Cardio-Thoracic/Mediastinum Anatomy plus Boobs Flashcards
Where is the axillary process of the breast located?
supero-lateral extension
Why is the axillary process of the breast important
localized region of increase breast tissue = increased incidence of tumours
between which 2 ribs is the breast usually located?
2 & 6
Which layer are breast implants usually put?
retromammary space
the shape of the deep coronal layer of the breast is convex?
False. Concave.
What are the two main areas in which the breast is innervated and blood supply comes and drains?
internal thoracic (laterally from sternum) From axilla
Describe the lymphatics of the breast
mirrored with blood vessels
You find a swollen lymph node in the axillary region of a female patient. Just a simple rhinovirus right?
Could be cancer.
which ribs articulate with sternum?
upper 7 ribs
what does rib 11 and 12 articulate with?
NOTHING!
where does cartilage rib 8,9,10 articulate?
with rib 7 cartilage
head of the ribs has one or two heads?
Two!
Superior
Inferior
Why is the lateral tubercle of the rib convex?
for attachments
describe the medial tubercle of the rib
concave, made for articulating
what’s the costal groove for?
VAN
Vein
Artery
Nerve
What are 3 dead give-aways that you’re looking at a thoracic vertebra?
demifacets on superior/ inferior body
facets on the transverse processes
long vertical spinous process
what’s so great about radial ligaments?
strong as heck, break the rib long before you dislocate it
2 places where you can find radiating ligament:
- costotransverse joints
2. costovertebreal joints
what’s a flail chest?
one rib, two breaks, floating and gets sucked in due to negative pressure while breathing: painful.
Some poor dude comes into the ER with broken ribs, a few of which are broken twice in the same rib, he’s got pain whilst breathing. You suspect
Flail chest
Follow the circumferential muscles of the diaphragm from sternum to vertebra, trace the journey with anatomical landmarks and take plenty of pictures along the way!
- xyphoid process
- costal margins
- tips of rib 11/12
- arcuate ligaments
- left and right crus
Left crus is longer than right. T/F?
False.
What do the crus of the diaphragm do?
anchors the diaphragm to the vertebral bodies
name the two muscles that pass through the arcuate ligaments:
- Quadratud lumborum laterally
2. psoas medially
What’s the mickey mouse tendon?
Central tendon of the diaphragm
What level does the aorta pass through the diaphragm?
T12 between the crura
what level does the IVC pass through the diaphragm?
T8
What level does the oesophagus pass through the diaphragm??
T10
What passes through T8 in the diaphragm?
IVC
What passes through T10 in the diaphragm?
oesophagus
What passes through T12 in the diaphragm?
Aorta
how do you paralyze a hemi diaphragm?
cut the phrenic nerve
3 layers of intercostal muscles: Go.
- external
- internal
- innermost
describe the external ICM
- front pockets facing
- used for inspiration
- external costal membrane anteriorly
describe the internal ICM
- back pockets facing (postero inferiorly)
- for expiration (but prolly for splinting rather)
- internal costal membrane located posteriorly
Describe the inner most ICMs
- discontinuous
- mirrors internal ICMs
- lateral, parasternal, paravertebral
Where is the costal neuromuscular bundle located between?
Internal and innermost ICMs
how are costals innervated from?
Ventral ramus of intercostal nerve
2 arterial blood supplies for costals:
- aorta
2. internal thoracic
need to stab you to get to your lungs, how do I avoid the neuromuscular bundle?
bounce in the top of the rib. never the bottom.
I change in 3 directions when I breath, they are:
- vertical
- lateral
- A-P
pump handle movement is which direction? by which ribs?
A-P. upper ribs
lateral movement of ribs when breathing are by which ribs? what is it called?
lower ribs. bucket handle
3 accessory muscles of respiration:
- abdominal muscles
- sternocleidomastoid
- scalenes
what anchors the diaphragm’s central tendon superiorly?
pericardium
what levels is the paricardial sac located?
Between T5 and T8
How much fluid in the pericardial cavity?
1-2 ml
Name the two layers of inner membrane of the pericardium:
Parietal and visceral serous membranes
What the the layer of membrane directly surrounding the heart?
visceral serous memrbrane
What the the outer most later of the pericardium called?
fibrous membrane
the vessels that enter and exit the pericardium all go through one opening with a serous membrane. T/F?
False. Each vessels has it’s own sleeve layer of serous membrane.
