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Anatomy > Thorax > Flashcards

Thorax Flashcards

1
Q

Which structures pierce the diaphragm and at what level do they pierce it?

A

IVC at T8
Oesophagus at T10
Aorta at T12

“I 8 10 EGGS AT 12”

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2
Q

Which dome of the diaphragm is higher and why?

A

The right dome because the liver is directly underneath.

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3
Q

In which direction do the external intercostal muscles run?

A

Antero-inferior. They are the “hands in the pockets” muscles.

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4
Q

In which direction do the internal intercostal muscles run?

A

Postero-inferior.

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5
Q

What is the action of the external intercostal muscles?

A

They elevate the ribs.

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6
Q

What is the action of the internal intercostal muscles?

A

They depress the ribs.

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7
Q

What runs through the intercostal space, and in what order?

A

VAN: intercostal vein, artery & nerve.

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8
Q

In the thorax, the intercostal nerve is another name for which part of the spinal nerve?

A

The ventral ramus.

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9
Q

Which artery do the intercostal arteries anastomose with?

A

Internal thoracic artery.

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10
Q

Where does the lymph of the breast drain to?

A

75% drains toward the axilla, ending up in the thoracic/right lymphatic duct. Some runs through parasternal nodes and up the bronchomediastinal trunk; some follows lymphatic channels in the abdomen.

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11
Q

At which landmark does the trachea bifurcate?

A

Plane of Louis.

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12
Q

Name the differences between the left & right main bronchi.

A

The right main bronchus is shorter, wider and more vertical.

You can see evidence of the left main bronchus at the hilum of the lung, but the right main bronchus divides into the next level of branching before it gets to the substance of the lung.

The right bronchus has three lobar bronchi; the left bronchus has two.

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13
Q

What is the function of the pulmonary artery?

A

The pulmonary artery takes DEOXYGENATED blood away (A for artery for away) from the right side of the heart toward the lungs.

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14
Q

What is the function of the pulmonary veins?

A

The pulmonary veins bring OXYGENATED blood from the lungs to the heart.

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15
Q

How are the vessels organised in the hilum of the lung?

A

Veins: anterior & inferior
Arteries: posterior & superior

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16
Q

Which spinal segments does the sympathetic innervation of the lungs originate from?

A

T1-T4

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17
Q

Where is lung pain often referred to?

A

Upper chest.

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18
Q

Where does the phrenic nerve run in relation to the lung?

A

Anterior to the root of the lung.

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19
Q

Which spinal segments contribute to the innervation of the diaphragm?

A

C3, C4, C5 keeps the diaphragm alive.

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20
Q

What parts of the thorax does the phrenic nerve supply?

A

Motor: all of diaphragm
Sensory: central part of diaphragm & pericardium

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21
Q

Where is pain from the central diaphragm referred?

A

Neck & upper limb (C3, C4, C5)

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22
Q

Where is pain from the peripheral diaphragm referred?

A

Thoracic wall.

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23
Q

Describe the “pump handle” and “bucket handle” movements of the ribs.

A

Pump handle: movement of the 2nd-5th ribs increases the anterior-posterior dimension of the ribcage.

Bucket handle: movement of the 7th-10th ribs increases the transverse diameter of the ribcage.

24
Q

Describe the layers of the pericardium and the heart.

A

Fibrous pericardium (thick, aponeurotic tissue)
Parietal layer of serous pericardium
Pericardial cavity
Visceral layer of serous pericardium/epicardium
Myocardium
Endocardium

25
Q

Which nerve(s) innervate the pericardium?

A

The phrenic nerves.

26
Q

Where is pain from the pericardium referred to?

A

Neck & upper limb (C3, C4, C5)

27
Q

What is the clinical significance of the pericardial sinuses?

A

Blood flow through the ascending aorta and the pulmonary trunk can be stopped by clamping the transverse sinuses, allowing you to operate on the heart.

28
Q

Behind which structures does the transverse sinus of the heart run?

A

The pulmonary trunk & the aortic arch.

29
Q

What kind of blood does the right chamber of the heart receive?

A

Deoxygenated blood.

30
Q

What kind of blood does the left chamber of the heart receive?

A

Oxygenated blood.

31
Q

Describe the function of the fossa ovalis.

A

Before a baby is born, their lungs are not aerated, so there is no functional pulmonary circulation happening. The foetus receives oxygen exchange through maternal circulation via the placenta. Blood is shunted straight from the right atrium to the left atrium through the fossa ovalis. Upon birth, it closes off.

