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Anatomy > Thorax > Flashcards

Thorax Flashcards

1
Q

Where does scarpas fascia end?

A

It is continuous with penile and peroneal fascia and attaches to the fascia lata just below the inguinal ligament

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2
Q

What is the blood supply to the body wall?

A

Intercostal
Subcostal
Lumbar
Internal thoracic
Superior and inferior epigastric arteries
Venous return does not follow arteries-anastomotic network of veins radiating away from the umbilicus

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3
Q

How many ribs are there and how many are false and true?

A

12 ribs
1-7 true (articulate with the sternum)
8-12 false (articulate with each other/ interchondral joints)
11-12 floating

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4
Q

Which vertebrae does the first rib articulate with?

A

T1

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5
Q

Which ligaments surround the synovial joints of the transverse processes?

A

Lateral costotransverse ligament
Costotransverse ligament
Superior costotransverse ligament

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6
Q

Which is the only rib to be connected to the sternum by a primary cartilaginous joint?

A

1st rib with the manubrium

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7
Q

What are the four muscles of the outer layer of the thorax?

A

Serratus posterior superior
Serratus posterior inferior
Levator costae
External intercostals

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8
Q 
Origin
Insertion
Action
Innervation
Special features
Serratus posterior superior
A

Spinous processes of c6-T2

Lateral to the angles of ribs 2-5

Elevate upper ribs-weak inspiratory muscles

Anterior rami

Dorsal scapular n and vessels run on posterior side of muscle. Glistening tendons

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9
Q 
Origin
Insertion
Action
Innervation
Special features
Serratus posterior inferior
A

T11-L2 spinous processes

Lateral to the angle of ribs 8-12

Depress lower ribs- weak expiratory muscles

Anterior rami

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10
Q 
Origin
Insertion
Action
Innervation
Special features
Levator costae
A

Tip of transverse process from C7-T11

Upper border of rib, below, lateral to its tubercle

Elevate ribs

Posterior rami of C8-T11

12 fan shaped pairs

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11
Q 
Origin
Insertion
Action
Innervation
Special features
External intercostals
A

Sharp lower border of rib above (from superior costotransverse ligament at back of intercostal space as far forward as costochondral junction)

Rib below

Elevate ribs

Intercostal nerves

Obliquely downwards
Anterior intercostal membrane replaces the muscle beyond costochondral junction

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12
Q

What is the middle layer of the thorax?

A

Internal intercostals

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13
Q 
Origin
Insertion
Action
Innervation
Special features
Internal intercostals
A

Costal groove

Upper border of rib below

Depress ribs

Intercostal nerves

Downwards and back wards. Extends as far forward as sternum but replaced posteriorly by posterior intercostal membrane.

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14
Q

Where does one insert a needle for a chest drain vs a needle to numb a rib?

A

Chest drains inserted just above a rib to avoid neurovascular bundle
Anaesthetic delivered just below a rib

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15
Q

Describe the course of the intercostal nerves

A

Passes between the internal intercostal and transversus thoracis. Gives off collateral (parietal pleura and periosteum) and lateral cutaneous branches. Posterior rib cage, nerve lies behind the artery, anteriorly nerve lies in front of the artery

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16
Q

What is the blood supply to the intercostal muscles?

A

From the back the upper 2 spaces: superior intercostal arteries (descending branch of costocervical trunk)
Remaining 9 spaces supplied by a separate branch of of descending thoracic artery: posterior intercostal arteries

At the front: anterior intercostal arteries (from internal thoracic artery in upper 6 spaces and musculophrenic in 7,8 and 9th). No anterior interocostal arteries in the last 2 spaces

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17
Q

Describe the drainage of the intercostal veins

A

1 posterior and 2 anterior veins
Lower 8 spaces azgyos vein on right and hemiazygos on the left

1st space drains into vertebral or brachiocephalic vein

2,3 and 4th spaces form a single trunk: superior intercostal vein which drains into azygos on right and brachiocephalic on left

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18
Q

What are the key branches of the internal thoracic artery?

A

2 anterior intercostal arteries in each intercostal space
Superior epigastric
Musculophrenic arteries
Pericardiophrenic artery

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19
Q

What are the crura of the diaphragm?

A

Tendons
Right crus- attached to upper 3 lumbar vertebrae
Left crus attached to upper 2 lumbar vertebrae
Some fibres of right crus pass up on abdominal surface from left crus to surround oseophageal orifice like a sling.
Crus fibres unit with each other at level of T12 to form median arcute ligament

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20
Q

What are the 3 large openings in the diaphragm?

