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Clinical Morphology > Week 4 > Flashcards

Week 4 Flashcards

1
Q

embryonic heart tube formation

A

forms from mesoderm in the 3rd week (days 18-22)

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2
Q

angioblasts

A

endocardial cells that differentiate from mesorderm in the formation of the heart tube surrounded by myoblasts

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3
Q

Truncus Arteriosis forms which adult structure(s)?

A

proximal aorta and pulmonary trunk

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4
Q

Bulbus Cordis forms which adult structure(s)?

A

Conus Arteriosis (RV), Aortic Vestibule (LV), and Trabeculated RV

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5
Q

Primitive Ventricle forms which adult structure(s)?

A

trabeculated LV

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6
Q

Primitive Atrium forms which adult structure(s)?

A

trabeculated RA and trabeculated LA

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7
Q

Sinus Venosus forms which adult structure(s)?

A

smooth RA and Coronary sinus

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8
Q

What’s the order of the regions of the embryonic heart?

A

top to bottom:
T B V A S
Truncus Arteriosus, Bulbus Cordis, Primitive Ventricle, Primitive Atrium, Sinus Venosus.

Arterial end at the top, Venous end at the bottom, BVA in the middle

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9
Q

What direction does the ventricular region of the heart move in “looping”?

A

ventrally, caudally, and to the right

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10
Q

What direction does the atrial region of the heart move in “looping”?

A

dorsally, cranially, and to the lefrt

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11
Q

What structures are required for “looping”?

A

cilia and dynein

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12
Q

What veins carry blood from the yolk sac to the heart?

A

vitelline veins

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13
Q

What veins carry blood from the placenta to the heart?

A

umbilical veins

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14
Q

What veins carry blood from the embryo to the heart?

A

cardinal veins

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15
Q

When does septation occur in the embyonic heart?

A

between 27-37 days

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16
Q

What occurs in septation of embryonic heart?

A

the single primitive atrium, ventricle, and outflow tract (truncus arteriosus) are separated by formation of septa (walls)

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17
Q

What is septum primum?

A

it grows from the roof of the common atrium down toward the atrioventricular canal

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18
Q

When does Septum Primum begin to form?

A

at the end of the 4th week

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19
Q

What is the foramen primum?

A

The septum primum does not form completely at first, leaving this foramen

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20
Q

What is foramen secundum?

A

Before foramen primum closes, cell death occurs in the septum primum forming this foramen secundum

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21
Q

What is septum secundum?

A

It form to the right of the septum primum, but also does not form completely

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22
Q

What is foramen ovale?

A

an opening in the septum secundum that allows blood flowing in from the IVC to push agains the septum primum and pass directly from the right atrium to the left atrium through the foramen secundum

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23
Q

What can cause atrial septal defects to occur?

A

If the septum secundum doesn’t grow enough or if the foramen secundum is too large

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24
Q

What are endocardial cushions?

A

They are proliferating endocardial cells on the dorsal and ventral walls of the heart. They grow toward each other and fuse, separating the single opening into 2.
They also form the atriventricular valves

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25
Q

How does septation of the ventricles occur?

A

Formation of a muscular and membranous septum.

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26
Q

Formation of the muscular septum

A

it develops from myoblasts in the midline on the floor of the primitive ventricle. It grows towards the fused endocardial cushions

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27
Q

Formation of the membranous septum

A

it forms from the fused endocardial cushions and the inferior ends of the conotruncal ridges of the truncus arteriosus

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28
Q

most common congenital cardiac defect

A

membranous ventricular septal defect

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29
Q

what is septation of the outflow tract and when does it occur?

A

splits the outflow tract into the aorta and pulmonary trunk beginning at week 5

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30
Q

How does septation of outflow tract happen

A

Occurs when neural crest cells migrate into the endocardium of the truncus arteriosus causing endocardial cells to proliferate and migrate to form the conotruncal ridges

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31
Q

What are the conotruncal (truncoconal) ridges?

A

a pair of opposing ridges that spiral around the truncus arteriosus and fuse in the middle, causing the spiral course of the aorta and pulmonary trunk

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32
Q

What are some defects in formation of the aorticopulmonary septum?

