Podcast
Questions and Answers
Which structure is located anterior to the esophagus in the superior mediastinum?
Which structure is located anterior to the esophagus in the superior mediastinum?
- Vagus nerve
- Trachea (correct)
- Azygos vein
- Thoracic duct
During a physical exam, the sternal angle is located at the level of which intervertebral disc?
During a physical exam, the sternal angle is located at the level of which intervertebral disc?
- T4-T5 (correct)
- T1-T2
- T6-T7
- T2-T3
Which of the following structures passes through the diaphragm at the T10 vertebral level?
Which of the following structures passes through the diaphragm at the T10 vertebral level?
- Aorta
- Right phrenic nerve
- Inferior vena cava
- Esophagus (correct)
Which nerve roots form the phrenic nerve?
Which nerve roots form the phrenic nerve?
Which of the following accurately describes the location of the aortic arch?
Which of the following accurately describes the location of the aortic arch?
Which of the following is the main lymphatic vessel in the body that drains lymph from the lower body and left upper body?
Which of the following is the main lymphatic vessel in the body that drains lymph from the lower body and left upper body?
Which of the following vertebral levels does the thoracic portion of the sympathetic chain typically extend?
Which of the following vertebral levels does the thoracic portion of the sympathetic chain typically extend?
Which nerve is most susceptible to damage during thyroid surgery due to its close proximity to the inferior thyroid artery?
Which nerve is most susceptible to damage during thyroid surgery due to its close proximity to the inferior thyroid artery?
Which anatomical feature contributes to the right lung having a slightly greater capacity for air exchange compared to the left lung?
Which anatomical feature contributes to the right lung having a slightly greater capacity for air exchange compared to the left lung?
Which of the following best describes the purpose of the transverse pericardial sinus?
Which of the following best describes the purpose of the transverse pericardial sinus?
What is the primary role of the chordae tendineae in the heart?
What is the primary role of the chordae tendineae in the heart?
What is the primary function of the cardiac skeleton?
What is the primary function of the cardiac skeleton?
Which blood vessel supplies oxygenated blood to the lung tissue itself?
Which blood vessel supplies oxygenated blood to the lung tissue itself?
Which veins drain blood into the coronary sinus?
Which veins drain blood into the coronary sinus?
What is the primary role of the azygos venous system?
What is the primary role of the azygos venous system?
If the inferior vena cava (IVC) is blocked, which venous system can provide an alternative route to the heart?
If the inferior vena cava (IVC) is blocked, which venous system can provide an alternative route to the heart?
Which statement correctly describes the location of the thymus in relation to other structures?
Which statement correctly describes the location of the thymus in relation to other structures?
A patient presents with hoarseness after undergoing a thoracic aortic aneurysm repair. Which nerve is most likely affected?
A patient presents with hoarseness after undergoing a thoracic aortic aneurysm repair. Which nerve is most likely affected?
A surgeon needs to access the ascending aorta and pulmonary trunk during a cardiac procedure. Which anatomical landmark will the surgeon use to best locate this region?
A surgeon needs to access the ascending aorta and pulmonary trunk during a cardiac procedure. Which anatomical landmark will the surgeon use to best locate this region?
Which branch is NOT one of the direct branches of the aortic arch?
Which branch is NOT one of the direct branches of the aortic arch?
The central tendon belongs to which of the following structures?
The central tendon belongs to which of the following structures?
Which of the following vertebral levels does the trachea bifurcate?
Which of the following vertebral levels does the trachea bifurcate?
Which artery supplies the anterior wall of the left ventricle?
Which artery supplies the anterior wall of the left ventricle?
Which layer of the pericardium is in direct contact with the surface of the heart?
Which layer of the pericardium is in direct contact with the surface of the heart?
The costodiaphragmatic recess can be located between which layers of the pleura?
The costodiaphragmatic recess can be located between which layers of the pleura?
The oblique pericardial sinus is found posterior to what?
The oblique pericardial sinus is found posterior to what?
Excessive fluid accumulation in the pericardial cavity that may compress the heart and hinder normal cardiac function is known as?
Excessive fluid accumulation in the pericardial cavity that may compress the heart and hinder normal cardiac function is known as?
A patient reports to their physician describing that foreign objects are more likely to enter their lung than the opposite lung. Which lung are they referring to?
A patient reports to their physician describing that foreign objects are more likely to enter their lung than the opposite lung. Which lung are they referring to?
Identify at which position of the vertebral column the azygos vein ascends?
Identify at which position of the vertebral column the azygos vein ascends?
Choose the INCORRECT option: Which anatomical structure supplies the heart with oxygen.
Choose the INCORRECT option: Which anatomical structure supplies the heart with oxygen.
Damage to the upper thoracic chain (T1-T3) causes which condition?
Damage to the upper thoracic chain (T1-T3) causes which condition?
What type of cells cause for adaptive immunity?
What type of cells cause for adaptive immunity?
What structures do the fibrous rings surround?
What structures do the fibrous rings surround?
Why would surgeons that perform open-heart surgery use their knowledge of the significance of the transverse?
Why would surgeons that perform open-heart surgery use their knowledge of the significance of the transverse?
After performing auscultation on a patient, you suspect a heart murmur, valvular stenosis, and regurgitation, Which of the following structure is affected
After performing auscultation on a patient, you suspect a heart murmur, valvular stenosis, and regurgitation, Which of the following structure is affected
A patient is experiencing a lot of pain after trauma, leading to pulmonary injuries. Which of the following nerve is irritated?
