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Emma III > Mediastina > Flashcards

Mediastina Flashcards

1
Q

boundaries of anterior mediastinum

A

anterior - transversus thoracis m., sternum, costal cartilages

posterior - fibrous pericardium

lateral - parietal pleura

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2
Q

contents of anterior mediastinum

A 
sternopericardial ligaments 
thymus (pre-puberty)
internal thoracic vessels
fat, lymph nodes
nerves
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3
Q

n. of cardiac plexus mostly arise from…

A

vagus (CN X)

sympathetic trunk

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4
Q

layers of mediastina

A
  1. veins
  2. great arterial vessels, ligament arteriosum
  3. trachea, vagus n. esophagus, thoracic aorta
  4. thoracic duct and azygos venous system
  5. mediastinal autonomic n.
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5
Q

retroesophageal R subclavian

A

no brachiocephalic trunk. RSA coming right off aorta and traveling behind esophagus
40% of Down syndrome pt

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6
Q

ligamentum arteriosum

A

vestige of fetal life ductus arteriosus, scars down bc of high oxygen content
from pulmonary trunk to arch of aorta

shunts venous blood into the aorta

point of weakness in trauma

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7
Q

ductus arteriosus

A

blood that gets into fetal RV and through pulmonary trunk takes shunt (ductus arteriosus)

blood is partly venous but also has maternal oxygenated blood

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8
Q

fetal blood flow

A

umbilical vein from placenta –> liver –> RA –> deflected toward foramen ovale by valve of IVC –> LV then out

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9
Q

ligamentum venosum

A

scarring down of umbilical vein after birth

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10
Q

if aspirate something, would it go to R or L bronchus?

A

R bronchi - more vertically oriented and larger

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11
Q

primary target of vagus n.

A

abd and below, but also innervates larynx

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12
Q

esophagus

A

long tube from C6 (cricopharynxgeus m.) to T10)

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13
Q

landmark for IVC

A

T8

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14
Q

landmark for esophageal hiatus

A

T10

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15
Q

landmark for thoracic aorta becoming abdominal

A

T12

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16
Q

main trunks of of nerves covering esophagus

A

mainly from vagus m.

also some sympathetic fibers

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17
Q

L vagus n. travels _____ to esophagus

R vagus n. travels _____ to esophagus

A

L vagus –> anterior to esophagus

R vagus –> posterior to esophagus

“LARP”

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18
Q

Gives more clear views of heart and valves, particularly useful it pt is obese

A

trans-esophageal echocardiography

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19
Q

hiatal hernia

A

weakening of R crus of diaphragm, pt of stomach goes into thorax

comm in elderly

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20
Q

thoracic (descending) aorta

A

T4/T5 to T12

firmly tethered by posterior intercostals

other unpaired branches

  • esophageal a.
  • bronchial a.
  • pericardial a. (to dorsal pericardium)
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21
Q

aortic hiatus

A

T12

22
Q

cisterna chyli

A

dilation at L1-L3 where thoracic duct begins

23
Q

thoracic duct runs anterior to

A

anterior longitudinal ligament

24
Q

thoracic duct traverses from R to L at which spinal level

A

~T4

25
Q

thoracic duct empties into

A

L. venous angle (junction of L. internal jugular v. and L. subclavian v.)

26
Q

RUQ drains into ______, while the rest drains into _____

A

RUQ –> right lymphatic duct
Everything else –> thoracic duct
(EXCEPT lower left lobe of lung, left atrium, left ventricle)

27
Q

Thoracic duct drains all but upper quadrant with the exception of…

A

lower left lobe of lung, left atrium, left ventricle

28
Q

lymphatic drainage of heart

A

right side –> left (thoracic duct)

left side –> right (R lymphatic duct)

29
Q

mediastinal lymph nodes

A 
Virchow's node (sentinal node) 
posterior mediastinal nodes
paratracheal nodes
superior/inferior tracheobronchial nodes
superior phrenic nodes
30
Q

Enlarged Virchow’s node can be first sign of…

A

gastric cancer

31
Q

system of veins draining thoracic and abd wall

A

azygos veins

32
Q

azygous v. forms from

A

ascending lumbar veins uniting with posterior intercostal veins

33
Q

hemiazygous v.

A

tributaries training into azygous v. –> highly variable

hemiazygous v. –> just above diaphragm

then a break

then accessory homozygous would be above

34
Q

Azygous vein functions

A

drains post. thoracic and abd walls

provides direct connection between IVC and SVC

provides imp venous shunts in SVC/IVC pathology

35
Q

Azygos v. has valves, T or F?

A 
False
No valves (like most non-extremity veins)
36
Q

IVC filters can function to

A

collect blood clots from legs so they don’t travel up to lungs

37
Q

SVC blocked… different routes for venous blood to RA?

A
  1. back up and travel thru azygous arch. down azygous v., join IVC and go up to heart.
  2. travel thru internal thoracic v. (on either side of sternum), connect to anterior intercostal v., which go around and become posterior intercostal v., join azygous v., go down and join heart via IVC
38
Q

mediastina autonomic n.

A

parasympathetic

sympathetic

  • cardiopulmonary splanchnic
  • thoracic splanchnic
39
Q

cardipulmonary splanchnic n.

A

sympathetic originating from T1-T4

1st neurons…
can either synapse at thoracic ganglia and post-synaptic fibers can travel to heart/trachea/esophagus…

OR

can travel upwards to synapse at cervical ganglia, then travel back down as superior/middle/inferior cardiac n. to innervate heart (trachea/esophagus.. to lesser extent)

40
Q

thoracic splanchnic n.

A

originate at T5-T12

pass through paravertebral ganglia (in abd), then post-ganglionic gibers follow blood vessels to abd targets

unite to form 3 distinct n. (greater, lesser, and least splanchnic n.)

all splanchnic n. fibers in thorax are preganglionic

41
Q

greater splanchnic n.

A

T5-T9

42
Q

lesser splanchnic n.

A

T10-T11

43
Q

least splanchnic n.

A

T12

44
Q

thoracic splanchnic n. have functions in thorax

T or F

A

F, only arise from thorax region bc that’s where sympathetic fibers arise

all function is BELOW diaphragm

45
Q

periarterial sympathetic plexus

A

post-ganglionic sympathetics fibers follows this to their targets

46
Q

ganglia of abd

A

celiac ganglia
aorticorenal ganglion
superior mesenteric ganglion and plexus
inferior mesenteric ganglion

47
Q

great arterial vessels

A
  1. brachiocephalic trunk
    - divides to form R subclavian and R common carotid
  2. L common carotid
  3. L subclavian
48
Q

brachiocephalic trunk may branch into

A

thyroid ima artery

49
Q

Why might dysphagia be an early sign of mediastinal pathology (aneurism, enlarged nodes, cancer, etc.)

A

bc esophagus passes thru mediastinum and expands during swallowing

50
Q

why might progressively worsening voice problems (hoarseness) or dyspnea (from brachial compression) be indicative of mediastinal pathology?

A

recurrent laryngeal n. (via vagus n.) may become damaged due to aortic aneurisms, enlarged lymph nodes, tumors

51
Q

circipharyngeus

A

upper esophageal sphincter

Emma III (28 decks)

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