Anatomy Flashcards
ectopia cordia
baby born with heart outside chest wall
pectus excavatum
“bowl shaped”overgrowth of costal cartilage. push sternum/xiphoid INWARD to chest
pneumothorax
lung deflates due to break in intraplural sealSx: absent breath soundsdyspnea
sternal angle of louis
2nd costal cartilage
mediastinum
“midway”central compartment of the thoracic cavity. It contains the heart, the great vessels of the heart, the esophagus, the trachea, the phrenic nerve, the cardiac nerve, the thoracic duct, the thymus, and the lymph nodes of the central chest.surrounded by loose connective tissue. superior and inferior portions divide at T4/T5
valvular areas for auscultation
places to put stethoscope where valvular sounds project to the chest surface (A,P, T, M)
aortic valve: 2RICS
pulmonic vlave: 2LICS
Tricuspid vavle: 4LICS
Mitral valve: apex, 4LICS or 5LICS at midclavicular line
primary mover of air in/out of lung
diaphragm
ventilation: movement of costovertebral joints and sternum
ribs rotate up and out to increase chest volume= “bucket handle”sternum pushes anterior= “pump handle”
chest tube btwn what muscles?
pect. major and latissimus dorsimid- or anterior- axillary line
placement of chest tube: where in ribs?
btwn 5th and 6th rib5th intercostal spacerun along TOP of rib to avoid V.A.N.mid- or anterior- axillary line
hemothorax
blood accumulates in the pleural spacelimiting the amount that the heart’s ventricles are able to fillSx: dyspnea, diminished (distant) blood soundspercussion= Dull resonance
flail chest
thoracic segment is loose and moves independently with “paradoxial motion”Sx: dyspnea
In expiration, the diaphragm rises to what level?
4th intercostal space at the level of the nipple, and thus chest drains should be placed above this level
pectus carinatum
pigeon chest/ “keel shaped”deformity of the chest characterized by a protrusion of the sternum and ribs.
dyspnea
Difficult or labored breathing; shortness of breath
what causes an elevated hemidiaphragm
see on XRAY: diaphragmatic position is not symmetricphrenic nerve palsy/damage”C3/C4/C5 keeps the diaphragm alive”
which fascia lines the entire thoracic cage
ENDOTHORACIC FASCIA
what is the hilum of the lung
the doorway of the lungthe vessels and bronchi pass through this (‘the root”)
XRAY: widened mediastinum
trauma/ rapid deceleration accident (MVA)torn aorta
posterolateral thoracotomy
an incision through fifth intercostal space on the back, and is often widened with rib spreaders. common approach for operations on the lung/mediastinum/ esophagus/pulmonary hilum (pulmonary artery and pulmonary vein)
poland syndrome
congenital abnorm: absence of stertnocostal head of pectoralis majorshortening of upper extremities/digitis
coarctation of the aorta
congenital abnormstenotic aorta (narrowed)intercostal arteries enlargedxray: notched/remodeling ribs(typically constriction found on aorta distal to branching of L subclavian artery)
arrangement of neurovascular bundle in costal grove
main intercostal Vein, Artery,m Nerve (VAN)superior to inferior
What as the embryonic origin of the respiratory system (trachea, bronci, lungs)?
respiratory diverticulum
at what age are the lungs fully mature?
8 years
compare development of right and left lungs/bronchi
right grows faster, and more vertically (has 3 lobes)left grows slower, more laterally- bronchi are oriented similarly (right is more vertical and wider)
Describe the most common tracheoesophageal fistula?
Proximal esophagus is closed off; distal esophagus communicates with trachea - Failure of primitive foregut to divide into ansterior trachia and posterior esophagus - Gastric acid could reflux into the lung
What develops from the M2A tube?
FILL IN
What is the origin of the pleural space?
Coelom (pocket of mesoderm)
Contrast the visceral and parietal pleura.
Visceral (splanchic) is adhered to the lung surface (can’t be separated). - autonomic innervation (no pain sens.)Parietal (somatic) lines the outside of the cavity, lines the inside of the ribcage; - innervated (intercostal and phrenic n.), can feel pain
Significance of rubbing sounds from the triangle of auscultation?
