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Anatomy(Thorax) Flashcards

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1
Q

Eisenmenger syndrome

A

Cyanosis from pulmonary hypertension with right to left shunt

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2
Q

Parts fused to form abdominal diaphragm

A
  1. septum transversum
  2. the mesentery of the foregut
  3. ingrowth from the body wal
  4. the pleuroperitoneal membrane (a small dorsal part).
    These close the primitive communications between
    pleura and peritoneal cavities.
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3
Q

Posterolateral hernia through the foramen of Bochdalek

A

(the pleuroperitoneal membrane)—more common on
the left

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4
Q

• A hernia through the foramen of Morgagn

A

anteriorly
between xiphoid and costal origins.

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5
Q

Why is the 10th rib an atypical rib?

A

Only one articular facet on head

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6
Q

Mnemonic of hilum of the lung

A

(AP<V{AB)V>SI}
V-VEIN
A-ARTERY
B-BRONCHUS
AP-ANTERIOR POSTERIOR
SI-SUPERIOR INFERIOR

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7
Q

Level of apex of lung above clavicle

A

Along a curved line 2.5 cm above inner third of clavicle

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8
Q

Meeting point of pleural reflexions anteriorly

A

Angle of Louis at midline coming down from sternoclavicular joint

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9
Q

Division point of pulmonary artery into right and left main branches

A

Anterior to left main bronchus

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10
Q

Which nerve is in contact with the ligamentum arteriosum?

A

Left recurrent laryngeal nerve

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11
Q

Origin of bronchial arteries

A

Descending aorta

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12
Q

Where does the visceral pleura continue with the parietal layer?

A

over the
root of the lung.

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13
Q

Where do collateral vessels develop in case of Coarctation of the Aorta?

A

between vessels above and
below the block

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14
Q

The superior intercostal artery, derived from?

A

Subclavian artery

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15
Q

Where intercoastal spaces are not covered by pleura?

A

Medial end of the fourth and fifth left intercostal spaces

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16
Q

Where does the pleura descends below the twelfth rib?

A

at its medial extremity (in mediastinum)
{So caution not to open during adrenal of kindness surgery}

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17
Q

Lower border of pleural vs lung vs ribs

A

Pleura Lung
8th mid clavicular 6th
10th mid axillary 8th
12th lateral of erector spinae. 10th

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18
Q

Nerve supply of visceral pleura and it’s sensitive

A

Vagus nerve, only sensitive to stretching not for pain

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19
Q

Which pleura is sensitive to pain

A

Parietal(referred to abdomen), mediastinal(referred to tip of shoulder), diaphragmatic pleura(tip of shoulder C4)

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20
Q

Position of psoas and lumborum

A

Psoas medial(arcuate ligament)
Lumborum lateral(arcuate ligament)

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21
Q

Which ribs give origin to abdominal diaphragm?

A

Lower 6 ribs (inner aspect)

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22
Q

Muscle originated from xiphoid process

A

Diaphragm
Transversus thoracis

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23
Q

Structures passing through aortic opening of diaphragm

A

Descending aorta(thoracic>abdominal)
Azygos vein
Thoracic duct

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24
Q

Structures passing through oesophageal opening (lying in right crus)

A

Oesophagus,
vagus,
Branches of left gastric artery and vein.

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25
Q

Structures passing through vagal opening

A

IVC
Right phrenic nerve

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26
Q

Which nerves pierce crura of diaphragm

A

Splanchnic nerves
(Both greater and lesser)

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27
Q

Structures passing behind the medial arcuate ligament (lying on psoas major)

A

Sympathetic chains

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28
Q

mechanism of paradoxical movement of diaphragm in phrenic nerve injury

A

Sure to raised intra abdominal pressure during inspiration and vice versa

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29
Q

Surfaces and borders of heart

A

Surfaces
Anterior -right atrium, right ventricle, strip of left ventricle
Posterior -left atrium, left ventricle
Inferior -right atrium with IVC entering, lower part of ventricles
Borders
Right. -SVC, right atrium, IVC
Left -auricle, left atrium, left ventricle
Inferior -right ventricle, apex of left ventricle

