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[OS 205] 1st Exam > [USMLE] Pericardium and Heart > Flashcards

[USMLE] Pericardium and Heart Flashcards

1
Q

Is a fibroserous sac that encloses the heart and the roots of the great vessels and occupies the middle mediastinum

A

Pericardium

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2
Q

Pericardium is composed of the

A

fibrous pericardium and serous pericardium

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3
Q

pericardium receives blood from the

A

pericardiophrenic, bronchial, and esophageal arteries

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4
Q

pericardium is innervated by

A

vasomotor and sensory fibers from the phrenic and vagus nerves and the sympathetic trunks

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5
Q

Is a strong, dense, fibrous layer that blends with the adventitia of the roots of the great vessels and the central tendon of the diaphragm.

A

fibrous pericardium

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6
Q

consists of the parietal layer and the visceral layer

A

serous pericardium

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7
Q

lines the inner surface of the fibrous pericardium

A

parietal layer

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8
Q

forms the outer layer (epicardium) of the heart wall and the roots of the great vessels

A

visceral layer

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9
Q

is an inflammation of the pericardium (has symptoms of dysphagia, dyspnea and cough, inspiratory chest pain, and paradoxic pulse)

A

pericarditis

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10
Q

pericarditis also causes the

A

pericardial murmur or pericardial friction rub

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11
Q

Is a potential space between the visceral layer of the serous pericardium (epicardium) and the parietal layer of the serous pericardium lining the inner surfaces of the fibrous pericardium

A

pericardial cavity

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12
Q

Is a subdivision of the pericardial sac

A

transverse sinus

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13
Q

transverse sinus boundaries

A

lying posterior to the ascending aorta and pulmonary trunk, anterior to the SVC, and superior to the left atrium and the pulmonary veins

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14
Q

transverse sinus is of great importance to the cardiac surgeon because

A

while performing surgery on the aorta or pulmonary artery, a surgeon can pass a finger and make a ligature through the sinus between the arteries and veins, thus stopping the blood circulation with the ligature

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15
Q

Is a subdivision of the pericardial sac behind the heart

A

oblique sinus

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16
Q

oblique sinus is surrounded by the

A

reflection of the serous pericardium around the right and left pulmonary veins and the inferior vena cava (IVC)

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17
Q

is an acute compression of the heart caused by a rapid accumulation of fluid or blood in the pericardial cavity from wounds to the heart or pericardial effusion (passage of fluid from the pericardial capillaries into the pericardial sac)

A

Cardiac tamponade:

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18
Q

tamponade can be treated by

A

pericardiocentesis

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19
Q

is an accumulation of fluid in the pericardial space resulting from inflammation caused by acute pericarditis, and the accumulated fluid compresses the heart, inhibiting cardiac filling.

A

Pericardial effusion

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20
Q

is a surgical puncture of the pericardial cavity for the aspiration of fluid, which
is necessary to relieve the pressure of accumulated fluid on the heart

A

pericardiocentesis

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21
Q

in pericardiocentesis, a needle is inserted into pericardial cavity through the

A

fifth intercostal space left to the sternum

Because of the cardiac notch, the needle misses the pleura and lungs, but it penetrates the pericardium.

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22
Q

apex of the heart location

A

is the blunt rounded extremity of the heart formed by the left ventricle and lies in the left fifth intercostal space slightly medial to the midclavicular (or nipple) line, about 9 cm from the midline

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23
Q

the apex of the heart location is useful clinically for determining the

A

left border of the heart and for auscultating the mitral valve

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24
Q

the base of the heart is formed by

A

primarily by the left atrium and only partly by the posterior right atrium

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25
Q

the right (acute) border of the heart is formed by the

A

SVC, right atrium, and IVC, and its left (obtuse) border is

formed by the left ventricle

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26
Q

in radiology, the left border of the heart consists of the

A

aortic arch, pulmonary trunk, left auricle, and left ventricle

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27
Q

the heart wall consists of three layers:

A

inner endocardium , middle myocardium , and outer

epicardium

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28
Q

a groove on the external surface of the right atrium

A

sulcus terminalis

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29
Q

sulcus terminalis marks the junction of the

A

primitive sinus venosus with the atrium in the embryo and corresponds to a ridge on the internal heart surface

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30
Q

a ridge on the internal heart surface

A

crista terminalis

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31
Q

a groove on the external surface of the heart

A

coronary sulcus

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32
Q

coronary sulcus marks the division between the

A

atria and the ventricles

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33
Q

is the point at which the interventricular and interatrial sulci cross the coronary sulcus

A

crux

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34
Q

The cardiovascular silhouette, or cardiac shadow, is the contour of the heart and great vessels seen on

A

posterior-inferior chest radiographs

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35
Q

the right border of the cardiovascular silhouette is formed by the

A

SVC, the right atrium, and the IVC

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36
Q

the left border of the cardiovascular silhouette is formed by the

A

aortic arch (which produces the aortic knob ), the pulmonary trunk, the left auricle, and the left ventricle

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37
Q

the inferior border of the cardiovascular silhouette is formed by the

A

right ventricle, and the left atrium shows no border

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38
Q

Has an anteriorly situated rough-walled atrium proper and the auricle lined with pectinate muscles and a posteriorly situated smooth-walled sinus venarum , into which the two venae cavae open

A

right atrium

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39
Q

right vs left atrium (size)

A

the right atrium is larger than the left atrium but has a thinner wall

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40
Q

the sinus venarum between two venae cavae is separated from the atrium proper by the

A

crista terminalis

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41
Q

right vs left atrium (pressure)

A

right atrium has a right atrial pressure that is normally slightly lower than left atrial pressure

