The Thorax

Question 1

What is the superior thoracic aperture

Answer 1

Opening at the top of the thoracic cavity
Connects neck to chest

Question 2

What makes up the anterior wall of the thoracic cavity

Answer 2

Ribs, costal cartilages, intercostal muscles and sternum

Question 3

What makes up the superior thoracic aperture

Answer 3

The first rib, T1 vertebral body and the sternum

Question 4

What makes up the lateral walls of the thoracic cavity

Answer 4

Ribs and the intercostal muscles

Question 5

What makes up the posterior wall of the thoracic cavity

Answer 5

Ribs, intercostal muscles and vertebra

Question 6

What is the inferior thoracic aperture

Answer 6

The lower opening of the thorax

Question 7

What structure separates the thorax from the abdomen

Answer 7

Diaphragm

Question 8

What makes up the inferior thoracic aperture

Answer 8

Diaphragm

Question 9

Where do the intercostal arteries arise from

Answer 9

Thoracic aorta and internal thoracic arteries

Question 10

What arteries arise from the thoracic aorta and the internal thoracic arteries

Answer 10

Intercostal arteries

Question 11

Where do the internal thoracic mammary arteries arise from

Answer 11

Subclavian artery

Question 12

What arteries arise from the subclavian artery

Answer 12

Internal thoracic mammary arteries

Question 13

Where does the intercostal nerve arise from

Answer 13

Anterior rami of the spinal nerve

Question 14

What arises from the anterior rami of the spinal nerve

Answer 14

Intercostal nerve

Question 15

Where do the intercostal artery, vein and nerve run

Answer 15

In the subcostal groove of the rib

Question 16

What structures run in the subcostal groove of the rib

Answer 16

Intercostal artery, vein and nerve

Question 17

What can the internal thoracic mammary artery be repurposed for

Answer 17

Coronary artery bypass graft
Breast reconstruction

Question 18

What is the mediastinum

Answer 18

Region between left and right lung

Question 19

What does the mediastinum contain

Answer 19

Most of the contents of the thorax apart from the two lungs

Question 20

How is the mediastinum divided

Answer 20

Divided into 4 regions
Superior and inferior
Inferior divided into anterior middle and posterior

Question 21

How is the superior and inferior mediastinum divided

Answer 21

Imaginary line between the angle of Louis and T4

Question 22

What is the boundary for the anterior mediastinum

Answer 22

Everything anterior to the fibrous pericardium of the heart

Question 23

What is the boundary for the middle mediastinum

Answer 23

Pericardium and the heart

Question 24

What is the boundary for the posterior mediastinum

Answer 24

Everything posterior to the fibrous pericardium

Question 25

What does the superior mediastinum contain

Answer 25

Major arteries- arch of the aorta, brachiocephalic, left common carotid, left subclavian Major veins- right and left brachiocephalic veins, superior vena cava Thymus Oesophagus Trachea Phrenic nerve Vagus nerve Left recurrent laryngeal nerve

Question 26

What nerve roots does the phrenic nerve originate from

Answer 26

C3,4 and 5

Question 27

What is the function of the phrenic nerve

Answer 27

Motor supply to the diaphragm Sensory supply to the pericardium, diaphragm and mediastinal pleura

Question 28

What cranial nerve is the vagus nerve

Answer 28

Cranial nerve X

Question 29

What is the name of cranial nerve X

Answer 29

Vagus nerve

Question 30

Where does cranial nerve X originate from

Answer 30

Medulla

Question 31

Where does the vagus nerve travel down from the medulla

Answer 31

Down the neck through the superior mediastinum and into posterior mediastinum

Question 32

What nerve originates from the medulla and travels down the neck through the superior mediastinum and into the posterior mediastinum

Answer 32

Vagus nerve or cranial nerve X

Question 33

What are the functions of the vagus nerve

Answer 33

Motor supply to muscles of pharynx and larynx Sensory- visceral sensation to heart and abdominal visceral Special sensory- taste sensation- epiglottis and root of the tongue Autonomic- parasympathetic fibres innervate trachea, bronchi, GI tract and heart

Question 34

What does the anterior mediastinum contain

Answer 34

Thymus gland Internal thoracic mammary arteries

Question 35

What part of the mediastinum would you find the thymus glands and the internal thoracic mammary arteries

Answer 35

Anterior mediastinum

Question 36

What does the middle mediastinum contain

Answer 36

Phrenic nerves, pericardium, heart Origin of major vessels- ascending aorta, pulmonary trunk and superior vena cava Bifurcation of trachea at T4

Question 37

What part of the mediastinum would you find the ascending aorta, pulmonary trunk, bifurcation of the trachea and the phrenic nerves

Answer 37

Middle mediastinum

Question 38

What does the posterior mediastinum contain

Answer 38

Vascular structures GI structures Lymphatic structures Nervous system structures

Question 39

What vascular structures are found in the posterior mediastinum

Answer 39

Thoracic aorta Azygous and hemi-azygous veins- drain thoracic walls and upper lumbar region- drains into superior vena cava

Question 40

What GI structure is found in the posterior mediastinum

Answer 40

Oesophagus

Question 41

What lymphatic structure is found in the posterior mediastinum

Answer 41

Thoracic duct

Question 42

What nervous system structures are found in the posterior mediastinum

Answer 42

Sympathetic trunk- short pre-ganglionic neurones, synapse in either paravertebral chain or pre-vertebral ganglia

Question 43

What is recurrent laryngeal nerve palsy

Answer 43

Laryngeal nerve branch of vagus nerve becomes damaged Can be caused by tumour from lung cancer Causes voice hoarseness and difficulty breathing

Question 44

What is gastroparesis

Answer 44

Condition caused by dysfunction of vagus nerve Leads to delayed stomach emptying, bloating abdominal pain, nausea and vomiting Commonly caused by diabetes

Question 45

What is boerhaave’s syndrome

Answer 45

Rupture of Oesophagus wall Mostly due to iatrogenic causes - result of medical treatment or interventions- or excessive vomiting/ straining 100% mortality rate without surgical intervention- 30% with Can lead to mediastinitis and sepsis

Question 46

What is lymphadenopathy

Answer 46

Swelling/ enlargement of lymph nodes due to infection or cancer

Question 47

What is lymphoedema

Answer 47

Swelling of body tissues due to blockage of lymphatic drainage Can occur secondary to removal of lymph nodes in cancer treatment

Question 48

In terms of the phrenic nerve why do patients sometimes feel shoulder tip pain if they have an ectopic pregnancy

Answer 48

Blood enters abdominal cavity due to pregnancy Blood irritates diaphragm and stimulates phrenic nerve Phrenic nerve controls diaphragm and has sensory fibres in shoulder region So both areas stimulated

Question 49

What is Gillian-Barre syndrome

Answer 49

Autoimmune condition Attacks peripheral nervous system Causes ascending paralysis Can lead to breathing difficulties