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Block 2 Anatomy > The thorax, tracheobronchial tree and lungs > Flashcards

The thorax, tracheobronchial tree and lungs Flashcards

1
Q

What are the borders of the superior thoracic aperture?

A

T1 vertebra

Left and right 1st rib

Sternum (manubrium)

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2
Q

Which bony anomaly could cause injury to the vessels passing in and out of the superior thoracic aperture? What symptoms might they get?

A

An extra cervical rib

Patient may present with a cold limb, weak pulse, or tingling in the upper limb

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3
Q

Compression of which nerves can cause atrophy of the 1st dorsal webspace?

A

C6 and C7

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4
Q

What are the borders of the inferior thoracic aperture?

A

Costal margin – lower border of costal cartilage

Ribs 10-12

Diaphragm crura attach to lumbar vertebrae

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5
Q

Which nerve provides motor and sensory innervation to the diaphragm?

A

Phrenic nerve (C3,4,5)

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6
Q

Intercostal nerves provide what to the diaphragm?

A

Additional sensory innervation on the periphery

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7
Q

Which specific element of cardiac surgery could cause injury to the phrenic nerve?

A

Saline slush from myocardial preservation

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8
Q

Which pathology would unilateral phrenic nerve injury cause?

A

Hemidiaphragmatic palsy

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9
Q

At which vertebral level does the IVC pass through the diaphragm?

A

T11

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10
Q

At which vertebral level does the oesophagus pass through the diaphragm?

A

T11-12

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11
Q

At which vertebral level does the aorta pass through the diaphragm?

A

T12

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12
Q

What are the two types of diaphragmatic hernia, where do they occur, and what do they involve?

A

Bochdalek hernia – occurs posterolaterally and involves abdominal organs such as liver pushing through the diaphragm into the chest cavity

Morgagni hernia – occurs retrosternally

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13
Q

What kind of condition / movement might a patient present with when breathing with broken ribs? How does this movement differ from usual conditions?

A

Flail chest – paradoxical breathing where the detached portion of rib cage moves inward during inhalation and outward during exhalation

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14
Q

What is the vertebral level of the jugular (suprasternal) notch?

A

T2 or T3

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15
Q

The sternal angle sits at which IV disc?

A

T4-T5 IV disc

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16
Q

What is the vertebral level of the xiphoid process?

A

T9

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17
Q

Which costal cartilage is lateral to the manubriosternal joint?

A

2nd costal cartilage

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18
Q

The mediastinum can be divided into superior and inferior parts by what?

A

Sternal plane – T4-T5 IV disc

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19
Q

What are the 3 rib classifications + which ribs do they include?

A

Vertebrosternal – ribs 1-7

Vertebrocostal – ribs 8-10

Floating – ribs 11 + 12

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20
Q

Between which muscles is the thoracic neurovascular bundle?

A

Internal and innermost intercostal muscles

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21
Q

Which area of the intercostal space should chest drains be inserted and why?

A

Inferior part of the intercostal space to avoid damaging the main neurovascular bundle

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22
Q

What is the origin of the intercostal nerves?

A

Ventral rami of spinal nerves

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23
Q

What are the 2 main branches of the intercostal nerves?

A

Lateral cutaneous branches and anterior cutaneous branches

24
Q

Describe the blood supply to the thorax.

A

Posterior intercostal arteries arise from the descending aorta and anastomose with the anterior intercostal arteries which arise from the internal thoracic artery and the musculophrenic artery

25
Q

In aortic coarctation, what is the route that blood flows to reach the descending aorta?

A

Internal thoracic artery – anterior intercostal artery – posterior intercostal artery – descending aorta

26
Q

Chronic use of collateral flow through the intercostal arteries can cause which radiological finding? Why does this occur?

A

Rib notching – where the extra pressure in the intercostal arteries causes the inferior rib edges to remodel

27
Q

Describe the venous drainage of the thorax.

