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mr C.S. > Anatomy: Thorax > Flashcards

Anatomy: Thorax Flashcards

1
Q

Abdominal breathing mechanism

A

Muscle fibres of diaphragm contract

Causes central tendon to move downwards (increases vertical diameter) - then movement arrested by the liver

This now acts as a fixed point - ebcomes the origing for muscle fibres to insert

Causing the elevation of the lower 6 ribs

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2
Q

Order of lung root structures (anterior to posterior)

A

Upper of the two pulmonary veins

pulmonary artery

bronchus

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3
Q

Where does the phrenic nerve travel in the middle mediastinum?

A

In between the fibrous pericardium and the mediastinal pleura

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4
Q

Three surfaces of the heart

A

Anterior - RA, RV, narrow strip of LV, auricle of LA

Posterior (base) - LV, LA + 4 pulmonary veins

Inferior (diaphragmatic) - LV + RV + inferior part of RA where IVC enters

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5
Q

Heart basics

Direction of apex and base

A

Free floting in pericardium - only attached to great vessels at base

Apex - downwards, forwards, left

Base - upwards, backwards, right

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6
Q

How to avoid pulmonary vasculature in development

A

Ductus arteriosus: RA - RV - PA - DA - aortic arch; becomes ligamentum arteriosus

Foramen ovale: RA - LA - LV - aortic arch; becomes fossa ovalis

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7
Q

Where is pleural pain referred to?

A

Parietal - eg. right lower lobe pneumonia via intercostal nerves to right lower abdomen mimicking appendicitis - goes to the corresponding thoraco-abdominal wall

Diaphragmatic pleura - via phrenic nerve to tip of the shoudler - C4 dermatome

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8
Q

Relations of the manubrium

A

Anterior boundary of superior mediastinum

Upper part = L brachiocephalic vein + artery; L common carotid artery; L subclavian

Lower part = aortic arch

Laterally = lungs and pleura

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9
Q

Nerve supply of pleura

A

Visceral - autonomic from vagus that supplies lung, sensitive only to stretching (no pain)

Parietal - somatic innervation from intercostal nerves (sensitive to pain)

Diaphragmatic pleura - phrenic nerve (sensitive to pain)

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10
Q

Composition of Trachea

A

Fibroelastic tissue

U shaped rings; open posteriorly; ends connected by trachealis muscle

Rings can get calcified on xray

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11
Q

What is the crista terminalis?

A

Muscular ridge separating the smooth walled posterior part of the RIGHT atrium (which is derived from the sinus venosus) from the rougher part derived from the true atrium (due to pectinate muscles)

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12
Q

Branches of the right coronary artery

A

Marginal branch along the lower border of the heart

Posterior interventricular branch - runs forward into the inferior interventricular groove - then anastamoses with the corresponding branch of the left coronary artery (also known as the posterior descending artery)

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13
Q

Location of AV node

A

Interatrial septum - above opening of coronary sinus

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14
Q

L bronchopulmonary segments

A

Upper lobe - apico-posterior (1,2), anterior (3), superior lingular (4), inferior lingular (5)

Lower lobe - superior (6), anteromedial basal (8), lateral basal (9), posterior basal (10)

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15
Q

How many pulmonary veins open into the LA?

A

4

Superior and inferior from each lung

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16
Q

4th costal cartilage significance in the pericardium relations

A

below 4th CC - pericardium in contact with the sternum

above 4th CC - lungs and pleura are in front

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17
Q

Venous drainage

A

Venae cordis minimae - tiny veins draining into the chambers

Anterior cardiac veins - small, open directly into the RA

Coronary sinus - main drainage, opens into the RA - below the AV node and left of the IVC opening, lies in the posterior AV groove; tributaries include - great cardiac vein, middle cardiac vein, small cardiac veins

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18
Q

Articulations of the Body of the Sternum

Number of parts of the body of the sternum

A

Most of the second costal cartilage

Third - Seventh costal cartilage

4 parts = stenebrae

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19
Q

Attachments and shape of the central tendon of the diaphragm

A

Shape - trefoil

Attachments - insertion of muscular fibres; above it fuses with the pericardium

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20
Q

Tributaries and routes of the coronary sinus

A

Great cardiac vein - anterior interventricular groove - follows the LAD

Middle cardiac vein - next to the posterior interventricular artery (drains the posterior and inferior surfaces of the heart)

Small cardiac vein - follows marginal artery, drains into the terminus of the coronary sinus

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21
Q

Distortion + widening of the carina

A

Lobar collapse

Pathology of the heart (LA enlargement)

enlargement of the tracheo-bronchial lymph nodes at the bifurcation due to carcinoma

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22
Q

Most common congenital abnormality of the heart

A

VSD

Small ones = ok

Large ones (esp in membranous septum below AV valves) = may require repair

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23
Q

Use of sternal puncture

A

Access bone marrow for the body of the sternum

Need to know the posterior relations of the sternum (brachiocephalic artery and vein / subclavian / common carotid / aortic arch)

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24
Q

Features of 11/12 rib

A

Short

No tubercles

One articular facet on head

11th shallow subcostal goove, 12th no subcostal groove

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25
Q

Tracheostomy

Incision style

A

Vertical (from cricoid cartilage passing between the anterior jugular veins)

or

transverse (cosmetic - halfway between cricoid cartilage and suprasternal notch)

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26
Q

Development of the diaphragm

A

4 parts

  1. Septum transversum (fibrous central tendon); (bare area of liver attaches here)
  2. mesentery of the foregut (area adjacent to the vetebral column becomes the crura + median part)
  3. Ingrowth from body wall
  4. Pleuroperitoneal membrane (R+L) - these close of the communications between the pleural and peritoneal cavities
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27
Q

Rib Fractures complications

A

Damage lung (contusion) or pneumothorax

Rupture spleen (L 9,10,11)

Rupture intercostal vessels = haemothorax

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28
Q

First Rib important structures

A

inner upper border - scalene tubercle where scalene anterior attaches

anterior to scalene tubercle - subclavian vein

posterior to scale tubercle (in the subclavian groove) - subclaviant artery and lowest trunk of brachial plexus below that

neck of first rib crossed by - M to L - sympathetic trunk, supreme intercostal vein, superior intercostal artery, t1 to brachial plexus

first digitation of serratus anterior attaches to outside edge

suprapleural membrane (sibson’s fascia) attached to inner border

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29
Q

Four borders of the heart

A

Right - RA + SVC + IVC

Left - LV + auricle of LA

Inferior - RV + apex of LV

Superior - RA + LA + great vessels

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30
Q

Use of no pleura at 4th 5th ICS

A

Needle goes staight into pericardium, useful for pericardiocentesis

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31
Q

What happen at angle of louis / sternal angle?

A

T4 plane

Sterno-manubrium

Bifurcation of trachea

Start and finish of aortic arch

Ligamentum arteriosum

Border of superior and inferior mediastinum

Azygos vein joins into the SVC

Thoracic duct runs from right to left

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32
Q

Rib

true

false

A

12 pairs

1-7 true - articulate with the sternum through costal cartilages

8-10 false articulate with costal cartilage, each with rib above

11-12 - no articulation, free anteriorly = floating

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33
Q

Muscles and directions of the intercostal muscles

A

External Intercostal muscles - downwards and forwards, replaced in the front by the anterior intercostal membrane

Internal intercostal muscles - downwards and backwards, replaced in the back by the posterior intercostal membrane

Innermost intercostal muscles - covers more than one intercostal space

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34
Q

Order of contraction for the AV bundle

A

Papillary muscle, then wall and septum from apex towards outflow tract

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35
Q

Damage to phrenic nerve complicaitons + clinical finidngs

A

Paralysis of diaphragm

Diaphragm elevated - dullness to percussion at base of lung + absent breath sounds

