main shit for test 4 Flashcards
draw arteries map
see sheet
MEDIASTINUM-Superior
Mnemonic: BATS & TENT B: Brachiocephalic veins A: Aortic Arch T: Thymus S: Superior vena cava & T: Trachea E: Esophagus N: Nerves Vagus Phrenic L. recurrent laryngeal T: Thoracic duct
Mediastinum-Inferior
Anterior Compartment
Mnemonic: LIT
L: Lymph nodes
I: Int. Thoracic vessels
T: Thymus (lower portion)
Mediastinum-Inferior
Middle Compartment
Mnemonic: (It's a) TRAHP T: Trachea (bifurcation and mainstem bronchi) R: Roots of great vessels 1. Superior/inferior vena cava 2. Pulmonary veins 3. Ascending aorta 4. Pulmonary trunk A: Arch of azygous vein H: Heart, coronary vessels, & pericardium P: Phrenic nerve
Mediastinum-Inferior
Posterior Compartment
Mnemonic: (I) L(o)V(e) DATES L: Lymph nodes V: Vagus nerve D: Descending aorta A: Azygous and hemizygous veins T: Thoracic duct E: Esophagus S: Splanchnic nerves (greater, lesser, and least)
4 Quadrants of abdomen
Upper Right
Liver
Upper Left
Spleen
Lower Right
Appendix, ascending colon
Lower Left
Descending colon, sigmoid colon, rectum
Conducting system
SA node- depolarizes spontaneously, and when it does it sends an electric signal to heart to contract. It is called the pace maker. Usually 60-100 times a minute hence normal heart rate. In right atrium
AV node- found in the floor of the right atrium, picks up electrical impulse from SA node and sends it to muscular fibers called bundle of his
Bundle of his- runs in the inter ventricular septum (wall that separates left and right ventricle) where it branches where it turns into two in the left ventricle branches (anteriosuperior left bundle branch and posterior left bundle branch) and one right ventricle branch (right bundle branch)
the bundle branches have perkinje fibers that come off of them. these fingerlike structures deliver the electrical impulse into the myocardium where it then contracts. This is mechanical contraction where it can then be pumped out to the lungs
Tricuspid valve
Found where in heart?
Best heard where?
Cusps?
Between R. atrium and R. ventricle
Best heard at L. 5th interspace
Cusps:
Anterior
Posterior
Medial
Bicuspid (mitral) valve
- Between what in the heart?
- Best heard where?
- Cusps?
Between L ventricle and L atrium
Best heard at L. 5th interspace - midclavicular line
Cusps:
Anterior
Posterior
Pulmonic (R. semilunar) valve
- Found between?
- Best heard where?
- Cusps?
Between R ventricle and Pulmonary a.
Best heard at L. 2nd interpsace
Cusps:
Left
Right
Anterior
Aortic (L. Semilunar) valve
Between?
Best heard where?
Cusps?
Between L. ventricle and aorta
Best heard at R. 2nd interspace
Cusps
Left
Right
Posterior
R atrium features
Fossa ovalis (btwn right and left atrium) Coronary sinus (where veins come together) SVC and IVC opening
R ventricle features
Conus arteriosus
what is the most posterior chamber of the heart?
the left atrium
left atrium features
Left AV orifice
Openings of pulmonary veins
Valve of foramen ovale
L ventricle features
thickest myocardium
Left AV orifice
blood flow of heart
superior vena cava receives blood from head, neck, upper limbs, and chest.
The inferior vena cava receives blood from the trunk, viscera, and lower limbs
both vena cava’s drain into the right atrium
- blood goes from right atrium to right ventricle through the tricuspid valve
- blood exits right ventricle through the pulmonary (R. Semilunar) valve and enters the pulmonary artery
- the pulmonary artery splits into left and right pulmonary arteries and goto each respective lung
- in the lungs gas exchange occurs. the lungs discard CO2 and pick up O2
- the blood comes back to heart via pulmonary veins and enters the left atrium
- the blood goes from the left atrium through the mitral/ bicuspid valve into the left ventricle
- the blood exits the left ventricle through the aortic (L. semilunar) valve into the aortic arch
- the aorta distributes blood to the body
What heart valves are open during diastole?