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42
Q

right atrium contains the

A

valve of the IVC and the valve of the coronary sinus

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43
Q

valve of the IVC

A

eustacian

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44
Q

valve of the coronary sinus

A

thebesian

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45
Q

Is the conical muscular pouch of the upper anterior portion of the right atrium, which covers the first part of the right coronary artery

A

Right auricle

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46
Q

Is a posteriorly situated, smooth-walled area that is separated from the more muscular atrium proper by the crista terminalis

A

Sinus venarum (sinus venarum cavarum)

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47
Q

sinus venarum develops from the _____ and receives the SVC, IVC, coronary sinus, and anterior cardiac veins

A

embryonic sinus venosus

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48
Q

Are prominent ridges of atrial myocardium located in the interior of both auricles and the right atrium

A

Pectinate muscles

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49
Q

Crista terminalis is a vertical muscular ridge running

A

anteriorly along the right atrial wall from the opening of

the SVC to the opening of the IVC

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50
Q

crista terminalis provides the

A

origin of the pectinate muscles

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51
Q

crista terminalis represents the junction between the

A

primitive sinus venarum (a smooth-walled region) and the right atrium proper

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52
Q

crista terminalis is indicated externally by the

A

sulcus terminalis

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53
Q

Are the smallest cardiac veins

A

Venae cordis minimae

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54
Q

Venae cordis minimae begins

A

in the substance of the heart (endocardium and

innermost layer of the myocardium)

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55
Q

Venae cordis minimae ends

A

in the atria at the foramina venarum

minimarum cordis

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56
Q

Is an oval-shaped depression in the interatrial septum

A

fossa ovalis

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57
Q

fossa ovalis represents the site of the

A

foramen ovale

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58
Q

in the foramen ovale, blood runs from the

A

right atrium to the left atrium before birth

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59
Q

upper rounded margin of the fossa is called the

A

limbus fossa ovale

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60
Q

the walls of the left atrium are smooth except fot a few

A

pectinate muscles in the auricle

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61
Q

left atrium boundaries

A

is the most posterior of the four chambers lying posterior to the right atrium but anterior to the esophagus and shows no structural borders on a posteroanterior radiograph

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62
Q

left atrium receives oxygenated blood through

A

four pulmonary veins

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63
Q

Makes up the major portion of the anterior (sternocostal) surface of the heart

A

right ventricle

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64
Q

the right ventricle contains

A

Trabeculae carneae cordis, Papillary muscles, Chordae tendineae, Conus arteriosus (infundibulum), Septomarginal trabecula (moderator band), IV septum

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65
Q

Are anastomosing muscular ridges of myocardium in the ventricles

A

Trabeculae carneae cordis

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66
Q

Are cone-shaped muscles enveloped by endocardium

A

Papillary muscles

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67
Q

papillary muscles extend from the anterior and posterior ventricular walls and the septum, and their apices are
attached to the

A

chordae tendineae

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68
Q

why papillary muscles contract?

A

to tighten the chordae tendineae, preventing the cusps of the tricuspid valve from being everted into the atrium by the pressure developed by the pumping action of the heart. This prevents regurgitation of ventricular blood into the right atrium

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69
Q

Extend from one papillary muscle to more than one cusp of the tricuspid valve

A

chordae tendinae

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70
Q

chordae tendinae prevent eversion of the valve cusps into the atrium during

A

ventricular contractions

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71
Q

Is the upper smooth-walled portion of the right ventricle, which leads to the pulmonary trunk.

A

Conus arteriosus (infundibulum)

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72
Q

Is an isolated band of trabeculae carneae

A

Septomarginal trabecula (moderator band)

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73
Q

Septomarginal trabecula (moderator band) forms a bridge between the

A

intraventricular (IV) septum and the base of the anterior papillary muscle of the anterior wall of the right ventricle.

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74
Q

septomarginal trabercula is called the moderator band for its ability to

A

prevent overdistention of the ventricle and carries
the right limb (Purkinje fibers) of the atrioventricular (AV) bundle from the septum to the sternocostal wall of the ventricle

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75
Q

Is the place of origin of the septal papillary muscle.

A

IV septum

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76
Q

IV septum is mostly muscular but has a small membranous upper part, which is a common site of

A

ventricular septal defects

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77
Q

left ventricle lies

A

at the back of the heart

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78
Q

the apex of the left ventricle is directed

A

downward, forward and to the left

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79
Q

left ventricle is divided into the

A

left ventricle proper and the aortic vestibule

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80
Q

the upper anterior part of the left ventricle and leads into the aorta

A

aortic vestibule

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81
Q

left ventricle contains

A

two papillary muscles (anterior and posterior) with their chordae tendineae and a meshwork of muscular ridges, the trabeculae carneae cordis

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82
Q

left vs right ventricle (function, thickness, size, shape)

A

the left ventricle performs harder work , has a thicker (two to three times as thick) wall, and is longer, narrower, and more conical-shaped than the right ventricle

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83
Q

is a necrosis of the myocardium because of local ischemia resulting from vasospasm or obstruction of the blood supply

A

Myocardial infarction

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84
Q

symptoms of myocardial infarction

A

severe chest pain or pressure for a prolonged period (more than 30 minutes), congestive heart failure, and murmur of mitral regurgitation

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85
Q

Myocardial infarction can be treated with

A

nitroglycerin, morphine, lidocaine or atropine

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86
Q

prevents coronary spasm and reduces myocardial oxygen demand

A

nitroglycerin

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87
Q

relieves pain and anxiety

A

morphine

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88
Q

reduces ventricular arrhythmias

A

lidocaine

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89
Q

restores conduction and increases heart rate

A

atropine

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90
Q

is characterized by attacks of chest pain originating in the heart and felt beneath the sternum, in many cases radiating to the left shoulder and down the arm

A

angina pectoris

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91
Q

angina pectoris is caused by an

A

insufficient supply of oxygen to the heart muscle because of coronary artery disease or exertion
(e.g., exercise, excitement) or emotion (e.g., stress, anger, frustration)

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92
Q

angina pectoris symptoms

A

severe chest pain or pressure for a prolonged period (more than 30 minutes), congestive heart failure, and murmur of mitral valve regurgitation

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93
Q

angina pectoris can be treated with

A

nitroglycerin, beta-adrenergic blockers, morphine,

lidocaine, or atropine

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94
Q

is a variant form of angina pectoris caused by transient coronary artery spasm.

