Sd Week 12

Front 1

the coelom is an embryonic cavity that divids into:

(4)

Back 1

1. pericardial cavity

2 and 3: pleural cavities

4. peritoneal cavity

Front 2

what do the pleuropericardial folds do?

(2)

Back 2

1. separate the pleural and pericardial cavities

2. produce fibrous pericardium

Front 3

what do the pleuroperitoneal membranes do?

Back 3

1. partition the pleural and peritoneal cavities

2. contribute to the diaphragm

Front 4

the right and left sides of the ceolom are brought together via:

Back 4

body folding

- dorsal mesentery now in between the two sides

Front 5

the somatic LPM is found laterally, on both sides of the ceolom; it forms:

Back 5

the parietal serous membrane

Front 6

the splanchnic LPM, found medially, forms the:

Back 6

visceral serous membrane

Front 7

after being brought caudally, the septum transversum separates:

Back 7

the primitive pericardial cavity from the primitive peritoneal cavity

- ***pericardioperitoneal canals connect the two and provide continuity***

Front 8

mesoderm covering the lung buds =>

Back 8

visceral pleura

Front 9

phrenic nerves are contained within:

Back 9

pleuropericardial folds

Front 10

***what forms the fibrous membrane?***

Back 10

***pleuropericardial folds*** fused together

Front 11

what are the 4 structures that make up the diaphragm?

Back 11

1. septum transversum

2. mesentery of esophagus

3. pleuroperitoneal membrane

4. myoblasts from body wall / C3-C5 somites

Front 12

**Congenital Diaphragmatic Hernia =

Back 12

failure of pleuroperitoneal folds to close

- generally occurs on left side

- contents of abdomen come up into thorax

=> lung can't develop as well

Front 13

multiple rib fractures (2 or more ribs broken in 2 places) =>

Back 13

flail chest with paradoxical movement

Front 14

paradoxical movement =

Back 14

breathe in - rib segments come out

- breathe out ==> rib segments come in

Front 15

thoracic outlet syndrome =

Back 15

compression of neurovascularture due to narrowed thoracic aperture

Front 16

thoracic aperture is bounded by:

Back 16

sternum, vertebra, and first ribs

Front 17

stypmtoms of TOS =

(3)

Back 17

1. pain in neck and shoulder

2. numbness/weakness

3. decreased pulse

Front 18

causes of TOS =

Back 18

trauma, cervical rib, other things

Front 19

example of a type of TOS:

Back 19

costoclavicular syndrome

Front 20

treatment for TOS =

(2)

Back 20

1. PT (usually)

2. surgery (occasionally)

Front 21

11 intercostal spaces and 1 subcostal - IC space 1 is under:

Back 21

rib 1,

and so on

Front 22

sternal angle is found at

Back 22

rib 2

- used to locate 2nd IC space

Front 23

IC VAN travels within:

Back 23

costal groove, on inferior aspect of every rib

Front 24

main action of all intercostal muscles =

Back 24

keep ribcage stable during breathing

Front 25

external IC's :

(2)

Back 25

1. down and in

2. function during inspiration - *elevate* the ribs

Front 26

internal IC's:

(2)

Back 26

1. down and out

2. funtion during expiration; depress the ribs

Front 27

(innermost intercostals ~

Back 27

vertical orientation)

Front 28

***ALL intercostals are innervated by:***

Back 28

IC nerves 1 - 11

Front 29

subcostal muscles:

(2)

Back 29

1. found posteriorly

2. depress the ribs

Front 30

transversus thoracis:

(2)

Back 30

1. found inside anterior aspect of rib cage

2. depress costal cartilage

Front 31

IC nerves =

Back 31

ventral rami

- and therefore contain all 4 somatic/autonomic types

Front 32

T2 ~

Back 32

intercostobrachial nerve - cutaneous to medial arm

(called the lateral cutaneous branch of T2)

Front 33

T3 through T6 are:

Back 33

typical IC nerves

Front 34

T7 - T11 innervate:

Back 34

the abdominal wall

Front 35

T12 =

Back 35

subcostal nerve

Front 36

***T4 dermatome ~

Back 36

plane of nipples

Front 37

***T10 dermatome ~

Back 37

plane of belly button

Front 38

***IC nerve block: preferred site of injection*** =

Back 38

**costal angle (that is, posterior thorax)**

Front 39

needle decompression =

Back 39

removal of fluid (air or liquid) from lungs

- **MUST avoid IC VAN)**

Front 40

***preferred sites for needle decompression =

(3)

Back 40

2nd, 3rd, or 5th IC space

Front 41

anterior IC arteries: 2 sources of origin:

Back 41

upper 6 originate from internal thoracic artery

lower 5, from the musculophrenic artery

Front 42

posterior IC arteries: 2 sources of origin:

Back 42

upper 2 originate at the superior thoracic artery,

lower 9 from the thoracic aorta

Front 43

3 major branches of the internal thoracic artery:

Back 43

1. anterior IC's (1-6)

2. superior epigastric artery

3. musculophrenic artery

Front 44

IC veins drain into:

Back 44

azygous and hemiazygous veins => vena cavae

Front 45

the pleural cavities are separated by:

Back 45

the mediastinum (cavity)

Front 46

pleural cavities are lined by:

Back 46

the pleura - outer parietal, inner visceral, and potential space in b/w

Front 47

superior mediastinum = area above

Back 47

T4/T5

Front 48

the superior mediastinum contains:

(5)

Back 48

1. thymus

2. great vessels

3. trachea

4. esophagus

5. nerves

Front 49

inferior mediastinum =

Back 49

anterior, middle, and posterior mediastinums

Front 50

the anterior mediastinum is very

Back 50

small

Front 51

middle mediastinum contains:

(2)

Back 51

1. heart

2. origin of greater vessels

Front 52

the posterior mediastinum contains:

(4)

Back 52

1. aorta

2. thoracic duct

3. azygous/hemiazygous

4. sympathetic trunks

Front 53

middle mediastinum also called:

Back 53

Thorax 2

- posterior mediastinum also called Thorax 3

Front 54

***4 masses of the anterior mediastinum:***

Back 54

1. enlarged thymus

2. enlarged thyroid

3. teratoma

4. lymphoma

Front 55

***middle mediastinum masses:***

(4)

Back 55

1. lymph nodes

2. aortic aneurysm

3. vascular dilation

4. cysts

Front 56

****signs and symptoms of both anterior and middle mediastinal masses:****

Back 56

1. retrosternal pain

2. cough/dyspnea

3. SVC syndrome

4. choking sensation

Front 57

pericardium is double-walled;

external portion =

internal portion =

Back 57

external = fibrous pericardium

internal = serous pericardium

Front 58

fibrous pericardium:

(2)

Back 58

1. sticks to diaphragm and sternum along with serous pericardium

2. pain is conveyed by the phrenic nerve

Front 59

serous pericardium also consists of 2 layers:

Back 59

1. parietal

2. visceral


also has a potential space

Front 60

***visceral serous pericardium is also called:***

Back 60

epicardium

Front 61

***what does the transverse pericardial sinus do?***

Back 61

**separates arteries from veins**

Front 62

***how is the oblique pericardial sinus formed?***

Back 62

by reflection onto the pulmonary veins of the heart

Front 63

***cardiac tamponade =

Back 63

**blood** in the pericardial space => heart can't fully expand

Front 64

signs of cardiac tamponade:

(3)

Back 64

1. engorgement of jugular vein

2. muffled heart sounds

3. dec. in diff. between systolic and diastolic BP

Front 65

pericardiocentesis =

Back 65

drainage of blood to treat cardiac tamponade

- occurs in IC space near sternum

Front 66

axillary tail =

Back 66

lateral extension of the breast

Front 67

line of nipples ~

Back 67

4th IC space

Front 68

breasts consist of:

(3)

Back 68

1. glandular tissue

2. adipose

3. CT septa

Front 69

another name for glandular tissue =

Back 69

mammary glands

Front 70

areola =

Back 70

area around nipple

Front 71

glandular tissue =

Back 71

10-20 lobes, each with lactiferous duct and lactiferous sinus

Front 72

retromammary space =

Back 72

loose CT that separates breasts from fascia of pec major and serratus anterior

Front 73

what attaches mammary glands to the overlying dermis?

