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GSSE anatomy > Thorax > Flashcards

Thorax Flashcards

1
Q

Broadly, what do the posterior rami of the spine supply

A

Extensor muscles of vertebral canal
Varying degrees, the skin

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2
Q

Which muscles do posterior rami supply

A

Erector spinae
Tramsversospinalis group deep to thoracolumbar fascia
Levator costae
Splenius (and all muscles deep)

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3
Q

What are the branches of the posterior rami (broadly)

A

Medial and lateral

In upper body, lateral = muscle, medial to skin

Lower body, lateral = skin, medial to muscle

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4
Q

Which spinal segment has NO cutaneous branch

A

C1

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5
Q

Which spinal segments reach the skin

A

All thoracic and all sacral

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6
Q

Which posterior rami supply limbs

A

NONE !!

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7
Q

Broadly, what does the anterior rami supply

A

All other muscles of trunk & limbs, skin at sides & front of neck & body

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8
Q

What are the rami of brachial plexus

A

Anterior rami of C5-8, T1

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9
Q

What rami supply muscles of anterior abdo wall

A

T7-12

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10
Q

What is the lowest spinal nerve to supply anterior abdominal wall

A

L1, via iliohypogastric & ilioinguinal nerve

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11
Q

What are the branches of the intercostal nerves

A

Lateral - side
Anterior terminal - front of body wall

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12
Q

What is the fascia of scarpa

A

Superficial fascia that slides freely over the underlying thoracic wall, rectus sheath & ext oblique aponeurosis

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13
Q

What does the scarpas fascia continue as, and where does it attach

A

Continues over penis & scrotum as colles fascia, below thighs attached to fascia lata

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14
Q

Where is campers fascia and where does it end

A

OVER external oblique muscle
Fades out over upper thoracic wall and along midaxillary line

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15
Q

Blood supply of the body wall

A

Flanks - intercostal, subcostal & lumbar As

Ventral - internal throacic & superior/internal intercostal arteries

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16
Q

Venous drainage of abdominal wall

A

Above umbi - latearl thoracic vein, ito axillary
Below umbi - greater saphenous vein

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17
Q

Nerve supply of the body wall

A

Anterior & latearl branches of ventral rami & smaller degree posterior rami

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18
Q

What makes up the skeleton of thoracic wall

A

12 TV
12 pairs of ribs
CC
Sternum

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19
Q

Which ribs are free

A

11, 12

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20
Q

What types of joints are in the thoracic skeleton

A

Costovertebral joint
Costochondrial joint
Sternocostal joint
Interchondral joint

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21
Q

Costovertebral joint features

A

Head of rib has 2 articular facets that connects to demifacets of vertebral body
- inferior facet of rib against superior costal facet of its own vertebra
- superior facet of rib against inferior costal facet of vertebra above

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22
Q

Costotransverse joint

A

Articular facet of rib with tip of transverse process of its own vertebra

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23
Q

What reinforces the costotransverse joint

A

Lateral cT lig
CT lig
Superior CT lig

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24
Q

Costochondral joint features and joint type

A

Rib with CC - primary cartilaginous joint

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25
Q

What type of joints are the interchondral joints

A

Joined by small synovial joint

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26
Q

Sternocostal joint - what type of joint is between the 1st cc and manubrium

A

Primary cartilaginous

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27
Q

Thoracic muscles & neurovascular plane

A

External intercostal m
Internal intercostal m
Neurovascular plane
Inner layer - subcostal, innermost intercostal, transversus thoracis

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28
Q

Outer layer of thoracic muscles

A

External intercostal continues anteriorly as
Anterior intercostal membrane

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29
Q

Posterior muscles , outer layer of thorax

A

Serratus posterior superior and serratus posterior inferior

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30
Q

Serratus posterior superior origin, insertion, features

A

Origin: spinous process of C6,7; T1,2
Insert: lateral angle rib 2-5

Glistening appearance, with deep dorsal scapular N * vessels run down on post surface b/w it and rhomboids

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31
Q

Serratus posterior inferior origin & insert

A

Spinous process of T11-12; L1-2
Insert into 4 lowest ribs

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32
Q

Middle layer of thorax

A

Internal intercostals, replaced posteriorly by posterior intercostals membrane

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33
Q

Inner layer muscle of thorax

A

Innermost intercostals
Subcostals
Transversus thoracis

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34
Q

Where is neurovascular plane in thorax

A

B/w innermost IC and internal IC

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35
Q

What is the order of the vessels in the ICS

A

Vein, artery, nerve

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36
Q

Branches of the intercostal nerves

A

Collateral branches
Lateral cutaneous branch
Anterior cutaneous branch

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37
Q

Collateral branch of intercostal nerve supplies

A

Supplies muscle of the space, parietal pleura, rib perisoteum

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38
Q

Lateral cutaneous branch of IC nerve supplies

A

Pierces IC muscle to supply body wall along mid-axillary line through its anterior & posterior branches

