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Anatomy Test Block III > Mediastinum and heart > Flashcards

Mediastinum and heart Flashcards

1
Q

What divides the mediastinum into superier and inferior ?

A

sternal angle of louis

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2
Q

What is within the superior mediastinum?

A

great vessels, thymus, esophagus, trachea, phrenic n., recurrent laryngeal n. thyroid.

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3
Q

What is within the interior posterior mediastinum?

A

thoracic aorta, azygos, esophagus, thoracic splanchnic, thoracic duct

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4
Q

What is within the inferiro middle mediastinum?

A

heart, pericardium, great vessels, bronchi, azygos, phrenic

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5
Q

What join in the superior mediastinum to make the superior vena cava?

A

left and right brachicephalic (inominant) veins

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6
Q

What nerve is attached to the pericardial sac as it travels down to the diaphragm?

A

phrenic n

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7
Q

How does Vagus nerve travel in the superior mediastinum?

A

the left vagus goes over the arch of the aorta - right is harder to find

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8
Q

thymus gland

A

lymphoid structure that sits behind the manubrium in children - is replaced by fat w/ aging - would see a widened superior mediastinum on xray of child

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9
Q

Where does the right recurrent (of Vagus) occur?

A

under the r. subclavian artery

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10
Q

Where does the left recurrent of vagus recur?

A

under the arch of the aorta

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11
Q

Explain how the vagus nerve branches as it travels through the mediastinum

A

The vagus nerves form a plexus around the esophagus and then branch into anterior and posterior vagal trunks

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12
Q

The anterior vagal trunk is primary from what?

A

left vagus

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13
Q

The posterior vagal trunk is primary from what?

A

right vagus

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14
Q

Anterior vagal trunk supplies?

A

parasympathetics to the foregut (stomach/liver)

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15
Q

Posterior vagal trunk supplies ?

A

mid and hind gut

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16
Q

How many pulmonary veins are there?

A

4

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17
Q

What is the organism that causes syphilis?

A

treponema palladium

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18
Q

syphillis invasion of the aortic arch

A

would damage the left recurrent laryngeal n. causing horseness b/c 1 side of vocal cords have been paralyzed; no longer happens due to discovery of penicillin

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19
Q

ligamentum arteriorsum is a remnant of what?

A

ductus arteriosus (right to left shunt of blood)

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20
Q

Explain the embryological structure ductus arteriosus.

A

the lungs werent needed as an embryo so when the heart contracted, blood would go out the pulmonary trunk straight to the aorta through ductus arteriosus. Right heart shunting blood to left side.

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21
Q

What occurs if the ductus arteriosus does not form the ligamentum arteriosum?

A

PDA - patent ductus arteriosum

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22
Q

Where is the carina located?

A

at sternal angle; it bifurcates there

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23
Q

What veins does the azygos drain?

A

intercostal veins

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24
Q

the azygos vein drains into what?

A

Right side: superior vena cava

Left: accessory hemiazygos and hemiazygos

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25
Q

Describe the splanchnic nerves in the inferior - posterior mediastinum

A

sympathetic preganglionics headed for the pre aortic ganglia in the gut

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26
Q

The thoracic duct is located where?

A

only on the LEFT

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27
Q

Thoracic duct

A

b/w descending aorta and azygos vein; starts in abdomen in cysterna chyli and is pushed into root of neck and empties into the junction of the internal jugular v and subclavian v on the LEFT

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28
Q

What all does the left thoracic duct drain?

A

all lymph drainage from lower extremeties, abdomen and pelvis (a small right duct drains the right side of head and upper extremity)

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29
Q

Greater splanchnic nerves

A

T5-T9

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30
Q

Lesser splanchnic nerves

A

T10 T11

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31
Q

Least splanchnic nerve

A

T12

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32
Q

From outside in, what are the layers of the heart?

A

fibrous pericardium, parietal layer of serous pericardium, paricardial cavity, visceral layer of serous pericardium

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33
Q

fibrous pericardium

A

dull in appearance, becomes continuous w/ the adventitia of the great vessels. has no stretch to it.

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34
Q

Serous pericardium

A

parietal layer attached to fibrous pericardium and visceral layer which is the outermost covering of the heart

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35
Q

Cardiac tamponade causes

A

blunt trauma to chest,malignancy, infection etc

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36
Q

Characteristics of cardiac tamponade

A

decreasing BP, faint heart sounds, low voltage EKG, PEA

37
Q

What causes PEA in cardiac tamponade?

A

when fluid or blood builds up around in the pericardial cavity, the fibrous pericardium won’t expand. Every time heart contracts, it lets more fluid in to the point it can no longer relax, causing normal cardiac activity but no cardiac output

38
Q

From outside to in, what are the layers of the heart itself?

A

epicardium, myocardium (heart muscle itself), endocardium

39
Q

the epicaridium aka outermost covering of the heart is also what?

A

visceral layer of serous pericardium

40
Q

endocardium

A

inside lining of the heart, continuous w/ the endothelium of vessels

41
Q

Base of heart

A

where the great vessels enter and leave

42
Q

What forms the right border of the heart?

