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Gross Anatomy > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Curvatures of the vertebral column

A

Primary- concave anteriorly toracic and sacral
Secondary- convex anteriorly cervical and lumbar

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2
Q

Potential abnormal curvatures

A

Kyphosis
Lordosis
Scoliosis

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3
Q

Scoliosis

A

Lateral bend

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4
Q

Kyphosis

A

Exaggerated thoracic curvature (convex)

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5
Q

Lordosis

A

Exaggerated lumbar curvature (concave)

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6
Q

Movements of the vertebral column

A

Flexion, extension, lateral bending, rotation

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7
Q

Extrinsic muscles of the thorax and their innervation

A

Innervation: ventral rami
Superficial layer: trapezius, latissimus dorsi
Intermediate: serratus posterior

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8
Q

Intrinsic muscles of the thorax and innervation

A

Innervated by dorsal rami
Superficial: splenius capitus
Middle: erector spinae
Deep: transversospinalis

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9
Q

Function of the intrinsic muscles of the thorax

A

Mostly extension bilaterally, and lateral flexion/rotation unilaterally

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10
Q

Movements of the spine

A

Bilateral extension and rotation

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11
Q

Longitudinal ligaments anterior and posterior

A

Allow flexion and extension while keeping vertebrae aligned
Ant- limits extension
post-prevents hyperflexion

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12
Q

Herniated intervertebral disc

A

Nucleus pulposus is displaced from intervertebral space

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13
Q

Nucleus pulposus

A

A gel like structure at center. Accounts for much of the strength and flexibility

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14
Q

Annulus fibrosus

A

Ring shaped disc of fibrous connective tissue that surrounds NP

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15
Q

What direction does the NP move when a disc gets herniated

A

Posterolaterally

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16
Q

Thorax wall

A

Jugular notch, manubrium, angle of sternum, body of sternum, xyphoid process of sternum, true ribs 1-7, costal cartilages, false ribs 8-12

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17
Q

Intercostal muscles layers (cross section)

A

External intercostal muscles
Internal intercostal nerve
Innermost intercostal muscles

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18
Q

Intercostal membranes

A

External IC membrane (posterior side)
Internal IC membrane (anterior side)

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19
Q

3rd layer of the thorax (internal)

A

Internal thoracic artery and vein, anterior intercostal arteries and veins and intercostal nerve, internal intercostal muscles, innermost intercostal muscles, transversus thoracis, musculophrenic artery and vein, superior epigastric artery and vein

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20
Q

Intercostal veins

A

Drain each space and has an anterior and posterior pattern similar to the arteries.

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21
Q

Intercostal arteries

A

Anterior- upper spaces off internal thoracic artery which comes off subclavian artery
Posterior- off descending aorta, upper two ICS from supreme intercostal artery from Costocervical trunk off subcalvian artery
*Ant ICA branch at about the 6th ICS into superior epigastric and musculophrenic artery *

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22
Q

Where does the internal thoracic artery divide

A

At the 6th ICS into superior epigastric and musculophrenic artery.

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23
Q

Intercostal nerve

A

Comes from ventral rami of thoracic spinal nerve (T1-12)

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24
Q

What nerve is T12

A

Subcostal nerve

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25
Q

Cervical nerves

A

C1-8

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26
Q

Thoracic nerves

A

T1-12

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27
Q

Lumbar nerves

A

L1-5

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28
Q

Sacral nerves

A

S1-5

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29
Q

Coccygeal nerve

A

Co1

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30
Q

Intercostal space contents posteriorly

A

Vein
Aretery
Nerve

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31
Q

What happens if you lacerate an artery off an area close to the aorta

A

You bleed out

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32
Q

Inspiration

A

Increases volume and diameter of thoracic cavity, draws air into lungs

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33
Q

Muscle contractions during inspiration

A

Contraction of the diaphragm increases vertical dimension and contraction of the intercostal muscles increases transverse and ant-post dimension

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34
Q

Muscles movements during expiration

A

Relaxation of intercostal muscles and thoracic diaphragm, intraabdominal pressure decreases, allows for the elastic recoil of the lungs

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35
Q

Pulmonary cavities

A

2 individual compartments containing lungs and pleurae

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36
Q

Mediastinum

A

1 central compartment containing all other thoracic structures. Separates pulmonary cavities from each other

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37
Q

Parietal pleura

A

Lines the inner surface of each pulmonary cavity. Can be dissected away form peripheral structures.

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38
Q

Visceral pleura

A

Completely invests lungs. Cannot be dissected away and gives lungs a shiny look

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39
Q

Pleural cavity

A

Potential space between parietal and visceral pleurae. Pleurae are continuous with each other at the root of the lung. It contained serous fluid that lubricates pleural linings and provides surface tension.

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40
Q

What keeps lungs in contact with the thoracic walls as they expand

A

The surface tension created by the serous fluid in the pleural cavity

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41
Q

Subdivisions of the parietal pleura

A

Cervical- covers area of apex of lung
Costal-lines internal surface of ribs and intercostal spaces
Diaphragmatic-cover the superior surface of the diaphragm on either side of the mediastinum
Mediastinal- covers both sides of the mediastinum

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42
Q

Subpleural membrane

A

Strengthens cervical pleura

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43
Q

Pulmonary ligament

A

Double layer of mediastinal pleura that extends inferiorly form root of lung

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44
Q

Innervation of the parietal pleura

A

Costal and peripheral diaphragmatic pleurae is innervated by intercostal nerves. Medisatinal and central diaphragmatic pleurae are innervated by the phrenic nerve.

