university of michigan heart

the sternocostal surface of the heart is formed primarily by the anterior wall of which heart chamber

right ventricle

the diaphragmatic surface of the heart is

left ventricle

the pulmonary surface of the heart if

left ventricle

a patient involved in an automobile accident presents with a sharp object puncture of the middle of the sternum at about the level of the 4th or 5th costal cartilage, if the object also penetrated pericardium and heart wall, which heart chamber would most likely be punctured

right ventricle

the blockage of which artery would lead to ischemia of the apex of the heart

anterior interventricular

If the ductus arteriosus does not spontaneously close off soon after birth (to become the ligamentum arteriosum), it may have to be surgically ligated. When clamping or ligating it, what important structure immediately behind it must be identified and saved?

left recurrent laryngeal nerve

A hand slipped behind the heart at its apex can be extended upwards until stopped by a line of pericardial reflection that forms the:

oblique pericardial sinus

A stethoscope placed over the left second intercostal space just lateral to the sternum would be best positioned to detect sounds associated with which heart valve?

pulmonary

if you want to listen to the aortic valve where would you place your stethoscope

lateral to the sternal angle

if you want to listen to the mitral valve where would you place your stethoscope

left fifth intercostal space, 8cm away from midline

if you want to listen to the tricuspid valve where would you place your stethoscope

left fourth intercostal space, just lateral to the sternum

Which valves would be open during ventricular systole? what is closed?

aortic and pulmonary; the tricuspid and mitral valves

what chambers anterior wall forms most of the sternocostal surface of the heart

right ventricle

a 3rd-year medical student was doing her first physical exam. in order to properly place her stethoscope to listen to heart sounds, she palpated bony landmarks. She began at the jugular notch, then slid her fingers down to the sternal angle. At which rib (costal cartilage) level where her fingers?

second rib

what is ventricular diastole

when ventricles relax and fill with blood, the right atrioventricular/tricuspid valve is open

a 23-year-old male injured in an industrial explosion was found to have multiple small metal fragments in his thoracic cavity. since the pericardium was torn inferiorly, the surgeon began to explore for fragments in the pericardial sac. slipping her hand under the heart apex, she slid her fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. her fingertips were in ?

oblique sinus, is behind left atrium

An elderly lady suffers a coronary occlusion and subsequently it is noted that there is a complete heart block (that is, the right and left bundles of the conduction system have been damaged). The artery most likely involved is the:

anterior interventricular/ left anterior descending; the right and left bundles of conduction travel in the interventricular septum

during fetal life and sometimes persisting into the adult there is an opening between the left and right atria called

foramen ovale

the heart sound associated with the mitral valve is best heard

in the 5th left intercostal space

which heart valve has leaflets described as anterior, left and right

pulmonary

in preparation for thoracic surgery, a median sternal splitting procedure was carried out. But an improper depth setting on the saw blade resulted in a slight nick on the underlying sternocostal surface of the heart. which heart chamber would have most likely been opened

right ventricle

The sound associated with tricuspid stenosis (narrowing) in a 40-year-old male would be best heard at which location on the anterior chest wall?

xiphoid area, just off the sternum; and fourth left intercostal space, just lateral to the sternum

what can be heard below the left nipple

mitral valve (5th intercostal space and apex of heart)

blockage of blood flow in the proximal part of the anterior interventricular artery could deprive a large area of heart tissue of blood supply, unless a substantial retroglade flow into this artery develops via an important anastamosis with which other artery

posterior interventricular

Traumatic, acceleration/deceleration injuries to the aorta usually occur where its mobile and fixed portions meet. This would be at the:

ligamentum arteriosum

Which posterior mediastinal structure is most closely applied to the posterior surface of the pericardial sac?

A. aorta

B. azygos vein

C. esophagus

D. thoracic duct

E. trachea

esophagus

In obstruction of the superior or inferior vena cava, venous blood is returned to the heart by an alternate route via the azygos vein, which becomes dilated in the process. Which structures might it compress as a result?

thoracic duct

Elevated systolic blood pressure in the right ventricle suggests stenosis of which valve?

pulmonary, its the valve immediately distal to the high pressure

stenosis of the aortic valve would cause

high pressure in the left ventricle

stenosis of the tricuspid valve would cause

high pressure in right atrium

stenosis in the mitral valve would cause

left atrium

during examination of a 62-year-old man, the senior resident tells you to put your stethoscope on the left 5th intercostal space, slightly below the nipple, and listen for a clearly audible murmur. You hear it and and know it must be associated with severe stenosis of which heart valve?

mitral

while attempting to suture the distal end of a coronary bypass into the anterior interventricular artery, the surgeon accidentally passes the needle through the adjacent vein. Which vein is damaged?

great cardiac

while listening to a patient's heart sounds with a stethoscope, you identify a high-pitched sound in the second right intercostal space, just lateral to the edge of the sternum. Your correct conclusion is that you have detected a stenosis in which valve

aortic

what happens during ventricular diastole

filling of coronary arteries, these are branches of the right and left cusps of the aortic valve. when ventricles are filling with blood because the mitral and tricuspid valve are open

what happens in ventricular systole

ventricles contract, av valves close, semilunar valves open, blood is forced out of ventricle

what layer provides a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall

endothoracic fascia

which nerve would be vulnerable to irritation when the tracheobronchial lymph nodes are enlarged due to a diseased situation

left recurrent laryngeal nerve

in cardiac surgery it is sometimes necessary to clamp off all arterial flow out of the heart. this could be done within the pericardial sac by inserting the index finger immediately behind the two great arteries and compressing them with the thumb of the same hand. the index finger would have to be inserted into which space

transverse pericardial sinus, which is behind the aorta and pulmonary trunk and anterior to superior vena cava

A needle inserted into the 9th intercostal space along the midaxillary line would enter which space?

costodiaphragmatic recess

During a heart transplant procedure, the surgeon inserted his left index finger through the transverse pericardial sinus, and then pulled forward on the two large vessels lying ventral to his finger. Which vessels were these?

pulmonary trunk and aorta