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Anatomy 1 - MD > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Thoracic Skeleton

A

12 pairs of C shaped ribs

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2
Q

Ribs 1-7

A

join at sternum with cartilage end points (true ribs)

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3
Q

Ribs 8-10

A

join sternum with combined cartilage at 7th rib (false ribs)

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4
Q

Ribs 11 + 12

A

no anterior attachment; attached to T11 + T12 (floating ribs)

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5
Q

Sternum: Manubrium

A

joins to clavicle and 1st rib; jugular notch

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6
Q

Sternum: Angle of Louis

A

found T4-T5 & marks bifurcation of atria

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7
Q

Sternum: Body

A

junction of manubrium with sternal body and attachment to 2nd rib

-sternal angle (Angle of Louis)

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8
Q

Sternum: Xiphoid Process

A

distal portion of sternum

-most common area of fractures in the sternum (chest compressions)

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9
Q

Fractured ribs 3-8 leads to:

A

Flail Chest (uneven)

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10
Q

Thorax

A

formed by 12 pairs of ribs that join posteriorly with the thoracic spine and anteriorly with the sternum (except ribs 11 + 12)

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11
Q

Thoracic Cavity

A
  • lined with thin layer of tissue (pleura)
  • one lung in each cavity
  • mediastinum is between chest cavity (pleura)
  • spinal cord protected by vertebral column
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12
Q

Lung Function

A

oxygenation

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13
Q

Mediastinum Components

A

heart, aorta, superior and inferior vena cava, trachea, major bronchi, espohagus

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14
Q

Pneumothorax

A

collapsed lung

  • cavity shrinks, decrease in pressure
  • usually seen in traumas
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15
Q

Mediastinal Shift

A

organs shift to where they do not belong

-caused by Pneumothorax

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16
Q

Reference Lines

A

points for dictating pain or location (ex. mass) when documenting / diagnosing

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17
Q

Anterior Chest Reference Lines

A
  • mid-sternal line
  • mid-clavicular line
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18
Q

Posterior Chest Reference Lines

A
  • vertebral line (midspinal)
  • scapular line
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19
Q

Lateral Chest Reference Lines

A
  • anterior axillary line
  • posterior axillary line
  • mid-axillary line
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20
Q

Anterior Thoracic Landmarks

A

-suprasternal notch (U shaped depression)

-sternum

-manubrium (angle of Louis)

-body

-xiphoid process

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21
Q

Posterior Thoracic Landmarks

A

-vertebra prominens (C7 projection at the end of neck, anterior to T1)

-spinous processes (fractured easily)

-scapula (shoulder blade; helps arm with degree of motion)

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22
Q

Superior Vena Cava

A

brings deoxygenated blood from head, eyes, neck and upper limbs to the R atrium of the heart

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23
Q

Inferior Vena Cava

A

brings deoxygenated blood from the abdomen and lower extremities to the R atrium

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24
Q

Right Atrium

A

receives deoxygenated blood from SVC + IVC

RA → tricuspid valve → RV

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25
Q

Right Ventricle

A

receives deoxygenated blood from R atrium through tricuspid valve

RV → pulmonary valve → pulmonary artery

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26
Q

Pulmonary Artery

A

carries R side (deoxygenated) blood to lungs for oxygenation

RV → PA → PV → LA

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27
Q

Pulmonary Vein

A

carries oxygenated blood from the lungs to the L side of the heart (L atrium)

PV → LA

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28
Q

Left Atrium

A

receives oxygenated blood from pulmonary veins

LA → mitral valve → L ventricle

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29
Q

Left Ventricle

A

receives oxygenated blood from L atrium through mitral valve

LV → aortic valve → aorta

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30
Q

Aorta

A

carries O2 rich blood to the rest of the body

LV → aortic valve → aorta

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31
Q

Trabeculae Carne

A

muscular columns projecting from inner surface of ventricles

-prevents suction of the blood due to pressure

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32
Q

Apex

A

PMI (point of max impulse)