A

Aortic opening T12
Oesophageal opening T10
Vena cava foramen T8

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21
Q 
Origin
Insertion
Action
Innervation
Special features
Intermost intercostals
A 
Costal groove
Upper border of rib below
Depress ribs
Intercostal nerves
Neurovascular bundle between internal and innermost. Lie on the side of rib cage
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22
Q 
Origin
Insertion
Action
Innervation
Special features
Subcostals
A

Internal surface of lower ribs
Superior borders of 2nd 3rd rib below
Lie at the back of rib cage

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23
Q 
Origin
Insertion
Action
Innervation
Special features
Tranversus thoracis
A

Posterior surface of lower sternum
Internal surface of costal cartilages 2-6
Lies at front of rib cage. Crosses more than one rib space

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24
Q

What passes through the aortic opening in the diaphragm?

A

T12
Aorta
Azygous vein
Thoracic duct from cisterna chyli

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25
Q

What passes through the oesophageal opening?

A

T10
Oesophagus
Vagal trunks
Oesophageal branches of left gastric artery

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26
Q

What passes through the vena caval foramen of the diaphragm?

A

T8
Lies between middle and right central tendon, fibres fuse with adventitia of vena cava
Inferior vena cava
Right phrenic nerve

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27
Q

What other smaller things pierce the diaphragm?

A 
Hemiazygous vein
Greater, lesser, least splachnic nerves
Sympathetic trunk
Subcostal nerve and vessels
Left phrenic nerve
Neurovascular bundles of 7-11 intercostal spaces
Superior epigastric vessels
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28
Q

What is the blood supply to the diaphragm?

A

Lower 5 intercostal and subcostal arteries

Right and left phrenic arteries from abdominal aorta

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29
Q

What is the nerve supply to the diaphragm?

A

C3, C4 (predominant) and C5 -> motor

Lower intercostal nerves give proprioceptive supply

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30
Q

What is the function of the diaphragm?

A

Contracts during inspiration
Expiration is passive
Contraction aids abdominal wall in raising intraabdominal pressure during heavy lifting, defecation, micturation, and giving birth

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31
Q

What are the divisions of the mediastinum?

A

Superior mediastinum is from the angle of Louis (T4) up to thoracic inlet
Below sternal angle inferior mediastinum is divided into 3; anterior, middle and posterior

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32
Q

What lies in the superior mediastinum?

A

Oesophagus against the body if T1 vertebrae
Trachea lies anterior to oesophagus
Arch of aorta -> brachiocephalic trunk -> left subclavian artery, left common carotid

Left brachiocephalic vein
Left and right( touches trachea)vagus nerves
Thymus

33
Q

Describe the course of the arch of the aorta

A

Ascending aorta becomes aortic arch at level of manubrium (T4)
Brachiocephalic trunk (thyroidea ima)
Left common carotid (no branches in mediastinum)
Left subclavian (no branches in mediastinum)
Arch is crossed on left by phrenic and vagus nerves.
Left recurrent laryngeal hooks ligamentum arteriosum
Pulmonary trunk bifurcates into left and right pulmoary arteries in the concavity of the arch
Adventitial layer of arch contains baroreceptors (carotid sinus)
Under arch there is ligamentum arteriosum which contains chemoreceptors (aortic bodies)

34
Q

What are the differences in course between the left and right brachiocephalic veins

A

Internal jugular vein lies lateral to internal carotid on anterior scalene muscle
Subclavian vein and anterior lies lateral and anterior to the lower part of anterior scalene
Right brachiocephalic vein: commences behind right sternoclavicular joint. Receives right jugular, subclavian and bronchomediastinal lymph trunks.

Left brachiocephalic vein: above arch of aorta, behind the thymus. Receives thoracic duct, inferior thyroid veins, left superior intercostal veins and a large thymic vein

35
Q

Where does the superior vena cava begin?

A

Lower border of first right costal cartilage where left and right brachiocephalic veins meet. Receives azygos vein. Enters right atrium at lower border of 3rd right costal cartilage

36
Q

How does the ligamentum arteriosum relate to the cardiac plexus?

A

Superficial cardiac plexus lies in front of ligamentum arteriosum, deep part is larger and lies to the right of the ligamentum arteriosum in front of bifurcation of trachea

37
Q

How long is the trachea and when does it bifurcate?

