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Thorax Flashcards

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1
Q

Where does scarpas fascia end?

A

It is continuous with penile and peroneal fascia and attaches to the fascia lata just below the inguinal ligament

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2
Q

What is the blood supply to the body wall?

A

Intercostal
Subcostal
Lumbar
Internal thoracic
Superior and inferior epigastric arteries
Venous return does not follow arteries-anastomotic network of veins radiating away from the umbilicus

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3
Q

How many ribs are there and how many are false and true?

A

12 ribs
1-7 true (articulate with the sternum)
8-12 false (articulate with each other/ interchondral joints)
11-12 floating

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4
Q

Which vertebrae does the first rib articulate with?

A

T1

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5
Q

Which ligaments surround the synovial joints of the transverse processes?

A

Lateral costotransverse ligament
Costotransverse ligament
Superior costotransverse ligament

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6
Q

Which is the only rib to be connected to the sternum by a primary cartilaginous joint?

A

1st rib with the manubrium

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7
Q

What are the four muscles of the outer layer of the thorax?

A

Serratus posterior superior
Serratus posterior inferior
Levator costae
External intercostals

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8
Q 
Origin
Insertion
Action
Innervation
Special features
Serratus posterior superior
A

Spinous processes of c6-T2

Lateral to the angles of ribs 2-5

Elevate upper ribs-weak inspiratory muscles

Anterior rami

Dorsal scapular n and vessels run on posterior side of muscle. Glistening tendons

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9
Q 
Origin
Insertion
Action
Innervation
Special features
Serratus posterior inferior
A

T11-L2 spinous processes

Lateral to the angle of ribs 8-12

Depress lower ribs- weak expiratory muscles

Anterior rami

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10
Q 
Origin
Insertion
Action
Innervation
Special features
Levator costae
A

Tip of transverse process from C7-T11

Upper border of rib, below, lateral to its tubercle

Elevate ribs

Posterior rami of C8-T11

12 fan shaped pairs

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11
Q 
Origin
Insertion
Action
Innervation
Special features
External intercostals
A

Sharp lower border of rib above (from superior costotransverse ligament at back of intercostal space as far forward as costochondral junction)

Rib below

Elevate ribs

Intercostal nerves

Obliquely downwards
Anterior intercostal membrane replaces the muscle beyond costochondral junction

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12
Q

What is the middle layer of the thorax?

A

Internal intercostals

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13
Q 
Origin
Insertion
Action
Innervation
Special features
Internal intercostals
A

Costal groove

Upper border of rib below

Depress ribs

Intercostal nerves

Downwards and back wards. Extends as far forward as sternum but replaced posteriorly by posterior intercostal membrane.

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14
Q

Where does one insert a needle for a chest drain vs a needle to numb a rib?

A

Chest drains inserted just above a rib to avoid neurovascular bundle
Anaesthetic delivered just below a rib

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15
Q

Describe the course of the intercostal nerves

A

Passes between the internal intercostal and transversus thoracis. Gives off collateral (parietal pleura and periosteum) and lateral cutaneous branches. Posterior rib cage, nerve lies behind the artery, anteriorly nerve lies in front of the artery

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16
Q

What is the blood supply to the intercostal muscles?

A

From the back the upper 2 spaces: superior intercostal arteries (descending branch of costocervical trunk)
Remaining 9 spaces supplied by a separate branch of of descending thoracic artery: posterior intercostal arteries

At the front: anterior intercostal arteries (from internal thoracic artery in upper 6 spaces and musculophrenic in 7,8 and 9th). No anterior interocostal arteries in the last 2 spaces

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17
Q

Describe the drainage of the intercostal veins

A

1 posterior and 2 anterior veins
Lower 8 spaces azgyos vein on right and hemiazygos on the left

1st space drains into vertebral or brachiocephalic vein

2,3 and 4th spaces form a single trunk: superior intercostal vein which drains into azygos on right and brachiocephalic on left

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18
Q

What are the key branches of the internal thoracic artery?

A

2 anterior intercostal arteries in each intercostal space
Superior epigastric
Musculophrenic arteries
Pericardiophrenic artery

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19
Q

What are the crura of the diaphragm?

