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Respi > Thoracic wall, Mediastinum & Diaphragm > Flashcards

Thoracic wall, Mediastinum & Diaphragm Flashcards

1
Q

three other minor muscles that help to move the ribs?

A

serratus posterior superior, serratus posterior inferior and levator costae

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2
Q

VAN occupies which groove?

A

costal groove
note: VAN is between internal intercostal and innermost intercostal muscles

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3
Q

whats the mediastinum?

A

central compartment of the thorax between the two pleural cavities

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4
Q

Structures at the transverse thoracic plane (T4/T5)? hint: 8

A
  • Bifurcation of trachea,
  • concavity of the aortic arch
  • just above it the bifurcation of the pulmonary trunk
  • the azygous enters the SVC,
  • thoracic duct reaches left side of oesophagus
  • ligamentum arteriosum with left recurrent laryngeal nerve recurving below it
  • tracheobronchial lymph nodes,
  • superficial and deep parts of cardiac plexus
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5
Q

structures found in superior mediastinum? hint: 9

A
  • esophagus
  • trachea
  • thoracic duct
  • brachiocephalic veins
  • superior vena cava
  • vagus nerve (L recurrent laryngeal n)
  • phrenic nerves
  • arch of aorta
  • thymic remnants
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6
Q

2 portions of the diaphragm?

A
  • peripheral- muscular part (sternal, costal, lumbar)
  • central- aponeurotic- tendon
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7
Q

middle/anterior leaflet of central tendon is fused with the pericardium. T or F.

A

T

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8
Q

From its circumferential origin the fibres of the diaphragm arch upwards in a pair of domes and then descend into a central tendon which lies at what level?

A

lies at the level of the xiphisternal joint at T8 level

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9
Q

Domes can ascend in full expiration to 4th intercostal space (normal position of nipples) on right and 5th rib on left. T or F.

A

T- right is higher than the left

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10
Q

Tendinous fibres of each crus unite with one another in front of the aorta at the level of T12 vertebra to form the?

A

median arcuate ligament

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11
Q

medial arcuate ligament?

A

thickening of the psoas fascia

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12
Q

lateral arcuate ligament?

A

a thickening of anterior layer of lumbar fascia on quadratus lumborum muscle

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13
Q

what passes alongside the inferior vena cava through the opening of the vena cava in the diaphragm?

A

right phrenic nerve

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14
Q

what passes alongside the aorta through the aortic opening in the diaphragm?

A

azygous vein and thoracic duct

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15
Q

what passes alongside the oesophagus through the oesophageal opening in the diaphragm?

A

Vagal trunks, oesophageal branches of the left gastric artery, veins and lymphatics

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16
Q

the walls of which part of the bronchial tree contains no cartilage but instead smooth muscle?

A

terminal bronchioles

17
Q

nerve supply of diaphragm?

A

motor nerve supply is solely from phrenic nerve (C3,4,5).

18
Q

whats the major role of the diaphragm?

A

inspiration
note: also used in abdominal straining for defaecation, micturition etc.

19
Q

outer layer of thoracic muscles?

A
  • serratus posterior superior (elevate upper ribs for inspiration)
  • serratus posterior inferior (depresses lower ribs for expiration)
  • levator costae muscles
  • external intercostals
20
Q

middle layer of thoracic muscles?

A
  • internal intercostal muscles
21
Q

inner layer of thoracic muscles?

A
  • innermost intercostal muscles
  • subcostal muscles
  • transverse thoracis
22
Q

whats a pleural tap?

A
  • Aspiration of pathological material from pleural cavity (serous fluid, fluid mixed with tumor cells, blood, pus, etc..) done through intercostal space.
  • Usually, intercostal space 6, 7 or 8
  • Needle or trocar inserted just above the rib forming lower boundary of the space to avoid main nerve and vessels
23
Q

central tendon is connected to what?

A

pericardium

24
Q

blood supply to the diaphragm?

A
  • costal margin: lower 5 intercostals and subcostal arteries
  • crura: right and left phrenic arteries of abdominal aorta
  • small contributions: musculophrenic and pericardiophrenic branches of internal thoracic artery; superior phrenic arteries of thoracic aorta
25
Q

major role of diaphragm?

A

inspiration- central tendon can be depressed to levels T8-T9
note: intra-abdominal pressure rises

26
Q

what does the diaphragm develop from?

A
  • septum transversum
  • pleuroperitoneal folds then pleuroperitoneal membranes
  • esophageal mesentery
27
Q

what are the types of congenital diaphragmatic hernias?

A
  • bochdalek’s foreamen (pleuroperitoneal membrane doesnt develop-abdominal organs enters the thoracic cavity-more common on left side)
  • morgagni’s foreamen (small hernia-junction of costal and xiphoid origins)
  • diaphragmatic eventration (abnormal displacement of intact diaphragm into chest cavity)
28
Q

what are the types of acquired diaphragmatic hernias?

A
  • sliding type (esophagogastric junction rises up into thorax)
  • paraosophageal/rolling type (part of stomach projects upwards alongside esophagus)

Respi (9 decks)

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