Abdominal Final Review WCUI 2022 with complete solution

Abdominal Final Review WCUI 2022 with complete solution Which structures lies medial to the left thyroid lobes -Answer- Larynx Common cause of thyroid disorders worldwide -Answer- Graves disease, toxic adenoma, toxic ...

Abdominal Final Review WCUI 2022 with complete solution Which structures lies medial to the left thyroid lobes -Answer- Larynx Common cause of thyroid disorders worldwide -Answer- Graves disease, toxic adenoma, toxic multinodular Parathyroid glands produce hormone that affects which organs -Answer- kidneys, bones gastrointinal bone Thyroid hormones -Answer- Thyroxine (T4) and Triiodothyronine (T3), calcitonion Multiple thyroid nodules are described as _________ -Answer- Multinodular goiter (MNG) What is the thin bridge of thyroid tissue called that straddles the trachea anteriorly? - Answer- Isthmus The isthmus is the smallest portion of the gland with an AP diameter of ____ to ____ mm -Answer- 4 to 6 How many strap muscles lie along the anterior surface of the thyroid gland -Answerthree The ______ muscle is posterior and lateral to each thyroid lobe along the anterior surface of the cervical vertebrae -Answer- longus colli When thyroid hormones are needed in the body, they are released into the bloodstream by the action of the ________ which is produced in the pituitary gland. -Answer- Thyroid stimulating hormone (TSH) Thyroid stimulating hormone is regulated by ___________ which is produced by the hypothalamus -Answer- Thyrotropin-releasing hormone (TRH) Normal parathyroid glands are located _______ to the surface of thyroid -Answerposterior ______ decreases the concentration of calcium in the blood by first acting on bone to inhibit its breakdown of calcium. -Answer- Calcitonin When thyroid is producing the correct amount of thyroid hormone, it is considered to be normal, or ________________. -Answer- EuthyroidUnder secretion of thyroid hormones is called _________ and is the most commo thyroid disorder. -Answer- Hypothyroidism What are the clinical signs and symptoms of hypothyroidism? -Answer- weight gain, hair loss, increased subcutaneous tissue around the eyes, lethargy, slowing motor, cold intolerance, constipation Oversecretion of thyroid hormone results in _______. -Answer- Hyperthyroidism _______ occurs when the entire thyroid gland is not functioning properly usually from diffuse enlargement or localized nodule or adenoma causing an over-production of thyroid hormones. -Answer- Grave's Disease Clinical signs and symptoms of hyperthyroidism -Answer- weight loss, increased appetite, irritable, tremor, excessive sweating, heat intolerance, palpitations, protruding eyes (exophthalmos) The most common laboratory test to evaluate thyroid function is ___________ -Answerserum thyroxine ______ is a thyroid test that can determine its function by combining iodine uptake scan and thyroid scan -Answer- Scintigraphy The _________ thyroid scan will detect the amount of radioactive tracer to image the thyroid glad and demonstrate the thyroid size, shape & position -Answer- nuclear medicine A concentrated amount of radioactivity in the thyroid will be imaged as a ______ (hyperfunction) nodule and an lower concentration of radioactive tracer will demonstrated absence of uptake as _______ (nonfunctioning) nodule -Answer- hot, cold Hot nodules are typically ______ and cold nodules have the potential to be ______ - Answer- benign, malignant Normal sonographic appearance of the thyroid gland is fine _______ echotexture that is slightly more echogenic that the surrounding musculature -Answer- homogeneous Approximately 80% of nodular thyroid disease is due to _________ or compensatory ______ forming micronodules and micronodules of the gland -Answer- hyperplasia, hypertrophy The most common cause of thyroid disorders worldwide is ______ deficiency, which leads to nodule and goiter formation -Answer- iodineAn _______ goiter may affect large groups of people in a specific geographic area where iodine levels in the soil, food and water are low -Answer- endemic A _______ goiter is condition where nodular enlargement causes hyperactivity of the thyroid gland and hyperthyroidism. -Answer- toxic ________ goiter occurs when nodular enlargement is not associated with thyroid dysfunction. -Answer- nontoxic A __________ is a benign thyrid neoplasm that represents 5% to 10% of all nodular diseases of the thyroid. -Answer- follicular adenoma The _______ is often solitary and slow growing unless hemorrhage occurs