Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anatomy for MRCS > Anatomy of the Thorax > Flashcards

Anatomy of the Thorax Flashcards

(81 cards)

Start Studying
1
Q

Boundaries of root of neck / superior thoracic aperture?

A

Anterior aspect of body of T1, medial part of rib 1, manubrium anteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Boundaries of inferior thoracic aperture?

A

Posteriorly = Vertebral body of rib 12.
Lower border of rib 12 and distal end of rib 11, cartilaginous ends of ribs 7-10
Xiphoid process anteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Relation of subclavian vessels and brachial plexus at root of neck?

A

Subclavian vessels and brachial plexus all pass over rib one and underneath the clavicle

Subclavian vein is most superficial, on top of scalenus anterior
Subclavian artery sits between scalenus anterior and medius
Brachial plexus sits behind artery at level of rib 1 - also between the scalenus muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Rough structure of the breast?

Why does malignancy cause pitting of the skin?

A

Series of ducts and secretory tubules
These converge to form 15-20 lactiferous ducts
This is surrounded by connective stromal tissue
Areas where this tissue thickens = suspensory ligaments

Suspensory ligaments are continuous with dermis of the skin. In malignancy they tighten = pitting of skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Blood vessels, innervation and lymphatics of breast?

A

Arterial:
Lateral = branches of axillary artery = sub scapular, lateral thoracic, superior thoracic + thoraco-acromial
Medial = Via internal thoracic (also called int. mammary), which is branch of subclavian

Venous = parallels

Innervation = intercostal nerves 2-6, nipple = 4th intercostal

LN’s = Mainly axillary, some parasternal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3 Muscles of the pectoral region?

A

Pectoralis major = adducts, flexes and medially rotates humerus at shoulder
Origin. = Medial half of clavicle and sternum
Insertion = lateral lip of intertubercular sulcus
Lateral and medial pectoral nerves

Pectoralis minor = protracts scapula, depresses tip of shoulder
Origin = anterior surface of ribs 3-5
Insertion = coracoid process
Medial pectoral nerve

Subclavius = Pulls clavicle medial to stabilise SCJ
Origin = Rib 1
Insertion = Groove on inferior third of clavicle
Nerve to subclavius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Order of structures in intercostal groove?

A

Vein is most superior
Then artery
Then nerve most inferior

Intercostal groove is on inferior margin of ribs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Rib one articulation with vertebrae and grooves?

A

Only has one articular surface for body of T1

Superior surface has distinct scalene tubercle which separates two grooves:

  • anterior = Subclavian vein
  • Posterior = subclavian artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is rib 10 special?

A

Has single facet for articulation with its own vertebra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What articulation occurs on manubrium?

A

Two oval facets for clavicles
Immediately inferior = large facet for rib 1
Lower end is Demi-facets for rib 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Angle of Louis?

Landmark for 4 things….

A

Manubriosternal joint = T4/T5

Costal cartilage of 2nd ribs
Arch of aorta + tracheal bifurcation
Union of azygous and SVC
Crossing of thoracic duct over the midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sternal facets for articulation?

A

Superiorly = 2 demifacets for rib 2
Facets for rib 3-6
Inferiorly = demifacets for rib 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Xiphoid process facets for articulation?

A

Demifacets for rib 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What ligament is routinely divided in midline sternotomy?

What vessels must we be wary of?

A

Interclavicular ligament

Brachiocephalic vein, is posterior at superior aspect of sternotomy incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is cervical rib?
How many are bilateral?
Classic signs?

A

Elongation of the transverse process of C7 = fibrous band attaches to Rib 1

70% bilateral

Neurological deficit and compression of subclavian can cause radial pulse absence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Intercostal muscles? - function, origin, insertion + innervation

A

External intercostals = assist inspiration, elevate ribs
Origin = inferior aspect of rib above
Insertion = superior aspect of rib below
Intercostal nerves

Internal intercostals = assist expiration, depress ribs
- deep to the external intercostals
Origin = Lateral edge of intercostal groove above
Insertion = Superior margin of rib below
Intercostal nerve

Innermost intercostals = assist internal intercostals = expiration
Origin = medial edge of costal groove above
Insertion = internal aspect of superior margin below
Intercostal nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Arteries and veins to thoracic wall?

A

Arteries = anterior and posterior intercostal arteries
POSTERIOR:
- upper two originate from supreme intercostal artery = branch of costocervical trunk
- Other 9 pairs originate from directly from posterior aspect of aorta

ANTERIOR:

  • All supplied in some way by internal thoracic (branch of subclavian)
  • upper 6 supplied directly
  • at 6th costal cartilage, the internal thoracic splits into Musculophrenic and superior epigastric artery
  • so lower 6 anterior ones are supplied by Musculophrenic arteries

Venous mirrors this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do the upper posterior intercostal veins form and then drain into?

