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Anatomy Y1 > Unit 4 - Lungs/ Heart/ Mediastinum > Flashcards

Unit 4 - Lungs/ Heart/ Mediastinum Flashcards

1
Q

What are the layers of thoracic wall?

A
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2
Q

Label the lateral side of lung.
How can we find the fissure?

A

-Oblique : Posterior T4 > 6th costal cartilage
-Horizontal - 4th rib

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3
Q

Label the medial side of the lung.

A
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4
Q

Label this image.

A
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5
Q

What are the 3 surfaces of the lung?

A

-Correspond to the area of fascia they face

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6
Q

What is parietal pleura give the 4 types?
What is visceral pleura?

A

> Visceral pleura – invests the lungs
Parietal pleura – lines the pulmonary cavities
-Costal pleura
-Mediastinal pleura
-Diaphragmatic pleura
-Cervical pleura

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7
Q

What is found in the Hilum? How can you tell what is what?

A
  1. Primary bronchi
  2. Pulmonary veins x2 (anterior ,inferior)
  3. Pulmonary arteries (superior)
  4. Lymphatics (bronchopulmonary lymph node)
  5. Autonomic nerves (sympathetic and parasympathetic)
  6. Bronchiole artery
  7. Bronchiole vein
    (6+7 - supply respiratory tree)
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8
Q

What is the AUTONOMIC innervation of lungs?

A

Parasympathetic : Vagus nerve
Sympathetic : Cardiac nerve T1-5

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9
Q

What is
-pleural cavity
-pleural reflections
-pleural recess

A
  1. Pleural cavity – Potential space between the layers of pleura , breath comfortably
  2. Pleural reflections – abrupt lines along which pleura changes directions
  3. Pleural recesses – pleura-lined gutters (made by reflections)
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10
Q

-Is pharynx or larynx connected to trachea? > what manages these 2 ?
At what vertebral level is the bifurcation of trachea (Carina)

A

-Larynx > epiglottis
Trans-thoracic plane
T4-5 - sternal angle

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11
Q

Where are the 2 layers of pleura continuous?

A
  • Hilum
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12
Q

How does the distribution of cartilage change throughout respiratory tree?

A
  • C- shaped rings of cartilage supported by trachealis muscle in trachea and bronchi become plates .. none in bronchioles
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13
Q

What are Primary, secondary, tertiary bronchus. What do they supply?

A
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14
Q

What is the clinical relevance of the parietal recesses?

A

Pleural effusion -Fluid accumulations
- drain costodiaphragamatic recess via 9th intercostal space
(FOUND AT T8-10)

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15
Q

Identify the phrenic nerve(s).
* What are its spinal roots?
* What does it innervate?
* What type of nerves are they (somatic/autonomic)?
Identify the phrenic nerve(s).
* Why do we have referred pain?

A
  • C3,4,5
  • Innervates:
    > Diaphragm,pericardium
    >Mediastinal pleura
    >Diaphragmatic pleura
    -SOMATIC
  • Fell the pain in our shoulder
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16
Q

What innovates Costal pleura and cervical pleura?

A
  • Intercostal nerves
    >Somatic
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17
Q
  1. How far superiorly does the apex of each lung extend?
  2. How far inferiorly does the lung extend? Consider how this changes during quiet and forced ventilation.
A
  1. 2.5 cm above clavicle
  2. Diaphram - during forced breathing the lung extends further into the recess e.g. costodiphragmatic recess
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18
Q

What is the smallest airway that is visible to the naked eye?

A

-Bronchioles

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19
Q

How does the right broncos vary from the left?

A
  • Shorter, wider and more vertical > foreign bodies passing beyond the larynx will usually slip into the right lung.
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20
Q

What are the 2 ways the respiratory system are split?

A
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21
Q

What are the types of upper respiratory system.

A
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22
Q

Pleural reflection surface landmarks for:
Midclavicular line
Midaxillary line
and posteriorly

A

2,4,6,8,10,12

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23
Q

Lung surface landmarks for:
Midclavicular line
Midaxillary line
and posteriorly

A
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24
Q

What are the 5 surfaces of the heart?

A

Base (posterior surface): Left atrium

Anterior surface: mainly right ventricle, small portion of right atrium

Left pulmonary surface: left ventricle, small parts of left atrium

Right pulmonary surface: right atrium

Diaphragmatic surface: 1/3 right ventricle; 2/3 left ventricle

Apex: most inferior, lateral point of heart, formed by left ventricle

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25
Q

What are the upper right/ left
and lower right/left surface markings of the heart?
What is its superior and inferior boundary?

