Cardio-Thoracic/Mediastinum Anatomy plus Boobs Flashcards by Jason Hsu

Where is the axillary process of the breast located?

supero-lateral extension

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Why is the axillary process of the breast important

localized region of increase breast tissue = increased incidence of tumours

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between which 2 ribs is the breast usually located?

2 & 6

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Which layer are breast implants usually put?

retromammary space

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the shape of the deep coronal layer of the breast is convex?

False. Concave.

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What are the two main areas in which the breast is innervated and blood supply comes and drains?

internal thoracic (laterally from sternum)
From axilla

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Describe the lymphatics of the breast

mirrored with blood vessels

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You find a swollen lymph node in the axillary region of a female patient. Just a simple rhinovirus right?

Could be cancer.

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which ribs articulate with sternum?

upper 7 ribs

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what does rib 11 and 12 articulate with?

NOTHING!

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where does cartilage rib 8,9,10 articulate?

with rib 7 cartilage

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head of the ribs has one or two heads?

Two!
Superior
Inferior

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Why is the lateral tubercle of the rib convex?

for attachments

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describe the medial tubercle of the rib

concave, made for articulating

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what’s the costal groove for?

VAN
Vein
Artery
Nerve

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What are 3 dead give-aways that you’re looking at a thoracic vertebra?

demifacets on superior/ inferior body
facets on the transverse processes
long vertical spinous process

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what’s so great about radial ligaments?

strong as heck, break the rib long before you dislocate it

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2 places where you can find radiating ligament:

costotransverse joints

2. costovertebreal joints

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what’s a flail chest?

one rib, two breaks, floating and gets sucked in due to negative pressure while breathing: painful.

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Some poor dude comes into the ER with broken ribs, a few of which are broken twice in the same rib, he’s got pain whilst breathing. You suspect

Flail chest

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Follow the circumferential muscles of the diaphragm from sternum to vertebra, trace the journey with anatomical landmarks and take plenty of pictures along the way!

xyphoid process
costal margins
tips of rib 11/12
arcuate ligaments
left and right crus

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Left crus is longer than right. T/F?

False.

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What do the crus of the diaphragm do?

anchors the diaphragm to the vertebral bodies

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name the two muscles that pass through the arcuate ligaments:

Quadratud lumborum laterally

2. psoas medially

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What's the mickey mouse tendon?

Central tendon of the diaphragm

What level does the aorta pass through the diaphragm?

T12 between the crura

what level does the IVC pass through the diaphragm?

What level does the oesophagus pass through the diaphragm??

T10

What passes through T8 in the diaphragm?

IVC

What passes through T10 in the diaphragm?

oesophagus

What passes through T12 in the diaphragm?

Aorta

how do you paralyze a hemi diaphragm?

cut the phrenic nerve

3 layers of intercostal muscles: Go.

1. external 2. internal 3. innermost

describe the external ICM

1. front pockets facing 2. used for inspiration 3. external costal membrane anteriorly

describe the internal ICM

1. back pockets facing (postero inferiorly) 2. for expiration (but prolly for splinting rather) 3. internal costal membrane located posteriorly

Describe the inner most ICMs

1. discontinuous 2. mirrors internal ICMs 3. lateral, parasternal, paravertebral

Where is the costal neuromuscular bundle located between?

Internal and innermost ICMs

how are costals innervated from?

Ventral ramus of intercostal nerve

2 arterial blood supplies for costals:

1. aorta | 2. internal thoracic

need to stab you to get to your lungs, how do I avoid the neuromuscular bundle?

bounce in the top of the rib. never the bottom.

I change in 3 directions when I breath, they are:

1. vertical 2. lateral 3. A-P

pump handle movement is which direction? by which ribs?

A-P. upper ribs

lateral movement of ribs when breathing are by which ribs? what is it called?

lower ribs. bucket handle

3 accessory muscles of respiration:

1. abdominal muscles 2. sternocleidomastoid 3. scalenes

what anchors the diaphragm's central tendon superiorly?

pericardium

what levels is the paricardial sac located?

Between T5 and T8

How much fluid in the pericardial cavity?

1-2 ml

Name the two layers of inner membrane of the pericardium:

Parietal and visceral serous membranes

What the the layer of membrane directly surrounding the heart?

visceral serous memrbrane

What the the outer most later of the pericardium called?

fibrous membrane

the vessels that enter and exit the pericardium all go through one opening with a serous membrane. T/F?

False. Each vessels has it's own sleeve layer of serous membrane.

