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133 Cards in this Set

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The first rib has a scalene tubercle and two grooves for?
Ventral to dorsal:
groove for the subclavian vein
scalene tubercle
groove for the subclavian artery and brachial plexus
what are the single facet ribs/articulate only with their own vertebrae?

These ribs don't have?
1st, 11th, 12th

Dont have a costal groove
sternal angle is at the level of ____ vertebrae and ______ rib
At the level of T4 vert dorsally and the 2nd costosternal joint ventrally
Thoracic curvature upon inhalation?
Increased kyphosis = more concave anteriorly

Rest = |
Inhalation = (
What runs anterior to the anterior scalene?
Phrenic n. and subclavian v.
scalene muscle innervation
ant. and middle = brachial plexus
post. = cervical
External intercostals function during
forced inspiration
internal intercostals - intrachondral part fxn
inspiration
internal intercostals - intraosseous part fxn
expiration
the intercostal a. n. and v. are found between
between the innermost and internal intercostals
subcostalis fxn = ?

transverse thoracis fxn = ?
subcostalis fxn = similar to internal intercostals

transverse thoracis fxn = expiratory
Which muscles elevate the rib cage for respiration?
the scalenes, sternocleidomastoid, intercostals, pec major & minor
The internal thoracic artery gives off the musculophrenic a. at the_______

the musculophrenic a. supplies the _____ intercostal spaces
6th intercostal space

7-9 anteriorly
Skin innervation of the thorax is from
the ventral rami of T2-T6
epithelium of the nipple?
keratinizing stratified squamous
sebaceous glands on the areola?
montgomary tubercles - oily secretion increases suppleness
Layers breast along chest wall from superficial to deep
Fat > retromammary space > deep/pectoral facia
breast extends into the axillary fossa aka
tail of Spence
the bands of fibrous tissue that support the breast are the ___________ and extend from the ____ to the _____
ligaments of Cooper

from the dermis to the deep facia
the glands/alveoli of the breast are lined by ____ epithelium
milk-secreting cuboidal epithlium
Milk production is via what hormone?

Let down of milk from duct to nipple opening is via what hormone
production = prolactin

let down = oxytocin
Innervation of the breast?
T4-T6

Dermatome of nipple = T4
Blood supply to breast is via
internal thoracic a., axillary a. (lat. thoracic), and intercostal aa
venous drainage of breast?
axillary and azygous
75% of breast lymphatics is via
axillary nodes
plexus of vessels under the areola where the lymphatics of other parts of the breast are received?
subareolar plexus of Sappay
dimpling/orange peel appearance?
tumor invasion of the suspensory ligaments/Coopers ligaments
Klinefelster's genotype? Notable sign?
XXY

gynecomastia
Mediastinum superior/inferior border?
line through Sternal angle/T4
supracardiac mediastinum contains?
-great vessels: arch of arota + its 3 branches, the azygous vein, superior vena cava, and R+L brachiocephalic vv
-part of the thymus, trachea, and esophagus
-phrenic nerves and the thoracic duct
Inferior mediastinum:
anterior part contains?
thymus, fat, lymph nodes
Inferior mediastinum:
middle part contains?
heart, coronary vessels and great vessels
ascending aorta
autonomic and phrenic nerves
Inferior mediastinum:
posterior part contains?
esophagus
vagus nerves
thoracic aorta
thoracic duct
azygous veinous system
sympathetic nn
thoracic (greater lesser least) splanchnic nn
cervical pleura is reinforced by the?
suprapleural membrane aka Simpson's facia
inferior to the hilum the duplicate of pleura is called the
pulmonary ligament
innervation of the pleura
parietal: local somatic nerves including the phrenic and intercostal nn

visceral: sensory autonomic nerves - insensitive to inflammatory pain
pain due to pleuritis caused by?
phrenic or intercostal nn causing sharp pain locally and referred pain to thoracic wall and neck
blood supply and drainage of the pleura
parietal: intercostal and internal thoracic aa; drainage by corresponding vessels

visceral: vessels of the lungs
Intrapleural pressure @

rest = ?
inspiration = ?
rest = -3cm H2O

inspiration = -6cm H20
Which levels are the inferior border of the lung?
midclavicular = 6th rib
midaxillary = 8th rib
scapular = 10th rib

inferior border in children is +1 for above values (7, 9, 11)
The oblique fissure extends posteriorly from ______ to the _____ chostachondral joint anteriorly
T2

6th costachondral
the horizontal fissure runs from the ______ costal cartilage level to the _______ at the midaxillary line
4th

oblique fissure @ midaxillary
Which lung has
1) cardiac impression anteriorly, groove for brachiocephalic vein and superior vena cava, grove for the arch of the azygos vein,
2) area for ascending and descending aorta, groove for arch of aorta, groove for subclavian a. and a larger cardiac impression
1) right lung

