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MRCS part B anatomy > Thorax anatomy > Flashcards

Thorax anatomy Flashcards

1
Q

Where is the caval opening located?

A

T8, central tendon of diaphragm

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2
Q

What structures pass through caval opening?

A

IVC + right phrenic nerve

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3
Q

Where is oesophageal hiatus located?

A

Right crus diaphragm, T10

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4
Q

What structures pass through oesophageal hiatus?

A

Oesophagus, posterior and anterior vagal trunks, oesophageal branch left gastric artery

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5
Q

How is aortic hiatus formed? What level is it at?

A

R and left crura and median arcuate ligament. T12

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6
Q

What passes through aortic hiatus?

A

Aorta, azygous vein, thoracic duct

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7
Q

Describe venous drainage of anterior chest wall

A

Anterior: anterior intercostal veins –> internal thoracic vein–> brachiocephalic vein

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8
Q

Describe venous drainage of upper 4 intercostal spaces posterior chest wall

A

Drained by azygous system into SVC

-1st space: B/l highest (supreme) intercostal vein –> brachiocephalic vein
-2nd-4th: posterior intercostal veins – superior intercostal vein

-R side: superior intercostal vein –> azygous vein
-L side: Superior intercostal vein –> accessory hemiazygous or brachiocephalic vein

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9
Q

Drainage of posterior 5-12 intercostal spaces posterior chest wall

A

Drained by azygous system into SVC

L side:
–> 5-8 drained by accessory hemiazygous
–> 9-11 hemiazygous vein
–> accessory hemiazygous +hemiazygous–> azygous –> SVC

R side:
-5-11: Azygous vein

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10
Q

How is venous drainage to chest wall divided?

A

Anterior

Posterior
–> upper 4 ( R + L)
–> 5-11 (R + L)

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11
Q

What is arterial supply of diaphragm?

A

Superior surface:

-internal thoracic
—>pericardiophrenic artery
—->musculophrenic arteries
-Descending thoracic aorta
—> superior phrenic

Inferior surface
-Abdominal aorta –> inferior phrenic arteries

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12
Q

Describe lymphatic drainage of breast

A

General rule:
-75% Lateral breast–> ipsilateral axillary nodes: anterior axillary nodes + central axillary nodes –> apical axillary nodes
-Medial breast –> Internal thoracic nodes

However: valveless channels connecting systems allow flow in both directions

Lymph also flows to:
-Infraclavicular + supraclavicular nodes
-Subscapular + interpectoral nodes
-Contralateral breast

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13
Q

Arteries supplying anterior chest wall

A

1-6: Internal thoracic –> anterior intercostal arteries
7-9: musculophrenic –> anterior intercostal arteries

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14
Q

Arteries supplying anterolateral chest wall:

A

Axillary artery –> superior + lateral thoracic

Below 12th rib:
–> descending thoracic aorta –> subcostal

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15
Q

Arteries supplying posterior chest wall

A

1 + 2: subclavian –> costocervical trunk –> superior intercostal arteries –> posterior intercostal arteries

3-12: Descending thoracic aorta –> posterior intercostal arteries

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16
Q

Arteries supplying chest wall

A

Arteries supplying anterior chest wall
-1-6: Internal thoracic –> anterior intercostal arteries
-7-9: musculophrenic –> anterior intercostal arteries
Arteries supplying anterolateral chest wall
-Axillary artery –> superior + lateral thoracic
-Below 12th rib:
–> descending thoracic aorta –> subcostal
Arteries supplying posterior chest wall
-1 + 2: costocervical trunk–> posterior intercostal arteries
-3-12: Descending thoracic aorta –> posterior intercostal arteries

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17
Q

What is the origin and insertion of pec minor?

A

Origin: 3rd-5th ribs (near costal cartilages)

Insertion: medial border + superiro surface coracoid process of scapula

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18
Q

What is innervation of pec minor?

A

Medial pectoral nerve (C8-T1)

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19
Q

What is the action of pec minor?

A

–> Stabilises scapula by drawing it inferiorly + anteriorly against thoracic wall
–> raises ribs on inspiration

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20
Q

What are the branches of the left and right coronaries?