A

Tendons
Right crus- attached to upper 3 lumbar vertebrae
Left crus attached to upper 2 lumbar vertebrae
Some fibres of right crus pass up on abdominal surface from left crus to surround oseophageal orifice like a sling.
Crus fibres unit with each other at level of T12 to form median arcute ligament

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20
Q

What are the 3 large openings in the diaphragm?

A

Aortic opening T12
Oesophageal opening T10
Vena cava foramen T8

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21
Q 
Origin
Insertion
Action
Innervation
Special features
Intermost intercostals
A 
Costal groove
Upper border of rib below
Depress ribs
Intercostal nerves
Neurovascular bundle between internal and innermost. Lie on the side of rib cage
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22
Q 
Origin
Insertion
Action
Innervation
Special features
Subcostals
A

Internal surface of lower ribs
Superior borders of 2nd 3rd rib below
Lie at the back of rib cage

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23
Q 
Origin
Insertion
Action
Innervation
Special features
Tranversus thoracis
A

Posterior surface of lower sternum
Internal surface of costal cartilages 2-6
Lies at front of rib cage. Crosses more than one rib space

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24
Q

What passes through the aortic opening in the diaphragm?

A

T12
Aorta
Azygous vein
Thoracic duct from cisterna chyli

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25
What passes through the oesophageal opening?
T10 Oesophagus Vagal trunks Oesophageal branches of left gastric artery
26
What passes through the vena caval foramen of the diaphragm?
T8 Lies between middle and right central tendon, fibres fuse with adventitia of vena cava Inferior vena cava Right phrenic nerve
27
What other smaller things pierce the diaphragm?
``` Hemiazygous vein Greater, lesser, least splachnic nerves Sympathetic trunk Subcostal nerve and vessels Left phrenic nerve Neurovascular bundles of 7-11 intercostal spaces Superior epigastric vessels ```
28
What is the blood supply to the diaphragm?
Lower 5 intercostal and subcostal arteries | Right and left phrenic arteries from abdominal aorta
29
What is the nerve supply to the diaphragm?
C3, C4 (predominant) and C5 -> motor | Lower intercostal nerves give proprioceptive supply
30
What is the function of the diaphragm?
Contracts during inspiration Expiration is passive Contraction aids abdominal wall in raising intraabdominal pressure during heavy lifting, defecation, micturation, and giving birth
31
What are the divisions of the mediastinum?
Superior mediastinum is from the angle of Louis (T4) up to thoracic inlet Below sternal angle inferior mediastinum is divided into 3; anterior, middle and posterior
32
What lies in the superior mediastinum?
Oesophagus against the body if T1 vertebrae Trachea lies anterior to oesophagus Arch of aorta -> brachiocephalic trunk -> left subclavian artery, left common carotid Left brachiocephalic vein Left and right( touches trachea)vagus nerves Thymus
33
Describe the course of the arch of the aorta
Ascending aorta becomes aortic arch at level of manubrium (T4) Brachiocephalic trunk (thyroidea ima) Left common carotid (no branches in mediastinum) Left subclavian (no branches in mediastinum) Arch is crossed on left by phrenic and vagus nerves. Left recurrent laryngeal hooks ligamentum arteriosum Pulmonary trunk bifurcates into left and right pulmoary arteries in the concavity of the arch Adventitial layer of arch contains baroreceptors (carotid sinus) Under arch there is ligamentum arteriosum which contains chemoreceptors (aortic bodies)
34
What are the differences in course between the left and right brachiocephalic veins
Internal jugular vein lies lateral to internal carotid on anterior scalene muscle Subclavian vein and anterior lies lateral and anterior to the lower part of anterior scalene Right brachiocephalic vein: commences behind right sternoclavicular joint. Receives right jugular, subclavian and bronchomediastinal lymph trunks. Left brachiocephalic vein: above arch of aorta, behind the thymus. Receives thoracic duct, inferior thyroid veins, left superior intercostal veins and a large thymic vein
35
Where does the superior vena cava begin?
Lower border of first right costal cartilage where left and right brachiocephalic veins meet. Receives azygos vein. Enters right atrium at lower border of 3rd right costal cartilage
