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Anatomy 2nd Bi > mediastinum > Flashcards

mediastinum Flashcards

1
Q

Occupied by the mass of tissue between the two pulmonary cavities

A

mediastinum

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2
Q

Central compartment of the thoracic cavity

A

mediastinum

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3
Q

Covered on each side by mediastinal pleura and contains all the thoracic viscera and structures EXCEPT the lungs

A

mediastinum

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4
Q

which boundary of the mediastinum is the superior thoracic aperture

A

superiorly

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5
Q

which boundary of the mediastinum is the diaphragm

A

inferiorly

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6
Q

which boundary of the mediastinum is the pleural cavities

A

laterally

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7
Q

which boundary of the mediastinum is the sternum and costal cartilages

A

anteriorly

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8
Q

which boundary of the mediastinum is the thoracic vertebrae

A

posteriorly

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9
Q

Extends inferiorly from the superior thoracic aperture to the horizontal plane that includes the sternal angle anteriorly and passes approximately through the junction (IV disc) of T4-T5 vertebrae posteriorly, often referred to as the transverse thoracic plane (imaginary line)

A

superior mediastinum

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10
Q

Between the transverse thoracic plane and the diaphragm

A

inferior mediastinum

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11
Q

the inferior mediastinum is further subdivided into

A

anterior, middle, posterior

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12
Q

includes pericardium, heart, and roots of its great vessels (ascending aorta, pulmonary trunk, SVC)

A

middle mediastinum (inferior)

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13
Q

A fibroserous membrane that covers the heart and the beginning of its great vessels

A

pericardium

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14
Q

pericardium has two layers

A

fibrous and serous

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15
Q

Tough fibrous membrane that covers the heart and the origin of the great vessels (arteries: pulmonary artery and the aorta)

A

fibrous pericardium

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16
Q

Avoids overdistension of the heart

A

fibrous pericardium (function)

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17
Q

Prevents sudden overfilling of the heart

A

fibrous pericardium (function)

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18
Q

Continuous superiorly with the tunica adventitia of the great vessels entering and leaving the heart and with the pretracheal layer of deep cervical fascia

A

superior continuation of the fibrous pericardium

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19
Q

Attached anteriorly to the posterior surface of the sternum by the sternopericardial ligaments

A

anterior continuation of the fibrous pericardium

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20
Q

Bound posteriorly by loose connective tissue to structures in the posterior mediastinum

A

posterior continuation of the fibrous pericardium

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21
Q

Continuous inferiorly with the central tendon of the diaphragm by the pericardiacophrenic ligament

A

inferior continuation of the fibrous pericardium

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22
Q

Composed mainly of mesothelium, a single layer of flattened cells forming an epithelium that lines both the internal surface of the fibrous pericardium and the external surface of the heart

A

serous pericardium

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23
Q

Lines the inner surface of the fibrous pericardium

A

parietal layer of the serous pericardium

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24
Q

Forms the outer layer (epicardium) of the heart wall and the roots of the great vessels

A

visceral layer of the serous pericardium

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25
Q

Is a potential space between opposing layers of the parietal and visceral layers of serous pericardium

A

pericardial cavity

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26
Q

Because of the lining, we will be able to appreciate that there are two potentialspaces at the back of the heart

A

pericardial sinuses

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27
Q

Posterior to the intrapericardial parts of the pulmonary trunk and ascending aorta, anterior to the SVC and superior to the atria of the heart

A

transverse pericardial sinus

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28
Q

a single layer of flattened cells forming an epithelium that lines both the internal surface of the fibrous pericardium and the external surface of the heart

A

mesothelium

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29
Q

While performing surgery on the aorta or pulmonary artery, a surgeon can pass a finger and make a ligature through the sinus between the arteries and veins, thus stopping the blood circulation with the ligature

A

transverse pericardial sinus

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30
Q

Between the great arteries

A

transverse pericardial sinus

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31
Q

Pericardial reflections of the PVs and IVC laterally

A

Oblique pericardial sinus

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32
Q

Wide pocket-like recess in the pericardial cavity posterior to the base (posterior aspect) of the heart, formed by the left atrium

A

Oblique pericardial sinus

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33
Q

BLOOD SUPPLY OF PERICARDIUM

A

pericardiophrenic artery
musculophrenic artery
bronchial, esophageal, and superior phrenic arteries
coronary arteries

