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103 Theme 1 - Anatomy > Dissection Room > Flashcards

Dissection Room Flashcards

1
Q
  1. Is this a right or a left lung?
  2. What are the names of the lobes A, B and C?
  3. What are the names of the fissures D and E?
A

1.Is this a right or a left lung?

Right

  1. What are the names of the lobes A, B and C?

Inferior, Superior, Middle

  1. What are the names of the fissures D and E?

Oblique fissure, Horizontal fissure

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2
Q

What impact does the heart have on the shape and size of each lung?

A
  • The heart forms the cardiac impression on the left lung
  • Left lung is more narrow
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3
Q
  1. Identify these borders of the lung (A and B)
  2. Identify these surfaces of the lung (C and D)
A
  1. Identify these borders of the lung (A and B)

Inferior, Anterior

  1. Identify these surfaces of the lung (C and D)

Diaphragmatic, Costal

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4
Q

What is the main difference between the anterior borders of the right and left lung?

A
  • Lingula
  • Cardiac notch
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5
Q

This is the mediastinal surface of the left lung

  1. What structure has caused the impression at A?
  2. Region B is normally occupied by what organ?
  3. Identify feature C
A

This is the mediastinal surface of the left lung

  1. What structure has caused the impression at A?

Aorta

  1. Region B is normally occupied by what organ?

The Heart

  1. Identify feature C

Lingula

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6
Q

Complete the diagram

A
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7
Q

What structures pass through the hilum of the lung?

A
  • Pulmonary artery
  • Pulmonary veins
  • Main bronchi
  • Lymphatic nodes and vessels
  • Autonomic nerves
  • Bronchial vessels
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8
Q

This is the mediastinal surface of the left lung

Identify structures A, B and C at the hilum

A

A - Left main bronchus

B - Left pulmonary artery

C - Left pulmonary vein

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9
Q

What is the clinical significance of a bronchopulmonary segment, especially when considering surgery?

A

It can be surgically resected

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10
Q
  1. Why is the thymus absent or very limited in most cadavers?
  2. In which division of the mediastinum is the thymus gland normally located?
A

1.Why is the thymus absent or very limited in most cadavers?

The thymus gland atrophies after puberty

  1. In which division of the mediastinum is the thymus gland normally located?

The anterior mediastinum

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11
Q
  1. Identify arteries A, B, C, D and E
  2. Identify structure F
A
  1. Identify arteries A, B, C, D and E

A: ascending aorta

B: Arch of aorta

C: Brachiocephalic trunk

D: Left common carotid artery

E: Left subclavian artery

  1. Identify structure F

Ligamentum arteriosum

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12
Q
  1. Why is the ligamentum arteriosum important in foetal circulation?
A

The ductus arteriosus in the foetus becomes the ligamentum arteriosum after birth. The ductus arteriosus is a conduit for blood to bypass the non-ventilated lungs in the foetus. It allows blood to flow from the right circulation to the left.

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13
Q
  1. What are the first two arteries to branch off the ascending aorta?
A

The right and left coronary arteries

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14
Q
  1. Identify veins A, B, C, D, E and F
  2. Nerve G loops underneath the arch of the aorta, can you identify this nerve?
A
  1. Identify veins A, B, C, D, E and F

A: Superior vena cava

B: Left brachiocephalic vein

C: Right brachiocephalic vein

D: Left subclavian vein

E: Right internal jugular vein

F: Inferior thyroid veins

  1. Nerve G loops underneath the arch of the aorta, can you identify this nerve?

Recurrent laryngeal nerve (a branch of the vagus nerve)

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15
Q
  1. Which structures or areas of the body do you think these veins are draining blood from?
    a) Internal jugular vein
    b) Subclavian vein
    c) Inferior thyroid vein
A

a) Head, neck and brain
b) Upper limb
c) Thyroid gland

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16
Q

Between which layers or sub-layers of the pericardium does the pericardial cavity lie?

A

Between the visceral and parietal layers of the serous pericardium

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17
Q

Here we are looking at the posterior surface of the heart

Identify chamber A

Identify great vessels B, C, D and E

A

Here we are looking at the posterior surface of the heart

Identify chamber A

Left atrium

Identify great vessels B, C, D and E

B- Right superior pulmonary vein

C- Left inferior pulmonary vein

D- Left pulmonary artery

E- Inferior vena cava

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18
Q

This is a superior view of the heart

Identify structures A, B and C

Identify coronary arteries D and E

What is the pink line?