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30
Q

Extension and function of moderator band of heart

A

Extending from interventricular septum to anterior wall of ventricle
Function is to prevent overdistension,
To conduct right branch of AV bundle to anterior wall of ventricle

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31
Q

Cusps of-
Mitral valve
Tricuspid valve
Pulmonary valve
Aortic valve

A

Mitral -anterior, posterior
Tricuspid - anterior, posterior, septal
Pulmonary - anterior,right, left
Aortic - anterior,right posterior, left posterior.

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32
Q

Origin points of right and left coronary arteries

A

Right -anterior aortic sinus
Left -left posterior aortic sinus

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33
Q

What does Crista Terminals of heart devide?

A

Atrial part firm sinus venosus and atrial part from true ariam

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34
Q

Which muscle contact first in heart

A

Papillary muscle

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35
Q

Veins of heart

A

Venae cordis minimae >right atrium
Anterior cardiac>right atrium
Great cardiac>coronary sinus
Middle cardiac>coronary sinus
Small cardiac>coronary sinus
Coronary sinus>right atrium left to the mouth of IVC

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36
Q

Nerve supply of heart

A

Sympathetic (cardio accelerator)
Vagus (cardio inhibitor)

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37
Q

Why anginal pain is experienced in chest and inner aspect of left arm

A

Due to excitation of spinothalamic tract via dermatomes T1-T4

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38
Q

Why anginal pain is experienced in neck and jaw

A

Vagus>nucleus tractus solitarius of medulla>upper cervical spinothalamic tract

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39
Q

Fusion of apex and base of pericardium

A

Apex with tunica adventitia of great vessels
Base with central tendon of diaphragm

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40
Q

Which coastal cartilages are related to pericardium

A

3rd to 6th

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41
Q

Which vertebrae are related to pericardium

A

T5-8

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42
Q

Why do Oblique and Transverse Sinuses form

A

At the pericardial reflections, veins are surrounded by one
sleeve of pericardium and arteries by another.

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43
Q

Clinical Points
For Fibrous pericardium

A

Fibrous pericardium can stretch gradually if there is
gradual enlargement of the heart.
But Sudden increase in pericardial contents as in sudden
bleeds: stretching does not occur and cardiac function
is embarrassed (cardiac tamponade).

44
Q

Surface anatomy of heart(easy points)

A

Superior-
1.2cm 2nd left 3rd right
Inferior-
9cm 5th left 1.2cm 6th right
Left-
Joining above lefts
Right-
Joining above rights

45
Q

Vertebrate behind superior mediastinum

A

T1-4

46
Q

Which one is inominate artery

A

One and only brachyocephalic artery

47
Q

Important of The Angle of Louis

A

• second costosternal joint
• junction of superior and inferior mediastinum
• commencement and termination of aortic arch
• ligamentum arteriosum lies on this plane.
• confluence of azygos vein with superior vena cava
• bifurcation of trachea
• thoracic duct runs from right to left
• plane of T4

48
Q

Direction of rotation of primitive heart tube

A

Inferior part goes to superolaterally on right side
Which is sinus venosus

49
Q

Origin of interventricular septum

A

From Apex to endocardial cushion

50
Q

Relation of septum primum and septum secundum

A

Primum is inferomedial
With foramen secundum superiorly
In Septum secundum case vice versa with a free lower edge

51
Q

Which septum is pushed to close the foramen ovale.

A

P—P
• At birth, where there is an increased blood flow through
the lungs and a rise in left atrial pressure, the septum PRIMUM is pushed across to right side to close the foramen ovale.

52
Q

Maintaining position of foramen ovale of heart

A

septum ➡
RA ⬇ secundum ⬆ septum ⬇ LA
➡ primum

53
Q

arches by Truncus arteriosus

A

Truncus arteriosus gives off six pairs of arches.