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45
Q

Visceral pleura innervation

A

Visceral afferents that run with sympathetics

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46
Q

Location of the Costodiaphragmatic recess

A

Potential space (recess) inferior in each pleural cavity—accommodate lung during deep inspiration

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47
Q

What forms the costodiaphragmatic recess

A

Formed by the costal and peripheral diaphragmatic parietal pleurae

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48
Q

Clinical significance of costodiaphragmatic recess

A

Low point where fluid/blood may accumulate

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49
Q

Location of the Costomediastinal recess

A

Potential spaces anteriorly in each pleural cavity. Larger on the left due to the heart

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50
Q

What forms the costomediastinal recess

A

Formed by costal and mediastinal pleurae

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51
Q

Pneumothorax

A

Entry way of air into the pleural cavity

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52
Q

Open pneumothorax

A

Wounds open space to lungs, penetrating injury to parietal pleura

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53
Q

Closed pneumothorax

A

Air leakage form damage to respiratory system itself

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54
Q

Hemothorax

A

Accumulation of blood in the pleural cavity

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55
Q

Hydrothorax

A

Accumulation of fluid in pleural cavity

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56
Q

What could a pneumo, hemo, and hydro thorax all result in?

A

A collapsed lung

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57
Q

Hilum location

A

Depression on medial surface of the lung

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58
Q

Hilum function

A

Entrance and exit for root structures

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59
Q

Root formation

A

Bronchi, pulmonary a and v, bronchial a and v, anterior and posterior pulmonary plexuses, lymphatics

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60
Q

Where does the pulmonary ligament extend form the root

A

Inferiorly

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61
Q

Apex of the lung

A

Extends above 1st rib, and is adjacent to the trachea and esophagus and Left common carotid and subclavian artery.

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62
Q

Base of the lung

A

Sits on diaphragm, opposite of apex.

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63
Q

Costal surface of the lung

A

Large surface and adjacent to costal pleura

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64
Q

Mediastinal surface of the lung

A

Concave medial surface and the pulmonary root and ligament are located here

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65
Q

Diaphragmatic surface

A

Deeper on right to accommodate liver

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66
Q

Right lung shape, lobes, fissures

A

Larger but shorter and wider
3 lobes; superior, middle, inferior
2 fissures; oblique and horizontal

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67
Q

Pulmonary artery of the right lung location

A

Anterior to bronchus

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68
Q

Location of pulmonary vein in the right lung

A

Most anteriorly and inferiorly located structures

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69
Q

Bronchus of the right lung location

A

Primary/lobar posterior in location

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70
Q

Left lung lobes and fissures

A

2 lobes; superior and inferior
Fissures; oblique

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71
Q

Cardiac notch

A

Located in the anterior margin of superior lobe of the left lung

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72
Q

Lingula

A

Tongue like tail on superior lobe

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73
Q

Impression of the left lung

A

Cardiac, aortic arch, and thoracic aorta

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74
Q

Pulmonary artery of the left lung

A

Superior to bronchus in Hilum

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75
Q

Pulmonary vein of left lung

A

Most anterior in location

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76
Q

Bronchus of left lung

A

Primary/lobar most posterior in location

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77
Q

RALS

A

Right pulmonary artery is Anterior to the bronchus Left pulmonary artery is Superior to the bronchus.

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78
Q

Origin of the tracheobronchial tree

A

Begins at inferior border of cricoid cartilage

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79
Q

Cartilage rings

A

16-20 C shaped rings, incomplete posteriorly, smooth muscle spans the gap and it abuts the esophagus

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80
Q

Bronchi

A

pass form trachea to root of lung

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81
Q

Carina

A

Internal ridge demarcating tracheal bifurcation into right and left bronchi. At the level of sternal angle and sensitive to cough reflex

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82
Q

Right primary bronchus

A

Wider, shorter, and more vertical. Has 3 lobar branches and is about 2.5 cm long.

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83
Q

Where is an aspirated body most likely to end up

A

In the right primary bronchus

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84
Q

Left primary bronchus

A

Narrower, longer, more horizontal. 5 cm long, 2 lobar branches.

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85
Q

How many segmental branches does each bronchi have

A

8-10

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86
Q

Bronchopulmonary segments

A

Largest subdivisions of a lobe and there are 8-10 per lung.

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87
Q

Contents of each bronchopulmonary segment

A

Tertiary (segmental) bronchus, tertiary pulmonary artery, autonomic nerve

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88
Q

If there was a tumor in a bronchopulmonary segment could the lung still function

A

Yes, the areas not taken out would compensate for the loss of lung tissue where the tumor was

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89
Q

Origin of the pulmonary arteries. What do they carry

A

Pulmonary trunk. Carry low O2 blood to lungs

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90
Q

Origin of pulmonary veins. What do they carry

A

Two from each lung. Right and left superior and inferior. Carry high O2 blood to left atrium

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91
Q

Bronchial artery origin and what does is supply

A

Originates in thoracic aorta. And supply lung itself.

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92
Q

What is contained in the pulmonary cavities

A

Lungs and pleura

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93
Q

Where is parietal pleura found

A

Lines pulmonary cavity entirely

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94
Q

Where is the pleural cavity

A

Between visceral and parietal pleura

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95
Q

What are the different regions of parietal pleura

A

Cervical, mediastinal, costal, diaphragmatic

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96
Q

What forms the pulmonary ligament

A

Mediastinal parietal

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97
Q

Where is the costodiaphragmatic recess

A

Inferior

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98
Q

What innervates costal and peripheral diaphragmatic parietal pleurae

A

Intercostal nerves

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99
Q

What are the two types of pneumothorax

A

Open- puncture wound that allows air into pleural cavity
Closed-injury to respiratory organs

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100
Q

Where is the Hilum of the lung

A

Mediastinal surface

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101
Q

What structures form the root of the lungs

A

Pulmonary arteries and veins, bronchus, lymphatics

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102
Q

Where is the lingula located

A

Left lung on the superior lobe

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103
Q

What is found in a bronchopulmonary segment

A

Tertiary bronchus, tertiary artery

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104
Q

Which arteries carry blood to the lungs for oxygenation

A

Pulmonary arteries

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105
Q

How many pulmonary veins are there coming back to the heart

A
  1. Right and left superior and inferior on each side
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106
Q

Which arteries supply the lung substance

A

Bronchial arteries

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107
Q

Where is the pericardium

A

Surrounds heart and proximal part of great vessels

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108
Q

Function of pericardium

A

Protects and stabilizes heart. Secretes serous fluid (paracardial fluid) to create friction free movement of the heart

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109
Q

Types of pericardium

A

parietal and visceral

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110
Q

Parietal pericardium

A

Fibrous and serous

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111
Q

Fibrous parietal pericardium

A

Outermost layer of pericardium and tough.

