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MRCS Part B > Anatomy - Thorax > Flashcards

Anatomy - Thorax Flashcards

1
Q

Which parts of the rib articulate with the vertabrae?

A

Head - vertebral body above and below forming the costovertebral joint

Tubercle - transverse process forming the costo-transverse joint

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2
Q

Which ligamentous structure supports the opening in the diaphragm through which the aorta passes?

A

Right and left crura giving rise to the median arcuate ligament

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3
Q

How are the extenal intercostal muscles involved in inspiration?

A

Contraction leads to upward and outward movement of the anterior chest wall

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4
Q

What are the muscles of inspiration?

A

Extenal intercostal muscles
Scalene muscles

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5
Q

What are the muscles of expiration?

A

Internal intercostal muscles
Abdominal wall muscles

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6
Q

What are the main branches of the arch of the aorta?

A

Brachiocephalic trunk
Left common carotid
Left subclavian

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7
Q

Which branches are given off in the first part of the subclavian artery?

A

Vertebral artery
Internal thoracic
Thyrocervical trunk

Remember: VIT C & D
Part 2: Costocervical trunk
Part 3: Dorsal scapula

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8
Q

Which veins form the brachicephalic vein?

A

Subclavian and inernal jugular vein

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9
Q

Which structure spearates the subclavian artery from the subclavian vein?

A

Saclenus anterior mucle

  • Subclavian artery behind (with brachial plexus)
  • Subclavian vein infront (with phrenic nerve)
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10
Q

Which structures form the superior vena cava?

A

Right (short) and left (long) brachiocephalic vein

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11
Q

Which structure arches over the right main brunchus?

A

Azygous vein

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12
Q

How does the drainage of the azygous veins operate?

A

Right chest wall drained by intercostal veins directly into azygos vein

Left chest wall drained by two hemiazygos veins which then drain into the azygos vein

The azygos vein drains into the posterior aspect of the superior vena cava

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13
Q

Pathway of the phrenic nerve in the neck

A

Runs infront of the scaelnus anterior muscle and subcian artery

Runs posterior to the subclavian vein

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14
Q

Pathway of the vagus nerve in the neck

A

Runs infront of the common carotid artery and subclavian artery

Runs behind the internal jugular vein

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15
Q

Where is the recurrent laryngeal nerve branches given off?

A

Right - beneath the subclavian artery

Left - beneath the arch of the aorta

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16
Q

How are the phrenic and vagus nerves ralted to the hilum of the lung?

A

Phrenic - infront

Vagus - behind

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17
Q

What is the anatomical boundaries of the breast?

A

Rib 2-6
Sternum - mid-axillary line

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18
Q

Describe the lactiferous duct system

A

Each breast has 15-20 lobules separated by ligaments of Cooper

Each lobule is drained by a lactiferous duct into the lactiferous sinus beneath the areola

Lactifeous sinus acts as a reservoir

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19
Q

Lymphatic drainage: breast

A

Axillary >75%
Parasternal 10-25%
Posterior intercostal 5%

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20
Q

What are the 3 levels of lymph node staging for breast cancer?

A

Level 1 - nodes lateral to Pec minor
Level 2 - nodes beneath Pec minor
Level 3 - nodes medial to Pec minor

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21
Q

What are the deep relations to the breast?

A

Pec major 2/3
Serratus ant 1/3

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22
Q

What are the main constituents of breast tissue?

A

Fat, fibrous and glandular tissues

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23
Q

What are Cooper’s ligaments of the breast?

A

AKA Suspensory ligaments

Fibrous septa which extend from subcutaneous tissue to the pectoral fascia, separating the breast lobules

