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Anatomy > thorax (SEM 2) > Flashcards

thorax (SEM 2) Flashcards

1
Q

1st rib order of structures that pass above (on superior surface)

A 
subclavian vein
scalene anterior to scalene tubercle
subclavian artery
brachial plexus
scalene medius
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2
Q

platysma

A 
facial nerve (cervical)
pulls corners of mouth down and mandible down to open mouth
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3
Q

what articulates with the facets of the vertebrae (Demi and costal)

A

costal transverse = tubercle of rib

demi + inferior demi of above vertebrae = rib head

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4
Q

true/false ribs

A 
1-7 = true
8-12 = false
11-12 = floating
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5
Q

pectoralis major

pectoralis minor

A

major:

  • ORIGIN: clavicle, sterno-costal cartilages, manubrium
  • INSERTION: inter-tubercular groove
  • INNERVATION : medial + lateral pectoral nerves

minor:

  • ORIGIN: ribs 3-5
  • INSERTION: coracoid process of scapula
  • INNERVATION: onlymedial
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6
Q

serrates anterior

A

Origin: external surfaces of 1-8th ribs
Insertion: medial border of scapula
long thoracic nerve (winged scapula)

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7
Q

serrates anterior

A

Origin: external surfaces of 1-8th ribs
Insertion: medial border of scapula
long thoracic nerve (winged scapula)

long thoracic = C5-7 roots of brachial plexus

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8
Q

paralysis of diaphragm

A

HEMI-DIAPHRAGM:
each dome has a separate nerve supply
On x-ray the paralysed dome appears higher

Instead of descending on inspiration, the paralysed dome is pushed superiorly by the abdominal viscera that are being compressed by the active side

The diaphragm falls during expiration in response to the positive pressure in the lungs

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9
Q

paralysis of diaphragm

A

HEMI-DIAPHRAGM:
each dome has a separate nerve supply
On x-ray the paralysed dome appears higher

Instead of descending on inspiration, the paralysed dome is pushed superiorly by the abdominal viscera that are being compressed by the active side

The diaphragm falls during expiration in response to the positive pressure in the lungs

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10
Q

internal thoracic artery

A

aka internal mammary artery
from subclavian
travels lateral to sternum

gives off many branches

divides into musculophrenic and superior epigastric at 6th intercostal space

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11
Q

Thoraco-acromial artery and vein

Lateral thoracic artery(external mammary artery)

A

both from 2nd part of axilla

thoraco-acromial = anterior axillary wall

Lateral thoracic = anterior+medial axillary wall
-gives rise to lateral mammary

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12
Q

medial and lateral pectoral nerve origin

thoracodorsal nerve

A

medial - medial cord of brachial plexus

lateral - lateral cord of brachial plexus
(both for major; only medial for minor)

thoracodorsal - posterior cord (supplies lattisumus dorsi)

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13
Q

blood supply of breast

A

medial(from internal thoracic)

and lateral mammary(from lateral thoracic) artery/veins

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14
Q

lymphatic drainage of breast

A

axillary lymph nodes
APICAL:
–Apical - medial to axillary vein, superior to pectoralis minor
-Posterior(subscapular) - along subscapular vessels
-Infra-clavicular -
-Central - near base of axilla
-Anterior (pectoral)- deep to pectoralis major
-Lateral (humeral) - behind axillary vein

medial breast) drains to the parasternal lymph nodes or the opposite breast

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15
Q

how are the axillary lymph nodes divided in surgical practice

A

divided into 3 levels in relation to the pectoralis minor

  • Level I : lateral to the lateral border of the muscle
  • Level II: behind the muscle
  • Level III: medial to medial border of muscle
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16
Q

deviation of the nipple and produce a leather-like, thickened appearance of the skin of breast - why?

A

Interference with the lymphatic drainage of the chest by cancer

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17
Q

anterior and posterior continuation of innermost intercostal muscles

A

anterior = transversus thoracis (sternocostalis)
-from posterior lower sternum/xiphoid to the inner costal cartilages of ribs 2-6

posterior = subcostalis (near angles of rib)

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18
Q 
intercostal arteries
(in each intercostal space there is 1 posterior, 2 anterior)
A

11 posterior(right are longer due to aorta being on left)

  • Upper 2 arise from supreme intercostal artery (branch of costocervical)
  • Lower 9 arise from back of thoracic aorta

9 anterior (2 in each space)

  • Upper 6 arise from internal thoracic artery
  • Lower 3 arise from musculophrenic artery

Upper anterior intercostal artery anastomoses with corresponding posterior intercostal artery.

