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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5185_Библиотеки_им_академика_М_И_Перельмана.pdf
CASE STUDIES
Case Study 1
A 25-year-old man presented with an enlarging mass in the right cervical region of
the neck. The mass was soft but nontender. A contrast-enhanced CT demonstrated
a fluid-filled cystic mass adjacent to the larynx, representing a laryngocele.
1. What cartilages make up the larynx?
2. What important structures are located within the larynx?
Case Study 2
A 38-year-old female was involved in a snow skiing accident. She presented to the
ER with complaints of a left-sided headache, neck pain, and pulsatile tinnitus. An
MRI demonstrated abnormal increased signal intensity surrounding the left internal
carotid artery, due to a dissection of the vessel.
1. At what level do the common carotid arteries bifurcate into the internal and external
carotid arteries?
2. What is the dilatation found at the origin of the internal carotid artery called?
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Copyright © 2018, Elsevier Inc. All rights reserved.Chapter 5 Neck
6
OBJECTIVES
1. Describe the structures that comprise the bony
thorax.
2. Define the thoracic inlet and outlet.
3. Understand the function and layers of the pleura.
4. Identify and describe the structures of the lungs.
5. Identify the mainstem bronchi and their divisions.
6. List the structures of the mediastinum, and describe
their anatomic relationships to each other.
7. Identify the structures of the heart, and explain the
circulation of blood through the heart.
8. Identify the great vessels, and describe the distribution of their associated arteries and veins.
9. Differentiate between pulmonary arteries and veins
by function and location.
10. Identify the coronary arteries and veins.
11. List the muscles involved with respiration by function
and location.
12. List and describe the layers of the breast.
Thorax
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Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 6 Thorax
After reading Chapter 6, see if you can complete the
following problems.
MULTIPLE CHOICE
1. The aorta arises from the:
a. Right atrium
b. Left atrium
c. Right ventricle
d. Left ventricle
2. The pulmonary veins bring blood to the:
a. Right atrium
b. Left atrium
c. Right ventricle
d. Left ventricle
3. The first vessel to branch off the aortic arch is the:
a. Brachiocephalic trunk
b. Left common carotid artery
c. Left subclavian artery
d. Left vertebral artery
4. Which of the following is the chief muscle of
respiration?
a. Intercostals
b. Diaphragm
c. Rhomboid
d. Serratus
5. The superior vena cava is formed by the junction of
the:
a. Internal jugular veins
b. External jugular veins
c. Subclavian veins
d. Brachiocephalic veins
9. The thickest, strongest muscle in the heart is located
in the:
a. Right atrium
b. Left atrium
c. Right ventricle
d. Left ventricle
10. Which of the following is located between the upper
thoracic vertebrae and trachea?
a. Aorta
b. Esophagus
c. Thoracic duct
d. Azygos vein
FILL IN THE BLANKS
Fill in the blank spaces in the following sentences.
1. The heart is lined by a serous membrane called the
_____________________________.
2. The _____________________________ is the middle muscular layer of the heart wall.
3. The ______________________________________
is the area where vessels and nerves enter and exit
the lungs.
4. The four _____________________________ bring
oxygenated blood to the left atrium.
5. The _____________________________ is located
between the parietal pericardium and the heart wall
and is most prominent around the inflow and outflow
of the heart.
6. Another name for the medial angle of the lung is the
_____________________________.
6. Which of the following makes up the apex of the
heart?
a. Right atrium
b. Left atrium
c. Right ventricle
d. Left ventricle
7. Collateral circulation between the inferior vena cava
and the superior vena cava is supplied by the:
a. Thoracic veins
b. Subclavian veins
c. Azygos veins
d. Intercostal veins
8. Which of the following is not considered a mediastinal
structure?
a. Heart
b. Lungs
c. Trachea
d. Thymus gland
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7. The _____________________________ supplies
blood to the right atrium and right ventricle of the
heart.
8. Within the mediastinum, clusters of _______________
are clumped around the great vessels, esophagus,
bronchi, and carina.
9. The aperture known as the ______________________
allows for the passage of nerves, vessels, and viscera
from the neck into the thoracic cavity.
10. The lateral angle of the lung is termed the
_____________________________.
11. Deep pockets or recesses of the pleural cavities are
the costomediastinal and _____________________________
recesses.
Copyright © 2018, Elsevier Inc. All rights reserved.Chapter 6 Thorax
12. The secondary bronchi further divide into the
5
_____________________________.
13. The diaphragm is attached to the lumbar spine via
two tendinous structures termed ______________________ .
MATCHING
Match each structure to its corresponding feature.
14. The _____________________________ layer of the
breast consists of glandular tissue, excretory ducts,
and connective tissues.
15. The thymus gland produces _____________________________ , a hormone
which is responsible for the development and maturation of lymphocytes.
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
HEART MAP
1. Aortic valve a. Laterally rotates and protracts scapula
2. Myocardium b. Opening on medial surface of the lungs
3. Tricuspid valve c. Cords of connective tissue
4. Hilum d. Elevates the ribs
5. Windpipe e. Middle layer of heart wall
6. Serratus anterior muscle f. Semilunar valve
7. Diaphragm g. Right atrioventricular valve
8. Azygos vein h. Collateral circulation
9. Levatores costarum i. Covers lung surface
10. Cooper’s ligaments j. Carries deoxygenated blood to lungs
11. Visceral pleura k. Chief muscle of respiration
12. Pulmonary arteries l. Trachea
Using the terms below, match the numbers on the drawing to their corresponding terms.