A

right atrium

43
Q

what forms the left border of the heart?

A

left ventricle (most of it on posterior side)

44
Q

What separates the 2 ventricles?

A

interventricular groove

45
Q

What is the lateral border of the heart?

A

apex

46
Q

What separates the ventricles from the atria?

A

coronary groove

47
Q

valve from the RA to RV

A

tricuspid

48
Q

valva from the LA to LV

A

mitral/bicuspid

49
Q

What are the first 2 branches off the ascending aorta?

A

coronary arteries

50
Q

Where is the left coronary a. found?

A

b/w the aorta and left auricle

51
Q

L. coronary branches into?

A

circumflex and LAD (left anterior descending aka anterior interventricular)

52
Q

LAD continues as?

A

posterior interventricular a

53
Q

circumflex a. supplies?

A

wraps around in the coronary sulcus to supply the back side of the heart

54
Q

How do you determine if you are right or left coronary dominant?

A

if the posterior interventricular branch is made up of mainly left coronary artery branches, you are left coronary artery dominany. (most are right)

55
Q

What is the first branch of the right coronary a. ?

A

it comes off in front of aorta and branches into nodal branch which supplies the SA node

56
Q

The right coronary a. continues in the coronary sinus to then give off what branch?

A

right marginal a. which supplies the inferior surface of the heart

57
Q

What arteries anastomose at the back of the heart?

A

circumflex, LAD and right coronary

58
Q

If there was an MI in the LAD what areas of the heart would be effected?

A

anterior, septal or lateral

59
Q

If there was an MI in the right coronary a. , what would be effect?

A

inferior and posterior parts of heart; disturbance of rythm due to SA or AV node involvement

60
Q

What vein drains the front of the heart?

A

great cardiac vein

61
Q

What vein drains the back of the heart?

A

middle cardiac vein

62
Q

What vein drains the inferior surface of the heart?

A

small cardiac vein

63
Q

What are the small veins that drain the right atrium and base of the r. ventricle?

A

anterior cardiac veins

64
Q

Where do the veins of the heart come together?

A

in the coronary sinus to drain into the right atrium

65
Q

What major structures are located w/i the r. atrium?

A

SA node and AV node and fossa ovalis

66
Q

fossa ovalis was what in embryological devpt?

A

foramen ovalis

67
Q

foramen ovalis

A

didn’t need blood going from r. atrium to l. ventricle so was shunted directly from r atrium to l atrium through foramen ovalis;

68
Q

If foramen ovalis does not close when the cord is clamped, what can persist?

A

ASD - atrial septal defects; usually in fossa ovalis

69
Q

Describe the anatomy within the right ventricle

A

cusps of the AV valces are attached to chordae tenineae which are connected to papillary muscles (ant. post. and septal). when atria contract the cusps openand when ventricles contract the papillary muscles contract to prevent regurg

70
Q

rough walls in the ventricles

A

trabecula carnae

71
Q

What is the muscular bridge w/i the ventricle?

A

septomarginal trabecula (moderator band)

72
Q

fibrous skeleton

A

anchors and supports the valves; separates the atrium from ventricles; electrically isolates the atria from ventricles

73
Q

What is the intrinsic automaticity of the heart ?

A 
SA = 60 bpm
AV = 40 bpm
74
Q

What determines the HR?

A

influence of parasympathetics and sympathetics input into the SA / AV nodes

75
Q

How is the electric impulse sent from the atria to ventricle?

A

when the impulse hits the AV node (atrial side), it is sent through the fibrous skeleton to the r. and l. bundle branches and release through the purkinje fibers. (want this to happen so the impulse is from the bottom up_

76
Q

Where does the right bundle branch pass through?

A

the moderator band

77
Q

What are the characteristics of RIGHT heart failure?

keep in mind that right side is where venous return is

A
  1. decrease in ability to pump blood through lungs
  2. back up of venous return
  3. increased jugular venous distension
  4. increased dependent pedal edema
78
Q

What are the characteristics of LEFT heart failure?

A
  1. decrese in cardiac output to body
  2. results in back up of blood in lungs
  3. CHF
79
Q

cor pulmonale

A

respiratory compromise as a result of cardiac failure

80
Q

Location for auscultation of aortic valve?

A

right 2nd intercostal space by sternum

81
Q

location for auscultation of pulmonic valve?

A

left 2nd intercostal space right by sternum

82
Q

location for auscultation of mitral valve?

A

5th intercostal space

83
Q

location of auscultation of tricuspid valve?

A

around the base of the sternum

84
Q

sympathetics to heart

A

chronotropic (increase HR) and inotropic (increase force of contraction) - thus creating myocardial oxygen demand

85
Q

parasympathetics to heart

A

slow heart rate

86
Q

sympathomimetics

A

epinephrine, dopamine, meth, crack, energy drinks, adderal, psudophed

87
Q

sympatholytics

A

proanolol (beta blocker) slows heart

88
Q

parasympathomimetic

A

vagal stimulation - stimulating parasympathetics slows heart. Ex of vagal maneuvers: gag reflex, val salva, close eyes press on eye ball, mammalian diving reflex

Anatomy Test Block III (5 decks)

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