Lower anterior intercostal artery anastomoses with collateral branch of the corresponding posterior intercostal artery.

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19
Q

intercostal nerves

A

within costal groove of ribs

In the 8th intercostal space, the nerve crosses deep to the costal margin and enters the anterior abdominal wall

The increasing obliquity of the intercostal nerves such that T10 supplies the level of the umbilicus and T12 supplies the skin at the supra-pubic level

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20
Q

chest drains

Thoracic Anaesthesia

A

CHEST DRAINS
above a rib to avoid structures in costal groove

done if haemothorax/pneumothorax/pleural effusion(inflammatory fluid)

THORACIC ANAESTHESIA
below a rib –> intercostal nerve between the paravertebral line (between transverse processes of vertebrae)

due to skin usually supplied by more than 1 nerve - doesn’t usually lead to complete loss of sensation unless >2 intercostal nerves are anesthetized

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21
Q

thoracic outlet syndrome

A

abnormal compression of brachial plexus

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22
Q

two roughened areas of 2nd rib

A

anterior - scalene anterior

posterior (superior) - scalene posterior

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23
Q

which ribs only articulate with one demi facet

A

1,10,11,12

24
Q

axillary artery border

A

lateral border of 1st rib to inferior border of teres major

25
Q

in a left tension pneumothorax which direction is the heart pushed towards

A

right

26
Q

pleural recesses

A

during quiet breathing lungs don’t fill these spaces of pleural cavity

Costo-diaphragmatic recess
Costo-mediastinal recess

27
Q

what does the pleural cavity become when lungs collapse

A

real space

28
Q

fissures of lung

A

oblique
T3–>6th rib

horizontal (right) 4th

29
Q

azygos lobe

A

on right where azygous vein may arch over the apex of right lung (instead of right hilum)

30
Q

mediastinum compartments

A

superior and inferior (t4/5 tans-thoracic plane)

inferior

  • anterior (thymus)
  • middle
  • posterior
31
Q

difference in position of mediastinum structures when standing/lying down

A

When lying down:

  • Arch of aorta lies superior to the transverse thoracic plane
  • Bifurcation of the trachea is transected by the plane
  • The central tendon of the diaphragm (or the diaphragmatic surface or inferior extent of heart) lies at the level of the xiphisternal junction and vertebra T9

When standing:

  • Arch of aorta is transected by the thoracic plane
  • Tracheal bifurcation lies inferior to the plane
  • Central tendon of diaphragm may fall to the level of the middle of the xiphoid process and the T9/10 intervertebral disc
32
Q

Transverse pericardial sinus

A

behind aorta and pulmonary trunk

Surgeons can stop or divert the circulation of blood of these arteries while performing surgery

33
Q

Cardiac Tamponade

A

heart compression as fibrous pericardium is tough and cannot expand

Thus reduces CO and circulation of blood

34
Q

coronary veins

A

Middle cardiac vein (back) - runs with posterior descending artery

Small cardiac vein (right) - runs with right coronary artery

Great cardiac vein (left) - runs with circumflex + LAD

35
Q

sensory innervation of pleura

A

Both intercostal nerves (From anterior rami) and phrenic nerves (From C3, C4 and C5 spinal nerves) provide sensory innervation for the PARIETAL pleura. —> referred pain

The visceral pleura receive no sensory innervation

36
Q

Insertion of a chest tube

A

Fluid (e.g. blood, pus) tends to accumulate in the costo-diaphragmatic recess (due to gravity). This would typically be removed with a chest tube. Chest tubes are inserted in the 5th intercostal space in the mid axillary line to avoid any vital structures.

37
Q

Malignant mesothelioma

A

The mesothelium is the epithelial lining of the pleura. This is the cell origin of malignant mesothelioma, which is a rare cancer associated with asbestos exposure that has a particular poor prognosis.