your mitral and tricuspid valves, blood is pouring through the atria into the ventricles
What heart valves are open during systole?
your pulmonic and aortic valves, because your heart is contracting. mitral and tricuspid must be closed to create pressure
blood flow with arrows
SVC/IVC → Right Atrium → Tricuspid Valve → Right Ventricle → Semilunar/Pulmonic valve → pulmonary arteries to lungs → pulmonary veins to heart → Left Atrium → Bicuspid Valve → Left Ventricle → Aortic Valve → Aorta
→ Brachiocephalic Trunk/ Left Common Carotid/ Left Subclavian/ Descending Aorta
pulmonary circulation
takes veins from the right ventricle to the lungs (right side of heart)
systemic circulation
from the left ventricle to the rest of the body (higher pressure than pulmonary)
coronary circulation purpose
to get oxygenated blood to the heart. Requires coronary (crown) arteries
coronary circulation of arteries
Left Coronary Artery: (comes off of ascending aorta, distal to aortic valve)
-Left Anterior Descending A (supplies left ventricle). → lat. left ventricular br. (secondary br) ((supplies left ventricle)
Circumflex (supplies most of left atrium) → diagonal br
Right Coronary Artery: (comes off of ascending aorta, distal to aortic valve)
Right Marginal A. (supplies the inferior surface of right ventricle)
Post. Descending A.
- Circumflex artery anastomoses with with right coronary artery
- posterior descending artery anastamoses with left anterior descending artery
Secondary Branches of Right Coronary Artery
Secondary Arterial Branches
- Br to SA node (heart attack here can require pace maker!)
- Ant. right atrial a.
Secondary Branches of Left Coronary Artery
Secondary Arterial Branches
- Posterolateral left ventricular br.
- Posterior left ventricular br.
Coronary arteries made easy
right coronary artery divides into the posterior descending artery that goes around the back and the marginal artery that is small and in the front. These arteries supply the right atrium, ventricle, and AV nodes.
the left coronary artery divides into the left anterior descending artery and the circumflex artery. These supply blood to the left atrium and the left ventricle. Specifically, the left atrium is supplied by the circumflex.
Coronary veins made easy
bring deoxygenated blood back to the right atrium through the coronary sinus
small cardiac vein from the right side of heart joins with coronary sinus and drains right ventricle
middle vein from the right ventricle joins coronary sinus
posterior vein from the left ventricle joins coronary sinus
great cardiac vein comes from the front of the heart and joins the coronary sinus
*anterior vein drains blood directly into right atrium, it does NOT join the coronary sinus
Great cardiac vein accompanies
the lateral anterior descending artery
Oblique vein
drains the atrium, joins w/ Greater Cardiac Vein and forms coronary sinus
Small cardiac vein
drains ventricles, empties into right atrium
Thebesian Veins
Blind ending
Arise from left ventricular myocardium (dump venous blood directly into left ventricle)
Drain into left ventricle (venous admixture, can never be 100% saturated O2)
bronchial veins sometimes drain into
pulmonary veins, which carry arterial blood
-so percent hemoglobin oxygen saturation is lowered
innervation of the heart
parasympathetic: vagus nerve (10)
sympathetic: T1-T3 or T4
External Intercostals:
- how many pairs?
- where do they begin and end?
- attach to sternum via?
- function
11 pairs, fibers down and forward, begin @ spine, end @ parasternal area, attach to sternum via external intercostal membrane - INHALATION
Internal Intercostals: How many pairs? Fibers orientation? Where? Action?
11 pairs
fibers down and backward,
begin @ sternum, end @ posterolateral thoracic area, attach to vertebrae via internal intercostal membrane
FORCED EXHALATION
innermost Intercostals: how many? and deep to what? Begin where? End where? Connect to spine by Action
11 pairs, deep to internal intercostals
begin @ transverse thoracia (muscle), ends @ paravertebral area
continues to spine as innermost intercostal membrane - FORCED EXHALATION
Diaphragm is innervated by?
and what does this nerve run with?
PHRENIC N.
