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Anatomy > CVR > Flashcards

CVR Flashcards

1
Q

What is surface anatomy?

A

Ability to visualise anatomical structures and how to locate from the surface.

E.g. knowing where to count the ribs.

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2
Q

Different palpable (something you can touch listen feel) landmarks?

A

Clavicle.
Manubrium.
Manubriosternal junction.
Costal angle.
Xiphoid process.
Suprasternal notch.

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3
Q

What’s a manubriosternal junction?

A

The joint where the manubrium and top of sternum meet.

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4
Q

What is the sternal angle?

A

Refers to the manubriosternal junction but you can touch or feel it. Surface.

Also known as angle of Louis.

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5
Q

What structures lie at sternal angle?
(RATPLANT).

A
  • Rib 2.
  • Aortic arch.
  • Tracheal bifurcation.
  • Pulmonary trunk.
  • Ligamentum arteriosum.
  • Azygous vein drains into SVC.
  • Nerves (e.g. cardiac plexus).
  • Thoracic duct.
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6
Q

What is the ligamentum arteriosum?

A

A small fibrous left over of a blood vessel that once played a role in fetal circulation.
Located between aortic arch and pulmonary trunk.

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7
Q

What is the tracheal bifurcation?

A

The point where the trachea splits into two main breaches called the primary bronchi. Into right and left bronchus.
Occurs at level T5.

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8
Q

What landmark should you be able to see?

A

Anterior axillary fold.
Posterior axillary fold.
Axilla (Axillary fossa).
Jugular notch.
Pectoralis major and other muscles.

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9
Q

How many lobes does the left lung have?

A

2.
Superior lobe.
Inferior lobe.

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10
Q

How many lobes does the right lung have?

A

3.
Superior.
horizontal fissure in middle.
Middle.
oblique fissure in middle.
Inferior.

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11
Q

Why is the right lung slightly larger than the left lung?

A

Because it doesn’t have to make space for the heart.

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12
Q

Safe triangle is important area to note for chest drains.

A

Top- Base of axilla.
Bottom- Line of fifth intercostal space.
Anterior- Lateral edge of pectoralis major.
Laterally by lateral edge of latissimus dorsi.

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13
Q

Location of heart?

A

Usually between ribs 2 and 5th intercostal space.
Extends from right medial border of sternum to having its apex close to midclavicular line on left.

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14
Q

Supine?

A

Person facing upwards.

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15
Q

Prone?

A

Person lying facing down.

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16
Q

The heart is located usually between vertebral levels?

A

T4-T9.

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17
Q

When standing the heart is located at vertebral levels?

A

T6-T9.
T= thoracic vertebrae.

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18
Q

When supine the heart is located at vertebrae levels?

A

T4/5-T8.

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19
Q

What is a pericardium?

A

Is a double layered sac that surrounds and protects the heart.

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20
Q

The heart is attached to the diaphragm via?

A

It’s pericardium.

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21
Q

The borders of the heart are variable depending on?

A

Position of the diaphragm.

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22
Q

Mediastinum?

A

Central compartment of the thoracic cavity, contains heart ,blood vessels, trachea and esophagus.

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23
Q

What is pleura?

A

Is a thin layer of tissue that lines the inside of the chest cavity and covers the lungs.

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24
Q

What is a mediastinal pleura?

A

Is a specific part of the parietal pleura that covers the mediastinum.

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25
Q

What is the parietal pleura?

A

The rest of the line of mediatinal pleura.
Out of the pleura it is the outer layer and visceral is inner layer.

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26
Q

The mediastinum is divided into?

A

Superior and inferior mediastinum by the sternal angle.
Imaginary line that extends from the sternal angle to the intervertebral disc T4 and T5.

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27
Q

Superior medistinum extends from?

A

T1-T4.

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28
Q

Inferior mediastinum extends from?

A

T5-T12.

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29
Q

The inferior mediastinum is further divided into 3 parts?

A

Anterior.
Middle.
Posterior.

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30
Q

Heart is located within the pericardium in the?

A

Middle mediastinum.

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31
Q

The inferior mediastinum is separated by?

A

The heart and its pericardial sac (pericardium).

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32
Q

Inferior surface of heart is in contact with?

A

Diaphragm.

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33
Q

Anterior surface of heart is in contact with?

A

Towards ribs and sternum and costal cartilage.

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34
Q

Right pulmonary surface of heart is in contact with?

A

Right pleura and lung.

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35
Q

Left pulmonary surface of heart is in contact with?

A

Left pleura and lung.

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36
Q

Coronary sinus acts as a?

A

Landmark to divide the base from inferior surface of the heart.

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37
Q

Base consists of?

A

Whole left atrium and part of right atrium.

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38
Q

Inferior surface made of?

