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MRCS Part A (KF edition) > Thorax anatomy > Flashcards

Thorax anatomy Flashcards

1
Q

What anatomical landmark splits the mediastinum into superior and inferior?

A

Sternal angle (angle of Louis)

Found at L4/L5

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2
Q

How is the inferior mediastinum further divided?

A

Anterior mediastinum
Middle mediastinum
Posterior mediastinum

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3
Q

What structures are found in the Superior mediastinum?

A

There are 10

  • SVC
  • Brachiocephalic vein
  • Arch of aorta
  • Thoracic duct
  • Trachea
  • Oesophagus
  • Thymus
  • Vagus nerve (CNX)
  • Phrenic nerve
  • Left recurrent laryngeal nerve
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4
Q

What are the 3 structures that lie in the Anterior mediastinum

A

Thymic remnants
Lymph nodes
Fat

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5
Q

What are the structures found in the middle mediastinum?

A
  • Pericardium
  • Heart
  • Aortic root
  • Arch of azygos vein
  • Main bronchi
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6
Q

What structures are found in the Posterior mediastinum?

V DATES

A

V DATES

  • Vagus nerve
  • Descending aorta (Thoracic aorta)
  • Azygos vein
  • Thoracic duct
  • Esophagus
  • Sympathetic nerve trunks / Splanchic nerves
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7
Q

What is the posterior boundary of the posterior mediastinum?

A

Last 8 thoracic vertebra

T5-T12

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8
Q

What are the anterior and lateral borders of the posterior mediastinum?

A

Anteriorly: Heart + Pericardium

Laterally: Lung pleura

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9
Q

If a patient had a stab wound to the sternal angle (L4-L5), what structure is most at risk of injury?

A

Arch of the aorta

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10
Q

What anatomical structures are found beneath the upper part of the manubrium?

A
  • Left common carotid
  • Left brachiocephalic vein
  • Left subclavian artery
  • Brachiocephalic artery
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11
Q

Which rib is found at the sternal angle?

A

2nd rib

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12
Q

What is the most common site for injury of the Thoracic duct?

A

When crossing to the midline at the sternal angle

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13
Q

During an oesophagectomy, where would the chyle accumulate if the thoracic duct is injured?

A

Posterior mediastinum

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14
Q

At what levels of the vertebrae does trachea begin and end?

A

C6 - T5 (upper border)

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15
Q

What is the arterial supply and venous drainage of the trachea?

A

Inferior thyroid arteries

Thyroid venous plexus

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16
Q

What lies posterior to the trachea?

A

Oesophagus and vagus nerve

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17
Q

What structures lie anterior to the trachea?

A
  • Isthmus of thyroid
  • Inferior thyroid veins
  • Sternothyroid
  • Sternohyoid
  • Cervical fascia
  • Anastomosing branches of the anterior jugular veins
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18
Q

What structures run laterally to the trachea?

A

Common carotids

Right and Left thyroid lobes

Inferior thyroid arteries

Recurrent laryngeal nerves

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19
Q

At which levels does the oesophagus begin and end?

A

C6 - T11

Pierces the diaphragm at T10

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20
Q

What kind of epithelium is found in the oesophagus?

A

Non-keratinised stratified squamous epithelium

It has no serosa and so holds sutures poorly

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21
Q

Where are the 4 areas of constriction of the oesophagus and distance from front incisors?

A

Cricoid cartilage: 15cm

Arch of the aorta: 22.5cm

Left principal bronchus: 27cm

Diaphragmatic hiatus: 40cm

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22
Q

How is the oesophagus divided?

A

Divided into Upper (cervical), Middle (thoracic) and Lower (abdominal) thirds

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23
Q

What is the blood supply of the upper third of the oesophagus and its lymphatic drainage?

A

Arterial: Inferior thyroid artery

Venous: Inferior thyroid vein

Lymphs: Deep cervical

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24
Q

What is the blood supply and venous drainage of the middle third of the oesophagus?

A

Arterial: Aortic branches

Venous: Azygos branches

Lymphs: Mediastinal

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25
Q

What is the blood supply to and from the lower third of the oesophagus?

A

Arterial: Left gastric

Venous: Left gastric vein

Lymph: Gastric

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26
Q

In which part of the oesophagus do oesophageal varies arise?

A

Lower third

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27
Q

What is the nerve supply of the oesophagus?

A

Upper half: Recurrent laryngeal nerve

Lower half: Vagus (oesophageal plexus)

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28
Q

How many lobes are there in the left and right lung?

A

Left: 2

Right: 3

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29
Q

What is found above the hilum of the right lung?

A

Azygos vein and groove for the SVC

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30
Q

Where does the oesophagus lie in relation to the hilum of the right lung?

A

The oesophagus sits in a vertical groove posterior to the hilum

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31
Q

What structure lies anterior to the hilum of the left lung?

