Help Me Term 2 Crash Part 3 Flashcards
The apex of the heart is mainly supplied by which artery?
Which neural structures are found in the superior mediastinum? (4)
Left recurrent laryngeal nerve
Phrenic nerve
Vagus nerve
Cardiac plexus
Which nerve functions to decrease the heart rate and force of cardiac contraction?
Vagus
Which other nerve plexus besides the pulmonary plexus has branches in the superior mediastinum?
Cardiac plexus
What’s the cardiac plexus, and formed from which nervous systems
Network of autonomic nerves and ganglia situated at the base of the heart
It is formed by cardiac branches derived from both the sympathetic and parasympathetic nervous systems
Which nerve supplies the para going to the heart?
V
Which structure functions to increase the heart rate and force of contraction?
Sympathetic trunk
What hormones are released by the sympathetic nervous system to increase HR and force of contraction?
Epinephrine and norepinephrine
Hiccups- surgical irritation of which nerve
Phrenic
Which nerve innervates fibrous and parietal serous layers of the pericardium?
Phrenic nerve
Mostly pain
Which nervous structure at the base of the heart is formed by both sympathetic and parasympathetic cardiac branches?
Cardiac plexus
Tumour infiltration of which ganglion leads to hornets
Cervicothoracic ganglion
Left common carotid cones from what?
Aortic arch
Which blood vessels drain oxygenated blood from the lungs to the left atrium?
Left pulmonary veins
Which vessels runs transversely along the posterior surface of the heart in the coronary sulcus?
Coronary sinus
Which heart Chamber comprises majority of anterior surface of the heart?
Right ventricle
On a CXR, which is the smallest and most inferior convexity of the heart on the right side?
Inferior vena cava
Apex of heart hidden by diaphragm in CXR?
Yes
Which artery runs down the anterior Interventricular sulcus to the cardiac apex where it anastomoses with the posterior interventricular artery?
Anterior interventricular artey
Left atrium = base
Ysh
Which vessels governs Veinous drainage of the heart?
Coronary sinus
The brachiocephalic trunk comes from where
Aortic arch
From which part of the aorta do the coronary arteries arise?
Ascending aorta
Guy stabbed at 5th intercostal space. Left of sternum What structure is most likely to have been injured?
Right ventricle of the heart
Which artery that runs within the atrioventricular groove supplies the posterior surface of the heart?
Right coronary artery
Which coronary artery supplies the apex? (And right ventricle)
Right marginal artery
Left marginal artery supplies what
Left ventricle
Left circumflex artery supplies what
Left atrium and ventricle
Right coronary artery supplies what
Right atrium and right ventricle
Posterior intevrnteicular artery supplies what
Right and left ventricles, and septum
Left anterior decanting artery supplies what
Right ventricle left ventricle
And interventeicular septum
Aorta develops from which part of the primitive heart tube?
Trunchs arteriosus
Bundle of his located where
Interventricular septum
Pectinate muscles vs papillary muscles
Pectinate = increase power of contraction, in agria
Papillary = in ventricles
Pre embryonic phase is what
0-3 weeks
What’s formed when several sperm surround the ovum, and a nucleus of a spark enters and fuses with the (pro) nucleus of the ovum to give:
A diploid cell called the zygote
When the zygote divides, it divides to form a
Blastocyst
When a blastocyst moved through uterine tube, where does it reach
Uterine cavity
After the zygote, a solid ball of cells called what is formed
Morula
As the morula increases in size, what’s difficult
So what happens
Getting nutrition to the central core
So blastocystic cavity develops
In morula, with a new blastocystic cavity, cells accumulate to form what
And what is the outer lining of the cell called
An inner cell mass
Outer lining of cells is called the trophoblast
Where does fertilisation actually occur?
Fallopian tube
What happens in week 2
Implantation occurs and placenta begins to develop
Where does implantation occur
In the uterine endometrial layer
(Week 2) cells that have implanted in the uterine endometrial layer (whilst placenta has started to develop)
Cells that later form the embryo, are currently what
A bilaminar disc
When do the sacs, membranes and cords to nourish human conceptus form
Week 2
Same as when placenta starts to grwo
Cells that form the outer cell mass is initially called the what
Trophoblast
What does the trophoblast become
The chorion
The trophoblast, which was the outer cell mass, ultimately forms the chorion. What does the chorion develop
Finger like processes called chorionic villi
chorionic villi do what
Help with implantation process
True or false: the chorion forms part of the placenta in due course
True
What secretes HCG, which is used to detect pregnancy?
