Anatomy & Embryology2

Front 1

3 types of embryological folding & what do they do

Back 1

lateral- creates abdominal & thoracic cavities
cranial- developing heart tube displaced into thoracic cavity
caudal

Front 2

most causes congenital defects

Back 2

UNKNOWN 40-60%
multifactoral 20-25%
genetic 15%
enviro 10%

Front 3

which weeks are critical for cardiac development

Back 3

3-6

Front 4

which germ layer heart derived from

Back 4

mesoderm

Front 5

what are the 4 areas of the heart tube (inferior --> superior)

Back 5

Front 6

key steps in atrial septation

Back 6

septum PRIMUM grows caudally, with the ostium primum opening.
septum SECUNDUM begins to grow caudally (right of primum)- opening is FORAMEN OVALE

Front 7

key steps in ventricular septation

Back 7

muscular interventricular septum grwos cranaially from flow of ventricles.
interventricular foramen.
fuses with MEMBRANOUS septum of the aorticopulmonary septum cotruncal ridges.

Front 8

which blood vessels empty into sinus venosus (smooth part of R.atrium) in development.

What dies it develop into.

Back 8

ALL VENOUS blood.
Lose vitelline & umbilical veins.
Left sinus horn --> CORONARY SINUS
R" --> S & IVC

Front 9

what are the venous origins and development of teh smooth parts of the right atria

Back 9

right venous valve & SA orifice --> cristae terminalis

Front 10

what is left of the foramen ovale

Back 10

fossa ovalis (thinner membranous part of interatrial septum)

Front 11

how many aortic arches in development & what they give rise to

Back 11

6 pairs, 1, 2 & 5 disappear
3- common carotids (& internal)
4- R subclavian & aortic arch
6- branched from po artery & L ductus arteriosus

Front 12

3 venous systems in embryo

Back 12

vitelline, umbilical & cardinal (systemic)

Front 13

what do the vitelline and umbilical venous systems develop into

Back 13

vitelline-- portal & heaptic
umbilical - breaks down at birth

Front 14

what changes in circulation happen at birth

Back 14

pressure changes
cease communication between atria (foramen ovale fuses)
ductus arteriosus becomes --> LIG ARTERIOSUS
umbilical vein breaks down

Front 15

what causes ASD

Back 15

failure of foramen ovale to fuse
atrial communication continues

Front 16

2 types of VSDs and most common type

Back 16

1) muscular most common (least severe)
2) membranous (most severe)

Front 17

6 common acyanotic congenital heart defects

Back 17

ASD
VSD
patent ductus arteriosus
aortic stenosis (bicuspid valve)
coarctation of aorta
po stenosis

Front 18

6 common CYANOTIC congenital heart defects

Back 18

tetralogy of fallot
transposition of great vessels
Ebstein's anomaly
hypoplastic left heart
total anomalous po venous drainage
tricuspid/ po atresia

Front 19

What's tetrology of fallot

Back 19

4 components: po stenosis, VSD, RVH, over-riding aorta

Front 20

what's ebstein's anomaly

Back 20

severe TR --> enlarged RA

Front 21

What's the phrenic nerve

Back 21

C3,4,5- diaphragm
cranio-sacral parasympathetic outflow
mixed- sensory & motor

Front 22

what's cardiac tamponade and haemopericardium.
signs

Back 22

fluid (blood) in pericardium
cardiogenic shock
falling BP, raising JVP, muffled heart sounds

Front 23

how do you treat cardiac tamponade (or haemopericardium)

Back 23

pericardiocentesis
needle inserted via infrasternal angle, direct superoposteriorly, aspirate continuously

Front 24

what and where is the transverse pericardial sinus

Back 24

"space" within pericardial cavity
post to ASCENDING aorta & po trunk

Front 25

where is right coronary artery located

Back 25

right atrio-ventricular groove (boundary of tricuspid valve)

Front 26

location of left (descending) coronary artery

Back 26

anterior interventricular groove

Front 27

where do the coronary arteries arise.

what layers of heart do they supply

Back 27

just superior to aortic valve (ascending aorta)

from the aortic valve SINUSES

myocardium & epicardium

Front 28

where is coronary sinus loc. what location does it indicate inside heart.
Where does it drain

Back 28

posterior atrioventricular groove- mitral valve

receives blood from most cardiac veins --> right atrium

Front 29

anatomy of aortic valve

Back 29

tricuspid SL with SINUSES (for coronary arteries)

Front 30

compare anatomy of tricuspid & bicuspid (mitral) valves

Back 30

both with cordae tenindae (tendenous cords) and anchored to papillary muscles.
tri =3: ant, post & septal cusps.
bu= 2: ant & post cusps.

