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Anatomy > Thorax > Flashcards

Thorax Flashcards

1
Q

Ostium primum

A

Failure of fusion of septum primum with endocardial cushions

= osmium primum defect lying immediately above AV boundary
–> may be associated with additional VSD

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2
Q

Ostium secundum

A

Septum primum successfully fuses with endocardial cushions
BUT septum primum fails to sufficiently cover primum

When septum primum and secundum fuse the defect remains

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3
Q

Ventricular septal defect

A

Most common defect

Large defects occurring in membranous part of septum just below aortic valves require surgical repair

Small defects in muscular septum may close spontaneously

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4
Q

Patent ductus arteriosus

A

Irregular transmission of blood between the aorta and the pulmonary artery

Requires surgical correction as it increased load on left ventricle and lead to pulmonary HTN

During surgery, left recurrent laryngeal nerve at risk

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5
Q

Fallots tetralogy

A

Ventricular septal defect

Pulmonary stenosis

Overiding aorta

Right ventricular hypertrophy

Causes Right - to - Left shunt = CYANOTIC

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6
Q

Developmental parts of the diaphragm

A

Septum transversum –> central fibrous tendon

Foregut mesentery –> crura and median part

Ingrowth from body wall

Pleuroperitoneal membrane

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7
Q

Failure of pleuroperineal part of development of diaphragm

A

= Bochdalek hernia

more common left vs right

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8
Q

Structures crossing the neck of the first rib

A

Medial –> Lateral

Sympathetic trunk

Superior intercostal artery

T1 of brachial plexus

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9
Q

Intercostal muscle layers

A

External intercostal: down and forwards

Internal intercostals: down and backwards

Neurovascular bundle lies here

Innermost intercostals: overlap more than one space

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10
Q

Levels of trachea

A

C6 –> T5

11cm

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11
Q

Lining of trachea

A

Columnar ciliated epithelium

Cartilaginous rings, open posteriorly U-shaped

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12
Q

Trachealis

A

Muscle connecting open ends of U-shaped tracheal cartilage

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13
Q

Azygous vein

A

RIGHT SIDED

arches over right main bronchus

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14
Q

Right bronchus

A

Shorter, 2.5cm

Wider

More vertical

Azygous vein arches over right main bronchus to enter SVC

Pulmonary artery below then anterior to it

Branches to upper bronchus before entering lung

Divides into middle and lower bronchus within lung

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15
Q

Left bronchus

A

Longer, 5cm

Branches into upper and lower once in lung

Pulmonary artery lies anterior and then above

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16
Q

Lingula of the lung

A

Left lung equivalent of the middle lobe

-lies between cardiac notch and oblique fissure

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17
Q

Bare areas of pleura

A

Medial end of 4th and 5th intercostal spaces

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18
Q

Lower borders of the lung

A

6th rib in the midclavicular line

8th rib in the midaxillary line

10th rib at the lateral border of erector spinae

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19
Q

Location of oblique fissure

A

T5 - 6th intercostal

~4cm from midline

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20
Q

Location of horizontal fissure

A

Right lung

-passes horizontally and medially from the oblique fissure at the level of the 4th costal cartilage

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21
Q

Pericardiocentesis without entering pleura

A

A needle passing through the left 4th and 5th
intercostal spaces immediately lateral to the sternal
edge will enter the pericardium without traversing
the pleura

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22
Q

Medial arcuate ligament

A

Condensation of fascia of psoas major

Join anteriorly over aorta

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23
Q

T10 diaphragmatic opening

A

Oesophagus

Vagus nerves

Branches of left gastric artery and vein

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24
Q

Sympathetic chain enters through diaphragm…

A

Passes behind median arcuate ligament on substance of psoas major

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25
Q

Greater and lesser splanchnic nerves enters through diaphragm…

A

Greater and lesser splanchnic nerves pierce the

crura

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26
Q

Accessory muscles of inspiration

A

Sternocleidomastoid

Scalenes

Pectoralis major
Pectoralis minor

Serratus anterior

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27
Q

Three surfaces of the heart

A

Antrior:

  • Rigth atrium
  • Right ventricle
  • Narrow strip of left ventricle
  • Auricle of left atrium

Posterior / base:

  • Left ventricle
  • Left atrium with 4 pulmonary veins entering it

Inferior / diaphragmatic :

  • Rigth atrium with IVC entering it
  • Lower part of right + left ventricles
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28
Q

Three borders of the heart

A

Right border
-Right atrium with IVC and SVC

Inferior border

  • Right ventricle
  • Apex of left ventricle

Left border

  • Left ventricle
  • Auricle of left atrium
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29
Q

Blood entering right atrium

A

Recieves blood from:

  • SVC
  • IVC
  • Coronary sinus
  • Anterior cardiac vein
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30
Q