Back 73

suspensory ligaments

Front 74

metastasis =

Back 74

spread

Front 75

BC uses

Back 75

the lymph system to spread

Front 76

***axillary nodes ~

Back 76

75% of lymph drainage of the breast

Front 77

25% of lymph drainage of breast occurs via:

(3)

Back 77

1. parasternal lymph nodes (medial)

2. opposite breast (~***spread of cancer***)

3. abdominal nodes

Front 78

20-30 axillary nodes are divided into 5 groups:

Back 78

1. ***pectoral/anterior***

2. humeral/lateral

3. subscapular/posterior

4. central

5. apical

Front 79

***which collection of nodes receives the majority of lymph from breast tissue?***

Back 79

the **pectoral/anterior** nodes

Front 80

***which lymph collection receives lymph from all the other ones?***

Back 80

the **apical nodes**

Front 81

all nodes drain to apical nodes =>

Back 81

right lymphatic or left thoracic duct => venous system

Front 82

BC => tumor => block of lymph channels => edema =>

Back 82

"orange peel" look of overlying skin

Front 83

what causes nipple retraction/deviation or dimpling of breast tissue?

Back 83

tumor pulls on suspensory ligaments

Front 84

mastectomy ~ potential for:

Back 84

damage to long thoracic nerve => winged scapula

Front 85

coronary sulcus =

Back 85

sulcus between atria and ventricles

- encircles the heart

Front 86

the right coronary artery is found in:

Back 86

the coronary sulcus

Front 87

3 main branches of the right coronary artery:

Back 87

1. branch to SA node

2. acute marginal branch

3. posterior interventricular artery

Front 88

the left coronary artery is also called:

Back 88

the left main artery

Front 89

3 branches of the left main artery (left coronary):

Back 89

1. anterior interventricular (LAD)

2. circumflex

3. obtuse marginal

Front 90

LAD =

Back 90

left anterior descending

Front 91

***the left coronary artery supplies:***

(4)

Back 91

1. most of LA

2. most of LV

3. most of the septum

4. AV bundles

Front 92

vessels used for coronary artery bypass grafts (CABG):

(3)

Back 92

1. great saphenous vien (watch for valves)

2. internal thoracic artery

3. radial artery

Front 93

***coronary sinus corresponds to:***

Back 93

veins

Front 94

venae cordis minimae drain into atria ________

Back 94

directly

Front 95

what is the septomarginal trabecula, and what is it unique to?

Back 95

septal limb + moderator band;

unique to the RV

Front 96

tricuspid valves' names =

Back 96

anterior, posterior, and septal

Front 97

papillary muscles ~

Back 97

*passive* shutting of valves via pressure difference

Front 98

papillary muscles connect:

Back 98

chorda tendinae to myocardium

- chordae tendinae attach to valves

Front 99

pulmonary valve (off of RV) ~

Back 99

3 semilunar cusps

as is the aortic valve

Front 100

mitral valve leaflet names' =

Back 100

anterior and posterior

Front 101

hyperplasia =

Back 101

inc. in amount of cells

Front 102

LV hypertrophy = result of:

(2)

Back 102

1. HTN

2. aortic/mitral valve disease

Front 103

all of the valves are in the same:

Back 103

plane

Front 104

50% of the time, the artery failure that causes MI =

Back 104

LAD artery

Front 105

***cardiac skeleton =

Back 105

rigid CT around each valve

Front 106

***purposes of cardiac skeleton =

(2)

Back 106

1. attachement site for cusps

2. barrier to electrical activity from atria to ventricles

Front 107

2 types of infacrts:

