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Med School > Y1Sem2MA2 > Flashcards

Y1Sem2MA2 Flashcards

1
Q

List the development of the 6 aortic arches.

A

1st: Maxillary capillary
2nd: Stapedial capillary
3rd: Right & Left common/internal carotid artery
4th: Arch of aorta (left) & Proximal right subclavian artery
5th: Disappears
6th: Right & Left pulmonary arteries (proximal) & Ductus arteriosus (left distal, the right distal disappears)

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2
Q

Describe the initial formation of blood vessels. (3)

A
  1. Cells in the extra-embryonic splanchnic mesoderm of the yolk sac becomes mesenchymal and forms blood islands.
  2. Peripheral cells form the endothelium and central cells form blood cells (primitive blood and blood stem cells)
  3. Adjacent blood islands fuse with one another
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3
Q

Describe the pathway of blood flow to the lower body when there is Post-ductal Coarctation?

A

Subclavian artery ➜ Internal thoracic artery ➜ Anterior intercostal artery ➜ Posterior intercostal artery ➜ Descending thoracic aorta

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4
Q

What is coarctation?

A

Narrowing of the aorta due to thickening of the aorta wall.
Two types:
Postductal and preductal

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5
Q

What is the anatomical basis of notching of rib?

A

There is an increase in blood flow, hence increased blood pressure along the (posterior) intercostal blood vessels due to coarctation.
This causes the intercostal blood vessels to enlarge and erode the ribs forming notches, accompanied with cold lower proximity.

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6
Q

Describe Patent Ductus Arteriosus.

A

The failure of closure of Ductus Arteriosus.
Most common cardiovascular anomaly.
Associated with maternal rubella infections.
Common is females, premature infants and those born in high altitude.

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7
Q

Describe formation of Double Aortic Arch and complications associated.

A

Arises when right subclavian artery fails to involute from the aorta.
Patients may suffer from compression of trachea and oesophagus, hence difficulty in breathing and swallowing.

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8
Q

Describe Dextrocardia.

A

Heart loops to the left instead of the right. Primitive atrium is on the left whereas primitive ventricle on right.

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9
Q

Describe Ectopia Cordis.

A

Heart is completely exposed. The sternum halves are separated and the cardiac sac open due to failure of the fusion of the lateral fold in the thoracic wall. Death is due to infection and cardiac failure.

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10
Q

Name the 3 Atrial Septal Defects

A

Ostium secondum defect
Patent foramen ovale
Prenatal closing of foramen ovale

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11
Q

Describe the difference between ostium secundum defects and patent foramen ovale.

A

Ostium secundum defect is the:
perforations of septum primum,
enlarged foramen ovale,
inadequate growth of the septum secundum or
excessive absorption of the septum primum.

Patent foramen ovale is the failure of fusion of the foramen.

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12
Q

What are disorders linked to PFO?

A

Cryptogenic neurologic events such as strokes and transient ischemia attacks (TIAs)

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13
Q

What is the method used to surgically close PFO?

A

Septal occlusion method.

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14
Q

Name 2 Ventricular Septal Defects.

A

Membranous inter-ventricular defect

Cardiomegaly

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15
Q

Describe Membranous inter-ventricular defect.

A

The membrane component fails to form and therefore leaving a gap between left and right ventricle causing excessive pulmonary flow leading to pulmonary hypertension. Dyspnoea and cardiac failure is common in early infancy.

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16
Q

Describe the consequences of uncorrected VSD.

A

Blood flow from left to right ➜ Increase in pulmonary blood flow ➜ pulmonary hypertension ➜ proliferation of musculature of tunica media and intima ➜ narrow lumen ➜ increased resistance ➜ blood flows back to left ➜ cyanosis (Eisenmenger syndrome)

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17
Q

What is Eisenmenger Syndrome?

A

Congenital cardiac defect that leads to pulmonary hypertension, reversal of flow and cyanosis.
Symptoms: excessive fatigue on exertion.

