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NPLEX I 2024 > Chest/Vascular Anatomy > Flashcards

Chest/Vascular Anatomy Flashcards

1
Q

what is the blood supply of the pericardium?

A

mainly the pericardiophrenic artery which is a branch of the internal thoracic artery**

also contributed by musculophrenic artery (terminal branch of internal thoracic), and the bronchial, esophageal, and superior phrenic artery of aorta

CAs supply visceral layer**

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2
Q

what veins drain the pericardium?

A

pericardiophrenic veins
tributaries of brachiocephalic or internal thoracic veins
variable tributaries of azygous venous system

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3
Q

innervation/nerve supply of pericardium

A

phrenic (C3-C5)
sympathetic trunks (vasomotor)
vagus nerve

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4
Q

what are the main branches of the coronary arteries (CAs)?

A

aortic root > RCA + LCA

RCA > right marginal
RCA > PDA

LCA > cirumflex
LCA > LAD

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5
Q

what CA supplies the ventricles?

A

the posterior branch of RCA supplies BOTH posterior ventricles

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6
Q

name the major aortic arch branches and name the first branch of the aorta

A

“ABCs”

Aortic Arch gives rise to:
Brachiocephalic trunk
(left) Common Carotid
(left) Subclavian

first branch of aorta is technically the CAs!! if thats an option, choose that.

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7
Q

name the heart valves in the order blood flows through them

A

“Try Pulling My Aorta”

tricuspid
pulmonoary
mitral
aortic

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8
Q

describe the order and anatomy of the layers of the heart

A

*endo > myo > epi (visc serous peri) > parietal serous peri > fibrous pericardium *

epicardium - thin, external layer of mesothelium formed by visceral serous pericardium

myocardium - muscular

endocardium - endothelium and subendothelial CT (lines valves, why we more often see vegetations and murmurs with endocarditis)

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9
Q

what supplies blood to the right atrium?

A

coronary sinus (from venous return)
IVC and SVC (from systemic circulation, inf and sup respectively)

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10
Q

where is the coronary sinus located and what supplies blood to it?

A

lies in the coronary grooves; receives blood from cardiac veins (venous sinus)

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11
Q

compare the atria v ventricles (and their septums) in their function and anatomy

A

atria = receiving chambers, have auricles and pectinate muscles, foramen ovale/fossa ovalis

IA septum = has upper membranous portion and lower thick muscular portion

ventricles = discharging chambers, papillary muscles (dont close valves, just help keep closed and prevent backflow)

IV septum = has conducting components

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12
Q

describe the pathway from the RV to the PT

A

the RV tapers to the conus arteriosus which > the pulmonary valve at the apex > PT

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13
Q

where is the LA located?

A

base of heart

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14
Q

where do the left and right pulmonary veins enter?

A

LA

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15
Q

the left auricle overlaps what structure?

A

PT

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16
Q

what chamber has the thickest myocardium and why?

A

LV - works the hardest

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17
Q

where do the CAs lie?

A

just deep to epicardium, embedded in fat

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18
Q

what do the CAs supply?

A

epicardium and myocardium

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19
Q

where does the endocardium get blood and nutrients from?

A

directly from chambers

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20
Q

describe the pathway of the RCA

A

RCA lies in coronary groove

> gives off SA nodal branch near origin

> descends to right marginal, running toward but no reaching apex

> crosess posteriorly to an AV nodal branch at the crus of the heart (junction of all 4 chambers) then descends in posterior IV groove toward apex

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21
Q

what does the posterior IV branch of RCA supply

A

both ventricles, and sends branches to IV septum

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22
Q

describe the pathway of the LCA

A

arises from L aortic sinus, passing b/w left auricle and L side of PT in coronary groove

> LAD > along IV groove to apex and along inferior border where it anastomoses with posterior IV branch of RCA

> circumflex > goes post and inf to become left marginal going to LV, terminates before crus

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23
Q

cardiac drainage is done by

A

coronary sinus along posterior AV groove > drains into RA between IVC and tricuspid

great, middle, and small cardiac veins

tracheobronchial lymph nodes

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24
Q

where does the thymus lie

A

posterior to manubrium, extends into anterior mediastinum from the superior mediastinum

