2. Anatomy Flashcards
chest pain the results from transient ischemia brought on by exertion
Angina pectoris
angina pectoris is due to
reduced blood flow because of narrowing of artery
angina pectoris
is substernal pain that may be referred over the ___
dermatomes
T1 -T5
T1 dermatome int he medial aspect of the left arm and forearm may be felt over the
cervical dermatomes in the neck up to level of the angle of the mandible
results from localized avascular necrosis of cardiac cells caused by prolonged ischemia
myocardial infarction
common site of occlusion for MI
anterior interventricular artery
difference of angina pectoris and MI
angina pectoris - tightness/ squeezing pain precipitated by stress or exertion
MI- more severe pain, not relieved by rest
Nerve supply of the heart
ANS via the cardiac plexuses
Sympathetic - cervical and upper thoracic
Parasympathetic - vagus nerve
As a pathologist, you are examining the heart of a victim of fatal trauma and note a tear at the junction of SVC and right atrium. This tear would likely damage the
Sinoatrial node
pacemaker of the heart
SA node
SA node is located
within atrial wall on right side of its junction with Superior vena cava
right/left bundle branches are located at
muscular portion of interventricular septum
V1 placement
4th ICS just to the right of sternum
V2 placement
4th ICS just to the left of the sternum
V3 placement
midway between V2 and V4
V4 placement
midclavicular line, 5th ICS
V5 placemement
anterior axillary line, 5th ICS
V6 placement
midaxillary line, 5th ICS
right atrium receives blood from
SVC, IVC, coronary sinus, anterior cardiac vein, vena cordis minimae
The following veins drain into right atrium EXCEPT? A. coronay sinus B. Superior vena cava C. Anterior cardiac D. Great cardiac
D.Great cardiac
internal wall of right atrium is composed of
sinus venarum (posterior) musculi pectinati (anterior)
fossa ovalis is remnant of
foramen ovale
if foramen ovale persists after birth it leads to
ASD
Atrial septal defect
internal surface of right ventricle has irregular muscular ridges called
trabeculae carnae
trabeculae carne is where this muscle originates
papillar muscle
apices of right ventrice are connected by fibrous strands called
choradae tendinae
modified trabeculae carnae that crosses the interventricular septum
moderator band
has thicker wall than right atrium
right ventricle
left atrium
left ventricle
this heart chamber receives 4 pulmonary veins on its posterior wall
left atrium
most posterior of 4 chambers
left atrium
walls twice as thick as right ventricle
left ventricle
how many papillary muscles does right and left ventricle have
3 papillary muscles (anterior, posterior, septal) - RV
2 papillary muscles (anterior, posterior) LV
presence of moderator band
RV
LV
RV- present
LV - absent
crescenteric cavity
chamber of heart
RV
circular cavity
heart chamber
left ventricle
The heart tube continues to elongate and bend on day
23
This bending, which may be due to cell shape changes, creates cardiac loop completed at day
28
primitive atrium forms the
left atrium
sinus venosis forms the
right horn -> right atrium
left horn -> coronary sinus
primitive ventricle forms
all of the left ventricle
bulbus cordis forms
all of the right ventricle
truncus arteriosus becomes partitioned to form the
root of aorta and pulmonary trunk
most common formof congenital heart diseases
Atrial septal defect
ASD is due to
most common form is due to patent foramen ovale
shunts blood from left atrium to right atrium
Atrial septal defect results in this adaptation
hypertrophy of right atrium, right ventricle, and pulmonary trunk
most common type of CHD 25%
Ventricular septal defect
ventricular septal defect is more common in this gender
males
membranous VSD is due to
incomplete closure of the IV foramen results from failure of the membranou part of IV septum to develop
left to right shunting of blood, increase blood flow to lungs and cause pulmonary hypertension
The anatomic description of this CHD
consists of an outlet ventricular septal defect (VSD), a single semilunar valve, and a common great artery that overrides the VSD.