A

Right sided structures drain into the azygous vein, which drains into the SVC

Left sided structures drain into either the accessory azygous vein or the hemiazygous vein, which cross the midline to drain into the azygous vein, and into the SVC

The very upper spaces drain straight into the right and left brachiocephalic veins, which unit to form the SVC

28
Q

The respiratory diverticulum, which is an outgrowth of the gut tube, appears at what stage in gestation?

A

4 weeks

29
Q

What are the stages of growth starting from the respiratory diverticulum?

A

Respiratory diverticulum – lung/bronchial buds – buds grow into splanchnopleuric mesoderm

30
Q

Name 2 embryological defects that can occur during the separation of the oesophagus from the trachea.

A

Proximal oesophageal atresia with a distal fistula

Fistula

31
Q

At which week gestation does respiratory epithelia begin developing in the lungs?

A

Week 26

32
Q

What are the fissures of each lung?

A

Right – oblique + horizontal

Left – oblique

33
Q

What is atelectasis?

A

The partial or complete collapse of the lung or section of the lung

34
Q

What kind of blood do the pulmonary arteries carry and from where?

A

Pulmonary arteries carry deoxygenated blood from the right ventricle of the heart to the lungs

35
Q

What kind of blood do the pulmonary veins carry and from where?

A

Pulmonary veins carry oxygenated blood from the lungs to the heart

36
Q

The pulmonary veins enter which section of the heart?

A

Left atrium

37
Q

Which nerves pass anterior and posterior to the hilum of the lungs?

A

Phrenic nerves pass anterior to the hilum

Vagus nerves pass posterior to the hilum

38
Q

Which nerves that innervate the larynx branch off the vagus nerve?

A

Recurrent laryngeal nerves

39
Q

What is the position that the right recurrent laryngeal nerve recurs?

A

Right lung apex under the right subclavian artery

40
Q

What is the position that the left recurrent laryngeal nerve recurs?

A

Aortic arch

41
Q

Which vascular pathology could cause paralysis of the left side of the larynx and how?

A

An aortic arch aneurysm, by compressing or damaging the left recurrent laryngeal nerve

42
Q

Where is a needle decompression to correct a pneumothorax carried out?

A

2nd intercostal space at the midclavicular line

43
Q

At which vertebral level does the trachea bifurcate?

A

T6

44
Q

Which muscle completes the posterior aspect of the trachea?

A

Trachealis

45
Q

If food is aspirated, which bronchus is it more likely to pass into and why?

A

Right – because it is wider and more vertical than the left bronchus

46
Q

What are bronchopulmonary segments?

A

The smallest functionally independent regions of the lungs that can be resected without affecting other regions

47
Q

How many bronchopulmonary segments does the right lung have?

A

10

48
Q

How many bronchopulmonary segments does the left lung have?

A

8-9

49
Q

How do pulmonary arteries travel within the bronchopulmonary segments?

A

With bronchi & bronchioles

50
Q

How do pulmonary veins travels within the bronchopulmonary segments?

A

Between segments

51
Q

When a patient is supine, which segment of the lungs will struggle to drain the most since it is most inferior?

A

The superior segment of the lower lobe

52
Q

What is the key difference between the composition of the walls of bronchi and bronchioles?

A

Bronchi contain cartilage, bronchioles do not

53
Q

How do parasympathetics affect the bronchioles?

A

Constricts bronchioles

54
Q

How do sympathetics affect the bronchioles?

A

Dilates bronchioles

55
Q

Which arteries supply oxygenated blood to the lung tissues (not for ventilation)?

A

Bronchial arteries

56
Q

What is the lymph drainage route from the lungs?

A

Hilar nodes

Subcarinal nodes

Paratracheal nodes

All to right lymphatic duct, which dumps into the right subclavian vein, except for the left superior lobe, which drains into the thoracic duct and dumps into the left subclavian vein

Block 2 Anatomy (6 decks)

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