that could cause sudden and painful enlargement. -Answer- adenoma A presence of a thin _______ ______ or halo due to compressed tissue surrounding the adenoma is consistent finding with a benign adenoma. -Answer- hypoechoic rim ________ of the thyroid is rare -Answer- carcinoma A solitary markedly hypoechoic thyroid nodule with the presence of cervical lymphadenopathy on the same side suggest ________ -Answer- malignancy The most common of thyroid malignancies is __________, which comprises approximately 70% of all thyroid cancers. affects females 3 times more often at ages 20 to 40 years of age -Answer- papillary carcinoma ________ is the second most common type of malignancy, affects females between the ages of 40 to 60 -Answer- Follicular carcinoma Follicular carcinoma usually presents as a ______ thyroid mass and may not be differentiated pathologically with FNA biopsy and may require surgical removal of the entire nodule to confirm diagnosis. -Answer- solitary Several diseases of the thyroid are characterized by _____________ of the gland causing enlargement without palpable nodule. -Answer- diffuse involvement _______ disease is an autoimmune disorder and the most common (85%) causes of hyperthyroidism. Lab test will demonstrate elevated T3 & T4 -Answer- Graves Uncontrolled acute hyperthyroidism may cause a severe complication of Grave's disease call _______, thyrotoxic crisis or thyroid storm. It usually occurs after infection and may be life threatening due to resulting hypothermia, tachycardia or heart failure - Answer- throtoxicosisThe overactivity of Grave's disease often demonstrates increased vascularity on color Doppler imaging, leading to term ___________ -Answer- thyroid inferno __________ is "a group disorders" that include inflammation of the thyroid gland with several causes such as bacteria or viral infections, postpartum, drug induced or related autoimmune abnormalities -Answer- Thyroiditis With acute thyroiditis the thyroid is _____, enlarged and may have increased color flow visualized -Answer- hypoechoic ________ thyroiditis is the most common form of thyroiditis, it is associated with a destructive autoimmune disorder, which leads to chronic inflammation of the thyroid. - Answer- Hashimoto's Parathyroid glands have 2 that lie _____ to the superior pole of the thyroid and the other 2 lie _____ to the inferior pole. -Answer- superior, posterior The normal parathyroid glands measure less than _____ millimeters (mm). -Answer- 5x3x1 The parathyroid glands produce _______ to control the serum calcium concentration using a feedback mechanism. -Answer- parathyroid hormone (PTH) When the serum calcium level __________, the parathyroid glands are stimulated to release PTH. -Answer- decrease A __________ is a benign, solid mass and the most common cause of primary hyperparathyroidism (80% to 85%) -Answer- parathyroid adenoma (PTA) ________ is an endocrine disorder caused by the increased function of the parathyroid glands affecting women 2 to 3 times more than men. -Answer- Primary Hyperparathyroidism Breast cancer screening -Answer- Age > 20 --> self breast exams Age 20 - 39 --> breast exam every 3 years Age > 40 --> breast exam annually Age 50-79 --> mammogram every year Clinical sign and symptoms of breast cancer -Answer- dominant, discrete, breast lump, unilateral single-duct nipple discharge, surface nipple lesions, nipple retraction, focal skin dimpling, red hot breast Common Primary Signs of breast cancer mammography -Answer- Irregular (Spiculated) high density mass, clustered pleomorphic, focal distortionBI-RADS Breast Imaging Reporting and Data System was implemented by which organization -Answer- American College of Radiology BI-RADS assessment for Mammographic masses -Answer- 1 - Negative 2 - Calcified fibroadenomas, multiple secretory calcification 3 -Noncalcified circumscribed solid mas 4 - Finding do not have classic appearance of malignancy 5. Classic breast cancers Ductal elements hypertrophy -Answer- gynecomastia Lymphatic glands drain to the ______ -Answer- axillary Breast extends deep towards lateral upper margin -Answer- axilla The terminal ends of the duct and acini form small lobular units referred to as ___________ -Answer- terminal ductal lobular units (TDULS) _____ connective septa within the breasts form a fibrous skeleton which is responsible for maintaining the shape and structure of breast -Answer- Coopers ligaments __________ generally appears hypoechoic, whereas Cooper's ligaments and other connective tissue appear