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112
Q

Attachments of the parietal fibrous pericardium

A

Continuous with central tendon of diaphragm and tunica adventitia of IVC. Continuous superiorly with tunica adventitia of great vessels; ascending aorta, pulmonary trunk, SVC, Pulmonary vein.

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113
Q

Serous parietal pericardium

A

Located in the mesothelial lining on inner surface of
fibrous parietal layer and it Secretes serous fluid

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114
Q

Visceral pericardium

A

Located Covering on external surface of heart – fatty layer. AKA epicardium. Also serous in nature and can vary in thickness.

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115
Q

What tends to increase the thickness of the visceral pericardium

A

Obesity

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116
Q

Visceral pericardium point of reflection

A

Continuous with serous layer
of parietal pericardium at root of great vessels

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117
Q

Where is the pericardial cavity

A

potential space between parietal and visceral layers of serous pericardium

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118
Q

Contents of pericardial cavity

A

serous (pericardial) fluid

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119
Q

Functions of the pericardial cavity

A

facilitates frictionless movement of heart

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120
Q

Pericardial sinuses

A

Located inside the pericardial cavity

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121
Q

Oblique pericardial sinus

A

Recess on posterior surface of heart, inferior to pulmonary veins.

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122
Q

Transverse pericardial sinus

A

Passage posterior to ascending aorta and pulmonary trunk, but anterior to SVC

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123
Q

Significance of transverse pericardial sinus

A

Used to access great vessels for heart bypass

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124
Q

Where are the pericardial neurovascular structures

A

Plane between fibrous pericardium and mediastinal pleura

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125
Q

What is the relationship of the pericardial neurovascular structures to the root of the lung

A

Pass anterior to root of lung

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126
Q

Pericardiacophrenic a

A

Originates from the internal thoracic artery and runs with the phrenic nerve

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127
Q

Phrenic nerve

A

Originates from VR C3-5. Runs with pericardiacophrenic artery and vein. Innervates thoracic diaphragm.

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128
Q

Great vessels of the heart

A

SVC, IVC, Ascending aorta, pulmonary trunk, pulmonary veins,

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129
Q

Formation and draining of the SVC

A

Union of right and left brachiocephalic veins. Drains all structures superior to thoracic diaphragm except for the heart and lungs.

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130
Q

Where is the SVC

A

It sits to the right of the aorta in vertical line with IVC as they enter right atrium. Terminates in the right atrium

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131
Q

Formation and drainage of inferior vena cava

A

Union of right and left common iliac vein and drains lower limbs, abdomen, and abdominal viscera

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132
Q

Where is the IVC

A

Sits to the right of the aorta and empties into the right atrium

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133
Q

Ascending aorta

A

Originates from the left ventricle and extends to the beginning of aortic arch. Branches into the right and left coronary artery

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134
Q

Pulmonary trunk

A

Originate from the right ventricle and is located anterior and to the left of the ascending aorta. Branches into right and left pulmonary artery

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135
Q

Ligamentum ateriosum

A

Circulatory modification between pulmonary trunk and aorta.

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136
Q

What is the Landmark where left recurrent laryngeal nerve loops around aortic arch

A

Ligamentum arteriosum

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137
Q

Pulmonary veins

A

Originate in the lungs and terminate/drain into the left atrium. 4 veins total, two right and two left superior and inferior.

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138
Q

What is the cardiac skeleton composed of

A

Four fibrous connective tissue rings that surround four heart valves.

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139
Q

Functions of the cardiac skeleton

A

Keep valves patent and from being overly distended, Attachment point for cusps, Separates atrial and ventricular muscles, Forms electrical insulator, Allows them to contract
independently

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140
Q

Sternocostal surface of the heart

A

Anterior, formed primarily by right ventricle.

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141
Q

Diaphragmatic (inferior) surface of the heart

A

Formed primarily by the left ventricle, small part by the right ventricle.

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142
Q

Right pulmonary surface of the heart

A

Formed primarily by right atrium

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143
Q

Left pulmonary surface of the heart

A

Formed primarily by left ventricle and creates cardiac impression on the left lung.

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144
Q

Base of the heart

A

AKA posterior surface—sits opposite of apex and primarily formed by the left atrium. Located where SVC, IVC, adn pulmonary veins enter heart.

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145
Q

Apex of the heart

A

Formed by the left ventricle. 9-10 cm left of midline at the 5th intercostal space.

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146
Q

Anterior interventricular groove

A

Located between the right and left ventricles on sternocostal surface. Contents are the anterior interventricular artery and great cardiac vein.

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147
Q

Atrioventricular groove

A

Located junction between atria and ventricles. Contents are the right and left coronary artery and coronary sinus.

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148
Q

Posterior interventricular groove

A

Furrow between right adn left ventricles on diaphragmatic surface. Posterior interventricular artery and middle cardiac vein run in this groove.

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149
Q

What vessels enter the right atrium

A

SVC, IVC and coronary sinus

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150
Q

Right auricle

A

Extends anteriorly over base of ascending aorta

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151
Q

Pectinate msucles

A

Found in the anterior wall of the right atrium and auricle.

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152
Q

Sinus venarum

A

Smooth posterior wall of right atrium. Has openings for SVC, IVC, and coronary sinus.

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153
Q

Crista terminalis—internal

A

Ridge separating pectinate muscles from sinus venarum (in right atrium)

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154
Q

Sulcus terminalis—external

A

Shallow external groove that corresponds to crista terminalis

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155
Q

SA node

A

Deep to epithelium located at junction of SVC and crista terminalis.

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156
Q

AV node

A

In interatrial septum near opening of coronary sinus.

