S1_L4: Large Vessels and Clinical Notes

Question 1

The dilatation (aneurysm) of the aorta showing as a pulsatile swelling in the suprasternal notch. It is caused by narrowing of aorta just proximal, opposite or distal to the attachment of the ligamentum arteriosum, its most common site.

Answer 1

Coarctation of the aorta

Question 2

The sign of coarctation of the aorta is decreased pulse in the ___ artery of both limbs.
Collaterals develop with dilatation of the intercostal arteries, internal thoracic, and subclavian arteries as a form of compensation.

Answer 2

femoral

Question 3

Determine the corresponding descriptions of the congenital heart diseases

1. Most common congenital cardiac malformation
2. Foramen ovale fails to close
3. Distal part of the aortic arch connects with left pulmonary artery
4. Causes high pressure aortic blood passing to pulmonary artery producing pulmonary hypertension and hypertrophy of R ventricle
5. Membranous or fibrous part of septum fails to close
6. Blood under high pressure passes from left to right causing enlargement of right ventricle

A. Atrial septal defect
B. Ventricular septal defect
C. Patent ductus arteriosus

Answer 3

1. B
2. A
3. C
4. C
5. B
6. B

Question 4

Enumerate the components of the Tetralogy of Fallot

Answer 4

1. Stenosis (narrowing) of the pulmonary trunk
2. Large ventricular septal defect (membranous)
3. Overriding of aorta
4. Severe hypertrophy of R ventricle due to high pressure in right ventricle

Question 5

Characterized by inflammation in the valve causing the edges of the valve cusps to stick together, causing fibrous thickening then loss of flexibility and shrinkage. The heart ceases to function as an efficient pump. Narrowing (or valvular stenosis) or regurgitation (valvular incompetence) may occur.

Answer 5

Valvular heart disease

Question 6

In Rheumatic heart disease (RHD), which valve is most commonly affected?

Answer 6

Mitral valve

Question 7

Pain due to reduce or lack of blood supply to the muscles of the heart (myocardium). It is a symptom of coronary artery disease. The patient may feel pressure on chest, squeezing, heaviness or tightness, pain in arms, neck, jaw, shoulder or back. It is accompanied by dizziness, fatigue, nausea, or shortness of breath.

Answer 7

Angina / Angina pectoris

Additional: This is aggravated by exertion and relieved by rest due to narrowing of the coronary arteries leading to myocardial ischemia. Exertion causes the heart to demand more blood supply.

Question 8

Nitroglycerine is a drug for the treatment of angina pectoris. It is a vasodilator for the ___ artery.

Answer 8

coronary

Question 9

A chronic bacterial infection that can develop after you inhale droplets sprayed into the air (as from a cough or a sneeze) by somebody who is infected. It can travel to any part of the body and one of its signs/symptoms is a cough with thick, cloudy, and sometimes bloody mucus (sputum) from the lungs for more than 2 weeks.

Answer 9

Tuberculosis

Question 10

Term for TB in children

Answer 10

Primary complex

Question 11

The most common cause of emphysema and bronchogenic carcinoma is?

Answer 11

cigarette smoking

Question 12

The (1)___ provides the systemic circuit flow, while the (2)___ provides the pulmonary circuit flow in the thorax.

Answer 12

1. aorta
2. pulmonary trunk

Question 13

The main arterial trunk that delivers oxygenated blood from left ventricle to tissues of body

Answer 13

Aorta

Question 14

Determine the corresponding descriptions of the parts of the aorta

1. Its branches are the Brachiocephalic artery, Left common carotid, and Left subclavian arteries
2. Its from left ventricle (base) up to sternal angle and found in the middle mediastinum
3. Its branches are Posterior intercostal arteries, Subcostal artery, Pericardial, esophageal, and bronchial arteries, and a mediastinal branch
4. Found in superior mediastinum behind the manubrium
5. Found in posterior mediastinum and it becomes the abdominal aorta at the 12th thoracic vertebra
6. Its branches are the coronary right and left arteries

A. Ascending aorta
B. Aortic arch
C. Descending thoracic aorta
D. Abdominal aorta

Answer 14

1. B
2. A
3. C
4. B
5. C
6. A

Question 15

Refers to the 3 bulges behind the aortic valve cusp

Answer 15

sinuses of the aorta

Question 16

These make up the “nutritive” vascular system of the pulmonary tissue.

