Book Flashcards

1
Q

 1. What is the name of the upper horizontal plane and where is it located?

A
  1. Subcostal plane, on costal cartilage 10
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2
Q
  1. What is the name of the lower horizontal plane and where is it located?
A
  1. Transtubecular plane, on iliac tubercles
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3
Q
  1. What is the name of the vertical planes and where do they come off of?
A
  1. Midclavicular, coming off the midpoint of the clavicle
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4
Q
  1. What is the upper right quadrant called and what is in it?
A
  1. Right hypochondriac, liver
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5
Q
  1. What is the upper middle quadrant called and what is in it?
A
  1. Epigastric, stomach
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6
Q
  1. What is the upper left quadrant called and what is in it?
A
  1. Left hypochondriac, spleen
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7
Q
  1. What is the middle right quadrant called and what is in it?
A
  1. Right lumbar, right kidney and ascending colon
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8
Q
  1. What is the middle middle quadrant called and what is in it?
A
  1. Umbilical, transverse colon
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9
Q
  1. What is the middle left quadrant called and what is in it?
A
  1. Left lumbar, left kidney and descending colon
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10
Q
  1. What is the lower right quadrant called and what is in it?
A
  1. Right inguinal, appendix and cecum
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11
Q
  1. What is the lower middle quadrant called and what is in it?
A
  1. Hypogastric, small intestine
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12
Q
  1. What is the lower left quadrant called and what is in it?
A
  1. Left inguinal, sigmoid colon
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13
Q
  1. How do clinicians divide the abdomen?
A
  1. Into four quadrants via the transumbilical and median planes
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14
Q
  1. What is the peritoneal cavity formed from?
A
  1. Intraembryonic coelomic cavity
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15
Q
  1. What is the peritoneal cavity?
A
  1. It is the space between the parietal and visceral peritoneums
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16
Q
  1. How many organs are contained in the peritoneal cavity?
A
  1. None
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17
Q
  1. What is peritoneum?
A
  1. A serous membrane
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18
Q
  1. What is a mesentery?
A
  1. A double layered peritoneum that surrounds an organ and attaches it to the body wall. Blood vessels also pass to the organs via a mesentery.
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19
Q
  1. What is a peritoneal ligament and name an example?
A
  1. A double layered peritoneum that attaches an organ to another organ or to the body wall. Falciform ligament attaches liver to umbilicus
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20
Q
  1. What does retroperitoneal mean?
A
  1. An organ that slightly protrudes into the peritoneum and lacks a mesentery
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21
Q
  1. What does primarily retroperitoneal mean and name an organ that is primarily retro?
A
  1. This means that the organ developed without a mesentery, kidneys
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22
Q
  1. What does secondarily retroperitoneal mean and name organs that are secondarily retro?
A
  1. This means that the organ developed in a mesentery but that it was reabsorbed by the body. The pancreas, duodenum, ascending and descending colon
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23
Q
  1. What is a recess?
A
  1. A blind ended sac or pouch
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24
Q
  1. Name some 3 recesses and the importance of 2 of them
A
  1. Subphrenic, Hepatorenal, Retrocecal. Hepatorenal is bounded by the liver, duodenum, colon and right kidney and is the lowest point of peritoneal cavity when person lies down. Retrocecal contains the vermiform appendix
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25
Q
  1. What are the names for the larger part of the peritoneal cavity?
A
  1. Peritoneal cavity proper or greater sac
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26
Q
  1. What are the names for the smaller part of the peritoneal cavity?
A
  1. Omental Bursa or lesser sac
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27
Q
  1. What is the omental bursa located between?
A
  1. Posterior to the stomach and anterior to the pancreas, laterally it is bounded by the gastrosplenic and lienorenal ligaments
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28
Q
  1. What three things are included in the omental bursa?
A
  1. Superior recess between liver and diaphragm, main portion and inferior recess between double layers of gastrocolic ligament (obliterated in adults)
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29
Q
  1. What does the omental bursa allow for?
A
  1. It allows for stomach distension
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30
Q
  1. How is it connected to the greater sac?
A
  1. Via the epiploic foramen of Winslow aka omental foramen
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31
Q
  1. What are the three mesenteries attaching to the posterior body wall and what do they suspend?
A
  1. Mesentery proper containing ileum and jejunum, Transverse mesocolon containing transverse colon, Sigmoid mesocolon containing sigmoid colon
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32
Q
  1. Where is the greater omentum suspended from?
A
  1. The greater curvature of the stomach
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33
Q
  1. What are the major and minor ligaments that comprise it?
A
  1. Gastrocolic is major, gastrosplenic and gastrophrenic are minor
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34
Q
  1. What mesentery is it a derivative of?
A
  1. Dorsal Mesentery
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35
Q
  1. Where is the lesser omentum suspended from?
A
  1. The lesser curvature of the stomach
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36
Q
  1. What are the major ligaments that comprise it?
A
  1. Hepatogastric and hepatoduodenal
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37
Q
  1. What mesentery is it a derivative of?
A
  1. Ventral Mesentery
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38
Q
  1. Where does the esophagus pierce the diaphragm?
A
  1. Esophageal hiatus, T10 level
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39
Q
  1. Where does the esophagus enter the stomach?
A
  1. At the cardiac orifice
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40
Q
  1. What two arteries supply the esophagus?
A
  1. Left gastric artery from celiac trunk and left inferior phrenic artery
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41
Q
  1. What are the notches on the greater and lesser curvatures of the stomach respectively?
A
  1. Cardiac notch, angular notch
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42
Q
  1. What are the four parts of the stomach?
A
  1. Cardiac antrum, fundus, body and pylorus
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43
Q
  1. What 3 arteries and their branches supply the stomach?
A
  1. Left gastric, splenic (short gastric and left epiploic branches) and common hepatic (right gastric and gastroduodenal branches) all arising from celiac trunk
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44
Q
  1. Name the boundaries of the foregut, midgut and hindgut?
A
  1. Foregut: pharynx to proximal duodenum. Midgut: distal duodenum to transverse colon. Hindgut: descending colon to anal canal
