Main Structures of the Thorax

Question 1

Pericardium

Answer 1

Sac in which the heart sits

Divided into tough fibrous (outer) and serous (inner) parts which surround the heart

Question 2

Fibrous Pericardium

Answer 2

Tough and not distensible; attached to diaphragm by pericardiophrenic ligaments; blend into adventitia of great vessels

Question 3

Serous Pericardium

Answer 3

Inner pericardial layer
Comprised of visceral layer (epicardium) and parietal layer (lining fibrous pericardium); potential space (pericardial cavity) between them

Lines fibrous pericardium

Both composed of a flattened layer of epithelial cells (mesothelium)

Question 4

Surfaces of the heart

Answer 4

Anterior/Sternocostal

Inferior/Diaphragmatic

Posterior/base

Pulmonary

Question 5

Anterior/Sternocostal Surface of the Heart

Answer 5

Formed mostly of right (with a bit of left) ventricle

Question 6

Inferior/Diaphragmatic Surface of the Heart

Answer 6

Mostly L (bit of R) ventricle

Question 7

Posterior/Base surface

Answer 7

Mostly L (bit of R) atrium and pulmonary vein

Question 8

Pulmonary Surface of the Heart

Answer 8

Mostly L ventricle, in cardiac notch of L lung

Question 9

Borders of Heart

Answer 9

Superior Border
Right Border
Inferior Border
Left Border

Remember
2 3 ics5 6

Question 10

Superior Border of the Heart

Answer 10

L cc2 - R cc3

Question 11

Right Border of the Heart

Answer 11

Convex to R

R cc3 –> R cc6

Mainly R atrium with SVC and IVC

Question 12

Inferior Border of the Heart

Answer 12

Lies on diaphragm central tendon

R cc6 –> L intercostal space 5

Mainly R ventricle and some LV

Question 13

Left Border of the Heart

Answer 13

Convex to L

From L ics5 and back to L cc2

Mainly LV and maybe some LV

Question 14

Valve positions (normal situation)

Answer 14

Valves are retrosternal in position and close to the midline

Pulmonary - medial to L cc3
Aortic - medial to L ics3
Bicuspid/Mitral - Medial to L cc4
Tricuspid - Medial to R ics4

Question 15

Valve Sounds

Answer 15

Question 16

Summary of Heart Locations for Auscultation

Answer 16

Question 17

Pleura

Answer 17

Serous membrane divided into parietal (outer) and visceral (inner) layers which surround the lungs and contain the pleural cavities; layers also separated by small amounts of serous fluid

Question 18

Parietal pleura and its Innervation

Answer 18

Lines thoracic cavity lateral to mediastinum; supplied by intercostal and phrenic nerves; sensitive to pain

Question 19

Visceral pleura

Answer 19

Covers lung and follows lung fissures; supplied by autonomic nerves (doesn’t feel pain i think)

Question 20

Pleuritis/Pleurisy

Answer 20

Inflammation of the pleura

Usually appears as localised roughness and redness; pleural rub can be heard with stethascope; leads to chest pain (usually sharp) when breathing or coughing

Question 21

Name the Surfaces of Lungs and vaguely what they face

Answer 21

Green: Mediastinal
Flat, faces mediastinum, contains hilum

Purple : Diaphragmatic
Convex, faces diaphragm

Red: Costal
Convex, faces ribs

Blue: Cervical
Extends into neck

Question 22

Pleural Reflections

Answer 22

Abrupt lines along which the pleura changes directions (reflects) from one wall of pleural cavity to another

Occurs where costal pleura becomes continuous with mediastinal pleura anteriorly and posteriorly and with diaphragmatic pleura inferiorly

Question 23

Why are pleural reflections important to know

Answer 23

Correct interpretation of chest X-ray and performing procedures like thoracentesis correctly

Remember 2,4,6,8,10,12

Question 24

Visceral Pleural Reflections

Answer 24

2,4,6,8,10

Question 25

Parietal Pleural Reflections

Answer 25

Question 26

Lobes of Right Lung

Answer 26

Question 27

Lobes of Left Lung

Answer 27

Question 28

Bronchopulmonary Segments

Answer 28

you do NOT need to know them, just understand how it works

Question 29

Be aware of lobes of lung in x-ray

Answer 29

Question 30

How can a tumour in a bronchopulmonary segment be treated

Answer 30

That segment is removed individually as opposed to the whole lobe or lung

Question 31

In which segments of the lung is fluid most likely to collect

Answer 31

Apical and Posterior segments in both the left and right lung

Question 32

Aortic Branches

Answer 32

Mneumonic device - remember your ABCs

A - Aortic Arch
B - Brachiocephalic Trunk
C - (Left) Common Carotid a
S - (Left) Subclavian a

Note: Right common and subclavian arteries are on the brachiocephalic trunk; the more lateral artery is the right subclavian

Question 33

Thoracic and Abdominal Aorta

Answer 33

Exactly what they sound like (one is in thoracic, the other is in abdominal cavity)

Question 34

Where do the posterior and anterior intercostal arteries come from; where do they run

Answer 34

Anterior intercostal arteries come from the internal thoracic artery

Posterior intercostal arteries come from the thoracic aorta

They run in the costal groove below each rib

Question 35

Azygous system

Answer 35

Azygous vein drains into SVC; be vaguely aware of how this drains

The system drains the posterior thoracic wall

Question 36

Costodiaphragmatic recess vs costophrenic

Answer 36

The recess is the potential space where fluid would collect but normally the angle is referred to as the costophrenic angle of the lung