The chorion
Which forms part of the placenta in due course
And comes from the trophoblast
How does implantation occur
With help of chorion
At 7 days the blastocyst begins to burrow in the uterine wall (endometrium)
What does HCG do
Secreted by chorion
Help maintain the decidia
What’s the decidua
Part of the endometrium deep to the implanted conceptus
The decidua has what blood vessels
Maternal
Maternal blood and urine levels of HCG increase till around what week
12 weeks
Cells of the inner cell mass, on the outskirts of the blastocyst cavity, form what
The bilaminar disc - which is 2 layers and separates the cavity
The bilaminar disc - which is 2 layers and separates the blastocystic cavity, now creates which 2 cavities
Amniotic cavity and yolk sac
The bilaminar disc - which is 2 layers and separates the blastocystic cavity, now creates 2 cavities : amniotic cavity and the yolk sac…. What are the two layers
The epiblast
The hypoblast
When were the epiblast and hypoblast created (amniotic cavity and yolk sac)
Week 2
placenta matured by when
18-20 weeks
There are two parts of the placenta:
Foetal part
Maternal part
Foetal part of placenta… what is it like
Smooth with foetal blood vessels and end of umbilical cord
What’s the maternal part of the placenta
Decidua basalis of endometrium
Rough and has maternal blood vessels
Fill in the blanks: x reached uterine cavity, y implants, outer cells form the z’s which will help implantation, # is formed and placental formation begins
Morula x
Blastocyst y
Chorionic villi z
Decidua basalis #
What 4 things happen in week 3
Gastrulation (germ layers)
Neurulation (neural tube)
Development of somites
Early development of cardio system
In imagery is it lobes or zones
Zones
CT pulmonary angiogram used why
For pulmonary embolsim
The SA node is extrinsically controlled by what
Vagus and sympathetic nerves from T1-4, via cardiac plexus
Signal-reaches epi or Endo first?
Reached epi last, Endo first
Auscultate aortic valve where
Upper right sternal border at level of 2nd right intercostal space
Auscultate pulmonary valve where
Upper left sternal border at level of 2nd left intercostal space
Auscultate tricuspid valve where
Lower left sternal border at the level of the 4th left intercostal space
Auscultate mitral
Apex beat
Mid clavicular, 5th
What lines heart chambers
Endocardium
Myocardium is the thick middle layer of heart wall
True
Myocardium has a rich capillary bed
True
Myocytes are connected by intercalated discs
Yes
Arteries have a thin adventitia
True
Whereas veins have a thick adventitia
Is there a tunica Adventitia in arterioles?
No
Explain layers of capillaries
Only tunica intimacy
Not media or adventurism
3 types of capillaries
Continuous
Fenestrated
Discontinuous
Example of where a fenestrated capillary might be
Kidney glands
Continuous capillary
Controls what’s exchsnged
Bone marrow has what type of capillaries
Discontinous
What type of capillary is the sinusoids
Discontinuous
What are arteriovenous shunts
They bypass capillary beds
Which has a larger lumen, arteries or veins
Veins have a larger linen
Which vein type has surrounding support from deep fascia and muscles, deep or superficial veins
Deep
What do the anchoring filaments in capillaries do
Fine collagenous filaments that link endothelial cell to surrounding tissue, keeping lumen open
5 main steps in heart development
Bilateral heart primordia
Primitive heart tube
Heart looping
Atrial and ventricular septation
Outflow septation
Two
Tube
Loops
Av sept
Out flow sept
Explain
Bilateral heart primordia
Primitive heart tube
Heart looping
Atrial and ventricular septation
Outflow septation
Two steps that occur before formation of heart tube
Formation of blood vessels
Formation of pericardium
What happens between looping of heart tube, and septation of primitive atrium and ventricles
formation of atrioventricular canal
After primitive a and v have been separated, what forms
Heart valves
When does cardiovascular system function
4th
What happens in week 3, cardiovascular system
Blood vessels (islands) first appear in the yolk sac, connecting stalk, and chorion
In week three blood vessels in lateral plate splanchnic mesoderm form what
Two heart tubes
In week 3, blood vessels in lateral plate splanchnic mesoderm form two heart tubes… these fuse and join what
Join blood vessels from other areas to form primordial cardiovascular system
After blood vessel islands form, what happens
We see formation of pericardium
How does formation of pericardium occur
Cranial folding of embryo heart tube, to lie dorsal to pericardial cavity
Parietal layer of serious pericardium and fibrous pericardium form from which mesoderm
Somatic
Visceral layer of serious pericardium forms from which mesoderm
Splanchnic mesoderm
Pericardial cavity forms from which coelom
Intra-embryonic coelom
Heart loop should loop which side
Right, so anti-clockwise
What’s dextrocardia
Where heart loops in opposite direction
The primitive atrium becomes what
L and r atria via septation
Same with ventricles
The heart partitioning in lies which two masses of tissue (5)
Endocardia cushions
Heart septae
What do the endocardia cushions do week 5
Created left and right atrioventricular canalsz
True or false: initially there is a shunt between right and left atrium
Yes- Foramen ovale
By what day has heart tube formed
Day 22
At day 22 initially… blood from yolk sac, embryo etc enters heart tube via what
Sinus venosus at caudal end
And passed out through aortic root
Folding of heart tube takes how long
6 days
So by day 28, has ventricles and atriums
Blood flow at day 28?