A patient is experiencing a lot of pain after trauma, leading to pulmonary injuries. Which of the following nerve is irritated?
When performing treatment options for the removal of cells that have metastasized into the lymphatic system from breast cancer, which nodes should a doctor be looking at?
When performing treatment options for the removal of cells that have metastasized into the lymphatic system from breast cancer, which nodes should a doctor be looking at?
A patient comes into a physician demonstrating symptoms shortness of breath . Further clinical evaluation revealed a blockage of which vital structure.
A patient comes into a physician demonstrating symptoms shortness of breath . Further clinical evaluation revealed a blockage of which vital structure.
For a patient that requires careful interpretation of ECG readings which of the following needs to be done with precision and accuracy?
For a patient that requires careful interpretation of ECG readings which of the following needs to be done with precision and accuracy?
After birth the foramen ovale closes and becomes which of the following structures?
After birth the foramen ovale closes and becomes which of the following structures?
What does a nurse have to be careful about when inserting a needle at the midaxillary line in the 7th9th intercostal spaces?
What does a nurse have to be careful about when inserting a needle at the midaxillary line in the 7th9th intercostal spaces?
Which sinus functions as a natural reservoir for heart accumulation and with proper evaluation, a clinician would be able to identify such as ?
Which sinus functions as a natural reservoir for heart accumulation and with proper evaluation, a clinician would be able to identify such as ?
Which of the following is a clinical symptom of having sympathetic overactivity?
Which of the following is a clinical symptom of having sympathetic overactivity?
During a surgical procedure in the thoracic cavity, a surgeon needs to identify the specific layer that directly separates the intercostal muscles from the parietal pleura. Which layer is the surgeon trying to identify?
During a surgical procedure in the thoracic cavity, a surgeon needs to identify the specific layer that directly separates the intercostal muscles from the parietal pleura. Which layer is the surgeon trying to identify?
A patient is experiencing difficulty expanding their ribcage during inhalation due to stiffness in the joints connecting the ribs to the sternum. Which joints are most likely affected?
A patient is experiencing difficulty expanding their ribcage during inhalation due to stiffness in the joints connecting the ribs to the sternum. Which joints are most likely affected?
A patient has been diagnosed with a tumor compressing the superior vena cava. Which of the following venous systems would most likely provide an alternative drainage pathway to the heart?
A patient has been diagnosed with a tumor compressing the superior vena cava. Which of the following venous systems would most likely provide an alternative drainage pathway to the heart?
A surgeon performing a mediastinoscopy needs to access the space between the ascending aorta/pulmonary Artery and the superior vena cava to access the heart and great vessels. Which anatomical landmark should the surgeon be targeting?
A surgeon performing a mediastinoscopy needs to access the space between the ascending aorta/pulmonary Artery and the superior vena cava to access the heart and great vessels. Which anatomical landmark should the surgeon be targeting?
A 50-year-old patient presents with chest pain radiating to the left arm. An angiogram reveals a blockage in a major coronary artery. If this blockage primarily affects the anterior wall of the left ventricle, which artery is most likely occluded?
A 50-year-old patient presents with chest pain radiating to the left arm. An angiogram reveals a blockage in a major coronary artery. If this blockage primarily affects the anterior wall of the left ventricle, which artery is most likely occluded?
A patient has a condition causing fluid accumulation in the pericardial cavity, restricting the heart's ability to pump effectively. Which normal function of the pericardium is being directly compromised in this scenario?
A patient has a condition causing fluid accumulation in the pericardial cavity, restricting the heart's ability to pump effectively. Which normal function of the pericardium is being directly compromised in this scenario?
A cardiologist is explaining the course of the right vagus nerve to a group of medical students. Which of the following best describes the path of this nerve as it enters the thorax?
A cardiologist is explaining the course of the right vagus nerve to a group of medical students. Which of the following best describes the path of this nerve as it enters the thorax?
A patient is scheduled for a procedure involving the placement of a central venous catheter. Which anatomical landmark corresponds to the T2-T3 vertebral level and serves as a reference point for this procedure?
A patient is scheduled for a procedure involving the placement of a central venous catheter. Which anatomical landmark corresponds to the T2-T3 vertebral level and serves as a reference point for this procedure?
During an autopsy, it's noted that the ligamentum arteriosum is closely associated with a specific nerve. Damage to which nerve would most likely result in hoarseness due to its innervation of the larynx?
During an autopsy, it's noted that the ligamentum arteriosum is closely associated with a specific nerve. Damage to which nerve would most likely result in hoarseness due to its innervation of the larynx?
A thoracic surgeon needs to ligate the pulmonary trunk and the ascending aorta. To isolate these vessels, which area would the surgeon access?
A thoracic surgeon needs to ligate the pulmonary trunk and the ascending aorta. To isolate these vessels, which area would the surgeon access?
In a patient with a known aortic aneurysm, which of the following clinical signs would be most indicative of compression of the left recurrent laryngeal nerve?
In a patient with a known aortic aneurysm, which of the following clinical signs would be most indicative of compression of the left recurrent laryngeal nerve?
During a cardiac procedure, a surgeon needs to temporarily halt blood flow through the ascending aorta and pulmonary trunk. Which anatomical space allows the surgeon to clamp these vessels effectively?