Pleurisy- inflammation of parietal pleura assc. w pneumonia- exudate is released (becomes invaded by fiboblasts)- rubbing causes pain and can be heard
What is pleural fluid?
a consituent of blood
What is the lowest portion of pleural cavity? Significance?
costodiaphragmatic recess- the site where fluid will accumulate when the patient is upright
What is another related association of shoulder pain?
pain sensation to the parietal pleura to the phrenic nerve (from same roots as nerves that supply the shoulder)
What is the origin of the visceral pleura?
derived from splanchnic mesoderm - innervated by pulmonary plexus (pressure/stretch, but not pain)
What lines the visceral pleura?
Simple squamous mesothelium
A trachial deviation is the hallmark of what underlying problem?
Tension pneumothorax- trachea will be pushed away from the pneumothorax by the influx of air pressure
What is a consolidation of the lung?
A lobe of lung that has filled with fluid; will appear opaque on chest radiograph
Where is the first division of the bronchi where air exchange occurs
respiratory bronchial
At which phase of lung development is gas exchange possible?
- Pseudoglandular period (6-16 weeks)2. Early Canalicular period (16-20 weeks)3. Late Canalicular period (20-26 weeks): fetus survival rare, but possible (answer)4. Sacular period (26-40 weeks)5. Alveolar period (term birth to 8 years)
What produces surfactant?
Type II Pneumocytes
most common site of FB/aspiration in lungs: R or L bronchus?
R bronchus intermediusR mainstem bronchus is shorter/straighter than the 90* L mainstemxray: airspace opacity in a lobe
In patients who aspirate while in a supine/recumbent position, which lung lobe is effected
superior segments of the RLL and the posterior segments of the RUL (right upper lobe)
In patients who aspirate while in a erect position, which lung lobe is effected
right lower lobe basilar segments
what are the five parts of the mediastinum?
- superior Inferior
- anterior
- middle
- posterior
what is located in the superior mediastinum (5)?
thymus
- great vessels (SVC, arch of Azygos, arch ofAorta) trachea
- esophagus thoracic duct
what is located in the anterior (inferior) mediastinum (1)?
THE THYMUS
what is located in the middle (inferior) mediastinum?
- heart
- pericardium
- roots of the great vessels
what is in the posterior (inferior) mediastinum (4)?
- thoracic aorta2. thoracic duct3. esophagus4. azygous venous system
in a trauma patient, what does an abnormally widened mediastinum indicate?
a torn aorta
what is usually torn in a trauma patient when the aorta tears?
the ligamentum arteriosum
What are the segments of the right superior lobe?
apical, posterior, anterior
what are the segments of the right middle lobe?
lateral and medial
what are the segments of the right inferior lobe?
superior, anterior basal, medial basal, lateral basal, posterior basal
what are the segments of the left superior lobe?
- apical, posterior (usu apicoposterior segment)
- anterior
- superior lingular
- inferior lingular
what are the segments of the left inferior lobe?
- superior
- anterior basal and medial basal (usu anteriomedial basal)
- lateral basal
- posterior basal
what are the three levels of brionchioles?
ConductingTerminalRespiratory
the mediastinum is a what vertebral level?
T4-T5(T5 vertebral disc)
the phrenic nerve is right against what tissue?
The pericardium
what nerve is located between the trachea and the arch of the aorta?
the left recurrent laryngeal nerve
what is hemopericardium? What does it cause?
blood in the paricardial cavityproduces cardiac tamponade
what is pericardiocentesis? what level is the wide-bore needle placed into?
drainage of fluid from the paricardial cavitythe 5th or 6th intercostal space
where do you listen to pleural rubs on a patient (be specific)?
in the triangle of ausculatation: bordered by trapezius, latissimus dorsi and rhomboid major (or medial border of scapula)
the phrenic nerve is sourced by which parts of the cervicalnerve?