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18
Q

Describe the formation of right aortic arch.

A

Due to abnormal obliteration of the distal portion left 4th aortic arch, forming abnormal left subclavian artery. Hence formation of aorta forms on the right instead.

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19
Q

Describe the signs of Cyanosis.

A

Bluish discolouration of the extremities: lips, fingers and toes.

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20
Q

What is Persistent Truncus Arteriosus?

A

The fusion of both pulmonary trunk and aorta due to failure of truncus septum formation. Always accompanied with interventricular septal defect.

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21
Q

Describe Transposition of Great Vessels

A

Aorta opens into right ventricle and pulmonary trunk opens into the left ventricle instead.
Marked cyanosis and incompatible with life.

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22
Q

How does Tetralogy of Fallot manifest?

A

From defects in bulbous cordis and truncus arteriosus.

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23
Q

What is the difference between aortic valvular stenosis and atresia?

A

Aortic valvular stenosis fusion of the thickened valves that only a pinhole opening remains. The size of the aorta itself is usually normal.

Aortic valvular atresia, the and fusion of the semilunar aortic valves is complete the aorta, left ventricle, and left atrium are markedly underdeveloped. It is usually accompanied by patent ductus arteriosus, which delivers blood into the aorta.

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24
Q

What are the features of Tetralogy of Fallot?

A

Pulmonary stenosis
Right ventricular hypertrophy
Over riding aorta
VEntricular septal defect

Cyanosis

PROVE

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25
Q

What are the signs of TOF?

A

Loud heart murmurs
Tet spells - hypercyanosis when crying or feeding
Breathing difficulty, faint spells

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26
Q

Relate flow, pressure and resistance of blood vessels using equations.

A

Flow = (Pa - Pb)/Resistance

Resistance = (8ηL)/(πr^4)

Pa - Pb, pressure difference
η, viscosity
r, radius
L, length

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27
Q

Explain the terms resistance and capacitance vessels.

A

Resistance vessels: Small arteries and involve in the regulation of arterial blood pressure as well as blood flow within the organ in response to changes in autonomic nerve activity and circulating hormones by constricting or dilating.

Capacitance vessels: Large veins that serve as primary capacitance vessels where most of the blood volume is found and where regional blood volume is regulated.

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28
Q

What are the two types of blood flow?

A

Laminar flow

Turbulence flow

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29
Q

Describe laminar flow.

A

Concentric layers (laminar)
Normal
Silent

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30
Q

Describe turbulent flow.

A 
Eddy currents
Increase velocity
Obstruction
Rough surface
Sharp turn
Murmurs
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31
Q

Outline the architecture of microcirculation.

A

50μm or less in diameter

Precapillary Arterioles
Metarterioles
Capillaries
Postcapillary Venules

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32
Q

Functions of microcirculation. (7)

A

Exchange of oxygen and carbon dioxide.
Removal of waste products.
Transport and supply of nutrients.
Heat exchange.
Hormones delivery.
Plasma filtration in glomerular capillaries.
Reabsorption of filtered substances in peritubular capillaries.

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33
Q

What is critical closing pressure?

A

The pressure whereby the blood flow through a vessel cease.

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34
Q

Equation for Probability of Turbulence.

A

Re = ρDV/η

Re, Reynold's number
ρ, density of fluid
D, diameter of vessel
V, velocity
η, viscosity
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35
Q

How are substances transported across the capillary walls?

A

Across Pores: fenestrations and sinusoids.

Across Cells: transcytosis, diffusion, filtration (glomerulus capillaries)

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36
Q

Name the 3 regulators of blood flow.

A

Caliber of arterioles
Vascular tone
Precapillary sphincter

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37
Q

Define oncotic pressure.

A

The drawing force into the capillaries.

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38
Q

Relate the oncotic pressure and loss of blood volume.

