Thorax and cardiovascular system Flashcards
1
Q
What is the function of the thorax?
A
- protection
- support
- conduit
- breathing
- pumping blood
2
Q
What encircles the thoracic contents and provides a stable thorax cage?
A
sternum
ribs (12)
thoracic vertebrae (12)
3
Q
What does the thorax protect?
A
visceral structures of the thorax and offers some protection for the abdominal viscera, including the liver, gallbladder, stomach. spleen, and the adrenal glands on both kidneys
4
Q
What does the thoracic skeleton form?
A
the osteocartilaginous thoracic cage
5
Q
What does the thoracic skeleton inlcude?
A
12 pairs of ribs and costal cartilages
12 thoracic vertebrae and IV discs
sternum
6
Q
What forms the anterior continuation of the ribs, providing a flexible attachment at their articulation with the sternum?
A
costal cartilage
7
Q
What is separated by the intercostal spaces?
A
ribs and their cartilages
8
Q
What can be found in the intercostal spaces?
A
intercostal muscle, vessels, and nerves
9
Q
What is inflammation of the costal cartilage called?
A
costochondritis
10
Q
What are the curved, flat bones that form most of the thoracic cage, are light in weight but highly resilient?
A
the ribs
11
Q
Each rib has a spongy interior containing what?
A
bone marrow
12
Q
What does the bone marrow in each rib form?
A
blood cells (hematopoietic tissue)
13
Q
What are the three classes of ribs?
A
true (vertebrosternal) ribs
false (vertebrochondral) ribs
floating (free) ribs
14
Q
Which ribs are attached directly to the sternum anteriorly through their own costal cartilages?
A
true ribs
15
Q
Which ribs are considered true ribs?
A
ribs 1-7
16
Q
Which ribs have cartilages on their anterior ends that are joined to the cartilage of the rib just superior to them; thus, there connection with the sternum is indirect?
A
false ribs
17
Q
Which ribs are considered false ribs?
A
ribs 8-10
17
Q
Which ribs have rudimentary cartilages on their anterior ends that do not connect even indirectly with the sternum; instead, they end in the posterior abdominal musculature?
A
floating ribs
18
Q
Which ribs are considered floating ribs?
A
ribs 11 and 12; sometimes the 10th
19
Q
When a few ribs in a row are broken or out of place, what can it cause?
A
flail chest
20
Q
Which ribs are considered “typical ribs”?
A
ribs 3-9
21
Q
Typical ribs have what parts?
A
-head of rib
-facet that articulates with body of numerically corresponding vertebrae
-facet that articulates with superior vertebrae
-neck of the rib
-tubercle of the rib
-body of the rib
-costal groove
22
Q
What protects the intercostal nerve and vessels?
A
costal groove
23
Q
Which ribs are considered atypical?
A
ribs 1, 2, and 10-12
24
Which rib is the shortest?
1st rib
25
Which ribs are short and have no neck or tubercles?
ribs 11 and 12
26
What prolongs the ribs anteriorly and contribute to the elasticity of the thoracic wall?
costal cartilage
27
What is the flat, vertically elongated bone that forms the middle of the anterior part of the thoracic cage?
sternum
28
What are the different parts of the sternum?
manubrium
body
xiphoid process
29
What is the name of the superior part of the sternum?
manubrium
30
What levels of the vertebral bodies can you find the manubrium?
T3 and T4
31
The manubrium and body of the sternum lie in slightly different planes, forming a projecting ______
sternal angle
32
The sternal angle is located opposite to the second pair of costal cartilages at the level of the IV disc between which vertebrae?
T4 and T5
33
What level can you find the body of the sternum?
T5-T9
34
What is longer, narrower, and thinner than the manubrium & its width varies because of the scalloping of its lateral borders by the costal notches?
body of the sternum
35
What level can you find the xiphoid process?
T10
36
What is the smallest and most variable part of the sternum; it is relatively thin and elongated; it is cartilaginous in young people but more or less ossified in adults older than 40?
xiphoid process
37
What level can you find the xiphisternal joint?
T9
38
What is the xiphisternal joint a midline marker for?