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33
Q

cardiac output =

A

stroke volume x HR

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34
Q

Cor Pulmonale

A

pulmonary/chronic HTN causing R sided heart failure

-R sided heart failure not caused by L

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35
Q

Cardiac Tamponade

A

compression of the heart caused by fluid collection in the pericardium (sac surrounding heart)

  • compression prevents the heart from filling w/ blood properly
  • results in dramatic drop in BP (possibly fatal)
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36
Q

Peripheral Edema

A

fluid in the lungs

-displays as SOB

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37
Q

Jugular Venous Distension (JVD)

A

pump failure caused by heart failure

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38
Q

Position of the Heart

A

about half the length of sternal body from T2-T6

-from sternal angle to xiphoid process

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39
Q

Where to auscultate for: Aortic Valve

A

2nd intercostal space, R sternal border

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40
Q

Where to auscultate for: Tricuspid Valve

A

5th intercostal space, L sternal border

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41
Q

Where to auscultate for: Pulmonary Valve

A

2nd intercostal space, L sternal border

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42
Q

Where to auscultate for: Mitral Valve

A

5th intercostal space, mid clavicular line

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43
Q

Systemic Circuit

A

BV transports blood to and from tissues

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44
Q

Pulmonary Circuit

A

BV carries blood to and from the lungs

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45
Q

Pericardium Characteristics

A

double walled sac around the heart

  • superficial fibrous pericardium
  • deep, 2 layer subserous pericardium
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46
Q

Pericardium Function

A

protects and anchors the heart, prevents overfilling with blood, allows heart to work friction free

-limits expansion to an extent

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47
Q

Pericardium: Parietal Layer

A

lines internal surface of fibrous pericardium (tissue)

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48
Q

Pericardium: Visceral Layer

A

separated by fluid filled sac of serous fluid, covers heart muscle layer

-aka epicardium

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49
Q

Pericardial Effusion

A

build up of fluid within the heart’s pericardium

no expansion = conduction defects

  • muffled heart sounds, SOB, edema
  • must drain fluid to revert A-fib to normal rhythm
  • check for lupus
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50
Q

Heart Wall contains:

A
  • epicardium
  • myocardium
  • fibrous skeleton
  • endocardium
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51
Q

Heart Wall: Epicardium

A

visceral layer of serous pericardium

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52
Q

Heart Wall: Myocardium

A

cardiac muscle forming bulk of heart

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53
Q

Heart Wall: Fibrous Skeleton

A

criss crossing interlacing layer of connective tissue

54
Q

Heart Wall: Endocardium

A

endothelial layer of inner surface

55
Q

Pericardial Sac

A

encloses the heart

-tough fibrous covering layer

-secretory lining: secretes pericardial fluid to reduce friction between pericardial layers

56
Q

Pericarditis

A

inflammation of pericardium

  • fluid in lung sac
  • increased fluid = pressure and compression of heart
57
Q

Complications of Pericarditis

A

-increased fluid = pressure and compression of heart

→ cardiac tamponade → heart cannot fill due to compression = decreased output

→ infection by Tuberculosis (TB): BCG vaccine prevents pulmonary TB in infants (weans over time)

58
Q

Complications of Ventricular Hypertrophy

A

Ventricular Hypertrophy (enlarged heart) → less space to pump blood → LV fails

→ back flow (regurgitation) to LA → LA fails (O2 rich blood dumps into LA from pulmonary veins)

→ blood goes backward into lungs → RV fail → Hepatomegaly + JVD

59
Q

Regurgitation

A

back flow of blood

ex. valve stops working and one-directional blood flow goes in the backwards direction

60
Q

Vessels that return blood to the heart

A

pulmonary veins, IVC, SVC

61
Q

Vessels that take blood away from the heart:

A

aorta, L common carotid, brachiocephalic, subclavian, pulmonary arteries

62
Q

Vessels that supply/drain the heart (anterior view)

A

Arteries:

  • R + L coronary (AV groove)
  • marginal
  • circumflex
  • anterior ventricular arteries

