneal expan and covered by penal ayer, ‘Option: The eum s the most conmon st ofa Meck verticlun. The ‘Option E: Tho spleen the organ tats composed af hie and ed pup. Tha spleen s ot a retroperitoneal organ. Loaring objective: The Kno, uote, suprrona ns pancreas, most of the duodenum, ascending clon, descending clon, and esophagus re reyopertonea orgs. Bsc‘A Ta.yoocokstomale with a pest mescal nity of dlaetes, hypertension, and hyperemia prosonts tthe emergency department wih sling ner lok neck, ‘ne onset wn few mone age Sh na lost. 5h) over he came cron, Se dons any ver nt seats ong. Physical xaminalon reves a paress| naling in ont of her lot a: Tero painless mphodenopathy below tho ox Biopsy ofthe lmph nodes reveals mecoepidrmecarcnams ofthe parotid gland Super planne! and the tumors emoved we yg to preserve a neve wich could be role What physical fading woud suggest iowement of he nena Is course trough the prot land? © A Loss of taste on he eft antvior 2 of the tongue © 8 Hypersenstuty to sound inthe et car Inti tose on roots 1. Numonse of he let ena (© E Reayced production eftars nthe at eye eae}Leave ‘A Ta.yoocokstomale with a pest mescal nity of dlaetes, hypertension, and hyperemia prosonts tthe emergency department wih sling ner lok neck, ‘ne onset wa few mone age Sa na let. 5h) over he came cron, ‘So donee any fever night ete ong, Physical eraninatlon roves 8 pines ewoing in ot of er le oar. Ther is sinless lmphadenepaty below the ea Biopsy of temp nodes reveals mucoepirmens carcnoms of he portland. Surgery planned andthe tors emaved while tying to preserve !narve which could be invlved. What physical ding would suggest involvement ‘ofthe neroin te course trough the pact lane? ‘Los lan on he ante 273 of te ogue a spray souan ie tea * ity toa nti ede on 1 Numines tte cee we feted rodney 8 SB Result: @ oneResult: Explanation: ‘Comect answer C: fr enng the antum tnough he stl foramen, the ‘moter voto he fatal we contrues antalya net Ie pares land ae can beafiecteby processes vol he gland such as infections ‘orto Wii the parotid land, tenet terminates by sping it ve ranches: tmporl aygomate bucal agin! mandbul, an cones ‘These branches are responsible fo inervting the muscles of fecal, ‘expressions, such as sting In tis patients case, Related Videos: © Smee vera tone Ocaimn First Aid References: Frat Aid forthe USMLE Stop 1 2019, 20h of: 94,520 Fst Ad forthe USMLE Step 12018, 28 of: Fst Afr the USMLE Stop 1 2017, 27First Aid References: Fst Ad forthe USMLE Step 12018, 29th Fert mace | Fst Ald forth USMLE Stop 12018, 25 ot: = Fst Afr the USMLE Step 12017, 27 ed iadatnoal ome ‘Option A: csion of tho faci nove prasimal othe so foramen rari porn wl lead lee o et on the anenoe 29 of rs onga Insge Taeineer lean . ‘Option A:A lesion ofthe facil nove proximal othe so fxamen (rwvacranit porter wat ead oss o ast on the anterie 273 fo tegen ‘roves bythe chord tan inaction othe fact that he mares oF facial expression wil be paralyzed ot severly weakened, ‘Option B: An nacrana ranch of he fc news, the chord rp Innowates he moto Mbers ofthe iapeds muscle wii he a. canal The taped and tercor part are muscles ofthe mio or Of note, the “aps the sale erat mrls nth human body Ate over ene ‘uncer a longthts purpose sto stabize tho sales bone nobody, tho taps. prevents xcs movement bythe stapes, ling o contol he condition ofecuns raves rom ts external enworment 6 hen et Parayss afte tapacus atows wide oscauon of the tapes, esutng 8 ‘nerotsed movement of ho autory asics in espera to Wenponic sau ato ‘Option D: The main nerve, the seccnd rancho the geminal neve (V2. artes