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Lungs & Heart

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jasuwojo's version from 2018-03-25 10:00

lungs

bronchial tree
Question Answer
name for collapsed lobeatelectatic lobe
sublaryngeal airway constitutestracheobronchial tree
trachea bifurcates at the level of ________ into what?TTP (transthoracic plane) --> R & L main (primary) bronchi
which main bronchus is shorter & wider?right
which main bronchus is more vertical?right
the left main bronchus passes inferior toarch of aorta
the left main bronchus passes anterior toesophagus & descending aorta
midline cartilaginous ridge separating lumens of primary bronchicarina
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anatomical features of the lungs
Question Answer
lungs are inside what cavity?pulmonary cavities
- pleural cavities do NOT contain the lungs (they surround)
apex of lungssuperior, blunt ends
- extend above 1st rib
3 surfaces of lung- costal
- mediastinal
- diaphragmatic
apex of the lung is post/anterior to the subclavian arteriesposterior
how might pathology of the lung affect the arm?presses on brachial plexus
R lung has ___ lobes3 (sup, mid, inf)
L lung has ___ lobes2 (sup, inf)
fissure(s) of R lungoblique
horizontal
fissure(s) of L lungoblique
where do vasculature & main bronchi enter lung?hilum
contents of hilumprimary bronchus
pulmonary a.
pulmonary v.
bronchial a.a.
in the R hilum, pulmonary a. is _________ to main bronchusanterior
in the L hilum, pulmonary a. is _________ to main bronchussuperior
mnemonic for hilum contents orderRAiLS
R- pulm a. Anterior to bronchus
L- pulm a. Superior to bronchus
groove for esophagus is posterior to ____ hilumright
groove for aorta is posterior to ____ hilumleft
groove (ant/post) to R hilumposterior, groove for esophagus
groove (ant/post) to L hilumposterior, groove for aorta
foreign bodies more frequently pass into the _____ bronchus becauseright, it's wider, shorter, and more vertical
____ lobe(s) of ____ lung are most frequently involved in obstruction by foreign bodiesmiddle & inferior of R lung
where should you look for an aspirated object?RIGHT side (likely middle/inferior)
why do foreign objects affect the L lung less frequently?more horizontal bronchus (less likely to fall in)
collapsed lungatelectatic / nonaerated lung
what accompanies atelectatic lung?shift of mediastinum toward collapsed lung
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pulmonary & bronchial circulation
Question Answer
pulmonary arteries carry (de/oxygenated) blooddeoxygenated
pulmonary veins carry (de/oxygenated) bloodoxygenated
divisions of pulmonary arterieslobar arteries --> segmental arteries
function & general structure of pulmonary circulationfollows bronchi, oxygenates blood to be returned to heart
function & general structure of bronchial circulationembedded throughout lung
- supplies nutrition to supporting tissues of lung & visceral leura
bronchial arteries arise fromthoracic aorta
drainage of blood supplied to lungs by bronchial arteriesbronchial & pulmonary veins
how are pulmonary & bronchial arteries distinguished histologically?proximity to airway
what is a pulmonary embolism?embolus in pulmonary artery
- blood clot
- fat globule
- air bubble
PEs often come throughIVC (from lower extremity) through heart
immediate result of PEpartial / complete obstruction of blood flow to lung
when a large embolus occludes a PA, patient suffersacute respiratory distress (decrease in oxygenation of lung)
- fatal if not treated immediately
how do you treat PE?evacuating clot
medications to break up clot
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lymphatic drainage of the lung
Question Answer
tree of lymphatic drainage of lungpulmonary lymph nodes
-> hilar / bronchopulmonary nodes
---> tracheobronchial nodes
-----> bronchomediastinal / tracheal nodes
----->(unite with) parasternal nodes
-------> bronchomediastinal trunk -> subclavian veins
pulmonary lymph nodes drain intohilar / bronchopulmonary nodes
hilar nodes drain intotracheobronchial nodes
tracheobronchial nodes drain intobronchomediastinal / tracheal nodes
tracheal nodes unite withparasternal nodes
bronchomediastinal nodes are also calledtracheal nodes
bronchomediastinal nodes drain intobronchomediastinal trunk --> subclavian vein
nodes in the deepest part of lungpulmonary lymph nodes
nodes at the hilumbronchopulmonary nodes
nodes along main bronchitracheobronchial nodes
nodes along tracheabronchomediastinal nodes
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innervation of the lungs
Question Answer
innervation the lungs is para/sympatheticboth
GVA & GVE innervation to the lungs are carried by branches from ____ & ____thoracic sympathetic chain
CNX (vagus n.)
sympathetic GVEs mediate what fxn in lungs?-vasoconstriction
- bronchiole DILATION
parasympathetic GVEs mediate what fxn in lungs?- bronchiole CONSTRICTION
parasympathetic GVE to the lungs is carried byvagus nerve (CN X)
sympathetic GVE to the lungs is carried byL & R sympathetic chains
nerve plexuses associated with lungA & P pulmonary plexuses
where are the A & P pulmonary plexuses?anterior & posterior aspects of main stem bronchi on each side
parasympathetic GVA from the lungs is carried by vagus nerve (CN X)
fxn of parasympathetic GVA from lungsrespiratory reflex afferents
where are pressure & chemical receptors?- carotid & aortic bodies & sinuses
pressure/ chemical sensation is carried by- glossopharyngeal (CN IX)
- vagus (CN X)
memorize

