S1_L3: Mediastinum and Heart Flashcards
1
Q
It divides the mediastinum into the superior and inferior mediastinum
A
Sternal angle of Louis (T4-T5)
2
Q
It is a thick movable partition that extends superiorly from the thoracic outlet and root of neck to the diaphragm inferiorly
A
Mediastinum
3
Q
Fibroserous sac enclosing the heart and roots of the great vessels that is found in the middle of the mediastinum.
A
Pericardium
4
Q
It occurs when coronary flow is suddenly reduced or stopped and cardiac muscle undergoes necrosis
A
Myocardial infarction
5
Q
Cardiac pain that occurs on exertion and relieved by rest
A
Angina pectoris
6
Q
Connection of the umbilical vein and inferior vena cava in the fetus
A
Ductus venosus
7
Q
Connection of the pulmonary artery and arch of the aorta in the fetus. Allows oxygenated blood to go to the arch of the aorta.
A
Ductus arteriosus
8
Q
Determine the corresponding descriptions of the walls of the heart
- Most superficial layer
- Lines the heart and creates the valves
- Striated muscle but is innervated by autonomics
- A layer of endothelium
- Part of the serous pericardium (visceral layer)
A. Endocardium
B. Myocardium
C. Epicardium
A
- C
- A
- B
- A
- C
9
Q
The borders of the heart are used when recognizing a radiograph of the heart. The (1)___ marks the right border, the (2)___ marks the left border, the (3)___ marks the lower/inferior border, and the (4)___ marks the apex.
A
- Right atrium
- Left auricle and left ventricle
- Right ventricle and right atrium
- Left ventricle
10
Q
The heart is a muscular organ made up of cardiac muscle. It is about the size of a (1)___ that moves with the diaphragm. It is (2)___ in shape, with its base above and apex below. It is found in the middle of the mediastinum, connected at the base to the great vessels.
A
- Fist
- Pyramidal
11
Q
Upon measuring a radiograph for the biggest horizontal diameter of the heart, it was noted that the heart is abnormally enlarged. What is this condition called?
A
Cardiomegaly
12
Q
Determine the corresponding descriptions of the surfaces of the heart.
- Has the posterior interventricular groove
- Directed downward, forward, and to the left
- Anterior surface formed by (R) atrium & ventricle, and part of (L) ventricle & auricle
- Sitting on the diaphragm, formed by right and left ventricles
- Posterior surface found opposite the apex, formed by left atrium where the 4 pulmonary veins open
A. Apex
B. Base
C. Sternocostal
D. Diaphragmatic
A
- D
- A
- C
- D
- B
13
Q
The apex of the heart is at the level of the ___ intercostal space 3.5 inches from midline midclavicular line.
A
5th
14
Q
The largest cardiac vein where venous blood of heart goes in.
A
Coronary sinus
15
Q
Determine the corresponding descriptions of the right and left coronary arteries.
- It is from left posterior aortic sinus of ascending aorta
- Larger of the two
- Supplies the atrioventricular bundle
- It is from anterior aortic sinus of ascending aorta
- Supplies the right bundle branch of AV bundle
A. Right coronary artery
B. Left coronary artery
A
- B
- B
- A
- A
- B
16
Q
Determine the corresponding descriptions of the right and left coronary arteries.
- Supplies diaphragmatic surface of left ventricle
- Supplies a small part of right ventricle
- Supplies posteroinferior third of ventricular septum
- Supplies parts of left atrium
- Supplies anterior ⅔ of ventricular septum
A. Right coronary artery
B. Left coronary artery
A
- A
- B
- A
- A
- B
17
Q
TRUE OR FALSE: The left bundle branch of the AV bundle is supplied by the right and left coronary arteries.
A
True
18
Q
Determine the corresponding descriptions of the right and left atria.
