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T2: Theme 1: Anatomy > Lecture 4: Posterior mediastinum > Flashcards

Lecture 4: Posterior mediastinum Flashcards

1
Q

What are the boundaries of the posterior mediastinum?

A 
Anterior - posterior pericardium
Posterior - vertebrae T5-12
Lateral - mediastinal pleura 
Superior - transverse thoracic plane
Inferior - diaphragm
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2
Q

What is the contents of the posterior mediastinum?

A 
Oesophagus
Thoracic aorta
Azygos system of veins
Thoracic duct
Vagus nerve
Sympathetic trunk
Splanchnic nerves
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3
Q

What is the sympathetic trunk?

A

Vertical chain of sympathetic nerves running the entire length of the vertebral column

Located on both sides of vertebral bodies

Paravertebral ganglia located along its length

In the thoracic spine usually one ganglion per spinal level

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4
Q

Describe the upper 5 ganglia in the sympathetic trunk.

A

Preganglionic sympathetic fibers leave the spinal cord (white rami communicantes) and synapse at the ganglion

Postganglionic sympathetic fibers leave the ganglion (grey rami communicantes) and pass to the pulmonary, cardiac & oesophageal plexi

These also carry afferent fibers (carrying sensory information) from the thoracic viscera they supply back to the brain

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5
Q

What is a dermatome?

A

An area of skin supplied by a single spinal cord level or spinal nerve

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6
Q

Describe the lower 7 ganglia in the sympathetic trunk.

A

Preganglionic sympathetic fibers leave the spinal cord (white rami communicantes) and enter the ganglion but don’t synapse

Hence, Preganglionic sympathetic fibers leave these ganglia and pass to the abdominal viscera

These form the 3 Splanchnic nerves

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7
Q

Which levels form the greater splanchnic nerves?

A

T5-T9

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8
Q

Which levels form the lesser splanchnic nerves?

A

T10-T11

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9
Q

Which levels form the least splanchnic nerves?

A

T12

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10
Q

What types of fibres are carried in the splanchnic nerves?

A

Preganglionic sympathetic fibers to the abdominal viscera

Visceral afferent fibers from the abdominal viscera

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11
Q

Where does the vagus nerve originate?

A

CNX

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12
Q

Where do the vagus nerves enter the superior mediastinum?

A

Posterior to the sternoclavicular joint

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13
Q

Which plexi do the vagus nerves contribute to?

A

Pulmonary, cardiac and oesophageal plexi

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14
Q

What type of supply is carried by the vagus nerve?

A

Parasympathetic

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15
Q

Where does the right recurrent laryngeal nerve travel?

A

Hooks under right subclavian artery and ascends between trachea and oesophagus

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16
Q

Where does the right vagus nerve travel?

A

Continues posterior to the right of the trachea, posterior to right brachiocephalic vein and lung root

17
Q

Where does the left recurrent laryngeal nerve travel?

A

Hooks inferiorly to the aortic arch, immediately lateral to ligamentum arteriosum

18
Q

Where does the left vagus nerve travel?

A

Runs posteriorly to lung root

19
Q

Which side of the vertebral column is the thoracic aorta?

A

Left

20
Q

At what vertebral levels is the descending aorta?

A

T5-T12

21
Q

Where is the oesophagus in relation to the thoracic aorta?

A

To its right

22
Q

At what level does the aorta enter the abdomen?

A

T12

23
Q

Where are the thoracic duct and azygos vein in relation to the thoracic aorta?

A

On its right side

24
Q

What are the branches of the thoracic aorta?

A 
Bronchial (paired)
Posterior intercostal
Subcostal
Pericardial
Oesophageal 
Superior Phrenic
25
Q

Which vessels drain into the azygos vein?

A

Posterior intercostal veins
Bronchial veins
Vertebral venous plexus

26
Q

Which levels of intercostal veins drain into the hemi-azygos vein?

A

Left side T9-T11

27
Q

Which levels of intercostal veins drain into the accessory hemi-azygos vein?

A

Left side T5-T8

28
Q

At what vertebral level does the (accessory) hemi-azygos cross to meet the azygos?

A

T7/T8

29
Q

What is the thoracic duct?

A

Largest lymph channel

Conveys all lymph from body except the head, neck, upper limb and thorax on the right side

30
Q

Where does the thoracic duct originate?

A

At the cisterna chyli

31
Q

At what vertebral level is the cisterns chyli?

A

L2

32
Q

Where in the diaphragm does the thoracic duct pass through?

A

Aortic hiatus

33
Q

Where does the thoracic duct drain into?

A

Left venous angle (junction internal jugular and subclavian junction)

34
Q

Which region of the heart is just anterior to the oesophagus?

A

The left atrium

35
Q

At what level does the oesophagus pierce the diaphragm?

A

T10

36
Q

At what level does the oesophagus enter the stomach?

A

T11

37
Q

What are the three constrictions of the oesophagus?

A

Arch of aorta
Left main bronchus
Diaphragm

38
Q

What innervates the oesophagus?

A

CNX and sympathetic trunk via the oesophageal plexus

39
Q

Which structures transcend from the superior mediastinum to the posterior mediastinum?

A 
Oesophagus 
 Thoracic duct
 Vagus nerve
 Phrenic nerve
 Aorta

T2: Theme 1: Anatomy (7 decks)

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