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24
Q

Blood supply: Breast

A
  1. Internal thoracic (1st Part of Subclavian artery)
  2. Lateral thoracic (2nd part of Axillary artery)
  3. Thoraco-acromial (2nd part of Axillary artery)
  4. Intercostal arteries via perforating branches
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25
Where do the right and left crus of the diaphragm attach?
Right - L3 vertabrae Left L2 vertabrae
26
Attachement: diapgragm
xiphoid process, lower 6 ribs, sternum, lumbar vertabrae
27
Contents of the anterior mediastinum
Thymus Internal thoracic artery Lymphatics
28
Contents of the middle mediastinum
Heart Aorta (ascending) SVC Main bronchus Pulmonary artery & vein Phrenic nerve Lymphatics
29
Contents of the posterior mediastinum
Descending aorta Azygos & hemiazygos vein Vagus nerve Thoracic duct Oesophagus Lymphatics
30
What are the layers pierced when inserting a subclavian line?
1. Skin 2. Platysma 3. Fascia 4. Pectoralis major 5. Subclavius 6. Subclavian vein
31
What is the anatomical landmarks for insertion of the subclavian line?
Needle inserted 1cm below the junction between the middle and medial thirds of the clavicle Directing the needle medially, slightly cephalad and posteriorly toward the suprasternal notch
32
Where should the catheter tip of a subclavian line sit?
Within the SVC above the pericardial reflection
33
What structures are at risk during subclavian line insertion?
1. Subclavian artery - haemothorax 2. Pleura - pneumothorax 3. Thoracic duct (left) - chylothorax 4. Phrenic nerve as it runs posteriorly
34
Where does the apex of the pleura project?
2.5cm above the junction between the medial and middle thirds of the clavicle
35
What is the nerve supply to the parietal and visceral pleura?
Parietal - intercostal nerves and phrenic nerve Visceral - pulmonary plexus (formed from branches of the vagus and sympathetic trunk)
36
What anatomical line separated the superior and inferior mediastinum?
Angle of Louis - Rib 2 - T4/
37
Contents of the superior mediastinum
From anterior to posterior 1. Thymus 2. Great veins 3. Great arteries 4. Trachea 5. Oesophagus
38
Role of the thymus gland
Specialised immune organ - active before birth and atrophies after puberty Involved in maturation of T-cells, desctruction of autoimmune T-cells and immune regulation of T-cells
39
How are ribs 1 and 2 atypical?
Rib 1 - short & wide, single facet, scalene tubercle on inner border Rib 2 - thin & long, superior tuberosity for serratus anterior
40
How are ribs 10,11,12 atypical?
Rib 10 - single facet articulating with T10 Rib 11 & 12 - floating, single facet, no neck
41
Inferior border of the heart
5th intercostal space mid-clavicular line to the 6th costal cartilage at the right parasternal edge
42
Superior border of the heart
3rd costal cartilage at the right parasternal edge to the 2nd intercostal space 2cm left of the sternum
43
What forms the majority of the anterior surface of the heart?
Right Ventricle
44
What forms the posterior aspect of the heart?
Left Atrium
45
Name the layers of the pericardium
Fibrous pericardium (attached to the central tendon of the diaphragm) Parietal serous pericardium Visceral serous pericardium
46
What is the normal SNA firing rate?
Natural pacemaker at 100-120 bpm Slowed to resting by parasympathetic stimulation
47
What is the blood supply of the SAN?
60% RCA 40% LCA
48
Where is the SAN located?
In the crista terminalis of the Right Atrium
49
Describe the venous drainage of the heart
2/3 drained by veins that drain into the coronary sinus and subsequently into the right atrium (inferior part between IVC and tricuspid valve) These veins are the great, middle, small, oblique and posterior The remaining 1/3 is drained by venae cordis minimae which drain directly into each chamber There are also 3-4 anterior cardiac veins which drain directly into the RA
50
Where does the coronary sinus open?
Inferior part of the RA, between the IVC and tricuspid valve
51
Surface anatomy of the pleura
Apex - 2.5cm above the junction between the medial and middle thirds of the clavicle Descends behind each sternoclavicular joint to meet at the midline at the level of rib2 Continues down to 6th costal cartilage on the right and 4th on the left (to accommodate the heart) On both sides, pleura crosses 8th rib in MCL, 10th rib MAL and 12th rib posteriorly (at lateral border of erector spinae)
52
How does the surface anatomy of the lungs differ to the pleura?
Same superiorly, differs at inferior border Lung lies 2 spaces above pleura Pleura - 8th rib in MCL, 10th rib MAL and 12th rib posteriorly Lung - 6th rib in MCL, 8th rib MAL and 10th rib posteriorly
53
Surface anatomy: oblique fissure
Line drawn obliquely downwards and outwards from 2.5cm lateral to the spine of T3 along the 5th ICS to the 6th costal cartilage approximately 5 cm from the midline
54
Surface anatomy: horizontal fissure
Only present on the right Runs from the edge of the 4th costal cartilage to the oblique fissure where it crosses the 5th rib
55
Vertebral level: suprasternal notch
T2/3
56
Vertebral level: angle of louis
T4/5
57
Vertebral level: xiphisternum
T9
58
How does the right phrenic nerve descend in the thorax?
Initially right of the brachiocephalic vein, then SVC, RA and IVC with which it transverses the diaphragm at T8
59
How does the left phrenic nerve descend in the thorax?
Initially left of the left subclavian artery, aortic arch, LV then pierces the diaphragm on its own
60
How do the vagus nerves descend?
Exit the skull via the jugular foramen Descends neck in the carotid sheath Travels posterior to lung hilum Forms plexus around oesophagus (right posteriorly and left anteriorly)
61
Vertebral level : trachea beginning
C6
62
Vertebral level : Carina
T4/5 Angle of Louis
63
Which bronchus is at high risk of occlusion by foreign body?
Right - more vertical, shorter and wider
64
Describe how each bronchopulmonary segment of the lung operates
Functionally independent area separated by connective tissue, with its own segmental bronchus, artery, vein and lymphatics There are around 10 in each lung
65
What structures make up the lung hilum?
Pulmonary arteries and veins Main bronchus Bronchial arteries and veins Lymph nodes Autonomic nerves
66
Where is needle compression of a tension pneumothorax performed?
Old guidance - 2nd ICS MCL New guidance - 4-5th ICS MAL Needle should be inserted directly above the rib to avoid the NVB Definitive treatment would include insertion of a chest drain
67
Anatomical landmarks of the safe triangle of chest drain insertion
Apex - base of the axilla Anterior - lateral border of pec major Posteriorly - lateral border of lattismus dorsi Inferiorly - 5 ICS Drain inserted directly above rib below to avoid NVB
68
What structures are passed during chest drain insertion?
1. skin 2. superficial fascia 3. subcutaneous fat 4. external intercostal muscle 5. internal intercostal muscle 6. innermost intercostal muscle 7. parieral pleura
69
Nerve supply of the diaphragm
Left and righ phrenic nerves C3,4,5
70
What structures pass through the diaphragm at T8?
IVC Right phrenic nerve
71
What structures pass through the diaphragm at T10?
Oesophagus Vagus nerves
72
What structures pass through the diaphragm at T12?
Aorta Azygos vein Thoracic duct
73
Why does gallbladder pain sometimes refer to the right shoulder?
Sensory supply of the diaphragm is via the phrenic nerve (C3,4,5) Pain may be referred to the C3,4,5 dermatome across shoulder
74

MRCS Part B (7 decks)

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