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MRCS part B anatomy > Thorax anatomy > Flashcards

Thorax anatomy Flashcards

(59 cards)

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1
Q

Where is the caval opening located?

A

T8, central tendon of diaphragm

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2
Q

What structures pass through caval opening?

A

IVC + right phrenic nerve

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3
Q

Where is oesophageal hiatus located?

A

Right crus diaphragm, T10

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4
Q

What structures pass through oesophageal hiatus?

A

Oesophagus, posterior and anterior vagal trunks, oesophageal branch left gastric artery

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5
Q

How is aortic hiatus formed? What level is it at?

A

R and left crura and median arcuate ligament. T12

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6
Q

What passes through aortic hiatus?

A

Aorta, azygous vein, thoracic duct

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7
Q

Describe venous drainage of anterior chest wall

A

Anterior: anterior intercostal veins –> internal thoracic vein–> brachiocephalic vein

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8
Q

Describe venous drainage of upper 4 intercostal spaces posterior chest wall

A

Drained by azygous system into SVC

-1st space: B/l highest (supreme) intercostal vein –> brachiocephalic vein
-2nd-4th: posterior intercostal veins – superior intercostal vein

-R side: superior intercostal vein –> azygous vein
-L side: Superior intercostal vein –> accessory hemiazygous or brachiocephalic vein

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9
Q

Drainage of posterior 5-12 intercostal spaces posterior chest wall

A

Drained by azygous system into SVC

L side:
–> 5-8 drained by accessory hemiazygous
–> 9-11 hemiazygous vein
–> accessory hemiazygous +hemiazygous–> azygous –> SVC

R side:
-5-11: Azygous vein

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10
Q

How is venous drainage to chest wall divided?

A

Anterior

Posterior
–> upper 4 ( R + L)
–> 5-11 (R + L)

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11
Q

What is arterial supply of diaphragm?

A

Superior surface:

-internal thoracic
—>pericardiophrenic artery
—->musculophrenic arteries
-Descending thoracic aorta
—> superior phrenic

Inferior surface
-Abdominal aorta –> inferior phrenic arteries

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12
Q

Describe lymphatic drainage of breast

A

General rule:
-75% Lateral breast–> ipsilateral axillary nodes: anterior axillary nodes + central axillary nodes –> apical axillary nodes
-Medial breast –> Internal thoracic nodes

However: valveless channels connecting systems allow flow in both directions

Lymph also flows to:
-Infraclavicular + supraclavicular nodes
-Subscapular + interpectoral nodes
-Contralateral breast

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13
Q

Arteries supplying anterior chest wall

A

1-6: Internal thoracic –> anterior intercostal arteries
7-9: musculophrenic –> anterior intercostal arteries

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14
Q

Arteries supplying anterolateral chest wall:

A

Axillary artery –> superior + lateral thoracic

Below 12th rib:
–> descending thoracic aorta –> subcostal

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15
Q

Arteries supplying posterior chest wall

A

1 + 2: subclavian –> costocervical trunk –> superior intercostal arteries –> posterior intercostal arteries

3-12: Descending thoracic aorta –> posterior intercostal arteries

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16
Q

Arteries supplying chest wall

A

Arteries supplying anterior chest wall
-1-6: Internal thoracic –> anterior intercostal arteries
-7-9: musculophrenic –> anterior intercostal arteries
Arteries supplying anterolateral chest wall
-Axillary artery –> superior + lateral thoracic
-Below 12th rib:
–> descending thoracic aorta –> subcostal
Arteries supplying posterior chest wall
-1 + 2: costocervical trunk–> posterior intercostal arteries
-3-12: Descending thoracic aorta –> posterior intercostal arteries

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17
Q

What is the origin and insertion of pec minor?

A

Origin: 3rd-5th ribs (near costal cartilages)

Insertion: medial border + superiro surface coracoid process of scapula

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18
Q

What is innervation of pec minor?

A

Medial pectoral nerve (C8-T1)

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19
Q

What is the action of pec minor?