Back 107

1. transmural

2. subendocardial

Front 108

subendocardial infarct =

Back 108

infarct limited to interior 1/3 of the ventricular wall

Front 109

transmural infarct =

Back 109

infarct across the entire ventricular wall

Front 110

blood carries

Back 110

sound

Front 111

auscultory locations: pulmonary valve ~

Back 111

left, 2nd IC space, just lateral to sternum

Front 112

auscultory locations: aortic valve ~

Back 112

right, 2nd IC space, just lateral to sternum

Front 113

auscultory locations: tricuspid valve ~

Back 113

lower part of sternum, slightly left

Front 114

auscultory locations: mitral valve ~

Back 114

left, 5th IC space, away from sternum

Front 115

SA node (pacemaker) =>

Back 115

AV node (pause) => Bundle of His (in septum) => Purkinje fibers (around ventricles)

Front 116

cardiac plexus =

Back 116

collection of parasympathetic and sympathetic nerves

- located at bifucation of trachea, just superior to heart

Front 117

**lub =

(S1)

Back 117

closing of AV valves

Front 118

**dub =

(S2)

Back 118

closing of semilunar valves

(pulmonic, aortic)

Front 119

heat initiates its own heart rate; the ANS:

Back 119

modifies it

Front 120

in the embryo: blood islands, located cranially, coalesce to form:

Back 120

*2* endocardial tubes => fusion => heart tube

Front 121

myocardium secretes:

Back 121

cardiac jelly

- helps heart beat during development

Front 122

layers of the heart:

(5)

Back 122

fibrous membrane =>

check

Front 123

what is the outermost layer of the heart?

Back 123

epicardium

Front 124

another name for epicardium =

Back 124

visceral pericardium

check

Front 125

crista terminalis =

Back 125

crest that separates pectinali muscles from sinus venarum

**in RA**

Front 126

***septum transversum =>***

Back 126

***epi***cardium

Front 127

4 main regions of the heart =

Back 127

1. bulbous cordis (truncus and conus arteriosus)

2. ventricle (becomes 2 ventricles)

3. atrium (becomes 2 atria)

4. sinus venosus

Front 128

***truncus arteriosus becomes:

Back 128

great vessels

Front 129

***conus arteriosus becomes:

Back 129

outflow of **ventricles**

Front 130

the sinus venosus becomes:

Back 130

the sinus venarum of the RA

Front 131

where does the septum primum grow?

Back 131

in the common atrium, partially separating it into two parts

Front 132

***what grows to the right of the septum primum?***

Back 132

the septum secundum

Front 133

***what is the opening of the septum secondum?***

Back 133

the foramen ovale

(flow goes through foramen secundum afterward)

Front 134

***septum primum =

Back 134

valve for the foramen ovale

Front 135

**myocardium is formed from:

Back 135

***endocardium*** (innermost layer)

Front 136

atrial septal defects =

Back 136

defects in the development of septum primum or secundum

Front 137

atrial septal defects are found in most:

Back 137

chromosomal abnormalities

Front 138

what partitions the AV canal into 2 AV canals (in the embryo)?

Back 138

endocardial cushions

Front 139

muscular IV septum begins growing from the bottom - first stage.

second stage =

Back 139

conotruncal cushions fuse with this muscular septum, creating the final IV septum

Front 140

Tetralogy of Fallot is the most common:

Back 140

cause of cyanotic heart disease

Front 141

symptoms of Tetralogy of Fallot:

(4)

Back 141

1, pulmonary stenosis

2. overriding aorta

3. IV septal defect

4. RV hypertrophy

Front 142

common cause of heart defects =

Back 142

incomplete septation

Front 143

phrenic nerve:

(3)

Back 143

1. on both sides

2. *between* parietal pleura and pericardium

3. has motor AND sensory components

Front 144

the somatic motor portion of the phrenic nerve innervates:

Back 144

the diaphragm

Front 145

the general sensory portion of the phrenic nerve innervates:

