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Thoracic > Chapter 1 > Flashcards

Chapter 1 Flashcards

1
Q

How is the mediastinum divided into compartments?

A

1) Four-compartment model (subdivided by thoracic plane)
2) Felson’s three-compartment model (no superior compartment)
3) Shield’s three-compartment model (prevasc-visc-paraverteb)

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2
Q

Where does thoracic duct go from R to L?

A

At T4, angle of Louis

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3
Q

Where does left recurrent laryngeale nerve loop around aortic arch?

A

At T4, angle of Louis

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4
Q

What is the arterial supply of the thymus?

A

a) Internal thoracic arteries
b) Inferior thyroid arteries
c) Superior thyroid arteries

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5
Q

What is the venous drainage of the thymus?

A

Via the posterior veins of Keynes which drain into the
a) brachiocephalic veins
b) internal thoracic veins
c) superior vena cava
d) inferior thyroid veins

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6
Q

What are the posterior veins of Keynes?

A

Venous drainage of thymus

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7
Q

How much of the lymphatic fluid flows via the thoracic duct into the venous system?

A

75%

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8
Q

What are the openings in the diaphragm?

A

T8: VCI + phrenic nerve r
T10: Oesophagus + both vagus nerves
T12: Aorta + thoracic duct + azygos vein

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8
Q

Where does the thoracic duct empty into?

A

Into venous circulation at superior aspect of the junction of the left internal jugular and subclavian veins, where it is related to the left common carotid artery and vagus nerve.

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9
Q

Total length of the trachea? + parts of trachea?

A

11-13 cm
Cervical part (5 cm) til suprasternal notch, thoracic part (6-8 cm)

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10
Q

How many tracheal rings?

A

18-22

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11
Q

Right main bronchus vs left?

A

Right is wider, shorter and more vertical

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12
Q

Arterial supply trachea?

A

Cervical: inferior thyroid arteries
Thoracic: bronchial arteries

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13
Q

Length of esophagus?

A

25 cm

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14
Q

Z-line

A

Squamocolumnar junction:
- Non-keratinising squamous epithelium
-> glandular epithelium

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15
Q

Most important layer to close when repairing perforations of the oesophagus?

A

Internal mucosal layer

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16
Q

2 plexi in body of oesophageal wall

A

A) Auerbach’s plexus / myenteric plexus (between circular and longitudinal muscular layers)
B) Meissner’s plexus / submucosal (within submucosal layer)

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17
Q

Why and where does perforation of oesophagus cause empyema and mediastinitis?

A

At level of T8: oesophagus moves to lie anterior to the descending thoracic aorta with both lateral surfaces covered by parietal pleura.

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18
Q

Arterial supply oesophagus?

A

Cervical: inferior thyroid artery
Thoracic: bronchial and oesophageal branches of descending thoracic aorta
Abdominal: left gastric and splenic arteries

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19
Q

Venous drainage of abdominal oesophagus?

A

Left gastric vein = tributary of portal system -> portosystemic venous anastomosis

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20
Q

Origin of phrenic nerve?

A

C3 - C4 - C5

21
Q

Relation of phrenic to subclavian artery and IMA?

A

Posterior to subclavian
Medial to IMA

22
Q

Vagus nerve is which cranial nerve?

A

10th

23
Q

Where does vagus nerve enter thorax?

A

Behind sternoclavicular joint and brachiocephalic vein

24
Q

How many paired sympathetic ganglia?

A

23
3 cervical
12 thoracic
4 lumbar
4 sacral

25
Q

Which ganglion gives Horner’s syndrome when damaged?

A

The stellate ganglion. Fusion of inferior cervical ganglion and the 1st thoracic ganglion

26
Q

Fissures of the lungs? left vs right?

A

Left: only oblique
Right: horizontal (upper one) and oblique (lower one)

27
Q

Segments of the lung?

A

Right: 10
Left: 10
See image

28
Q

Each bronchopulmonary segment is

A
  • Roughly equal in sze
  • Pyramidal in shape with apex pointing towards hilum of the lung
  • Supplied by own bronchus en pulmonary artery branch; branches of vein run in inter-segmental planes
29
Q

Pig bronchus anomaly?

A

RUL apical segmental bronchus arises from traches rather than RUL bronchus
Occurs in 3% of patients
Can make lung isolation with double-lumen tube difficult

30
Q

After RUL bronchus, what is bronchus called?

A

Bronchus intermedius, is about 2 cm long

31
Q

RML and RLL bronchus: which one anterior, which one posterior?

A

RML anterior
RLL posterior

32
Q

Middle lobe syndrome?

A

Narrowing of RML bronchus due to extrinsic nodal compression

33
Q

Course of RML bronchus?

A

Passes under RLL pulmonary artery branch
Lies between inferior part superior pulmonary vein and RML pulmonary artery branch

34
Q

What must you take care of when dividing and closing bronchus of RLL?

A

Narrowing of RML bronchus!

35
Q

What makes bronchial sleeve resection on the left more complicated?

A

Presence of secondary carina on the left rather than an equivalent to the bronchus intermedius

36
Q

Anatomy of tracheobronchial tree?

A
  • Conducting zone 1-16: no gas exchange
  • Respiratory zonde: 17-23: gas exchange: bronchioles, alveolar ducts and alveolar sacs
37
Q

Difference between bronchioles and bronchi?

A

Bronchioles lack cartilage, thereby making them collapsible

38
Q

Pulmonary acinus

A

Represents a respiratory bronchiole and all of its branches

39
Q

Danger zone of right pulmonary artery

A

After giving of RUL artery, it goes behind superior pulmonary vein, in danger of damage when encircling that structure.

40
Q

What is special about artery posterior segment upper lobe right?

A
  • Ascending pulmonary artery branch supplies it
  • Is accessedby dissecting major fissure
  • Sits behind lymph node station 11s, whic is between lower border of upper lobe bronchus en bronchus intermedius
41
Q

Drainage lobes rights

A
  • Upper: superior portion superior pulmonary vein
  • Middle: inferior portion superior pulmonary vein
  • Lower: inferior pulmonary vein
42
Q

Troubleshooting encircling vein lower lobe right

A

Inferior pulmonary vein: drainage from apical segment may join very proximally and may be missed!

43
Q

Veins forming common trunk prior to entering pericardium?

A

Left much more often than right (25 vs 3%)

44
Q

Troubleshooting encircling pulmonary vein left

A

Left often common trunk before entering pericardium -> preop CT is important

45
Q

Lymph node stations of the lungs

A
  • Mediastinal nodal stations: single digit
  • Pulmonary stations: double digit
    See image
46
Q

Which lymphatics cross the midline?

A

The lymphatic channels of the mediastinum

47
Q

Which structures pass through the thoracic inlet?

A
  • Subclavian artery
  • Brachial plexus
  • Subclavian vein
  • Stellate ganglion of the sympathetic chain
  • Thoracic duct
48
Q

Major muscles of chest wall?

A
  • Latissimus dorsi (n. thoracodorsalis)
  • Serratus anterior (long thoracic nerve of Bell)
  • Pectoralis major
  • Trapezius (accessory XI nerve)
  • External oblique
49
Q

Which crus of the diaphragm is larger and longer?

A

Right is larger and longer than left, and completely surrounds the oesophagus

50
Q
A

Thoracic (3 decks)

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