thorax anatomy Flashcards
1
Q
which is the only rib to articulate with only 1 facet ?
A
the first rib, all others are their own vertebral body and also the fascet joint above.
2
Q
the neurovascular bundle under the rib, the three structures run superiorly to inferiorly in what order?
A
vein
artery
nerve
3
Q
which bronchus does the aotric arch go over?
A
the left main bronchus
4
Q
what are the surface markings of the lower most point of the jugular veins where they meet the subclavian?
A
the Sternal mcostal joint on the left and right
5
Q
what are the two tribuitaries going to the SVC?
A
the innominate vein on th e left and the brachiocephalic vein ont he right
6
Q
where does the azygous vein join the IVC in relation to the lung?
A
over the hilum of the right lung. Which is in line with the 2nd intercoastal joint.
7
Q
which costrocondral jucntion does the SVC join the right artium ? (cavoartial junction)
A
the 3rd costrocondral junction
8
Q
what is the surface markings of the right heart?
A
the 3rd to the 6th costal cartilage
9
Q
the right atrial appendage is in what relation to the ascending aorta
A
anterior
10
Q
the opening of the coronary sinus is in what relation to the IVC
A
left of it
11
Q
the right coronary artery runs in what relation to the right atrium?
A
is runs in the AV groove anteriorly and obliquely in between the right artium and ventricle.
12
Q
where is the manbranous septum found int he heart?
A
at the top of the LVOT where it is attached to the fiberous speleton of the heart
13
Q
Where is the SA Node located?
A
in the upper part of the right artium, at the cavoartial junction near the crista terminalis
14
Q
where is the AV node loacted?
A
within the membranous septum in the lower part of the atria
15
Q
the SA node contains more or less myocardial fibres than other cells int he heart?
A
contain less myocardial fibres.
16
Q
what is found at the apex of the triangle of coch?
A
the AV node and AV bundle
17
Q
which main artery provides blood supply to the posterior ventricle (giving septal branches)?
A
the RCA
18
Q
Which artery gives blood supply to the SA and AV node?
A
the RCA
19
Q
the left coronary artery arrises from the coronary sinus in what relation to the pulmonary trunk?
A
behind it
20
Q
the diagonal arteries come off which main artery in the heart?
A
the LAD
21
Q
the diagonar arteries supply which part of the septum?
A
the anterior 2/3rds
22
Q
the obtuse marginal artery comes off which artery in the heart?
A
the LcX
23
Q
the anterior cardiac veins drain intot what location ?
A
into the right artium through the AV groove
24
Q
what percentage of venous return of the heart comes through the venous sinus?
A
85%
25
the great cardiac vein runs in what relation to the anterior interventricular branch of the LAD?
it is parralell and to the left
26
is the left or the right pulmonary artery longer ?
the right is longer
27
which main bronchus is longer?
the left main bronchus is longer
28
above the second rib which nerve supplies the skin on the shoulders and thorax?
supraclavicular baranches of the cervical plexus (c4)
29
the upper 7 ribs are attached to the sternum and the sternal costal joint , the next 3 ribs articulate with what?
articulate with eachother (interchondral joints)
| and the last 2 ribs are free
30
the sternum is attached to the xyphisternum and the manubrium via which type of joint?
a symphysis
A symphysis consists of a compressable fibrocartilaginous pad that connects two bones. This type of joint allows for some movement. The hip bones, connected by the pubic symphysis, and the vertebrae, connected by intervertebral discs, are two examples of symphyses.
31
do the last 2 ribs articular with their own and the vertebrae above?
no, only their own
32
how does the first rib help stabilise the pectoral girdle?
by being fixed to the manubrium they move as one, it is a primary cartilagenous joint not synovial like the rest.
33
the neurovascular bundle is inbetween which two muscle groups?
the transversus group and the internal intercostal
34
the superior intercoastal artery comes off which artery?
costocervical trunk which comes off the second part of the subclavian artery. it enters the thorax by passing across the front of th eneck of the first rib where it has the sympathetic trunk on its medial side
35
the internal thoracic artery comes off which artery?
the subclavian, before the scalenus anterior.
