Thorax

Question 1

What is the pulmonary ligament?

Answer 1

A cuff of pleura projected around the lung root that hangs as an empty fold

Question 2

What is the function of the pulmonary ligament?

Answer 2

Provides dead space for descent of the lung root in inspiration, esp the pulmonary vein

Question 3

What is the pleura made of?

Answer 3

A single layer of mesothelium

Question 4

Nerve supply of the pleura?

Answer 4

Parietal- somatic nerves, mostly intercostal. Over the diaphragm and mediastinum- phrenic nerve. Visceral is only supplied by autonomic

Question 5

Which nerves pierce the crura?

Answer 5

The splanchnic nerves

Question 6

What does the right phrenic nerve pass through when exiting the thorax?

Answer 6

The central tendon of the diaphragm

Question 7

Where do the sympathetic trunks enter the abdomen?

Answer 7

Behind the medial arcuate ligaments

Question 8

Where does the vagus pass through the diaphragm?

Answer 8

The oesophageal opening at T10

Question 9

What is the sensory function of the phrenic nerve?

Answer 9

Innervated the central part of the diaphragm, the pericardium and the mediastinal part of the parietal pleura

Question 10

Where does the phrenic nerve arise?

Answer 10

At the lateral border of the anterior scalene muscle. It then passes over the anterior scalene

Question 11

Is the phrenic nerve deep to the prevertebral layer of cervical fascia?

Answer 11

Yes

Question 12

Where does the phrenic nerve run in relation to the subclavian vein?

Answer 12

Posterior

Question 13

Where does the right phrenic nerve pass in relation to the subclavian artery?

Answer 13

Anteriorly over the lateral part

Question 14

Where do the right and left phrenic nerves enter the thorax?

Answer 14

Via the superior thoracic aperture

Question 15

What is the course of the right phrenic nerve in the thorax?

Answer 15

It descends anteriorly along the right lung root and courses along the pericardium of the right atrium of the heart

Question 16

Where does the right phrenic nerve leave the thorax?

Answer 16

It pierces the diaphragm at the inferior vena cava opening and innervated the inferior surface of the diaphragm

Question 17

What is the course of the left phrenic nerve in the thorax?

Answer 17

Descends anterior to the left lung root
Crosses the aortic arch and bypasses the vagus nerve
Courses along the pericardium of the left ventricle

Question 18

Where does the left phrenic nerve leave the diaphragm?

Answer 18

Pierces and innervated the inferior surface of the diaphragm

Question 19

What is the blood supply to the breast?

Answer 19

Mostly from lateral thoracic with additional from internal mammary

Question 20

Where does the lymph of the lateral breast drain to?

Answer 20

Axillary and infraclavicular lymph nodes

Question 21

Where is the breast located on the chest wall?

Answer 21

2nd to 6th ribs

Question 22

Where does the lymph of the medial breast drain to?

Answer 22

Internal thoracic (parasternal) nodes

Question 23

What is the surface markings of the heart valves?

Answer 23

They all lie behind the sternum in a nearly vertical line in the order PAMT
Tricuspid midline lower sternum, mitral above and a little to the left.
Aortic and pulmonary are behind the left border of the sternum at the third costal cartilage

Question 24

Where do you auscultate the pulmonary valve?

Answer 24

2nd intercostal space, left sternal border

Question 25

Where do you auscultate the aortic valve?

Answer 25

right sternal margin, second intercostal space

Question 26

Where do you auscultate the tricuspid valve?

Answer 26

left sternal border 4th intercostal space

Question 27

Where do you auscultate the mitral valve?

Answer 27

5th intercostal space, midclavicular line

Question 28

What is the azygous vein formed by?

Answer 28

The union of right lumbar and subcostal veins

Question 29

Where do the pulmonary veins lie in relation to the main bronchus in the right lung root?

Answer 29

Anterior and inferior

Question 30

Does the right upper lobe bronchus leave the main bronchus outside the lung?

Answer 30

Yes

Question 31

What are the features of tetralogy of Fallot?

Answer 31

pulmonary stenosis with an overriding aorta, ventricular septal defect, and consequent right ventricular hypertrophy.

Question 32

What are the cusps of the pulmonary artery?

Answer 32

The pulmonary valve has left, right, and anterior cusps

Question 33

What are the cusps of the aortic valve?

Answer 33

The aortic valve has left, right, and posterior cusps

Question 34

Which is higher the aortic or pulmonary valve?

Answer 34

The pulmonary

Question 35

The vagal trunks accompany which structure on their passage through the diaphragm?

Answer 35

The oesophagus

Question 36

What is the posterior surface of the heart mainly made up of?

Answer 36

The left atrium

Question 37

What is the diaphragmatic surface of the heart made up of?

Answer 37

right atrium, the atrioventricular groove, one-third of right ventricle and two-thirds of left ventricle, and the posterior interventricular artery

Question 38

What is the anterior surface of the heart made up of?

Answer 38

The anterior surface is made up of right atrium, right ventricle, atrioventricular groove and a fine portion of the left ventricle

Question 39

What type of epithelium lines the trachea and bronchi?

Answer 39

Ciliated columnar epithelium

Question 40

How many anterior and posterior veins are there per interspace?

Answer 40

2 anterior and 1 posterior vein per interspace

Question 41

Where do the anterior intercostal veins drain into?

