MGA Block 2 Exam

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Mediastinum

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307 Terms

1

Mediastinum

central portion of the thoracic cage, between two pleural cavities

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2

Mediastinum Anterior Boundary

sternum, coastal cartilages

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Mediastinum Posterior Boundary

thoracic vertebral bodies

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4

Mediastinum Lateral Boundary

mediastinal pleura

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5

Transverse plane at level of sternal angle

separates the mediastinum into a superior and inferior mediastinum

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6

Pericardial sac

subdivides inferior mediastinum into anterior, middle and posterior mediastinum

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Superior Mediastinum

posterior to manubrium of sternum & anterior to first 4 thoracic vertebrae

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8

Thymus, R/L Brachiocephalic Veins, Superior Vena Cava, Arch of Aorta and Branches, Trachea and Esophagus, Phrenic and Vagus Nerves, Left Recurrent Laryngeal Nerve, Thoracic Duct

What are the major structures located within the superior mediastinum? (Anterior to Posterior)

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9

Thymus

most anterior component in superior mediastinum

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10

Thymus

Involved in early development of immune system (T-Cell Development)

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11

Thymus

Large in children, starts to atrophy after puberty, "Thymic remnant"

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12

Thymus

R/L brachiocephalic veins are located immediately posterior

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13

brachiocephalic vein

formed by union of Internal Jugular & Subclavian Veins

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14

Superior Vena Cava

Left brachiocephalic vein crosses midline to join Right Brachiocephalic Vein to form.....

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15

Brachiocephalic trunk, Left common carotid artery, left subclavian artery

Braches of Arch of Aorta - "Boston College Sucks"

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trachea

flexible tube held open by c-shaped rings of cartilage

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17

trachea

divides into primary bronchi at sternal angle

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18

Right primary bronchus

shorter wider and more vertically oriented bronchus

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19

Right primary bronchus

What bronchus are foreign objects most likely to get stuck in

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20

Hilus

Where do primary bronchi enter the lung?

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secondary/lobar bronchi

division after hilus

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22

3

of right lobar bronchi

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23

3

of left lobar bronchi

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24

lobar bronchi

divide into territory or segmental bronchi

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25

alveoli

gas exchange occurs at this level

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26

Esophagus

connects pharynx to stomach

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27

Esophagus

located posterior to the trachea, but anterior to thoracic vertebrae in superior mediastinum

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28

vagus nerves

forms esophageal plexus of nerves

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29

Phrenic Nerves

nerves with diffuse pain

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30

Phrenic Nerves

nerves that pass anterior to the lung roots between the mediastinal pleura and pericardium

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Phrenic Nerves

nerves that provide motor and sensory innervation to diaphragm

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32

"C3 ,4, & 5 keep the diaphragm alive"

Phrenic Nerves pneumonic

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33

mediastinal pleura, fibrous pericardium & parietal pericardium

where phrenic nerves provide sensory innervation....

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34

Vagus Nerves

provide parasympathetic innervation to thoracic and abdominal viscera

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35

Vagus Nerves

Pass posterior to the lung roots

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36

Left Recurrent Laryngeal Nerve

passes inferior to the arch of the aorta and ascends in a groove between trachea & esophagus

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37

Cancer of Lung

Smoker with hoarse voice

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38

Thoracic Duct

the major duct of the lymphatic system

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39

thoracic duct

beings as confluence of lymphatic trunks in abdomen

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40

Thoracic duct

located posterior to esophagus in between aorta and azygos vein - posterior mediastinum

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41

Thoracic Duct

enters inferior portion of superior mediastinum and empties into Jan of L subclavian & L internal jugular veins

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42

Pericardial Sac

inferior mediastinum - subdivided into anterior, middle and posterior mediastinum

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43

portion of thymus, internal thoracic blood vessels

anterior mediastinum contains....

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44

anterior mediastinum

posterior to the body of sternum & anterior to pericardial sac

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45

middle mediastinum

centrally located in thoracic cavity

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46

pericardium, heart, origins of great vessels, various nerves

middle mediastinum contains.....

