Anat 411 Gross Thorax

Front 1

1. What is the derivation of the skin layers?

Back 1

Epidermis- ectoderm; dermis- mesoderm

Front 2

2. Describe the axilla as a four sided pyramid.

Back 2

Anterior axillary fold (pec major); posterior axillary fold (latisimus dorsi); Medial aspect (seratus anterior); lateral aspect (humerus); floor (skin)

Front 3

3. What is responsible for the shape of the breast?

Back 3

Fat

Front 4

4. The breast can be described as a modified _________________.

Back 4

Sweat gland

Front 5

5. What is the purpose of the secretions of the areola?

Back 5

Assist in breast feeding (two glass surfaces with liquid in between)

Front 6

6. Where in the breast is the milk stored?

Back 6

Ampullas (swellings in the ducts)

Front 7

7. How is the breast organized?

Back 7

Organized by septa

Front 8

8. Describe the suspensory ligaments of Cooper.

Back 8

Septa found in the upper portion of the breast opposing the forces of gravity

Front 9

9. Where does 60% of the blood flow to the breast come from?

Back 9

Internal thoracic artery

Front 10

10. Where does 30% of the blood flow to the breast come from?

Back 10

Lateral thoracic artery

Front 11

11. What portion of blood flow do the intercostal arteries supply to the breast?

Back 11

10%

Front 12

12. Where is the bulk of the lymphatic drainage of the breast?

Back 12

Axillary lymph nodes (anterior)

Front 13

13. What quadrant of the breast is most susceptible to cancer?

Back 13

Upper outer quadrant

Front 14

14. Where specifically in the breast is cancer most likely?

Back 14

Ducts and ampulla

Front 15

15. What structure introduces complications involving removal of breast cancer? Why?

Back 15

Axillary tail; Vessels and nerves that are associated with the structure (lateral thoracic artery, long thoracic nerve, thoracodorsal artery and nerve, etc.)

Front 16

16. What other structure makes this breast surgery difficult?

Back 16

Fascia- tough membranous

Front 17

17. Describe the appearance of skin involving a breast with pathology?

Back 17

Normally raised over the nipple; would also be raised over the mass; reduced lymphatic drainage from the mass pushing against

Front 18

18. What CT structure is always deep to the skin and may have membranous and fatty layers such as in the breast?

Back 18

Superficial fascia

Front 19

19. What are the two locations where a breast implant may be placed?

Back 19

Retromammary space- anterior to the deep fascia along pec major; behind the pec major

Front 20

20. What is the advantage to each location of implantation?

Back 20

Retromammary- quicker recovery time; Behind the pec major- shape looks more natural

Front 21

21. What are the three points of origin of the pectoralis major?

Back 21

Medial third of the clavicle; the sternum; cartilaginous portion of the ribs

Front 22

22. What is the point of insertion of the pectoralis major?

Back 22

Lateral lip of the intertubercular groove of the humerus

Front 23

23. What results from contraction of the pec major?

Back 23

Adduction= arm across the midline

Front 24

24. What is the origin of the pectoralis minor?

Back 24

Combination of ribs 2,3,4 or 3,4,5 etc

Front 25

25. What is the point of insertion of the pec minor?

Back 25

Coracoid process of the scapula

Front 26

26. What results from contraction of the pec minor?

Back 26

Depression of the scapula

Front 27

27. What two nerves innervate the pec major?

Back 27

Medial and lateral pectoral nerve

Front 28

28. What does the medial innervate?

Back 28

Lower portion

Front 29

29. What does the lateral innervate?

Back 29

Superior portion

Front 30

30. Describe the naming of these nerves?

Back 30

Not based on location; medial is actually located lateral to the pectoral nerve; named based on branching from brachial plexus- lateral and medial cords

Front 31

31. What does the paracromiotrunk branch into? Which of these vascularizes the pectoralis major?

Back 31

Deltoid, Acromial, Clavicular, Pectoral- obviously the pectoral muscle will be from this one

Front 32

32. Describe the venous drainage of the pectoralis major?

Back 32

Cephalic vein into the subclavian vein

Front 33

33. What is the name of the nerves above the pectoralis major muscle?

Back 33

Cutaneous

Front 34

34. What are the three layers of the intercostal muscles?

Back 34

External, internal, innermost

Front 35

35. How would you describe the fiber direction of the external intercostals muscles?

Back 35

Hands in your pocket.