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45
Q
  1. What are the four parts of the duodenum?
A
  1. Superior (aka duodenal bulb), descending, horizontal, ascending
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46
Q
  1. What parts are completely retroperitoneal?
A
  1. Descending and horizontal
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47
Q
  1. What parts are not completely retroperitoneal?
A
  1. Superior and ascending
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48
Q
  1. At what vertebral levels are the parts of the duodenum found?
A
  1. Superior at L1, descending to L3, horizontal at L3, ascending to L2
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49
Q
  1. Where do the common bile duct and main pancreatic duct enter the duodenum?
A
  1. Via the ampulla of Vater in the descending portion
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50
Q
  1. What marks the entrance of the common bile duct and main pancreatic duct inside the duodenum?
A
  1. The main duodenal papilla
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51
Q
  1. Which portions of the duodenum are susceptible to ulcers?
A
  1. Superior and descending, above the main duodenal papilla
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52
Q
  1. Describe the arcades and vasa recta of the jejunum and ileum.
A
  1. Jejunum has more arcades and longer vasa recta while ileum has fewer arcades and shorter vasa recta
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53
Q
  1. Are plicae circularis (spiral folds of mucous membranes) more prominent in jejunum or ileum?
A
  1. Jejunum
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54
Q
  1. What arteries supply the jejunum and ileum?
A
  1. Intestinal arteries branching off of the superior mesenteric artery
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55
Q
  1. What parts of the colon have a mesentery?
A
  1. Transverse colon (transverse mesocolon) and sigmoid colon (sigmoid mesocolon)
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56
Q
  1. What three features distinguish the large intestine from the small intestine?
A
  1. Taenia coli, haustra and appendices epiploicae
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57
Q
  1. What is Taenia coli?
A
  1. Incomplete longitudinal muscle layer that forms three stripes on surface of the large intestine
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58
Q
  1. What is haustra?
A
  1. Sacculations on large intestine
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59
Q
  1. What are appendices epiloicae?
A
  1. Fat-filled peritoneal sacs
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60
Q
  1. What are the two flexures in the large intestine and what do they connect?
A
  1. Left hepatic (ascending and transverse) and Right splenic (transverse and descending)
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61
Q
  1. What artery supplies the transverse colon?
A
  1. Middle colic artery from superior mesenteric artery
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62
Q
  1. What artery supplies the ascending colon?
A
  1. Right colic artery from superior mesenteric artery
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63
Q
  1. What artery supplies the cecum and appendix?
A
  1. Iliocolic artery (gives off appendicular branch) from superior mesenteric artery
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64
Q
  1. What artery supplies the descending colon?
A
  1. Left colic artery from inferior mesenteric artery
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65
Q
  1. What artery supplies the sigmoid colon?
A
  1. Sigmoid arteries from inferior mesenteric artery
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66
Q
  1. What artery supplies the rectum?
A
  1. Superior rectal artery from inferior mesenteric artery
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67
Q
  1. How do gastric ulcers cause hemorrhage?
A
  1. They can erode the gastric wall and the splenic artery
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68
Q
  1. What is ascites?
A
  1. Peritoneal cavity fills with fluid
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69
Q
  1. What causes peritonitis?
A
  1. Gastric ulcers releasing stomach contents into omental bursa
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70
Q
  1. What are adhesions?
A
  1. Scar tissue connection parietal and visceral peritoneums
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71
Q
  1. What are the four peritoneal gutters?
A
  1. Right lateral paracolic, left lateral paracolic, and gutters to the right and left of the mesentery
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72
Q
  1. Which gutter has a special significance?
A
  1. Right lateral paracolic because it serves as a pathway for infection from the hepatorenal pouch to the pelvis
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73
Q
  1. Is the autonomic nervous system generally considered efferent or afferent?
A
  1. Efferent
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74
Q
  1. What is the embryonic origin of the PSNS and SNS?
A
  1. Neural crest
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75
Q
  1. Where are preganglionic and postganglionic fibers of PSNS and SNS found?
A
  1. Preganglionic neuron found in CNS and postganglionic neuron found in PNS
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76
Q
  1. Where do preganglionic sympathetic neurons arise?
A
  1. In the lateral horn at levels T1-L2/3
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77
Q
  1. Describe the sympathetic trunk (other names, where it goes, ganglia, how it ends)
A
  1. This is also called the sympathetic chain or paravertebral ganglion, it goes from the base of the skull to the coccyx, it has 3 cervical/11 thoracic/4 lumbar/4 sacral ganglia, it ends by both trunks uniting in coccygeal region at ganglion impar
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78
Q
  1. How many white rami communicans are there and what is their function?
A
  1. There are 14 pairs and they are the site through which all preganglionic sympathetic fibers pass through
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79
Q
  1. What is the preganglionic sympathetic neurotransmitter?
A
  1. Acetylcholine
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80
Q
  1. What is the postganglionic sympathetic neurotransmitter?
A
  1. Norepinephrine (noradrenaline)
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81
Q
  1. What is the exception to the postganglionic sympathetic neurotransmitter?
A
  1. Acetylcholine goes to the sweat glands
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82
Q
  1. Describe the 4 pathways that preganglionic sympathetic fibers can pass through.
A
  1. First: preganglionic fibers from lateral horn in CNS levels T1-L2/3 leave via the ventral root into the white rami communicans before they synapse on a postganglionic neuron in the sympathetic chain and pass through the gray rami commnicans to leave via the dorsal and ventral primary rami