- Known as the primary pump
- Its ventral wall has rough pectinate muscle
- Receives O2-rich blood from four pulmonary veins
- On its interatrial septum, the remnant of Foramen Ovale (Fossa ovalis) is located
- One of its openings is the (L) atrioventricular orifice guarded by mitral valve
- Anatomically associated with the crista terminalis and sulcus terminalis
A. Right atrium
B. Left atrium
A
- A
- A
- B
- A
- B
- A
19
Q
A vertical groove on the outside of heart at the junction between the right atrium and auricle
A
Sulcus terminalis
The inner part of the sulcus terminalis is called the crista terminalis
20
Q
TRUE OR FALSE: The atrial portion has thick walls and is divided by the interatrial septum. The ventricular portion has thin walls and is divided by the interventricular septum.
A
False
Ventricles have thick walls, atria have thin walls
21
Q
The heart’s “electricity” (conducting system) passes through this. It is also for attachments of structures that form the valves.
A
Skeleton of the heart / 4 fibrous rings
22
Q
Enumerate the 3 branches of the arch of the aorta
A
- Brachiocephalic artery / Innominate artery
- Left common carotid artery
- Left subclavian artery
23
Q
What is the largest branch of the arch of the aorta?
A
brachiocephalic artery / innominate artery
24
Q
Where does the brachiocephalic artery divide into the right common carotid & right subclavian arteries (and occasionally thyroid ima artery)?
A
At the right sternoclavicular joint
25
What structure marks the beginning and end of the arch of the aorta, end of the ascending aorta, and beginning of descending aorta?
Sternal angle of Louis
26
Where does the aorta begin?
Left atrium
27
The inferior mediastinum is bounded anteriorly by the (1)___, posteriorly by the (2)____ thoracic vertebrae, and laterally by the pleura.
1. Body of sternum
2. Lower 8 thoracic (T5-T12)
28
At what landmark does the esophagus begin?
6th cervical vertebra / pharynx
29
Enumerate the 3 constrictions of the esophagus
1. Where the pharynx joins the upper end of esophagus
2. Where the aortic arch and left bronchus cross
3. As the esophagus passes the diaphragm
30
Determine the corresponding blood supply of the esophagus
1. Upper third
2. Middle third
3. Lower third
A. Gastric artery
B. Branches of the descending thoracic aorta
C. Inferior thyroid artery
1. C
2. B
3. A
31
At what level / landmark does the esophagus pass the diaphragm to join the stomach?
10th thoracic vertebra / Esophageal opening
32
It is a smooth and muscular organ that is tubular in shape and 10 inches long.
Esophagus
33
Determine the appropriate locations of the superior mediastinum boundaries
1. plane of thoracic outlet
2. mediastinal pleura
3. anterior surface of bodies of T1-T4 vertebrae
4. plane of sternal angle of Louis
5. manubrium of the sternum
A. Anterior
B. Posterior
C. Superior
D. Inferior
E. Lateral
1. C
2. E
3. B
4. D
5. A
34
What is the nerve supply to the diaphragm and pleura?
Phrenic nerve
35
What is the primary function of the thymus gland?
Secretes T cells / lymphocytes;
Site for development of T (thymic) lymphocytes
36
A flattened bilobed structure between the sternum and pericardium. It is an endocrine gland found in the most anterior part of the superior mediastinum. It is large in children and atrophies after puberty.
Thymus
Additional: Supplied by inferior thyroid and internal thoracic arteries
37
TRUE OR FALSE: In adults, the thymus is at the inferior part of the anterior mediastinum. In children, it is in the superior part of the anterior mediastinum.
True
38
What is the remnant of the ductus arteriosus called in adults?
Ligamentum arteriosum
39
What is the remnant of the umbilical vein called in adults?
Round ligament of liver / Ligamentum teres of liver
40
What is the remnant of the umbilical artery (within fetus) and umbilical cord (leaving fetus) called in adults?
Medial umbilical ligaments
41
What is the term for ligamentum venosum in the fetus?
Ductus venosus
42
In the fetus, what brings oxygenated blood to the liver?
Umbilical vein
43
In all of the veins in the body, what are the two veins that bring oxygenated blood?