Persistent Truncus Arteriosus
most common cause of cyanotic heart disease
Transposition of the Great Arteries
The anatomic description of this CHD is
aorta lies anterior to the right of he pulmonary trunk and arises anteriorly from the morphological RV and pulmonary trunk arises from the morphological LV
TGA
Transposition of Great Arteries
TGA is associated with
ASD and VSD
right to left shunting of blood and cyanosis
Tetralogy of Fallot
components of tetralogy of fallot
pulmonary stenosis
VSD
dextropositio of aorta/ overriding aorta
right ventricular hypertrophy
before birth, the respiratory function of the lungs are performed by
placenta
these vasculature carry oxygenated blood back to the heart
umbilical veins
pathway for oxygenated blood in fetus
umbilical vein -> ductus venosus -> Inferior vena cava -> right atrium -> foramen ovale -> left atrium -> left ventricle -> aorta
pathyway for unoxygenated blood in fetus
superior vena cava -> right atrium -> right ventricle -> pulmonary trunk -> ductus arteriosus -> aorta
these shunts close when the baby is born
foramen ovale
ductus arteriosus
ductus venosus
anatomical closure of foramen ovale occurs by
3rd month ]
foramen ovale -> fossa ovalis
remnant of umbilical vein
ligamentum teres
remnant of umbilical arteries
medial umbilical ligaments
remnant of ductus venosus
ligamentum venosum
remnant of foramen ovale
fossa ovalis
remnant of ductus arteriosus
ligamentum arteriosum
when does ductus arteriosus close
close immediately after burth
complete obliteration and fibrosis by 3-4 weeks
remains patent and may be used for exchange transfusions of blood during early infancy
umbilical vein and ligamentum teres
Patent ductus arteriosus is more common in this gender
females
most common congenital anomaly associated with maternal rubella infection during early pregnancy
patent ductus arteriosus
failure of the ductus arteriosus to involute after birth and form the ligamentum arteriosum
Patent ductus arteriosus
This congenital defect will result in aortic blood shunted
Patent ductus arteriosus
the pharyngeal arches develop during
4th week
returning blood from the placenta; involutes after birth
umbilical/allantoic or placental veins
returning blood from the splanchopleura (yolk sac and gut derivatives ) become the portal system
vitelline or omphalomesenteric veins
returning blood from the somatopleura of embryo; be come the caval system
cardinal veins
carry well oxygenated blood from the placenta to the sinus venosus
umbilical veins
2 parts of pleura
visceral
parietal
4 subdivisions of the lungs
costal pleura
mediastinal pleura
diaphragmatic pleura
cervical pleura/ cupula
What is the inferior limit of the parietal pleura in the Midaxillary line
rib 10
A thoracentesis is performed to aspirate an abnormal accumulation of fluid with pleural effusion. A needle should be inserted at the midaxillary line between whihc of the following two ribs as to avoid puncturing the lung
ribs 8 and 10
Costal line of pleural reflection passes OBLIQUELY across the
MCL- 8th rib
MAL- 10th ib
Rib sides of vertebral column -12th rib
Lower margin of lungs
MCL- 6th rib
MAL - 8th rib
rib sides of verterbal column - 10th rib
Parietal pleura is sensitive to
pain, touch
temperature
presure
visceral pleura is sensitive to
stretch
nerve supply of parietal pleura
costal - intercostal nerve
mediastinal - phrenic nerve
diaphragmatic - phrenic and intercostal
nerve supply of visceral pleura
pulmonary plexus
The following are characteristics of left lung except
a. deep cardiac notch
b. provided with middle lobe
c. with oblique fissure
d. provided with lingula
b. provided with middle lobe
vital organ of respiration
lungs
this lung is larger, heavier, shorter and wider
right lung
each lung has
apex
hilum of the lung
root of the lung
3 surfaces of the lung
costal
mediastinal
diaphragmatic
3 borders of the lung
anterior
inferior
posterior
where parietal and visceral pleura meet
root of the lung
contains bronchi, pulmonary artery
pulmonary veins
lymph vessels
and bronchial vessels
root of the lung
type/s of bronchi present in right lung
eparterial and hyparterial
type of bronchi present in left lung
hyparterial
which of the following forms the lower division of the upper lobe of the left lung
superior and inferior lingular
largest subdivision of a lobe
bronchopulmonary segment
bronchopulmonary segment are named according to
the segmental bronchus supplying it
what separates bronchopulmonary segments
connective tissue
anatomical and surgical unit of the lung
bronchopulmonary segments
bronchopulmonary segments of right lung
SUPERIOR LOBE
Apical
Posterior
Anterior
MIDDLE LOBE
Lateral
Medial
INFERIOR LOBE Superior Anterior basal Medial basal Lateral basal Posterior basal
bronchopulmonary segments of left lung
SUPERIOR LOBE Apico-posterior Anterior Superior/Inferior Lingular INFERIOR LOBE Superior Anterior basal lateral basal Posterior basal
eparterial bronchus
right superior bronchus
main bronchi that is wider, shorter, more vertical
right main bronchi
types of bronchi
main/primary
secondary/lobar
tertiary/segmental
type of secondary bronchus
right lung
a. eparterial - superior
b. hyparterial - middle and inferior
left lung
both hyparterial
a thoracic surgeon removed a right middle lobar bronchus along with lung tissue from a 57 year old heavy smoker with lung cancer. Which of the following bronchopulmonary segments must contain cancerous tissues?
lateral and medial bronchopulmonary segment
Lung cancer located near the cardiac notch, a deep indentation of the lung. Which of the following lobes is most likely to be excised
superior lobe of the left lung
A child suspected of aspirating a small metal button is seen in the emergency room. Although the child does not complain of pain, there is frequent coughing. DIminished breath sounds should be heard
right inferior lobe
examination of the bronchi using a bronchoscope
bronchoscopy
which bronchus will foreign body likely enter
right bronchus - shorter, wider, more vertical
in a patient who is standing or sitting, the foreign body tends to lodge in thus segmement
posterobasal segment of the inferior lobe of the lung
foreign body aspiration
supine position
which BPS
superior BPS of the right lower lobe
foreign body aspiration
lying on the right side
which BPS
posterior BPS of the right upper lobe
foreign body aspiration
lying on the left side
which BPS
inferior lingular BPS of the left upper lobe
blood supply of the lung
bronchial arteries - from descending thoracic aorta
pulmonary arteries - from pulmonary trunk
venous drainage of lungs
bronchial veins -> drain into azygous and hemiazygous vein
pulmonary veins
- empty into left atrium
superior pulmonary sulcus tumor
Pancoast tumor
A 56 year old man diagnosed with pancoast tumor. The patient has symptoms of shoulder pain associated with ptosis, miosis, enophthalmos, and anhidrosis
cervical sympathetic trunk
pancoast syndrome
lower trunk brachial injury - pain radiating to shoulder and medial aspect of the arm; atrophy of muscles of forearm and hand
lesions of cervical sympathetic ganglia - - horner syndrome (pstosis, enophthalmos, miosis, anhidrosis, and vasodilation)
lymph drainage of the lungs
superficial/subpleural plexus
deep plexus
lies deep in the visceral pleura and drains lymph from the surface to the hilum of the lung
superficial/subpleural plexus
drain into bronchopulmonary / hilar LN to tracheobronchial LN
deep plexus
posterior intercostal artery is branch of
thoracic aorta
anterior intercostal artery is branch of
internal thoracic artery and musculophrenic artery
posterior intercostal vein drain into
azygous / hemiazygous veins
anterior intercostal vein drain into
internal thoracic vein
posterior intercostal arteries are supplied by
first two- superior intercostal of the costocervical trunk
remaining branches- supplied by descending aorta
anterior intercostal arteries are supplied by
Upper six- Internal thoracic artery
remainign - musculophrenic
THORACENTESIS - the needle is inserted ____ to avoid damage to intercostal vessels and nerves
ABOVE the rib
order of structures of intercostal space
VAN
Vein
Artery
Nerve
site of thoracentesis
midaxillary lien MAL
8th intercostal space
layers: skin, superficial fascia,, 3 layers of intercostal muscles and parietal pleura
the highest level thoracentesis is done without induring the lung in MAL is
8th intercostal space
lowest level to perform thoracentesis lie at level of which rib
10th rib
the subclavian artery is divided into three parts by this muscle
scalenus anterior
first part of subclavian artery
vertebral
thyrocervical (inferior thyroid, superficial cervical, suprascapular)
internal thoracic
portion of aorta
Ascending aorta
Arch of aorta
Descending aorta
Abdominal aorta
Ascending aorta branches
right and left coronaries
arch of aorta branches
brachiocephalic
left common carotid
left subclavian
descending aorta branches
bronchial mediastinal esophageal posterior intercostal pericardial subcostal
aneurysm of the aortic arch - sign
pulsatile swelling in the suprastenal notch
aneurysm of the aortic arch- can lead to
compress the trachea, esophagus, left recurrehnt laryngeal nerve
DOB
difficulty swallowing
hoarseness
types of coarctation of aorta
postductal coartation
preductal coartation
infantile form of coarctation of aorta
postductal coartation
constriction of varying length of aorta
coarctation of aorta
coarctation of aorta
gender twice more at risk
males
coarctation of aorta
constriction is just DISTAL to the ligamentum arteriosum
postductal coarctation
coarctation of aorta
constriction is just PROXIMAL to the ligamentum arteriosum
preductal coarctation
adult form of coarctation
postductal coarctation
coarctation of the aorta
blood pressure sign
BP reduced in lower limbs and
elevated in the head, neck and upper limbs
continuation of sigmoid sinus
internal jugular vein
Internal jugular vein leaves the skull through
jugular foramen
Internal jugular vein is closely related to these nodes
deep cervical nodes
Internal jugular vein position in carotid sheath
lateral to vagus nerve
and internal and common carotid arteries
Internal jugular vein
tributaries
inferior petrosal facial lingual pharyngeal superior thyroid middle thyroid
indications for central venous catheter
- administration of drugs and parenteral nutrition
- hemodynamic monitoring
- rapid fluid administration
- long term venous access
common sites of central venous catheters
internal jugular
subclavian (infraclavicular approach)
femoral
infraclavicular approach will have the needle pierce the following structures
skin superficial fascia pectoralis major (clavicular head) clavipectoral fascia suclavius muscle wall of subclavian vein
aantomical problems of
subclavian catheterization
infraclavicular approach
hitting the clavicle
hitting the first rub
hitting the subclavian artery
hitting the phrenic nerve
complications of
subclavian catheterization
infraclavicular approach
pneumothorax hemothorax subclavian artery puncture internal thoracic artery puncture diaphragmatic paralysis
advantages of using right IJV in catheterization
larger than the left
its course to the SVC is straight
disadvantages and risks of using left IJV in catheterization
- chylothorax- thoracic duct joins the left IJV; misplaced catheter may result in chylothorax
- pneumothorax- cervical pleura extends further into the neck on the LEFT
- longer - it turns and joins the subclavian to form the brachiocephalic vein and again to enter the SVC
important landmark of right IJV catheterization
supraclavicular fossa
union of the internal thoracic and subclavian vein
brachiocephalic vein
brachiocephalic vein is formed at the level of
inferior border of first right costal cartilage
tributaries of brachiocephalic vein
internal thoracic
vertebral
inferior thyroid
superior intercostal
union of the right and left brachiocephalic veins
superior vena cava
at this level, superior vena cava ends to enter the right atrium
3rd RIGHT costal cartilage
connects SVC from IVC
azygos vein
azygos vein is formed by the union of
right ascending lumbar
and
right subcostal veins
this vasculature ascends through the aortic opening in the diaphragm on the RIGHT side of the aorta to the level of 5th thoracic vertebra
azygos vein
tributaries of azygos vein
intercostal vein mediastinal vein esophageal bronchial hemiazygos ( left subcostal and ascending lumbar) accessory hemiazygos
etiology of superior vena cava syndrome
compressed by LN enlargement because of metastasis from a bronchogenic carcinoma
signs and symptoms of
Superior vena cava syndrome
headache
edema of the head and neck
prominent superficial veins and cyanosis
in complete occlusion of SVC, venous return from the head, neck and upper limbs is shunted into
tributaries of IVC
what causes changes of breast morphology in breast cancer
interference with the lymphatic drainage of the breast by cancer -> deviation of the nipple and produce a thickened with prominent pores of the skin (Peau d’ orange sign)
retraction of the nipple is caused by
pulling on the lactiferous ducts
skin dimpling is caused by
shortenng of the suspensory/ cooper ligament
the breast lies in this layer
superficial fascia
the breast overlies these muscles
pectoralis major
serratus anterior mucles
external oblique muscles
rectus abdominis
cooper ligament connects
dermis - pectoral fascia
nipple is usually at this level
4th ICS
breast adenocarcinomas most commonly begin as painless masses in the
upper lateral quadrant
late stage signs of breast adenocarcinoma
retraction
fixation of the nipple
dimpling of the skin
breast adenocarcinomas metastasize mainly to
axillary lymph node
radical mastectomy
what structures are removed
breast
pectoralis major/minor muscles
axillary lymphnodes and vessels
nerve injuries related ater radical mastectomy
winging of the scapula
long thoracic nerve
nerve injuries related ater radical mastectomy
difficulty in horizontal extension of the upper extremities
thoracodorsal nerve
nerve injuries related ater radical mastectomy
loss of sensation on the upper inner aspect of the arm
intercostal nerve
nerve injuries related ater radical mastectomy
difficulty in lifting her child, flapping ehr arms, doing arm wrestling
medial pectoral nerve
nerves that can be injured
radical mastectomy
long thoracic nerve
thoracodorsal nerve
intercostal nerve
medial pectoral nerve
blood supply of the breast
a. internal thoracic from subclavian artery
b. lateral thoracic and thoracoacromial from axillary
c. post intercostal from thoracic aorta
venous drainage ofthe breast
internal thoracic vein
lateral thoracic and thoracoacromial to axillary vein
lateral quadrants of the breast drain to ___ LN
axillary LN
medial quadrants of the breast drain to ___ LN
parastenal
nerve supply of the breast
4-6th intercostal nerve
A 45 year old woman is noted to have a 1.5 cm breast cancer located in the UPPER INNER QUADRANT of the RIGHT breast.