heart

orientation of the heart in situ
Question Answer
____ of the heart is to the R of midline1/3
____ of the heart is to the L of midline2/3
acute border is akaright broder
the right border is formed by- SVC
- right atrium
- IVC
apex points ant/posteriorlyanteriorly
what is the apex?tip of L ventricle
obtuse border is akaleft border
the left border is formed byleft ventricle
the inferior border is formed byright ventricle
atria are (A/P) to ventriclesposterior
ventricles are (A/P) to atrialanterior
right ventricle is (A/P) to leftanterior
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pericardium
Question Answer
outer layer of pericardiumfibrous pericardium (single layer)
inner layer of pericardiumserous sac
- parietal layer
- visceral layer
function of serous pericardiumsac to lubricate mvmt of heart
pericardial sinuses develop as a consequence offolding of primordial heart
--> reflections of serous pericardium
2 pericardial sinuses- transverse pericardial sinus
- oblique pericardial sinus
transverse pericardial sinus lies posterior tointrapericardial parts of
- pulmonary trunk
- ascending aorta
transverse pericardial sinus lies anterior toSVC
transverse pericardial sinus lies superior toatria of heart
transverse pericardial sinus lies _________ to SVCanterior
transverse pericardial sinus lies _________ to atriasuperior
transverse pericardial sinus lies _________ to pulmonary trunkposterior
transverse pericardial sinus lies _________ to ascending aortaposterior
oblique pericardial sinus is in the pericardial cavity ______ to heartposterior
how do you find the transverse pericardial sinus?- open pericardial sac anteriorly
- pass finger/probe through trans. pericard. sinus
---- posterior to aorta & puomonary trunk
surgical significance of transverse pericardial sinus through sinus, can
- pass clamp or ligature around aorta & pulmonary trunk
--- divert circulation
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anatomical features of the heart
Question Answer
tricuspid valve is betweenR atrium & R ventricle
valve between R atrium & R ventricletricuspid
structure of tricuspid valve3 leaves
pulmonary valve is betweenR ventricle & pulmonary artery
valve between R ventricle & pulmonary arterypulmonary valve
structure of pulmonary valvetricuspid (3 leaves)
cusps of pulmonary valveR, L, A
pulmonary valve is also calledpulmonary semilunar valve
mitral valve is betweenL atrium & L ventricle
valve between L atrium & L ventriclemitral
structure of mitral valvebicuspid (2 leaves)
mitral valve is also calledbicuspid
aortic valve is betweenL ventricle & aorta
valve between L ventricle & aortaaortic
aortic valve is also calledaortic semilunar valve
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Question Answer
tricuspid valve sounds project to- midline
- L side of sternum @ 5th intercostal space
what valve has site of auscultation closest to midlinetricuspid
what valve has site of auscultation at the L side of the sternum @ 5th intercostal spacetricuspid
mitral valve sounds project to- apex of heart
- 5th intercostal space below L nipple
what valve has site of auscultation at the apex of the heartmitral valve
what valve has site of auscultation at the 5th intercostal space below the L nipplemitral
aortic semilunar valve sounds project to- R of sternum @ 2nd intercostal space
- neck over carotid artery
what valve has site of auscultation to the R of the sternum @ 2nd intercostal spaceaortic semiliunar
what valve has site of auscultation on the neck over the carotid arteryaortic semilunar
pulmonary semilunar valve sounds project to- L of sternum @ 2nd intercostal space
what valve has site of auscultation to the L of the sternum @ 2nd intercostal spacepulmonary semilunar
ductus arteriosus murmur can be auscultated- just lateral to semilunar valve sound
--- L of sternum @ 2nd intercostal space
what is the ductus arteriosus?only in developing fetus (aka ductus Botalli)
- blood vessel connecting pulmonary artery & descending aorta
where are pectinate muscles found in the R atrium?anterior wall
anterior wall of R atrium structurepectinate muscles
posterior wall of R atrium structuresmooth
what is the crista terminalis?ridge between smooth & muscular portions of R/L atrium
where is the opening of coronary sinus?R atrium
fossa ovalis is a remnant offoramen ovale
fxn of auriclesusually closed
- can increase capacity of atria
what vessels drain to the R atriumS & IVC
what connects tricuspid/mitral valves to papillary muscles?chordae tendinae
papillary muscles contract to tightenchordae tendinae
papillary muscles contract when?just before ventricles contract
fxn of papillary musclespull on chordae tendinae to hold valve closed (so blood doesn't flow back)
do papillary muscles close valves?NO, help hold closed though
where are trabecular carneae found?"meaty ridges"
- inner R/L ventricle -->
where are pectinate muscles found?R atrium
R&L auricles
where are papillary muscles found?R & L ventricles
papillary muscles are a subset oftrabecular carneae
where is the moderator band found?R ventricle (base of papillary muscle --> ventricular septum)
another name for moderator bandseptomarginal trabecula
fxn of moderator band?carries R bundle branch of AV bundle --> anterior papillary muscle
papillary muscles contract (before/after) ventricles contractms before
coronary sinus opening is found in (R/L/both) atrium(a)R only
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innervation of the heart
Question Answer
heart rate & ejection volume are controlled by ______ via ______autonomic NS
via cardiac plexus
parasympathetic division (accelerates/slows) heartslows
parasympathetic division (increases/reduces) stroke volumereduces
parasympathetic nerve to the heartvagus (CN X)
vagus nerve carries _____ fibers to heartparasympathetic
pathway of parasympathetic fibersvagus nerve --> surface of heart, nodal areas
*synapse*
postganglionic fibers --> myocardium
origin of sympathetic preganglionic fibersthoracic spinal cord (lateral horn)
sympathetic division (accelerates/slows) heartaccelerates
sympathetic division (increases/reduces) stroke volumeincreases
pathway of sympathetic fiberslateral horn (thoracic SC) --> upper sympathetic chain ganglia
*synapse*
postganglionic fibers --> SA / AV nodes of heart & ventricular muscles
which node is the "pacemaker"SA
which nerves innervate ventricular muscles?postganglionic sympathetic
GVAs run along (para/sympathetic) pathways to the spinal cordsympathetic
pain originating from the heart is usually referred to- L arm/ shoulder
- precordium
(- R arm)
(- back)
(- lower chest)
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cardiopulmonary cycle
Question Answer
deoxygenated blood entersR atrium
deoxygenated blood is carried into the heart viasuperior & inferior vena cava
oxygenated blood exitsL ventricle
thickest wall of heartL ventricle
pathway of bloodbody ----SVC & IVC--->
RA ---tricuspid valve--->
RV --pulmonary valve-->
pulm aa. -->
lungs -->
pulmonary veins --->
LA ---mitral valve-->
LV ---aortic valve---> aorta -> body
stab wounds that puncture the heart & cause blood to enter the pericardial cavity causehemopericardium
-- cardiac tamponade
what is cardiac tamponade?blood accumulates in pericardial sac
- ventricles can't fill
- contraction compromised
why do veins of face become engorged in cardiac tamponade?accumulation of blood in SVC impedes return of blood from head
treatment for tamponadepericardiocentesis
- remove blood from pericardial cavity
how is a pericardiocentesis done?large needle into L 5/6 intercostal space
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coronary circulation
Question Answer
pathway of R coronary circulationaorta