During a cardiac procedure, a surgeon needs to temporarily halt blood flow through the ascending aorta and pulmonary trunk. Which anatomical space allows the surgeon to clamp these vessels effectively?
A patient presents with symptoms of superior vena cava syndrome due to a tumor. Which of the following anatomical structures is directly compressed, leading to these symptoms?
A patient presents with symptoms of superior vena cava syndrome due to a tumor. Which of the following anatomical structures is directly compressed, leading to these symptoms?
During the dissection of a cadaver, it is observed that the posterior intercostal arteries arise directly from the thoracic aorta. Which layer of the thoracic wall would these arteries primarily supply?
During the dissection of a cadaver, it is observed that the posterior intercostal arteries arise directly from the thoracic aorta. Which layer of the thoracic wall would these arteries primarily supply?
A patient is diagnosed with a tumor affecting the right side of their thorax. Which lymphatic trunk is responsible for draining the right thorax? Choose the correct option
A patient is diagnosed with a tumor affecting the right side of their thorax. Which lymphatic trunk is responsible for draining the right thorax? Choose the correct option
A patient who has difficulty swallowing most likely has damage in which of the following structures?
A patient who has difficulty swallowing most likely has damage in which of the following structures?
The inferior mediastinum houses the aorta, which allows transit through the abdomen. In what way does it enter?
The inferior mediastinum houses the aorta, which allows transit through the abdomen. In what way does it enter?
In which of the following locations would you see the central tendon?
In which of the following locations would you see the central tendon?
A patient is undergoing an examination for a suspected aortic dissection. Which vertebral level signifies the start of the structure?
A patient is undergoing an examination for a suspected aortic dissection. Which vertebral level signifies the start of the structure?
Of the following options, which best explains what the purpose of the medulla in the thymus serves?
Of the following options, which best explains what the purpose of the medulla in the thymus serves?
Before a physician treats a patient, they want to ensure that if the blood supply is altered by a tumor, their heart can adapt. What system should they review?
Before a physician treats a patient, they want to ensure that if the blood supply is altered by a tumor, their heart can adapt. What system should they review?
During a bronchoscopy, a physician identifies the carina in the patient's trachea. Which surface landmark can they also identify?
During a bronchoscopy, a physician identifies the carina in the patient's trachea. Which surface landmark can they also identify?
Following a motor vehicle accident, a patient presents with a flail chest. Which of the intercostal muscles are involved?
Following a motor vehicle accident, a patient presents with a flail chest. Which of the intercostal muscles are involved?
A patient comes into a physician describing a build up of lymphatic fluid into the pleural cavity. Which condition is this?
A patient comes into a physician describing a build up of lymphatic fluid into the pleural cavity. Which condition is this?
A patient involved in a car accident has a condition where his thoracic region is affected. Further evaluation revealed a tumor. What are the anatomical names that this area is referred to?
A patient involved in a car accident has a condition where his thoracic region is affected. Further evaluation revealed a tumor. What are the anatomical names that this area is referred to?
During a surgical procedure, a structure is visualized crossing from right to left at T5-T6 before emptying into the left venous angle. Which structure is being identified?
During a surgical procedure, a structure is visualized crossing from right to left at T5-T6 before emptying into the left venous angle. Which structure is being identified?
Where is the superior mediastinum?
Where is the superior mediastinum?
What encloses the heart?
What encloses the heart?
Where does lymphatic fluid drain into?
Where does lymphatic fluid drain into?
Anatomical research reveals the absence of the sternocleidomastoid in a cadaver. Which structure is affected?
Anatomical research reveals the absence of the sternocleidomastoid in a cadaver. Which structure is affected?
Which structure forms both the aortic hiatus of the diaphragm and the union of both the right ascending lumbar vein at the level L1-L2, contributing to venous return from the abdomen.
Which structure forms both the aortic hiatus of the diaphragm and the union of both the right ascending lumbar vein at the level L1-L2, contributing to venous return from the abdomen.
What best describes the flow of deoxygenated blood into the heart.
What best describes the flow of deoxygenated blood into the heart.
What causes the creation of the pericardial sinuses?
What causes the creation of the pericardial sinuses?
A patient is having trouble with the way they produce a motor or sensory to certain parts of their body. What is the structure that can provide that information to a doctor?
A patient is having trouble with the way they produce a motor or sensory to certain parts of their body. What is the structure that can provide that information to a doctor?
Which blood vessel is found in the Atrioventricular groove?
Which blood vessel is found in the Atrioventricular groove?
What are the three visceral branches to supply thoracic organs?
What are the three visceral branches to supply thoracic organs?
Which anatomical feature allows for oxygen exchange to be slightly higher.
Which anatomical feature allows for oxygen exchange to be slightly higher.
What provides the thoracic duct with a place to meet and converge?
What provides the thoracic duct with a place to meet and converge?
Which heart chamber forms most of the heart's base?
Which heart chamber forms most of the heart's base?
What encloses the heart from infection, adjacent parts, and external parts?
What encloses the heart from infection, adjacent parts, and external parts?
During the procedure, the first rib ends up receiving damage. Which vessel is at risk?
During the procedure, the first rib ends up receiving damage. Which vessel is at risk?
What is the importance of the azygos system of veins?
What is the importance of the azygos system of veins?
When is the sternoclavicular joint prone to fracture?
When is the sternoclavicular joint prone to fracture?