1. superior level of the liver
2. central tendon of the diaphragm
3. inferior border of the heart
39
The thoracic cage provides muscular support, attachment, weight support for what?
upper limb (pectoral girdle)
40
What provides the anchoring attachment of many of the muscles that move and maintain the position of the upper limbs relative to the trunk?
thorax
41
What provides for a superior and inferior thoracic aperture and a central mediastinum?
thorax
42
What does the superior thoracic aperture convey?
1. large vessels
2. important nerves
3. thoracic lymphatic duct
4. trachea
5. esophagus between the neck and thorax
43
What is another name for the superior thoracic aperture?
the anatomical thoracic inlet
44
What does the inferior thoracic aperture convey?
1. IVC
2. aorta
3. esophagus
4. nerves
5. thoracic lymphatic duct between the thorax and abdominal cavity
45
What is another name for the inferior thoracic aperture?
the anatomical thoracic outlet
46
What is the mediastinum divided into?
1. superior mediastinum
2. inferior mediastinum
47
What is the midline compartment that lies above an imaginary horizontal transverse thoracic plane that passes through the manubrium of the sternum (sternal angle) and the IV discs between T4 and T5?
superior mediastinum
48
What is the midline compartment below an imaginary horizontal transverse thoracic plane that is further subdivided into an anterior, middle, and posterior mediastinum?
inferior mediastinum
49
What is contained in the superior mediastinum?
1. SVC
2. brachiocephalic veins
3. arch of the aorta
4. thoracic duct
5. trachea
6. esophagus
7. thymus
8. vagus nerves
9. left recurrent laryngeal nerve
10. phrenic nerves
50
What is contained in the anterior mediastinum?
1. remnants of the thymus
2. lymph nodes
3. fat
4. connective tissue
51
What is contained in the middle mediastinum?
1. heart
2. roots of the great vessels
3. arch of the azygos vein
4. main bronchi
52
Where is the middle mediastinum located?
boundaries of which correspond to the pericardial sac
53
What is contained in the posterior mediastinum?
1. esophagus
2. thoracic aorta
3. azygos and hemiazygos veins
4. thoracic duct
5. vagus nerves
6. sympathetic trunks
7. splanchnic nerves
54
Where is the posterior mediastinum located?
posterior to the pericardium
55
What is the functionary component of the breast?
mammary gland
56
What is the function of the mammary gland?
synthesizes, secretes, and delivers milk to the newborn
57
What do the lobules within mammary glands produce?
milk
58
What transports the milk into openings in the nipples?
lactiferous ducts
59
What is the structural support for the pectoral muscles and the mammary glands primarily provided by?
the upper 8 ribs along with their attachment to the lateral part of the sternum by way of costal cartilages
60
What is considered a modified sweat gland consisting of 15-25 lobes?
the breast
61
What is the pigmented skin surrounding the nipple?
areola
62
What attaches the breast to underlying muscle?
suspensory ligaments
63
lobules within the lobes of the breast contain what that produce milk?
glandular alveoli
64
Milk is passed into ________ and then into the ______ that open to the outside at the nipple?
lactiferous ducts, lactiferous sinuses
65
Glandular structure is underdeveloped in who?
non-nursing women
66
The arterial supply of the breast is derived from what vessels?
- medial mammary branches of perforating branches and anterior intercostal branches of the internal thoracic artery (originating from subclavian artery)
- mammary branches of lateral thoracic and thoraco-acromial arteries (branches of the axillary artery)
-posterior intercostal arteries (branches of the thoracic aorta)
67
The venous drainage of the breast is mainly to what?
axillary vein but there is some to the internal thoracic vein
68
Most lymph of the breast drains to what?
axillary lymph nodes
69
Most of the lymph of the breast first drains to what lymph nodes?
pectoral nodes
70
Some of the lymph from the lateral quadrants of the breast drains into which lymph nodes?
central nodes
71
Lymph from the medial breast quadrants drain to what?
parasternal lymph nodes or to the opposite breast
72
Lymph from the inferior breast quadrants may pass deeply to what?
abdominal lymph nodes (inferior phrenic nodes)
73
Breast lymph from the axillary nodes drains to what?