Crista terminalis

A

RIGTH ATRIUM:
Runs between cavae-muscular ridge

Separating:
-Smooth-walled posterior part of atrium derived from sinus venosus
WITH
-Rougher area with pectinate muscles derived from atrium

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31
Q

Fossa ovalis

A

Site of fetal foramen ovale

Oval depression in intra-atrial septum

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32
Q

Leaflets of the tricuspid valve

A

Septal

Anterior

Posterior

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33
Q

Chordae tendinae

A

Present in right ventricle

Attach leaflets of tricuspid valves to papillary muscles within right ventricle

Prevent eversion of the tricuspid valve during ventricular contraction

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34
Q

Moderator band

A

RIGHT VENTRICLE
Muscle bundle crossing from the interventricular septum to the anterior wall of the hear

  • Prevents over-distension of ventricles
  • Conducts right branch of AV bunclde to anterior ventricular wall
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35
Q

Auricle of the left atrium

A

Extends forwards and to right and wraps overlapping pulmonary trunk

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36
Q

Left atrium

A

In the left atrium, the pectinate muscles, fewer and smaller than in the right atrium, are confined to the inner surface of its atrial appendage

Smaller than the right.

Consists of principal cavity and auricle

Four pulmonary veins open into the cavity (two from
each lung: superior and inferior)

Shallow depression on septal surface corresponds
to fossa ovalis of right atrium

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37
Q

Left ventricle

A

Three times thicker vs right

Chordae tendineae run from the ventricular surfaces
of cusps to papillary muscles

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38
Q

Cusps of mitral valve

A

Two cusps

Anterior - larger

Posterior

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39
Q

Aortic sinuses

A

Right coronary artery = anterior sinus

Left coronary artery = left posterior sinus

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40
Q

Location of sinoatrial node

A

Situated right atrial wall at upper end of crista terminalis

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41
Q

Location of AV node

A

Inter-atrial septum immediately above opening of coronary sinus

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42
Q

Right coronary artery

A

Arises from anterior aortic sinus

Passes to the right of pulmonary trunk between it and teh auricle of left atrium

Runs along atrioventricular groove around inferior border of the heart
–> anastomoses with left coronary artery at posterior interventricular groove

Branches

  • Marginal branch, along lower border
  • Posterior interventricular // posterior descending
  • -> runs forward in interventricular groove to anastomose with branch of left coronary artery
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43
Q

Branches of right coronary artery

A

Branches

-Marginal branch, along lower border

  • Posterior interventricular // posterior descending
  • -> runs forward in interventricular groove to anastomose with branch of left coronary artery
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44
Q

Left coronary artery

A

Arises from left posterior sinus

Passes to left of pulmonary trunk to AV groove

Lies under cover of the left auricle where it divides into two equally sized branches.
-Anterior interventricular branch // left anterior descedning
–> runs down to apex in anterior interventricular groove supplying wall of ventricle
–> anastomoses with posterior interventricular branch
-Circumflex: continues round the left side of
the heart in the AV groove to anastomose with
the terminal branches of the right coronary
artery.

Larger vs RCA

45
Q

Branches of left coronary atery

A

Lies under cover of the left auricle where it divides into two equally sized branches.

  • Anterior interventricular branch // left anterior descedning
  • -> runs down to apex in anterior interventricular groove supplying wall of ventricle
  • -> anastomoses with posterior interventricular branch

-Circumflex: continues round the left side of
the heart in the AV groove to anastomose with
the terminal branches of the right coronary
artery.

46
Q

‘Left dominance’

A

Left coronary and circumflex arteries may be larger
and longer than usual and give off the posterior
intraventricular artery before anastomosing with the
right coronary artery, which is smaller than usual

Rigth dominance is normal, 90%

47
Q

‘Left dominance’

A

Left coronary and circumflex arteries may be larger
and longer than usual and give off the posterior
intraventricular artery before anastomosing with the
right coronary artery, which is smaller than usual
-10%

Rigth dominance is normal

48
Q

Co-dominance

A

Right and left have equal contributions to posteiror interventricular artery

-10%

49
Q

Three branch left main stem vairant

A

Left main stem may divide into three vs two branches

-3rd lies between the anterior interventricular and
circumflex arteries and may be large
-supplying the lateral wall of the left ventricle

50
Q

Blood supply to SA node

A

60% population: right coronary artery

40%: circumflex artery of LCA

3% - dual supply

51
Q

Blood supply to AV node

A

90%: supplied by right coronary artery

10%: circumflex artery of LCA supply

52
Q

Coronary sinus

A

Main venous drainage

Lies in posterior atrioventricular groove

Drains into rigth atrium just to left of IVC

Tributaries of coronary sinus:
-great cardiac vein: ascends in anterior interventricular
groove next to anterior interventricular artery
-middle cardiac vein: drains posterior and inferior
surfaces of heart and lies next to the posterior interventricular artery
-small cardiac vein: accompanies marginal artery
and drains into termination of coronary sinus.

