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thhth > Block 1 - Anatomy - Thorax - Gray's Review > Flashcards

Block 1 - Anatomy - Thorax - Gray's Review Flashcards

1
Q

A 2-day-old newborn is diagnosed with transposition of the great arteries. Which structure is primarily responsible for the division of the truncus arteriosus into the great arteries?

A. Septum secundum

B. Septum primum

C. Bulbar septum

D. Aorticopulmonary septum

E. Endocardial cushions

A

D. Aorticopulmonary septum

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2
Q

What defect accounts for 25% of all congenital heart defects?

A

Ventricular septal defect

(most commonly membranous)

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3
Q

What heart defect can keep a child with transposition of the great arteries alive until the transposition is corrected?

A

A patent ductus arteriosus

(to allow mixing of oxygenated and unoxygenated blood)

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4
Q

A 32-year-old woman in her third trimester of pregnancy is undergoing a routine ultrasound examination.

The examination of the fetus reveals enlarged and echogenic lungs, an inverted diaphragm, and fetal ascites. Which condition is best characterized by these signs?

A. Laryngeal atresia

B. Tracheal atresia

C. Polyhydramnios

D. Lung hypoplasia

E. Oligohydramnios

A

A. Laryngeal atresia

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5
Q

Ultrasound examination of a fetus with laryngeal atresia might show what signs?

A

Enlarged and echogenic lungs, an inverted diaphragm, fetal ascites

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6
Q

A child presents with a loud S1 and a wide, fixed-split S2. What is the likely diagnosis?

A

Atrial septal defect

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7
Q

What heart murmur indicates an atrial septal defect?

A

A loud S1 and a wide, fixed-split S2

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8
Q

For what type of heart defects are children with Down syndrome especially at risk?

A

Atrial and ventricular septal defects

(endocardial cushion defects)

(especially septum-primum atrial defects)

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9
Q

Tetralogy of Fallot and truncus arteriosus are both associated with what genetic predisposition?

A

22q11 deletions

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10
Q

What heart defects are associated with 22q11 deletions?

A

Tetralogy of Fallot and truncus arteriosus

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11
Q

Which pharyngeal arches lead to the development of the portions of the aorta that may become congenitally coarcted?

A

The 3rd, 4th, and 6th arches

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12
Q

What primordial structure must fail to develop in order for a tracheoesophageal fistula to form?

A

The tracheoesophageal septum

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13
Q

What type of atrial septal defect can occur along the junction with the superior vena cava?

A

A sinus venosus ASD

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14
Q

Where can sinus venosus atrial septal defects be found?

A

Close to the entry of the superior vena cava

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15
Q

Failure of fusion of the lateral folds during development can lead to what congenital heart defect?

A

Ectopia cordis

(the heart is located outside the chest wall)

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16
Q

What is ectopia cordis?

A

A congenital defect in which the heart is located outside the body cavity.

(due to failure of the lateral folds to fuse during development)

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17
Q

A newborn baby is diagnosed with eventration of the diaphragm. In this condition, half of the diaphragm ascends into the thorax during inspiration, while the other half contracts normally. What is the cause of this condition?

A. Absence of a pleuropericardial fold

B. Absence of musculature in one half of the diaphragm

C. Failure of migration of diaphragm

D. Failure of the septum transversum to develop

E. Absence of a pleuroperitoneal fold

A

B. Absence of musculature in one half of the diaphragm

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18
Q

What structure, in particular, should a surgeon be careful not to disrupt in closing a ventricular septal defect?

A

The right bundle branch

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19
Q

If a patient with retrosternal chest pain (that radiates to the left arm) can relieve some of the pain by leaning forward, what would that indicate?

A

This is a pericardial friction rub, likely due to pericarditis

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20
Q

What three nerves are most at risk for damage during a mastectomy?

A

The long thoracic nerve, the intercostobrachial nerve, and the thoracodorsal nerve.

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21
Q

The intermediolateral horns of the spinal cord at levels T5 - T9 contain cell bodies for neurons innervating what region of the body?