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47

posterior mediastinum

posterior to pericardial sac & anterior to the vertebral bodies of mid and lower thoracic vertebrae

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48

Esophagus and Associated Nerve Plexus, Thoracic Aorta and branches, Azygos System of Veins, Thoracic Duct, Sympathetic Trunks, Thoracic Splanchnic Nerves

major structures located within posterior mediastinum....

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49

1 - 7

true ribs

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50

True Ribs

articulate directly with sternum

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51

8 - 12

False Ribs

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52

8 - 10

costal cartilage of ribs _________ articulates with superior coastal cartilage

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53

11 - 12

floating ribs

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54

11 - 12

ribs that do not have anterior connections with other ribs or sternum

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55

Head

Posterior end of rib

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56

costal cartilage

connects anterior end of rib to sternum

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57

Sternal Angle

manubriosternal joint - angle name

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Rib 2

what articulates at sternal angle

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Manubrium, body of sternum, xiohoid procress

Parts of sternum (order of top to Bottom)

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60

External Intercostal Muscles

inferior margins of ribs above to the superior margins of ribs below

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External Intercostal Muscles

extend from tubercles of the ribs to costal cartilages

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External Intercostal membrane

extends from costal cartilage to sternum

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External Intercostal membrane

most active in inspiration

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"Hands in your front pockets"

External Intercostal Muscles pneumonic

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65

Internal Intercostal Muscles

inferior margins of the ribs above to the superior margins of the ribs below

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66

Internal Intercostal Muscles

run deep and at right angles to External Intercostal muscles

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Internal Intercostal Muscles

muscle fibers extend from sternum to angle of ribs

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Internal Intercostal membrane

this membrane extends posteriorly towards the vertebral column

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69

Internal Intercostal Muscles

Most active in expiration (interosseous portion) (depresses ribs)

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70

Innermost Intercostal Muscles

most evident in lateral thoracic region

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71

love handle region

lateral thoracic region

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72

Innermost Intercostal Muscles

fibers run in same direction as the internal intercostal muscle fibers

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73

Innermost Intercostal Muscles

help with expiration

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74

Transverse Thoracic Muscles

active with expiration

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75

posterior portion of diploid process

where do Transverse Thoracic Muscles originate from? (posterior)

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76

inferior aspect of the body of the sternum & adjacent costal cartilages

where do Transverse Thoracic Muscles originate from? (inferior)

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77

superolaterally

how do transverse thoracic muscles run?

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78

lower borders of ribs 2-6

where do transverse thoracic muscles insert?

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79

Intercostal vein, artery, nerve

VAN

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80

Internal Intercostal & Innermost Intercostal muscles

where do blood vessels and nerves run (VAN) between?

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81

collateral braches

What is inferior to VAN structure?

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82

2

how many injections in Intercostal Nerve Block?

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83

high for intercostal nerve and low for collateral branch

2 injection locations for Intercostal nerve block

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84

air in

low pressure and high volume

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85

air out

high pressure and low volume

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86

Inspiration

diaphragm descends

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87

Inspiration

ribs elevate ("bucket handle" motion)

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88

Inspiration

ribs are elevated, sternum moves superior and anterior ("Pump-handle" motion)

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89

Inspiration

Increased intrathoracic volume, but a decreased intrathoracic pressure --> air flows passively into lungs

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90

Expiration

diaphragm ascends

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Expiration

ribs descend

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92

Expiration

sternum moves inferiorly & posteriorly

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93

Expiration

decreased intrathoracic volume, but an increased intrathoracic pressure --> air flows out of the lungs

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94

Internal thoracic arteries

arise form subclavian arteries

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95

internal thoracic arteries

give rise to Anterior intercostal arteries (Upper 6)

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96

posterior intercostal arteries

arise from thoracic aorta

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97

supreme intercostal artery

first 2 posterior intercostal arteries arise from....

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98

superior epigastric & musculophrenic arteries

internal thoracic arteries terminate by dividing into....

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99

musculophrenic arteries

lower anterior intercostal arteries arise from....

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100

superior vena cava

azygos system of veins drains into...

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