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219 Cards in this Set
- Front
- Back
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What is the origin of the internal thoracic arteries?
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Subclavian Artery
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What two areas or structures does it nourish?
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Intercostal spaces anteriorly via small intercostal branches and from the musculophrenic artery and the rectus abdominis via the superior epigastric artery
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What muscles holds the internal thoracic artery to the inside of the chest wall?
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Transverse thoracic
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What is the sensory innervation to the pleura lining the
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a. thoracic cavity (costal part): Intercostal nerves
b. mediastinum: Phrenic nerve c. diaphragm: Phrenic (central part and intercostal nerves (peripheral) d. costal and diaphragmatic surface of lungs: Visceral afferents e. oblique fissures: visceral afferents |
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In general, by how many ribs higher does the inferior border of the lungs lie than the lowest extent of the parietal pleura?
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2
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In the mid axillary line, in mid-inspiration, the lungs cross the ___ rib, while the lower border of the parietal pleura crosses the ___ rib.
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8th
10th |
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To drain fluid from the pleural cavity the drain tube is commonly placed in the 8th or 9th intercostal space, mid-axillary line. The drain enters what recess?
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Costodiaphragmatic recess
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What intercostal muscle layers does the intercostal neurovascular bundle travel between?
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The intermost intercostal and internal intercostal muscles
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Developmentally, each lung has how many broncho-pulmonary segments?
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10
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Anatomically the superior lobe of the lung lies mostly ____, while the inferior lobe lies mostly ___
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Anterior
Posterior |
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What is the lingula
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• lower projection off the left upper lobe of lung
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The lingula is synonymous with what part of the right lung?
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Middle lobe
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The apex of each lung lies above the ____ & ____ to extend into the root of the neck
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Clavicle
First Rib |
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What travels with the segmental bronchi through the middle of the broncho-pulmonary segment
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• Segmental bronchi and artery
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What is the result of sympathetic innervation to the lung
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• Vasodilation of pulmonary and bronchial vessels, decreased mucus secretion & bronchodilation. The book deffers from my answer in that it states that the sympathetics vasoconstricts the pulmonary and bronchial arteries. Supposedly this increases the pressure, but does not make sense to me so this particular point (vasodilation/vasoconstriction) will not be tested over
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Lymphatic drainage of the lungs is collected by what set of lymph nodes
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• Pulmonary to hilar
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Other than pulmonary vessels, what is the blood supply to the lungs and bronchi?
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• Bronchial arteries
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The lung and viscera pleura are insensitive to most stimuli, except for
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Stretch or Distension
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Which primary bronchus is more likely to receive a foreign body and why?
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• Right main bronchus, it is wider a straighter continuation of the trachea
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What is another name for the right upper lobar bronchus and why
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• Epiarterial, it lies above the right pulmonary artery
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At the hilum of the lung, what pulmonary structure(s) generally lies most anterior?
Posterior? Superior? |
Pulmonary veins
Bronchus Pulmonary artery |
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At what vertebral body level and sternal level does the trachea bifurcate
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• At the sternal angle, 4th thoracic vertebral body level
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What is the upward pointing projection on the inside of the trachea at its bifurcation into primary bronchi
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carina
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What nerve runs anterior to the root of the lung
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phrenic nerve
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What nerve runs just posterior to the root of the lung?
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Vagus
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What component of the autonomic nervous system is found on the lateral sides of the vertebral bodies in the thorax?
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• Sympathetic chain and greater splanchnic nerve
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Where is the needle placed to avoid the intercostal neurovascular bundle while removing fluid from the costodiaphragmatic recess?
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• Through the middle of the space, using the superior border of the rib below as a guide.
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In a unilateral sucking or open pneumothorax, what does the mediastium and inflated lung do during inspiration?
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• They deviate to the side opposite the opening in the thoracic wall.
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In a unilateral tension pneumothoarx what does the mediastinum and inflated lung do upon expiration?
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• They remained deviated to the side opposite the opening in the thoracic wall
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During inspiration describe the changes in shape and volume of the thoracic cavity.
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• All volumes increase, thus pressure decrease w/in the thoracic cavity. The ribcage elevates increasing the side-to-side diameter (bucket handle) and the anterior-posterior diameter (pump handle), while the diaphragm contracts and drops, increasing the superior-inferior diameter.
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What bony landmark divides the superior and inferior mediastina?