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83
Q
  1. Describe the four prevertebral ganglion and what they supply
A
  1. Celiac Ganglion: Greater splanchnic nerves (T6-9) synapse and supplies foregut
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84
Q
  1. What do the first, second and third pathways supply respectively?
A
  1. First and Second: blood vessels, sweat glands and arrector pili muscles
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85
Q
  1. What is the neurotransmitter of the PSNS?
A
  1. Acetylcholine
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86
Q
  1. What 4 cranial nerves make up PSNS?
A
  1. CN III, VII, IX, X
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87
Q
  1. What does cranial nerve X supply?
A
  1. Neck, thorax, gut up to transverse colon with preganglionic fibers going all the way to the gut and synapsing on the gut wall in terminal ganglia. It is a preganglionic parasympathetic fiber
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88
Q
  1. What levels form the sacral portion of PSNS?
A
  1. S2, S3, S4
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89
Q
  1. What are these nerves (2 types) called?
A
  1. Nervi erigens and pelvic splanchnic nerves
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90
Q
  1. What do they innervate?
A
  1. Nervi erigens innervate the penis and clitoris while pelvic splanchnic innervate hindgut, organs in pelvis and genitalia
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91
Q
  1. How do PSNS and SNS affect gut?
A
  1. PSNS increases peristalsis, SNS decreases peristalsis
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92
Q
  1. How do PSNS and SNS affect heart?
A
  1. PSNS decreases heart rate, SNS increases heart rate
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93
Q
  1. How do PSNS and SNS affect sweat glands?
A
  1. Only SNS increases secretion
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94
Q
  1. How do PSNS and SNS affect bronchioles?
A
  1. PSNS constricts bronchioles, SNS dilates bronchioles
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95
Q
  1. How do PSNS and SNS affect eyes?
A
  1. PSNS constricts for light vision, SNS dilates for dark vision
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96
Q
  1. How do PSNS and SNS affect peripheral and skeletal blood vessels?
A
  1. Only SNS vasoconstricts peripheral and vasodilates skeletal
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97
Q
  1. How do PSNS and SNS affect sex organs?
A
  1. PSNS erects penis/clitoris, SNS promotes ejaculation
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98
Q
  1. How do PSNS and SNS affect adrenal gland?
A
  1. Only SNS enhances secretion of adrenalin via preganglionic fibers
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99
Q
  1. How do PSNS and SNS affect salivary glands?
A
  1. PSNS increases secretion, SNS decreases secretion
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100
Q
  1. Where do visceral afferent fibers not pass through?
A
  1. Gray rami communicans, only pass through white rami communicans
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101
Q
  1. What is the major function of the spleen?
A
  1. Lymphoid organ
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102
Q
  1. What are the two surfaces of the spleen and the divisions of one of the surfaces?
A
  1. Diaphragmatic and visceral. The visceral is divided into the gastric, renal and colic surfaces
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103
Q
  1. What is the hilus of the spleen?
A
  1. Where vessels go into the spleen
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104
Q
  1. What is the arterial supply of the spleen?
A
  1. Splenic artery from celiac trunk
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105
Q
  1. What are the four anatomical lobes of the liver?
A
  1. Right lobe, caudate (posterior), quadrate (anterior), left lobe
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106
Q
  1. What are the two functional lobes of the liver and their blood supply?
A
  1. Right lobe (right hepatic artery), Left lobe including caudate and quadrate (left hepatic artery). Both arise from celiac trunk
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107
Q
  1. What is the significance of the bare area of the liver?
A
  1. It is not covered by peritoneum
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108
Q
  1. What are the five ligaments of the liver?
A
  1. Falciform (connects liver to umbilicus), Ligamentum Teres (remnant of umbilical vein within falciform), Ligamentum venosum (remnant of ductus venosum), coronary ligaments (liver to diaphragm), lesser omentum ligaments (hepatogastric, hepatoduodenal)
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109
Q
  1. What artery supplies the gall bladder?
A
  1. Cystic artery usually a branch off of the right hepatic artery
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110
Q
  1. What is contained in the porta hepatis?
A
  1. Hepatic artery, right and left hepatic ducts, hepatic portal vein
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111
Q
  1. Describe the biliary duct system
A
  1. The right and left livers give off right and left hepatic ducts, which come together to form the common hepatic duct, which joins the cystic duct of the gall bladder to form the common bile duct. The common bile duct and common pancreatic duct join together and empty into the descending duodenum at the Ampulla of Vater into the major duodenal papilla. Emptying occurs via opening of the sphincter of Oddi
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112
Q
  1. What is the name of the process on the head of the pancreas?
A
  1. Uncinate process
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113
Q
  1. Which portion of the pancreas is not retroperitoneal?
A
  1. Tail
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114
Q
  1. Where does the left gastric artery come off of and what does it supply?
A
  1. Celiac trunk, supplies the esophagus and stomach
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115
Q
  1. Where does the common hepatic artery come off of and what are its branches?
A
  1. Celiac trunk, hepatic artery proper and gastroduodenal artery
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116
Q
  1. What does the right gastric artery supply and what does it anastomose with?
A
  1. Stomach, left gastric artery
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117
Q
  1. What does the right hepatic artery supply?
A
  1. Right functional lobe of the liver and gives off cystic artery to supply gall bladder
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118
Q
  1. What does the left hepatic artery supply?
A
  1. Left functional lobe of the liver
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119
Q
  1. What are the branches of the hepatic artery proper?
A
  1. Right hepatic, Left hepatic, Right gastric
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120
Q
  1. What are the branches of the gastroduodenal artery and what do they supply?
A
  1. Supraduodenal (superior duodenum), superior pancreaticoduodenal (anastomoses with inferior pancreaticoduodenal from superior mesenteric artery), right gastroepiploic (anastomoses with left gastroepiploic to supply greater curvature of stomach)
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121
Q
  1. Where does the splenic artery come off of and what are its branches?
A
  1. Celiac trunk, splenic, short gastric, left gastroepiploic
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122
Q
  1. What does the superior mesenteric artery supply in general?
A
  1. The midgut
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123
Q
  1. What are the branches of the superior mesenteric artery and what do they supply?
A
  1. Inferior pancreaticoduodenal (duodenum), intestinal arteries (jejunum and ileum), iliocolic (cecum, appendix), right colic (ascending colon), middle colic (transverse colon)