53
Q

Venous drainage of the heart

A

Coronary sinus: main drainage

Venae cordis minimae: tiny veins draining directly into chambers of heart

Anterior cardiac veins: small veins that open up directlty into rigth atrium

54
Q

Tributaries of the coronary sinus

A

Great cardiac vein: ascends in anterior interventricular groove next to anterior interventricular artery

Middle cardiac vein: drains posterior and inferior surfaces of heart, lies next to posterior interventricular artery

Small cardiac vein: accompanies marginal artery
and drains into termination of coronary sinus

55
Q

Pericardium fusion sites

A

Apex: fuses with adventita of great vessels

Base: fuses with central tendon of diaphragm,

56
Q

Level of pericaridum

A

T5 - T8

3rd to 6th costal cartilages

57
Q

Transverse sinus of heart

A

Lies between the aorta and pulmonary trunk in front,

and the SVC and left atrium behind.

58
Q

Oblique sinus of heart

A

Bounded by the pulmonary veins

Forms a recess between pericardium and left atrium

59
Q

Surface anatomy of the heart

A

Superior:
line from second left costal cartilage
to third right costal cartilage

Inferior:
line from the sixth right costal cartilage
to fifth left intercostal space, 9 cm from midline

60
Q

Border between superior and inferior mediastinum

A

Angle of Louis

T4/T5

61
Q

Anatomical points at the Angle of Loius

A

Start and end of arotic arch

Bifurcation of trachea / end of trachea

Junction of superior and inferior mediastinum

Second intercostal joint / cartilage

Confluence of azygous vein and SVC (over rigth main bronchus)

Throacic duct passes from right to left

Ligamentum arteriosum

62
Q

Level of superiormargin of manubrium

A

T 2 / T3

63
Q

Level of joint between costal margin and sternum

A

T9 / T 10

Posterior margin of inferior thoracic aperture (T 12) is inferior to anterior magrin (joint of costal cartilage with sternum)

64
Q

Superior margin of diaphragmatic proction

A

5th rib

65
Q

Superior mediastinum level

A

T1 –> Angle of Louis T4/T5

66
Q

Inferior mediastinum level

A

From T4/T5 to diaphragm

Split into

  • Anterior
  • Middle / pericardium
  • Posterior
67
Q

Dermatone over xiphoid process

A

T6

68
Q

Dermatome over umbilicus

A

T10

69
Q

Lactiferous ducts

A

Mammary glands consist of a series of ducts and secretory lobules

These ocnverge onto 15 - 20 lactiferous ducts that open indenendently on the nipple

70
Q

Ligaments of Cooper

A

=suspensory ligaments

Exten from dermis of skin to pectoral fascia

Fluid accumulation within breast tissue and tensioning of ligaments –> peau d’orange = malignancy

71
Q

Retromammary space

A

Layer of loose conective tissue that seperates breast from deep pectoral fascia

72
Q

Base of attachment of breast

A

Ribs II - VII
2- 7

Sternum –>
Extend to mid-axillary line

73
Q

Innervation of breast

A

2nd to 6th intercostal nerves

74
Q

Innervation of nipple

A

4th intercostal nerve

75
Q

Drainage of axillary nodes

A

75% lymphatic drainage from breast

Axillary nodes drain into subclavian trunks

76
Q

Innervation of pectoralis major

A

Innervated by medial and lateral pectoral nerves

O:

  • medial half of clavicle
  • anterior surface of sternum
  • costal cartilages 1 - 7
  • aponeurosis of external oblique

I: lateral lap of intertubercular sulcus of humerus

F: adduction, medial rotation and flexion of the humerus

77
Q

Innervation of pectoralis minor

A

Innervated by medial pectoral nerve

O: anterior surface of 3rd, 4th and 5th ribs
+ deep fascia overlying intercostal spaces

I: coracoid process of scapula

F: depresses tip of shoulder and protracts scapula

78
Q

Innervation of subclavius

A

Innervated by nerve to subclavius

O: 1st rib at junction between rib and costal cartilage

I: groove on inferior middle third of clavicle

F: pulls clavicle medially to stabilise sternoclavicular joint

79
Q

Three rib articulations with vertebral bodies

A

Two demofacets: corrospond with facets on head of rib
Inferior costal facet of vertebrae = part of head of rib below

Supeior costal facet of vertebrae = part of head of own rib
=costotransverse joint

Transverse costal facet at end of transverse process: articulates with tubercle of own rib

80
Q

Variants in rib articulation

A

1st rib

  • head articulated with superior and inferior facet on T1
    i. e. does not articulate with vertebral body above C7