36
How does the ligamentum arteriosum relate to the cardiac plexus?
Superficial cardiac plexus lies in front of ligamentum arteriosum, deep part is larger and lies to the right of the ligamentum arteriosum in front of bifurcation of trachea
37
How long is the trachea and when does it bifurcate?
10cm | Bifurcates into main bronchi at T5
38
What is the difference between the course of the right and left phrenic nerves?
Right phrenic nerve: medial to VENOUS structures | Left phrenic nerve: medial to ARTERIAL structures
39
What is the difference between the course of the right and left vagus nerves?
Left vagus: held away from trachea by great vessels. Gives recurrent laryngeal branch which hooks around ligamentum teres Right vagus: in contact with trachea. recurrent branch hooks around right subclavian artery
40
What are the anterior and posterior structures of the thymus?
Anterior: sternohyoid, sternothyroid, manubrium and upper sternum Posterior: Pericardium and arch of aorta
41
Why is it impossible to separate the heart from the diaphragm without dissection?
Fibrous pericardium is continuous with adventitia of vessels and central tendon of diaphragm
42
What is the difference between the transverse sinus and oblique sinus of the heart?
Serous layer inside fibrous pericardium Transverse sinus: passage above heart between ascending aorta and pulmonary trunk in front Oblique sinus: behind the heart between the left atrium in front and fibrous pericardium behind
43
Where does the pain of pericarditis come from?
Phrenic nerve Parietal nerve of serous pericardium innervated but not visceral layer. Angina is sympathetic nerves
44
What make up the right and left borders of the heart?
Left: Left ventricle and left auricle. Left second costal cartilage to 6th costal cartilage Right: right atrium. Extends from right 3rd costal cartilage to right 6th costal cartilage
45
What makes up the inferior/diaphragmatic surface and posterior surface of the heart?
Inferior: One third right ventricle and 2/3 left ventricle Posterior:Left atrium and 4 pulmonary veins
46
What is the crista terminalis and how does it relate to the embryology of the heart?
Within the right atrium of the heart there is a projection of vertical muscle- crista terminalis. To the right of the muscle the atria is smooth, but between the crista and the auricle there are pectinate muscles (true auricular chamber of embryonic heart)
47
What forms the posterior wall of the right atrium and what is found there?
``` Interatrial septum Fossa ovalis (foramen ovale in the fetus) ```
48
What are the attachments of the tricuspid valve?
Three leaflets, each have chordae tendinaea which diverge from papillary muscles to prevent cusps being everted when ventricle contracts
49
How many cusps does the pulmonary valve have?
3 2 anterior 1 posterior
50
What enters the left atrium?
``` Coronary sinus (runs from right to left) 4 pulmonary veins ```
51
How many cusps does the aortic valve have?
3 1 anterior 2 posterior
52
Where do the coronary arteries come from?
The aortic sinuses in the walls of the ascending aorta- one above each cusp
53
Where does the pulmonary trunk sit in relation to the aorta?
Higher than aortic orifice Initially in front then to the left of ascending aorta Spiral within the pericardium in front of the transverse sinus
54
Where is the sinuatrial node?
Subepicardially in the wall of right atrium, just below superior vena cava, at the top of sulcus terminalis (no macroscopic features to indicate its location)
55
Where is the atrioventricular node?
Right atrium | Interatrial septum, above attachment of septal cusp of tricuspid valve, to the left of the opening of coronary sinus
56
Describe the course of the right coronary artery and its branches
Passes between auricle and infundibulum of right ventricle. Runs in atrioventricular groove and runs posteriorly. Branches: conus artery, SA nodal artery (supplies SA node in 60% of hearts), right marginal artery, posterior interventricular branch, AV nodal artery
57
Describe the course of the left coronary artery and its branches
Emerges between left auricle and infundibulum of right ventricle Divides into circumflex and anterior interventricular(LAD) In 40% of hearts the circumflex gives the SA nodal artery. Circumflex supplies AV node. 10% of hearts LAD is short and is replaced by circumflex (left dominance)
58
What are the tributaries to the coronary sinus?