36
the fiberous pericardium and the central tendon of the diaphragm are inseperable (T/F?)
true
37
the aortic opening is in line with what level of the thoracic verterbrae ?
T12
38
where in the diaphragm does the aorta come out of?
It is behind the median arculate ligament and therefore behind the diaphragm not in it.
39
what else goes through the diaphragm with the aorta?
the thoracic duct and the azygous vein.
| the duct is between the two vessels
40
the esophagus passes through the diaphragm at what level?
T10 vertebral level
41
at what level does the vena cava pass through the dipahragm?
T8
42
the phrenic nerve on the right lies in what relation to the IVC?
alongside the vena cava medial, then when it goes through the diaphragm it is on the fiberous pericardium.
43
what structures pass the diaphragm at the median arcuate ligament ?
the hemiazygous vein, the greater, lesser and least splanchnic nerves pierce each crus the sympathetic trunk goes behind the median arcuate ligment
44
the left phrenic nerve enters the disphragm where?
anterior to the central tendon , just to the left of the pericardium.
45
the muscles of passive inhalation are?
the diaphragm
the intercostal muscles adjacent to the sternum and the
scalene muscles
46
the superior mediastinum is defined as the structures at which level and above?
the T4 vertebral level, the transthoracic plane. this is through the sternal angle . below this plane is the interior mediastinum
47
the inferior mediastinum is divided into three parts what are they?
the anterior, the middle and the posterior
48
what structures lie in the trans thoracic plane?
```
CLAPTRAP
cardiac plexus
ligamentum arteriosum
aortic arch, concavity
pulmonary trunk
tracheal bifurcation
right to left crossing thoracic duct
azygous jein joins SVC
pretracheal/ prevertebral fascia end.
```
49
what two great arteries come off the aortic arch and make a V around the trachea ?
the brachiocephalic on the right and left coartid on the left.
50
does the vagus nerve touch the trachea on the right and left at the thoracic inlet?
only on the right does it touch, the left the carotid is in the way and the left are held off.
51
where are the phrenic and vagus nerves on the left in relation to the aortic arch.
phrenic=front
vagus=behind
the lung root.
52
discribe the path of the left superior intercostal vein
passes forward avross the aortic arch, superficial to vagus and deep to phrenic to empty into the brachiocephalic vein.
53
what part of the aorta does the left recurrent laryngeal nerve hook around?
Lateral to the arteriosum
54
the path of the recurrent laryngeal nerve after hooking around th eligamentum arteriosum?
ascends between the trachea and the esophagus
55
which layer of the aortic arch contains the baroreceptors ?
the adventitia
56
under the arch in the region of the arteriosum you can find what ?
the aortic bodies, controlled by the vagus, small massess of tissue , conscerned with detecting hypoxia and determining rate.
57
what surface marking denotes the bifuraction of the brachiocephalic into the right subclavian adn common carotid?
behind the right sternoclavicular joint
58
is the brachiocephalic vein in front or behind the artery?
in front
59
where can the trachea be found in the thoracic inlet?
at the jugular knotch
60
does the left common caortic artery have any branches in the mediastinum?
no
61
does the left subclavian artery have any branches in the mediastinum?
nil
62
the left subclavian artery arches over the apex of the left lung?
yes, it leaves a deep groove
63
discribe the path of the blood flow through the ligamentum arteriosum?
from the commencement of the left pulmonary artery to the concavity of the aortic arch beyond the point that the subclavian has branched off. this is directly in front of the left pain bronchus
64
the superior pulmonary vein is anterior or posterior to the to the pulmonary artery?
anterior
65
the inferior pulmonary vein in in what relation to the right main bronchus? at the level of the right lung root?
inferior it is the lowest structure in the root
66
the two brachiocephalic veins join together in line with which costal cartilage?
the first
67
what are tribuitaries going into the left brachiocephalic vein (innominate)?
```
subclavian
vertebral
internal thoracic
the thoracic duct
infreior thyoid plexus
vein from thymus
superior intercostal vein joins near SVC
```
68
pain from the heart is carried on what type of fibres?
sympathetic
69
how many cm above the jugular notch is the commencement of the trachea at C6?
