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MRCS anatomy > Thorax- thoracic wall/pleural cavities > Flashcards

Thorax- thoracic wall/pleural cavities Flashcards

1
Q

Muscles of thoracic wall

A

External intercostal

Internal intercostal

Innermost intercostal

Subcostales

Transversus thoracis

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2
Q

Origin and insertio of subcostales

A

Internal surface of lower ribs to internal surface of second or third rib below

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3
Q

Origin and insertio of transversus thoracis

A

Inferior margin of 2-6th rib to inferior aspect of sternum, xiphoid and ribs 4-7

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4
Q

Innervation of muscles of thoracic wall

A

Intercostal nerves

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5
Q

Action of subcostales

A

May depress ribs

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6
Q

Action of transversus thoracis

A

Depress costal cartilages

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7
Q

Where do you find the vasculature in relation to ribs

A

Inferior border

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8
Q

Arterial supply of thoracic wall

A

Internal thoracic artery gives

  • intercostal arteries
  • superior gastric artery
  • musculophrenic artery
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9
Q

Venous drainage of thoracic wall

A

Intercostal veins either into azygous, hemiazygos and accessory hemiazygos veins or internal thoracic vein

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10
Q

Chest drain insertion site

A

Lat dorsi, Pec major, apex of axilla and horizontal line across nipple

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11
Q

Where is suprapleural membrane

A

Covers superior aspect of cervical pleura

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12
Q

Where is the root of the lung

A

Mediastinal pleura between T5-T7 reflects off mediastinum

Covers lymph, vessels, nerves

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13
Q

Structures at the hilum of the lungs

A

Anterior to posterior:

Pulmonary artery, pulmonary veins

Bronchus

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14
Q

Ribs levels of lungs mid-clavicular, mid-axillary, and posteriorly

A

Anterior: 6th rib

Mid-axillary: 8th rib

Posteriorly: 10th rib

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15
Q

Ribs levels of pleura mid-clavicular, mid-axillary, and posteriorly

A

mid-clavicular: 8th rib

mid-axillary 10th rib

posteriorly 12th rib

(2 spaces below the lungs)

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16
Q

Trachea vertebral level

A

C6 to T4/5 (sternal angle)

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17
Q

Bronchal tree from proximal to distal

A

Main bronchus

Lobular bronchus

Segmental bronchus (*10 segments each)

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18
Q

Innervation of lungs

A

Vagus- constricts bronchioles

Sympathetic- dilates bronchioles

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19
Q

Lymph drainage of lungs

A

Other lymphs drain into bronchomediastinal lymph nodes

Which drain into deep veins at the base of neck/thoracic duct/right lymphatic trunk

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20
Q

Subclavian artery branches

A

VIT C&D

Vertebral

Internal thoracic

Thyrocervical

Costocervical

Dorsal scapular

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21
Q

Branches of thyrocervical artery

A

Inferior thyroid

Suprascapular

Transverse cervical

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22
Q

Branches of costcervical artery

A

Deep cervical

Highest intercostal

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23
Q

Which muscles does the breast lay anterior to

A

Pec major

Serratus anterior

External oblique

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24
Q

Arterial supply of breast

A

Internal mammary (thoracic) artery (subclavian a)

Lateral thoracic artery (axillary a)

Anterior intercostal arteries

Thoraco-acromial artery

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25
Q

Extension of parietal pleura into cervical region

A

Cupola: extends 2.5 cm above clavicle

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26
Q

Fascia between innermost intercostal muscle and pleura

A

endothoracic fascia

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27
Q

Which ribs level is costophrenic angle found

A

8-10

28
Q

Where is stellate ganglion situated

A

Inferior cervical ganglion fuses with suoerior thoracic ganglion, forming stellate ganglion at level of C7

Anterior to neck of first rib

Anterior to scalene medius, posterior to subclavian artery

Compression results in horner syndrome sx

29
Q

Position of recurrent laryngeal nerve in relation to oesophagus and trachea

A

Runs in the middle

30
Q

What is azygous lobe

A

Commonest accessory lobe seen in 1% of pts

Azygous vein leaves a deep impression in the lung on that side during development