echogenic and are dispersed in a linear pattern -AnswerSubcutaneous fat Generally, young woman have _________ tissue elements predominate and as a woman ages have a ______ tissue. -Answer- Fibrous, fatty Breast implants create _______ appearance, sometimes termed ________ -Answerechogenic, stapladder sign Malignant tumors are aggressive and tend to grow finger like extension sometimes termed ________ -Answer- spiculation Benign lessions typically are round oval, grow within tissue planes or _________ - Answer- wider than tall Malignancy lessions typically are sharp, angular margins and invade other tissue or _________ -Answer- taller than wide ___________ within a solid mass are associated with a malignancy -AnswerMicrocalcification Most common benign breast tumor and growth is stimulated by estrogen -AnswerFibroadenoma__________ causes an enlarged, reddened tender breast and is often confined to one area of the breast -Answer- Acute mastitis _________ is an inflammation of glandular tissue, typically in older women -AnswerChronic Mastitis ________ is small, benign tumor that grows within acini of breast, frequently in women 35 to 55 years of age -Answer- Intraductal papilloma Cancer of the breast has two types _____ and ______ -Answer- sarcoma & carcinoma ________ breast cancer has a tumor that arise from supportive or connective tissue; grows rapidly -Answer- Sarcoma ______ breast cancer has a tumor that arise from epithelium; in ductal & glandular tissue -Answer- Carcinoma _________ accounts for nearly 80% of breast cancer begin in ducts but spread to fatty tissue -Answer- Invasive ductal carcinoma _______ is an intraductal solid carcinoma that has duct filled with yellow paste like material -Answer- Comedocarcinoma _______ arises in the retroareolar ducts & grows in direction of nipple; spreading into intraepidermal region of nipple & areola -Answer- Paget's disease _______ intraductual tumor with extensive fibrous tissue, most common form of breast cancer & often no histologic pattern -Answer- Scirrhous carcinoma _________ is a densely cellular tumor that contains large, round tumor -Answermedullary carcinoma Normal size of testes -Answer- 4cm length x 2 diam x 3 wide Epidiymis is divided into what three parts -Answer- head, body & tail Testis is completely covered by dense, fibrous tissue called ________ -Answer- tunica albuginea The _________ lines the inner walls of the scrotum, covering each testis and epididymis. -Answer- tunica vaginals Common spot for fluid to collect in testis -Answer- Between partietal & visceral layer or the tunica vaginalsThyroglossal duct cyst is a palpable mass _______ midlines between hyoid bone - Answer- anterior Hyperfunction of all parathyroid glands with no apparent occurs with which one of the following -Answer- primary hyperplasia of parathyroid gland Which disease is marked with increased vascularity with color Doppler and is termed thyroid inferno -Answer- Graves disease Abnormal lymph nodes demonstrate __________ -Answer- round contour Sonographic appearance of normal testis -Answer- homogenous with medium level echoes Epididymis courses _______ & _______ to testis -Answer- superior & posterolartally Which one of the following may transpire 2nd to epididymites in testis -Answer- orchitis Intratesticular cysts have association with _________ -Answer- spermatoceles Microlithiasis of testis is associated with _______ -Answer- malignant neoplasm _______ is by the superior pole of testis between epididymis and testis -AnswerAppendix testis _______ is "not considered a cancer" -Answer- lobular carcinoma in situ Microlithiasis is not considered to be abnormal unless more than ___ appear on single image -Answer- 5 The ______ is a fibrous band that stretches from the xiphoid to the symphysis pubis - Answer- linea alba The retroperitoneal cavity contains the _______, ______, ureters, _______, aorta, IVC, bladder, uterus & prostate gland -Answer- pancreases, kidneys, adrenal glands The ________ pararenal space is located between the anterior surface of the renal fascia (Gerota's fascia) and the posterior area of the peritoneum. -Answer- Anterior The most common renal neoplasm affecting the IVC is ________ usually from the right kidney -Answer- renal cell carcinoma The ______ is formed posterior to the pancrease by the union of the SMV and splenic veins. -Answer- portal veinThe liver receives a dual blood supply from the ____ and _____ -Answer- portal vein & hepatic artery Peritoneal Cavity -Answer- Liver is in what cavity? Posterior