A

Persistent truncus arteriosus (no septum forms), transposition of the great vessels (the septum doesn’t spiral) and tetralogy of fallot ( the septum forms asymmetrically)

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33
Q

Persistent truncus arteriosus

A

no septum forms

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34
Q

transposition of the great vessels

A

the septum doesn’t spiral in septation of truncus arteriosus

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35
Q

tetralogy of fallot

A

the septum in truncus arteriosus forms asymmetrically

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36
Q

What are the 3 shunts in fetal circulation

A

ductus venosus, foramen ovale, and ductus arteriosus

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37
Q

What does ductus venosus do

A

shunts blood from the umbilical vein to the IVC, bypassing the fetal liver

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38
Q

what does foramen ovale do

A

shunts blood that enters right atrium from IVC to the left atrium

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39
Q

what does ductus arteriosus do

A

blood from the SVC still manages to get into the right ventricle, which goes to the pulmonary trunk
ductus arteriosus shunts blood from the pulmonary trunk to the descending aorta, bypassing the lungs

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40
Q

Why does blood bypass the lungs in fetal circulation

A

pressure/pulmonary vascular resistance is high due to amniotic fluid in the lungs

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41
Q

Pressure changes in circulation after birth

A

Pressure in left atrium increases, pressure in right atrium decreases, and pressure in lunch decrease

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42
Q

what causes pressure change in left atrium after birth?

A

lungs fill with air, blood flows into lungs, and returns to the left atrium increasing its pressure

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43
Q

what causes pressure change in right atrium after birth?

A

the umbilical veins constrict, decreasing pressure in RA

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44
Q

what cause the foramen ovale to close after birth?

A

increased pressure in the LA pushes the septum primum and secundum together, by about 3 months they fuse

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45
Q

what is probe patency?

A

incomplete fusion of foramen ovale after birth. it occurs in about 20-25% of people. Also called patent foramen ovale

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46
Q

what causes the ductus arteriosus to constrict?

A

peptide hormone Bradykinin constricts the ductus arteriosus, and it is fully closed within 24 hours of birth

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47
Q

what keeps ductus arteriosus open before birth?

A

Prostaglandin E2 from the placenta

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48
Q

What is the adult remnant of the ductus venosus?

A

ligamentum venosum

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49
Q

What is the adult remnant of foramen ovale?

A

fossa ovale

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50
Q

What is the adult remnant of ductus arteriosus?

A

ligamentum arteriosum

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51
Q

What are the stages of embryonic lung development?

A

Embryonic, pseudoglandular, canalicular, saccular, and alveolar
(Every Pulmonologist Can See Alveoli)

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52
Q

What happens in embryonic stage of lung development?

A

Weeks 3-6

lung bud from the foregut branches to form tertiary (segmental) bronchi

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53
Q

What happens in pseudoglandular stage of lung development?

A

Weeks 6-16

bronchi branch to form terminal bronchioles

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54
Q

What happens in canalicular stage of lung development?

A

Weeks 16-26
Terminal bronchioles divide into respiratory bronchioloes and alveolar ducts; surrounded by capillaries. Also airways increase in diameter

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55
Q

What happens in saccular stage of lung development?

A

Weeks 26-36

Alveolar ducts divide into terminal sacs (primitive alveoli) with type I and II pneumocytes

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56
Q

What happens in alveolar stage of lung development?

A

Weeks 36 to 8 years old

Alveoli increase, mature, and have well-developed epithelial-endothelial contacts

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57
Q

What can errors in embryonic stage of lung development cause?

A

tracheoesophageal fistula

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58
Q

Respiration is impossible during which before which stage of lung development?

A

canalicular (weeks 16-26); the formation of alveoli and their associated capillaries are required for respiration

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59
Q

When does respiration become possible?

A

25 weeks

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60
Q

When do pneumocytes begin to develop?

A

at 20 weeks, during the canalicular stage of lung development

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61
Q

What do type II pneumocytes do

A

make surfactant, which decreases surface tension of alveoli to keep them from collapsing

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62
Q

how many alveoli are present at birth versus at 8 years old

A

20-70 million versus 300-400 million

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63
Q

Origin of epithelium of larynx, trachea, bronchi and lungs

A

endodermal

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64
Q

What separates the developing lung bud from the esophagus

A

a mesodermal septum

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65
Q

What is tracheoesophageal fistula?

A

Error in embryonic stage of lung dev; Occurs when the mesodermal tracheoesophageal septum does not form correctly. Trachea can communicate with the esophagus.