31
Q

Azygous lobe appearance on xray

A

reverse comma sign

32
Q

Where is aztgous lobe found

A

Right upper lobe

33
Q

How many bronchopulmonary segments in each lung

A

10

34
Q

Sympathetic ganglions

A

Paravertebral and prevertebral

35
Q

Where are paravertebral ganglia located

A

anterior to abdo aorta

Coeliac, Superior mesenteric and inferior mesenteric ganglia

36
Q

Where are perivertebral ganglia found

A

Parallal to the spinal cord, from base of the skull down to pelvis, joining to form ganglia impar

37
Q

Sympathetic innervation of head and neck

A

Branches of peri-arterial carotid nerve plexus

T1-T3

38
Q

Sympathetic innervation of thorax

A

Cardiopulmonary splanchnic nerves

T4-T6

39
Q

Sympathetic innervation of abdomen

A

Greater, lesser and least splanchnic nerves

and

Coeliac, SM, IM plexuses

T7-T11

40
Q

Sympathetic innervation of pelvis

A

Lumbar splanchnic nerve

T12-L3

41
Q

Parasympathetic innervation of body

A

CN3, 7, 9, 10

and

Pelvic splanchnic nerve

42
Q

Pelvic splanchnic nerve aka

A

nerve erigentes

43
Q

Route of thoracic duct

A

Ascends through aortic opening of diaphragm, to the right of descending aorta

Goes up posterior to oesophagus, when it crosses to the left side at T5

Ascends to the left of the oseophagus

Crossess the left subclavian artery to enter left brachiochalic vein

44
Q

Areas of the body drained by thoracic duct

A

3/4 of body except the top right

45
Q

Path of azygous vein in relation to right main bronchus

A

First posterior

Then arches superior to the right main bronchus

46
Q

Sympathetic chain course through thorax and abdomen

A

Lateral to aorta and oesophagus

Enters abdo posterior to medial arcuate ligament over psoas major

47
Q

Relation of vagus nerve to oesophagus

A

Left vagus: anterior to oesophagus

Right vagus: posterior to oesophagus

48
Q

Sibsons fascia

A

Suprapleural fascia

49
Q

Which artery at risk in level one axillary dissection

A

Thoraco-dorsal branch of subscapular artery

50
Q

Which artery is at risk in level 3 axillary dissection

A

thoraco-acromial

51
Q

Surface marking for lung fissures

A

Oblique → transverse process of T2 to 6th costal cartilage

Horizontal → under the 4th rib

52
Q

Name different parts of the sternum and their vertebral level

A

Jugular notch: T2-3

Angle of louis: T4-5

Xiphoid process: T9

53
Q

Sensory nerve supply of diaphragm

A

Central: phrenic (C3-5)

Peripheral: T5-T12

Central irritation such as splenic rupture refers to shoulder (C3-5)

54
Q

Blood supply to diaphram

A

Superior and inferior phrenic from aorta

Musculophrenic from internal mammary

55
Q

Describe female breast anatomy

A

Ducts + Glands + fat

Terminal duct-lobular units produce milk → 10-20 lactiferous ducts converging into the nipple with individual openings

56
Q

Cooper ligament of breast

A

Supports the glandular tissue of the breast

From Dermis to deep fascia/posterior capsule behind breast

Support the shape of a young breast, but weaken with age

57
Q

Lymph drainage of breast

A

Lateral parts mainly drained by axillary lymph nodes

Medial parts mostly by internal thoracic nodes

Multiple valveless channels connecting the 2 systems

58
Q

Borders of the breast base

A

2nd to 6th intercostal space

Lateral sternum to mid axillary line

59
Q

Blood supply of breast

A

Laterally: lateral thoracic

Medially: internal mammary

Inferiolateral: intercostal vessels

Deep: perforators to pec major (thoracoacromial trunk)

60
Q

Nerve supply to breast skin

A

Supraclavicular (C3-4)

branches of intercostal nerves

intercostobrachial nerve

61
Q

Which nerve supplies sensory to nipple

A

Fourth intercostal

62
Q

Typical rib appearance

A

Facet on tubercle joins facet on transverse process

Facet on head joins facet on vertebral body

63
Q

First rib anatomy

A

Scalene tubercle: attachment for scalene anterior

64
Q

What layers do you go through for subclavian vein cannulation

A

Skin

Subcut fat

Deep fascia

Pec major

Clavicopectoral fascia

Subclavius

Subclavian vein wall

65
Q

Structures at risk of damage during subclavian vein cannulation

A

Subclavian a

Phrenic n

Apex of lung

Thoracic duct (on the left side)

MRCS anatomy (27 decks)

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