Atherosclerosis

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What are the three layers of a vessel?: Inside layer = intima Middle layer = media (smooth muscle) Outside layer = Adventitia
What are the "glue" sheets that separate/border the layers: Innermost = endothelium (divides lumen and intima) Internal Elastic Lamina (divides intima and media) External Elastic Lamina (divides media and adventitia)
What are the "windows" in the external elastic lamina called?: Fenestrae
What are 6 main arteries that are affected by atherosclerosis?: 1) Mesenteric 2) Iliac 3) Cerebral 4) Carotid 5) Coronary 6) Aorta
What things are in the fibrous cap?: -Smooth muscle cells -Macrophages -Foam Cells -Lymphocytes -Collagen -Elastin -Proteogrlycans -Neovascularization
What things are in the necrotic center?: -Cell Debris -Cholesterol crystals -Foam cells (these are in both) -Calcium *IN THE NECROTIC CENTER, YOU HAVE DEBRIS (NOT THINGS IN A LIVING ORGANISM
Progression of lesions: Initial Lesion > Intermediate Lesion > Complicated Lesion *FATTY STREAK separates initial and intermediate lesion *ATHEROMA (formation of plaque) and FIBROATHEROMA (deposition of fibrous tissue inside that plaque) separate Intermediate and Complicated lesion
Heat (calor) is caused by: -increased blood flow -elevated cellular metabolism at the site
Redness (rubor) is caused by: -Vasodilation -Increased Blood Flow
Swelling (tumor) is caused by: -vasodilation -cellular influx (chemotaxis) -Elevated cellular metabolism
Pain (dolor) is caused by: -release of soluble mediators -cellular influx (chemotaxis) -elevated cellular metabolism
What is the thorax?: The superior portion of the trunk
What does costal relate to?: The ribs
What is the first portion of the sternum called?: The manubrium
What is the junction of the manubrium and the sternal body called?: The sternal angle
What is the third part of the sternum called?: The xiphoid process
What rib number connects at sternal angle?: 2nd rib
What is the name of this artificial line at the sternal angle and what are the two reasons it is significant?: Transthoracic plane -It is the point where the trachea bifurcates -It is the undersurface of the aortic arch
Where are the breasts usually located with respect to the intercostal spaces?: 4th intercostal space
What numbered ribs are "true" ribs?: 1-7
What numbered ribs are "false" ribs?: 8, 9, 10
What ribs are "floating ribs"?: 11, 12
What is the costochondral joint?: "fake joint"; really just a transition from bone to cartilage on a rib
What is the sternocostal joint?: "true joint"; connects cartilage on rib to sternum
What part of the sternum gets really stiff on old people? What organ do you have to worry about damaging during chest compressions on old people?: xiphoid process; the liver
What makes up the Superior thoracic aperature (aka thoracic inlet)?: T1 vertebra (back), manubrium (front) and first ribs (NOT clavical)
What makes up the Inferior thoracic aperature (aka thoracic outlet)?: T12 vertebra (hence, the rib cage takes up the entire thorax), 11th and 12th ribs (back), costal margin (front), xiphoid-sternum joint (front)
What is the costotransverse joint?: connects rib to transverse process of the spine
The head of EACH ribis anchored to what 3 things?: 2 vertebra and the intervertebral disc
What is the costovertebral joint?: connects rib to 2 vertebra and the intervertebral disc in between them
The tubercle contains an articular part which connects to the (?) and a nonarticular part which connects to the (?): articular part connects with the transverse process of the vertebra nonarticular part connects with the muscles of the back
What is the costal groove?: It's the internal indent at the bottom of each rib where the intercostal vein artery and nerve (VAN) go
Even though ribs seem fairly fixed, what are the four joints that each rib has?: Costochondral Joint Sternocostal Joint Costotransverse Joint Costovertebral Joint
How is quiet expiration passive?: it is powered by the recoil of the elastic fibers in the lungs
What is different about active expiration?: the abdominals contract to help force air out ex: coughing
What happens in emphysema?: The elastic fibers are destroyed (patient can't passively exhale), so the patient has to work much harder and use their abdominal muscles to push up their diaphragm
What is the pigmented skin around the nipple called?: Areola
What kind of glands does the aerola have?: Sebaceous glands (like arial and sebastian from the little mermaid)
What kind of ducts produce the milk from little openings in the nipple?: lactiferous ducts
Where is the greatest amount of mammary tissue and duct tissue in the breast?: In the superior lateral quadrant that contains the axillary tail
Alveolar glands produce milk > Lactiferous ducts > lactiferous sinus (single serving storage dilation just before the nipple) >: ...
