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Gross Anatomy Block 2 > Mediastinum > Flashcards

Mediastinum Flashcards

1
Q

Structure of the thymus?

A

Consists of 2 flat lobes; sometimes extends past the mediastinum into the root of the neck (by the thyroid gland)

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2
Q

Thymus is a ___ lymphoid organ which does?

A

Primary; produces T lymphocytes

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3
Q

What is the superior vena cava formed by?

A

The joining of right and left brachiocephalic veins

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4
Q

Where does the superior vena cava run to and from?

A

First costal cartilage to third costal cartilage

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5
Q

What is the only vein that drains into the SVC? Location?

A

Azygos vein; superior mediastinum

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6
Q

Function of IVC?

IVC is mostly located where

A

Collects venous blood from body structures below the diaphragm (SVC does everything above)

In the abdomen

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7
Q

Where is the descending aorta?

A

Diaphragm; its divided by diaphragm into thoracic and abdominal parts

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8
Q

Ascending aorta comes from the ___ and goes in what direction

Pulmonary trunk comes from ___ and goes in what direction

A

Left ventricle; up and to the right

Right ventricle; up and to the left
So they kind of cross each other

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9
Q

Listen to the heart sounds of the aortic valve on what side of the chest?

Listen to the heart sounds of the pulmonary valve where?

A

Right side (medial end of 2nd right intercostal space)

Medial end of 2nd left intercostal space

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10
Q

What is the only branch of the ascending aorta

A

Left and right coronary arteries (which supply the heart itself)

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11
Q

Arch of aorta starts at what level?

Where does it terminate?

A

Level of the sternal angle (as a continuation of the ascending aorta)

Lower border of body of T4 (just to the left of the midline)

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12
Q

Root of the left lung has what arch?

Root of the right lung has what arch?

A

Arch of the aorta above it

Arch of the azygos vein above it

~these arches are vascular

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13
Q

What is the first (and largest) branch of the aortic arch? What direction does it go? What does it divide into?

A

Brachiocephalic trunk/artery runs up and to the right - divides into right common carotid artery and right subclavian artery

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14
Q

What is the second branch of the aortic arch? Where does it run?

A

Left common carotid artery - passes through superior thoracic aperture into the root of the neck

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15
Q

What is the third and final branch of the aortic arch? Where does it run?

A

Left subclavian artery - passes over apex of the lung and first rib then into upper limb

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16
Q

Ligamentum arteriosum is the remnant of what?

A

Ductus arteriosum- connects pulmonary artery and aorta in uterine; allows blood to bypass the lung (since lung is collapsed at this point)(closes within 24 hours of being born)

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17
Q

What is the foreamen ovale?

A

Opening in interatrial septum which allows blood to go from right and left atrium to bypass the lung in utero

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18
Q

Patent ductus arteriosum is ?

When does this usually happen?

A

Ductus arteriosum does not close when baby is born

This usually happens in premature babies because there lungs are still not fully developed yet

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19
Q

Pressure in pulmonary circulation is ___ than in the aorta during intrauterine life. Why?

A

Higher because ductus arteriosum is carrying blood from pulmonary trunk to aorta

~this flips when born because the capillary beds open up and left side of heart is going to be receiving more blood

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20
Q

What happens to blood flow if you have a patent foramen ovale?

A

Pressure gradient shifts and patent foramen ovale is going to transfer blood from the left atrium to the right atrium

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21
Q

When would a condition be a cyanotic malformation?

A

In any condition that creates a right to left shunt of blood

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22
Q

Do patent foramen ovale and patent ductus arteriosum create cyanosis?

What happens?

A

No because they are a left to right shunt

Pulmonary trunk receives more blood than normal so pressure increases causing pulmonary hypertension and hypertrophy of RV

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23
Q

In case of pulmonary hypertension, which part of the heart will have to work harder

A

Right ventricle because it has to pump harder to get blood into pulmonary trunk because the pressure is so high (so you get right ventricle hypertrophy)

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24
Q

Subclavian artery gives off what branch?