A

Form the superior intercostal vein
On right drains into azygous
On left into brachiocephalic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Embryology of the diaphragm?

A

Formed due to progressive fusion of septum transverse, pleuroperitoneal folds and muscular ingrowth

Septum transversum = Central tendon
Pleuro. folds = parietal membranes

Cervical somites C5-7 = muscular components

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where does central tendon attach superiorly, and what is its continuation posteriorly?

A

Superiorly attaches to pericardium

Posteriorly it forms median arcuate ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Apertures of the diaphragm?

A

I ate ten eggs at 12

IVC = T8 - right phrenic nerve too
Oesophagus = T10 - also have vagus here 
Aorta = T12 - also have thoracic duct here and azygous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Arterial supply of diaphragm?

A

Inferior and superior aspects

Superior = from pericardiophrenic and Musculophrenic = both branches of internal thoracic (subclavian)

Inferior = Superior phrenic from lower thoracic aorta directly + inferior phrenic from abdominal aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Diaphragmatic hernias?

A

Morgagni = right anterior, good prognosis, minimal disruption

Bochdalek = left posterior, scaphoid abdomen and pulmonary hypoplasia ± pulmonary HTN.
Poor prognosis and requires surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which cell type lines the pleural cavity?

A

Mesothelial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What covers the parietal pleura of the lung superiorly?
Suprapleural membrane | Attaches laterally to medial part of first rib and transverse process of C7
26
at what level is the root of lung / pleural reflection?
T5-T7
27
Lobes and fissures of each lung?
``` Right = 3 lobes + oblique and transverse fissure Left = 2 lobes + oblique fissure ```
28
Inferior border of lungs?
6th rib MCL 8th rib MAL 10th rib posteriorly
29
What does the root of the lung contain, and its arrangement? from the root, what is the inferior projection of the lung pleura called?
1 pulmonary artery 2 pulm. veins 1 main bronchus Bronchial veins, arteries and nerves Artery is superior Veins inferior Hilum posterior Inferior to root of each lung, pleura projects inferiorly = pulmonary ligament
30
Right lung - arrangement of vessels etc medially?
Right: Above hilum is azygous vein - feeds into SVC Above this is groove for SVC and right innominate vein Behind hilum is groove for oesophagus. Azygous sits posterior to this Right bronchus = wider and straighter. = foreign body Left: Above hilum = furrow for aortic arch, superiorly = groove for left subclavian Behind the hilum = vertical groove for descending aorta Left main bronchus at T6
31
What level does the pulmonary trunk bifurcate? Relations of left and right pulmonary arteries?
T4/5 Right has longer course crossing midline. - Anteroinferior to tracheal bifurcation - Passes posterior to right superior pulmonary vein, ascending aorta and SVC Left: Anteroinferior to tracheal bifurcation Passes anterior to descending aorta Posterior to superior pulmonary vein
32
Where does trachea start and what level is the tracheal bifurcation?
C6 - T4/T5
33
Tracheal relations in the neck vs thorax?
Neck: Anterior = isthmus of thyroid, Sternohyoid and sternothyroid, cervical fascia and inferior thyroid veins + thyroid ima Lateral = inferior thyroid arteries, common carotids and recurrent laryngeal POSTERIOR =. OESOPHAGUS Thorax: Anterior = Manubrium Aortic arch, left common carotids + deep cardiac plexus Lateral - right = pleura and right vagus, left. = left recurrent nerve, aortic arch, left common carotids and subclavian arteries
34
Divisions of the mediastinum?
Superior = above transverse line from angle of Louis Inferior is below this, further subdivided into..... Anterior, middle = pericardium, posterior
35
Contents of each section of mediastinum?
``` Superior: SVC, brachiocephalic veins and arch of aorta Trachea, oesophagus and thymus thoracic duct Vagus, phrenic and recurrent laryngeal ``` Anterior = LN's and fat Middle = pericardium, heart, origin of great vessels, main bronchi + arch of azygous ``` Posteiror: azygous and thoracic aorta Oesophagus thoracic duct Vagus, splanchnic and sympathetic ```
36
Structure of pericardium?
Fibroserous sac Fibrous layer = tough connective tissue - base is on diaphragm = central tendon - anteriorly connect to sternum via sternopericardial ligament - Apex continues with adventitia of vessels - Phrenic nerve passes via this fibrous layer. Serous layer = inner parietal and visceral layers - 2 reflections = oblique and transverse sinuses
