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MRCEM Primary > Thoracic anatomy > Flashcards

Thoracic anatomy Flashcards

1
Q

Which 2 ribs does the manubrium articulate with?

A

1st and 2nd

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2
Q

The sternal angle marks the level of which costal cartilage?

A

2nd

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3
Q

The tip of the xiphisternum is located at which vertebral level?

A

T10

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4
Q

Name the 5 atypical ribs

A

1
2
10
11
12

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5
Q

Which muscle originates from rib 2?

A

Serratus anterior

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6
Q

Which muscle inserts onto rib 1?

A

Scalenus anterior

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7
Q

Which are the true ribs?

A

1-7

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8
Q

Where do true ribs attach to anteriorly?

A

The sternum

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9
Q

Which ribs are the false ribs?

A

8-10

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10
Q

Where do the false ribs attach to?

A

Costal cartilages superior to them

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11
Q

Which are the floating ribs?

A

Ribs 11 and 12

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12
Q

Where do the floating ribs terminate?

A

Do not have an anterior attachment - they end in the abdominal musculature

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13
Q

Which vertebra does the first rib articulate with?

A

T1

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14
Q

Which 3 muscles form the innermost layer of the thoracic wall?

A

Transversus thoracis (most superficial)
Innermost intercostals
Subcostals

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15
Q

Which muscles form the internal layer of the thoracic wall?

A

Internal intercostals

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16
Q

Which muscles form the external layer of the thoracic wall?

A

External intercostals

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17
Q

What is the innervation of the transversus thoracis?

A

Intercostal nerves T1-T11

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18
Q

The transversus thoracis is continuous with which muscle inferiorly?

A

Transversus abdominis

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19
Q

What separates the innermost intercostals from the internal intercostals?

A

Intercostal neuromuscular bundle

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20
Q

What is the innervation of the innermost intercostals?

A

Intercostal nerves

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21
Q

What is the function of the muscles in the innermost layer of the thoracic wall?

A

Depress the rib cage

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22
Q

What is the innervation of the subcostals?

A

Intercostal nerves

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23
Q

How many pairs of internal intercostal muscles are there?

A

11

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24
Q

The internal intercostals are continuous with which muscles?

A

Internal obliques

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25
Q

What is the innervation of the internal intercostals?

A

Intercostal nerves

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26
Q

What is the function of the internal intercostals?

A

Depress the rib cage (decrease thoracic volume)

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27
Q

How many pairs of external intercostals are there?

A

11

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28
Q

What are the external intercostal muscles continuous with?

A

The external obliques

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29
Q

What is the innervation of the external intercostals?

A

Intercostal nerves

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30
Q

What is the function of the external intercostals?

A

Elevate the ribcage (increase thoracic volume)

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31
Q

The central tendon of the diaphragm fuses with the inferior surface of which structure?

A

Fibrous pericardium

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32
Q

Which vertebral level is the caval hiatus at?

A

T8

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33
Q

Which vertebral level is the oesophageal hiatus at?

A

T10

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34
Q

Which vertebral level is the aortic hiatus at?

A

T12

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35
Q

Which structures pass through the caval hiatus?

A

IVC
Terminal branches of right phrenic nerve

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36
Q

Which structures pass through the oesophageal hiatus?

A

Oesophagus
Right and left vagus nerves
Oesophageal branches of left gastric artery + vein

37
Q

Which structures pass through the aortic hiatus?

A

Aorta
Azygous vein
Thoracic duct

38
Q

What is the motor innervation of the diaphragm?

A

C3-C5

39
Q

What are the accessory muscles of inspiration?

A
40
Q

What are the accessory muscles of expiration?

A
41
Q

Describe the ‘pump-handle’ movement in inspiration.

A

Where ribs 2-6 cause the sternum to move up and out in the sagittal plane on inspiration.

42
Q

Describe the ‘bucket-handle’ movement in inspiration.

A

Where the lateral portions of ribs 7-10 move up and out in the coronal (frontal) plane on inspiration.

43
Q

What is the anterior border of the thoracic inlet?

A

Superior border of the manubrium and costal cartilage of 1st rib.

44
Q

What is the lateral border of the thoracic inlet?

A

1st pair of ribs

45
Q

What is the posterior border of the thoracic inlet?

A

T1

46
Q

What are the superior relations of the thoracic inlet?

A

Root of neck
Brachial plexus (superolateral)

47
Q

What are the anterior relations of the thoracic inlet?

A

Manubrium

48
Q

What are the inferior relations of the thoracic inlet?

A

Superior mediastinum

49
Q

Name the structures that pass through the thoracic inlet.

A

Trachea
Oesophagus
Thoracic duct
Lung apexes
Nerves (phrenic, vagus, recurrent laryngeal, sympathetic trunks)
Arteries (common carotid, subclavian)
Veins (internal jugular, brachiocephalic, subclavian)
Lymph nodes and lymphatic vessels

50
Q

What causes thoracic outlet syndrome?

A

Compression of subclavian artery or C8/T1 nerves.

51
Q

Give the causes of thoracic outlet syndrome.