A

This is a superior view of the heart

Identify structures A, B and C

A- Pulmonary trunk

B- Ascending aorta

C- Superior vena cava

Identify coronary arteries D and E

D- Left coronary artery

E- Right coronary artery

Transverse sinus

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19
Q

Which heart chambers do the aorta and pulmonary trunk exit from?

A

The aorta exits from the left ventricle

The pulmonary trunk exits from the right ventricle

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20
Q

This is a view into the right atrium

Identify structures A and B

Identify venous vessels C and D

A

This is a view into the right atrium

Identify structures A and B

A- Fossa ovalis

B- Pectinate muscle

Identify venous vessels C and D

C- Opening of the coronary sinus

D- Superior vena cava

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21
Q

Why is the Foramen Ovale important in foetal life?

A

To shunt blood from the right atrium into the left atrium, thereby bypassing the lungs

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22
Q

Here we are looking at the bicuspid and tricuspid valves

Which valve (A or B) is the bicuspid valve?

Identify the septal leaflet of the tricuspid valve

A

Here we are looking at the bicuspid and tricuspid valves

Which valve (A or B) is the bicuspid valve?

A

Green starred valve

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23
Q

What is the purpose of the bicuspid and tricuspid valves? How do they work?

A

To prevent reflux of blood back into the atria from the ventricles. The valve leaflets are attached to chordae tendineae which are, in turn attached to papillary muscles. These prevent the valve from prolapsing.

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24
Q

This is a posterior view of the heart

Identify grooves A and B

Identify coronary arteries C, D and E

Is this a left or a right dominant heart?

A

This is a posterior view of the heart

Identify grooves A and B

A: Atrioventricular

B: Interventricular

Identify coronary arteries C, D and E

C- Right coronary artery

D- Posterior Interventricular artery

E- Left circumflex artery

Is this a left or a right dominant heart?

Right

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25
Q

This is view of the heart from the left side

Identify cardiac veins A, B and C

Where does cardiac vein A drain into?

A

This is view of the heart from the left side

Identify cardiac veins A, B and C

A- Coronary sinus

B- Posterior cardiac vein

C- Great cardiac vein

Where does cardiac vein A drain into?

Right atrium

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26
Q

First, identify valves 3 and 12

Can you name the leaflets 2, 7, 15, 6, 14 and 10?

What do 8 and 9 show?

A

First, identify valves 3 and 12

3) Aortic valve
12) Pulmonary valve

Can you name the leaflets 2, 7, 15, 6, 14 and 10?

2) Anterior
7) Left
15) Right
6) Left
14) Right
10) Posterior

What do 8 and 9 show?

8) Opening for RCA
9) Opening for LCA

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27
Q

Identify vessels A and B

Identify coronary arteries C, D, E, F, G and H

A

Identify vessels A and B

A)Ascending Aorta

B)Pulmonary Trunk

Identify coronary arteries C, D, E, F, G and H

C) Right coronary artery

D) Right marginal artery

E) Left coronary artery

F) Anterior interventricular artery

G) Diagonal branch

H) Left marginal artery

28
Q

Identify coronary arteries A, B, C and D

Is this heart left or right dominant?

A

Identify coronary arteries A, B, C and D

A)Right coronary artery

B)Right marginal artery

C)Posterior interventricular artery

D)Anterior interventricular artery

Is this heart left or right dominant?

Right

29
Q

What is the clinical significance of left-right dominance if one of the coronary arteries is blocked?

A

•Stenosis of the main right/left coronary artery will have different outcomes

Planning for coronary artery bypass grafting

30
Q

What surface of the heart is this?

Identify cardiac veins 3, 4, 12 and 21

A

What surface of the heart is this?

Posterior

Identify cardiac veins 3, 4, 12 and 21

3) Coronary sinus
4) Great cardiac vein
12) Middle cardiac vein
21) Small cardiac vein

31
Q

Name the three major veins that drain directly into the right atrium?

A

1) Superior vena cava (10)
2) Inferior vena cava (4)
3) Coronary sinus (6)

32
Q

Complete the diagram

A
33
Q

Which vessel of the leg is commonly used during by-pass surgery?

A

Saphenous vein

34
Q

The valves of the heart are also commonly replaced if they are failing. An old-fashioned replacement method was the “ball and cage” replacement method. Can you think of any problems with this method?

A

Patient would require life long anticoagulation

35
Q

A newer style replacement is using valves from pigs. Can you think of any problems with this method?

A

Porcine valves do not have as long a lifespan (10-15 years)

36
Q

Where is the Sinoatrial (SA) node located?

Where is the atrioventricular (AV) node located?

A

Where is the Sinoatrial (SA) node located?