Where can surgeons and curious medical student stick their finger in the heart safely for landmarking?
transverse pericardial sinus
Where is the base of the heart
right supero-lateral aspect
the 5th intercostal space is above or below the 5th rib?
below, low, low, low, low…….
Superior vena cava has valves?
Nope.
What are the muscle-y rough textured wall of the right atria called?
musculi pectinati
where is the coronary sinus?
near the rudimentary IVC valve
Describe the sinus venarum in one word
smooth
what’s the crista terminalis
where all the musculi pectinati meet and end
in adults what is the reminent of the foramen ovalis called?
fossa ovalis
what stops the tricuspid valve from bursting open into the atria when ventricular pressure > atrial pressure?
chordae tendinae
What’s the papillary muscle? how many are there?
gives rise to the chordae tendinae
there are 3
right atria wall is thicker than the right ventricle?
False
what’s the analagous structure to musculi pectinati in the right ventricle?
trabeculae carnae
smooth area right before the pulmonary trunk is called what? describe it in one word:
conus arteriosus/infundibulum
Smoooooooooooooooooth!
how many papillary muscles connect to the mitral valve via it’s chordae tendinae?
Two
describe the left atrium chamber in one word.
Yep. Smooth bro. Real smooth.
Does the heart have a skeleton? What two things does it do?
- yes a fibrous one
2. archors and electrically isolates them
what’s a coronet?
wraps around the aorta and pulmonary trunk. Two of them.
what’s the ‘figure 8’ fibrous skeleton of the heart feature called?
Trigones. Two of them. Remember: once the blood passes through the valves “y’gotta let trigones be trigones…..”
Which side of the mitral and tricuspid valve is smooth?
atrial side
name three parts of the tricuspid valve
- anterior
- septal cusp
- posterior cusp
How are the chordae tendinae attached to the cusps?
each chordae attaches to half of one cusp, and half to another cusp for maximal closure/seal
2 places where semilunar valves found?
- aortic valve
2. pulmonary valve
pulmonary valves are passive valves. T/F?
true
what supports the semilunar valves?
fibrous skeleton: the coronets
where is the origin of the right and left coronary arter?
near the right and left cusp of the aortic valves respectively
Origin of the SA node?
top of the cristae terminalis
Where is the AV node?
between tricuspid and coronary sinus
what’s at the top of the cristae terminalis?
SA node
What’s between the tricuspid and the coronary sinus?
AV node
bundle of His is on the atrial or ventricle side of the fibrous skeleton?
ventricle side
bundle of His give rise to?
Purkinje Fibres.
where is the cardiac plexus situated?
Base of the heart. I know right? the superior aspect bro.
what runs between the SA and AV node on the outside of the heart?
Right coronary artery
The circumflex artery is on the left or right?
branches off the left coronary artery
2 places of anastamosis for coronary arteries. Go.
- right coronary and left circumflex branches posteriorly
2. Anterior interventricular branch and posterior interventricular branch.
between which vertebrae is the middle mediastinum ?
T5-8
What two nerves are always with aortic arch?
vagus
phrenic
What two structures follow the oesophagus
thoracic duct
L recurrent laryngeal nerve
Where does the azygous vein drain into?
behind 2nd right intercostal cartilage
What is the remnant of the pulmonary circulation shunt in foetus called?
Ligamentum arteriosum
If someone has dysphagia, what rare anatomical variation could be causing it?
Retroesophageal right subclavian artery
4 places phrenic nerve passes through
anterioe scalenes
between subclavian artery/vein
anterior to lung root
pieces diaphragm`
T/F left phrenic nerve pierces diaphragm with IVC at T8.
False, that’s the RIGHT phrenic nerve dummy!
What are the most lateral structures in the media stinum?
phrenic nerves
motor to diaphragm
sensory to mediastinal, pericardium
What kind of nerve is it?
Mixed nerve (phrenic)
Vagus nerve path
Along trachea
behind lung root
ant. oesophagus
Where does the vagus pierce diaphragm?
with oesophagus at T10
Which one is in front of lung root? which one is behind? Phrenic or vagus?
Phrenic in front
Vagus behind
In a cadaver, how can you tell which is the oesophagus, which is trachea?
oesophagus is flattened
trachea is open
What level do the bronchi branch?
T4-5
What loops around the subclavian?
recurrent laryngeal vagus
What on earth is the cisterna chyli?
Where the thoracic duct starts (L2)
where does the thoracic duct dump the lymph into?
left subclavian/left internal jugular
Four branches of descending thoracic aorta:
- intercostal
- bronchial
- Pericardial
- oesophageal
