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MRCS > Thorax > Flashcards

Thorax Flashcards

1
Q

How is the mediastinum divided into 2 parts

A

By an imaginary line running between the sternal angle and T4
Divides the mediastinum into superior and inferior

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2
Q

Where does the superior mediastinum extend to

A

Upwards, terminating at the superior thoracic arpeture

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3
Q

Where does the inferior mediastinum extend to

A

Downwards, terminating at the diaphragm

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4
Q

What is the inferior mediastinum further divided into

A

Anterior, middle and posterior mediastinum

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5
Q

What are the borders of the superior mediastinum

A

Superior - thoracic inlet
Inferior - Continuous with the inferior mediastinum at the level of the sternal angle
Anterior - manubrium of the sternum
Posterior - vertebral bodies of T1-4
Lateral - pleural of the lungs

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6
Q

Which vessels are found within the superior mediastinum

A

Arch of aorta and the following branches:
-Brachiocephalic a
- Left common carotid a
- Left subclavian

SVC and the following tributaries
- Brachiocephalic veins
- Left superior intercostal vein
- Supreme intercostal vein
- Azygos vein

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7
Q

Which nerves are found within the superior mediastinum

A

Phrenic nerve
Vagus nerve
Cardiac nerves
Sympathetic trunk

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8
Q

Which organs and muscles are found in the superior mediastinum

A

Thymus
Trachea
Oesophagus
Thoracic duct
Muscles - sternohyoid and sternothyroid

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9
Q

What is the borders of the anterior mediastinum

A

Lateral - mediastinal pleura
Anterior - body of sternum and transversus thoracis muscles
Posterior - pericardium
Roof - continuous with superior mediastinum at the level of the sternal angle
Floor - diaphragm

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10
Q

In which part of the mediastinum is there no major structures

A

Anterior mediastinum

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11
Q

What are the borders of the middle mediastinum

A

Anterior - Anterior margin of the pericardium
Posterior - posterior margin of the pericardium
Laterally - Mediastinal pleura of the lungs
Superiorly - imaginary line between the angle of mandible and T4
Inferiorly - surface of diaphragm

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12
Q

What are the contents of the middle mediastinum

A

Heart and pericardium
Tracheal bifurcation into left and right bronchi
Ascending aorta
Pulmonary trunk
SVC
Cardiac plexus
Phrenic nerves
Tracheobronchial lymph nodes

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13
Q

What are the borders of the posterior mediastinum

A

Lateral - mediastinal pleura
Anterior - pericardium
Posterior - T5-T12 vertebrae
Roof - imaginary line between the angle of mandible and T4
Floor - diaphragm

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14
Q

What is contained within the posterior mediastinum

A

Thoracic aorta
Oesophagus
Thoracic duct
Azygous system of veins
Sympathetic trunks

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15
Q

What are the 3 major veins of the azygous system of veins

A

Azygos vein
Hemiazygos vein
Accessory hemiazygos vein

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16
Q

What does the thoracic duct originate from and where does it enter the thorax

A

Cisterna Chylii
Enters the thorax via the aortic hiatus (T12)

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17
Q

What arteries branch from the aorta in the posterior mediastinum

A

Posterior intercostal arteries
Bronchial arteries
Oesophageal arteries
Superior phrenic arteries

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18
Q

What can the aorta be divided into

A

Ascending aorta
Aortic arch
Descending aorta
Abdominal aorta

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19
Q

What are the branches of the ascending aorta

A

Left and right aortic sinuses which give rise to the right and left coronary arteries

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20
Q

At what level does the aortic arch end

A

T4

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21
Q

What connects the aortic arch to the pulmonary trunk

A

Ligamentum arteriosus

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22
Q

What are the branches of the aortic arch

A

Left common carotid
Left subclavian
Brachiocephalic trunk

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23
Q

At what point does coarctation of the aorta usually occur

A

At the insertion of the ligamentum arteriosus

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24
Q

From which vertebral levels does the descending aorta span

A

T4 - T12

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25
Q

What are the paired branches of the descending aorta

A

Bronchial arteries
Mediastinal arteries
Oesophageal arteries
Pericardial arteries
Superior phrenic arteries
Intercostal and subcostal arteries