“C3, 4, and 5 keep the diaphragm alive.”
what is the difference between pneumothorax and tension pneumothorax?
in tension pneumothorax, the air is not excaping the pleural spacewheras in pneumothorax, air is flowing freely through a hole in the pleura
what are the two layers of the pericardial sac?
the outer fibrous pericardiumand inner serous pericardium
what is the sinus venarum?
the smooth part of the right atrial wall that is derived from the sinus venosus
what is the sulcus terminalis?
the groove between the sinus venarum and the rest of the right atrium(*separates the rest of the atrium from the sinus venarum)
what is the crista terminalis?
the ridge deep to the sulcus terminalis
what is the musculi pectinati?
the pectinate muscles. The are found in the anterior wall as muscular ridges.(pectin= comb)
what is the fossa ovalis?
a remnant of the foramen ovale that is now simply a depression (in the righ atrium)
what is the infundibulum in the right ventricle?
the conus arteriosusinfundibulum is latin for funnel. It is a narrowing of the r.ventricle before the pulmonary semilunar valve.
what are the trabeculae carnae?
meaty columns thatare not musculi pectinatialso, pillars of cardiac muscles
what are the papillary muscles connected to?
the chordae tendineae
what is the function of papillary muscles?
the contract early in the cardiac cycle IOT anchor the cusps of the atrioventricular valve and prevent regurgitation or backwards flow of bloodinto the atrium.
what are the chordae tendineae and what is their function?
- tendinous cords that attachthe leaflets of the tricuspid valve to the papillary muscles
- they assist the papillary muscles in preventing regurgitation
what is the moderator band? What is significantabout it
septomarginal trebeculaethis band of muscle connects the interventricular septum to the papillary muscles.the moderator band contains electrical conducting fibers
where is the atrioventricular node located?
between the valve of the coronary sinus and the tricuspid valve
where is the SA node located?
between the SVC and the Right atrium
the right recurrent laryngeal vein loops around what structure?
the right subclavianartery
the transverse pericardial sinus runs under what two structures?
the ascending aorta and the pulmonary trunk
the roght coronary artery runs in what feeature of the heart?
the coronary sulcus
the fibrous skeleton wraps around what structures?
the 4 valves: semilunar (aortic and pulmonary) and atrioventricular (mitral and tricuspid)
identify one feature of the heart that makes it susceptible to blockage
the vessels do not highlyanastomose (feed into each other)
list the vessels, chambers and valves a drop of blood would flow through beginning at theR atrium:
through the tricsupid valvetotheR ventriclethrough the pulmonary valve into thepulmonary trunkinto thepulmonary arteriesto the lungs back through thepulmonary veinsinto the L atrium through thmitral valveinto the L ventriclethrough theaortic valveinto the ascending aorta, to the arch of the aorta to systemic circulation via the brachiocephalic trunk (R subclavian and common carotid arteries) , L common carotid, L subclavian and thoracic aorta, to the arterioles, into the capillaries of organs out through the venules, into the IVC, (if on the left side) hemiazygous and accessory hemiazygous veins, (if on the right side) azygous vein,SVC (fed from the R and L brachiocephalic vein), and coronary sinus (from the heart) and back into theR atrium.
what is an aortic lunule? an aortic nodule?
the lunule is the thickenededge of a valve cusp while the nodule is the apex of the angulated lunules (free edges)
what doesthe right coronary (RCA) artery supply (4)?
right atriumSAand AV nodesthe posterior interventricular sulcus
what is the artery to the SA node called?
the SAnodal artery
what does the right marginal artery supply?
the right ventricle andthe apex of the heart
what does the posterior interventricular artery supply?
the right and left ventricles and the posterior third of the interventricular sulcus
what does the circumflex artery supply?What artery does it branch from?
the left atrium and ventricleLCA
what does the left marginal branch supply?
left ventricle
what are the branches of the left ccoronary artery?
the anterior interventricular artery or LAD (left anterior descending)left circumflexleft marginal
what are the branches of the right coronary artery?
sinuatrial (SA/AV nodes)right marginalposterior interventricular
what is the dividing point between the great cardiac vein and the coronary sinus?
the oblique vein of Marshall (aka the oblique vein of the left atrium)
what is a myocardial infarction? What happens?
necrotic myocardiuma heart attack: when an embolus occludes a vessel and blocks blood flow to the heart (ie. in acoronary artery) thus leading to necrosis of that part of the heart due to lack of oxygen
what are the three most common sites of coronary artery occlusion?