T 10 lacks inferior demifacets: only articulates with its own rib

T 11 often lacks infeiro demifacet

T 11 and T 12 lack transverse costal facets and inferior demifacets: both wholy articulate with their own rib just at the head

81
Q

True ribs

A

1 - 7

82
Q

False ribs

A

8 -12

11 - 12 = floating

83
Q

Facets on head of rib

A

Separated by crest

Superior = smaller, articulates with inferior costal facet of vertebrae ABOVE

Inferior = larger, articulates with superior costal facet of OWN vertebra

84
Q

Distinct features of 1st rib

A

Only articulates with T1
-one vertebral articulation

Scalene tubercle

Anterior groove
-sibclavian vein

Posterior groove
-subclavian artery

85
Q

Facets of the body of the sternum

A

Upper demifacet - lower portion of rib 2

4 full facets for ribs 3 - 6

Lower demifacet - upper portion of rib 7

86
Q

Attachment of crest of head of rib

A

Intra-articular ligament

Connects crest of head to intervertebral disc

Splits the joint into two synovial capsules: superior and inferior

87
Q

Ligaments of rib articulation to vertebral body

A

Three

Costotransverse ligaments

  • medial to costotransverse joint
  • neck of rib to transverse process

Lateral costotransverse ligaments

  • lateral to costotransverse joint
  • transverse process to tubercle of rib

Superior costotransverse ligaments
superior surface of neck –> transverse process of vertebra above

88
Q

1st sternocostal joint

A

Fibrocartilagenous

ALL OTHERS ARE SYNOVIAL

89
Q

Internal thoracic arteries

A

Major branch of subclavian arteries

Passes anteriorly over dome of pleura and descends through superior thoracic apertue

1cm lateral to sternum

Anterior intercostal arteries branch off during descent

Two terminal branches

  • Superior epigastric artery
  • Musculophrenic artery
90
Q

Anterior intercostal arteries

A

Lateral branches of internal thoracic artery

Supply upper six intercostal spaces

91
Q

Musculophrenic artery

A

Terminal branch of internal throacic artery

Supplies lower six intercostal spaces

92
Q

Intercostal node drainage

A

Upper six: bronchomediastinal

Lower six: thoracic duct

93
Q

Intercostal nerves

A

Anteriro rami T1 - T11

94
Q

Subcostal nerve

A

= anterior rami of T12

95
Q

Branches of intercostal nerves

A

Lateral cutaneous branch

  • Largest
  • Pierces thoracic wall and divides into anterior and posterior branch
  • Innervates overlying skin

Anterior cutaneous branch

  • Emerge parasternally
  • Supply skin over sternum
96
Q

Intercostobrachial nerve

A

=Lateral cutaneous branch of second intercostal nerve

Contributes to somatic innervation of medial surface of upper arm

97
Q

Level of xiphoid

A

T8 - T9

98
Q

Main blood supply to diaphragm

A

Inferior phrenic arteries

99
Q

Contents of each lung root

A

A pulmonary artery

Two pulmonary veins

A main bronchus

Bronchial vessels

Nerves
Lymphatics

100
Q

Vagus nerve passes …. to root of lung

A

Both vagus nerves pass POSTERIORLY to roots of lung

101
Q

Phrenic nerve passes … to root off lung

A

Both phrenic nerves pass ANTERIORLY to roots of lung

102
Q

Right main brinchus branhces…

A

In root of lung prior to entering lung

103
Q

Surface marking of RIGHT oblique fissure

A

Spinous process T4

  • ->crosses 5th interspace laterally
  • -> follows contour of rib 6 anteriorly
104
Q

Surface marking of LEFT oblique fissure

A

More oblique vs right

Curved line between spinous process T3/4

  • -> 5th interspace laterally
  • ->follows contour of rib 6
105
Q

Bifurcation of pulmonary trunk

A

Angle of Louis

T4/T5

LEFT of midline
LEFT of bifurcation of trachea

106
Q

Right pulmonary artery

A

Longer vs left

Passes anterior to right main bronchus
Passes posteriorly to ascending aorta, SVC and upper right pulmonary vein

In root of lung gives off superior branch to superior lobe

Continues into hilum, giving off another branch the recurrent branch of superior lobe

Then divides into middle and inferior lobes

107
Q

Pulmonary veins

A

On each side:

  • Superior pulmonary vein
  • Inferior pulmonary vein

Carries blood back to left atrium

108
Q

Bronchial arteries

A

1 right
-right bronchial artery from 3rd posterior intercostal artery

2 left

  • left brocnhial arteries branch directly from anterior surface of throacic aorta
  • -> superior left bronchial artery = T5
  • -> inferior left bronchial artery = inferior to left bronchus
109
Q

Bronchial veins

A

Drain into either pulmonary veins or left atrium
–> creates a shunt
OR superior intercostal vein / hemizygous vein

RIGHT
into azygous vein

Anatomy (22 decks)

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