Gray's Notes - Thorax Flashcards
What does the aorticopulmonary septum do?
divides the truncus arteriosus and the bulbus cordis into the aorta and pulmonary trunk
what does the bulbus cordis form?
ventricle
what does the trucus arteriosus form?
aorta and pulmonary trunk
what happens below the laryngeal atresia?
airways dilate, lungs enlarge and become echogenic, diaphragm flattens (inverts), fetal as cities/hydrops develop
what is tracheal atresia commonly found with?
tracheoesophageal fistula
what is polyhydraminos? what is it associated with?
excess of amninotic fluid
associated with esophageal atresia or tracheoesophageal fistula
what is lung hypoplasia and where is it commonly found?
reduced lung volume
infants with congenital diaphragmatic hernia
what is oligohydraminos? What is commonly associated with?
decrease in amniotic fluid
associated with stunted lung development and pulmonary hypoplasia
if you have a child with transposition of the great arteries, what structure would be good to remain patent until surgery? Why?
patent ductus arteriosus
would act as a shunt between the aorta and pulmonary trunk allowing oxygenated and deoxygenated blood to mix and therefore allowing SOME oxygenated blood to reach tissues
what does superior malalignment of the sub pulmonary infandibulum cause?
stenosis of the pulmonary trunk - this leads to the tetralogy of Fallot
what is a defect in the formation of the transposition of great arteries?
aorticopulmonary septum defect
what type of defect is associated with membranous type VSD?
endocardial cushion defect
what two things are associated with Di George’s syndrome (22q11)?
Tetralogy of Fallot and truncus arteriosus
what is associated with maternal diabetes?
transposition of the great arteries
what are present in individuals with Down Syndrome (trisomy x)?
VSD, ASD
what is associated with Turner Syndrome?
coarctation of the aorta
what is associated with Marfan syndrome?
aortic atresia
what would cause the diaphragm to protrude into the thoracic cavity forming a pouch that the abdominal viscera can protude?
absence of musculature in one half of the diaphragm
what are pleuropericardial folds responsible for?
separating the pericardial cavity from the pleural cavity
what does abnormal septation of the sinus venosus lead to?
can lead to inappropriate pumlonary connections
what does the first aortic arch develop into?
maxillary a.
what does the second aortic arch develop into?
stapedeal a. and hyoid
what does the third aortic arch develop into?
common carotid
what does the fourth aortic arch develop into?
aortic arch on L and subclavian on R
what does the Left sixth aortic arch develop into? (there is no right!)
ventral - pulmonary a.
dorsal - ductus arteriosus
what does common truncus arterioles result from?
separation of the pulmonary trunk and aorta
what does common trucus arteriosus present with?
severe cyanosis and right to left shunt
when closing a VSD what should I be careful of?
don’t suture over the right bundle branch because it carries impulses from the AV node to the apex of the heart through right bundle of His
an incomplete division of the foregut into respiratory and digestive poritions or incomplete division of the tracheoesophageal septum results in what?
esophageal atresia
where is the incision made for a tracheostomy?
level of the C6 near cricoid cartilage
what structure is most likely to be damaged in a tracheostomy?
left brachiocephalic vein
when you hear S1 what is it?
closing AV valves (lub)
when you hear S2, what is it?
closing semilunar valves (dub)
what does a murmur at S2 mean?
artioventricular valve defect
what would cause murmur at S1?
trnasposition of great arteries and aortic stenosis
what does a left to right shunt mean?
oxygenated blood is mixing with deoxygenated blood and being circulated to body
what is the location of the preganglionic neural cell bodies involved in increase heart rate (sympathetics)?
lateral horn of T1 to T4
which nerves carry pain fibers from the heart to the CNS?
cardiopulmonary splancnic (or thoracic visceral) nerves
what nerves carry parasympathetic fibers to the heart?
vagus n.
what nerve carries preganglionic sympathetic fibers to the abdomen and carry afferent (sensory) for pain from the abdomen?
greater and lesser splancnic nerves
what are 2 somatic nerves that are not involved in innervating the heart or lungs?
phrenic n. and intercostal n.
what nerve is responsible for innervation of the skin on the medial surface of the upper arm?
intercostobrachial n.
which nerve transmits pain fibers radiating from pericardial friction rub (pericarditis)?
phrenic n.
why does the phrenic n. have referred pain in shoulder?
its supplied by C3, C4, C5 and those also supply the skin of the shoulder
what nerve is responsible for radiating pain to the arm during MI?
intercostobrachial n.
what do ventral rami contain and do?
have both sensory and motor fibers
also sympathetics to body wall except for rissues of the back
what do dorsal roots have and do?
somatic and visceral sensory information from the periphery
what is the pharynogoesophageal junction?
where the pharynx ends and the esophagus begin at the level of the 6th cervical vertebrae
where is the apex of the heart located (rib)?
5th intercostal space around midclavicular line
what does left dominant mean?
the LCA provides the posterior interventricular a. as a terminal branch of the coronary circumflex
what is near the opening to the IVC?
the estuchian valve is an ebryolic remnant of teh valve of the inferior NC and is not a functional valve
what is the thespian valve?
semicircular fold at the orfice of the coronary sinus
what do you want to be careful of when acessing the right atrium?
crista terminalis - a muscular ridge that provides the pathway taken by the posterior internodal pathway (of Thorel) between the sinoatrial and atrioventular nodes
where do you insert a needle for pericardiocentesis?
below the xyphoid process, or in the left 5th intercostal space in the mid clavicular line
whats another name for anterior interventrucular artery?
left anterior descending artery
what would a finger passing through the transverse pericardial sinus pass directly behind?
the great arteries - pulomary trunk and aorta - could clamp if needed
what does the onlique sinus provide access to?
