Systemic Examination Station L3

lunalovegood's version from 2015-10-05 02:30

Section 1

Question Answer
The area in the thorax that lies between the lungs...mediastinum
The ___ mediastinum starts at the first rib, goes down to the junction between the sternum and manubrium, then goes posteriorly to the disc between T4 and T5.superior
The superior mediastinum starts at rib number _________.1
The superior mediastinum goes from the 1st rib to the junction of the ___ and ___.sternum, manubrium
The superior mediastinum border draws a line from the sternomanubrial junction to the disc between _________ and _________.T4, T5
The inferior mediastinum is divided into 3 parts: ____, middle, and ___. anterior, middle, and posterior
Sternomanubrial junction aka.... sternal angle or Angle or Louis (named after Antoine Louis...Lewis is for dot structures)
In the Superior Mediastinum?: gland?thymus
In the Superior Mediastinum?: big artery?: arch of the aorta (brachiocephalic artery, left common carotid, subclavian arteries)
In the Superior Mediastinum?: big veins?SVC, brachiocephalic veins, arch of azygos
In the Superior Mediastinum?: nerves?: vagus, phrenic and cervical cardiac branches
In the Superior Mediastinum?: a tube I like to fill with pizza!: esophagus
In the Superior Mediastinum?: a tube I like to fill with air!: trachea
In the Superior Mediastinum?: not Jurassic Ducks: thoracic ducts
What is the most anterior structure in the superior mediastinum? thymus
What has the nerve to hook around the arch of the aorta? left recurrent larygneal nerve (this is repeated offense, Larry!)
The trachea and esophagus are located in the _________ (anterior, posterior ) part of the superior mediastinum. posterior
In the Middle Mediastinum?: I love you organs?: heart and pericardium
In the Middle Mediastinum?: Great vessels of the heart?: ascending aorta, pulmonary trunk, SVC, IVC
In the Middle Mediastinum?: Nerves?: phrenic nerves
In the Middle Mediastinum?: Vessels?: pericardiophrenic vessels
In the Posterior Mediastinum?: lymph-y things?: thoracic ducts, some lymph glands
In the Posterior Mediastinum?: food tube?: esophagus
In the Posterior Mediastinum?: nerves?: vagus and splanchnic nerves
In the Posterior Mediastinum?: veins?: azygos and two hemiazygos veins
In the Posterior Mediastinum?: the thoracic part of the ___ ___ : descending aorta
Which mediasatinum?: thymus? superior
Which mediasatinum?: arch of the aorta? (with brachiocephalic, LCC, and subclavian): superior
Which mediasatinum?: SVC?: superior, middle
Which mediasatinum?: brachiocephalic veins and arch of azygos?: superior
Which mediasatinum?: vagus?: superior, posterior
Which mediasatinum?: phrenic nerves?: superior, middle
Which mediasatinum?: cervical cardiac branches?: superior
Which mediasatinum?: esophagus?: superior, posterior
Which mediasatinum?: trachea?: superior
Which mediasatinum?: thoracic ducts?: superior, posterior
Which mediasatinum?: left recurrent laryngeal nerve?: superior
Which mediasatinum?: heart and pericardium?: middle
Which mediasatinum?: ascending aorta, pulmonary trunk and IVC?: middle
Which mediasatinum?: pericardiophrenic vessels?: middle
Which mediasatinum?: splanchnic nerves?: posterior
Which mediasatinum?: azygos and two hemiazygos veins?: posterior
Which mediasatinum?: the thoracic part of the descending aorta?: posterior
Which mediasatinum?: bifurcation of the trachea and two bronchi?: middle
Which mediasatinum?: right and left pulmonary veins?: middle
Which mediasatinum?: bronchial lymph glands?: middle
Which mediasatinum?: pulmonary artery dividing into its 2 branches?: middle
Which mediasatinum?: the anterior esophageal plexus?: posterior