To what kind of nerves do these cell bodies belong?

A

Abdominal organs;

sympathetic preganglionic nerves

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22
Q

The intermediolateral horns of the spinal cord at levels T1 - T4 contain cell bodies for neurons innervating what region of the body?

To what kind of nerves do these cell bodies belong?

A

The upper limbs and thoracic cavity;

sympathetic preganglionic nerves

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23
Q

What nerve carries the cardiac sympathetic efferent fibers from the sympathetic ganglia to the thoracic viscera and visceral afferent fibers for pain from these organs?

A

The cardiopulmonary splanchic nerves

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24
Q

For what is the cardiopulmonary splanchnic nerve responsible?

A

The cardiac sympathetic efferent fibers;

the visceral afferent fibers for the thoracic organs

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25
Q

Which nerve carries pericardial sensation (especially pain) to the CNS?

A

The phrenic nerve

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26
Q

Which nerve is responsible for innervation of the skin on the medial surface of the arm?

(the inner aspect of the arm and axilla)

A

The intercostobrachial nerve

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27
Q

A 2-day-old newborn male is admitted to the pediatric intensive care unit with cyanosis and tachypnea.

Cardiac ultrasound (echocardiography) and magnetic resonance imaging (MRI) examinations reveal totally anomalous pulmonary connections. Which of the following embryologic events is responsible for this malformation?

A. Abnormal septation of the sinus venosus

B. Abnormal development of the septum secundum

C. Abnormal development of the left sinus horn

D. Abnormal development of the coronary sinus

E. Abnormal development of common cardinal vein

A

A. Abnormal septation of the sinus venosus

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28
Q

A 4-year-old girl is admitted to the hospital with high fever. Staphylococcus aureus is isolated from her blood cultures and antibiotic therapy is initiated.

A loud, harsh murmur is heard on auscultation. A chest radiograph shows prominent pulmonary arteries. Echocardiography shows all the valves to be normal. Which congenital heart disease most likely explains these findings?

A. Atrial septal defect

B. Tetralogy of Fallot

C. Coarctation of the aorta

D. Patent ductus arteriosus

E. Aortic atresia

A

D. Patent ductus arteriosus

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29
Q

A 3-day-old infant is admitted to the cardiology unit with severe cyanosis.

During echocardiographic examination a right-to-left shunt is identified. Which of the following conditions will most likely produce this type of shunt?

A. Interatrial septal defect

B. Interventricular septal defect

C. Patent ductus arteriosus

D. Corrected transposition of the great arteries

E. Common truncus arteriosus

A

E. Common truncus arteriosus

  • (failure of septation into the aorta and pulmonary trunk;*
  • options* A - C would all result in left-to-right shunting;
  • option D is a corrected pathology)*
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30
Q

A 4-day-old infant is admitted to the pulmonary unit suffering from dyspnea and cyanosis.

Radiologic examination revealed a left hypoplastic lung and herniation of the abdominal intestines into the left thoracic cavity. Which of the following embryologic structures most likely failed to develop properly?

A. Septum transversum

B. Pleuroperitoneal membrane

C. Tracheoesophageal septum

D. Laryngotracheal groove

E. Foregut

A

B Pleuroperitoneal membrane

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31
Q

A 2-day-old infant is diagnosed with incomplete division of the foregut into respiratory and digestive portions. Which is the most common congenital condition characteristic of this description?

(Note: tracheoesophageal fistula is the most common of these conditions in general)

A. Esophageal atresia

B. Esophageal achalasia

C. Tracheoesophageal fistula

D. Congenital diaphragmatic hernia

E. Esophageal fistula

A

A. Esophageal atresia

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32
Q

What major vein is at risk for accidental damage during a tracheotomy when performed on young children?

(vertical incision along anterior neck to expose and puncture the cricothyroid membrane to secure the airway)

A

The left brachiocephalic v.

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33
Q

What is another name for the cardiopulmonary artery?

A

Thoracic visceral a.

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34
Q

What nerve innervates the fibrous and parietal pericardium?

