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41 Cards in this Set
- Front
- Back
What is the mediastinum?
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area btwn two pleural cavities, central thorax
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what are the mediastinum borders?
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-Superior thoracic aperture to diaphram (superior to inferior border)
-Sternum to vertebral bodies (anterior to posterior) -Two pleural cavities (lateral borders) |
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The mediastinum is divided into superior & inferior portions, above & below the sternal angle. What parts are the inferior mediastinum further subdivided into
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anterior: body of sternum to pericardial sac
middle: pericardial sac to heart posterior: pericardial sac to vertebral bodies T5-12 |
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Borders of the superior mediastinum
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-Manubrium of sternum to T1- T4 (ant to post)
-Superior thoracic aperture to sternal angle (disc btwn T4&5) (sup to inf) - |
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The superior mediastinum contains:
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thymus
R & L brachiocephalic veins superior vena cava arch of aorta & major branches trachea esophagus phrenic nerves vagus nerves thoracic duct |
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The _______________ is an asymmetric bilobed structure, immediately posterior to manubrium of sternum
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thymus
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Most adults have completely involuted thymus, what are some exceptions?
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some types of cancer & some autoimmune conditions
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Where are the R & L brachiocephalic veins located?
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immediately posterior to thymus
*formed from the junction of internal jugular & subclavian veins |
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What do the brachiocephalic veins joint to form at the lower edge of the R 1st costal cartilage?
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superior vena cava
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What are some of the common access points for performing a central line (CVC)?
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jugular vein, subclavian vein, & femoral veins
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What are some of the common uses for central lines?
What are some common complications |
Uses:
-monitor CVP -administer medications (long term pain meds, chemotherapy, antibiotics) -frequent blood draws complications: -pneumothorax -infection -thrombosis |
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The thoracic portion of the aorta can be divided into what 3 structures?
Which is the only one in the superior mediastinum? |
ascending aorta, arch of aorta, thoracic (decending) aorta
only the arch of the aorta is w/i the superior mediastinum |
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What are the 3 large branches that arise superiorly from the arch of the aorta?
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left subclavian
left common carotid brachiocephalic trunk |
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The __________________ gives rise to the R subclavian & R common carotid arteries
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brachiocephalic trunk
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What occurs during aortic dissection (dissecting aneurysm)?
which type requires immediate surgery? |
blood is forced through a small tear in tunica intima & layers of arterial wall begin to seperate.
type A *life threatening condition, rupture 80% mortality, most common males 40-60 |
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The _______ is a flexible tube formed by c-shaped cartilaginous rings. Sits inferior to larynx.
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trachea
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The trachea divides into the R & L main bronchi at the __________ vertebral level
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T4-T5
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The phrenic nerves (C3-5) descends through the superior medistinum, along the pericardial sac, w/i the fibrous pericardium, anterior to root of lung. What do they innervate here?
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mediastinal pleura, fibrous pericardium, & parietal layer of serous pericardium
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A spinal cord injury at the level of _____ or above will result in a patient not being able to breathe on their own.
If a _____________ nerve is damaged, one side of the diaphram will be paralyzed. |
C3
phrenic nerve |
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What is Ondine's Curse?
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congenital central hypoventilation syndrome (CCHS)
primary alveolar hypoventilation brainstem disorder causes you to stop breathing in sleep |
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What nerve provides parasympathetic innervation to the thoracic & abdominal viscera
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vagus nerves (CN X)
*descend through superior & posterior mediastinum on their way to the abdomen |
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The R & L vagus nerves give rise to R & L ____________________ nerves, which innervate the muscles of the larynx
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recurrent laryngeal nerves
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The ___ recurrent laryngeal n passes under the __ subclavian a before ascending to larynx
The ___ recurrent laryngeal n passes under the ________ before ascending to larynx |
Right - under right subclavian artery
Left- under arch of aorta artery |
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Lymph node enlargement, due to spread of lung cancer, among other things, may lead to compression of the _______________________ nerve, resulting in vocal cord paralysis & voice hoarseness.
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left recurrent laryngeal nerve
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What does the anterior mediastinum contain?
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(green space)
-fat -CT -lymph nodes -mediastinal branches of internal thoracic vessels -sternopericardial ligaments -remnants of thymus |
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What does the middle mediastinum contain?
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(pink space)
-pericardial sac -heart -origins of great vessels -phrenic nerve C3-C5 -perocardiacophrenic vessels **bordered by pericardium |
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What does the posterior mediastinum contain?
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(blue space)
-esophagus -thoracic aorta -azygos system of veins -thoracic duct -sympathetic trunks & thoracic splanchnic nerves |
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The ___________ is a muscular tube that runs from pharynx to stomach, descending through both the superior & posterior mediastinum on way to abdomen.
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esophagues
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The esophagus receives part of its innervation from the __________ nerves. The left _______ nerve continues as the anterior ________ trunk & the right _______nerve as the posterior ___________ trunk.
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vagus nerves
left vagus nerve anterior vagal trunk right vagal nerve posterior vagal trunk |
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4 sites of esophageal constriction:
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1. jxn of esophagus & larynx in neck
2. where arch of aorta crosses esophagus 3. where left main bronchus crosses over esophagus 4. at esophageal hiatus of diaphram |
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The sympathetic trunks & thoracic splanchnic nerves are major components of what?
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the sympathetic division of ANS
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As thoracic aorta descend through post. mediastinum it gives off:
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-post. intercostal a., which supply lower 9 intercostal spaces (3-11)
-bronchial arteries, which supply bronchi & lungs -esophageal arteries, supply esophagus |
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Azygos system of veins formed by what 2 veins that drain blood from body wall to superior vena cava?
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azygos vein on right
hemiazygos & accessory hemiazygos veins on left |
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Designate drainage of posterior intercostals & ascending lumbar veins on Right side
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Azygos vein
T9-T12 T5-T8 Right superior intercostal vein T2-T4 (drains into azygos vein) Right T1 intercostal vein (drains into right brachiocephalic vein) |
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Designate drainage of posterior intercostals & ascending lumbar veins on Left side
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Hemiazygos vein
T9-T12 Accessory hemiazygos vein T5-T8 Left superior intercostal vein T2-T4 (drains into left brachiocephalic vein) Left T1 intercostal vein (drains into left brachiocephalic vein) |
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In case of obstruction of the inferior vena cava, blood may be rerouted through the _________ vein in order to return to the heart
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azygos vein
*rerouting leads to dilation |
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What is the main channel of lymph return from body to the venous system?
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thoracic duct
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The thoracic duct begins as the ______________ in the abdomen & extends superiorly into the thorax through the _____________ & empties into the junction of the left subclavian & left internal jugular veins
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cisterna chyli (chyle cistern)
aortic hiatus of diaphram |
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The R arm & side of the head & neck are drained by what?
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right lymphatic duct
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What is chylothorax?
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lymph fluid accumulating in pleural cavity, caused by leak of thoracic duct (usually due to lymphoma or direct trauma)
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The thoracic duct transports up to _____ of chyle per day. This allows rapid accumulation of fluid in chest (chylothorax)
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4 L
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