snsoy lfomation fom the lower ey ad cheek, the nares and ‘the phar, the masa. etmot and sohenod sinuses and pats ofthe ‘meninges, V2 does net course through the pect gland and tena affected by ‘processes wit the gland. ‘Option E:Pregangtoni: parasympathetic brs eignat in the superior salivary nucleus ofthe prs and pass through the gonicdat ganglion of the ‘aca nerve, but nether synapse nor have ther el bodes located there. The ‘same preganglont parasympathete bers ex the geicuategangen asthe ‘renter pettosal nerve. Th greater petrol parvo uimately synapses wth the ptengopaltine gangon whose paresrmpathetc postganglionic bers enter B bsctho tt‘leer neath ts purpose isto sablize the sales bone nthe body ‘the stapes. Itprevents excess movement bythe tapes, helping 1 conal the Porayss ofthe stapacis nto wider oxclaion of the tapes, esting Incressed movement of te autor esicesin response to ympanc sound ‘Option D: The masta nerve, to second branche the woomina ne V2. cates snsor formation fom the lower ey sc check, tho ners “Upper tp, te upper teth and gums to nasa mucosa, the alte and root of ‘te pharynx, to masa, etna and sphenad sinuses and pas ofthe ‘moninges. V2 dos nt couse through the parotid land and not affected by procesces win the gan ‘Option E Presangtoni: parasimpathete brs eight nthe superior vary nucleus of he pos and pass though the gonicdate ganglion othe ‘aca nave, but nother synapse nor have thar el bodes locate thet. The ‘sume preganglont parasympathte bers este gericate ganna the ‘teat pevosal nove. The greater petosal pave ultimately synapses wth the playgopalzine gangion whose palasyrouthetc pesgangionic bers enter ‘the arma lan andthe mucosal glands ofthe nose palate and pan \oaring objective: The facil nerve courses trough te ator aed ner ar othe pate gland, hn the pret gland, the nerve terminates by Spiting into te branches temporal 2y9omau, buccal, marginal menus, ‘nd cones. The nore ors ranches con be fected by ary process Involang te glan, suchas nections or tumors. These branches are ‘espenible orimervang the musces offal exesslons, such as sing. Bsca ‘53 youd male presents tone pyscan wt a conplantefbeck pan fr he . ost 2 mont. The pons present traughout to dey. and oven tight when he Nes down He also complas of dct waking pst and syste reconty statedto wea aut laprs because he seams to hae det contating Ns bowel movoments. He vl sigs re win normal its, The neurlogical ‘romination reveled lateral toner Imb weakness, rnsshedtemperatre Ssenction, and decreased bratty sense. The rectal examination reveled a hard aly cause of is Smptoms? © A Spingonyetis © 8 Sphatmetstess Homiated se Epica abscose © E spnatnematema Bsc h e‘53 youd male presents tone pyscan wt a conplantefbeck pan fr he ost 2 mont. The pons present traughout to dey. and oven tight when he Nes down He also complas of dct waking pst and syste reconty statedto wea aut laprs because he seams to hae det contating Ns bowel movoments. He vl sigs re win normal its, The neurlogical ‘romination reveled lateral toner Imb weakness, rnsshedtemperatre Ssenction, and decreased bratty sense. The rectal examination reveled a hard aly cause of is Smptoms? A Spingomyeia om 1. Spinal metasasts su © CHominted se x Epica abscose * £ Spinal nematoma % Result: @ concer, LeaveExplanation: ‘Comect answer B: This patent assigns and symptoms of pina cord compression (SCO). Between Sk and 10% of cancer patets havo SCC Prosnte cancer the most common cancer in men, Other metastatic cancers tothe spine include breast and lungs. n 189 Stphen Paget deserbed his “cood acai hypatnen,nwhich ne