Section 2

Question Answer
Ascending, Arch or Descending? right and left coronary arteries?ascending
Ascending, Arch or Descending? brachiocephalic artery?arch
Ascending, Arch or Descending? left common carotid artery?arch
Ascending, Arch or Descending? left subclavian artery?arch
Ascending, Arch or Descending? posterior intercostal artery?descending
Ascending, Arch or Descending? bronchial artery?descending
Ascending, Arch or Descending? pericardiac artery?descending
Ascending, Arch or Descending? mediastinal artery?descending
Ascending, Arch or Descending? esophageal artery?descending
Ascending, Arch or Descending? superior phrenic artery?descending
Ascending, Arch or Descending? subcostal artery?descending
What drains the back, the walls of the thorax and abdomen, and the mediastinal viscera?azygos vein system
Azygos Vein System: what drains the right side?azygose vein
Azygos Vein System: what drains the left side?superior and inferior hemiazygose veins
Obliterated ductus arteriosus which carries blood from left pulmonary artery to the arch in the fetus...ligamentum arteriosus
Arch - ascends superolaterally to reach the right side of the trachea where it divides into the right common carotid and right subclavian...brachiocephalic artery
Arch - ascends to the left side of the trachea and mainly supplies left side of head and neck...left common carotid artery
Arch - arises posterior to the left common carotid and continues into the left upper limb...left subclavian artery
Arch or from Brachiocephalic Artery - supplies the thyroid gland...thyroid ima artery (only in 3-10% of the population)
Descending aorta - supplies the lower trachea and bronchial tree...bronchial arteries
Descending aorta - supplies the pericardium...pericardial arteries
Descending aorta - supplies the intercostal muscles, spinal cord, vertebral column, deep back muscles, and the skin and superficial fascia overlying the intercostal spaces...posterior intercostal arteries
Descending aorta - supplies the diaphragm...superior phrenic arteries
Descending aorta - supplies lower 2/3 of esophagus...esophageal arteries
Descending aorta - supplies lymph nodes and tissues of the posterior mediastinum ... mediastinal arteries
Descending aorta - supplies the vertebrae, spinal cord, and the skin muscles and fascia of the upper abdominal wall. Just like the intercostal arteries, but below 12th rib...subcostal arteries
Once the thoracic aorta goes through the _________ _________ in the diaphragm, it becomes the abdominal aorta.aortic hiatus
The azygos vein enters the thoracic cavity through the ___ ___ in the diaphragm.aortic hiatus
Azygos Vein Formation 1: Could be formed by the union of the _________ ___ vein with the ___ ___ veins.right subcostal vein, ascending lumbar veins
Azygos Vein Formation 2: Could start directly from the ___ ___ ___.inferior vena cava
Azygos Vein Formation 3: Could start directly from the ___ ___ vein.right renal
The azygos vein runs up the right side of the vertebrae, arches over the right root of the lung, and joins the ___.SVC
The _____ vein receives blood from the right posterior intercostals, right bronchial, inferior hemiazygos, and accessory superior hemiazygos veins. And esophageal, bronchial, and pericradiac veinsazygos vein
The hemiazygos vein (inferior) ascends up to ~ ___T9
The hemiazygos vein (inferior) receives blood from the ___ ___ ___ veins and some smaller veins draining the ____ viscera before crossing over the vertebral column to meet the azygos vein.left posterior intercostal veins, mediastinal viscera
The accessory hemiazygos vein (superior) runs along the right side of the spinal column between _________ and _________.T5 and T8
The ____ ____ vein (superior) receives blood from posterior intercostal veins and some others....accessory hemiazygos


Question Answer
The trachea inclines slightly to the ___ (right, left) side.right
At what level does the trachea divide into right and left main bronchi?sternal angle
What is the arterial supply of the trachea?inferior thyroid artery and bronchial arteries
The esophagus enters the mediastinum also a little to the right of the median plane. It is just posterior to the ___ .trachea
The esophagus leaves the thoracic cavity through the esophageal hiatus at the level of ___.T10
The esophagus is innervated by...esophageal plexus
The esophageal plexus is composed of the ___ nerves and ____ trunks.vagus nerves and sympathetic trunks
Esophageal Constrictor 1: crossing of the _________ _________: aortic arch
Esophageal Constrictor 2: crossing of the ___ ___: left bronchus
Esophageal Constrictor 3: esophageal ___ of the diaphragm.: hiatus (opening)
The phrenic nerve is from _________, _________ and ___.C3, C4, C5
The right phrenic descends on the right side of the _________, the left phrenic descends on the left side of the _________.heart, heart
Both right and left phrenic nerves terminate at the _________ .diaphragm
Phrenic nerves supply the diaphragm with both _________ and ___ fibers.motor and sensory (sensory fibers to pleurae and pericardium)