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• Sternal angle
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The thymus is found in which division(s) of the mediastimum?
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• Superior and anterior
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What is the primary “artery” found in the posterior mediastinum?
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• Descending aorta
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The middle mediastinum is the “home” for what major structure/organ?
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• heart
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What structures run along side the thoracic duct in the posterior mediastinum?
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• Aorta, vertebral bodies, esophagus
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What is the name for the thin membrane which lines the inside of the fibrous pericardium?
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• Parietal layer of serous pericardium
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What is the procedure called when the pericardial sac is tapped with a needle for removal of fluid?
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• pericardiocenthesis
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Where on the anterior chest wall is the aortic valve best heard? The mitral valve?
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2nd intercostal space, right of sternum.
Apex of heart, 5th intercostal space near left mid-clavicular line. |
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Where on the anterior chest wall is the apex of the heart projected?
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• 5th intercostal space near left mid-clavicular line
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What valve is heard best at about its anatomic position as projected onto the anterior chest wall?
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• Tricuspid valve
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What is the name of the external depression on the heart which divides the atria from ventricles?
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• Coronary sulcus
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Auricles are part of which heart chamber(s)?
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• Atria
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The pulmonary trunk carries blood from which chamber of the heart?
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• Right ventricle
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What is the name of the A/V valve that sits between the right atrium and ventricle?
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• tricuspid
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The “rough” muscular part of the atria walls are termed the _____ muscles.
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Pectinate
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What is the function of the papillary/chordae tendenae complexes?
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• Prevent AV valve cusps from regurgitation into atria upon ventricular contraction.
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How many pulmonary veins usually enter the left atrium?
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4
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What is the usual origin for the left subclavian artery?
The right subclavian artery? |
Aortic Arch
Brachiocephalic trunk |
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The azygos vein arches over the root of the lung to enter what vessel?
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• SVC (superior vena cava)
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In general the venous drainage from the heart in collected in what structure before being emptied into the right atrium?
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• Coronary sinus
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In a left dominant coronary artery distribution pattern, which parts of the heart are supplied by branches of the left coronary artery?
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• Both interventricular sulci and the posterior surface of the left ventricle.
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The coronary arteries arise from the aortic sinuses of
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Valsalva
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The impulse wave from the AV node is transmitted to the ventricles by what bundle?
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• AV bundle of His
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Which nerve supplies parasympathetic innervation to the thoracic viscera?
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• CN X (vagus)
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What affect does sympathetic innervation have on the heart?
Lungs? |
Increased heart rate and force of contractility, dilation of coronary arteries.
Bronchodilation, decreased mucus secretion, vasodilation of pulmonary vessels. |
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Where is the cardiac skeleton located?
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• At the level of the coronary sulcus
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What is the cardiac skeleton made of in the human?
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• Semi-rigid, dense connective tissue
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Name three functions of the cardiac skeleton.
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• Attachment for valves
• Attachment for cardiac muscles • Insulation of ventricles from electrical impulses |
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What is the feature of the right atrium that represents a right to left shunt in fetal life?
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• Foramen ovale
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In fetal life, most of the blood from the pulmonary trunk is shunted to the aorta via the
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ductus arterosum
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What does the structure in the question above become in the adult?
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• Ligamentum arteriosum
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What chamber of the heart helps form the left heart border on PA plain film radiograph?
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• Mostly left ventricle. The left atrial appendage also forms a tiny part of it.
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The absence of what feature of the cardiac silhouette indicates the presence of enlarged lymph nodes or masses in the mediastinum.
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• The aorto-pulmonary window or wedge is missing with enlarged lymph nodes on the left. The right side shows widened mediastinum in the same region.
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What is the superior extent of the pleural cavity?
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About 1 inch above the clavicle/1st rib
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What is the name of the peritoneal lined space between the body wall and the diaphragm?
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Costodiaphragmatic recess
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A PA chest XRAY should exhibit how many pairs of ribs?
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At least 8 pairs
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The anterior aspect of each rib is located ____ to the posterior aspect of the rib
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below/inferior
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In a normal chest XRAY what radiopaque structure can be seen in the substance of the lung?
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Pulmonary vessels
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What forms the majority of right heart border? Left heart border?
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Right atrium (and SVC)
Left ventricle (and pulmonary trunk and aorta) |
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What is the aortic knob?
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Arch of the aorta on the left mediastinal border
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What part of the heart lies most anterior in the thorax? Posterior?