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34
Q

main arterial supply of the pericardium

A

pericardiophrenic artery

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35
Q

Arterial supply to the pericardium, branches of the internal thoracic artery (ITA)/ internal mammary artery (IMA)

A

pericardiophrenic artery

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36
Q

a branch coming from the subclavian artery

A

internal thoracic artery (ITA)/ internal mammary artery (IMA)

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37
Q

Often accompanies or at least parallels the phrenic nerve to the diaphragm

A

pericardiophrenic artery

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38
Q

Terminal branch of the ITA

A

musculophrenic artery

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39
Q

Branches coming from the anterior wall of the descending thoracic aorta; At the back of the pericardium

A

Bronchial, Esophageal, and Superior phrenic arteries

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40
Q

supplies the visceral layer of the pericardium only; The first branches of the aorta

A

coronary arteries

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41
Q

venous drainage of the pericardium

A

pericardiophrenic veins
Variable tributaries of the azygos venous system

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42
Q

Tributaries of the brachiocephalic (or internal thoracic) veins

A

Pericardiacophrenic veins

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43
Q

Drain directly to the brachiocephalic (innominate vein) or sometimes it can drain directly into the branches that comes along with the internal thoracic artery

A

Pericardiacophrenic veins

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44
Q

nerve supply of the pericardium

A

phrenic nerve (C3-C5)
vagus nerve
sympathetic trunks

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45
Q

Primary source of sensory fibers of the pericardium

A

phrenic nerve (C3-C5)

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46
Q

Pain sensations conveyed by these nerves are commonly referred to the skin (C3–C5 dermatomes) of the ipsilateral supraclavicular region (top of the shoulder of the same side)

A

phrenic nerve (C3-C5)

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47
Q

vasomotor of the pericardium

A

sympathetic trunks

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48
Q

A phenomenon whereby noxious stimuli originating from a structure are perceived as pain arising from a superficial part of the body

A

referred pain

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49
Q

Supraclavicular area (C3-C5)
Pain sometimes at the level of the shoulder

A

pericardial involvement

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50
Q

Chest and arm (T1-T4)
T1 - T3 (Moore’s)
Chest pains, back, arm

A

heart/cardiac pain

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51
Q

pain in the back

A

MI

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52
Q

Superior to the transverse thoracic plane, passing through the sternal angle and the junction (IV disc) of vertebrae T4 and T5

A

superior mediastinum

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53
Q

includes (from anterior to posterior):
Thymus
Great vessels, with the veins anterior to the arteries and related nerves
Inferior continuation of cervical viscera and related
nerves
Thoracic duct and lymphatic trunks

A

superior mediastinum

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54
Q

veins of superior mediastinum

A

Brachiocephalic
SVC

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55
Q

arteries of superior mediastinum

A

Arch of aorta and roots of its major branches
Brachiocephalic trunk
Left common carotid artery
Left subclavian artery

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56
Q

nerves of superior mediastinum

A

Vagus nerve
Phrenic nerve
Cardiac plexus of nerves

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57
Q

cervical viscera

A

Anterior: trachea
Posterior: esophagus

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58
Q

related nerves in the inferior continuation of cervical viscera

A

Left recurrent laryngeal nerves

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59
Q

Traverses the superior mediastinum

A

Thoracic duct and lymphatic trunks

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60
Q

the order of the majorstructuresin the superior mediastinum, from anterior to posterior,

A

(1) thymus, (2) veins, (3) arteries, (4) airway, (5) alimentary tract, and (6) lymphatic trunks

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61
Q

Primary lymphoid organ at the inferior part of the neck and anterior to the superior mediastinum

A

thymus

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62
Q

Flat gland with flask-shaped lobes that lies posterior to the manubrium and extends into the anterior mediastinum, anterior to the fibrous pericardium

A

thymus

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63
Q

After puberty → involution and replaced by fat

A

thymus

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64
Q

For pediatric patients, are relatively bigger compared to adults, in adults replaced by fatty tissue

A

thymus

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65
Q

arterial supply of thymus

A

Derived mainly from:
Anterior intercostal arteries
Anterior mediastinal branches of the ITA/IMA

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66
Q

venous drainage of thymus

A

End in the left brachiocephalic, ITA/IMA, and inferior thyroid veins

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67
Q

lymphatic vessels of thymus

A

End in the parasternal, brachiocephalic, and tracheobronchial lymph nodes

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68
Q

great vessels

A

brachiocephalic
SVC
ascending aorta
aortic arch

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69
Q

The right and left _____ are formed posterior to the sternoclavicular (SC) joints by the union of the internal jugular and subclavian veins