infraclavicular and supraclavicular nodes and then to the subclavian lymphatic trunk
74
Breast lymph from the parasternal nodes enters what?
bronchomediastinal trunks, which ultimately drain into the thoracic or right lymphatic duct
75
What does the thoracic duct drain?
the chest
76
What are the principal muscles of inspiration?
external intercostals and diaphragm
77
What are the active breach muscles of expiration?
internal intercostals and abdominals
78
What muscles help elevate the ribs in inspiration?
external intercostals
79
What muscles pull the ribs down in expiration?
internal intercostals
80
What is the vital organ responsible for circulating blood throughout the body by contraction of its muscular wall?
heart
81
What does the heart effectively function as?
a 2 pump system with one side devoted to circulating oxygen-poor blood, and the other circulating oxygen-rich blood
82
What are the 3 layers of the heart from superficial to deep?
1. epicardium
2. myocardium
3. endocardium
83
What is the thin external layer of the heart formed by the visceral layer of serous pericardium?
epicardium
84
What is the thick middle layer of the heart composed of cardiac muscle?
myocardium
85
What is the thin internal layer of the heart or lining membrane that also covers its valves?
endocardium
86
What is the motor system of the heart?
myocardium
87
What does the trabeculae carnae do?
prevents blood from being stuck to the wall of the heart
88
Where is the trabeculae carnae found?
only in the ventricles of the heart
89
What is the "plumbing" system of the heart?
chambers and valves
90
What receives nutrient-rich but O2-poor blood from systemic circulation?
right atrium
91
What pumps to the pulmonary circulation (pulmonary trunk)?
right ventricle
92
What receives nutrient-poor and O2-rich blood from pulmonary circulation?
left atrium
93
What pumps to systemic circulation (aorta)?
left ventricle
94
Which side of the heart will have the higher pressure?
left
95
What forms the right border of the heart and receives venous blood from the SVC, IVC and coronary sinus?
right atrium
96
Where are the pectinate muscles located?
right and left atrium
97
Where does the coronary sinus drain into?
right atrium
98
At what level is the opening of the SVC into the right atrium?
3rd costal cartilage
99
At what level is the opening of the IVC into the right atrium?
5th costal cartilage
100
What is the name of the thumbprint-sized depression in the right atrium and what is it the remnant of?
fossa ovalis
remnant of the foramen ovali
101
What forms most of the base of the heart and forms the superior part of the left border of the heart and overlaps the pulmonary trunk?
left atrium
102
How many veins enter the posterior wall of the left atrium?
4 pulmonary veins
103
What parts of your heart are at a higher risk for developing blood clots and why?
the left and right atrium because there is lower pressure that causes the blood not to move as much
104
What forms the largest part of the anterior surface of the heart, a small part of the diaphragmatic surface, and almost the entire inferior border of the heart?
right ventricle
105
Superiorly, the right ventricle tapers into what?
an arterial cone, the conus arteriosus, which leads into the pulmonary trunk
106
The inflow part of the right ventricle receives blood from what?
right atrium through the right AV (tricuspid) orifice (located at the level of the 4th and 5th intercostal spaces)
107
What connects the interventricular septum to the anterior wall of the right ventricle and carries the right branch of the atrioventricular bundle of the heart's conduction system to the anterior papillary muscle?
septomarginal trabecula (moderator band)
108
What forms the apex of the heart, nearly all of its left surface and border, and most of the diaphragmatic surface?
left ventricle
109
What performs more work, the left or right ventricle?
left ventricle
110
What are the characteristics of the trabeculae carneae in the left ventricle?
finer and more numerous than those in the right ventricle
111
What is the size comparison between the anterior and posterior papillary muscles in the left and right ventricle?
they are larger in the left ventricle than those in the right ventricle
112
What is the most important chamber of the heart?
left ventricle
113
What valve is associated with the left ventricle?
mitral (bicuspid) valve
114
How many papillary muscles are in the left and right ventricle?
