Final Lecture Questions (Pelvic cavity, thoracic wall, respiratory, heart, etc.) Flashcards
1
Q
What is the function of the pelvic cavity?
A
-Contains and supports the urinary bladder, rectum, anal canal, and reproductive tracts
-Contains most of the reproductive tracts in women and part of the reproductive tracts in men
2
Q
What are the contents of the pelvic cavity in women?
A
-Fallopian/uterine tube
-Ovary
-Uterus
-Bladder
-Vagina
-Urethra
-Ureter
-Internal iliac artery/veins
-Rectum
-Anal canal
-Anal aperture
3
Q
What are the contents of pelvic cavity in men?
A
-Ductus deferens
-Seminal vesicle
-Prostate
-Ejaculatory duct
-Rectum
-Anal canal
-Anal aperture
-Bladder
-Urethra
4
Q
How many parts are there in the male urethra?
A
4 parts
5
Q
What triangles are there in the pelvis?
A
-Anal triangle of perineum
-Urogenital triangle of perineum
6
Q
What is the sacrum? What does it articulate with?
A
-Formed by the fusion of the five sacral vertebrae
-The base of the sacrum articulates with L5
-The apex articulates with the coccyx
7
Q
What part of the sacrum projects into the pelvic inlet?
A
Promontory
8
Q
What does the lumboscaral joint consist of?
A
-Formed by L5 and the sacrum
-2 facet joints (zygapophysial joints)
-An intervertebral disc that joins the body of L5-S1
-Stabilized by iliolumbar ligament, lumbosacral ligament, and anterior longitudinal ligament
9
Q
What movements do the lumbosacral ligaments stabilize?
A
They stabilize all movements of L5-S1
10
Q
What is the sacroiliac joint? What does it consist of?
A
-Synovial joints between the L-shapes articular facets on the lateral surfaces of the sacrum & facets on the iliac parts of the pelvic bones
-Anterior sacro-iliac ligament
-Interosseous sacro-iliac ligament
-Posterior sacro-iliac ligament
11
Q
Which is the largest and strongest of the sacro-iliac ligaments?
A
Interosseous sacro-iliac ligament
12
Q
What happens to the sacro-iliac joint as we age?
A
It becomes a fibrous joint, and can completely ossify
13
Q
What does the pubic symphysis joint consist of ?
A
-Lies anteriorly between the adjacent surfaces of the pelvic bones
-Joint surfaces are covered by cartilage
-Can sometimes become fibrous or ossified
14
Q
What ligaments stabilize the pubic symphysis joint?
A
-Superior pubic ligament
-Inferior pubic ligament
-These ligaments stabilize the pubic symphysis during childbirth
15
Q
What are the muscles that make up the lateral pelvic wall?
A
-Obturator internus
-Piriformis
16
Q
What nerve roots form the sacral & coccygeal plexuses? Where is it located?
A
-Situated on the posterolateral wall of the pelvic cavity
-Posterior to internal iliac vessels
-Formed by the ventral rami of S1-Co with a significant contribution from L4 & L5
17
Q
What areas/muscles does the sacral & coccygeal plexus innervate?
A
-Muscles of the lower limb
-Muscles of the pelvis and perineum
-Cutaneous branches supply skin over the medial side of the foot, posterior aspect of lower limb, and most of the perineum
18
Q
What forms the sacral plexus? Where is it located? Where does it pass through?
A
-Formed by anterior rami of S1-S4 and the lumbosacral trunk (L4 & L5)
-Located anteriorly to the piriformus muscle which is part of the posterolateral pelvic wall
-Passes out of the anterior sacral foramina & course laterally & inferiorly on the pelvic wall
19
Q
Which major lower extremity nerves are formed by branches of the sacral plexus?
A
-Sciatic nerve
-Gluteal nerves
-Pudendal nerve (innervates perineum)
-Nerve to quadratus femoris
-Posterior femoral cutaneous nerves
-Nerve to piriformis
-Nerves to levator ani, coccygeus, and external anal sphincter
20
Q
Where do most nerves from the sacral plexus exit the pelvic cavity?
