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78 Cards in this Set

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  • Back
What are the boundaries of the thoracic wall?
Anterior: sternum and costal cartilages
Lateral: ribs and intercostal contents
Posterior: vertebral column and posterior portions of ribs
What are the boundaries of the thoracic inlet and outlet?
Inlet: 1st thoracic vertebrae, 1st rib, manubrium of the sternum
Outlet: 12th thoracic vertebra, lowest ribs, costal cartilages, xiphoid process of sternum
What are the true ribs?
Ribs 1-7, costal cartilages articulate directly with the sternum
What are the false ribs?
Ribs 8-12, costal cartilages of 8,9 and 10 articulate with cartilage of rib above; 11 and 12 have no anterior articulation and are called "floating ribs"
What are the six parts of the typical rib?
1. Head (w/ articular facets that articulate with vertebral column)
2. Neck
3. Tubercle (articular facet articulates with transverse process of vertebrae)
4. Shaft
5. Angle - point of maximum curvature
6. Costal groove (at inferior border)
What is 'special' about the 1st rib?
"Superlative" rib, broadest, strongest, flattest, most curved, usually shortest, with ONE facet on the head
What is the 'uncertain rib'? Why is it called that?
The 10th rib - it may articulate with the 9th cartilage or remain free as a floating rib
What are the floating ribs? What do they have in common?
The 11th and 12th ribs; they don't have any anterior articulation.
Both only have one facet on the head, and have no neck or tubercle
The 12th lacks an angle or costal groove.
What innervates the intercostal muscles?
The intercostal nerves
How are neurovascular bundles arranged on the inferior borders of the ribs?
(From superior to inferior)
VAN - Vein, Artery, Nerve
What arteries supply the thoracic wall?
Posterior intercostal and anterior intercostal arteries
What artery supplies the upper two intercostal spaces?
Posterior intercostal artery; branches from the highest intercostal artery, which is a branch of the costocervical trunk of the subclavian artery.
What arteries supply the intercostals (below the first two)?
Branches from the thoracic aorta and the anterior intercostal artery (from the internal thoracic branch of the subclavian artery)
Where is the anterior intercostal artery located?
It circles the thoracic cage in the intercostal spaces
What veins drain the intercostal muscles?
1. The azygos (drains right side intercostals) and hemiazygos (drains left side intercostals - may be absent - drains into azygos)
2. Anterior intercostal vein - drains into the internal thoracic vein (accompanies internal thoracic artery)
What are the intercostal nerves?
Ventral primary rami of thoracic spinal nerves (associated with blood vessels)
Where does the subcostal nerve originate?
From the 12th thoracic spinal nerves
What is the region between the left and right pleural cavities in the thorax?
The mediastinum
Where are the plural cavities located and what fills them?
There is a left and right plural cavity, and they are located between the visceral pleural lining and parietal pleural lining. The space is filled with serous fluid.
What is a hemothorax? A pneumothorax?
Both can be caused by blunt trauma to the chest.

In a hemothorax, blood enters the pleural cavity. In a pneumothorax, air enters the pleural cavity.
What is the difference between visceral and parietal pleura?
Visceral pleura dips into fissures and adheres to the lung. Parietal pleura lines the interior wall and is divided according to location.
What are the four divisions of the parietal pleura?
1. Mediastinal (next to the pericardium)
2. Costal (next to the costal cartilages)
3. Diaphragmatic (superior surface of the diaphragm)
4. Dome/cervical (apex of the lung)
What are the functional compartments for gas exchange?
Primary bronchi divide into _______ and then to smaller _________.
Bronchi; bronchioles
What are the four sections of the lung?
1. Apex - near the clavicle/cervical region (penetrating trauma above clavicle could puncture the apex)
2. Base (right above the diaphragm)
3. Right lung (3 lobes); left lung (2 lobes)
4. Root/hilus
In the respiratory tract, what is the first place with no cartilage in the walls of the tube?
What is the basic air pathway (four components)?
Bronchus to bronchioles to alveolar ducts to alveolar sacs
What are the six components of the hilus of the lung?