(C3 C4 C5 KEEP THE DIAPHRAGM ALIVE)
Runs b/w subclavian a and v
Costodiaphragmatic Recess
apex of heart is covered tightly with pleura, but the pleura goes down 2 EXTRA RIB SPACE - that space is filled with fluid and allows for expansion and limits friction of lungs. This space is called the:
Pulmonary Artery carries what kind of blood
DEoxygenated
Pulmonary Vein carries what kind of blood
Oxygenated
Bronchial Arteries and Veins
1 right: off 3rd intercostal a. 2 left: off aortic arch ** run with airways ** veins run with the arteries ** empty into SUPERIOR vena cava
Each lobe of each lung is divided into
bronchopulmonary segments
Right Bronchopulmonary Segments
Right: (10)
Anterior: apical, anterior, posterior
Middle: medial, lateral
Lower: superior, medial and lateral basal, anterior and posterior basal
Left Bronchopulmoary Segments
Left: (8)
Upper lobe: anterior, apico-posterior
Lingula: superior, inferior
Lower lobe: superior, posterior basal, lateral basal, anterio-medial basal
The lingual is an extension of the
left upper lobe of lung
Trachea:
Size?
It’s unique feature?
Where does it bifurcate?
2” cervical 2” thoracic
- 20 C shaped cartilaginous rings
- bifurcates at sternal angle (~T5-T7)
Boundaries of the heart
Lateral: mediastinal pleura and lungs
Posterior: esophagus (sits b/w heart and descending aorta)
Superior: trachea and tracheal bifurcation
Inferior: diaphragm
Base of the heart location
2nd-3rd costal cartilage
Apex of heart location
cross of midclavicular line of 5th interspace
CONDUCTING SYSTEM with arrows
SA node → right atrium → AV node → Bundle of His → Anterior/Posterior Left Bundle Branches → Purkinje Fibers take depolarized current to ventricular muscle fibers to contract
LAD = Left Anterior Descending Artery =
heart attack
Quadratus Lumborum
T12, L1-L4
Psoas Major and Minor
L2-L4
Iliacus innervated by
femoral n
Rectus Abdominis Innervation
7-11 intercostal nerves
External Oblique innervation
7-11 intercostal ns., subcostal n (T12)
-hands in pocket is how they run! your hands go diagonally inward
Internal Oblique Innervation
7-11 intercostal ns, subcostal n, (T12), iliohypogastric n, ilioinguinal n.
Hesselbach’s Triangle
see pic on slideshow
Inferior Epigastric Artery and interalveolar ligament
Free edge of Rectus Abdominis
Inguinal Ligament and Lacunar Ligament
Medial = Linea Semilunaris or lateral margin of rectus sheath. Superolateral = Inferior Epigastric Vessels Inferior = Inguinal Ligament
Inguinal Canal/ Hesselbach’s Triangle Hernias
Direct: Hasselbach’s triangle
Indirect: deep inguinal ring
Ductus Deferens
Leaves deep inguinal ring LATERAL to inf. Epigastric a, crosses ext iliac vessels and ureters, enters urethra
Broad Ligament:
binds uterus laterally
Mesometrium: largest
Mesovarium: supports ovaries
Mesosalpinx: supports fallopian tubes
Homologues
Male: Female:
Testes Ovary
Prostatic Utricle Uterus
Prostate Gland Skene’s Gland (Lesser Vestibular)
Penis Clitoris
Scrotum Labia Majora
Bulbourethral Glands (Cowper) Bartholins Glands (G. Vestibular)
SEE LAST GOOGLE SLIDE IF THIS DOESN’T COME THROUGH CORRECTLY
Perineum
see diagram
Sperm Pathway
- Testes ->
- seminiferous tubercles ->
- epidydimis ->
- vas deferens ->
- ejaculatory duct ->
- urethra
Hepatic portal veins
see chart
bronchial artery supplies the
lungs
venous drainage of the lungs
bronchial veins
what supplies the heart with blood?
R & L coronary arteries
What veins drain the heart?
great, middle, small and anterior cardiac veins
Upper GI includes? And what is the artery that supplies the upper GI?
stomach, spleen, gallbladder, pancreas, duodenum, esophagus, liver
ALL SUPPLIED BY BRANCHES OF CELIAC A.
