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Anatomy - Charis > Mediastinum > Flashcards

Mediastinum Flashcards

1
Q

Boundaries of the mediastinum

A

Anterior: Sternum
Posterior: Spinal vertebrae
Superior:Thoracic inlet (superior thoracic aperture)
Inferior: Thoracic outlet (inferior thoracic aperture)

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2
Q

Boundaries of thoracic inlet

A

T1
Rib 1
Manubrium

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3
Q

2 components of periardium

A

Fibrous

Serous

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4
Q

2 components of serous pericardium

A

Parietal

Visceral

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5
Q

What is cardiac tamponade?

A

Build up of fluid in pericardial cavity

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6
Q

What leads to the increased pressure in cardiac tamponade?

A

The fact that the fibrous pericardium doesn’t stretch

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7
Q

What is pericarditis?

A

Inflammation of the pericardial layers

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8
Q

What causes pain in pericarditis and what can result if not treated?

A

Inflamed and thickened layers of pericardium rub against each other
Can lead to cardiac tamponade

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9
Q

At which level does the oesophagus start?

A

C6/7 end of pharynx

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10
Q

At which level does the trachea start?

A

C6 end of larynx

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11
Q

Superior mediastinum structures from anterior to posterior (8)

A 
Thymus
Phrenic nerves - motor + sensory
Great veins 
Main lymphatic trunks
Vagus nerves
Great arteries
Trachea and main brochi
Upper oesophagus
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12
Q

Which veins make up each brachiocephalic vein?

A

Jugular vein

Subclavian vein

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13
Q

Where does the thoracic duct drain?

A

Junction between L jugular and subclavian veins

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14
Q

What is the function of the thoracic duct and what is the exception?

A

Thoracic duct lymph from whole of the body with the exception of the right upper quadrant of the body that is drained by the right lymphatic duct

lymph from lower limbs, pelvis, abdomen & left thoracic wall to blood

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15
Q

What do the brachiocephalic veins drain?

A

Arms and head

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16
Q

Where do the inferior thyroid veins come from?

A

Brachiocephalic veins

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17
Q

At which level does the azygos arise?

A

L1/2 juncton between right subcostal vein and right ascending lumbar vein

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18
Q

What is the function of the azygos?

A

Drain posterior wall of chest and upper abdomen

Drain posterior mediastinal organs

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19
Q

Course of azygos veins and where do they enter?

A

Arch over right lung root at T4

Enter SVC from behind just above the right atrium

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20
Q

Where does the azygos vein pierce the diaphragm to get into the thorax and along with which other structures?

A

T12, aorta, thoracic duct

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21
Q

What is the right superior intercostal vein made up of?

A

A single vessel formed by 2nd, 3rd, 4th IC veins

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22
Q

List 7 tributaries of the azygos vein

A 
Accessory azygos + hemiazygos vein
Right superior intercostal vein
Right Bronchial veins
5-11 posteror IC veins
Esophageal veins
Mediastinal veis
Pericardial veins
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23
Q

Where does the hemiazygos vein arise from?

A

L ascending lumbar vein and L subcostal vein

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24
Q

How does the hemiazygos enter the thorax?

A

L crus of diaphragm or through aortic hiatus

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25
Q

At which level does the hemiazygos enter the azygos?

A

T9

crosses vertebral column posterior to thoraci duct, esophagus, thoracic aorta

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26
Q

List 3 tributaries of the azygos vein

A

Lowest 4-5 posterior IC veins
Esophageal veins
Mediastinal veins

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27
Q

Where does the accessory hemiazygos enter the azygos vein?

A

T8

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28
Q

Where does the thoracic duct begin from and where does it end?

A

T12 as a continuation of the cysterna chili
L1 including cysterna chili

lecture: Begins below diaphragm at cisterna chyli
Starts between oesophagus and aorta on right

Ends at C7

29
Q

Course of thoracic duct from T12-T5

Course of thoracic duct from T5-C7

A

Midline + posterior
T5 crosses the midline to the left and enters the superior mediastinum
To the left of the oesophagus

30
Q

Where does the aortic arch end/where does the descending aorta begin?

A

T4

31
Q

Where do the coronary arteries arise from and at which level?

A

Ascending aorta
R coronary artery - R aortic sinus
L coronary artery - L aortic sinus

at the level of the ascending aorta

32
Q

List the 3 branches of the aortic arch

A

Brachiocephalic artery
Left common carotid artery
Left subclavian artery

33
Q

What is the ligamentum arteriosum and what is its function?

A

Remnant of the ductus arteriosus allows blood to bypass the lungs during development (lungs are inactive in the womb)

Connects pulmonary trunk with arch of the aorta

34
Q

Phrenic nerve - motor innervation to

A

Diaphragm

35
Q

Phrenic nerve - sensory innervation to

A

Pericardium
Mediastinal pleura (parietal)
Peritoneum of central diaphragm
Central tendon of diaphragm

36
Q

Vessels supplying the phrenic nerve?