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124
Q
  1. What does the inferior mesenteric artery supply in general?
A
  1. Hindgut
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125
Q
  1. What are the branches of the inferior mesenteric artery and what do they supply?
A
  1. Left colic (transverse colon and descending colon), sigmoid arteries (sigmoid colon), superior rectal artery (rectum)
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126
Q
  1. What are the three paired visceral arteries?
A
  1. Renal arteries, middle suprarenal arteries (from abdominal aorta), testicular/ovarian arteries
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127
Q
  1. What is the only unpaired parietal artery?
A
  1. Median sacral artery that anastomoses with lateral sacral arteries
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128
Q
  1. What are the two paired parietal arteries?
A
  1. Inferior phrenic arteries and lumbar arteries
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129
Q
  1. At what vertebral level does the vena cava pierce the diaphragm and name its foramen?
A
  1. T8, inferior vena caval foramen
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130
Q
  1. Describe portal circulation of the liver and its function
A
  1. Blood flow from the GI tract through the hepatic portal vein, through sinusoids and then leaves the liver via the hepatic vein to the inferior vena cava. Its function is to bring things from the GI tract to be metabolized in the liver
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131
Q
  1. What two veins form the hepatic portal vein?
A
  1. Superior mesenteric vein and splenic vein
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132
Q
  1. Where are the five anastomoses for the hepatic portal vein and systemic circulation?
A
  1. Left gastric vein with esophageal veins, Colic vein with systemic retroperitoneal veins, Splenic and Pancreatic veins with renal veins, paraumbilical veins with cutaneous veins of anterior body wall, superior rectal veins with middle and inferior rectal veins
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133
Q
  1. What is the most commonly injured abdominal organ and where is it located?
A
  1. Spleen, between ribs 9 and 12
134
Q
  1. How do gallstone attacks occur in fat female forty women after eating and where does the pain occur?
A
  1. Lodging of gallstone in bile duct, pain starts from epigastric region to infrascapular region on the right side
135
Q
  1. What causes portal hypertension, who is susceptible (and why) and what does it cause?
A
  1. Blockage in the sinusoids, alcoholics get this due to connective tissue infiltration of the liver in cirrhosis and it causes blood to take alternate routes through portal-caval anastomoses
136
Q
  1. Describe the four parts that the diaphragm is formed from
A
  1. Septum transversum forms the central tendon, skeletal muscle derived from somatic mesoderm of the body wall forms the peripheral muscle layer, the mesoesophagus forms the crus of the diaphragm, pleuroperitoneal folds close off pericardioperitoneal canals
137
Q
  1. What causes diaphragmatic hernias?
A
  1. Failure of the pleuroperitoneal folds to properly fuse
138
Q
  1. What are the esophagus and stomach derived from?
A
  1. Foregut
139
Q
  1. What are the dorsal mesogastrium and ventral mesogastrium and what are they derived from?
A
  1. They are the mesenteries of the stomach and are derived from the septum transversum
140
Q
  1. What two things are derived from the dorsal mesogastrium?
A
  1. Omental bursa and greater omentum
141
Q
  1. What two things are derived from the ventral mesogastrium?
A
  1. Lesser omentum and falciform ligament
142
Q
  1. Where are the four parts of the duodenum derived from?
A
  1. Superior and descending portions are foregut while horizontal and ascending portions are midgut
143
Q
  1. Describe the embryology of the liver
A
  1. The liver bud (hepatic diverticulum) invades the septum transversum and begins to grow from the foregut
144
Q
  1. What is derived from the ventral pancreatic bud and dorsal pancreatic bud respectively?
A
  1. Head and uncinate process of pancreas, body and tail of pancreas
145
Q
  1. What is annular pancreas?
A
  1. The ventral pancreas splits and obstructs the duodenum
146
Q
  1. What is the spleen derived from?
A
  1. Mesoderm, NOT foregut
147
Q
  1. What is an omphalocoele?
A
  1. When the gut fails to return to the abdominal cavity
148
Q
  1. What is the cloaca?
A
  1. An endodermal lined cavity that is in direct contact with surface ectoderm
149
Q
  1. What is the significance of the cloaca and how is it divided?
A
  1. The terminal portion of the hindgut enters the cloaca and it is divided by the urorectal septum
150
Q
  1. What are the foregut derivatives (11)? What are they supplied by?
A
  1. Pharynx, lungs, bronchi, trachea, esophagus, stomach, superior duodenum, descending duodenum, liver, gall bladder, pancreas. Celiac trunk
151
Q
  1. What are the midgut derivatives (6)? What are they supplied by?
A
  1. Horizantal duodenum, ascending duodenum, jejunum, ileum, ascending colon, transverse colon. Superior mesenteric artery
152
Q
  1. What are the hindgut derivatives (4)? What are they supplied by?
A
  1. Descending colon, sigmoid colon, rectum, anal canal to pectinate line. Inferior mesenteric artery
153
Q
  1. What are the derivatives of the ventral mesentery (2)?
A
  1. Falciform ligament and lesser omentum (hepatogastric and hepatoduodenal ligaments)
154
Q
  1. What are the derivatives of the dorsal mesentery (5)?
A
  1. Greater omentum (gastrocolic, gastrosplenic, gastrophrenic ligaments), lienorenal ligament, mesentery of jejunum and ileum, transverse and sigmoid mesocolon, mesoduodenum (lost in adult)
155
Q
  1. What germ layer is kidney derived from?
A
  1. Mesoderm
156
Q
  1. What is the uretic duct derived from and what does it give rise to?
A
  1. Mesonephric duct, collecting duct system and vas deferns/epididymis in males
157
Q
  1. What is pelvic kidney?
A
  1. A failure of the kidney to ascend during fetal development that may be diagnosed as a tumor and interfere with pregnancy
158
Q
  1. What is horseshoe kidney?
A
  1. Kidneys become too close together during ascent and lower poles fuse anterior to abdominal aorta
159
Q
  1. At what vertebral level are the kidneys found and which one is lower?
A
  1. T12-L3, right is lower due to liver
160
Q
  1. Since the kidney lacks a mesentery, what is it encased in?
A
  1. Perirenal fat that is encased in renal fascia
161
Q
  1. In what order do the vessels enter the hilus of the kidney anteriorly to posteriorly?
A
  1. Renal vein, renal artery, ureter
162
Q
  1. Describe the anatomy of the kidney
A
  1. The kidney has the outer cortex and inner medulla. Within the medulla there are renal pyramids that are separated by renal columns. At the tip of the pyramids is the renal papilla, which drain into the minor calyces, which then drain into the major calyces and then into the renal pelvis (expanded portion of ureter).