What does this mean for pain during pericardial effusion?

A

The phrenic nerve;

The phrenic nerve contains sensory nerve fibers from C3 to C5, spinal nerve levels that also supply the skin of the shoulder area; therefore, pain carried by the phrenic nerve may be referred to the shoulder.

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35
Q

A 39-year-old man is admitted to the hospital with a complaint of severe retrosternal pain that radiates to the left shoulder. The pain is relieved by leaning forward.

Auscultation reveals a pericardial friction rub, leading to a diagnosis of pericarditis. Which of the following nerves is responsible for the radiating pain to the shoulder?

A. Intercostobrachial

B. Phrenic

C. Long thoracic

D. Greater thoracic splanchnic

E. Cardiopulmonary

A

B. Phrenic

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36
Q

A 62-year-old patient is admitted to the hospital with a complaint of suddenly occurring, tearing pain radiating to his back. A CT examination reveals that the patient has an aortic aneurysm. An urgent placement of an endovascular stent-graft is performed.

Which of the following nerves are most likely responsible for the tearing sensation radiating to his back?

A. Somatic afferent

B. Thoracic visceral afferent

C. Sympathetic postganglionics

D. Sympathetic preganglionics

E. Parasympathetic afferent

A

B. Thoracic visceral afferent

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37
Q

What two valves could potentially be responsible for an abnormally loud S1 heart sound?

A

Tricuspid or mitral

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38
Q

What is another name for the LAD artery?

A

Anterior interventricular a.

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39
Q

How long is the left main coronary artery in most hearts?

A

Very short (~1 cm) before branching into the circumflex and LAD

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40
Q

Are the branches of the coronary arteries end arteries?

Are anastomoses possible and/or present between them?

A

No (collaterals are present - an end artery is an artery that is the sole provider of blood flow to a region - also known as a ‘terminal artery’);

yes

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41
Q

What is another name for an end artery?

What differentiates these arteries from others?

A

Terminal artery;

they are the sole blood supply to a final area of tissue (no collaterals or anastomoses)

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42
Q

If the atria are contracting normally but both ventricles are undergoing arrhythmias, what structure of the heart may be damaged?

A

The Bundle of His

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43
Q

What type of fiber makes up the Bundle of His and bundle branches?

A

Purkinje fibers

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44
Q

Which artery supplies the anterior right ventricle?

Which artery supplies the posterolateral right ventricle?

Which artery supplies the right atrium and SA node?

A

Right conus a.;

acute marginal a.;

posterior descending a.

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45
Q

What region of dense connective tissue between the tricuspid and mitral valves allows for passage of the Bundle of His from the AV node to the ventricles?

A

The right fibrous trigone

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46
Q

What structure passes through the right fibrous trigone?

A

The atrioventricular Bundle of His

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47
Q

A 72-year-old man is admitted to the hospital with severe chest pain. ECG examination provides evidence of severe myocardial infarction of the lower part of the muscular interventricular septum.

The function of which of the following valves will be most severely affected?

A. Pulmonary

B. Aortic

C. Tricuspid

D. Mitral

E. Eustachian

A

C. Tricuspid

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48
Q

Which heart valve would be most affected by occlusion of an artery feeding the muscular interventricular septum?

A

The tricuspid

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49
Q

A 69-year-old woman with advanced stage of laryngeal cancer has a tracheostomy and needs to be tube fed. A nasogastric tube is inserted.

What is the last site at which resistance would be expected as the tube passes from the nose to the stomach?

A. Pharyngoesophageal junction

B. Level of the superior thoracic aperture

C. Posterior to the aortic arch

D. Posterior to the left main bronchus

E. Esophageal hiatus of the diaphragm

A

E. Esophageal hiatus of the diaphragm (at T10)

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50
Q

What are the four major constrictions of the esophagus?

A
  1. The pharyngoesophageal junction
  2. Passing posterior to the arch of the aorta
  3. Passing posterior to the left main bronchus
  4. The esophageal hiatus
51
Q

What are the first two major constricting points of the esophagus?

