Anatomy Flashcards
What is the role of the epicardium?
Secretes pericardial fluid lubricant
What border of the heart do the phrenic nerves descend across?
The lateral borders
What happens when the pericardial cavity fills with blood - haemopericardium?
The pressure around the heart increases and can prevent cardiac contraction (a condition known as cardiac tamponade).
What is pericardiocentesis?
Drainage of fluid from the pericardial cavity
What does the pulmonary trunk divide into?
Left and right pulmonary arteries
Where do you palpate for the apex beat?
5th left intercostal space in the midclavicular line (mitral area)
What three structures come from the aortic arch (right to left)?
Brachiocephalic trunk, left common carotid artery, left subclavian artery
What does the brachiocephalic trunk bifurcate into?
Right subclavian artery and right common carotid artery
The superior vena cava divides into three structures as it moves upwards - what are they from inferior to superior?
Left brachiocephalic vein, right subclavian vein, right internal jugular vein
Which coronary artery descends in the anterior interventricular groove?
The left anterior descending (LAD)
Which coronary artery descends in the coronary groove?
Right coronary artery - the groove indicates the surface marking for the tricuspid valve (boundary between right atrium and right ventricle).
Which branch of the SVC branches out posteriorly?
Azygous vein
What is the coronary sinus and what does it do?
It is a short venous conduit (in the atrioventricular groove posteriorly) which receives deoxygenated blood from msot of the cardiac veins and drains into the right atrium.
What artery is a branch of the right coronary artery and travels transversely along the anterior inferior aspect of the heart?
The right marginal artery
Which two arteries does the left main coronary artery branch into?
Circumflex artery and LAD
What is an atrial septal defect?
A hole in the interatrial septum
What is a ventricular septal defect?
A hole in the interventricular septum
What does having mixed arterial and venous blood do? What is this called?
Reduces the oxygen content of systemic arterial blood in the aorta - this is called hypoxaemia
What three openings does the right atrium have?
Superior vena cava
Coronary sinus
Inferior vena cava
Where is the tricuspid valve?
Between the right atrium and right ventricle
Where is the pulmonary valve?
Between the right ventricle and the pulmonary trunk
Where is the mitral valve?
Between the left atrium and the left ventricle
Where is the aortic valve?
Between the left ventricle and the aorta
What does the moderator band in the heart do?
Carries fibres of right bundle branch to the papillary muscle of the anterior cusp
Where would you listen for the aortic valve?
2nd right intercostal space, sternal edge
Where would you listen for the pulmonary valve?
2nd left intercostal space, sternal edge
Where would you listen for the tricuspid valve?
5th/6th left ICS, lower left sternal edge
Where would you listen for the mitral valve?
5th left ICS, midclavicular line
What is the first heart sound caused by?
Closure of the tricuspid and mitral valves
What is the second heart sound caused by?
Closure of pulmonary and aortic valves
How do the sympathetic nerves and the parasympathetic nerves reach the heart?
Via the cardiac plexus
Where do presynaptic sympathetic fibres from the brain exit the spinal cord?
In one of T1 - L2/3 spinal nerves (thoracolumnar)
Once the presynaptic sympathetic fibres have exited the spinal cord in either T1-L2/3 spinal nerves what are the five following options?
- Go into ganglion of that level and synapse
- Travel superiorly in the sympathetic chain to another ganglion and synapse
- Travel inferiorly in the sympathetic chain to another gangion and synapse
- Pass straight through the sympathetic chain ganglion without synapsing, as abdominopelvic splanchnic nerves, to synapse in one of the prevertebral ganglia of the abdomen (e.g. celiac ganglion)
- Pass straight to the adrenal medulla without synapsing as an abdominopelvic splanchnic nerve (directly stimulating adrenaline release)
What do the cardiopulmonary splanchnic nerves supply?
Sympathetic nerves to the heart and lungs
What do cardiopulmonary splanchnic nerves contain?
Post-synaptic fibres from cervical and upper thoracic sympathetic chains
What does the cardiac plexus contain?
Sympathetic fibres
Parasympathetic fibres
Visceral afferents
What do spinal sacral nerves supply?
Organs of the lower abdomen, pelvis and perineum (pelvic splanchnic nerves are parasympathetic)
How do parasympathetic signals reach the organs?
Via cranial nerves III, VII, IX and X (occulomotor, facial and glossopharyngeal + vagus)
The aortic arch innervation is done by what?
Baroreceptor reflex afferents in the vagus nerve
What is vagal tone?
Continuous background action potentials in CN X to slow the heart rate
Where are chemoreceptor nerve endings found?
In the root of the aorta and IV septum
Where are the 6 locations of visceral afferent nerve endings?
- inner aortic arch
- pulmonary trunk
- around the SA node
- outflow tracts from both ventricles
- papillary muscles
- vena cavae
What happens at the postcentral gyrus of parietal love (somatosensory)?
Action potentials arriving here bring body wall (somatic) sensations into “consciousness”
What happens at the precentral gyrus of the frontal lobe (somatomotor)?
