ANATOMY

Question 1

where is the heart contained?

Answer 1

middle mediastinum

Question 2

what is the hilum?

Answer 2

root of the lung

Question 3

what is contained within the hilum?

Answer 3

pulmonary artery
main bronchus
pulmonary veins
pulmonary lymphatic vessels and bronchopulmonary lymph nodes
pulmonary visceral afferents and autonomic motor nerves

Question 4

where do the phrenic nerves travel?

Answer 4

descend across the lateral borders of the pericardium

Question 5

what is haemopericardium?

Answer 5

when the pericardial cavity fills with blood

Question 6

what is the consequence of haemopericardium?

Answer 6

pressure around the heart can prevent cardiac contraction - cardiac tamponade

Question 7

what is pericardiocentesis?

Answer 7

drainage of fluid from the pericardial cavity

Question 8

how is pericardiocentesis performed?

Answer 8

needle inserted via infrasternal angle and directed superoposteriorly, aspirating continuously

Question 9

what is the transverse pericardial sinus?

Answer 9

a space within the pericardial cavity

Question 10

where is the transverse pericardial sinus?

Answer 10

lies posteriorly to the ascending aorta and pulmonary trunk

Question 11

name the surfaces of the heart

Answer 11

anterior (sternocostal) surface
base (posterior) surface
inferior (diaphragmatic) surface

Question 12

name the borders of the heart

Answer 12

right border
left border
inferior border
superior border

Question 13

where can the apex of the heart be palpated?

Answer 13

5th left intercostal space in the midclavicular line (mitral area)

Question 14

where does cardiomegaly shift the apex beat to?

Answer 14

normally to the left

Question 15

where are the coronary arteries contained?

Answer 15

just deep to the epicardium, usually embedded in adipose tissue

Question 16

where do the coronary arteries arise from?

Answer 16

the ascending aorta

Question 17

where is the right coronary artery?

Answer 17

in the right atrioventricular groove

Question 18

what does the RCA branch into?

Answer 18

right marginal artery

posterior interventricular artery

Question 19

where is the left (main stem) coronary artery?

Answer 19

in the left atrioventricular groove between pulmonary trunk and the left auricle

Question 20

name the branches of the LCA

Answer 20

circumflex artery
left anterior descending
left marginal artery
lateral (diagonal) branch

Question 21

what is the coronary sinus?

Answer 21

a short venous conduit which received deoxygenated blood from most of the cardiac veins and drains into the right atrium

Question 22

where is the coronary sinus?

Answer 22

in the atrioventricular groove posteriorly

Question 23

what divides the heart into right and left sides?

Answer 23

septum (interatrial and interventricular)

Question 24

what are septal defects?

Answer 24

holes in the septum which can allow mixing of arterial ad venous blood

Question 25

how does the heart allow unidirectional flow?

Answer 25

the cardiac valves

Question 26

tricuspid valve

Answer 26

between right atrium and right ventricle

Question 27

pulmonary valve

Answer 27

between right ventricle and pulmonary trunk

Question 28

mitral (bicuspid) valve

Answer 28

between left atrium and left ventricle

Question 29

aortic valve

Answer 29

between left ventricle and the aorta

Question 30

tricuspid valve features

Answer 30

anterior, posterior and septal cusps

Question 31

mitral valve features

Answer 31

papillary muscles tendinous cords valve leaflets

Question 32

aortic valve features

Answer 32

right, left and posterior cusps and sinuses

Question 33

pulmonary valve

Answer 33

anterior right and left cusps

Question 34

where is the aortic valve auscultated?

Answer 34

2nd right ICS sternal edge

Question 35

where is the pulmonary valve auscultated?

Answer 35

2nd left ICS sternal edge

Question 36

where is the tricuspid valve auscultated?

Answer 36

4th left ICS sternal edge (lower left sternal edge)

Question 37

where is themitral valve auscultated?

Answer 37

5th left ICS midclavicular line

Question 38

summarise blood flow from chamber to chamber

Answer 38

Diastole: blood returns via vena cave to RA and pulmonary veins to LA Tricuspid & mitral valves open so blood drains into RV & LV Impulse originates at SA node and spreads across atria Atrial contraction completes ventricular filling Impulse spreads across ventricles Ventricles begin to contract – once pressure in ventricles > pressure in atria tricuspid & mitral valves snap shut Ventricles continue to contract – once pressure in ventricles > pressure in PT & aorta pulmonary and aortic valves forced open and blood ejected into great arteries Ventricles begin to relax – once pressure in ventricles < pressure in great arteries blood starts to fall back towards ventricles causing pulmonary & aortic valves to snap shut

Question 39

where do presynaptic sympathetic fibres exit the spinal cord?