A

Boundaries:
Superior: sternal angle (rib 2; T4/5)
Inferior: xiphisternal angle (T9)

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26
Q

Label the layers of the pericardium and what layers make up the heart?

Where does the apex of the heart lie?

A

Heart:
1- Viceral pericardium ( Epicardium)
2 - myocardium
3- Endocardium

-5th intercostal space / Mid-clavicular line

27
Q

What is the innervation of the fibrous + serous layer of pericardium?
What is the blood supply/venous drainage?

A
  • Fibrous+Parietal serous pericardium =
    (SOMATIC)
    Phrenic nerve , feel pain in neck/shoulders - C3,4,5 (REFERRED PAIN)
  • Visceral serous pericardium = (AUTONOMIC) Sympathetic trunks + Vagus nerve - parasympathetic

Blood supply: pericardial phrenic artery (branch on internal thoracic artery)
Venous drainage: Azygos system

28
Q

Relate structure of the pericardium to the function.

A

Fibrous:
* Fixes the heart in the mediastinum and limits its
motion > attached to the diaphragm, the
sternum, and the tunica adventitia (outer layer) of
the great vessels
* Prevents overfilling of the heart.
* Protection from infection. The fibrous pericardium
serves as a physical barrier to adjacent organs prone to infection, such as the lungs.

Serous:
* Lubrication, reduces the friction generated by the heart as it moves within the thoracic cavity

29
Q

What are the 4 chambers of the heart and name the septa/um that separates them.

A
30
Q

Label the right atrium.

A
31
Q

Label right ventricle

A
32
Q

Label left atrium.

A
33
Q

Label left ventricle

A
34
Q

What are the inputs and outputs of blood?

A
35
Q

Label the great vessels carrying oxygenated blood.

A
36
Q

Label the great vessels carrying deoxygenated blood.

A
37
Q

Label the conducting system.
What are the main parts of this system?

A
  • Sinoatrial (SA) node
    -crista terminalis >right atrium + opening of the superior vena cava
  • Atrioventricular (AV) node
  • Bundle of His
  • Subendocardial
    fibres
38
Q

Describe the autonomic regulation of the heart.

A
  • Sympathetic: accelerate heart rate and dilate coronary vessels
  • Parasympathetic (Vagus): Slow the rate of the heart and constrict coronary vessels
39
Q

What are the 4 valves of the heart?

What does the papillary muscle do?

A
  • Composed of the four heart valves
  • Atrioventricular valves
  • Semi-lunar valves

-contract to prevent inversion or prolapse of these valves on systole

40
Q

Where are the positions of the valves?

A

Tricuspid Valve (Right side)
Bicuspid valve (Left side)

Pulmonary valve
Aortic Valve
(openings for coronary arteries (low pressure filling during diastole)

41
Q

Ascultation of valves ,when do we get lupp/dubb?

A
42
Q

Where do we Ascultate for valves?

A

Aortic Valve: right 2nd intercostal space at sternal border

Pulmonary Valve: left 2nd intercostal space at sternal border

Tricuspid Valve: left 5th intercostal space at sternal border

Bicuspid Valve: left 5th intercostal space at midclavicular line

43
Q

Label the normal variation of coronary arteries.

A

-LAC
-RPM

44
Q

What are the common sites of acclusion for a myocardial infarction?
How is this treated?

A

-Angioplasty : catheter with a small inflatable balloon passed into coronary artery , balloon is inflated to flatten obstruction.

45
Q

Label the normal variation of coronary veins.

A

> Coronary sinus drains straight into right atrium

46
Q

What is a cardiac tamponade?

Where would you feel the pain?

A

-Abnormal amounts of fluid accumulate in the pericardial sac putting pressure on your heart.
>pericardial effusion.

– Fibrous+Parietal serous pericardium = Phrenic nerve (somatic), feel pain in neck/shoulders - C3,4,5 (REFERRED PAIN)

-Visceral serous pericardium = insensitive

47
Q

What causes heart size to enlarge? What is this disease called?

A

-Damage to the heart muscle or any condition that makes the heart pump harder than usual
>Cardiomegaly

48
Q

What vertebral level is the sternal angle? What happens at the sternal angle?

A

o Sternal angle is at vertebral level T4/5
o Second costal cartilage and rib lies at this level.
o Superior and inferior mediastinum are demarcated.
o Ascending aorta ends.
o Arch of aorta begins.
o Arch of aorta ends.
o Descending aorta begins.
o Trachea ends and divides/bifurcates into two principal bronchi.
o The right and left pulmonary arteries arise from the pulmonary
trunk at the level of the sternal angle

49
Q

What are the 2 main divisions of the mediastinum?
What separates these 2?