A

10cm

Bifurcates into main bronchi at T5

38
Q

What is the difference between the course of the right and left phrenic nerves?

A

Right phrenic nerve: medial to VENOUS structures

Left phrenic nerve: medial to ARTERIAL structures

39
Q

What is the difference between the course of the right and left vagus nerves?

A

Left vagus: held away from trachea by great vessels. Gives recurrent laryngeal branch which hooks around ligamentum teres
Right vagus: in contact with trachea. recurrent branch hooks around right subclavian artery

40
Q

What are the anterior and posterior structures of the thymus?

A

Anterior: sternohyoid, sternothyroid, manubrium and upper sternum
Posterior: Pericardium and arch of aorta

41
Q

Why is it impossible to separate the heart from the diaphragm without dissection?

A

Fibrous pericardium is continuous with adventitia of vessels and central tendon of diaphragm

42
Q

What is the difference between the transverse sinus and oblique sinus of the heart?

A

Serous layer inside fibrous pericardium
Transverse sinus: passage above heart between ascending aorta and pulmonary trunk in front
Oblique sinus: behind the heart between the left atrium in front and fibrous pericardium behind

43
Q

Where does the pain of pericarditis come from?

A

Phrenic nerve
Parietal nerve of serous pericardium innervated but not visceral layer.
Angina is sympathetic nerves

44
Q

What make up the right and left borders of the heart?

A

Left: Left ventricle and left auricle. Left second costal cartilage to 6th costal cartilage
Right: right atrium. Extends from right 3rd costal cartilage to right 6th costal cartilage

45
Q

What makes up the inferior/diaphragmatic surface and posterior surface of the heart?

A

Inferior: One third right ventricle and 2/3 left ventricle
Posterior:Left atrium and 4 pulmonary veins

46
Q

What is the crista terminalis and how does it relate to the embryology of the heart?

A

Within the right atrium of the heart there is a projection of vertical muscle- crista terminalis. To the right of the muscle the atria is smooth, but between the crista and the auricle there are pectinate muscles (true auricular chamber of embryonic heart)

47
Q

What forms the posterior wall of the right atrium and what is found there?

A 
Interatrial septum
Fossa ovalis (foramen ovale in the fetus)
48
Q

What are the attachments of the tricuspid valve?

A

Three leaflets, each have chordae tendinaea which diverge from papillary muscles to prevent cusps being everted when ventricle contracts

49
Q

How many cusps does the pulmonary valve have?

A

3
2 anterior
1 posterior

50
Q

What enters the left atrium?

A 
Coronary sinus (runs from right to left)
4 pulmonary veins
51
Q

How many cusps does the aortic valve have?

A

3
1 anterior
2 posterior

52
Q

Where do the coronary arteries come from?

A

The aortic sinuses in the walls of the ascending aorta- one above each cusp

53
Q

Where does the pulmonary trunk sit in relation to the aorta?

A

Higher than aortic orifice
Initially in front then to the left of ascending aorta
Spiral within the pericardium in front of the transverse sinus

54
Q

Where is the sinuatrial node?

A

Subepicardially in the wall of right atrium, just below superior vena cava, at the top of sulcus terminalis (no macroscopic features to indicate its location)

55
Q

Where is the atrioventricular node?

A

Right atrium

Interatrial septum, above attachment of septal cusp of tricuspid valve, to the left of the opening of coronary sinus

56
Q

Describe the course of the right coronary artery and its branches

A

Passes between auricle and infundibulum of right ventricle.
Runs in atrioventricular groove and runs posteriorly.
Branches: conus artery, SA nodal artery (supplies SA node in 60% of hearts), right marginal artery, posterior interventricular branch, AV nodal artery

57
Q

Describe the course of the left coronary artery and its branches

A

Emerges between left auricle and infundibulum of right ventricle
Divides into circumflex and anterior interventricular(LAD)
In 40% of hearts the circumflex gives the SA nodal artery. Circumflex supplies AV node.
10% of hearts LAD is short and is replaced by circumflex (left dominance)

58
Q

What are the tributaries to the coronary sinus?

A 
Great cardiac vein
Anterior interventicular
Middle cardiac vein
Small cardiac vein
Posterior vein of left ventricle
Oblique vein of left atrium
59
Q

What are the abnormalities in tetrology of fallot?

A

Pulmonary stenosis
Right ventricular hypertrophy
VSD
Overriding aorta

60
Q

Which structures are found in the posterior mediastinum?

