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103 Theme 1 - Anatomy > Posterior Mediastinum > Flashcards

Posterior Mediastinum Flashcards

1
Q

What are the boundaries of the posterior mediastinum?

Anterior

Posterior

Lateral

Superior

Inferior

A

Anterior – posterior pericardium

Posterior – vertebrae T5-12

Lateral – mediastinal pleura

Superior – transverse thoracic plane

Inferior – diaphragm

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2
Q

What 7 structures make up the posterior mediastinum?

A
  • Oesophagus
  • Thoracic aorta
  • Azygos system of veins
  • Thoracic duct
  • Vagus nerve
  • Sympathetic trunk
  • Splanchnic nerves
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3
Q

What is the sympathetic and parasympathetic supply to the posterior mediastinum?

A

Sympathetic - thoracolumbar outflow: T1 to L2

Parasympathetic - craniosacral outflow: some cranial nerves (including Vagus nerve) and S2, S3, S4

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4
Q
A
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5
Q

What is the sympathetic chain and where is it located?

A
  • Vertical chain of sympathetic nerves running the entire length of the vertebral column
  • Located on both sides of vertebral bodies
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6
Q

Where are paravertebral ganglia located?

A

Along the sympathetic chain

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7
Q

How many ganglia are there in the sympathetic chain?

A

In the thoracic spine usually one ganglion per spinal level

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8
Q

Complete the diagram of nerves

A
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9
Q

Complete the diagram of the sympathetic chain

A
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10
Q

Which spinal levels of the sympathetic chain does thoracic sympathetic supply come from?

A

T1-T4/5

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11
Q

Describe what is happening in the diagram at -

The pink line

The blue line

The yellow line

A

Pink line - preganglionic sympathetic fibres leave the spinal nerve (white rami communicantes) and synapse at a paravertebral ganglion

Blue line - postganglionic sympathetic fibers leave the ganglion (grey rami communicantes) and pass to the pulmonary, cardiac & oesophageal plexi

Yellow line - these nerves also carry afferent fibers (carrying sensory information) from the thoracic viscera they supply back to the brain

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12
Q

What is a dermatome?

A

An area of skin supplied by a single spinal cord level or spinal nerve

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13
Q

Where can pain from the heart be felt and which spinal level is this?

A

Can be felt down arm and across chest (T1-T4/5)

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14
Q

Where does the sensory supply for the diaphragm originate from and where is referred pain from the diaphragm felt?

A

The sensory supply to the diaphragm is partially carried by the phrenic nerve - C3, C4, C5

Referred pain from the diaphragm can be felt at the shoulder

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15
Q

What are the 3 splanchnic nerves and which spinal level do they originate from?

A
  1. Greater splanchnic nerves arise from levels T5-9
  2. Lesser splanchnic nerves arise from levels T10-11
  3. Least splanchnic nerves arise from level T12
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16
Q

Where do the splanchnic nerves travel?

A

Descend medially from ganglia across the vertebral bodies and enter abdomen by piercing the diaphragm

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17
Q

What nerve fibres make up the splanchnic nerves?

A

Carry preganglionic sympathetic fibres and visceral afferent fibres from the abdominal viscera

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18
Q

What nerves have been highlighted in this diagram?

A

Splanchnic nerves

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19
Q

Complete the diagram

A
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20
Q

Complete the diagram

A
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21
Q

Which cranial nerve is the vagus nerve?

A

CNX

Cranial nerve 10

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22
Q

Complete the diagram of the nervous structures

A
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23
Q

Where does the vagus nerve enter the superior mediastinum?

A

Enters superior mediastinum posterior to sternoclavicular joint

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24
Q

Which nerves branch from the vagus nerve in the superior mediastinum?