5cm
70
the azygous vein enters the SVC by first hooking forward over what?
the right main bronchus
71
the pulmonary trunk bifurcates to the right or left of the bronchial bifurcaton ?
arteries are to the left of the bifurcation
72
the pulmonary trunk bifurcates into the right and left sides to the right or left of the tracheal bifurcation?
to the left of the tracheal bifurcation
73
what is the arteriolar adnvenous supply to the trachea?
the inferior thyroid artery adn drains into the inferior thyriod plexus
74
what is the lymph node drainage of the trachea?
the posterior inferior group of deep cervical and to paratracheal nodes.
75
the sympathetic nervous supply to the trachea is innervated from what?
upper ganglia of the sympathetic trunks supply the smooth muscle and blood vessels.
76
what is the name of the mucle at the back of the trachea ?
trachialis
77
what is the histology of the inner layer of the trachea?
respiratory epithelium. pseudostratified columnal ciliated epithelium with goblet cells mucus glands and scattered lymphoid follicles.
78
phrenic nerve pathway from neck to diaphragm
mainly from C4 of C456
obliquely over the anterior scalene muscle
across the dome of the pleura behind the subclavian vein
in front of each lung root
lies in the thorax as lateral as possible on the mediastinal pleura
descending medial relations are asymetrical
79
the left phrenic nerve:
| passes the aortic arch anterior or posterior to the vagus nerve?
anterior
80
the enterance of the right phrenic nerve into the diaphragm?
through the ICV foramen in the central tendon
81
what are the names of the branches of the phrenic nerves after they have passed through under the diaphragm?
the anterior , posterior and lateral
82
what fraction of thephrenic nerve fibres are motor vs sensory?
2/3 motor 1/3 sensory
83
what does the seonsory part of the phrenic nerve innervate?
the diaphragm (more centrally) intercostals do laterally
the mediastinal pleura
the fiberous pericardium
the parietal layer of the serous pericardium
the diaphragmatic parts of the pleura and peritoneum
84
what is the neurovascualr bundle that follows the phrenic nerve?
phrenic nerve runs in parralell journey with its artery adn vein the pericardiophrenic artery ( a branch of the internal thoracic)
85
which vagus nerve is touching the trachea?
the right, the left is being held off by the great vessels.
86
the vagus nerve on the left is anterior or superior to the superior intercoastal vein?
posterior
87
the right vagu nerve runs arterior or posterior to the arch of the azygous vein?
posterior
88
the vagus nerve bilaterally runs on which side of the lung root?
behind the lung root
89
at what point in the thorax does the vagus nerve attach to the esophagus?
behind the lung root after it has given off the plexi to the lungs
90
how many lobes does the thumus have?
2
91
what is the blood supply to the thymus?
the internal thoracic and inferior thyroid
92
what fascia is anterior to the thymus?
the pretracheal fascia
93
the embryonic derivative of the thymus?
epithelium: endoderm - 3rd 4th branchial pouches both sides
ectoderm from the branchial clefts : source of hormoned for T cell differentiation.
mesoderm: for the connective tissue
94
which mediastinal cavity do the lung roots belong to?
the meddle mediastinum.
95
is the fiberous pericardium fused with the IVC?
no the IVC is fused with the central tendon of he diaphragm
96
the fiberous pericardium is attached to upper and lower ends of the sternum by which ligament?
the sternal pericardial ligament
97
within the serous pericardium there are two sinuses, what are they called?
the transverse adn oblique
98
if a ligature is placed in the transverse sinus what arteries can be occluded?
the pulmonary trunk and aorta
99
what is the innervation of the serous visceral and parietal layers of the pericardium?
the parietal is innervated by the phrenic withthe fiberous pericardium but he visceral is not innervated.
