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MRCS A > ANATOMY - thorax p2 > Flashcards

ANATOMY - thorax p2 Flashcards

1
Q

what level does the SVC enter the RA?

A

at level 3rd rib

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2
Q

where do the pulmonary aa receive blood from and where does it send it to?

A

deoxy blood from the RV –> lung

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3
Q

which valve separates the pulmonary aa and the RV?

A

pulmonary valve

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4
Q

at what spinal level does the pulmonary aa/trunk split into the R + L pulmonary aa

A

T5/6

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5
Q

where do the pulmonary vv receive blood from and where does it send it to?

A

oxy blood from the lungs –> LA on the posterior surface

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6
Q

what structure is in between the L + R pulmonary vv?

A

oblique pericardial sinus

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7
Q

where does the IVC receive blood and where does it drain into?

A

blood from all structures inf to diaphragm –> inferior portion of the RA

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8
Q

at what spinal level does the IVC enter the pericardium?

A

T8

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9
Q

what are the 5 surfaces of the heart

A

ant - RV
post - LA
inf - LV + RV
R pulmonary - RA
L pulmonary - LV

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10
Q

what are the 4 borders of the heart?

A

R - RA
inf - LV + RV
left - LV
sup - RA/LA/ great vessels

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11
Q

another name for coronary sulcus

A

atrioventricular groove

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12
Q

what important structure is contained within the coronary sulcus

A

RCA

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13
Q

what forms pericardial sinuses?

A

because of how the pericardium folds around the great vessels

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14
Q

where is the transverse pericardial sinus?

A

posterior the ascending aorta + pulmonary trunk
anterior to the SVC
superior to the LA

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15
Q

what does the transverse sinus separate and what is its surgical use

A

separates the aa from the vv
used to ligate the aa of the heart during a CABG

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16
Q

which 3 vv drain into the RA

A

SVC
IVC
Coronary vv

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17
Q

where is the R auricle within the RA?

A

anteromedially

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18
Q

role of the R auricle?

A

increases the capacity of the heart

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19
Q

what divides the inferior surface of the RA into 2?

A

crista terminalis

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20
Q

what 2 parts does the division of the RA by the crista terminalis make?

A

Sinus veranum (posterior to crista)
Atrium proper (anterior to crista)

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21
Q

where does the sinus veranum receive blood from

A

SVC + IVC

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22
Q

wall smooth or rough - sinus veranum

A

smooth

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23
Q

embryological origin sinus veranum

A

sinus venosus

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24
Q

wall smooth or rough - atrium proper

A

rough

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25
Q

name of the oval shaped depression in the interatrial septum

A

fossa ovalis

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26
Q

what is the fossa ovalis a remnant of?

A

foramen ovale

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27
Q

how does an atrial septal defect cause HF?

A

L –> R shunt –> LV overload –> pulm HTN –> RVH –> RHF

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28
Q

where is the L auricle>

A

superior aspect of the LA

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29
Q

inferiorly, what is the LA divided into?

A

inflow portion + outflow portion

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30
Q

which vessels does the inflow portion of the LA receive blood from?

A

pulmonary vv

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31
Q

what structure is the inflow portion of the LA derived from and how does it affect its surface

A

derived from pulmonary vv
hence smooth surface

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32
Q

what type of mm is the outflow portion of the LA?

A

pectinate mm

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33
Q

what structure divides the RV into the inflow and outflow sections?

A

supraventricular crest

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34
Q

name of the irregular ridges on the inflow portion of the RV

A

trabecula carnae

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35
Q

what are the 3 types of the trabeculae carnae

A

ridges
bridges (cont R bundle branches)
Pillars (papillary mm)

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36
Q

what are the pillar trabeculae carnae attached to

A

chordae tendinae + tricuspid valves (presents prolapse)

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37
Q

another name for the outflow portion of the RV

A

conus arteriosus

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38
Q

embryological origin conus arteriosis

A

bulbus cordis (smooth walled)

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39
Q

difference between the superior and inferior interventricular septum

A

sup - membranous and thinner, part of the fibrous skeleton
inf - muscular, same thicness as the LV

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40
Q

what structure lines the inflow portion of the LV

A

trabeculae carnae
+ 2 papillary mm (attach to mitral valve)

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41
Q

another name for outflow portion of the LV

A

aortic vestibule

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42
Q

embryonic origin aortic vestibule

A

bulbus cordis
smooth walled

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43
Q

what is tetralogy of Falot?

