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MRCS > Thorax > Flashcards

Thorax Flashcards

1
Q

Ribs articulation

A

I to VII articulate with sternum, VIII to X articulate with costal cartilage above them. XI and XII are floating ribs

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2
Q

Superior thoracic aperture borders

A

TI vertebrae posteriorly, rib I margin and manubrium anteriorly

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3
Q

Superior margin of manubrium level

Sternal angle level

A

same horizontal plane as intervertebral disc between TII and TIII.
intervertebral disc between TIV and TV.

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4
Q

Borders of axillary inlet

A

Superior margin of scapula posteriorly
Clavicle anteriorly
Lateral margin of rib I medially.
Apex of inlet is directed laterally and formed by medial margin of coracoid process.

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5
Q

Structures passing through diaphragm

A

IVC - central tendon of diaphragm at T8
Oesophagus - muscular part exiting left of midline at T10
Aorta - posterior to diaphragm at T12
Vagus nerve passes with oesophagus
Thoracic duct passes behind with aorta
azygos and hemiazygos veins also pass through aortic hiatus or through crura of diaphragm

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6
Q

Vertebrae level T4 and T5

A

Sternal angle
separate superior and inferior mediastinum
marks where arch of aorta begins and ends
passes through the site where SVC penentrates pericardium to enter the heart
Level where trachea bifurcates
Marks superior limit of pulmonary trunk

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7
Q

Left brachiocephalic vein

A

crosses midline immediately posterior to manubrium and delivers blood from left head and neck, left upper limb and part of left thoracic into SVC

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8
Q

hemiazygos veins

A

drain posterior and lateral left thoracic wall, and drains into azygos vein on the right side.

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9
Q

Breast anatomical location

A

From rib II to VI. Lies on deep fascia but has retromammary space (loose connective tissue) in between

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10
Q

Breast arterial supply

A

From axillary artery - superior thoracic, thoraco-acromial, lateral thoracic and subscapular
From internal thoracic arteries
From intercostal arteries - 2nd to 4th

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11
Q

Breast innervation

A

Anterior and lateral cutaneous branches of 2nd to 6th intercostal nerves, nipple supplied by 4th

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12
Q

Breast lymphatic drainage

A

75% axillary nodes
Most of the remaining into parasternal nodes deep to anterior thoracic wall and associated with internal thoracic artery
Some may occur via lateral branches of posterior intercostal arteries and connect with intercostal nodes

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13
Q

Drainage of axillary nodes

A

Into subclavian trunks

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14
Q

Drainage of parasternal nodes

A

Into bronchomediastinal trunks

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15
Q

Drainage of intercostal nodes

A

Either thoracic duct or into bronchomediastinal trunks

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16
Q

Mastectomy nerve damage

A

Risk of damage to long thoracic nerve (Serratus anterior) and thoracodorsal (latissimus dorsi)

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17
Q

Pectoralis major

A

Origin: medial half of clavicle and anterior surface of sternum, first 7 costal cartilages
Insertion: lateral lip of intertubular sulcus of humerus
Innervation: medial and lateral pectoral nerves
Function - adduction, flex and medially rotate arms

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18
Q

Pectoralis minor

A

Origin: anterior surface of 3 4 5 ribs
Insertion: coracoid process of scapula
Innervation: medial pectoral nerves
Function: depresses tip of shoulder, protracts scapula

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19
Q

Subclavius

A

Origin - rib I at junction between rib and costal cartilage
Insertion - interior surface of middle third of clavicle
Innervation - nerve to subclavius
Function - pulls clavicle medially to stabilise sternoclavicular joint, depresses tip of shoulder

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20
Q

Pectoral muscles

A

Pectoralis major, pectoralis minor and subclavius

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21
Q

Manubriosternal joint

A

Symphysis

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22
Q

Rib I and manubrium joint

A

Fibrocartilagious joint other articulation of ribs and sternum is synovial

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23
Q

Internal thoracic artery

A

paired artery, running on each side of the sternum, about 1cm from the sides of sternum.
branch of subclavian artery and descends posterior to costal cartilage of upper six ribs and lateral to sternum.
runs deep to external oblique, but superficial to vagus nerve.
Divides into musculophrenic artery and superior epigastric artery

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24
Q

Anterior intercostal artery

A

supply first six ribs, as branches of internal thoracic artery

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25
Q

Musculophrenic artery

A

Supplies the lower spaces of the ribs

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26
Q

Venous drainage of thorax

A

Anterior intercostal veins drain into azygos system or internal thoracic vein which drain into brachiocephalic vein.
Upper posterior intercostal veins form left/right superior intercostal veins. left side drain into left brachiocephalic vein, right side drain into azygos vein.

