Mediastinum, Pericardium & Heart Published on August 30, 2020 by ehudspeth Mediastinum, Pericardium & Heart Which of the following correctly identifies the following structures in the correct order? Aortic bulb, left ventricle, right atrium, superior vena cava, main pulmonary artery Aortic bulb, right ventricle, right atrium, superior vena cava, main pulmonary artery Main pulmonary artery, left ventricle, right atrium, superior vena cava, aortic bulb Aortic bulb, left ventricle, left atrium, superior vena cava, main pulmonary artery Aortic bulb, right ventricle, left atrium, inferior vena cava, main pulmonary artery A 24 y/o male was in a car accident and was unfortunately pronounced dead on scene. Autopsy reveals a compression fracture damaging spinal nerves C3, C4, & C5. Which of the following nerves were most likely responsible for the cause of death? Phrenic nerve Vagus nerve Recurrent laryngeal nerves Lower intercostal nerves Sphlantic nerves While dissecting the posterior mediastinum, you find a structure on the anterior surface of the vertebral bodies between the thoracic aorta and the azygos being, running superiorly and inferiorly. What was the most likely structure found. Accessory hemiazygos vein Esophagus Hemiazygos vein Thoracic duct Trachea The following picture shows a CT image at the level of the superior mediastinum. Which of the following correctly labels #4? Left subclavian artery Left common carotid artery Brachiocephalic trunk Trachea Right subclavian artery A 78-year old patient presents with an advanced cancer in the posterior mediastinum. The surgeons are in a dilemma as to how to manage the condition. Which of the following structures is most likely damaged? Arch of the aorta Arch of the azygos vein Brachiocephalic veins Hemiazygos vein Trachea The presence of a retrosternal goiter is an indication for which of the following mediastinal lesions? Thymus Thyroid Thoracic aorta Terrible lymphoma Trachea Teratoma and germ cell tumors Ebstein’s anomaly, a rare congenital defect, which may lead to enlargement of the heart or even heart failure. Which of the following defects would cause this disorder? Displacement of the tricuspid valve toward the apex of the heart Displacement of the mitral valve toward the apex of the heart Incomplete fusion of the foramen ovale during fetal development Enlargement of the left ventricle Weakening of papillary muscles that control blood flow through the heart Where is the ideal location to auscultate the mitral valve? Right 5th intercostal space, 7-9 cm from the midline Left 3rd intercostal space, 5-7 cm from the midline Left 5th intercostal space, 7-9 cm from the midline 8th intercostal space, at the midline Right 3rd intercostal space, 5-7 cm from the midline The interventricular sulcus demarcates the boundary between the left and right ventricles. Which vessels can be found together along the posterior interventricular sulcus? Posterior interventricular artery and the great cardiac vein Anterior interventricular vein and the circumflex coronary artery Great cardiac vein and the right marginal artery Middle cardiac vein and the right marginal artery Posterior interventricular artery and the middle cardiac vein Pacemaker cells are specialized cardiomyocytes that create electrical impulses (action potentials) within the heart. These pacemaker cells are connected to neighboring contractile cells, which enable them to locally depolarize adjacent cells. What structure is responsible for this communication between pacemaker cells and the nearby contractile cells? Zonula adherens Macula adherens Gap Junctions Zonula occludens Desmosomes Cardiac tamponade is a serious medical condition in which blood or fluids fill the pericardial cavity. This places extreme pressure on your heart. In these cases, pericardiocentesis must be performed to relieve the pressure. Which of the following is the correct location for where pericardiocentesis must be performed? 5th intercostal space right to the sternum 7th intercostal space left to the sternum 7th intercostal space right to the sternum 5th intercostal space left to the sternum 2nd intercostal space left to the sternum You are on rotations when an attending asks you if you would like to scrub in for surgery involved coronary artery bypass grafting. While in surgery, you ask the surgeon where the transverse pericardial sinus is located. But instead of telling you, the surgeon decides to showing you by slipping his index finger through the sinus. Which of the following best represents where the surgeon’s index finger is located? Posterior to the aorta/pulmonary trunk and anterior to the superior vena cava Posterior to the aorta, pulmonary trunk, and superior vena cava Anterior to aorta, pulmonary trunk, and superior vena cava Anterior to the aorta/pulmonary trunk and posterior to the superior vena cava Posterior to the superior vena cava/aorta, anterior to the pulmonary trunk Which of the following correctly lists the layers associated with the heart from most superficial to most deep? Fibrous pericardium → parietal pericardium → Endocardium → Myocardium → Epicardium Fibrous pericardium → parietal pericardium → Epicardium → Myocardium → Endocardium Parietal pericardium → Fibrous pericardium → Epicardium → Myocardium → Endocardium Parietal pericardium → Fibrous pericardium → Endocardium → Myocardium → Epicardium Myocardium → Fibrous pericardium → parietal pericardium → Epicardium → Endocardium Your patient who came in following a myocardial infarction has been scheduled for a triple coronary bypass surgery. Which three coronary arteries are being surgically altered in this procedure? Anterior interventricular branch, posterior interventricular branch, circumflex branch Circumflex branch, right coronary artery, left coronary artery Anterior interventricular branch, circumflex branch, right coronary artery Posterior interventricular branch, marginal artery, left coronary artery Anterior interventricular branch, left coronary artery, right coronary artery A baby was born with a congenital defect in which its foramen ovale was still open after birth. What defect would this be characterized as? Atrioventricular defect Ventricular septal defect