37
Which nerve passes through fibrous part of pericardium?
Phrenic nerve, as do the pericardiophrenic vessels
38
Nerves and vessels of pericardium?
Arteries = internal thoracic, pericardiophrenic, Musculophrenic, and inferior phrenic Veins enter azygous system Nerve = phrenic. Referred pain to shoulder as C345
39
What are the two external sulci of the heart and what runs in them?
Coronary sulcus: - Separates the atria from the ventricles - RCA, small cardiac vein, coronary sinus and LCx Posterior interventricular sulcus = middle cardiac vein, PI artery Anterior inter ventricular sulcus = Great cardiac vein, AI artery
40
Where does the coronary sinus open into the RA?
Immediately medial to opening of SVC
41
How is right atrium divided?
From line between IVC AND SVC this line is marked internally by crista terminalis, and externally by the sulcus terminalis cordis Space posterior to crista = sinus of venae Space anterior = atrium proper
42
What defines the atrium proper, and what are its walls covered in?
Anterior to crista terminalis = atrium proper Atrium proper's walls are covered in muscular ridges = pectinate muscles
43
What does the inflow portion of RV have? What do these attach to and what do they prevent?
Trabeculae carnae / papillary muscles Some attach to the Chorda tendinae which connect to free edge of cusps of tricuspid valves = prevent eversion of valve with high ventricular pressure
44
What is the outflow tract of the RV called?
Infundibulum / conus arteriosus
45
How many cusps does pulmonary valve have, and what structure do these have to cause closure?
Three semi-lunar cusps Each has a pocket like structure = fills with bloods after ventricular contraction recoils. blood = closure
46
How does left atrial structure differ to right?
Contains musculi pectinate, BUT NOT CRISTA TERMINALIS
47
How do the trabeculae in LV differ to the ones in RV? | How do papillary muscles differ?
They are finer and more delicate . Papillary muscles = larger
48
what location would metallic valves be on CXR?
R 3rd ICS = A L 4th ICS = M R 5th ICS = T
49
Where does coronary sinus and sit and where does it receive what veins from?
Sits in coronary sulcus Great cardiac vein comes from anterior interventricular groove Middle comes from posterior Small cardiac vein drains into right atrium directly
50
What are the veins of Thesebius?
Small group of veins that drain directly into the RV and RA
51
Where does RCA originate and what does it supply?
Originates from right aortic sinus from ascending aorta Descends vertically in coronary sulcus to the posterior inter ventricular sulcus SA node in 60%, AV node in 80% posterior third of interventricular septum Right atrium Lower part of RV
52
LCA - where it originates and what it supplies?
Originates from left aortic sinus of ascending aorta Anterior 2/3rds of interventricular septum other 40% of SA node Most of LA and LV part of RV
53
Location of deep and superficial cardiac plexus?
Deep sits posterior to ascending aorta and anterior to bifurcation of trachea Superficial sits superior to bifurcation of pulmonary trunk and inferior to aortic arch
54
what gives parasympathetic supply to the heart?
Vagus
55
What level does the pulmonary trunk divide, and relations of right and left branch?
T5/T6 Right passes posterior to ascending aorta and SVC + superior pulmonary vein. Anterior and inferior to tracheal bifurcation Left passes anterior to descending aorta, anterior and inferior to tracheal bifurcation. Posterior to superior pulmonary vein
56
When does ascending aorta become aortic arch?
At second costal cartilage, where it enters superior mediastinum
57
Superior mediastinum borders?
Transverse plane above sternal angle, oblique plane from sternal notch to T1 Posterior sternum and anterior body of thoracic vertebrae
58
Contents of superior mediastinum?
TOT = trachea, oesophagus and thymus Aortic arch, azygous vein, brachiocephalic trunk + SVC Vagus, phrenic and recurrent laryngeal Thoracic duct
59
Thymus - where does it sit in the superior mediastinum, arterial supply and venous drainage? Cellular make up of thymus?
Most anterior component of superior mediastinum Arterial = internal mammary or pericardiophrenic (from internal thoracic) Venous = left brachiocephalic Cortex is tightly packed lymphocytes. Medulla is epithelial cells, concentrically arranged around a keratinised centre = HASSALLs Corpuscle
60
Branches of aortic arch?
``` First = brachiocephalic trunk 2nd = L common carotid 3rd = L subclavian artery ```
61
What is anterior trachea or oesophagus?
``` Trachea = Towards the front Oesophagus = Out back ```
62
Vagus nerve: route of right vs left?