2) left lung
Trachea is ___ long and ____ wide.
It extends from _____ to carina at _____
12cm long and 2cm wide

extends from C6-T4
level of the cricoid cartilage/where pharynx merges with esophagus?
C6
Respiratory component of resp. system?
respiratory bronchioles, alveolar ducts, and alveoli
Conducting componenet?
Everything else:
nasal cavity, pharynx, larynx, trachea, and the bronchial tree all the way down to the terminal broncioles
Outter layer of trachea has what type of connective tissue?
loose connective tissue
connective tissue between cartilages of trachea that allow elongation?
fibrous connective tissue - the annular ligament
Inner layer of trachea has what type of epithelium?
pseudostratified ciliated columnar epithelium
mucosa of the bronchioles has what type of epithelium and cells?
simple ciliated columnar epithelium with clara and collagen and elastic fibers
terminal and respiratory bronchioles have what type of epithelium?
simple ciliated cuboidal
alveolar ducts have what type of epithelium?
simple squamous epithelium

(think of the respiratory epithelium gradually getting simpler and flatter as air moves down)
What are clara cells?
they can diffrentiate from ciliated cells, secrete glycosaminoglycans, and metabolize airborne toxins
thickness of alveolar capillary?
0.3-0.7 um
Type 1 pneumocytes:
cell type, functions?
cell type: simple squamous with tight junctions that dont divide

fxn: gas exchange
Type 2 pneumocytes:
cell type, functions?
cell type: cuboidal shaped cells that contain microvili and tight junctions; can divide; found near septae

fxn: provide surfactant
composition of surfactant and fxn
cholesterol, dipalmitoyl phosphatidylcholine and proteins

fxns to reduce surface tension
Tidal Volume?
inspired/exhaled in normal breathing = 0.5L
IRV
volume one can inspire in addition to TV = 3L
ERV
volume one can expire in addition to TV = 1.2 L
RV
volume of gas remaining after maximal expiration (TV + ERV) = 1.2L (deadspace air)
FRC = ?
Functional Residual Capacity = ERV + RV = 2.4L
VC or FVC
Vital capacity or forced vital capacity = TV + IRV + ERV = 4.7L
TLC = ?
VC + RV = Add up all lung capacities = 5.9L

cant be measured
FEV1? normal value =?
volume of air that can be forcefully exhaled in the first second

FEV1 = 80% of FVC => FEV1/FVC = 0.8
Values in the alveoli:

PO2 = ?
PCO2 = ?
Values in the alveoli:

PO2 = 100 mmHg
PCO2 = 40 mmHG
Values in the venous blood:

PO2 = ?
PCO2 = ?
Values in the venous blood:

PO2 = 40 mmHG
PCO2 = 46 mmHG
Innervation of the lung:
vagal efferent?
vagal afferent?
vagal efferent (motor) = bronchoconstriction, vasodilation, secretion

vagal afferent (sensory) = mediate the cough reflex, baroreceptors, and chemoreceptors. senses pain from trachea
Innervation of the lung:
sympathetic efferent?
sympathetic afferent?
sympathetic efferent (motor): bronchodilation, vasocronstriction, decreased secretions

sympathetic afferent (sensory): pain conducting (nociceptive) from visceral pleura and bronchi
FEV1/FVC in copd?
Decreases (<0.8) because FEV1 decreases (pt can't get rid of air easily)
FEV1/FVC in fibrosis/restrictive disease?
FEV1/FVC increases or is normal because (= or > 0.8) FEV1 and FVC decrease together or FVC decreases more
pancinar emphysema has a deficiency of what enzyme
alpha-1-antitrypsin enzyme (protease inhibitor)
visceral pericardium aka
epicardium
pericardial blood supply?
mainly pericardiophrenic and musculophrenic arteries from thoracic a. and indirect branches of thoracic aorta

epicardium is also supplied by coronary aa
pericardial venous drainage?
azygous venous system and pericardiophrenic vv
pericardium innervation
sympathetic and parasympathetic (vagus)

and phrenic nn
ligament of Botallo?
aka ligamentum arteriosum

ductus arteriosus during embryological life
Borders of the heart?
BP in aorta?