A

The left and right recurrent laryngeal nerves

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25
Where does the vagus nerve supply in the posterior mediastinum?
Contributes to pulmonary, cardiac and oesophageal plexuses supply
26
Is the vagus nerve supply in the posterior mediastinum sympathetic or parasympathetic?
Parasympathetic
27
At which point is the vagus nerve no longer made of preganglionic fibres?
The plexus
28
Which nerve is this?
Right vagus nerve
29
Where does the left and right recurrent laryngeal branch loop?
Left recurrent laryngeal nerve hooks inferiorly to the aortic arch, immediately lateral to ligamentum arteriosum. Right recurrent laryngeal branch hooks under right subclavian artery and ascends between trachea and oesophagus.
30
Where does the right and left vagus nerve travel to after giving off the recurring laryngeal branches?
Right vagus continues posterior to the right of the trachea, posterior to Right Brachiocephalic vein and lung root/ hilum. Left vagus runs posteriorly to lung root.
31
Which nerve is this?
Left vagus nerve
32
Which part of the aorta is the thoracic aorta continious with?
Arch of aorta
33
Where does the thoracic aorta travel in the posterior mediastinum?
Descends on the left side of vertebrae T5-T12 Oesophagus positioned to its right
34
Where does the thoracic aorta terminate and which other structures also pass through the diaphragm?
* Terminates at vertebral level T12 where it enters the abdomen through the aortic hiatus in the diaphragm * Thoracic duct and azygos veins ascend on its right hand side and also pass through diaphragm at the aortic hiatus
35
Complete the diagram of the branches of the thoracic aorta
Paired 1) Posterior intercostal 2) Subcostal 3) Bronchial 4) Superior Phrenic Unpaired a) Pericardial b) Oesophageal c) Mediastinal
36
Complete the diagram of the azygous system?
37
Complete the diagram of the azygous system
38
Complete the diagram of the azygous system
39
Where does the azygous vein arise from?
Arises on right side by junction of subcostal (T12 level) and ascending lumbar veins
40
Where does the hemi-azygous vein arise from?
Arises on left side by junction of subcostal (T12 level) and ascending lumbar veins
41
Where does the azygous vein drain deoxygenated blood from?
The posterior thoraco-abdominal walls and viscera. Usually receives blood from the hemiazygos veins which drain the left side.
42
What are the tributaries of the azygous vein?
Posterior intercostal veins (levels T5-T11), bronchial veins, vertebral venous plexus
43
Where does the azygous vein arch over?
Root of right lung to join superior vena cava
44
The azygous vein forms a collateral pathway between which 2 vessels?
Superior vena cava and inferior vena cava
45
Where do the hemi-azygous veins ascend to?
Ascends on the left side posterior to aorta draining left posterior intercostal veins levels T9-11
46
Where does the accessory hemi-azygous vein drain from?
Levels T5-T8 on left side
47
Where does the accessory hemi-azygous vein cross over to join the azygous vein?
Crosses T7/8 to join azygos and sometimes joins hemi-azygos
48
What is the largest lymph channel?
Thoracic duct
49
Which areas of the body does the thoracic duct drain lymph from?
Conveys all lymph from body except the head, neck, upper limb and thorax on the right side
50
Where does the thoracic duct originate from and where does it travel to?
1. Originates in the Cisterna Chyli in abdomen (L2) 2. Ascends through the Aortic hiatus passing anterior to thoracic vertebrae 3. Ascends into superior mediastinum and drains into venous system at the left venous angle
51
Where is the venous angle?
Junction of internal jugular and subclavian veins
52
Complete the diagram
53
Complete the diagram of lymph drainage of the body
54
Does the oesophagus travel superiorly or anteriorly to the trachea?
Posteriorly
55
How does the oesophagus pass in relation to the aorta? Anterior/Posterior Left/Right
Passes posterior and to the right of aorta
56
Does the oesophagus veer slightly left or right when piercing the diaphragm?
Slightly left
57
Does the oesophagus become anterior or posterior to the abdominal aorta before passing into the stomach?
Anterior
58
What is the innervation of the oesophagus?
CNX and Sympathetic trunk via Oesophageal plexus
59
Where are the 3 constrictions of the oesophagus?
1. Arch of aorta 2. Left main bronchus 3. Diaphragm
60
Complete the diagram of the 3 constrictions of the oesophagus

103 Theme 1 - Anatomy (7 decks)

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