A

VSD
overriding aorta - dexoy blood into aorta
pulnary valve stenosis
RVH
(R –> L shunt)

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44
Q

what are the 4 aspects of the conductive system of the heart?

A

SAN
AVN
AV ‘bundle of His’
Purkinje gfibres

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45
Q

conducting system from SAN to contraction

A

1) AP created by SAN
2) wave of excitation spreads across the atria via gap junctions to contract
3)wave reaches AVN where signal is delayed
4) signal then is conducted in bundle of His in interventricular septum
5) bundle of His and Purkinje fibres spread waves across the ventricles –> contraction

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46
Q

where is the SAN?

A

upper RA at the junction where the SVC enters

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47
Q

sympathetic inn of the SAN –>

A

incr firing rate –> incr HR

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48
Q

parasymp inn of the SAN –>

A

decr firing rate –> decr HR

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49
Q

where is the AVN

A

in the atrioventricular sinus, near the opening of the coronary sinus

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50
Q

how long is the AVN delay? what is the significance of it

A

120ms
to that the atria can fully eject

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51
Q

where is the Bundle of HIs?

A

down the membranous portion of the IV septum

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52
Q

what are the purkinje fibres?

A

sub-endocardial plexus of conduction cells

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53
Q

which energy form are Purkinje fibres abundant in

A

glycogen

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54
Q

where are the Purkinje fibres?

A

in the subendocardial surface of ventricle walls

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55
Q

what are the 3 layers of the heart wall?

A

endocardium, myocardium, epicardium

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56
Q

what cell types make up the endocardium

A

CT
simple swuamous ep

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57
Q

what is the name of the single sheet of cells making up the parietal layer of the pericardium?

A

mesothelium

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58
Q

what is the fibrous layer of the pericardium continuous with

A

centra tendon of the diaghragm

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59
Q

what material makes up the fibrous pericardium and what is its function (and danger)

A

connective tissue
prevents rapid overfilling of heart
liable to tamponade, especially the right)

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60
Q

what type of muscle is the myocardium

A

involuntary striated muscle

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61
Q

what does the connective tissue of the epicardium do

A

secretes pericardial fluid into pericardial cavity

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62
Q

what is the outer surface of the epivardium lined by

A

simple squamous ep = mesothelium

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63
Q

where is the subendocardial layer of the heart

A

in between the endocardium + pericardium

64
Q

where is the subepicardial layer of the heart

A

in between myocardium + epicardium

65
Q

what is the pericardium

A

fibroserous, fluid filled sac which surrounds the body of the heart and the roots of the great vessels

66
Q

layers of the pericardium (+ how to remember)

A

Farty Priya Shits Viscously
Fibrous
Parietal
Serous fl/space
Visceral

67
Q

what are the punctiosn of the pericardium (4)

A

fixes heart in the mediastinum + limits motion
prevents overfilling of heart
lubrication - reduces friction
protection from infection

68
Q

innervation of the pericardium

A

C3-5 phrenic nn

69
Q

what are the 2 AV valves

A

tricuspid
mitral

70
Q

what are the 2 semi-lunar valves

A

aortic
pulmonary

71
Q

when do the AV valves close?

A

start of ventricular contraction/systole –> 1st heart sound

72
Q

where is the tricuspid valve

A

between the RA+RV

73
Q

name of the 3 tricuspid valve csusps

A

ant, septal, post

74
Q

where is the mitral valve?

A

between LA + LV

75
Q

name of the 2 mitral valve cusps

A

ant + post

76
Q

why dont the AV valves prolapse into the atria?

A

supported by chordae tendinae which are attached to papillary muscles

77
Q

when do the semi-lunar valves close?

