ANATOMY - Thorax p1 Flashcards
1
Q
what is the mediastinum between?
A
pleural sacs
2
Q
how is the mediastinum divided in half?
A
by an imaginary line between the sternal angle –> T4
3
Q
how is the inferior mediastinum further divided?
A
anterior
middle
posterior
4
Q
superior border superior mediastinum
A
thoracic inlet
5
Q
inferior border superior mediastinum
A
inferior mediastinum
6
Q
anterior border superior mediastinum
A
manubrium
7
Q
posterior border superior mediastinum
A
VB T1-4
8
Q
lateral border superior mediastinum
A
lung pleura
9
Q
contents superior mediastinum
A
arch of aorta + 3 branches (BCA, LCCA, LSCA)
SVC + tributaries - BCV, L sup intercostal v, supreme intercostal vv, azygous vv,
R + L vagus, L recurrent laryngeal nn
phrenic nn
cardiac nn –> sup + deep plexus
symp trunk
thymus
trachea + bifurcation point (T5)
oesophagus
thoracic duct (to left of oesoph)
sternohyoid, sternothyroid, inferior aspect longus colli mm
10
Q
most anterior structure superior mediastinum
A
thymus
11
Q
lateral border anterior mediastinum
A
pleura
12
Q
anterior border anterior mediastinum
A
body sternum
13
Q
posterior border anterior mediastinum
A
pericardium
14
Q
roof border anterior mediastinum
A
sup mediastinum
15
Q
floor border anterior mediastinum
A
diaphragm
16
Q
contents anterior mediastinum
A
loose CT
fat
lymphatic vessels
LN
branches internal thoracic vessels
17
Q
what structure can be found in the anterior mediastinum in children ?
A
thymus
18
Q
anterior border middle mediastinum
A
ant margin pericardium
19
Q
posterior border middle mediastinum
A
posterior margin pericardium
20
Q
lateral border middle mediastinum
A
pleura
21
Q
superior border middle mediastinum
A
sup mediastinum
22
Q
inferior border middle mediastinum
A
diaphragm
23
Q
contents middle mediastinum
A
heart/pericardium
tracheal birfurc T5
ascending aorta –> L+R coronary aa
pulmonary trunk –> R + L pulmonary aa
SVC
Cardiac plexus (at base of heart)
L + R Phrenic nn
tracheobronchial LN
24
Q
lateral border posterior mediastinum
A
pleural
25
anterior border posterior mediastinum
pericardium
26
posterior border posterior mediastinum
T5-12
27
roof border posterior mediastinum
sup mediastinum
28
floor border posterior mediastinum
diaphragm
29
contents posterior mediastinum
descending aorta + major branches: post intercostal aa, bronchial aa, oesophageal aa, sup phrenic aa
azygous system - 3 major vv - azygous vv, hemiazygos vv, accessory hemiazygos vv
oesophagus
oesophageal plexus
thoracic duct
sympathic trunks
30
contents posterior mediastinum
descending aorta + major branches: post intercostal aa, bronchial aa, oesophageal aa, sup phrenic aa
azygous system - 3 major vv - azygous vv, hemiazygos vv, accessory hemiazygos vv
oesophagus
oesophageal plexus
thoracic duct
sympathic trunks
31
what is the largest lymph vessel in the body?
thoracic duct
32
where does the thoracic duct originate from?
cisterna chyli
33
where does the thoracic duct lie?
anterior to T6-12
deviates left to enter the sup mediastinum
34
what 2 veins form to make the azygos vein?
R. lumbar + R subcostal
35
where does the azygos vein enter the mediastinum?
aortic hiatus
36
what 2 veins form the hemiazygos veins?
L lumbar
L subcostal
37
when does the hemiazygos vein join the azygos vein?
at T8 when it turns right
38
what veins form the accessory hemiazygos vein?
union 4th-8th intercostal veins
39
when does the accessory hemiazygos vein join the azygos vein?
at T7
40
how many rib pairs are there?