Superior surface of the medial left lobe, bordered by IVC psteriorly -AnswerWhere is caudate lobe located? Falciform Ligament -Answer- Divides liver into Rt and Lt lobes. Ligamentum Teres/Round Ligament -Answer- Divides the left lobe into medial and lateral segments. Ligamentum Teres -Answer- Remnant of the umbilical vein extending from umbilicus to the left portal vein. Ligamentum Venosum -Answer- Remnant of the ductus venosum. (fetal circulation shunt) Subpherenic Space -Answer- What is the space between the diaphragm and the liver called? Portal Triad -Answer- Group of structures is surrounded by Glisson's Capsule, w/c accounts for echogenecity of this region. CBD,Hepatic Artery and Portal Vein -Answer- What are the vessels in Portal Triad? Splenic Vein and SMV -Answer- Portal vein is confluence of ________________ and _____________________. Portal Vein -Answer- Echogenic walls, hepatopedal, low velocity, low resistance, continous flow, horizontal positioning and intra segmental. Hepatic Vein -Answer- Thin walls, hepatofugal, high resistance, pulsatile and tri-phasic, vertical positioning, and intersegmental Kupffer Cells -Answer- Excretory function, detoxification, Phagocytosis Lab Values for liver -Answer- AST, ALT, ALP, AFP, Bilirubin, Hematocrit, Leukocytosis, Prothrombin Time and Serum Proteins Alanine Amino Transferase -Answer- High levels of _______________________ in the blood can indicate a liver problem, even before you have signs of liver disease, such as jaundice, a condition that causes your skin and eyes to turn yellow.Liver Disease -Answer- An ALT blood test may be helpful in early detection of _________________________.. Alkaline Phosphatase -Answer- High _____________________________ usually means that either the liver has been damaged or a condition causing increased bone cell activity is present. Hematocrit Level -Answer- test measures the proportion of red blood cells in your blood. Red blood cells carry oxygen throughout your body. Having too few or too many red blood cells can be a sign of certain diseases. Leukocytosis -Answer- refers to an increase in the total number of WBCs due to any cause. Prothrombonin Time -Answer- Your doctor might order this test to check for a bleeding disorder. Serum Protein Electrophoresis -Answer- test measures specific proteins in the blood to help identify some diseases. Chronic Cellular Damage -Answer- What do elevation of AST indicate? Enzyme release from the liver damage disease -Answer- What do elevation of ALT indicate? Hepatoma/Hepatoblastoma -Answer- What do elevation of alkaline phosphatase (ALP)indicate? Jaundice -Answer- What does the elevated total bilirubin indicate? Biliary Tract Obstruction and Hepatocellular Disease -Answer- What does the elevated direct bilirubin indicate? Hemolytic Disease -Answer- What does the elevated indirect bilirubin indicate? Hepatoblastoma -Answer- A rare malignant germ-cell tumor. The most common malignant liver tumor that occurs in infancy and childhood. Portal Hypertension -Answer- Increased pressure in the PV as a result of obstruction of the flow of blood through the liver. Stage1-Necrosis, Stage2-Regeneration and Stage3-Fibrosis -Answer- Stages of Cirrhosis. Cirrhosis -Answer- Progressive/irreversible disease of the liver.Hydatid/Echinoco Cyst -Answer- Parasite most often causing disease in humans Fundus, Neck and Body -Answer- What are the parts of GB? Inside the cystic duct -Answer- Where are the 2 normal variants? <5 mm -Answer- What are the normal measurement of CBD? Concentrates, Stores and Transport -Answer- What are the functions of the GB? Acute Cholecystitis -Answer- Inflammation of the GB wall Adenoma -Answer- Benign epithelial cell tumor representing localized overgrowth of the lining epithelium. Polyps -Answer- Adenoma AKA _____________. Most common benign neoplasm. Klatskin Tumor -Answer- A rare carcinoma of the intrahepatic bile duct specially at hepatic hilum. Pancreatic Duct > Prox CBD. Cystic Duct >GB Dilation (Hydrophic Mucocele, CBD Dilation Intrahepatic Duct -Answer- List the structures that will be associated (dilated) with the obstruction of CBD. Retroperitoneal -Answer- Whereis the pancreas located? Wirsung Duct -Answer- What is the another name of the pancreatic duct? Head, Body Tail -Answer- Define the pancreatic subdivision. GDA, SMA and Splenic Artery -Answer- Which vessels provide blood flow to the pancreas? GDA and CBD -Answer- Vessels are present in the head of the pancreas. Exocrine and Endocrine -Answer- Pancreas performs both ______________ and ____________ functions. Exocrine -Answer- secretes hormones Lipase, Trypsin, and Amylase -Answer- What are the exocrine products of the pancreas? Amylase -Answer- Breakdown complex carbs. Islets of Langerhans -Answer- Which cells perform the endocrine functions?Alpha Cells, Beta Cells and Delta Cells -Answer- What are the endocrine products of the pancreas? Alpha Cells -Answer- Secretes glucagon stimulates the liver, convert glycogen to glucose. Beta Cells -Answer- Stimulates cell receptors to open and receive glucose. Cholecystokinin -Answer- Stimulates secretion of pancreatic enzymes relaxation of intestinal sphincters and GB contraction. Renal Cortex, Medulla and Renal Pelvis -Answer- What are the 3 subdivisions of the kidney? Renal Pelvis -Answer- Which is the most echogenic portion of the kidney? Medulla -Answer- Which is the darkest part of the kidney? Gerota's Fascia, Fibrous Capsule and Pararenal Fat -Answer- What are 3 surrounding layers of the kidney? Blood Vessels, Peripelvic Fat, Nerves, and Lymphatics -Answer- What are the contents of renal sinus? What is the normal size of the kidney -Answer- 9-13 cm length, 4-5 wide, 2-3 thick Urine Test, Pyuria, Proteinia, PH level of the urine, BUN and Serum Creatinine - Answer- What are the lab values for abnormal renal functioning/failure? Excretion of waste, Urine Production, it influence blood pressure, regulation of acid base/electrolytes ions, and control blood concentration -Answer- What are the functions of kidney's? <0.5 to 0.7 -Answer- What is the normal resistive index? Adult Polycystic Kidney Disease -Answer- A genetic disorder. Associated with Burry's aneurysm Multicystic Dysplastic Kidney -Answer- Most common childhood renal cystic disease. Multiple renal cysts of variable size are typical w/ largest ones usually peripheral. Hydronephrosis -Answer- Dilation of renal collecting system caused by obstructive outflow of the urine. Hypernephroma -Answer- RCC AKAAngiomyolipoma -Answer- Common benign neoplasm composed of angiolipotoma composed of fat, blood, vessel and smooth muscle fibers. Lymphatic Systems and IVC -Answer- Define the ways cancer can mestatisize from kidney. Perinephric fat, Gerota's Fascia, Renal Vein, IVC, Heart, Lymph Nodes, and Adjacent structures (Adrenal gland, spleen, liver contralateral kidneys) -Answer- Name the various locations of invasion of the metastasize from the kidneys. 24-72 hrs to define texture, size, blood flow and fluid collection -Answer- What does the baseline examination include for transplanted kidney? Anterior Superior and medial to the Kidney bilateral -Answer- Where is the location of adreanl glands? RetroPeri -Answer- Is adrenal glands retro or peritoneal? Aldestrone, Cortisol and Estrogen/Androgen -Answer- Which are the hormones produced by the cortex of adrenal gland? Epinephrine and Non Epinephrine -Answer- Which are the hormones produced by the medulla of adrenal gland? Addison's Disease -Answer- List the diseases caused by the hypoadrenalism. Atrophy -Answer- Addison's disease is due to __________ of the gland. Cushing's Syndrome, Conn's Syndrome, and Pheochromacytoma -Answer- List the diseases caused by hyperadrenalism. Cushing's Disease -Answer- Caused by the pituitary tumor or adrenal corticol tumor. Conn's Disease -Answer- Caused by too much aldesterone-benign tumor Pheochromacytoma -Answer- Tumor arises from medulla and causes sustained hypertension, headaches, sweating, tachycardia, anxiety nausea, and vomiting. Phagocytosis -Answer- Filters blood damage cells and amino organism Tunica Intima, Media and Externa -Answer- List the 3 layers of an artery/ Bi-Phasic Flow -Answer- What are type of blood flow is present in aorta?Celiac Axis, SMA, Renal Artery, Gonadal Artery and IMA -Answer- What are the branches of abdominal AO (cephalad to caudal) and which structures receive blood form them? Celiac Axis -Answer- The artery supplies blood to liver, stomach, spleen and pancreas. SMA -Answer- The artery supplies blood to small intestine, cecum, asc. colon, pancreas and hepatic flexure. Renal Artery -Answer- The artery supplies blood kidney, ureters, adrenal glands. Gonadal Artery -Answer- The artery supplies blood to ovaries/testicles. common hepatic artery -Answer- Liver get the blood supply from what artery? Lt. Gastric Artery -Answer- Stomach get the blood supply from what artery? Splenic Artery -Answer- Spleen and pancreas get the blood supply from what artery? SMA and IMA -Answer- Which artery has dual resistance in our body and when