A

-Sternal angle/Thoracic plane T4/5

50
Q

How would you identify Aorta on scan?

A

-Look at vertebral body
-Aorta at the back on the left

51
Q

What are the boundaries of the superior mediastinum?
>What is its contents?

A

P: T1-4 vertebral body
A: Manubrium
L: Mediastinal parietal pleura
I: Thoracic plane
S: Superior thoracic aperture

1.SVC 2. Aortic arch 3. LSA 4. LCCA 5. Trachea 6. Brachiocephalic artery 7. L+R brachiocephalic veins 8. Thymus 9. Oesophagus 10. Thoracic duct 11. azygous 12a. Vagus 12b. Left reccurent laryngeal nerve 13. Phrenic

52
Q

What areas of the thorax are drained by each part of the azygous system?
How does it different on the left and right side?
How is the azygous involved in the spread of cancer?

A

-Has no valves .. blood can flow backwards sp cancer spreads more easily.

53
Q

Describe the course of the thoracic duct.
What is its origin?
What is its termination?

A

Begins at Cisterna chyli L1/2 > crosses diaphragm at aortic hiatus T12 > Ascends between thoracic aorta on the left and azygous on the right > Crosses over to the left side at T5 > Ascends behind aortic arch and L subclavian artery > Lies anterior to left phrenic nerve > Drains at venous angle between left subclavian vein and left internal jugular vein

54
Q

How is the Superior Vena Cava formed?

A
  • Confluence of :
    1. Azygous vein
    2. Left Brachiocephalic vein
    3. Right Brachiocephalic vein
55
Q

What veins drain into the right atria?

A
  1. SVC
  2. IVC
  3. Coronary sinus
56
Q

What are the 3 constrictions of the oesophagus?
How does its structure change between superior and inferior mediastinum?

A
  1. Pharynx : C5/6
  2. Crossed over by aortic arch + left primary bronchus at T4/5
  3. Diaphragm at T10

> 1st 1/3 = skeletal muscle
2/3 = mixture
last 1/3 is = smooth muscle ( autonomic control)

57
Q

What is the Recurrent laryngeal nerve?
What part of the mediastinum is it found?

A

-Branch of the vagus nerve (CNX)
- Parasympathetic innervation
-Superior mediastinum

> Left : loops under the aortic arch
Right : loops under subclavian artery

58
Q

What are the boarders of the anterior mediastinum?
What is its contents?

A

A: Body+ Xiphoid process
P: Pericardium
I: Diaphragm
S: Thoracic plane
L: Mediastinal parietal pleura

  1. Thymus, lymph nodes
59
Q

What is the contents of the middle mediastinum?

A
  1. Pericardium / Heart
  2. Ascending aorta
  3. Pulmonary trunk
    + R/L pulmonary artery
  4. IVC
  5. Pulmonary veins
  6. Azygous vein
  7. Phrenic nerve
  8. Vagus nerve
60
Q

What are the boarders of the posterior mediastinum?
What is its contents?
( 3 goose 1 duck)

A

P: T4-12 VERTEBRA
A: Pericardium
L: Mediastinal parietal pleura
S: Thoracic plane
I: Diaphragm

  1. Oesophagus
  2. Azygous vein
  3. Vagus (A vagal trunk - LEFT / P vagal trunk - RIGHT )
  4. Thoracic duct
  5. Thoracic aorta
  6. Sympathetic chain
61
Q

What is the order of exist from the CNS:
1. Vagus nerves
2. Phrenic nerve
3. Cardiac nerves
5. Greater splanchnic
6. Intercostals
7. Subcostal

A
  1. Vagus nerves : Brain CNX
  2. Phrenic nerve : C3,4,5 , NECK
  3. Cardiac nerves : T1-5 > sympathetic trunk
  4. Greater splanchnic : T5-9 > Sympathetic trunk
  5. Intercostals > T1-11 lie between ribs
  6. Subcostal : spinal cord > lies below last rib
62
Q

-Compare the type of innervation of vagus and phrenic.
-In relation to lungs where are they found?
- What do they innervate?

A
  • PHRENIC: Somatic
    >Anterior to lung
    1.Diaphragm
    2. Fibrous + Parietal serous pericardium
    3. Mediastinal pleura
    4. Diaphragmatic pleura

-VAGUS: Autonomic (parasympathetic)
>Posterior to lung
1. Heart
2.Lungs
3. Foregut
4. Midgut

63
Q

Describe the sympathetic chain.

A
64
Q

Compare aortic dissection and aneurysm.

A
  1. Aortic dissection = inner lining is torn + begins to separate from the rest of the arterial wall
  2. Aneurysm = bulge in aorta

Anatomy Y1 (10 decks)

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