Which of the following is NOT a structure found in the mediastinum/
Which of the following is NOT a structure found in the mediastinum/
During a surgical procedure requiring temporary clamping of the ascending aorta and pulmonary trunk, which anatomical landmark would best guide the surgeon to the ideal access point?
During a surgical procedure requiring temporary clamping of the ascending aorta and pulmonary trunk, which anatomical landmark would best guide the surgeon to the ideal access point?
A patient is diagnosed with a thoracic aortic aneurysm compressing the esophagus. Which vertebral level is most closely associated with the aortic constriction that may lead to difficulty swallowing?
A patient is diagnosed with a thoracic aortic aneurysm compressing the esophagus. Which vertebral level is most closely associated with the aortic constriction that may lead to difficulty swallowing?
A cardiologist is performing a pericardiocentesis via the subxiphoid approach. Which anatomical layer is the needle passing through directly before entering the pericardial cavity?
A cardiologist is performing a pericardiocentesis via the subxiphoid approach. Which anatomical layer is the needle passing through directly before entering the pericardial cavity?
A patient is experiencing ischemia in the lateral wall of the left ventricle. Which vessel is most likely affected?
A patient is experiencing ischemia in the lateral wall of the left ventricle. Which vessel is most likely affected?
A clinician is palpating for the sternal angle to count the ribs of a patient. Which surface landmark is closest to the position?
A clinician is palpating for the sternal angle to count the ribs of a patient. Which surface landmark is closest to the position?
A patient is diagnosed with a Pancoast tumor affecting the lung apex. Which vertebral level is most closely associated with the location of this tumor?
A patient is diagnosed with a Pancoast tumor affecting the lung apex. Which vertebral level is most closely associated with the location of this tumor?
A patient showing a superior mediastinum syndrome due to a tumor compression, what are the signs and symptoms that the physician could look for?
A patient showing a superior mediastinum syndrome due to a tumor compression, what are the signs and symptoms that the physician could look for?
What type of vessels go from the apex of their hearts down to the inferior portion of their diaphragm?
What type of vessels go from the apex of their hearts down to the inferior portion of their diaphragm?
A patient reports pain at the medial part of their lungs near the left subclavian near the neck region. What lymphatic drainage is associated with the following pain?
A patient reports pain at the medial part of their lungs near the left subclavian near the neck region. What lymphatic drainage is associated with the following pain?
You have a patient that had difficulty swallowing with an inflamed aorta close to their esophagus. Which of the following has occurred in with relationship to the trachea?
You have a patient that had difficulty swallowing with an inflamed aorta close to their esophagus. Which of the following has occurred in with relationship to the trachea?
Which of the veins are drained through the internal thoracic vein?
Which of the veins are drained through the internal thoracic vein?
After performing the correct landmark and placement of an ECG, the T1-T4 are placed at which structure to cause an increasing heart rate,and to further contract?
After performing the correct landmark and placement of an ECG, the T1-T4 are placed at which structure to cause an increasing heart rate,and to further contract?
Which component is the last to occur when in contact with the arterial system?
Which component is the last to occur when in contact with the arterial system?
A trauma surgeon is treating a patient with a diaphragmatic rupture following a motor vehicle accident. Which has the higher chance of infection or other spread of infections?
A trauma surgeon is treating a patient with a diaphragmatic rupture following a motor vehicle accident. Which has the higher chance of infection or other spread of infections?
During a mediastinoscopy, a surgeon is working in the superior mediastinum and needs to carefully avoid damaging the nerves that provide parasympathetic innervation to the thoracic viscera. Which of the following nerve pairs are they trying to avoid?
During a mediastinoscopy, a surgeon is working in the superior mediastinum and needs to carefully avoid damaging the nerves that provide parasympathetic innervation to the thoracic viscera. Which of the following nerve pairs are they trying to avoid?
During a procedure, there is a specific location the heart may be vulnerable to several disorders. Which location is being referred to?
During a procedure, there is a specific location the heart may be vulnerable to several disorders. Which location is being referred to?
If the heart is pumping faster than usual with a quicker and rapid contraction what is affected from this action?
If the heart is pumping faster than usual with a quicker and rapid contraction what is affected from this action?
The vagus nerve has 5 branches, which branch has direct influence with external ear and the auditory canal?
The vagus nerve has 5 branches, which branch has direct influence with external ear and the auditory canal?
You have a patient that is showing signs of heart failure due to high blood pressure. During evaluation, what chamber of the heart is affected that will affect the patient's result?
You have a patient that is showing signs of heart failure due to high blood pressure. During evaluation, what chamber of the heart is affected that will affect the patient's result?
The azygos vein arches over which structure before draining into the superior vena cava?
The azygos vein arches over which structure before draining into the superior vena cava?
Flashcards
Anterior Thoracic Wall
Anterior Thoracic Wall
The front portion of the thorax (chest) that protects vital organs
Bony Framework of Thoracic Wall
Bony Framework of Thoracic Wall
Sternum parts including: manubrium, body (gladiolus), and xiphoid process
Ribs
Ribs
True ribs (1-7) directly attach to the sternum, false ribs (8-10) attach indirectly, and floating ribs (11-12) do not attach.