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39
Q

Anterior cutaneous branch of IC nerve suplies

A

Passes anterior to internal thoracic A and pierces the IC muscle to reach teh skin

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40
Q

What does the lateral cutaneous branch of 2nd intercostal nerve cross to become

A

Crosses axilla as the intercostobrachial nerve

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41
Q

What is the subcostal nerve and where does it pass to supply…

A

T12, passes behind the lateral arcuate lig of diaphram into the abdomen below subcostal A+V

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42
Q

Superior (supreme) intercostals artery arise from

A

Costocervical trunk

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43
Q

Where do the superior IC artery travel to enter the thorax

A

Pass across the front of the neck of the 1st rib

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44
Q

Where does the superior IC artery supply

A

Upper 2 spaces

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45
Q

Posterior intercostal arteries supply…

A

Remaining 9 IC spaces

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46
Q

Anterior intercostal arteries arise from

A

Internal thoracic (1-6) and musculophrenic A (7-9)

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47
Q

How many intercostal veins are there

A

1 posterior
2 anterior intercostal veins

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48
Q

Where do the anterior IC veins drain into

A

Musculophrenic & internal thoracic veins

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49
Q

Posterior intercostal veins drain into…

A

Lower 8, into the azygos system (right = azygos, hemiazygos & accessory on L)

2,3,and sometimes 4ths into superior intercostal (r => azygos, L => brachiocephalic)

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50
Q

Internal thoracic A arises from

A

1st part of subclavian A

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51
Q

Termination of internal thoracic artery

A

Forms superior epigastric and musculophrenic A

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52
Q

Branch of internal thoracic a

A

2 anterior IC arteries at each ICS
Pericardiophrenic branch

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53
Q

Where does the pericardiophrenic branch run and what does it supply

A

Runs with phrenic N and supplies branches to the nerve, the pleura, the fibrous & parietal pericardium!

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54
Q

Attachments of suprapleural membrane

A

Inner border of 1st rib to transverse process of C7

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55
Q

Diaphragm features

A

Central tendon (note inseparable from fibrous pericardium)
Right and L crus

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56
Q

What FORMS the median arcuate ligament

A

Where each crus unite in front of each other at T12

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57
Q

What forms the medial arcuate ligament

A

Thickening of psoas fascia

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58
Q

What forms the lateral arcuate ligament

A

Thickening of the anterior layer of the lumbar fascia on the front of quadratus lumborum

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59
Q

Where is vena cava opening & contents

A

T8
IVC
R phrenic N

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60
Q

Where is oesphageal opening & contents

A

T10
In fibres of L crus
Vagal trunks, oesophageal branches of L gastric
veins
Lymphatics

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61
Q

Where is aortic opening and contents

A

T12
Aorta, agygos vein & thoracic duct

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62
Q

How does hemiazygos pass through diaphragm

A

L crus

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63
Q

How do the splanchnic nerves greater, lesser and least enter the diaphragm

A

Pierce each crus

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64
Q

How does sympathetic trunk enter diaphragm

A

Medial arcuate lig

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65
Q

How does subcostal N+vessels pass through diaphragm

A

Behind lateral arcuate lig

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66
Q

How does the L phrenic N pass through diaphragm

A

Pierce L dome

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67
Q

Blood supply of diaphragm

A

5 intercostal & subcostal A
R+L inferior phrenic A
Pericardiophrenic & musculophrenic branches

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68
Q

Nerve supply of diaphragm

A

C3,4,5 (phrenic)

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69
Q

Which main muscles are active in inspiration

A

Diaphragm
External intercostal

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70
Q

Which main muscle is most active in expiration

A

Diaphragm
Internal intercostal

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71
Q

Parts of inferior mediastinum

A

Ant
Middle
Post

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72
Q

Sternal angle level

A

T4

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73
Q

What space is the anterior mediastinum continuous with

A

The superior with the pretracheal space

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74
Q

Post mediastinum is continuous with

A

Superior through the retropharyngeal & paratracheal space of neck up to base of skull

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75
Q

Where does an infection behind the prevertebral fascia track

A

From neck into superior mediastinum
Ceases at T4

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76
Q

What are things that happen at the sternal angle (in the chest)

