Flashcards in thorax gross anatomy Deck (86):
The lower respiratory system develops from ?
From endoderm from the ventral wall of the foregut as :
The respiratory diverticulum
The respiratory epithelium develops from ?
To separate the invagination from the gut develops ?
A kid with history of polyhidramnios, has milk regurgitation gagging and cyanosis after feeding, presents abdominal Distention and also cough for the last month ?
Probable diagnosis ?
A traqueoesophageal fistula develops most commonly in which part of the trachea ?
Distal third of the trachea
Pulmonary hypoplasia can develop from which circumstances ?
1) Bilateral renal agenesia (oligohydramnios)
2)Congenital diaphragmatic hernia
A child born of 25 to 28 weeks can survive ?
/yes with intensive care
At that time pneumocytes 2 are present bt th amount of surfactant is critical.
How are the structures in the costal groove distributed ?
Vein, artery, nerve
Intercostal arteries provide collateral circulation between ?
The branches of the subclavian artery and branches of the thoracic aorta
Respiratory distress syndrome is caused by ?
Low surfactant in premature infants or with diabetics mothers.
hyaline membrane disease is ?
Caused by surfactant deficiency , and repeated and gasping inhalations damage the alveoli producing atelectasis and pink fluid covering alveoli.
The pleura is innervated by ?
intercostal nerves: costal and periphery of the diaphragmatic pleura
Phrenic nerve: Center of the diaphragmatic pleura and mediastinal pleura
Pain referred to the shoulders during inspiration should suggest ?
Mediastina inflammation referred pain by the phrenic nerve to segments C3-C5
An open pneumothorax is characterized by ?
Air the pleural cavity,generally by a penetrating wound that lets air move freely.
Mediastinum moves to the other side and compress the other lung, during expiration airs exits and normally position returns.
A tension pneumothorax is produced by ?
Shortness of breath and painful respiration.
When air enters the pleural cavity with a valve mechanism, air enters and gets trapped, increasing the pressure reducing the function and venous return of the opposite lung
NAme the pleural recesses ?
The costomediastinal recesses in the midclavicular line extends until ?
parietal pleura : 8 rib
Visceral pleura: 6 rib
The costomediastinal recesses in the midaxillary line extends from ?
The visceral pleura : 8 rib
Parietal pleura: 10 rib
The costomediastinal recesses in the para vertebral line ?
Visceral pleura: 10 rib
Parietal pleura: 12 rib
How many lobes the right lung has ?
three ( sup,med,inf)
A foreign body in the respiratory airways more often will enter ?
The right primary bronchus
The oblique fissure of the lungs follows ?
The 5th rib direction
The horizontal fissure of the left lung follows ?
The 4th rib
To auscultate the superior lobes the stethoscope is placed in which area of the chest wall ?
The anterior chest wall,
For the rigth lung above the 4th rib
To auscultate the inferior lobes we have to put the stethoscope in ?
The posterior chest wall
The truncus arteriousu gives rise to ?
The bulbus cordis gives rise to ?
Smooth area of the right ventricle (infudibulum) and the smooth area of the left ventricle (aortic vestibule)
Trabeculated protions of the ventricles derive from ?
Trabeculated areas of the atriums ( pectinate muscles) derive from ?
The sinus venosus gives rise which structures ?
Smooth part of the right atrium (sinus venarum)
Vascular shunts during fetal circulation ?
The ductus venosus remnant in the adult life is called ?
Round ligament or ligamementun venosum
What functions does the foramen ovale has ?
Shunt blood from the right atrium to the left atrium preventing mixing of deoxygenated blood with oxygenated blood
What happens with circulation after birth ?
1) umbilical arteries close
2) Umbilical vein will close, closing the ductus venosus
3) lungs expand and reduce vascular resistance
4) The foramen ovale closes
5) After hours the ducturs arteriousus closes
The remnant of the ductus arteriosus is called ?
The remnants of the umbilical arteries are called ?
Medial umbilical ligaments
Ligamentum teres of the liver is formed by ?
remnant of the ductus venosus
Septation of the atria and ventricles start ?
Why during fetal life the pressure in the right atrium is higher that in the adult life ?
* High vascular resistance in the lungs
* High amount of blood that comes from the placenta
Types of Atrial septal defects ?
2) prymun type
Non cyanotics heart defects ?
Cyanotic heart defects ?
* Persistent truncus arteriousus
Secudum type ASD is caused by ? and the defect is located by ?