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157
Q

Coronary sinus

A

Located in the right atrium posteromedial to IVC

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158
Q

Fossa Ovalis

A

Oval shaped depression in the interatrial septum of right atrium. Fetal remnant of foramen ovale

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159
Q

Right AV orifice

A

Entrance of the tricuspid valve. Inferior in right atrium.

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160
Q

Trabeculae carneae

A

Irregular muscle that lines right and left ventricles.

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161
Q

Conus arteriosus (infindibulum)

A

Funnel-shaped smooth area leading to the pulmonary trunk.

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162
Q

Tricuspid valve

A

Prevents back flow of blood from right ventricle back intro right atrium.

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163
Q

Chordae tendineae function to

A

Pass from papillary muscles to cusps. Prevent prolapse of cusps during ventricular contraction.

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164
Q

Papillary muscles

A

Function to tense the chordae tendineae

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165
Q

Septomarginal trabecula

A

Interventricular septum to anterior papillary muscle. Gets papillary muscles contracting before ventricular contraction.

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166
Q

Contents of the septomarginal trabecula

A

Right bundle branch of AV bundle

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167
Q

Pulmonary Semilunar valve

A

Between right ventricle and pulmonary trunk

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168
Q

Cusps of the pulmonary semilunar valve

A

Lunule, nodule, sinus. They are the ‘pockets’

169
Q

Function of pulmonary semilunar valve

A

Splay towards arterial wall during systole. Valve closes as pulmonary trunk recoils during diastole forcing blood back to heart.

170
Q

Left atrium

A

Located posteriorly with four pulmonary veins entering.

171
Q

Where are pectinate muscle found in the left atrium

A

Only in the auricle. Left atrium is primarily smooth.

172
Q

Can you see the fossa ovalis in the left atrium

A

You may be able to an indentation on the interatrial septum

173
Q

Left atrioventricular orifice

A

Bicuspid valve into left ventricle

174
Q

Muscles of the left ventricle

A

2-3X thicker than right ventricle and has more trabeculae carneae. Also has papillary muscles.

175
Q

Bicuspid valve

A

Left atrioventricular valve and only has 2 cusps

176
Q

Aortic vestibule

A

Smooth outflow region leading to aortic semilunar valve

177
Q

Aortic semilunar valve

A

Between left ventricle and ascending aorta. 3 cusps—same as pulmonary semilunar valve

178
Q

Right and left coronary artery

A

Open an aortic side of valve, in right and left sinuses of cusps respectively.

179
Q

Interventricular septum

A

Strong, oblique partition between the ventricles. It has a muscular part and a membranous part. Membranous part sits superiorly and posteriorly to muscular part

180
Q

Where is a common site of ventricular septal defects

A

Membranous part of the interventricular septum

181
Q

Coronary artery

A

Can be variable. Is under autonomic control and are considered functional end arteries. They do not have anastomoses because they only supply the heart.

182
Q

Origin of the coronary artery

A

Ascending aorta superior to aortic semilunar valve. In the left and right sinuses.

183
Q

When do the coronary arteries fill

A

Fill during diastole, when backflow of blood fills aortic semilunar valve.

184
Q

Right coronary artery

A

Supplies right atrium, right ventricle, posterior left ventricle, part of the IV septum, SA and AV nodes. It is located posterior to the pulmonary trunk in the atrioventricular groove.

185
Q

Branches of right coronary artery

A

SA nodal artery, right marginal artery, posterior interventricular artery (this artery can come from circumflex)

186
Q

Left coronary artery

A

Supplies left atrium, most of left ventricle, and most of interventricular septum (including AV bundle). It is typically short

187
Q

Where is the left coronary artery

A

Lies between left auricle and pulmonary trunk

188
Q

Branches of the left coronary artery

A

Circumflex artery, anterior interventricular artery, posterior interventricular artery (less seen branching off LCA).

189
Q

What artery is the widowmaker

A

Anterior interventricular artery/ left anterior descending.

190
Q

Coronary sinus

A

Receives majority of venous drainage from heart, in atrioventricular groove, drains into right atrium with low O2 blood.

191
Q

Anterior cardiac vein

A

Drain directly into the right atrium. Crosses over right coronary artery.

192
Q

Great cardiac vein

A

Runs with anterior interventricular artery

193
Q

Middle cardiac vein

A

Runs with posterior interventricular artery

194
Q

Small cardiac vein

A

Runs with right marginal artery.

195
Q

Which layers of the pericardium are serous

A

Serous parietal and visceral pericardium

196
Q

Where are parietal and visceral pericardium continuous with each other

A

The great veins

197
Q

Where is the pericardial cavity found

A

Between parietal and visceral pericardium

198
Q

The phrenic nerve and pericardiacophrenic vessels pass posterior to root of the lung. T/F

A

False. It passes anterior

199
Q

What forms the superior vena cava

A

Right and left brachiocephallic veins

200
Q

Where does the ascending aorta end

A

Sternoangle/transverse thoracic plane

201
Q

Where is the Ligamentum arteriosum located

A

Between PT and aorta.

202
Q

Where do the pulmonary veins drain? What are they rich in

A

Left atrium. O2

203
Q

What are functions of the fibrous skeleton

A

Electrical insulations, keeps valves open/patent, attachment for myocardium of arteries and ventricles.

204
Q

Which chamber primarily forms the base of the heart

A

Left atrium

205
Q

Where is the coronary sinus located

A

Atrioventricular groove

206
Q

Where is pectinate muscle found

A

Right atrium and left atria in the auricle

207
Q

What openings are found in the sinus venarum

A

Coronary sinus, SVC and IVC

208
Q

Where is the crista terminalis found? What landmark corresponds externally ?

A

Right atrium between pectinate (anterior) and sinus venarum (posterior). Sulcus venalis

209
Q

How many papillary muscles are found in the right ventricle

A

Three

210
Q

What are the attachment points for the chordae tendineae

A

Papillary muscles and valve cusps.