Question Answer
Sympathetic: _________-_________ are cardiac and pulmonary plexuses.T1-T5
Sympathetic: _________-_________ ganglia form the greater splanchnic nerve.T5-T9
Sympathetic: ___-_________ ganglia form the lesser splanchnic nerve.T10 and T11
Sympathetic: ___ ganglion forms the least splanchnic nerve.T12
Sympathetic Splanchnics: passes through crura of diaphragm to end in CELIAC GANGLION.Greater splanchnic nerve (T5-T9)
Sympathetic Splanchnics: passes through diaphragm with the greater end in the AORTICORENAL GANGLION.Lesser splanchnic nerve (T10 and T11)
Sympathetic Splanchnics: enters the abdomen with the sympathetic trunk to end in the RENAL PLEXUS.Least splanchnic nerve (T12)
Parasympathetic: descends to the right side of the trachea --> posterior esophageal plexus --> in the abdomen as the posterior gastric nerve.right vagus
Parasympathetic: descends between the left common carotid and left subclavian arteries --> anterior esophageal plexus --> in the abdomen as anterior gastric nerve.left vagus


The Journey of the Sir Thoracic Duct
Question Answer
Where does the thoracic duct begin?chili cistern (cisterna chili, cisterna chyli, chyli cysterne, cysterne chyli FUCK --- there was a chilly cistern full of beer, this is where Sir Thoracic begins his journey)
The thoracic duct begins in the abdomen from the chili cistern behind the ___.IVC (Sir Thoracic sipped from the chilly cistern thinking, he's behind even the most inferior, even that inferior Vena Cava Spanish singer was in front of him)
The thoracic duct utilizes the ___ _________ to enter the thoracic cavity through the diaphragm.aortic opening (He opened up his heart! Through the aortic opening he went!)
Whilst the wily Sir Thoracic Duct wallows through the aortic opening, he is accompanied by the azygos vein on the ____ side and the aorta on the ____ side.right, left (Sir Azygos was an intelligent man - he was always right - The aorta just followed his heart, and he was left behind)
After passing through the aortic opening, Sir Thoracic felt more feelings in his heart. So he switch from the ___ to the ___ of the mediastinum behind the esophagus.right, left - bleeding heart liberal Sir Thoracic)
After passing through the aortic opening, Sir Thoracic moved from right to left at the level of _________-___.T4-T5 (he asked the pretty Ms. Esophagus if they should have Tea at 4 or 5?)
But the brawny left ___ vein got in the way! A brawl was to be had over Ms. Esophagus! Sir Thoracic spewed the entirety of his lymph contents at left _________ vein and won the battle!left brachiocephalic vein
Sir Thoracic to this day can be found on the left side of Ms. __________ (he kept his bleeding heart which she loved!) and continues to terminate the left _____ vein.esophagus, brachiocephalic
Sir Thoracic is a bleeding heart left liberal and always felt a bit inferior. Which parts of the body does he drain?All of the body below the diaphragm and the left half of the body above the diaphragm
There's a large elephant named Right Lymphatic Trunk. What does he drain?the right side of the body above the diaphragm
Internal Jugular Vein + Subclavian Vein = ___brachiocephalic vein (the angle between the left internal jugular and left subclavian becomes brachiocephalic is where Sir Thoracic is)


Question Answer
Mass in the _______ can cause retrosternal pain, dyspnea, dysphagia, cough, choking sensation and SVC syndrome.mediastinum
Mediastinal Masses: moma thythymoma
Mediastinal Masses: ____ ___ (goiter)thyroid mass
Mediastinal Masses: ______ benign or malignant tumor that has all three germ layers.teratoma
Mediastinal Masses: phoma lymlymphoma
Mediastinal Masses: ____ aneurysmaortic
Mediastinal Masses: sts cycysts
Mediastinal Masses: _____ tumor or diverticulum.esophageal
Mediastinal Masses: _____ tumor ( schwannomas)neurogenic
The arch of the aorta or descending aorta has an abnormal narrowing (stenosis) leading to an obstruction to blood flow to the lower part of the body.coarctation of the aorta
Leakage of lymphatic fluid into thoracic cavity because of injury to the thoracic duct as a complication of surgery in the mediastinum.chylothorax
The sternal angle, second costal cartilage, bifurcation of the trachea, bifurcation of the pulmonary trunk and the beginning and termination of the arch of the aorta are all at level _________.T4
The mortality rate for mediastinitis is _________-_________%14-40
Respiratory difficulty, tachyacardia, erythema, edema, skin necrosis, crepitus, chest pain, back pain, shock, dysphagia, fever and trismus are all symptoms of...mediastinitis
T/F: treatment for mediastinitis includes --> IV antibiotics, cervical drainage for above T4, transthoracic drainage for below T4, subxyphoid approach for the anterior, and thoracostomy tubes.: T