Front 36

36. Describe the fiber direction of the internal compared to the external.

Back 36

90 degrees

Front 37

37. Where do the external intercostals run from?

Back 37

Junction of cartilage/bone ribs posteriorly around to the vertebral column

Front 38

38. Where do the internal intercostals muscles run?

Back 38

Sternum to the costal angle of the ribs

Front 39

39. Where are the innermost intercostals muscles found?

Back 39

Occupy a space in between the external and internal; don’t go to either sternum or vertebral column

Front 40

40. Do any of the intercostals muscles go completely from sternum to vertebral column?

Back 40

No

Front 41

41. The intercostal arteries and veins are branches of what vessels?

Back 41

Internal thoracic

Front 42

42. Where are the intercostals vessels/nerves housed and protected in the rib?

Back 42

Costal groove

Front 43

43. Where is the transversus thoracis found?

Back 43

Posteriorly between the 3rd and 5th ribs at the level of the innermost intercostals muscles

Front 44

44. Where are the sensory cells bodies of the somatic nervous system located?

Back 44

Dorsal root ganglia

Front 45

45. Where do the cell bodies for the somatomotor nerves sit?

Back 45

Ventral horn

Front 46

46. At what levels are the preganglionic cell bodies (symp) of the lateral horn (gray matter) located?

Back 46

Between T1 and L2

Front 47

47. Where does the internal thoracic artery branch from?

Back 47

Subclavian artery

Front 48

48. What does the internal thoracic vein become?

Back 48

Brachiocephalic vein

Front 49

49. At the 6th rib, the internal thoracic artery becomes what?

Back 49

Epigastric (rectus abdominus); musculophrenic (to 10th rib)

Front 50

50. Do the 11th and 12th ribs receive vascularization from an anterior intercostal?

Back 50

No; don’t make all the way anterior

Front 51

51. Which is longer, the sternum or vertebral column?

Back 51

Vertebral column

Front 52

52. Ribs 1-7 are true ribs for what reason?

Back 52

They attach directly to the sternum

Front 53

53. Ribs 8-12 are called what? Why?

Back 53

False ribs; attach the rib above; don’t attach to sternum directly

Front 54

54. What is the classification of ribs 11-12?

Back 54

Floating ribs

Front 55

55. Describe the development of the sternum.

Back 55

From 6 bones; middle 4 fuse during puberty to form the body

Front 56

56. What is the superior portion of the sternum called?

Back 56

Manubrium

Front 57

57. What is the sternal angle?

Back 57

Point where the body of the sternum and manubrium join

Front 58

58. What vertebral level is at the sterna angle?

Back 58

Intervertebral disc of the 4th and 5th thoracic vertebra

Front 59

59. What does rib 1 articulate with?

Back 59

Manubrium

Front 60

60. What does rib 2 articulate with?

Back 60

Sternal angle

Front 61

61. What do ribs 3-6 articulate with?

Back 61

The body of the sternum

Front 62

62. Where does rib 7 articulate?

Back 62

Xiphoid process

Front 63

63. What part of the rib articulates with the vertebral body?

Back 63

Head

Front 64

64. What does the tubercle of the rib articulate with?

Back 64

Transverse process of the vertebra

Front 65

65. What is the most common point of fracture/breakage in the ribs?

Back 65

Costal angle

Front 66

66. What ligaments hold the rib against the vertebral body?

Back 66

Radiate ligaments

Front 67

67. What is the role of the costotransverse ligaments?

Back 67

Hold the rib to the transverse process

Front 68

68. What is mostly responsible for changing the vertical dimensions of the rib cage?

Back 68

Diaphragm

Front 69

69. What motion of the ribs helps with inspiration?

Back 69

Bucket handle motion

Front 70

70. What intercostals muscle have been shown to aid in inspiration?

Back 70

External and interchondral part of internal intercostals

Front 71

71. At what time in development does the trachea bud off of the gut tube (esophagus)?

Back 71

Four to six weeks

Front 72

72. Where does this diverticulum differentiate from in the 4th week?

Back 72

Pharyngeal arch

Front 73

73. What does the developing lung grow into?

Back 73

Splanchnic mesenchyme

Front 74

74. What is the pleura derived from?

Back 74

Splanchnic mesenchyme

Front 75

75. Describe the difference between visceral and parietal pleur

Back 75

a. Visceral is immediately surrounding the lung while the parietal surrounds the ribs. These two surfaces with rub against each other.