anterior IV (LAD) branch of the LCA (aka the “widow-maker”)right coronary artery (RCA)circumflex branch of the LCA
How can a coronary occlusion affect the conducting system?
if the RCA is blocked, blood supply to the SA and AV node could be dirupted and cause aheart block(a problem with the heart’s electrical system)
what is a heart block? what is the resulting effect?
damage to the heart’s electrical systemit can change the rate and rhythm of the heart rate
what is myogenic conduction? What does it produce?How is it regulated?
muscle propagated conductionproduces alateasynchronous contractionregulate/fix with a cardiac pacemaker
if you were to injure yourself through the sternum, which part of the heart would be damaged?
the right ventricle
What connects the aorta to the pulmonary artery?
the ligamentam arteriosus (previously the ductus arteriosus)
if you sweep your hand up and behind the heart but stop right behind the veins, there is your hand located?
in the oblique pericardial sinus
(T/F) The pulmonary valve is attached to the cardiac skeleton.
False. the pulmonary valve is not attached.
In the aortic valve, there are ostiums that lead to what to arteries?
the left and right coronary arteries
the heart has four valves. which are passive and which are active?
the semilunar valves are passive and the aorticoventricular valves are active
what is Virchow’s triangle for thrombosis?
- Hypercoagulability (risk for blood clots)
- Endothelial injury (intima of blood vessels)
- Hemdynamic changes (blood flow)
Thrombosis is more common in the L or R heart? If there is a clot in the Left heart, what could it lead to?
Right heart. There is a lot of empty space in the left heart.stroke
What muscular structure is the first thing activated by the AV node? What does it do (what is the muscle’s function)?
the moderator bandit closes the AV valve
How does angina present in men?
as cardiac referred pain in the left shoulder
How does the thymus change with age? Does it have any function past puberty?
initially it helps to develop and supportthe immune system.at puberty, it begins to shrinkin adulthood, it is replaced with fat butcontinues to produce T-lymphocytes
What are the 5 auscultatory areas of the chest? Where are they located?
- Mitral area (5th left intercostal space-5LICS)2. Tricuspid area (4LICS)3. Secondary pulmonic area (3LICS)4. Pulmonic area (left upper sternal border-LUSB)5. Aortic area (RUSB)
what is valvular stenosis?
the failure of a valve to fully open so that blood flow is slowed
what is valvular insufficiency?
the valves do not shut completely therefore blood flow regurgitates.Nodule formation also arises along with scarring or conrtaction of the cusps. This prevents the valve from sealing properly.
When valvular insufficiency or stenosis is present, what effect does it have on the heart?
The heart has an increased workload
what is a murmur? what causes it?
murmurs are audible vibrations caused by small whirlpools (eddies) resulting from turbulence. turbulence usually arises from stenosis or regurgitation)
What is a thrill?
a superficial vibratory sensation felt on the skin over an area ofturbulence
what separates the trachea from the esophagus?
the tracheoesophageal septum
what is a transesophageal fistula? What is the most common form?
an abnormal connection (fistula) between the trachea and esophagus.the proximal part of the esophagus has a blind end and the distal part has a narrow opening right at the bifurcation of the trachea
what does vagal nerve stimulation cause
negative chronotropic effect= bradycardia
what does adrenergic stimulation cause
positive chronotropic effect= tachycardia
positive inotropic efect= increased force of contraction
why does BP drop in a pneumothorax
increased pressure in the pleural space= pressure on IVC decreases blood flow into the heart
*insert a chest tube/needle decompression
Tension pneumothorax: where do you insert a needle into the chest for needle decompression
A 14-16G intravenous cannula is inserted into the second rib space in the mid-clavicular line.