Right: Enters sup. mediastinum between brachiocephalic trunk and vein Crosses anterior to subclavian artery, at this point gives of recurrent laryngeal. descending posterior to the trachea Crosses lateral surface of trachea and passes posterior to the root of the right lung Just before it reaches oesophagus it is crossed by azygous Left: Enters superior mediastinum posterior to left brachiocephalic vein, between the common carotid and subclavian artery Crosses left side of aortic arch anteriorly. here it gives off recurrent laryngeal, just lateral to ligamentum arteriosum. Descends posteriorly behind root of left lung Both exit with the oesophagus at T10 In oesophageal hiatus
63
Phrenic nerve: Root of right vs left?
Both enter posterior mediastinum lateral to vagus, and posterior to subclavian vein / anterior to anterior scalene / subclavian artery. Right: Continues inferiorly along right side of brachiocephalic vein and SVC Descends on right side of pericardial sac, in fibrous membrane Anterior to root of lung Leaves thorax passing through diaphragm at T8 with IVC Left: Descends across the left lateral aortic arch, SUPERFICIAL to the vagus Enters fibrous layer of pericardium, and passes anterior to left lung root Leaves thorax piercing diaphragm near apex of heart
64
Posterior mediastinum contents?
azygous and thoracic aorta Oesophagus thoracic duct Vagus, splanchnic and sympathetic
65
Oesophagus: route and relations posterior and anterior?
As it approaches diaphragm it moves left and anterior Anterior = Right pulmonary and left main bronchus + left atrium Posterior = Thoracic duct - high up is on left, lower down on right. Thoracic aorta sits on its left hand side
66
4 narrowings of the oesophagus?
Border of pharynx Aortic arch = superior mediastinum Left main bronchus = posterior Oesophageal hiatus = posterior
67
thoracic aorta boundaries? Branches?
T4-T12 Paired = posterior intercostal and superior phrenic Un paired = Bronchial, pericardial, oesophageal and mediastinal
68
When does subclavian artery become the axillary? Branches of subclavian artery?
When it reaches lateral border of first rib 1st part = Vertebral, internal thoracic and thyrocervical 2nd part = Costocervical 3rd part = Dorsal scapular
69
What does thyrocervical artery arises from, and where?
From first part of subclavian, at inner border of scalenus anterior
70
How does brachiocephalic veins form? How do these go on to form SVC?
Subclavian and internal jugular veins unite. Right brachiocephalic Is posterior to medial clavicle and descends Left brachiocephalic is posterior to medial clavicle, crosses over to the right and joins the right brachiocephalic.
71
What is the left superior intercostal vein formed of and where does it drain to?
Formed by 2/3/4 posterior intercostal veins Passes over left side of aortic arch Passes between the phrenic and vagus = medial to phrenic and lateral to vagus
72
Where does azygous vein join SVC?
Immediately before it enters right atrium
73
What are the key landmarks of the IVC?
Forms at L5 by merging of common iliac veins L1-5 = lumbar veins join L2 = right gonadal vein joins (left joins into the L renal vein) L1 = supra-renal veins and renal veins join T8 = Hepatic vein, inferior phrenic and pierces diaphragm
74
Is IVC to the right or left of midline?
Right
75
What forms the azygous vein?
Union of right ascending lumbar and right subcostal veins at L1/L2
76
How do thoracic duct and azygous vein enter thorax?
Both enter via the aortic hiatus Azygous is on the right, thoracic duct on left
77
Does azygous vein pass anterior or posterior to right lung root?
Anterior, to join SVC
78
How is the semi-azygous vein formed and how does it enter thorax? How far does it ascend? How far does accessory nerve descend?
Via left ascending lumbar and left subcostal vein joining Pierces diaphragm at left crus T9 T8
79
Whats thoracic duct a continuation of? Where does it enter thorax? How is it related to oesophagus?
Cisterna chyli in abdomen T12 Posterior to oesophagus on right, crosses to left at T5 (angle of Louis)
80
Where do left and right side of head and neck drain?
Left > subclavian and jugular . joins thoracic duct prior to inserting in left brachiocephalic vein Right side > Subclavian and jugular trunks > right lymphatic duct. > mediastinal trunk > right brachiocephalic vein
81
Thoracic vertebrae poets of attachment for ribs?
three sites: 1. Oval facet at ed of each transverse process articulates with tubercle of rib. 2. x2 demifacets on inferior and superior vertebral body. Superior articulates with head of its own rib, inferior with that of rib below.

Anatomy for MRCS (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions