Anatomy Flashcards
pericardium supply/drain/innerv? what is the pericardial cavity?
pericardiacophrenic a/v; phrenic n/CN10/sympathetic trunk (for vasomotor). phrenic n = C3-5 for shoulder pain. potential space b/w parietal & visceral pericardial layers
transverse vs oblique pericardial sinus
b/w inflow sVC & pulm vv and outflow aorta & pulm trunk vs wide pocket-like recess of pericardial cavity post to base of heart
heart in middle mediastinum of pericardial sac & rests on central tendon. base vs apex vs crux of heart?
LA w/ lil bit of RA anchored by great vessels vs 5th intercostal space not anchored in pericardial sac vs where all 4 chambers meet
sternocostal vs diaphragmatic vs R pulm vs L pulm surface of heart? sup vs inf vs R vs L border of heart?
ant vs inf vs RA vs LA
R/LA & auricles vs RV w/ lil bit LV vs RA b/w sVC & IVC vs LV w/ lil bit L auricle
R/LCA branch off what? 4 RCA branches: sA nodal vs R marginal vs post intervent vs AV nodal. LCA branches: ant intervent vs circumflex (vs L marginal)
ascending aorta. RA & sA node vs apex & RV vs R/LV, post 1/3 IV septum, anastomoses w/ IV branch of LCA near apex vs AV node. ant R/LV & ant 2/3 IV septum including IV bundle vs LA vs LV
how to determine dominance of coronary aa? PDA supplies what?
if post intervent is coming off of RCA or circumflex (LCA). generally R > L dominance. AV node
great cardiac vs mid cardiac vs small cardiac vs ant cardiac vs L post ventricular vv drain what?
LA, both V vs post IV septum vs post RA/V vs ant RA/V vs diaphragmatic surface of LV
lymphatic drainage = crossed –>
LA/V -> L coronary trunk -> inf tracheobronchial nodes -> bronchomediastinal trunk -> R venous jxn. RA/V -> R coronary trunk -> ascending aorta -> brachiocephalic nodes -> L venous jxn. pericardium -> sup phrenic nodes & bronchiomediastinal trunks -> R/L venous jxns
heart’s conduxn system innerv by? symph vs parasymph innerv cause? what are visceral sensory fibers?
autonomic nn of cardiac plexus. inc rate & force of ctx, thoracic splanchnic nn dil coronary aa vs dec rate of ctx, CN10 constrict coronary aa. carry pain sensation & travels w/ symph CN10 to T1-5 of spinal cord
describe sA node vs AV node vs AV bundle/His vs Purkinje fibers & their locations
pacemaker of heart, starts ctx; on external surface of heart in myocardium of RA & sVC vs stimulated by sA node (myogenic conduxn) & transmits impulse to His; base of IA septum above septal cusp of triscuspid vs transmit impulse to vent walls; membranous IV septum -> R/L bundle branches vs where bundle branches end -> subendocardial fibers that ascend in muscular walls of ventricles
cardiac cycle overview
- initial diastole -> A/V relaxed, AV & sL valves closed
- late diastole -> A fill -> AV valves open -> V fill
- stim sA node -> A ctx -> force rest of blood to V
- V pressure inc -> AV valves close -> LUB
- stim AV node -> His init V ctx (vent systole)
- inc interventricular pressure -> sL valves open -> RV to pulm trunk, LV to aorta
- V relax (ventricular diastole) -> sL valves close -> DUB
3 major spaces & floor of thoracic cavity? perks of having a dome shaped thoracic cage?
2 pulm cavities, 1 central mediastinum, diaphragm floor. rigidity; protect organs, resist neg internal pressure, attach, support, maintain wt of UE, abd, neck, back, respiration
where/how do rib fx occur? costochondral vs sternocostal vs costovertebral joints
typically at rib angle; from blunt trauma, hard to see on plain film. b/w bone & cartilage 1-10 vs b/w sternum & cartilage 1-7 (1 = fibrocart, 2-7 = synovial) vs b/w ribs & vertebrae
typical vs atypical ribs. pump handle vs bucket handle ribs
2-6 b/c facets vs 1, 11-12 b/c diff facets. 1-6 have convex articular surfaces -> transverse rotation; oblique ribs = horiz during inhal -> inc AP diameter vs 7-10 have flat articular surfaces -> glide -> inc lat diameter
external vs internal intercostal vs innermost mm. which thoracic spinal n vs branches make up intercostal n?
elev ribs in inhal, cont w/ external obliques vs fibers perpend to ext; dep ribs in forced exhal, cont w/ internal obliques vs same action as int, separated by intercostal a/n. ant rami of T1-11, T12 subcostal n vs collateral, lat cutaneous, ant cutaneous branches
what’s flail chest? thoracic outlet syndrome and tx?
many ribs broken –> chest wall moves inward on inspiration & impairs ventilation. n/a/v compressed in sup thoracic aperture/root of neck (broken clavicle, supernumerary rib, tumor, aneurysm); surg decompression
sup vs inf thoracic aperture borders & contents
thoracic inlet by T1, R1, manubrium; esophagus, trachea, n/a/v of head & UE vs thoracic outlet by T12, R11/12, costal cartilage, xiphoid process; structures to/from abd/thorax thru openings of diaphragm (esophagus, IVC, aorta)
what’s the diaphragm? borders?
musculotendinous sheet separating thorax from abd primarily for inspiration; insert onto central tendon; costal margin, vert bodies L1-3, med/lat arcuate lig, xiphoid process, R&L crura attach to lumbar
cardiothoracic ratio. cardiomegaly? wide mediastinum?
max horiz cardiac width/max horiz thoracic width. >50% on PA film. >9cm on PA CXR at lvl of aortic arch
acute vs chronic mediastinitis; complication & tx?
rapid inflamm from trauma, necrotic tumor, iatrogenically from invasive procedures; CXR wide mediastinum, pneumo/hydrothorax vs slow illness either idio or granulomatous infxn (TB, histoplasmosis), neoplasm, rads; SVC & surgical debridement of fascial planes
sxs vs dx vs tx vs complications of mediastinal mass
retrosternal pain, cough, dyspnea, choking; SVC -> inc ICP, periorbital & facial edema, proptosis, UE swell vs incidental CXR -> CT w/ IV (best) vs surg removal x/ lymphoma -> chemo vs pneumothorax, perforation great vessels/pericardium, nerve injury (phrenic most risk -> paralyze diaphragm)
pericarditis & sxs. tx?
pericardial layers inflamed –> CP; pericardial friction -> superficial scratchy/squeaking sound over L sternal border; EKG changes; pericardial effusion vs NSAIDS but some cases = idio or viral (Coxsackie)
fibrinous pericarditis
shaggy fibrinous exudte on epicardial surface, bread/butter pericarditis; fibrin from friction rub b/w epicardium & pericardium
acute cardiac tamponade
life threatening heart compression d/t pericardial accum of pus/blood/gas from effusion/trauma/rupture/high ventilatory pressures -> RA/V collapse in diastole -> impaired fill -> dil IVC, dec blood return & CO; more common in stab > GSWs