+ paradoxical movement on respiration

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36
Q

Route of the left coronary artery

A

Left posterior aortic sinus

Passses below then to the left of the pulmonary trunk

follows the left AV groove into the cover of the left auricle

then divides into two branches

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37
Q

Nerve supply of the heart

A

Sympathetic - cardio accelerator

Vagus - cardio inhibitor

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38
Q

L lung gross anatomy

A

Oblique fissue / 2 lobes - upper and lower

Cardiac notch on the anterior border

Middle lobe equivalent = lingula - lies between the cardiac notch and the oblique fissure

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39
Q

Structures seen when view the mediastinum from the right

A

Oesophagus

Trachea

Veins - SVC

Nerves - vagus, phrenic, sympathetic chain

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40
Q

What is the mediastinum?

What are the sections?

A

Space between the two pleural cavities

Superior

Middle

Anterior

Posterior

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41
Q

Purpose of Ductus venosus

A

Bypasses the liver

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42
Q

Cusps of tricuspid valve

A

Septal, anterior, posterior

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43
Q

Differences between R and L main bronchus

Size

Length

Route

Branches

A

R is wider, shorter and more vertical

R is 2.5cm; L is 5cm

Both pass downwards and laterally: R behind ascending aorta and SVC; L below aortic arch and in front of oesophagus and descending aorta

R gives of upper lobe branch before entering hilum; left does not give off any branches

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44
Q

R lung gross anatomy

A

Larger than L

3 lobes - upper (horizontal) middle (oblique) lower

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45
Q

Inspiration muscles used

Quiet

Forced

A

Abdominal + thoracic muscle combination

SCM, scalenes, serratus anterior, pec major, pec minor

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46
Q

Great vessels

A

6 pairs of arches

1 + 2 disappears

3 carotid

4 subclavian R; aortic arch L (giving L subclavian)

5 disappears

6 R+L pulmonary arteries connecting to dorsal aorta - R disappears; L connects to aortic arch via ductus arteriosus

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47
Q

Nerves related to the diaphragm

A

Phrenic nerve (C3,4,5) - main motor innervation of the diaphragm

Greater and lesser splanchnic nerves pierce through the crura

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48
Q

Route of the L pulmonary artery - where it divides in front of the left main bronchus

A

Connected at its origin to the aortic arch via the ligamentum arteriosum

Runs in front of the left main bronchus and descending aorta

Left recurrent laryngeal nerve loops below the ortic arch in contact with the ligamentum arteriosum

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49
Q

Cardiac referred pain

A

Cardiac sensation - T1-4; referred pain of these dermatomes - arm (route: cardiac plexus - sympathetic chain - DRG - spinothalamic tract)

for jaw: vagal - nucleus of tractus solitarius in the medulla - upper cervical spinothalamic

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50
Q

How to work out the horizontal fissure?

A

Horizontally and medially from the 4th CC of the oblique fissure

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51
Q

R main bronchus

A

Downwards and laterally

Behind ascending aorta and SVC; azygous vein arches over it from behind to enter SVC

Gives off upper lobe bronchi before entering hilum

Divides into bronchi for middle and lower lobes within lung

Pulmonary artery lies below then anterior to it

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52
Q

Cusps of mitral valve:

Cusps of aortic valve:

A

anterior / posterior

right posterior (NCC) / anterior (RCC) / left posterior (LCC)

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53
Q

Relations of the body of the sternum

A

R - right pleura, thin anterior border of the right lung (intervenes between it and the pericardium)

L - upper two parts - left pleura, left lung

L - lower two parts - pericardium

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54
Q

Dextrocardia vs Situs inversus

A

Just heart vs all viscera

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55
Q

What’s special about 10th rib?