2 in the left ventricle
3 in the right ventricle
115
What are the two valves on the right side of the heart?
right AV valve (tricuspid)
right semilunar valve to pulmonary circulation
116
What are the two valves on the left side of the heart?
left AV valve (bicuspid/mitral)
left semilunar valve (aortic) to systemic circulation
117
The atrioventricular valves (tricuspid, bicuspid) have what type of mechanism and what does that mean?
passive--open/close in response to pressure differences on either side of the valve (has a unidirectional flow)
118
What is the most common form of valvular abnormality?
mitral valve prolapse
119
What is mitral valve prolapse typically due to?
leaflet and chordae degeneration (myxomatous degeneration)
120
What is a connective tissue disorder characterized by thickening and elongation of the mitral leaflets and chordae and by dilation of the mitral annulus?
myxomatous degeneration
121
What can a mitral valve prolapse cause?
regurgitation
122
As ventricles contract and intraventricular pressure rises, blood is pushed up against semilunar valves, forcing them to _____
open
123
As ventricles relax and intraventricular pressure falls, blood flows back from arteries, filling the cusps of semilunar valves and forcing them to _____
close
124
What is a dense connective tissue that maintains the structural integrity of the valves of the heart?
cardiac skeleton
125
What allows the heart to go into "auto pilot"?
conducting system
effective pumping
126
What allows for frictionless movement between visceral and parietal pericardium?
serous pericardium
127
What limits the expansion of the heart during ventricular filling phase (diastole)?
fibrous pericardium
128
What is inflammation of the pericardium?
pericarditis
129
What is a double-walled fibroserous membrane that encloses the heart and the roots of the great vessels, much like the pleura encloses the lungs?
pericardium
130
What lies posterior to the body of the sternum and the 2nd to 6th costal cartilage at the level of T5-T8 vertebra?
a conical pericardial sac
131
What part of the pericardium is continuous with the central tendon of the diaphragm?
fibrous pericardium
132
The pericardial sac is influenced by the movements of the heart and great vessels, sternum, and diaphragm because the fibrous pericardium is:
1. fused with the tunica adventitia of the great vessels entering and leaving the heart
2. attached to the posterior surface of the sternum by sternopericardial ligaments
3. fused with the central tendon of the diaphragm
133
The pericardium is a relatively ________ fibrous sac
avascular
134
What does the potential space between the two layers of the pericardium normally contain?
10 to 50 mL of fluid, which is an ultrafiltrate of plasma
135
The pericardium is well innervated, so inflammation may produce what?
severe pain and trigger vagally mediated reflexes
136
What are the functions of the pericardium?
1. limits distention and facilitates interaction of the cardiac chambers
2. influences ventricular filling
3. prevents excessive torsion and displacement of the heart
4. minimizes friction with surrounding structure
5. prevents the spread of infection from contiguous structures
6. equalizes gravitational, hydrostatic, and inertial forces over the surface of the heart
7. has immunologic, vasomotor, fibrinolytic, and metabolic activities
137
The arterial supply of the pericardium is mainly from what?
pericardiacophrenic artery, a branch of the internal thoracic artery
138
What does the pericardiacophrenic artery course with to the diaphragm?
phrenic nerve
139
What are the smaller contributions of blood to the pericardium?
-musculophrenic artery
-bronchial artery
-esophageal artery
-superior phrenic arteries
-coronary arteries
140
What do the coronary arteries supply in the pericardium?
only the visceral layer of serous pericardium
141
What is the musculophrenic artery a terminal branch of?
internal thoracic artery
142
What do the bronchial, esophageal, and superior phrenic arteries come from?
thoracic aorta
143
What is the venous drainage of the pericardium?
-percardiacophrenic veins (tributaries of the brachiocephalic-or internal thoracic-veins)
-variable tributaries of the azygos venous system
144
The nerves supply of the pericardium is from what nerves?
-phrenic nerves (C3-C5)
-vagus nerve (CN X)
-sympathetic trunks
145
What is the function of the phrenic nerves for its innervation of the pericardium?
it is the primary source of the sensory fibers; pain sensations conveyed by these nerves are commonly referred to the skin of the ipsilateral shoulder region
146
What is the function of the vagus nerve as it innervates the pericardium?
uncertain
147
What is the function of the sympathetic trunk as it innervates the pericardium?
vasomotor
148
What are the sources of blood to the right atrium?