A

–> Stabilises scapula by drawing it inferiorly + anteriorly against thoracic wall
–> raises ribs on inspiration

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20
Q

What are the branches of the left and right coronaries?

A

Left
-LAD
-Left marginal
-Left circumflex

Right
-Right marginal anteriorly
-Posterior interventricular posteriorly (left in 25% of patients)

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21
Q

What territory is supplied by RCA?

A

R atrium + most of R ventricle, SA (60%) + AV (20%) nodes + posterior 1/3rd interventricular septum + diaphragmatic surface left ventricle

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22
Q

What territory is supplied by right marginal?

A

Right ventricle
Apex

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23
Q

Left anterior descending territory

A

Right ventricle, left ventricle, anterior 2/3rd IVS

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24
Q

Left marginal territory

Study These Flashcards
A

Left ventricle

25
Left circumflex territory
Left atrium + ventricle
26
What does left coronary supply?
left atrium/ventricle, IVS, AV node branches
27
Posterior descending territory:
R ventricle, L ventricle, posterior 1/3rd IVS
28
What is the arterial supply to the oesophagus?
Arterial supply is segmental Cervical part: Subclavian--> thyrocervical trunk--> inferior thyroid Thoracic part: Branches from descending thoracic aorta Abdominal part: oesophageal branch L gastric + inferior phrenic
29
Describe venous drainage of oesophagus
Cervical: inferior thyroid Thoracic: azygous, hemiazygous, accessory azygous Abdominal: Azygous + left gastric
30
Name important anatomical structures at level of manubriosternal junction
-SVC entering right atrium -Bifurcation of trachea -Bifurcation of pulmonary trunk -Arch of aorta -Thoracic duct crosses from right to left mediastinum -L recurrent laryngeal nerve hooks around aortic arch
31
Innervation of diaphragm
Motor supply: phrenic nerves C3-C5 Sensory: --> Central: phrenic nerve c3-5 ---> Peripheral: Intercostal nerves T5-T12
32
Arterial supply to breast
1) Internal thoracic --> medial mammary perforating + anterior intercostal branches 2) Axillary --> Lateral thoracic + thoracoacromial arteries 3) Thoracic aorta --> posterior intercostal arteries
33
What is first branch of ascending aorta?
Coronary arteries
34
What is the origin of right and left coronary arteries?
L + R aortic sinus
35
What territory does R coronary artery supply?
-All surfaces R atrium -25-30% right ventricle -Inferior wall right ventricle -SA node 60% + AV node
36
What territory does L coronary supply?
-L atrium -Most of L ventricle -Part of R ventricle -Most of interventricular septum -SAN in 40%
37
What territory does L coronary supply?
-L atrium -Most of L ventricle -Part of R ventricle -Most of interventricular septum -SAN in 40%
38
What is the action of pec major?
Clavicular head: flexes + adducts arm Sternal head: Adducts and medially rotates arm, accessory muscle of inspiration
39
What is origin and insertion of pec major?
Origin -Clavicular head: anterior border medial 1/2 of clavicle -Sternocostal: anterior surface of sternum, superior 6 costal cartilages Insertion -Lateral lip bicipital groove of humerus
40
What is innervation of pec major?
Clavicular head: C5-C6 (lateral pectoral nerve) Sternocostal head: C7-T1 (medial pectoral nerve)
41
What is the contents of the superiro mediastinum?
PVT Left BATTLE Phrenic nerve Vagus nerve Thoracic ducts Left recurrent laryngeal Brachiocephalic vein Aortic arch Thymus Trachea Lymph node Oesophagus
42
What are the contents of middle mediastinum
Vessels: ascending aorta, lower 1/2 SVC, Azygous vein, pulmonary arteries + veins Nerves: Phrenic nerves Viscera: Heart + Pericardium, tracheal bifurcation Others: bronchial lymph glands
43
What are the contents of the posterior mediastinum?
