G: Superior, Posterior Mediastinum

Question 1

The medastinum is subdivided into 4 smaller regions _____

Answer 1

superior

inferior (anterior, middle posterior)

Question 2

Mediastinum extends from the ___ to the ___ (superior to inferior)

and from __ to __ (anterior to posterior)

Answer 2

thoracic inlet to diaphragm

sternum to 12th thoracic vertebrae

Question 3

The retropharyngeal space is between __ and __

Answer 3

between buccopharyngeal fascia and alar fascia

Question 4

The retropharyngeal space communicates from the ___ of the skull to the ___ mediastinum

Answer 4

base of skull to superior mediastinum

Question 5

Sternal angle articulates w. rib __

Sternal angle is at what vertebral level

Answer 5

2

vertebral level t4/5

Question 6

Anterior mediastinum is between __ and ___

Middle mediastinum is between __ and __

Posterior mediastinum is between __ and __

Answer 6

anterior - between sternum and pericardium

middle - between pericardium and related structures

posterior - between pericardium and T5-T12

Question 7

Anterior mediastinum is a continuation of the __ fascia

Answer 7

pretracheal fascia

Question 8

What are the contents of the superior mediastinum?

Answer 8

1. thymus gland
2. SVC and great vv
3. arch of aorta and great aa
4. vagus nn and phrenic nn
5. trachea and esophagus
6. thoracic duct

Question 9

Thymus gland lies
posterior to ___
anterior to ___

Answer 9

posterior to manubrium

anterior to brachiocephalic vv

Question 10

Thymus gland is prominent and active in ___ prior to ___

It’s function during this period is for ____

Answer 10

active in childhood prior to puberty

function - T CELL MATURATION

Question 11

t cell maturation in childhood prior to puberty occurs in the ___

Answer 11

thymus gland

Question 12

The thymus gland in adults is functionally ___

This appears as a ____

Answer 12

functionally inactive
this atrophies
appears as fatty mass in older adults

Question 13

What veins are found in the superior mediastinum?

Answer 13

SVC and great veins

great veins = azygos vein, right brachiocephalic vein, left brachiocephalic vein

Question 14

The LEFT brachiocephalic vein crosses the ___ anteriorly

Answer 14

trachea

Question 15

The azygos vein empties into the ____

This vein drains the ____

Answer 15

empties into superior vena cava

drains superior to the superior right bronchus

Question 16

The aortic arch begins and ends at the same level: ____

Answer 16

sternal angle or T4/5

Question 17

What are the 3 portions of the aorta

Answer 17

1. ascending aorta coming out of left ventricle
2. arch of aorta begins/ends in superior mediastinum (t4/5)
3. descending aorta

Question 18

The ascending aorta is found in the ___ mediastinum

The descending aorta is found in the ___ mediastinum

Answer 18

both in inferior mediastinum

ascending - middle mediastinum

descending - posterior mediastinum

Question 19

Aortic arch arces over ____ and ____

Answer 19

left main bronchus and right pulmonary artery

Question 20

The aortic arch gives rise to 3 great arteries before descending.

What are they?

Answer 20

brachiocephalic trunk
left common carotid artery
left subclavian artery

Question 21

vagus nerve and phrenic nerves pass through the ____ between a vein and an artery

Answer 21

thoracic inlet

Question 22

vagus nerve and phrenic nerve are located in ___ mediastinum

Answer 22

superior

Question 23

Aortic arch is found in the ___ mediastinum

Answer 23

superior

Question 24

Vagus nerve descends ____ to root of lung

Answer 24

posterior

Question 25

Vagus nerve provides ___ innervation to ____

Answer 25

parasympathetic innervation to thorax and abdomen

Question 26

What kind of parasympathetic innervation does vagus nerve carry?

Answer 26

pre-synaptic parasympathetic

Question 27

Phrenic nerve is what vertebral levels?

Descends ___ to root of lung

Answer 27

C3-4-5 keep me breathing and a live

descends anterior to root of lung

Question 28

Phrenic nerve supplies __ innervation to ___

Answer 28

somatic innervation to diaphragm

Question 29

The phrenic nerve follows the course on the _____ via ____

Answer 29

follows course of pericardial sac

via pericardiacophrenic a/v

Question 30

How do right and left phrenic n get through the diaphragm?

Answer 30

right phrenic - pierces through w/ inferior vena cava @ hiatus (T8)

left phrenic - pierces diaphragm alone right under apex of heart

Question 31

The trachea is located in the ___ mediasitnum

Answer 31

superior

Question 32

Trachea descends immediately ___ to the esophagus

Answer 32

anterior

Question 33

Trachea bifurcates at the inferior limit of the ___

What vertebral level is this?

Answer 33

superior mediastinum

T4/5 (corresponds to sternal angle and rib 2 articulation with manubrial @ manubriaosternal joint)

Question 34

What is the carina of the trachea?

Answer 34

internal ridge at the bifurcation of the trachea

Question 35

Numerous ___ are found around the carina

Answer 35

lymph nodes

Question 36

The carina is usually positioned ___ to median plane

This results in foreign bodies being aspirated into ____

Answer 36

carina is positioned Left of median plane

so Right bronchi is more vortically oriented than left, so right bronchus aspirates more foreign bodies usually

Right main bronchus is shorter and wider than left main bronchus as well

Question 37

Esophagus

• begins in the ___
• descends immediately ___ to trachea
• pierces diaphragm at ____
• empties into the ___

Answer 37

begins in neck

descends immediately posterior to trachea

pierces diaphragm @ esopahgeal hiatus (T10)

empties into the stomach

Question 38

Arteries supplying the esophagus arise from ___, ___ and ___

Answer 38

branches to esophagus are branches of:

1. thoracic a
2. bronchial a
3. ascending left gastric a

Question 39

Venous drainage of the esophagus via __, ___ and ___

Answer 39

azygos vein
hemiazygos vein
left gastric vein

Question 40

Lymphatics draining the esophageal area are ___

Answer 40

posterior to mediastinum

Question 41

What is a hiatal hernia?

Answer 41

stomach may herniate through esophageal HIATUS

Question 42

What are the 2 types of hiatal hernias?

Answer 42

1. sliding hiatal hernia

2. paraesophageal hernia

Question 43

Describe a sliding hiatal hernia

Answer 43

stomach slides freely in the thorax

most common
often asymptomatic

Question 44

Describe a paraesophageal hernia

Answer 44

fundus goes through hiatus

often fixed in position = risking gastric blood supply!

Question 45

The danger space is between __ and __

This continues from __ of skull to __ mediastinum

Answer 45

between alar layer and prevertebral layer

from base of skull to posterior mediastinum

Question 46

infection from the retropharyngeal space can spread into the ___

Answer 46

danger space