A

Left ventricle including apex.
Part of right ventricle.
Coronary vessels.

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39
Q

Left pulmonary surface made up of?

A

Mainly left ventricle.
Partially left atrium.

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40
Q

Right pulmonary surface made up of?

A

Mainly right atrium.

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41
Q

Pulmonary surfaces form a?

A

Cardiac impression on medial surface of the lungs.

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42
Q

Apex lies?

A

Lies deep to 5th intercostal space along midclavicular line.

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43
Q

Cardiomegaly means?

A

Enlarged heart.

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44
Q

Cardiomegaly apex beat will be dispatched more towards?

A

Axilla.

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45
Q

Pericardium can be split into?

A

3 layers.
- Fibrous. Outer
- Serous. Inner
Parietal and visceral.
- Pericardial cavity.
Space between the parietal and visceral layers of the serous pericardium.

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46
Q

Pericardial fluid?

A

Contained within the pericardial cavity.

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47
Q

Pericardial fluid is secreted by?

A

Serous mesothelium.

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48
Q

Fibrous pericardium attaches where?

A

Continuous with the diaphragm at the bottom and attaches to the sternum at the front helping it to anchor the heart in place within the chest cavity.

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49
Q

Which nerve carries information from diaphragm to brain?

A

Phrenic nerves.

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50
Q

Serous pericardium layer is split into?

A

2 layers.
Parietal layer.
Visceral layer.

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51
Q

Parietal layer?

A

Lines inner surface of heart.

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52
Q

Visceral?

A

Adheres to heart and most inner covering. Also known as epicardium.

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53
Q

Pericardial effusion?

A

Fluid build up in pericardial sac.

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54
Q

How can pericardial effusion occur?

A

Aortic aneurysms (bulge or swelling in aorta).
Heart attacks.
Penetrating injuries.
Inflammation of the heart (pericarditis).

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55
Q

What will pericardial effusion lead to?

A

Puts pressure on heart and hence heart functions impaired.
In extreme cases can lead to Cardiac tamponade.

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56
Q

Cardiac tamponade?

A

Fluid accumulates too fast, compresses heart.
Leads to rapid breathing and shortness of breath, sharp stabbing chest pains and cyanosis.

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57
Q

Cardiac tamponade treatment?

A

Pericardial tap/ pericardiocentesis.

(Fluid is aspirated out using a syringe).

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58
Q

Cyanosis means?

A

Discolouration of lips, skin and mucous membranes (inside mouth) and nails.

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59
Q

Heart is 4 chambered structure divided in half by?

A

A septum.

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60
Q

Right side of the heart?

A

Takes deoxygenated blood from body and sends to lungs to be oxygenated.
Known as pulmonary circuit.

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61
Q

Left side of the heart?

A

Takes newly oxygenated blood from lungs and sends to the rest of the body.
Known as a systematic circuit.

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62
Q

Between each chamber and major blood vessels like pulmonary artery and aorta there are?

A

One way valves to prevent blood flowing backwards.

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63
Q

Steps on right side of heart?

A
  1. Right atria collects deoxygenated blood from the body via superior vena cava, inferior vena cava and coronary sinus.
  2. Right atria contracts to pass blood through tricuspid valve into the right ventricle.
  3. Right ventricle contacts and blood passes through the semi lunar valve(pulmonary valve) at the entrance of the pulmonary trunk and continues towards to the lung to be oxygenated.
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64
Q

Steps on left side of heart?

A
  1. Left atrium collects oxygenated blood from lungs via the 4 pulmonary veins.
  2. Left atrium contracts to pass blood through the mitral valve into the left ventricle.
  3. Left ventricle contracts and blood passes through the aortic valve at the entrance of the aorta as it continues towards the rest of the body.
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65
Q

2 types of atrioventricular valves?

A

Tricuspid (3 valves).
Bicuspid (2 valves).

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66
Q

Sulci/ Grooves?

A

The structures that separate the chambers of the heart internally creates impressions on the external surface of the heart known as sulci.
Creates a passageway for coronary arteries and veins and their main branches.

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67
Q

3 main sulci?

A
  • Coronary sulcus.
  • Anterior interventricular sulcus.
  • Posterior interventricular sulcus.
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68
Q

What does the cardiac skeleton do?

A
  • Acts as structural support for attachment of cusps of valves.
  • Provides attachment for the myocardium.
  • Forms an electrical insulator.
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69
Q

The cardiac skeleton also acts as a?

A

A partition to isolate the atria from the ventricles so one electrical pulse for contraction won’t cause the other to contract.

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70
Q

Whats a cusp?

A

Between chambers there are valves and they have small thin flaps.

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71
Q

The tricuspid valve has how many valves?

A

3.

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72
Q

The mitral valve has how many cusps?

A

2.