A
Most exit by passing through the greater sciatic foramen, inferior to the piriformis muscle
21
Q
What does the coccygeal plexus innervate?
A
Sensory to the perineum
22
Q
What are the boundaries of the thoracic wall?
A
-The superior thoracic aperture bordered by vertebrae T1, rib 1, and the manubrium of the sternum
-The inferior thoracic aperture bordered by vertebrae T12, rib 12, the end of rib 11, costal margin, and the xiphoid process of the sternum
23
Q
What is the skeletal framework of the thoracic wall?
A
-Thoracic vertebrae
-Intervertebral discs
-Ribs
-Sternum
24
Q
What are the classifications of the ribs?
A
-True ribs
-False ribs
-Typical
-Atypical
-Floating ribs
25
Which ribs are the true ribs?
1-7
26
Which ribs are the false ribs?
8-12
27
Which ribs are floating ribs?
11 & 12
28
Which ribs are the typical ribs?
3-9
29
Which ribs are atypical?
1 & 2, 10-12
30
What are distinct features of rib 1?
-Has a scalene tubercle for attachment of the anterior scalene
-Has a groove for the subclavian artery
-Has a groove for the subclavian vein
-Only articulates with T1
31
What are distinct features of rib 2?
Has a tubercle for attachment of serratus anterior
32
What are distinct feature of rib 10?
The head has a single facet for articulation with T10 (instead of 2 facets)
33
What does the sternum consist of?
-Manubrium
-Body
-Xiphoid process
34
What are distinct features of ribs 11 & 12?
-Only articulate with the bodies of their corresponding vertebrae & have no tubercles
-Both are short w/ little curve
-Point anteriorly
-No articulation w/ sternum
34
Which of the sternocostal joints is not a synovial joint? Why is it a fibrocatilaginous joint?
-Sternocostal joint 1
-It is a fibrocartilaginous joint so that it does not move upward and compress major vessels and nerves/brachial plexus that passes over the top of it
34
What portions of the sternum have demifacets? What ribs are they for?
-There is one demifacet that crosses the manubriosternal joint that is for rib 2
-There is another demifacet where the body and xiphoid process articulate which is for rib 7
35
What movements occur at the interchondral joints?
The interchondral joints allow for gliding movements to allow false ribs to move
36
What movement does the manubriosternal joint/sternal angle allow for?
Allows for anterior displacement during inhaling
37
What intercostal space are the aortic vale and pulmonary valves located in?
The second intercostal space (under rib 2)
38
What is the level of the sternal angle in relation to the vertebral column?
At the level of T4-T5 intervertebral disc
39
What does the sternal angle/angle of Louis mark the level of? What does it overlie?
-It marks the level of the transverse thoracic plane which divides the mediastinum into the superior and inferior mediastinum
-It overlies the aortic arch on the left and the superior vena cava on the right
40
What structure extends downwards from just superior to the angle of Louis to the xiphisternal joint?
The pericardium
41
Where does the trachea bifurcate?
-Roughly at the level of the angle of Louis
-The tracheal carina is deep to the sternal angle
42
Where does the pulmonary trunk bifurcate?
Roughly at the level of the angle of Louis (sternal angle between manubrium and body)
43
What does the intercostal space consist of?
-Intercostal vessels
-Intercostal nerves
-3 layers of intercostal muscles
44
Where does the intercostal nerves and associated vessels lie?
They lie in the costal groove along the inferior margin of the superior rib & pass between the inner two muscle layers
45
What is the order of the nerves and vessels in the intercostal space?
-The vein is the most superior
-Then the artery is inferior to the vein
-The nerve is the most inferior
46
What structure in the intercostal space is not protected by bone?
Intercostal nerves
47
Which of the intercostal muscles contracts with the diaphragm and favors inspiration? What direction are the fibers?