Depending on variant, food/drink can enter lungs from esophagus or the esophagus can end as a blind-ended tube (esophageal atresia)

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66
Q

fistula definition

A

abnormal connection

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67
Q

What is respiratory distress syndrome (RDS)?

A

a common problem in premature infants; most often occurs in babies born before 28 weeks, but can occur in babies born before 37 weeks.
Occurs when there is not enough surfactant in lungs, and can cause infants to require extra oxygen and help with breathing.

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68
Q

Surfactant

A

made by type II pneumocytes starting around week 26; keeps alveoli from from collapsing by decreasing their surface tension

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69
Q

Hypertrophy of heart

A

thickening of cardiac muscle due to overworking

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70
Q

atrophy of heart

A

thinning of the cardiac muscle

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71
Q

necrosis of heart

A

damage induced cell death in heart muscle

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72
Q

what is heart tissue

A

the bulk of it is striated, involuntary cardiac muscle, which can undergo hypertrophy, atrophy, necrosis, and apoptosis

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73
Q

what are the 3 layers of the heart

A

epicardium, myocardium, and endocardium

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74
Q

epicardium

A

AKA visceral pericardium
thin layer of simple squamous mesothelial cells covering fibrous and adipose CT. Contains nerves and blood vessels that supply the heart

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75
Q

myocardium

A

thickest layer of heart; bundles of cardiac muscle cells organized into spiraling fascicles.

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76
Q

What distinguishes cardiac muscle cells?

A

striations, intercalated discs, branched fibers, and centrally located nuclei. NO neuromuscular junctions!

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77
Q

endocardium

A

simple squamous epithelium over a layer of variable thickness CT called subendocardium.

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78
Q

Where are purkinje fibers found?

A

in the subendocardium

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79
Q

density of mitochondria in cardiac muscle cells

A

higher than skeletal muscle; 40% compared to 2%

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80
Q

what are intercalated discs

A

specialized junctional complexes that join cardiac muscle cells to each other. They contain desmosomes, adherens junctions, and gap junctions.

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81
Q

SA node

A

AKA pacemaker
in normal conditions, SA node spontaneously generated electrical activity. The impulse is propagated through the right atrium and to the left atrium and AV node

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82
Q

AV node

A

area of specialized tissue between atria and ventricles specifically near the opening of the coronary sinus (koch’s triangle). It conducts the normal electrical impulse from the atria to the ventricles

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83
Q

bundle of his (atrioventricular bundle)

A

transmits the electrical impulse from the AV node through the cardiac skeleton and membranous interventricular septum to the apex of the muscular interventricular septum where it splits into the bundle branches

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84
Q

left and right bundle branches

A

a group of purkinje fibers that run in the subendocardial space along the interventricular septum and give rise to purkinje fibers that are distributed to the the cells of the ventricular muscle

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85
Q

purkinje fibrers and cells

A

they conduct cardiac action potentials more quickly/efficiently than any other cells in the heart.
large light-staining cells in H&E staining. Few myofilaments and increased glycogen and gap junctions

86
Q

vascular flow direction

A

arteries of decreasing diameter > arterioles > capillary beds > venules > veins of increasing diameter

87
Q

layers of the blood vessels (except for capillaries)

A

Innermost is tunica intima, then tunica media, then tunica adventitia

88
Q

tunica intima

A

single layer of squamous endothelial cells at the lumen of the vessel

89
Q

tunica media

A

concentric layers of smooth muscle cells with elastic fibers, type III collagen, and proteoglycans.

90
Q

What is primarily responsible for the regulation of vascular tone, vessel diameter, and blood pressure?

A

the smooth muscle of tunica media

91
Q

what controls contraction of smooth muscle in blood vessels?

A

autonomic nerves, hormones, and local physiologic conditions

92
Q

tunica adventitia

A

connective tissue layer containing fibroblasts, type I collagen, and elastic fibers. Can contain vaso vasorum and autonomic nerve fibers that control contraction of smooth muscle in tunica media

93
Q

What differentiates veins and arteries of similar size?

A

Veins will have less well developed tunica media and often contain valves to prevent backflow of blood in a low pressure system. In sections, the artery will hold its circular shape, while veins will usually be collapsed

94
Q

arterioles

A

have only 1-3 layers of smooth muscle cells. Important for regulation of blood flow into capillary beds

95
Q

function of capillaries

A

site of fluid, gas, and small molecule exchange between blood and tissues.

