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Heart
Sympathetic
Symp. Function
VASOCONSTRICTION, SECRETOMOTOR
ACTIVITY OF BRONCHIAL GLANDS
Parasympathetic
VAGUS N.
Parasymp. Function
Lymphatic Drainage
AXILLARY NODES
PARASTERNAL NODES
SUPRACLAVICULAR NODES
CONTRALAT. BREAST / ANT. ABDOMINAL WALL
Nodal Drainage
BRONCHOMEDIASTINAL
HILAR
PRE-AORTIC
PARA-AORTIC
PARASTERNAL
6. MUSCLES OF RESPIRATION
Complete the following table:
Type of breathing
Muscles responsible
Relaxed Inspiration
Relaxed Expiration
Forced Inspiration
Forced Expiration
TRANSVERSE THORACIC
Pump-handle effect
ANTERIOR-POSTERIOR
Rotation effect
TRANSVERSE THORACIC
The bucket-handle effect is due to elevation of the ribs as they rotate upwards in
inspiration. The pump-handle effect is due to elevation of the sternum as a result of
upward rotation of the crossed axes. The rotation effect is due to rotation of the ribs
(which are concave on their interior surface) on inspiration.
8. BREATHING DIFFICULTIES
Why is breathing more difficult for the elderly? How do they (and children) compensate for
this?
Calcification of costal cartilages reduced thoracic compliance.
Both elderly and children tend to breathe diaphragmatically (vs. costal breathing).
What type of breathing do obese people favor and why?
Obese people, persons wearing girdles or corsets, and women in advanced
pregnancy cannot effectively contract the diaphragm and therefore favor costal
ventilation.
If a patient is bed ridden and having difficulties breathing, name one simple, non-invasive
procedure you could perform to help. Why is this procedure so successful?
Sit her up in bed. Gravity will pull down on abdominal organs, decreasing resistance
on diaphragm.
9. PLEURAL RECESSES
What are pleural recesses and name the two of them?
Potential spaces between the parietal and visceral pleura filled by a thin layer of fluid.
Costomediastinal and L&R costodiaphragmatic.
What might you find in them in a pathological situation?
Air (pneumothorax), Blood (hemothorax), Lymph (chylothorax), Pus (pylothorax)
Where do you tap a patient with hemothorax to sample the fluid and why?
Posterior to midaxillary line above ICS 9 (to avoid liver) but 1-2 ICSs below fluid level
and just above superior surface of rib (to avoid neurovascular bundle).
Complete the following table:
Type of
Symptoms
pneumothorax
Consequences
Sucking
Mediastinal
flutter
Tension
Mediastinal shift
Movement (Y/N)
Examples
Synarthrosis
No
Amphiarthrosis
Yes (limited)
Diarthrosis
Yes (free)
Location
Aortic
Aorta
Thoracic duct
Azygos vein
Esophageal
Esophagus
Left & right vagus nerves
Caval
13.
CARDIAC CYCLE
Shunts blood
to:
Umbilical Veins
MOTHER VIA
UMBILICUS
Ductus Venosus
Foramen Ovale
Ductus
Arteriosus
Umbilical
Arteries
UMBILICAL VEIN
R. ATRIUM
PORTAL V./
DUCTUS
VENOSUS
INF. VENA CAVA
L. ATRIUM
L. PULMONARY
ARTERY
AORTA
L/R INTERNAL
ILIAC ARTERIES
MOTHER VIA
UMBILICAL
ARTERIES
Vascular Pathology
Sequelae
PULMONARY EMBOLISM
SYSTEMIC, CEREBRAL
EMBOLISM
Small VSD
INCOMPLETE INTERVENTRICULAR
SEPTUM
INCOMPLETE INTERVENTRICULAR
SEPTUM AND PULMONARY
ARTERY STENOSIS
A. VSD ALLOWS
INTERVENTRICULAR
COMMUNICATION
B. PRESSURE IN LV
TRANSMITTED TO RV CAUSING
RV HYPERTROPHY
C. HYPERTROPHY OF
SUPRAVENTRICULAR CREST
CAUSES PULM. STENOSIS AND
FORCES BLOOD THROUGH TO
THE LV
VSD w/ pulmonary
artery stenosis
Ventricular
Septal
Tetralogy of Fallot
ASYMPTOMATIC: LR
SHUNT B/C L ATRIAL
PRESSURE > R ATRIAL
PRESSURE
ASYMPTOMATIC LR
SHUNT
RL SHUNT LEADING TO
CYANOSIS
THE FUNCTIONAL
OCCLUSION OF THE
PULMONARY OUTFLOW
TRACT FORCES A RL
SHUNT SENDING
DEOXYGENATED BLOOD
TO THE LV AND THEN
INTO THE AORTA.
Pitch
Atrioventricular
INSUFFICIENCY
SYSTOLIC MURMUR
LOW PITCHED
Atrioventricular
STENOSIS
DIASTOLIC MURMUR
Semilunar
INSUFFICIENCY
DIASTOLIC MURMUR
Semilunar
STENOSIS
SYSTOLIC MURMUR
HIGH PITCHED
Arterial Supply
RCA gives off posterior descending
branch, supplying the septum but not
significantly supplying the left ventricle.
Circumflex artery gives rise to the posterior
descending branch, so that both arteries
supplying the septum arise from the same
stem lower chance of survial w/infarct
RCA reaches into typical distribution of the
circumflex artery, supplying a substantial
portion of the left ventricle.
T4