A

CLAPTRAP
Cardiac plexus - superifical * deep
Ligamentum arteriosum
Aortic arch
Pulmonary trunk/pericardium
Tracheal bifurcation
Thoracic duct reaches L side of oesphagus
Recurrent laryngael N L
Azygos enters SVC
Phrenic N
Spinal cord

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77
Q

Boundaries of superior mediastinum

A

Manubrium, first 4 thoracic verebra

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78
Q

Thoracic inlet contents

A

oesophagus against T1
Trachea
Arch f aorta
Ligamentum arteriosum
Brachiocephalic V
SVC
Cardiac pleus
Phrenic & vagus N

79
Q

Branches of aortic arch

A

Brachiocephalic
LCCA
L subclavian

80
Q

What nerves cross the arch of aorta

A

L side by phrenic & vagus nerve

81
Q

Course of phrenic nerve in the mediastinum

A

Arch over arch of aorta
Pass infront of lung root

82
Q

Course of vagus nerve in the mediastinum

A

Arch over arch of aorta
Behind lung root

83
Q

What is the relationship b/w L superior IC vein and the phrenic/vagus n

A

Passes deep to phrenic
Superficial to vagus

84
Q

What is the ligamentum arteriosum remnant

A

Ductus arteriosus

85
Q

What forms brachiocephalic V

A

IJV and subclavian V

86
Q

Where does the thoracic duct drain

A

Into L brachiocephalic V

87
Q

SVC commences at

A

1st R CC

88
Q

What forms the SVC

A

2 brachiocephalic V

89
Q

What are the nervous elements of cardiac plexus

A

SNS
PSNS
Afferent fibres
Small ganglia

90
Q

What are the 2 parts of the cardiac plexus

A

Superficial part = in front of ligamentum arteriosum

Deep part = to the R of the ligamentum
In front of trachea and behind aortic arch

91
Q

Where does the trachea commence and how long is it

A

C6, bifurcates at T5
10cm long

92
Q

What is the relationship b/w trachea and vagi

A

On the R, lies against it, separated from the R lung by pleura & arch of azygos

On the L, the LCCA and L subclavian prevent the pleural and the L vagus nerve from coming into contact

93
Q

Blood supply of trachea

A

Inferior thyroid
Bronchial A

94
Q

Nerve supply for trachea

A

Vagi
Recurrent laryngeal N

95
Q

Course of phrenic nerve in the neck

A

From C4 —> passes down over ant scalene muscle —> cross infront of subclavian A —> dome of pleura —> behind subclavian V
Cross ant to the vagus
Runs through mediastinum anterior to lung root

96
Q

What vessels lie MEDIAL to the R phrenic N

A

R brachiocephalic
SVC
Pericardium

97
Q

What vessels lie MEDIAL to the L phrenic N

A

L CCA
L SUbclavian

98
Q

How does R phrenic nerve enter diaphragm

A

Passes through diaphragm with IVC

99
Q

How does L phrenic N enter the diaphragm

A

Pierces diaphragm to the L of pericardium

100
Q

What is the supply of phrenic N

A

Motor to diaphragm
Sensory to diaphragm, mediastinual pleura, fibrous pericardial, parietal layer of serous pericardium, central tendon, peritoneum

101
Q

Relation of R vagus to azygos V

A

R vagus runs medial to arch of azygos

102
Q

Relation of vagus to superior intercostal vein

A

Crosses arch medial to the L superior IC Vein

103
Q

What plexuses do the recurrent laryngeal nerves give branches to

A

Deep cardiac plexus
Whole trachea
Adjacent oesophagus
Larynx

104
Q

Which side of the lung is in contact with the trachea

A

The R side of the lung (Apex)
The L is separated by L CCA and L subclavian

105
Q

Contents of anterior mediastinum

A

Thymus
Sternopericardial lig
Few LNs
Branches of internal thoracic vessels

106
Q

Blood supply to the thymus

A

Inferior thyroid
Internal thoracic A
(Corresponding veins)

107
Q

Broadly the contents of middle mediastinum

A

Pericardium
Heart
Adjoining greater vessels
Lung roots
Phrenic N
Deep cardiac plexus