Front 76

76. How is the parietal pleura anchored to the ribs?

Back 76

Endothoracic fascia

Front 77

77. How many lobes on the right lung? What are they?

Back 77

Three; upper (superior), middle, lower (inferior)

Front 78

78. What does the horizontal fissure separate? What about the oblique fissure?

Back 78

Upper and middle lobe; middle and lower lobe

Front 79

79. Which lung is shorter, the right or left? Why?

Back 79

Right; liver pushes up on it

Front 80

80. Which lung is more voluminous?

Back 80

Right

Front 81

81. How many lobes on the left lung and what separates the lobes?

Back 81

2; oblique fissure

Front 82

82. Where does visceral pleura oppose visceral pleura?

Back 82

The fissures

Front 83

83. What structure in the left lung is formed by the cramping of the heart?

Back 83

Cardiac notch

Front 84

84. What is the anterior projection of the left lung and what lobe is it’s equivalent on the right?

Back 84

Lingula; middle lobe

Front 85

85. Where are pericardial taps performed and for what reason?

Back 85

5th intercostals space next to the sternum. There is no pleura present here, thus preventing a pneumothorax.

Front 86

86. Describe the level of the lungs during quiet breathing?

Back 86

6, 8, 10; midclavicular= 6th rib; midaxillary= 8th rib; midscapular= 10th rib

Front 87

87. Describe the level of the lungs during deep breathing?

Back 87

8, 10, 12; midclavicular =8th rib; midaxillary= 10th rib; midscapular= 12th rib

Front 88

88. What is the term for the inferior of both the lungs?

Back 88

Costodiaphragmatic recess

Front 89

89. Where does parietal pleura oppose parietal pleura?

Back 89

Costodiaphragmatic recess; Costosternal recess

Front 90

90. What is the costosternal recess?

Back 90

Medial extension of the pleura surrounding the left lung

Front 91

91. Past what rib, does a puncture injury begin to include both the thorax and abdomen?

Back 91

The 7th intercostal space

Front 92

92. Describe the danger of a kidney biopsy.

Back 92

Safe below the 12th rib, but often times, it may be vestigial and may be in fact palpating the 11th rib. If too high, then could puncture the pleura leading the pneumothorax.

Front 93

93. Is it possible for the right lung to only have two lungs?

Back 93

Yes

Front 94

94. What is found at the root of the lung?

Back 94

Pulmonary artery, bronchial apparatus, pulmonary veins, bronchial arteries/veins, lymphatics and innervation

Front 95

95. What term refers to the plane of this root of the lung?

Back 95

Hilus

Front 96

96. What color is the pulmonary artery and why?

Back 96

Blue, deoxygenated blood to the lungs

Front 97

97. How can you use the anterior and posterior properties to differentiate between the lungs?

Back 97

Posteriorly, the surface is rounded; anterior has a sharp edge

Front 98

98. What are the three surfaces of the lung?

Back 98

Diaphramatic, mediastinal, costal

Front 99

99. What innervates the mediastinal parietal pleura?

Back 99

Phrenic nerve

Front 100

100. What innervates the costal and diaphragmatic parietal pleura?

Back 100

Intercostal nerves

Front 101

101. What innervates the visceral pleura?

Back 101

Nothing; it is insensitive

Front 102

102. What impression on the left lung are you most likely to see?

Back 102

Impression from the aortic arch

Front 103

103. What is the role of the pulmonary ligament?

Back 103

Accomodates the movement of the lung up and down

Front 104

104. If looking at a CT scan and noticed a mass posteriorly, which lobe is it most likely found?

Back 104

Lower lobe

Front 105

105. What is the relation between the pulmonary artery and primary bronchus in the hilus of the right lung?

Back 105

Side by side (Pulmonary Artery is Anterior to the Bronchus)

Front 106

106. Where is the pulmonary vein found in relation to the pulmonary artery and bronchus in the hilus of the right lung?

Back 106

Found anterior and inferior

Front 107

107. What is the relation between the pulmonary artery and bronchus in the left lung?

Back 107

Pulmonary artery found superior to the primary bronchus.

Front 108

108. In a CT scan, if you see a mass in the middle of the right lung, which lobe is it found?

Back 108

Middle lobe; anything posterior would be the lower lobe.

Front 109

109. If you inhale a foreign object would it preferentially enter the left or right primary bronchus? What are the three reasons why?

Back 109

Right; There is a corina the tilts to the left; the right primary bronchus is wider; the right primary bronchus is 25 degrees off vertical while the left is 45 degrees.