The needle is advanced until air can be aspirated into a syringe.
classic signs of a tension pneumothorax
pushes the mediastinum to the opposite hemithorax
obstructs venous return to the heart.
circulatory instability
deviation of the trachea away from the side with the tension
a hyper-expanded chest increased percussion note
tachycardic
hypoxic
cyanotic
hypotensive
Dyspnea
Tachypnea
Hyper resonance of the chest wall on the affected side
Diminished breath sounds on the affected side
JVD
classic signs of cardiac tampanode
blood in pericardium: increased JVD decreased heart sounds hypotensive cyanotic tachycardic **need pericardiacentesis
Beck’s Triad
signs of cardiac tamponade:
low arterial blood pressure
distended neck veins
distant (muffled) heart sounds
how to treat cardiac tampanode
pericardialcentesis
insert needle to L of xiphoid process into pericardium and drain off blood
Diaphragmatic hernia
tear/hole in the diaphragm that allows the abdominal contents to move into the chest cavity
common on L side after MVA
high-force blunt trauma
Treatment: surgery
aortic transection
Traumatic aortic rupture
mostly after MVA, rapid deceleration
site: proximal descending aorta, near where the left subclavian artery branches off; near ligamentum arteriosum
xray: widened mediastinum
signs of aortic transection
widened mediastinum tracheal/L bronchus/esophagus displacement decompression main stem process apical cap risk: 1st rib fracture
complications of repair of transected aorta
damage to L recurrent pharengeal nerve and
anterior spinal artery
signs of damage to L recurrent pharengeal nerve
hoarse voice
Vocal cord paralysis
explain cardiac referred pain
heart attack pain is referred to the shoulder/neck/back/arm
percardium nerves cross others on their path to spinal cord
CABG
Coronary artery bypass graft surgery (CABG) is a procedure used to treat coronary artery disease
“heart bypass”
when is the mitral valve open
during mid diastole, diastasis, and atrial systole
what is isovolumic systole
phase btw mitral valve closure and aortic valve opening
both valves closed
ventricle volume is constant
“circulation dominance” of the coronary arterial system
“right dominance” pattern = PDA (posterior descending/interventricular coronary artery) comes from the RCA
“Left dominance”= PDA comes from the LCX
heart block
“AV node block”
electrical signal that controls the heartbeat is partially or completely blocked from reaching the ventricles (in AV node or bundle of His)
bundlebranch block
blocks R or L bundle branches
delay or obstruction along the pathway of electrical impulses
predicted area of myocardial damage that results from acuteocclusion of the: left main coronary a.
(LCA)
L atrium/ventricle
IVS
AV bundles
predicted area of myocardial damage that results from acuteocclusion of the: right main coronary a (RCA)
SA and AV node
nodal dysfunction= bradycardia or heart block
also serves posterior part IVS
predicted area of myocardial damage that results from acuteocclusion of the: left anterior descending coronary a (LAD)
common site of occlusion: huge MI
L ventricle surface
most interventricular septum (IVS)
anterior papillary muscle
Which coronary artery most commonly supplies: The interventricular septum and apex of the heart (left ventricle) ?
Left anterior descending coronary a (LAD)
when in cardiac cycle do coronary arteries fill with blood?
during diastole
aortic valve occlude openings to coronary arteries in systole
complications of an enlarged L atrium
compressed esophagus= difficulty swallowing (dysphagia)
compressed L recurrent laryngeal nerve= hoarseness
Cerebrovascularaccident (CVA)
A stroke - blood flow to a part of your brain is stopped either by a blockage or a rupture of a blood vessel
valvular stenosis
narrowing of the valve
valvularinsufficiency
regurgitation – retrograde flow; incompetency
valvular prolapse
enlarged, floppy, redundant valve
billowing of valve leaflets
myocardial infarction
occlusion of artery
myocardial area becomes bloodless
necrosis
3 most common sites for coronary artery occlucion
(50%) LAD branch of LCA
(30%) RCA
(20%) circumflex branch of LCA
fibrillation
many rapid contractions/twitchings of muscular fibers
irregular
uncoordinated
Are right or left indirect hernias more common? Why?
Right. The right testicle descends later, so the patent opening stays open for longer (more opportunity to fail to close).
Are hernias always due to herniation of intestines?
No. Fat or other tissue could come through.
What is the earliest point in development that the testis should be located in the scrota sac?
7 months: in the inguinal canal 9 months (33rd week)): anchored in the scrotum
Why are indirect hernias less common in women in men?
The size of the necessary opening in development is smaller in women than men.
(Note: indirect hernias are still the most common hernias in women, but incidence is less than in men.)
Where do you look for blood/fluid collection in the female pelvis (both standing up and supine)?