A
  1. The pharyngoesophageal junction
  2. Passing posterior to the arch of the aorta
52
Q

What are the second two major constricting points of the esophagus?

A
  1. Passing posterior to the left main bronchus
  2. The esophageal hiatus
53
Q

A 72-year-old man is admitted to the hospital with complaints of severe chest pain radiating to his left arm. ECG examination provides evidence of significant myocardial infarction of the posterior wall of the left ventricle.

Which of the following nerves is responsible for the radiation of pain to the arm during myocardial infarction?

A. Phrenic

B. Vagus

C. Intercostobrachial

D. Greater splanchnic

E. Suprascapular

A

C. Intercostobrachial

54
Q

A 43-year-old male hunter is admitted to the emergency department after falling over a barbed wire fence, as a result of which he suffered several deep lacerations along the left midaxillary line.

When the patient is examined in the outpatient clinic several days later, numbness and anhydrosis are observed anterior to the area of the cuts. Which structures were most likely damaged to result in these signs?

Explain why each answer choice is correct or incorrect.

A. Dorsal roots

B. Ventral roots

C. Cutaneous branches of dorsal rami

D. Cutaneous branches of ventral rami

E. Rami communicans

A

D. Cutaneous branches of ventral rami

55
Q

In what space does the left recurrent laryngeal nerve travel after looping around the aortic arch?

A

The tracheoesophageal groove

56
Q

A mass in what location could potentially result in dyspnea, dysphagia, hoarseness?

What structure(s) and nerve(s) might be involved?

A

A mass associated with a bronchus and associated compression of the esophagus;

the bronchus (dyspnea), the esophagus (dysphagia), the left recurrent laryngeal nerve (hoarseness)

57
Q

What heart structure is most anterior (just posterior to the sternum)?

What heart structure is most posterior?

A

The right ventricle;

the left atrium

58
Q

Describe the eustachian valve (a heart structure).

A

The eustachian valve is an embryologic remnant of the valve of the inferior vena cava and is not a functional valve.

59
Q

What structure is an embryologic remnant of the valve of the inferior vena cava?

Is it functional?

A

The eustachian valve;

no

60
Q

Describe the thesbian valve (a heart structure).

What is its hypothesized function?

A

It is a semicircular fold at the orifice of the coronary sinus;

to prevent backflow from the left atrium into the coronary sinus

61
Q

What structure is located on the inside of the left atrium to prevent backflow into the coronary sinus?

A

The thesbian valve

62
Q

What specialized sinus in the aorta creates vortices to help close the aortic valve leaflets?

A

The sinus of Valsalva

63
Q

What muscular ridge runs from the SVC to the IVC and is the path of the posterior internodal pathway?

What two conduction centers does this pathway it connect?

A

The crista terminalis;

the SA and AV nodes

64
Q

Where is the correct location for a pericardiocentesis?

What imaging modality guides the procedure?

A

Below the xiphoid process, or in the left fifth intercostal space in the midclavicular line;

ultrasound

65
Q

What is a simple way to remember the location of the transverse pericardial sinus?

A

It separates the arteries (aorta and pulmonary a.) from the veins (SVC and pulmonary v.)

66
Q

This finger is inside what specific space?

A

The transverse pericardial sinus

67
Q

What space lies between the IVC and pulmonary veins?

A

The oblique pericardial sinus

68
Q

A midline, longitudinal incision of the pericardium would best be made to prevent injury to which of the following structures? (as opposed to a transverse incision)

A. Auricular appendage of the left atrium

B. Coronary sinus

C. Left anterior descending artery

D. Left phrenic nerve

E. Left sympathetic trunk

A

A. Auricular appendage of the left atrium (posterior to heart)

B. Coronary sinus (posterior to heart )

C. Left anterior descending artery

D. Left phrenic nerve (too deep - between the heart and lung)

E. Left sympathetic trunk (posterior to heart )

69
Q

What is an example of a heart valve condition that can cause left atrial dilatation?

What effect can this have on the GI system?