A

Only one articular facet on head, rather than 2

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56
Q

Structures seen when viewing the mediastinum from the left

A

Heart

Arteries - left subclavian, left common carotid descending aorta

Nerves - phrenic, vagus, left recurrent laryngeal

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57
Q

Cervical Rib Complications

A

Artery: Post-stenotic dilation of subclavian artery - turbulene, thrombi, distal emboli, ischaemia, Raynaud’s, subclavian aneurysm

Vein: thrombosis

Nerve: Brachial plexus - C8/T1 - wasting of small muscles of the hand; sensory loss in C8/T1 distribution

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58
Q

Fibrous pericardium expansion?

A

Gradual, but rapid stretching does not occur = causing tamponade

59
Q

Thoracic Cage components

A

Vetebral coumn

Ribs and Intercostal spaces

Sternum and Costal Cartilages

60
Q

Route of AV bundle

A

Through the fibrous skeleton of the heart

Then to the membranous part of interventricular septum

Then into left (larger) and right Bundle of His

Travels under the endocardium

61
Q

Where does the NV bundle for ribs lie?

A

In the subcostal groove at the bottom of each rib

Between the innermost and internal intercostal muscles

62
Q

Fusion between primum and secondum takes place when?

Failure to fuse causes?

Murmur?

A

3 months after birth

Atrial Septal defect; but normal in 10%

fixed split S2

63
Q

Transverse sinus

A

Posterior to the Aorta + pulmonary ttrunk,

Anterior to the SVC,

Superior to the upper margin of left atrium

Useful in separating the great vessels during cardiothoracics to tie them off

64
Q

Where does the right crus originate from?

A

Front of the bodies of the first 3 lumbar vetebrae + intervetebral discs

65
Q

Location of the auricle of the LA

A

Extends forwards and to the right; overlapping the commencement of the pulmonary trunk

Makes up the left border of the heart with the LV

Also makes up part of the anterior surface

66
Q

Complications of PDA

A

Machine like murmur

Increased load on left ventricle and pHTN

67
Q

Lung

Shape

Apex

Base

Parietal surface

Mediastinal surface

Anterior border

Hilum

Posterior border

A

Conical, conforms to shape of pleural cavities

Blunt, extending above sternal end of 1st rib

Concave, relating to diaphragm

Convex, relating to ribs

Concave, relating to pericardium

Thin, deficient on the left side over the cardiac notch

Bronchi and vessels passess to and from the root

Rounded, occupies the groove by the side of the vetebrae

68
Q

Lining of the trachea

A

Ciliated columnar epithelium - goblet cells

69
Q

Variations of the coronary arteries

A

Left dominance - where LAD/LCX is larger/longer and supplies the posterior interventricular artery (usually the RCA)

Co-dominance - supplied by RCA and LAD/LCX

3rd branch of LMS - inbetween LAD and LCX - supplies the lateral wall of the left ventricle

SA node - usually RCA, but 40% LCX, 3% dual

AV node - usually RCA, but 10% LCX

70
Q

Cervical Rib

Incidence and Complete/Incomplete

A

Incidence 1:200; bilateral 1:500 (twice the sides, twice as uncommon)

Complete: articulates with transverse process of C7 and first rib; incomplete: free distally or just a fibrous band

71
Q

Types of ASD

A

Secondum - too short secondum, so when fusion occurs between primum and secondum, ASD remains, aka “ostium secondum”

Primum - failure of primum to fuse with the endocardial cushions; aka “ostium primum”; usually on AV boundary so may be associated with a VSD

72
Q

Where does medial arcuate ligament arise?

A

Condensation of fascia of psoas major

73
Q

Bronchopulmonary segments

Number

Shape and location of the apex

What is each segment supplied by?

Can each segment communicate?

How are the boundaries marked?