-SVC
-IVC
-coronary sinus
149
What is the primary venous drainage of cardiac vv?
coronary sinus
150
What is the flow of blood through the heart?
1. systemic circulation (SVC, IVC, coronary sinus)
2. right atrium
3. tricuspid valve
4. right ventricle
5. pulmonic valve
6. pulmonary trunk
7. pulmonary circulation
8. pulmonary vv
9. left atrium
10. mitral valve
11. left ventricle
12. aortic valve
13. systemic circulation
151
What occurs when atrial pressure is greater than ventricular pressure and both AV valves open and when ventricular pressure is less than aortic/pulmonary pressure, both semilunar valves close?
ventricular filling
152
What occurs when atrial pressure is less than ventricular pressure and both AV valves close, and when ventricular pressure is greater than aortic/pulmonary pressure, both semilunar valves open?
ventricular ejection
153
What allows for the heart to have a resting tone, "rest and digest"?
parasympathetic stimulation
154
What deceases heart rate and contractile force and allows vasoconstriction of coronary arteries?
parasympathetic stimulation
155
What accelerates the heart and gives your body the "fight or flight" mode?
sympathetic stimulation
156
What increases heart rate and contractile force and has a reduction in parasympathetic tone that results in coronary artery vasodilation?
sympathetic stimulation
157
How many nerves do parasympathetic stimulation and where do they come from?
7
-come from the medulla (4 cranial, 3 sacral *craniosacral division*)
158
What is sympathetic stimulation mediated by?
the adrenal medulla
159
Another name for the systemic accelerator of the heart?
sympathetics
160
What is the vagal tone of your heart?
resting heart rate (60-100bpm)
161
What is the intrinsic rate of the SA node?
80-100 bpm
162
parasympathetic fibers from the vagus nerve course as what?
preganglionic nerves that synapse on postganglionic neurons in the cardiac plexus or within the heart wall itself
163
Parasympathetic stimulation innervated by the vagus nerve does what?
1. decreases heart rate
2. decreases force of contraction
3. vasodilates coronary resistance vessels (although most vagal effects are restricted directly to the SA nodal region)
164
Parasympathetic fibers come down from what?
medulla oblongata
165
What is the innervation of the diaphragm?
phrenic nerve
166
what does the phrenic nerve originate from?
C3, C4, C5 spinal cord segments of the cervical plexus and descends anterior to the anterior scalene muscle in the neck
167
The phrenic nerve enters the mediastinum posterior to what?
subclavian vein and descends anterior to the roof of the lung together with the pericardiacophrenic blood vessels between the pericardium and the mediastinal pleura to the diaphragm
168
What does the phrenic nerve provide motor innervation to?
diaphragm
169
What does the phrenic nerve provide sensory innervation to?
pericardium, the diaphragmatic pleura, and the parietal peritoneum at the abdominal side of the diaphragm (phrenicoabdominal branches)
170
What do the sympathetic fibers arise from?
the upper thoracic cord levels (intermediolateral cell column of T1-T4/T5) and enters the sympathetic trunk
171
The preganglionic fibers of the sympathetic fibers synapse where?
in the upper cervical and thoracic sympathetic chain ganglia
172
After the sympathetic preganglionic fibers synapse, what happens?
postganglionic fibers are sent to the cardiac plexus on and around the aorta and pulmonary trunk
173
Sympathetic stimulation does what?
1. increases heart rate
2. increases force of contraction
3. minimally vasoconstricts the coronary resistance vessels (via alpha adrenoceptors)
174
What are important components of the sympathetic part of the autonomic division of the peripheral nervous system and are usually considered a component of the posterior mediastinum as they pass through the thorax?
sympathetic trunks
175
What are the two types of medial branches that are given off by the ganglia of the sympathetic trunks?