A
  • Phrenic nerve
  • Vagus nerve
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32
Q

What structure is found superior to the hilum of the left lung?

A

Aortic arch and more superiorly, the groove accommodating the left subclavian artery

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33
Q

What structure runs posterior to the hilum of the left lung?

A

Descending aorta

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34
Q

What is the posterior border of the lung cavity?

A

Transverse process of C7 - T10

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35
Q

At what costal level is the cardiac notch found?

A

Left lung deviates laterally from the sternum at the 4th costal cartilage to form the cardiac notch

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36
Q

At what vertebral levels are the hillas of the lung found?

A

T5, T6, T7

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37
Q

At what rib level does the lung end?

A

10th rib

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38
Q

Injury to the posterior 8th rib would cause injury to which structure?

A

Lung

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39
Q

Which vertebral levels does the oblique fissure of the lung originate from and where does it end?

A

T3/4 to T6

40
Q

What are the most anterior structures in the hilum of the lung?

A

Pulmonary artery and vein

41
Q

What structures lie most posteriorly in the lung hilums?

A

Main bronchus

42
Q

What structures are found in the hilum of the lung?

A
  • Pulmonary artery and vein (most ant)
  • LN
  • Bronchial artery and vein
  • Autonomic nerves
  • Main bronchus (most post.)
43
Q

What is the name of the fascia that covers the lung apex?

A

Sibsons fascia

44
Q

What are the 3 structures found in the intercostal space and based on this, where should a chest tube be inserted in relation to the rib?

A

VAN (from superior to inferior)

Intercostal Vein
Intercostal Artery
Intercostal Nerve

Insert tubes ABOVE the rib as structures are found directly below the rib

45
Q

What is the most likely source of bleeding after insertion of a chest drain?

A

Intercostal artery

46
Q

Where is the safest site for needle decompression and chest drains?

A

5th intercostal space, anterior to the mid-axillary line

47
Q

What sensation is the visceral pleura sensitive to?

A

Stretch (supplied by autonomic fibres from the pulmonary plexus)

48
Q

What sensations is the parietal pleura sensitive to?

A

Pain, Pressure, Temperature and Touch

49
Q

What is the nerve supply of the costal pleura?

A

Intercostal nerves

50
Q

What is the nerve supply of the mediastinal pleura?

A

Phrenic nerves

51
Q

What is the thoracic continuation of the cisterna chyli?

A

Thoracic duct

52
Q

At which vertebral level does the thoracic duct enter the thorax?

53
Q

What is the course of the thoracic duct?

A
  • Enters thorax at T12
  • Lies posterior to the oesophagus and passes to its left at T5
    Lies within the posterior and superior mediastinum
54
Q

Where does the lymphatic drainage of the left side of the head and neck join with the thoracic duct?

A

Just prior to its insertion into the left brachiocephalic vein

55
Q

Why do some surgeons administer a cream coloured liquid to patients prior to an oesophagectomy?

A

The thoracic duct is colourless and lies closely to the oesophagus.

The cream aids with visualising the thoracic duct

56
Q

What are the nerve roots of the phrenic nerve?

57
Q

What is the route of the right phrenic nerve?

A
  • Travels down alongside internal jugular vein
  • Crosses anterior to scalenus anterior and anterior to the 2nd part of the subclavian artery
  • Runs posterior to the subclavian vein and internal thoracic artery to enter thorax
  • In the superior mediastinum, travels anterior to Rt. Vagus and laterally to SVC
  • In the middle mediastinum, travels to the right of the pericardium and passes over the Rt Atrium
  • Exits diaphragm at T8 via vena cava hiatus
58
Q

What is the path of the left phrenic nerve?

A
  • Travels down alongside internal jugular vein
  • Crosses anterior to 1st part of subclavian artery
  • Runs posterior to the subclavian vein and internal thoracic artery to enter thorax
  • Passes lateral to aortic arch and left ventricle and anterior to left hilum of the lung
  • Pierces diaphragm alone
59
Q

What are the 3 papillary muscles that attach to the Chordae tendanae and where are they found?

A

Found in the ventricles of the heart

  • Anterior papillary
  • Posterior papillary
  • Septal papillary
60
Q

What are the anatomical relations of the Transverse sinus of the heart?

A

Anteriorly lies: Aorta & Pulmonary trunk

Posterioly lies: SVC & Lt atrium

61
Q

Where is the oblique sinus of the heart found?

A

Between the pericardium and left atrium

62
Q

What makes up the inferior (diaphragmatic) surface of the heart?

A

Rt ventricle + part of Lt ventricle at apex

63
Q

What makes up the anterior surface of the heart?

A

Rt atrium and Rt ventricle + part of Lt ventricle

64
Q

A stab injury to the right side of the sternum would likely injure which part of the heart?

