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Anatomy > Mediastinum and Heart 1 > Flashcards

Mediastinum and Heart 1 Flashcards

1
Q

Define the margins of the mediastinum

A

Superior thoracic aperture superiorly, the manubrium anteriorly, 1st ribs laterally, T1 posteriorly, and the inferior diaphragm inferiorly

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2
Q

The mediastinum can be defined as what?

A

The thoracic space in between the pleural cavities

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3
Q

Where is the mediastinum is divided into the superior and inferior mediastinum?

A

At the sternal angle (T4/T5)

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4
Q

Describe the location of the thymus

A

Posterior to the manubrium and sternal body, anterior to the heart, situated in between the superior and inferior mediastinum

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5
Q

How does the thymus change as we age in life (physically and functionally)?

A

Physically, it is well developed in early life but gradually involutes (decreases in size) and is replaced by fat, however it remains functional

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6
Q

What type of organ is the thymus?

A

Lymphoid (part of the lymphatic system)

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7
Q

Where is the pericardium found in relation to the thymus?

A

Posterior and inferior to the thymus

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8
Q

From superficial to deep, name the layers of the pericardium

A

Fibrous pericardium, parietal layer of serous pericardium, visceral layer of serous pericardium

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9
Q

What does the pericardium surround?

A

The heart and proximal portions of the great vessels

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10
Q

The great vessels can be defined as what?

A

The aorta and the pulmonary trunk

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11
Q

Describe the fibrous pericardium

A

Tough external layer of the pericardium, inelastic (which protects the heart against overfilling),

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12
Q

Describe the points of attachment of the fibrous pericardium

A

Attached to the central tendon of the diaphragm

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13
Q

What type of innervation does the fibrous pericardium recieve?

A

Somatic sensory innervation via the phrenic nerve

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14
Q

What nerve is responsible for supplying sensory innervation to the fibrous pericardium?

A

The phrenic nerve

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15
Q

How does the point of attachment(s) of the fibrous pericardium impact the heart?

A

Since it is attached to the central tendon of the diaphragm, the heart and pericardium will move superior and inferior with respiration

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16
Q

Describe the relative location of the serous pericardium

A

Immediately deep to the fibrous pericardium

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17
Q

Describe the function of the parietal layer of the serous pericardium

A

Line the inner surface of the fibrous pericardium

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18
Q

What type of sensory innervation is received by the parietal layer of the serous pericardium?

A

Somatic sensory innervation via the phrenic nerve

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19
Q

What type of sensory innervation is received by the visceral layer of the serous pericardium?

A

Visceral sensory innervation (don’t need to know the specific nerve that innervates it)

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20
Q

Describe the location of the visceral layer of the serous pericardium in relation to the heart

A

Lined/adhered to the surface of the heart

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21
Q

What is another name for the visceral layer of the serous pericardium?

A

Epicardium

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22
Q

The parietal and visceral layers of the serous pericardium are continuous at what structure?

A

The great vessels

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23
Q

What is pericarditis?

A

The inflammation of the serous pericardium, causing rubbing/friction to occur (may be heard during auscultation)

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24
Q

What is the pericardial cavity?

A

The potential space between the parietal and visceral layers of the serous pericardium

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25
Q

What is a cardiac tamponade?

A

The pathological accumulation of fluid in the pericardial cavity (very dangerous!)

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26
Q

What occurs during a cardiac tamponade?

A

The buildup of fluid in the pericardial cavity compresses the heart (the fibrous pericardium is inelastic), making it efficient

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27
Q

What is the emergent treatment for cardiac tamponade?

A

Pericardiocentesis

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28
Q

Describe the subxiphoid approach to a pericardiocentesis

A

Needle inserted immediately to the left of the xiphoid process

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29
Q

What are the 2 approaches of a pericardiocentesis?

