Anatomy Flashcards
(117 cards)
1
Q
Where is the middle mediastinum?
A
the central area that contains the heart in the pericardium
2
Q
What is the pericardium?
A
the grey tissue over the heart, it is a tough fibrous sac
3
Q
What are the layer of the pericardium?
A
- grey outermost layer is the fibrous pericardium
- serous pericardium which has two parts which are differentiated by what side it is in contact with
- if it is in contact with the fibrous part then it is the parietal serous pericardium
- if it is in contact with the heart side it is the visceral pericardium
4
Q
What is the epicardium another name for?
A
visceral serous pericardium
5
Q
What is a haemopericardium and when does it become a cardiac tamponade?
A
haemopericardium is when there is blood in the pericardial space and if there is a lot of blood and the heart becomes crushed then this is cardiac tamponade
6
Q
What is a pericardiocentesis and how is it performed?
A
A pericardiocentesis is moving a needle into the cavity to remove any excess blood or fluid
A needle is inserted via the infrasternal angle which is then moved superiorly and posteriorly while you are continuously aspirating so the fluid will be removed
7
Q
Where is the transverse pericardial sinus and what is it used for?
A
the transverse pericardial sinus is a space within the cavity behind the ascending aorta and the pulmonary trunk that a surgeon puts his finger in to locate the great vessels and put the patient on bypass
8
Q
What is another name for the anterior surface of the heart?
A
sternocostal surface
9
Q
What is another name for the posterior surface of the heart?
A
base surface
10
Q
What is another name for the inferior surface of the heart?
A
diaphragmatic surface
11
Q
What are the borders of the heart?
A
- right lateral
- left lateral
- inferior border
- superior border
12
Q
Where does the phrenic nerve Iie?
A
anterior to the root of the lung
13
Q
Where does the vagus nerve lie?
A
posterior to the root of the lung
14
Q
Where does the internal jugular been bring blood from?
A
head and neck
15
Q
Where does the subclavian vein bring blood from?
A
upper limb
16
Q
What vein in made when the internal jugular join with the subclavian?
A
brachiocephalic vein
17
Q
What forms when the right and left brachiocephalic veins join?
A
superior vena cava
18
Q
What does the pulmonary trunk split into?
A
right and left pulmonary arteries
19
Q
What are then three parts of the aorta?
A
ascending, descending and arch
20
Q
What does the brachiocephalic trunk of the aorta spilt into?
A
common carotid artery and the right subclavian
21
Q
Where does the brachiocephalic trunk of the aorta take blood to?
A
the heart and upper limb
22
Q
What is the purpose of the auricles?
A
to increase the surface-area of the atria
23
Q
What does the right coronary groove mark?
A
the separation between the atria and the ventricles
24
Q
What does the anterior inter ventricular groove mark?
A
the separation between the right and left ventricles
25
What artery is contained in the anterior interventricular groove?
the anterior inter ventricular artery
26
What separates the base and the inferior surface of the heart?
the coronary sinus
27
What does the coronary sinus do?
it is the big venous drain for the heart muscle
28
What does the azygous vein do?
drains the blood from the intercostal veins back to the heart
29
What is the first branch off the aorta?
the coronary arteries (before brachiocephalic trunk)
30
What does the right coronary artery branch into?
the right marginal artery which runs down the side and the posterior interventricular artery that moves around the back
31
What are the branches off the left coronary artery?
the left anterior descending which branches into the lateral diagonal branch
the circumflex artery (anastomoses with the posterior interventricular artery)
the left marginal artery
32
What is the only coronary vein we need to know?
coronary sinus
33
Where does the coronary sinus drain to?
the right atrium
34
What are the two type of holes in the heart?
an atrial septal defect or a ventricular septal defect
35
What does a hole in the heart result in?
hypoxaemia
36
What are the three openings in the right atrium?
IVC and SVC and the opening of the coronary sinus
37
What feature is on the wall of the atria?
oval fossa
38
What does the crista terminalis divide?
smooth from the rough
39
What cusps is the tricuspid valve made up of?
anterior, posterior and septal cusps
40
What are the names of the mitral cusps?
anterior and posterior
41
What design are the atrioventricular valves and what design are the pulmonary/aortic valves?
leaflet for tri and mit
| semilunar for aortic and pulmonary
42
What are the cords from the leafs in the a-v valves and what are they attached to?
tendinous cords that join to the papillary muscles
43
What is the purpose of the tendinous cords and the papillary muscles on the a-v valves?
to prevent prolapse of the valves
44
What do the moderator bands on the valves do?
ensure that the cusps of the tricuspid valve all close at the same time
45
What is the Lub from?
closure of the mitral and the tricuspid
46
What is the Dub from?
the closure of the aortic and pulmonary
47
Where do pain fibres travel to?
the spinal cord alongside sympathetic nerves
48
Where do reflex afferents mainly travel to?
vagus nerve
49
What is the anatomy of the sympathetic chain and the neurotransmitters involved?
