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Anatomy of Thorax > Thorax Anatomy > Flashcards

Thorax Anatomy Flashcards

1
Q

What vertebral level does the trachea start and end at?

A

C6 to T4/T5

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2
Q

What is the name of the hooked cartilage at the bottom of the
trachea?

A

Carina

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3
Q
  1. What are the three divisions of the bronchi?
A

Primary - Lobar - Segmental

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4
Q

What are the cartilaginous structures found at the top of the
airway?

A

Thyroid Cartilage Cricoid Cartilage

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5
Q

What is the clinical significance of the gap between these two structures?

A

In an emergency situation, a cricothyroidotomy can be performed by
piercing a hole in the median cricothyroid ligament.

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6
Q

How are the two primary bronchi different?

A

The right bronchus has a larger diameter and is more vertical

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7
Q

How many bronchopulmonary segments are there per lung?

A

10

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8
Q

What do the vessels, nerves and bronchi from the mediastinum

have to pass through to get to the lungs?

A

Root of the lung

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9
Q

Where is the apex of the lung?

A

3-4 cm above the level of the first costal cartilage

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10
Q

What are the three edges of the lung?

A

Anterior, Posterior, Inferior

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11
Q

What are the three surfaces of the lung?

A

Costal, Mediastinal, Diaphragmatic

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12
Q

What does the diaphragm separate?

A

Right lung from the right lobe of the liver

Left lung from the left lobe of the liver, the stomach and the spleen

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13
Q

What is found above and behind the cardiac impression on the

mediastinal surface of the lung?

A

The hilum of the lung where the vessels, bronchi and nerves enter the lung from the mediastinum

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14
Q

Describe the arrangement of the vessels and bronchi in the hilum of the lung.

A

The pulmonary artery is superior to the pulmonary veins. Bronchus is generally superior. The left bronchus divides into lobar bronchi within the lung. The right bronchus may divide into lobar bronchi in the hilum (before entering the lung).

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15
Q

Name the lobes in the right and left lung.

A 
Right = superior, middle and inferior
Left = superior, inferior
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16
Q

Name the fissures separating the lobes.

A

Right:
Superior from Middle = horizontal Middle from Inferior = oblique Left:
Superior from Inferior = oblique

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17
Q

What structures enter of leave the hilum of the lung?

A

Pulmonary artery, pulmonary veins, bronchus, pulmonary nerve plexus, lymph vessels and nodes

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18
Q

What is the pulmonary ligament?

A

Inferior fold of pleura (below the hilum)

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19
Q

Where do the visceral and parietal pleura become continuous?

A

At the hilum of the lungs

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20
Q

What is the gap between the inferior surface of the lung and the inferior surface of the pleura called?

A

Costo-diaphragmatic recess

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21
Q

What are the attachments of the diaphragm?

A

Costal margin
Xiphoid process
Ends of ribs 11 and 12 Lumbar vertebrae

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22
Q

How do the dimensions of the thoracic cavity change when inspiring?

A

Anteroposterior diameter increases

Transverse diameter increases

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23
Q

What causes expiration?

A

Expiration is PASSIVE - it is caused by the natural recoil of the lungs

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24
Q

What happens in forced expiration?

A

The abdominal muscle contracts pushing the abdominal viscera against the diaphragm and pulling the costal margin down.

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25
Q

What are the main contents of the mediastinum?

A

Trachea, Oesophagus, Aorta, Superior Vena Cava, Heart, pericardium,
thoracic duct, nerves

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26
Q

What are the different divisions of the mediastinum?

A

Superior (above sternal angle), Inferior (below the sternal angle)
Inferior is divided into anterior, middle and posterior

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27
Q

Describe the arrangement of the vagus nerve and phrenic

nerve in the mediastinum.

A

Vagus nerve runs posterior to the airways

Phrenic runs anterior to the airways and is embedded in the pericardium

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28
Q

What vertebral level do the phrenic nerves emerge from?

A

C3, 4 and 5

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29
Q

What is the name of the connection between the pulmonary artery and the aorta? What is this a remnant of?

A

Ligamentum Arteriosum - remnant of the ductus arteriosus

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30
Q

Where does the vagus nerve go through the diaphragm?

A

T10 - along with the oesophagus

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31
Q

Describe the position and orientation of the azygous vein.

