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CPRS > L2, L3, L5: Anatomy Of Mediastinum > Flashcards

L2, L3, L5: Anatomy Of Mediastinum Flashcards

1
Q

Division of mediastinum

A
  1. Superior (Divided at angle of Louis T4, T5)
  2. Inferior
    - Anterior (sternum - pericardium)
    - Middle
    - Posterior (pericardium - vertebral column)
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2
Q

Components of ribs

A
  1. Head (2 facets)
  2. Neck
  3. Tubercle (prominence between head and facet)
  4. Shaft (Costal groove for intercostal VAN)
  5. Angle (downward and anterior)
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3
Q

True ribs and false ribs

A

True: 1-7th
False: 8-10th
Floating: 11-12th

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4
Q

Components of thoracic vertebrae

A
  1. Body
  2. Transverse process
  3. Lamina
  4. Pedicle
  5. Spine
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5
Q

Components of sternum

A 
Manubrium (manubriosternal joint)
Body
Xiphoid process (xiphisternal joint)
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6
Q

Sternal angle / Manubriosternal joint / Angle of Louis

A

Attachment of 2nd rib
T4-T5
Level of carina

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7
Q

Cartilaginous joints and synovial joints

A

Cartilaginous: 1st rib
Synovial: 2nd - 7th rib

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8
Q

What is in costal groove

A

Intercostal artery, vein and nerve (VAN)

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9
Q

Where is rib attached to?

A

Posterior: Body (costovertebral joint, intra-articular ligament) + transverse process (costotransverse joint, costotransverse ) of thoracic vertebrae

Anterior: costal cartilage —> sternum

Both costovertebral and costotransverse joints are synovial joints

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10
Q

Contents of the intercostal space

A
  1. External IM (hands in pocket, only present in lateral side)
  2. Internal IM (surgeon hand gesture)
  3. Innermost IM (surgeon hand gesture)
  4. Transversus thoracic muscle / Sternocostalis (2-6th rib to posterior of sternum)
  5. Subcostalis
  6. Intercostal VAN (between IM and INM)
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11
Q

Arterial blood flow in thoracic cavity

A

All starts from aorta

Posterior:
Thoracic aorta —> Posterior intercostal artery (only 1) —> 3-11th posterior ICS
Subclavian artery —> Costocervical trunk —> Superior intercostal artery —> 1-2nd posterior ICS

Anterior:
Subclavian artery —> Internal thoracic artery —> Anterior intercostal artery (1-6th anterior ICS) + Musculophrenic artery (7-9th anterior ICS + diaphragm) + Superior epigastric artery (Rectus abdominis)

Subcostal artery and nerve = below 12th rib (T12)

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12
Q

Venous blood flow in thoracic cavity

A

Posterior:

Right: 1-2nd ICS —> Right superior intercostal vein —> Azygos —> SVC
Left: 1-2nd ICS —> Left superior intercostal vein —> Accessory hemiazygos —> Azygos —> SVC

Right: 3-11th ICS —> Posterior intercostal vein —> Azygos —> SVC
Left: 3-11th ICS —> Hemiazygos —> Azygos —> SVC

Anterior:
Anterior chest wall —> Anterior intercostal vein —> Internal thoracic vein —> Left brachiocephalic vein

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13
Q

Nerve supply of intercostal space

A

Anterior rami of 1-11th spinal nerves (Intercostal nerves within costal groove)

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14
Q

Nerve supply of parietal and visceral pleura

A

Parietal:
Costal pleura + peripheral diaphragmatic pleura: Intercostal nerve
Central diaphragmatic pleura: Phrenic nerve (C3-C5)
Mediastinal pleura: Phrenic nerve (C3-C5)

Visceral: Pulmonary plexus (T2-T5; Vagus nerve)

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15
Q

Left vs Right bronchus

A

Left: narrower, horizontal, longer
Right: wider, vertical, shorter (短小精悍)

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16
Q

Level of trachea

17
Q

Contents of hilum

A
  1. Pulmonary artery and pulmonary vein
  2. Bronchial artery and bronchial vein (supply bronchi, CT, visceral pleura)
  3. Pulmonary plexus
  4. Bronchus
  5. Lymph nodes
18
Q

Blood supply of pericardium and diaphragm

A

Pericardicophrenic A+V

19
Q

Drainage of lymph vessels

A

Superficial LN (subpleural lymphatic plexus)
—> Deep LN (pulmonary —> bronchopulmonary —> tracheobronchial —> paratracheal)
—> Bronchomediastinal lymphatic trunk
—> Thoracic duct (left) + Right lymphatic duct (right)
—> Brachiocephalic vein
—> SVC

20
Q

Intersection of MAL, MCL, PPL with visceral and parietal pleura respectively

A 
MAL + parietal: 10th rib
MAL + visceral: 8th rib
MCL + parietal: 8th rib
MCL + visceral: 6th rib
PPL + parietal: 12th rib
PPL + visceral: 10th rib
21
Q