Which of the following LN is most liekly affected
parastenal node
Level 1 axillary node
anterior/pectoral LN
posterior/ scapular LN
lateral/ humeral LN
level 2 axillary LN
central LN
level 3 axillary LN
apical LN
clinical stage of breas cancer
carcinoma in situ; confined to the ductal system
0
clinical stage of breas cancer
less than or equal to 2 cm; LNs are uninvolved
1
clinical stage of breas cancer
less than or equal to 5 cm; oneto three axillary nodes involved
2
less than or equal to 5 cm; 4 or more axillary nodes are involved
3
clinical stage of breas cancer
distant metastases are present
4
motor nerve supply of the diaphragm
phrenic nerve
sensory nerve supply of diaphragm
central - phrenic nerve
peripheral - intercostal nerves
right crus of the diaphragm
is at this level
L1-L3
left crus of the diaphragm
is at this level
L1-L2
phrenic nerve
arises from
C3,C4, C5
the right lymphatic duct drains the
right side of the body above the diaphragm
three openings of diaphragm
aortic hiatus
esophageal hiatus
caval foramen
caval foramen lies in this level
T8
esophageal foramen lies in this level
T10
aortic hiatus lies in this level
T12
caval foramen contains
inferior vena cava
right phrenic nerve
aortic hiatus contains
aorta
thoracic duct
azygous vein
esophageal hiatus contains
esophagus
vagus nerve
umbilicus is normally at what level
L3-L4
subcostal plane is at this level
10th rib ; L3
transtubercular plane lies at this level
L5; transtubercular
nine regions of abdomen
epigastric
umbilical
hypogastric/ Pubic
R/L hypochondriac
R/L lumbar
R/L inguinal
how many muscles in the abdomen
4 paired muscles (3 flat, 1 strap-like)
strengthens the abdominal wall
muscles
most superficial abdominal muscle
external oblique
free inferior margin of external oblique muscle
inguinal ligament
form aponeurosis which splits to form rectus sheath
internal oblique
innmermost abdominal muscle
transversus abdominis
aponeurosis of these abdominal muscles contribute to a conjoint tendon
Internal oblique
Transversus abdominis
abdominal muscle on either side of linea alba
rectus abdominis
lateral borders convex of rectus abdominis
linea semilunaris
cresenreric border on the posterior wall, midway between the umbilicus and pubic crest
arcuate line
contents of the rectus sheath
rectus abdominis pyramidalis superior epigastric vessels inferior epigastric vessels lower 5 infercostal and subcostal vessels and nerves
blood supply of the abdomen
A. Superior epigastric artery - from internal thoracic artery
B. Inferior epigastric artery - from external iliac artery
C. Deep circumflex iliac artery - from external iliac
venous drainage of the abdomen
A.Superior epigastric vein - to internal thoracic vein
B. Inferior epigastric vei - to external iliac vein
C. Deep circumflex iliac - to external iliac vein
nerve supply of the abdomen
ventral rami of lower 6 thoracic nerves ( T7-T12)
First lumbar nerve
inguinal region extends between
ASIS and pubic tubercle
floor/ inferior border of inguinal canal
inguinal ligament
what fascia does deep inguinal ring lie
fascia transversalis
what fascia does superficial inguinal ring lie
external oblique aponeurosis
spermatic cord
structures within
vas deferens testicular artery testicular veins (pampiniform plexus) testicular lyph vessels autonomic nerves autonomic nerves processus vaginalis cremasteric artery artery of vas deferens genital branch of genitofemoral nerve
Abnormal cysts in the spermatic cord includes
hydrocele
hematocele
spermatocele
varicocele
accumulation of serous fluid in the scrotum
hydrocele
accumulation of blood; results form the rupture of testicular blood vessels after trauma
hematocele
cyst containing sperm that develops in the epididymis
spermatocele
results from the dilations of tributaries of testicular vein
varicocele
also known as Poupart ligament
Inguinal ligament
boundaries of Hesselbach triangle
rectus abdominis - medial
inferior epigastric artery - superior, lateral
inferior and lateral - inguinal ligament