Exam 1 Review - Thoracic Viscera

Question 1

The scalene tubercle of the first rib is grooved to allow insertion of the anterior scalene muscle.

a) What crosses the rib anterior to the scalene tubercle?
b) What crosses the rib posterior to the scalene tubercle?

Answer 1

a) The subclavian vein crosses the rib anterior to the scalene tubercle
b) The subclavian artery and inferior trunk of the brachial plexus cross the rib posterior to the scalene tubercle.

Question 2

In coronary artery disease, pain is referred along what nerve to the medial side of the arm?

Answer 2

2nd (sometimes 3rd) intercostal nerve (lateral cutaneous branch)

Question 3

The phrenic nerve provides sensory innervation to what parts of the diaphragm?

Answer 3

Central part of the diaphragmatic parietal pleura

Central part of the diaphragmatic parietal peritoneum

Question 4

Besides the diaphragm, the phrenic nerve provides sensory innervation where?

Answer 4

Fibrous pericardium
Parietal serous pericardium
Mediastinal parietal pleura

Question 5

The upper six intercostal spaces are supplied by branches of what anterior intercostal artery?

Answer 5

Internal thoracic artery

Note: These anastomose laterally with the posterior intercostal arteries.

Question 6

The lower anterior intercostal spaces are supplied by the ______ artery, a terminal branch of the internal thoracic artery.

Answer 6

Musculophrenic artery

Question 7

Which costomediastinal recess is larger (left or right) and why?

Answer 7

The LEFT costomediastinal recess is larger due to the cardiac notch of the left lung.
Note: The lingula of the left lung enters the costomediastinal recess here during deep inspiration.

Question 8

Where is the plane between superior and inferior mediastinum?

Answer 8

4th thoracic vertebrae/sternal angle

Question 9

The superior mediastinum is chiefly behind the?

Answer 9

Manubrium sterni

Question 10

What are the contents of the superior mediastinum?

Answer 10

Aortic arch
Brachiocephalic veins/SVC
Cardiac plexus of nerves
Vagus and phrenic nerves
Left recurrent laryngeal nerve
Esophagus
Trachea
Thymus gland
Thoracic duct
Lymph nodes

Question 11

The trachea and esophagus are crossed by what vein on the right?

Answer 11

Azygous vein

Question 12

The trachea and esophagus are crossed by what structure on the left?

Answer 12

Aortic arch

Question 13

Where does the aortic arch begin and end?

Answer 13

It commences at the RIGHT border of the sternal angle, runs left and downward anterior to trachea/esophagus, ends at sternal angle

Question 14

The brachiocephalic trunk divides into right subclavian and right common carotid arteries where?

Answer 14

Behind the right sternoclavicular joint

Question 15

Where does the left common carotid enter the neck?

Answer 15

Behind the left sternoclavicular joint

Question 16

What causes notching of inferior border of the ribs?

Answer 16

Dilated intercostal arteries pressing on the inferior border of the ribs causing localWized areas of respiration. This occurs in coarctation of the aorta.

Question 17

Where do the left brachiocephalic and right brachiocephalic veins form the superior vena cava?

Answer 17

Behind sternal end of first costal cartilage

Question 18

Where do the vagus nerves descend?

Answer 18

In FRONT of subclavian arteries;

BEHIND roots of the lungs

Question 19

What is the path of the left recurrent laryngeal nerve?

Answer 19

Hooks around left side of arch of aorta
Behind ligamentum arteriosum
Ascends in a groove between trachea and esophagus
In superior mediastinum!

Note: The right recurrent laryngeal nerve is NOT found in the mediastinum - it hooks around the right subclavian in the root of the neck.

Question 20

Which structure descends between the subclavian artery and vein?

Answer 20

Phrenic nerve

Question 21

Which structure descends between the internal jugular vein and common carotid artery?

Answer 21

Vagus nerve

Question 22

What enters the superior mediastinum between the trachea and vertebral column, behind the left principal bronchus?

Answer 22

Esophagus

Question 23

What are four places where the esophagus faces constrictions?

Answer 23

a. Where the pharynx joins the upper end
b. Where it contacts the arch of the aorta
c. Where it contacts the left principal bronchus
d. The esophageal hiatus of the diaphragm

Question 24

What does a barium swallow highlight?

Answer 24

Esophageal constriction sites

Question 25

What is the most common site of intestinal cancer?

Answer 25

Esophageal hiatus of the diaphragm

Question 26

What passes up on the right side of the aorta at the aortic hiatus but on the left side of the azygous vein?

Answer 26

Thoracic duct