Upper GI includes? And what vein drains them?
stomach, spleen, gallbladder, pancreas, duodenum, esophagus, liver
Hepatic Portal Veins
Middle GI includes? And what is the artery that supplies the Middle GI?
pancreas, duodenum, jejunum, ileum, cecum, appendix, ascending colon, R. portion of transverse
Branches of Superior Mesenteric A.
Middle GI includes? And what is the vein that drains the Middle GI?
pancreas, duodenum, jejunum, ileum, cecum, appendix, ascending colon, R. portion of transverse
Hepatic Portal Veins
Lower GI includes? And what is the artery that supplies the Lower GI?
L portion of transverse, descending colon, sigmoid colon, rectum, and part of anal canal
Branches of Inferior Mesenteric A.
Lower GI includes? And what is the vein that drains the Lower GI?
L portion of transverse, descending colon, sigmoid colon, rectum, and part of anal canal
Hepatic Portal Veins
The artery for the anal canal?
the pudendal artery
the vein for the anal canal?
the hepatic vein
penis artery?
internal pudendal artery
penis vein?
dorsal vein
gonads (testicular or ovarian) artery and vein
gonadal arteries and dorsal veins
kidneys artery?
renal arteries
pleural effusion
fluid backup into the lungs
Subcostal innervates
T12 -MOTOR for external / internal oblique, transversus/ rectus abdominal, pyrimidalis
iliohypogastric innervates
L1
SENSORY for pubic, gluteal
MOTOR for external/ internal oblique, transversus abdominas
ilioinguinal innervates
L1
SENSORY for medial thigh and scrotum/labia
MOTOR for external/ internal oblique, transversus abdominas
Geniofemoral innervate
L1 & L2
SENSORY for femoral triangle
MOTOR for cremaster and scrotom/ labia majora
lateral femoral cutaneous innervation
L2 & L3
sensory to anterolateral thigh
Accessory Obturator (9%) innervates
L3 & L4
motor to pectinius
Obturator innervates
L2-L4
SENSORY to medial thigh
MOTOR to thigh adductors, hip/knee joint
Femoral innervates
L2-L4
SENSORY to Anteriomedial thigh and leg
MOTOR to pectinous, anterior thigh, hip/knee joint
Pudenal Nerve Innervates
S2-S4
MOTOR anal & urethral sphincter, pelvic diaphragm
bulbospongiosus, ischiocavernosus
SENSORY to penis/clitorus
Inferior Rectal and Perineal Branches of Pudenal N innervate
S2-S4
scrotum, labia, perineal muscles
Pelvic Splacnic N innervates
S2-S4
parasympathetic pelvis and colon
sacral splanchnic nerve arises from sympathetic chain
appendages of large intestine?
Teniae Coli
Haustra
Mental (epiploic)
Organ at left colic flexure, where transverse colon becomes descending colon
spleen
Organ at right colic flexure, where ascending colon becomes transverse colon
liver (hepatic)
Blood supply to end of transverse colon to all distal GI features?
Inferior Mesenteric Artery
3 parts of small intestine superior to inferior
duodenum, jejunum, ileum
vessel overlying the suprarenal gland on the right side of body
inferior vena cava
Nerve passing through esophageal hiatus
vagus
Nerve on the medial border of psoas major
obturator nerve
nerve on the lateral border of psoas major
femoral nerve
nerve that pierces psoas major
genitofemoral N
Superficial fatty abdominal fascia
campers fascia
membranous abdominal fascia (under campers)
scarpas fascia
splenic vein and superior mesenteric vein drain into
hepatic portal vein
Organ palpable below right intercostal margin, indicates cancer metastasis
Liver
Organ in fossa on liver, behind 9th costal cartilage
Gallbladder
parts of stomach
cardia, fundus, pylorus, body
Retroperitoneal structures
suprarenal aorta duodenum pancreas ureters colon kidneys esophagus rectum
pancreatic tumor most likely to cause jaundice
pancreatic head
Nutcracker effect vessel that crosses 3rd part of duodenum
superior mesenteric artery
pleural effusion (fluid) accumulates here
costodiaphragmatic recess
Has a horizontal fissure and three lobes?
right lung
Has cardiac notch and 2 lobes?
left lung
Most common place for a foreign body airway obstruction (wider, shorter, more verticle)?
right mainstem bronchis
What helps prevent stuff from going down left bronchus?