Answer 16

Bronchial arteries & veins

Question 17

The right bronchial artery arises from the ___ artery or upper left bronchial artery, while the left arises from the descending thoracic aorta.

Answer 17

3rd posterior intercostal

Question 18

This artery is found to the right of the trachea. It divides into the right common carotid and right subclavian artery behind right SC joint.

Answer 18

Brachiocephalic artery

Question 19

Bifurcation of pulmonary trunk (into R and L pulmonary arteries) occurs to the left of the midline inferior to what thoracic level/s?

Answer 19

T4-T5

(Or also occurs anteroinferior to the left of the bifurcation of the trachea)

Question 20

This is a fibrous band that used to be an open artery. It connects the bifurcation of pulmonary trunk to the aortic arch and allows blood to bypass lungs during development. It is also important during embryonic circulation when ductus arteriosus is patent.

Answer 20

Ligamentum arteriosum / Ligamentum arteriosus

Additional: This closes after birth. As the child breathes, the pressure prevents blood to go through the ductus arteriosum, thus becoming non-functioning and closes.

Question 20

Determine the corresponding descriptions of the right and left pulmonary arteries

1. Lies posterior to superior pulmonary vein
2. Longer and passes horizontal across mediastinum
3. Gives off 3 branches, a large branch to superior lobe and gives a second recurrent branch to divide and supply the middle & inferior lobes
4. Lies anterior to descending aorta
5. Lies posterior to ascending aorta, SVC, upper right pulmonary vein
6. Lies anterior to bifurcation of aorta and right main bronchus

A. Right pulmonary artery
B. Left pulmonary artery

Answer 20

1. B
2. A
3. A
4. B
5. A
6. A

Question 21

This vein pierces the central tendon opposite 8th thoracic vertebra (caval opening) and enters the lowest part of the right atrium. It receives blood from the body below the level of the diaphragm (LE, abdomen).

Answer 21

Inferior vena cava

Question 22

Determine the corresponding descriptions of the branches of the descending thoracic aorta

1. Supply the upper part of the esophagus
2. Run along lower border of the 12th rib to enter abdominal wall
3. Supply the lungs, pleura, mediastinum
4. Supply the lower 9 intercostal spaces

A. Posterior intercostal arteries
B. Subcostal artery
C. Pericardial branch
D. Esophageal branch
E. Bronchial arteries
F. Mediastinal branch

Answer 22

1. D
2. B
3. E
4. A

Question 23

A bypass is done by harvesting a segment of blood vessel and using that to circumvent a blockage in a coronary artery. What 2 blood vessels are the usual options used to make the bypass?

Answer 23

1. Great saphenous vein
   OR
2. Internal thoracic artery

Question 24

A method for treating coronary artery disease where an instrument like a balloon is placed to open / dilate the coronary artery

Answer 24

Angioplasty

Question 25

TRUE OR FALSE: Abdominal conditions in the wall or viscera, such as when the esophagus or stomach is involved, can cause chest pain.

Answer 25

True

Question 26

General degeneration and fibrosis of the myocardium that gradual cause narrowing of the coronary arteries (blockage). There is plaque formation (caused by fat) around the wall of the coronary arteries, causing coronary artery disease.

Answer 26

Atherosclerosis

Question 27

TRUE OR FALSE: The brachiocephalic and azygos veins and the superior vena cava receive blood drainage from the head, neck, upper limbs and thorax.

Answer 27

True

Question 28

The superior vena cava conveys all venous blood from head and neck and both UE. It passes down to end at the R atrium of the heart. What veins join to form the superior vena cava?

Answer 28

2 brachiocephalic veins

Question 29

The azygos vein joins the ___ part of the superior vena cava

Answer 29

posterior

Question 30

The right and left brachiocephalic vein form at the root of the neck on each side from the union of what 2 veins?

Answer 30

Subclavian and internal jugular veins Additional: Head, neck = received by internal jugular UE = received by subclavian

Question 31

On each side, 2 pulmonary veins (a superior pulmonary vein and inferior pulmonary vein) carry ___ blood from lungs back to the left atrium of heart, beginning from the hilum and passing the root of lung to drain to the left atrium.