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27
Q

Supreme intercostal artery

A

upper two posterior intercostal arteries on each side, branch of costocervical trunk which is a branch of subclavian artery

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28
Q

Thoracic wall lymphatic drainage

A

Mainly to parasternal nodes, intercostal nodes and diaphragmatic nodes.
Superficial regions of thoracic wall drain mainly into axillary lymph nodes

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29
Q

Intercostal nerves carry

A

motor to muscles of thoracic wall
sensory from skin and parietal pleura
Postganglionic sympathetic fibers to the periphery
lower ones also supply muscles, skin and peritoneum of abdominal wall

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30
Q

Arterial supply to diaphragm

A

From above, pericardiophrenic and musculophrenic which are branches of internal thoracic artery.
Superior phrenic arteries from lower parts of thoracic aorta
largest arteries supplying diaphragm arise from below it - inferior phrenic artery which is branch of abdominal aorta.

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31
Q

Each lung hilum contains

A

1 pulmonary artery (superior)
2 pulmonary veins (inferior)
bronchi (posterior)
nerves, bronchial vessels and lymphatics

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32
Q

medial surface of right lung

A

SVC, IVC, azygos vein, heart and oesophagus

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33
Q

medial surface of left lung

A

thoracic aorta, aortic arch, heart and oesophagus

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34
Q

Trachea level

A

from C6 to T4/5

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35
Q

Right pulmonary artery position (longer than left)

A

Anterior to trachea and right main bronchus

Posterior to ascending aorta, SVC and upper right pulmonary vein

36
Q

Left pulmonary artery position (shorter than right)

A

Anterior to left main bronchus and descending aorta

Posterior to superior pulmonary vein

37
Q

transverse pericardial sinus

A

separates arteries and veins

38
Q

oblique pericardial sinus

A

hand placed under apex of heart and moved superiorly slips into oblique sinus

39
Q

source of somatic sensation (pain) from parietal pericardium is carried by somatic afferent fibres in the phrenic nerves - that’s why there is referred pain

A

nil

40
Q

nerves supplying pericardium

A

vagus nerves, sympathetic trunks and phrenic nerves

41
Q

venous drainage of diaphragm

A

brachiocephalic veins in neck
Azygos system of veins
abdominal veins (left suprarenal and IVC)

42
Q

coronary sulcus circles the heart and separates atria and ventricles. What are its contents?

A

Right coronary artery, circumflex branch of LCA, small cardiac vein and coronary sinus

43
Q

anterior interventricular sulcus contents

A

anterior interventricular branch of LCA, great cardiac vein

44
Q

posterior interventricular sulcus contents

A

posterior interventricular artery branch of RCA< middle cardiac vein

45
Q

Branches of RCA

A

Atrial branch - sinu atrial node
Marginal branch - along inferior surface of heart
Posterior interventricular branch

46
Q

RCA supplies

A

Right atrium, right ventricle, SAN, AVN, interatrial septum and portion of left atrium, posteroinferior one third of interventricular septum and portion of posterior part of left atrium

47
Q

LCA branches

A

anterior interventricular branch (LADA)

circumflex branch

48
Q

LCA supplies

A

most of the left atrium and left ventricle, and most of the interventricular septum.

49
Q

Cardiac plexus - superficial part

A

Between aortic arch and pulmonary trunk

50
Q

Cardiac plexus - deep part

A

between aortic arch and tracheal bifurcation

51
Q

Right pulmonary artery passes

A

posteriorly to ascending aorta and SVC

52
Q

Left pulmonary artery passes

A

inferiorly to aortic arch, anterior to descending aorta

53
Q

contents of superior mediastinum

A 
thymus
right and left brachiocephalic veins
left superior intercostal vein
SVC
aortic arch with its three large branches
trachea
oesophagus
phrenic nerves
vagus nerves
left recurrent laryngeal branch of vagus nerves
thoracic duct
54
Q

thymus

A

most anterior component of superior mediastinum
upper extent can reach into neck as high as thyroid gland, lower portion typically extends into anterior mediastinum over pericardial sac
arteries - typically small branches from internal thoracic arteries.
venous - left brachiocephalic veins and possibly into internal thoracic veins
developed from third pharyngeal pouch.