1. Primary bronchus
2. Pulmonary artery
3. Pulmonary veins
4. Bronchial arteries and veins
5. Lymph vessels and nodes
6. Branches of vagus nerve and sympathetic trunk
What do the pulmonary artery and veins do?
The pulmonary artery is located above the bronchus and carries deoxygenated blood to the lungs.
The pulmonary veins are generally located below the bronchus and they carry oxygenated blood from the lungs to the heart.
When foreign bodies are aspirated, which of the primary bronchi is most likely to be obstructed?
The right bronchi, because it is more of a "straight shot" from the pharynx.
What do the bronchial arteries (sup.) and veins (inf.) do?
The bronchial arteries and veins bring oxygenated blood to and drain blood from lung tissue (respectively).
Of the contents of the lung hilum, what is blackened by air pollutants (not necessarily smoking)?
Lymph nodes
What are the boundaries of the imaginary plane between the superior and anterior/middle/posterior sections of the mediastinum?
The plane is between the sternal angle and the disc between the 4th and 5th thoracic vertebrae.
What are the four divisions of the mediastinum?
1. Superior (toward the thoracic inlet)
2. Anterior
3. Middle (surrounded by pericardium)
4. Posterior
What region of the mediastinum contains the aortic arch, brachiocephalic veins, superior vena cava, vagus and phrenic nerves, esophagus, trachea, and thoracic duct?
The superior mediastinum
What are the three branches off the arch of the aorta (from right to left)?
Brachiocephalic artery, left common carotid artery, and left subclavian artery
What does the brachiocephalic artery branch into?
The right common carotid and right subclavian arteries
Where do the brachiocephalic veins drain into?
The superior vena cava
What is the vagus nerve? The phrenic nerve?
1. Vagus - parasympathetic nerve to viscera of thorax (heart and lungs) and abdomen
2. Innervates the diaphragm
What is the thoracic duct?
A large lymphatic vessel that typically goes to the left brachiocephalic vein
What makes up the anterior mediastinum?
Loose (areolar) connective tissue
What are the three components of the middle mediastinum?
Pericardium, heart, and phrenic nerves
What part of the medistinum includes the esophagus, descending aorta, vagus nerves, thoracic duct, and azygos and hemiazygous veins?
The posterior mediastinum
What do the azygous and hemiazygous veins do?
The azygous is located more to the right, draining the right intercostal muscles.
The hemiazygous may be absent, but if present, it is more to the left, draining the left intercostals, then emptying into the azygous.
How big (approximately) is a normal heart?
The size of a fist
Describe the heart in anatomical position.
The apex points down and to the left and the base points opposite.
The right heart is anterior, and the left heart is posterior.
What are the two layers of the pericardium?
The outer fibrous layer and inner serous layer (serous fluid deep to tissue - keeps the heart surrounded by fluid, keeping mechanical functions running smoothly)
How is mechanical activity divided in the heart?
Superiorly and inferiorly
True or false: The ventricles of the heart contract simultaneously.
What is the flow of blood through the heart (beginning in the sup/inf. vena cava)?
Right atrium --> right ventricle --> pulmonary trunk --> pulmonary arteries --> lungs --> pulmonary veins --> left atrium --> left ventricle --> aorta
True or false: The right ventricle has a thicker, more muscular wall than the left ventricle.
What are the five great vessels coming to/from the heart?
Superior vena cava, inferior vena cava, pulmonary veins (4), pulmonary artery, and the aorta
Which side of the heart has a higher oxygen content?
The left side of the heart
What valves are closed during ventricular systole?
Tricuspid (right) and bicuspid (left) valves (atrioventricular valves)
What valves are closed during ventricular diastole?
Pulmonary semilunar and aortic semilunar
Where are the bicuspid and tricuspid valves located?
Bicuspid (mitral)- between the left atrium and ventricle
Tricuspid - between the right atrium and ventricle
Where is the fossa ovalis located? What embryonic opening does it form from?
Located in the atrial septum; depression formed from the foramen ovale
What are the two parts of the ventricular septum? Which part is more likely to have a ventricular septum defect?