A

Prinzmetal’s angina

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95
Q

The vasospasm typically occurs at

A

rest

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96
Q

is a restoration of cardiac output and pulmonary ventilation following cardiac arrest and apnea (cessation of breathing) by external cardiac massage

A

Cardiopulmonary resuscitation (CPR)

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97
Q

CPR is performed by applying firm pressure to the chest vertically downward over the

A

inferior part of the sternum to move it posteriorly, forcing blood out of the heart and into the great vessels

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98
Q

pulmonary valve lies behind the

A

medial end of the left third costal cartilage and adjoining part of the sternum

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99
Q

pulmonary valve is most audible over the

A

left second intercostal space just lateral to the sternum

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100
Q

pulmonary valve is opened by the

A

ventricular systole

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101
Q

pulmonary valve is shut slightly after

A

closure of the aortic valve

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102
Q

aortic valve lies behind the

A

left half of the sternum opposite the third intercostal space

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103
Q

aortic valve is closed during the

A

ventricular diastole

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104
Q

closure of the aortic valve at the beginning of ventricular diastole causes the

A

second heart sound

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105
Q

the aortic valve is most audible over the

A

right second intercostal space just lateral to the sternum

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106
Q

tricuspid valve aka

A

right AV

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107
Q

tricuspid valve lies between the

A

right atrium and ventricle, behind the right half of the sternum opposite the fourth intercostal space

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108
Q

tricuspid valve is covered by

A

endocardium

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109
Q

the tricuspid valve is most audible over the

A

right lower part of the body of the sternum

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110
Q

tricuspid valve has

A

anterior, posterior, and septal cusps

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111
Q

anterior, posterior, and septal cusps are attached by the

A

chordae tendineae to three papillary muscles that keep the valve closed against the pressure developed by the pumping action of the heart.

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112
Q

tricuspid valve is closed during

A

ventricular systole (contraction)

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113
Q

its closure contributes to the

A

first heart sound

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114
Q

bicuspid valve (left AV) is aka

A

mitral valve

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115
Q

why is it called mitral valve?

A

it is shaped like a bishops miter

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116
Q

bicuspid valve lies between the

A

left atrium and ventricle, behind the left half of the sternum at the fourth costal cartilage

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117
Q

bicuspid valve has how many cusps?

A

two; larger anterior and smaller posterior

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118
Q

bicuspid valve is closed slightly before the tricuspid valve by the

A

ventricular contraction (systole)

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119
Q

the closure at the onset of ventricular systole causes the

A

first heart sound

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120
Q

the bicuspid valve is most audible over the

A

apical region of the heart in the left fifth intercostal space at the midclavicular line

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121
Q

is a condition in which the valve everts into the left atrium and thus fails to close properly when the left ventricle contracts

A

Mitral valve prolapse

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122
Q

mitral valve prolapse may cause

A

chest pain, shortness of breath,

palpitations, and cardiac arrhythmia

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123
Q

s a characteristic sound generated by turbulence of blood flow through an orifice of the heart

A

Cardiac murmur

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124
Q

first heart sound is caused by

A

the closure of the tricuspid and mitral valves at the onset of ventricular systole

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125
Q

second heart sound is caused by

A

the closure of the aortic and pulmonary valves (and vibration of walls of the heart and major vessels) at the onset of ventricular diastole

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126
Q

Is composed of modified, specialized cardiac muscle cells that lie immediately beneath the endocardium
and carry impulses throughout the cardiac muscle, signaling the heart chambers to contract in the proper
sequence

A

Conducting system of the heart

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127
Q

aka pacemaker of the heart and initiates the heartbeat

A

Sinoatrial (SA) node

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128
Q

SA node is a small mass of specialized cardiac muscle fibers that lies in the myocardium at the

A

upper end of the crista terminalis near the opening of the SVC in the right atrium

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129
Q

SA node is supplied by the

A

sinus node artery

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130
Q

sinus node artery is a branch of the

A

right coronary artery

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131
Q

AV node lies in the

A

interatrial septum, superior and medial to the opening of the coronary sinus in the right atrium

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132
Q

AV node receives the impulse from the ____ and passes it to the _____

A

SA node and passes it to the AV bundle

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133
Q

AV node is supplied by the

A

AV nodal artery

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134
Q

AV nodal artery arises from the

A

right coronary artery opposite the origin of the posterior interventricular artery

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135
Q

AV node is innervated by the

A

autonomic nerve fibers, although the cardiac muscle fibers lack motor endings

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136
Q

Splits into right and left branches, which descend into the muscular part of the interventricular septum, and breaks up into terminal conducting fibers (Purkinje fibers) to spread out into the ventricular walls.