BP in pulmonary trunk?
aorta = 120/80

trunk = 25/10
cardiac valves are a duplicature of
the endocardium
smooth upper part of L ventricle
aortic vestibule
Rough anterior portion of R atrium?
pectinate muscles
Smooth posterior part of atrium
sinus venarum
vertical line on inside of R atrium is called the _________ which corresponds to the ________ on the outside
vertical line on inside of R atrium is called the crista terminalis which corresponds to the sulcus terminalis on the outside
The opening to the inf. vena cava is partially covered by
the sickle shaped valve of Eustachius
A valve at the opening of the coronary sinus
valve of thebesius
upper smooth section of R ventricle
infundibulum aka conus arteriosus
lower rough section of R ventricle
trabeculae carneae
AV node aka
aschoff-Tawara node
Bachman bundle?
transmits cardiac impulse from R atrium to L atrium
small square on ECG =?
0.04s

0.1mV
5 small squares on ecg =
0.2s

0.5mV
_________ surrounds the __________ area and represents the true size of the heart
relative cardiac dullness surrounds the absolute dullness area and represents the true size of the heart
The first heart sound is heard at the timing of the _______ on ECG and is produced by ____________
The first heart sound is heard at the timing of the QRS on ECG and is produced by the closure of the AV valves
The second heart sound is produced by the _________ and corresponds to the __________ on ECG
The second heart sound is produced by the closure of the semilunar valves and corresponds to the T-wave on ECG
Site of auscultation for the aortic valve
lateral to sternum at right intercostal space 2
Site of auscultation for the pulmonary valve
lateral to sternum at left intercostal space 2
Site of auscultation for the tricuspid valve
over the sternum at left intercostal space 5
Site of auscultation for the mitral valve
at the apex on the midclavicular line at left intercostal space 5
heart sounds picture
Major branches of RCA
SA-nodal artery
right marginal artery
posterior interventricular artery
AV nodal artery
SA nodal artery supplies?
SA node and pulmonary trunk
right marginal artery supplies
right ventricle and apex
posterior interventricular a supplies
both ventricles including post. and inf. left ventricle and post. interventricular spetum
AV nodal artery
near origin of posterior interventricular a. supplies AV node
LCA branches?
anterior interventricular artery
circumflex a
left marginal a
anterior interventricular a supplies?
both ventricles and anterior 2/3 of interventricular septum
circumflex supplies?
left atrium, left surface of heart, and left ventricle
left marginal artery supplies?
branch of circumflex supplies left ventricle
The main cardiac veins drain into the ______

exception?
coronary sinus

exception = anterior cardiac veins on R ventricle usually enter right atrium directly
smallest cardiac veins aka?
thebesian veins/venae cordis minimae open directly into heart chambers
Innervation of heart:
sympathetic nerve originates from intermediolateral gray column of ___________ and synapse in the sympathetic chain including the _____ and _____ ganglia
5-6 thoracic nerves

stellate and middle cervical sympathetic ganglia
Innervation of heart:
postsynaptic fibers of the sympathetic __________ nerves end on the
cardiopulmonary splanchnic nerves end on SA and AV node
Innervation of heart:
sensory information is transmitted through ______ whose cell bodies are in the ______
T1-T5

DRG

referred pain in shoulder b/c brachial plexus is C5-T1; T1 is common
Systole:
Isovolumetric contraction?
beginning of systole and all valves are closed.
when intraventricular pressure = aortic pressure the aortic valve opens
Systole:
ejection period
aortic valve opens and 70mL of blood is ejected.

intraventricular pressure falls below aortic pressure and valves close
Diastole:
Isovolumetric relaxation
AV and SL valves are closed with residual volume (70mL) causing intraventricular pressure to be less than atrial pressure
Diastole:
Filling time
AV valve opens and blood enters passively. Atrial contraction then takes place.
location of cisterna chyli
to the right of L1-L2
The esophagus is ____ long and ends in the stomach at ___ below the diaphragm between _____ and_____
The esophagus is 25-30cm long and ends in the stomach at cardia below the diaphragm between T10-T12
The esophagus passes through the diaphram at ____ accompanied by
T10 accompanied by two vagus nerves
Three major narrowing points of the esophagus
upper sphincter (around cricoid)
aortic narrowing
diaphragmatic narrowing
pg 184!
!
page 185!
!
Major openings of the diaphragm:
aortic hiatus = ?
esophageal hiatus = ?
foramen for the inferior vena cava = ?
aortic hiatus = T12
esophageal hiatus = T10
foramen for the inferior vena cava = T8
blood supply to the diaphragm is via
inferior phrenic, superior phrenic, musculophrenic, and pericardiophrenic aa
Innervation of diaphragm
phrenic n. C3-C5
L1-L2 nn
intercostal (sensory) nn
esophageal blood supply
upper = inf thyroid a.

middle = esophageal a., bronchal a.

lower = left gastric a, inf. phrenic a.
the greater splanchnic nerve is from
T5-T9
the lesser splanchnic n is from
T10-T11
The least splanchnic n is from
T12