1. Pulmonary vein
2. Umbilical vein (in fetus)
44
In the fetus, oxygenated and deoxygenated blood in the right atrium goes directly to the left atrium through what structure?
foramen ovale
45
In fetal circulation, how many % of blood bypasses the liver, going directly to the inferior vena cava?
60%
46
Determine the corresponding descriptions of the parts of the inferior mediastinum
1. Contains the thoracic part of the descending aorta
2. There is no big structure here
3. Broadest/largest part of inferior mediastinum
4. Mostly/only exists on the left side where the left pleura diverges from the midsternal line
5. Contains the heart and ascending aorta
A. Anterior mediastinum
B. Middle mediastinum
C. Posterior mediastinum
1. C
2. A
3. B
4. A
5. B
47
Determine the appropriate locations of the esophagus
1. Mediastinal pleura, azygos vein
2. Trachea, left recurrent laryngeal nerve, left principal bronchus, pericardium
3. Left subclavian artery, aortic arch, thoracic duct, mediastinal pleura
4. Bodies of thoracic vertebrae, thoracic duct, azygos vein, intercostal arteries, and descending aorta
A. Right side
B. Left side
C. Anterior
D. Posterior
1. A
2. C
3. B
4. D
48
It is bounded anteriorly by the body of the sternum, laterally by 2nd to 6th costal cartilages, and posteriorly by the T5-T8 vertebrae. It is anchored at the base where the roots are, but it is free underneath.
Pericardium
Additional: Also restricts the heart’s movement, aside from covering it, so it wouldn’t move left and right during contraction.
49
The pericardium has a pericardial cavity located between the parietal and visceral layers of the serous pericardium. It contains ___ fluid for lubrication
50 ml
50
Determine the descriptions of the components of the serous pericardium
1. Closely applied to heart itself
2. passage between serous pericardium around aorta and pulmonary trunk
3. Reflected around roots of great vessels and is continuous with visceral layer of serous pericardium
4. reflection of serous pericardium around a large vein
A. Parietal layer
B. Visceral layer
C. Oblique sinus
D. Transverse sinus
1. B
2. D
3. A
4. C
51
Determine the landmarks of the surface anatomy of the heart
1. left 4th costal cartilage
2. 3rd left costal cartilage
3. 3rd left intercostal space
4. right 4th intercostal space
A. Aortic valve
B. Pulmonary valve
C. Tricuspid valve
D. Mitral valve
1. D
2. B
3. A
4. C
52
Determine the landmarks of the auscultation anatomy of the heart
1. apex beat, 5th left ICS 9 cm from midline
2. right half of lower end of body of sternum
3. medial end of 2nd left ICS
4. medial end of 2nd right ICS
A. Aortic valve
B. Pulmonary valve
C. Tricuspid valve
D. Mitral valve
1. D
2. C
3. B
4. A
53
When do the semilunar valves (aortic and pulmonary valves) open?
Ventricular systole (contraction)
54
It is located at the wall of right atrium in upper part of sulcus terminalis. It is the pacemaker of the heart that initiates excitation of the atria
SA Node
55
In a resting adult, the normal cardiac rate is ___ beats per minutes.
70-90
NOTE: 60-100 in Intro to PT
56
The conducting system of the heart originates where specifically?
Right atrium
57
TRUE OR FALSE: The conducting system of the heart spreads excitation across the ventricle and delays excitation of the ventricles to allow time for atria to empty blood.
True
58
It is the only connection of impulse starting from atria to ventricles
AV Bundle of His
59
Determine the corresponding contents of the mediastinum
1. Descending aorta
2. Heart
3. Arch of aorta
4. Trachea
5. Thymus
A. Superior mediastinum
B. Inferior mediastinum
C. Both
1. B
2. B
3. A
4. A
5. C
60
Which brachiocephalic vein crosses the midline and joins the other brachiocephalic vein to form the superior vena cava?
Left
61
At what level/landmark does the superior vena cava enter the right atrium?