A

The azygous vein runs along the right side of the vertebral bodies and arches anteriorly over the right main bronchus to join the SVC.

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32
Q

What are the three main branches of the aortic arch?

A

Brachiocephalic trunk, left common carotid, left subclavian

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33
Q

Describe the arrangement of the veins that drain into the superior vena cava.

A

Right and Left brachiocephalic veins join together to form the SVC Each brachiocephalic vein is made up of an internal jugular vein and a subclavian vein

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34
Q

What is the nerve that branches off the vagus in the mediastinum near the left lung?

A

Left recurrent laryngeal nerve

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35
Q

What part of the diaphragm and at which vertebral level does the IVC go through the diaphragm?

A

T8

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36
Q

Where do the right and left coronary arteries arise?

A

Ascending Aorta - from just above the cusps of the aortic valve

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37
Q

Describe the position of the ascending and descending aorta in relation to the airways.

A

Ascending aorta is anterior to the airways and the arch loops around the left main bronchus posteriorly and the descending aorta is posterior to the left main bronchus.

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38
Q

What vertebral levels do the IVC, oesophagus and aorta go through the diaphragm?

A

8, 10, 12

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39
Q

Other than the internal and external carotid arteries, what other arteries supply the head and neck?

A

Vertebral arteries from the subclavian arteries

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40
Q

Where does the oesophagus begin and end?

A

C7 to T11

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41
Q

What happens to the oesophagus at T7

A

The oesophagus is to the right of the aorta above T7
Beyond T7 the oesophagus starts moving towards the left
The oesophagus also starts to bend more anteriorly

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42
Q

How many constrictions does the oesophagus have?

A

Four

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43
Q

Where are the four constrictions of the oesophagus?

A

The junction between the pharynx and the oesophagus
Where the oesophagus is crossed by the arch of the aorta Where the oesophagus is compressed by the left main bronchus At the oesophageal hiatus

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44
Q

Describe the azygos venous system.

A

The azygos vein runs along the right side of the vertebral bodies and drains the right side of the chest wall. The accessory hemiazygos (superior to the hemiazygos) and the hemiazygos drain the left side of the chest wall and drain into the azygos. The azygos then arches anteriorly over the lung root and joins the superior vena cava.

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45
Q

Describe the relations of the azygos vein.

A

Azygos vein arches anteriorly over the lung root to join the superior vena cava.

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46
Q

What structures do the phrenic nerves provide sensory and motor innervation to?

A

Motor - diaphragm

Sensory - central tendon of diaphragm, mediastinal pleura, pericardium, peritoneum of central diaphragm

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47
Q

Describe the path of the right phrenic nerve to reach the diaphragm.

A

The right phrenic nerve passes along the right brachiocephalic vein, along the superior vena cava, and along the right side of the heart and pericardium to the diaphragm.

48
Q

Describe the relations of the vagus nerves to the great arteries.

A

The vagus nerves run lateral to the two common carotid arteries.

49
Q

Describe the paths of the left vagus and left phrenic nerves.

A

The left vagus crosses anteriorly to the aortic arch. The left phrenic
nerve crosses more anteriorly in front of the aortic arch.

50
Q

Describe the path of the left recurrent laryngeal nerve.

A

The left recurrent laryngeal nerve is a branch of the left vagus nerve, which arches around the ligamentum arteriosum and moves up towards the larynx.

51
Q

Describe the path of the right recurrent laryngeal nerve.

A

The right recurrent laryngeal nerve branches off the right vagus nerve more superiorly and loops around the right subclavian artery.

52
Q

What structure does the right vagus nerve lie on?

A

Trachea

53
Q

What are the main branches of the vagus nerve?

A

Parasympathetic to the heart and lungs (control of smooth and cardiac muscle + glands of gut and airways)
Large sensory from the gut
Recurrent laryngeal nerve is NOT parasympathetic - it runs up the neck to supply most skeletal muscles of the larynx

54
Q

Which spinal nerves do the sympathetic trunk receive branches from?

A

T1-L2

55
Q

Where do the nerves to the body wall synapse?

A

In the sympathetic ganglia

56
Q

Where do the nerves to the internal organs synapse?

A

In local ganglia

57
Q

What are the fibres in the lower sympathetic trunk called and
which vertebral levels do they branch off at?

A

Splanchnic Nerves - T5-T12

58
Q

Describe the arrangement of the thoracic duct.