Front 110

110. Which primary bronchus is longer?

Back 110

Left

Front 111

111. What does the right primary bronchus divide into?

Back 111

Superior (upper), middle, and inferior (lower) lobar bronchi

Front 112

112. What does the left primary bronchus divide into?

Back 112

Superior and inferior lobar bronchi.

Front 113

113. How many segmental bronchi are found in each lung?

Back 113

10 in each lung

Front 114

114. What does the superior lobar bronchus divide into (right lung)?

Back 114

Apical, posterior, and anterior segmental bronchi

Front 115

115. What does the middle lobar bronchus divide into (right lung)?

Back 115

Lateral and medial segmental bronchi

Front 116

116. What does the inferior lobar bronchus divide into (right lung)?

Back 116

Superior, medialbasal, anteriorbasal, lateralbasal, and posteriorbasal segmental bronchi

Front 117

117. What does the inferior lobar bronchus divide into (left lung)

Back 117

Superior, medialbasal, anteriorbasal, lateralbasal, and posteriorbasal segmental bronchi

Front 118

118. What does the superior lobar bronchus of the left lung immediately divide into?

Back 118

Superior and inferior (lingular) divisions

Front 119

119. What does the superior division of the left lung divide into?

Back 119

Apical, posterior, and anterior segmental division (as on right side)

Front 120

120. What does the inferior lingular division divide into?

Back 120

Superior lingular segmental and inferior lingular segmental bronchus

Front 121

121. What is the derivate of both hyaline cartilage and smooth muscle of the respiratory system?

Back 121

Splanchnic mesenchyme

Front 122

122. What is the vascular supply for the lung tissue itself?

Back 122

Bronchial arteries and veins

Front 123

123. What vessels are responsible for gas exchange?

Back 123

Pulmonary arteries and veins

Front 124

124. Why is it possible for a segmentectomy to be performed?

Back 124

Each segment has its own segmental artery, bronchus and vein; they can be removed without compromising other segments

Front 125

125. How many openings are there in the heart to receive the pulmonary veins?

Back 125

Four

Front 126

126. What does the right superior vein drain into the heart?

Back 126

Superior and middle lobes

Front 127

127. What are the other pulmonary veins?

Back 127

Left superior, left inferior, right inferior, right superior

Front 128

128. Describe the best location for the percussive technique?

Back 128

Right apical segment

Front 129

129. Why is performing the percussive technique on the basal segment problematic?

Back 129

Liver (right) and stomach (left) pushing up on the lungs and cold give a dull thud.

Front 130

130. Where does the phrenic nerve appear to be imbedded?

Back 130

The fat surround the heart

Front 131

131. What does the symphathetic innervation lead to?

Back 131

Bronchodilation and vasoconstriction

Front 132

132. What does the parasympathetic innervations lead to?

Back 132

Bronchoconstriction

Front 133

133. T/F, there are lymph nodes past the segmental levels of the lung?

Back 133

False

Front 134

134. What vessel/s vascularize/s the pericardium?

Back 134

Pericardiacophrenic artery

Front 135

135. Where does the pericardiacophrenic artery branch from?

Back 135

Internal thoracic artery

Front 136

136. What vessel runs along side the pericardiophrenic artery and where does it go?

Back 136

Pericardiophrenic vein to the brachiocephalic and the internal thoracic veins

Front 137

137. Where does the phrenic nerve run in relation to the lung?

Back 137

Anterior to the root of the lung

Front 138

138. What does the phrenic nerve innervate?

Back 138

Outer two layers of the pericardium

Front 139

139. What nerve innervates the inner layer of the pericardium (epicardium)?

Back 139

Nothing; it is insensitive

Front 140

140. What does the pericardium fuse with anteriorly and superiorly?

Back 140

Anteriorly= diaphragm; superiorly; the tunica adventitia of the great vessels

Front 141

141. What is the term for the fusion of the pericardium to the sternum?

Back 141

Pericardiosternal ligament

Front 142

142. What are the three layers of the pericardium?

Back 142

Outer fibrous layer; parietal serous layer; visceral serous layer (epicardium)