A

AV bundle (bundle of His)

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137
Q

AV bundle (bundle of His) begins and runs along where

A

at the AV node and runs along the membranous part of the interventricular septum

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138
Q

damage to the conducting system causes

A

heart block

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139
Q

coronary arteries arise from the

A

ascending aorta

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140
Q

coronary arteries are filled with blood during the

A

ventricular diastole

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141
Q

coronary arteries have maximale blood flow during

A

diastole

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142
Q

coronary arteries have minimal blood flow during

A

systole because of compression

of the arterial branches in the myocardium during systol

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143
Q

right coronary artery arises from the

A

anterior (right) aortic sinus of the ascending aorta,

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144
Q

right coronary artery pathway

A

runs between the root of the pulmonary trunk and the right auricle

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145
Q

right coronary artery descends in the

A

right coronary sulcus

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146
Q

right coronary artery generally supplies the

A

right atrium and ventricle

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147
Q

Passes between the right atrium and the root of the ascending aorta, encircles the base of the SVC

A

Sinuatrial nodal artery

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148
Q

Sinuatrial nodal artery supplies the

A

SA node and the right atrium

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149
Q

marginal artery pathway

A

Runs along the inferior border toward the apex

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150
Q

Runs along the inferior border toward the apex supplies the

A

inferior margin of the right ventricle

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151
Q

Is a larger terminal branch

A

Posterior IV (posterior descending) artery

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152
Q

Posterior IV (posterior descending) artery supplies

A

a part of the IV septum and left ventricle and the AV node

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153
Q

AV nodal artery arises

A

opposite the origin of its posterior IV artery

154
Q

AV nodal artery supplies the

A

AV node

155
Q

is characterized by the presence of sclerotic plaques containing cholesterol and lipoid material that impair myocardial blood flow, leading to ischemia and myocardial infarction

A

Coronary atherosclerosis:

156
Q

is an angiographic reconstruction (radiographic view of vessels after the injection of a radiopaque material) of a blood vessel made by enlarging a narrowed coronary arterial lumen

A

Coronary angioplasty

157
Q

involves a connection of a section of vein (usually the saphenous vein) or of the internal thoracic artery or other conduit between the aorta and a coronary artery distal to an obstruction in the coronary artery, shutting blood from the aorta to the coronary arteries

A

coronary bypass

158
Q

the thoracic artery is connected to the

A

coronary artery distal to the obstructive lesion

159
Q

left coronary artery arises from the

A

left aortic sinus of the ascending aorta just above the aortic semilunar valve

160
Q

left coronary artery is usually distributed to more of the

A

myocardium

161
Q

left vs right coronary artery (length)

A

left coronary artery is shorter than the right coronary artery

162
Q

is the chief source of blood to the IV septum and the apex

A

Anterior IV (left anterior descending) artery

163
Q

Anterior IV (left anterior descending) artery generally supplies the

A

anterior aspects of the right and left ventricles

164
Q

circumflex artery runs in the

A

coronary sulcus

165
Q

Circumflex artery gives off the

A

left marginal artery

166
Q

Circumflex artery supplies the

A

left atrium and left

ventricle

167
Q

Circumflex artery anastomoses with

A

terminal branch of the right coronary artery

168
Q

Is the largest vein draining the heart and lies in the coronary sulcus , which separates the atria from
the ventricles.

A

coronary sinus

169
Q

coronary sinus opens into the

A

right atrium between the opening of the IVC and the AV opening

170
Q

coronary sinus has how many cusp

A

one-cusp valve at the right margin of its aperture

171
Q

coronary sinus receives the

A

great, middle, and small cardiac veins; the oblique vein of the left atrium; and the posterior vein of the left ventricle

172
Q

great cardiac vein begins

A

at the apex of the heart

173
Q

great cardiac vein ascends along with the

A

IV branch of the left coronary artery

174
Q

great cardiac vein turn to the left to lie in the coronary sulcus and continues as the

A

coronary sinus

175
Q

Middle cardiac vein begins at

A

the apex of the heart

176
Q

Middle cardiac vein ascends in the

A

posterior IV groove accompanying the poterior branch of the right coronary artery

177
Q

Middle cardiac vein drains

A

into the right end of the coronary sinus

178
Q

Small cardiac vein runs along the

A

right margin of the heart in company with the marginal artery and then posteriorly in the coronary sulcus to end in the right end of the coronary sinus

179
Q

Oblique vein of the left atrium descends to empty into the

A

coronary sinus, near its left end

180
Q

Anterior cardiac vein drains the

A

anterior right ventricle

181
Q

Anterior cardiac vein crosses the

A

coronary groove

182
Q

anterior cardiac vein ends directly in the

A

right atrium

183
Q

Smallest cardiac veins (venae cordis minimae) begin

A

in the wall of the heart

184
Q

Smallest cardiac veins (venae cordis minimae) empty

A

directly into its chambers

185
Q

Lymphatic vessels of the heart receive lymph from the

A

myocardium and epicardium

186
Q

Lymphatic vessels of the heart follow the right coronary artery to empty into the

A

anterior mediastinal nodes

187
Q

Lymphatic vessels of the heart follow the left coronary artery to empty into the

A

tracheobronchial node

188
Q

Cardiac plexus receives the superior, middle, and inferior cervical and thoracic cardiac nerves from the

A

sympathetic trunks and vagus nerves

189
Q

lies beneath the arch of the aorta in front of the

pulmonary artery

A

superficial cardiac plexus

190
Q

lies posterior to the arch of the aorta in front of

the bifurcation of the trachea

A

deep cardiac plexus

191
Q

cardiac plexus richly innervates the

A

conducting system of the heart

192
Q

right sympathetic and parasympathetic branches terminate chiefly in the region of the