A

Decrease in blood volume is a result of blood loss.
Hemoconcentration increases leading to rise of oncotic pressure.
Leading to movement of interstitial fluid into intravascular space to maintain blood volume.

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39
Q

What are Staring Forces?

A

Measurement of the pressure in the arterial or venous end.

Fluid movement across the capillary
=k[ (Pc - Pi) - (πc - πi) ]

k, capillary filtration coefficient
Pc, hydrostatic pressure of capillary blood
Pi, hydrostatic pressure of interstitial fluid
πc, oncotic pressure of capillary blood
πi, oncotic pressure of interstitial fluid

(Pc - Pi), filtration pressure, driving force out of capillary
(πc - πi), osmotic pressure gradient, drawing force into capillary

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40
Q

Name the 4 factors influencing interstitial fluid volume.

A

Increased filtration pressure
Decreased oncotic pressure gradient
Increased capillary permeability
Inadequate lymph flow

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41
Q

What causes increased filtration pressure?

A

Arteriole dilation and venular constriction.

Increased venous pressure:
Gravity
Venous obstruction
Incompetent venous valves
Heart failure
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42
Q

What causes decreased oncotic pressure gradient?

A 
Decrease plasma protein level:
Starvation
Poor protein diet
Loss of albumin
Maldigestion & Malabsorption

Osmotically active particles in interstitial tissue.

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43
Q

What causes increased capillary permeability?

A

Histamine
Kinins

Allergic reaction
Inflammatory reaction
Insect bites (local edema)

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44
Q

What causes inadequate lymph flow?

A

Removal of lymph node (breast cancer surgery)
Obstruction of lymph (elephantiasis)
Lymphedema (non-pitting oedema)

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45
Q

List the 3 shunts present in foetal life and their locations.

A

Ductus Venosus at liver
Ductus Arteriosus at between aorta and pulmonary trunk
Foramen Ovale between atria of heart

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46
Q

What is the function of Ductus Venosus?

A

Connects the left portal vein to the left hepatic vein.

Blood from left umbilical vein bypasses liver and directed to inferior vena cava.

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47
Q

What is the function of Ductus Arteriosus?

A

Allow blood from pulmonary trunk to bypass the lungs and enter the aorta.

48
Q

What is the function of foramen ovale?

A

Directs blood from vena cava to flow into the left atrium. Bypassing the ventricles.

49
Q

What are the 5 remnants after closure of foetal circulation?

A

Ductus Venosus ➜ Ligamentum Vesosum
Ductus Arteriosus ➜ Ligamentum Arteriosum
Foramen Ovale ➜ Fossa Ovalis
Left Umbilical Vein ➜ Ligamentum Teres
Right & Left Umbilical Arteries ➜ Medial Umbilical Ligament

50
Q

Describe the architecture of the pulmonary circulation.

A

Pulmonary trunk ➜
Right and Left pulmonary arteries ➜
3 lobar arteries to right lung, 2 lobar arteries on left lung ➜
Arterioles ➜ capillaries ➜
2 Superior & 2 Inferior pulmonary veins ➜
Left atrium.

51
Q

Describe the segments of the aorta from the left ventricle onwards.

A 
Ascending Aorta ➜ 
Aortic Arch ➜
Descending Aorta ➜
Thoracic Aorta at T4 ➜
Abdominal  Aorta at T12 ➜
Ends at L4 ➜ Right and Left common iliac arteries
52
Q

List the branches from the Ascending Aorta.

A

2 coronary arteries to the heart

53
Q

What are the 3 branches of the Aortic Arch?

A 
Brachiocephalic trunk
     right common carotid artery
     right subclavian artery
Left common carotid artery
Left subclavian artery
54
Q

What are the 3 branches of subclavian artery?

A

Vertebral artery
Thyrocervical artery
Costocervical artery

55
Q

List the 3 branches of External Carotid Artery.

A

Maxillary artery
Superficial temporal artery
Occipital artery

56
Q

Describe the route of internal carotid artery.

