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Flashcards in thorax gross anatomy Deck (86):
1

The lower respiratory system develops from ?

From endoderm from the ventral wall of the foregut as :
The respiratory diverticulum

2

The respiratory epithelium develops from ?

Endoderm

3

To separate the invagination from the gut develops ?

Traqueoesophageal septum

4

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 ?

Traqueoesophageal fistula

5

A traqueoesophageal fistula develops most commonly in which part of the trachea ?

Distal third of the trachea

6

Pulmonary hypoplasia can develop from which circumstances ?

1) Bilateral renal agenesia (oligohydramnios)
2)Congenital diaphragmatic hernia

7

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.

8

How are the structures in the costal groove distributed ?

Vein, artery, nerve

9

Intercostal arteries provide collateral circulation between ?

The branches of the subclavian artery and branches of the thoracic aorta

10

Respiratory distress syndrome is caused by ?

Low surfactant in premature infants or with diabetics mothers.

11

hyaline membrane disease is ?

Caused by surfactant deficiency , and repeated and gasping inhalations damage the alveoli producing atelectasis and pink fluid covering alveoli.

12

The pleura is innervated by ?

intercostal nerves: costal and periphery of the diaphragmatic pleura
Phrenic nerve: Center of the diaphragmatic pleura and mediastinal pleura

13

Pain referred to the shoulders during inspiration should suggest ?

Pleurisy
Mediastina inflammation referred pain by the phrenic nerve to segments C3-C5

14

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.

15

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

16

NAme the pleural recesses ?

Costodiaphragmatic recesses
Costomediastinal recesses

17

The costomediastinal recesses in the midclavicular line extends until ?

parietal pleura : 8 rib
Visceral pleura: 6 rib

18

The costomediastinal recesses in the midaxillary line extends from ?

The visceral pleura : 8 rib
Parietal pleura: 10 rib

19

The costomediastinal recesses in the para vertebral line ?

Visceral pleura: 10 rib
Parietal pleura: 12 rib

20

How many lobes the right lung has ?

three ( sup,med,inf)

21

A foreign body in the respiratory airways more often will enter ?

The right primary bronchus

22

The oblique fissure of the lungs follows ?

The 5th rib direction

23

The horizontal fissure of the left lung follows ?

The 4th rib

24

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

25

To auscultate the inferior lobes we have to put the stethoscope in ?

The posterior chest wall

26

The truncus arteriousu gives rise to ?

Aorta
Pulmonary trunk
Semilunar valves

27

The bulbus cordis gives rise to ?

Smooth area of the right ventricle (infudibulum) and the smooth area of the left ventricle (aortic vestibule)

28

Trabeculated protions of the ventricles derive from ?

Primitive ventricles

29

Trabeculated areas of the atriums ( pectinate muscles) derive from ?

Primitive atriums

30

The sinus venosus gives rise which structures ?

Smooth part of the right atrium (sinus venarum)

31

Vascular shunts during fetal circulation ?

Ductus venosus
Foramen ovale
ductus arteriosus

32

The ductus venosus remnant in the adult life is called ?

Round ligament or ligamementun venosum

33

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

34

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

35

The remnant of the ductus arteriosus is called ?

Ligament arteriousus

36

The remnants of the umbilical arteries are called ?

Medial umbilical ligaments

37

Ligamentum teres of the liver is formed by ?

remnant of the ductus venosus

38

Septation of the atria and ventricles start ?

4th week

39

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

40

Types of Atrial septal defects ?

1)Secudum type
2) prymun type

41

Non cyanotics heart defects ?

* ASD


* VSD
PDA

42

Cyanotic heart defects ?

* Fallot

* Trasnposition

* Persistent truncus arteriousus

43

Secudum type ASD is caused by ? and the defect is located by ?

most common
Excessive resorption of the septum primun or underdevelopment of the septum secundum

44

Prymun type ASD

Less common
Defect in endocardial cushions migration causing failure to fuse with septum primun.
Associated with valvular defects

45

THe ventricular septum is composed of two parts ?