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73
Q

When do the atrioventricular valves open?

A

When the atria contact to send blood to the ventricles.
When the ventricles contract the pressure closes the valve.

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74
Q

The chordae tendinae is tensed by?

A

The contraction of papillary muscles and tension is maintained throughout contraction, prevents the cusps of the tricuspid or mitral valves from prolapsing when ventricular pressure rises (ventricular systole).

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75
Q

Prolapsing in this context means?

A

Stay open for too long.

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76
Q

The closure of these two AV valves together create the first?

A

Heart sound (LUB).

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77
Q

How many semi lunar valves are there?

A

2.
Pulmonary and aortic.
Semi lunar valves have 3 crescent shaped cusps.

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78
Q

The semi lunar causes of the aortic valves have opening to the right and left coronary arteries within their sinuses.

A
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79
Q

Semi lunar valves open when the ventricles contract and send blood to the outward vessels.

A
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80
Q

Steps of ejection?

A
  • Initially there is a high amount of blood pressure causing these valves to stay open.
  • As the ventricles empty and the blood pressure lessens these valves begin to slowly close.
  • The closure of these valves is achieved when the pressure has dropped enough that blood tries to flow back into the ventricle.
  • The blood pools in the sinuses of these cusps and close the valves.
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81
Q

The closure of semilunar valves together creates the?

A

Second heart sound (DUB).

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82
Q

Two types of abnormalities of the heart valves?

A
  • Stenosis: A narrowing of the valves meaning they don’t open properly.
  • Regurgitation: The valve is compromised and cannot close properly. Also known as insufficiency.
  • can cause heart murmurs which can be heard when auscultating the heart.
  • Treatment: To fix these valves is through heart valve replacement surgery.
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83
Q

Epicardium? (Visceral pericardium).

A
  • Outermost layer.
    Visceral pericardium, adipose tissue and connective tissue.
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84
Q

Myocardium?

A

Middle layer.
Muscular wall of heart that is responsible for contraction of the heart.
Thicker in certain areas, eg. left vertical wall.

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85
Q

Endocardium?

A

Inner layer.
Smooth layer lining the lumen of the heart chambers in direct contact with circulation blood.

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86
Q

Epicardium has two layers?

A
  • Serous membrane.
  • Subepicardial.
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87
Q

Serous layer?

A
  • Outer layer of epicardium.- Visceral layer of pericardium. Made of mesothelium simple squamous and cuboidal cells that secretes serous fluid.
  • Pericarditis: Smooth lining can be lost and cause characteristic pericardial friction rub.
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88
Q

What is the subepicardial layer?

A

The inner layer of the epicardium.

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89
Q

What’s subepicardial layer made of?

A

Loose connective tissue (fibrocollagenous and elastic).

Adipose tissue.

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90
Q

Adipose tissue acts as a?

A

Shock absorber and supports branches of coronary vessels.

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91
Q

Epicardial fat?

A
  • Lies between visceral (epicardium) and myocardium of heart.
  • Acts to protect and support heart during normal function.
  • Aids in insulating the heart and electrical activity.
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92
Q

Epicardial fat covers around?

A

80% of the heart.
More present (abundant) in AV and IV grooves.

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93
Q

Increased amounts of Epicardial fat is associated with?

A

Age.
Obesity.
Diabetes.
More common in females.

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94
Q

Increase in Epicardial fat is associated with conditions like?

A

Cardiovascular disease.

Atherosclerosis (thickening or hardening of the arteries).

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95
Q

Myocardium is the?

A

Middle and largest layer of the heart.

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96
Q

Myocardium is composed of?

A

Striated specialised muscle fibres and myocytes.

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97
Q

What do intercalated discs do?

A

Mechanically and electrically link cells and allow them to function in coordinated way.

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98
Q

What is an intercalated disc?

A

Myocytes branched and joined end to end and side to side.

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99
Q

No satellite cells means?

A

Regeneration of cardiac muscles after injury does not readily occur.

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100
Q

Which muscle cell is most richly vascularised (provided with vessels)?

A

Cardiac muscle cell.

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101
Q

The amount of myocardium and diameter of muscle fibres varies?

A

Between chamber and cardiac workload.

For example atria smaller than right ventricle.
Left ventricle larger than right ventricle.

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102
Q

Endocardium is the internal layer of the heart wall that is in direct contact with blood. Composed of?

A

3 layers.
Innermost (endothelial layer).
Middle layer.
Layer in contact with myocardium.

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103
Q

Endothelial layer?

A

Flat endothelial cells.
Simple squamous epithelium.
Continuous with endothelium of Venus and arteries that enter and leave the heart.

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104
Q

Middle layer?

A

Subendothelial layer.
Collagen fibres with number of elastic fibres.

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105
Q

Layer in contact with myocardium?