211
Q

How would you identify the septomarginal trabeculae/moderator band

A

Interventricular septum and anterior papillary muscle in right ventricle

212
Q

How many cusps does the pulmonary semilunar valve have

A

3

213
Q

When do cusps of valve close

A

During diastole/ventricular filling

214
Q

The muscular interventricular septum as thick as the wall of the right ventricle. T/F

A

False. In the left ventricle.

215
Q

Where is the aortic vestibule

A

Just before aortic SL valve

216
Q

How many cusps does the aortic semilunar valve have

A

3

217
Q

Where do the right and left coronary arteries run

A

Atrioventricular groove

218
Q

Where do the anterior cardiac vein drain

A

Into right atrium

219
Q

Which vein runs with the right marginal artery

A

Small cardiac

220
Q

Which artery does the great cardiac vein run with

A

Anterior interventricular

221
Q

Placenta

A

Site of O2 and nutrient exchange

222
Q

Umbilical cord contents

A

Umbilical vein and umbilical arteries

223
Q

Umbilical vein

A

Carries O2 rich blood to IVC via ductus venosus.

224
Q

What does the blood in the umbilical vein bypass and how

A

Bypasses the liver via ductus venosus

225
Q

Foramen ovale

A

Opening between the right and left atria where blood is shunted from right to left atrium and it bypasses the lungs. Blood then goes to left ventricle into aorta

226
Q

Ductus arteriosus

A

Connects pulmonary trunk to arch of aorta and it bypasses the lungs

227
Q

Umbilical artery

A

Branches of internal iliac artery and it returns low O2 blood to placenta for reoxygenation

228
Q

Patent ductus arteriosus

A

A ductus arteriosus that doesn’t close

229
Q

Ductus arteriosus in fetus

A

Allows blood to pass form pulmonary artery to aorta through this structure and largely bypasses the lungs.

230
Q

After birth what happens to ductus arteriosus

A

Normally constricts, and then closes to become ligamentum arteriosum.

231
Q

Causes of a patent ductus arteriosus

A

Preterm birth and congenital heart issue

232
Q

Results of a patent ductus arteriosus

A

Results in high pressure aortic blood passing through pulmonary artery. Raises BP in pulmonary circulation. Pulmonary hypertension could lead to right sided heart failure.

233
Q

Foramen ovale in fetus

A

Passes blood from right atrium to left atrium bypassing the lungs because the mother is oxygenating blood for the fetus.

234
Q

What happens to the foramen ovalis after birth

A

Normally closes with pressure changes and becomes fossa ovalis.

235
Q

What percentage of adults have a small patency of the foramen ovalis

A

15-25%

236
Q

What happens with a large patency of the foramen ovale

A

May overload pulmonary circulation. Hypertrophy of right atrium and ventricle.

237
Q

Pathway of blood through the heart in the pulmonary circuit

A

Right atrium—>tricuspid valve—>right ventricle—>pulmonary SL valve—>pulmonary trunk—>pulmonary arteries—>capillary beds of lungs—>pulmonary veins

238
Q

Pathway of blood through the systemic circuit

A

Left atrium—>bicuspid valve—>left ventricle—>aortic SL valve—>aorta—>systemic arteries—>capillary beds of body tissues—>systemic veins/vena cava

239
Q

Blood qualities in the right side of the heart (pulmonary circuit)

A

O2 poor blood form the body and heart enter the right atrium through the IVC, SVC, anterior cardiac vein and coronary sinus

240
Q

Blood qualities of blood in the left side of the heart (systemic circulation)

A

O2 rich blood enters the left side of the heart via the right and left pulmonary veins.

241
Q

Gas and nutrient exchange of the heart

A

Coronary artery

242
Q

Gas and nutrient exchange of body

A

Systemic artery

243
Q

Systole

A

Ventricular shortening and contraction

244
Q

Diastole

A

Ventricular elongation and filling

245
Q

“Lub” sound

A

First heart sound due to the AV valves closing during systole

246
Q

“Dub” sound

A

Second heart sound heard as the semilunar valves close during diastole

247
Q

Where is the tricuspid valve auscultated

A

In the 5th intercostal space just left of the sternum

248
Q

Auscultation of the mitral/bicuspid valve

A

Auscultated in the 5th intercostal space 9-10cm left of midline

249
Q

Auscultation of pulmonary semilunar valve

A

Auscultated in 2nd intercostal space adjacent to left sternum

250
Q

Where is the aortic semilunar valve auscultated

A

In the 2nd intercostal space to right of sternum

251
Q

Valvular heart disease

A

Increased workload for heart and may be acquired or congenital

252
Q

Valvular stenosis

A

Failure of valve to open fully, almost always a chronic process, slows blood flow from the chamber

253
Q

What can valvular stenosis result in

A

Turbulence or “heart murmur”

254
Q

Valvular insufficiency

A

Failure of valve to close completely, scarring and contraction of cusps or rupture of cords causing them to be overly large or floppy. Can also result in a heart murmur

255
Q

AV node

A

Located on interatrial wall near coronary sinus opening. Conveys impulses to AV bundle.

256
Q

AV bundle

A

Carries signal through membranous interventricular septum. Passes through cardiac skeleton, electrical link between contraction in atria and ventricles.

257
Q

Right and left bundle branches

A

Located in muscular interventricular septum and conveys impulses to purkinje fibers

258
Q

Cardiac plexus

A

Conduction system modified by autonomic nervous system. It contains sympathetic, parasympathetic, and visceral afferent nerves also present.

259
Q

Function of cardiac plexus

A

Regulates rate and strength of contraction but not required to initiate beat.

260
Q

Where is the ductus arteriosus and what does it do

A

Between pulmonary trunk and arch of aorta and it shunts blood from PT to aorta

261
Q

The umbilical artery carry high O2 content blood black to the fetus. T/F

A

False. In the umbilical vein

262
Q

Which chambers of the heart function in the pulmonary circuit? Which valves?