96
Q

capillary composition

A

single layer of endothelial cells and a basement membrane.

97
Q

Pericyte

A

a smooth muscle-like cell; in some tissues a pericyte will associate with the outer wall of the capillary acting as a sphincter to control capillary blood flow

98
Q

continuous capillary

A

found in muscle, nerve, and connective tissue

have tight intercellular junctions to restrict leakage and utilize pinocytotic vesicles

99
Q

fenestrated capillary

A

found in GI and endocrine systems

contain permanent channels or fenestrations (pores) across the endothelial cells

100
Q

sinusoidal capillary

A

found in bone marrow, liver, spleen, and lymph nodes

contain large discontinuities between the endothelial cells

101
Q

what is angiogenesis

A

formation of new capillaries from existing capillaries. The process follows a consistent series of steps in all tissues.
Can be normal or pathalogic (excessive and abnormal angiogenesis in diabetic retinopathy)

102
Q

steps of angiogenesis

A
  1. stimulation of endothelial cells by angiogenic factors, such as vascular endothelial growth factor (VEGF)
  2. degradation of the vessel basement membrane by activated endothelial cells and the formation of endothelial sprouts
  3. proliferation of endothelial cells and formation of new capillary roots
  4. new vessel stabilization/ maturation (new basement membrane formation and association of pericytes)
103
Q

conducting portion of respiratory system

A

provides tubular conduit through which air can travel to and from lungs and plays role in conditioning the inspired air.
consists of trachea, bronchi, and bronchioles

104
Q

layers of the organs in conducting portion of the respiratory system

A

mucosa, lamina propria, submucosa, and adventitia

105
Q

mucosa of conducting portion

A

layer of ciliated pseudostratified columnar epithelium with goblet cells (called “respiratory epithelium). It cleans, moistens, and warms the inspired air before it enters the lungs.

106
Q

function of goblet cells

A

produce a rich mucous secretion. These are abundant in the upper portions of the conducting portion of respiratory system

107
Q

What changes occur as we move further down the conducting portion and approach the respiratory portion?

A

number of goblet cells decrease and ciliated pseudostratified columnar epithelium transitions to a simple columnar and cuboidal epithelium

108
Q

lamina propria of conducting portion

A

thick, loosely organized vascularized CT that supports the mucosa

109
Q

submucosa of conducting portion

A

forms the bulk of the thickness of the wall and contains 3 main components in varying amounts depending upon the level of the bronchial tree: smooth muscle cells, hyaline cartilage, and seromucous glands

110
Q

function smooth muscle cells in submucosa

A

smooth muscle contracts and restricts/regulates the amount of airflow through the conducting tubes

111
Q

function hyaline cartilage in submucosa

A

important in preventing collapse of tubular walls. can form c-shaped rings, irregular rings, and small plates

112
Q

trend of components of submucosa as we move down the bronchial tree

A

as the diameter of the tubes decreases, the quantity of bundles of smooth muscle tends to increase and the cartilage tends to decrease.

113
Q

structure of trachea

A

thin walled tube about 10 cm long extending from the larynx to the point at which it divides into the 2 main bronchi. it has 16-20 c-shaped rings of hyaline cartilage in the submucosa. they have fibroelastic cartilage and smooth muscle on the posterior aspect

114
Q

primary bronchi

A

trachea divides into 2 primary bronchi, one for each lung

115
Q

secondary or lobar brinchi

A

divisions of the primary bronchi, they are smaller in diameter each supply a lobe of the lung

116
Q

tertiary or segmental bronchi

A

divisions of the secondary bronchi. they supply the segments of the lung and give rise to bronchioles

117
Q

trend of bronchi histologically as you proceed toward the bronchioes

A

epithelium becomes more simplified, seromucous gland decrease in quantity, amount of cartilage decreases, and bundles of smooth muscles and elastic connective tissue increase

118
Q

structure of bronchioles

A

last and simplest part of the conducting portion. consist of airways with diameters of 5mm or less. Mucosa contains NO glands or cartilage. epithelium is now cuboidal. submucosa contains mainly smooth muscle and elastic fibers

119
Q

respiratory portion of respiratory system

A

is the site of gas exchange in the lung; consists of respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli

120
Q

structure of respiratory bronchioles

A

each terminal bronchiole divides into 2 or more respiratory bronchioles. Mucosa resembles that of terminal bronchioles except the walls are interrupted by numerous saccular alveoli

121
Q

structure of alveoli

A

sac-like structures about 200 micrometers in diameter that are organized into larger structures called acini. Oxygen and carbon dioxide are exchanged between air and blood here. alveoli covered by rich capillary network, fibroblasts, and elastic and reticular fibers

122
Q

how many alveoli in mature adult lungs?