Uses of the boundaries

A

Bronchopulmonary segments

10

Wedge shaped, apex at the hilum

segmental bronchus, artery, vein

No communication between segments

Intersegmental veins

Minimal bleeding/disruption if excised along boundaries

74
Q

Composition of the pulmonary valve

A

3 semilunar cusps

75
Q

Anatomy of the Trachea

Start to finish

Length of trachea

A

lower border of cricoid cartilage (sixth cervical vertebra)

into the two main bronchi (fifth thoracic vertebra)

11 cm

76
Q

Oblique sinus

A

J shaped oblique sinus - blind ended

bounded by the pulmonary veins - behind inferior to the left atrium

forms a recess between the pericardium and left atrium

77
Q

Parts of the LA

A

Principal cavity and eft auricle (which is located on the anterior surface and makes up part of the left border of the heart)

78
Q

Expiration muscles used

Quiet

Forced

A

Elastic recoil of lung and chest wall

rectus abdominis, external / internal obliques, transversus abdominis, latissimus dorsi

79
Q

Surface anatomy of lungs

A

Apex follows cervical pleura

Anterior border follows mediastinum (with distinct cardiac notch on left side at 5th and 6th CC)

Lower border is 2 below pleura - 6th MCL, 8th MAL, 10th MSL (lateral border of erector spinae)

80
Q

Route of the right pulmonary artery - from dividing anterior to the left main bronchus

A

Anterior to the oesophagus, but behind the ascending aorta and the SVC

At the root of the lung it is anterior and in between the right main bronchus and its upper lobe branch

Then divides into 3 branches - 1 for each lobe

81
Q

Differences in surface of valves

A

Atrial surface = smooth

Ventricular surface = rough - due to chordae tendinae that attach to the papillary muscles to prevent eversion of the valve

82
Q

Where does the costal part and the sternal part of the diaphragm attach to?

A

Costal part - inner portion of the lower six ribs

Sternal portion - two small slips from the back of the xiphoid process

83
Q

Fetal Circulation route

A

Placenta - Umbilical Vein - Ductus venosus - IVC

RA - FO - LA - LV - aortic arch

AND

RA - RV - PA - DA - aortic arch

Abdo aorta - common iliac

Internal iliac arteries - umblical arteries - placenta

84
Q

Where does the trachea divide into the left and right main bronchus?

A

Sternal angle

85
Q

Layers of pericardium

A

Fibrous

Serous - parietal and visceral

86
Q

Blood supply of bronchopulmonary segments

A

Leaves RV

Anterior to ascending aorta

Passes upwards then backwards - to the left of ascending aorta

Reaches concavity of aortica arch

Then divides in front of the left main bronchus –> into the left and right pulmonary arteries

87
Q

Fibrous pericardium

Shape

Apex fuses with?

Base fuses with?

A

Conical

Adventitia of great vessels - about 5cm from the heart

Central tendon of the diaphragm

88
Q

Route of the right coronary artery

A

Starts from the sinus of the anterior cusp of the aortic valve

Goes to the right of the pulonary trunk between it and the auricle of the right atrium

Follows down the AV groove

where it anastomoses into the left coronary artery at the posterior interventricular groove

89
Q

Meeting of parietal and visceral pleura

A

As a sleeve at the hilum

Hangs down interiorly at the pulmonary ligament

Capacity to expand if needed - if pulmonary veins have increased blood flow

90
Q

Articulations of the Manubrium

A

Clavicle

First costal cartilage

Upper part of second costal cartilage

Body of sternum (manubriosternal joint / angle of louis)

91
Q

What is the moderator band?

What is its function?

A

muscle bundle crossing from the interventricular spetum to the anterior wall of the heart (the RV)

Function - prevents overdistension of the ventricle; conducts right branch of AV bundle to the anterior wall of ventricle

92
Q

Causes of bleeding during tracheostomy

A

Adults - anastamosis of anterior jugular veins, inferior thyroid veins, thyroidea ima artery

Children - braciocephalic artery, L braciocephalic vein, thymus may be seen in the lower part

93
Q

Dvision of the sternum provides access to?

A

Heart

Retrosternal goitre

Thymus

Ectopic parathyroid tissue

94
Q

Eisenmenger’s pathophyshiology

A

ASD / VSD / PDA - increased pulmonary flow / pHTN - left to right shunt

eventually pulmonary pressure is so great the shunt is reversed

causing CYANOSIS

95
Q

Where does the left crus originate from?