Front 143

143. What is found in between the visceral layer and the parietal layer?

Back 143

Pericardial space

Front 144

144. How much fluid is normally held in the pericardial space? What is purpose of this?

Back 144

30-50 cc; lubricates the mechanism for contraction

Front 145

145. What layer of the heart forms the valves?

Back 145

Endocardium

Front 146

146. Where are the pericardiacophrenic vessels found?

Back 146

Between the parietal pleura and fibrous pericardium

Front 147

147. Where can you find the transverse sinus?

Back 147

Under the aorta and the pulmonary trunk (using fingers)

Front 148

148. What is the oblique pericardial sinus?

Back 148

Sinus that gives access to the pulmonary veins and the inferior vena cava (important for surgeons)

Front 149

149. What vessels does the transverse sinus give access to?

Back 149

Superior vena cava, aorta, pulmonary trunk

Front 150

150. What makes up the base of the heart?

Back 150

The left atrium

Front 151

151. Where is the apex of the heart found?

Back 151

Bottom; the right ventricle/ left ventricle

Front 152

152. Describe why the heart is not simply mirror images of anterior and posterior?

Back 152

Frameshift so that the left side of the heart is to the left of the right and is tilted anterior

Front 153

153. Where does the right atrium receive blood from?

Back 153

Superior and inferior vena cava

Front 154

154. Describe the heart as two separate pumps?

Back 154

One gets blood from the body to the lungs; one that gets the blood from the lungs and sends it out to the body

Front 155

155. What is the coronary sulcus a surface indicator of?

Back 155

Atrioventricular septum (separating the atria and ventricles)

Front 156

156. What is the anterior/posterior interventricular sulcus a surface indicator of?

Back 156

Interventricular septum (between two ventricles)

Front 157

157. What is surface indicator for the interatrial septum?

Back 157

There is none

Front 158

158. Where does the coronary sinus drain to?

Back 158

Right atrium for subsequent deoxygenation

Front 159

159. What vessel travels directly underneath the arch of the aorta?

Back 159

Right pulmonary artery

Front 160

160. What is remnant of the foramen ovale and where is it found?

Back 160

Fossa ovalis; right atrium

Front 161

161. Describe the function of the foramen ovale?

Back 161

Shunting already oxygenated blood from the right to left atrium, therefore bypassing the lungs

Front 162

162. What structure located adjacent to the fossa ovalis/foramen ovale is the point of venous drainage of the blood of the heart?

Back 162

Osteum of the coronary sinus

Front 163

163. What muscles are found in the wall of the atria?

Back 163

Pectinate muscles

Front 164

164. Describe the wall of the atrial septa?

Back 164

Smooth wall

Front 165

165. What is the name of the vertical ridge that separates the smooth and rough parts of the atrial wall (internally)?

Back 165

Crista terminalis

Front 166

166. Where can you find the SA node?

Back 166

At the lateral end of the crista terminalis

Front 167

167. Where would the AV node be found?

Back 167

In the interatrial septum between the osium of the coronary sinus and the septal cusp of the tricuspid valve

Front 168

168. What structure tends to obscure the origins of the surface beginnings of the right coronary artery? What about for the left coronary artery?

Back 168

Right auricle; left auricle

Front 169

169. What are the cusps of the tricuspid valve?

Back 169

Anterior; septal; posterior

Front 170

170. Which cusp is most likely to be seen and which is sometimes missing?

Back 170

Anterior; posterior

Front 171

171. What cords connect the cusps to the papillary muscles?

Back 171

Chordae tendinae

Front 172

172. At least how many papillary muscles are associated with each cusp?

Back 172

Two

Front 173

173. What is the function of the papillary muscles?

Back 173

Contraction will prevent the inversion of the valves.

Front 174

174. What is divided by the supraventricular crest?

Back 174

The smooth and rough portions of the right ventricle.

Front 175

175. What muscles are found in the wall of the right ventricle and what does their name translate to?

Back 175

Trabeculae carne= beads of flesh

Front 176

176. What is the significance of the moderator band?

Back 176

Part of the conducting system found only in the right ventricle (from interventricular septum to the anterior wall); not just trabeculae carneae

Front 177

177. Describe the direction of blood flow in the right ventricle upon systole.

Back 177

Force above the supraventricular crest into the cornus arteriosum (infundibulum) and out through the semilunar cusps and through the pulmonary valve.