A

Enters the skull through the carotid canal
Branches into Ophthalmic artery
Divides into anterior and middle cerebral arteries.

57
Q

Describe the route of Right and Left vertebral arteries.

A

Ascend through the foramen a of C6 to C1 transverse process.
Enters the skull through foramen magnum.
Merge (anastomoses) to form Basilar artery.
Basilar artery branches to form posterior cerebral arteries.

58
Q

What are the arteries that make up Circle of Willis?

A 
Anterior cerebral artery
Anterior communicating artery
Internal carotid artery
Posterior cerebral artery
Posterior communicating artery
59
Q

Describe Circle of Willis.

A

Branches of arteries circling the pituitary gland and optic chiasma, supplying blood to the brain.

60
Q

Describe the arterial route of the upper limb.

A 
Subclavian artery enters the axilla ➜
Axillary artery ➜
Brachial artery, splits into ➜
Ulnar and radial artery, anastomose ➜
Palmar arch
61
Q

What are the 6 branches of the Thoracic Arota?

A 
Bronchial arteries
Mediastinal arteries
Esophageal arteries
Pericardial arteries
Superior phrenic artery
Pssterior intercostal arteries
62
Q

Describe the intercostal muscles arterial supply.

A

The posterior intercostal arteries are branched off the thoracic aorta.
The anterior intercostal arteries are branched off internal thoracic artery of the subclavian artery.

63
Q

What are the 3 major branches of the abdominal aorta and the locations they supply?

A

Celiac trunk, supplies left gastric, splenic and common hepatic.
Superior mesenteric, supplies intestines.
Inferior mesenteric, supplies distal half of large intestine.

64
Q

What is the definition of mesenteries?

A

Double layered sheets of peritoneum that support most organ in the abdominal cavity.

65
Q

Define: phrenic, gastric, hepatic, renal and colic.

A 
Phrenic: relating to the diaphragm.
Gastric: originating in the stomach.
Hepatic: relating to liver.
Renal: relating to kidney.
Colic: pertaining to the colon.
66
Q

What do the other minor Abdominal Aorta branches supply? (4)

A

Adrenal glands, kidneys, gonads, abdominal body wall.

67
Q

Describe the origin and location of common iliac artery and its branches.

A

Originates from splitting of the Abdominal Aorta at L4.

Branches into Internal and External iliac artery.

68
Q

What does the Internal iliac artery supply? (4)

A

Supplies the pelvic organs, perineum, buttocks and medial thighs.

69
Q

Describe the route of the external iliac artery.

A 
External iliac ➜
Femoral artery (under inguinal ligament) ➜
Popliteal artery (behind knee) ➜
Posterior tibial & fibular artery ➜
Dorsalis pedis ➜
Plantnar arch
70
Q

What are the 3 major veins that enters the right atrium?

A

Superior vena cava
Inferior vena cava
Coronary sinus

71
Q

Describe briefly the function and architecture of the Dural Sinuses.

A

Dural sinuses drains blood from the veins of the brain.

Consisting of cavernous sinuses and sigmoid sinuses anastomosing and empty into the internal jugular vein.

72
Q

Describe the function of the external and internal jugular vein.

A

Internal JV: drains blood from brain, merge with subclavian vein to form brachiocephalic vein.

External JV: drains blood from face and scalp.

73
Q

What is the system that drains the thorax?

A

The Azygos System.

74
Q

What is the name of the vein in the arm where blood is drawn from?

A

Median cubital vein.

75
Q

Describe the tributaries of the IVC.

A 
"I Like To Rise So High", 
Iliac vein (common), 
Lumbar vein, 
Testicular (gonadal) vein, 
Renal vein, 
Suprarenal vein and 
Hepatic vein
76
Q

Describe the structure of the hepatic portal vein.

A

The superior mesenteric and splenic vein anastomoses to form the hepatic portal vein which goes up into the liver.