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Right ventricle
Left atrium and left ventricle |
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What structure normally makes an impression on the esophagus
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Aorta-superiorly
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On inspiration what is the position of the diaphragm
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the diaphragm descends
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Pneumonia of which lobe of he lung obscures the right heart border on PA view?
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Right middle lobe
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How would free air in the abdominal cavity show up on plain film xray?
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As a radiolucent (dark) region inferior to the diaphragm.
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How do you describe a PA chest xray of a person with severe emphysema?
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Barrel shaped – long and rounded, but low hemi-diaphragm domes
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Fluid accumulating in the pleura space is referred to as a
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Pleural effusion
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In contrast to pneumonia, how do large pleural effusions affect the organs of the thorax?
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Pneumonias occupy the lung space w/ little or no displacement, effusions push the lungs and mediastinum to the opposite side – space occupying.
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On a pneumothorax the visceral pleura of the partially deflated lung is seen as a thin
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white line
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Name four reasons for mediastinal widening that are caused by disease states.
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Pulmonary HTN, lung cancer, aorta rupture, enlarged mediastinal lymph nodes, cardiomegaly
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Cardiomegaly due to mitral valve regurgitation is due mainly to enlargement of the
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left atrium
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Cardiomegaly due to aortic valve regurgitation is due mainly to the enlargement of the
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left ventricle
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What view is best on aortogram to clearly visualize the three chief supra-aortic branches off the aortic arch?
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Lateral view
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What is the vertical midline feature on the abdominal wall that intersects the umbilicus?
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Linea alba
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In the quadrant system what is the landmark for the two perpendicular lines?
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umbilicus
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In the quadrant system, where is the appendix located, the liver, the stomach?
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Lower right quadrant
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What is the bony component of the abdominal wall inferiorly?
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The pelvis (ilium, pubis, sacrum)
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How many lumbar vertebrae are there?
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5
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Which ribs supports the posterior abdominal wall posteriorly?
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11 & 12
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What is the name of the thick fatty layer on the abdominal wall?
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Camper’s fascia
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What is the clinical significance of Scarpa’s fascia?
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Forms the wall for a potential space btw the superficial fascia of the skin and the underlying abdominal wall.
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How do the lateral abdominal muscles compare to the intercostal muscles?
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They are three in number, innervated mostly by thoracic nerves, helps control pressure in body cavity.
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What are the collective functions of the abdominal muscles?
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Protection, flex trunk, helps control intra-abdominal pressure
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What is the makeup of the anterior rectus sheath above the arcuate line?
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In general the anterior rectus sheath is composed of the aponeuroses of the external oblique and the internal oblique above the arcaute line, and all three aponeuroses below the arcuate line. The posterior rectus sheath above the arcuate line is composed of the transversus abdominis and internal oblique, and below the arcuate line only transverses fascia.
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How do the lateral abdominal muscles differ in innervation from the anterior abdominal muscles?
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The three lateral muscles are innervated by T7-L1, the rectus abdominis is supplied by T7-T12
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How do the nerves and vessels reach the rectus abdominis?
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They run btw the two inner lateral muscle layers and pierce the rectus sheath laterally
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What makes up the inguinal ligament?
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The tickened lower margin of the external oblique aponeurosis.
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What forms the anterior wall of the inguinal canal? the floor? the roof?
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External oblique aponeurosis – other answers coming soon
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What runs through the inguinal canal in the male? the female?
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Spermatic cord. Round ligament
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What muscle layer gives rise to the cremasteric fascia?
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Internal oblique, rarely transverses abdominis too.
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What is the name given to the testicular vein in the spermatic cord?
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Pampiniform plexus
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What is the name of the sperm duct?
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Vas deferens, or ductus deferens
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What is the name of the peritoneal sac located in the scrotum, anterior to the testes?
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Tunica vaginalis
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What is the thick coat of the testes called?
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Tunica albugenia
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What structure is responsible for storing sperm, once produced by the testes?
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Epididymus
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In performing a vasectomy, what layers are incised to reach the vas deferens?
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Skin, Colles fascia, dartos muscle, external spermatic fascia, cremasteric fascia/muscle, internal spermatic fascia, extraperitoneal fat.
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What is the relationship of the hernia neck of a indirect hernia to the inferior epigastric vessels?
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The neck of the indirect hernia lies lateral to the inferior epigastric vessels.