A

Cervical rib
Enlarged C7 transverse process
Muscular abnormalities
Neck trauma
Tumours (pancoast)
Subclavian artery aneurysm

52
Q

Thoracic outlet syndrome usually presents with a gradual onset of which features?

A

Neurological and vascular features

53
Q

Describe vascular features of thoracic outlet syndrome.

A

Weak radial pulse
Low BP
Limb pallor on elevation
Raynaud’s
Adson’s sign positive

**All above happen on affected side

54
Q

Describe some sensory features of thoracic outlet syndrome.

A

Pain or paraesthesia on ulnar border of hand or distal forearm
Sensory deficit (aggravated by exercise)

55
Q

Describe some motor features of thoracic outlet syndrome.

A

Weakness or wasting corresponding to part of brachial plexus involved
Wasting of thenar muscles

56
Q

Where does the trachea arise?

A

Lower border of cricoid cartilage (C6)

57
Q

Where does the trachea bifurcate?

A

Sternal angle (carine = T5)

58
Q

Which epithelium lines the conducting respiratory airways?

A

Ciliated pseudo stratified columnar epithelium (with interspersed goblet cells)

59
Q

What are the 6 anterior relations of the trachea in the neck?

A

Isthmus of thyroid gland
Inferior thyroid veins
Thyroid ima artery (in 10%)
Sternohyoid
Sternothyroid
Cervical fascia

60
Q

What are the 6 anterior relations of the trachea in the thorax?

A

Manubrium
Remains of thymus
Left brachiocephalic vein
Aortic arch
Brachiocephalic trunk
Left common carotid artery

61
Q

What are the 2 posterior relations of the trachea in the neck?

A

Oesophagus
Vertebral column

62
Q

What are the 2 posterior relations of the trachea in the thorax?

A

Oesophagus
Vertebral column

63
Q

What are the 6 lateral relations of the trachea in the neck?

A

Common carotid arteries
Right and left lobes of thyroid
Recurrent laryngeal nerves
Internal jugular
External jugular
Omohydoid

64
Q

What are the 4 lateral RHS relations of the trachea in the thorax?

A

Pleura
Right vagus nerve
Brachiocephalic trunk
Azygous vein

65
Q

What are the 6 lateral LHS relations of the trachea in the thorax?

A

Pleura
Left recurrent laryngeal nerve
Aortic arch
Left common carotid artery
Left subclavian vein
Thoracic duct

66
Q

What is the thymus?

A

A specialise primary lymphoid organ of the immune system where T cells mature.

67
Q

Where is the thymus located?

A

Within superior mediastinum, posterior to manubrium.

68
Q

Where is the cortex of the thymus located?

A

Peripherally within each follicle of the thymus.

69
Q

What is the cortex of the thymus mainly composed of?

A

Lymphocytes supported by a network of branches of epithelial reticular cells.

70
Q

Where is the medulla of the thymus located?

A

In the centre of each follicle

71
Q

What cells are found within the medulla of the thymus?

A

Epithelial reticular cells
Reticulocytes (though fewer than in cortex)
Hassall’s corpuscles (remains of epithelial tubes)

72
Q

The thymus is derived from which embryological structure?

A

3rd pharyngeal pouch

73
Q

What happens to the thymus after pubity?

A

Decreases in size

74
Q

What is divided for a median sternotomy to be performed?

A

Incision made to divide sternum.
No muscle layers involved.

75
Q

Where is the incision for an anterolateral thoracotomy made?

A

Incision is made in 4th intercostal space extending from the sternal edge to the midaxillary or posterior axillary line.

76
Q

Which muscle layers are divided for an anterolateral thoracotomy?

A

Pectoralis major
Pectoralis minor
Anterior parts of serratus anterior
Intercostal muscles

77
Q

What happens to perform a clamshell thoracotomy?

A

Bilateral anterolateral thoracotomy where the sternum is also divided.

78
Q

Which muscles are divided in a posterolateral thoracotomy?

A

Latissimus dorsi
Serratus anterior
Intercostal muscles

79
Q

What are the 3 groups of lymph nodes which receive lymph from breast tissue?

A

Axillary (75%)
Parasternal (20%)
Posterior intercostal nodes (5%)

80
Q

Where does lymph from the nipple and areola drain?

A

Subareolar lymphatic plexus

81
Q

Where should chest drains be inserted?

A

The safe triangle

82
Q

What are the 4 borders of the safe triangle?

A

Base of axilla
Lateral border of latissimus doors
Lateral border of pectorals major
5th intercostal space

83
Q

Where should a large bore annul be inserted for a thoracocentesis in adults?

A

4th or 5th intercostal space in the mid-axillary line.

84
Q

Where should a large bore annul be inserted for a thoracocentesis in children?

A

2nd intercostal space MCL

85
Q

What type of thoracotomy is used as a resuscitative thoracotomy?

A

Anterolateral

86
Q

When should a left sided resuscitative thoracotomy be used?

A

Traumatic cardiac arrest
Those with left sided injuries

87
Q

When should a right sided resuscitative thoracotomy be used?

A

In patients who have not arrested but have profound hypotension and right sided chest injuries

88
Q
A

MRCEM Primary (39 decks)

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