Block 1 - Anatomy - Thorax - Gray's Text Flashcards
Does the IVC pass directly through the diaphragm?
Does the esophagus pass directly through the diaphragm?
Does the aorta pass directly through the diaphragm?
Yes (at T8);
yes (at T10);
no (it passes behind it at T12)
What plane divides the superior and inferior mediastinum?
What structural points are relevant to this area?
A plane transecting T4 to the sternal angle;
the arch of the aorta passes just over it;
the top of the pericardium is just below;
it is the level of the carina
What three veins are very important in shunting blood from the left side of the body to the SVC (which is found right of midline)?
The left brachiocephalic, the accessory vein of the hemiazygous, and the hemiazygous vein
What set of small nerves connect the paravertebral (sympathetic) ganglia to the ventral ramus of the spinal cord?
Which is proximal (medial) and which is distal (lateral), respectively?
The white and gray rami;
gray, white
By what system can cancers be staged (in very basic terms)?
The TNM system
tumor size, nodal involvement, metastasis
What is unique about the first costovertebral joint?
What other three rib levels are similar?
The first rib only interacts with the first thoracic vertebra, unlike most ribs which interact with two vertebrae (their same level and the superior vertebra);
the ribs at TX, TXI, and TXII
Which thoracic vertebrae lack transverse costal facets?
Ribs at TXI and TXII
What rib interacts with the manubriosternal joint?
What rib interacts with the xiphisternal joint?
II;
VII
Is the rib attached to the vertebrae by anything other than positioning on the costal facets?
Yes;
an intra-articular ligament; a lateral, a superior, and a primary transverse ligament; and a synovial joint
What connects ribs I - VII directly to the sternum? What is absent in rib I that is present in the others?
Costal cartilage (hyaline); a synovial capsule
What is a potential result of the presence of a cervical rib?
Thoracic outlet syndrome
What muscle of the rib cage lies deep to the internal thoracic vessels?
Transversus thoracis
What differentiates the uppermost two posterior intercostal arteries from the rest?
They are derived from the supreme (superior) intercostal artery
Of what structure is the supreme (superior) intercostal artery a branch?
The costocervical trunk
Where does the right superior intercostal vein drain?
Where does the left drain?
The azygous v.;
the left brachiocephalic v.
What is a thoracostomy? Where is it performed?
A chest tube inserted to drain the pleural space;
the 4th or 5th intercostal space, just superior to the rib
Which artery passes near the phrenic nerve?
The pericardiacophrenic artery
Pain in the lateral neck and supraclavicular region could be referred from what structures?
(Hint: this is the C3, C4, and C5 dermatome)
The diaphragm, diaphragmatic pleura, parietal or fibrous pericardium, and mediastinal pleura
What is the largest pleural space?
The costodiaphragmatic recess
Identify which of the following structures passes posterior to the lung roots:
SVC vagus nerves esophagus phrenic nerves thoracic duct descending aorta ascending aorta azygous vein
vagus nerves esophagus thoracic duct descending aorta azygous vein
What landmarks typically outline the general path of the oblique fissure?
TIV –> cross the 5th intercostal space –> follow rib VI to the sternum
Pericarditis and MI can present in similar ways. What is one method of differentiating their presentations?
The pain associated with pericarditis can be relieved by leaning forward
What should normally happen to the jugular venous pulse upon inspiration?
What is called if the opposite happens? What might this indicate?
It drops (due to increased blood flow into the pulmonary system out of the right side of the heart);
Kussmaul’s sign, constrictive pericarditis (thickening of the pericardium)
Necrosis of what structure can lead to valve prolapse in the heart?
What might lead to this outcome?
The papillary muscle associated with that particular valve leaflet;
infarction
Where is the diaphragm at developmental week 4?
Week 6?
Week 8?
C4;
T4;
L1
Identify which of the following structures passes anterior to the lung roots:
SVC vagus nerves esophagus phrenic nerves thoracic duct descending aorta ascending aorta azygous vein
SVC
phrenic nerves
ascending aorta
What is another name for the bundle of His?
The atrioventricular bundle
Where are the bundle branches and plexus of Purkinje fibers within the heart wall?
They are subendocardial
the contraction is initiated on the inside of the heart wall and spreads across it from inside to out
The beginning of the atrioventricular bundle (bundle of His) is called the ________________ ______.
Atrioventricular node
Both the transverse and oblique coronary sinuses are within what structure?
The pericardial sac
What is a common potential location for ectopic parathyroid glands?
(Hint: remember how the pharyngeal arches develop)
The thymus (3rd pharyngeal arch)
From insertion in the subclavian, internal jugular, or axillary vein, to where are central line endpoints guided?
The distal SVC
What structure is useful for accessing the IVC and liver via guidewire catheterization?
The SVC (often through a transjugular approach)
What are the three fixed points of the thoracic aorta?
In what scenario are they most susceptible to being damaged?
Aortic valve, ligamentum arteriosum, aortic hiatus of the diaphragm;
trauma
What is the term referring to a complete inversion of the body organs (from left-to-right)?
With what heart pathology is it associated?
Situs inversus;
dextrocardia
What might be a presenting symptom of an abnormal right subclavian artery projecting from the aortic arch to supply the right arm?
Dysphagia
the great vessels form a ring around the trachea and esophagus
Do visceral afferents in the vagus n. carry pain information to the CNS?
What nerves do?
No;
the cardiopulmonary and splanchnic nerves
What name is given to the space between the pulmonary trunk and aorta?
What nervous structure passes through this space?
The aortopulmonary window;
the left recurrent laryngeal nerve
What information do visceral afferents in the vagus n. carry to the CNS?
Normal physiologic processes (no pain fibers)
A flat, thin structure is noted along the right posterior mediastinum near the esophagus. The structure is branched. What might it be?
What vessel might be present alongside it?
The azygous vein;
the thoracic duct between it and the esophagus
At what level does the trachea bifurcate?
To what level is the aortic arch just superior?
What plane separates the superior and inferior mediastinal spaces?
T4 to the sternal angle;
T4 to the sternal angle;
T4 to the sternal angle
Accessory cervical ribs may lead to thoracic outlet syndrome. What are three potential effects of this syndrome?
Subclavian artery compression - atheroma and embolus formation;
T1 nerve compression - musculature wasting of the intrinsic hand and medial forearm;
Subclavian vein compression - axillary vein thrombosis
What condition can cause notching of the ribs, and through what medium is this visualized?
Coarctation of the aorta;
CXR
What types of effects can an aortic dissection have on systemic circulation?
It can occlude peripheral arteries all along the aorta, potentially causing infarction of the heart, kidneys, intestines, legs, and other locations