Answer 41

musculophrenic and internal thoracic veins. The 2nd and 3rd — and sometimes fourth— spaces drain into the superior intercostal vein

Question 42

Where does the first anterior intercostal vein drain?

Answer 42

The 1st interspace is drained by the supreme intercostal vein which drains into the vertebral or brachiocephalic veins

Question 43

What is the order of neurovascular structures in the interspace?

Answer 43

VAN- vein artery nerve

Question 44

Which muscles attach to the first rib?

Answer 44

Scalenus anterior, scalenus medius and subclavius, intercostals

Question 45

What are the position of structures relative to the right vagus in the mediastinum?

Answer 45

The trachea—medial The right lung root—anterior The right subclavian artery—posterior

Question 46

At what level does the thoracic duct commence?

Answer 46

T12

Question 47

Where does the thoracic duct enter the thorax?

Answer 47

With the aorta at T12

Question 48

Where does the thoracic duct lie in relation to the oesophagus in the mediastinum?

Answer 48

travels from right to left behind the oesophagus, around vertebral level T5 in the posterior mediastinum

Question 49

What does the thoracic duct drain into?

Answer 49

confluence of left subclavian and internal jugular veins in the neck

Question 50

Which part of the serous pericardium receives no innervation?

Answer 50

The visceral; the parietal is innervated by the phrenic nerve

Question 51

Which part of the pericardium fuses with the central tendon of the diaphragm?

Answer 51

The fibrous pericardium

Question 52

What is the surface marking of the right border of the heart?

Answer 52

lower aspect of the right third costal cartilage to the lower aspect of the right sixth costal cartilage

Question 53

What is the surface marking of the inferior border of the heart?

Answer 53

he inferior border extends from the right sixth costal cartilage to the apex, which is usually in the left fifth intercostal space

Question 54

What is the surface marking of the left border of the heart?

Answer 54

From the apex, the left border extends upwards to the lower border of the left second costal cartilage approximately 2 cm from the margin of the sternum.

Question 55

What is the blood supply of the SA node?

Answer 55

60% of people from right coronary, 40% from circumflex (branch of left coronary)

Question 56

Where is the SA node located?

Answer 56

wall of the right atrium, just below the superior vena cava

Question 57

Where is the AV node located?

Answer 57

in the interatrial septum above and left of the coronary sinus orifice

Question 58

Where does the phrenic nerve lie in the mediastinum?

Answer 58

As far laterally as possible

Question 59

What are the medial relations of the right phrenic nerve?

Answer 59

Venous structures: the brachiocephalic and azygos veins, right atrium, and the superior and inferior vena cava

Question 60

What are the medial relations of the left phrenic nerve?

Answer 60

left superior intercostal vein and left ventricle as its medial relations

Question 61

Which fissure separates the upper and middle lobes in the right lung?

Answer 61

The horizontal fissure

Question 62

Which fissure separates the middle and lower lobes in the right lung?

Answer 62

The oblique fissure

Question 63

What is the fissure called that separates the left lung into upper and lower lobes?

Answer 63

The oblique fissure

Question 64

Where is the rough portion of the right atrium?

Answer 64

To the left of the crista terminalis- this is the atrium proper

Question 65

Where is the smooth portion of the right atrium?

Answer 65

To the right of the crista terminalis- called the sinus venosum

Question 66

Does the phrenic nerve have more motor or sensory fibres?

Answer 66

Motor

Question 67

Which part of the subclavian artery does the internal thoracic branch from?

Answer 67

The first part

Question 68

Where does the lymph of the middle area of the oesophagus drain to?

Answer 68

The visceral preaortic nodes

Question 69

What do the tracheobronchial lymph nodes drain?

Answer 69

the heart and lungs

Question 70

What lies anterior to the trachea in the thorax?

Answer 70

Anterior to the thoracic trachea lie the great vessels arising from the aortic arch.

Question 71

Where do the posterior intercostal veins drain?

Answer 71

Into the azygous/ hemiazygous system

Question 72

Is there intervening pericardium between the aorta and pulmonary trunk?

Answer 72

No

Question 73

Do the pulmonary veins and IVC share a common sleeve of serous pericardium?

Answer 73

Yes

Question 74

Where is the transverse sinus in relation to the aorta and pulmonary trunk?

Answer 74

Posterior

Question 75

Which vertebrae is the right crus attached to?

Answer 75

L1-3 and intervertebral discs

Question 76

Which vertebrae is the left crus attached to?

Answer 76

L1-2 and the intervertebral discs

Question 77

Which plexus does the thoracic sympathetic trunk send fibres to?

Answer 77

The cardiac plexus

Question 78

What forms the greater splanchnic nerve?

Answer 78

The thoracic sympathetic trunk from 5th-9th ganglia

Question 79

What forms the lesser splanchnic nerve?

Answer 79

The thoracic sympathetic trunk from 10th and 11th ganglia

Question 80

How many bronchial arteries are there usually?

Answer 80

3

Question 81

Where do the bronchial arteries come from?

Answer 81

Two bronchial arteries are located on the left and are direct branches from the aorta. One bronchial artery is located on the right and is a branch from the third right posterior intercostal artery

Question 82

Branches of sublcavian artery? (VIT C and D)

Answer 82

Vertebral, internal thoracic, thyrocervical Costocervical trunk Dorsal scapula

Question 83

Branches of sublcavian artery? (VIT C and D)

Answer 83

Vertebral, internal thoracic, thyrocervical Costocervical trunk Dorsal scapula