A

Collagen fibres merge with cardiac muscle fibres.
May contain purkinje fibres - modified cardiac muscle cells found in interventricular septum.

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106
Q

Interventricular septum?

A

Separates the ventricles and allows for proper blood flow through the heart.

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107
Q

Endocardium is thicker in?

A

Atria than ventricles.
Thicker middle layer due to elastic fibres needed in atria for expansion.

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108
Q

AV valves are slightly thicker than?

A

The SL valves.

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109
Q

Left sided valves are slight to thicker than?

A

Right sided valves.

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110
Q

Endocardium covers?

A

Leaflets or cusps.

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111
Q

Injury to endothelial cells can cause?

A

Infiltration.
So presence of WBC in tissue is greater than normal numbers.

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112
Q

Connective tissue cells receive nutrients from?

A

Directly from blood in lumen of heart via simple diffusion.

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113
Q

Heart valves originate from?

A

Cardiac skeleton.

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114
Q

The heart needs oxygenated blood to function. It receives this from?

A

Coronary circulation.

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115
Q

How many coronary arteries are there?

A

2.
Right and left coronary artery.

116
Q

Coronary arteries circle the heart in the?

A

Coronary sulcus.

117
Q

What drains blood an empties into the coronary sinus?

A

Cardiac veins.

118
Q

Coronary sinus lies on the?

A

Posterior aspect of the heart in the coronary sulcus.

119
Q

Right coronary artery branched off into multiple branches?

A

SA node.
Right marginal artery.
Small branch to AV node.
Posterior descending artery (PDA).

120
Q

Left coronary artery enters the coronary sulcus and divides into?

A

2 branches.
- Anterior branch of left coronary artery.
- Circumflex artery.

121
Q

Major variations to the basic distribution of the coronary arteries often occurs. This is referred to as?

A

Coronary dominance.

122
Q

Majority of people the the origin of the PI artery is form?

A

RCA.
Supplies large portion of the posterior wall of left ventricle.
Right dominanace.

123
Q

If circumflex artery of LCA is origin of PI?

A

10%.
Supplies most if not all of posterior wall of left ventricle.
Left dominance.

124
Q

If both LCA and RCA equally contribute?

A

20%.
Supplies portrait wall of left ventricle equally.
Co dominance.

125
Q

The SA node is usually supplied by?

A

Right coronary artery - 60% people.
Left circumflex coronary artery- 40%.

126
Q

AV node usually supplied by?

A

Right coronary artery- 90%.
Left circumflex coronary artery- Variations.

127
Q

Best way to view coronary arteries is via?

A

Arteriogram/ Angiogram.

128
Q

How’s it done? Arteriogram/ Angiogram.

A

Done by inserting a thin tube into an artery and injecting a contrast dye.
Used to detect blockages in vessels, important myocardial infarctions.

129
Q

Primary drainage for the cardiac veins is?

A

Coronary sinus.

130
Q

Clinical cases relating to coronary circulation?

A

Coronary artery bypass graft.
Angiogenesis.

131
Q

Coronary artery bypass graft?

A

Coronary arteries sometimes become obstructed.
Revascularisation must occur by transplanting (graft) an artery from somewhere else in body to bypass.

132
Q

Angiogenesis?

A

Buffing of new blood vessels to aid revascularisation.
Vita for establishing blood flow to damaged areas.

133
Q

What does innervate mean?

A

Supply with nerves.

134
Q

Conduction system?

A
  1. Starts at sinoatrial node.
  2. Internodal branches send impulses to AV node (branch at Bachmanns bundle).
  3. AV node sends impulses into interventricular septum as bundle of his to stimulate contraction of ventricles.
  4. Bundle of his divides into main left and right branches.
    Gives of smaller terminal branches called purkinje fibres.
    Stimulates muscle cells to contract.
135
Q

Bundle of His?

A

Collection of nerve fibres extending into the interventricular septum.

136
Q

Cardiac cycle starts with?

A

Atrial systole and ends with ventricular diastole.

137
Q

Systole means?

A

Contraction that heart undergoes while it pumps blood.

138
Q

Diastole?

A

Period of relaxation when heart chambers fill with blood.

139
Q

Atrial systole?

A

Atrial contraction forces blood into ventricles.

140
Q

Ventricular systole?

A
  • Ventricular contraction pushes AV valves closed.
  • Semi lunar valves open and blood is ejected.
141
Q

Ventricular diastole?

A
  • Semi lunar valves closed and blood flows into atria.
  • Chambers relax and blood fills ventricles passively.
142
Q

Innervation of heart?

A
  1. Parasympathetic nerve (vagus).
    Slows heart rate.
  2. Sympathetic.
    Increase heart rate.
    Presynaptic fibres T1-T4.
  3. Visceral afferent.
    Travel with (hitchhike) synthetic fibres.
143
Q

What’s visceral afferent?