A

first 2 lumbar vetebrae and intervetebral discs

96
Q

Surface anatomy of the heart

A

Superior - 2nd CC L to 3rd CC R (both 1.2cm away from sternal edge)

Inferior - 5th ICS MCL (9cm away from midline) L to 6th CC R 1.2cm away from sternal edge

Left border - curved line joining 2nd CC to 5th ICS

Right boder - curved line joing 3rd CC to 6th CC

97
Q

Typical rib anatomy

A

Head - 2 facets to articulate with corresponding vetebra and one above

Neck - gives attachment to the costo-transverse ligament

Tubercle - with a smooth facet to articulate with transverse process of corresponding vetebra

Shaft - flattened side to side, possessed an angle to mark to the lateral limit of attachment for erector spinae

Shaft also has a groove = subcostal groove - located inferiorly - contrains neurovascular bundle

98
Q

Branches of the left coronary artery

A

From the left main stem:

Anterior interventricular (anterior descending) - goes down to the apex in the anterior interventricular groove; then anastomises with the posterior interventricular (posterior descending) –> supplies the wall of the ventricles

Circumflex - round the left side of the heart in the AV groove - anastomises with the terminal branches of the right coronary artery - also gives off the marginal branch

99
Q

What is the pulmonary ligament?

Where?

Purpose?

A

Loose fold of pleura

Root of the lung

Allows pulmonary vein to expand

100
Q

What is the infundibulum of the right ventricle?

A

Outflow tract of RV - directed upwards and to the right into the pulmonary trunk

101
Q

Bronchial arteries

Source

Function

A

Bronchial arteries

Branches of the descending aorta

Supplies the air passages

102
Q

Composition of the root of the lung

A

principle bronchus

pulmonary artery and 2 veins

bronchial arteries and veins

pulmonary plexuses of nerves

lymph vessels

bronchopulmonary lymph nodes

103
Q

Boundaries of the superior mediastinum

A

Anterior: Manubrium of sternum

Posterior: T1-4 vertebrae

Above: root of neck

Below: level of sternal angle - where it becomes inferior mediatinus (anterior / middle / posterior)

104
Q

Contents of the superior mediastinum

A

Longus coli
OEsophagus
Trachea (lower end)
Vagus Phrenic Lt recurrent laryngeal nerve

SVC + (RBV+LBV+TD+LSIC) AoA + (LSA+LCCA+LBT)

Thymus

Sternothryoid, sternohyoid

+ lymph nodes, cardiac nerves, innominate artery + veins

105
Q

Structure and Function of the Xiphoid Process

A

Small and cartilaginous

Prominent in adults if they lose significant weight - presents as a lump previously covered in fat

106
Q

Features of the aortic valve cusps

A

Each have:

a central nodule on its free edge

a sinus / dilatation in the aortic wall alongside each cusp

107
Q

Types of congenital diaphragmatic hernias

A
  1. Posterolateral hernia - through foramen of bochdalek (pleuroperitoneal membrane) - more common on left side; presents later, worse prognosis
  2. Hernia through a deficiency of the whole central tendon
  3. Hernia through the foramen of Morgagni anteriorly - xiphoid and costal cartilagel presents earlier
  4. Hernia through a congenitally large oesophageal hiatus
108
Q

Relations of the trachea in the neck

A

Anterior - isthmus of the thyroid (2nd-4th tracheal rings); sternohyoid; sternothyroid

Laterally - lobes of the thyroid gland; carotid sheath

Posteriorly - oesophagus, recurrently laryngeal nerves in the groove between trachea and oesophagus

109
Q

Order of NV bundle in ribs

A

Rib

Vein (lies in the groove)

Artery

Nerve

Rib

110
Q

Layers of incision

A

Skin

Superficial fascia

Platysma (lateral part of transverse incision only)