A

SA node

193
Q

left branches end chiefly in the region of the

A

AV node

194
Q

are devoid of motor endings and are activated by the

conducting system

A

cardiac muscle fibers

195
Q

cardiac plexus supplies the heart with

A

sympathetic fibers

196
Q

sympathetic fibers _____ the heart rate and the force of the heartbeat

A

increase

197
Q

sympathetic fibers cause _____ of the coronary arteries

A

dilation

198
Q

parasympathetic fibers _____ heart rate

A

decrease

199
Q

parasympathetic fibers _____ the coronary arteries

A

the coronary arteries

200
Q

Ascending aorta origin

A

from the left ventricle within the pericardial sac

201
Q

Ascending aorta ascends behind the

A

sternum to end at the level of the sternal angle

202
Q

ascending aorta lies in the

A

middle mediastinum

203
Q

ascending aorta has how many aortic sinuses

A

three

204
Q

location of the three aortic sinuses

A

immediately above the cusps of the aortic valve

205
Q

ascending aorta gives off the

A

right and left coronary artery

206
Q

arch of aorta is found within the

A

superior meiastinum

207
Q

arch of aorta pathway

A

begins as a continuation of the ascending aorta, and arches over the right pulmonary artery and the left main bronchus

208
Q

arch of aorta forms a prominence that is visible on the radiograph as the

A

aortic knob

209
Q

arch of aorta gives rise to the

A

brachiocephalic, left common carotid, and left subclavian arteries

210
Q

is a sac formed by dilation of the aortic arch that compresses the left recurrent laryngeal nerve, leading to coughing, hoarseness, and paralys is of the ipsilateral vocal cord

A

Aneurysm of the aortic arch:

211
Q

dysphagia

A

difficulty in swallowing; resulting from pressure on the esophagus

212
Q

dyspnea

A

difficulty in breathing; esulting from pressure on the trachea, root of the lung, or phrenic
nerve

213
Q

is an inheritable disorder of connective tissue that affects the skeleton, skin, eyes, heart, and blood vessels.

A

Marfan’s syndrome:

214
Q

Is formed by the union of the right and left brachiocephalic veins and returns blood from all structures superior to the diaphragm, except the lungs and heart

A

superior vena cava

215
Q

superior vena cava pathway

A

Descends on the right side of the ascending aorta, receives the azygos vein , and enters the right
atrium

216
Q

upper half of the SVC

A

superior mediastinum

217
Q

lower half of the SVC

A

middle mediastinum

218
Q

pulmonary trunk pathway

A

Arises from the conus arteriosus of the right ventricle, passes obliquely upward and backward across the
origin and on the left side of the ascending aorta within the fibrous pericardium, and bifurcates into the
right and left pulmonary arteries in the concavity of the aortic arch

219
Q

Development of the Heart begins to form angiogenic cell clusters formed in the

A

splanchnic mesoderm

220
Q

Development of the Heart involves fusion of two endocardial tubes into a

A

single primitive heart tube

221
Q

primitive heart tube develops into the

A

endocardium

222
Q

the splanchnic mesoderm surrounding the tube develops into

A

myocardium and epicardium

223
Q

Primitive heart tube forms how many dilations

A

five (truncus arteriosus, bulbus cordis, primitive ventricle, primitive atrium, and sinus venosus)

224
Q

Primitive heart tube undergoes a folding into a

A

U-shape

225
Q

Primitive heart tube brings the arterial and venous ends of the heart together and moving the ventricle ____ and the atrium _____.

A

caudally; cranially

226
Q

forms aorta and pulmonary trunk by formation of the

aorticopulmonary (AP) septum.

A

Truncus arteriosus (ventral aorta)

227
Q

forms conus arteriosus (smooth part of right ventricle) and aortic vestibule (left ventricle

A

Bulbus cordis

228
Q

forms trabeculated part of right and left ventricles

A

Primitive ventricle

229
Q

forms trabeculated part of right and left atrium

A

Primitive atrium

230
Q

forms sinus venarum (smooth part of right atrium), coronary sinus, and oblique vein of left atrium

A

Sinus venosus

231
Q

heart divides into how many chambers?

A

four

232
Q

by formation of its

A

septum and valves

233
Q

Four main septa involved in dividing the heart include the

A

AP septum, the atrial septum, the AV septum,

and the IV septum

234
Q

grow in a spiral fashion and fuse to form the AP septum

A

The truncal ridges and the bulbar ridges derived from neural crest mesenchyme

235
Q

The AP septum divides the truncus arteriosus into the

A

aorta and pulmonary trunk

236
Q

grows toward the AV endocardial cushions from the roof of the primitive atrium

A

Septum primum

237
Q

forms to the right of the septum primum and fuses with the septum primum to form the atrial septum

A

Septum secundum

238
Q

separates the right and left atria

A

atrial septum

239
Q

forms between the free edge of the septum primum

A

Foramen primum

240
Q

allowing a passage between the right and left atria

A

AV septum

241
Q

foramen primum is closed by growth of the

A

septum primum

242
Q

forms in the center of the septum primum

A

Foramen secundum

243
Q

an oval opening in the septum secundum that provides a communication between the atria

A

Foramen ovale

244
Q

The dorsal and ventral AV endocardial cushions fuse to form the

A

AV septum

245
Q

AV septum partitions the AV canal into the

A

right and left AV canals

246
Q

develops as outgrowth of muscular wall in the floor of the primitive ventricle and grows toward the AV septum but stops to create the IV foramen, leaving the septum incomplete

A

Muscular IV septum

247
Q

Membranous IV septum forms by fusion of the

A

bulbar ridges with the endocardial cushion, the AP

septum, and the muscular part of the IV septum

248
Q

The membranous IV septum closes the _____,

completing partition of the ventricles

A

IV foramen

249
Q

It is characterized by right-to-left shunting of blood and cyanosis.