12
41
what do ribs terminate anteriorly as?
costal cartilage
42
what are the 3 sections of a typical rib?
head, neck, body
43
what are the 4 points of interest on a typical rib?
superior articular facet
inferior articular facet
tubercle costal groove
44
role of superior articular facet of rib
articulates with vertebra above
45
role of the inferior articular facet of rib
articulates with numerically corresponding vertebra
46
role of tubercle of rib
articulates with numerically corresponding vertebra
47
role of costal groove rib
for intercostal vv, aa, nn
48
which are the atypical ribs? (5)
1
2
10
11
12
49
what is atypical about rib 1?
shorter + wider
only 1 articular facet
on superior surface has 2 grooves for subclavian vessels
50
what is atypical about rib 2?
thinner and longer
roughened area upper surface where the serratus anterior originates
51
what is atypical about rib 10
only 1 facet
52
what is atypical about rib 11/12
no neck
1 facet
53
what are the 2 posterior articulations of the ribs?
costotransverse joint - tubercle --> transverse costal facet
costovertebral joint - sup costal facet of same vvert + inf costal facet vertebrae above
54
anterior articulation ribs 1-7
to sternum
55
anterior articulation ribs 8-10
costal cartilages superior to them
56
anterior articulation ribs 11 + 12
no anterior attachments
hence floating ribs
57
name of top depression of manubrium
jugular notch
58
what part of the sternum articulates with the clavicle to form the sternoclavicular joint?
manubrium
59
level of sternal angle
2nd CC
T4/5
60
name of joint between manubrium and body of sternum
manubriosternal joint
61
name of joint between body of sternum and xiphoid process
xiphisternal joint
62
up to what age is the xiphoid process largely cartilaginous?
40
63
what spinal level is the tip of the xiphoid process?
T10
64
why do sternal fractures have a high mortality rate? (up to 45%)
due to being concurrent with damage to viscera underneath
65
why are sternal fractures usually undisplaced?
due to attachment to pectoralis mm
66
how many thoracic vertebra
12
67
what do the costal facets of T1-10 articulate with?
tubercle rib
68
what to the thoracic demifacets articulate with?
head of rib
69
what are the thoracic demifacets lined with?
cartilage
70
unique ligaments to thoracic spine - radiate ligament head of rib
head of rib to bodies of 2 vertebra + IVD
71
unique ligaments to thoracic spine - costotransverse ligament
neck of rib to TP
72
unique ligaments to thoracic spine - lateral costotransverse ligament
TP to tubercle rib
73
unique ligaments to thoracic spine - superior costotransverse ligament
upper border neck of rib --> TP of vertebra superior to it
74
how many pairs of external intercostal muscles?
11
75
in which direction do the external intercostal muscles run?
inferoanteriorly
76
what muscle of the abdomen are the external intercostal muscles continuous with?
external obliques
77
origin/insertion external intercostal muscles
lower border rib --> sup border rib below
78
action external intercostal muscles
elevate ribs
increase thoracic volume
79
innervation external intercostal muscles
intercostal nn T1-11
80
are the internal intercostal muscles superficial or deep to the external intercostal muscles?
deep
81
in what direction do the internal intercostal muscles run?
inferoposterior
82
what abdominal muscle are the internal intercostal muscles continuous with?
internal obliques
83
origin/insertion internal intercostal muscles
lateral edge costal groove --> sup surface to rib below
84
action internal intercostal muscles
decrease thoracic volume and elevate ribs
85
innervation internal intercostal muscles
internal nn T1-11
86
how are the internal and innermost intercostal muscles separated?
by NV bundle (intercostal tunnel) containing intercostal aa,vv, nn
87
origin/insertion innermost intercostal muscles
medial edge costal groove --> sup surface rib below
88
action innermost intercostal muscles
decrease thoracic volume
elevate ribs
89
innervation innermost intercostal muscles
intercostal nn T1-11
90
what muscle is the transversus thoracis muscle continuous with inferiorly?
tranversus abdominis
91
origin/insertion transversus thoracis
posterior surface inferior sternum --> internal surface CC 2-6
92
action transversus thoracis
weakly depresses ribs
93
innervation transversus thoracis
intercostal nn T2-6
94
direction of subcostal mm fibres in comparison to innermost intercostal mm
parallel
95
origin/insertion subcostal mm
inferior surface lower ribs (near angle) --> sup border rib 2/3 or below
96
action subcostal mm
elevates ribs
decreases thoracic vol
97
innervation subcostal mm
intercostal nn T1-11
98
what are the 2 main functions of the diaphragm
separate thoracic cavity from abdocavity
insp/exp
99
what are the 3 peripheral attachments of the diaphragm?
lumbar vertebra/arcuate ligaments
costal cartilages ribs 7-10
xiphoid process sternum
100
where does the R crus of the diaphragm arise from ?