A

brachiocephalic veins

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70
Q

At the level of the inferior border of the 1st right costal cartilage, the _____ unite to form the SVC

A

brachiocephalic veins

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71
Q

: twice as long as the right brachiocephalic vein

A

left brachiocephalic vein

72
Q

shunt blood from the head, neck, and upper limbs to the right atrium (RA

A

brachiocephalic veins

73
Q

Returns blood from all structures superior to the diaphragm EXCEPT for the heart and the lungs

74
Q

Passes inferiorly and ends at the level of the 3rd costal cartilage, where it enters the RA of the heart

75
Q

Begins at the aortic orifice

A

ascending aorta

76
Q

Its only branches are the coronary arteries, arising from the aortic sinuses

A

ascending aorta

77
Q

The ascending aorta is intrapericardial, and for this reason, and because it lies inferior to the transverse thoracic plane, it is considered a content of the middle mediastinum

A

ascending aorta

78
Q

Begins at the sternal angle

A

aortic arch

79
Q

Arches superiorly, posteriorly and to the left, and then inferiorly (descends posterior to the L root of the lung)

A

aortic arch

80
Q

The superior mediastinum is a very critical area. Injuries can potentially hit neurovascular structures, including the aerodigestive system

81
Q

also known as cranial nerve X

A

Vagus nerve

82
Q

Exit at the cranium and descend through the neck posterolateral to the common carotid arteries

A

Vagus nerve

83
Q

Usually contain at the level of the neck within the carotid sheath along with the internal jugular vein and carotid artery

A

Vagus nerve

84
Q

Enters the thorax anterior to the RSCA, where it gives rise to the right recurrent laryngeal nerve

A

right vagus nerve

85
Q

Hooks around the RSCA and ascends between the trachea and esophagus to supply the larynx

A

Right recurrentlaryngeal nerve

86
Q

gives rise to the right recurrent laryngeal nerve

A

right vagus nerve

87
Q

Continues postero- inferiorly through the superior mediastinum on the R side of the trachea

A

right vagus nerve

88
Q

passes posterior to the R brachiocephalic vein, SVC, and root of the R lung where it divides into many branches contributing to the right pulmonary plexus and esophageal (nerve) plexus

A

right vagus nerve

89
Q

Descends in the neck posterior to the LCCA

A

left vagus nerve

90
Q

Enters the mediastinum between the LCCA and LSCA

A

left vagus nerve

91
Q

At the arch, it diverges posteriorly from the phrenic nerve

A

left vagus nerve

92
Q

The LVN is separated laterally from the phrenic nerve by the left superior intercostal vein

A

left vagus nerve

93
Q

Curves medially at the arch to give rise to the left recurrent laryngeal nerve

A

left vagus nerve

94
Q

give rise to the left recurrent laryngeal nerve

A

left vagus nerve

95
Q

Passes inferior to the arch of the aorta, immediately lateral to the ligamentum arteriosum, and ascends to the larynx in the groove between the trachea and the esophagus

A

Left recurrentlaryngeal nerve

96
Q

Continues inferiorly and posterior to the root of the left lung, where it breaks up into many branches that contribute to the left pulmonary and esophageal (nerve) plexus

A

left vagus nerve

97
Q

main difference of the right and left vagus nerve

A

Main difference with the right is the course of the vagus nerve around the arch of the aorta

98
Q

Right side vagus nerve would usually loop around the subclavian artery

99
Q

Left side vagus nerve would loop around the arch of the aorta to become recurrent laryngeal nerve

100
Q

difference of the r and l vagus nerve

A

Right side would usually loop around the subclavian artery

Left side would loop around the arch of the aorta to become recurrent laryngeal nerve

101
Q

Both vagus nerve continues within the chest cavity, extending toward the abdominal area

102
Q

Main supply to the diaphragm

A

Phrenic Nerve

103
Q

Supply the diaphragm with motor and sensory fibers (1/3)

A

Phrenic Nerve

104
Q

Also supplies sensory fibers to the pericardium and mediastinal pleura

A

Phrenic Nerve

105
Q

Enters the superior mediastinum between the SCA and origin of brachiocephalic vein, anterior to the roots of the lungs

A

Phrenic Nerve

106
Q

To differentiate phrenic nerve from vagus nerve

A

Phrenic nerve would lie anterior to the pulmonary hilum

Vagus nerve would course at the posterior of the hilum

107
Q

Passes along the R side of the R brachiocephalic vein, SVC, and pericardium over the RA

A

right phrenic nerve

108
Q

It also passes anterior to the root of the right lung and descends on the right side of the IVC to the diaphragm, which it pierces near the caval opening

A

right phrenic nerve

109
Q

Descends between the LCCA and LSCA, left surface of the aortic arch, anterior to the root of the lung and over the fibrous pericardium of the LA and LV

A

left phrenic nerve

110
Q

Most branching of the phrenic nerves or distribution to the diaphragm occurs on the diaphragm’s inferior (abdominal) surface.

