anatomy

Question 1

angle of louis
AKA sternal angle

Answer 1

between the manubrium and the sternal body (where rib 2 meets sternum)

between T4 and T5 (posteriorly)

plane of Ludwig divides superior and inferior mediastinum

Question 2

what nerve innervates the pericardium of the heart?

Answer 2

phrenic nerve

Question 3

pericardial sinuses

Answer 3

where the parietal becomes the visceral pericardium

Question 4

transverse pericardial sinus

Answer 4

potential space between the pulmonary trunk, aorta, and superior vena cava

a finger can placed between this space

clinical significance: separates the arterial and venous ends of the heart, can clamp these vessels during surgery

Question 5

oblique pericardial sinus

Answer 5

potential space between the posterior surface of the heart/pericardium and the anterior aspect of the esophagus, hands can come in contact with the pulmonary veins entering the L atrium back there

Question 6

where is the L atrium located in the thorax (near which other anatomical structure)

Answer 6

directly related to the esophagus at the level of the tracheal bifurcation

Question 7

pectinate muscles

Answer 7

“teeth of a comb” muscles of the atria

Question 8

trabeculae carnae

Answer 8

rounded, irregular shaped muscles of the ventricles

Question 9

crista terminalis

Answer 9

the rounded edge where the pectinate muscle starts/ends

Question 10

what 2 structures are found in the R atrium

Answer 10

fossa ovalis
opening to the coronary sinus

Question 11

conus arteriosus

Answer 11

smooth wall that lacks trabeculae
between the R ventricle and the pulmonary trunk

forms the outflow tract of the R ventricle?

Question 12

moderator band

Answer 12

“conducting band”, “septo-marginal band”
carries purkinje fibers into the right ventricular wall to the papillary muscle

Question 13

how many cusps do each of the valves have?

Answer 13

tricuspid (3)
mitral/bicuspid (2)
pulmonary (3)
aortic (3)

Question 14

coronary ostia

Answer 14

openings in the aortic sinuses that are the openings of the coronary arteries (feed the heart)

Question 15

which vein drains the great, middle, and small cardiac veins

Answer 15

coronary sinus –> R atrium

Question 16

where do the anterior cardiac veins drain into?

Answer 16

directly into the R atrium

Question 17

ductus (patent ductus) arteriosus –> ligamentum arteriosum

Answer 17

during development, connects the aorta to the pulmonary artery
closes at birth –> becomes a ligament that connects the 2 structures

Question 18

heart innervation

Answer 18

sympathetic - levels T1-T4
parasympathetic - vagus nerve

Question 19

diaphragm, pericardium innervation

Answer 19

phrenic nerve

Question 20

Beck’s Triad

Answer 20

low BP
distension of jugular veins
muffled heart sounds

indicative of cardiac tamponade

Question 21

cardiac tamponade

Answer 21

build up of fluid, blood, or air in the pericardial sac which can compress the heart

appears as a “shoe shaped or money bag or balloon appearance” of cardiac shadow (enlarged heart, especially on the L)

Question 22

where would you inject the needle to extract fluid in the case of cardiac tamponade?

Answer 22

subxiphoid - just left to the xiphoid process
at a 30 degree angle

Question 23

rib types

Answer 23

1-7 true ribs
8-10 false (interchondral joints)
11-12 floating ribs

Question 24

where is the neuro-vascular bundle found?

Answer 24

contained in the costal groove of the rib
(embedded in the curve of the rib)

Question 25

thoracic outlet syndrome

Answer 25

abnormal compression of the brachial plexus nerves or vessels that pass through the axillary inlet to the upper limb

Question 26

causes of thoracic outlet syndrome

Answer 26

extra cervical rib (attaches to C7 and rib 1) muscular abnormalities (i.e. scalene muscles) injury tumor

Question 27

clinical presentation of thoracic outlet syndrome

Answer 27

abnormal compression of subclavian artery/vein --> thrombosis/embolization abnormal compression of nerves C8-T1 --> sensory deficit medial arm and muscle wasting sx: neurological pain, paresthesias, paresis/paralysis, pallor, pulselessness, edema due to venous compression, poikilothermia (cold) due to inability to regulate body temperature

Question 28

what artery do the pericardiophrenic arteries (supplying the pericardium) branch from?

Answer 28

internal thoracic

Question 29

intercostal nerve innervation

Answer 29

ventral primary rami --> lateral and anterior cutaneous branches sensory and motor innervation to the thoracic wall, upper abdomen, and lateral limb of the diaphragm (only sensory), and parietal pleura

Question 30

subcostal nerve

Answer 30

AKA intercostal nerve below rib 12 (T12?)

Question 31

where are thoracotomy tubes (chest tubes) placed?

Answer 31

5th intercostal space at the mid-axillary line this is a good spot because there's very little muscle here indication: pneuomothorax

Question 32

where is a thoracocentesis (needle aspiration of the lung) performed?

Answer 32

9th intercostal space at the mid-axillary line needle inserted into the pleural cavity and a sample of fluid is obtained indication: pleural effusion (fluid between the parietal and visceral pleura)