Grays Review Notes Flashcards
Crista terminalis corresponds to what embryologically?
Sinus venosus (also makes vena cava & sinus venarum)
Sinus venarum
The smooth part of the right atrium that the two vena cava open up to
Describe formation of the blastocyst
Blastomere -> morula -> blastocyst, which implants at the end of the first week
Dizygotic twins are necessarily ___ chorionic, __amniotic
di-, di-
Most monozygotic twins are ..
monochorionic, diamniotic.
However, 30% are di-,di-.
Somatopleuric mesoderm is associated with ___derm and is the dorsal layer of the lateral pate mesoderm. It forms the ___ and ___.
Associated with ectoderm.
Forms bodywall and dermis.
Splanchopleuric mesoderm is associated with ___derm and is the ventral layer of the lateral plate mesoderm. Forms the __ and __.
Assocaited with endoderm
Forms the viscera and heart.
Oropharyngeal membrane forms
A septum between the primitive mouth and pharynx
What ligament would be affected in “spinal canal stenosis”?
Ligamentum flavum forms the posterior wall of the vertebral canal.
Highest point of the iliac crest
L4/L5; used in lumbar punctures
T7
Inferior angle of scapula
T12
Lowest ribs
Where is the PSIS?
S2
Vasoconstriciton is sympathetic or parasympathetic?
Sympathetic
Which ligament protects the spinal cord in herniation?
Posterior longitudinal ligament, because it spans the posterior side of the vertebral bodies and intervertebral discs
Where does the cruciform ligament of atlas attach?
It attaches to pedicles.
The T4 thoracic vertebra articulates with the head of which ribs?
Articulates with the 4th rib in its superior facet
Articulates with the 5th rib in its inferior facet.
If you crush the spinal cord at C6, what muscles are paralyzed?
All spinal nerves form C6 and below are paralyzed.
Ex) Deltoid will be paralyzed because it’s innervated by the axillary nerve from C5 & C6
Spinal nerves come out of the ___ so they get crushed in a ____.
intervertebral formen
Thus, they get crushed in hernias.
The dens articulates with the ____ of the atlas.
Anterior arch
What is the most superior intervertebral disc?
Between C2 & C3
Third occipital nerve : the medial branch of the dorsal ramus of C3. It supplies what?
Skin of the nuchal region
Suboccipital nerve lies within the suboccipital triangle and innervates those muscles.
Rectus capitis minor and major, and obliquus capitis.
Can see vertebral arch through it.
With herniations,
It’s always the second vertebra!
The aorticopulmonary septum divides the ___ and __ into the __ and ___
Divides the truncus arteriosus & bulbus cordis into the aorta & pulmonary trunk
A man has increased brachial arterial pressure, decreased femoral artery pressure, and delayed femoral pulses. Which aortic arch failed to develop normally?
The fourth, because that’s what develops into aortic arch and the right brachiocephalic & subclavian arteries.
____ does NOT have a murmur!
Tetralogy of fallot
Patient has prominent pulmonary arteries and a loud, harsh murmur.
Patent ductus arteriosis: blood leaving the left ventricle of the heart into the aorta is reshunted back into the left pulmonary artery –> murmur
At the right bundle branch, electrical impulses then travel along __ and __ in the ventricles.
moderator band and purkinje fibers
Greater & lesser splanchnic nerves carry __mpathetic, __ganglionic fibers
Sympathetic preganglionic
Cardiopulmonary splanchnic nerves (AKA thoracic visceral nerves) carry cardiac ___mpathetic _fferent fibers and ___, _fferent fibers for pain from these organs.
Sympathetic, efferent fibers to speed up heartbeat
Visceral, afferent fibers for pain
After an MI, pt has pain radiating to the left arm. What nerve is responsible?
Intercostobrachial nerve
It is the lateral cutaneous branch of the second intercostal nerves; it serves a cutaneous function in both the thoracic wall and medial aspect of the arm.
After detecting pericarditis by pericardial friction rub, pt has pain radiating to shoulder. What nerve is responsible?
The phrenic nerve innervates the pericardium, but C3-C5 also supplies the skin of the shoulder area.