Excessive resorption of the septum primun or underdevelopment of the septum secundum
Prymun type ASD
Defect in endocardial cushions migration causing failure to fuse with septum primun.
Associated with valvular defects
THe ventricular septum is composed of two parts ?
Which congenital heart disease is the most common ?
VSD (more in males )
Associated to defects in neural crest cells migration.
Left to right shunt
Patients may complain of fatigue upon exertion .
What is the Eisenmengers complex ?
When a non cyanotic defect becomes cyanotic.
A VSD can increase the pressure to the lungs, this increases gradually the resistance in the lung endothelium causing pulmonary hypertension reverting the pressure back to the right atrium reverting the shunt.
How to keep a PDA open ?
without increasing the O2
how to close an PDA ?
By which mechanisms does the DA closes ?
1) smooth muscle contraction
by high o2 and low prostaglandins at birth
Tretallogy of Fallot features ?
most common cyanotic condition
The Aortico pulmonary septum develops toward the right side
1. Overriding aorta
3. Right ventricle hypertrophy
Transposition of the great vessels is caused by ?
The AP septum develops in a straight manner rather than spiral.
The aorta exits the right ventricle and the pulmonary trunk exits the left ventricle
Presents severe cyanosis at birth
Why children with transposition of the great vessels can be alive ?
Other defects kept them alive
Persistent truncus arteriosus is caused by ?
Partial development of the AP septum.
One large vessel exits the Heart
Always accompanied by VSD
Limits of the mediastinum?
Posterior: 12 thoracic vertebrae
Lateral: pleural cavities
which plane is used to divide into a lower and superior mediastinum ?
The sternal angle to the disc between T4-T5
How the inferior mediastinum is divided into anterior posterior and middle. ?
By the fibrous pericardium layers
Which structures lie inside the posterior mediastinum ?
The thoracic descending aorta
Which important branches of the aorta are in the thoracic descending portion ?
posterior intercostal aa.
Which structures reside in the superior mediastinum ?
From anterior to posterior :
* Veins: right and left brachiocephalic veins
* Arteries: aortic arch and branches ( Right brachiocephalic artery, common carotid, left subclavian aa)
* Also: phrenic nerves and the vagus nerves
Limits of the superior mediastinum ?
Lateral: Parietal pleuras
The pulmonary and cardiac plexuses come from ?
The vagus nerves descending through the mediastinum
A patient diagnosed with aorta aneurims at the arc presents with problems to speak < what nerve may be injured ?
The left recurrent laryngeal nerve because curves under the aortic arch
The right recurrent laryngeal nerve is inside the mediastinum
True or false
this nerve derives from the right vagus and curves under the right subclavian artery.
Types of aorta coarctations?
Preductal type: infantile, less common
Postductal: adult, more common, distal to DA so closes and obliterates
A patient with Aorta coarctation usually has ?
Hypertension in the upper body
Hypotension in the lower body with weak pulses
Collateral circulation with costal notching
A patient that comes with reduced heart sounds, anxiety, jugular distention, and a low arterial pressure. Should think in ?
Which important region is used by surgeons to separate arteries from veins in the heart ?
The transverse pericardial sinus
Borders of the heart:
Right: Right atrium
Left border: left ventricle
Apex: tip of the left ventricle
Superior border : right and left auricles
Inferior border: right ventricle
Where is the SA node located ?
in the right atrium in the top of the crista terminalis
The atrioventricular valve of the right heart is called ?
The left atrioventricular valve is called ?
Bicuspid or mitral valve
The chordae tendinae of the valves attach to ?
The papillary muscles in the ventricles.
The S1 sound indicates ?
closure of the AV valves
Begin of systole
S2 sound means ?
Closure of the semilunar valves
A valvular insufficiency means ?
A valvular stenosis means ?
Stenosis: can open fully
Insufficiency: cant close correctly
Which are the most common valves affected ?
The mitral and the aortic valves
The most common artery affected by occlusive problems is ?
The left anterior descending artery
The SA node and the AV node are irrigated by ramus of the ?
THe right coroary artery
The His bundle is irrigated by ?
The heart innervation
Sympathetic: Increase the heart rate, also sensory fibers that sense ischemia , they reach conscious levels(T1-T5)
Parasympathetic: Slows the heart rate, sensory nerves carry feedback responses through the vagus nerves.
Which patients can course with a silent ischemia ?
The diaphragm is innervated by ?
The phrenic nerve from segments C3 to C5
The Aorta cross to diaphragm by the ?
Aortic hiatus located by T12, accompanied by the thoracic duct