163
Q
  1. How many minor and major calyces exist in the kidney?
A
  1. 7-14 minor, 2-3 major
164
Q
  1. Where do the renal arteries arise from?
A
  1. Abdominal aorta
165
Q
  1. What do the right and left renal veins empty into?
A
  1. Inferior vena cava
166
Q
  1. Which nervous system innervates the kidney?
A
  1. Sympathetic
167
Q
  1. What is the pathway for the ureters?
A
  1. Renal pelvis ureters, urinary trigone, urinary bladder
168
Q
  1. What arteries supply the ureters?
A
  1. Renal, gonadal and abdominal aorta
169
Q
  1. In what three regions to the ureters become constricted often forming kidney stones?
A
  1. Pelvis to ureter, pelvic inlet and entrance into urinary bladder
170
Q
  1. Where does the pain for kidney stones go from and to?
A
  1. From loin to groin
171
Q
  1. What is the shape of the suprarenal gland on the left and right kidneys respectively?
A
  1. Semilunar and top hat
172
Q
  1. What is the suprarenal gland embryologically derived from?
A
  1. Cortex is derived from mesoderm while medulla is derived from ectoderm of neural crest cells
173
Q
  1. What does the cortex of the adrenal gland produce?
A
  1. Steroid hormones
174
Q
  1. What does the medulla of the adrenal gland produce?
A
  1. Catecholamines, mostly adrenaline/epinephrine
175
Q
  1. What is the nerve supply of the medulla of adrenal gland?
A
  1. Preganglionic sympathetic fibers via the greater splanchnic nerve (does not synapse on the celiac ganglia)
176
Q
  1. What is the arterial supply of the adrenal gland?
A
  1. Superior suprarenal from the inferior phrenic artery, middle suprarenal from the aorta, inferior suprarenal from the renal artery
177
Q
  1. What is the venous drainage of the adrenal gland?
A
  1. The right suprarenal vein drains into the inferior vena cava and left suprarenal vein drains into the renal vein
178
Q
  1. What are the two innervations of the diaphragm?
A
  1. Phrenic nerve (C3,C4,C5) gives sensory (to central tendon) and motor innervation, intercostal nerves supply the periphery
179
Q
  1. What are the three ligaments of the diaphragm?
A
  1. Median arcuate ligament (connects crura), medial arcuate ligament (connects crura to transverse process of L1), lateral arcuate ligament (transverse process of L1 to 12th rib)
180
Q
  1. Where do most ruptures of the diaphragm occur?
A
  1. Vertebrocostal triangle, superior to lateral arcuate ligament
181
Q
  1. What are the apertures of the diaphragm and what vertebral levels are they located at?
A
  1. Inferior Vena Caval Foramen (T8), esophageal hiatus (T10), aortic hiatus (T12)
182
Q
  1. What is the arterial supply to the diaphragm?
A
  1. Inferior phrenic artery from abdominal aorta (to inferior surface), Thoracic aorta and musculophrenic/pericardiophrenic from internal thoracic (all three to superior surface)
183
Q
  1. What is the proximal attachment of psoas major?
A
  1. Bodies and discs of T12-L5 and transverse processes of lumbar vertebrae
184
Q
  1. What is the proximal attachment of iliacus?
A
  1. Iliac crest
185
Q
  1. What is the distal attachment of iliopsoas and combined action?
A
  1. Lesser trochanter of femur, flexes thigh at hip
186
Q
  1. What is the innervation of psoas major?
A
  1. Ventral branches of lumbar nerves
187
Q
  1. What is the innervation of iliacus?
A
  1. Femoral nerve
188
Q
  1. What are the attachments of psoas minor?
A
  1. Bodies of T12-L1 to pectineal line and iliopectineal eminence
189
Q
  1. What is the innervation of psoas minor?
A
  1. Ventral branches of L1 nerve
190
Q
  1. What are the attachments of quadratus lumborum?
A
  1. 12th rib, lumbar transverse processes, iliac crest
191
Q
  1. What is the action of quadratus lumborum?
A
  1. Extends and laterally flexes vertebral column, fixes 12th rib during inspiration
192
Q
  1. What is the innervation of quadratus lumborum?
A
  1. Ventral branches of T12-L4 nerves
193
Q
  1. What forms the lumbar plexus?
A
  1. Ventral rami of L1-L4 within psoas major
194
Q
  1. What does splanchnic mean with reference to nerves?
A
  1. Visceral, NOT sympathetic
195
Q
  1. Where do the subcostal nerve and lumbosacral trunk originate?
A
  1. T12 and ventral rami of L4 respectively. Neither is part of the lumbar plexus
196
Q
  1. What are the six lumbar plexus nerves?
A
  1. Iliohypogastric (L1), Ilioinguinal (L1), Genitofemoral (L1-L2, forms genital and femoral branches), lateral femoral cutaneous (L2-L3), Femoral (L2,3,4), Obturator (L2,3,4)
197
Q
  1. Where is pain in the diaphragm referred to?
A
  1. Dermatomes C3-C5
198
Q
  1. Where is pain in the heart referred to?
A
  1. C8-T5
199
Q
  1. Where is pain in the stomach referred to?
A
  1. Dermatomes T6-T9
200
Q
  1. What is the cisterna chyli?
A
  1. Visceral lymph nodes and lumbar trunks that unite to form the thoracic duct
201
Q
  1. What are the dorsal and ventral landmarks of the thoracic inlet? What are the boundaries of the inlet?
A
  1. Dorsal: T1 vertebra, Ventral: Manubrium of sternum (higher dorsally than ventrally allowing lungs to expand beyond sternum). Bounded by clavicles, sternum, first ribs and thoracic vertebrae