At the level of 3rd right intercostal
62
The superior vena cava receives blood from the ___ before entering pericardial sac
Azygos vein
63
Determine whether the description pertains to sympathetic or parasympathetic stimulation
1. Vasodilation of coronary arteries
2. Increase force of contraction of cardiac muscle
3. Acceleration of cardiac rate
4. Vasoconstriction of the coronary arteries
5. Reduction in cardiac rate
A. Sympathetic
B. Parasympathetic
1. A
2. A
3. A
4. B
5. B
64
Which cranial nerve is responsible for parasympathetic nerve supply to the heart?
Vagus (CN X)
65
Somatic pain is carried to the afferent fibers of the phrenic nerve, so pain in pericardium may be referred to (1)____ region of shoulder or (2)____ neck (C3,4,5)
1. Supraclavicular
2. Lateral
Additional: Phrenic nerve is responsible for feeling the pain felt by the heart
66
Determine the corresponding branches of the coronary arteries
1. Right conus artery
2. Anterior interventricular artery
3. Marginal branch of anterior ventricular branches
4. Posterior interventricular artery
5. Circumflex artery
A. Right coronary artery
B. Left coronary artery
1. A
2. B
3. A
4. A
5. B
67
Determine the corresponding areas supplied by the right coronary artery
1. AV node
2. infundibulum of right ventricle and upper part of anterior wall
3. Artery to the SA node
4. diaphragmatic surface, right & left ventricles, inferior wall, posterior of ventricle
5. supply anterior surface of right ventricle
A. Right conus artery
B. Posterior ventricular branches
C. Anterior ventricular branches
D. Septal branches
E. Atrial branches
1. D
2. A
3. E
4. B
5. C
68
Also known as the power pump
Left ventricle
69
A muscular band forming a bridge connecting the anterior papillary muscle to interventricular septum. It carries part of cardiac conduction system (right branch of AV bundle).
Moderator bands
NOTE: Not present in left ventricle
70
The right ventricle receives O2 - poor blood from right atrium through ___
tricuspid valve
71
Part of the heart with the thickest wall (3x) because it needs to pump blood for the whole body
Left ventricle
72
It lines the fibrous pericardium and coats the heart
Serous pericardium
73
Nerve supply to the fibrous pericardium and parietal layer of serous pericardium is the (1)____. Nerve supply to the visceral pericardium is the (2)____.
1. Phrenic nerve
2. Vagus nerve & sympathetic trunks
74
The fibrous pericardium is attached to the posterior of the sternum via what ligament?
sternopericardial ligament
75
In the left ventricle, the (1)___ valve guards the AV orifice while the (2)___ valve guards the aortic orifice.
1. mitral
2. aortic
76
In the right ventricle, the (1)___ valve guards the AV orifice while the (2)___ valve guards the pulmonary orifice.
1. tricuspid
2. pulmonary
77
Funnel / cone shape part towards the pulmonary orifice
infundibulum (conus)
78
The fibrous pericardium is a fibrous part of sac attached to the ___ tendon
Central
79
Cone-shaped muscle to which chordae tendinae are anchored connecting to cusps of tricuspid valve. When it contracts, it closes the tricuspid valve.
Papillary muscle
Note: The anterior papillary muscle is the largest and most constant.
80
The pulmonary valve has 3 ___ cusps formed by folds of endocardium with connective tissue enclosed. Also it has 3 dilations, or sinuses, one present in each cusp.
Semilunar
81
The following are structures that are found in the Superior
mediastinum
a. brachiocephalic vein
b. sympathetic trunk
c. descending aorta
d. A and B only
e. all
d. A and B only
82
Among the structures listed, which of the following is the
most posterior structure in the inferior mediastinum?
a. sympathetic trunk
b. pericardium (posterior surface)
c. thymus gland
d. esophagus
e. thoracic duct
a. sympathetic trunk
83
A pediatric patient was diagnosed with a mitral valve stenosis. She was referred for therapy for conditioning
exercises. You are doing an initial evaluation. Where would you best hear the mitral valve when doing your auscultation?