A

Carry sensations to brain.
Link to referred pain.

144
Q

Sympathetic innervation ?

A
  • Spinal cords levels T1-T4 and a bit of 5 become cervical cardiac and thoracic cardiac solanchic nerves then become part of the cardiac plexus. Branches to SA and AV nodes and to myocardium.
    Releases noradrenaline.
  • Increases heart rat, conduction rate and force of contraction.
145
Q

Parasympathetic innervation?

A

Vagus nerve (main nerves of parasympathetic pathway).
Branches to become cervical cardiac and thoracic cardiac branches which merge to become cardiac plexus.
Releases acetylcholine.
Decreases heart rate, conduction rate and force of contraction.

146
Q

Referred pain occurs?

A

This pain is when you feel the pain somewhere but the pain is actually somewhere else.
This occurs because the brain cannot distinguish between sensory input from visceral sensory neurons within ANS and spinal nerves from somatic nervous system.

147
Q

Circulatory system does what?

A

Transports fluids throughout the body.
Includes cardiovascular and lymphatic system.

148
Q

Cardiovascular systems made of?

A

Heart and blood vessels.

149
Q

How many types of blood vessels are there?

A

3.
Arteries.
Veins.
Capillaries. (Site of gas and nutrient exchange).

150
Q

All these blood vessel walls consists of how many layers?

A

3.

151
Q

Another word for blood vessel layers?

A

Tunica.

152
Q

What are the 3 blood vessel layers?

A
  1. Externa: (adventitia) outer connective tissue layer.
  2. Media: middle smooth muscle (contains varied elastic fibre amount).
  3. Intima: inner endothelial lining.
153
Q

Small vessel capillaries don’t have tunica media. They instead have?

A

Pericytes.

154
Q

Main difference between vessels?

A
  • Arteries have thicker walls and narrower lumens.
    Based on amounts of smooth muscle and elastic fibre contributing to tunica media.
  • Veins have thinner walls and larger lumens. Thickest layer is tunica externa.
155
Q

Veins hold around how much blood?

A

70-80%.
Generally appears flattened or irregular.

156
Q

Generally circulatory system goes from oxygenated to deoxygenated blood except?

A

Capillaries- Site of gas and nutrient exchange.
Only fits 1 blood cell at a time.
Smallest vascular structures.

157
Q

Capillaries primary function?

A

Deliver nutrients rich blood to tissues or cells.
Take away waste.

158
Q

Pericytes help to?

A

Maintain normal micro circulation of local tissues and organs, regulate capillary blood flow.

159
Q

3 major types of capillaries?

A
  • Continuous.
  • Fenestrated.
  • Discontinuous.
160
Q

Continuous capillaries?

A

Endothelial cell forms internal lining.
Tightly attached to basement membrane.
Fitted with gap junctions.
Rich with transport vesicles.

161
Q

Fenestrated capillaries?

A

Endothelial cells pierced by pores (fenestrations).
Pores allow easier exchange, permeable to larger molecules. Mainly small intestine.

162
Q

Discontinuous capillaries?

A

Absent or discontinuous basement membranes with large pores.
Facilitated leaks of fluid and large molecules. Like plasma proteins.

163
Q

2 main artery types?

A
  • Elastic (conducting largest).
    Substantial elastic tissue in tunica media.
    Allow high pulsatile (regular) forces.
  • Muscular (distributing, large).
    Elastic fibers only at intersection of intima and media.
    Allows contraction(vasoconstriction) and relaxation(vasodilation).
164
Q

Archer of aorta (main blood supply to head neck thorax arms)?

A

1st from right= Left subclavian artery.
Middle= Left common carotid artery.
Lastly= Brachiocephalic artery. This splits in 2.
Furthest to left= Right subclavian.
Right common carotid.

165
Q

Descending aorta?

A

Many branches.
Supplies all body except superior aspect.

Consist of different parts:
Thoracic aorta. Above diaphragm.
Abdominal aorta. Below diaphragm.

Passes through aortic hiatus in diaphragm.
Posterior medistinum.
T12.

166
Q

Carotid artery consists?

A

-Carotid sinus.
Close to common carotid artery.
Baroreceptors sensitive to bp.

-Carotid body.
At bifurcation (division in two) of common carotid artery.
Chemoreceptors sensitive to oxygen, CO2 and hydrogen ion conc.

167
Q

Before attic dissection, a thoracic aortic what occurs?

A

Aneurysm (swelling). Out crouching of blood vessel.

168
Q

Aortic dissection is?

A

A tear of the tunica intima letting liminal blood into media.

169
Q

Diagnosis would suspect with?

A

Widened mediastinum in chest x ray.

170
Q

Veins are?