-External intercostal muscle
-Fibers are in the same direction as external oblique (think of putting something in your pocket)
48
Which of the intercostal muscles favors expiration? What is another function of these muscles? What direction are the fibers?
-Internal intercostal muscle (middle muscle)
-Innermost intercostal muscle
-They are stiff to provide a wall between the thoracic wall and pleura
-Fibers are in the same direction as internal oblique
49
What arteries supply the thoracic wall?
-Posterior intercostal artery
-Internal thoracic artery
-Anterior intercostal artery
-Musculophrenic artery
50
What artery is also known as the mammary artery?
Internal thoracic artery
51
Where is the musculophrenic artery located?
It runs obliquely downward behind the cartilages of the false ribs
52
Where is the internal thoracic artery located? What branches off of it?
-Lateral to sternum on both sides
-Anterior intercostal arteries branch off of it
53
What veins supply the thoracic wall?
-Azygous vein
-Right and left superior intercostal veins
-Right and left subcostal veins
-Accessory hemiazygous vein
-Hemiazygous vein
-Anterior intercostal vein
-Posterior intercostal vein
-Internal thoracic vein
54
Where is the azygous vein located? What does it branch off from?
-It is located on the right side of the thoracic wall just anterior to the vertebral bodies
-It branches directly off the superior vena cava
55
Where is the accessory hemiazygous vein located? What does it branch off from?
-It is located on the superior left side of the thoracic wall just anterior to the vertebral bodies
-It branches off the superior intercostal vein superiorly, and the azygous vein inferiorly
56
Where is the hemiazygous vein located? What does it branch off from?
-It is located on the inferior left side of the thoracic wall just anterior to the vertebral bodies
-It branches off the azygous vein
57
Where is the internal thoracic vein located?
Lateral to the sternum on both sides
58
Where do the superior intercostal veins branch off from?
Both right and left branch off the brachiocephalic veins
59
What are the intercostal nerves? What do they innervate? What muscles are they located between?
-Anterior rami of spinal nerves T1-T11
-They segmentally innervate the intercostal muscles
-Located between the internal and innermost intercostal muscles
-They are just called spinal nerves before it reaches the intercostal space
60
What is the main goal behind rib movement? What movements of the ribs create inspiration and which create expiration?
-To change the pressure in the thoracic cavity
-Elevation of ribs favors inspiration
-Depression of ribs favors expiration
61
What are the divisions of the respiratory system?
-Mouth
-Nasal cavities
-Pharynx
-Larynx
-Trachea & bronchial tree
-Lungs & pleural membranes
-Alveoli
62
What are the two classification systems for the respiratory system?
-Upper & lower respiratory system
-Conductive & respiratory zones
63
What structures make up the upper respiratory zone?
-Mouth
-Nasal cavities
-Pharynx
-Larynx
64
What structures make up the lower respiratory system?
-Trachea & bronchial tree
-Lungs & pleural membranes
-Alveoli
65
What structures make up the conductive zone?
-Nose
-Larynx
-Trachea
-Bronchi
-Bronchioles
-Terminal bronchioles
66
What structures make up the respiratory zone?
Alveoli
67
What are the major structures in the larynx?
-Epiglottic cartilage
-Thyroid cartilage: superior horn
-Arytenoid cartilage
-Cricoid cartilage
68
What is the function of the epiglottis?
-Can open & close larynx
-Closes during swallowing/eating so that food goes to esophagus and not into the airways
69
What is the function of the arytenoid process?
-Muscular process for muscle attachment
-Helps to move vocal cords to produce phonation (talking)
70
What is the function of the cricoid cartilage?
It ensures that the airways are open
71
What nerve innervates the muscles of the larynx? What nerve is this a ramification from? What happens if this nerve is damaged?
-Recurrent laryngeal nerve
-Ramification of vagus nerve
-Patients will have a hard time swallowing and may aspirate their food
72
Where is the partietal pleura attached to?