IVC, posterior wall of the left atrium, right atrium and right and left pulmonary v.
where do the leads of pacemakers go to reach the right ventricle?
brachiocephalic v. superior VC RA tricuspid RV
what is mitral valve stenosis?
leads to left atrial dilation - compress the esophagus
what is the surgical anastomosis that can alleviate symptoms of portal hypertension?
splenic v. and left renal v.
what artery is repsonsible for fundic bleeding?
short gastric or dorsal gastric branches of the splenic artery
what type of hernia is most common in females?
indirect inguinal hernia
do femoral hernias occur more frequently in males or females?
females
are inguinal hernias more common in males or females?
males
are direct inguinal hernias common in males or females?
both - equal occurence
Where is the SA node located specifically in the RA?
near the opening of the superior vena cava
where is the AV node?
junction of the coronary sinus and the RA upon the right bfibrous trigone
what does the moderator band carry?
the right bundle branch of the conduction system just beneath endocardial layer
where should a chest tube be placed at the midclavicular line?
6-8
where should the chest tube be placed at teh midaxillary line?
8-10
where should the chest tube be placed paravertebral line?
10-12
what layer of lung must be anesthetized to reduce pain during apiration or chest tube placement with pleural effusion?
parietal pleura - innervated by intercostal nerve = sensitive to pain = somatic innervation
what structure is present at the right fourth costal cartilage?
horizontal fissure of the right lung
what are inversion of nipple, dimpling over overlying skin common with?
retraction of suspensatory ligaments of Cooper
where are the inferior tracheobronchial nodes (carinal nodes) located?
inferior aspect of the carina - site of bifurcation
where do the pulmonary nodes lie?
on secondary bronchi
where are bronchpulmonary nodes (hilar)
run along primary bronchi
where are superior tracheobronchial nodes
junction of bronchi and trachea
where are the paratracheal nodes
run along trachea
what nerve is responsible for the innervation of teh skin above the mons pubis?
anterior cutaneous branch of the iliohypogastric n.
what are indicative of appendicitis (2)?
mc burneys point and positive psoas test
what nerves transmit pain (visceral afferent) to the rectum?
pelvic splanchnic nerves
what supplies the parasympathetic supply to the rectum?
pelvic splanchnic n.
where does an aortic aneuyrism usually occur?
L3 and L4 below the bifurcation of teh aorta
where does most lymph drain from the breast first?
axillary nodes, more specifically to the anterior pectoral nodes
what is one of the cardinal signs of coarctation of the aorta?
notching of the ribs due to reversal of direction of blood flow through the anterior intercostal branches of the internal thoracic a.
what does the thoracic duct drain?
the entire body except the right upper quadrant
dilation of the esophagus in lower thorax can compress the thoracic duct, what would this cause?
edema of lower limb
what would a midline tumor of the thymus gland in the young cause?
compression of the left brachiocephalic vein
what is another name for cervical pleura?
cupula - dome of the pleura
what presents as a “wood like” texture in the breast?
cancer en cuirasse
where does lymph form the lower 1/3 of the esophagus drain?
to posterior mediastinual and left gastric lymph nodes
where does the middle 1/3 of the esophagus drain?
posterioer and superior mediastinal lymph nodes
where does the upper 1/3 of the esophagus drain?
deep cervical nodes
what would be compressed if there was a left deviation of trachea due to tumor in thyroid gland?
left brachiocephalic v.
what is commonly used to guide the placement of a centrla venous line?
carina!
with a patent ductus arteriosus what is the flow of blood?
blood leaves the left ventricle
intro the aorta
reshunted to left pulmonary artery
what are signs of patent ductus arteriosus?
murmur during ascultation
enlarged pulmonary a
increased atrial pressure
what are the cyanotic congenital heart defects?
transposition of great arteries common ventricle truncus arteriosus tetrology of Fallot total anomolous pulmonary return
what are the common acyanotic congenital heart defects?
ASD VSD Patent ductus arteriosus coarctation of aorta aorta valve stenosis pulmonary valve stenosis
what is the result of an incomplete division of the foregut into respiratory and digestive portions (or tracheoesophageal septum)?
esophageal atresia
what nerves carry pain fibers from the heart to the CNS? like with angina?
cardiopulmonary (thoracic visceral)
what do ventral rami contain?
sensory and motor fibers and sympathetics to teh body wall
= somatic plexus!
what provides the sensory and sympathetic supply to the areola and nipples?
anterior and lateral cutaneous branches
at what level does aorta pass through diaphragm?
T 12
what level does esophagus pass through diaphragm?
t 10
what level does IVC enter diaphragm?
T 8
injury to which conduction tissue would cause problems in both ventricles?
bundle of His
what artery supplies the upper porition of the anterior right ventricle ?
artery of the conus
its from the RCA
what resembles a thrombus in the right atrium near the opening of the IVC?
eustachian valve
where do you insert a needle for pericardial centesis?
just below xiphoid process
left ICS in the midclavicular line
what artery supplies the AV node?
branch of RCA
regurgitation through any heart valve will eventually decrease what?
systemic blood flow
what does the moderator band carry?
right bundle branch
what direction does pump handle movement increase intrathoracic capacity?
anteiror - posterior
what direction does bucket handle increase intrathoracic capacity?
medial lateral - transverse
what is the most important factor in increases the intrathoracic capacity in inspiration?
descent of the diaphragm - increase vertical dimensions