1. Muscular (inf.)
2. Membranous (sup.) - can have a ventricular septum defect if not fully formed
What is a ventricular septum defect?
The most common cardiac defect; the ventricular septum doesn't fully form, causing recirculation of oxygenated blood through the lungs = less blood to the periphery.
Often results in breathing problems during activity.
What are the trabeculae carnae?
Irregularities in the inner surface of both ventricles.
What are the papillary muscles? What do they do?
Fingerlike muscles in both ventricles that are attached to the AV valves by chordae tendineae.
These muscles keep the AV valves closed during contraction (systole). They do NOT open the valves.
Where are the pectinate muscles located?
In the right inner atrial wall.
Where is the SA node located? The AV node?
SA node: wall of right atrium
AV node: floor of right atrium
What is order of the conduction system of the heart?
Electrical pulse starts in the SA node, goes to the AV node, to the Bundle of His (splitting into left and right bundle branches), and to the Purkinje fibers
What is the pacemaker of the heart?
SA node
What innervates the conduction system of the heart (esp. SA node)?
The vagus (parasympathetic) and sympathetic nerves
What do parasympathetic and sympathetic innervation do to heart rate?
Parasympathetic: decreases heart rate
Sympathetic: increases heart rate
Where are the following conduction components located in the heart:
-Bundle of His
-Left and right bundle fibers
-Purkinje fibers
1. Bundle of His: in the membraneous ventricular septum
2. Left and right bundle fibers: go through muscular septum to walls of ventricles
3. Purkinje fibers: between ventricular muscle cells
What two cardiac vessels branch from the left coronary artery? What do they supply?
1. Circumflex artery: supplies left atrium and ventricle
2. Anterior descending: interventricular; between ventricles - supplies both
What two cardiac vessels branch from the right coronary artery? What do they supply?
**smaller vessels off the right coronary artery supply the right atrium**

1. Marginal artery: down the right margin of the heart; supplies the right ventricle
2. Posterior descending artery: between ventricles; supplies both
What are the cardiac veins?
1. Great cardiac vein (anterior)
2. Middle cardiac vein (posterior)
**both are next to interventricular arteries**
Where do the cardiac veins drain to?
They drain into the coronary sinus (between the left atrium and ventricle), then the sinus empties blood into the right atrium.
What do the following embryonic circulatory structures become after birth?
1. Umbilical artery
2. Umbilical vein
3. Ductus venosus
4. Ductus arteriosus
1. Umbilical artery --> medial umbilical ligament
2. Umbilical vein --> ligamentum teres hepatis
3. Ductus venosus --> ligamentum venosum
4. Ductus arteriosus --> ligamentum arteriosum
Describe embryonic circulation.
-Fetal blood is oxygenated at the placenta, and the oxygenated blood re-enters the umbilical vein.
-The umbilical vein is shunted through the liver through the ductus venosus into the inferior vena cava.
-Oxygenated blood is pressurized and tends to pass from the right atrium to the left atrium via the foramen ovale. This is technically a lung bypass - fetal lungs are non-functioning.
-Some blood does go to the lungs, but blood from the pulmonary trunk goes through the ductus arteriosus to the aorta.
Describe the transformation from fetal to infant circulation (after birth).
-Smooth muscle in the umbilical arteries constrict (becomes the ligamentum teres), and blood is drained through the umbilical vein to the ductus venosus.
-As the the structures drain, they close and become ligaments.
-The ductus arteriosus constricts and becomes the ligamentum arteriosus (between the pulmonary arteries and the aorta) = lung bypass closes, so blood begins to fill the lungs.
-More blood in the left atrium, and the pressure from the increased volume closes the foramen ovale.
What happens if the foramen ovale doesn't close completely?
Can have right to left shunting of blood. This results in poor oxygenation (cyanotic) and usually requires surgery to repair.
What coronary vessel is most often blocked?
The anterior descending artery ("Artery of Death")
What happens in coronary artery disease?
Coronary arteries become blocked (ex: with plaque - atherosclerosis). As a result, the heart becomes ischemic = myocardial infarction.