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25
what happens to the thymus as we age? why?
replaced by fat after puberty the function of the thymus is to promote function and maturation of t lymphocytes (WBC); as we age we have less to mature
26
what hormones are associated with the thymus?
thymosins
27
blood supply of the thymus
anterior intercostal and anterior mediastinal branches of internal thoracic arteries
28
drainage of thymus
veins of thymus end in L brachiocephalic, int thoracic, and inf thyroid veins lymph vessels end in parasternal, brachiocephalic, and tracheobronchial nodes
29
where does the posterior mediastinum lie?
anterior to T5-T12
30
name the components of the posterior mediastinum
DATES In Vagus Descending Aorta Azygos/hemizygos, Accessory hemizygos veins Thoracic Duct Esophagus Sympathetic trunk and Splanchnic nerve Intercostal arteries (post) Vagus nerve (plexus and trunks)
31
location of the thoracic aorta
begins on the L border of the body of T4 and descends in post mediastinum on the left sides of T5-T12
32
at what location does the thoracic aorta become the abdominal aorta?
T12
33
nerve supply thoracic aorta
thoracic aorta plexus; autonomic nerve network surrounding aorta
34
thoracic duct in relationship to thoracic aorta
thoracic duct and azygous vein descend on the right side of the thoracic aorta and accompany it through the hiatus
35
location of thoracic duct
originates at chyle cister in the abdomen and ascends through aortic hiatus lies on inferior 7 vertebrae at T4-T6, duct crosses to the left posterior to esophagus and ascends into sup mediastinum
36
function of thoracic duct
carries most of bodies lymph (except from 9-12 o clock)
37
where does the thoracic duct empty
left venous angle
38
where does the thoracic duct recieve from
middle and upper intercostal spaces via collecting ducts
39
veins of posterior mediastinum
azygos system of veins on both sides of vertebal column drains back, thoacoabdominal walls, and mediastinal viscera azygos vein forms collateral path between SVC and thorax/abdomen azygos system communicates with vertebral venous plexus (drains back, vertebral canals)
40
nerves of posterior mediastinum
thoracic sympathetic trunks lie against heads of ribs in superior thorax the CV joins in mid thorax, and sides of bodies in the inferior part lies close to spinal cord
41
what are some of the atypical ribs
1st - widest, shortest, most sharply curved, 2 grooves for subclavian vessels separated by scalene tubercle 2nd - 2 facets on head for articulation with bodies of T1 + T2 10-12 - only one facet 11 + 12 - short with no necks or tubercles, end in posterior abdominal musculature
42
at what level is the jugular notch location in relationship to the spine
T2
43
at what level is the manubrium located in relationship to the spine
T2-T4
44
at what level is the sternal body located in relationship to the spine
T4-T9
45
at what level is the sternal angle located in relationship to the spine
T4
46
at what level is the xiphoid process located in relationship to the spine
T9/T10
47
what are the true, false, and floating ribs
true 1-7 false 8-10 (some sources mark 8-12) floating 11-12
48
at what level is the heart located in relationship to the spine
T5-T8/9
49
at what level does the thoracic aorta become the abdominal aorta in relationship to the spine
T12, after going through diaphragm
50
explain the different layers of blood vessels and their composition
Tunica Adventitia: Outermost. Contains blood and lymph vessels and nerves that supply the artery. Fibroelastic CT, vasa vasorum. Tunica Media: Middle layer lining blood vessels, made of smooth muscle/collagen/reticular and elastic fibers. Muscle cells, CT. Tunica Intima: Inner lining, flattened epithelial cells. Includes endothelium and internal elastic lamina. Endothelium, basal lamina, CT layer, internal elastic membrane.
51
elastic v muscular arteries
Elastic Arteries: Tunica intima, media, and externa, NO internal elastic lamina. Thin wall with high elastin content. Aorta and major branches. Muscular Arteries: Tunica intima, media, adventitia. Thick muscular walls. Distribute blood via contraction or relaxation.
52
describe the location of the right ventricle on the heart in relationship to the body. explain the result of this location
the most anterior part; most commonly injured in trauma
53
describe the location of the left atrium on the heart in relationship to the body
most posterior
54
what is responsible for S1 and S2 heart sounds? where is each sound heard loudest? explain their involvement in relationship to the cardiac cycle.
S1: Mitral and tricuspid CLOSE, loudest at mitral area (SYSTOLE) S2: Aortic and pulmonic CLOSE, loudest at L upper sternal area (DIASTOLE) S1 - systole - S2 - diastole - S1 - systole...etc
55
describe the borders of the heart
RA: right LA: posterior RV: anterior, inferior LV: left
56
enlargement of the left atrium can lead to what?
enlargement via mitral stenosis/regurg > - compression of esophagus (dysphagia) - compression of L laryngeal n (hoarseness/Ortner Syndrome) ortner syndrome can also be caused by coimrpession from thoracic AA
57
where is the coronary sinus located?
in the RA between IVC and tricuspid valve
58
describe the location and anatomy of the pericardium
lies within mediastinum; inferior wall of fibrous pericardium attaches to diaphragm (outer to inner) - fibrous pericardium - parietal layer of serous pericardium (pericardial cavity) - visceral layer of serous pericaridum
59
Where does the IVC cross the diaphragm?
T8
60
Name the venous branching poitns of the IVC in relation to spinal level
T8: hepatic T12: L + R suprarenal L1: L + R renal, L gonadal L2: R gonadal L5: L + R common iliac S1: L + R external iliac
61
Location of heart valve sounds
Aortic: 2nd R ICS Pulmonic: 2nd L ICS Erb's - 3rd L ICS Tricuspid: 5th L ICS Mitral: 5th L ICS, MCL (apex)
62
RCA Blood Supply:
right heart, SA node
63
RMA Blood Supply:
RV
64
LAD Blood Supply:
anterior 2/3 IV septum anterior LV anterolateral papillary muscle
65
LCX Blood Supply:
LA post walls LV anterolateral papillary muscle
66
PDA Blood Supply:
AV node post 1/3 IV septum posteromedial papillary muscle
67
right vs left dominance in coronary circulation
dominant side supplies AV node RIGHT (RCA) - MOST COMMON left (LCX) codominant (both)
68
what vessels come directly off the aortic arch?
- coronary arteries - brachiocephalic trunk > R common carotid and R subclavian - L subclavian - L common carotid
69
Aorta origin and path
asc aorta comes off of LV via semilunar valve > aortic arch, moves downward into desc aorta
70
Key landmarks of aorta
T12: desc aorta crosses diaphragm via aortic hiatus and becomes abdominal aorta T12: celiac trunk (foregut) L1: sup mesenteric artery (midgut) L1-L2: renal arteries L2: gonadal arteries L3: inf mesenteric artery (hindgut) L4: bifurcation into 2 common iliac arteries at navel
71

NPLEX I 2024 (23 decks)

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