Answer 31

oxygenated

Question 32

Determine the corresponding descriptions of the thoracic lymphatics 1. Posterior thoracic wall drains into the 2. Mediastinum drains into the 3. Receives the right jugular, right subclavian, and right bronchomediastinal trunks which drain from the right side of head and neck, right upper limb, and right side of thorax 4. Anterior thoracic wall drains into the 5. Intercostal spaces drains into the A. Anterior axillary nodes B. Internal thoracic nodes C. Posterior axillary nodes D. Bronchomediastinal trunk and thoracic duct E. Right lymphatic duct

Answer 32

1. C 2. D 3. E 4. A 5. B

Question 33

Part of the thoracic lymphatics that starts below the abdomen at the cisterna chyli and ascends and enters the thorax via the aortic opening. It receives the left jugular, left subclavian, and left bronchomediastinal lymph trunks.

Answer 33

Thoracic duct (Main)

Question 34

Most inferior part of the thoracic duct; its abdominal origin

Answer 34

cisterna chyli

Question 35

Determine the corresponding descriptions of the azygos veins 1. Formed from the union of right ascending lumbar vein and right subcostal vein, ascends the aortic opening to the right of aorta at T5 2. Joins the azygos at T7 3. Seen in the right side so it receives blood from the right side of the thoracic wall 4. Joins the azygos at T8 5. From the union of left ascending lumbar vein and left subcostal vein, enters left crus of diaphragm A. Main azygos vein B. Superior hemiazygos / Accessory hemiazygos C. Inferior hemiazygos

Answer 35

1. A 2. B 3. A 4. C 5. C

Question 36

The azygos veins join the ___ before entering the pericardium.

Answer 36

superior vena cava (posterior aspect)

Question 37

The phrenic nerve receives sensation from the peritoneum covering the (1)__ part of diaphragm, pleura pericardium, and (2)__ pleura.

Answer 37

1. central 2. mediastinal parietal

Question 38

What are the 2 major nerves supplying the thoracic cavity?

Answer 38

1. vagus nerve 2. phrenic nerve

Question 39

TRUE OR FALSE: With less alveolar walls, there is lesser gas exchange in the alveoli.

Answer 39

True In smokers, their alveoli is a single wall because the numerous walls were destroyed. Lungs are unable to recoil adequately causing incomplete expiration.

Question 40

Emphysema and pulmonary fibrosis causes loss of ___ of the lungs

Answer 40

elasticity

Question 41

Inflammation or swelling of the lining of the tracheobronchial tree (respiratory tract) that results in increased mucus production causing hoarseness, cough, and fever.

Answer 41

Bronchitis

Question 42

TRUE OR FALSE: Acute bronchitis is most often caused by cigarettes, inhaling dust or chemicals. Chronic bronchitis is usually the result of an infection in the respiratory tract, caused by a cold or flu virus, or, less often, bacteria.

Answer 42

False; interchange the causes to make the statements true

Question 43

TRUE OR FALSE: Both 1st and 2nd hand smokers can develop bronchitis, but it is more common and severe on the 1st.

Answer 43

True

Question 44

These are caused by airway hyperresponsiveness, the overreaction of the bronchi and bronchioles to various environmental and physiological stimuli.

Answer 44

Asthma attacks Additional: Treatment for asthma is to give bronchodilators (medicines or nebulize), mucolytic, and steroids (to prevent inflammation).

Question 45

The irritation to the tracheobronchial tree when a person is hypersensitive to dust or pollen, causing an allergic reaction. This results in spasms of the smooth muscles in the bronchioles reducing the diameter of bronchioles during expiration (bronchoconstriction and inflammation).

Answer 45

Bronchial Asthma

Question 46

Bronchial Asthma causes a greater difficulty in expiring than inspiring, resulting in ___. The lungs become distended and the thoracic cage becomes permanently enlarged (barrel chest) and excess mucus is present.

Answer 46

wheezing

Question 47

The most common pain due to Bronchogenic Carcinoma is located where in the body?

Answer 47

In the spine

Question 48

A highly malignant primary lung tumor that is common in male and female and between the ages of 45 and 70. It spreads / metastasizes very fast via the blood and lymphatics.

Answer 48

Bronchogenic Carcinoma This is very hard to treat because when the tumor is discovered, usually the tumor has already metastasized and is at the last stage of cancer.