A

at the beginning of ventricular diastole aka 2nd heart sound

78
Q

where is the pulmonary valve?

A

between RV + pulmonary trunk

79
Q

name of the 3 pulmonary valve cusps

A

L, R, ant

80
Q

where is the aortic valve?

A

betw LV + aorta

81
Q

what are the 3 aortic valve cusps called

A

R, L, post

82
Q

where do the R+ LCA originate from?

A

L + R aortic sinuses

83
Q

how do the aortic sinuses fill with blood?

A

blood recoils during diastole –> fills sinuses –> coronary aa –> myocardium

84
Q

what structure do most of the coronary vv drain into to for blood to reach the RA?

A

coronary sinus

85
Q

what are the 4 main venous tributaries of the heart

A

great cardiac vv
small cardiac vv
middle cardiac vv
post cardiac vv

86
Q

great cardiac vv - route back to the coronary sinus

A

apex of the heart –> ascending in ant interventricular groove –> cuves to L –> post surface of heart –> enlarges to become coronary sinus

87
Q

small cardiac vv - route back to coronary sinus

A

anterior surface of heart in groove between RA + RV –> post to coronary sinus

88
Q

middle cardiac vv - route back to coronary sinus

A

apex of heart in post interventricular groove –> coronary sinus

89
Q

post cardiac vv - route back to coronary sinus

A

post surface LV –> on left to middle cardiac vv –> coronary sinus

90
Q

inferior MI - where on ECG + which aa occluded

A

II, III , AVF
RCA

91
Q

anteroapical MI - where on ECG + which aa occluded

A

V3+4
distal LAD

92
Q

anteroseptal MI - where on ECG + which aa occluded

A

V1/2 LAD

93
Q

anterolateral MI - where on ECG + which aa occluded

A

I
avL
V5/6
circumflex

94
Q

true post MI - where on ECG + which aa occluded

A

tall R V1
RCA

95
Q

RCA - which region of heart supplied + subsequent venous drainage

A

RA, SAN, AVN, post part IV septum
small and middle cardiac vv

96
Q

R marginal aa - which region of heart supplied + subsequent venous drainage

A

RV
Apex
small and middle cardiac vv

97
Q

post interventricular aa - which region of heart supplied + subsequent venous drainage

A

RV
LV
post 1/3 IVS
l post ventricular vv

98
Q

L coronary aa - which region of heart supplied + subsequent venous drainage

A

LA, LV
IVS
AV bundles
great cardiac vv

99
Q

LAD - which region of heart supplied + subsequent venous drainage

A

RV, LA, ant 2/3 IVS
great cardiac vv

100
Q

L marginal aa - which region of heart supplied + subsequent venous drainage

A

LV
L marginal + great cardiac vv

101
Q

Circumflex aa - which region of heart supplied + subsequent venous drainage

A

LA +LV
great cardiac vv

102
Q

structures in close proximity to medial surface L lung (4)

A

heart
arch aorta
thoracic aorta
oesophagus

103
Q

structures in close proximity to the medial surface of the R lung (5)

A

oesophagus
heart
IVC
SVC
azygous vv

104
Q

how many lobes Left lung

A

2

105
Q

how many lobes right lung

A

3

106
Q

where doe sthe horizontal fissure of the lung extend between

A

horizontally from stenrum at level 4th rib to meet oblique fissure

107
Q

where does the oblique fissure extend between?

A

inferior border of the lung in a superopost direction

108
Q

what are the 3 surfaces of the lungs

A

costal, mediastinal + diaphragmatic

109
Q

what are the 3 borders of the lugns

A

anterior, inferior, posterior

110
Q

what is the anterior border of the lung

A

convergence of the mediastinal + costal surfaces

111
Q

name of the notch of the L lung anterior border

A

cardiac notch

112
Q

contents of the root of the lung (6)

A

bronchus, PA, 2 PV, bronchial vessels, pulmonary plexus nn, lymhatic vessels

113
Q

through what do structures enter and leave the lung?