A

Tetralogy of Fallot

250
Q

occurs when the AP septum fails to align properly with the AV septum, resulting in pulmonary stenosis (obstruction to right ventricular outflow), overriding aorta (dextroposition of aorta), interventricular septal defect , and hypertrophy of the right ventricle.

A

Tetralogy of Fallot

251
Q

occurs when the AP septum fails to develop in a spiral fashion, causing the aorta to open into the right ventricle and the pulmonary trunk to open into the left ventricle.
It results in right-to-left shunting of blood and cyanosis

A

Transposition of the great vessels

252
Q

is caused by abnormal development of the septum primum or secundum, resulting in a patent foramen ovale

A

Atrial septal defect (ASD)

253
Q

A blood clot , which usually forms in the deep veins of the thigh or the leg, travels

A

to the right atrium, the left atrium through the atrial septal
defect, the left ventricle, the systemic circulation, and eventually to the brain, causing a stroke

254
Q

occurs commonly in the membranous part of the IV septum because of failure of the membranous IV septum to develop, resulting in left-to-right shunting of blood through the IV foramen, which increases blood flow to the lungs and causes pulmonary hypertension

A

Ventricular septal defect (VSD)

255
Q

The arterial system develops from the

A

aortic arches and branches of the dorsal aorta

256
Q

Aortic arch 1 has no derivative because

A

it disappears soon after development

257
Q

Aortic arch 2 has no derivative because

A

it persists only during the early development

258
Q

Aortic arch 3 forms the

A

common carotid arteries and the proximal part of the internal carotid arteries

259
Q

Aortic arch 4 forms the _____ on the left and _____ on the right

A

aortic arch on the left;

and the brachiocephalic artery and the proximal subclavian artery on the right

260
Q

Aortic arch 6 forms the

A

proximal pulmonary arteries and ductus arteriosus

261
Q

Form the intercostal, lumbar, vertebral, cervical, internal thoracic, and epigastric arteries, and arteries to
upper and lower limbs.

A

Posterolateral branches

262
Q

Form the renal, suprarenal, and gonadal arteries.

A

Lateral branches

263
Q

form the celiac (foregut), superior mesenteric (midgut), and inferior mesenteric (hindgut) arteries

A

Vitelline arteries

264
Q

form a part of the internal iliac and superior vesical arteries

A

Umbilical arteries

265
Q

The venous system develops from the

A

vitelline, umbilical, and cardinal veins

266
Q

The venous system drain into the

A

venosus

267
Q

Return poorly oxygenated blood from the yolk sac

A

Vitelline veins

268
Q

Right (vitelline) vein forms the

A

hepatic veins and sinusoids, ductus venosus, hepatic portal, superior mesenteric, inferior mesenteric, and splenic veins and part of the IVC

269
Q

Left (vitelline) vein forms the

A

hepatic veins and sinusoids and ductus venosus

270
Q

Carry well-oxygenated blood from the placenta.

A

Umbilical veins

271
Q

Right (umbilical) vein degenerates during

A

early development

272
Q

Left (umbilical) vein forms the

A

ligamentum teres hepatis

273
Q

Return poorly oxygenated blood from the body of the embryo

A

cardinal veins

274
Q

Anterior cardinal vein forms the

A

internal jugular veins and SVC

275
Q

Posterior cardinal vein forms

A

a part of the IVC and common iliac veins

276
Q

Subcardinal vein forms

A

a part of the IVC, renal veins, and gonadal veins

277
Q

Supracardinal vein forms

A

a part of the IVC, intercostal, azygos, and hemiazygos veins

278
Q

the fetus has blood that is oxygenated in the

A

placenta rather than in the lungs

279
Q

the fetus has_____ shunts that partially bypass the lungs and liver

A

three

280
Q

Is an opening in the septum secundum.

A

Foramen ovale

281
Q

Foramen ovale usually closes functionally at

A

birth, but with anatomic closure occurring later.

282
Q

Foramen ovale shunts blood from the

A

right atrium to the left atrium, partially bypassing the lungs (pulmonary circulation).

283
Q

Ductus arteriosus is derived from the ______ connects the bifurcation of the pulmonary trunk

A

sixth aortic arch

284
Q

Closes functionally soon after birth, with anatomic closure requiring several weeks

A

Ductus arteriosus

285
Q

Ductus arteriosus becomes the

A

ligamentum arteriosum

286
Q

connects the left pulmonary artery (at its origin from the

pulmonary trunk) to the concavity of the arch of the aorta

A

ligamentum arteriosum

287
Q

Ductus arteriosus shunts blood from the

A

pulmonary trunk to the aorta, partially bypassing the lungs (pulmonary circulation).

288
Q

results from failure of the ductus arteriosus to close after birth. It is common in premature infants

A

Patent ductus arteriosus

289
Q

Shunts oxygenated blood from the umbilical vein (returning from the placenta) to the IVC, partially
bypassing the liver (portal circulation).

A

Ductus venosus

290
Q

Ductus venosus joins the left branch of the portal vein to the IVC and is obliterated to become the

A

ligamentum venosum after birth

291
Q

Carry blood to the placenta for reoxygenation before birth.

A

Umbilical arteries

292
Q

Umbilical arteries become what after birth

A

medial umbilical ligaments after birth, after their distal parts have atrophied

293
Q

Carry highly oxygenated blood from the placenta to the fetus

A

Umbilical veins

294
Q

Umbilical veins consists of the right vein, which is obliterated during the

A

embryonic period

295
Q

Umbilical veins consists of the left vein, which is obliterated to form the

A

ligamentum teres hepatis after birth

296
Q

Is a muscular tube that is continuous with the pharynx in the neck and enters the thorax behind the trachea

A

esophagus

297
Q

length of esophagus

A

about 10 inches long

298
Q

the 3 constrictions of the esophagus

A

one at the level of the sixth cervical vertebra, where it begins;
one at the crossing of the left main stem bronchus;
and one at the tenth thoracic vertebra, where it pierces the diaphragm.