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26
Q

What are the paired branches of the abdominal aorta

A

Inferior phrenic arteries
Middle suprarenal arteries
Renal arteries
Gonadal arteries
Lumbar arteries

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27
Q

What are the unpaired branches of the abdominal aorta

A

Coeliac axis
SMA
IMA
Medial sacral artery

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28
Q

What are the unpaired branches of the descending aorta

A

Bronchial arteries
Mediastinal arteries
Oesophageal arteries
Pericardial arteries

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29
Q

What does the abdominal aorta bifurcate to form

A

right and left common iliac

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30
Q

What does the SVC form from

A

The union of the left and right brachiocephalic trunks

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31
Q

Through which part of the mediastinum does the SVC pass

A

Superior mediastinum

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32
Q

At which level does the SVC receives the azygos vein

A

T4

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33
Q

Which pharyngeal pouch is the thymus developed from

A

Third

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34
Q

Where is the thymus located

A

In the superior mediastinum, immediately posterior to the manubrium of the sternum

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35
Q

What is the blood supply of the thymus

A

Anterior intercostal arteries and small branches of the internal thoracic arteries
Venous drainage - left brachiocephalic and internal thoracic veins

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36
Q

In which syndrome does thymic aplasia occur

A

DiGeorge Syndrome

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37
Q

The breast can be considered in 2 regions, what are these

A

Circular body
Axillary tail

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38
Q

What are the anatomical structures of the breast

A

Mammary glands
Connective tissue stroma
Pectoral fascia

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39
Q

What forms the suspensory ligaments of Cooper and what are their function

A

Fibrous stroma condenses down to form the suspensory ligaments of Cooper
Function - Attach and secure the breast to the dermis and underlying pectoral fascia.
Separate the secretory lobules of the breast.

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40
Q

What does the base of the breast lie on and what attaches here

A

Pectoral fascia
Suspensory ligiaments of Cooper attach here

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41
Q

What is the blood supply of the breast

A

60% - internal mammary artery (internal thoracic)
Lateral thoracic and thoracoarcromial
Lateral mammary branches
Mammary branch

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42
Q

What is the venous drainage of the breast

A

Axillary and internal thoracic veins

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43
Q

What is the lymph drainage of the breast

A

Axillary nodes - 75%
Parasternal nodes - 20%
Posterior intercostal nodes - 5%

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44
Q

What is the nervous innervation of the breast

A

Anterior and lateral cutaneous branches of the 4th-6th intercostal nerves

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45
Q

At what level does the pulmonary trunk split into the right and left pulmonary arteries

A

T5-T6

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46
Q

How does the anatomy of the right and left inferior pulmonary veins differ

A

Inferior left pulmonary vein - found at the hilum of the lung
Inferior right pulmonary vein - runs posteriorly to the SVC and the right atrium

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47
Q

At what level does the IVC enter the thorax

A

T8

48
Q

What are the 2 parts of the right atrium and what separates them

A

Sinus venarum
Atrium proper

Separated by the crista terminalis

49
Q

Which part of the right atrium has smooth walls and receives blood from the SVC and IVC

A

Sinus Venarum

50
Q

Which ventricle forms the majority of the anterior border of the heart

A

Right

51
Q

What divides the right ventricle into an inflow and outflow portion

A

Supraventricular crest

52
Q

What are trabeculae carnae

A

A series of irregular muscular elevations which are found in the ventricles of the heart

53
Q

What is the conus arteriosus

A

The outflow portion of the right ventricle - it is smooth

54
Q

What is the aortic vestibule

A

The outflow portion of the left ventricle

55
Q

Where does the coronary sinus open into

A

the right atrium between the inferior vena cava orifice and the right atrioventricular orifice.

