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MRCS Anatomy > Anatomy of Thorax > Flashcards

Anatomy of Thorax Flashcards

1
Q

What fuses to become the primitive heart tube?

A

Paired endothelial tubes

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2
Q

What are the 5 regions of the pericardial cavity?

A

Sinus venosus, Atrium, Ventricle, Bulbus cordis and truncus arteriosis.

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3
Q

Sinus venosus becomes incorporated into what?

A

The atrium

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4
Q

What part of the pericardial cavity tube incorporates into the ventricle?

A

The bulbus cordis

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5
Q

How does the interventricular septum develop?

A

From the apex upwards towards the endothelial cushions

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6
Q

Fusion of what leads to the formation of the foramen secundum?

A

The septum primum fuses with the endocardial tissues

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7
Q

What two defects form the foramen ovale?

A

Septum secundum
Septum primum

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8
Q

What is the purpose of the foramen ovale:

A

Allows blood to go directly from the right to the left side f the heart in a developing foetus. The septum secundum acts as a valve like structure to facilitate this.

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9
Q

How does the foramen ovale close?

A

After birth there is an increased blood flow through the lungs which causes a rise in left atrial pressure - the septum primum is then pushed across to close the foramen ovale.

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10
Q

What is the name given to the residual dimple after the foramen ovale closes:

A

The fossa ovalis

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11
Q

What is the most common type of cardiac defect?

A

Ventricular septal defect

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12
Q

What defect causes increased load on the left ventricle and can lead to pulmonary hypertension?

A

Patent ductus arteriosus

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13
Q

When surgically (open) repairing a patent ductus arteriosus, what vessel must you take care to avoid?

A

The LEFT recurrent laryngeal nerve

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14
Q

What is reverse shunting

A

Right to left shunting / flow of blood

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15
Q

Increased ___________ flow leads to reverse shunting

A

Pulmonary

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16
Q

What defects can lead to reverse shunting

A

ASD, VSD and PDA

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17
Q

What is the name for cyanosis secondary to reverse shunting

A

Eisenmenger’s syndrome

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18
Q

What congenital condition can lead to Eisenmenger’s syndrome

A

Tetralogy of Fallot

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19
Q

What are the four components of tetralogy of fallot:

A

VSD
Stenosed pulmonary outflow tract
Right ventricular hypertrophy.
Wide aorta overriding the right and left ventricles.

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20
Q

The degree of cyanosis depends on the degree of what?

A

The severity of pulmonary outflow obstruction

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21
Q

When is notching of the rib inferior border seen on a CXR and what condition causes this?

A

When patient has enlarged intercostal arteries which become torturous
Caused by Coartication of the aorta

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22
Q

Delayed / weak / absent femoral pulses are seen in what condition:

A

Coartication of the aorta

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23
Q

What are the 4 developmental parts of the diaphragm?

A

Septum Transversum
Mesentery of the foregut
Ingrowth from the body wall
Pleuroperitoneal membrane

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24
Q

Which rib does the scalenus anterior insert onto?

A

Rib 1 - upper surface prominent tubercle

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25
Q

What vessel crosses the first rib infront of the scalene tubercle?

A

The subclavian vein

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26
Q

What is the incidence of cervical ribs?

A

1 in 200
( 1 in 500 if bilateral)

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27
Q

What is the superior border of the superior mediastinum?

A

Thoracic inlet

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28
Q

What is the onferior border of the superior mediastinum?

A

Continuous with the inferior mediastinum

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29
Q

What is the anterior border of the superior mediastinum?

A

Manubrium of sternum

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30
Q

What is the posterior border of the superior mediastinum?

A

Vertebral bodies of T1 to T4

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31
Q

What is the Lateral border of the superior mediastinum?

A

Pleura of lungs

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32
Q

What vessels are found in the superior mediastinum?

A

Arch of the aorta -
- brachiocephalic (right only),
- left common carotid
- left subclavian
Superior vena cava -
- Azygous vein
- Brachiocephalic vein
- Left intercostal vein
- Supreme intercostal vein

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33
Q

What nerves are found in the superior mediastinum?

A

Vagus nerve - right and left
Phrenic nerve
Cardiac nerves
Sympathetic trunk

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34
Q

List structures found within the superior mediastinum:

A

Thymis
Trachea
Oesophagus
Thoracic duct

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35
Q

What muscles are found within the superior mediastinum?

A

Sternohyoid
Sternothyroid

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36
Q

At what level is the mediastinum segregated into superior and inferior compartments:

A

T4 (aka sternal angle)

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37
Q

How is the inferior mediastinum segregated?

A

Anterior, middle and posterior sections

38
Q

What forms the lateral border of the anterior mediastinum?

A

Mediastinual pleura

39
Q

What forms the anterior border of the anterior mediastinum?

A

Body of sternum
Transversus thoracis muscles

40
Q

What forms the posterior border of the anterior mediastinum?

A

Pericardium

41
Q

What forms the roof of the anterior mediastinum?

A

Peridcardium

42
Q

What forms the floor of the anterior mediastinum?