A

Mitral stenosis;

dysphagia (due to compression of the esophagus or esophageal nerve)

70
Q

During surgical repair of a congenital cardiac anomaly in a 15-year-old boy with a right dominant coronary arterial system, the surgeon accidentally injured a vessel that usually supplies part of the conduction system.

This results in intermittent periods of atrioventricular block and severe arrhythmia. The injured artery was most likely a direct branch of which of the following arteries?

A. Distal anterior interventricular artery

B. Circumflex artery

C. Left coronary artery

D. Marginal artery

E. Right coronary artery

A

E. Right coronary artery

(the AV node is supplied by branches of the right coronary artery)

71
Q

Which branch of the left coronary artery supplies part of the conduction system?

A

The first septal perforating branch of the anterior interventricular artery (LAD)

(It passes directly to the point of bifurcation of the common atrioventricular bundle of His)

72
Q

What artery supplies the point of bifurcation of the bundle of His?

A

The first septal perforator of the LAD

73
Q

Describe the location of the SA node.

A

Within the myocardium at the upper end of the crista terminalis, near the opening of the superior vena cava into the right atrium

74
Q

What is another name for the right fibrous trigone?

A

The central fibrous body

75
Q

Where is the AV node located?

A

The junction of the coronary sinus and the right atrium upon the right fibrous trigone (central fibrous body)

76
Q

In order to avoid damaging the lungs, a chest tube should be placed below the level of the lungs, in the costodiaphragmatic recess. What intercostal level(s) would be ideal for this purpose?

A

The eighth or ninth intercostal space

77
Q

Describe the right main bronchus characteristics as they relate to the left main bronchus.

A

Shorter, wider, more vertical

78
Q

What is the alteration in the thoracic cavity that increases the intrathoracic area the most?

A

Diaphragmatic contraction

79
Q

What’s another name for the cervical pleura?

Is it considered mediastinal pleura?

A

The cupola;

no

80
Q

What plane is ideal for viewing the sternal angle via radiograph?

A

Lateral

81
Q

Name the locations where the following heart valve sounds are best auscultated:

aortic

pulmonic

tricuspid

mitral

A

2nd intercostal space, right parasternal area;

2nd intercostal space, left parasternal area;

4th intercostal space, left parasternal area;

4th or 5th intercostal space, left midclavicular line (apex of heart)

82
Q

Name each labeled nerve in this image.

A

A. Lateral pectoral n.

B. Suprascapular n.

C. Long thoracic n.

D. Thoracodorsal n.

E. Lower subscapular n.

83
Q

Which of these is the most common?

A. Esophageal atresia

B. Esophageal achalasia

C. Tracheoesophageal fistula

D. Congenital diaphragmatic hernia

E. Esophageal fistula

A

C. Tracheoesophageal fistula

84
Q

What two major coronary arteries provide separate sources of blood flow to the posterior heart?

A

The circumflex a. and posterior descending a.

85
Q

A 35-year-old woman is admitted to a surgical ward with a palpable mass in her right breast and swollen lymph nodes in the ipsilateral axilla. Radiologic studies and biopsy reveal carcinoma of the breast.

Which group of axillary lymph nodes is the first to receive lymph drainage from the secretory tissue of the breast and therefore most likely to contain metastasized tumor cells?

A. Lateral

B. Central

C. Apical

D. Anterior (pectoral)

E. Posterior (subscapular)

A

D. Anterior (pectoral)

(Pectoral > Central > Apical > Sentinel > Subclavian)

86
Q

Place the axillary lymph drainage of the breast in order:

Central

Pectoral

Sentinel

Subclavian

Apical

A

Pectoral > Central > Apical > Sentinel (scalene) > Subclavian

87
Q

What breast cancer description refers to a breast with hard, woody thickening of the skin over the tumor?

A

Cancer en cuirasse

88
Q

What is unique about the segment of broken ribs during breathing when an individual has flail chest?