A

about 300 million alveoli with SA of 140 meters squared form the parenchymal structure of lungs

123
Q

type I alveolar cells/pneumocytes

A

squamous cells that make up about 97% of the alveolar surface. They all have desmosomes and tight occluding junctions and a form a gas permeable barrier of minimal thickness

124
Q

type II alveolar cells/ pneumocytes

A

interspersed among the type I cells. Cuboidal in shape. Resemble secretory cells; produce pulmonary surfactant

125
Q

content of lamellar bodies in type II pneumocytes

A

lipid, glycosaminoglycans, and protein

126
Q

alveolar macrophage

A

AKA dust cell
derived from monocytes and can be found on interior of alveolus or on its outer surface. Often contain large amounts of carbon and dust, which they phagocytose from the alveolar lumen

127
Q

components of blood-air barrier

A

1) surface and cytoplasm of type I pneumocytes 2) fused basal laminae of alveolar cells and the capillary endothelial cells 3) the cytoplasm of the endothelial cells

128
Q

function of blood-air barrier

A

separates air in the alveoli from blood in the capillary; oxygen from alveolar air diffuses through layers of the alveolar wall toward the capillary while carbon dioxide diffuses in the opposite direction

129
Q

thoracic inlet

A

superior thoracic aperture; bounded by T1 vertebra, first pair of ribs, and superior border of manubrium

130
Q

thoracic outlet

A

inferior thoracic aperture; bounded by T12, xyphoid process, and 7th-10th costal cartilages. Opening is closed by the diaphragm

131
Q

intercostal muscles

A

raise and lower the ribs for respiration

132
Q

intercostal nerves

A

the ventral rami of the thoracic spinal nerves

133
Q

innervation of diaphragm

A

phrenic nerve (ventral rami of C3, C4, and C5)

134
Q

3 main openings of diaphragm

A

aortic haitus, esophageal hiatus, caval opening

135
Q

aortic hiatus

A

opening in diaphragm at the level of T12
is through the right and left crura and marks the termination of thoracic aorta/beginning of abdominal aorta, thoracic duct, and often azygos vein

136
Q

esophageal hiatus

A

opening of diaphragm at the level of T10

within the muscular part of diaphragm and transmits the esophagus and vagus nerves

137
Q

caval opening

A

opening of diaphragm at level of T8

located within the central tendon and contains IVC and sometimes right phrenic nerve

138
Q

What divides superior and inferior mediastinum?

A

a line drawn horizontally from the sternal angle (jxn of manubrium to body) to the lower border of T4

139
Q

anterior mediastinum

A

contains CT, fat, and remnants of the thymus gland

140
Q

middle mediastinum

A

contains the heart and roots of the great vessels (SVC, aorta, pulmonary trunk and pulmonary veins) enclosed in the pericardial sac as well as the phrenic nerves

141
Q

posterior mediastinum

A

contains descending aorta, azygos vein, thoracic duct, esophagus, trachea, and vagus nerves

142
Q

what is the only point of attachment for lungs in the thoracic cavity?

A

the root or hilum of the lung, where the pulmonary arteries, veins, and primary bronchi enter the lungs

143
Q

visceral pleura

A

the part the the serous membrane that covers the lung

144
Q

parietal pleura

A

the portion of the serous membrane that line the thoracic cavity

145
Q

pleural cavity

A

the space between the visceral and parietal pleura; it contains about 15 mL of pleural fluid that lubricates the surfaces of pleural membranes and facilitates association of lungs with the thoracic wall

146
Q

pneumothorax

A

accumulation of air in the pleural cavity causing the lung to collapse

147
Q

costodiaphragmatic recess

A

recess within the pleural cavity formed by the reflection of the costal and diaphragmatic pleura; can collect fluids that can be aspirated