Sinu-atrial defect Atrial septal defect Right marginal defect Your patient comes in with chest pain and there is cause that it may be a heart attack. What vein runs alongside the artery that is most likely to be occluded? Posterior cardiac vein Left marginal cardiac vein Middle cardiac vein Left posterior ventricular cardiac vein Great cardiac vein While performing a pericardiocentesis in your very first clinical rotation the attending ask you what an alternative approach would be to the procedure, rather than entering “through the 5th or 6th intercostal space, proximal to the sternum”. You respond by telling him which of the following? Enter at the infrasternal angle and pass the needle inferoposteriorly Enter the needle at the suprasternal notch and pass the needle superoposteriorly Enter the needle from the intervertebral space of T1-T2 passing the needle inferoanteriorly Enter at the infrasternal angle and pass the needle superoposteriorly There is no alternative approach Which of the following structures would you expect to find in the anterior mediastinum? Esophagus Trachea Thymus Remnants All of the above After an acute myocardial infarction some patients will develop a murmur that they didn’t previously have. Which of the following is a potential reason as to why this is? The myocardial infarction caused papillary muscle dysfunction The blood now pumps through the heart at a slower rate The myocardial infarction created a hole in the interventricular septum The dead tissue of the heart slows down the blood through the valves The valves have become paralyzed and remain open. Walter is in the ER with chest pain from a possible myocardial infarction and claims that he has shooting pains down his left arm. Which of the following explain this? The electrical impulses of the heart are firing rapidly causing pain to shoot along the pathway taken from the left ventricle which goes down the left arm The vagus nerve in the superior mediastinum is sending signals to the abdominal viscera which is causing a viscerosomatic pain as it passes the dermatome of the left arm The phrenic nerves in the middle mediastinum is sending signals to the diaphragm which is causing a viscerosomatic pain as it passes the dermatome of the left arm The splanchnic nerves in the posterior mediastinum is sending signals to the abdomen which is causing a viscerosomatic pain as it passes the dermatome of the left arm The electrical impulses are causing the vessels of the arm to constrict and blood pressure to increase. This causes pain as the blood rushes through the now narrower blood vessels. In which structure would you find deoxygenated blood from the entire body? Superior vena cava Inferior vena cava Coronary sinus Azygous vein Sinus of venarum In which layer of the heart is the conduction system? Epicardium Myocardium Endocardium Subendothelial connective tissue Subcardium A problem in the maturation of the pleuropericardial membrane is a defect that is not compatible with life. This is because the pleuropericardial membrane... Becomes the fibrous pericardium and without it, the heart would not stay in place Becomes the serous pericardium and without it, the heart would rub against the cavity wall Is involved in the formation of the divisions of the heart and without it, the heart would not be able to compartmentalize It is involved in the separation of heart from lungs and without it, neither one would be functioning It is involved in responsible for drainage of fluids around the heart and without it they would accumulate and have nowhere to go. A baby is born with patent fossa ovalis meaning that their fossa ovalis did not fully fuse. What problems would you expect this child to have if left untreated? They would not be able to efficiently pump blood throughout their body They would not be able to efficiently pump blood to their lungs They would not be able to perfuse their tissues efficiently They would have a mitral murmur They would have a tricuspid murmur The circumflex artery has an almost complete occlusion. Which of the following anastomoses ensures that the left atrium is still receiving adequate blood flow? Posterior Interventricular artery Anterior Interventricular artery Right coronary artery Left marginal artery Right marginal artery After running from a vicious chiwawa, which of the following is triggering your SA node to decrease your heart rate back to normal? Vagus nerve Neurons from the lateral horn of T1-T4 Preganglionic sympathetic fibers Left recurrent laryngeal nerve Cardiac plexus In the event of observing a bull charge towards you in a closed-off alleyway, you notice your heart rate has started to increase. Which of the following would you expect to be involved in signaling for this physiological event? The Vagus nerve The Accessory Nerve Preganglionic sympathetic fibers The Phrenic Nerve The Pelvic Splanchnic Chris is a patient of yours that has recently suffered from an aneurysm is his ascending aorta. Which of the following anatomical factors makes it more likely for a patient to have such an event? Serous pericardium covers the entire heart Fibrous pericardium reinforcement is only found on the surfaces of the heart Fibrous pericardium reinforcement doesn’t begin until the start of the aortic arch The endothelial lining of the distal ascending aorta sustains a great deal of thrust during each phase of diastole Which of the following is true regarding the thymus? It increases hormonal secretion at puberty It is located posterior to the great arteries of the heart It is located in the pericardium It is bilobar It is the place of maturation for B-cells Which of the following is the most anterior? Brachiocephalic trunk Left common carotid artery Left subclavian artery Left brachiocephalic vein Thymus While obtaining a history from a new patient of yours, you ask about any prior medical history. They state that they had an aortic coarctation 1 year earlier. What would be the most probable location of such pathology? At the start of the ascending aorta As the descending aorta bifurcates The likelihood of coarctation remains constant throughout the entire aorta The aortic root At the site of the ligamentum arteriosum Time is Up!