A

left phrenic nerve

111
Q

Fibromuscular tube that extends from the pharynx to the stomach

112
Q

Enters the superior mediastinum between the trachea and vertebral column, where it lies anterior to the bodies of the T1–T4 vertebrae

113
Q

Flattened A-P, inclines to the left but pushed back to the median plane by the arch of the aorta

114
Q

Compressed anteriorly by the root of the left lung

115
Q

Thoracic duct lies left to the esophagus, deep (medial) to the arch of the aorta

116
Q

Below the arch, inclines to the left as it approaches the esophageal hiatus (T10)

117
Q

posterior mediastinum is inferior to

A

transverse thoracic plane

118
Q

posterior mediastinum is anterior to

A

T5-T12 vertebrae

119
Q

posterior mediastinum is posterior to

A

pericardium and diaphragm

120
Q

posterior mediastinum is between the

A

parietal pleura of the 2 lungs

121
Q

includes:
Thoracic aorta
Thoracic duct
Lymphatic trunks
Posterior mediastinal lymph nodes
Azygos and hemi-azygos veins
Esophagus
Esophageal nerve plexus

A

posterior mediastinum

122
Q

Continuation of the arch of aorta

A

thoracic aorta

123
Q

Begins on the left side of the inferior border body of the T4 vertebra

A

thoracic aorta

124
Q

Descends in the left sides of T5-T12 (pos mediastinum)

A

thoracic aorta

125
Q

Approaches the median plane as it descends and displaces the esophagus to the right

A

thoracic aorta

126
Q

Surrounded by thoracic aortic plexus

A

thoracic aorta

127
Q

Lies posterior to the root of the left lung, pericardium, and esophagus

A

thoracic aorta

128
Q

Terminates at the anterior to the inferior border of T12

A

thoracic aorta

129
Q

Enters the abdomen through the aortic hiatus

A

thoracic aorta

130
Q

Thoracic duct and azygos vein ascend on its right side and accompany it through the hiatus

A

thoracic aorta

131
Q

when the thoracic aorta terminates at the anterior to the inferior border of T12 it becomes

A

abdominal aorta

132
Q

Branches of the descending aorta arise and course within three vascular planes except

A

superior phrenic arteries and pericardial branches

133
Q

Anterior, midline plane of unpaired visceral branches to the gut (embryonic digestive tube) and its derivatives

A

esophageal arteries (A in inset)

134
Q

Lateral planes of paired visceral branches serving viscera other than the gut and its derivatives

A

bronchial arteries (B in inset)

135
Q

Although the right and left bronchial arteries may arise directly from the aorta, most commonly, only the paired left bronchial arteries do so; the right bronchial arteries arise indirectly as branches of a right posterior intercostal artery (usually the 3rd)

136
Q

Posterolateral planes of paired (segmental) parietal branches to the body wall

A

9 posterior intercostal arteries

137
Q

Descends into the posterior mediastinum, passing posterior to and to the right of the arch, posterior to the pericardium and LA

138
Q

Constitutes the primary posterior relationship of the base of the heart

139
Q

It then deviates to the left and passes through the esophageal hiatus in the diaphragm at the level of the T10 vertebra, anterior to the aorta

140
Q

3 constrictions (impressions) of the esophagus

A

Arch
Left main bronchus
Diaphragm

141
Q

Constrictors are created because of its close relationship within the mediastinum
- Arch of the aorta can create an impression in the leftside of the esophagus
- Anteroposteriorly it is compressed by the left main bronchus
- Diaphragm almost likely a sphincter so circumferential compression

142
Q

Largest lymphatic channel

A

Thoracic duct

143
Q

Conveys most lymph in the body except from the right superior quadrant (right half of the face, right upper limb, right thorax)