1. branches from the upper five ganglia of the sympathetic trunk
2. branches from the lower seven ganglia of the sympathetic trunk
176
The first type of of branches from the upper five ganglia of the sympathetic trunk is mainly what?
postganglionic sympathetic fibers which supply the various thoracic viscera; they are relatively small and also contain visceral afferent fibers
177
The second type of branches from the lower seven ganglia of the sympathetic trunk is mainly what?
preganglionic sympathetic fibers
178
The preganglionic sympathetic fibers from the lower seven ganglia of the sympathetic trunk supply what?
the various abdominal and pelvic viscera
179
What are the characteristics of the preganglionic sympathetic fibers from the lower seven ganglia of the sympathetic trunk?
-branches are longer
-carry visceral afferent fibers
-form the three splanchnic nerve referred to as the greater, lesser, and least splanchnic nerves
180
What does the greater splanchnic nerve usually arise from?
the 5th to 9th or 10th thoracic ganglia
181
What descends across the vertebral bodies moving in a medial direction, passes into the abdomen through the crus of the diaphragm, and ends in the celiac ganglion?
greater splanchnic nerve
182
What does the lesser splanchnic nerve usually arise from?
9th and 10th or 10th and 11ths thoracic ganglia
183
What descends across the vertebral bodies moving in a medial direction, and passes into the abdomen through the crus of the diaphragm to end in the aorticorenal ganglion?
lesser splanchnic nerve
184
What does the least splanchnic nerve usually arise from?
12th thoracic ganglion
185
What descends and passes into the abdomen through the crus of the diaphragm to end in the renal plexus?
least splanchnic nerve
186
GVA fibers travel with both parasympathetic and sympathetic nerves but have what?
different functions
187
Sensations for reflex control (from heart or receptors in the aortic arch; blood pressure, levels of O2 or CO2) accompany what?
parasympathetic fibers
188
Pain sensations (ischemia, metabolic byproduct accumulation) accompany what?
sympathetic fibers (T1-T5)
189
The fuel for the cardiac circulation is what?
the endocardium (lining chambers)
190
What is the fuel for the coronary circulation?
myocardium conduction system
191
During ventricular diastole, what happens?
coronary arteries fill
192
What can you find between the atria and ventricles?
coronary sulcus
193
What can you find between the right and left ventricles?
anterior and posterior interventricular sulci
194
What are the names of the external sulci (grooves) of the heart?
-anterior and posterior interventricular sulci
-coronary sulcus
195
Most of the veins of the heart will be found where?
coronary sulcus
196
What are the branches of the right coronary artery?
-atrial br./SA nodal br.
-right marginal a.
-posterior interventricular a. (posterior descending a. ; PDA)
-AV nodal a.
197
What is the course of the right coronary artery?
coronary sulcus
198
What is the course of the atrial and SA nodal branches off the right coronary a.?
between SVC and ascending aorta
199
What is the course of the right marginal a.?
inferior margin of the heart towards the apex
200
What is the course of the posterior interventricular a.?
posterior IV sulcus
201
What is the course of the AV nodal a.?
superior to crux of heart (intersection of coronary and post. IV sulci)
202
What is the distribution of the atrial and SA nodal branches of the right coronary a.?
right atrium and SA node
203
What is the distribution of the right marginal a.?
right and left ventricles; posterior 1/3 of IV septum
204
What is the distribution of the AV nodal a.?
AV node
205
What comes off the left coronary artery?
-anterior interventricular a. (left anterior descending, LAD)
-circumflex a.
206
What is the course of the left coronary a.?
between the ascending aorta and pulmonary trunk
207
What is the course of the anterior interventricular a.?
anterior IV groove
208
What is the course of the circumflex a.?
coronary groove
209
What is the distribution of the anterior interventricular a.?
right and left ventricles; anterior 2/3 IV septum (bundle branches)
210
What is the distribution of the circumflex a.?
left atrium and ventricle
211
What is the very important structure that comes off the left main and if there is a laceration to this structure, people usually die?
LAD
212
In a right dominant heart, what are there anastomoses between?
right and left coronary arteries
213
What is included in the arterial supply to the conducting system in a right dominant heart?
-branches to SA and AV nodes (from right coronary a.)
-AV bundle and bundle branches (LAD from left coronary a.)