56
Q

Where is the SAN found

A

The upper wall of the right atrium, at the junction where the superior vena cava enters

57
Q

What is the fibrous pericardium continuous with

A

The central tendon of the diaphragm

58
Q

What are the layers of the pericardium

A

Fibrous layer
Parietal layer of serous pericardium
Serous fluid
Visceral layer of serous pericardium

59
Q

Where is the transverse pericardial sinus found

A

Posterior to the ascending aorta and pulmonary trunk
Anterior to the SVC
Superior to the left atrium

60
Q

What is the innervation of the pericardium

A

Phrenic nerve

61
Q

What is the anterior surface of the heart

A

Right ventricle

62
Q

What is the posterior surface of the heart

A

Left atrium

63
Q

What is the inferior surface of the heart

A

Left and right ventricles

64
Q

What are the 3 main sulci of the heart

A

Coronary sulcus
Anterior interventricular sulcus
Posterior interventricular sulcus

65
Q

What is found in the coronary sulcus of the heart

A

The right coronary artery
Circumflex branch of the left coronary artery
Small cardiac vein
Coronary sinus

66
Q

What is found in the anterior interventricular sulcus of the heart

A

Anterior interventricular artery (also known as the left anterior descending artery)
Great cardiac vein

67
Q

What is found in the posterior interventricular sulcus of the heart

A

posterior interventricular artery
Middle cardiac vein.

68
Q

What are the branches of the left coronary arteries

A

Left anterior descending
Left marginal artery
Left circumflex artery

68
Q

What structures support the mitral and tricuspid valves

A

Chordae tendinae which are attached to the papillary muscles on the inferior surface of the ventricles

69
Q

What are the branches of the right coronary arteries

A

Right marginal artery
In 80-85% branches to give posterior interventricular artery

70
Q

Where does the coronary sinus drain into

A

Right atrium

71
Q

What are the tributaries of the coronary sinus

A

Great cardiac vein
Small cardiac vein
Middle cardiac vein
Posterior cardiac vein

72
Q

What structures are related to the right lung

A

Oesophagus
Heart
Inferior vena cava
Superior vena cava
Azygous vein

73
Q

What structures are related to the left lung

A

Heart
Arch of aorta
Thoracic aorta
Oesophagus

74
Q

What does the lung root contain

A

bronchus
pulmonary artery
two pulmonary veins
bronchial vessels
pulmonary plexus of nerves and lymphatic vessels

75
Q

How does the drainage of the right and left bronchial veins differ

A

Right bronchial vein - drains into the azygos vein
Left bronchial vein - drains into the hemiazygos vein

76
Q

What level does the horizontal fissure of the right lung run at

A

T4

77
Q

What epithelium lines the trachea and bronchi

A

Ciliated pseudostratified columnar epithelium, interspersed by goblet cells

78
Q

Which nerve provides sensory innervation of the trachea

A

Recurrent laryngeal nerve

79
Q

What is the arterial supply of the trachea

A

Inferior thyroid artery

80
Q

What is the left main bronchus related to

A

Aortic arch - passes inferiorly
Thoracic aorta - passes anteriorly
Oesophagus

81
Q

Which nerve innervates the bronchi

A

Vagus nerve

82
Q

Where are the 2 pleural recesses

A

Costodiaphragmatic – located between the costal pleurae and the diaphragmatic pleura

Costomediastinal – located between the costal pleurae and the mediastinal pleurae, behind the sternum.

83
Q

What are the 3 peripheral attachments of the diaphragm

A

Lumbar vertebrae and arcuate ligaments
Costal cartilages of ribs 7 -10
Ribs 11 - 12
Xiphoid process of sternum

84
Q

Where does the right crus of the diaphragm arise from

A

Arises from L1-L3 and their intervertebral discs

85
Q

Where does the left crus of the diaphragm arise from

A

Arises from L1-L2 and their intervertebral discs.