Muscles of the Thoracic Wall
Muscles of the Thoracic Wall
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Nerve Supply of Thoracic Wall
Nerve Supply of Thoracic Wall
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Lateral Thoracic Wall
Lateral Thoracic Wall
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Intercostal Spaces
Intercostal Spaces
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Costovertebral Joints
Costovertebral Joints
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Sternocostal Joints
Sternocostal Joints
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Sternoclavicular Joint
Sternoclavicular Joint
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Reinforcement of SC Joint
Reinforcement of SC Joint
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Thoracic Inlet Boundaries
Thoracic Inlet Boundaries
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Thoracic Outlet Boundaries
Thoracic Outlet Boundaries
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Sternal Angle
Sternal Angle
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Structures Passing Through Aortic Hiatus
Structures Passing Through Aortic Hiatus
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Structures Passing Through Esophageal Hiatus
Structures Passing Through Esophageal Hiatus
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Structures Passing Through Caval Opening
Structures Passing Through Caval Opening
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Tracheal Bifurcation Level
Tracheal Bifurcation Level
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Vertebral Level Landmarks
Vertebral Level Landmarks
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Mediastinum division
Mediastinum division
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Segmental Innervation
Segmental Innervation
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Layers of the Thoracic Wall
Layers of the Thoracic Wall
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External Intercostal Muscles
External Intercostal Muscles
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Internal Intercostal Muscles
Internal Intercostal Muscles
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Diaphragm
Diaphragm
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Central Tendon
Central Tendon
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Diaphragm's Motor Innervation
Diaphragm's Motor Innervation
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Inspiration mechanics
Inspiration mechanics
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Expiration Mechanics
Expiration Mechanics
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Pleural and Pericardial Cavities
Pleural and Pericardial Cavities
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Mediastinum Contents
Mediastinum Contents
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Suprapleural Membrane
Suprapleural Membrane
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Lung Size Comparison
Lung Size Comparison
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Autonomic Innervation of lungs
Autonomic Innervation of lungs
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Pulmonary Circulation blood flow
Pulmonary Circulation blood flow
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Trachea
Trachea
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Bronchopulmonary Segment
Bronchopulmonary Segment
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Superior Mediastinum Boundaries
Superior Mediastinum Boundaries
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Anterior Mediastinum
Anterior Mediastinum
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Middle Mediastinum
Middle Mediastinum
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Branches Subclavian Arteries
Branches Subclavian Arteries
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Courses of Vagus Nerves
Courses of Vagus Nerves
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Recurrent Laryngeal Nerves
Recurrent Laryngeal Nerves
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Difference L and R Recurrent Laryngeal
Difference L and R Recurrent Laryngeal
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Thymus
Thymus
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Pericardium
Pericardium
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Transverse Pericardial Sinus
Transverse Pericardial Sinus
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Aortic Hiatus (T12)
Aortic Hiatus (T12)
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Deoxygenated Blood Flow
Deoxygenated Blood Flow
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Oxygenated Blood Flow
Oxygenated Blood Flow
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Ductus Venosus
Ductus Venosus
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ConductingSystem Components
ConductingSystem Components
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Study Notes
Thoracic Wall, Surface Landmarks, and Joints
- Imaginary lines describe the placement of anatomical elements alongside clinical findings
- Protection of organs such as the heart is provided by the anterior thoracic wall
- It consists of bone, muscles, fascia, and skin in several of its layers
Thoracic Wall - Bony Framework
- The sternum is a flat bone in the midline, composed of the Manubrium, Body, and Xiphoid process
- Ribs and Costal Cartilages: True ribs (1-7) directly connect to the sternum via costal cartilages
- False ribs (8–10) connect indirectly through the cartilage of rib 7
- Floating ribs (11-12) do not connect to the sternum
- Clavicles connect the sternum to the scapulae (shoulder blades)
Thoracic Wall - Muscles
- The several muscle layers of the thoracic wall offer movement, protection, and respiration
- Pectoralis Major is a large superficial muscle that aids arm movement