A

The thoracic duct begins as the cisterna chyli (L2) below the diaphragm just to the right of the aorta (between aorta and oesophagus).
The thoracic duct then crosses to the left side between T4-T7.
The thoracic duct drains into the left brachiocephalic vein.

59
Q

What do somatic spinal nerves provide somatic sensory

innervation to?

A

Body wall but NOT to viscera

60
Q

What is a dermatome?

A

An area of skin that is supplied by a single spinal nerve on one side or
from a single spinal cord level

61
Q

What is a myotome?

A

Part of a skeletal muscle that is supplied by a single spinal nerve on one
side or from a single spinal cord level

62
Q

How many intercostal nerves are there?

A

11 intercostal + 1 subcostal

63
Q

What are the branches of the intercostal nerves?

A

There is a lateral cutaneous branch (anterior and posterior branches)
and an anterior cutaneous branch (medial and lateral branches)

64
Q

What structures do the phrenic nerves provide sensory and

motor innervation to?

A

Motor = diaphragm Sensory:
Central diaphragm Mediastinal pleura Pericardium
Peritoneum of central diaphragm

65
Q

Where do sympathetic preganglionic neurones to the body wall

synapse?

A

In the ganglia of the sympathetic trunk

66
Q

Where do sympathetic preganglionic neurons to the viscera

synapse?

A

In unpaired ganglia

67
Q

The sympathetic trunk receive which spinal nerves?

A

T1-L2

68
Q

What is the significance of sympathetic fibres in spinal nerves T5-T12?

A

These are the thoracic splanchnic nerves that carry sympathetic fibres
to the abdomen.

69
Q

What are the five sets of nerves that contain parasympathetic
fibres?

A

Occulomotor (III)
Facial (VII) Glossopharyngeal (IX) Vagus (X)
Sacral spinal nerves (S2-S4)

70
Q

Which spinal nerves do sympathetic fibres to the heart and lungs come from?

A

T2-T4 passing through cervical and upper thoracic ganglia

71
Q

Where do many of these fibres synapse?

A

In ganglia of the pulmonary and cardiac plexuses rather than in the trunk ganglia

72
Q

What effect do sympathetic and parasympathetic nerves have on bronchioles?

A

Sympathetic - bronchodilation

Parasympathetic - bronchoconstriction

73
Q

What are the effect of sympathetic and parasympathetic

efferents to the heart?

A

Sympathetic - increase heart rate and force of contraction (inotropic and chronotropic effect)
Parasympathetic - decrease heart rate and vasoconstrict coronary arteries

74
Q

What are the roles of sympathetic and parasympathetic afferents from the heart?

A

Sympathetic - relay pain sensations from the heart

Parasympathetic - relay blood pressure and chemical information from the heart

75
Q

Where does the vagus nerve arise and where does it leave he skull?

A

Vagus nerves arise in the medulla and it leaves the skull via the jugular
foramina

76
Q

Describe the path of descent of the vagus nerve.

A

The two vagus nerves pass postero-laterally to the common carotid arteries.
Right vagus passes posterior to the right lung root
Left vagus nerve crosses over anterior to the aortic arch and then posterior to the left main bronchus

77
Q

What are roles of sympathetic and parasympathetic efferents from the oesophageal plexus?

A

Sympathetic - relays pain sensation from the oesophagus Parasympathetic - senses normal physiological information from the oesophagus

78
Q

Branches of the vagus provide sensory content from…?

A

Gut and lungs

79
Q

Branches of the vagus provide sensory content from…?

A

Gut and lungs

80
Q

State a feature of the left recurrent laryngeal nerve. What does it innervate?

A

It is NOT parasympathetic

It innervates most of the skeletal muscle of the larynx

81
Q

How do the vagi in the posterior and anterior mediastinum

differ?

A

In the posterior part of the oesophagus, you form the posterior oesophageal nerve which mainly takes right vagal fibres through the diaphragm to the abdominal viscera.
The left vagus provides fibres to the oesophageal plexus and then continutes as the anterior oesophageal nerve.

82
Q

How many lymph nodes are there in humans?

A

600-700

83
Q

Describe the arrangement of the lymphatics across the body.

State where the lymphatics join the venous circulation.

A

Right upper quadrant drains into the right subclavian vein. Other three quadrants all drain via the thoracic duct into the left subclavian vein.