L1-3
+ IVD
101
where does the L crus of the diaphragm arise from?
L1-2
IVD
102
what does the central tendon of the diaphragm fuse with
inferior surface fibrous pericardium
103
level caval hiatus diaphragm
T8
104
what passes through caval hiatus (2)
IVC
Terminal branches phrenic nn
105
level oesophageal hiatus diaphragm
T10
106
what passes through oesophageal hiatus (3)
oesophagus
R + L CNX
oesophageal branches of L gastric aa vv
107
level aortic hiatus diaphragm
t12
108
what passes through aortic hiatus (3)
aorta
thoracic duct
azygos vv
109
innervation of diaphragm
phrenic nn
C3-5
110
aa supply diaphragm
inferior phrenic aa is MAIN
also:
sup phrenic
pericardiophrenic
musculophrenic
111
what is inferior phrenic aa a branch of?
abdominal aorta
112
vv supply diaphragm
follow aa hence
inferior phrenic aa is MAIN
also:
sup phrenic
pericardiophrenic
musculophrenic
113
how many valves in the superior vena cava?
valveless HENCE 0
114
where is the SVC taking blood to and from?
from upper body
to Right Atrium
115
which 2 veins form the SVC and at what level
L + R BCV
1st RCC
116
position of SVC in superior mediastinum
behind intercostal spaces
to the right of aorta + trachea
117
position of SVC in middle mediastinum
enters at level of 2nd CC
here = surrounded by fibrous pericardium
118
what level does the SVC terminate to empty into the RA?
3rd CC
119
other tributaries to the SVC (apart from BVC) (4)
azygos vv (enters T4)
mediastinal vv
osoeophageal vv
pericardial vv
120
why are JVP and SVC related?
as the SVC is valveless
pressure from RA = conducted up into IJV
121
causes of JVP raise (3)
R sided HF
pulmonary HTN
SVC obstruction
122
why is the SVC vulnerable to compression?
thin walled
low pressure
123
common causes of SVC compression ? (3)
lung cancer
mets
lymphoma
124
Sx SVC compression
swelling neck face upper limbs
SOB
distention vv
125
how to assess SVC compression
Pembertonsw test
pt raises both arms
above head 1 min
+ve --> facial oedema/cyanosis occur
126
where does the aorta receive blood from?
LV
127
what are the 4 sections of the aorta>
ascending
arch
thoracic (descending)
abdominal
128
what level does the aorta terminate and what does it become
L4
L + R common iliac aa
129
where does the ascending aorta arise from
aortic orifice LV
130
what are the branches of the ascending aorta
L + R aortic sinuses at level of aortic valve --> R + L coronary aa
131
what level does the aortic arch begin
2nd CC
132
what level does the aortic arch end?
T4
133
what connects the aortic arch to the pulmonary trunk ?
ligamentum arteriosum
134
what is the ligamentum arteriosum a remnant of?
ductus arteriosus
135
branches of aortic arch
BC trunk
L SCA
L CCA
136
what does the BC trunk supply?
R side H+N
R upper limb
137
what does the L SCA supply
L upper limb
138
What does the L CCA supply
L H+N
139
what part of the aortic arch does CoA tend to happen
at insertion of ligamentum arteriosum
140
level thoracic aorta spans between
T4 --> T12
141
level abdominal aorta spans between
T12-L4
142
paired arteries thoracic aorta? (2)
intercostal aa
sup phrenic aa
143
how many pairs of intercostal arteries are there?