32
Q

How many papillary muscles does the right ventricle have?

A

3

33
Q

How many papillary muscles does the left ventricle have?

A

2

34
Q

Describe the function of the chordae tendinae & papillary muscles when blood is pushed through the right atrium & ventricle.

A

When the right atrium contracts, pressure in the atrium > pressure in the ventricle, and blood is shunted through the tricuspid valve. When the right atrium stops contracting, the pressure gradient disappears and the tricuspid valve closes. The chordae tendinae & papillary muscles are NOT involved.

When the right ventricle contracts, pressure in the ventricle > pressure in the pulmonary trunk. The pulmonary valve is pushed open and blood is shunted through. At this point, pressure in the ventricle > pressure in the atrium, so there is potential for the blood to go backwards. When the ventricle contracts, the papillary muscles & chordae tendinae also contract to anchor the tricuspid valve closed.

35
Q

What is the function of the ductus arteriosus?

A

The ductus arteriosus is a small tube connecting the pulmonary trunk to the arch of the aorta, allowing any blood that does not go through the fossa ovalis and makes its way up into the pulmonary trunk to be returned to circulation. It closes over upon birth.

36
Q

Which nerve is responsible for parasympathetic innervation of the heart?

A

Vagus.

37
Q

Where is pain from the heart often referred to?

A

Upper chest/shoulder.

38
Q

Describe the path of an electrical signal in the heart.

A

The signal begins at the SA node, which causes the atrial muscles to contract. It then travels to the AV node and through the Bundle of His to reach the Purkinje fibres, which cause the ventricles to contract.

39
Q

What happens if there is damage to the SA node?

A

While the SA node drives most of the atrial contraction, the AV node can still pace intrinsically in its absence.

40
Q

What happens if there is damage to the AV node?

A

Damage to the AV node results in heart block, because SA activity can no longer reach the ventricles.

41
Q

Describe how a pulse generator is inserted into the heart.

A

The pulse generator is passed into the subclavian vein, through the brachiocephalic vein and down the SVC into the right side of the heart.

42
Q

What is the name of the border that separates the superior & inferior mediastinum?

A

Plane of Louis.

43
Q

Which structure separates the anterior & posterior mediastinum?

A

The heart.

44
Q

Name the contents of the superior mediastinum.

A

“PVT Left BATTLE”

Phrenic nerve
Vagus nerve
Thoracic duct

LEFT recurrent laryngeal nerve

Brachiocephalic veins
Aortic arch (and its 3 branches)
Thymus
Trachea
Lymph nodes
(O)esophagus
45
Q

Name the contents of the anterior mediastinum.

A

Remnants of thymus & lymph nodes.

46
Q

Name the contents of the middle mediastinum.

A 
Phrenic nerve
Heart
Pericardium
Ascending aorta
Pulmonary trunk
SVC
47
Q

Name the contents of the posterior mediastinum.

A

“DATES”

Descending aorta
Azygos & hemiazygos vein
Thoracic duct
(O)esophagus
Sympathetic trunk/ganglia
48
Q

Where is pain from the oesophagus referred to?

A

Upper thorax (T1-T6)

49
Q

Describe the nerve supply of the oesophagus.

A

The oesophagus is supplied by the oesophageal plexus, which is made up of branches of vagus (parasympathetic) and branches from the sympathetic trunk (sympathetic).

50
Q

Which geographical features allow you to identify the azygos vein?

A

It runs posterior to the right main bronchus and drains into the SVC.

51
Q

At what level do the accessory azygos and hemiazygos veins cross the midline?

A

Accessory azygos: T8

Hemiazygos: T9

52
Q

Which artery supplies the SA & AV nodes?

A

The right coronary artery.

53
Q

What is the dominant artery?

A

The artery that has the posterior interventricular artery.

54
Q

What is the most common access site for a cardiac catheterisation?

A

The femoral artery (but the radial/brachial arteries are also used).

55
Q

An occlusion in which artery causes an anterior myocardial infarct?

A

Anterior interventricular artery.

56
Q

An occlusion in which artery causes a posterior/lateral myocardial infarct?

A

Circumflex artery.

57
Q

An occlusion in which artery causes an inferior myocardial infarct?

A

Right coronary artery.

Anatomy (8 decks)

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