A

Right atria and right ventricle. Right AV/tricuspid valve and pulmonary semilunar valve

263
Q

The ventricles shorten and contract during systole. T/F

A

True

264
Q

Which heart sound is heard with contraction of the AV valves

A

“Lub”

265
Q

What is also known as the “pacemaker of the heart”?

A

SA node

266
Q

What carries the impulse from the AV node to the right and left bundle branches

A

Bundle of hiss

267
Q

What serves as an electrical insulator between the atria and the ventricles

A

Cardiac skeleton

268
Q

Borders of the mediastinum division

A

Superior thoracic aperature, thoracic diaphragm inferiorly

269
Q

Divisions of the mediastinum

A

Superior mediastinum, inferior mediastinum

270
Q

Superior mediastinum

A

Above transverse plane between sternal angle and T4-5 IVD.

271
Q

Inferior mediastinum

A

Below transverse place between sternal angle and T4-5 IVD. Further divided into 3 regions.

272
Q

Contents of the superior mediastinum

A

Mediastinal lymph nodes, thymus, brachiocephallic vein, SVC, arch of aorta, vagus, phrenic, and recurrent laryngeal nerve. Trachea, esophagus, thoracic duct.

273
Q

Where is the thymus located

A

Immediately posterior to manubrium, anterosuperior to pericardium.

274
Q

Function of the thymus

A

Primary lymphoid organ and the site of T-lymphocyte development.

275
Q

What happens to the thymus after it undergoes involution after puberty

A

It becomes fatty tissue

276
Q

What forms the brachiocephallic vein

A

The union of the internal jugular and subclavian vein

277
Q

Which brachiocephallic vein is longer

A

The left is twice as long as the right

278
Q

Where does the brachiocephallic vein drain blood from

A

From the head, neck, and upper extremities

279
Q

Where do the brachiocephalic veins end

A

Unite to form the SVC inferiorly

280
Q

What forms the superior vena cava

A

Union of the right and left brachiocephalic veins

281
Q

Azygos vein

A

SVC receives azygos just superior to entry into pericardial sac. Arch of azygos passes superior to root of right lung.

282
Q

Where does the SVC terminate

A

Drains into the right atrium

283
Q

Aortic arch

A

Begins at the sternal angle anteriorly and ends at the sternal angle posteriorly.

284
Q

Branches of the aortic arch

A

Brachiocephalic trunk, left common carotid, left subclavian artery.

285
Q

Continuation of aortic arch

A

Becomes descending thoracic aorta

286
Q

Origin of trachea

A

Begins at inferior border of cricoid cartilage.

287
Q

Location of trachea

A

Sits anterior to the esophagus and to the right of midline

288
Q

Trachealis muscle

A

Smooth muscle that spans the gap posterior. Abuts esophagus.

289
Q

Where does the trachea terminate

A

At sternal angle (T4-T5). Not found in posterior mediastinum.

290
Q

Esophagus

A

Fibromuscular tube from pharynx to stomach

291
Q

Where does the esophagus enter the superior mediastinum

A

Between the trachea and vertebrae

292
Q

Where does the esophagus enter the posterior mediastinum

A

Inferior to aortic arch

293
Q

Right vagus nerve

A

Is anterior or right subclavian artery and gives rise to right recurrent laryngeal nerve. Passes through superior mediastinum to the right of the trachea.

294
Q

Left vagus nerve

A

Located between the left common carotid artery and left subclavian artery. Passes anterolaterally over aortic arch.

295
Q

Left recurrent laryngeal nerve

A

Loops posteriorly around aortic arch, behind ligamentum arteriosum.

296
Q

Both vagus nerves pass..

A

Posterior to root of lung

297
Q

Esophageal plexuses

A

Left vagus nerve-contributes to anterior esophageal plexus
Right vagus nerve- contributes to posterior esophageal plexus

298
Q

Origin and classification of phrenic nerve

A

VPR C3-5. Motor and sensory to thoracic diaphragm.

299
Q

On the right the phrenic nerve

A

Sits to the right of the right brachiocephallic vein and the SVC

300
Q

On the left the phrenic nerve

A

Crosses the arch of the aorta; passes over the L vagus nerve, and the superior intercostal vein

301
Q

Path of the phrenic nerve

A

Both pass anterior to root of lung, between mediastinal pleura and parietal pericardium, runs with pericardiacophrenic artery and vein

302
Q

Boarders of the Inferior mediastinum

A

Transverse plane between sternal angle and T4-5 IVD. Thoracic diaphragm inferiorly

303
Q

Three regions of the inferior mediastinum

A

Anterior, middle, and posterior.

304
Q

Contents of the anterior inferior mediastinum

A

Lower part of thymus remnant, internal thoracic vessels, paraphernalia lymph nodes, adipose tissue.

305
Q

Middle mediastinum contents

A

Heart, pericardium, root of great vessels, phrenic nerve and pericardiacophrenic artery and vein on fibrous pericardium.

306
Q

Posterior mediastinum borders

A

T5-12, posterior to pericardium between pulmonary cavities.

307
Q

Contents of posterior mediastinum

A

Descending thoracic aorta, esophagus and esophageal plexus, anterior and posterior fatal trunks, thoracic duct and lymph nodes, azygos system of veins, thoracic sympathetic trunk and splanchnic nerve

308
Q

Descending thoracic aorta

A

Descends through thorax on left side of T5-T12 and it displaces esophagus to the right.

309
Q

Aortic hiatus

A

T12, behind thoracic diaphragm, descending aorta passes through and becomes abdominal aorta.

310
Q

Paired visceral branches of descending thoracic aorta

A

Bronchial artery

311
Q

Blood supply of esophagus

A

Esophageal artery from descending thoracic aorta

312
Q

Location of esophagus

A

Between trachea and T1-4 vertebrae in superior mediastinum. Posterior to pericardium adjacent to T5-10 in posterior mediastinum.

313
Q

Esophageal hiatus

A

At level of T10 opening for esophagus to pass through to go to stomach

314
Q

What forms the esophageal plexus

A

Formed by left and right vagal nerve

315
Q

Anterior vagal trunks

A

Neurons from left vagus nerve emerging from anterior esophageal plexus. On the anterior surface of esophagus.