202
Q
  1. What are the boundaries of the thoracic outlet?
A
  1. Posterior: T12 vertebra, Lateral: ribs 10-12, Anterior: costal cartilages of ribs 7-10 and junction of body of sternum and xiphoid process, Inferior: diaphragm
203
Q
  1. What three parts make up the sternum?
A
  1. Manubrium, body, xiphoid process
204
Q
  1. What is the midline superior notch located on the manubrium called?
A
  1. Jugular or suprasternal notch
205
Q
  1. What is the junction of the manubrium to body called and what vertebral level does it occur?
A
  1. Sternal Angle, Intervertebral disc between T4 and T5
206
Q
  1. Which costal cartilages attach to the body of the sternum and what type of joint is it?
A
  1. Costal cartilages of ribs 2-7, sliding joint
207
Q
  1. Where does costal cartilage of rib 2 attach?
A
  1. Immediately inferior to the sternal angle
208
Q
  1. At what vertebral level does the xiphoid process attach to the body?
A
  1. T10
209
Q
  1. Though uncommon, where do most fractures of the sternum occur?
A
  1. At the sternal angle
210
Q
  1. In the case of sternum damage, what 2 things should a physician be concerned with?
A
  1. Trauma to diaphragm and herniation of abdominal contents into thorax; heart trauma and its pericardium
211
Q
  1. Surgical splitting of the sternum allows access to what?
A
  1. Mediastinum
212
Q
  1. What is sternal puncture used for?
A
  1. To check for blood dyscrasias
213
Q
  1. What is it referred to when the sternum is sunken in? What does this affect?
A
  1. Pectus excavatum, compromises respiration by limiting the vital capacity of the chest
214
Q
  1. Which ribs are true ribs and why?
A
  1. Ribs 1-7 because their costal cartilages attach to the sternum anteriorly
215
Q
  1. Which ribs are false ribs and why?
A
  1. Ribs 8-10 because their costal cartilages attach to the rib above
216
Q
  1. Which ribs are floating ribs and why?
A
  1. Ribs 11-12 because they have no anterior attachment
217
Q
  1. Which surface (superior or inferior) of a rib is grooved and why? Which one is smooth?
A
  1. Superior is smooth, inferior is grooved to allow for intercostal veins, arteries and nerves (neurovascular bundle)
218
Q
  1. Procaine can be injected into the intercostal nerves to relieve pain from what?
A
  1. Herpes zoster (shingles) or old chest wall injuries
219
Q
  1. When the aorta is obstructed, what condition does this cause in the ribs?
A
  1. Rib notching where blood is shunted through collateral circulation such as through intercostal arteries and this causes arteries to expand and erode the bones of the ribs
220
Q
  1. What is flail chest and what causes it?
A
  1. Fractures of several ribs causes flail chest, which leads to paradoxic respiration where those ribs move inward during inspiration and outward during expiration
221
Q
  1. Where do the heads of a rib articulate and what type of joint is it?
A
  1. With one or two thoracic vertebral bodies, sliding joint
222
Q
  1. Where do the necks and tubercles of a rib articulate?
A
  1. Transverse processes of thoracic vertebrae
223
Q
  1. Which ribs do not have articulations with transverse processes?
A
  1. Ribs 11 and 12
224
Q
  1. What type of joint is the first rib?
A
  1. Synchondrosis (synovial) joint
225
Q
  1. What three (or four) muscles are located in the intercostal spaces most superior to deep?
A
  1. External intercostal muscles, internal intercostal muscles, innermost intercostal muscles (only found at midaxillary line), transversus thoracic posteriorly
226
Q
  1. What innervates the intercostal muscles?
A
  1. Neurovascular bundles with each intercostal nerve
227
Q
  1. Which direction do ribs 1-7 increase the chest cavity diameter?
A
  1. Pump handle increase anterior posterior diameter
228
Q
  1. Which direction do ribs 8-10 increase the chest cavity diameter?
A
  1. Bucket handle increase medial lateral diameter
229
Q
  1. What artery supplies intercostal spaces 3-12?
A
  1. Posterior intercostal artery
230
Q
  1. What artery supplies intercostal spaces 1-2?
A
  1. Superior intercostal artery (arising from axillary artery)
231
Q
  1. What supplies the intercostal muscles and overlying skin?
A
  1. Anterior intercostal artery (continuation of posterior intercostal artery)
232
Q
  1. What are the two anastomoses formed by the anterior intercostal artery?
A
  1. Internal thoracic artery (branch of subclavian artery) in superior chest and musculophrenic artery (branch of internal thoracic artery) in lower rib cage
233
Q
  1. What are the two terminal branches of internal thoracic artery?
A
  1. Musculophrenic and superior epigastric arteries
234
Q
  1. Between which two muscles is the neurovascular bundle found?
A
  1. Between the internal intercostal muscles and innermost intercostal muscles
235
Q
  1. What are the two divisions of the intercostal nerves?
A
  1. Posterior primary ramus and Anterior primary ramus
236
Q
  1. Where does the posterior primary ramus go and what does it innervate?
A
  1. Paraspinal region, supplies muscle and skin
237
Q
  1. What are the anterior primary rami branches?
A
  1. Lateral branch at the midaxillary line that further divides into posterior and anterior; Anterior branch at the lateral border of the sternum further divides into medial and lateral
238
Q
  1. What does the anterior primary ramus innervate?
A
  1. Muscles and branches innervate skin
239
Q
  1. What is pneumothorax?
A
  1. Air in the pleural cavity
240
Q
  1. What is tension pneumothorax?
A
  1. Air in the pleural cavity continues to go in but cannot go out causing increasing intrapleural pressure and thereby causing collapse of the lung
