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41 Cards in this Set

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What is the mediastinum?
area btwn two pleural cavities, central thorax
what are the mediastinum borders?
-Superior thoracic aperture to diaphram (superior to inferior border)
-Sternum to vertebral bodies (anterior to posterior)
-Two pleural cavities (lateral borders)
The mediastinum is divided into superior & inferior portions, above & below the sternal angle. What parts are the inferior mediastinum further subdivided into
anterior: body of sternum to pericardial sac

middle: pericardial sac to heart

posterior: pericardial sac to vertebral bodies T5-12
Borders of the superior mediastinum
-Manubrium of sternum to T1- T4 (ant to post)
-Superior thoracic aperture to sternal angle (disc btwn T4&5) (sup to inf)
-
The superior mediastinum contains:
thymus
R & L brachiocephalic veins
superior vena cava
arch of aorta & major branches
trachea
esophagus
phrenic nerves
vagus nerves
thoracic duct
thymus
R & L brachiocephalic veins
superior vena cava
arch of aorta & major branches
trachea
esophagus
phrenic nerves
vagus nerves
thoracic duct
The _______________ is an asymmetric bilobed structure, immediately posterior to manubrium of sternum
thymus
Most adults have completely involuted thymus, what are some exceptions?
some types of cancer & some autoimmune conditions
Where are the R & L brachiocephalic veins located?
immediately posterior to thymus

*formed from the junction of internal jugular & subclavian veins
What do the brachiocephalic veins joint to form at the lower edge of the R 1st costal cartilage?
superior vena cava
What are some of the common access points for performing a central line (CVC)?
jugular vein, subclavian vein, & femoral veins
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
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
What are the 3 large branches that arise superiorly from the arch of the aorta?
left subclavian
left common carotid
brachiocephalic trunk
left subclavian
left common carotid
brachiocephalic trunk
The __________________ gives rise to the R subclavian & R common carotid arteries
brachiocephalic trunk
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
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
The _______ is a flexible tube formed by c-shaped cartilaginous rings. Sits inferior to larynx.
trachea
The trachea divides into the R & L main bronchi at the __________ vertebral level
T4-T5
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?
mediastinal pleura, fibrous pericardium, & parietal layer of serous pericardium
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
What is Ondine's Curse?
congenital central hypoventilation syndrome (CCHS)
primary alveolar hypoventilation

brainstem disorder causes you to stop breathing in sleep
What nerve provides parasympathetic innervation to the thoracic & abdominal viscera
vagus nerves (CN X)

*descend through superior & posterior mediastinum on their way to the abdomen
The R & L vagus nerves give rise to R & L ____________________ nerves, which innervate the muscles of the larynx
recurrent laryngeal nerves
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
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.
left recurrent laryngeal nerve
What does the anterior mediastinum contain?
(green space)
-fat
-CT
-lymph nodes
-mediastinal branches of internal thoracic vessels
-sternopericardial ligaments
-remnants of thymus
(green space)
-fat
-CT
-lymph nodes
-mediastinal branches of internal thoracic vessels
-sternopericardial ligaments
-remnants of thymus
What does the middle mediastinum contain?
(pink space)
-pericardial sac
-heart
-origins of great vessels
-phrenic nerve C3-C5
-perocardiacophrenic vessels
**bordered by pericardium
(pink space)
-pericardial sac
-heart
-origins of great vessels
-phrenic nerve C3-C5
-perocardiacophrenic vessels
**bordered by pericardium
What does the posterior mediastinum contain?
(blue space)
-esophagus
-thoracic aorta
-azygos system of veins
-thoracic duct
-sympathetic trunks & thoracic splanchnic nerves
(blue space)
-esophagus
-thoracic aorta
-azygos system of veins
-thoracic duct
-sympathetic trunks & thoracic splanchnic nerves
The ___________ is a muscular tube that runs from pharynx to stomach, descending through both the superior & posterior mediastinum on way to abdomen.
esophagues
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.
vagus nerves
left vagus nerve
anterior vagal trunk
right vagal nerve
posterior vagal trunk
4 sites of esophageal constriction:
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
The sympathetic trunks & thoracic splanchnic nerves are major components of what?
the sympathetic division of ANS
As thoracic aorta descend through post. mediastinum it gives off:
-post. intercostal a., which supply lower 9 intercostal spaces (3-11)
-bronchial arteries, which supply bronchi & lungs
-esophageal arteries, supply esophagus
-post. intercostal a., which supply lower 9 intercostal spaces (3-11)
-bronchial arteries, which supply bronchi & lungs
-esophageal arteries, supply esophagus
Azygos system of veins formed by what 2 veins that drain blood from body wall to superior vena cava?
azygos vein on right
hemiazygos & accessory hemiazygos veins on left
Designate drainage of posterior intercostals & ascending lumbar veins on Right side
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)
Designate drainage of posterior intercostals & ascending lumbar veins on Left side
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)
In case of obstruction of the inferior vena cava, blood may be rerouted through the _________ vein in order to return to the heart
azygos vein

*rerouting leads to dilation
What is the main channel of lymph return from body to the venous system?
thoracic duct
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
cisterna chyli (chyle cistern)

aortic hiatus of diaphram
The R arm & side of the head & neck are drained by what?
right lymphatic duct
What is chylothorax?
lymph fluid accumulating in pleural cavity, caused by leak of thoracic duct (usually due to lymphoma or direct trauma)
The thoracic duct transports up to _____ of chyle per day. This allows rapid accumulation of fluid in chest (chylothorax)
4 L