108
Q

What is the fibrous pericardium

A

Single outer layer that encloses heart & great vessels, fuses with adventitia

109
Q

What is the serous pericardium

A

Lines the inside of the fibrous pericardium

Has 2 layers - parietal and visceral

110
Q

What is between the 2 serous pericardiums

A

SINUSES
Transverse
Oblique

111
Q

Nerve supply of pericardium

A

Fibrous - phrenic
Parietal serous - phrenic
Visceral - insensitive

112
Q

Blood supply of the pericardium

A

Internal thoracic A
Pericardiophrenic & musculophrenic branches
Bronchial A
Thoracic A

113
Q

Venous drainage of pericardium

A

Azygos system

114
Q

What is the R border of the heart

A

RA

115
Q

Inferior border of the heart

A

mostly RV, some LV

116
Q

Apex of heart

A

LV

117
Q

Left border of the heart

A

LV with auricle of LA forming uppermost surface

118
Q

Sternocostal surface of the heart

A

Mainly RV, bit of RA + LA

119
Q

Diaphragmatic surface of the herat

A

1/3 RV

2/3 LV

120
Q

Posterior surface of the heart

A

Entirely of LA

121
Q

Where is the crista terminalis and what does it do

A

In the RA, vertical ridge of muscle

Separates pectinate muscle from smooth muscle inside the wall of RA

122
Q

What are the features of RV

A

Moderator band of septomarginal trabeculae
Post/ant/septal papillary muscles
Conus arteriosus => PULMONARY TRUNK

123
Q

What are the cusps of tricuspid valve

A

Anterior
Posterior
Septal

124
Q

Cusps of pulmonary trunk

A

Anterior, right , left

125
Q

Cusps of mitral valve

A

Anterior
Posterior

126
Q

Aortic valve cusps

A

Posterior
Left
Right

127
Q

Conducting system of heart

A

SA node
AV node
Bundle of His
R+L limbs of bundle
Purkinje fibres

128
Q

Where is SA node

A

Junction of crista terminalis & SVC

129
Q

Where is AV node

A

Within triangle of koch
Base of RA

130
Q

Where does Right coronary Artery rise

A

Anterior aortic sinus

131
Q

Where does the L coronary A arise

A

L posterior aortic sinus

132
Q

Course of RCA

A

Runs down AV groove
Turns backwards at inferior border of the heart
Run posterior

133
Q

Branches of RCA

A

Conus artery
SA nodal
R marginal A
Posterior interventricular branch (to AV node)

134
Q

LCA branches

A

Circumflex
LAD (Conus branch, marginal branch)
L marginal

135
Q

Coronary sinus tributaries

A

Great cardiac vein
Middle
Small
Oblique
Posterior

136
Q

Where does coronary sinus open

A

RA - b/w IVC and AV valve

137
Q

Posterior mediastinum boundaries

A

T5-12
Pericardium and sloping border of diaphragm

138
Q

Contents of the posterior mediastinum

A

Oesphagus
Thoracic aorta
Azygos
Hemiazygos
Accessory hemiazygos
Thoracic duct
LNS

139
Q

Where does descending aorta start

A

T4

140
Q

Branches of thoracic desc aorta

A

9 pairs of posterior IC arteries
Subcostal A
Bronchial A
Oesophageal vessels
Small pericardial & phrenic branches

141
Q

Where does oesophagus start

A

C6, lower border of cricoid cartilage

142
Q

Where does oesophagus enter the abdomen

A

Through diaphragm T10
R crus sweeps around oesophageal opening

143
Q

How long is the oesphagus

A

25cm

144
Q

Narrowest parts of oesophagus

A

Inferior constrictor (cricopharyngeal)
Crossed by arch
L principal arch
Diaphragm

145
Q

Parts of the oesphagus

A

Upper
Middle
Lower

146
Q

Blood & nerve supply of upper oesphagus

A

Inferior thyroid A
Brachiocephalic V
Recurrent laryngeal N

147
Q

Blood & nerve supply of middle oesophagus

A

Oesophageal branches from aorta, bronchial A
Azygos system
Thoracic symp trunk, greater splanchnic nerves, vagus

148
Q

Blood & nerve supply of lower oesophagus

A

L gastric A
Oesophageal tributaries => Portal V
Thoracic symp trunk, greater splanchnic
Vagus