38
Q

how does sympathetic/parasympathetic innervation affect the bronchioles/ pulmonary vessels

A

sympathetic

  • bronchodilation
  • vasoconstriction

parasympathetic (vagus)

  • bronchoconstriction
  • vasodilation
39
Q

3 hiatuses of diaphragm

A

T8- CAVAL through central tendon

T10- oesophageal

T12 - aortic behind diaphragm(median arcuate ligament)

vena cava/aorta not affected by muscle contraction

40
Q

blood supply of diaphragm

A

superior supply

  • superior phrenic (thoracic aorta)
  • musculophrenic (internal thoracic)
  • pericardiacophrenic (internal thoracic)

inferior supply
-inferior phrenic artery (from abdominal aorta)

41
Q

ligaments of diaphragm + what passes through them

A
  • Median arcuate ligament is attaches together via the right(to3rd) and left crus(2nd lumbar vertebrae)
  • aorta*
  • Medial arcuate ligament is from the vertebral body to the transverse process
  • psoas major/ sympathetic chain*
  • Lateral arcuate ligament is from the transverse process to the 12th rib
  • quadratus lumborum*
42
Q

recurrent pharyngeal nerve (branch of vagus) loops around what

A

left = aorta

right = subclavian

43
Q

which vagus nerve make up posterior/anterior oesophageal plexus vagal trunk

A

left = anterior

right = posterior

44
Q

splanchnic nerves (roots from sympathetic chain)

A

T5-T9 form the greater splanchnic nerve (to foregut)

T10-T11 form the lesser splanchnic nerve (to midgut)

T12 forms the least splanchnic nerve (to kidneys)

45
Q

T1-T5 sympathetic chain form what plexuses

A

Cardiac plexus
Pulmonary plexus
Aortic plexus
Oesophageal plexus

46
Q

3 constrictions of the oesophagus

A
  1. Upper/pharyngeal constriction
  2. Middle/aortic constriction
  3. Inferior/diaphragmatic constriction
47
Q

where does thoracic duct start and empty

A

start = cisterna chyli

empties into the point where the internal jugular and left subclavian veins join in the neck

it runs up via aortic hiatus (diaphragm) and then behind oesophagus

48
Q

tracheobronchial lymph nodes (4)

A

Tracheal - either side of trachea

Bronchial - in the angles between lower part of trachea and bronchi and in the angle between the 2 bronchi
(usually black due to smoke)

Bronchopulmonary - in the hilum of each lung

Pulmonary - in the parenchyma(lung tissue that also surrounds alveoli), on the larger branches of the bronchi

49
Q

oblique pericardial sinus

transverse pericardial sinus

A

oblique pericardial sinus lies posterior to the left atrium, you can get to it if your finger from the apex (posterior side) of the heart and move it up, you will slip it into the oblique pericardial sinus.

transverse pericardial sinus is between the aorta and pulmonary arteries in front, and superior vena cava behind.

50
Q

Pericardial reflections

A

parietal layer is continuous with visceral layer around the roots of the great vessels forming pericardial reflections

51
Q

modulator band in the heart

A

in right ventricle

carries the right bundle branch of the AV bundle of the conduction system of the heart to the anterior papillary muscle

52
Q

most common place for aortic Coarctation and what happens if it occurs inferior to this site

A

near the point of attachment of the ligamentum arteriosum

collateral circulation may develop between the proximal and distal parts of the aorta through the intercostal and internal thoracic arteries.

53
Q

branches of thoracic aorta

A

Visceral

  • Bronchial arteries
  • Oesophageal arteries
  • Pericardial arteries

Parietal

  • Superior phrenic arteries
  • Posterior intercostals arteries (lower 9 pairs)
  • Subcostal arteries (1 pair)
54
Q

further triangle divisions of anterior triangle

A

Carotid
Muscular
Digastric
Sub-mental

55
Q

torticollis

A

abnormal position of neck for a long time due to no innervation to move on one side

(eg. no accessory nerve innervation to SCM)

56
Q

azygos system

+ tributaries of azygous vein

A

drainage of posterior thoracic wall:

Right:

  • superior intercostal vein(2nd-4th intercostal spaces) drains to azygos vein
  • azygos vein drains into SVC

left:

  • Hemiazygos(left ascending lumbar+ left subcostal) - drains to azygos
  • Accessory hemiazygos(4th-8th Posterior intercostal) - drains to azygos
  • Left superior intercostal - drains 2nd-4th intercostal spaces to the left brachiocephalic vein

azygos vein = RIGHT subcostal vein + RIGHT ascending lumbar vein (tributaries from 4th-11th,subcostal, hemiazygos,a.hemiazgous, oesophageal and right bronchial)

57
Q

what is the 1st intercostal (posterior) vein called

A

SUPREME intercostal vein

Anatomy (12 decks)

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