It is attached to the thoracic wall & innermost intercostal muscle
73
What is the pleura? What does it create?
-Membranes of the lung
-There is a parietal and visceral pleura
-Creates the pleural sac, where serous fluid circulates between the two layers
74
What is the visceral pleura attached to?
It is attached to the surface of the lung
75
What is the pulmonary ligament formed by?
It is formed by where the pleura join together at the root of the lung
76
Where is the apex of the lungs located?
Located above rib 1 and extends into the root of the neck
77
Where does the bottom of the lungs extend into?
Extends to a level just above the costal margin
78
What is the innervation of the parietal pleura?
-Intercostal nerves
-Diaphragmatic and mediastinal parts are innervated by the phrenic nerve
79
What is the suprapleural membrane?
It is a ligament that attaches to the transverse processes of C7 and the medial border of rib 1
80
What muscle is attached to the suprapleural membrane? What happens if this muscle is too lax?
-The scalenes attach to this ligament
-If the scalenes are too lax/loose, the apex of the lungs will be depressed
81
What vessel delivers oxygenated blood from the lungs to the heart?
Pulmonary veins
82
What vessel delivers deoxygenated blood to the lungs?
Pulmonary arteries
83
What type of blood is sent back to the heart from the lungs via the pulmonary veins? Where does it enter the heart?
-Oxygenated blood
-Goes into the left atrium
84
What surface do all structures enter and exit the lungs?
Mediastinal surface
85
What are the main landmarks on the lungs?
-Anterior border
-Posterior border
-Mediastinal surface
-Inferior border
-Base/diaphragmatic surface
-Costal surface
86
What structure surrounds the primary bronchii and pulmonary vessels? What do all of those structures together make up?
-Hilum
-Root is made up of the hilum and all the structures within the hilum
87
What structures pass through the hilum?
-Pulmonary artery
-2 pulmonary veins
-A main bronchus
-Bronchial vessels
-Nerves
-Lymphatics
88
What vessels supply blood to the lungs?
Bronchial vessels
89
Where does the vagus nerve pass in relation to the lungs?
It passes immediately posterior to the roots of the lungs in the mediastinum
90
Where does the phrenic nerve pass in relation to the lungs?
It passes immediately anterior to the root of the lungs in the mediastinum
91
What lobes are there in the right lung?
-Superior lobe
-Middle lobe
-Inferior lobe
92
What fissures separate each lobe in the right lung?
-Horizontal fissure separates the superior and middle lobes
-Oblique fissure separates the inferior lobe from the superior & middle lobes
93
What is the mediastinum?
The space between the lungs
94
Where do the lungs attach to each other?
The two lungs only attach to one another at the root
95
What structures pass on the middle surface of the right lung?
-Superior and inferior vena cava
-Esophagus
-Heart
-Azygous vein
96
What lobes are there in the left lung?
-Superior lobe
-Inferior lobe
-Lingula
97
What fissure separates the lobes of the left lung?
Oblique fissure separates the superior and inferior lobes
98
What is the lingula?
-The lingula is a tongue looking structure on the left lung that is similar to the middle lobe on the right lung
-It is independent of the other lobes
-Attached to the superior lobe
99
What structures pass on the middle surface of the left lung?
-Aortic arch
-Descending/thoracic aorta
-Esophagus
-Heart
100
Where does the trachea start and end in relation to the vertebral column?
The trachea extends from C6 to T4/5 where it bifurcates into the right and left main bronchus
101
How is the trachea held open?
-It is held open by C-shapes transverse cartilage rings emdedded in its wall
-The open portion of the rings face posteriorly
102
What is the lowest tracheal ring? What is it called?
-A hook-shaped structure that projects backward in the midline between the origins of the two main bronchii
-Called the carina
103
What does the main bronchii split into in order from largest to smallest?