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What is the most common age groups for occurrence of indirect inguinal hernias? direct inguinal hernias?
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Young males: mostly new born and toddlers less than 1 yr of age.
Middle aged to old males, with weak abdominal muscles. |
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What is the difference between hematocele & hydrocele?
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The tunica vaginalis contains blood in a hematocele, but peritoneal-like fluid in a hydrocele.
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On which side is a varicocele most common found?
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Left
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A patent processes vaginalis is a ready made path for which type of inguinal hernia?
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Indirect
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What is the initial lymphatic drainage of the testes and why is it different from that of the scrotum?
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Testis lymphatics follow testicular vessels toward the para-aortic (lumbar); scrotal lymphatics follow external pudendal vessels toward the superficial inguinal lymph nodes. Difference due to fact that testes develop high on the posterior abdominal wall and descend into the scrotum, unlike scrotum that develops from anterior abdominal wall. Generally, lymphatics follow the vessels that supply the organ or region.
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What is the name of the peritoneum lining the GI tract organs?
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Visceral peritoneum
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How does the peritoneum compare to the pleura?
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It is the same, except for location
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Name three functions of the mesenteries.
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Support, fat storage, transmits vessels, nerves & lymphatics.
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What is the name of the mesentery that drapes off the greater curvature of the stomach?
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Greater Omentum
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Why is it referred to as the “Policeman of the abdomen”?
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It adheres to inflamed tissue and tends to separate it from the rest of the peritoneal cavity.
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In what quadrant is the liver located?
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Upper Right
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What are the three parts of the small intestine?
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Duodenum, jejunum, ileum
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What part of the GI tract “frames” the small intestine?
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Large intestine (colon)
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In what quadrant of the abdomen would you find the appendix?
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Lower Right
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What is the name of the mesentery to the sigmoid colon?
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Sigmoid mesocolon
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What is the name of the mesentery to the the small intestine?
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Mesentery proper
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What is the location of the spleen?
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Left side, posterior to the mid-axillary line, oriented along the long axis of the 10th rib.
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What is the name of the colic flexure where the transverse colon turn into the descending colon?
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Left colic flexure or splenic flexure
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What is the characteristic shape of the stomach?
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J
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What part of the stomach usually contains swallowed air?
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fundus
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What is the name of the mucosal folds in the stomach?
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rugae
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What is the name of the sphincter that lies between the stomach and duodenum?
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pyloric
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How is the first part of the duodenum like the last part of the stomach?
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It has a smooth mucosa
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What empties into the 2nd part of the duodenum?
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Major duodenal papillae
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What is the characteristic shape of the duodenum?
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C
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What lies nestled in the curve of the duodenum?
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Head of pancreas
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What is the name of the mucosal folds in the small intestine?
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Plicae circularae
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Name 5 ways the ileum differs from the jejunum?
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Ileum is smaller in size, has fewer and lower plica, is less vascular, has more encroaching mesenteric fat, has shorter vasa recti, more complicated arcades, have Peyer patches, possible Meckel’s diverticulum.
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What is the name of the part of the large intestine that connects to the ileum and the appendix?
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Cecum
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What is McBurney’s Point?
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Surface projection onto anterior abdominal wall of the location where the appendix originates from the cecum.
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What characteristics distinguish the large intestine from the small intestine?
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The presence of tenia coli, plica semilunares, haustra, and epiploic appendages.
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What arterial trunks supplies the foregut? midgut? hindgut?
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Celiac
SMA IMA |
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What are the three branches off the celiac artery?
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Left gastric, splenic, common hepatic
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Name the arteries that collectively supply the jejunum and ileum?
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Intestinal
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What is the origin of the middle colic artery and what general region does it supply?
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SMA, transverse colon
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Why are the vessels to the gut smaller than they initially appear on visual inspection?
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They are “coated” with an autonomic nerve plexus
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Which unpaired artery gives rise to the left colic artery and sigmoidal arteries?
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IMA
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What is functional significance of the marginal artery?
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Provides for a continuous anastomotic sypply of blood to the colon in the event that major colic branches are compressed, temporarily or permanently.
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What three veins converge to form the portal vein?
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Spenic and SMV, plus the IMV
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Where is the portal vein formed?
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Behind the neck of the pancreas
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What is the function of the portal vein?
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Bring nutrient rich, still moderately oxygenated, blood to the liver for processing from the GI tract.