A

More abundant than arteries.
Venous return aided by body movement so muscle contractions and gravity.

171
Q

Valves prevent?

A

Backflow.

172
Q

What’s a vena comitantes?

A

Two veins accompanying medium sized deep or small arteries.

173
Q

What does a vena comitantes serve as?

A

Countercurrent heat exchanger.
Forms arteriovenous pump so arterial contraction propels venous blood.

174
Q

Superior vena cava?

A

Drains blood from head neck upper limbs and thorax.

175
Q

Converging veins?

A
  • Right left subclavian, external jugular, internal jugular veins from right left brachiocepahlic veins.
  • Azygos vein.
    Hemiazygos.
    Accessory hemiazygos.
176
Q

Inferior vena cava?

A

Veins from all abdominal organs.
Including hepatic portal system (part of body’s filtration system).

177
Q

Hepatic portal vein formed by?

A

Superior mesentric veins and splenic vein at transpyloric plane (L1/L2). Spine.

178
Q

Feral circulation?

A

Allows blood to bypass liver and non functioning lungs.

179
Q

There are three vascular shunts?

A
  • Foramen ovale: (between atria). Blood bypasses pulmonary circulation.
  • Ductous arteriosus: Linksdutsal arch of aorta with pulmonary trunk. Blood bypasses pulmonary circulation.
  • Ductus venosus: Shunts umbilical blood 30% from primitive liver to inferior vena cava to make sure enough oxygen reaches brain.
180
Q

Fetus obtains oxygen via?

A

From mother via placenta circulation.

181
Q

These three vascular shunts are open?

A

Pre natally and close after birth.

182
Q

During transition to adult?

A

Closure of foramen ovale.
Closure of ductus arteriosus (constricts) and venosus (degenerates).

183
Q

Lymphatic system?

A

A series of
Organs.
Vessels.
Nodes.
That collect and filter excess tissue fluid (lymph) before returning it to the venous circulation.

184
Q

Function of lymphatic system?

A
  • Drain excess interstitial fluid from tissues.
  • Produce and transport lymphocytes.
  • Mount immune response.
  • Transport dietary lipids from GI tract into blood.
185
Q

Lymphatic return process?

A
  1. Fluid leaves blood capillaries and enters interstitial space.
  2. Fluid enters lymphatic system through lymphatic capillaries within interstitial space which unite to form lymphatic vessels.
  3. Lymph flow is slow passes through lymph nodes before draining into trunks.
186
Q

These trunks converge to form the?

A

Thoracic duct and right lymphatic ducts which drains into circulation at subclavian veins (left and right angles).
Known as jugulo subclavian junction.

187
Q

Thoracic duct?

A

Collects lymph from full body.
Starts at right but shifts to left.

188
Q

Right lymphatic duct?

A

Collects lymph from right head neck thorax and upper limb.

189
Q

Left atrium and ventricle drain into?

A

Right jugulo subclavian.

190
Q

Right atrium and vehicle drain into?

A

Left jugulo subclavian.

191
Q

A unique crossed pattern is present for?

A

The lymphatic drainage of the heart.

192
Q

Right internal jugular vein?

A

Drains right head and neck.

193
Q

Right subclavian vein?

A

Drains right upper limb. Receives stuff from right external jugular too.

194
Q

Right lymphatic duct?

A

Drains close to the formation of this vein.

195
Q

Thoracic duct drains at?

A

The V formation of this vein.

196
Q

Azygos vein enters?

A

SVC just before it drains into the right atrium.
Drains multiple areas of thorax and mediastinum.

197
Q

IVC drains?

A

All of abdomen and lower limbs. Just before it passes through diaphragm at T8.

198
Q

Pulmonary trunk exits hearts from?

A

Right ventricle after pulmonary valve.

Right pulmonary artery- 2 as it enters hilum of right lung.

Left pulmonary artery- 2 once it enters hiking of left lung.

199
Q

Generally two pulmonary veins leave form each hilum of lung these then enter either side of left atrium.

A
200
Q

Venous drainage in body involves?

A

Superficial and deep vessel while arteries do not have same pattern.

201
Q

Venous system more complex- superficial and deep veins.

Arterial system largely deep and direct.

Arteries located deep to protect from injury.

A
202
Q

Thoracic cage is made up of?

A

Sternum.
12 pairs of ribs.
Thoracic vertebrae.

203
Q

Purpose of thoracic cage?

A

To provide structure and to protect thoracic contents.

204
Q

Sternal angle found at?

A

T4.

205
Q

Ribs attached anterior to the sternum via?

A

Costal cartilages.

206
Q

Either side of jugular notch is?

A

Sternoclavicular joints.

207
Q

On the lateral edges of the manubrium?