-Main bronchus
-Lobar bronchii
-Segmental bronchii
-Bronchioles
-Terminal bronchioles
104
Which of the main bronchii are wider and more vertical through the hilum?
The right main bronchus
105
What are the bronchioles? How big are they? What is the main element of them?
-The smallest branches from the bronchial tree
-Less than 1mm in diameter
-Cartilage plates disappear in bronchioles
-Muscle is the main element of the wall
106
How does gas exchange occur in the alveoli?
-A pulmonary arteriole surrounds the alveolar sacs
-Carbon dioxide exits the blood into the alveoli
-Oxygen enters the blood from the alveoli
107
How many independent segments are there in each lung?
There are 10 independent areas in each lung
108
What are the bronchial vessels known as?
The "nutrition" of the lungs
109
What are the main bronchial arteries?
-Right bronchial artery
-Superior left bronchial artery
-Inferior left bronchial artery
110
Where does the right bronchial artery branch off from?
The third posterior intercostal artery
111
Where does the superior left bronchial artery branch off from?
The aorta
112
Where does the inferior left bronchial artery branch off from?
The descending aorta
113
What two pulmonary veins enter the lungs?
Superior & inferior
114
Where do the pulmonary arteries originate from?
Pulmonary trunk
115
What is the difference between the right and left pulmonary arteries?
-The right is longer and passes horizontally across the mediastinum
-The left is shorter and lies anteriorly to the descending aorta and posterior to the superior pulmonary vein
116
What are the lungs innervated by?
-Right and left vagus nerve
-Right and left phrenic nerve
-Anterior and posterior pulmonary plexus
-Sympathetic trunk
117
What is the main functions of the cardiovascular system?
-Transportation
-Blood=transport vehicle
-Carries oxygen, nutrients, waste, and hormones
-Movement provided by pumping of heart
118
What is the pulmonary circuit?
Circulation between the heart and lungs
119
What is the systemic circuit?
Circulation between the heart and all the body tissues
120
What are general characteristics of blood?
-Blood flows 4.5-5.5 times slower than water
-38 degrees C/ 100.4 F
-pH 7.35-7.45
-0.85-0.90% salt concentration
-About 8% of total body weight
-Females have 4-5L
-Males have 5-6L
121
What are the functions of the blood?
-Transports oxygen, carbon dioxide, nutrients, wastes, hormones, enzymes
-Regulates pH
-Prevents body fluid loss through the clotting mechanism
-Protects against toxins and foreign microbes
122
What is the general structure of arteries and veins?
-Tunica intima (innermost)
-Tunica media (middle)
-Tunica externa (outermost)
-Layers are enclosed in endothelium
123
What is the difference between the walls in arteries and veins?
The smooth muscle layers (tunica intima, media, and externa) are all much thicker in arteries than in veins
124
What are the characteristics of arteries? What is its function?
-Elastic tissue for recoil
-Muscular for distribution: regulates flow and blood to different parts of the body
-Walls contain smooth muscle fibers
125
What are arterioles? What is their function?
-Tiny branches off arteries that connect to venules through capillaries
-Major site of blood flow resistance
-Serve as reduction valves
-Narrow lumens
-Thick muscular walls
-Regulate the degree of pressure within the system
126
What are capillaries? What is their function?
-Where aterioles and venules connect
-One cell wall thick
-Tight junction
-Internal respiration takes place (gas exchange with tissue)
-Tissue nutrition
127
What are the characteristics of venules and veins?
-Venules connect with arterioles via capillaries
-Both easily distend
-Some smooth muscle for venoconstriction
-Veins in exremities have one way valves
-Low blood pressure
-Slow flow
-70% of total blood volume is in veins
-Larger lumens and thinner walls than arteries
-No elasticity
-Less smooth muscle than arteries
-More collagen than arteries
128
What is the orientation of the heart?
-Located in the middle mediastinum
-Great veins and arteries at the base
-Pointed tip is apex
129
What is the pericardium? What is its function?