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What is portal hypertension?
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Restriction of blood flow through the portal vein
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What are some symptoms of chronic portal hypertension?
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Splenomeagaly, hemorrhoids, esophageal varices, caput medusa.
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How can these symptoms be alleviated?
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Surgically routing portal to the IVC through fusion of these vessels, or other adjacent portal/caval vessels (left renal & splenic veins). Also an interventional procedure called TIPS-Trans Intrahepatic Portal Shunt
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How many lobes does the liver have?
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2-4: Right & Left (caudate & quadrate part of right anatomic, but part of left functional lobe)
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What separates the liver into anatomic lobes?
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Falciform ligament and left sagittal fissure
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What lies in the right hepatic fossa?
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Gallbladder & IVC
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What is the round ligament of the liver?
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The remnant of the umbilical vein.
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What is the porta hepatis?
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Hilum of liver (transverse hepatic fissure) –contains components of hepatic artery, hepatic ducts and portal vein.
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What are the two sources of blood to the liver?
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Portal vein (70%), hepatic artery (30%)
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What separates the liver into functional lobes?
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Physically-the middle epatic vein. By definition – the right and left brancing of the hepatic arteries, portal veins and hepatic ducts.
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What is the function of the gallbladder?
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Stores, concentrates and releases bile.
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What is the name of the duct that transmits bile to and from the gallbladder?
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Cystic duct
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What is the special connective tissue formation in the duct that prevents over distension and collapse of the duct to the gallbladder?
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Spiral valve (of Heister)
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What is the route of bile once produced until it reaches the duodenum?
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Liver, hepatic ducts, common hepatic duct, cystic duct, gallbladder, cystic duct, common bile duct, ampula of Vater, major duodenal papillae, duodenum
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What is the function of the pancreas?
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Endocrine – sugar metabolism: glucagon & insulin. Exocrine- digestion: bicarbonate, lipases, amylases, proteases
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Where is the head of the pancreas located? the tail?
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Nestled in the C-shaped crook of the duodenum
At the hilum of the speen |
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What is the relationship of the main pancreatic duct and the common bile duct?
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They empty into a common site – the ampula of Vater
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Where is the spleen located?
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Posterior to the mid-axillary line, left side, along the 10th rib.
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Why is it commonly injured in motor vehicle accidents (MVA)?
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It is on a pedicle made from the greater omentum and is relatively mobile. It therefore can become a projectile w/in the peritoneal cavity during a severe MVA and crashes against the inside of the rib cage. It is often bruised or lacerated.
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What other organ is also at risk in MVA that injures the spleen?
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Tail of pancreas as well as the splenic vessels.
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What does the muscular component of the diaphragm attach to “centrally”?
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Central tendon of the diaphragm
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What passes through the diaphragm at the level of the 10th thoracic vertebral body? What other structure accompanies it?
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Esophagus
Vagus nerves |
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What is the effect on diaphragm function if the right phrenic nerve is damaged?
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Right hemidiaphragm is paralyzed-expansion of lung on affected side more difficult
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What are the two muscles in the posterior abdomen that forms the chief flexor of the thigh?
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Iliacus & psoas
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Where does the kidneys originate during development?
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In the pelvis
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What is the order of structures at the hilum of the kidney?
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Vein, artery, ureter/renal pelvis
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What are the major structures in the kidney medulla
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Renal Pyramids
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Into what structure does the renal papillae empty urine?
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Minor calyx
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What is the name of the fatty “encasement” that surrounds the kidney?
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Perirenal fat
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Why are accessory/aberrant renal arteries common?
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During its ascent out of the pelvis, the kidneys lose & re-establish their arterial supply and thus may have multiple branches rather than just one renal artery to each kidney.
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How can accessory/aberrant renal arteries lead to hydronephrosis?
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Accessory arteries to the inferior pole of the kidney can compress the ureter, thus restricting urine flow and eventual dilation of the collecting system w/in the kidney w/ backed up urine.
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What are end arteries and give 4 examples.
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Arteries that do not anastomose w/ other arteries
Vasa recti Segmental renal arteries Segmental hepatic arteries Segmental pulmonary arteries The appendicular artery (which is a named vas recti) |
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What is the shape of the left suprarenal gland?
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Crescent
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Where is the hilum of the suprarenal gland?