316
Q

Posterior vagal trunk

A

Neurons from right vagus nerve emerging from posterior esophageal plexus. On posterior surface of esophagus.

317
Q

What does the thoracic duct look like

A

Small, thin walled and often beaded die to numerous valves

318
Q

Location of thoracic duct

A

Posterior to esophagus, anterior to thoracic vertebrae, between thoracic aorta and azygos veins.

319
Q

Function of thoracic duct

A

Drains lymph from entire body except upper right quadrant and inferior lobe of left lung

320
Q

Cisterna chyle

A

Origin of thoracic duct in abdomen at L1, enters thorax via aortic hiatus. Around T4 it passes to the left.

321
Q

Termination of thoracic duct

A

Typically drains into left venous angle. Junction of left subclavian and left internal jugular vein.

322
Q

What does azygos mean

A

Unpaired

323
Q

Azygos system of veins

A

Are highly variable and valveless. Drains back, thoracoabdominal walls and mediastinal viscera.

324
Q

Azygos vein

A

In posterior mediastinum on right side. Arch of azygos veins superior to root of right lung. Receives blood from right side.

325
Q

Hemi-azygos veins

A

In posterior mediastinum on left side inferiorly. Usually crosses over around T9 to drain into azygos vein. Receives blood from lower left side

326
Q

Accessory hemi-azygos veins

A

In posterior mediastinum on left side superiorly. Usually crosses over around T8 to drain into azygos veins. May join up with hemiazygos vein and form one vein to drain into azygos. Receives blood from upper left side.

327
Q

What does the azygos system of veins connect to

A

Lumbar vein and IVC

328
Q

Thoracic sympathetic trunk

A

Series of paravertebral ganglia linked by interganglionic remi

329
Q

Location of the thoracic sympathetic trunk

A

Parallel vertebral column bilaterally and are continuous with cervical and lumbar sympathetic trunks.

330
Q

Thoracic splanchnic nerve

A

AKA abdominopelvic splanchnic nerve that arises from sympathetic trunk ganglia. Preganglionic sympathetic fibers and they supply viscera inferior to the thoracic diaphragm.

331
Q

Lesser thoracic splanchnic nerve

A

T10-T11

332
Q

Greater thoracic splanchnic nerve

A

T5-T9

333
Q

Least thoracic splanchnic nerve

A

T12

334
Q

Attachments of the thoracic diaphragm

A

Xiphoid process, lower 6 ribs and costal cartilages, posterior body wall via arcuate ligaments, vertebrae via crura (left crus-bodies L1-2/3. Right crus-bodies of L1-3/4)

335
Q

Blood supply of thoracic diaphragm

A

Musculophrenic artery, superior phrenic artery, inferior phrenic artery.

336
Q

Thoracic diaphragm posterior abdominal wall attachments

A

Median arcuate ligaments, medial arcuate ligaments, lateral arcuate ligaments

337
Q

Caval hiatus

A

Located in the thoracic diaphragm. Most anterior through central tendon. IVC at T8

338
Q

Esophageal hiatus

A

Created by R crus of diaphragm, esophagus at T10, vagal trunks as well.

339
Q

Aortic hiatus

A

Most posterior and surrounded by R/L crura. Thoracic aorta at T12. Thoracic duct and azygos vein here as well.

340
Q

I 8 10 eggs at 12

A

IVC at T8
T10 esophagus
Aortic at T12

341
Q

What are the landmarks for the recurrent laryngeal nerve

A

Behind ligamentum arteriosum

342
Q

Where are the vagus nerves in relationship to the root of hte lung

A

Posterior to it

343
Q

What does the phrenic nerve supply and what are its roots

A

Diaphragm and C3-5

344
Q

Which vagus nerve forms the anterior vagal trunk

A

Left vagus

345
Q

Where is the thoracic duct located

A

Posterior to esophagus
Anterior to vertebral column
Sits between aorta and azygos vein

346
Q

Where does the azygos vein drain

A

SVC

347
Q

The sympathetic trunk runs the entire length of the vertebral column bilaterally. T/F

A

True

348
Q

Where do the thoracic splanchnic nerve arise

A

Thoracic sympathetic trunk

349
Q

Which spinal levels contribute to the greatest thoracic splanchnic nerve

A

T5-9

350
Q

What are the attachment points for the diaphragmatic crura

A

Vertebral bodies

351
Q

Which arcuate ligament arches over the psoas major muscle

A

Medials (2)

352
Q

Three groups cell bodies exist in

A

Nuclei, ganglia, intramural ganglia or cluster

353
Q

Cell body #1

A

In CNS and is Preganglionic, axon is myelinated and synapses with cell body #2

354
Q

Cell body #2

A

Postganglionic. In PNS and axon is unmyelinated and travels to the target visceral organ

355
Q

Dual innervation

A

Each organ is innervated with sympathetics and parasympathetics. Usually antagonistic (I.e, symp increases heart rate and para decreaes heart rate).

356
Q

Parasympathetic actions on organs

A

Can act on each organ separately

357
Q

Sympathetic actions

A

Discharges as a complete system

358
Q

Sympathectomy

A

Cuts off sympathetic chain. Not ideal but can be done

359
Q

PS v S effects on coronary vessels

A

PS constricts, S dilates

360
Q

PS vs S actions on pupil

A

PS constricts, S dilates

361
Q

Preganglionic parasympathetic NT and receptor

A

ACh and nicotinic receptor

362
Q

Preganglionic sympathetic NT and receptor

A

ACh and nicotinic

363
Q

Postganglionic parasympathetic NT and receptor

A

ACh and muscarinic

364
Q

Most post ganglionic sympathetic NT and receptors

A

Norepi and adrenergic

365
Q

Some postganglionic sympathetic NT and receptors

A

ACh and muscarinic. Only in sweat glands and arrector pili muscles

366
Q

What is the main contributor of the ANS

A

Hypothalamus

367
Q

Other contributions to ANS

A

Lambic system, brain, and spinal cord

368
Q

Another name of sympathetic nervous system

A

Thoracolumbar

369
Q

Where are the first cell bodies in the sympathetic nervous system found

A

In the Intermediolater nucleus (IML) of T1-L2

370
Q

Intermediolateral nucleus

A

A group of cell bodies in the lateral horn of the spinal cord

371
Q

Paravertebral ganglia

A

Are part of the sympathetic chain seen on either side of the vertebral columns

372
Q

Prevertebral ganglia

A

Sit in front of the vertebral bodies

373
Q

Rami communicates

A

Are the connecting branches between the spinal nerve adn teh sympathetic chain. There are both white and grey