-Double walled sac around the heart
-Composed of a superficial fibrous pericardium and two serous layers called parietal pericardium and visceral pericardium
-The layers are separated by fluid called the pericardial fluid
-Protects and anchors the heart
-Prevents overfilling of the heart with blood
-Allows for the heart to work in a relatively friction-free environment
130
What are the two layers of the wall of the heart?
-Epicardium (same thing as visceral pericardium)
-Myocardium
131
What is the epicardium? What layers does it have?
-Serous membrane that adheres to the outer surface of the heart
-Superficial layer: mesothelium
-Covers ordinary connective tissue
-Deeper layer- large blood vessels, more fat
-Continuous with endomysium of underlying cardiac muscle
132
What is the myocardium?
-Cardiac muscle
-Muscular and thickest part of the wall
-Lies deep to the epicardium
-Composed of cardiac muscle
133
What is the endocardium? What is its function?
-Connective tissue
-Squamous cells
-Folds to form valves
-Lines the atrial and ventricular cavities and all structures that project into the heart
-Very thin
-Has three layers
134
What is the skeleton of the heart?
Fibrous rings that separate the atria from ventricles
135
What are the major structures that are in the heart or come off the heart?
-Left common carotid
-Brachiocephalic trunk
-Superior & inferior vena cava
-Pulmonary trunk & arteries
-Right and left atria
-Right and left ventricles
-Left subclavian artery
-Pectinate muscles
-Tricuspid/right AV valve
-Chordae tendinae
-Trabeculae carneae
-Aorta
-Right and left pulmonary veins
-Mitral/bicsupid/left AV valve
-Aortic semilunar valve
-Pulmonary semilunar valve
-Papillary muscles
-Interventtricular septum
-Epicardium
-Myocardium
-Endocardium
136
What are the 4 chambers of the heart?
-Right and left atria
-Right and left ventricles
137
Where does the right atria receive blood from?
It receives deoxygenated blood from the superior and inferior vena cava
138
Where does the left atria receive blood from?
It receives oxygenated blood from the pulmonary veins
139
Where does the left ventricle receive blood from? Where does it pump blood to?
It receives oxygenated blood from the left atrium and pumps it to the aorta to the systemic circulation
140
Where does the right ventricle receive blood from? Where does it pump blood to?
It receives deoxygenated blood from the right atrium and pumps it into the pulmonary artery to the pulmonary circulation
141
What is the function of the heart valves?
They ensure unidirectional blood flow through the heart
142
What are the characteristics of the tricuspid valve?
-Right AV orifice
-Anterior, septal, and posterior cusps
-Close during ventricular contraction
143
What are the characteristics and location of the pulmonary valve?
-Located in the right ventricle that leads to the pulmonary artery
-3 semilunar cusps
144
What are the characteristics of the mitral valve?
-Left AV orifice
-Anterior and posterior cusps
-Closes during ventricular contraction
145
What are the characteristics and location of the aortic valve?
-Located in the left ventricle that leads to the aorta
-3 semilunar cusps
-Right, left, and posterior aortic sinuses
146
Where is the coronary sulcus located?
Between the right atrium and right ventricle
147
What are the coronary arteries?
-Arteries that supply blood to the heart
-Right coronary artery
-Sinu-atrial nodal branch of right coronary artery
-Left coronary artery
-Circumflex branch of left coronary artery
-Left marginal branch of circumflex branch
-Anterior interventricular branch of left coronary artery
-Diagonal branch of anterior interventricular branch
-Right marginal branch of right coronary artery
-Posterior interventricular branch of right coronary artery
148
Where does the left coronary artery branch off of? Where does the right branch off of?
-Left branches from the left aortic sinus
-Right branches from the right aortic sinus
149
What is coronary artery disease? How severe is it?
-Occlusion of a major coronary artery which leads to an inadequate oxygenation of an area of myocardium
-The severity depends on the size & location of the artery involved & whether or not the blockage is complete
150
What are the main cardiac veins?