The inferior mesenteric vein empties into the splenic vein.

77
Q

Describe the hepatic portal system. (3)

A

Delivers digested nutrients from stomach and intestine to the liver for storage and detoxification.

Consists of 2 capillary beds (stomach & intestine, liver)

Route:
Artery ➜ gut capillaries ➜ hepatic portal vein ➜ liver capillaries ➜ hepatic vein ➜ IVC

78
Q

Describe the leg vein drainage route.

A

It is similar to the arterial supply route. Recall it.

79
Q

What is the vein used in grafting of coronary artery bypass?

A

Great saphenous vein in the superior femoral region.

80
Q

What are the two types of arteries?

A 
Elastic arteries (large sized)
Muscular arteries (medium sized)
81
Q

List the layers of a blood vessel.

A

Tunica intima
Tunica media
Tunica adventitia

81
Q

What are the properties of tunica intima?

A

Contains:
Endothelium (simple squamous epithelium), which allows smooth blood flow.
Subendothelium, loose connective tissue.

83
Q

What are the properties of tunica media?

A

Smooth muscle: allows vasoconstriction to direct blood around the body.
Elastic fibres: allows forced vasodilation during heart contraction (compensatory mechanism)

84
Q

What are the properties of tunica adventitia? (5)

A

Dense fibrous connective tissue which thins out to loose connective tissue.
Protects the blood vessel.
Gives the vessel shape.
Anchors the vessel to surrounding tissue.
Vasa vasorum can be found here.

85
Q

What is Vasa Vasorum?

A

A vessel that supplies oxygen to the main blood vessel layers, subendothelium onwards to tunica adventitia.
Endothelium is not supplied by it because it is in contact with the blood.

86
Q

Describe a lumen.

A

A ventral blood-filled space of a vessel.

87
Q

Compare artery to vein. (5)

A 
Arteries:
Carries blood away from heart.
Have smaller lumen than veins.
Have thicker tunica media than veins.
Have more elastin than veins.
Have no valves, unlike veins. (High pressure in arteries ensures no backflow)
88
Q

Describe elastic arteries. (4)

A 
Largest arteries (aorta and major branches).
High elastin content in tunica media and also intima.
Compensates the systolic pressure by expanding.
Contracts (return to original size) during diastole and pumps blood, known as elastic recoil.
89
Q

Describe muscular arteries. (4)

A

Distributes blood via vasoconstriction.
Distal to elastic arteries.
Thick tunica media with dense smooth fibres.
Dilates when not contracting.

90
Q

Describe the characteristic of an arteriole. (3)

A

Has only 2 layers, endothelium and tunica media.
Lumen is completely closed when contract.
Larger arteriole look like muscular artery.

91
Q

How to recognise stroke?

A 
Smile
Talk
Raise both arms
Open mouth and stick out tongue
Keep comfortable
Emergency help required
92
Q

Describe the characteristic of capillaries. (3)

A

Diameter a size of a single RBC.
Only have endothelium, one cell thick.
Exchange of oxygen, carbon dioxide, nutrients, hormones and waste.

93
Q

List the 3 types of capillary.

A

Continuous (common)
Fenestrated (have pores)
Discontinuous, sinusoids (large gaps)

94
Q

What is the properties of a continuous capillary?

A

Have intracellular cleft for plasma fluid leakage to supply oxygen and nutrients.
Only leukocytes can move through the cleft.

95
Q

What are the properties of fenestrated capillaries?

A 
Have pores (small gaps)
Found in areas where lots of fluid is exchanged, eg. Synovial membrane and small intestine.
96
Q

What are discontinuous capillaries?

A

Known as sinusoids.
Have large gaps.
Anything can pass through even RBC.
Found in Red Bone Marrow, where RBCs are made and enters to the circulation through sinusoids.
Also in liver and spleen where RBCs are destroyed.

97
Q

What is the function of precapillary sphincter?