Into common atrium
Then atrioventricular canal, into primitive left ventricle
Then through Foramen to primitive right ventricle
And out through bulbus cordis
At week 4, endocardia cushions divide canal, appearing
Superiorly and inferiorly
The endocardia cushioninitally create
Common atrium and a common ventricle
What grows to separate atrium, and leaves what gap
What second hole appears to replace that first one
Septum primum, therefore leaving the gap: ostiuk primum, allowing blood to flow from right to left
Ostium secundum
What second wall appears after septum primum
Septum secsundum
Gaps created by primum and secundum septum is called what (acts as shunt)
Foramen ovale
After birth what happens to foramane ovale
Pressure in right greater than left, so septum secundum pushes against septum primum, closes off, leaving FOSSA OVALIS, which is an indentation
What grows up to form intervebtricukar septum
Muscular septum and also cushions as muscular part up top
Middle part of septum comes as a ‘membranous’ part
What divides the bulbis cordis and trunks arteriosus into aorta and pulmonary trunk?
Aorticopulmonary septum
It’s the bottom of the aorticopulmonary septum that fuses with the muscular ventricular septum, and endocardia cushions, to form membranous interventricukar septum and close the interventricular Foramen
Yes
Aortic I pulmonary septum divides what two parts of the primitive heart tube thingy unit the aorta and pulmonary trunk
Bulbis cordis
Trunchs arteriosus
What did the valve of the oval Foramen used to be
Original septum primum
We have two parts of the intervebtricukar septum:
Muscular portion (inferior)
Membranous portion
The most common type of CHD is what
Ventricular septal defect
Can Ventricukar septal defects just close
Yah
What type of ventricular septal defects is most coming
Membranous
When does the bulbis cordis and the Truncus arteriosus divide into aorta and pulmonary trunk
Week 5
What divides the bc and t a unit aorta and pulmonary trunk
Aorticopulmonary septum
A transposition of great vessels might occur if Aorticopulmonary septum doesn’t take a spiral course
True
In the tetralogy of fallot, exchange between systemic and pulmonary circulation is permitted
Yes
The commenest cause of cyanotic disease is what
Transposition of great vessels
The cusps, chordae tendinae and papillary muscles of the av valves develop from where
Ventricular wall
The semilunar valves are formed from where
The subendocardial valve tissue
Where are the early pacemakers
Cardiomyocytes
In primitive atrium and sinus venosus
When does the SA node develop
Week 5
When does the AV node and bundle develop from
The cells of AV canal and sinus venosus
SIDS- sudden yeah, and m cot death is related to what
Abnormalities of conducting tissue, which develop in week 5
As node from primitive atrium and sinus venosus
And Av node and bundle develop from cells of AV canal, and sinus venosus
Which arteries are the first to appear in the embryo
Right and left primitive aortae
Each primitive aortae has two parts:
Ventral and dorsal part
The aortic sac becomes an extension of the truncus arterisosus, the aortic sac is formed by fusion of what 2 ventral aortae
What arises from the aortic sac
Aortic arch brnaches
When do the aortic arches form
Week 5 and 6
How many aortic ar he’s are formed from the aortic sac
6 pairs, these unite with dorsal aortae
What happens to the 1st and 2nd aortic arches
Disappear early
3rd aortic arch becomes what
Common carotid
4th aortic arch becomes what
Right subclavian
4th left arch becomes what
Aortic arch
5th arch does what
Disappear
6th right arch forms what
Right pulmonary artery
The 6th left arch = left pulmonary artery and duct is arteriosus
Yes
Which arches disappear
1 2 5
3rd arch =
Common carotid
4th right
Right sub artery
4th left
Aortic arch
6th right
Right pulm art
Left pulm art and ductus arteriosus =
6th left arch
If in a CHD, the right subclavian artery has an abnormal origin on the left, it may construct what
Trachea and oesophagus
When does a double aortic arch occur
With non-regression of the right aortic arch, so it kinda forms a ring around the trachea and oesophagus. Which usually causes difficulty breathing and seallowinf
What’s patent ductus arteriosus associated with, what infection.
Maternal rubella infection
What causes patent ductus arteriosus?
Failure of muscular wall to contract, respiratory distress syndrome, lack of surfactant in the lungs
Where does coarctation of the aorta usually occur?
Where aorta is narrow, especially where ductus arteriosum (which becomes ligamentum arteriosum) inserts
Why might coarctation of the aorta occur?