- Pectoralis Minor; stabilizes the scapula, Serratus Anterior assists in scapular motion
- Intercostal Muscles sit between ribs, External intercostals for inhalation, Internal intercostals for exhalation
- Innermost intercostals aid in structural support, and the Small Subclavius muscle stabilizes the clavicle
Thoracic Wall - Fascia and clinical relevance
- Superficial fascia contains fat and skin, Deep fascia surrounds structural muscles
- Endothoracic fascia; separates muscles from the pleura, the lung lining
- Fractures, Pectus excavatum and carinatum can form
- Thoracic outlet syndrome may develop around the clavicle
- the side portion of the thorax is the Lateral thoracic wall, and it assists the upper limb
Lateral Thoracic wall - Key Features
- Ribs: 12 pairs form the side of the thoracic cage, and Costal cartilages; connect ribs to sternum
- Intercostal spaces: Gaps between ribs contain muscles, nerves, and vessels
- Intercostal Muscles are between ribs; external intercostals for inspiration, internal intercostals for expiration
- Serratus anterior and Latissimus dorsi are the "other muscles"
Lateral Thoracic wall - Clinical significance
- Rib fractures are common in trauma, can lead to Lung injury
- Long thoracic nerve injury leads to Winged scapula, affecting Serratus anterior function
- Intercostal neuralgia is pain along Intercostal nerves
Surface Landmarks: Heart, vessels, trachea etc
- Apex of the Heart is located at the 5th intercostal space, Right Border originates from the 3rd to 6th costal cartilage
- Left Border originates from the 2nd left costal cartilage and the base of the heart sits at the level of the 2nd costal cartilage
- At the T4-T5 level, the Aortic Arch, is also found, as well as the sternal angle
- The Pleural margins extend along the Midclavicular line; 6th rib, Midaxillary line; 8th rib, Paravertebral line; 10th rib
Osteological Features of the Thoracic Region
- T1 to T12 heart shaped thoracic vertebrae form components of the axial and appendicular skeletons
- Located in the upper part, the Manubrium, includes a Jugular Notch (Suprasternal Notch)
- The rest of the Body is the longest, and connects; ribs 2-7, the Sternal Angle, is an anatomical landmark, and the Xiphoid Process is an inferior cartilaginous point
- True Ribs (1–7) connect to the sternum, False Ribs (8–10) attach to the sternum through rib 7 cartilage, and Floating Ribs (11-12) do not connect to the sternum
Spinal Joint, Head, Neck, Tubercle and Clavicle
- The head, neck and tubercle connect the neck to the tubercle
- It also features; a shaft for thin, curved nerves, and a single broad first rib
- The clavicle connects to the sternoclavicular (medial) and Acromial (lateral) ends
- Smooth, with features like the conoid tubercle, helps shoulder mobility
Joints of the Thorax
- The costovertebral are articulations of ribs and the vertebral column, allowing respiratory movement through two types
- Joints are connecting costocorporeal (costovertebral) or costotransverse joints , to the vertebral bodies or the vertebra
- The vertebral body connects with the same and superior same, then the Costovertebral and Radiate ligament support
- Superior costotransverse helps provide support, then, the pain relief of Costovertebral treatment
Rib and Sterneal Joint Movement
- The Joints allow respiratory movements:
- Respiratory movements involve Pump-handle movement of the ribs and Bucket-handle movement of lower ribs
- Arthritis is clinical relevance to joint inflammation, limiting rib cage mobility
- Rib fractures may also damage the joints making breathing difficult
Sterneal Costal and Clavicular Regions
- Two sternocostal joint types exist depending on structure of: First Sternocostal or Sternocostal Joints of Ribs 2–7,
- Rib 1 has a cartilage connection and Ribs 2-7 have a Synovial Plane joints
- Radiate and Intra-articular Sternocostal Ligaments assist and Costoxiphoid Ligaments attach the Xiphoid process
- Small movements at these joint help with rib cage elevatation
- The Sternoclavicular (SC) joint is between the clavicle and the sternum
- Articular Surfaces with fibrocartilage covering the joint make it function akin to a ball-and-socket joint
Sternoclavicular Joints
- A strong joint capsule with Sternoclavicular, Interclavicular, and Costoclavicular ligament provide support and absorb shock
- Scapular mobility and upper limb function from, Elevation, Depression and Rotation the plane allow
- Dislocation or Posterior dislocation can cause injury and compress or cause Sternoclavicular Arthritis
Boundaries of the Thoracic Inlet
- The passage of vital structures connecting the thorax with the neck and abdomen are in the thoracic inlet and outlet
- Manubrium, ribs 1, and T1 make up the thoracic inlet with passing Trachea and esophagus
- Also passing are Common carotid and Subclavian arteries etc
- Xiphisternal joint, ribs 11/12, and thoracic vertebra T12 form outlet
- Aortic, Esophageal and Caval diaphraghm opening
Sternal Angle and Landmark
- A palpable bony landmark formed at "Angle of Louis" a manubrium meets the body
- As it can be useful for rib counting and the second costal cartilage landmark
- The superior and inferior mediastinum is divided, aligns arch of aorta and trachea
Vertebral and Bone Markers
- The jugular notch serves as a reference for venous catheter placement at T2-T3
- At T4-T5 level (Angle of Louis) there is tracheal bifurcation, and aortic arch also begins
- The xiphisternal joint, positioned at T10, marks the bottom of the heart but the xiphoid proces is for CPR reference
- Tracheal splitting can be located at T4-T5 aiding bronchoscopy and endotracheal intubation, as is aortic origin
Heart, Spinal Cord and Sternal Angle
- The IVC pierces allowing blood into the right atrium, from T5 to T8
- Although not in the region, the spinal cord in adults ends at vertebral level L1-L2 for spinal injury
- Diaphragmatic openings help with abdominal-thoracic communication and niatal hernias