•Junction of right atrium and inferior vena cava

Where is the atrioventricular (AV) node located?

•Interatrial septum

37
Q

What is the parasympathetic nerve supply to the heart and what is the effect on heart rate?

From which spinal cord levels does the sympathetic nerve supply to the heart originate?

A

What is the parasympathetic nerve supply to the heart and what is the effect on heart rate?

•The vagus nerve, increases heart rate

From which spinal cord levels does the sympathetic nerve supply to the heart originate?

T1-T4

38
Q

Locate the bifurcation of the trachea. At what level does the trachea bifurcate?

Identify the oesophagus

Identify the thoracic aorta

A

Locate the bifurcation of the trachea. At what level does the trachea bifurcate?

  • 6
  • T4/5

Identify the oesophagus

•7/9

Identify the thoracic aorta

•24/25

39
Q

Identify the left and right vagus nerves

A

Identify the left and right vagus nerves

  • Left: 13
  • Right: 1
40
Q

At what thoracic level does the descending thoracic aorta begin?

Which structures are present within both superior and the posterior mediastinum?

A

At what thoracic level does the descending thoracic aorta begin?

•T4/5

Which structures are present within both superior and the posterior mediastinum?

  • Oesophagus
  • Vagus nerve
  • Thoracic duct
  • Azygos veins
  • Sympathetic chain

Phrenic nerve

41
Q

Identify the sympathetic trunk

Identify a paravertebral ganglion

Identify the greater splanchnic nerve

A

Identify the sympathetic trunk

•Circled in yellow

Identify a paravertebral ganglion

•Circled in green

Identify the greater splanchnic nerve

•Blue arrow

42
Q

Can you identify the thoracic duct?

Where does the thoracic duct enter into the venous system?

A

Can you identify the thoracic duct?

•Yellow arrow

Where does the thoracic duct enter into the venous system?

•Left venous angle (junction of left internal jugular vein and left subclavian vein)

43
Q

Precisely what type of nerves are carried in the Splanchnic nerves?

How do these Splanchnic nerves differ from the sympathetic nerves travelling to the thoracic organs?

A

Precisely what type of nerves are carried in the Splanchnic nerves?

•Preganglionic sympathetic

How do these Splanchnic nerves differ from the sympathetic nerves travelling to the thoracic organs?

•Sympathetic nerves travelling to the thoracic organs are postganglionic sympathetic

44
Q

Identify the vessels and nerves A, B and C

A

Identify the vessels and nerves A, B and C

A)Posterior intercostal vein

B)Posterior intercostal artery

C)Intercostal nerve

45
Q

Identify the vessels A, B and C

Which posterior intercostal veins typically drain into veins A, B and C?

A

Identify the vessels A, B and C

A)Azygos vein

B)Hemiazygos vein

C)Accessory hemi-azygos vein

D)Arch of azygos vein

Which posterior intercostal veins typically drain into veins A, B and C?

A)T5-T11

B)T9-T11

C)T5-T8

46
Q

Identify the Inferior Vena Cava

Identify the aorta

The azygous vein and thoracic duct travel through the aortic hiatus with the aorta. Identify the azygous vein and thoracic duct

Identify the oesophagus

A

Identify the Inferior Vena Cava

•8

Identify the aorta

•23

The azygous vein and thoracic duct travel through the aortic hiatus with the aorta. Identify the azygous vein and thoracic duct

  • Azygous vein 2
  • Thoracic duct 24

Identify the oesophagus

•1 and 16

47
Q

Complete the table

A
48
Q

This is a posteroanterior radiograph.

What chamber is located at A?

Identify structures 1-4

Why is the right hemi-diaphragm higher than the left hemi-diaphragm?

A

This is a posteroanterior radiograph.

What chamber is located at A?

•Left ventricle

Identify structures 1-4

1) Arch of aorta
2) Right dome of diaphragm
3) Apex of heart
4) Scapula

Why is the right hemi-diaphragm higher than the left hemi-diaphragm?

•Liver

49
Q

What is unusual about this radiograph and can you think of an explanation?

A

What is unusual about this radiograph and can you think of an explanation?

•The heart is orientated in the opposite direction (situs inversus)

50
Q

Identify the labelled structures on this CT image

A

Identify the labelled structures on this CT image

A) Right atrium

B) Right ventricle

C) Interventricular septum

D) Left ventricle

E) Left atrium

F) Descending aorta

G) Azygos vein

H) Oesophagus

I) Right pulmonary vein

51
Q

Consider that a stab wound has been made to the side of the thorax that has penetrated through to the lung.

Using the prosection, explain from superficial to deep, which layers of tissue the knife has traversed through.