Action potentials originating here bring about contractions of body wall (somatic) skeletal muscle
What divides the postcentral gyrus of the parietal lobe and the precentral gyrus of the frontal lobe?
The central sulcus
What causes herpes zoster (shingles) and describe/explain the pain?
Reactivation of dormant virus in posterior root ganglion.
Pain can be felt anywhere in that dermatome - pain precedes blisters
Patient with shingles developing in T4/T5 dermatome may present with central chest pain
What two muscles could cause central chest pain if strained?
Pectoralis major and intercostal muscles
What joint dislocation can cause central chest pain?
Costochondral joint
Dull (visceral) central chest pain can be caused by what in relation to the trachea?
Tracheitis
Dull (visceral) central chest pain can be caused by what in relation to the aorta?
Ruptured aneurysm of aortic arch
Dull (visceral) central chest pain can be caused by what in relation to the abdominal viscerae?
Gastritis
Cholecystitis
Pancreatitis
Hepatitis
Dull (visceral) central chest pain can be caused by what in relation to the oesophagus?
Oesophagitis
Dull (visceral) central chest pain can be caused by what in relation to the heart?
Angina
Myocardial infarction
The thoracic duct courses down which side of the medastinum?
The left
The azygous vein courses down which side of the mediastinum?
The right
What is the ligamentum arteriosum?
Remnant of ductus arteriosus connecting pulmonary trunk to arch of the aorta
Where is the most common place for coronary atherosclerosis to occur?
LAD
What is the thoracic inlet bounded by?
Ribs 1, T1 vertebra and the jugular notch
Where is the transverse thoracic plane?
Between the sternal angle and T4/T5 intervertebral disc
What - beginning with T - is present in the anterior medastinum?
Thymus (gland/lymhpoid organ producing T lymphocytes in childhood - involutes and becomes replaced by adipose tissue after puberty)
Where do the intercostal veins drain posteriorly into?
The azygous vein
What is the opening in the diaphragm where the aorta passes through called?
The aortic hiatus
Where does the right lymphatic duct drain lymph into?
The right venous angle
Where does the thoracic duct drain lymph into?
Left venous angle
What lymph nodes are congregated around the bifurcation of the trachea?
Tracheo-bronchial lymph nodes
What lymph nodes surround the main bronchus at the lung root?
Bronchopulmonary lymph nodes
What is the surface anatomy of the left venous angle?
Left sternoclavicular joint
What is the swollen start of the thoracic duct in the abdomen called?
Cisterna chyli
What structure does the phrenic nerve pass through the diaphragm with?
The IVC
What special branch comes from the left vagus nerve, near the lung roots?
The recurrent laryngeal branch of the left vagus nerve
What rib does the subclavian vein cross?
Rib 1
What postition should the patient be in to view the jugular venous pressure (JVP)?
head/neck/chest raised to 45 degrees, head turned to the left
(At 45 the JVP should be no more than 3cm to the sternal angle)
What causes the JVP to be seen?
Atrial contraction then filling of the right atrium against a closed tricuspid valve causes a “double pulsation” (pressure wave) conducted in a retrograde direction into the central veins that can be observed in the internal jugular vein.
What test can you do to view the JVP?
Abdominojugular test (increases venous return)
Which is more medial - the vagus nerve or phrenic nerve?
The vagus
What artery does the right recurrent laryngeal nerve hook under?
Right subclavian artery (nerve doesnt enter chest)
What structure does the left recurrent laryngeal nerve hook under?
The arch of the aorta (nerve enters chest)
Once the vagus nerves have given off their recurrent laryngeal branches what fibres are they left containing (only fibres left)?
parasympathetic fibres
What nerves supply the dermatomes over the shoulder tip?
Supraclavicular nerves (C3 and C4)
What nerves enter the spinal cord at the same level as the phrenic nerve?
Supraclavicular nerves
What muscles does the left recurrent laryngeal nerve supply?
The muscles of the larynx
What is the cephalic vein?
Superficial vein of the upper limb
What great vein courses down the inside of the leg?
The great saphenous vein and the musculo-venous pump
Where will you find the pulse in the neck?
Bifurcation of common carotid artery - anterior to sternocleidomastoid muscle at the level of the superior border of thyroid cartilage
Where will you find the brachial artery pulse?
Medial to biceps brachii tendon in the cubital fossa
Where will you find the radial artery pulse?
Lateral to the tendon of flexor carpi radialis
Where will you find the pulse of the femoral artery?
Inferior to the midpoint of inguinal ligament
Where will you feel the popliteal artery?
In the popliteal fossa (immediately posterior to the knee joint)
Where will you feel the pulse of the posterior tibial artery?
Between the posterior border of the medial malleolus and the achilles tendon
Where will you feel the pulse of the dorsalis pedis artery?
Medial to the tendon of extensor hallucis longus on the dorsum of the foot
What makes up the brachial plexus?
Anterior rami of C5-T1 spinal nerves - supplies the upper limb
What two vessels is the scalenus anterior muscle between?
On the right - subclavian artery and right subclavian vein