dered te sooding of meesate callsto the ibs and vette via sseminon toh Batson tele) ‘venous plow, SCC the 2” met conmon neurcogi complaint nance atts, 2~ only to compas imeang tho an, ‘Symptons vary. depending on ho lcation of ho motasasis, Carica spine lesions generally enue upper lm pon, weakness, anos of soa, ier nna! hs gual care ows in pa weakens hd ping, whore here may be sign and symptoms of pain, weskner, and os of Senssn. The horace pan canbe inthe form of chest or back pan Back pala isa classe symptom of SCC ands reported in 9 of 1 patent. Ts "opto vsuy occur month belore oer sree flowed by eto, sensory and atone det IPs eal} Related Videos: Spinal Cord Patil: Ineecucton © Seem seo vse Cnc First Aid References: Frat Aid forth USMLE Sop 12018, 29h 40 Fst Ad forthe USMLE Stp 12018, 260 oh St Fst Ad forthe USMLE Step 12017 27 ed man concopt nat scussod book closest 500sensaton The hore pan canbe nthe fo of ches or beck po Bock pain sa asi symptom of SCC and roportod in of pation, Tie Fst Ai forthe USMLE Sop 12017, 27th ed main concept not discussed “smptom usualy occurs months befor othe symptoms folowed by met, book: loses 500 sensory and atenemic defi ~ ass Ds ee eee mage: Anatomy of pial cord compression tuner By Lecto ‘The pans itatylocakzed tom bony destruction fomed by rater pa ‘toma mass eect ve te compxesson ofthe aqacent eve oes. Mancuvets sat inzeace tho iathoace aressir can worsen the pan The aWrocy Leave Fst Ad forthe USMLE Step 12018, 28h od 5Hmage: Anatomy of pial ord compression by tuner By Loco ‘Te pans itty locakzed om bony destruction ftomed by racer pan ‘toma mas fect cue te compression ofthe edacent ewe oo. Manouvets ‘mat nceace he ivatnaace pressure can worsen he pan. The aybwocyte sedimentation rate (ESR can spre ot nfectous processes. Pla flrs ‘may show osteoblast or osteo lasons ofthe vertebrae. G2doiium ‘ernanced MRI woud be alo isualzo each sen andthe one spinal cord should bo scanned to detect multe sions Lumbar punctures comaindcated because lumbar puncture may worsen the Symptoms. Racttherapy the tancard of ae. couse of doxanettasoneis used to lp ediceilmaton and edema, Select patient may recquite surgery {teinecioty The teanest i ied of eal aor manogenvont th the ‘0a fregarang lt neurologic, Mis mporan to note thatthe ‘ueatment isnot aimed aa cue, but toward symptomatic ee paaon ‘Some tumors, uch a Hodgins ymphoms, repand a chemtherapy. ‘tre case, chemotherapy can be used as an adn to radathrapy (metattie bear. posta cance, ce mite myeon) ‘Option A: Sringomyeais characterized by cyt or cos in the conta ‘cana ofthe spiel cord The signs and amps tat alow are dec ‘elated tothe ize ofthe elon. Ashe cyst or avy increases in le the est ‘or cavy wll compress the adjacent atenor wha commissure rst, causng a toss of decusseng hers of ho spnatelamc pam and tomperature thers. wn turner expansion. thee could be velvet ofthe vera hows, hus ‘iectng he tower meter ures end leding to Meci paralysed ‘nvolement of thonteral home ane dorsal colune The intermediate ty han Involvement atthe levee Ti can eatin Home's syncome, volvement of B bsctto tt(metastatic neat prostata cance, mute mean) ‘Option A: Syringomyea is characterized by cyt or cos in the conta ana ofthe spa td The signs and symptoms tal alow ao ae relted tothe ize ofthe elon. Ashe cyst or avy increases in le, te est ‘or cavy wll compress te adjacent antenor whe commissure rst causng a toss of docussetng ors oho spinatalamic pain and tompertive hers. wan tutor oxpanion. ter could be velvet ofthe vortal hms, hus affecting the loner moter neers ae lacing to acid paras nd