374
Q

White rami

A

Lateral and Preganglionic so it is myelinated

375
Q

Great rami

A

Medial and postganglionic therefor unmyelinated

376
Q

Preganglionic axons start in the IML, travel through the white rami into the sympathetic chain and then have 3 choices

A

1)Synapse immediately
2) Ascend or descend to another vertebral level ganglia to synapse
3) Exit without synapsing at all (Splanchnic) (still preganglionic, myelinated)

377
Q

Splanchnics

A

Thoracic splanchnics are greater, lesser, and least. (T5-T9), (T10-T11), and (T12) respectively.

378
Q

Where do teh preganglionic fibers of the splanchnics leave and synapse

A

Leave the sympathetic chain and synapse in the abdominal prevertebral ganglia

379
Q

What do all splanchnic nerves innervate

A

Viscera

380
Q

Where are the first cell bodies of the parasympathetic NS located

A

Brain stem

381
Q

What are the parasympathetic head and neck ganglia

A

Cilliary, pterygopalatine, submandibular, otic

382
Q

What cranial nerve is the ciliary head and neck ganglia associated with

A

CN III

383
Q

What cranial nerve is the pterygopalatine head and neck ganglia associated with

A

CN VII

384
Q

What cranial nerve is the submandibular head and neck ganglia associated with

A

CN VII

385
Q

What cranial nerve is the otic head and neck ganglia associated with

A

CN IX

386
Q

Where are the parasympathetic head and neck ganglia located

A

In the walls of viscera

387
Q

Two neuron system

A

Preganglionic fiber that’s myelinated and a postganglionic fiber that’s unmyelinated

388
Q

Where are the first and second cell bodies in the sacral portion located

A

First cell bodies are located in S2-S4. Second cell body is in the organ wall.

389
Q

What are the parasympathetic brain stem nuclei and associated CN

A

Edinger-westphal (III), superior salivatory (VII), inferior salivatory (IX), Dorsal n of vagus (X)

390
Q

Cardiopulmonary splanchnics

A

Post ganglionic sympathetic

391
Q

Thoracic splanchnics

A

Preganglionic sympathetic

392
Q

Pelvic splanchnics

A

Preganglionic parasympathetic

393
Q

Sacral splanchnics

A

Postganglionic sympathetic

394
Q

Lumbar splanchnics

A

Preganglionic sympathetic

395
Q

What are the three plexi in the thorax

A

Cardiac plexus, pulmonary plexus, esophageal plexus

396
Q

What plexi are the same but differ in location

A

Cardiac and pulmonary

397
Q

Where is the cardiac plexus

A

The superior mediastinum

398
Q

What are the two regions of the cardiac plexus

A

Superficial cardiac plexus in the concavity of the aortic arch. deep cardiac plexus between the aortic arch and trachea.

399
Q

Where are the first cell bodies of the sympathetic NS

A

The IML of T1-T6

400
Q

Cell body number two of the sympathetic NS is called a _____________

A

Cardiac nerve

401
Q

How are the second cell bodies in the sympathetic NS named

A

Respectively based off the ganglia it came from

402
Q

Second cell bodies of the sympathetic NS

A

Superior sympathetic cardiac nerve, middle sympathetic cardiac nerve, inferior cardiac nerve, T1-T4 cardiac nerves

403
Q

What are the origins of the cardiac nerves

A

Superior ganglia, middle ganglia, inferior ganglia, T1-T4 thoracic sympathetic ganglia

404
Q

What is the parasympathetic supply to the heart and cardiac plexus

A

Cardiac branches (CNX) and they are preganglionic

405
Q

Parasympathetic contribution to the pulmonary plexus

A

Preganglionic from vagal nuclei to ganglia. Postganglionic from cell body number two to target

406
Q

Sympathetic contribution to pulmonary plexus

A

Preganglionic (#1) from IML T1-T6 to cervical ganglia and T1-4 chain ganglia (#2). Cardiac nerve and postganglionic to targets.

407
Q

Parasympathetic effects on the lungs

A

Vasodilate, bronchoconstriction, increased mucus secretion

408
Q

Sympathetic effects on lungs

A

Vasoconstriction, bronchodilation, decreased mucus secretion

409
Q

What is the relationship of the pulmonary plexus with the deep cardiac

A

It is continuous with it at the tracheal bifurcation (around T4)

410
Q

What does the pulmonary plexus communicate with

A

The esophageal plexus

411
Q

What are the divisions of the pulmonary plexus

A

Anterior pulmonary plexus and posterior pulmonary plexus

412
Q

PS effects on BP, HR, and coronary vessels

A

Decrease, decrease, constrict

413
Q

Sympathetic effects on BP, HR, and coronary vessels

A

Increase, increase, dilate

414
Q

What nervous system innervate the SA and AV nodes

A

Sympathetic

415
Q

What do the SA and AV nodes do

A

They are the conduction system of the heart

416
Q

What does the SA node do

A

Initiates impulse and spreads this signal to both atria via the AV node and Bachmann’s bundle

417
Q

What does the AV node do

A

Electrically connects the atria and ventricles

418
Q

Bundle of Hiss

A

Extension of the AV node into the interventricular septum is called the bundle of Hiss

Gross Anatomy (2 decks)

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