(3)

Back 145

1. *central* diaphragm

2. mediastinal pleura

3. pericardium

Front 146

***lower/lateral aspects of the diaphragm are innervated by:***

Back 146

lower IC nerves - especially costal pleura

(sensory ONLY - somatic motor of phrenic controls all muscular funtion)

Front 147

prime muscles of inspiration =

(2)

Back 147

1. diaphragm

2. external IC's

Front 148

accessory muscles of inspiration =

(2)

Back 148

SCM, scalenes

Front 149

major drive of inspiration =

Back 149

**relaxation of lungs and ribs (a passive process)

Front 150

*forced* expiration is accomplished by:

(2)

Back 150

1. internal IC's

2. abdominals

Front 151

**parietal pleura is innervated by a general sensory nerve; this means:

Back 151

it's sensitive to pain

Front 152

the visceral pleura is innervated by:

Back 152

a VSN

- doesn't feel pain

Front 153

what reflects at the hilum?

Back 153

mediastinal parietal pleura

- enclosing vessels in roots and becoming visceral pleura

Front 154

lung don't fill entire cavity => pleural recesses. what are their names?

(3)

Back 154

contodiaphragmatic (one on each side)

and

costomedial recess (on **left**)

Front 155

**expansion into the pleural recesses occurs during:***

Back 155

**forced** inspiration

Front 156

simple pneumothorax =

Back 156

air in pleural cavity

- can be open or closed

Front 157

open pneumothorax ~

Back 157

air entered form outside

Front 158

closed pneumothorax ~

Back 158

air came form lung itself

Front 159

tension pneumothorax =

Back 159

air enters pleural cavity on each inspiration, but can't exit

=> ST adhering visceral pleura to lung is broken

=> **lung collapses** due to natural elasticity

Front 160

symptoms of tension pneumothorax:

(3)

Back 160

1. diminished breath sounds on affected side

2. distended neck veins

3. **tracheal deviation**

Front 161

treatment of tension pneumothorax =

(2)

Back 161

needle decompression (to make it simple pneumothorax)

or chest tube

Front 162

right lung:

(2)

Back 162

3 lobes (sup, middle, inf),

2 fissures (horizontal and oblique)

Front 163

left lung:

(3)

Back 163

2 lobes, 1 (oblique) fissure, 1 lingula

Front 164

**right main bronchus is wider and straighter:** =>

Back 164

inhaled foreign bodies tend to lodge here

Front 165

how should lungs look on x-rays?

Back 165

*black*

Front 166

COPD =

(3)

Back 166

chronic bronchitis, asthma, or emphysema

Front 167

emphysema =

Back 167

permanent enlargement of airways/destruction of bronchiole walls by inflammation

Front 168

effect of emphysema:

Back 168

**decreased elasticity of lungs** => airways collapse during expiration => patients have to force air out => barrel chest due to hypertrophy of internal IC's

Front 169

**idiopathic pulmonary fibrosis** =

Back 169

chronic, restrictive lung disease

- CT squeezes alveoli => hard to get air ***IN***

Front 170

2 facets of idiopathic pulm fibrosis:

Back 170

1. men affected more than women

2. diagnosed b/w 30 and 50 years

Front 171

bronchopulmonary segments: each gets its own:

(2)

Back 171

1. segmental bronchus

2. pulmonary artery


- but veins run *in between*

Front 172

each bronchopulmonary segment is:

Back 172

functionally independent

- can remove one without affecting rest of lung

Front 173

what do pulmonary arteries carry?**

Back 173

de-oxygenated blood

Front 174

pulmonary embolism occurs because:

Back 174

lungs naturally filter blood clots

Front 175

95% of the time, thromboemboli originate from:

Back 175

deep leg veins

Front 176

3 major causes of pulmonary embolism:

Back 176

1. venous stasis

2. trauma

3. **coagulation** disorders

Front 177

60% of pulm embolisms are small - called:

Back 177

silent pulm. embolisms

Front 178

symptoms of lesser pulmonary embolism:

(4)

Back 178

1. tachypnea

2. anxiety

3. dyspnea

4. vague substernal pressure

Front 179

massive embolization =>

Back 179

occlusion of vessels => infarct

Front 180

bronchiol arteries come off of

Back 180

aorta or its branches

- run with bronchi, provide O2 to pulmonary tissue

Front 181

where do bronchiol veins drain into?

