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80 Cards in this Set
- Front
- Back
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Mnemonic for sup. mediastinum structures |
A PVT Left BATTLE (Arch of azygous, Phrenic nerve, Vagus nerve, Thoracic duct, Left recurrent laryngeal nerve, Brachiocephalic veins, Arch of aorta-&3branches, Thymus, Trachea, Lymph nodes, Esophagus) |
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SM structures anterior to posterior |
Thymus, veins, arteries, trachea, esophagus, lymphatics |
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Anterior, lateral and posterior borders of thymus |
Anterior: Manubrium Lateral: Costomediastinal recesses Posterior: SVC and L Brachicephalic vein |
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Arterial and Venous Blood supply to thymus |
Artery: Anterior intercostal & internal thoracic Vein: Branches drain into brachiocephalic, internal thoracic, and inferior thyroid veins |
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Thymoma |
Cancer of thymus -if in R side, it can constrict SVC and cause swelling of head, neck and upper limbs -if in L side, it can constrict brachiocephalic and cause swelling on L side |
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SVC drains which structures |
All structures superior to diaphragm except the heart which is drained by coronary sinus into R atrium or via anterior cardiac veins |
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R & L brachiocephalic veins unite at _____ to form _____ |
-1st R costal cartilage -SVC |
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Pathway of azygos in sup. mediastinum |
goes over root of R lung before opening into SVC |
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Where do the right and left recurrent laryngeal nerves loop? |
R: loops under R subclavian artery L: loops under arch of aorta Originate from R and L vagus |
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Superior tracheobronchial, hilar nodes, and R tracheal or lung tumors can easily compress what vessel?e |
Arch of azygos |
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Retroesophageal R subclavian |
Compresses esophagus leading to dysphagia Rt subclavian artery passes post to esophagus |
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Double arch of aorta |
Compresses esophagus and trachea Sxs: Stridor and dysphagia Ring formed around esophagus and trachea |
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Compression of L recurrent laryngeal nerve by _________ can cause ______ sxs |
-aortic arch aneurysm, esophageal tumors, tracheal tumors, mediastinal tumors -Unilateral damage: Hoarseness -Bilateral damage: Loss of voice -aphonia |
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What innervates the intrinsic muscles of the larynx? |
Recurrent laryngeal nerves |
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R & L phrenic nerves accompany what vessels? |
Pericardiophrenic vessels |
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Peripheral diaphragm is supplied by which nerves? |
6-12 intercostal nerves |
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Phrenic nerves supply? |
Central diaphragm, mediastinal pleura, and pericardium |
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Irritation of phrenic nerve or tissues supplied by the nerve can illicit ____ reflexes |
hiccup |
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Where does the trachea begin? |
Larynx |
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L recurrent laryngeal nerve lies between what two structures? |
esophagus and trachea |
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Posterior Mediastinum contains what structures |
DATES In Vagus (Descending aorta, Azygous/hemiazygous/accessory azygous, Thoracic duct, Esophagus, Sympathetic trunks and splanchnic nerves, intercostal arteries, vagus nerve) |
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Posterior to the root of the left lung, pericardium, and esophagus is the: |
thoracic aorta |
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Most inferior part of aorta displaces esophagus to the (left or right) |
Left |
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Three branches of thoracic aorta |
1. Anterior unpaired (gut, pericardium, mediastinum) 2. Lateral paired (visceral other than gut) 3. Posterolateral paired (3-11 post. intercostal arteries, 1 subcostal that supplies diaphragm) |
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Why are R posterior intercostal arteries longer than the left? |
Because they come from aorta on L and need to cross over vertebral bodies to go R |
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Abdominal aortic aneurysm |
Found inf to where renal arteries come off (L2), they can compress the inferior mesenteric artery - if it bursts open and you're not in a hospital, you're dead Risk factors: atherosclerosis, CT disorders, Trauma |
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Postductual coarctation of the aorta -What collateral circulation will be used? -How will it present? |
Most common location is distal to L subclavian artery CollatCirc: Arch of aorta, subclavian, internal thoracic, anterior intercostal, 3rd-9th posterior intercostal (retrograde flow), thoracic aorta Presentation: low BP in lower body, high BP in upper body, Feeble pulse, dilated tortuouds arteries, rib notching |
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Why aren't 1&2nd and 10&11th intercostal arteries used in collateral circulation for a postductal coarctation of aorta?