A

Skin

Subcutaneous tissue

Dependent on site of stab wound: pectoralis major and minor, serratus anterior

Intercostal muscles (external, internal, innermost)

Pleura (parietal and visceral)

52
Q

A man is stabbed in the left side of his neck following an altercation at a local pub. The stab wound is about 2.5 cm above the medial third of the clavicle. Paramedics give the man oxygen in response to his sudden and very rapid breathing. On arrival at hospital, a physical examination is performed and reveals poor breath sounds on the left side of the chest and a significant shift of the apex beat of the heart to the right side of the thorax.

ØWhat condition is this man likely to be suffering from?

ØDescribe a possible procedure that could rectify this condition.

ØDescribe where on the body this procedure might be carried out?

ØWhat structures are vulnerable during this procedure? What precautions would you take to protect these structures?

A

Pneumothorax (air in pleural cavity). Pressure of air in pleural cavity and loss of surface tension between pleural layers causes lung to collapse.

Procedures to rectify this condition: needle aspiration (emergency), chest tube insertion (non-emergency)

Varied locations have been suggested for these procedures, please check current guidelines. Recommended areas are within the safe triangle, above the clavicle or in the mid clavicular line at the 2nd intercostal space.

The intercostal bundles are vulnerable during these procedures. To avoid intercostal bundles (that run along the inferior margin of each rib) these procedures should be carried out just superior to the rib.

53
Q

ØOn x-ray the trachea and mediastinal structures appear to be shifted to the right. Explain this mediastinal shift as well as the shift of the apex beat.

A

This x-ray shows a tension pneumothorax. The left lung has collapsed and air has accumulated in the pleural cavity. The resulting increase in pressure on the left side of the thorax leads to mediastinal shift away from the affected lung. This will also result in a shift of the apex beat.

54
Q

ØWhat has become lodged and where?

ØIn which main bronchus would the debris from an inhaled object become lodged and why?

ØIn basic terms, how might the foreign material be removed?

ØIf the object was lodged more superiorly, how might it be removed?

ØIf such objects were not removed, what would be the likely consequence?

A

Peanut in the trachea, just above the bifurcation of the trachea into the 2 main bronchi.

The lumen of the right main bronchus is more vertical and slightly wider than that of the left, therefore aspirated objects are more likely to become lodged in the right main bronchus.

There are 3 methods that could be used to remove a foreign object. As this object is so far down the trachea a bronchoscope would be used to remove it. If the object was more superior, it might be possible to visualise using a laryngoscope and then remove with forceps. It might also be possible to remove an object lodged more superiorly up the trachea using the Heimlich manoeuvre or back blows.

The most common complication from a foreign body aspiration is a pulmonary infection, such as pneumonia or a lung abscess. Patients may develop inflammation of the airway walls from a foreign body remaining in the airway.

55
Q

ØExplain what pulmonary emphysema (COPD) is.

ØWhat do you notice about the appearance of the lung tissue, in particular the alveoli?

ØWhat do you think the consequence of the change in alveolar structure would be on gas exchange?

A

Emphysema is a chronic lung condition in which the air sacs (alveoli) may be collapsed, destroyed or narrowed. Pulmonary emphysema is part of a group of lung diseases called COPD (chronic obstructive pulmonary disease). COPD lung diseases cause airflow blockage and breathing problems. The 2 most common conditions of COPD are chronic bronchitis and emphysema.

Overinflation of the air sacs is a result of a breakdown of the alveoli walls. Damage to the air sacs can’t be fixed and causes permanent holes in the lung tissue.

It causes a decrease in respiratory function and breathlessness. There is no way to repair or regrow the damaged lung tissue. The goal of treatment for people with pulmonary emphysema is to live more comfortably, control symptoms, and prevent the disease from getting worse.

56
Q

Examine pathology pot ED32 showing multiple pulmonary emboli and pulmonary metastasis.

ØExplain what a pulmonary embolism is?

ØTry to locate the pulmonary embolism – (think about which structure you would expect it be located in).

ØWhat is a pulmonary metastasis?

A

Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from deep veins in the legs or, rarely, from veins in other parts of the body (deep vein thrombosis).

The pulmonary emboli in the lung above are circled in green

Pulmonary metastases are common and the result of metastatic spread from a variety of primary tumours via blood or lymphatics. Tumour cells reach the lungs via the pulmonary circulation, where they lodge in small distal vessels. The pulmonary metastasis is circled in yellow.

57
Q

Coarctation of the aorta is a congenital abnormality in which the aortic lumen is constricted just distal to the origin of the left subclavian artery.

