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Q1 > mediastinum and heart exam 3 anatomy > Flashcards

mediastinum and heart exam 3 anatomy Flashcards

1
Q

contents of superior mediastinum

A

svc, brachiocephalic veins, arch of aorta, thoracic duct, trachea, esophagus, thymus, vagus nerves, left recurrent laryngeal nerve, phrenic nerves

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2
Q

what is the inferior mediastinum divided into?

A

anterior, middle, posterior

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3
Q

contents of anterior mediastinum

A

thymus, lymph nodes, fat, connective tissue

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4
Q

contents of middle mediastinum

A

heart, roots of great vessels, arch of azygos vein, main bronchi

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5
Q

contents of posterior mediastinum

A

esophagus, thoracic aorta, azygos and hemi azygos veins, thoracic duct, vagus nerves, sympathetic trunks, splanchnic nerves

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6
Q

where does bifercation of the trachea and thymus gland happen?

A

sternal angle

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7
Q

what innervates the diaphragm?

A

phrenic nerves

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8
Q

functions/characteristics of fibrous pericardium

A

tough, inelastic, limits filling capacity

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9
Q

what is the fibrous pericardium attached to ?

A

attached to central tendon of diaphragm

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10
Q

layers of serous pericardium

A

parietal and visceral layer

*visceral layer also called epicardium

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11
Q

pericardial cavity

A

-potential space between parietal and visceral layers of serous pericardium
-serous fluid

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12
Q

pericarditis

A

inflammation of the pericardial cavity

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13
Q

cardiac tamponade

A

-accumulation of fluid in pericardial cavity and can compress heart
*if over 250 mL

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14
Q

what can lead to cardiac tamponade?

A

gsw, seatbelt or airbag trauma, iv drug use, coronary rupture

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15
Q

pericardiocentesis

A

relieves excess fluid in pericardium

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16
Q

what are the 2 approaches to pericardiocentesis

A
  1. peristernal approach
    2.paraxyphoid approach
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17
Q

sympathetic trunks are in which part of the mediastinum?

A

posterior

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18
Q

where is the base of the heart when standing?

A

xyphosternal angle

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19
Q

borders of the heart

A

superior border- atria
left border- left ventricle
inferior border-right ventricle
right border-right atrium

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20
Q

where is the apex of the heart located?

A

left ventricle

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21
Q

what part of the heart is the base?

A

L atrium

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22
Q

great vessels of the heart

A

internal jugular veins, subclavian veins, brachiocephalic veins, superior vena cava, IVC, ascending aorta, arch of aorta

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23
Q

venous drainage superior to diaphragm

A

superior vena cava

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24
Q

venous drainage inferior to diaphragm

A

inferior vena cava

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25
Q

what vertebral level is the arch of the aorta located at?

A

T4/T5

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26
Q

what arteries branch from brachiocephalic trunk?

A

right subclavian artery and right common carotid artery

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27
Q

what arteries branch from aorta?

A

brachiocephalic trunk, left common carotid artery, left subclavian artery

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28
Q

transverse pericardal sinus

A

During cardiac surgery, the transverse pericardial sinus allows a surgeon to isolate the pulmonary trunk and ascending aorta and apply a temporary ligature or clamp.

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29
Q

parasympathetic innervation of the heart

A

vagus nerve

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30
Q

vagus nerve innervation tract in heart

A

pregang cb- brain
pregang fibers- dissected vagus nn
postgang cb and fibers- walls of heart

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31
Q

right vagus nerve branches off what nerve?

A

right recurrent laryngeal nerve (in root of neck, deep to right subclavian artery)

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32
Q

left vagus nerve branches off what artery?

A

left current laryngeal nerve (in mediastinum, under arch of aorta, deep to ligamentum arteriosum)

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33
Q

what would you see in a pt with an aneurysm of the aortic arch?