1) Membranous
2) muscular

46

Which congenital heart disease is the most common ?

VSD (more in males )

47

Membranous VSD

Associated to defects in neural crest cells migration.
Left to right shunt
Patients may complain of fatigue upon exertion .

48

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.

49

How to keep a PDA open ?

without increasing the O2
Administering prostaglandins

50

how to close an PDA ?

Indomethacin
Administering O2

51

By which mechanisms does the DA closes ?

1) smooth muscle contraction
by high o2 and low prostaglandins at birth

52

Tretallogy of Fallot features ?

most common cyanotic condition
The Aortico pulmonary septum develops toward the right side
Findings:
Pulmonary stenosis

1. Overriding aorta

2. VSD

3. Right ventricle hypertrophy

53

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

54

Why children with transposition of the great vessels can be alive ?

Other defects kept them alive
ASD
VSD
PDA

55

Persistent truncus arteriosus is caused by ?

Partial development of the AP septum.
One large vessel exits the Heart
Always accompanied by VSD

56

Limits of the mediastinum?

Anterior: sternon
Posterior: 12 thoracic vertebrae
Lateral: pleural cavities

57

which plane is used to divide into a lower and superior mediastinum ?

The sternal angle to the disc between T4-T5

58

How the inferior mediastinum is divided into anterior posterior and middle. ?

By the fibrous pericardium layers

59

Which structures lie inside the posterior mediastinum ?

The thoracic descending aorta
The esophagus
Thoracic duct
Azygos veins

60

Which important branches of the aorta are in the thoracic descending portion ?

Bronchial
Esophageal
posterior intercostal aa.

61

Which structures reside in the superior mediastinum ?

From anterior to posterior :
Thymus

* Veins: right and left brachiocephalic veins

* Arteries: aortic arch and branches ( Right brachiocephalic artery, common carotid, left subclavian aa)

* Trachea

* Esophagus

* Also: phrenic nerves and the vagus nerves

62

Limits of the superior mediastinum ?

Anterior: sternum
Posterior: T1-T4
Lateral: Parietal pleuras

63

The pulmonary and cardiac plexuses come from ?

The vagus nerves descending through the mediastinum

64

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

65

The right recurrent laryngeal nerve is inside the mediastinum
True or false

False
this nerve derives from the right vagus and curves under the right subclavian artery.

66

Types of aorta coarctations?

Preductal type: infantile, less common
Postductal: adult, more common, distal to DA so closes and obliterates

67

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

68

A patient that comes with reduced heart sounds, anxiety, jugular distention, and a low arterial pressure. Should think in ?

Cardiac tamponade

69

Which important region is used by surgeons to separate arteries from veins in the heart ?

The transverse pericardial sinus

70

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

71

Where is the SA node located ?

in the right atrium in the top of the crista terminalis

72

The atrioventricular valve of the right heart is called ?

Tricuspid

73

The left atrioventricular valve is called ?

Bicuspid or mitral valve

74

The chordae tendinae of the valves attach to ?

The papillary muscles in the ventricles.

75

The S1 sound indicates ?

closure of the AV valves
Begin of systole

76

S2 sound means ?

Closure of the semilunar valves
Diastole begins

77

A valvular insufficiency means ?
A valvular stenosis means ?

Stenosis: can open fully
Insufficiency: cant close correctly

78

Which are the most common valves affected ?

The mitral and the aortic valves

79

The most common artery affected by occlusive problems is ?

The left anterior descending artery

80

The SA node and the AV node are irrigated by ramus of the ?

THe right coroary artery

81

The His bundle is irrigated by ?

LAD

82

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.

83

Which patients can course with a silent ischemia ?

Chronic diabetics
Transplanted hearts

84

The diaphragm is innervated by ?

The phrenic nerve from segments C3 to C5

85

The Aorta cross to diaphragm by the ?

Aortic hiatus located by T12, accompanied by the thoracic duct

86

Why the esophagus can be used as an access to echocardiography ?

Because the left atrium is contact with the anterior wall of the esophagus