A

A small muscle at the entrance of each capillary.
Controls the blood flow to individual capillaries.
Opens and closes depending on the needs of individual cells.

98
Q

What is the indifference between function or arterioles and precapillary sphincters?

A

Arterioles direct blood to specific tissue.

Precapillary sphincters direct blood to specific cells.

99
Q

What are the two types of veins?

A

Venuole, from capillary to vein

Vein, to the heart

100
Q

What are the properties of veins? (4)

A

Thinner walls (low pressure)
Large and irregular lumen (slow movement of blood)
Skeletal muscle milks the vein to move blood against gravity
Valves present (blood move in one direction)

101
Q

What are the 3 blood pumps?

A

Heart
Elastic arteries
Muscular constriction of veins (milking action)

102
Q

What are the 3 clinically significant veins?

A

Greater saphenous vein: coronary bypass, can become varicose
Facial vein: ‘danger triangle’, infection spread to meninges in brain
Renal vein: low oxygen and lowest concentration of nitrogenous waste

103
Q

What are the 3 veins that are high in oxygen and nutrients?

A

Pulmonary vein
Hepatic portal vein
Umbilical vein

104
Q

Describe the pathology of varicose vein.

A

Large dilated veins
Valves are incompetent
Cannot close due to fluid build up and lumen stretched wider
Either asymptomatic or phlebitis (inflammation of vein wall)

105
Q

What are the treatments for varicose vein?

A

Shut it off from blood flow by:
Sealing by lasering the distal end
Injecting sclerosing agents (alcohol or saline)
Surgically remove

106
Q

What is telangiectasias?

A

Small dilated blood vessels near surface of skin, known as spider veins.
Turns colourless with direct pressure.
Commonly found in nose, cheeks, upper thighs.
Non-pathogenic.
Treatment similar to varicose veins.

107
Q

Relate oedema and varicose veins.

A

When veins are varicosed for a long time, plasma may leaked into the tissues causing oedema.

108
Q

How does venous stasis ulcer develops?

A

When blood plasma leaks onto the tissues (oedema), acid products can eventually erode all the way to the skin.
Common in diabetics.

109
Q

What is phlebitis?

A

It is the inflammation of the vein commonly in legs.

Associated with Deep Vein Thrombophlebitis.

110
Q

What are the signs and symptoms of DVT? (4)

A

Erythema (redness) and increase in temperature of minimum one degree
Pain or burning along the vein (phlebitis)
Swelling (oedema)
Vein is hard and cordlike

111
Q

What is the primary cause of gangrene?

A

Reduced blood supply to the affected tissues which results in cell death.

112
Q

What is peripheral vascular disease (PVD) and it’s symptoms (4)?

A

Obstruction of large arteries particularly at lower extremities.
Usually caused by atherosclerosis.

Symptoms:
Claudication, cramping in muscle due to reduced blood flow
Wounds or ulcers that heal slowly
Cyanosis
Diminished hair and nail growth on affected limb

113
Q

What is Buerger’s disease?

A

Inflammation and thrombosis of small and medium blood vessels, commonly in legs leading to gangrene, associated with tobacco use.

114
Q

Define atherosclerosis.

A

A vascular disease characterised by formation of intimal lesion (between tunica media and intima) called atheroma that protrude into lumen.
Primary affects elastic or large & medium sized muscular arteries.

115
Q

Define atheroma.

A

Known as atheroma tours or atherosclerotic plaque.
Consists of soft, yellow, grumous core of lipid (mainly cholesterol and cholesterol esters) covered by a firm, white fibrous cap.

116
Q

What are the risk factors of atherosclerosis? (12)

A 
Increasing age
Male
Family history
Genetic abnormalities
Hyperlipidemia
Hypertension
C-reactive protein
Diabetes
Smoking
Obesity, high carbohydrate intake
Chlamydia pneumoniae infection
Oestrogen deficiency

Med School (2 decks)

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