A

Left
-LAD
-Left marginal
-Left circumflex

Right
-Right marginal anteriorly
-Posterior interventricular posteriorly (left in 25% of patients)

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21
Q

What territory is supplied by RCA?

A

R atrium + most of R ventricle, SA (60%) + AV (20%) nodes + posterior 1/3rd interventricular septum + diaphragmatic surface left ventricle

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22
Q

What territory is supplied by right marginal?

A

Right ventricle
Apex

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23
Q

Left anterior descending territory

A

Right ventricle, left ventricle, anterior 2/3rd IVS

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24
Q

Left marginal territory

A

Left ventricle

25
Q

Left circumflex territory

A

Left atrium + ventricle

26
Q

What does left coronary supply?

A

left atrium/ventricle, IVS, AV node branches

27
Q

Posterior descending territory:

A

R ventricle, L ventricle, posterior 1/3rd IVS

28
Q

What is the arterial supply to the oesophagus?

A

Arterial supply is segmental

Cervical part: Subclavian–> thyrocervical trunk–> inferior thyroid

Thoracic part: Branches from descending thoracic aorta

Abdominal part: oesophageal branch L gastric + inferior phrenic

29
Q

Describe venous drainage of oesophagus

A

Cervical: inferior thyroid

Thoracic: azygous, hemiazygous, accessory azygous

Abdominal: Azygous + left gastric

30
Q

Name important anatomical structures at level of manubriosternal junction

A

-SVC entering right atrium
-Bifurcation of trachea
-Bifurcation of pulmonary trunk
-Arch of aorta
-Thoracic duct crosses from right to left mediastinum
-L recurrent laryngeal nerve hooks around aortic arch

31
Q

Innervation of diaphragm

A

Motor supply: phrenic nerves C3-C5

Sensory:
–> Central: phrenic nerve c3-5
—> Peripheral: Intercostal nerves T5-T12

32
Q

Arterial supply to breast

A

1) Internal thoracic –> medial mammary perforating + anterior intercostal branches

2) Axillary –> Lateral thoracic + thoracoacromial arteries

3) Thoracic aorta –> posterior intercostal arteries

33
Q

What is first branch of ascending aorta?

A

Coronary arteries

34
Q

What is the origin of right and left coronary arteries?

A

L + R aortic sinus

35
Q

What territory does R coronary artery supply?

A

-All surfaces R atrium
-25-30% right ventricle
-Inferior wall right ventricle
-SA node 60% + AV node

36
Q

What territory does L coronary supply?

A

-L atrium
-Most of L ventricle
-Part of R ventricle
-Most of interventricular septum
-SAN in 40%

37
Q

What territory does L coronary supply?

A

-L atrium
-Most of L ventricle
-Part of R ventricle
-Most of interventricular septum
-SAN in 40%

38
Q

What is the action of pec major?

A

Clavicular head: flexes + adducts arm

Sternal head: Adducts and medially rotates arm, accessory muscle of inspiration

39
Q

What is origin and insertion of pec major?

A

Origin
-Clavicular head: anterior border medial 1/2 of clavicle
-Sternocostal: anterior surface of sternum, superior 6 costal cartilages

Insertion
-Lateral lip bicipital groove of humerus

40
Q

What is innervation of pec major?

A

Clavicular head: C5-C6 (lateral pectoral nerve)

Sternocostal head: C7-T1 (medial pectoral nerve)

41
Q

What is the contents of the superiro mediastinum?

A

PVT Left BATTLE

Phrenic nerve
Vagus nerve
Thoracic ducts
Left recurrent laryngeal
Brachiocephalic vein
Aortic arch
Thymus
Trachea
Lymph node
Oesophagus

42
Q

What are the contents of middle mediastinum

A

Vessels: ascending aorta, lower 1/2 SVC, Azygous vein, pulmonary arteries + veins

Nerves: Phrenic nerves

Viscera: Heart + Pericardium, tracheal bifurcation

Others: bronchial lymph glands

43
Q

What are the contents of the posterior mediastinum?

A

on the DATE Vivian Slapped Larry

Descending thoracic aorta
Azygous/hemiazygous vein
Thoracic duct
Esophagus

Vagus nerve
Splanchnic nerves
Lymphatics

Vessels: thoracic part of descending aorta, azygous and hemiazygous veins

Nerves: Vagus + splanchnic nerves (arising from sympathetic trunk to supply viscera in thorax + abdomen)

Viscera: oesohpagus

Others: Lymph nodes + thoracic duct

44
Q

What are the branches of subclavian artery?