A

via the hilum

114
Q

bronchial tree from trachea to alveoli

A

trachea
-> L + R bronchus
–> hilum where divides into lobar bronchi - 1 supplies 1 lobe
–> segmental vronchi (each provides air to 1 broncho-pulmonary segment)
–> conducting bronchioles
–> terminal bronchioles
–> respiratory bronchioles which cont alveoli

115
Q

aa/vv supply to the lungs

A

bronchial aa + vv

116
Q

bronchial aa are a branch of

A

thoracic aorta

117
Q

R bronchial vv drains into

A

azygous vv

118
Q

L bronchial vv drains into

A

accessory azygous vv

119
Q

parasymp contribution + function pulmonary plexus

A

CN X
stims secretions, bronchial glands
contraction of SM
VD of pulmonary vessels

120
Q

symp contribution + function pulmonary plexus

A

symp trunks
relaxation of SM
VC of pulmonary vessels

121
Q

visceral afferent contribution pulmonary plexus

A

pain impulses to the sensory ganglion CNX

122
Q

LN drainage lung parenchyma

A

superificial/subpleural plexus —> tracheobronchial LN (at bifurfaction) –> L + R bronchomediastinal trunks

123
Q

LN drainage lung root

A

deep plexus –> tracheobronchial LN (at bifurcation)
–> L + R bronchomediastinal trunks

124
Q

where does the trachea extend between

A

lower border cricoid cartilage –> sternal angle

125
Q

what mm supports the free ends of the tracheal rings

A

trachealis mm

126
Q

lining trachea

A

ciliated pseudostratified columnar ep + goblet cells

127
Q

name of bifurcation of the trachea

A

carina

128
Q

inn trachea

A

rec laryngeal nn CNX

129
Q

aa supply trachea

A

tracheal branches inf thyroid aa

130
Q

vv drainage trachea (3)

A

brachiocephalic, azygous + accessory hemiazygous vv

131
Q

which bronchus is shorter, wider and descends more vertically?

A

right bronchus

132
Q

what 2 structures are sup and post to L main bronchus

A

sup = arch aorta
post = thoracic aorta + esophagus

133
Q

nn supply bronchi

A

pulmonary branches CNX

134
Q

aa supply bronchi

A

branches bronchial aa

135
Q

vv supply bronchi

A

bronchiole vv

136
Q

what cartilage do the bronchioles contain

A

none

137
Q

instead of goblet cells, what cells do the bronchioles have? (+ their fct)

A

club cells
prodc surfactant lipoprotein - prevents airways sticking during expiration

138
Q

cell type alveoli

A

simple squamous epithelium

139
Q

how many alveoli in the adult lungs

A

300 million

140
Q

where are the visceral and parietal pleura continuous with eachothoer?

A

at the hilum of the lungs

141
Q

which is thicker - parietal or visceral pleura

A

parietal

142
Q

what are the 4 sections of the parietal pleura

A

cervical
costal
mediastinal
diaphragmatic

143
Q

what does the cervical parietal pleura cover

A

lines extension of the pleural cavity into neck

144
Q

what does the costal parietal pleura cover

A

covers inner aspects of the ribs, costal cartilages, intercostal mm

145
Q

what dose the mediastinal parietal pleural cover

A

lateral mediastinal area

146
Q

what does the diaphragmatic parietal pleura cover

A

sup surface of the diapgragm

147
Q

aa supply parietal pleural

A

intercostal aa

148
Q

nn supply parietal pleura

A

phrenic + intercostal nn

149
Q

to what sensation is the parietal pleura sensitive to

A

pressure
pain
temperature

150
Q

aa supply visceral pleura

A

bronchial aa

151
Q

inn visceral pleura

A

autonomic mm from pulmonary plexus

152
Q

what sensation is the visceral pleura sensitive to?

A

stretch only

153
Q

what forms the pleural recesses?

A

where opposing surfaces of the parietal pleura touch

154
Q

what are the 2 pleural recesses?

A

costodiagrapgmatic (between costal pleura + diaphragmatic pleura)
costomediastinal - behind sternum

155
Q

clinical importance of pleural recesses?

A

pleural effusions can form here

MRCS A (36 decks)

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