100
the right border of the heart consists entirely of ?
right atrium
101
the inferior border of the heart is made up entirely of ?
right ventricle with a small amount of the left ventricle
102
the left border of the heart is mainly?
left ventricle
103
the sternum abutts which part of the heart?
the right ventricle, the right atrium adn the AV groove
104
the term base of the heart is referring to which anatomical area?
the left atrium on the posterior surface
| not the area where the great vessels emmerge
105
the left atrium lies in what relation to the right artium?
behind it
106
to the right of the ctista terminal is the internal layer of the right atrium could be discribed as what?
smooth
107
in the right atrium betweent he crista and the right auricle the myocardium is projected into a series of horizontal ridges like teeth of a comb, these muscles are called what?
the pectinate muscles
108
the fossa ovalis can be found in a vertical line between which two openings in the right atrium?
inbetween the SVC and IVC
109
the opening to the coronary sinus in the right atrium is located?
medial to the fossa ovalis and superior to the ridge of the IVC (the septal susp) of the tricuspid valves
110
the cusps of the tricuspid valve are the ?
septal , anterior and posterior.
111
the right branch of the conducting bundle run down which papillary muscle?
the anterior papillary muscle.
| this is the septo marginal trabeculae which was formerly the moderator band.
112
the pulmonary valve cusps are called?
anterior left and right
113
WHICH HEART CHAMBER FORMES the anterior wall of the oblique sinus?
the left atrium
114
the two cusps of the mitral valve are called?
anterior and posterior
115
the LV is how much thicker than the RV?
three times
116
in the mitral valve which cusp is larger and thicher and had a larger and thicker papillary muscle?
anterior
117
blood enters the LVOT behind the anterior mitral cusp and exits anterior to the same cusp? (T/F)
true
118
what is the histology of the aortic and pulmonary valves?
they are fibro elastic with vascular endothelium
119
what is in front of the transverse sinus?
the aorta dn pulmonary trunk
| where they share a common sleve of serous pericardium
120
the SA node contains which type of cells and what do they do ?
Stellate cells, or P cells, P for pacemaker cells, which generate impulses for contrction. they contain fewer myofillaments than other cardiac muscle
121
what % of peoples SA node is supplied by the RCA?
60 %
122
the AV nodal artery is a branch off the RCA?
yes, with anastomosis from the felt circumfelx
123
another name for the posterior descending artery is the ?
posterior interventricular artery
124
the marginal artery is a branch of the ?
RCA
125
which artery is sitting on the diaphragmtic surface?
the posterior interventricular artery
126
the left coronary artery coming out of the left coronary sinus is in front or behind the lulmonary trunk?
behind
127
where can be an annomalous orgigin of the left coronary artery?
the pulmonary trunk
128
in 40% of hearts which artery can supply the SA node ?
left circumflex
129
the anterior interventricular artery is also called?
the LAD
130
the LAD runs down which landmark to anastomose with the posterior descending artery/ posterior interventricular?
the interventricular groove
131
the diagonal and obtuse branches come off which artery?
the LAD
132
what is the defining feature of if the heart is right or left dominant?
which side provides the posterior descending artery is the dominant side. 90% right but 10% left
133
the venous drainage of the heart can be divited into three areas, what are they?
```
the cordis minimae
the anterior cardiac vein
the coronary sinus with its 5 tribuitaries
1. great
2. middle
3. small
4. the postrior vein of the left ventricule
5. the oblique vein of the left atrium
```
134
the coronary sinus lies where?
in the posterior part of the AV groove
135
where does the coronary sinus open?
at the right lower end into the posterior wall of the right atrium to the left of the inferior venacava operning
136
the venae cordis minimae provide how much venous blood return to the heart?
negligible
| they do open in the respective chambers, being most prolific in the RA
137
the retropharyngeal space is continuious with which part of the mediastinum ?
posterior
138
the heart and lungs drain into which lymph nodes?
tracheobronchial lymph nodes, which lie around the bifurcation of the trachea
139
where does the thoracic trunk commence?
at the cysterna chyli, at the T12 vertebral body
140
the thoracic duct runs between which two vessels?
the azygous and the aorta
141
when passing across the thorax at the level of T7 does the thoracic trunk go behind or in front of the esophagus?
behind
142
the thoracic duct drains into the venous system at what point?
the confluence fo the subclavian and and internal jugular veins on the left.