on the DATE Vivian Slapped Larry Descending thoracic aorta Azygous/hemiazygous vein Thoracic duct Esophagus Vagus nerve Splanchnic nerves Lymphatics Vessels: thoracic part of descending aorta, azygous and hemiazygous veins Nerves: Vagus + splanchnic nerves (arising from sympathetic trunk to supply viscera in thorax + abdomen) Viscera: oesohpagus Others: Lymph nodes + thoracic duct
44
What are the branches of subclavian artery?
1st part medial to anterior scalene, 2nd behind, 3rd lateral VITCD 1st part --> vertebral artery --> Internal thoracic artery --> Thyrocervical trunk 2nd part --> Costocervical trunk and dorsal scapular artery 3rd part --> No branches (occasionally dorsal scapular)
45
Name layers gone through when inserting chest drain
Superficial to deep: Skin Subcut fat Deep fascia Serratus anterior External intercostal muscles (infero-anterior orientation of fibres) Internal intercostal (infero-posterior) lateral part intercostal space only Innermost intercostal -lateral part intercostal space only Endothoracic fascai Parietal pleura
46
What is a bronchopulmonary segment?
1) Segment of lung 2) Segmental/tertiary bronchus 3) Segmental branch tertiary arteries 4) Segment of lung tissue 5) Surrounding connective tissue septum
47
How many bronchopulnonary segments does each lung have?
Right has 10 --> upper lobe 3, middle 2, lower 5 L has 10 --> upper + lower 5 each
48
What are the boundaries of the posterior mediastinum?
Anterior: pericardium Inferior: diaphragm Posterior: Thoracic vertebrae Lateral: mediastinal pleura Roof: line from sternal angle + T4 vertebra
49
Describe musculature of the oesophagus
2 planes: external longitudinal fibres + internal circular upper 1/3rd: Striated Middle 1/3rd: mixture of striated and smooth Lower 1/3rd: smooth muscle
50
Where does the breast lie anatomically?
Base of breast: --> sternum to mid-axillary line --> 2nd-6th rib 2/3rd medially overlies pec major 1/3rd laterally overlies serratus anterior
51
What is the blood supply to the breast?
Mainly lateral thoracic Also: --> internal thoracic --> Thoraco-acromial --> posterior intercostals
52
How does right bronchus differ from left?
-Right is shorter, wider and more vertical -Therefore foreign bodies preferentially go down right main bronchus -Material aspirated by supine/anaesthetised pt also gravitates to apical part of right lung: common site for aspiration pneumonia/abscess
53
What is the superior limit of pleura? What is the clinical significance of this?
2.5cm above medial 1/3rd clavicle Does not extend above 1st rib Injuries above clavicle (e.g. central line) can involve pleura ---> pneumothorax
54
What is the lower border of pleura?
Extends below medial border 12th rib, behind upper border of kidney
55
Structures at hilum
-Bronchus is posterior, artery always superior, vein inverior -BAV: bronchus, artery, vein
56
Relations of lungs
Right: SVC, oesohpagus, azygouis Left: Aorta, heart, oesophagus Both -Diaphragm
57
How do you orientate side of lungs?
-Diaphragm faces down -Thinner sharper border faces forwards
58
Branches axillary artery
Semen tastes like sweet apple pie Superiro thoracic thoraco-acromial Lateral thoracic Subscapular Anterior circumflex humeral Posterior circumflex humeral
59
Describe venous drainage of chest wall
Anterior: anterior intercostal veins --> internal thoracic vein--> brachiocephalic vein Upper 4 spaces posterior: Drained by azygous system into SVC -1st space: B/l highest (supreme) intercostal vein --> brachiocephalic vein -2nd-4th: posterior intercostal veins -- superior intercostal vein -R side: superior intercostal vein --> azygous vein -L side: Superior intercostal vein --> accessory 5-12 posterior chest wall: Drained by azygous system into SVC L side: --> 5-8 drained by accessory hemiazygous --> 9-11 hemiazygous vein --> accessory hemiazygous +hemiazygous--> azygous --> SVC R side: -5-11: Azygous vein

MRCS part B anatomy (16 decks)

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