54
Q

Ultimate form of sinus venosus of primitive heart

A

The sinus venosus joins the atria, becoming the two venae cavae on the right and the four pulmonary veins on the left.

55
Q

Connection of ductus venous

A

Umbilical vein Anne IVC

56
Q

Connection of ductus arteriosus

A

Left pulmonary artery to arch of aorta just before its termination

57
Q

PDS increases load of which chamber of heart

A

Left ventricle

58
Q

Pulmonary and systemic sides of heart and
Eisenmenger syndrome

A

Pulmonary Right
Systemic Left
In eisenmenger syndrome first pathology causing raised right side overload. Then right to left shunt causing mixing of oxygenated and deoxygenated blood. Resulting in cyanosis

59
Q

Relation of blood shunting with eisenmenger syndrome

A

LR shunt>RL shunt>cyanosis

60
Q

Relation of cyanosis in tetralogy of Fallot

A

Because there is a right-to-left shunt due to pulmonary trunk stenosis across the VSD there is usually cyanosis at an early stage.

61
Q

Determinant of cyanosis in Fallot’s Tetralogy

A

The degree of cyanosis depends mainly on the severity of the pulmonary outflow obstruction.

62
Q

Origin of crural part of diaphragm

A

Mesentery of foregut

63
Q

Parts of primitive abdominal diaphragm

A

The diaphragm develops from the fusion of four parts:

64
Q

Defect in Posterolateral congenital diaphragmatic hernia

A

pleuroperitoneal membrane
Called hernia through the foramen of Bochdalek

65
Q

Name of hernia anteriorly
between xiphoid and costal origins

A

A hernia through the foramen of Morgagni

66
Q

Number of ‘true’ ribs

A

14

67
Q

Number of false rib

A

6

68
Q

Why called floating rib

A

Ribs 11 and 12 are free anteriorly. These are ‘floating ribs’ as they have no anterior articulation.

69
Q

Articulation of head of rib

A

A head has two articular facets for articulation with the CORRESPONDING vertebra and the vertebra ABOVE

70
Q

Ligament attached to neck of rib

A

Costotransverse

71
Q

Why is the subclavian groove on 1st rib for

A

Subclavian artery &
Lowest trunk of brachial plexus

72
Q

Ribs with single articular facet on head

A

10
11
12

73
Q

Rib without subcostal groove

A

12

74
Q

Origin of superior intercostal artery

A

Costocervical trunk of subclavian artery

75
Q

Reason for notching which can be seen on X-ray in Coarctation of aorta

A

superior intercostal artery supplies blood to the intercostal arteries, vessels dilate and become more tortuous eroding the lower border of the ribs

76
Q

vascular symptom of seventh cervical rib

A

poststenotic dilatation of the subclavian artery
Subclavian aneurysm
subclavian vein thrombosis

77
Q

Effect of 7th cervical rib on hand

A

• Pressure on the lower trunk of the brachial plexus may result in paraesthesia of dermatomal distribution of C8/T1 together with wasting of small muscles of hands
(myotome T1).

78
Q

Type of cartilage of ribs

A

Hyaline

79
Q

Relation of manubrium

A

• Lowest part is related to arch of aorta.
• Upper part is related to left brachiocephalic vein; left
brachiocephalic artery; left common carotid artery; left subclavian artery

80
Q

Extension of trachea and length

A

C6 -T5 (11cm)

81
Q

Lining of trachea with special cell

A

Ciliated columnar epithelium with goblet cells

82
Q

Peculiar bronchus

A

wider, shorter and more vertical always right

83
Q

Vessels in front of right bronchus

A

Ascending aorta
SVC
Azygos vein arches over it from behind to enter SVC
Pulmonary artery lies first below and then anterior to it

84
Q

Relation of vessels with left bronchus

A

It passes downwards and laterally below arch of aorta,
in front of descending aorta
pulmonary artery lies at first anterior to, and then
above, the bronchus

85
Q

What indicates distortion and widening of the carina

A

enlargement of the tracheobronchial lymph nodes
at the bifurcation by carcinoma.