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Where the suprarenal vein exits the gland
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Name four different paired arteries off the abdominal aorta , from superior to inferior?
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Inferior phrenic, renal, testicular/ovarian, lumbar, common iliac
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At what lumbar vertebral level does the aorta bifurcate?
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L4
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Into what venous structure does most of the veins of the retroperitoneum drain on the right vs the left side?
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Right-IVC
Left-Left Renal vein |
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What does the vein in Q17 pass over to reach the inferior vena cava?
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Aorta
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What nerves of the lumbar plexus are involved in the cremaster reflex?
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The cremaster reflex tests the integrity of L1-L2 spinal cord level. By stroking the skin over the femoral triangle, the cremaster muscle reflexly contracts, raising the testicle. The nerve involved is mostly the genitofemoral nerve, but some sensory from ilioinguinal nerve.
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What are the two lumbar plexus nerves that innervate the thigh?
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Femoral & Obturator
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What nerve gives parasympathetic innervation to most of the GI tract?
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Vagus
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What is the result of parasympathetic innervation to the gut?
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Increased peristalsis, increased secretion of digestive juices, sphincter control.
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What are visceral afferents and what is the characteristic of the pain associated with them compared to somatic afferents?
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Sensory nerves of the GI tract. Visceral afferents that carry pain perception are through stretch receptors. It is perceived as dull, achy, poorly localized pains over general areas either referred to the midline or over the affected solid organs.
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In the gut, what does increased sympathetic tone result in in the GI tract?
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Vasoconstriction of vessels to the gut.
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In the abdominal cavity, the GI tract drains into which set of lymph nodes?
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Preaortic or intestinal nodes
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The Retroperitoneum and lower extremities drains into which set of lymph nodes?
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Para-aortic or lumbar nodes
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In general, the lymphatic drainage of the abdomen and its contents follows the path of what other system?
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Blood vessels
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Into which lymph nodes do the testes/ovary drain?
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Para-aortic/lumbar nodes
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Into which lymph nodes does the scrotum initially drain into?
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Superficial inguinal nodes
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What is the key characteristic of the lumen of the esophagus following barium swallow?
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Monotonously smooth
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When the patient is lying on his/her back, what part of the stomach is most posterior and thus fills with barium after a partial barium swallow?
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Fundus
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What internal structures are obvious on partial emptying of the stomach?
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Rugae
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What characteristic shape does the first part of the duodenum exhibit on barium filling?
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Arrow head or Christmas tree
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Where is the anatomical location of the duodeno-jejunal junction?
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Posterior to the stomach
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What is the characteristic appearance of the lumen of the jejunum on barium swallow study?
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Feathery
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The ileum is mostly located in the lower abdomen and loops fall into the
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Pelvic Cavity
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On barium enema of the large intestine what are bulges/segments of the gut called?
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Haustra
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Because of the motility of the sigmoid colon, it is often ____ on itself and the rectum on barium study.
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Superimposed
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To study the lining of the large intestine, a small amount of barium is used to coat the gut lining when placed under ___
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Pressurized Gas
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On CT the normal liver appears as a ___ mass in the upper right abdominal cavity.
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Homogeneous
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On CT the pancreas appears as a lightly ___ elongated tissue that stretches across the left posterior and middle abdominal wall.
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lobulated
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On CT___ is considered the radiologist’s “friend” because it provides a dark outline to most soft tissue organs.
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FAT
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On CT the ___ can be seen on the posterior abdominal cavity wall on the left upper quadrant.
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SPLEEN
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On CT the kidneys lie in the posterior abdominal region in a position, surrounded by radiolucent ____.
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Retroperitoneal
Perirenal Fat |
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On excretory and retrograde cystogram, the contents bile duct and pancreatic duct can be seen emptying into the ____
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Duodenum
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On ultrasound gallstones appear as ___ objects surrounded by ___ bile.
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White (hyperechoic)
Dark (anechoic) |
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On SMA arteriogram, the intestinal branches are mostly found X of the midline.
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LEFT
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Arteriogram reveals that the two largest branches of the celiac artery are the X & X
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Common hepatic
Splenic arteries |
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IMA arteriogram revealed that the X is a continuation of the IMA after the sigmoidal arteries come off.
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Superior Rectal
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Venogram of the IVC shows that there are X hepatic veins that drain the liver to the IVC.
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THREE
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On excretory urogram the X is also normally filled with excreted dye.
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Urinary Bladder
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