Cutaneous branches of the __ intercostal nerves provide sensory and sympathetic supply to the areolae and nipples
4th
Where to auscultate the mitral valve? If you hear pulsations in this area, what’s responsible?
Left 5th intercostal space (below left nipple)
Also where the apex is, if you feel pulsations.
Where to auscultate the aortic valve?
Right 2nd intercostal space
Where to auscultate the pulmonary valve?
Left 2nd intercostal space
Where to auscultate the tricuspid valve?
Left 5th intercostal space (like mitral), but much more medial.
What valve is most intimately associated with the inter ventricular septum?
Tricuspid valve because of the moderator band.
What does a splitting S2 sound indicate?
Aortic & pulmonary valves aren’t closing simultaneously
While the different bundle branches affect the ventricles separately, injuring ____ would affect both branches.
Bundle of His: arises from the AV node and passes through the right fibrous trigone (connects mitral, tricuspid, and aortic valve), then splits into right and left bundle branches at the upper portion of the IV septum
Where is the AV node? What is it?
A group of specialized cardiac muscle cells that decrease the conduction rate to the ventricles; deep in the septal wall of the right atrium.
Which part of the heart is most likely to be compressed due to cardiac tamponade?
Right atrium because it has the lowest pressure
The internodal pathway that connects the SA to the AV node lies in the ___
crista terminalis, which is also the origin of pectinate muscles
How can mitral valve stenosis cause compression of the esophagus?
It causes the left atrium to dilate.
The moderator band carries the ___ bundle branch
Right
The SA node, the primary pacemaker, is where?
near the opening of the SVC into the right atrium; upper end of crista terminalis
the AV node is at __
The junction of the coronary sinus and the right atrium upon the right fibrous trigone
Where to auscultate the lower lobe of the right lung?
6th intercostal space, midaxillary line
Pericardiocentesis is usually done through the infrasternal angle, passing up through the diaphragm. If it went too far, what chamber of the heart would you hit?
The right ventricle is not only the most anterior part of the heart, but also the most diaphragmatic.
Pain from the heart is transmitted back to the cell bodies where?
Int he dorsal root ganglia of spinal nerves T1-T4, which is also the origin of the heart’s sympathetic innervation.
Path of a pacemaker
Threaded through the subclavian vein > SVC > right atrium > right ventricle > stimulate the Purkinje fibers
Peau d’orange
Blockage of cutaneous lymphatic vessels results in edema of the skin surrounding hear follicles.
If the sympathetic fibers of T1 to T4 loss their myelin, what happens?
Heartbeat slows.
Because SA node isn’t receiving this sympathetic preganglionic fibers from T1 to T4.
In terms of pain,
Parietal pleura is innervated by _____.
Visceral pleura is innervated by ____.
Parietal pleura - somatic afferents from intercostal nerves
Visceral pleura - visceral afferents from phrenic nerve
In terms of heart pain,
Parietal layer of serous pericardium & the fibrous pericardium are supplied by _____.
Visceral layer of the serous pericardium is supplied by ___.
Parietal & fibrous pericardium - phrenic nerve
Visceral pericardium - vagus nerve
What intercostal space marks the lingula on the left lung and the fissure between the upper& middle of the right lung?
3/4th intercostal
What supplies blood to the lungs?
Superior bronchial artery (branches off aorta, so this is systemic pressure)
___ bronchiole is where you start seeing alveoli, but ___ bronchiole is the last part that’s covered in alveoli.
Respiratory bronchiole
Terminal bronchiole
_____ connect alveoli so that air that gets in can also get out
Pores of kohn
Oxygenated air you breathe in and deoxygenated pulmonary arterial blood travel together down teh airway as a ____. Once they perform gas exchange at the alveoli, oxygenated blood now leaves and travels up the ___ to enter the pulmonary veins back to the heart.
Travel down together as bronchovascular bundle
Travel up septa
Where to auscultate the apex of the right or left lung?
Above the clavicle
Where to auscultate the middle lobe/lingula
Nipple
Where to auscultate the inferior lobe
Anterior to the axilla in the 7th intercostal space
Where to auscultate the superior lobe
2/3rd intercostal