55
Q

right brachiocephalic vein

A

begins posterior to medial end of right clavicle.
tributaries - vertebral, first posterior intercostal vein, internal thoracic veins. inferior thyroid and thymic veins may drain into it too

56
Q

left brachiocephalic vein

A

begins posterior to medial end of left clavicle. joins with RBV to form SVC posterior to lower edge of right first costal cartilage close to right sternal border.
Crosses midline posterior to manubrium in adults, but in infants and children rises above superior border of manubrium hence is less protected.

57
Q

SVC

A

starts at posterior to lower edge of right first costal cartilage and terminates at lower edge of right third costal cartilage
Lower half within pericardial sac hence contained in middle mediastinum
SVC receives azygos vein immediately before entering pericardial sac

58
Q

arch of aorta

A

only part in superior mediastinum (descending aorta and ascending aorta are not)
all 3 branches of arch of aorta are posterior to LBV

59
Q

brachiocephalic trunk

A

branches out of arch of aorta behind manubrium,
splits into right common carotid artery and right subclavian artery near right sternoclavicular joint
occasionally has thyroid ima artery which contributes to thyroid gland

60
Q

left common carotid artery

A

ascends through superior mediastinum to left of trachea

61
Q

ligamentum arteriosum

A

is also in superior mediastinum. was ductus arteriosus allowing blood to bypass lungs during development

62
Q

aorta has 3 fixed point of attachment more likely to tear in deceleration injury

A

at aortic valve
ligamentum arteriosum
and where it passes behind median arcuate ligament of diaphragm to enter abdomen

63
Q

right vagus nerve

A

lies between RBV and brachiocephalic trunk
descends in posterior direction toward trachea, crosses lateral surface of trachea and passes posteriorly to the root of the right lung to reach oesophagus. Just before oesophagus, crossed by arch of azygos vein.

64
Q

left vagus nerve

A

posterior to LBV and between left common carotid and left subclavian.
Lies deep to mediastinal part of parietal pleura and crosses to left side of aortic arch. Continues to descend posteriorly and passes posterior to root of left lung to reach oesophagus.

65
Q

Left recurrent laryngeal nerve

A

Arises from left vagus nerve at inferior margin of aortic arch just lateral to ligamentum arteriosum. passes inferior to aortic arch before rising on its medial surface. between trachea and oesophagus to terminate in larynx

66
Q

Phrenic nerve innervates

A

Somatic afferent fibers to mediastinal pleura, fibrous pericardium and parietal layer of serous pericardium

67
Q

right phrenic nerve

A

enters superior mediastinum lateral to right vagus nerve and lateral and slightly posterior to beginning of RBV. Continues inferiorly along right side of RBV and right side of SVC.
Descends along right side of pericardial sac, within fibrous pericardium, anterior to root of right lung. Leaves thorax by passing through diaphragm with IVC.

68
Q

Left phrenic nerve

A

lateral to left vagus nerve and lateral and slightly posterior to beginning of left brachiocephalic vein, continues to descend lateral surface of aortic arch, passing superficially to left vagus nerve and left superior intercostal vein.
Follows left side of pericardial sac, within fibrous pericardium anterior to root of left lung, leaves thorax by piercing diaphragm near apex of heart.

69
Q

right recurrent laryngeal nerve

A

hooks around right subclavian artery as it passes over cervical pleura.

70
Q

Structures in posterior mediastinum

A 
oesophagus and associated nerve plexus
thoracic aorta and its branches
azygos system of veins
thoracic duct and associated lymph nodes
sympathetic trunks
thoracic splanchnic nerves
71
Q

oesophagus

A

starts at C6 (inferior border of cricoid cartilage, ends at T11.
initially right of thoracic aorta then crosses anteriorly to the left of it.
Secured superiorly by attachment to pharynx and inferiorly by attchment to diaphragm
thoracic duct is right side inferiorly, but crosses to left more superiorly.