-Coronary sinus
-Great cardiac vein
-Middle cardiac vein
-Anterior veins of right ventricles
-Posterior cardiac vein
-Right marginal vein
151
What does the cardiac conduction system do? What are the components of it?
-The musculature of the heart is capable of contracting spontaneously, so the conduction system initiates and coordinates contractions
-Sinu-atrial (SA) node
-Atrioventricular (AV) node
-Atrioventricular bundle (Bundle of His)
-Subendocardial plexus of conduction cells called Purkinje fibers
-Bachmann's bundle
152
Where is the SA node located?
Right atrium
153
Where is the AV node located?
In between the right atrium and right ventricle
154
Where is the right bundle branch located?
The right side of the interventricular septum
155
Where is the left bundle branch located?
The left side of the interventricular septum
156
Where is Bachmann's bundle located?
It is located in both the right and left atria
157
What part of the nervous system is responsible for innervating the heart? What does it regulate?
-The autonomic nervous system
-Regulates heart rate, force of each contraction, and cardiac output
158
What does the cardiac plexus consist of?
-Branches from both the parasympathetic and sympathetic systems
-Consists of a superficial part and a deep part
159
Where is the superficial part of the cardiac plexus located?
Inferior to and between the aortic arch and pulmonary trunk
160
Where is the deep part of the cardiac plexus located?
Between the aortic arch and tracheal bifurcation
161
What nerves does the superficial part of the cardiac plexus consist of?
-Cardiac nerves from sympathetic trunk
-Left vagus nerve
-Vagal cardiac branches
162
What nerves does the deep part of the cardiac plexus consist of?
-Right and left recurrent laryngeal nerve
-Right and left vagus nerve
-Vagal cardiac branches
163
How does parasympathetic input to the heart effect it?
-Decreases heart rate
-Reduces force of contraction
-Constricts the coronary arteries
164
How does sympathetic input to the heart effect it?
-Increases heart rate
-Increases the force of contraction
165
What are the visceral afferents of the heart? What is their function?
-Afferent fibers that pass through the cardiac plexus and return to the CNS
-Associated with the vagal cardiac nerves and sense alterations in blood pressure and chemistry
-Afferents associated with the sympathetic system conduct pain sensation from the heart, which is detected at the cellular level from tissue damaging events (cardiac ischemia)
166
How does the American Heart Association define heart failure?
"A heart that cannot keep up with its workload. The body may not get the oxygen it needs"
167
What can heart failure do to the myocardium?
It can weaken the myocardium which leads to less blood being pumped out of the heart
168
What is a normal ejection fraction?
50-70%
169
What is a borderline ejection fraction?
41-49%
170
What is a reduced ejection fraction?
Less than or equal to 40%
171
What are some facts about chronic heart failure in the US?
-Over 6 million people in the US have heart failure
-Expected to reach 9 million people by 2030
-High mortality
-Estimated cost is $30.7 billion each year
172
What does the urinary system consist of?
-Kidneys
-Ureters
-Urinary bladder
-Urethra
173
What are the functions of the urinary system?
-Removes metabolic waste and retains nutrients
-Regulates blood volume and blood pressure
-Regulates concentration of potassium, sodium, chloride, etc
-Helps to stabilize blood pH
174
Where are the kidneys located?
-There are 2 kidneys located on either side of the spine
-Between T12 and L3
-Left kidney is slightly superior
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How are the kidneys stabilized?
By connective tissue
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What color are the kidneys? How big are they?
-Reddish brown
-About 10 cm long
-5.5 cm wide
-3 cm thick
-Mass of 150 g
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What structures are on top of the kidneys?
Suprarenal glands
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What are the landmarks of the kidneys?
-Lateral margin
-Anterior surface
-Superior pole
-Medial margin
-Renal hilum
-Renal artery (on top of vein)
-Renal vein
-Renal pelvis
-Ureter
-Inferior pole
-Renal sinus
-Anterior and posterior lips
-Posterior surface
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What are structures that are related to the anterior surface of the right kidney?