86
Q

What about platysma in Tracheostomy

A

in the transverse incision, platysma will be located in the lateral part of the incision

87
Q

Relation of stap muscles with thyroid in tracheostomy

A

After splitting the pretracheal fascia and retracting the strap muscles, the isthmus of the thyroid will be encountered

88
Q

What to do with thyroid during tracheostomy

A

may be either retracted upwards or divided between clamps to expose the cartilages of the trachea.

89
Q

Part of left lung equivalent to midday lobe of right lung

A

The equivalent of the middle lobe of the right lung in the left lung is the lingula, which lies between the cardiac notch and oblique fissure.

90
Q

Marking of intersegmental lung boundary

A

marked by intersegmental veins

91
Q

Division point of pulmonary trunk

A

Below the concavity of the aortic arch divides in front of the left main bronchus into right and left branches.

92
Q

Relation of right pulmonary artery with ascending aorta and SVC

A

Passes to the root of the right
lung behind the ascending aorta and SVC.

93
Q

Origin and function of bronchial artery

A

• Supply the air passages.
• Branches of the descending aorta.

94
Q

Which part of diaphragm has vena canal opening

A

Central tendon

95
Q

Relation of sympathetic chain with diagram

A

• Sympathetic chain passes behind the medial arcuate ligament lying on psoas major.

96
Q

Sensory and motor innervation of diaphragm

A

The sensory innervation of the central tendon of the diaphragm is via the phrenic nerve but the periphery of the diaphragm is supplied by the lower six intercostal nerves.

Phrenic nerve (C3, 4, 5): the phrenic nerve is the sole motor nerve supply to the diaphragm.

97
Q

Points of injury of phrenic nerve at neck

A

Percussion dullness
Absent breath sounds
Paradoxical movement of diaphragm

98
Q

Reason of lung expansion during inspiration

A

The negative intrapleural pressure is increased and the lung expands.

99
Q

Does Latissimus dorsi help during respiration

A

It is one of the muscles required to use during forced expiration

100
Q

Surfaces of heart

A

Anterior
Posterior (base)
Inferior

101
Q

Location of pericardiophrenic vessels

A

Middle mediastinum

102
Q

drainage of thoracic duct

A

The thoracic duct drains lymph from most of the body into the venous system at the junction of the left subclavian and jugular veins. The thoracic duct is the larger of the two lymphatic ducts in the body, and is responsible for draining lymph from the following areas:
Lower extremities
Pelvis
Abdomen
Left side of the thorax
Left upper extremity
Left side of the head and neck

103
Q

Origin of thoracic duct

A

The thoracic duct typically starts at the second lumbar vertebra at the cisterna chyli. It contains smooth muscle that propels lymph upward, as well as white blood cells, eosinophils, and a high protein content.

104
Q

Cause of chylothorax

A

Diagram
Anatomy
Mnemonic
Steps
Pdf
Radiology
Wikipedia
Lymph
Left
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থোরাসিক নালীর নিষ্কাশন

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+7
The thoracic duct drains lymph from most of the body into the venous system at the junction of the left subclavian and jugular veins. The thoracic duct is the larger of the two lymphatic ducts in the body, and is responsible for draining lymph from the following areas:
Lower extremities
Pelvis
Abdomen
Left side of the thorax
Left upper extremity
Left side of the head and neck

The thoracic duct typically starts at the second lumbar vertebra at the cisterna chyli. It contains smooth muscle that propels lymph upward, as well as white blood cells, eosinophils, and a high protein content.

A leak in the thoracic duct, known as chylothorax, can cause lymph to collect in the pleural space. This can lead to significant morbidity, including loss of lymph and respiratory distress. A number of conditions can cause a thoracic duct rupture, including trauma, malignancies, tuberculosis, sarcoidosis, and superior vena cava obstruction.

105
Q

Location of base and apex of pericardium

A

Base with central tendon
Apex with great vessels

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