299
Q

The left atrium also presses against the

A

anterior surface of the esophagus

300
Q

the esophagus has a physiologic sphincter, which is the circular layer of smooth muscle at the gastroesophageal junction aka ____ by clinicians

A

inferior esophageal sphincter

301
Q

esophagus receives blood from

A

three branches of the aorta (the inferior thyroid, bronchial, and esophageal arteries)
and from the left gastric and inferior phrenic arteries

302
Q

is a condition of impaired esophageal contractions because of failure of relaxation of the inferior esophageal sphincter, resulting from degeneration of myenteric (Auerbach’s) plexus in the esophagus

A

Achalasia of esophagus

303
Q

is a systemic collagen vascular disease and has clinical features
of dysphagia for solids and liquids, severe heartburn, and esophageal stricture

A

Systemic sclerosis (scleroderma)

304
Q

thoracic aorta begins

A

at the level of the fourth thoracic vertebra

305
Q

thoracic aorta pathway

A

Descends on the left side of the vertebral column and then approaches the median plane to end in front
of the vertebral column by passing through the aortic hiatus of the diaphragm

306
Q

thoracic aorta gives rise to

A

nine pairs of posterior intercostal arteries and one pair of subcostal arteries

307
Q

The first two intercostal arteries arise from the

A

highest intercostal arteries of the costocervical trunk

308
Q

The posterior intercostal artery gives rise to

A

a collateral branch, which runs along the upper border of the rib below the space

309
Q

thoracic aorta also gives rise to

A

pericardial, bronchial (one right and two left), esophageal, mediastinal, and superior phrenic branches

310
Q

occurs when the aorta is abnormally constricted just inferior to
the ductus arteriosus

A

Coarctation of the aorta

311
Q

Is formed by the union of the right ascending lumbar and right subcostal veins. Its lower end is connected to the IVC.

A

Azygos (unpaired) vein

312
Q

Azygos (unpaired) vein enters the thorax through the

A

aortic opening of the diaphragm

313
Q

Azygos (unpaired) vein receives the

A

right intercostal veins, the right superior intercostal vein , and the hemiazygos and accessory hemiazygos veins.

314
Q

Azygos (unpaired) vein arches over the root of the

A

right lung

315
Q

Azygos (unpaired) vein empties into the

A

SVC, of which it is the first tributary

316
Q

Is formed by the union of the left subcostal and ascending lumbar veins. Its lower end is connected to the left renal vein.

A

Hemiazygos vein

317
Q

Hemiazygos vein ascends on the left side of the vertebral bodies behind the

A

thoracic aorta, receiving the ninth, tenth, and

eleventh posterior intercostal veins

318
Q

Accessory hemiazygos vein pathway

A

Begins at the fourth or fifth intercostal space;
descends, receiving the fourth or fifth to eighth intercostal veins;
turns to the right; passes behind the aorta;
and terminates in the azygos vein

319
Q

Is formed by a union of the second, third, and fourth posterior intercostal veins

A

Superior intercostal vein

320
Q

Superior intercostal vein drains into the

A

azygos vein on the right and the brachiocephalic vein on the left

321
Q

The first posterior intercostal vein on each side drains into the

A

corresponding brachiocephalic vein

322
Q

The second, third, and often the fourth posterior intercostal vein joins to form the

A

superior intercostal vein

323
Q

The rest of the veins drain into the

A

azygos vein on the right and into the hemiazygos or accessory hemiazygos veins on the left

324
Q

Thoracic duct begins in the

A

abdomen at the cisterna chyli

325
Q

is the dilated junction of the intestinal, lumbar, and

descending intercostal trunks

A

cisterna chyli

326
Q

Thoracic duct drains the

A

lower limbs, pelvis, abdomen, left thorax, left upper limb, and left side of the head and neck

327
Q

Thoracic duct passes through the

A

aortic opening of the diaphragm

328
Q

Thoracic duct ascends through the

A

posterior mediastinum between the aorta and the azygos vein

329
Q

Thoracic duct arches laterally over the

A

apex of the left pleura and between the left carotid sheath in front and the
vertebral artery behind

330
Q

Thoracic duct runs behind the

A

left internal jugular vein

331
Q

Thoracic duct empties into

A

the junction of the left internal jugular and subclavian veins.

332
Q

Right lymphatic duct drains the

A

right sides of the thorax, upper limb, head, and neck

333
Q

Right lymphatic duct empties into the

A

junction of the right internal jugular and subclavian veins

334
Q

Is composed of motor, or efferent, nerves through which cardiac muscle, smooth muscle , and glands
are innervated

A

Autonomic Nervous System in the Thorax

335
Q

thoracolumbar outflow

A

sympathetic

336
Q

craniosacral outflow

A

parasympathetic

337
Q

cholinergic fibers use ____ as neurotransmitter

A

acetylcholine

338
Q

adrenergic fibers use _____ as the neurotransmitter

A

norepinephrine

339
Q

fight-or-flight division; Enables the body to cope with crises or emergencies

A

Sympathetic nervous system

340
Q

Sympathetic nervous system contains preganglionic cell bodies that are located in the lateral horn or intermediolateral cell column of the spinal cord segments between

A

T1 and L2

341
Q

Sympathetic nervous system has _____ that pass through the white rami communicantes and enter the sympathetic chain ganglion, where they synapse

A

preganglionic fibers

342
Q

Sympathetic nervous system has _____ that join each spinal nerve by way of the gray rami communicantes and supply the blood vessels, hair follicles (arrector pili muscles), and sweat glands.