Back 181

the azygous system

Front 182

the pulmonary plexus ~

Back 182

the cardiac plexus

Front 183

the vagus nerve is ______ than the phrenic

Back 183

deeper

Front 184

superficial and deep lymph nodes of the lungs drain into:

Back 184

the tracheobronchiol lymph nodes

=> **bronchomediastinal** trunks

Front 185

signs/symptoms of posterior medistinal masses =

(3)

Back 185

1. pain

2. neurologic symptoms

3. difficulty swallowing

Front 186

esophagus is innervated by:

Back 186

both sympathetic AND parasympathetic nerves

Front 187

azygous vein:

(3)

Back 187

1. ~ **right** side

2. receives all right IC veins

3. empties into **SVC**

Front 188

hemiazygous vein:

(2)

Back 188

1. *left* side

2. receives lower 4 *post.* IC veins

Front 189

accessory hemiazygous vein:

(2)

Back 189

1. left side

2. receives *middle* 4 *posterior* IC nerves

Front 190

the thoracic duct is located between:

Back 190

the aorta and the azygous vein

- runs up the esophagus, ends up on the left side on top

Front 191

thoracic splanchnic nerves innervate:

Back 191

organs of the abdomen

Front 192

what keeps the diaphragm alive?

Back 192

C3, C4, C5

Front 193

paranchyma =

Back 193

lung tissue

Front 194

left lobes officially has ____ segments

Back 194

8

- right has 10

Front 195

foregut =

Back 195

tube that will form parts of the digestive system

Front 196

respiratory diverticulum =

Back 196

ventral outpocketing of foregut

Front 197

the respiratory diverticulum will become:

(2)

Back 197

1. trachea

2. lungs

Front 198

what separates the respiratory diverticulum from the foregut?

Back 198

the ***tracheoesophageal*** ridge

**which means it will separate trachea from esophagus**

Front 199

the distal end of the respiratory diverticulum becomes:

Back 199

the lungs buds

- rest of it becomes trachea

Front 200

the tracheoesophageal septum may fail to form in the proper location; ==>

(2)

Back 200

1. esophageal fistula

2. esophageal atresia

Front 201

fistula =

Back 201

abnormal opening

Front 202

atresia =

Back 202

abnormal closure

Front 203

**only the *lining* of the respiratory tree comes from the:

Back 203

endoderm

- the remaining tissues come from the ***splanchnic mesoderm***

Front 204

what directs the branching of the bronchial buds?

Back 204

**the splanchnic mesoderm**

=> primary, secondary, and tertiary bronchi

- completed in childhood

Front 205

alveoli go from cuboidal cells to

Back 205

flat cells

Front 206

**the diaphragm is HIGH;**

Back 206

"chest" trauma can actually be an abdominal injury

Front 207

**lungs are big** - found above:

Back 207

clavicles, and below xiphoid

Front 208

the heart takes up a lot of

Back 208

space in the chest

Front 209

3 risks of subclavian venous line placement:

Back 209

1. pneumothorax

2. subclavian artery injury

3. brachial plexus injury

Front 210

to pinpoint needle decmpression:

Back 210

mid-calvicular line by 2nd IC space

Front 211

what do chest tubes do?

Back 211

drain blood from the lungs

Front 212

X-ray: Span of heart (cardiac silhouette) should be less than half:

Back 212

the diameter of the thorax
- If greater, it’s probably a cardiomegaly or pericardial effusion

Front 213

x-ray: a sharp border is probably formed by a:

Back 213

fissure

=> Fissure ~ volume loss

=> pneumothorax, hemothorax