Front 31

name the main coronary arteries & branches (2 maj, 8 total)

Back 31

L main stem --> LAD (--> lateral) + L.Marginal + circumflex
RCA --> R marginal + posterior interventricular

Front 32

what embryological remnant is seen on the interior aspect of the atria

Back 32

fossa ovalis from the closure of the foramen ovale

Front 33

what are the moderator bands (loc & role)

Back 33

from ventricular septum --> papillary muscles

carry bundle branches from purkinjie fibres

Front 34

which artery from the heart is most anterior

Back 34

ascending aorta

Front 35

auscultatory areas

Back 35

po artery - 2nd ICS sternal edge
aorta- 2ns ICS sternal edge
tricuspid- 5/6th ICS sternal edge
mitral- apex

Front 36

apart from para & symp ANS innervation of heart, what other fibres are assoc with heart & what are the roles

Back 36

VISCERAL AFFERENTS;
1) presynaptic PAIN SENSORY --> spinal cord with symp nerves (i.e. alter symp outflow to heart)
2) visceral REFLEX (e.g. from baroreceptors) --> brain (mainly via CNX/ vagus)

Front 37

where's the symp outflow?

which part supplies heart?

what's different about symp supply to MIDLINE organs

Back 37

T1- L2/3 (thoracolumbar outflow)

cardiopo splanchnic nerves (upper region)

midline oragns receive BILATERAL symp nerve innervation

Front 38

when post-synaptic impulses exit symp trunk they follow either which 5 paths

Back 38

1) enter gangiol at SAME level
2) synapse at SUPERIOR ganglion
3) synapse at INFERIOR ganglion
4) abdominopelvic splanchnic nerves synapse in PREVERTEBRAL GANGLIA of abdo
5) DON'T SYNAPSE --> adrenal medulla

Front 39

what's the cardiac plexus

Back 39

mech network of symp , parasymp & visceral afferents

surround arch of aorta, po artery.. atrida, ventricles, co arteries

Front 40

crainio-sacral parasym outflow contains which cranial nerves (CNs)

Back 40

CN 3,7,9,10

(oculomotor, facial, glossopharyngeal, vagus)

Front 41

symp fibres synapse in the paravertebral ganglia of sympathetic trunk. Where do parasymp fibres synapse

Back 41

in WALL of organs (i.e. v.short post-synaptic fibres)

Front 42

afferent sensory pain signals travel where in brain

Back 42

somtosensory area of postcentral gyrus (parietal lobe)

[posterior to preccentral gyrus of frontal lobe]

Front 43

compare visceral and somatic chest pain

eg's of each in the thorax

Back 43

visceral- nauseating, dull, ache, poorly localised. (heart, great vessels, trachea, oesophagus, abdominal viscera)

somatic- sharp, stabbing, well localised. (muscles, joints, bones, intervertebral discs, nerves)

Front 44

route somatic sensory APs take to reach consciousness

Back 44

skin mechanoreceptors in dermatome
--> pain pathway CROSSES in spinal cord
--> cerebral cortex- SOMATOSENSORY region of POSTCENTRAL GYRUS of perietal lobe (consciousness)
--> somatomotor signals from PRECENTRAL gyrus of frontal lobe
--> skeletal muscle contraction

Front 45

which features in mediastinum particularly lie towards right side

Back 45

S & IVC & azygous vein
thoracic duct

Front 46

which features in mediastinum particularly lie towards left side

Back 46

aorta
thoracic duct
lig arteriosum
L recurrent laryngeal nerve (from vagus)

Front 47

where does the oesophagus lie in relation to the thoracic duct & aorta

Back 47

thoracic duct right
oesophagus midline
descending aorta left

Front 48

route visceral afferents

Back 48

from chest organs
--> usually travel with symp fibres
--> thalamsu & hypothalamus
--> diffuse areas of cortex

Front 49

what's the significance of the level somatic sensory & visceral afferents enter the spinal cord

Back 49

influences referred pain

Front 50

explain radiating pain (somatic and visceral)

Back 50

pain at damaged site & elsewhere

SOMATIC origin --> radiates along dermatome

visceral origin --> radiates to dermatomes supplied by spinal cord levels at which visceral afferents enter symp chain/ spinal cord

Front 51

areas heart pain radiates/ refers to

Back 51

Front 52

define MI

4 most common sites of coronary artery occlusion

Back 52

irreversible necrosis of myocardium due to coronary artery occlusion:
- LAD > RCA > circumflex > LCA (mainstem)

Front 53

dominance of myocardium blood supply usually R or L

Back 53

R (remember posterior interventricular)

Front 54

3 grafts used in CABG

Back 54

radial & internal thoracic arteries
great saphenous vein

Front 55

where does the blood supply to the SA/ AV nodes & bundle branches originate

Back 55

SA- RCA
AV- post interventricular (RCA)
bundle branches- LAD & post interventricular

Front 56

Where does lymph drain into venous system

Back 56

right lymphatic duct
left throacic duct

Front 57

what are the lateral branches of the descending throacic aorta

Back 57

intercostal arteries (followed by intercostal nerve and vein- run in intercostal groove)