does it changes its resistance of blood flow? Low Resistance -Answer- SMA/IMA resistance after eating? Distal IVC -Answer- What vessel is anterior to to spine and ascends in the abdomen to the right of the abdominal AO. Does the distal IVC has pulsatile or phasic flow? -Answer- phasic IVC -Answer- The following veins drains to ___________________. CIV, Rt GV, Rt and Lt Renal V, Hepatic V and Rt Adrenal V Fusiform -Answer- A true aneurysm. Uniform dilation of all 3 layers of an artery. Saccular -Answer- Focal outpouching on one side of the vessel wall. Lt. CIA -Answer- What is the most common location of Saccular Aneurysm? Intrarenal -Answer- What is the most common location of Fusiform Aneurysm? Dissecting Aneurysm -Answer- occurs when intimal lining of the arterial wall tears and allow the blood to flow between intima and media causing inflammation. Thoracic Region -Answer- What is the most common location of Dissecting aneurysm?Pseudoaneurysm -Answer- Fasle aneurysm. These aneurysm do not have a wall. Surrounded by clot. T3, T4 and Calcitonin -Answer- Which hormones are produced by thyroid gland? T3 and T4 -Answer- Stimulation growth of the body Calcitonin -Answer- Balances calcium/blood level Parathormone -Answer- Which hormone is produced by parathyroid gland? CCA and IJV -Answer- The lateral borders of the thyroid glands? Strap Muscle -Answer- The anterior border of the thyroid glands? Longus Colli -Answer- The posterior borders of the thyroid glands? Multinodular and Hashimoto Thyroiditis -Answer- List the diseases caused by hypothyroidism. Grave's Disease, Thyroid Cysts, and Follicular Adenoma -Answer- List the diseae caused by the hyperthyroidism. Mucosal, Submucosal, Muscularis, Serosal, and Mesothelium -Answer- What are the layers of the GI tract?(from innermost to outermost) Head, Body and Tail -Answer- What are the portions of epididymis? Hydrocele -Answer- Abnormal accumulation of fluid in the tunica vaginalis. Varicocele -Answer- Enlargment of the veins of the seromatic cord that will cause infertility. Hematocele -Answer- Blood in serotal sac because of injury or surgery. Spermatic Cord Tosion -Answer- The spermatic cord w/c is composed of arteries, veins, vas deferens, nerves and lymphatic ducts is twisted and cut off the blood supply to the testicle. Subcutaneous, Mammary, and Retromammary -Answer- What are the layers of breast? Fibradenomas -Answer- What is the most common benign breast mass? Infiltrating Ductal Carcinoma, Medullary Carcinoma and Infiltrating lobular Carcinoma - Answer- List the malignant masses of the breast.A Stone -Answer- Intraluminal echogenic structure casting a distal acoustic shadow. gravity dependent and moves or float. Posterior shadowing Hemorrhage, Urinoma, Lymphocele and Abscess -Answer- List the fluid collections in the retro peritoneal cavity. Hepatopedal -Answer- Flow toward the liver Hepatofugal -Answer- Flow away the liver Hyperglycemia -Answer- Uncontrolled increase in glucose Porcelain GB -Answer- Calcification of the GB wall Hydropic GB -Answer- Hydrops occurs with distention of the GB Santorini Duct -Answer- A variant or accessory pancreatic duct Ampulla of Vater -Answer- Small opening in the duodenum in which the pancreatic and CBD enter to release secretions retroperitoneum -Answer- space behind the peritoneal lining of the abdominal cavity vas deferens -Answer- tube that connects the epididymis to the seminal vesicle rete testis -Answer- network of tubules between the seminiferous tubules and the epididymis ureterocele -Answer- a dilated distal portiob of ureter seen in the bladder. maybe unilateral or bilateral Courvoisier's sign -Answer- it's enlarged non diseased GB associated w/ an extrinsic obstruction of the distal CBD McBurneys point -Answer- site of maximal tenderness in the RLQ; usually appendicitis located by drawing a line from the right anterosuperior iliac spine to the umbilicus at approximately the midpoint of thisbline lies the rootof the appendix. Positive Murphy's sign -Answer- focal tenderness over the GB Exopthalmus -Answer- bulging eyes, often from thyroid disease due to Graves disease tunica vaginalis -Answer- The delicate layer of serous membrane that covers the testis is called thepampiniform plexus -Answer- a network of testicular veins that drain the testes and absorb body heat from the testes and scrotum cyptoorchidism -Answer- undescend testicles risk for cancer Valsalva maneuver -Answer- forcible exhalation against a closed glottis, resulting in increased intrathoracic pressure