A

chest pain, hoarseness, recurrent laryngeal referred pain, tachycardia

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34
Q

vagus nerve plexuses

A

cardiac plexus, left and right pulmonary plexuses, esophageal plexuses

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35
Q

sympathetic innervation of the heart

A

pregang cb- lateral horn
pregang fibers:
*ventral root, spinal nerve, ventral ramus, white ramus communicans, sympathetic trunk
post gang cb-paravertebral ganglia
post gang fibers- cardiac nerves

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36
Q

what happens when ventricular walls get too thick?

A

hypertrophy, decreased chamber size, systemic hypertension

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37
Q

what is the left ventricle thicker?

A

systemic circulation pumps blood to majority of body

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38
Q

what do the coronary arteries arise from?

A

the ascending aorta

39
Q

what are the branches of the right coronary artery?

A

sinoatrial (SA) nodal branch, right marginal branch, posterior interventricular branch

40
Q

what branch of the left coronary artery is nicknamed the ‘widow maker’

A

anterior interventricular branch (LAD)

41
Q

what are the branches of the left coronary artery (LCA)

A

anterior interventricular branch, circumflex branch, left marginal branch

42
Q

what arteries can you use in a coronary bypass?

A

radial, internal thoracic, internal mammary artery

43
Q

venous drainage of heart

A

coronary sinus
*great cardiac vein
*middle cardiac vein
*small cardiac vein

44
Q

pt has ischemia in apex of heart, which vessel is likely affected?

A

LAD

45
Q

what openings are in the right atrium?

A

openings of the IVC, SVC, and coronary sinus

46
Q

tricuspid (right atrioventricular) valve

A

located in right ventricle, three cusps, opens passively during atrial contraction

47
Q

what structures are in the right atrium?

A

-right auricle with pectinate muscles
-crista terminalis
-internal septum
-fossa ovalis

48
Q

what structures are in the right ventricle?

A

-tricuspid valve
-trabeculae carnaea (aid in turbulent flow and create suction)
-papillary muscles (3)- helps close valves
-chordae tendineae
-interventricular septum
-septomarginal trabecula (moderator band)

49
Q

describe the pulmonary valve during ventricular CONTRACTION

A

it is open!
when is relaxes we get small backflow that closes the valve during ventricular RELAXATION

50
Q

what part of the heart are the openings of the pulmonary veins in?

A

left atrium

51
Q

mitral (left atrioventricular) valve

A

-two cusps
-opens passively during atrial contraction
-in left ventricle

52
Q

structures in the left ventricle

A

-trabeculae carneae
-papillary mm (2)
-chordae tendineae
-mitral valve

53
Q

where does blood in aortic sinuses flow?

A

into coronary arteries

54
Q

if chordae tendinae are pulled tight on tricuspid valve are they open or closed?

A

closed

55
Q

postnatal circulation right side*be able to diagram this out

A

ivc/svc/coronary sinus
right atrium
right ventricle
pulmonary trunk/left and right pulmonary arteries

56
Q

postnatal circulation left side

A

pulmonary veins
left atrium
left ventricle
ascending aorta/arch/thoracic aorta

57
Q

fetal circulation

A

umbilical vein
ductus venosus
IVC
right atrium

58
Q

what are the bypasses in the fetal heart?

A

foramen ovale (right to left atrium)
ductus arteriosus (pulmonary trunk to aorta)

59
Q

which fetal chamber of the heart has an increased percentage of deoxygenated blood?

A

right atrium

60
Q

what arteries are responsible for fetal circulation?

A

umbillical arteries

61
Q

in postnatal circulation blood that has just traversed the pulmonary valve has just exited which chamber?

A

the right ventricle

62
Q

during atrial contraction the pulmonary valve is…

A

closed

63
Q

during ventricular contraction the aortic valve is…

A

open

64
Q

during ventricular contraction the tricuspid valve is…

A

closed

65
Q

what are adult remnants of fetal bypasses?