Pre-tracheal fascia (split longitudinally) - this is where bleeding may be encountered - anastamosis of the anterior jugular veins, inferior thyroid veins, thyroidea ima artery

Strap muscles - leading to isthmus - either retracted upwards or divided upwards and clamped

Exposes the cartilaginous rings of the trachea

Incision to admit the tracheostomy tube

111
Q

Surface anatomy of pleura

A

Behind the 1/3-2/3 if the clavicle

Extends 2.5cm above clavicle

Comes behind the sternoclavicular joint

Meets in the midline at sternal angle

R - lateral border of sternum then 8th at MCL, 10th at MAL, 12th at MSL (or lateral border of erector spinae)

L - arches at 4th CC laterally, then follows R pleura (4th/5th ICS not covered by pleura)

Pleura descends below the 12th rib at its medial extremity

112
Q

Where does visceral meet parietal?

A

Hilum of lung

113
Q

Second rib vs the first

A

Twice as long

Less curved

114
Q

Order of lung root structures (cranial to caudal)

A

R - upper lobe bronchus, pulmonary artery, right principle bronchus, lower pulmonary vein

L - pulmonary artery, bronchus, lower pulmonary vein

115
Q

Recurrent Laryngral Nerve position

A

Hooks around the 4th on the R as 5+6 disappears

Hooks around the 6th on the L (which is ductus arteriosus / ligamentum arteriosum in adults)

116
Q

Components of the muscular part of the diaphragm

A

Arcuate ligaments

Crura

Ribs

Sternum

117
Q

Process at birth

A

Baby breathes - LA pressure increases - pushing septum primum into secondum closing foramen ovale

Increased blood flow throguh PA; becomes poorly oxygenated - due to systemic venous blood

Vascular resistance (and presssure) lowered abruptly as lungs inflate - DA obliterated over next few days

Ligation of cord - thrombosis of umbilical artery, vein and DV

118
Q

Relations of the fibrous pericardium

A

Anterior - sternum - 3-6 costal cartilage, thymus, anterior edges of lungs and pleura

Posterior - oesophagus, descending aorta, T-5-8 vetebrae

Lateral - roots of the lung, phrenic nerve, mediastinal pleura

119
Q

Co-arctation pathophysiology

A

Failure of obliteration of ductus arteriosus = obstruction

Collateral flow through intercostal vessels supplied by superior intercostal artery of the costocervical trunk of the subclavian

Causes dilation and more tortuous vessels = rib notching

120
Q

Where does the lateral arcuate ligament arise?

A

Condensation of fascia ascia over quadratus lumborum

121
Q

Development of the heart

A

Two endothelial tubes fuse = primitive heart tube (in pericardial cavity)

5 sections - SV A V BC TA; SV into A, BC into V

Becomes U then S shaped

Boundary tissue between single atrial cavity and single ventricle grows as dorsal / ventral EC cushions

EC meet in the midline dividing common AV orifice into right (tricuspid) and left (mitral) orifices

Interventricular septum - apex to EC

Septum primum - atrium to EC, leaves small gap for FO

Septum secondum - right of primum; acts as valve for right to left shunt

At birth - decreased PP = primum pushed to close FO, primum and secondum fuse and obliterate FO leaving fossa ovalis

SV - joins atria + forms 2 vena cava on right and 4 pulmonary veins on left

122
Q

Costal Cartilage

Composition

Function

A

Hyaline Cartilage

Increase resilience, reduce fractures

123
Q

Boundaries of the anterior, middle and posterior mediastinum

A

Anterior Anterior sternum; posterior pericardium

Middle Anterior a. mediastinum; posterior p. mediastinum

Posterior anterior pericardium, root of lungs, diaphragm; posterior T4-T12

124
Q

Irritation of intercostal nerves eg during needle decompression

A

Part of the anterior rami of the thoracic nerves

Causes referred pain to the anterior chest or abdominal wall (where the nerve terminates)

125
Q

How are pericardial sinuses formed?