148
Q

costomediastinal recess

A

recess within the pleural cavity where the costal and mediastinal pleura meet; can collect fluid that can be aspirated

149
Q

pleural effusion

A

abnormal accumulation of fluid in pleura space; can be treated by thoracentesis, which need to be done 1-2 intercostal spaces below the effusion, but no lower than the 8th intercostal space to avoid damage to liver, spleen, and diaphragm

150
Q

innervation of costal parietal pleura

A

intercostal nerves

151
Q

innervation of mediastinal parietal pleura and diaphragmatic parietal pleura

A

phrenic nerves

152
Q

innervation of visceral pleura

A

autonomic nerves

153
Q

pericardium

A

fibro-serous sac that encloses heart and roots of the great vessels (SVC, IVC, ascending aorta, pulmonary trunk, and pulmonary veins)

154
Q

Fibrous pericardium

A

the outer surface of the pericardium; strong, dense, and fibrou; blends with the adventitia of the roots of the great vessels and the central tendon of the diaphragm

155
Q

serous pericardium

A

consists of parietal layer and visceral layer

156
Q

parietal pericardium

A

lines the inner surface of the fibrous pericardium

157
Q

visceral pericardium

A

forms the outer layer of the heart (epicardium) and the roots of the great vessels. visceral pericardium reflects back to become the parietal pericardium at the roots of the great vessels, forming the pericardial sinuses

158
Q

pericardial cavity

A

a potential space between visceral pericardium and parietal pericardium

159
Q

transverse pericardial sinus

A

lies posterior to the ascending aorta and pulmonary trunk and anterior to the SVC. It is surgically important because you can make a ligature through the sinus between arteries and veins to stop blood circulation

160
Q

oblique sinus

A

located behind the heart, surrounded by a reflection of serous pericardium around the right and left pulmonary veins

161
Q

direction of flow in the heart

A

IVC and SVC > right atrium > tricuspid > right ventricle > pulmonary valve > pulmonary trunk > lungs > pulmonary veins > left atrium > mitral (bicuspid) valve > left ventricle > aortic valve > aorta > body

162
Q

semilunar valves

A

the aortic and pulmonic valves; they are tricuspid (having 3 cusps)

163
Q

where can you find the openings for coronary arteries in the aorta?

A

adjacent to the left and right cusps fo the aortic valve

164
Q

coronary flow

A

coronary valves fill when the aortic valve closes; thus coronary flow occurs during diastole

165
Q

what causes AV valves to open and close?

A

pressure gradients across the valve

166
Q

cardiac skeleton

A

collection of dense fibrous CT in the form of 4 interconnected rings in a plane between the atria and ventricles; it helps maintain integrity of the valve openings and provides points of attachment for the cusps. Also electrically separates the atrial from ventricular musculature as the collagen fibers are impermeable to electrical propagation

167
Q

anterior surface of the heart

A

covered by the sternum and 3rd-6th costal cartillages

168
Q

posterior surface of heart

A

in front of the posterior mediastinum. also called the base

169
Q

inferior (diaphragmatic) surface of heart

A

the heart rests on this surface

170
Q

what can be some consequences of left atrial enlargement?

A

compression of esophagus (causing dysphagia) or hoarseness (due to compression of left recurrent laryngeal nerve)
the left atrium is most posterior

171
Q

anterior and posterior sulci

A

mark the separation between right and left ventricles and contain the coronary arteries and veins that supply the heart

172
Q

coronary sulcus

A

marks the division between the atria and ventricles

173
Q

vertebral level that passes through the sternal angle

A

T4-T5

174
Q

what does the sternal angle represent

A

separation of superior and posterior mediastinum; ascending aorta becomes aortic arch then aortic arch becomes thoracic aorta and trachea bifurcates

175
Q

what are the landmarks for the margins of the heart?

A

upper limit of heart reaches as high as the 3rd costal cartilage and 2nd intercostal space on left side of sternum

right margin of the heart extends from 3rd costal cartilage to near the right 6th costal cartilage

left margin of the heart descends laterally from the 2nd intercostal space to the apex located near the midclavicular line in the 5th intercostal space

lower margin of the heart extends from the sternal end of the right 6th costal cartilage to the apex in the 5th intercostal space near the midclavicular line

176
Q

which ventricular wall is thicker?