A

There is a facet for articulation with costal cartilage of 1st rib.
And a demi facet- 2nd rib.

208
Q

Lateral edges of sternum marked by?

A

Articular facets articulate ribs 3-6.
2 smaller demi facets for 2 and 7.

209
Q

Xiphoid process?

A

Most inferior and smallest part of sternum.
Tip located at T10.

210
Q

True ribs?

A

1-7.

211
Q

False ribs?

A

8-10.

212
Q

Floating ribs?

A

11-12.
No anterior articulation.

213
Q

Two classifications of ribs?

A

Typical.
Atypical.

214
Q

Typical ribs?

A

Consist of head neck body(shaft).
Head has two facets.
Neck connects head with body.
Rough tubercle with facet with transverse process.

Shaft is flat and curved.

215
Q

Atypical ribs?

A

Can be described as ribs 1,2,10,11,12.

Rib 1- Shorter and wider.
Rib 2- Thinner and longer than rib 1.
Rib 10- Only one facet.
Ribs 11-12- Articulate with only bodies of their own.

216
Q

Typical ribs?

A

3-9.

217
Q

Thoracic vertebrae increase in size as they go down.

A
218
Q

Ribs anchored posterity to 12?

A

Vertebrae- T1-T12.

219
Q

Each thoracic vertebrae has?

A

2 Demi facets.
Superior and inferior.

220
Q

On transverse processes there is a?

A

Transverse costal facet.

221
Q

Each rib forms two joints?

A

Costovertebral joint between head of rib.
Costotransverse joint between tubercle and transverse process.

222
Q

Respiratory system can be divided into upper and lower.

A
223
Q

Upper:

A

Nose.
Nasal passages.
Paranasal sinuses.
Pharynx and portion of larynx above vocal cords.

224
Q

Lower?

A

Larynx below vocal cords.
Trachea.
Bronchi.
Bronchioles and lungs.

225
Q

Inside nasal cavity there are 3 bones covered in mucosa. These are called?

A

Conchae.
Top= Superior.
Middle.
Inferior.

226
Q

Function of conchae?

A

Increase surface area.
Spin air so inhaled air can be warmed and moistened.

227
Q

Oral cavity?

A

Top= Hard palate.
Back= Soft palate.
Dangly bit= Uvula.

228
Q

Pharynx?

A

Divided into 3 parts:
Nasopharynx.
Oropharynx.
Laryngopharynx.

229
Q

Food travels down?

A

Oesaphagus to stomach.

230
Q

Air travels down?

A

Trachea to lungs.

231
Q

Tracheobronchial tree formed from?

A

Trachea.
Bronchi.
Bronchioles.

232
Q

Larynx?

A

Voice box.
Larynx to trachea.

233
Q

Normally epiglottis keeps food away from windpipe.

A
234
Q

Trachea runs from?

A

Lower level of cricoid cartilage to T4.

Here it bifurcates (splits) into left and right primary bronchi.

Trachea is formed from c shaped rings of hyaline cartilage held together by dense connective tissue.

235
Q

Trachea has membrane void of cartilage covered in smooth muscle called?

A

Trachealis muscle.

236
Q

At bifurcation of trachea lies?

A

Carina.
Widening of carina may indicate cancer in lymph nodes.
These lymph nodes are called inferior tracheobronchial lymph nodes.

237
Q

Bronchoscopy?

A

Used to view airways and check for any abnormalities.

238
Q

Right primary bronchi is?

A

Wider shorter steep vertical angle.
Inhaled foreign objects are more likely to get lodged in right.

239
Q

Left primary bronchi is?

A

Narrower and more horizontal.

240
Q

Left and right further divide into?

A

Secondary (lobar) bronchi.
2 left.
3 right.

Secondary bronchi then further divide to give tertiary (segmental) bronchi.
Usually 10 for each lung.

241
Q

Each tertiary bronchi give rise to (cause)?

A

Many terminal bronchioles.
Differ in structure because there’s no hyaline cartilage in their walls.

242
Q

What beaches from the terminal bronchioles?

A

Respiratory bronchioles.
Each respiratory bronchiole ends in an acinus of clustered alveoli.

243
Q

Majority of respiratory tree from nasal cavity to bronchi is lined by?

A

Pseudostartified columnar ciliated epithelium.

244
Q

Bronchioles are lined by?

A

Simple columnar to simple cuboidal epithelium as tube gets narrower.

245
Q

Alveoli possess a lining of thin?

A

Simple squamous epithelium.

246
Q

The alveolar wall has different structure to bronchioles?

A

No cilia or smooth muscle.
Wall is lined by simple squamous cells called pneumocytes.

247
Q

Pneumocytes?

A

Most regular are called Type 1 responsible for gas exchange.

But some called Type 2 have ability to secrete substance called surfactant (decreases surface tension, helps to keep open).