43
Q

What are the contents of the anterior mediastrinum:

A

No Major structures
Stern pericardial ligaments
Thymus can extend into the anterior mediastinum in children

44
Q

What forms the anterior border of the middle mediastinum?

A

Anterior margin of the pericardium

45
Q

What forms the posteroir border of the middle mediastinum?

A

The posteroir border of the pericardium

46
Q

What forms the lateral border of the middle mediastinum

A

Mediastinal pleura of lungs

47
Q

What forms the superior border of the middle mediastinum?

A

Imaginary line of the T4 vertebra / sternal angle

48
Q

What forms the inferior border of the middle mediastinum?

49
Q

What organs are found in the middle mediastinum

A

Heart + pericardium
Tracheal bifurcation
L and R main bronchi

50
Q

What vessels are found in the middle mediastinum?

A

Ascending aorta
Pulmonary trunk
Superior vena cava

51
Q

What nerves are found in the middle mediastinum?

A

Cardiac plexus
Phrenic nerves L and R

52
Q

What lymphatics are located within the middle mediastinum?

A

The tracheobronchial lymph nodes (form a gathering at the hila of the lungs)

53
Q

What forms the lateral border of the posterior mediastinum?

A

Mediastinal pleura

54
Q

What forms the anterior border of the posterior mediastinum?

A

Pericardium

55
Q

What forms the posterior border of the posterior mediastinum?

56
Q

What forms the roof of the posterior mediastinum?

A

Sternal angle (imaginary line)

57
Q

What forms the floor of the posterior mediastinum?

58
Q

What vessels are contained in the posterior mediastinum?

A

Thoracic aorta:
- Posterior intercostal arteries
- Bronchial arteries
- Oesophageal arteries
- Superior phrenic arteries

59
Q

At what level does the thoracic aorta become the abdominal aorta?

60
Q

What else is contained in the posterior mediastinum?

A

Oesophagus
Oesophageal plexus
Thoracic duct
Azygous vein
Accessory hemizygous vein
Sympathetic trunks –> form lower thoracic splanchnic nerves

61
Q

At what level does the oesophagus pass through the oesophageal hiatus of the diaphragm?

62
Q

Where does the thoracic duct originate>

A

Cisterna Chyli

63
Q

What does the thoracic duct pass through in the diaphragm

A

The aortic hiatus

64
Q

What nerves give branches to form the oesophageal plexus?

A

Left and right vagus nerves

65
Q

What structure does the azygous vein drain into

A

Superior vena cava

66
Q

What is unique about the thoracic vertebrae

A

They have costal facets on the transverse process

67
Q

What is the role of the ligamentum flavum?

A

Connects the laminae of the adjacent vertebrae

68
Q

What is the role of the interspinous ligament?

A

Connects the spinous process of the adjacent vertebrae

69
Q

What are the anterior and posterior longitudinal ligaments?

A

Long ligaments which run the length of the vertebral column, covering the vertebral bodies and intervertebral discs.

70
Q

What other vessel travels with the ascending aorta in the pericaridal sheath?

A

The pulmonary trunk

71
Q

At what vertebral level does the aortic arch end?

72
Q

What connects the aortic arch to the pulmonary trunk?

A

The ligamentum arteriosum

73
Q

What are the 3 main branches of the aortic arch?

A

Brachiocephalic Trunk
Left common carotid
Left subclavian artery

74
Q

Where does the aorta typically coarticate?

A

At the insertion point of the ligamentum arteriosum (former ductus arteriosum)

75
Q

What vessels come off the ascending aorta?

A

Left and right coronary artery

76
Q

Where does the left and right coronary artery originate from?

A

The right and left aortic sinus at the level of the aortic valve

77
Q

List the branches of the descending aorta from proximal to distal?

A

Bronchial arteries
Mediastinal arteries
Oesophageal arteries
Pericardial arteries
Superior phenic arteries
Intercostal and subcostal arteries

78
Q

At what level does the aorta exit the diaphragm via the aortic hiatus?

79
Q

Define an aortic anuerysm?

A

Aortic dilation of >1.5cm

80
Q

What symptom may suggest an aneurysm of the aortic arch and why?

A

Hoarse voice
Compression of the recurrent laryngeal nerve

81
Q

Where are the intercostal nerves?

A

T1 - T11
11 pairs - run in between the the intercostal muscles

82
Q

Where do the intercostal muscles lie

A

In the intercostal spaces.

83
Q

What intercostal muscles are responsible for increasing the thoracic volume and elevating the ribs?

A

The external intercostal muscles

84
Q

What is the role of the transversus thoracis?

A

Weakly depresses ribcage

85
Q

Where is the transversus thoracis?

86
Q

At what level does the IVC exit the diaphragm?

87
Q

What vessels pass through the caval hiatus?

A

The inferior vena cava
The terminal branches of the phrenic nerve

88
Q

What is the arterial supply to the diaphragm>

A

The inferior phrenic arteries

89
Q

Give 3 causes of a raised JVP:

A

Right heart failure
Pulmonary hypertension
SVC obstruction

90
Q

What level is the cardioesophageal junction?

MRCS Anatomy (8 decks)

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