A

postganglionic fibers

343
Q

Sympathetic nervous system increases the

A

heart rate

344
Q

Sympathetic nervous system dilates the

A

bronchial lumen and the coronary arteries

345
Q

Is composed primarily of ascending and descending preganglionic sympathetic fibers and visceral
afferent fibers, and contains the cell bodies of the postganglionic sympathetic (GVE) fibers.

A

Sympathetic trunk

346
Q

Sympathetic trunk descends in

A

front of the neck of the ribs and the posterior intercostal vessels

347
Q

Sympathetic trunk contains the

A

cervicothoracic (or stellate) ganglion

348
Q

cervicothoracic (or stellate) ganglion is formed by

A

fusion of the inferior cervical ganglion with the first thoracic ganglion

349
Q

sympathetic trunk enters the abdomen through the

A

crus of the diaphragm or behind the medial lumbocostal arch

350
Q

sympathetic trunk gives rise to

A

cardiac, pulmonary, mediastinal, and splanchnic branches

351
Q

sympathetic trunk is connected to the thoracic spinal nerves by

A

gray and white rami communicantes

352
Q

is an injection of local anesthetic near the stellate ganglion by placing the tip of the needle near the neck of the first rib. It produces a temporary interruption of sympathetic function such as in a patient with excess vasoconstriction in the upper limb.

A

Stellate block

353
Q

Contain preganglionic sympathetic GVE (myelinated) fibers with cell bodies located in the lateral horn (intermediolateral cell column) of the spinal cord and GVA fibers with cell bodies located in the dorsal root ganglia.

A

White rami communicantes

354
Q

Contain postganglionic sympathetic GVE (unmyelinated) fibers that supply the blood vessels, sweat glands, and arrector pili muscles of hair follicles

A

Gray rami communicantes

355
Q

Gray rami communicantes are connected to every spinal nerve and contain fibers with cell bodies located in the

A

sympathetic trunk

356
Q

Contain sympathetic preganglionic GVE fibers with cell bodies located in the lateral horn (intermediolateral cell column) of the spinal cord and GVA fibers with cell bodies located in the dorsal root ganglia

A

Thoracic splanchnic nerves

357
Q

Arises usually from the fifth through ninth thoracic sympathetic ganglia, perforates the crus of the
diaphragm or occasionally passes through the aortic hiatus, and ends in the celiac ganglion

A

Greater splanchnic nerve

358
Q

Is derived usually from the tenth and eleventh thoracic ganglia, pierces the crus of the diaphragm,
and ends in the aorticorenal ganglion.

A

Lesser splanchnic nerve

359
Q

Is derived usually from the twelfth thoracic ganglion, pierces the crus of the diaphragm, and ends in
the ganglia of the renal plexus.

A

Least splanchnic nerve

360
Q

Parasympathetic nervous system decreases the

A

heart rate

361
Q

Parasympathetic nervous system constricts the

A

bronchial lumen

362
Q

Parasympathetic nervous system causes

A

vasoconstriction of the arteries

363
Q

Right vagus nerve gives rise to the

A

right recurrent laryngeal nerve

364
Q

right recurrent laryngeal nerve hooks around the right subclavian artery and ascends into the neck between the

A

trachea and the esophagus

365
Q

right vagus nerve pathway

A

Crosses anterior to the right subclavian artery, runs posterior to the SVC, and descends at the right
surface of the trachea and then posterior to the right main bronchus.

366
Q

right vagus nerve forms the posterior vagal trunk (or gastric nerves) at the

A

lower part of the esophagus

367
Q

right vagus nerve enters the abdomen through

A

the esophageal hiatus

368
Q

left vagus nerve enters the thorax between the _____ and _____ and behind the _____

A

left common carotid and subclavian arteries;

left brachiocephalic vein

369
Q

left vagus nerve descends on the

A

arch of the aorta

370
Q

Left vagus nerve gives rise to the

A

left recurrent laryngeal nerve

371
Q

hooks around the arch of the aorta to the left of

the ligamentum arteriosum

A

left recurrent laryngeal nerve

372
Q

Left vagus nerve ascends through the superior mediastinum and the neck in a

A

groove between the trachea and esophagus

373
Q

Left vagus nerve gives off the

A

thoracic cardiac branches

374
Q

Left vagus nerve breaks up into the

A

pulmonary plexuses

375
Q

Left vagus nerve continues into the

A

esophageal plexus

376
Q

Left vagus nerve forms the

A

anterior vagal trunk

377
Q

caused by a bronchogenic or esophageal carcinoma,
enlargement of mediastinal lymph nodes, or an aneurysm of the aortic arch, causing respiratory
obstruction, hoarseness, and an inability to speak because of paralysis of the vocal cord

A

Injury to the recurrent laryngeal nerve

378
Q

is transection of the vagus nerves at the lower portion of the esophagus in an attempt to reduce gastric secretion in the treatment of peptic ulcer

A

vagotomy

379
Q

increases heart rate, dilates coronary arteries, and thus increases blood flow through the vessels, supplying more oxygen and nutrients to the myocardium.

A

Sympathetic stimulation

380
Q

Sympathetic nerve also produces

A

bronchodilation and vasoconstriction of pulmonary vessels

381
Q

slows the heart rate, constricts the coronary arteries, produces bronchoconstriction (motor to smooth muscle) and vasodilation of the pulmonary vessels, and increases
glandular secretion of the bronchial tree (secretomotor).

A

Parasympathetic stimulation

[OS 205] 1st Exam (6 decks)

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