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FRCEM Primary > Anatomy - Thorax > Flashcards

Anatomy - Thorax Flashcards

1
Q

Dermatomes of the thorax and abdomen

A

C4, T2 - Upper chest where arms attach.
T4 nipples
T10 umbilicus
L1 Genitalia

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2
Q

Which rib is atypical

A

Rib 1

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3
Q

Which ribs are true ribs

A

2-7

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4
Q

Which ribs are false ribs

A

8-12

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5
Q

With which vertebra does rib 1 articulate?

A

T1

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6
Q

Thoracic wall has 3 muscle layers. Outer layer contains

A

External intercostals - down and forward

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7
Q

Thoracic wall has 3 muscle layers. Intermediate layer contains

A

Internal intercostals - down and backwards

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8
Q

Thoracic wall has 3 muscle layers. Inner layer contains

A

Innermost intercostals and transversus

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9
Q

Pump handle action of breathing

A

All ribs drawn together and raised up towards the fixed first rib. The anterior aspect of each rib rises above the posterior end.

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10
Q

Bucket handle action of breathing

A

The lateral aspect of each rib is raised. The false ribs open anteriorly like a book. This increases the anterior diameter of the chest.

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11
Q

In quiet respiration rib elevation is carried out by which muscles

A

External intercostals with support from scalene muscles

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12
Q

In forced inspiration rib elevation is supported by

A

pectoral muscles, sternocleidomastoid, serratus anterior and latissimus dorsi

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13
Q

Abdominal breathing is facilitated by

A

Contraction of the diaphragm which increases the vertical diameter of the thorax

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14
Q

The intercostal groove of the upper rib contains

A

The neurovascular bundle

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15
Q

The intercostal space contains (3)

A

Muscle layers - three - external, internal, transverse
Fascia - endothoracic fascia, lined internally by parietal pleura
Neurovascular bundle - containing Intercostal vein, artery and nerve

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16
Q

Chest drain or pleural aspiration site

A

5th interncostal space, midaxillary line, just over the lower rib

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17
Q

Surface markings of the diaphragm from (3)

A

Xiphoid process
Lower 6 costal cartilages
First 3 lumbar vertebrae

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18
Q

Surface markings of the diaphragm to (1)

A

Central tendon

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19
Q

Diaphragm central tendon sits

A

Behind xiphisternal joint

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20
Q

Right dome of diaphragm sits at

A

Level of upper border of 5th rib midclavicular line

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21
Q

Left dome of diaphragm sits at

A

Level of lower border of 5th rib midclavicular line

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22
Q

Aortic opening of diaphragm at vertebral level

A

T12

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23
Q

Aortic opening through diaphragm contains (3)

A

Aorta
Azygous vein
Thoracic duct

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24
Q

Oesophageal opening of diaphragm at veterbral level

A

T10

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25
Q

Oesophageal opening through diaphragm contains (4)

A

Oesophagus
Right and left vagus nerves
Oesophageal branches of left gastric vessels
Lymphatics from lower 1/3 oesophagus

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26
Q

Vena caval opening of diaphragm sits at veterbral level

A

T8

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27
Q

Vena caval opening through diaphragm contains (2)

A

Inferior vena cava

Branches of right phrenic nerve

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28
Q

Congenital diaphragmatic hernias (4)

A

Bochdalek’s hernia
Absence of diaphragm
Absence of central tendon
Morgagni hernia

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29
Q

Bochdalek’s hernia

A

Hernia through pleuriperitoneal canal, more common on left which closes last

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30
Q

Morgagni hernia

A

Small defect in anterior diaphragm close to sternum

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31
Q

Acquired hiatus hernia (2)

A

Sliding - raised intra-abdominal pressure and obesity. Stomach slides through oesophageal opening causing relflux.
Rolling - Fundus of stomach passess alongside oesophagus into chest. No refulx but can become strangulated or perforate.

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32
Q

Emergency thoracotomy approach

A

Stand on the left, abduct left arm. Incision starts medial end 5th intercostal space, extend laterally into the axilla along the top of the 6th rib. Use rib retractors and tough scissors to divide the sternum into the right 5th intercostal space. OPen the pericardium, close myocardial defects and or perform cardiac massage.

