Med Com's Thorax

7/31/2019 Med Com's Thorax

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Important Points Of

Thorax

1. Diaphragmatic Aperture:

Spinal Levels:

Aortic Hiatus...(12 letters)...T12

Esophagus ....(10 letters)....T10

Vena Cava........(8 letters)....T8

2. In thorax all veins r on right side n arteries on left side,on increase blood flow veins

expand enormously while large arteries don't,due to creation of dead space tumors n

fluids r likely to project in right side

3. PREVERTBRAL fascia of deep cervical fascia is attached inferiorly to 4th thoracic

vertebra so infection to this fascia extend only to superior mediastinum,but pretracheal

fascia is also the fascia on neck,blends with arch of aorta,the infection b/w the above 2

fascia can extend in superior as well as posterior mediastinum.

4. Right vagus nerve is crossed by azygous vein left vagus by left phrenic nerve.

5. Reflections in pleura of lungs r to mark the extensions of pleural cavity. 2.no pain

sensations in visceral pleura.

6. Blood supply of lungs is bronchial vessels not pulmonary vessels.

7. Hilum: where the bronchi, blood vessels, and nerves enter and leave the lungs.

8. Root: by which the lung is connected to the heart and the trachea. 5.hilum is not

covered by pleura but root is by parietal pleura.

9. Pulmonary ligament provides dead space into which veins expand on increased venous

return.

10. Extent of root of lung is t5-t7

11. No anastomosis b/w superficial n deep lymphatic vessels but some can open.


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12. During pulmonary segment removal surgeons work along pulm. vein 10. pulmonary

vein don't accompany arteries/bronchi so each bronchopulmonary segment is not

bronchovascular,

13. Smallest cardiac veins have direct openings in rt.atrium

14. Transverse pericardial sinus separates arteries 4m veins n oblique sinus is duereflection of pulmonary veins.

15. Left n right coronary artery arise 4m right n left aortic sinus,post sinus is non

coronary sinus.

16. Crista terminalis separates auricle from right atrium,crista terminalis absent in left

atrium

17. Right coronary artery dominates the coronary circulation of heart. 16.damage 2

suprapleural membrane cause pneumothorax.

18. Thorax wall have 3 layers of muscles,

Outer layer: serratus post sup.+serratus post inf+levator

costae+external intercostal

Middle layer: internal intercostal

Inner layer:subcostal+intercostal intimi+transversus thoracis

19. Each half of diaphragm have its own sided phrenic nerve supply,on abdominal side

this nerve divides into ant+post+lat branch.

20. 4th intercostal space is b/w t4 n t5,not b/w t3 n t4.

21. Simple thoracotomy is done along 5th or 6th rib but thoracoabdominal incision is

done along 8th or 9th rib

22. Superficial cardiac plexus lies ant to ligmentum arteriosum n deep plexus lies post to

it,left recurrent laryngeal nerve hook around it.

23. Pericardial drainage is done on 45 degree angle.

24. Angle of lois is 140 degree.

25. Esophagus starts from C6 passes 4m diaphragm at T10 n enters stomach at T11.

26. Venous anastomosis around esophagus is on T8 level


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27. On level of t5 esophagus returns to midline n thoracic duct comes to right side of it

28. Pleural aspiration is done by choice of any space but generally its 4th space

29. On both sides of lungs apical segment of lower lobe is supplied by bronchus

30. Material aspirated by supine,comatose,anesthetized patient would tend to go sup.

segment of right lower lobe

31. Cardiac temponade is heart compression

32. Supine position central tendon of diaphragm is on level of T9 n in sitting or standing

upright position its on T9-T10

33. HEMOPTYSIS is 95% due to hemorrhage in bronchial vessels 4.hematogenous

metastasis of bronchogenic carcinoma is towards brain,bones,lungs,suprarenal gland

35. Irritation 2 costal n diaphragmatic part of diaphragmatic pleura results pain in thoracic

and abdominal wall

36. Irritation 2 mediastinal n central diaphragmatic parts of pleura cause pain to root of neck

and over shoulder(C3-C5)

37. Thoracentesis is for getting sample of fluid,remove blood/pus n its done in 9th costal

space

38. Insertion of chest tube(tube thoracostomy)is for removal of major amount of

blood,fluid,pus,air n its done in 5th /6th costal space

39. On lung collapse actually pulmonary cavity is not decreasing on inspiration but size of

lung

40. Chest pain also occur in gallbladder,intestinal,musculoskeletal disorder

41. The most common septal defect is membranous interventicular septal defect

42. The most common stenosis is Aortic stenosis

43. In axilla all lobes of lung can be checked physically

44. Chances of coronary occlusion LAD 50%,RCA 40%,circumflex 20%

45. Great cardiac vein is on ant interventicular groove with LAD,n middle vein is with post

interventicular branch of RCA


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46. Anesthetic material is injected around the nerve not in the nerve 14.pleural space

normally contains 5-10ml of pleural fluid

47. Collection of pus without air in plural space is emphysema,and collection of serous fluid

is pleural effusion

48. Left atrium lies in close relation of esophagus so left sided heart failure can be checked

by help of esophagus

49. Azygous vein collects all blood from inf vena cava but not from liver

50.

Q.which areas of heart gets ischemic if there is sudden occlusion in artery lying in post

interventicular groove?

Ans: Artery will be post interventicular artery branch,so it supplies 1/3 of interventicular

septum,little of post part of left ventricle,little part of left atrium n if we take completeright coronary artery then additional right atrium ventricle,SA node,AV node will be

affected,n if you take left coronary artery then remaining parts will b ans

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Med Com's Thorax