A

left

177
Q

trabeculae carneae

A

muscular ridges of myocardium found in ventricles

178
Q

septomarginal trabecula (moderator band)

A

distinct band of trabeculae carneae that forms a bridge between the interventricular septum and the base of anterior papillary muscle of the right ventricle.
Provides pathway for part of the cardiac electrical conduction system

179
Q

papillary muscles

A

cone-shaped muscles that extend from the ventricular walls and septum, their apices are attached to cordae tendineae that extend and attach to the cusps of the AV valves. Their contraction prevents cusps of AV valves from everting into atrium during ventricular contraction (preventing ventricular regurgitation)

180
Q

atria anatomy

A

mainly smooth walls

181
Q

pectinate muscles

A

muscular ridges found in the right atrium. also found in the auricles of both atria

182
Q

sinus venarum

A

the smooth portion of the muscular walls of the right atrium

183
Q

crista terminalis

A

boundary between the pectinate muscles and the sinus venarum

184
Q

blood supply to the heart

A

coronary arteries (the first branches off the ascending aorta) supply the heart, coronary venous blood is returned through the coronary sinus which drains into the right atrium through the opening of the coronary sinus

185
Q

branches off the right coronary artery

A

posterior descending artery, right marginal artery, SA nodal artery, AV nodal artery

186
Q

posterior descending artery supplies

A

right atrium, right/left ventricle, 1/3 of septum

187
Q

right marginal artery supplies

A

right ventricle

188
Q

SA nodal artery supplies

A

SA node and surrounding myocardium

189
Q

AV nodal artery supplies

A

AV node and surrounding myocardium

190
Q

Branches of left coronary artery

A

left anterior descending artery, left marginal artery, circumflex artery

191
Q

left anterior descending artery supplies

A

right ventricle, left ventricle, 2/3 of septum

192
Q

left marginal artery supplies

A

left ventricle

193
Q

circumflex artery supplies

A

posterior surface of left ventricle

194
Q

dominance of coronary blood supply

A

refers to the artery that gives rise to the posterior interventricular artery. Right dominant is about 85% of population

195
Q

parasympathetic innervation of heart

A

through the vagus nerve

preganglionic fibers from the vagus nerve originate from neurons in the brainstem

196
Q

sympathetic innervation of heart

A

T1-T4 levels of sympathetic trunk
axons of preganglionic neurons originate in the IML of T1-T4 and exit via ventral root. Some synapse at the same level, while others ascend in the sympathetic trunk

197
Q

Afferent nerves of the heart

A

travel back to the spinal cord following the T1-T4 sympathetic nerves

198
Q

referred somatic pain

A

pain arising from musculoskeletal or connective tissue
ie fibrous pericardium, mediastinal pleura, and diaphragm are innervated by phrenic nerves, thus pain from these areas is referred to the shoulder or neck and is usually localized and sharp

199
Q

referrred visceral pain

A

for example: visceral afferents from the heart enter at the T1-T4 spinal cord segments traveling with sympathetics. The pain is felt as coming from the chest and medial arm and is usually dull and diffuse

200
Q

where to auscultate for aortic valve?

A

left of sternum (patient’s right) inferior to sternal angle

201
Q

where to auscultate for pulmonary valve

A

right (patient’s left) of sternum inferior to sternal angle

202
Q

where to auscultate for tricuspid valve

A

right (patient’s left) of the sternum at the level of the 5th rib

203
Q

where to auscultate for mitral valve

A

right (patient’s left) of sternum near the nipple

204
Q

What produces heart sounds

A

closure of AV valve (lub, S1) and closure of semilunar valves (dub, S2)

205
Q

carina

A

the level where the trachea bifurcates into right and left primary bronchi at the level of the sternal angle

206
Q

right main bronchus

A

shorter, wider, and more vertical than the left; more foreign bodies that enter through trachea will be lodged here

207
Q

blood supply to tracheobronchial tree

A

brachial arteries that arise from the descending aorta

208
Q

organization of right lung

A

superior lobe > horizontal fissue > middle lobe > oblique fissure > inferior lobe

209
Q

left lung

A

superior lobe > oblique fissure > inferior lobe

210
Q

innervation of the lung

A

vagus nerves and T1-T4 levels of sympathetic trunk

Clinical Morphology (25 decks)

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