Where can surgeons and curious medical student stick their finger in the heart safely for landmarking?

transverse pericardial sinus

Where is the base of the heart

right supero-lateral aspect

the 5th intercostal space is above or below the 5th rib?

below, low, low, low, low.......

Superior vena cava has valves?

Nope.

What are the muscle-y rough textured wall of the right atria called?

musculi pectinati

where is the coronary sinus?

near the rudimentary IVC valve

Describe the sinus venarum in one word

smooth

what's the crista terminalis

where all the musculi pectinati meet and end

in adults what is the reminent of the foramen ovalis called?

fossa ovalis

what stops the tricuspid valve from bursting open into the atria when ventricular pressure > atrial pressure?

chordae tendinae

What's the papillary muscle? how many are there?

gives rise to the chordae tendinae | there are 3

right atria wall is thicker than the right ventricle?

False

what's the analagous structure to musculi pectinati in the right ventricle?

trabeculae carnae

smooth area right before the pulmonary trunk is called what? describe it in one word:

conus arteriosus/infundibulum | Smoooooooooooooooooth!

how many papillary muscles connect to the mitral valve via it's chordae tendinae?

Two

describe the left atrium chamber in one word.

Yep. Smooth bro. Real smooth.

Does the heart have a skeleton? What two things does it do?

1. yes a fibrous one | 2. archors and electrically isolates them

what's a coronet?

wraps around the aorta and pulmonary trunk. Two of them.

what's the 'figure 8' fibrous skeleton of the heart feature called?

Trigones. Two of them. Remember: once the blood passes through the valves "y'gotta let trigones be trigones....."

Which side of the mitral and tricuspid valve is smooth?

atrial side

name three parts of the tricuspid valve

1. anterior 2. septal cusp 3. posterior cusp

How are the chordae tendinae attached to the cusps?

each chordae attaches to half of one cusp, and half to another cusp for maximal closure/seal

2 places where semilunar valves found?

1. aortic valve | 2. pulmonary valve

pulmonary valves are passive valves. T/F?

true

what supports the semilunar valves?

fibrous skeleton: the coronets

where is the origin of the right and left coronary arter?

near the right and left cusp of the aortic valves respectively

Origin of the SA node?

top of the cristae terminalis

Where is the AV node?

between tricuspid and coronary sinus

what's at the top of the cristae terminalis?

SA node

What's between the tricuspid and the coronary sinus?

AV node

bundle of His is on the atrial or ventricle side of the fibrous skeleton?

ventricle side

bundle of His give rise to?

Purkinje Fibres.

where is the cardiac plexus situated?

Base of the heart. I know right? the superior aspect bro.

what runs between the SA and AV node on the outside of the heart?

Right coronary artery

The circumflex artery is on the left or right?

branches off the left coronary artery

2 places of anastamosis for coronary arteries. Go.

1. right coronary and left circumflex branches posteriorly | 2. Anterior interventricular branch and posterior interventricular branch.

between which vertebrae is the middle mediastinum ?

T5-8

What two nerves are always with aortic arch?

vagus | phrenic

What two structures follow the oesophagus

thoracic duct | L recurrent laryngeal nerve

Where does the azygous vein drain into?

behind 2nd right intercostal cartilage

What is the remnant of the pulmonary circulation shunt in foetus called?

Ligamentum arteriosum

If someone has dysphagia, what rare anatomical variation could be causing it?

Retroesophageal right subclavian artery

4 places phrenic nerve passes through

anterioe scalenes between subclavian artery/vein anterior to lung root pieces diaphragm`

T/F left phrenic nerve pierces diaphragm with IVC at T8.

False, that's the RIGHT phrenic nerve dummy!

What are the most lateral structures in the media stinum?

phrenic nerves

motor to diaphragm sensory to mediastinal, pericardium What kind of nerve is it?

Mixed nerve (phrenic)

Vagus nerve path

Along trachea behind lung root ant. oesophagus

Where does the vagus pierce diaphragm?

with oesophagus at T10

Which one is in front of lung root? which one is behind? Phrenic or vagus?

Phrenic in front | Vagus behind

In a cadaver, how can you tell which is the oesophagus, which is trachea?

oesophagus is flattened | trachea is open

What level do the bronchi branch?

T4-5

What loops around the subclavian?

recurrent laryngeal vagus

What on earth is the cisterna chyli?

Where the thoracic duct starts (L2)

where does the thoracic duct dump the lymph into?

left subclavian/left internal jugular

Four branches of descending thoracic aorta:

1. intercostal 2. bronchial 3. Pericardial 4. oesophageal

Cardio-Thoracic/Mediastinum Anatomy plus Boobs Flashcards

(106 cards)