kenhub clinical qs mediastino

Question 1

A 65-year-old male presents with sharp chest pain aggravated by inspiration and relieved by sitting up and leaning forward. In addition he complains of shoulder pain. An echocardiography performed reveals inflammation of the pericardium (pericarditis). Which nerve innervates the pericardium and is responsible for the referred pain to the shoulder?

Answer 1

The phrenic nerves (C3-C5) provide mostly somatic afferent (pain, temperature sensory) innervation to the pericardium.

They pass directly through the fibrous pericardium.

Pain within the diaphragm usually projects to dermatomes C3-C5, so it is felt within the ipsilateral supraclavicular region.

Question 2

Which of these nerves are present in the posterior inferior mediastinum (mediastinum posterius)?

Answer 2

The following nerves are present in the posterior inferior mediastinum:

greater thoracic splanchnic nerve (n. splanchnicus thoracicus major)
vagus nerve (n. vagus)
esophageal plexus (plexus oesophageus).

Question 3

A positive Pemberton’s sign is marked by facial congestion and cyanosis after 1 minute of having the patient elevate both arms and indicates a pathology of which structure?

Answer 3

Pemberton’s sign is used to evaluate venous obstruction. The sign is positive when bilateral arm elevation causes facial congestion. It has been attributed to a “cork effect” resulting from the thyroid obstructing the thoracic inlet, thereby increasing pressure on the venous system.

A positive Pemberton’s sign would indicate obstruction of the superior vena cava (vena cava superior).

Question 4

Which fibroserous double-walled sac resides in the middle mediastinum (mediastinum medium)?

Answer 4

The pericardium

Question 5

Which structures lie immediately posterior to the esophagus in the mid region of the thorax?

Answer 5

aorta
thoracic duct
azygos vein

Question 6

The anterior inferior mediastinum (mediastinum anterius) has no major contents except the remnants of which structure?

Answer 6

thymus.

Question 7

Which veins are found in the posterior inferior mediastinum (mediastinum posterius)?

Answer 7

The azygos vein and hemiazygos vein

Question 8

Which of these structures pass through the openings of the diaphragm (diaphragma)?

Answer 8

azygos vein
thoracic duct
esophagus
inferior vena cava

Question 9

Which cranial nerve is found passing through the mediastinum?

Answer 9

vagus nerve

Question 10

Neurogenic tumors are the most common tumors of the posterior mediastinum. Which of the following structures will get most likely compressed by these tumors?

Answer 10

esophagus

Question 11

A 51-year-old man reports constant troubles with swallowing and heartburns. After performing a specialized X-ray (using barium swallow), the doctor diagnoses a hiatal hernia. Through which of the following structures does the stomach herniate into the posterior mediastinum in this condition?

Answer 11

esophageal hiatus

Question 12

The anterior inferior mediastinum extends posteriorly from which muscle to the pericardium?

Answer 12

transversus thoracis muscle

Question 13

Which of these neurovascular structures are found in the middle inferior mediastinum?

Answer 13

ascending aorta
phrenic nerve
superior vena cava

Question 14

The compression of which vein is a common result of a tumor in the mediastinum?

Answer 14

superior vena cava