A

fossa ovalis
ligamentum arteriosis

66
Q

conducting system of heart

A

SA node
AV node
AV bundle

67
Q

SA (sinoatrial) node

A

junction SVC/right atrium
sympathetics stimulate and PS inhibit

68
Q

AV (atrioventricular) node

A

interatrial septum

stimulated by atrial contraction

69
Q

AV bundle

A

*under av node
interventricular septum
right and left bundles
*moderator band

70
Q

location of esophagus

A

posterior to trachea
in super mediastinum

*lies to the right of thoracic aorta
*posterior to base of heart

71
Q

where does the esophagus pass through in the diaphragm?

A

esophageal hiatus (T10)

72
Q

where is the aortic hiatus located? (vertebral level)

A

T12

73
Q

arteries branching off of thoracic aorta

A

-bronchial artery=oxygen rich blood to tissue of lungs
-esophageal artery=blood supply of esophagus
-posterior intercostal artery (VAN)
-subcostal artery

74
Q

azygos system

A

*NO VALVES
SVC
AZYGOS VEIN
-what dumps into it:
rigth of midline, bronchial veins, esophageal veins, posterior intercostal veins, lumbar veins

75
Q

What branches off of the ayzgos vein?

A

accessory hemiazygos vein
hemiazygos vein

76
Q

what is the location of the thoracic duct?

A

lies on vertebral bodies (between azygos vein and esophagus)

77
Q

sympathetic innervation of the abdominal organs

A

greater splanchnic nerve
lesser splanchnic nerve
least splanchnic nerve

78
Q

sympathetic innervation abdominal organs tract

A

lateral horn> splanchnic nerves > prevertebral ganglia > organs

79
Q

myocardial infarction

A

sudden occlusion of artery by embolus

most common cause- insufficiency due to coronary artery atherosclerosis

*atery atherosclerosis= lipid deposits in tunica intima of coronary arteries

80
Q

coarctation of the aorta

A

arch or descending aorta has abnormal narrowing, or stenosis

81
Q

atrial and ventricular septal defects

A

ASD- incomplete closure of foramen ovale
VSD- embryologic origin

82
Q
  1. The sternocostal surface of the heart is formed primarily by the anterior wall of which heart chamber?
A

Right ventricle

83
Q
  1. A patient involved in an automobile accident presents with a sharp object puncture of the middle of the sternum at about the level of the 4th or 5th costal cartilage. If the object also penetrated pericardium and heart wall, which heart chamber would most likely be damaged?
A

Right ventricle

84
Q
  1. Blockage of which of the following arteries would lead to ischemia of the apex of the heart?
A

Anterior interventricular (descending)

85
Q

Which valves would be open during ventricular systole?

A

Aortic and pulmonary

86
Q

Which statement is true of the right atrioventricular valve?

A

It is open during ventricular diastole

87
Q

During fetal life and sometimes persisting into the adult there is an opening between the right and left atria; this opening is called the:

A

Foremen ovale

88
Q

Which heart valve has leaflets described as “anterior, left and right”?

A

Pulmonary

89
Q

The sound associated with tricuspid stenosis (narrowing) in a
40-year-old male would be best heard at which location on the anterior chest wall?

A

Left4-5th intercostal space near sternum

90
Q

Blockage of blood flow in the proximal part of the anterior interventricular artery could deprive a large area of heart tissue of blood supply, unless a substantial retrograde flow into this artery develops via an important anastomosis with which other artery?

A

Posterior interventricular

91
Q

Which structure does NOT lie in the coronary sulcus?

A

Right bronchial artery

92
Q
  1. Elevated systolic blood pressure in the right ventricle suggests stenosis of which valve?
A

Pulmonary

93
Q

While attempting to suture the distal end of a coronary bypass onto the anterior interventricular artery, the surgeon accidentally passed the needle through the adjacent vein. Which vein was damaged?

A

Great cardiac vein

Q1 (15 decks)

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