Front 58

what vessel does the external iliac artery become in the lower limb

Back 58

femoral artery

Front 59

what's an end artery and what are it's risks

eg of an end artery

Back 59

insufficient anastomoses to maintain viability of tissue is occlusion occurs.

eg. central artery of retina --> blindness

Front 60

why do varicose veins (varicosities) develop

Back 60

deep venous system is higher pressure than superficial venous system.
Malfunctioning valves mean venous blood --> superficial veins --> dilatation

Front 61

where is the transverse thoracic plane

Back 61

sternal angle --> T4/5 interspace

Front 62

what is the thoracic inlet bounded by

Back 62

jugular notch, rib 1 & T1

Front 63

structures found in superior mediastinum

Back 63

Trachea, oesophagus thoracic duct (some of thymus & lymph nodes)
Arch of aorta, L.subclavian, common carotid arteries
Bracheocephalic vein & SVC
Vagus (& LRL) & phrenic nerves

Front 64

structure in anterior mediastinum

Back 64

thymus

Front 65

Structures in posterior mediastinum

Back 65

Trachea & main bronchi, oesophagus thoracic duct
Thoracic aorta
Azygous vein
Vagus & symp chains

Front 66

anterior surface of thoracic aorta gives rise to which branches (arteries)

Back 66

bronchial
oesophageal
mediastinal
pericardial
phrenic

Front 67

What are the venous angles and their significance

Back 67

subclavian & cephalic veins unite (L&R)
Central venous access.
Where lymph drains.

Front 68

which 2 structures in the mediastinum is at risk of RUPTURE in chest trauma

which side dies it lie

Back 68

AZYGOUS vein & THORACIC duct

azygous - right side

Front 69

where in the neck would you auscultate for carotid bruits and palpate a pulse

Back 69

bifurcation of carotid arteries, anterior to SCM, upper border of thyroid cartilage

Front 70

where exactly in upper limb can you palpate 2 pulses

Back 70

radial artery- lateral to tendon of flexor carpi radialis
brachial artery- medial to biceps tendon (in cubital fossa)

Front 71

which 4 places in lower limb can you palpate a pulse

Back 71

FEMORAL- inferior to midpoint of inguinal ligament (femoral canal)
POPLITEAL- popliteal fossa
post TIBIAL- post border medial malleolus
DORSALIS pedis- lateral to tendon of extensor hallucis longus

Front 72

how is arterial access to left heart gained

Back 72

via SUBCLAVIAN, RADIAL or FEMORAL arteries

Front 73

how is CENTRAL venous access to RIGHT heart gained

why might this be necessary

Back 73

FEMORAL vein

unblock occlusion
deliver drugs

Front 74

2 sets of lymph node groups in mediastinum

Back 74

hilar (bronchopulmonary)
tracheobronchial

Front 75

which nerve in mediastinum:
- more medial
- posterior to bracheocephalic
- posterior to hilum
- branches- what are they and where?
which fibres does this nerve carry?

Back 75

CNX/ VAGUS nerve- somatosensory/motor & parasymp
- L. RECURRENT LARYNGEAL nerve: loops under aortic arch, post to lig arteriosum. Ascends right of arch, left of trachea.
- R. RECURRENT LARYNGEAL nerve: root of neck

Front 76

PHRENIC nerve:
- origin
- fibres
- path/ relations

Back 76

C3,4,5
somatic SENSORY & MOTOR
between mediatinal pleura & pericardium
PHrenic in PHront of Hilum
LATERAL to vagus

Front 77

what fibres are in the reccurrent laryngeal nerves & vagus after branching

Back 77

RLN's: SOMATIC motor and sensory only to PHARYNX & LARYNX

Vagus: PARASYMP only!! to thoacic & abdo organs

Front 78

phrenic nerves carry SOMATIC SENSORY and MOTOR nerves- where to?

Back 78

somatic MOTOR- diaphragm

somatic SENSORY (3P's)- parietal Pleura, Pericardium, parietal Peritoneum

Front 79

why does peritoneal pathology sometimes present with shoulder tip pain

(e.g. liver abscess, GB inflam)

Back 79

diaphragmatic parietal peritoneum irritated --> C3,4,5
--> enter same level of spinal cord that supplies shoulder

REFERRED pain

Front 80

why might dysphagia & hoarseness indicate mediastinal mass

Back 80

lung ca can spread to lymph nodes/ mass --> COMPRESS RECURRENT LARYNGEAL nerves
--> paralysis/ weaken vocal cords

Front 81

where's the cephalic vein

Back 81

superficial vein upper limb
groove between deltoid & pec major

Front 82

loc internal throacic arteries and veins

Back 82

Front 83

loc inferior epigastric, external iliac & femoral vessels

Back 83

Front 84

loc internal and external common carotids

Back 84

bifurcation of carotid arteries, anterior to SCM, upper border of thyroid cartilage.
External- anterior supply