Involvement of tho ateral Ros and dorsal clune. The termediate gry hon lnvolement atthe lovee TI can eatin Home's syncome volvement of prepriocpton, and wbraton. ‘Option C: Hemi aac ly occu lower inthe spl core thas veg ‘the lumbosacral region. This elon isa weight bearing area that aso etientinsuppotng pesooatral igen. Ths, withthe ack Soimerioussuppot ae te herent anatomic weakness inthe posttcaer a:pec ofthe intarverebal dec, the nucleus pulposus abe te hernake ‘trough th ruptured enna rena nd caus amass alot onto adjacent pervert, Tass uel fatal aca be tested nin wh 9 taht egrate test Treatment med at symptomatic eet ret core strength velopment. and surgey as tho las reson, ‘Option D: A sina epaual abscess elatvely uncommon bt can occur Inravenous drug abusers va emogonous spread to he vertebral area or {oxm rom pre- A Parone mph nodes (© 8 Supertil inguinal lymph nodes rasa group) {© Deop gua yngh nodes © D.Superca inguinal nodes tater! gous) © © Pararectaymph nodes eae}£1.38 you.old malo presen wehpaniossswoting fhe ight estas ae . eration of heaviness. The phys xamationrevsled an ea escular sold mass that could not et separately fem th tests. ter thorough evaluation, ho was dlagnosod wit atesiculr seminoma Which th allowng group oF lymph nodes are mot ly inated? 1. Pra-aonc mph pes 52% £8, Superial ingunal lymph nodes inedal coup) 18 © Doap nguinl yp nodes x _. Super inguial mph noes tral grou) ™ £ Paravectalimph nes * Resul @ neon Explanation: Related Videos: “comet answer A: Tho Impl week fom the tts a ro the prs ,Explanation: Comet answer A: Tho ympicwessls tom tho tests an ote ara etc tumbar group oflmphndes nthe abdomen. Ths canbe easy ‘ppccciotd when we tink aboutthe enbryoogy ofthe estos. Testos ‘tenate nth abdomen an during fetal fo migrate ana desc into the ‘sot. The testos-essoiatedIymohatis develop before the testes descend Int the srotum. Th fring important when managing testcularures Inthis eats, mage of the abaoman must be pat ofthe wor, The ‘verjin sroum drains ito the supertalyinph nodes. The ess anova. ‘hoped male reproductive organ thats covered by fibrous sve ico ‘bog whic ios banat the eral ayer of th tinea vagal. The epididymis ataced ts poster tera surace ofthe ests A scp Related Videos: “nssoGoum Co Tuma 27) First Aid References: Fst Ad forthe USMLE Step 1 2018, 2th 638 Fst Ad forthe USMLE Stop 1 2018, 28h od 634 Frat Aid forthe USMLE Stop 12017, 27 ed 5att pcs “estes produce spermatazoa ang secret etostetone. The att apply ta tho torts the tosicuar artery a branch of he abomin! arta whe tho venous ranage via the pampiform pons. The tester mph vessels ‘second wih the testicular yee ond dain note are sor nodes a he ‘ovo of ough afte tescular anes (2 verb ‘Option B: upertsalingutalymph nods ocave mph om th ower abdominal wo below the unbies, btocks, pens, cotum, anal canal and In females om te abium maj ana the over par ef he vacna a wel ‘Option: Deep inguinal mph nodesrecoive mph om the lower ib, {pper pats one vagina and ana canal ‘Option D: Supetcainguna lymph nodes teceve lymph rm the lower ‘anal anal, an in feral from the abium majs and lower pars ofthe vagina sel ‘Option EPara-ectal mph nodes receive hmph fromthe descending cln, ‘mol colon, and uppor pate ne rectum. Loaming objective: Testicular mph rans nto ho paraaore fbn mph ‘odes, The overing scotum rans ino the aperalinguinal oh node. B bsctcho tt‘45 youd man prsonis tothe physica wit he conplants at cased winary frequency and decreasing vlunes forthe pat 2 months, He does not complsin of ‘ny am tng urination bs etanrated tat hae to wake yp 2 oF 3 mes por right te uinat even hough he wed reducing to amount ef water Ne consumes before bed and made sme other try changes without ny improves He hes no fami sory of prostate disease. Physical examinations negate for any suprapubic mss of endemess, and thee sno castvereba angle endeess. 