Answer 39

in one of the T1-L2/3 spinal nerves (thoracolumbar)

Question 40

what contains the sympathetic nerves to the heart and lungs?

Answer 40

cardiopulmonary splanchnic nerves

Question 41

what is contained within the cardiac plexus?

Answer 41

sympathetic fibres parasympathetic fibres visceral afferent fibres

Question 42

which cranial nerves contain parasympathetic ganglia?

Answer 42

CN III, VII, IX, X

Question 43

which cranial nerve is the presynaptic parasympathetic fibre for the heart and lungs?

Answer 43

CN X (vagus nerve)

Question 44

which nerves are the parasympathetic supply to the lower abdomen, pelvis and perineum?

Answer 44

sacral spinal nerves

Question 45

describe somatic pain

Answer 45

sharp stabbing well localised

Question 46

sources of somatic pain

Answer 46

``` muscular joint bony intervertebral disc fibrous pericardial nerve ```

Question 47

describe visceral (organ) pain

Answer 47

dull aching nauseating poorly localised

Question 48

where does radiating pain from the chest go?

Answer 48

upper limbs back neck

Question 49

sources of visceral chest pain

Answer 49

heart and great vessels trachea oesophagus abdominal viscerae

Question 50

describe referred pain

Answer 50

pain only felt at site remote from area of tissue damage in the chest

Question 51

where does referred pain from the chest go?

Answer 51

upper limbs back neck

Question 52

describe radiating pain

Answer 52

pain felt in the centre of the chest and felt spreading from there

Question 53

postcentral gyrus of parietal lobe

Answer 53

somatosensory | Aps arriving here bring body wall sensations into consciousness

Question 54

precentral gyrus of frontal lobe

Answer 54

somatomotor | aps originating here bring about contractions of body wall skeletal muscle

Question 55

what is the normal pattern of arterial supply of the heart?

Answer 55

right dominant

Question 56

name the sites of coronary atherosclerosis in order of most commonly seen to least commonly seen

Answer 56

1. LAD of LCA 2. RCA 3. circumflex branch 4. LCA (main stem)

Question 57

where are grafts anastomosed in CABG?

Answer 57

proximally to the ascending aorta to coronary artery distal to the narrowing hence the narrowing is bypassed

Question 58

what are commonly used grafts?

Answer 58

radial artery internal thoracic (mammary artery) great saphenous vein

Question 59

which artery is used by pedicle and what does this mean?

Answer 59

internal thoracic artery meaning that the distal end of the vessel is anastomosed distal to the narrowing

Question 60

where does the SA node usually receive blood from?

Answer 60

RCA

Question 61

where does the AV node usually receive blood from?

Answer 61

posterior interventricular artery

Question 62

where does the interventricular septum (containing the conducting branches) receive blood from?

Answer 62

LAD posterior interventricular artery

Question 63

what is the thoracic inlet bounded by?

Answer 63

ribs 1, T1 vertebra and jugular notch

Question 64

where is the transverse thoracic plane?

Answer 64

between sternal angle and T4/T5 intervertebral discs

Question 65

what is in the anterior mediastinum?

Answer 65

thymus

Question 66

what is in the middle mediastinum?

Answer 66

pericardium heart parts of the great vessels

Question 67

what is in the posterior mediastinum?

Answer 67

``` azygous vein sympathetic trunks thoracic duct oesophagus thoracic aorta trachea and 2 main bronchi vagus nerves ```

Question 68

where does the right lymphatic duct drain lymph into?

Answer 68

right venous angle | top right 1/3 of the body

Question 69

where does the left lymphatic duct drain lymph into?

Answer 69

left venous angles | rest of the body

Question 70

what are the central veins?

Answer 70

the large veins close enough to the heart such that the pressure within them is said to approx reflect the pressure within the right atrium

Question 71

name the central veins

Answer 71

``` internal jugular veins subclavian veins brachiocephalic veins superior vena cava inferior vena cava iliac veins femoral veins ```

Question 72

which of the laryngeal nerves does not enter the chest?

Answer 72

right recurrent laryngeal nerve

Question 73

where does referred pain from the diaphragm go?

Answer 73

shoulder

Question 74

neck pulse

Answer 74

bifurcation of the common carotid artery

Question 75

upper limb pulses

Answer 75

brachial artery | radial artery

Question 76

lower limb pulses

Answer 76

femoral artery popliteal artery posterior tibial artery dorsalis pedis artery