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33
Q

Thoracic inlet boundaries

A

T1 vertebra, medial borders of 1st ribs, superior border of manubrium

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34
Q

Thoracic inlet contains

A 
Oesophagus
Trachea
Subclavian arteries
Aortic arch
Subclavian veins
Brachiocephalic trunk
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35
Q

Branches of the aortic arch R-L

A

Brachiocephalic arch splitting into right common carotid and right subclavian
Left common carotid artery
Left subclavian artery

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36
Q

Posterior to the trachea in the neck is the (2)

A

Oesophagus

Recurrent laryngeal nerve

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37
Q

Lateral to the trachea n the neck is the (3)

A

Thyroid isthmus at 2-4th tracheal rings
Carotid sheath
Anterior jugular veins

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38
Q

Trachea origin

A

Below cricoid cartilage of the larynx at the level of C6

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39
Q

Trachea termination

A

At the sternal angle at the level of T4 where it splits into left and right main bronchus

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40
Q

Anterior relations of the trachea in the mediastinum (6)

A 
Sternum
Thymus
Left brachiocephalic vein
Origin of brachiocephalic artery
Origin of left common carotid artery
Arch of aorta
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41
Q

Posterior relations of the trachea in the mediastinum (2)

A

Oesophagus

Recurrent laryngeal nerve

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42
Q

Right sided relations of the trachea in the mediastinum (3)

A

Azygous vein
Right vagus nerve
Pleura

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43
Q

Left sided relations of the trachea in the mediastinum (6)

A 
Arch of aorta
Left common carotid artery
LLeft subclavian artery
Left vagus nerve
Left phrenic nerve
Pleura
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44
Q

The thymus is

A

Lymphatic tissue moulded around the great vessels and trachea

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45
Q

The thymus lies

A

In anterior mediastinum between manubrium and pericardium

46
Q

Change in size of thymus over time

A

Large at birth, getting bigger until puberty when it involutes

47
Q

Blood supply of thymus

A

Inferior thyroid and internal thoracic arteries

48
Q

Fibrous pericardium role

A

Strong outer layer. Fuses with the outer layer of the great vessels that pass through it.

49
Q

Serous pericardium role

A

Parietal layer - Lines fibrous pericardium, reflects around the roots of the great vessels, becomes continuous with the
Visceral layer - closely applied to the heart, forms a cavity between the parietal layer that contains pericardial fluid to lubricate the movement of the heart

50
Q

Right heart border is

A

right atrium

51
Q

Left heart border is

A

Left atrium

Left ventricle

52
Q

Superior heart border is

A

Roots of great vessels

53
Q

Inferior heart border is

A

Right ventricle

Apex of left ventricle

54
Q

Surface markings of the heart - apex

A

Left 5th intercostal space 9cm from midline

55
Q

Surface markings of the heart - superior border

A

2nd left costal cartilage, 1.5cm from edge of sternum to 3rd right costal cartilage 1.5cm from sternum

56
Q

Surface markings of the heart - right border

A

3rd right costal cartilage to 6th right costal cartilage, 1.5cm from sternum

57
Q

Surface markings of the heart - left border

A

2nd costal cartilage to apex of heart 5th intercostal space 9cm from midline

58
Q

Surface markings of the heart - inferior border

A

6th right costal cartilage to apex of heart 5th intercostal space 9cm from midline

59
Q

Tricuspid valve sits

A

Between right atrium and right ventricle.

60
Q

Mitral valve sits

A

Between left atrium and left ventricle

61
Q

Pulmonary valve sits

A

Guards pulmonary orifice

62
Q

Aortic valve sits

A

Guards aortic orifice

63
Q

Surface marking of tricuspid valve

A

Behind right half of sternum opposite 4th intercostal space

64
Q

Surface marking of mitral valve

A

Behind left half of sternum opposite 4th costal cartilage

65
Q

Surface marking of pulmonary valve

A

Behind medial end of 3rd left costal cartilage and sternum

66
Q

Surface marking of aortic valve

A

Behind left half of sternum opposite 3rd intercostal space

67
Q

Auscultation point for tricuspid valve

A

Right sternal edge, 5th intercostal space

68
Q

Auscultation point for mitral valve

A

Apex beat

69
Q

Auscultation point for pulmonary valve

A

Left sternal edge 3rd costal cartilage

70
Q

Auscultation point for aortic valve

A

Right sternal edge, 2nd intercostal space

71
Q

Ascending aorta originates from

A

Base of left ventricle. Runs upwards and forwards to lie behind right half of sternum.

72
Q

Pulmonary trunk originates from

A

Upper part of right ventricle. It runs upwards, backwards and to the left.