248
Q

Surfactant is?

A

A mixture of fats and proteins and acts as a lubricant. Allows air sacs to slide without sticking.

249
Q

Surfactant production begins?

A

24-28 weeks gestation.

34 weeks= enough.

250
Q

A baby born prematurely will likely not have enough surfactant which is why?

A

This can cause respiratory distress syndrome shortly after birth.

251
Q

Lungs main function?

A

Gas exchange.

252
Q

Lungs are functional organs of respiration. We have 2 lungs.

A
253
Q

Diaphragm lies inferior to lungs which separates thoracic cavity from abdominal cavity.

A
254
Q

Another function of lungs is to?

A

Oxygenate blood.
Bring in inhaled air into close contact with oxygen poor blood in luminary capillaries.

255
Q

Each lung is contained within a a sepsis member and called a?

A

Pleural sac.

Contains parietal outer layer.
Visceral inner layer.

In the middle the space is called pleural cavity.

256
Q

Pleural cavity contains?

A

Pleural fluid which provides lubrjcation because lungs expand which helps prevent friction.

257
Q

What is the hilum?

A

Located in the middle of each lung.
Site where veins etc leave lung.
Doorway into lung.

258
Q

In addition to having lobes, the lungs can be further divided into?

A

10 segments.
These segments have their own artery and air supply.
Named brochopulmonary segments.
Right- 10.
Left- 8-10.

259
Q

Pulmonary arteries deliver blood to?

A

Capillaries around alveoli.

260
Q

Pulmonary veins return blood back to?

A

Heart.

261
Q

Trachea and bronchial tree need some supply and receive blood directly from?

A

Thoracic aorta.

262
Q

Bronchial arteries branch form thoracic aorta or sometimes from posterior intercostal arteries.

A
263
Q

On left bronchial veins drain into accessory hemazygous vein which drains into azygos (right).

On right bronchial veins drain into azygos vein.

A
264
Q

The inferior tracheobrinchial lymph nodes can blunt carina when enlarged.

A
265
Q

The most important muscle of respiration?

A

Diaphragm.

266
Q

Diaphragm is comprised of?

A

2 domes.

Peripherally is muscular- muscle fibres unite as a central tendon of the diaphragm more centrally.

267
Q

Diaphragm is innervated(supplied with nerves) by?

A

Phrenic nerve.
Keeps the diaphragm alive.

268
Q

The karts of the diaphragm that arise from vertebrae are known as the?

A

Right and left crura.
- Right: Arises from L1-L3.
- Left: Arises from L1-L2.

269
Q

Contraction of diaphragm results in?

A

Downward movement of central tendon.
Increase in vertical size of thoracic cavity in inhalation.

270
Q

Relaxation results in diaphragm returning to?

A

Resting position.
Decrease in vertices size of thoracic cavity in exhalation.

271
Q

Thoracic volume is increased in three planes during inspiration?

A
  • Anterposterior : pump handle.
  • Transverse: 2 handles bucket.
  • Vertical: Increased by downward pull of diaphragm.
272
Q

3 major opening in diaphragm?

A

Aorta. Passes through T12.
IVC. Passes at T8.
Oesaphagus. Passes at T10.

273
Q

Space between ribs are called?

A

Intercostal space.

274
Q

Each intercostal space contains?

A

Intercostal muscles which help to move ribs during breathing.

275
Q

External intercostal?

A

Most superficial layer.
Runs from inferior border of one rib to rib below.
Contraction causes ribs to elevate.

276
Q

Internal intercostal?

A

Middle layer.
Runs from superior border of one rib to inferior border of rib above.
Contraction draws adjacent ribs nearer together.
Only function in forced exhalation.

277
Q

Innermost intercostal?

A

Deepest layer.

278
Q

Each intercostal space has a separate blood and nervous supply?

A

Neurovascular bundle.

279
Q

Neurovascular bundel runs along inferior aspect of the rib in the?

A

Costal groove.
Arrangement of VAN.

280
Q

Accessory muscles of inhalation ?

A

Sternocleidomastoid m.
Pectoralis minor.
Scalene.

281
Q

Accessory muscles of exhalation ?

A

External oblique.
Internal oblique.
Transversus.
Rectus abdominis.

282
Q

Relaxed inhalation?

A

Diaphragm contracts and external intercostals elevate thoracic cavity.

283
Q

Relaxed exhalation?

A

Muscles above relax, allows lungs to recoil and push air out.

284
Q

Active/ Forced inhalation?

A

On top of relaxed inhalation accessory muscles elevate ribs and sternum.

285
Q

Active/ Forced exhalation?

A

Muscles relax.
Internal and innermost contract.
Accessory muscles depress ribs and squeeze abdominal cavity.

Anatomy (1 decks)

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