A

Rt atrium

Rt border of the heart is made up of the right atrium

65
Q

What are the auscultatory areas of the heart?

A

All Patients Take Meds

Aortic: Rt 2nd ICS parasternally

Pulmonary: Lt 2nd ICS parasternally

Tricuspid: Lt 5th ICS parasternally

Mitral: Lt 5th ICS mid-clavicular line

66
Q

What is the surface anatomy of artificial valve locations?

A

Aortic, Mitral, Tricuspid (AMT) - all parasternal

Aortic: Rt, 3rd ICS
Mitral: Lt, 4th ICS
Tricuspid: Rt 5th ICS

67
Q

Where do the left and right coronary arteries arise from?

A

RCA: from ANTERIOR sinus of ascending aorta

LCA: from POSTERIOR sinus of ascending aorta

Both arise just above the aortic valve

68
Q

What are the branches of the RCA?

A
  • SA nodal art (60% of supply to SAN + Rt atrium)
  • Rt marginal (rt ventricle)
  • Posterior Intraventricular art (IV septum)
  • AV nodal art (AVN)
69
Q

What are the branches of the LCA?

A
  • Circumflex art (gives rise to Left marginal aka Obtuse marginal artery (Lt ventricle) + SA nodal art (40% of supply to SAN))
  • LAD aka Anterior Intraventricular art (RV + LV + IV Septum)
70
Q

What 3 veins drain into the coronary sinus prior to draining into the right atrium and what is their path?

A
  • Great cardiac vein: anterior inter-ventricular groove
  • Middle cardia vein: posterior inter-ventricular groove
  • Small cardiac vein: runs with marginal artery
71
Q

Where does the anterior cardiac vein drain into?

A

Directly into Right atrium

72
Q

What is the parasympathetic supply of the heart?

A

Right Vagus nerve - Indirect innervation

73
Q

Where does the sympathetic supply of the heart originate from?

A

Cervical and Upper thoracic portions of the sympathetic trunks (Cardiac plexus - Direct innervation)

74
Q

What are the first 2 main arteries that arise from the ascending aorta?

A

RCA and LCA

75
Q

Where is the arch of the aorta found and what 4 vessels does it give rise to?

A

Arch is in the Superior Mediastinum (T4)

  • Brachiocephalic (branches into Right subclavian and Right common carotid)
  • Left common carotid
  • Left subclavian
  • Sometimes Thyrida ima artery
76
Q

Which vessel is most at risk after a fracture injury to the medial third of the right clavicle?

A

1- Right subclavian vein
2- Right subclavian artery

77
Q

Where does the descending aorta start and end?

A

Starts in the posterior mediastinum at T4 and ends at T12 (becomes abdominal aorta)

78
Q

What 3 structures pierce the diaphragm and at what vertebral levels does this occur?

A

IVC: T8

Oesophagus + vagus: T10

Aortic hiatus: T12

79
Q

When is the mediastinum considered to be widened?

A

greater than 6-8cm

80
Q

What is the likely cause of a widened mediastinum in a patient with no trauma?

A

Aortic dissection of the Ascending aorta

81
Q

What is the likely cause of a widened mediastinum in a patient who has suffered trauma?

A

Aortic dissection of the Isthmus (beginning of the Descending aorta)

82
Q

What is the course of the vena azygos?

A
  • Begins posterior to the IVC at L2
  • Pierces diaphragm through aortic hiatus at T12
  • Lies posterior to oesophagus at T4
  • Crosses the oesophagus ABOVE the root of the lung before draining into SVC
83
Q

How many intercostal veins are there?

A

11

the 12th vein is called Subcostal vein

84
Q

Where do the first 3 left intercostal veins drain into?

A

Left brachiocephalic vein

85
Q

What area of the body does the T1 dermatome correspond to?

A

Medial side of forearm

86
Q

What is the dermatome of the umbilicus?

87
Q

What is the conus arteriosus?

A

Infundibulum - smooth walled outflow tract of the right ventricle leading to the pulmonary trunk

88
Q

Where are trabeculae carnae found?

A

Right ventricle

89
Q

From which structure is the central tendon of the diaphragm derived?

A

Septum transversum

90
Q

What is the embryological origin of the pulmonary artery?

A

6th pharyngeal arch

91
Q

Which structure is responsible for co-ordination of contraction of papillary muscles and where is it found?

A

Moderator band

Found in Rt ventricle

92
Q

What vein drains the lateral wall of the left ventricle?

A

Left marginal vein

93
Q

Through which structure is a cardioplegic agent delivered in retrograde?

A

Coronary sinus

94
Q

What is the most likely site of origin of a ventricular septal defect?

A

Perimembranous

95
Q

What arterial supply determines dominance of left coronary artery?

A

PDA

Posterior interventricular artery

MRCS Part A (KF edition) (22 decks)

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