``` Great cardiac vein Anterior interventicular Middle cardiac vein Small cardiac vein Posterior vein of left ventricle Oblique vein of left atrium ```
59
What are the abnormalities in tetrology of fallot?
Pulmonary stenosis Right ventricular hypertrophy VSD Overriding aorta
60
Which structures are found in the posterior mediastinum?
``` Oesophagus Thoracic aorta Azygos Hemiazygos Thoracic duct Lymph nodes ```
61
Where does the thoracic aorta begin and end?
T4 where arch of aorta ends T12 ends by passing behind the diaphragm between the crura Gives off 9 pairs of posterior intercostal arteries, subcostal arteries, bronchial arteries, oesophageal vessels and a few small cardiac and phrenic branches
62
Describe the course of the oesophagus
25cm long Narrowest part is at its commencement Travels to the left of midline Crossed by arch of aorta on left Crossed by azygos on right Crossed anterior by left main bronchus and pulmonary artery Thoracic duct and hemiazgos run posterior
63
What is the blood supply to the oesophagus?
Inferior thyroid arteries, bronchial arteries and oesophageal branch of left gastric artery
64
What is the nerve supply to the oesophagus?
Recurrent laryngeal nerves Sympathetic fibres Motor supply is vagus
65
Where does the thoracic duct begin?
Cisterna chyli at T12 | Drains lymph from whole body except right upper limb and right halves of thorax and head and neck
66
What forms the azygos vein?
Ascending lumbar vein and subcostal vein of right side Drains into superior vena cava Joined by hemiazygos veins at T7 and T8
67
How does the pleura vary across the lung?
At the 2nd rib the 2 pleura meet 4th rib right pleura descends vertically but left pleura goes out sideways half way to apex of heart Both pleura turn laterally at the 6th rib, crossing mid clavicular line at 8th rib and mid axillary line at 10th rib. Pleura continues down to level of 12th rib
68
What are the key differences between the right and left lung roots?
Left: Left pulmonary artery, 2 pulmonary veins, left bronchus all enclosed in pleura Right:Bigger, upper lobe bronchus and branch of pulmonary artery to upper lobe originate outside of the lung. Therefore they lie above main bronchus and main right pulmonary artery
69
Which pulmonary artery is longer?
Right pulmonary artery
70
How many lobes and segments in each lung?
Right lung: 3 lobes 2 fissures; horizontal and oblique 10 segments (4 and 5 named lateral and medial middle lobe) Left lung: 2 lobes 1 fissure; oblique 10 segments ( 4 and 5 named superior and inferior lingular)
71
Which ribs do the lungs start and end at?
Commence above first rib Hilum at T5-7 End around 6th rib anteriorly and 10th rib posteriorly Oblique fissure lies around 5th rib
72
Why are foreign bodies more likely to enter the right main bronchus?
Right main bronchus is 2.5cm long, shorter wider and more vertical than the left
73
What is the blood supply to the bronchi?
2 bronchial arteries on left (directly from aorta) one on right Veins of right main bronchus drain to azygos Left main bronchus veins drain to accessory hemiazygos Pulmonary artery supplies alveoli with deoxygenated blood but does NOT supply the bronchi
74
What is the nerve supply to the lungs
Afferent and efferent vagal fibres. Vagal efferents are bronchoconstrictor, vasodilator and secretomotor to mucus glands Sympathetic efferents are bronchodilator and vasoconstrictor
75
When do bronchi become bronchioles?
``` When the cartilage in their walls disappears Then become lobular bronchioles Then terminal bronchioles Then respiratory bronchioles Then alveolar ducts Then alveolar sacs ```
76
What are alveolar cells lined with?
90% type 1 alveolar cells for gas exchange | 10% type 2 surfactant cells
77
Describe the variety of joints found at the sternum
Sternoclavicular joint-atypical synovial First costal cartilage to manubrium- primary cartilaginous joint All other costal cartilages attached to body of sternum are synovial
78
Why does the head of a rib have two articulating facets?
Lower facet is vertical and articulates with own vertebra. Upper facet is sloping and articulates with vertebra above.
79
What is unique about the 1st rib?
Very curved Head only carries a single facet Tubercle for costotransverse ligament Under surface of Shaft is covered by parietal pleura Upper surface of shaft houses subclavian artery and brachial plexus Scalene tubercle for scalenus anterior tendon

Anatomy (6 decks)

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