A

Paradoxically, the broken ribs move opposite the chest during deep breathing

(i.e. they are sucked in while the chest expands and they puff out while the chest contracts)

89
Q

What radiographic landmark can be used to verify that a central venous line is in the proper location?

A

The carina

90
Q

In placing a central venous line, damaging what structure can easily lead to chylothorax due to disruption of the termination of the thoracic duct?

A

The left brachiocephalic vein

91
Q

A pregnant mother whose blood pressure drops significantly when supine may be undergoing what complication?

A

The fetus compresses the IVC when the mother is supine

(leading to reduced blood return to the heart)

92
Q

What term refers to the crackling sounds heard in the lungs due to fluid buildup?

A

Rales

93
Q

What are rales?

A

The crackling sounds heard in the lungs due to fluid buildup

94
Q
A
95
Q

Auscultating what area of the rib cage is associated with the lower lobe of the right lung?

A

The 6th intercostal space at the midaxillary line

96
Q

Pacemakers are generally designed to replace the normal pacemaking function of what bundle of conductive tissue?

Where is the pacemaker tip usually located? Why?

What fibers are being stimulated?

A

The SA node;

the right ventricle (the left ventricle is harder to access);

Purkinje fibers

97
Q

What nerves provide motor innervation to the diaphragm?

What nerves provide sensory innervation to the costal (parietal) pleura?

What nerves provide sensory innervation to the diaphragmatic and mediastinal (parietal) pleura?

A

The phrenic nerves;

the intercostal nerves;

the phrenic nerves

98
Q

What nerves provide sympathetic and pain innervation to the thoracic organs?

What nerves provide sympathetic innervation to the abdominal organs?

A

The cardiopulmonary nerves (from the T1 - T4 levels);

the splanchnic nerves

99
Q

What heart condition results from a bending of the heart tube to the left instead of to the right?

What TGF-beta factor is involved in embryonic cardiac looping?

A

Dextrocardia;

nodal

100
Q

What lung lobes are involved in the pathology in this image?

What is the underlying condition?

A

The superior, middle, and inferior lobes of the right lung;

pneumonia

101
Q

Which coronary artery is indicated in this angiogram?

A

The lateral diagonal branch (often present) of the LAD

102
Q

A 35-year-old male bartender is admitted to the hospital due to severe dysphagia. A CT scan (Fig. 2-3 ) reveals carcinoma of the middle segment of the esophagus.

Which of the following structures will most likely be affected if the carcinoma increases greatly in size?

A. Inferior vena cava

B. Left atrium

C. Pulmonary artery

D. Left ventricle

E. Vertebral body

A

B. Left atrium

103
Q

What aortic structure can become inverted in cases of pneumomediastinum (air in the mediastinum)?

A

The aortic ‘nipple’

104
Q

What is the ‘aortic nipple?’

A

The left superior intercostal vein coursing around the aortic knob

(viewed from an AP or PA view)

105
Q

Which coronary artery (or arteries) supplies the diaphragmatic surface of the heart?

A

The posterior descending artery

106
Q

A 30-year-old man is admitted emergency department following involvement in a domestic dispute with a jilted lover. The man reported that he was stabbed in his right anterior chest wall with a sharp instrument.

Initial assessment revealed a man in acute respiratory distress. Physical examination showed a puncture wound in the third right intercostal space at the midclavicular line and distended neck veins. There was a hyperresonance on percussion and absent breath sounds on right hemithorax. A radiograph revealed a deviated trachea to the left. Which one of the following is the most likely diagnosis?

A. Right tension pneumothorax

B. Right simple pneumothorax

C. Right simple pneumothorax and cardiac tamponade

D. Right tension pneumothorax and cardiac tamponade

E. Cardiac tamponade

A

A. Right tension pneumothorax

107
Q

What is the inferior extent of the pleural cavity at the midclavicular line?

What is the inferior extent of the pleural cavity at the midaxillary line?

What is the inferior extent of the pleural cavity at the paravertebral line?

A

The 6th and 7th intercostal spaces;

the 8th and 9th intercostal spaces;

the 10th and 11th intercostal spaces

108
Q

What coronary vein runs alongside the LAD artery?