84
Q

What is the size of a normal lymph node?

A

<2.5 cm

85
Q

What is a common cause of lymphadenopathy?

A

Infection

86
Q

What is lymph usually like?

A

Colourless and odourless

87
Q

How is lymph from the small intestines different? What is it

called?

A

It is opaque and milky due to absorption of fats (chylomicrons) It is called chyle

88
Q

What causes movement of lymph through the vessels?

A

Skeletal muscle contraction

Pulses in arteries

89
Q

What prevents backflow in the vessels?

A

Valves

90
Q

What three groups of lymph nodes does the thoracic wall drain to?

A

Parasternal (associated with internal thoracic arteries)
Intercostal
Diaphragmatic

91
Q

Which larger lymph vessels do these three groups of nodes drain to?

A

Parasternal - bronchomediastinal trunk
Upper intercostal - bronchomediastinal trunk
Lower intercostal - thoracic duct
Diaphragmatic - brachiocephalic nodes + aortic/lumbar part of the thoracic duct
Superficial - axillary and parasternal nodes

92
Q

Where does the thoracic duct start? State the vertebral level.

A

It begins with the cysterna chyli - L2

93
Q

Describe the path of ascension of the thoracic duct.

A

The thoracic duct ascends just to the right of midline, in between the aorta and the azygos vein. It crosses over to the left side at T5 and it then empties into the left subclavian vein.

94
Q

Where do the lymphatics in the lungs drain to?

A

Tracheobronchial nodes - this is the largest collection of lymph nodes in the body

95
Q

What do the tracheobronchial lymph vessels join with and what does this form?

A

Tracheobronchial lymph vessels join the parasternal and brachiocephalic lymph vessels to form the BRONCHOMEDIASTINAL trunk

96
Q

Describe the lymphatic drainage of the heart

A

Lymphatic drainage of the heart follows the coronary arteries and drains into the:
Tracheobronchial nodes
Brachiocephalic nodes

97
Q

What do the nodes on the aorta receive lymph from?

A

Oesophagus, diaphragm, pericardium and liver

98
Q

Where do the nodes on the aorta drain to?

A

Thoracic duct and posterior mediastinal nodes

99
Q

What marks the base of the breast?

A

Rib 2 - Rib 6 (midclavicular line)

100
Q

What muscles underlie the breast?

A

Pectoralis Major

Laterally: Serratus Anterior + External Oblique

101
Q

What subunits are the breast made of? How many of them are

there?

A

Ductal Lobular Units - 15-20 of them

102
Q

How many milk ducts are there in the breast?

A

4-18

103
Q

What is interspersed between the ductal lobular units?

A

FAT

104
Q

What structures divide the breast?

A

Fibrous septae - Suspensory ligaments of Cooper

105
Q

What are the two views in a mammogram?

A

Cranio-Caudal

Medial-Lateral Oblique (MLO)

106
Q

Is the upper part of a cranio-caudal mammogram the lateral or
medial side?

A

Lateral

107
Q

What can breast cancer cause that appears as white streaks

following the ducts?

A

Microcalcification

108
Q

What happens if the tumour interferes with the suspensory

ligaments of Cooper?

A

Tethering of the skin

109
Q

Describe the blood supply to the breast

A 
Rich blood supply with branches from:
Internal thoracic artery
Lateral thoracic artery
 Thoraco-dorsal artery
Thoraco-acromial artery
Intercostal arteries
110
Q

What nerves are mainly involved in providing sensory innervation to the breast?

A

Anteromedial and anterolateral branches of intercostal nerves T3-T5

111
Q

What nerve supplies the nipple?

A

lateral cutaneous branch of the intercostal nerve T4

112
Q

How are benign lumps different to breast cancer?

A

They are smooth and longer than they are tall in the longitudinal place

113
Q

Where does the lymph from the superficial and deep parts of the breast initially drain to?

A

Superficial - subareolar plexus

Deep - submammary plexus

114
Q

Where does the lymph from the superficial and deep parts of the breast drain to after the plexuses?

A

Axillary group of pectoral lymph nodes

115
Q

When using dye to identify the sentinal lymph node, two blobs can appear on the X ray. What is the large blob usually caused by?

A

Bigger blob is probably the site of injection of the dye

Anatomy of Thorax (4 decks)

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