A

Costocervical trunk; inferior branch = superior intercostal artery (which gives of posterior intercostal arteries for the upper two intercostal spaces)

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25
Q

Where do the other posterior intercostal arteries originate from?
What else originates from here?

A

Descending thoracic aorta

Subcostal arteries, also small arteries for esophagus and bronchioles and posterior part of the diaphragm

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26
Q

Where does the phrenic nerve originate?

A

The neck (its a branch from the cervical plexus)

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27
Q

How to distinguish between vagus and phrenic nerve?

A

Phrenic nerve passes anterior to the root of lung; vagus passes posteriorly

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28
Q

Inferiorly, the right phrenic nerve supplies sensory innervation to?
Where does the right phrenic nerve run through inferiorly?

A

Central part of peritoneum and diaphragmatic pleura, mediastinal pleura, pericardium
Caval opening of diaphragm

29
Q

Phrenic nerve only supplies motor to the diaphragm; what does it supply sensory innervation to?

A

Fibrous pericardium and parietal layer of serous pericardium, mediastinum pleura and central part of diaphragmatic pleura

30
Q

What supplies sensory innervation to the peripheral part of the diaphragmatic pleura?

A

Intercostal nerves

31
Q

Sometimes when a patient presents with shoulder pain, it can indicate?

A

A problem with the diaphragm because shoulder is dermatome for C3-5

32
Q

What forms the root of right lung?

A

Right principal bronchus, right pulmonary artery and both right pulmonary veins

33
Q

Where does right vagus nerve run?

A

Runs down right side of trachea; passes between trachea and arch of the azygos
Vagus passes posterior to the root of the right lung

34
Q

What supplies parasympathetic innervation to the right lung?

A

Branches of the vagus nerve for the pulmonary plexus

35
Q

Left side of the mediastinum is referred to as ?

A

The arterial side of the mediastinum (right side is venous side)

36
Q

Where are each of the three subdivisions of the inferior mediastinum located?

  1. Middle
  2. Anterior
  3. Posterior
A
  1. Pericardial sac with its contents
  2. Between body of sternum and pericardial sac
  3. Limited anteriorly by pericardial sac and posteriorly by T5-T12
37
Q

Brachiocephalic veins are formed by the union of?

Difference in appearance between right and left?

A

Subclavian and internal jugular veins

Right is short and almost vertical, left is longer and oblique

38
Q

What does the ligamentum arteriosum connect?

A

Bifurcation of pulmonary trunk to lower surface of aortic arch

39
Q

Where does the descending thoracic aorta begin?

When does it become continuous with the abdominal aorta?

A

Lower border of body of T4

T12 (when it passes through aortic hiatus of diaphragm)

40
Q

Function of the pulmonary trunk?

Where does it begin and end?

A

Carries deoxygenated blood from RV to lungs

Begins at RV and ends inferior to aortic arch by dividing into right and left pulmonary arteries

41
Q

Where does right pulmonary artery pass?

Left pulmonary artery?

A

Right- to the right, posterior to ascending aorta and SVC toward hilum of R lung

Left- to the left, anterior to descending thoracic aorta, toward hilum of left lung

42
Q

Phrenic nerves are accompanied by?

A

Pericardiacophrenic vessels

43
Q

Difference in location of the right and left vagus nerves?

A

Left is primarily on the anterior surface of the esophagus; right is on the posterior surface of esophagus

44
Q

Vagus nerve branches supplies ___ innervation to all thoracic organs

A

Preganglionic parasympathetic and visceral sensory fibers

45
Q

Left vagus enters the superior mediastinum between what two arteries

A

Left common carotid and left subclavian artery

46
Q

Left recurrent laryngeal nerve is branch of left vagus nerve. Lesion of this nerve causes what?