2. Unnsyas and serum crteine © B.Uvasenogtaphy © D.Digta rca raination © E Prostate specie aigen Bsc h eLeave ‘45 youd man prsonts oho physian wlohe compas of eroasod twin fequency ad docrosng volumes forthe past 2 months, He doesnot ‘complain of ay pain dung wnaten He is fustatea that he has to wakeup 2 03 “umes por nightie uinat eve hough e ved fein ho amount et wate he ‘consumes before bed and mado some other itary changes without ay Improvement. Hota no amily istry of prostate dsease Psi xarnatcn agatve for any suprapubic mass or endemess, nd eres no cestovertabval nal tendomess Whi of ho folowing the best net stop in he management ch this pase ‘A Uns and serum eating © s.unssonography Reossuonce ©. igtatretl examination giaga Prostate spect angen Result:Result: Explanation: CCorect answer : Benign prostatic hyperplasia BPH ‘sore i sen mn a many 351i 3 males over the age of 50 yeas. The tatatels hormonal stinubted by dydtoteststerone DHT) amore potent ncrogene drvave of eetortorona 526ductaee eho ony responsible otis conversion and, hus, the target of many popular ‘medication aimed a reducing eels of DHT. BPH was intially Houghtto be Socondary te atypartopny ofthe smoot muzce, but econ een ‘suggests tis a hyperplastic process oa mixture of bth ‘medial and ltr oboe, these los ar leo the cnes tat aa to Syms ‘of etaddo out costco (600) because of a hypetpasa Patents may ‘prose with lower urinary act symptoms LUTS) hat maybe de to bdr ‘uit eberction 00), Symptoms may include incompet voiding, wes {rvary steam. fiity stag unten, and aibbing ater uinaten. First Aid References: Fst Ad fr the USMLE Step 12018, 20h: 639 Fst Ad forthe USMLE Step 1 2018, 28h oh: Fst A forthe USMLE Step 1 2017, 27h ed 619‘The sgn of DH emo iccigleayvth ax much a 70 af malas hy tno age of 70. mediate symptomate ett may bo achieved wit ana. ‘locker ea erazosn er tamsulosin drugs wth th cn suf 9s they help relax stom smooth muscle nthe prostate around te bladder neck an ina, Se.redutas nar ho aster conto to reducing the mount of tostostrone conversion to DMT, thereby reducing the stnltion {or prostate enlargement “This 's a more rata process. nd nprovement ses seen when he rortatee> 40 mk. combination of bot clases of medication maybe Denatcatto some pation For patets that ar eter to medal apy eae‘The agnosis of PH fs made stotogiaty wth as much as 70% of males by tho age of 70. immediate symptom ett may o achieved with ana- locker ea terazosn er tameuosin drugs wih th on sufi 9s they help relax re stom smooth muscle inthe prostate round the ladder neck an (ina, Se-redutas intr ho aster contbto to reducing tho amount of tstosterone conversion to DH, thereby reducing tho stnultion {oe prostate eis gement “Triste 2 more rat process. and provement sbest sean when ho prostate 40 ml. combination of bath clases of medication maybe Denetcalto some pation For paterts that ar etectry to medical thaapy and have moderate to severe symptoms, surgery maybe Vile option (wansretival resect ofthe prostate (TURP} of open prostatectomy prostate ‘snes 759. ‘option A: Unnayss can be ordered on ations prosoning with LUTS. Nis el too to quik ule xt a unary rt fect Yockngateukooyts [stents and tes ut cn lo eth elnsian non more amino ane sich ae blood nthe uno. load tse such a the bood rea itrogen (UN) ‘nd creatine eves are nota