Location of apex of lung

A

2.5cm above thoracic inlet

22
Q

Two parts of diaphragm

A
  1. Muscular part (peripheral)

2. Central tendon

23
Q

3 openings of diaphragm

A

ACO:

  1. Aortic (T12): Aorta, thoracic duct, Azygous vein
  2. Caval (T8): IVC, phrenic nerve
  3. Oesophageal (T10): Oesphagus, vagus nerve, blood vessels
24
Q

Blood supply of diaphragm

A
  1. Musculophrenic A/V

2. Inferior phrenic A/V

25
Nerve supply of diaphragm
Phrenic nerve (C3-C5) Phrenic nerve: does not belong to ANS but contain somatic, motor and sympathetic (ANS) neurone
26
Diaphragm arises from:
1. Medial arcuate ligament | 2. Lateral arcuate ligament
27
``` Muscle contraction in: Passive inspiration Active inspiration Passive expiration Active expiration ```
Passive inspiration: Diaphragm + External IM Active inspiration: Diaphragm + External IM + Scalene (fix 1st rib) + Pectoralis (major&minor) + Serratus Passive expiration: Diaphragm (relaxation) + Internal IM + Inn IM + Lung recoil Active expiration: Diaphragm (relaxation) + Internal IM + Inn IM + Abdominal + Latissimus dorsi + Quadratus lumborum (fix 12th rib)
28
Components of thoracic cavity
1. Mediastinum 2. Lungs 3. Pleura
29
What is mediastinum
- Space located between the lung - extending to the root of the neck - below to the diaphragm
30
Actions of diaphragm
1. Respiration (increase vertical diameter) | 2. Valsalva’s maneuver
31
Contents of mediastinum
Superior: Great vessels, Phrenic nerve, Vagus nerve, Sympathetic trunks, Plexus, Trachea, Oesophagus Anterior: Lymph nodes, remnants of thymus gland, Sternopericardial ligament Middle: Pericardium, Heart, Trachea Posterior: Aorta, Azygous, Sympathetic trunks, Splanchnic nerve, Vagus nerve, Thoracic duct, Oesophagus
32
Classification of nervous system
Anatomically: Central vs Peripheral 1. Central: Brain + Spinal cord 2. Peripheral: Cranial nerve (12 pairs) + Spinal nerve (31 pairs) Functionally: Somatic vs Autonomic 1. Somatic: Sensory + Motor 2. Autonomic: Sympathetic + Parasympathetic
33
Sympathetic vs Parasympathetic NS
1. Function SNS: Flight or fight, prepare for emergency PNS: Conserves and restores energy 2. Anatomical outflow SNS: T1-L2 PNS: CN3,7,9,10 + S2-S4 3. Preganglionic fibre Both: myelinated + ACh as transmitter 4. Ganglia SNS: paravertebral + prevertebral PNS: small ganglia close to viscera 5. Postganglionic fibre SNS: Long, non-myelinated (NE most, ACh very few) PNS: Short, non-myelinated (ACh) 6. Activity SNS: widespread + NE&E from adrenal medulla PNS: discrete due to few postganglionic fibre 7. Higher control Both: hypothalamus
34
5 plexus and their nerve supply
1. Cardiac plexus Vagus (CN10) + T2-T5 2. Pulmonary plexus Vagus + T2-T5 3. Aortic plexus Vagus + T5-T11 4. Renal plexus Vagus + T12 5. Hypogastric plexus S2-S4 (pelvic splanchnic nerve) + L1-L2
35
Nerve supply of eye, lacrimal gland, submandibular + sublingual, parotid gland (less important)
Eye: CN3 + T1-T2 Lacrimal gland: CN7 + T1-T2 Submandibular + sublingual: CN7 + T1-T2 Parotid gland: CN9 + T1-T2
36
Sympathetic afferent and efferent pathway
Afferent: Myelinated fibres from viscera through sympathetic ganglion (without synapsing) —> white rami communicantes —> Posterior ganglionic root —> Higher centre / reflex arc ``` Efferent: Lateral column (anterior horn) —> white rami communicantes —> paravertebral ganglion —> sympathetic trunk ```
37
Parasympathetic afferent and efferent pathway
Afferent: From target organ (without synapsing) —> white rami communicantes —> Posterior ganglionic root / CNS —> Higher centre / reflex arc Efferent: Anterior horn —> Plexuses —> Post-ganglionic neurone
38
Lymphatic drainage of trunk
Left: Left side: bronchomediastinal, jugular, subclavian trunk (left) —> Thoracic duct Below diaphragm: Intestinal + lumbar trunk —> Cisterna chyli —> Thoracic duct Right: Right upper side (head, thorax, limb) —> bronchomediastinal, jugular, subclavian trunk (right) —> Right lymphatic duct Thoracic duct + Right lymphatic duct —> Brachiocephalic vein —> SVC

CPRS (75 decks)

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