Veins:

  • small cardiac
  • great cardiac
  • anterior cardiac
63
Q

Vessels that supply/drain the heart (posterior view)

A

Arteries:

  • R coronary artery (AV groove)
  • posterior interventricular artery

Veins:

  • great cardiac vein
  • posterior vein to L ventricle
  • coronary sinus
  • middle cardiac vein
64
Q

Heart Valves Function

A

ensure unidirectional blood flow through the heart

65
Q

Atrioventricular (AV) Valves

A

prevent back flow into the atria when vessels contract

-tricuspid + mitral (bicuspid)

66
Q

Tricuspid Valve

A

RA to RV

-deoxygenated blood

67
Q

Mitral Valve

A

LA to LV

-oxygenated blood

68
Q

Chordae Tendonae

A

anchor AV valves to papillary muscles and prevent valves from being inverted

69
Q

Semilunar Valves

A

prevent regurgitation of blood into the ventricles (one way flow)

-pulmonary valve + aortic valve

70
Q

Pulmonary Valve

A

RV to pulmonary trunk → lungs

-deoxygenated blood

71
Q

Aortic Valve

A

LV to aorta → rest of body

-oxygenated blood

72
Q

Endocarditis

A

inflammation of heart’s inner linings of chambers/valves

destruction of chordae tendonae

  • decreased function in chordae tendonae = valve failure (leaks), ventricle not getting enough blood → hypertrophy
  • also caused by M.I., connective tissue disorder, infection
73
Q

Ventricle not getting enough blood causes a….

A

Murmur

74
Q

Incidental Murmur

A

in children - may go away with age

  • must listen for sounds between “lub-dub” (S1 and S2)
    ex. rumbling between 1st + 2nd, or between 2nd and 1st
75
Q

Increased pressure from contraction closes ______

A

valve

76
Q

Pressure gradient problems leads to _______

A

valve complications

77
Q

Mitral Valve Prolapse

A

mitral valve is no longer one way flow to the ventricle

-instead, opens towards atria → regurgitation

-diagnose by echocardiogram

-concerning for pregnancy: more pressure in the heart = high risk pregnancy

78
Q

Interatrial Septum

A

divides LA and RA

79
Q

Interventricular Septum

A

divides RV and LV

80
Q

L side has _____ pressure than R side

A

higher

81
Q

Septal Defect Complications

A

hole in heart → less blood to LV = hypoxia

→ cyanosis (peripheral - toes, fingers)

increased pressure RA → heart failure

82
Q

Foramen Ovale

A

hole in interatrial septum that shunts oxygenated blood from R to L atria

-in utero

83
Q

Fossa Ovalis

A

remnant of foramen ovale; depression in the RA of the heart

-post natal

84
Q

Patent Foramen Ovale (PFO)

A

foramen ovale does not close after birth

-causes murmur due to septal defect

85
Q

Ductus Arteriosus

A

bypasses non-functional lungs in fetus, pumping blood away from the lungs

  • right ventricle
  • in utero
86
Q

Patent Ductus Arteriosus (PDA)

A

oxygenated blood from aorta enters pulmonary artery & mixes with deoxygenated blood

-both systolic and diastolic murmurs

87
Q

Ligamentum Arteriosum

A

attaches aorta to pulmonary artery

remnant of ductus arteriosus; serves no function in adults

-post natal

88
Q

Ventricular Septal Defect (VSD)

A

superior part of interventricular septum fails to form; blood mixes between RV + LV

89
Q

Transposition of the Great Vessels

A

aorta comes from RV, pulmonary trunk comes from L

  • result of bulbus cordis not dividing properly
  • deoxygenated blood passes through systemic circuit
  • oxygenated blood passes through pulmonary circuit
  • pulmonary artery is not pulmonary artery
90
Q

Coarcitation of Aorta

A

part of aorta is narrowed → increase work on LV

1/1500 births

91
Q

Tetralogy of Fallot

A

multiple defects

  • pulmonary trunk is too narrow and PV stenosed
  • ventricular septal defect
  • aorta opens from both ventricles
  • RV wall thickened from overwork
92
Q