- The sternal angle (T4-T5) is for rib counting with Diaphragmatic openings
Intercostal Nerves and Arteries
- The thoracic wall and spinal nerves supply from T1-T11 anterior rami spinal nerves
- They Run towards the intercostal muscles, provide motor supply intercostal muscles
- The thoracic and intercostal arteries come from the thoracic aorta
- Drain into the venous system azygos and hemiazygos venous (posterior)
Segmental and deep tissues
- Segmental innervation (dermatomes) of the thoracic is provided at the spinal nerves T1–T12
- T4 dermatome passes nipple line
- T10 is the umbilicus
Thoracic Wall Layers
- Superficial tissue, deep fascia, then intercostal muscles are layers
- The endothoracic separates muscles, allowing fluid during expansion
- The outmost layer, parietal, can also support
Breathing Muscles
- The intrinsic breathing muscles aid expansion
- External Intercostal Muscles Run superomedially, and innervate with Nerves T1-T11
- Internal intercostal muscles contract during action and elevation
- Inner/sub Constal and Transversus Thoracics all contribute
Diaphragm, Phrenic Nerves
- Structure: Dome skeletal separating thoracic and abdominal
- Function: Volume for muscle motor respiration, aids organ return to the heart
- Innervated by sensory (centre) and motor (side) nerves
- Location: right 4th intercostal and left lower
- Spinal levels, T8 is for veins, the caval opening, T10 is for muscle/esophagus, T12 for Aortic, is for the lymph drainage
Phrenic Nerves and the CAVs
- Origin: C3-C5 spinal cord to the diaphragm
- Course: Posterior to the neck, anterior to muscle
- Function: Contain Pericardium/pleura fibers
- Inspiration expands Diaphragm, elevattes ribs, moves sternum increasing anteroposterior diameter
- Expiration reduces Diaphragm, lowers ribs and is passive Elastic recoil
Pleural and Pericardial
- The pleural and pericardial serve protection, within the parietal and visceral pleura and pericardium
- serous fluid, reduce, while infection would otherwise cross-contaminate through a pleural cavity
- The Thorastic cavity houses vital mediatisnum and lungs, Right and Left
- The trachea at T4-T5 level leads to descent and divides (sternal angle)
Endothoracic, Suprapleural
- The Fascia lines the separating intercostal muscles from the inner surface
- The diaphragm travels down and forms between diaphragm and the apex forming a Suprapleural membrane
Respiratory
- The apex reinforcements come in the lungs with vessel support
- The lungs are essential organs of inspiration for oxygen intake, filtration and waste removal
- Lung's work diaphragm and muscle to facilitate inhalation
Left and Right Lungs
- The right lung features three lobes, horizontal and obliques fissures, the left lung features two
- Differing sizes are responsible for slight angle changes
Lungs Innervation and Circulation
- Function is mostly together by the right and left ensure to exchange oxygen & CO2
- Sympathetic Innervation: Originates from the sympathetic trunk (T1-T5), and causes bronchodilation and vasoconstriction
- Parasympathetic Innervation: Provided by the vagus nerve (CN X), and causes bronchoconstriction, mucus secretion, and vasodilation
- Blood is transported by: Pulmonary arteries for blood that require cleaning and Bronchial circulation to oxygenate
Tree
- The Trachea extends from cricoid cartilage (C6) the carina (T4-T5), that conducts air
- The Branch Tree air branches trachea to alveoli into smaller bronchioles millions of alveoli
- Bronchi: is either Main, Secondary or Tertiary, Bronchopulmonary, ending with alveoli ducts
Bronchopulmonary Segment and Divisions
- The Bronchopulmonary Segment is a distinct anatomical and functional unit of the lungs
- It receives segmenting bronchi and blood, and is significant in gas subdivision exchange
- Diagnosing of lung infection, tumor and other condition allows proper intervention by treatment
Mediastinal Cavity Boundaries
- The mediastinum cavity is central in division by transverse T4 or T5
- Boundaries: Thoracic Inlet, transverse plane, sternum, and vertebrae
- Thymus, Great Vessels, Trachea, Esophagus; are the Contents
- Boundaries depend on whether it is Superior or Inferior, Anterior, Middle or Posterior
subclavian arteries for thorax supply
- The subclavian arteries supply the thoracic wall, Vertebral, Dorsal Scapular, Thyrocervical structure
- Internal Thoracic, Costocervical, region are arteries that supply structure
Vagus Nerve structure
- The vagus control the thorax with parasympathetic innervation
- Passes the Jugular then the carotid sheath before Thoracic aperture
- Branches to Left-lung, while Right side, loops to larynx and cardiac
Recurrent Laryngeal Nerves
- Recurrent Laryngeal motor and sesnory nerves for the thorax as well
- Cardiac/Pulmonary regulate heart and Bronchoconstriction
- Right Recurrent loops and ascends around and the subclavian body towards tracheoesophageal
- LRLN loops the aortic arch, before ascending toward the tracheoesophageal
Left vs Right Recurrent
- The RVLN arise from the subclavian root
- the Left LRLN in aortic arch that connects with the ligamentum arteriosum
- LRLN are mostly neck and shorter but LRLN enter thorax, longer
Body
- Similarities: Both nerves provide motor innervation larynx, carry sensory fibers
- left and right Nerves serve function and aid body
Relationships of the Thymus
- Location: in anterior mediastinum, behind upper pericardium
- size and Function is large in Infants, but smallest in Adults
- The Thymus also important in conditions like thymomas or hyperplasia
- Tumours, cysts and other complications can constrict surrounding organs and airways
Pericardium Layers
- There exixts is a double-layered that helps hold vessels and provide protective lubrication
- Structures, include Superior great vessels, Inferior diaphragm, Anterior sternum and Posterior esophagus and aortas
- A double Inner Layer, Serous, helps reduce friction with Outer layer, Fibrous