Maybe because when ductus arteriosus contricts, part of the arch attaching to it also constricts
Vitelline vessels that supply yolk sac become what
Adult guy vessels
Umbilical vessels that supply placenta become what
Internal iliac vessels
Cardinal vessels that supply rest of the body become what
Vena cava
When does the lymphatic system develop
Sixth week
6 primary lymph sacs develop at the end of the lymphatic system
True
How many primary lymph sacs develop at the end of the lymphatic system
6
What comes first, lymphatic vessels or lymph sacs
Lymph sacs
Then vessels
Thoracic duct develops from two vessels anterior right what
The aorta
Two vessels anterior to the aorta become the left and right what
Embryonic thoracic ducts
The left embryonic thoracic duct gives rise to what
Upper third of the adult thoracic duct
Whereas the right one forms the lower 2/3s
Foetal circulation before birth: how many shunts are there
3
How did the shunt: ductus venosus work
Shunts blood in left umbilical vein, directly into the IVC
Allows oxygenated blood from placenta to bypass the liver
How did the shunt, Foramen ovale work
Shunts blood from right atrium to left, to bypass the lungs
How did the shunt ductus arteriosus work
Shunts blood from right ventricle and pulmonary arteries to the aorta
Allows blood to bypass the lunfs
Name the two shunts that allow bypass of the lungs
Foramen ovale
Ductus arteriosus
Oxygenated blood from placenta to bypass the liver- allowed by what shunt?
Ductus venosus
Umbilical arteries arise from where
The internal iliac arteries
What do the umbilical arteries do
Take arterial blood from the iliac arteries, to the placenta
Embryological aorta has what type of blood
Mixed
Placenta oxygenated blood, yes or no
Yes
Near the liver, the umbilical vein, which was in the umbilical cord, divides into what
Ductus venosus to the inferior vena cava
Hepatic portal vein to liver
Why does the blood become mixed in the inferior vena cava
Well it was deox from the lower embryological body
Then ductus venosus brought ox from placenta
The. Mixed
In embryos- the inferior vena cava is mixed, what about superior
It’s deox
Embryo: right ventricle, what after that
Pulmonary artery, then we encounter shunt of ductus arteriosus to aorta
Fetal placenta does what
Acts as kings and kidney for foetus
Oxygenated blood from placenta reaches foetal IVC via umbilical vein, mostly bypassing foetal liver.
Closure of shunts after birth:
Ductus venosus becomes
Ductus venosus becomes the ligamentum venosum of the liver
Foramen ovale becomes
Fossa ovalis
Ductus arteriosum becomes what
Ligamentum arteriosum bwtween left pulmonary artery, and the aorta
What do the umbilical arteries become
Medial umbilical ligaments of the anterior abdominal wall
Name the different components of the primitive heart tube, arterial to venous end
Aortic root
Truncus arteriosus
Bulbis cordis
Primitive ventricle
Primitive atria
Sinus venosus
Which veins drain into the sinus venosus?
Vitelline veins (drains from yolk sac)
Umbilical veins (drains from placenta)
Cardinal veins (drains from embryo body)
Parts of heart tube responsible for the formation of cardiac loop?
Primitive ventricle, and bulbis cordis
What’s dextrocardia
Apex of heart of right side of the body
What’s ectopia cordis
Congenital malformation in which the heart is abnormally located, either partially or totally outside the thorax
Closure of Foramen ovale at birth
Pressure in pulmonary heart vessels drop, so septum primum against septum secundum
When does septation of the atria and ventricles commence and complete
Between the middle of the fourth week and the end of the fifth week
The apex of the heart is supplied by which artery?
Right marginal artery
Cardiac arteries come from
Sinus venosus
Aortic arch comes from what
4th keft
Apex is where
5th left intercostal slace
What happens to functional residual capacity in a pneumothorax?
Decreases. Affected king has recoiled and thus has a smaller volume than before
The functional unit of the lung is the pulmonary alveolus
True
Only 25% of the oxygen carried by haemoglobin is used by the body at rest
Trye
A pneumothorax resulting from penetrating injury to the thoracic wall will cause intrapleural pressure to become less negative
True
Is intrapleural pressure positive or negative
Negative- less than atmospheric pressuee
Usually the left lung comprises two lobes separated by the horizontal fissure
FALSE
Oblique
Peripheral chemoreceptors mediate hypercapnia of high altitude
Yeah
An increase in CO2 in the blood = what to affinity
Decreases oxygen and haemoglobin affinity
The volume which can be flexible exhaled in one second is greater than 70% in a healthy adult
True dat
Chronic bronchitis need spirometry for diagnosis
Doesn’t require
It’s clinical diagnosis
‘One’ is a steroid
Yes
Fluticasone is worse than beclomethasone
Trye
RATE of decline if FEV1 can be changed
Yes
In chronic bronchitis, new goblet cells can appear in small airways
True
And more in large