A

Thoracic duct

144
Q

Originates from the cisterna chyli (chyle cistern) in the abdomen and ascends through the aortic hiatus in the diaphragm

A

Thoracic duct

145
Q

It ascends in the posterior mediastinum among the thoracic aorta on its left, the azygos vein on its right, the esophagus anteriorly, and the vertebral bodies posteriorly

A

Thoracic duct

146
Q

At the level of the T4, T5, or T6 vertebra, the thoracic duct crosses to the left, posterior to the esophagus, and ascends into the superior mediastinum

A

Thoracic duct

147
Q

Near its termination, the thoracic duct often receives the jugular, subclavian, and bronchomediastinal lymphatic trunks (although any or all these vessels may terminate independently)

A

Thoracic duct

148
Q

In continuity with the cervical and lumbar sympathetic trunks

A

thoracic sympathetic trunks

149
Q

Lie against the heads of the ribs in the superior part of the thorax, the costovertebral joints in the midthoracic level, and the sides of the vertebral bodies in the inferior part of the thorax

A

thoracic sympathetic trunks

150
Q

Part of the abdominopelvic splanchnic nerves supplying the viscera below the diaphragm

A

Lower Thoracic Splanchnic Nerves(5th- 12th sympathetic ganglia)

151
Q

They supply sympathetic innervation or most of the abdominal viscera

A

Lower Thoracic Splanchnic Nerves(5th- 12th sympathetic ganglia)

152
Q

Smallest subdivision of the mediastinum

A

anterior mediastinum

153
Q

Lies between the body of the sternum and the transversus thoracis muscles anteriorly, and the pericardium posteriorly

A

anterior mediastinum

154
Q

Continuous with superior mediastinum superiorly, limited inferiorly by the diaphragm

A

anterior mediastinum

155
Q

Consists of loose connective tissue (sternopericardial ligaments), fat, lymphatic vessels, a few lymph nodes, and branches of the internal thoracic vessels

A

anterior mediastinum

156
Q

Contains the inferior part of the thymus (in infants and children)

A

anterior mediastinum

157
Q

No vitalstructures, mainly fatty tissues

A

anterior mediastinum

158
Q

In tumors involving anterior mediastinum, usual differential diagnosis include the 4Ts (tinoma, terrible lymphoma, thyroid anterathoma)

159
Q

The outline of the heart can be traced on the anterior surface of the thorax by using the following guidelines:

Superior - Inferior border of the 2nd left costal cartilage to the 3rd right costal cartilage

Right - 3rd right costal cartilage to the 6th right costal cartilage (this border is slightly convex to the right)

Inferior - Inferior end of the right border (6th right costal cartilage) to a point in the 5th ICS close to the left MCL (the left end of this line corresponds to the location of the apex of the heart and the apex beat

Left - Line connecting the left ends of the lines representing the superior and inferior borders

160
Q

auscultatory areas of the heart for pulmonary area

A

2nd ICS (intercostal space) LUSB (left upper sternal border)

161
Q

auscultatory areas of the heart for 2nd pulmonic area

162
Q

auscultatory areas of the heart for aortic area

A

2nd ICS RUSB

163
Q

auscultatory areas of the heart for mitral area

A

5th LICS (apex of the heart)

164
Q

auscultatory areas of the heart for tricuspid area

165
Q

auscultatory areas of the heart for the aortic valve

A

2nd ICS, right of the sternum

166
Q

auscultatory areas of the heart for the pulmonary valve

A

2nd ICS, left of the sternum

167
Q

auscultatory areas of the heart for the tricuspid valve

A

5th ICS, left of the sternum

168
Q

auscultatory areas of the heart for the mitral valve

A

5th ICS, between sternum and nipple

169
Q

auscultatory areas for the apex of the left lung

A

just above the 1st rib; left side, back

170
Q

auscultatory areas for the superior lobe of the left lung

A

2nd ICS, left side, back

171
Q

auscultatory areas for the inferior lobe of the left lung

A

7th ICS, left side, back

172
Q

auscultatory areas for the inferior lobe of the right lung

A

6th ICS, right, front, midaxilliary

173
Q

auscultatory areas for the superior lobe of the right lung

A

2nd ICS, below sa line sa neck

174
Q

auscultatory areas for the middle lobe of the right lung

A

4th ICS, left sa nipple adjacent

175
Q

auscultatory areas for the apex of the right lung

A

above the 1st rib, front, right, may clavicle

Anatomy 2nd Bi (5 decks)

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