214
In a right dominant heart, the posterior IV a. comes off of what?
right coronary artery
215
In a left dominant heart, the posterior interventricular a. comes off what?
left coronary artery
216
What percentage of people have a right dominant heart?
75%
217
What percentage of people have a left dominant heart?
15%
218
What does the conduction system of the heart include?
-SA node
-AV node
-AV bundle (of His) and bundle branches
219
What is the blood supply to the SA node in a right dominant heart?
right coronary a
SA nodal a
220
What is the blood supply to the AV node in a right dominant heart?
right coronary a, near junction with the PDA
221
What is the blood supply to the AV bundle (of His) and bundle branches in a right dominant heart?
LAD from left coronary a. (anterior 2/3 of IV septum)
222
What is the blood supply to the SA node in a left dominant heart?
right coronary a
SA nodal a
223
What is the blood supply to the AV node in a left dominant heart?
left coronary a. near junction with PDA
224
What is the blood supply to the AV bundle (of His) and bundle branches in a left dominant heart?
LAD and post IV a. from left coronary artery (entire IV septum but left coronary a)
225
What percentage of people have a variation where the SA nodal branch comes off of the circumflex branch?
40%
226
What arises at the level of the transverse thoracic plane, ascends up into the superior mediastinum, and descends in the posterior mediastinum?
aortic arch
227
What are the 3 branches of the aortic arch?
1. brachiocephalic trunk
2. left common carotid a.
3. left subclavian a.
228
What does the brachiocephalic trunk supply?
right side of the head and neck and right upper limb
229
What does the left common carotid artery supply?
the left side of the head and neck
230
What does the left subclavian artery supply?
the left upper limb
231
What descends alongside and slightly to the left of the esophagus and gives rise to 7 arteries before piercing the diaphragm at T12 vertebral level?
thoracic aorta
232
What are the 7 arteries that branch off the thoracic aorta?
1. pericardial arteries
2. bronchial arteries
3. esophageal arteries
4. mediastinal arteries
5. posterior intercostal arteries
6. superior phrenic arteries
7. subcostal arteries
233
What are that small arteries that branch from the thoracic aorta and supply the posterior pericardium and are variable in number?
pericardial aa
234
What are the arteries that supply blood to the lungs; usually one artery to the right lung and two to the left lung, but variable in number?
bronchial aa
235
What are the arteries that supply the esophagus and are variable in number?
esophageal aa
236
What are the small branches that supply the lymph nodes, nerves, and connective tissue of the posterior mediastinum?
mediastinal aa
237
What are the paired arteries that supply blood to the lower nine intercostal spaces?
posterior intercostal aa
238
What are the small arteries to the superior surface of the respiratory diaphragm; anastomose with the musculophrenic and pericardiacophrenic arteries?
superior phrenic aa
239
What are the paired arteries that lie below the inferior margin of the last rib; anastomose with the superior epigastric, lower intercostal, and lumbar arteries?
subcostal aa
240
What is the placement of the aorta, esophagus, and the trachea from front to back?
1. aorta
2. trachea
3. esophagus
241
Most venous blood from the heart drains through what?
the coronary sinus to the right atrium
242
What is the exception to the venous drainage of the heart?
the anterior cardiac vv drains directly into the right atrium
243
Arteries of the heart are referred to as?
"coronary"
244
Veins of the heart are referred to as?
"cardiac"
245
What are the veins of the heart we need to know?
-anterior cardiac vv
-small cardiac v
-great cardiac v
-middle cardiac v
-coronary sinus
246
What do the anterior cardiac veins course over?
right coronary artery
247
What does the great cardiac vein course with?
anterior interventricular a. (LAD)
248
What does the middle cardiac vein course with?
posterior interventricular a. (PDA)
249
What does the small cardiac vein course with?
acute marginal artery from the right coronary artery
250
What vessels occupy the coronary sulci?
-right coronary a
-circumflex branch of the left coronary a
-small cardiac v
251
What vessels occupy the IV sulci?
-anterior interventricular a. (LAD)
-great cardiac v
252
What drains the posterior thorax and forms an important venous conduit between the IVC and SVC?
the azygos venous system
253
What are the thoracic veins in the azygos venous system?