-> sinoatrial nodal a.
-> R marginal a.
-> posterior interventricular a.
pathway of L coronary circulatoinaorta

-> anterior interventricular (LAD)
-> circumflex a.
coronary arteries branch fromfirst branches of ascending aorta
another name for anterior interventricular arteryL anterior descending a. (LAD)
another name for LADanterior interventricular
course of R coronary arterybetween R atrium & R ventricle
course of marginal branch of R coronary arteryalong inferior margin of R ventricle
course of sinoatrial nodebranches first off R coronary artery --> SA node
course of L coronary arterybetween L auricle & L ventricle behind pulmonary trunk
course of anterior interventricular branch of L coronary arterybetween R & L ventricles
course of circumflex branch of L coronary arterybetween L auricle & L ventricle
great cardiac vein runs withanterior interventricular artery
middle cardiac vein runs withposterior interventricular artery
small cardiac vein runs withright marginal artery
right atrium directly receivesanterior cardiac veins
anterior interventricular artery runs with what vein?great cardiac vein
posterior interventricular artery runs with what vein?middle cardiac vein
right marginal artery runs with what vein?small cardiac vein
all coronary veins drain intocoronary sinus --> R atrium
what is CABG?coronary artery bypass graft
- part of coronary artery bypassed by putting vessel between aorta & distal portion of blocked artery
why might someone get a CABG?restore blood flow if stenosis/disease of coronary artery
what vein from the leg is used in CABG?saphenous
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