CNS→ preganglionic fibre→ sympathetic chain ganglion→ postsynaptic fibres→ organ
ACh is the neurotransmitter in the synapse between the axon of the presynaptic neuron and the cell body of the postsynaptic neuron then noradrenaline between the postsynaptic fibre and the organ
50
Where do presynaptic sympathetic fibres travel and where do they exit?
Presynaptic sympathetic fibres form the brain travel inferiorly within spinal cord tracts and then exit in one of the T1-L2 nerves (thoracolumbar outflow)
51
Where do the postsynaptic sympathetic fibres go?
get to organs by the cardiopulmonary splanchnic nerves
52
What are the cardiopulmonary splanchnic nerves?
part of the nerve structure carrying post-synaptic fibres towards heart
53
What is the cardiac plexus?
a network of nerves with the sympathetic fibres, the parasympathetic fibres and visceral afferents
54
What delivers the parasympathetic fibres to the cardiac plexus?
vagus nerve
55
What is the route for the parasympathetic fibres from CNS to organ?
CNS→ presynaptic fibre→ parasympathetic ganglion synapse→ postsynaptic→ organ
56
What are the neurotransmitters for the parasympathetic fibres?
ACh for both
57
What nerves get the parasympathetic fibres to the organs?
CN 3,7,9 and 10
58
Which of abdominopelvic and pelvic splanchnic is sympathetic and which is parasympathetic?
Abdominopelvic is sympathetic
| Pelvic splanchnic nerves are parasympathetic
59
Where is somatic pain from and what does it feel like?
Somatic pain is from muscle, joint, bone, intervertebral etc and feels sharp, stabbing and localised
60
Where is visceral pain from and what does it feel like?
Visceral pain is from heart, trachea etc and feels dull, aching, nauseating and poorly localised
61
What is the precentral gyrus and what does it do?
is the somatomotor gyrus which is where APs originate that bring about contractions of body wall skeletal muscle
62
What is the postcentral gyrus and what does it do?
is the somatosensory gyrus and APs that arrive here bring the body wall sensations into consciousness
63
What is the role of the sensory homunculus?
sensory homunculus is the different areas of the cerebral neocortex where sensations from different body wall structure reach consciousness
64
What are examples of conditions that would give rise to central chest pain?
- Shingles: reactivation of dormant chicken pox, pain within T4/5 and blistering on the body wall
- Muscle, joint and bone: pectoralis muscle strain, joint inflammation, slipped disc
- Parietal pleura and fibrous pericardium: pleurisy and pericarditis
65
What are the parts of the mediastinum?
- superior
| - inferior (anterior, middle and posterior)
66
Where do visceral afferent action potentials move to?
pass bilaterally to thalamus and hypothalamus then diffuse areas of the cortex
67
What is radiating pain?
radiating pain is felt at the site and moves to a peripheral area
68
Where does somatic radiating pain move to?
if is originating in a somatic structure the radiation is along the affected dermatome
69
Where does radiating pain from the heart move to?
the radiation is to the dermatomes supplied by the spinal cord levels at which the cardiac visceral afferent enter the sympathetic chain so bilaterally to cervical and upper thoracic dermatomes
70
What is referred pain and what is it due to?
Referred pain is only felt at a site remote from the area of tissue damage
It is due to afferent sensory fibres from soma and from viscera entering the spinal cord at the same level so the brain thinks the pain is from the soma
71
What is an MI?
MI is irreversible death of the myocardium due to occlusion of its arterial blood supply
72
What are the different type of dominance in relation to the arteries?
there is a right dominant artery in around 70% of patients, some have left-dominance and even less have codominance
73
What are the most common places for a coronary artery occlusion in descending order?
LAD of left coronary artery
Right coronary artery
Circumflex branch of left coronary artery
Left main stem coronary artery
74
What is a coronary artery bypass graft?
coronary artery bypass grafting is when there is a blockage identified and a graft from somewhere else in the body
eg great saphenous vein in the leg, radial artery, internal thoracic artery by pedicle is taken and replaces the old one
75
Where are the SA and AV nodal branches?
from the right coronary artery
76
Where is the blood supply to the septum from?
the left anterior descending
77
Where is the mediastinum?
the area between the lungs
78
Where exactly is the superior mediastinum?
above the line between the sternal angle and the T4 vertebrae all the way up to the thoracic inlet
(contains aortic arch)
79
What is the inferior border of the mediastinum?
the diaphragm
80
Where is the anterior mediastinum?