A

Paralysis of left vocal cord, which results in hoarseness

47
Q

Sensory fibers that carry pain from internal organs in thorax travel with

A

Preganglionic sympathetic nerves that innervate that organ

48
Q

Location of tracheobronchial lymph nodes

If they are enlarged what could happen?

A

Bifurcation of trachea

Can compress left recurrent laryngeal nerve (usually secondary to malignancies) and can cause hoarseness of throat

49
Q

The right and left vagus nerve form?

What kind of fibers does this have?

A

Esophageal plexus

Parasympathetic and sympathetic fibers

50
Q

If patient has a disease that causes dilation of the LA, what could happen

A

(CHF) dilated LA can compress esophagus and give patient dysphagia

51
Q

Where in the esophagus are swallowed foreign bodies most likely to lodge?

A

3 esophageal constrictions:

  1. Between pharynx and esophagus
  2. Where esophagus is crossed by L primary bronchus and aortic arch
  3. Where esophagus passes through the diaphragm
52
Q

Main purposes of Azygos venous system

A

To drain blood from thoracic and abdominal walls; additionally, can provide collateral circulation if SVC or IVC is obstructed

53
Q

Most of the venous blood from the heart is collected by

A

The coronary sinus which drains into RA

54
Q

Azygos vein is formed by union of?

A

Ascending lumbar and subcostal veins on right side (may also have a connection inferiorly with IVC)

55
Q

Tributaries of azygos vein?

A

All right posterior intercostal veins (except 1st because this one drains into right brachiocephalic), hemiazygos and accessory hemiazygos

56
Q

Location where hemiazygos vein joins azygos?

What veins does hemiazygos receive?

A

Ascends to T9

9-11th posterior intercostal veins

57
Q

Location where accessory hemiazygos joins azygos?

What veins does it receive

A

Descends to T8

Posterior intercostal veins from 4th-8th spaces on left as well as left bronchial and mediastinal veins

58
Q

Arch of azygos creates an impression on the __ lung, where?

A

Right; immediately above the hilum

59
Q

Where does thoracic duct begin and what is sometimes unique about this location?

Where does it terminate?

A

L2 (passes through the aortic hiatus of diaphragm); sometimes begins as a dilated sac (cisterna chyli)

At the union of left subclavian and internal jugular veins

60
Q

Thoracic duct drains all parts of the body except ?

What drains these parts?

A

Right side of: thorax, head, neck and upper limb

Right lymphatic duct

61
Q

Function of white communicating rami?

A

Carry preganglionic sympathetic fibers into the sympathetic chain

~all ganglia are connected to corresponding intercostal nerves by white and gray communicating rami

62
Q

Which is more lateral: white or gray communicating rami

A

White is more lateral

63
Q

Lower part of sympathetic trunk provides ___; what are they involved in ? Not involved in?

What do they contain?

A

Thoracic splanchnic nerves. Involved in innervation of abdominal organs; not involved in innervation of thoracic organs

Contain preganglionic sympathetic fibers (even though they originate from the sympathetic trunk)

64
Q

What structure arches of the root of the left lung

A

Aortic arch

65
Q

What 2 structures pass through the superior thoracic aperature to reach the root of the neck

A

Left common carotid artery and left subclavian artery

66
Q
  1. Right pulmonary artery passes to the right —

2. Left pulmonary artery passes to the left—

A
  1. Posterior to ascending aorta and SVC, toward hilum of right lung
  2. Anterior to descending thoracic aorta, toward hilum of left lung
67
Q

Which nerve passes anterior to the root of the right lung?

A

Right phrenic nerve (left passes anterior to the root of left lung)

68
Q

Right vagus nerve lies between which two structures?

Where in the body does it give branches to pulmonary plexuses?

A

Right brachiocephalic vein and brachiocephalic trunk

When it passes posterior to root of left lung

69
Q

What passes inferior to aortic arch and posterior to ligamentum arteriosum

A

Left recurrent laryngeal nerve

Gross Anatomy Block 2 (8 decks)

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