-azygos vein
-hemiazygos vein
-accessory hemiazygos vein
254
What are the tributaries of the azygos vein?
right ascending lumbar, subcostal, and intercostal tributaries
255
If the accessory hemiazygos vein is present, where does it usually begin?
at the 4th intercostal space
256
What ascends just right of the midline of the body to empty into the SVC?
azygos vein
257
Hemiazygos vein is located on which side of the body?
left
258
The "widow maker" term comes from the blockage of which coronary vessel?
left anterior descending artery (LAD)
259
What is a symptom of coronary artery disease in which there is chest pain/discomfort caused by inadequate blood supply?
angina
260
True GVA pain is in which locations in heart-related conditions?
retrosternal and epigastric discomfort/pain
261
Referred pain can be where in heart-related conditions?
arm, back, shoulders, jaw
262
Where would the pain of pericarditis refer in a patient with pericarditis (inflammation of the pericardium)?
the back (since the fibrous and parietal layer of the serous pericardium receive sensory innervation via the phrenic n)
263
What is the name for interstitial fluids collected by lymphatic vessels?
lymph
264
What are the characteristics of lymph vessels?
-valves for unidirectional flow
-intermittent lymph nodes (populated with immune cells)
-drain into venous system
265
The lymphatic system acts as what for the body?
immune surveillance and filtration
266
What is the principal channel through which lymph from most of the body is returned to the venous system?
thoracic duct
267
The thoracic duct begins as a confluence of lymph trunks in the abdomen, sometimes forming a saccular dilation referred to as what?
cisterna chyli
268
What does the cisterna chyli drain?
the abdominal viscera and walls, pelvis, perineum, and lower limbs
269
What does the thoracic duct extend from?
vertebra L2 to the root of the neck
270
What does the left jugular trunk drain?
the left side of the head and neck
271
What does the left subclavian trunk drain?
the left upper limb
272
After being joined by the left jugular trunk and the left subclavian trunk, the thoracic duct empties into what?
the junction of the left subclavian and left internal jugular veins
273
What drains 2/3rd of the entire body (left face, neck, upper limb, and total lower limb)?
thoracic duct
274
What drains 1/3rd of the entire body (right face, neck, and upper limb)?
right lymphatic duct
275
What are the functions of the placenta?
-provide nutrients (GI)
-respiratory function (lungs)
-detox (kidneys, liver)
276
The umbilical vv have what type of oxygen and nutrient level?
rich
277
The umbilical aa have what type of oxygen and nutrient level?
poor
278
O2 and nutrient rich blood are returned to the fetus via what?
umbilical v
279
What allows for oxygenated blood in the umbilical vein to bypass the liver and acts as a shunt that connects the umbilical vein to the IVC?
ductus venosus
280
After the oxygenated blood from the umbilical v. reaches the right atrium via the ductus venosus, the O2 and nutrient blood is then directed to what structure in order to bypass the lungs and go directly into the left atrium and ventricle?
foramen ovale
281
In fetal circulation, the "best blood" goes where first?
the developing heart (coronary aa) and brain (carotid aa)
282
in fetal circulation, high and low quality blood in the right atrium mix and go into what and why?
the right ventricle and then the pulmonary trunk because the developing lung parenchyma needs a small portion of blood for normal development
283
Most of the blood in fetal circulation bypasses the lungs via what?
ductus arteriosus
284
Degradation of blood quality occurs only after what?
it reaches the carotid aa in the brain
285
What does the ductus arteriosus become in postnatal circulation?
ligamental arteriosus
286
What shunts blood from the pulmonary a. to the aorta in fetal circulation?
ductus arteriosus
287
What does the foramen ovale become in postnatal circulation?
fossa ovalis
288
What does the ductus venosus become in postnatal circulation?
ligamental venosum
289
What does the umbilical vein become in postnatal circulation?
ligamentum teres
290
What do the umbilical arteries become in postnatal circulation?
medial umbilical ligaments
291
What is chylothorax?
lymph formed in the digestive system accumulates in the chest cavity
292
What does the junction of the left internal jugular vein and left subclavian vein form?
proximal left brachiocephalic vein