Pulmonary Stenosis

A

pulmonary semilunar valve is narrowed (stenosis) → decreased blood flow to lungs

93
Q

High Frequency Sounds

A

related to opening

-closure sounds = S1 + S2

94
Q

Low Frequency Sounds

A

related to closing

-early and late diastolic filling events of LV

-S3 + S4

95
Q

S1 + S1 Sounds

A

Lub-Dub

  • audible with stethoscope
  • contraction
96
Q

S3 + S4

A

usually not audible under normal conditions

97
Q

Ventricular Systole

A

when mitral valve and tricuspid valve close

contraction

S1 + S2

98
Q

Ventricular Diastole

A

occurs w/ closure of aortic and pulmonary valves

relaxation

S2 + S1

99
Q

Most heart sounds are associated with closing. Hearing the valve opening means it is ________

A

stenotic

100
Q

Factors affecting S1

A

-structural integrity of valve → inadequate joining of mitral valve (SOFT S1) or loss of leaflet tissue (SOFT S1)

-velocity of valve closure → position of mitral valve can be altered by atrial and ventricular systole

-status of ventricular contraction → increased myocardial contractility = increased LV pressure [exercise, high output state] (LOUD S1) or decreased contractility due to M.I. or myocarditis (SOFT S1)

-heart rate → tachycardia (LOUD S1) [shorter PR interval, wide valves due to short diastole increase myocardial contractility

-transmission characteristics → obesity, emphysema, pericardial effusion decreases intensity of auscultory events, thin chest wall increases intensity

101
Q

Conditions causing LOUD S1

A
  • mitral stenosis
  • mitral valve prolapse
  • exercise
  • tricuspid stenosis
  • atrial septal defect
  • anomalous pulmonary venous connection with increased tricuspid flow
102
Q

Mitral Stenosis

A

LOUD S1

increased L arterial pressure, mitral valve trying to close, flaps are thicker, turbulent blood flow due to narrow space

103
Q

Mitral Valve Prolapse

A

LOUD S1

floppy leaflet snaps into prolapsed position and makes a loud click

increases regurgitation

104
Q

Exercise

A

LOUD S1

increased HR, increased ventricular pressure

105
Q

Tricuspid Stenosis

A

LOUD S1

thickened tricuspid leaflets, increased turbulence (narrow)

106
Q

Atrial Septal Defect

A

LOUD S1

exists in foramen ovale during fetal development

normal conditions: shunt blood to RA → LA

hole doesn’t close: increased volume to RA → increased flow across pulmonic valve

107
Q

Anomalous Pulmonary Venous Connection w/ Increased Tricuspid Flow

A

PV drains blood to RA instead of LA → mixes with deoxygenated blood → increased volume and increased pressure on tricuspid

108
Q

Conditions causing SOFT S1

A
  • mitral regurgitation
  • calcific mitral stenosis (immobile mitral valve)
  • severe atrial regurgitation
  • left bundle branch block (LBBB) (decreased LV contractility)
109
Q

S2 Split

A

normally during inspiration

AV closes before PV

-usually seen in RBBB (conduction issue)

110
Q

Wide Split S2

A

deeper inhalation

AV closes a while before PV

-usually seen in Pulmonary Stenosis

111
Q

Paradoxical Split S2

A

seen during expiration but disappears on inspiration

PV closes before AV

  • think pediatric cardiomyopathy
  • Aortic Stenosis, LBBB, HCM (hypertrophic cardiomyopathy)
112
Q

Fixed Split S2

A

no change in S2 w/ deeper inspirations

-Atrial Septal Defect (ASD), R Ventricular failure

113
Q

S3 Sounds

A

rare extra heart sound that occurs soon after normal “lub-dub” (heard between S2 and S1)

-associated with LV heart failure

-normal in children and young people w/o abnormalities

114
Q

S4 Sounds

A

very difficult to hear

caused by vibration of ventricular wall during atrial contraction

-associated with stiffened ventricle (low ventricular compliance)