A

Due to refellections of the parietal and visceral pericardium

126
Q

Irritation of the diaphragm - where is the referred pain?

A

Cutaneous supply of phrenic nerve - C4 dermatome - shoulder tip

127
Q

Why is a sinus significant for the aortic valve cusps?

A

The anterior sinus opens into the right coronary artery

The left posterior sinus opens into the left coronary artery

128
Q

Where is the fossa ovalis located?

A

Interatrial septum

129
Q

L main bronchus

A

Downwards and laterally below arch of aorta in front of oesophagus and descending aorta

Gives off no branches until it enters hilum of lung - then gives of upper and lower lobe bronchi

Pulmonary artery lies anterior then above the bronchus

130
Q

Relations of the trachea in the thorax

A

Anteriorly - brachiocephalic artery, L brachiocephalic vein, L common carotid, thymus

Posteriorly - oesophagus, recurrent laryngeal nerves

Right - vagus nerve, azygos vein, pleura

Left - aortic arch, L common carotid, L subclavian vein, L recurrent laryngeal nerve, pleura

131
Q

Importance of pleura descending below the 12th rib in the medial extremity

A

Can be cut open in a loin approach to the kidney or adrenal

132
Q

Diaphragm

Shape

Composition

A

Dome

Peripheral muscular part; central tendon

133
Q

TOF components

A

Pulmonary stenosis

RVH

VSD

Overriding aorta

Cyanosis in the first few months + bootshaped heart

134
Q

R bronchopulmonary segments

A

Upper lobe - apical (1), posterior (2), anterior (3)

Middle lobe - lateral (4), medial (5)

Lower lobe - superior (6), medial basal (7), anterior basal (8), lateral basal (9), posterior basal (10)

135
Q

Serous pericardium

A

Parietal layer - in contact with fibrous layer

Visceral layer - synonymous with epicardium

Parietal is reflected onto visceral near the great vessels - the aorta and pulmonary trunk and the SVC / IVC and pulmonary veins

136
Q

Parts of the sternum

A

Manubrium

Body

Xiphoid

137
Q

What is the fibrous skeleton of the heart?

A

AV orifice - figure-of-8 conjoined fibrous ring

Purpose - acts as a skeleton for the attachment of muscles and valves

Maintains shape and position of the heart

138
Q

Contents of the inferior mediastinum

Posterior

Middle

Anterior

A

Posterior Thoracic duct
OEsophagus
Desecending aorta
(SAHAV) Splanchnic nerves (G,L,L) Azygos vein, Hemiazygos vein, accessory hemiazygos vein, vagus

Middle Great vessels (aorta / pulm trunk / SVC (lower) / 4 pulm veins); phrenic nerve, cardiac plexus

Anterior Sternopericardial ligaments
Thymus (in children)
Lymph nodes

139
Q

How to work out the oblique fissure?

A

Abduct arm fully - corresponds to the medial border of the scapula

OR

2.5cm lateral to T5 vertebrae to the 6th CC

140
Q

Where does the right atrium receive blood from?

A

SVC

IVC

Coronary sinus

Anterior cardiac vein

141
Q

How is the median arcuate ligament formed?

A

From the medial borders of the medial arcuate ligament

joins anteriorly over the aorta

142
Q

Location of SA node

A

Upper end of crista terminalis - right atrial wall

143
Q

Coarctation of aorta pathophysiology

A

abnormality of the obliterative process which normally occludes ductus arteriosus

results in hypertension in upper limbs; weak delayed femoral pulses

rib notching on CXR - intercostal arteries located on inferior border of ribs

144
Q

Pump handle vs bucket handle mechanism of respiration

A

Pump handle - anterior portion of the ribs + sternum is raised (usually below the posterior portion) - increasing AP diameter

Bucket handle - lateral portion of ribs 4-7 is raised (usually below the anterior and posterior portion) - increasing transverse diameter

mr C.S. (4 decks)

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