A

Subxiphoid approach and left parasternal approach

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30
Q

Describe the left parasternal approach to a pericardiocentesis

A

Needle inserted to the left of the sternum, medially in the 5th or 6th intercostal space

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31
Q

What structure(s) make up the right boarder of the heart?

A

Right atrium

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32
Q

What structure(s) make up the left boarder of the heart?

A

Left ventricle

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33
Q

What structure(s) make up the superior boarder of the heart?

A

The left and right atria

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34
Q

What structure(s) make up the inferior boarder of the heart?

A

The right ventricle

35
Q

What structure(s)/surface make up the base of the heart?

A

The posterior surface, formed by the left atrium

36
Q

What structure(s)/surface make up the apex of the heart?

A

Inferior and to the left, formed by the left ventricle

37
Q

Describe the relative location of the transverse pericardial sinus

A

Posterior to the pulmonary trunk and aorta, Anterior to the parietal pericardium

38
Q

What is the surgical benefit of the transverse pericardial sinus?

A

Allows the great vessels (the pulmonary trunk and the aorta) to be easily isolated during surgery, allowing them to be easily ligated or clamped (particularly during heart surgery)

39
Q

Describe the relative location of the pulmonary trunk

A

Inferior to the sternal angle

40
Q

Which structure of the heart does the pulmonary trunk emerge from?

A

The right ventricle

41
Q

Describe the relative location of the ascending aorta

A

Inferior to the sternal angle

42
Q

Which structure of the heart does the ascending aorta emerge from?

A

The left ventricle

43
Q

At the level of the sternal angle, the ascending aorta becomes what structure?

A

The arch of the aorta

44
Q

Describe the direction in which the arch of the aorta goes towards

A

Posteriorly and to the left

45
Q

At what point does the arch of the aorta become the thoracic/descending aorta?

A

Below the sternal angle

46
Q

Describe how the locations of the branches of the aortic arch change going from right to left

A

3 asymmetric branches, become more posterior as you move from right to left

47
Q

What are the 3 branches of the aortic arch (going right to left)

A

The brachiocephalic trunk, the left common carotid artery, the left subclavian artery

48
Q

What happens to the brachiocephalic trunk after branching off the aorta

A

It bifurcates into the right subclavian artery and the right common carotid artery

49
Q

Where does the right subclavian artery go to?

A

The right upper limb, but helps to supply the head and neck as well (primarily the brain)

50
Q

Where does the right common carotid artery go to?

A

The right side of the head and neck

51
Q

Where does the left subclavian artery go to?

A

The left upper limb, but helps to supply the head and neck as well (primarily the brain)

52
Q

Where does the left common carotid artery go to?

A

The left side of the head and neck

53
Q

Describe the relative location of the internal jugular veins and the subclavian veins in relation to the great arteries around them

A

The veins are anterior to the arteries

54
Q

What structure(s) are the internal jugular veins responsible for draining?

A

Primarily the head and neck

55
Q

What structure(s) are the subclavian veins responsible for draining?

A

Primarily the upper extremities

56
Q

The internal jugular veins and the subclavian veins converge to form what structure(s)?

A

The left and right brachiocephalic veins

57
Q

Describe the symmetry of the convergence that forms the brachiocephalic veins

A

They are asymmetric (near the point of convergence)

58
Q

How do the left and right brachiocephalic veins compare to one another?

A

The right brachiocephalic vein is shorter and more vertical than the left. Additionally, the left has to cross the midline in order to converge with the right brachiocephalic vein.

59
Q

The union of what structures form the superior vena cava (SVC)

A

The left and right brachiocephalic veins

60
Q

Describe the difference between the brachiocephalic trunk and the left/right brachiocephalic veins

A

The brachiocephalic trunk is the anteriormost branch arising from the aortic arch (bifurcates into the right subclavian artery and the right common carotid artery) and carries oxygenated blood AWAY from the heart. The left and right brachiocephalic veins are formed via the convergence of the internal jugular and subclavian veins, and carry deoxygenated blood TOWARDS the heart.