9
144
role intercostal aa
supply intercostal spaces
also contribute to vertebra, back mm, body wall + skin
145
which intercostal spaces are not supplied by intercostal arteries (and what supplies them instead)
1 + 2
supplied by SCA
146
what do the sup phrenic aa supply
diaphragm (sup)
contribute to vertebra, back mm, body wall + skin
147
what are the 4 unpaired aa of the thoracic aorta?
bronchial aa
pericardial aa
oesophageal aa
mediastinal aa
148
what does the bronchial aa supply
air passages respiratory tract, lung tissue
149
what does the pericardial aa supply
dorsal pericardium
150
what does the oesophageal aa supply
oesophagus
151
what does the mediastinal aa supply
mediastinal structures
152
what are the 6 paired arteries from the abdominal aorta?
inferior phrenic (T12)
Adrenal aa (L1)
Renal aa (L1-2)
Gonadal aa - testicular/ovarian L2
Lumbar aa (L1-4)
Common iliac aa (L4)
153
inferior phrenic aa level and direction
T12
posterior
154
what does the inferior phrenic aa supply
diaphragm
inferior oesophagus
155
adrenal aa level and direction
posterior
L1
156
what does the adrenal aa supply
adrenals
157
renal aa level and direction
L1-2
lateral
158
what do the renal aa supply
kidneys
159
gonadal aa level and direction
lateral
L2
160
what do the gonadal aa supply?
testes
ovaries
161
how many pairs of lumbar aa?
4
162
lumbar aa level and direction
L1-4
posterolat
163
what do the lumbar aa supply?
vertebra
SC
abdominal wall
lumbar region
164
what are the 4 unpaired aa of the abdominal aorta?
coeliac trunk (T12)
sup mesenteric (L1)
inf mesenteric (L3)
medial sacral aa (L4)
165
level and direction coeliac trunk
T12
anterior
166
what 3 vessels does the coeliac trunk become?
left gastric aa
splenic aa
common hepatic aa
167
what does the L gastric aa supply
stomach
adjacent oesophagus
168
what does the splenic aa supply
spleen
stomach
pancreas
169
what does the common hepatic aa supply
liver
stomach
GB
duodenum
pancreas
170
sup mesenteric aa level and direction
L1
anterior
171
what does the superior mesenteric aa supply ?
pancreas
Small intestine
appendix
1st 2/3 large intestine
172
inferior mesenteric aa level and direction
L3
anterior
173
what does the inferior mesenteric aa supply?
last 1/3 large intestine
from splenic flexure to rectum
174
median sacral aa level and direction
posterior
L4
175
what does the median sacral aa supply?
coccyx
lumbar vertebra
sacrum
176
role of thymus gland in puberty
development of the immune system
177
what happens to the thymus gland after puberty
largely replaced by fat
178
what 2 things are the follicles of the thymus gland composed of
central medullary (less lymphocytes more epithelial cells)
peripheral cortical (lymphocytes, supported reticular cells)
179
which part of the mediastinum is the thymus mainly in?
superior
180
arterial supply thymus
anterior intercostal aa
(+ small branches int thoracic aa )
181
venous drainage thymus
L BCV
internal thoracic vv
182
thymic aplasia is seen in what condition?
Di George (ps with recurrent infections)
183
horizontal border of the breast
lateral border of the sternum --> mid axillary line
184
vertical border of the breast
2nd to 6th CC
185
what 2 muscles does the breast lie on?
pectoralis major
serratus anterior
186
anatomical structure breast (draw)
connective tissue stroma =fibrous stroma + fatty component
mammary gland = lobule + lactiferous ducts
on top of pec major = pectoral fascia = attachment for suspensory ligaments from fibrous stroma
space betw breast + breast = retromammary space
187
arterial supply to medial breast
internal thoracic aa aka internal mammary aa
188
what is the internal thoracic/mammary aa a branch of?
SCA
189
arterial supply lateral breast
lateral thoracic branches axillary aa
lateral mammary branches of posterior intercostal aa
mammary branch of anterior intercostal aa
190
venous drainage breast
follows arterial
191
where does the venous drainage of the breast then drain into?
axillary and internal thoracic aa
192
which lymph node group of the breast is most likely for breast Ca to metastasise to?
axillary aa
193
% drainage axillary LN breast
75%
194
5 types of axillary LN breast (going clockwise)
axillary
pectoral
posterior
central
lateral
195
% drainage parasternal LN breast
20%
196
% drainage posterior intercostal LN breast
5%
197
skin of breast is drained by which LN?
axillary
inferior deep cervical
infraclavicular
198
nipple/areolar region of breast is drained by which LN?
subareolar lymph plexus
199
nerve supply to breast (autonomic/sensory)
anterior + lateral cutaneous branches 4th - 6th intercostal nn