Recto-uterine pouch of Douglas
- diagnose w ultrasound
What is the innervation for the internal vs external rectal sphincters?
Internal: pelvic splanchnics (S2, S3, S4)
External sphincter: pudendal nerve (S2, S3, S4)
What is a patent urachus?
Failure of the allantois to atrophy
- babies in utero pee both via the urethra and via the umbilical cord (allantois)
- if it doesn’t close, properly at birth, babies can pee via their umbilicus
What can tear with a urinary catheter?
Membranous urethra
- more vulnerable bc it’s fixed between the bones
What is the prostatic utricle?
Blind opening. Homologous to the female uterus.
indirect hernia
- goes through the triangle of Hesselbach MEDIAL to epigastric vessels
- acquired
- weak abdominal wall
direct hernia
- congenital
- lateral to epigastric vessels
- goes through inguinal canal inside processes vaginalis
- young males
hydrocele
accumulation of excess peritoneal fluid in a persistent processes vaginalis
torsion of spermatic cord
twisting of cord against venous drainage. leads to edema and hemorrhage and arterial damage
-can lead to necrosis.
treat with surgery
nerves of the lumbar plexus in order
subcostal genitofemoral iliohypogastric ilioinguinal lateral femoral cutaneous obturator femoral
superficial lymphatic vessels below the transumbilicated plane drain:
to superficial inguinal nodes
lymphatic vessels superior to the transumbilicated plane drain:
axilliary lymph nodes?
remnant of the embryonic ventral mesentery
falciform ligament
remnant of the umbilical vein
round ligament
the falciform ligament encloses which ligament?
the ligament of teres (round ligament)
lateral umbilical folds are
ridges of parietal peritoneum that cover the inferior epigastric vessels
medial umbilical ligaments were once
umbilical arteries
median umbilical ligaments is a remnant of the
urachus.
significance of inguinal triangle of Hasselbach
direct hernias pooch through the abdominal wall here
the round ligament is a remnant of
the gubernaculum
the processus vaginalis does what in females?
recedes
the deep inguinal ring is lateral to the
inferior epigastric artery
in the inguinal canal, males have a what? women have what?
males have a spermatic cord, women have the round ligament of the uterus
most commonly, abdominal weakness for direct hernias is below the 1 line. This is because there is no __2__ (internal oblique aponeurosis) behind the rectus muscle.
1- arcuate
2-rectal sheath
Subcutaneous tissue in the abdomen becomes what in the spermatic cord?
Dartos muscle or fascia
external oblique muscle and fascia in the abdomen becomes what in the spermatic cord?
external spermatic fascia
internal oblique muscle in the abdomen becomes what in the spermatic cord?
Cremaster muscle
transversus abdominis muscle in the abdomen becomes what in the spermatic cord?
NOTHING
transversalis fascia in the abdomen becomes what in the spermatic cord?
internal spermatic fascia (Buck’s)
Peritoneum in the abdomen becomes what in the spermatic cord?
parietal layer, cavity and visceral layer of the tunica vaginalis
cremasteric reflex
rubbing a male’s inner thigh elevates the testis. Used to asses a spinal cord injury
cremasteric muscle is innervated by the
ilioinguinal nerve for sensory, genital branch (of genitofemoral) for motor
pampiniform plexus of veins drains into the
IVC on right and renal vein on left.
3 stages of labor
1- thinning of cervix to 10cm dilation
latent phase and active phase of labor
2- complete dilation to delivery of baby’s head
3- delivery of baby and placenta
Cardinal movements of labor (5)
engagement internal rotation extension external rotation expulsion
define prolapse
falling of an organ into the vaginal area
cause:weak ligaments from age, chronic pressure
define cystocele
prolapse of bladder into vagina
define rectocele
prolapse of rectum into the vagina
define urethrocele
prolapse of the female urethra into the vagina
define effacement during birth
thinning of the cervix
urogenital triange
pubic symphysis, ischial rami, ischial tuberosities
anal triangle
coccyx, ischioanal tuberosities
describe different blood flow in ovarian veins (Lvs R)
R ovarian vein returns to inferior vena cava
L ovarian vein drains into L renal vein