What coronary vein runs alongside the acute marginal artery?

What coronary vein runs alongside the circumflex artery?

What coronary vein runs alongside the posterior descending artery?

What space do the veins drain into before emptying into the left atrium?

A

The great cardiac v.;

the small cardiac v.;

the posterior cardiac c.;

the middle cardiac v.;

the coronary sinus

109
Q

A widely patent foramen ovale can reflect underdevelopment of what structure?

A

The septum secundum

110
Q

What major embryonic vessel gives rise to the thoracic aorta?

Malformation of this structure can lead to what aortic pathology?

A

The dorsal aorta;

postductal coarctation of the aorta

111
Q

What type of coarctation of the aorta is most common in adults?

This results from a developmental malformation in what embryonic vessel?

A

Postductal coarctation;

the dorsal aorta (which gives rise to the thoracic aorta)

112
Q

To where does lymph from the lower 1/3 of the esophagus drain?

To where does lymph from the middle 1/3 of the esophagus drain?

To where does lymph from the upper 1/3 of the esophagus drain?

A

The posterior mediastinal and left gastric lymph nodes;

the posterior and superior mediastinal lymph nodes;

the deep cervical lymph nodes

113
Q

What three lymph clusters (in order) drain the primary bronchi?

A

The inferior tracheobronchial nodes –>

the superior tracheobronchial nodes –>

the paratracheal nodes

114
Q

What structure(s) drain to the inferior tracheobronchial nodes (which drain to the superior tracheobronchial nodes (which drain to the paratracheal nodes))?

A

The primary bronchi

115
Q

Failure of regression of what embryonic structures will result in a retroesophageal subclavian artery?

A

The right dorsal aorta distal to the seventh intersegmental artery

(the subclavian artery forms from the right 4th aortic arch and the 7th intersegmental artery)

116
Q

A 30-year-old woman delivered a 6-lb female infant at term via spontaneous vaginal delivery. The infant was noted to have an elevated respiratory rate and was admitted to the neonatal intensive care unit.

She developed a fever day later with no resolution of the tachypnea. A chest radiograph showed bilateral basal hazy opacification and a right-sided cardiac shadow. A whole-body CT scan was ordered which showed normal orientation of the other viscera. What is the most likely cause of this infant’s cardiac condition?

A. Posterior and superior growth of the primordial atrium

B. Anterior and inferior growth of the primordial ventricle

C. Anterior and inferior growth of the bulbus cordis

D. Growth of primordial heart tube to the left

E. Growth of the primordial heart tube to the right

A

D. With isolated dextrocardia, the abnormal position of the heart is not accompanied by displacement of other viscera. This defect is usually complicated by severe cardiac anomalies (e.g., single ventricle and transposition of the great vessels).

117
Q

Defects in septation of what embryonic structure might result in total anomalous pulmonary venous return?

A

The sinus venosus

118
Q

Preductal coarctation of the aorta is most likely to result from defects in what embryologic structure?

And postductal coarctation?

Which type is more commonly identified in adults?

A

4th aortic arch;

left dorsal aorta;

postductal

119
Q

In cases of pneumomediastinum, what changes will be present on CXR?

What visible structure is responsible?

A

An inverted aortic nipple;

the left superior intercostal vein

120
Q

Do the alar and transverse ligaments of the dens attach to the same bony structures besides the dens?

A

No;

the alar ligaments attach to the medial surface of the occipital condyles, and the transverse ligaments attach to the pedicles of the atlas

121
Q

What term refers to the space between the SVC and the IVC (within the right atrium)?

A

The sulcus terminalis cordis

122
Q

What nerve innervates the suboccipital muscles?

What nerve innervates the splenius capitis?

What nerve innervates the semispinalis capitis?

A

Suboccipital nerve;

dorsal rami;

greater occipital nerve

123
Q

What embryologic abnormality can result in dextrocardia?

A

Bending of the primitive heart tube to the left instead of the right

thhth (10 decks)

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