Carina
Horizontal vessel across the mediastinum
left brachiocephalic vein
part of sternum broken during CPR
xiphoid
True Ribs
1-7
Individually attach to costal cartilage
False Ribs
8-10
attached as a group to costal cartilage
Floating Ribs
11-12
No attachment to costal cartilage
Order of intercostal vessels under the rib?
VAN
Vein, Artery, Nerve
-these are right under a rib so you always want to put a needle directly over a rib
Muscle that raises ribs for inspriation
External Intercostals
Muscles that depresses ribs for exhalation
Internal Intercostals
Inspiration and expiration is active or passive?
inspiration = active expiration = passive
Thymus, lymph nodes are in which part of mediastinum?
anterior
heart, SVC, phrenic nerve are in what part of mediastinum?
middle
descending aorta, esophagus, thoracic duct, azygos vein are in what part of mediastinum?
posterior
Beginning of thoracic duct?
Cisterna Chyli
Base of the heart location
3rd costal cartilage
Apex of the heart location
Midclavicular, 5th intercostal space
Valve at the opening of coronary sinus
thebesian valve
valve at the opening of IVC
Eustachian valve
thick myocardium, pumps blood to body
left ventricle
thin myocardium, conus arteriosus, moderator band, septal band, pumps blood to lungs
right ventricle
Remnant of ductus arteriosus
ligamentum arteriosum
Heart valve at the right second intercostal space sternal border
Aortic
“all physicians take money”
Heart valve at the left 2nd intercostal space sternal border
Pulmonic
“all physicians take money”
Heart valve heard at the left 4th intercostal space sternal border
Tricuspid
“all physicians take money”
Heart valve heard at the left 5th intercostal space midclavicular
Mitral
“all physicians take money”
Erbs point is best for listening to
murmurs
“Widowmaker”, supplies inter ventricular septum, branch of left coronary artery
Left Anterior Descending Artery
Male sterilization, vasectomy ligature of what structure
Ductus Deferens (Vas Deferens)
Line denoting inner from outer GI tract
pectinate line
Kegal exercises strengthen this muscle, urinary incontinence post childbirth
puborectalis (part of levator ani)
damage to this nerve causes bowel / bladder incontinence, erectile dysfunction
pudenal
nerve for pudenal:
“S2-S4 Keeps pee, poo, and penis off the floor”
Levator ani and coccygenous make up the
pelvic diaphragm
muscle in scrotum
dartos
raising of testicle on side of stroked thigh
cremaster reflex
ilioinguinal nerve and genital part of the genitofemoral nerves
Normal position of uterus
Anteverted and anteflexed
3 section of urethra in males
prostatic
membranous
spongy
Muscle that composes bladder walls
detrusor
gland felt on digital rectal exam
prostate
structures that produce majority of ejaculate
seminal vesicles
female structure analogous to scrotum
labia majora
inguinal hernia location (indirect hernia)
inguinal canal
location of sample taken for pap smear
uterine cervical os
uterine layer shed during menstruation
endometrium
most likely location of ectopic pregnancy
ampulla of fallopian tube
uterine artery passes over which structure (water under the bridge)
Ureter (at level of cervix)
Urethral meatus on ventral penis, defect in what tissue?
Hypospadias, corpus spongiosum
Spermatic Cord Superficial -> Deep
Skin → dartos muscle (pulls/wrinkles scrotum) → external spermatic fascia → cremaster muscle (raises scrotum, cremaster reflex) → internal spermatic fascia → processus vaginalis (covers SC) → tunica vaginalis (covers testis)
Sensory to spermatic cord
Scrotum: ilioinguinal n. (upper) and genitofemoral n- genital br (lower)
Spermatic Cord Contents
Testis Epididymis Cremaster Venous plexus (pampiniform) Testicular artery Ductus deferens Ilioinguinal n. Genitofemoral b. (genital br)
FEMALE Spermatic cord?
Ilioinguinal n.
Sensory to labia majora
Genitofemoral n.
Sensory to labia majora
Round Ligament of Uterus
(female version of spermatic cord)
Fat Pad