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1&2nd posterior intercostal arteries don't branch from thoracic aorta, they branch from superior intercostal artery 10&11th dont have anterior intercostal arteries |
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What is located posterior to pericardium and L. atrium? |
Esophagus |
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What constitutes the main posterior part of the base of heart? |
Esophagus |
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At what vertebral level does esophagus exit diaphragm? Through what structure does it exit? With what other structures does it exit |
T10 through esophageal hiatus with anterior and posterior vagal trunks |
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What are three esophageal sites prone to constriction? |
1. Left main bronchus 2. Level of aortic arch 3. level of diaphragmatic esophageal hiatus |
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What is the largest lymphatic channel in the body? |
thoracic duct |
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Where does the thoracic duct originate? |
Chyle cistern in abdomen at L2 |
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Describe the thoracic duct pathway in relation to these structures: esophagus, thoracic aorta, azygous, sternal angle, venous angle |
Left of asygous vein, posterior to esophagus, R of thoracic aorta, crosses left at sternal angle, empties at left venous angle which is a union of L internal jugular and subclavian |
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What does the R lymphatic duct drain? L lymp duct? |
R. upper quadrant of body (L lymph duct drains the rest) |
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What results from laceration of thoracic duct? |
Lymph escapes and enters pleural cavity to produce chylothorax |
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Virchow's nodes |
Lymph nodes in L supraclavicular fossa |
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Troisiers sign |
Enlarged Virchows nodes are diagnosed as Troisier's sign and indicate GI (gastric) cancer that has metastasized through the thoracic duct |
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What three things does the azygous vein drain? |
Back, thoracoabdominal wall, and mediastinal viscera |
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What three nerves are in the posterior mediastinum? |
Sympathetic trunks Vagus (esophageal plexus) Splanchnic nerves |
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Nerve origins of: Greater splanchnic Lesser splanchnic Least splanchnic |
-T5-T9 -T10-T11 -T12 (inferior to diaphragm) |
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What three fibers make up the esophageal vagal plexus? |
-postsynaptic sympathetic fibers -parasympathetic fibers -visceral afferent fibers |
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1st Posterior intercostal veins drain into: |
brachiocephalic veins (LBCV) |
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Left-side equivalent of azygos vein is made up of what three structures? |
1. Left superior intercostal vein (drains 2-4th intercostal spaces into LBCV) 2. Accessory hemiazygos (drains L 5-8th intercostal veins and crosses to R side at T7 or T8 to drain into azygos vein) 3. Hemiazygos vein (drains 9-12th intercostal spaces; crosses to R at 9th vert. body to drain into azygos vein) |
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In the right hilum, name the structures superiorly to inferiorly |
1. Eparterial bronchus 2. Pulmonary artery 3. Hyparterial brochus 4. Pulmonary veins (2) |
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Oblique fissure on both lungs extend from ___ to ____ |
from T2 vert. to 6th costal cartilage |
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Horizontal fissure on R lung extends along ___ and _____ |
4th rib & costal cartilage |
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The middle lobe of the R lung corresponds to what intercostal space? |
4th intercostal space |
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If using the percussion technique, what do these sounds tell you: -Dull -Flat |
-Fluid filled -Solid |
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Where to listen for lung auscultation on anterior chest: Apex - Superior lobe - Middle lobe - Inferior lobe - |
-superior to medial third of clavicle -2nd intercostal space -4th intercostal space -6th or 7th intercostal space |
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Where to auscultate on posterior chest: Apex - Superior - Inferior - |
-Superior to medial third of clavicle -2nd intercostal space - triangle of auscultation (Trap, lat, and medial border of scapula) |
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What are three types of pneumothorax? |
1. Open - air sucked in an out of pleural cavity, lung collapses, mediastinal and tracheal shift to affected side 2. Tension - air enters pleural cavity through valve-like opening (one-way valve); mediastinal and tracheal shift to unaffected side- air build up in affected side 3. Spontaneous - usually small and asymptomatic, no tracheal shift |
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Trachea divide at sternal angle into two ________ which divided into _______ which divide into 18-20 ____________ |
1. main (priamry) bronchi 2. lobar (secondary) bronchi 3. segmental (tertiary) bronchi |
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Aspirated bodies will most likely lodge into: |
Right main bronchus b/c it's straight, short, and wide in comparison to L |
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Where does aspirated fluid vomitus go when: -seated upright: -lying supine: |
-Right posterior basal segment -Right superior segment |
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Pancoast tumor -What is it? -What can it compress? |
-Lung cancer in apex of lung, associated w/compression syndromes
-Compresses sympathetic trunk Horners syndrome- miosis, ptosis, anhidrosis -Compresses brachial plexus (lower brachial plexus injury-C5-T1; Klumpkes palsy-C8-T1) -Compression of subclavian a. & v. (pulselessness, pallor, pain) |
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What is a carinal tumor indicative of?