72
Q

oesophagus compressed at 4 points

A

Junction of oesophagus with pharynx in neck
where it is crossed by aortic arch
where it is compressed by left main bronchus
at the oesophageal hiatus in diaphragm

73
Q

oesophagus arterial supply

A

Arise from thoracic aorta, bronchial arteries and ascending branches of left gastric artery in abdomen

74
Q

oesophagus innervation

A

arise from vagus nerves and sympathetic trunks.
Striated muscle in upper portion - branchial arches
Smooth muscle fibers - parasympathetic system, visceral efferents from vagus nerves. Preganglionic fibres synapse in myenteric and submucosal plexus of enteric nervous system in oesophageal wall.
visceral afferents of vagus - normal physiological process and reflex activity. No pain
visceral afferents of sympathetic trunks and splanchnic nerves - detection of oesophageal pain

75
Q

oesophageal rupture

A

typically happens in lower third of oesopahgus due to sudden rise in intraluminal oesophageal pressure secondary due to uncoordination and failure of cricopharyngeus muscle to relax.
Tears typically occur on left hence often associated with large left pleural effusion.

76
Q

branches of thoracic aorta

A

pericardial branches
bronchial branches
eosophageal branches - anastomotic connection include branches of inferior thyroid superiorly and branches of left inferior phrenic and left gastric arteries inferiorly
mediastinal branches
posterior intercostal - nine pairs usually lower 9 spaces (first 2 spaces by supreme intercostal artery usually a branch of costocervical trunk)
superior phrenic arteries - supply diaphragm anastomose with musculophrenic and pericardiophrenic artery
subcostal artery

77
Q

azygos vein

A

starts opposite vertebra LI or LII at junction between right ascending lumbar vein and right subcostal vein.
azygos goes through aortic hiatus of diaphragm, or right crus of diaphragm. Ascends through posterior mediastinum usually to right of thoracic duct.
At T4, arches anteriorly over root of right lung to join SVC before SVC enters pericardial sac.

78
Q

hemiazygos vein

A

starts at junction between left ascending lumbar vein and left subcostal vein. Usually enters thorax through left crus of diaphragm but may be through aortic hiatus. Ascends to approx T9, then crosses vertebral column posterior to thoracic aorta, oesophagus and thoracic duct to enter azygos vein.

79
Q

Accessory hemiazygos vein

A

Descends from superior portion of posterior mediastinum to approx T8, then crosses vertebral column to join azygos.

80
Q

Thoracic duct

A

Begins as a confluence of lymph trunks in abdo (cisterna chyli), which drains abdo viscera and walls, pelvis, perineum and lower limbs.
Extends from vertebra LII to root of the neck.
Enters thorax posterior to aorta through aortic hiatus, ascends to right of midline between thoracic aorta (on left) and azygos vein (on right). Lies posterior to oesophagus.
Moves across to the left at T5.
Joined by left jugular trunk and left subclavian trunk empties into junction of the left subclavian and left internal jugular veins.

81
Q

Sympathetic trunk in thorax

A

T1-T5 supply thoracic viscera
T5-9 greater splanchnic nerves - ends in coeliac ganglion
T10-11 lesser splanchnic nerves - ends in aorticorenal ganglion
T12 least splanchnic nerves -end in renal plexus

82
Q

Ribs articulation with thoracic vertebrae

A

Thoracic vertebrae has demifacet - superior to head of its own rib, inferior demifacet to head of lower rib
Facet at end of transverse process - tubercle of own rib

83
Q

External intercostal muscles

A

Superior attachment - inferior margin of rib above
Inferior attachment - superior margin or rib below
Innervated by intercostal nerves T1 -T11
Active during inspiration, moves ribs superiorly

84
Q

Internal intercostal muscles

A

Superior attachment - Lateral edge of costal groove of rib above
Inferior attachment - Superior margin of rib below
Innervated by intercostal nerves T1 -T11
Most active during expiration, moves ribs inferiorly

85
Q

Innermost intercostal muscles

A

Superior attachment - medial edge of costal groove of rib above
Inferior attachment - internal aspect of superior margin of rib below
Innervated by intercostal nerves T1 -T11
Acts with internal intercostal muscles

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