143
does the thoracic duct have valves?
yes
144
the thoracic wall and upper lumbar regions are drained by which vein into what system?
the posterior intercostal and lumbar veins into the azygous system.
145
where does the azygous vein system commence?
at the IVC just above the renal veins but at this point it is usually an avascular fiberous cord. the union of the ascending lumbar vein with the subcostal vein of the right side is the functional commencement of the azygous
146
what vein joint the azygous vein as it arches over the right bronchus?
the superior intercostal vein
147
how many hemiazygous veins are there?
two
148
the two hemiazygous veins join the azygous at which vertebral level?
T8 T9
149
the hemiazygous veins cross the midline infront or behind the esophagus?
behind the esophagus
150
the superior and inferior azygous veins have differnt names what are they?
the superior one is the accessory hemiazygous and the inferior one is the hemiazygous
151
where can the thoracic sympathetic trunk be found ?
lying on the necks of the ribs just lateral to their heads , anterior to the intercostal vessels and nerves
152
the cervical sympathetic trunk ascends up into the cervical area by going above or below the 1st rib?
above the nect of the first rib
153
what embryonic derivative does pleura comes from?
mesoderm
154
the visceral layer of the pleura extends into the depts of the interlobar clefts (T/F)
true
155
the fascial lining the thoracic wall is called?
the endothoracic fascia
156
what is the nerve supply of the parietal plura on the diaphragm, mediastinum and lateral thoracic wall?
the diaphragm and mediastinum is the phrenic but the lateral parietal is the intercostals segmentally in zones and the peripheral aspect of the disphragm.
157
the visceral pleura is innervated by what?
supplied by the autonomic nerves (vasomotor) supply it is insensitive to ordinary stimuli.
158
the pulmonary trunk devides in front of what structure?
th left pain bronchus
159
when a lung is removed by a clean cut at the side of the mediastinum the cut sirface on the mediastinum is the ____? and the corresponding cut surface ont he lung is the ____?
lung root
| hilum
160
the right pulmonary artery gived off its branch to the upper lobe bronchus before or after it enters the lung?
before
161
which costal cartilages do the hilum of the lungs hide behind?
the 3rd and 4th costal cartilages at the sternal margin , in level with the 5th 6th and 7th vertebrae.
162
how many bronchopulmonary segments are there in each lung?
10
163
discribe the bronchial blood supply on the right and left of the lung
brinchial arteries straight from the aorta. 2 on the left which are direct branches from the aorta
except
one on the right comes from the third right posterior intercostal artery
164
the bronchial veins drain in to which system? right and left
the azygous on the right and the hemiazygous on the left
165
blood draining from the deepest parts of lung drain into what?
the main pulmonary vein or the left atroum directly , mixing oxygenated and deozygenated blood
166
the two pulmonary veins leave the lungs at the hilum in what relation to the oblique fissure?
one above and one below the oblique fissure
167
the nervous supply of the lungs comes from which plexus?
the cardiac plexus , autonomic fibres run along the bronchial tree.
168
what is the role of sympathetic fibres int he lung?
dilator to the pulmonary aterioles to respond to increased need for respiration with higher cardiac output
169
what is the role for the PNA afferents and the efferents in the bronchioles.
afferents: cough reflex (receptora are unmyelinated endings inthe epithelium)
efferents : motor to the smooth muscle of the bronchi and arterioles
170
when do bronchi becomes bronchioles?
at about 1 mm diameter when it looses its cartilage
171
what is the division between bronchioles and respiratory bronchioles?
when the cilliated epithelium dissapears
172
what is a feature of a respiratory duct?
many alveoli strouting off them
173
the walls of the alveoli contain what types of cells?
capillaries, macrophages, mast cells, fibroblasts
174
what are the 2 types of epithelial cells in the alveoli?
95% squamous cells, type 1, gas exhange occurs here
| 5% secretory cells, type 2, containing whorl, like lamellar bodies with high phospholipid content, surfactant.