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Aortic semilunar valve
Pulmonary semilunar valve
Bicuspid valve
Tricuspid valve
Arch of the aorta
Left common carotid artery
Pulmonary veins
Pulmonary arteries
Inferior vena cava
Superior vena cava
Brachiocephalic trunk
Interventricular septum
Right atrium
Left atrium
Right ventricle
Left ventricle
Left subclavian artery
17
16
15
14
13
12
1
11
2
3
4
6
7
8
9
10
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Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 6 Thorax
SHORT ANSWER
TRUE/FALSE
1. List six structures located within the mediastinum.
2. Describe the primary function of the thymus gland.
3. What areas of the body does the thoracic duct drain?
4. Describe how blood enters the heart, is circulated
through the heart, and then exits the heart.
5. Describe how the short-axis (SA) view can be
obtained.
6. List the three main branches of the aortic arch.
7. List the tributaries of the superior vena cava.
8. Describe the coronary sinus.
9. What is the function of the azygos venous system?
Circle either True or False for each of the following
statements.
True/False 1. The inferior lobe of the right lung is
separated from the middle and superior lobes by the horizontal fissure.
True/False
2. Each lung has an opening on its
medial surface termed the hilum.
True/False
3. The visceral pleura is continuous
with the thoracic wall and diaphragm
and moves with these structures
during respiration.
True/False
4. The trachea bifurcates into the left
and right mainstem bronchi at approximately the level of T10.
True/False 5. The inner surface of the fibrous peri-
cardium consists of a double-layered
serous membrane termed the serous
pericardium.
True/False 6. During embryonic development of
the heart, an oval opening exists
within the interatrial septum called
the foramen ovale.
True/False 7. The pulmonary semilunar valve is
located at the juncture of the left
ventricle and pulmonary trunk.
True/False 8. The left pulmonary artery is shorter
and smaller than the right pulmonary
artery and is the most superior of the
pulmonary vessels.
True/False
9. The right superior pulmonary vein
passes anterior and inferior to the
right pulmonary artery.
True/False 10. The right coronary artery arises from
the base or root of the aorta.
True/False 11. The ascending aorta begins at the
base of the right ventricle.
10. List the three layers of breast tissue.
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Copyright © 2018, Elsevier Inc. All rights reserved.Chapter 6 Thorax
FILL IN THE TABLE (See Table 6.6)
Fill in the blanks in the following table.
Muscles of the Anterior and Lateral Walls of the Thorax
Muscle Origin Insertion Action
Pectoralis major Clavicular head—medial half of
_______________ _______________
clavicle.
Sternal head—lateral manubrium
and sternum, six upper costal
cartilages
Pectoralis minor Anterior surface of 3rd–5th ribs
_______________
First rib and cartilage Inferior surface of the
_______________
clavicle
Serratus anterior Angles of superior 8th or 9th ribs Medial border of scapula
IDENTIFY
1. On Figure 6.12, coronal CT reformat of lungs, label the following structures.
a. _____________________________________
Elevates ribs of scapula,
protracts scapula, and
assists serratus anterior
Depresses the shoulder
and assists pectoralis in
inspiration
_______________
bc
b. _____________________________________
c. _____________________________________
d. _____________________________________
d
a
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Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 6 Thorax
2. On Figure 6.18, axial CT of chest, label the following structures.
a. _____________________________________
b. _____________________________________
c. _____________________________________
d. _____________________________________
3. On Figure 6.38, coronal MRI of the heart, label the following structures.
a. _____________________________________
b. _____________________________________
c. _____________________________________
a
d. _____________________________________
d
c
a
b
d
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bc
Copyright © 2018, Elsevier Inc. All rights reserved.Chapter 6 Thorax
4. On Figure 6.49, axial CT of heart, label the following structures.
a. _____________________________________
a
b. _____________________________________
c. _____________________________________
d. _____________________________________
b
5. On Figure 6.93, sagittal MRI of inferior vena cava, label the following structures.
a. _____________________________________
b. _____________________________________
d
c
c
c. _____________________________________
d. _____________________________________
a
d
b
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Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 6 Thorax
6. On Figure 6.99, axial CT of chest, label the following structures.
a. _____________________________________
b. _____________________________________
c
c. _____________________________________
d. _____________________________________
d
7. On Figure 6.144, axial CT of chest, label the following structures.
a. _____________________________________
b. _____________________________________
a
c. _____________________________________
a
b
d
d. _____________________________________
e. _____________________________________
e
b
c
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Copyright © 2018, Elsevier Inc. All rights reserved.Chapter 6 Thorax
8. On Figure 6.159, sagittal MRI of female breast, label the following structures.
a. _____________________________________
b. _____________________________________
c. _____________________________________
d. _____________________________________
a
d
bc
9. On Figure 6.47, axial CT of heart, label the following structures.
a. _____________________________________
b. _____________________________________
c. _____________________________________
d. _____________________________________
a
b
d
c
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Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 6 Thorax