-Right suprarenal gland
-Liver
-Descending part of duodenum
-Right colic flexure
-Small intestine
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What are structures that are related to the anterior surface of the left kidney?
-Left suprarenal gland
-Stomach
-Spleen
-Pancreas
-Left colic flexure
-Descending colon
-Jejunum
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What structures are related to the posterior surface of the kidneys?
-Ribs 11-12
-Diaphragm
-Psoas major muscle
-Quadratus lumborum muscle
-Transverse abdominis muscle
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What are the external layers of the kidneys?
-Renal fascia (outermost)
-Adipose capsule-perirenal fat (middle)
-Renal capsule- fibrous (innermost)
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What are the structures on the inside of the kidney?
-Pyramids in renal medulla
-Renal column
-Renal cortex
-Renal papilla
-Renal sinus
-Major calyx
-Minor calyx
-Renal pelvis
-Renal artery
-Renal vein
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What is the hilum of the kidney? Where is it located?
-A deep vertical slit through which renal vessels, lymphatics, and nerves enter and exit the kidney
-On the medial margin of each kidney
-Continuous with the renal sinus
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What is the renal cortex?
A continuous band of pale tissue that completely surrounds the renal medulla
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What are the renal columns?
Divide the renal medulla into discontinuous aggregations of triangular shaped tissue called pyramids
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What artery supplies the kidneys?
-A single large artery that branches off the abdominal aorta supplies each kidney
-Called the renal artery
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What is the blood flow through the nephrons?
-Segmental artery
-Arcuate artery
-Interlobular artery
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What are ureters?
Muscular tubes that transport urine from the kidneys to the bladder
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Where are the three points of constriction of the ureters? What can happen at these three points?
-1st is at ureteropelvic junction
-2nd is where the ureters cross the common iliac vessels/pelvic inlet
-3rd is where the ureters enter the wall of the bladder
-Kidney stones can become lodged at these three constrictions
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What is the bladder? Where is it located?
-Three sided pyramid shaped structure
-Holds the urine before excretion
-It has an apex, a base, a superior surface, and two inferolateral surfaces
-The most anterior element of the pelvic viscera
-It can expand into the abdominal cavity when full
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Where is the neck of the bladder located?
-Surrounds the origin of the urethra at the point where the two inferolateral surfaces and the base intersect
-The neck is the most inferior part and the most "fixed" part
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How is the neck of the bladder anchored into position?
It is anchored by a pair of tough fibromuscular bands, which connect the neck and pelvic part of the urethra to the posteroinferior aspect of each pubic bone
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What are the fibromuscular bands that hold the neck of the bladder to the pelvic bones called in females? What about in males?
-Pubovesical ligament
-Puboprostatic ligament
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What structures help to support the bladder?
-Pubovesical/puboprostatic ligament
-Perineal membrane and associated muscles
-Levator ani muscles
-Pubic bones
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Where does the urethra begin? Where does it end?
It begins at the neck of the bladder & ends with an external opening in the perineum
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How long is the urethra in females? Where does it pass through?
-It is about 4cm long
-It passes through the deep perineal pouch and perineal membrane before opening in the vestibule that lies between the labia minora
-The opening is anterior to the vaginal opening
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What are the Skene's glands? Where do they drain?
-Two small paraurethral mucous glands that are associated with the lower end of the urethra in females
-Each drains via a duct that opens onto the lateral margin of the external urethral orifice
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What are the different parts of the urethra in males?
-Preprostatic part
-Prostatic part
-Membranous part
-Spongy part
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How long is the urethra in men? Where does it pass through?
-20 cm long
-Begins at the base of the bladder
-Passes inferiorly through the prostate, through the deep perineal pouch, perineal membrane
-It then enters the root of the penis and the body of the penis