uly aban but are lf oo ‘ecognaing renainsiicency hiss more kel patents wth high pesild ‘sida (PVR} wlanes). though laboratory testing can bo ust nung out ‘bier eiferetals or compliations, thoy are net aways routinely performed in the evaivaon of BPH and are done ony ate the dtl recta examinaten (078 ‘Option B: gta recta raminaton vsualy underestimates the size of the restate and uvasonograpty can help accurately quart the 320 of he ‘ronne The gross best wsalzed ws rantetluasonography At ‘the sme ive the bled ucts, and kidneys can be assessed en.(088. ‘Option 6: Dita rectal exaninaton wuaty underestimates he se of he protete and utazonograpty ean alp accurately quart the 220 ofthe ‘rotate The fora best wstzed ws ranretaluaeonocraphy At the sme ee the blader sete, ond kidney can be assessed Luasonogaphy, thou avery use, nat eat oral eaten or uncomplicated UTS, ‘Option: The pent presenting vith symptoms of LUTS mos ly fom £200 snd would bene rom rer nveetaaten ‘Option E The le ofS n BH controversial PSA eno vests cagnose ‘of grado the soverty of, The concem = who load o overdiagnosis {nd his overtetment of prostate cance that etorise wed vo Been Seymptomat, The al say should ert with he patent afer else has Been ‘nfomeat of he pres and cons of beng screened fo restate cancer wah PSA Tis paints symplemati and wil benoit fom PSA. However cia ‘amination come befor nboratory vestigation Plots at ncreared include ican Americans and those wh st degree relives agnosed wth ‘ory 9 0 yor, ‘Learing objective: SPH, postatts and prostate cance are the 3 common ‘ptestate pathologies. An important tool inthe evaluation of the prostate the ‘gal rectal examination Tho DRE dona wih th ght index gar anda ‘steeping motion long the posterior surface ofthe prostate looking for ‘ymmeiny, snes, ack tenement nal tons. Thi es done 9 {special raninaton thats added tote ouino physical oxamnation and the bt stop evaluntng xorate pathology alr deta tory tks.£.50,yoarot4 man andi ito are bought in by anbuanco tothe emegoncy ‘department ith iffy breathing and speaking, Sho repr that he might have fnlewred a ehbone Wilting history he ptent develope 2 paeayem cough Visuazation fis etophary and layne shows fh bone oaged nthe Fight iter recess. fer successtuly remening the fhbone tho patient fools ‘oma, but he ota o cough le before, Damage to whe of he Tolowing naves & response fo the mpated cough telex inthis pave? 1 becena argent news 8 ireralanyge nerve ( Recuent anmgeal neve © inte area! nowe E Supotorlanmgeal nove£.50,yoarot4 man andi ito are bought in by anbuanco tothe emegoncy ‘department ith iffy breathing and speaking, Sho repr that he might have fnlewred a ehbone Wilting history he ptent develope 2 paeayem cough Visuazation fis etophary and layne shows fh bone oaged nthe Fight iter recess. fer successtuly remening the fhbone tho patient fools ‘oma, but he ota o cough le before, Damage to whe of he Tolowing naves & response fo the mpated cough telex inthis pave? 1 becena argent news * £8 teal longest nerve Pd © Recurent ayngea neve on © inte area! none x E Supotorlanmgeal nove 1Explanation: uated on other sde ofthe entrance of the lan ts bounded meal by {he ayepigiotc fis and tray by the thyroid ealage ng weal. foods dered by the esophagus tvoughpfom recessesino he sophags ‘The superior inygea! nerve (Opin E} aides to Honma and to ‘eternal lnyngen nerves. The terra nrfges! nerve supptes sensory Roers {othe mucous membrane ofthe por foe and he lanx down oar ‘terallnyngen nerve Isa motor nerve located ose ote sero rks artery and supplies the eicotytokd muscle (Option A. etal he