86
Q

What passes through the hiatus in the diaphragm at T8

A

IVC
Terminal branches of the right phrenic

87
Q

What passes through the hiatus of the diaphragm at T10

A

Oeosphagus
Right and left vagus nerve
Oesophageal branches of the left gastric artery/vein

88
Q

What passes through the hiatus of the diaphragm at T12

A

Aorta
Thoracic duct
Azygous vein

89
Q

Which muscle is the primary muscle of inspiration

A

Diaphragm

90
Q

What is the arterial supply of the diaphragm

A

Inferior phrenic artery

91
Q

Describe the attachment of the intercostal muscles

A

Originate at the lower border of the first rib inserts into the superior aspect of the rib below

92
Q

What is the innervation of the intercostal muscles

A

Intercostal nerves (T1-T11)

93
Q

The internal intercostal muscles are continuous with which muscle of the abdominal wall

A

Internal oblique muscle

94
Q

What are the 3 layers of muscles between the ribs

A

Intercostal muscles
Internal intercostal muscles
Innermost intercostals

95
Q

Where does transversus thoracis attach

A

From the posterior surface of the inferior sternum to the internal surface of costal cartilages 2-6.

96
Q

Which ribs are considered typical ribs

A

Ribs 3- 9

97
Q

Which ribs are considered atypical ribs

A

Ribs 1,2, 10, 11, 12

98
Q

What are the posterior articulations of the ribs

A

Costotransverse joint - between the tubercle of the rib and the transverse costal facet of the corresponding vertebrae
Costoverterbal joint - Between the head of the rib, superior costal facet of the corresponding vertebra, and the inferior costal facet of the vertebra above.

99
Q

What are the anterior articulations of the ribs

A

Ribs 1-7 attach to the sternum
Ribs 8-10 attach to costal cartilage
Ribs 11 -12 do not have an anterior attachment

100
Q

Which are the ‘free floating’ ribs

A

11 and 12

101
Q

What are the 3 parts of the sternum

A

Manubrium
Body
Xiphoid process

102
Q

The fossa at either side of the jugular notch of the manubrium articulate to form which joint

A

Sternoclavicular joint

103
Q

The sternal angle marks the level of what ribs

A

CC of 2nd rib

104
Q

The tip of the xiphoid process is found at which level

A

T10

105
Q

In which part of the spine are the spinous processes of the vertebrae long and slanting

A

Thoracic spine

106
Q

From superficial to deep what are the ligaments of the spine

A

Supraspinous ligament
Interspinal ligament
Ligamentum flavus
Posterior longitudinal ligament
Anterior longitudinal ligament

107
Q

The superficial muscles of the back are associated with movements of what

A

Shoulders

108
Q

The intermediate muscles of the back are associated with movements of what

A

Thoracic cage

109
Q

The deep muscles of the back are associated with movements of what

A

Movements of the vertebral column

110
Q

What are the superficial back muscles

A

Trapezius
Latissimus dorsi
Levator scapulae
Rhomaboid major and minor

111
Q

What are the intermediate back muscles

A

Serratus posterior superior
Serratus posterior inferior

112
Q

What is the function of serratus posterior superior and what innervates it

A

Elevates ribs 2-5
Intercostal nerves

113
Q

What is the function of serratus posterior inferior and what innervates it

A

Depresses ribs 9-12
Intercostal nerves

114
Q

What are the superficial deep back muscles

A

Splenius capitus
Splenius cervicis

115
Q

What are the intermediate deep back muscles

A

Erector spinae
Iliocostalis
Longissimus
Spinalis

116
Q

What are the 3 groups of the deep layer of the deep back muscles

A

semispinalis, multifidus and rotatores.

MRCS (17 decks)

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