73
Q

Ascending aorta terminates at

A

At the sternal angle it becomes the arch of the aorta

74
Q

Pulmonary trunk terminates at

A

Terminates at the concavity of the aortic arch by dividing into left and right pulmonary arteries

75
Q

SA node sits in the

A

Wall of the right atrium

76
Q

The AV node sits in the

A

wall of the interatrial spetum

77
Q

The bundle of His is

A

Divided into left and right branches and transmits to Purkinje fibres. It sits in the interventricular septum

78
Q

Purkinje fibres do what

A

Conduct impulses to left and right ventricles. They are in the subendocardial tissue

79
Q

Right coronary artery supplies (4)

A

Right ventricle
SA node (in 60% of people)
Parts of the atria
Parts of the interventricular septum including the AV node

80
Q

Left coronary artery supplies (4)

A

Left ventricle
SA node (in 40%) of people
Parts of the atria
Parts of the interventricular septum

81
Q

Emergency Pericardiocentesis approach

A

18G needle on a syringe and 3way tap. Insert needle below xiphisternum, direct superiorly and posteriorly towards tip of right scapula. Aspirate as advancing until blood is aspirated.

82
Q

Vertebral levels of the oesophagus

A

C6-T10

83
Q

Constriction point of cervical oesophagus

A

Where pharynx joins upper end - 6cm from incisors

84
Q

Constriction point of thoracic oesophagus

A

Where left bronchus and aortic arch cross, 25cm from incisors

85
Q

Constriction point of abdominal oesophagus

A

Where oesophagus passes through diaphragm, 41cm from incisors

86
Q

Nerve supply of cervical oesophagus (2)

A

Recurrent laryngeal

Sympathetic fibres from middle cervical ganglion

87
Q

Nerve supply of thoracic oesophagus (3)

A

Vagus nerve
Sympathetic trunk
Greater splanchnic nerve

88
Q

Nerve supply of abdominal oesophagus (2)

A

Vagal plexus

Oesophageal plexus

89
Q

Visceral pleura nerve supply (1)

A

Pulmonary plexus - feels stretch not pain

90
Q

Parietal pleura nerve supply (2)

A

Intercostal nerve
Phrenic nerve
Feels stretch and pain

91
Q

Surface markings of pleura - top

A

Sternoclavicular joint to 2.5cm higher than clavicle 1/3rd along.

92
Q

Surface markings of pleura - right (4)

A

6th costal cartilage
8th rib - midclavicular line
10th rib midaxillary line
12th rib border of erector spinae

93
Q

Surface markings of pleura - left (5)

A 
4th costal cartilage indents laterally separated from the chest wall by the pericardium, meaning the left 4th and 5th rib have no pleura medially.
Then same as right - 
6th costal cartilage
8th rib - midclavicular line
10th rib midaxillary line
12th rib border of erector spinae
94
Q

Right lung lobes

A

Upper
Middle
Lower

95
Q

Right lung fissure

A

Transverse

Oblique

96
Q

Left lung lobes

A

Upper
Lower
Lingula - between oblique fissure and cardiac notch

97
Q

Left lung fissure

A

Oblique

98
Q

Lung roots contain (6)

A 
Bronchi
Pulmonary artery
Pulmonary veins
Lymph vessels
Bronchial vessels
Nerves
99
Q

Lung roots are

A

surrounded by tubeal sheath of pleura, connecting lung roots to mediastinum

100
Q

Surface anatomy of lung - Superior

A

Sternoclavicular joint to inner third/outer 2/3 junction of clavicle with apex 2.5cm above clavicle

101
Q

Surface anatomy of lung - anterior

A

Right lung - Sternoclavicular joint to sternal angle, down to xiphisternal joint.
Left lung same but deviates laterally at 4th costal cartilage for the cardiac notch, then down to xiphisternal notch

102
Q

Surface anatomy of lung - lower border

A

6th rib at midclavicular line
8th rib at midclavicular line
10th rib adjacent to veterbral column

103
Q

Surface anatomy of lung - posterior

A

Spinous process of C7 down to T10 4cm from midline

104
Q

Surface anatomy of the lung - Oblique fissure

A

Spine of the scapula down, anterior and lateral along the 6th rib to the 6th costochondral junction

105
Q

Surface anatomy of the lung - Horizontal fissure

A

Along 4th costal cartilage to meet the oblique fissure in the midaxillary line

106
Q

Superficial lymph drainage of lung

A

Over the surface then via bronchopulmonary nodes in the hilum

107
Q

Deep lymph drainage of the lung

A

Deep plexus along course of bronchi and pulmonary vessels to the bronchopulmonary nodes in the hilum

108
Q

From the hilum lymph drains via

A

the tracheobronchialnodes and into the bronchomediatinal trunks

109
Q

The pulmonary plexus contains

A

efferent and afferent autonomic nerve fibres from the sympathetic trunk
parasympathetic fibres of the vagus nerve

110
Q

Sympathetic efferent fibres cause

A

Bronchodilation

Vasoconstriction

111
Q

Parasympathetic efferent fibres cause

A

Bronchoconstriction

Vasodilation

FRCEM Primary (32 decks)

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