A

1st part medial to anterior scalene, 2nd behind, 3rd lateral

VITCD

1st part
–> vertebral artery
–> Internal thoracic artery
–> Thyrocervical trunk

2nd part
–> Costocervical trunk and dorsal scapular artery

3rd part
–> No branches (occasionally dorsal scapular)

45
Q

Name layers gone through when inserting chest drain

A

Superficial to deep:

Skin
Subcut fat
Deep fascia
Serratus anterior
External intercostal muscles (infero-anterior orientation of fibres)
Internal intercostal (infero-posterior) lateral part intercostal space only
Innermost intercostal -lateral part intercostal space only
Endothoracic fascai
Parietal pleura

46
Q

What is a bronchopulmonary segment?

A

1) Segment of lung
2) Segmental/tertiary bronchus
3) Segmental branch tertiary arteries
4) Segment of lung tissue
5) Surrounding connective tissue septum

47
Q

How many bronchopulnonary segments does each lung have?

A

Right has 10
–> upper lobe 3, middle 2, lower 5

L has 10
–> upper + lower 5 each

48
Q

What are the boundaries of the posterior mediastinum?

A

Anterior: pericardium
Inferior: diaphragm
Posterior: Thoracic vertebrae
Lateral: mediastinal pleura
Roof: line from sternal angle + T4 vertebra

49
Q

Describe musculature of the oesophagus

A

2 planes: external longitudinal fibres + internal circular

upper 1/3rd: Striated
Middle 1/3rd: mixture of striated and smooth
Lower 1/3rd: smooth muscle

50
Q

Where does the breast lie anatomically?

A

Base of breast:
–> sternum to mid-axillary line
–> 2nd-6th rib

2/3rd medially overlies pec major
1/3rd laterally overlies serratus anterior

51
Q

What is the blood supply to the breast?

A

Mainly lateral thoracic

Also:
–> internal thoracic
–> Thoraco-acromial
–> posterior intercostals

52
Q

How does right bronchus differ from left?

A

-Right is shorter, wider and more vertical
-Therefore foreign bodies preferentially go down right main bronchus
-Material aspirated by supine/anaesthetised pt also gravitates to apical part of right lung: common site for aspiration pneumonia/abscess

53
Q

What is the superior limit of pleura? What is the clinical significance of this?

A

2.5cm above medial 1/3rd clavicle
Does not extend above 1st rib

Injuries above clavicle (e.g. central line) can involve pleura
—> pneumothorax

54
Q

What is the lower border of pleura?

A

Extends below medial border 12th rib, behind upper border of kidney

55
Q

Structures at hilum

A

-Bronchus is posterior, artery always superior, vein inverior
-BAV: bronchus, artery, vein

56
Q

Relations of lungs

A

Right: SVC, oesohpagus, azygouis
Left: Aorta, heart, oesophagus

Both
-Diaphragm

57
Q

How do you orientate side of lungs?

A

-Diaphragm faces down
-Thinner sharper border faces forwards

58
Q

Branches axillary artery

A

Semen tastes like sweet apple pie

Superiro thoracic
thoraco-acromial
Lateral thoracic
Subscapular
Anterior circumflex humeral
Posterior circumflex humeral

59
Q

Describe venous drainage of chest wall

A

Anterior: anterior intercostal veins –> internal thoracic vein–> brachiocephalic vein

Upper 4 spaces posterior:

Drained by azygous system into SVC

-1st space: B/l highest (supreme) intercostal vein –> brachiocephalic vein
-2nd-4th: posterior intercostal veins – superior intercostal vein

-R side: superior intercostal vein –> azygous vein
-L side: Superior intercostal vein –> accessory

5-12 posterior chest wall:

Drained by azygous system into SVC

L side:
–> 5-8 drained by accessory hemiazygous
–> 9-11 hemiazygous vein
–> accessory hemiazygous +hemiazygous–> azygous –> SVC

R side:
-5-11: Azygous vein

MRCS part B anatomy (16 decks)

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