241
Q
  1. What is the pleura that extends above the clavicle to the root of the neck called?
A
  1. Cupula
242
Q
  1. Where does the pleural cavity extend anteriorly, laterally and posteriorly respectively?
A
  1. Rib 8, rib 10, rib 12
243
Q
  1. At the lung hilum, what two things come together?
A
  1. The visceral and parietal pleura
244
Q
  1. What three things are found superiorly to inferiorly in the lung hilum?
A
  1. Pulmonary artery, primary bronchus, pulmonary vein
245
Q
  1. How many lobes does each lung have?
A
  1. 3 right (superior, middle, inferior), 2 left (superior, inferior)
246
Q
  1. What are the names of the fissures of the lungs?
A
  1. Oblique (major) fissure separates the superior and inferior lobes, Horizantal (minor) fissure separates superior and middle lobes in right lung
247
Q
  1. What are the inferior borders of the lung anteriorly, laterally and posteriorly?
A
  1. Rib 6, rib 8, rib 10
248
Q
  1. What is the rule of 2’s?
A
  1. The lungs go from ribs 6, 8 and 10 anteriorly to laterally to posteriorly while the pleura goes from ribs 8, 10 and 12
249
Q
  1. What is the arterial supply to the lungs (oxygenated blood)?
A
  1. Bronchial arteries
250
Q
  1. What is the nerve supply to the visceral pleura?
A
  1. Vagus nerve (PSNS) and sympathetic nerve plexus, autonomic
251
Q
  1. What is the nerve supply to the parietal pleura?
A
  1. Intercostal nerves and phrenic nerve, somatic
252
Q
  1. What is the arterial supply to the superior diaphragm?
A
  1. Musculophrenic and pericardiophrenic arteries from internal thoracic, also thoracic aorta
253
Q
  1. What is the arterial supply to the inferior diaphragm?
A
  1. Inferior phrenic arteries
254
Q
  1. What is the arterial supply to the peripheral diaphragm?
A
  1. Intercostal arteries
255
Q
  1. What nerve supplies the central diaphragm?
A
  1. Phrenic nerve (C3, C4, C5), motor and sensory (to central tendon)
256
Q
  1. What nerve supplies the peripheral diaphragm?
A
  1. Intercostal nerves
257
Q
  1. What three structures pass through the diaphragm and at what vertebral levels?
A
  1. Inferior vena cava (T8), esophagus (T10), aorta (T12)
258
Q
  1. What are the impressions on the right lung?
A
  1. Cardiac impression, esophageal impression, impression of the azygos vein
259
Q
  1. What are the impressions on the left lung?
A
  1. Cardiac impression, impression of the arch of the aorta, impression of the descending aorta
260
Q
  1. What are the boundaries of the mediastinum?
A
  1. Superiorly by thoracic inlet, anteriorly by sternum, posteriorly by bodies of thoracic vertebrae, laterally by pleural sacs
261
Q
  1. What are the boundaries of the anterior, middle and posterior portions of the inferior mediastinum?
A
  1. Anterior between posterior sternum and anterior pericardium, middle is pericardium and heart, posterior between posterior pericardium and anterior surface of T5-T12
262
Q
  1. What are the boundaries of the superior mediastinum?
A
  1. Posterior surface of the manubrium and anterior surface of T1-T4
263
Q
  1. What is found in the anterior mediastinum (2)?
A
  1. Thymus gland and internal thoracic artery
264
Q
  1. Describe the origin and branches of the internal thoracic artery.
A
  1. It is a branch off of the subclavian artery and divides into two terminal branches: musculophrenic and superior epigastric arteries. Also, it gives off anterior intercostal arteries and the pericardiophrenic artery
265
Q
  1. What is the significance of the internal thoracic artery (and its branches)?
A
  1. They form anastomoses with the aorta if the aorta is congenitally narrowed and are used during coronary artery bypass surgery
266
Q
  1. What is the most anterior structure in the superior mediastinum?
A
  1. Thymus gland
267
Q
  1. Where are the venous and arterial sides of the heart located?
A
  1. Venous (right), Arterial (left)
268
Q
  1. What is the positioning of arteries, ducts and veins in the superior mediastinum?
A
  1. Anterior: veins, middle: arteries, Posterior: ducts
269
Q
  1. Are the phrenic nerves found medially or laterally? Which side runs with a vein and which with an artery?
A
  1. Found laterally, right side runs with a vein while left side runs with an artery
270
Q
  1. What branch comes off the vagus nerve and can be seen in the superior mediastinum?
A
  1. Left recurrent laryngeal nerve
271
Q
  1. Where do right and left brachiocephalic veins drain?
A
  1. Left brachiocephalic vein meets the right and they both drain into the superior vena cava that empties into the right atrium