149
Q

Where does the anterior oesophageal trunk arise from

A

L vagus

150
Q

Where does thoracic duct commence

A

Upper end of cisterna chyli at T12

151
Q

Where does the thoracic duct travel

A

B/w aorta & azygos V

152
Q

Where does the thoracic duct in proximity to oesophagus

A

To the RIGHT, at T5 it moves to the L behind oesophagus

153
Q

What part of the body does the thoracic duct NOT drain

A

R upper limb & R half of thorax

154
Q

What does the azygos vein drains

A

Collects blood from the thoracic wall & upper lumbar region

The posterior intercostals
Lumbar veins drain into the azygos

155
Q

What forms the azygos V

A

Ascending lumbar V
Subcostal V on R side

156
Q

Where does the azygos V end

A

In SVC at T4

157
Q

Where do the hemiazgos veins join the azygos

A

at T7/8

158
Q

Where are the hemiazygos V

A

On L side of bodies of thoracic vertebra

159
Q

What forms the hemiazygos veins

A

Union of L ascending lumbar & subcostal V

160
Q

What does the accessory hemiazygos receive

A

Bronchial V from L lung

161
Q

What does the thoracic sympathetic trunk consist of

A

12 ganglia, lying anterior to heads of ribs

162
Q

What does each thoracic ganglia

A

Each ganglion receives a preganglionic white ramus from anterior ramus of corresponding spinal N

163
Q

Where do the splanchnic (least, lesser, greater) arise from

A

Lower 8 ganglion
Greater = 5-9th ganglion
Lesser = 10-11th ganglion
Least = 12th ganglion

164
Q

What types of cell lines pleura

A

Mesothelium - single layer of flat cells

165
Q

What are the pleura types & attachments

A

Parietal = lines ribs, vertebra, diaphragm; attached to inferior surface of suprapleural membrane at thoracic inlet & mediastinul surface of fibrous pericardium

Visceral - adherent to lung

166
Q

What is the pulmonary lig

A

Cuff of lung root too big, hangs down and allows expansion of vessels

167
Q

Arterial supply of pleura

A

Intercostal A
Internal thoracic A
Musculophrenic A

168
Q

Venous drainage of pleura

A

Azygos system

169
Q

Nerve supply of pleura

A

Intercostals = costovertebral pleura, periphery of diaphragm

Phrenic = diaphragm domes, mediastinal pleura

170
Q

Hilum of lung features

A

Main bronchus
1x pulmonary A
2x pulmonary Veins

171
Q

Lobes of L lung

A

Upper
Lower

172
Q

Lobes of R lung

A

Upper
Middle
Lower

173
Q

What is the role of oblique fissure

A

B/w upper and lower lobes
In both lungs

174
Q

Horizontal fissure

A

R lung only, from middle to upper lobe

175
Q

What is the most superior vessel in the hilum

A

Pulmonary Artery

176
Q

What is the most posterior vessel in the hilum

A

Bronchus

177
Q

Where does the hilum lie

A

3rd-4th CC
T5-7

178
Q

What are the break up of the bronchi from bronchus to resp bronchioles

A

Bronchus
Lobar bronchi
Segmental bronchi
Bronchioles
Lobular bronchioles
Terminal bronchioles
Respiratory bronchioles

179
Q

Arterial supply to the lungs

A

Bronchial Arteries from the aorta

180
Q

Venous drainage of the lungs

A

Superficial - azygos/accessory hemiazygous

Deep - main pulmonary vein or into LA

181
Q

Lymph drainage of the lungs

A

Along lung surface with the pulmonary vessels to bronchopulmonary or hilar LN

182
Q

Nerve supply to lungs

A

Autonomic from cardiac plexus
SNS
Forms a pulmonary plexus
Anterior and posterior to the hilum

183
Q

Components of sternum

A

Manubrium
Body
Xiphoid process

184
Q

What muscles are attached to manubrium

A

SCM
Sternohyoid
Sternothyroid

185
Q

What CC articular with manubrium

A

1st CC
2nd CC

186
Q

What CCs attach to sternal body

A

3-7 CC

187
Q

What muscles attach to body of sternum

A

Anterior and intercostal membranes
Pec major
Transversus thoracis

188
Q

Typical rib features

A

Head
Neck
Tubercle
Shaft

189
Q

What are features of head of rib

A

2 articular facets
Lower facet - own vertebra
Upper facet - upper vertebra
Synovial

190
Q

Features of tubercle of rib

A

2 facets
Smooth medial - TP of own vertebra
Rough lateral - lateral costotransverse lig

191
Q

Which ribs are atypical

A

1st, 11th, 12th

192
Q

First rib features

A

Strongest
Broadest
Flattest
Most curved
Single facet on head for T1
Groove for subclavian A
Attachment for middle scalene and anterior scalene

193
Q

11th rib features

A

Head, single facet for T11
Short neck
No tubercle
Slight angle

194
Q

12th rib features

A

Head, single facet for t12
No tubercle
No angle
No costal groove

GSSE anatomy (8 decks)

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