A 
Oesophagus
Thoracic aorta
Azygos
Hemiazygos
Thoracic duct
Lymph nodes
61
Q

Where does the thoracic aorta begin and end?

A

T4 where arch of aorta ends
T12 ends by passing behind the diaphragm between the crura
Gives off 9 pairs of posterior intercostal arteries, subcostal arteries, bronchial arteries, oesophageal vessels and a few small cardiac and phrenic branches

62
Q

Describe the course of the oesophagus

A

25cm long
Narrowest part is at its commencement
Travels to the left of midline
Crossed by arch of aorta on left
Crossed by azygos on right
Crossed anterior by left main bronchus and pulmonary artery
Thoracic duct and hemiazgos run posterior

63
Q

What is the blood supply to the oesophagus?

A

Inferior thyroid arteries, bronchial arteries and oesophageal branch of left gastric artery

64
Q

What is the nerve supply to the oesophagus?

A

Recurrent laryngeal nerves
Sympathetic fibres
Motor supply is vagus

65
Q

Where does the thoracic duct begin?

A

Cisterna chyli at T12

Drains lymph from whole body except right upper limb and right halves of thorax and head and neck

66
Q

What forms the azygos vein?

A

Ascending lumbar vein and subcostal vein of right side
Drains into superior vena cava
Joined by hemiazygos veins at T7 and T8

67
Q

How does the pleura vary across the lung?

A

At the 2nd rib the 2 pleura meet
4th rib right pleura descends vertically but left pleura goes out sideways half way to apex of heart
Both pleura turn laterally at the 6th rib, crossing mid clavicular line at 8th rib and mid axillary line at 10th rib.
Pleura continues down to level of 12th rib

68
Q

What are the key differences between the right and left lung roots?

A

Left: Left pulmonary artery, 2 pulmonary veins, left bronchus all enclosed in pleura

Right:Bigger, upper lobe bronchus and branch of pulmonary artery to upper lobe originate outside of the lung. Therefore they lie above main bronchus and main right pulmonary artery

69
Q

Which pulmonary artery is longer?

A

Right pulmonary artery

70
Q

How many lobes and segments in each lung?

A

Right lung:
3 lobes
2 fissures; horizontal and oblique
10 segments (4 and 5 named lateral and medial middle lobe)

Left lung:
2 lobes
1 fissure; oblique
10 segments ( 4 and 5 named superior and inferior lingular)

71
Q

Which ribs do the lungs start and end at?

A

Commence above first rib
Hilum at T5-7
End around 6th rib anteriorly and 10th rib posteriorly
Oblique fissure lies around 5th rib

72
Q

Why are foreign bodies more likely to enter the right main bronchus?

A

Right main bronchus is 2.5cm long, shorter wider and more vertical than the left

73
Q

What is the blood supply to the bronchi?

A

2 bronchial arteries on left (directly from aorta) one on right
Veins of right main bronchus drain to azygos
Left main bronchus veins drain to accessory hemiazygos
Pulmonary artery supplies alveoli with deoxygenated blood but does NOT supply the bronchi

74
Q

What is the nerve supply to the lungs

A

Afferent and efferent vagal fibres. Vagal efferents are bronchoconstrictor, vasodilator and secretomotor to mucus glands
Sympathetic efferents are bronchodilator and vasoconstrictor

75
Q

When do bronchi become bronchioles?

A 
When the cartilage in their walls disappears
Then become lobular bronchioles
Then terminal bronchioles
Then respiratory bronchioles
Then alveolar ducts
Then alveolar sacs
76
Q

What are alveolar cells lined with?

A

90% type 1 alveolar cells for gas exchange

10% type 2 surfactant cells

77
Q

Describe the variety of joints found at the sternum

A

Sternoclavicular joint-atypical synovial
First costal cartilage to manubrium- primary cartilaginous joint
All other costal cartilages attached to body of sternum are synovial

78
Q

Why does the head of a rib have two articulating facets?

A

Lower facet is vertical and articulates with own vertebra. Upper facet is sloping and articulates with vertebra above.

79
Q

What is unique about the 1st rib?

A

Very curved
Head only carries a single facet
Tubercle for costotransverse ligament
Under surface of Shaft is covered by parietal pleura
Upper surface of shaft houses subclavian artery and brachial plexus
Scalene tubercle for scalenus anterior tendon

Anatomy (6 decks)

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