272
Q
  1. What does superior vena cava syndrome cause?
A
  1. Edema in the head, neck and upper extremity due to obstruction of superior vena cava
273
Q
  1. What are the three portions of the aorta?
A
  1. Ascending, arch, descending
274
Q
  1. Where does the ascending aorta ascend to?
A
  1. To the sternal angle
275
Q
  1. What are the branches of the arch of the aorta anteriorly to posteriorly?
A
  1. Brachiocephalic, left common carotid, (sometimes left vertebral), left subclavian arteries
276
Q
  1. What does the thyroidea ima artery supply and what is it a branch of?
A
  1. Supplies the thyroid, branch of the brachiocephalic artery
277
Q
  1. What are the two branches of the brachiocephalic artery?
A
  1. Right common carotid, Right subclavian
278
Q
  1. What is the bifurcation of the trachea into right and left primary bronchi called? At what level is it located?
A
  1. Carina, sternal angle
279
Q
  1. If objects are aspirated, which lung do they tend to go into and why?
A
  1. Right lung because the right mainstem bronchus is vertical and larger
280
Q
  1. Which is posterior to the other, esophagus or trachea?
A
  1. Esophagus is posterior to trachea
281
Q
  1. Where does the thoracic duct drain into?
A
  1. Junction of left subclavian and left internal jugular veins
282
Q
  1. What areas are not drained by the thoracic duct?
A
  1. The right portion of head and neck, the right upper extremity, the right thorax
283
Q
  1. What drains the area not drained by the thoracic duct?
A
  1. The right lymphatic duct
284
Q
  1. Where does the right lymphatic duct drain into?
A
  1. The junction of the right subclavian and right internal jugular veins
285
Q
  1. What does the right vagus nerve form?
A
  1. Esophageal and cardiac plexuses
286
Q
  1. Which nerve is affected with aneurysms of the aortic arch?
A
  1. Left recurrent laryngeal nerve causes patient’s voice to be hoarse
287
Q
  1. What nerve system is found in the superior mediastinum?
A
  1. Sympathetic ganglion
288
Q
  1. What are the five contents of the posterior mediastinum?
A
  1. Esophagus and vagus plexus, descending aorta, azygos veins, splanchnic nerves, thoracic duct
289
Q
  1. Where are the three constrictions of the esophagus?
A
  1. Origin, midpoint constriction by left mainstem bronchus and aortic arch, entrance into diaphragm
290
Q
  1. What conditions are affected by venous drainage of the esophagus anastomosing with the stomach?
A
  1. Esophageal varices in portal hypertension secondary to liver disease
291
Q
  1. What drains into the azygos vein?
A
  1. Intercostal spaces 5-12 on the right side, and spaces 2-4 empty into superior intercostal vein that then empties into the azygos vein
292
Q
  1. What are three branches of the descending (thoracic) aorta?
A
  1. Paired posterior intercostal arteries, bronchial arteries and esophageal arteries
293
Q
  1. What type of fibers is contained in splanchnic nerves?
A
  1. Preganglionic sympathetic fibers
294
Q
  1. What are the branches of the azygos vein?
A
  1. Accessory hemiazygos and hemiazygos veins
295
Q
  1. What does pericarditis cause?
A
  1. It can cause the fluid accumulation in the pericardial cavity
296
Q
  1. What is accumulation of fluid in the pericardial space called?
A
  1. Tamponade
297
Q
  1. What procedure removes this excess fluid from the pericardial space?
A
  1. Pericardiocentesis
298
Q
  1. What are the two sinuses in the pericardium?
A
  1. Transverse and oblique sinus
299
Q
  1. Where are the right and left ventricles found?
A
  1. Right ventricle is anterior and left ventricle is posterior (and to the left)
300
Q
  1. What separates the atria from the ventricles?
A
  1. Atrioventricular sulcus (aka coronary groove)
301
Q
  1. What forms the ventricular septum?
A
  1. Anterior and posterior interventricular sulci
302
Q
  1. Where is the base of the heart located?
A
  1. The posterior portion
303
Q
  1. Where is the apex of the heart located?
A
  1. The inferolateral tip in the fifth intercostal space and midclavicular line
304
Q
  1. What is situs inversus?
A
  1. When the abdominal and thoracic organs are found on the opposite side of the body
305
Q
  1. What is the blood supply to the heart muscle and where does it travel?
A
  1. Coronary arteries and cardiac veins travel in epicardium (aka visceral pericardium)
306
Q
  1. Where does the right coronary artery originate and what does it supply?
A
  1. Right aortic sinus, supplies right ventricle, right atrium, SA node
307
Q
  1. What are the branches (including terminal branch) of the right coronary artery? Are there any anastomoses?
A
  1. Nodal artery and right marginal artery; terminal branch is posterior interventricular artery (which anastomoses with the anterior interventricular artery
308
Q
  1. Where does the left coronary artery originate and what does it supply?
A
  1. Aorta, supplies left ventricle, left atrium, ventricular septum, right ventricle
309
Q
  1. What are the branches of the left coronary artery?
A
  1. Left anterior interventricular artery, circumflex artery
310
Q
  1. What is the branch of the circumflex artery and what does it anastomose with?
A
  1. Left marginal artery, anastomoses with right coronary artery branches
311
Q
  1. What is the most common cardiac dominance, right or left? What determines dominance?
A
  1. Right dominance, if the right coronary artery gives rise to the posterior interventricular artery this is right dominance.
312
Q
  1. Where is the coronary sinus found?
A
  1. In the wall of the right atrium
313
Q
  1. What is the main vein that drains the heart?
A
  1. The great cardiac vein
314
Q
  1. Where is the fossa ovalis found?
A
  1. Wall of the right atrium
315
Q
  1. What is the largest valve of the heart?
A
  1. Tricuspid
316
Q
  1. What do chordae tendinae come off of and what do they do?
A
  1. They come off the papillary muscle and prevent the av valves from blowing back during systole
317
Q
  1. Describe diastole and systole and their correlation with lub and dub
A
  1. During diastole, the ventricles are filling up and when the av valves close we hear the lub. During systole, the ventricles are emptying and when the semilunar valves close we hear the dub
318
Q
  1. What is the moderator band composed of and what does it connect to?
A
  1. It is composed of the right bundle of His and connects to the papillary muscle
319
Q
  1. Where is the ligamentum arteriosum found and what is it a remnant of?
A
  1. Between the aorta and the pulmonary artery, remnant of ductus arteriosus
320
Q
  1. What are the layers of the pericardium?
A
  1. The outer fibrous layer, the outer serous (parietal) layer, the pericardial space and the inner serous (visceral) layer (aka epicardium)
321
Q
  1. What do aortic bodies do and where are they found?
A
  1. They are chemoreceptors in the aortic arch and sense pH and CO2 changes in the blood
322
Q
  1. What infection can damage valves?
A
  1. Rheumatic fever
323
Q
  1. Where are the tricuspid and bicuspid valves found?
A
  1. Tricuspid between the right atrium and right ventricle, bicuspid between the left atrium and left ventricle
324
Q
  1. Where is the aortic valve heard?
A
  1. The right second intercostal space
325
Q
  1. Where is the pulmonic valve heard?
A
  1. The left second intercostal space
326
Q
  1. Where is the tricuspid valve heard?
A
  1. Left xiphosternal junction at fifth intercostal space
327
Q
  1. Where is the bicuspid valve heard?
A
  1. Left fifth intercostal space at midclavicular line
328
Q
  1. What is the pacemaker of the heart?
A
  1. SA node
329
Q
  1. What is the nerve supply to the heart?
A
  1. PSNS& SNS form cardiac plexus and visceral afferent nerves
330
Q
  1. What levels are the preganglionic sympathetic nerve fibers to the heart found
A
  1. T1-T6