61
Q

What structure(s) drain blood into the right atrium?

A

The superior and inferior vena cava

62
Q

The SVC is responsible for draining what area(s) of the body?

A

Anything superior to the diaphragm

63
Q

The IVC is responsible for draining what area(s) of the body?

A

Anything inferior to the diaphragm

64
Q

What nerve is responsible for the parasympathetic innervation of the thoracic and abdominal viscera?

A

The vagus nerve (cranial nerve X/10)

65
Q

Describe the position of the vagus nerve in relation to the root of the lungs

A

Runs posterior to the hilum

66
Q

Describe the position of the vagus nerve in relation to the phrenic nerve

A

Posterior to the phrenic nerve (phrenic nerve runs anterior to the root of the lungs)

67
Q

Describe the anterior vagal trunk

A

The anterior vagal trunk is the continuation of the left vagus nerve as it follows the esophagus through the esophageal hiatus and into the abdominal cavity

68
Q

Describe the posterior vagal trunk

A

The posterior vagal trunk is the continuation of the right vagus nerve as it follows the esophagus through the esophageal hiatus and into the abdominal cavity

69
Q

The posterior vagal trunk is a continuation of what nerve?

A

The right vagus nerve

70
Q

The anterior vagal trunk is a continuation of what nerve?

A

The left vagus nerve

71
Q

Describe the relative location of the esophagus in the mediastinum

A

In the posterior mediastinum, located posterior to the pericardium and anterior to thoracic vertebrae T5 through T12

72
Q

What nerve does the recurrent laryngeal nerve branch off of? Where (generally speaking) does it do so?

A

The vagus nerve, in the mediastinum (posterior to the veins)

73
Q

Describe the pathway of the recurrent laryngeal nerves after branching off of the vagus nerve

A

The left recurrent laryngeal nerve loops under the aortic arch and the right recurrent laryngeal nerve loops under the right subclavian artery

74
Q

What are the right and left recurrent laryngeal nerves responsible for innervating?

A

The larynx (voice box)

75
Q

Describe the position/location of the right recurrent laryngeal nerve in the thorax

A

Hooks under the right subclavian artery, very superior in the thorax (difficult to access)

76
Q

Describe the position/location of the left recurrent laryngeal nerve in the thorax

A

Hooks underneath the arch of the aorta (so inferior to the aortic arch), superior to the pulmonary trunk, and posterior to ligamentum arteriosum

77
Q

Describe a possible indication that a patient is experiencing compression of the left or right recurrent laryngeal nerve

A

Hoarseness in their voice

78
Q

What is the ligamentum arteriosum (arterial ligament)?

A

A remnant of a fetal structure known as the ductus arteriosus, a small ligament that attaches the aorta to the pulmonary trunk (formed within 3 weeks after birth)

79
Q

Describe the relative location of the phrenic nerve in the mediastinum

A

Passes anterior to the root of the lung (vagus nerve passes posterior to the root of the lung)

80
Q

Describe the function of the phrenic nerve in the thorax

A

Provide somatic motor innervation to the entire diaphragm, and provide somatic sensory innervation to part of the parietal pleura, the central part of the diaphragm, the fibrous pericardium, and the parietal layer of serous pericardium

81
Q

A patient arrives to the emergency department with a gunshot wound in the thorax. The bullet injured a nerve located posterior to the root of the left lung. What type of nerve fibers have been injured?

A

Preganglionic parasympathetic fibers

82
Q

Describe the effect(s) of parasympathetic innervation by the vagus nerve on the lungs

A

Causes bronchoconstriction

83
Q

Describe the effect(s) of parasympathetic innervation by the vagus nerve on the heart

A

Decreases heart rate

84
Q

Describe the effect(s) of parasympathetic innervation by the vagus nerve on the stomach and intestines

A

Stimulates peristalsis and the secretion of various fluids

Anatomy (5 decks)

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