Front 178

178. Describe the development of the musculature of the heart.

Back 178

Muscle fiber handing off skeleton and formed in a spiral fold. Deep spiral muscle wraps around the trabeculae carneae and becomes more and more spiraled. When the heart contracts, it is like wringing out a dishrag

Front 179

179. What cusps do the aortic and pulmonary valves both have?

Back 179

Left and right

Front 180

180. What cusp does the aorta have that the pulmonary does not?

Back 180

Posterior cusp

Front 181

181. What cusp does the pulmonary valve have that the aorta does not?

Back 181

Anterior; remember APPA (aorta-posterior;pulmonary-anterior)

Front 182

182. What are the four features of tetralogy of Fallot?

Back 182

Stenosis of pulmonary trunk; hypertrophy of right ventricle; misplaced aorta; ventricular septal defect (VSD)

Front 183

183. What is the effect of the misplaced aorta?

Back 183

Receive both deoxygenated and oxygenated blood

Front 184

184. What is ventricular septal defect?

Back 184

Hole in the ventricular wall allowing deoxygenated blood to be sent out the aorta

Front 185

185. What happens to the blood that drops back down the pulmonary trunk and aorta?

Back 185

Cusps will catch it and send it out the coronary arteries

Front 186

186. What structure is found at the top of each cusp and contributes to the clicking sound of the valves?

Back 186

Nodule

Front 187

187. What is the lunule?

Back 187

Rest of the top lining of the shirt pocket (cusp)

Front 188

188. What is the inside of the cusp referred to as?

Back 188

Sinus

Front 189

189. Where does the right coronary artery come from and sit?

Back 189

The opening above the right cusp; will sit in the coronary sulcus

Front 190

190. Where does the right coronary artery branch?

Back 190

Branch goes up and vascularizes the SA node (sinuatrial branch); conus branch will vascularize the conus arteriosum of the right ventricle; branch goes down to the posterior interventricular artery within the interventricular sulcus.

Front 191

191. Where does the left coronary artery come from and sit?

Back 191

From the left cusp of the aorta and sits temporarily in the coronary sulcus

Front 192

192. Where does the left coronary artery branch?

Back 192

Splits into the circumflex branch, which continues in the coronary sulcus; the anterior interventricular (LAD) branch in the anterior interventricular sulcus.

Front 193

193. What vein sits in the anterior interventricular sulcus with the LAD and where does it move?

Back 193

Great cardiac vein moves up into the coronary sulcus and transitions into the coronary sinus.

Front 194

194. What is the significance of the oblique vein of the left atrium?

Back 194

Point where the great cardiac vein becomes the coronary sinus and the point where the left coronary artery splits into the circumflex and LAD

Front 195

195. What vein sits in the posterior interventricular sulcus with the posterior interventricular artery?

Back 195

Middle cardiac vein

Front 196

196. What two vessels run together paralleling the inferior portion of the heart?

Back 196

Small cardiac vein and marginal artery

Front 197

197. Where does the small cardiac vein drain?

Back 197

Coronary sinus

Front 198

198. The small cardiac veins of what vessel go directly into the wall of the right atrium and drain?

Back 198

Coronary sinus

Front 199

199. What parts of the pericardium are innervated and by what?

Back 199

Fibrous and parietal serous layer by the phrenic nerve

Front 200

200. How is the heart muscle (myocardium) capable of sensing pain?

Back 200

Sensory innervations of the sympathetic afferents

Front 201

201. What are the stretch receptors of the heart?

Back 201

Afferents of the parasympathetic

Front 202

202. What are the branches of the vagus nerve that innervate the heart?

Back 202

Superior cardiac branch, inferior cardiac branch, thoracic cardiac branch

Front 203

203. What are responsible for increasing rate of heart contraction and dilation of the coronary vessels?

Back 203

Efferents of the sympathetic

Front 204

204. What are responsible for decreasing the rate of heart contraction?

Back 204

Efferents of the parasympathetic

Front 205

205. Where do the preganglionic cell bodies of the sympathetic innervations of the heart arise?

Back 205

T1-T4

Front 206

206. Where is the point of auscultation of the aortic valve?

Back 206

Right side- second intercostal space next to sternum

Front 207

207. Where is the point of auscultation of the tricuspid valve?

Back 207

Left side- 4th intercostals space next to sternum

Front 208

208. Where is the point of auscultation of the mitral valve?

Back 208

Left side- 5th intercostals space at junction of cartilaginous and bony portion of ribs

Front 209

209. Where is the point of auscultation of the pulmonary valve?

Back 209

Left side- 2nd intercostal space next to sternum

Front 210

210. Looking at a CT scan at T8, what structure is unique at this level?

Back 210

Inferior vena cava

Front 211

211. What is the mediastinum?

Back 211

Space between the pleural sacs and the lungs

Front 212

212. What are the boundaries of the mediastinum?

Back 212

Lateral= lungs and pleural sacs; anterior= sternum; posterior= vertebral column; superiorly= thoracic inlet between T1 and top of manubrium; inferiorly= diaphragm