a. 5th left intercostal space 3.5 in from midline
b. behind the left half of the sternum opposite 4th costal
cartilage
c. right half of the lower end of the body of sternum
d. 2nd left intercostal space medial end
e. medial end of the 2nd right intercostal space
a. 5th left intercostal space 3.5 in from midline
84
True regarding the left coronary artery
a. is larger
b. supplies major parts of the heart
c. comes from the ascending aorta
d. only A and C
e. all
e. all
85
Which of this is not a branch of the right coronary artery?
a. atrial branch
b. right conus artery
c. posterior descending artery
d. anterior ventricular branch
e. circumflex branch
e. circumflex branch
86
The SA node is the pacemaker of the heart. It is found in
the wall of the right atrium.
a. statement 1 is true and 2nd is false
b. statement 1 is false and 2nd is true
c. both statements are true
d. both statements are false
c. both statements are true
87
The anterior surface of the heart is primarily formed by the
a. right atrium
b. right ventricle
c. left ventricle
d. A and B only
e. B and C only
d. A and B only
88
The conducting system of the heart receives its arterial
supply from the
a. right coronary artery
b. left coronary artery
c. Both
c. Both
89
The Fibrous Cardiac skeleton
a. are interconnected fibrous rings surrounding the AV
valves as well as aortic and pulmonary valves
b. become continuous with the atrial septum and upper part of ventricular septum
c. the effect of this fibrous skeleton is for functional separation of the atria and ventricular chambers of the heart
d. A and B only
e. all
e. all
90
Components of the intrinsic conduction system area the
following:
a. Right and left bundle branches
b. Sinoatrial node
c. Subendocardial branches
d. A and B
e. all
e. all
91
All of the following receive the blood supply primarily from
the left coronary artery except:
a. left atrium
b. left ventricle diaphragmatic surface
c. anterior of the ventricular septum
d. AV bundle
e. none
b. left ventricle diaphragmatic surface
92
Sympathetic activity in the circulatory system will cause
a. increase in heart rate
b. increase in force of contraction of heart
c. vasodilation of the coronary arteries
d. A and B only
e. All
e. All
93
Primary pump of the heart is the
a. right atrium
b. left atrium
c. right ventricle
d. left ventricle
a. right atrium
94
True regarding the semilunar valves EXCEPT:
a. have 3 cusps
b. have chordae or papillary muscles like the AV valves
c. sides of the cusps are attached to the arterial wall
d. are open during ventricular systole
e. none
b. have chordae or papillary muscles like the AV valves
95
Openings found in the right atrium
a. vena cava (superior and inferior)
b. aortic sinus for opening of the coronary artery
c. the atrioventricular opening guarded by the tricuspid valve
d. A and C only
e. all
d. A and C only
96
TRUE OR FALSE: The SA node determines the rate of contraction of the
heart.
True
97
TRUE OR FALSE: The veins that enter and drain to the chamber of the heart
do not have functioning valves.
True
98
TRUE OR FALSE: The fossa ovalis which is a remnant of the fetal foramen ovale, is found in the wall of the atrial septum at the right atria.
True
99
TRUE OR FALSE: The ductus arteriosus is a fetal artery that connects the
pulmonary vein with the aorta.
False
100
TRUE OR FALSE: There are four pulmonary veins (2 each lung) receiving
oxygenated blood coming from the lungs.
True
101
TRUE OR FALSE: The sensory supply of the serous (visceral ) pericardium is
the phrenic nerve.
False
102
TRUE OR FALSE: The AV valves open during ventricular systole.
False
103
TRUE OR FALSE: The fossa ovalis is a depression in the atrial septum of the
right atrium, that is the foramen ovale in the fetus.
True
104
TRUE OR FALSE: The base, also known as the posterior surface of the heart,
is opposite the apex.
True
105
TRUE OR FALSE: The pericardium is bounded anteriorly by the sternum and
2nd to 6th costal cartilages and posteriorly by the 5th to 8th
ribs.
True