-heard in patterns w/ Ventricular Hypertrophy + Myocardial Ischemia (tissue dies + no function)

115
Q

Heart Murmurs

A

abnormal sounds produced due to abnormal flow of turbulent blood through abnormal heart valves

ex. stenosis or incompetence
- increased velocity = murmur sounds

116
Q

When blood is forced through a stenotic valve, produces an abnormal ______ sound

A

whistling

117
Q

When blood forced backward through an incompetent valve (regurgitation), it produces a ________ sound

A

swishing or gurgling murmur

118
Q

Rheumatic Fever

A

autoimmune disease triggered by streptococcus bacterial infection

  • antigen-antibody complexes damage the valve
  • stenotic valve dysfunction often caused by a missed strep infection
  • most common strep = Impetigo
119
Q

Systolic Murmur

A

produced during systole of ventricle (contraction) between S1 and S2

  • innocent murmurs
  • common in children and young adults
  • ex. Aortic Stenosis + Mitral Incompetence
120
Q

Diastolic Murmur

A

produced during diastole of ventricle (relaxation) between S2 and S1

-ex. Aortic Incompetence + Mitral Stenosis

121
Q

ASS - BACKWARDS

A = P

T = M

Aortic Stenosis is Systole

A

Aortic Stenosis = systole

Pulmonary Stenosis = systole

Tricuspid Stenosis = diastole

Mitral Stenosis = diastole

Aortic Regurgitation = diastole

Pulmonary Regurgitation = diastole

Tricuspid Regurgitation = systole

Mitral Regurgitation = systole

122
Q

Ventricular Septal Defect (VSD)

A

commonly caused by congenital defect; hole in the heart between LV + RV that may never be identified

  • undiagnosed → gets louder w/ age
  • LV shunts blood to RV, increasing RV pressure
  • may be associated w/ other defects: Tetralogy of Fallot
123
Q

VSD Complications

A

LV shunts blood to RV, increasing RV pressure

RV hypertrophy → R side failure

regurgitation in R side causes blood to pool in venous system

L side oxygen poor → cyanosis

124
Q

Electrical Conduction System

A

AV Node

SA Node

Bundle of HIS

Bundle Branch

Purkinje Fibers

125
Q

AV Node blocked → _______ will start its own electrical impulse (supraventricular rhythm)

A

Bundle of HIS

126
Q

Supraventricular rhythm becomes so irregular / not in sync, causing __________

A

Ventricular Tachycardia

127
Q

Cardiac cells produce their own __________

A

electrical impulse

128
Q

_________ will shock the heart until the optimal rhythm is achieved

A

Pacemaker

129
Q

RBBB

A

affects electrical conductivity of the heart

130
Q

Contraction begins at ______

A

apex

131
Q

Autonomic Innvervation

A

sympathetic - increase rate/force of contractions

parasympathetic - slow HR by Vagus nerve stimulation

132
Q

Flow of Fetal Blood Circulation:

A
  1. Oxygenated / nutrient rich blood from PLACENTA travel through UMBILICAL VEIN
  2. UMBILICAL VEIN passes through the LIVER (still oxygenated) and combines with IVC (deoxygenated)
  3. Mixed blood enters the heart through RA
  4. SVC brings deoxygenated blood to RA, pumping from RA to RV to PULMONARY TRUNK to DUCTUS ARTERIOSUS then DESCENDING AORTA
  5. Some mixed blood enters RV but most enters LA through FORAMEN OVALE
  6. LA pumps to LV
  7. LV pumps to AORTA
  8. Any blood that entered the PULMONARY TRUNK instead of FORAMEN OVALE or RV can re-enter the AORTA through the DUCTUS ARTERIOSUS
  9. ILLIAC ARTERIES are mostly now deoxygenated after blood moves through tissues and returns to UMBILICAL VEIN for oxygenation

Anatomy 1 - MD (6 decks)

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