ØImagine a Coarctation of the Aorta has occurred immediately distal or lateral to where the left subclavian artery branches from the aortic arch. Can you suggest a collateral way in which oxygenated blood can reach the thoracic aorta?

A

The most common collateral pathway for oxygenated blood to reach the thoracic aorta as a result of coarctation of the aorta is via the subclavian artery to internal thoracic (mammary) artery to intercostal arteries (resulting in inferior rib notching) to post-coarctation part of descending thoracic aorta.

58
Q

ØSee the xray image showing a case of “notching of the ribs” due to Coarctation of the Aorta. Explain how this notching develops.

A

Notching of the ribs occurs due to the increased diameter of the intercostal arteries. The intercostal arteries increase in size because of the route for collateral circulation.

59
Q

Complete the diagram

Transverse section at the level of the third thoracic vertebra

A

1) Pectoralis major
2) Pectoralis minor
3) Right brachiocephalic vein
4) Left brachiocephalic vein
5) Brachiocephalic trunk
6) Left common carotid artery
7) Left lung
8) Axillary vein (not yet covered)
9) Left subclavian artery
10) Oesophagus
11) Spinal cord
12) Trachea
13) Lymph nodes

60
Q

Complete the diagram

Transverse section at the level of the sixth thoracic vertebra

A

1) Inferior vena cava entering into right atrium
2) Pericardium
3) Internal thoracic artery
4) Sternum
5) Myocardium of right ventricle
6) Aortic valve
7) Anterior interventricular artery and great cardiac vein
8) Left ventricle
9) Descending aorta
10) Azygos vein
11) Oesophagus
12) Pericardial cavity (oblique sinus)
13) Pleural cavity
14) Oblique fissure of right lung
15) Right lung

61
Q

Complete the diagram

Transverse CT image at the level of the fifth thoracic vertebra

A

1) Superior vena cava
2) Ascending aorta
3) Pulmonary trunk
4) Descending aorta
5) Right pulmonary veins

62
Q

Identify the following structures

  • Phrenic nerve
  • Right and left Internal jugular veins
  • Brachiocephalic veins
  • Superior vena cava
  • Hilum of lungs
  • Trachea
  • Inferior thyroid vein
A

Phrenic nerve: 31, 16

Right and left Internal jugular veins: 29, 14

Brachiocephalic veins: 11, 26

Superior vena cava: 36

Hilum of lungs: 24

Trachea: 37

Inferior thyroid vein: 5

63
Q

Identify the following structures

•

  • Ascending aorta
  • Pulmonary trunk
  • Pulmonary arteries
  • Ligamentum arteriosum
  • Pulmonary veins
  • Inferior vena cava
  • Left and right common carotid arteries
  • Pericardium
  • Diaphragm
A

Ascending aorta: 3

Pulmonary trunk: 33

Pulmonary arteries: 42, 23

Ligamentum arteriosum: 26

Pulmonary veins: 38, 20, 50

Inferior vena cava: 14

Left and right common carotid arteries: 18, 36 (5 is brachiocephalic trunk)

Pericardium:10, 46

Diaphragm: 19, 37

64
Q

Identify the following structures

  • Arch of aorta
  • Descending aorta
  • Brachiocephalic trunk
  • Right subclavian artery
  • Left subclavian artery
  • Vagus nerve
  • Posterior intercostal vein
A

Arch of aorta: 2

Descending aorta: 7

Brachiocephalic trunk: 5

Right subclavian artery: 34

Left subclavian artery: 22, 4

Vagus nerve: 23

Posterior intercostal vein: 29

65
Q

Identify the following structures

Right and Left coronary arteries

Anterior interventricular artery

Posterior interventricular artery

A

Right and Left coronary arteries: 6 (R) and 5(L)

Anterior interventricular artery: 10

Posterior interventricular artery: 15

66
Q

Identify the following structures

  • Papillary muscle
  • Moderator band
  • Chordae tendineae
A

Papillary muscle: 2 and 8

Moderator band: 11

Chordae tendineae: 5

67
Q

Identify the following structures

Main bronchus

Oblique fissure

Apex of lung

Diaphragmatic surface of lung

Impression of arch of the aorta

Pulmonary artery

Pulmonary veins

Pulmonary ligament

A

Main bronchus: 16

Oblique fissure: 20

Apex of lung: 2

Diaphragmatic surface of lung: 13

Impression of arch of the aorta: 8

Pulmonary artery: 17

Pulmonary veins: 15, 18

Pulmonary ligament: 21

103 Theme 1 - Anatomy (7 decks)

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