between the sternum and the line of the fibrous pericardium
81
What is the anterior mediastinum filled with in adults and children?
in adults = fat
| in children prior to puberty = the thymus gland that produces T lymphocytes
82
What does the middle mediastinum contain?
heart and the first parts of the great vessels
pericardial sac
just the ascending aorta not the arch
83
What does the posterior mediastinum contain?
trachea, primary bronchi, oesophagus, vagus nerve, azygous vein and sympathetic chain
84
Where does the right vagus nerve travel?
along the surface of the trachea and becomes a plexus with the left nerve extending the full length of the oesophagus
85
Where does the left vagus nerve travel?
along arch of aorta then becomes a plexus with the right nerve extending the full length of the oesophagus
86
What happens to the plexus made up of the right and left vagal nerves as it descends?
spilts into right and left vagal trunk that passes through the diaphragm
87
Where do the intercostal veins drain into?
the azygous vein
88
What are the benches coming off the aorta?
coronary arteries which come off the ascending aorta, then the brachiocephalic trunk, the left common carotid and the left subclavian artery
89
What are the midline branches that come off the descending aorta?
bronchial, oesophageal, mediastinal, pericardial and phrenic
90
What is the aortic hiatus?
the hole in the diaphragm where the descending aorta moves through
91
Where does the right lymphatic duct drain to?
the right venous angle
92
What drains into the right lymphatic duct?
the right arm and then half the body up from around the umbilicus
93
Where does the thoracic duct drain?
the rest of the body (excluding the right arm and then half the body up from around the umbilicus)
94
What are the two main types of lymph nodes in the lungs?
bronchopulmonary and tracheobronchial
95
Where does the thoracic duct lie?
between the oesophagus and the azygous nerve
96
Where does the vagus and phrenic nerves run in relation to the root of the lung?
vagus goes posterior to the root of the lung
| phrenic goes anterior to the root of the lung
97
Where is the recurrent laryngeal branches on the left and on the right?
right is root of the neck
| left is in the chest
98
What fibres remain in the vagus nerve after the recurrent laryngeal branch is given off?
parasympathetic nerve fibres
99
What does the vagus nerve contain?
somatic sensory for the palate, laryngopharynx and larynx
somatic motor for the pharynx and the larynx
autonomic parasympathetic nerves for thoracic and abdominal organs
100
What is in the superior mediastinum from anterior to posterior?
```
Brachiocephalic veins and SVC
Arch of aorta
Trachea
Oesophagus
Thoracic duct
```
101
What is in the superior mediastinum from lateral to medial?
Phrenic nerve
Vagus nerve
Recurrent laryngeal nerve
102
What are the central veins?
internal jugular, subclavian, brachiocephalic, superior vena cava, right atrium, inferior vena cava, iliac and femoral veins
103
What does the phrenic nerve contain?
somatic motor to the diaphragm
somatic sensory to the mediastinal parietal pleura, fibrous pericardium, diaphragmatic parietal pleura and diaphragmatic parietal peritoneum
contains sympathetic fibres that supply arterioles in all the structures innervated by the phrenic nerve
104
Why does diaphragmatic pathology present as shoulder tip pain?
If an abscess irritates the parietal peritoneum lining the surface of the diaphragm, the phrenic nerves (C3,4,5) are affected
C3,4 supply the dermatomes over the shoulder tip and water the spinal cord at the same level as the phrenic nerve
the brain refers the pain to the more superficial structure which is the skin over the shoulder tip
105
Where does the right recurrent laryngeal nerve run?
hooks under the right subclavian artery but does not enter the chest
106
Where does the left recurrent laryngeal nerve run?
hooks under the arch of the aorta and does enter the chest
107
What do the recurrent laryngeal nerves supply?
larynx and the laryngopharynx
108
What causes the double pulsation in the JVP?
atrial contraction then filling of the right atrium against a closed tricuspid valve causes a double pulsation
109
What are all the common pulses?
Neck-bifurcation of the common carotid artery
Upper limb- brachial artery, radial artery
Lower limb- femoral, popliteal, posterior tibial artery and dorsalis pedis artery
110
What is the radial artery used for?
cannulation for arterial blood pressure monitor or ABG sampling
111
What is the femoral artery used for?
intravascular interventions
112
What is the subclavian artery used for?
insertion of cardiac pacing wire under ultrasound guidance
113
What is the IJV used for?
insertion of central line with ultrasound
114
What is the femoral vein used for?
insert central line
115
What layer is most closely associated to the route of the phrenic nerve through the chest?
the fibrous pericardium
116
What are the landmarks in the right atrium?
fossa ovalis (formaten in unborn child) and the crista terminalis (ridge)
117
What are the three branches off the aortic arch?
brachiocephalic trunk, left common carotid and left subclavian