- Parietal (lines inner layer) and Visceral layer (directly covers) are constituents
- During inflammation, pericarditis occurb and can lead to tamponade
Sinuses
- Reflected serous Pericardium around blood vessels form Sinuses
- Transverse forms between Pulmonary, right venous structures and the SVA
- Surgeons can use sinus to control artial flow with clamps
- Oblique is a blind recess found posterior
- Sinus forms around interiour vena Cava etc
Heart Pathway
- Blood enter from body -> superior and inferior vena Cava
- Travel Right artrium -> Tricuspid valve -> Right ventricle and Semilunar
- Next -> Pulmonary Arteries -> lung for gas exchange
Side heart
- The Oxygenated blood travels, pulmonary vein -> Left Atrium
- Left Side: is left ventricle-> Aortic Semilunar ->aerta
- The aorta distributes the oxygenated blood to the entire body
Circulation, Birth, Anatomy
- Fetal do not use for lungs relying On Placenta which the circulation
- Umbilical Vein, Venosus, Foramen , Arteriosus
- Fetal also use Umbilical arteries for nonfunctional distribution blood
Anatomy
- Hear External: is Four chambered organ, (base to chambers)
- Internal is deoxygenated blood SA into the Right Atrium
- The right vents pumps to lungs, receives and pumps from artium
Cardiac Anatomy Skeleton
- Valves: Atrioventricular prevent backflow from the aorta
- Cardiac skeleton: Fibrous supports electrical activity and valves
- Fibrous Rings (with two Fibrous Trigones) that connect
Cardiac Skeleton
- Mechanical valves maintain shape Integrity
- Electric insulation through AV nodes ensures proper and electrical timing
- Valve over stretching can stop dilation preventitive methods
- Conduction, and calcification or valvular stenosis can clinical cause damage
Heart Structure Valves
- They contain Four valves which ensures unidirectional blood of flow through heart for circulation
- Atrioventricular (AV) Valves: Tricuspid prevent to the atria
- Semilunar Valves: Aortic valves close with ventricular flow
L and R atrioventricular valves
- Tricuspid - right atrium - ventricle, Bicuspid (Mitral) - left atrium-ventricle
- A Pulmonary valve helps oxygen for circulation
Vessels of the Heart, blood
- Arterial - coronary system, Myocardium and begins With Arteries
- Coronary - left descends and circles Lateral - Left Descending (LAD)
- Right branch and help conduction parts, blood
- Venous System. large posterior - collecting heart
- Returns flow by, middle, great, the Cardiac
Nodes of the Heart
- SA node- located In SA of contraction (atria)
- Atriums, AV node contraction, fibers AV node for signals (atria)
- SA node - fires impulse- (atrial) and reach nodes
- Signals travel -to purkinje- cause (ventricle) contraction
Autonomic Control
- Nerves with autonomic innervation
- Sympathetic heart rate - flight/fight, increase
- Parasympathetic - the digestive
- heart beat regulated balance resting, or exercise
Mediastinal Structure divisions
- Subdivision of the inferior mediastinum is the posterior region, between spinal column and pericardium
- It passes vessels while being bounded with Pericardium and Diaphragm
- The vessels run to spinal area on right and thoracic column on vertebra
- descends (aorta), Thoracic (duct), also Vagus nerves, and sympathetic areas
Aorta Relationships
- Structures front; left root,
- pericardium and Esophagus on
- Structures from the Back: vertebra
- Structure Right : duct and veins, Structue Left on Pleura
Aorta and Vein Relevance
- Arteries help in aorta for thoracic, ribs and aorta for lumbar
- Arterial - aorta for organs, veins drain a blood for heart if low level IVC
Vein Function
- Colloteral circulation blocked, azygos (aorta) vein, and more
- The Enlarge esophageal Varices. , bleeding the aorta
Thymic Tissue and Clinical Correlation
- Subdiaphragmatic or Abdominal Nodes
- The lymphatic are important for Lymphoma cancer
- Metastatic Pathways help control lymph infection
Duct Pattern
- Control patterns with drainage for thoracic
- The vessel drains lymph upper from body
- Drainage into - right lymph/jugular trunk
- And from Right and Left sides thoracic
The Sympathetic Chain and Branches
- The Thoracic chain is from the T1 to T12 by heads from the ribs
- Chains aid the inter cervical with the ganglion form stellate ganglia
- Gray & White communicate supply to to the to spinal nerves
- Esophagus through plexus , to the Abdomen
Key Vein Landmarks
- Superior : mediastium, Syndrome/ Compression
- Middle pericardis affects - tamponade/effusion
- inferior: aneurism / cancers affects esophagus /nerves
- They also affect lymph movement and blood signals
Sinuses Pericardial
- Serous membrane for Pericardial for heart protection
- The transvereses aid the artery in the pulmonaries, by aortic Sinus is for cardiac intervention
- The Pericardial the left artium is for the Sinuses
Heart Pathway of flow explained
- The pathway of the blood in the heart enters with deoxy fluid
- Enter to valve and to blood vessel for cleaning oxygenation
- Comes back travel from atrium back to the left and right pumps
Nerves in the heart
- The Phrenic is involved and a motor and sensory by diaphragm
- The Aorta is important in disease with vessel
- The thymus important with the autoimune in conditions with abnormalities
Circulation pathway from heart
- Blood returns with lungs blood vessel
- Serous sac for with attachments at aoria, vena, and diapharm
Artery and Heart
- Valves for Atria, valves
- Fibrous and the heart
Contractions for Heart
- Structural myocardium
- Muscle fibers aid structure.
- Electric signals
Anatomy
- Aorta , vein all affect to the area
- Heart and ateriovenus system function with flow
Coronary Arteriy
- Responsible for oxygenates - myocardium area for effectively
Valves of Heart Structure
SL : prevent and ventricle blood
- P Valve RV- to LA three
- Bicuspid has functions ventricle preventing LA
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