A

pericardiacophrenic vessels

37
Q

Course of R phrenic nerve

A 
Lateral to the right vagus nerve
Lateral and slightly posterior to the beginning of the right brachiocephalic vein
Right side of SVC
Enters middle mediastinum
Right side of pericardial sac
Within fibrous pericardium 
Anterior to the root of the right lung
Leaves thorax by passing through diaphragm at T8 with IVC
38
Q

To which organs do vagus nerves give their branches?

A

Esophagus, Heart, Lungs

39
Q

Course of L vagus nerve

A

Posterior to L brachiocephalic vein between the L common carotid and the L subclavian arteries
Lateral to common carotids
Anterior to aortic arch (!)
Posterior to lung roots
forms a plexus following oesophagus into the abdomen

40
Q

Course of R vagus nerve

A

Lies between R brachiocephalic vein + R brachiocephalic trunk
Lies on the trachea
Descends in posterior direction
Towards the trachea
Crosses the lateral surface of the trachea
Passes posteriorly to the root of the right lung to reach the oseophagus
Just before the oesophagus it is crossed by the archof the azygos vein

41
Q

What does the R recurrent laryngeal nerve recurs around?

A

R Subclavian artery

42
Q

What does the L recurrent laryngeal nerve recurs around?

A

Ligamentum arteriosum and arch of the aorta

43
Q

Where do sympathetic trunks lie?

A

On each side of the posterior mediastinum

44
Q

From which spinal nerves do the sympathetic trunks receive branches from?

A

T1-L2

45
Q

Where do nerves to body wall synapse?

A

In ganglia of trunks

46
Q

Where do nerves to viscera (internal organs) synapse?

A

In local ganglia (close to the organ of interest)

47
Q

What is the splanchnic nerve?

A

Fibres from lower T5-T12 that reach the abdomen in bundles

48
Q

2 functions of the sympathetic trunks?

A
  1. Distribute sympathetic nerves to smooth muscle and glands throughout the body (visceral efferents)
  2. Bring pain fibres back to CNS from viscera (visceral afferents)
49
Q

Contents of posterior mediastinum (7)

A 
Oesophagus
Descending aorta
Thoracic duct
Azygos venous system
Posterior mediastinal lymph nodes
Thoracic sympathetic trunks
Splanchnic nerves
50
Q

Course of esophagus

A 
Begins at C7 (end of pharynx)
Enters superior mediastinum and then makes its way to posterior mediastinum
At T7:
Deviates to the left 
Inclines anteriorly to pass in front of the descending thoracic aorta
Progressively anterior to aorta below T7
T10 Passes through the diaphragm (+CN10)
T11 ends at stomach
51
Q

Where are the constrictions of the oesophagus?

A
  1. Junction between pharynx and oesophagus
  2. Where oesophagus is crossed by the arch of the aorta
  3. Where the oesophagus is compressed by the L main bronchus
  4. At esophageal hiatus (diaphragm)
52
Q

Branches to chest and abdomen

Sympathetic/Parasympathetic?

A

Parasympathetic

53
Q

Recurrent laryngeal nerve

Sympathetic/Parasympathetic?

A

Sympathetic

Supplies skeletal muscles of larynx

54
Q

What is the mediastinum?

A

Is a thick midline partition that separates the two pleural cavities.

55
Q

How is the SVC formed?

A

By asymmetric union of right and left brachiocephalic veins

56
Q

Where does the trachea lie?

A

Behind + between the brachiocephalic and L common carotid arteries

57
Q

Distribution of common carotid arteries

A

Divide to internal and external carotids high in neck

58
Q

What do the subclavian arteries supply?

A

Vertebral arteries

59
Q

What do the carotid arteries supply?

A

Head and neck

60
Q

In a horizontal section through TIII why can’t you see the R current laryngeal nerve?

A

It’s much higher up

RIGHT Recurrent Laryngeal nerve HIGHER than LEFT Recurrent Laryngeal nerve. So LEFT Recurrent Laryngeal nerve is longer.

61
Q

Which nerve is more anterior Vagus or recurrent laryngeal nerve?

A

Vagus

62
Q

What vertebral level separates superior + inferior mediastinum?

A

T4/5

63
Q

Which structure is the ligamentum arteriosum closely associated with?

A

Left recurrent laryngeal nerve

64
Q

What can cardiac tamponade lead to?

A

Biventricular failure

65
Q

What is a pericaridal effusion?

A

is where excess fluid builds up between the parietal and visceral layers of the serous pericardium

66
Q

At which vertebral level does the R bachiocephalic trunk bifurcate?

A

T1-Sternoclavicular joint

67
Q

At which vertebral level does the aortic arch end?

A

T4-Sternal angle

68
Q

At which vertebral level do the two brachiocephalic veins join?

A

T3

Posterior to the lower edge of the 1st CC

Anatomy - Charis (4 decks)

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