Front 213

213. What allows for the division of superior and inferior mediastinum?

Back 213

Sternal angle at T4-T5 IV disc

Front 214

214. What are the divisions of the inferior mediastinum?

Back 214

Anterior, posterior, and middle

Front 215

215. Where is the heart located (what division of mediastinum)?

Back 215

Middle mediastinum

Front 216

216. What occurs at the sternal angle (6 things)?

Back 216

Beginning and end of the arch of the aorta; formation of superior vena cava; azygous system drains into superior vena cava; split of pulmonary trunk into left and right arteries; trachea bifurcates into the primary bronchi; the thoracic duct makes it way towards the brachiocephalic vein

Front 217

217. Where is the thymus located?

Back 217

In the superior and anterior mediastinum

Front 218

218. What is the thymus and how does it change during development?

Back 218

Lymph gland that begins to involute between 5-6 years of age and puberty; replaced by fat but the capsule that is retained allows the shape to persist.

Front 219

219. What does the superior vena cava form from?

Back 219

Left brachiocephalic and the right brachiocephalic veins coming together

Front 220

220. What does the superior vena cava drain (broad)?

Back 220

Everything superior to the diaphragm

Front 221

221. Which of the brachiocephalic veins crosses the midline?

Back 221

Left

Front 222

222. Where does the right recurrent laryngeal nerve go?

Back 222

Branch from vagus and loop around the right subclavian artery

Front 223

223. What is the first branch off the aorta?

Back 223

Coronary arteries

Front 224

224. What is the first branch off the aortic arch? Second? Third?

Back 224

Right brachiocephalic trunk; left common carotid artery; left subclavian artery

Front 225

225. What does the right brachiocephalic trunk split into?

Back 225

Right subclavian and right common carotid artery

Front 226

226. What are the three defects that can occur involving the great vessels arrangement with the trachea and esophagus?

Back 226

Double aortic arch= splitting of the arch around the trachea and esophagus
b. Retroesophageal right aortic arch= arch goes behind the trachea and esophagus instead of normally in front
c. Retroesophageal right subclavian artery- Right subclavian artery wraps around the trachea and esophagus

Front 227

227. What are the effects of these three defects?

Back 227

Swallowing becomes difficult and breathing could be impeded.

Front 228

228. What Is patent ductus arteriosus (PDA)?

Back 228

The ductus arteriosus which during fetal development shunts blood from the pulmonary trunk to the aorta does not close after birth to become the normal ligamentum arteriosum. This results in deoxygenated blood being sent out to the body.

Front 229

229. What would be done surgically to rectify PDA? What dangers are involved?

Back 229

Throw 10 ligatures around the d. a. and block flow to the aorta. Must be careful to not hit the left recurrent laryngeal nerve which swings around the arch of the aorta near the d. a (or ligamentum arteriosum)

Front 230

230. What muscles do the recurrent laryngeal nerves innervate?

Back 230

All the intrinsic muscles of the larynx except for the cricothyroid.

Front 231

231. What specific muscles are we interested in when discussing the recurrent laryngeal nerve? What do these muscles do?

Back 231

Cricoarytenoid muscles; they are the only muscles the abduct the vocal cords and, if nicked, would result in a hoarse voice

Front 232

232. What is the disorder involving a narrowing of the aortic arch?

Back 232

Coarctation of the aorta

Front 233

233. Where does the coarctation usually occur?

Back 233

At the l. arteriosum

Front 234

234. How can a coarctation persist into adulthood asymptomatically?

Back 234

Blood will go from the subclavian arteries to internal thoracic arteries and then the intercostals which can grow in size and swell in the costal grooves.

Front 235

235. Are coarctations found anywhere other than the arch of the aorta?

Back 235

No

Front 236

236. What lymph nodes are associated with the bifurcation of the trachea?

Back 236

Corinal lymph nodes

Front 237

237. Which side of the body (thorax) is more venous?

Back 237

Right; superior vena cava, inferior vena cava, azygous system

Front 238

238. What does azygous translate to and why is this relevant?

Back 238

“Without twin”; it is not parallel on the left side

Front 239

239. Which side of the body (thorax) is dominated by arteries?

Back 239

Left; arch of aorta

Front 240

240. Where does the trachea bifurcate and how does this affect the esophagus?

Back 240

Bifurcates at T4-T5 IV disc (sternal angle) which is where the esophagus is no longer protected by the trachea. It is kicked a little to the right side.