Suspensory ligaments are continuations of connective tissue septa and anchor the breast to (?) but NOT (?): Anchors breast to skin but not underlying muscle
Where do plastic surgeons put saline bag to enlarge breasts?: retromammary space
The xyphoid process is actually made out of...?: cartilage
External intercostal muscles do what to the ribs?: Elevate ribs and help in active inspiration
Innermost and subcostal muscles (muscles located on the inside of the BACK of the rib cage; these "jump" ribs and connect adjacent, or even further than adjacent ribs) do what to the ribs?: Lower ribs and help with active expiration (along with abdominal muscles)
What ribs are about equal with the top and bottom of the main sternal body?: rib 2 at top and rib 6 at bottom
What does pneumothorax mean?: Air in the pleural cavity (causes lung to collapse)
What does hemothorax mean?: Blood in the pleural cavity
What does chylothorax mean?: lymph in pleura cavity
What does pleuritis mean?: Inflammed pleura (may produce enough pleural effusion to collapse a lung)
The developing airway extends down into the chest cavity, which is continuous with the abdomen at that point and is referred to as...: pericardio-peritoneal canal
The pericardio-peritoneal canal gives rise to...: the pleural cavities
What gives rise to the visceral pleura? What gives rise to the parietal pleura?: The visceral pleura comes from SPLANCHNIC mesoderm The parietal pleura comes from SOMATIC mesoderm (which is associated with the body wall)
What is your mneumonic for remembering the 4 maturation phases of the lungs?: Sue Can Terminate All -pseudoglandular -canalicular -terminal sac -alveolar
What are the different weeks that each phase spands?: pseudoglandular 6-16 canalicular 16-26 terminal sac 26-birth alveolar sac 32-8 years old *note: the first three are perfectly adjacent (don't overlap); only the 3rd and 4th overlap
When is surfactant produced in significant quantities?: Terminal Sac period
Which stage continues after birth?: Alveolar stage
Congenital lung cyst: -caused by a blockage of an airway -air or fluid filled cyst -usually on visceral surface of lung
Lung agenesis: -developmental signals that normally direct buds to grow into the chest aren't present -bronchial buds don't grow into splanchnic mesoderm in chest -it's possible for an infant to survive with only 1 lung
Lung hypoplasia: -problem with diaphragm forming properly, resulting in abdominal contents squirting into the thoracic area -usually FATAL!
Respiratory Distress Syndrome = Hyaline Membrane Disease: *called hyaline membrane disease because protein from blood is present in large doses in the membrane of the alveoli and it can be seen on x-ray or histology etc. -MOST PREVALENT neonatal disease -30% of all neonatal diseases -INSUFFICIENT SURFACTANT in lumen of alveoli and alveoli collapse during expiration (atelectasis) -Physical stress of alveoli opening and closing causes capillaries to become leaky and plasma in blood leaks into the lumen of the alveoli -RBCs in the walls of the alveoli
If the physician thinks the infant will be born prematurely, they can sample the amniotic fluid and look at the phospholipid levels: If the Lectin/Sphingomyelin (L/S ratio) is under 1.5, it means there is not enough surfactant present
What are the two ways to treat RDS?: 1) Treat mother with betamethason (steroid) and thyroid hormone (stimulates the maturation of the type II pneumocytes) 2) Postnatal Treatments -Exogenous surfactant (genetically engineered human or cow surfactant) -Continuous Positive Airway Pressure (CPAP): respirator that maintains postiive airway pressure; the lungs never have a chance to collapse; oxygen is continually circulated Complications: -Pneumothorax (if you don't have the airpressure just right, the lungs will tear and collapse) -Intraventricular Hemmorage (lack of oxygen to brain causes bleeding into the ventricles)
What vertebra are aligned with the sternal angle?: In between vertebra 4 and 5 divides the mediastinum into superior and inferior
What is pericardiocentesis?: when you have a trauma and start bleeding inside the pericardial sac and it starts compressing the heart (makes heart unable to expand, so it won't be able to push the blood) -Doctors treat this by draining blood with a needle (when the signals of the electrocardiogram invert, you know the needle is in the right place)
What is the subepicardium?: Space internal to the Epicardium (aka the visceral pleura). In between the epicardium and the myocardium
What is the most inner layer of the heart?: The endocardium (the SUBendocardium is kind of a misnomer, because it is actually more external than the endocardium)
Where do myocardial infarctions start?: In the subendocardium
What intercostal spaces are the boundaries of the heart?: 2nd intercostal space and 5th intercostal space (the apex of the heart is perfectly aligned with the midclavicular line)
Important Right Atrium Components: 1) Fossa Ovalis (a depression that used to be the communication between right and left atrium during development) 2) Limbus of Fossa Ovalis (the edge around the depression) 3) Crista Terminalis 4) Musculi Pectinati (tooth of comb) 5) valve of coronary sinus
Important Right Ventricle Components: Triscupid Valve (anterior cusp, septal cusp, posterior cusp) is anchored in wall and papillary muscle Conus Arteriosus Septal Papillary Muscle (where contraction starts) Septomarginal trabecula (has part of conduction system running through it)
3 components of atrioventricular valves: 1) Fibrous Ring (parachute=valve) 2) Chordae Tendineae (cords of parachute) 3) Papillary Muscle ("human" in the parachute, keeps the cords stretched and the parachute open; prevents valves from opening in the wrong direction)
Trabeculae Carneae: The more of this you have, the less power you have, so the right ventricle has a lot more than the left ventricle
What is a major difference between the aortic valve and the pulmonary valve?: The aortic valve has coronary arteries that give blood to the heart when the heart is relaxed (diastole)
What are nodules? What are lunules?: Nodules are the tips of the valve like ends of an insect antenna Lunules are edges of the valves
Where do you put the stethoscope for aortic and pulmonary valve?: 2nd intercostal space (right below the sternal angle) on either side of the sternal body)
Where do you put the stethoscope for tricuspid and mitral valve?: 5th intercostal space -Tricuspid=right edge (from my perspective) of sternal body -Mitral=midclavicular line
Septomarginal Trabecula: The septomarginal trabecula (also known as moderator band) is a muscular band of heart tissue found in the right ventricle. It is well-marked in sheep and some other animals, and frequently extends from the base of the anterior papillary muscle to the ventricular septum. This septomarginal trabecula is important because it carries part of the right bundle branch of the AV bundle of the conduction system of the heart to the anterior papillary muscle. This shortcut across the chamber of the ventricle seems to facilitate conduction time, allowing coordinated contraction of the anterior papillary muscle; (see electrical conduction system of the heart).

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