prim oes important because common te fr lodgmnt of sharp ingestod bodes sch a ih Danes, whch can damage he ‘nial lange note as thre sony hin layer of macs mobrane that ‘over the prferm recesses, Te presence of sich a foekn Body medal causes the patent to cough violent Mucous Related Videos: agus Nene First Aid References: Ft Bi fr the LEME Step 12040, Dh Fst Ad forthe USMLE Step 1 2018, 26 oh Fst Ad forthe USMLE Step 12017, 27‘esophegs Tho supoveraygea! nerve (Opin) aides too ntrnal and tho tema! lnyngoa nares. The terra argos! nerve suppee sensory Ross tothe micas membrane ofthe por fossa andthe lags down a= far 9 te vocal corde and mecates the aerent kn of he cough eles. The (eteweileygeal ere as mcr mace lose cose oe superior cid rer and sunpes the cic yok mace Option A). ‘etal he prox fossa is mportant because Mia common ste for lodgment of sharp ngestd Bodies such a fh bones, whch can damage the ‘memallayngea owe a are is ony ain aor of macs membrane at overs the pitfrm recesses, The presence of sch aforen body mmedtotely causes the patent o cough volenty Mucous membrane reflected, Epiitis Ayepilate folds Ee Pf recess oe — tryeideortiage Mucous membrane intact 1. = G First Aid References: Fst Ad forthe USMLE Stop 12019, 2h od Fst Ad forthe USMLE Stop 12018, 25 od Fst Afr the USMLE Step 12017, 27 ed‘overs the pt recesses. The presence of such afoekn ody ennedtately causes tho patent to cough violent Mucous membrane ee reflected, ‘Aryepiglotic folds —Eoe larynges! nerve FP try carttage Mucous membrane intact Recurentlaynges nerve ‘opuonc: Te vagus nave ihe ne ys Be eng ta ne below + Superior anges! neve which brnches nt ternal an external lnsyngeal ners + Recurent area! neve:on th ght sito, the ntwe hooks eran ho fet pat of to subcavan artery and then ascends the roo¥e botween he trachea and he esophagus. On the ede, te neve botweon he ches an he esophogu. The nerve i cosy elated to‘Option: The vagus nore nthe neck gs the etiowingwrancns mage below + Super lanmges! neve hich brnches nt intemal an external lnsyngeal ners Recuont aygoa nrveon tho ight sds, tho nove nooks around ho fret part ofthe subctvan artery and then ascends nthe groove betwen the raha an he esophagitis, te ne Intent aches andthe eh: Tare ls ooay ead ‘he inferior yes ary, ad suppes al the muscles ofthe ary, excepto cieotyrad muse, to mucous membrane ofthe ty bow the vos! cords, andthe mucous membrane of he upper prt of the racen Option O) The emina branch of te recent nigel rere the inferior nygea nave, Inferior vagal Pharyngeal branch engin Superior laryngeal Internal laryngeal nerve Superior thyroid Thyrohyola anon External ‘Common carotid laryngeal nerve arenInferior vogl Praryngeal branch sangiion Superior laryngeal Internal laryngeal nerve ‘Superior hyrole Thyrahyoig = External ‘Common carotid laryngeat nerve aren, ‘Vagus nerve (CNX) Crieotnyroia Inferior lyngeat nerve ] trecres Right recurent Sudelavian atory lavyngeal nerve Brechlocephalc trunk Right lateral view ‘Learing objective: Thera lryngeal nerve passes inthe po fossa, Ldemeath thin ayer of mucous membrane. ts prone te damage fem 2 ‘oxagnbody egngin te aor fossa causing impaement of he ough reflec aTest Results © Comect: 16 17%) @ Incomrect: 5/6 (63%) © Omitted: 0/6 (0%) feud Mates Sater Spine eton ° 22 teaory ered Pees e Stony deine Sten e 196 bratomy eration Oncloy 8 7 betomy epee Sten e | mabey epesunve Spon© Correct: 16 (17%) ‘Omitted: 0/6 (0%) oud MniedSbjce Spine ‘ation ° 2 hoy Gerard cee ==] e story Externe Stem : e 1% ietory Herabiogy8 Oncloy e 7 sesiorw eoeenv Sen = e mm tesory Reps System 8 ot teaory tan