Front 241

241. What are the 3 points of esophageal constriction?

Back 241

Pharyngoesophageal constriction
i. Cricopharyngeus muscle (point where esophagus actually starts
b. Thoracic (aortobronchial) constriction
i. Aorta with left primary bronchus
c. Diaphragmatic constriction (inferior esophageal sphincter)
i. Where the esophagus passes the diaphragm

Front 242

242. What is the clinical significance of the points of constriction?

Back 242

Most likely to be the points of irritation and where esophageal cancer is most likely to form

Front 243

243. What vascularizes the esophagus?

Back 243

Esophageal branches of the descending aorta (above diaphragm); esophageal branches of left gastric artery (below the diaphragm)

Front 244

244. Where does the left gastric artery branch from?

Back 244

Celiac trunk

Front 245

245. What may result from portal hypertension? Why?

Back 245

Varicosities of the esophagus; there are points of anastomosis between the poral and caval systems

Front 246

246. Is the azygous system part of the caval system?

Back 246

Yes

Front 247

247. What nerves innervate the esophagus and how/why does their orientation change?

Back 247

Right and left vagus nerves become the posterior and anterior vagal plexuses (respectively); the gut rotation causes this change as they vagus nerve arborizes.

Front 248

248. What does the thoracic duct drain into? Where does that vessel drain?

Back 248

The thoracic duct to the formation of the left brachiocephalic vein to dump into either the internal jugular, subclavian, or brachiocephalic vein

Front 249

249. What does the thoracic duct drain?

Back 249

The entire body except for the upper right quadrant.

Front 250

250. What drains the upper right quadrant? What does it drain in particular? To where does it drain?

Back 250

Right lymphatic duct; Right side of head, right arm, and right side of thorax; drains to the right brachiocephalic vein

Front 251

251. All blood from the thoracic wall will drain into where?

Back 251

The azygous system

Front 252

252. Describe the venous drainage on the right side of the thoracic wall?

Back 252

Superior intercostals vein drains into the right brachiocephalic vein; remaining 11 drain into the azygous vein which drains into the superior vena cava just at the formation at the sternal angle

Front 253

253. How is the azygous vein formed?

Back 253

When the ascending lumbar vein from the abdomen coalesces with the 12th intercostals (subcostal) vein

Front 254

254. What are the 3 groups of the 4 intercostal veins on the left side of the thoracic wall?

Back 254

Superior; accessory hemiazygous; hemiazygous

Front 255

255. Where do the superior hemiazygous veins drain?

Back 255

Commonly into the right brachiocephalic vein

Front 256

256. Where do the accessory hemiazygous veins drain?

Back 256

Cross the midline over to the azygous on the right side

Front 257

257. Where do the hemiazygous veins drain?

Back 257

Over to the azygous

Front 258

258. What does the dorsal ramus of the spinal nerve innervate?

Back 258

Muscles of the back and skin

Front 259

259. What does the ventral ramus innervate?

Back 259

Somatosensory, somatomotor, sympathetic, but no parasympathetic

Front 260

260. Where do all preganglionic cell bodies for the entire body reside?

Back 260

T1-L2

Front 261

261. What are the three options for a preganglionic neuron sending its axon out to the sympathetic chain ganglia?

Back 261

Synapse at the level it came off
b. Go up/down the chain and synapse (superior cervical ganglia for the heart)
c. Don’t synapse, instead they leave as preganglionic fibers to the celiac ganglia (plexus) then they become postganglionic and innervate structures of the embryonic foregut.

Front 262

262. What are the divisions of the splanchnic nerves and where do they branch from?

Back 262

Greater splanchnic nerve; Lesser splanchnic nerve; lowest splanchnic nerve; these all come off the sympathetic chain

Front 263

263. Where are the preganglionic cell bodies of the greater splanchnic nerve located? What does it innervate?

Back 263

T5-T9; innervates the embryonic foregut

Front 264

264. Where are the preganglionic cell bodies of the lesser splanchnic nerve located?

Back 264

Between T10 and T11

Front 265

265. Where are the preganglionic cell bodies of the lowest splanchnic nerve located?

Back 265

Between T11 and T12