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metastasizing bronchogenic carcinoma |
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How many bronchopulmonary segment does a pulmonary tertiary segment artery and bronchus supply? |
one |
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How many pulmonary veins drain a single lobe? |
two |
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What vessels are at risk of damage during a segmentectomy? |
Veins are at risk of damage during surgical resection of a single lung segment b/c one vein supplies two adjacent segments |
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What vessels supply and drain the lung tissue? |
Bronchial arteries and veins |
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Hemoptysis |
Spitting blood; if originating from lungs, 95% of blood is from bronchial vessels Has many causes - bronchitis, cancer, TB, etc |
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Pulmonary Embolism |
Obstruction of pulmonary artery by blood clot that's usually dislodged from deep veins of the lower limbs (femoral, deep femoral, popliteal) sxs: dyspnea, sharp chest pain, blood-tingled foamy sputum |
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Acute cor pulmonale |
dilated right heart ventricle |
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Two lymphatic pathways of lungs |
1. Superficial lymph plexus - first drains into bronchopulmonary (Hilar) nodes 2. Deep lymph plexus - first drains into pulmonary nodes |
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Lung lymphatic drainage pathway after bronchopulmonary (hilar) nodes |
tracheobronchial nodes (sup. & inf.->carinal), paratracheal nodes, bronchomediastinal lymph trunk, L(thoracic duct) & R(R lymp duct), venous system (R & L venous angles) |
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What ganglia are compressed in association with Horner's syndrome? |
Middle cervical ganglia Cervicothoracic (stellate) ganglion |
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Nociceptive fibers from the: trachea accompany ___ nerve visceral pleura and bronchi accompany ___ nerve |
1. vagus 2. sympathetic |
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What causes tracheo-esophageal fistulas? |
Incomplete division of foregut into esophageal and respiratory portions -polyhydramnios is a complication -in over 90% of cases its assoc. w/esophageal atresia |
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Which bronchi has a larger lumen? |
Right main bronchus |
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How many segmental brochi are there on right and left sides? |
R: 10 L: 8 |
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Lungs Where is the visceral pleura derived from? Where is the parietal pleura derived from? |
Splanchnic mesoderm Somatic mesoderm |
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Four periods of lung maturation |
1. Pseudoglandular (5-17wks) 2. Canalicular (16-25/28wks) 3. Terminal sac (24-birth) 4. Alveolar (birth-8yrs) |
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If fetus born before 24 wks, they can suffer from: How can this be treated? |
Respiratory distress syndrome Glucocorticoid tx to accelerate fetal lung development and surfactant production Artificial surfactant therapy |
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95% of mature alveoli do not develop until: |
after birth |
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Unilateral pulmonary agenesis |
Failure of one lung to develop; you can live with one lung |
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Pulmonary hypoplasia |
All pulmonary components are present, but are incompletely developed |
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Diaphragm develops from 4 components |
1. Septum transversum 2. Pleuroperitoneal membranes 3. Dorsal mesentery of esophagus 4. Muscular ingrowth from somites at cervical levels C3-C5 |
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Congenital Diaphragmatic Hernia |
Part of gut tube goes into thoracic cavity, so lung is smaller (pulmonary hypoplasia) -pleuroperitoneal folds fail to form properly, 85% of time on left side |
