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BS V, Module II > 1. Pulmonary and Lower Respiratory Anatomy > Flashcards

1. Pulmonary and Lower Respiratory Anatomy Flashcards

1
Q

The gross anatomy of the upper respiratory tract, including:
• ____
• Nasal cavity
• ____
• Larynx
was discussed in detail
and dissected in your first year of study

A

nose

pharynx

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2
Q

TRACHEA
• ____ form the skeleton of the trachea and prevent collapse of the lumen
• A membrane with ____ bands of smooth muscle (____) connects the ends of the rings ____

A

c-shaped cartilaginous rings
transverse
trachealis

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3
Q

Trachealis is in a ____ of contraction, relaxing as the oxygen needs of the body increase to dilate the trachea

The elastic membrane between the rings ensures ____ air flow thru the respiratory tract even as
the flexible ____
moves in multiple directions

A

steady state
constant
cervical spine

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4
Q

The superior thoracic aperture transmits the trachea between the ____ and ____

A

deep neck

superior mediastinum

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5
Q

The plane of the
STERNAL ANGLE
marks the plane of the
bifurcation of the ____ as well as the boundary between the ____

A

trachea

superior and inferior mediastinum

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6
Q

CARINA

The carina, a wedge shaped cartilage marks the bifurcation of the trachea into ____

As the carina lies slightly to the ____ of the bifurcation, it tends to divert inhaled foreign objects to the ____ bronchus

A

left and right primary bronchi
left
right

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7
Q 
The right main bronchus is
• \_\_\_\_
• wider
• more \_\_\_\_ than the left
main bronchus...

Thus ____ are more likely to enter and obstruct the right bronchus

Consequently, both ____ and pneumonia caused by ____ are more common in the right lung!

A 
shorter
vertical
aspirated foreign objects
lung abscesses
microbial infection
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8
Q

Repeated branchings of the ____ and the associated

____ form the substance of the lungs

A

bronchi

blood vessels

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9
Q
  • The tracheobronchial tree develops initially as a ventral ____ of the embryonic ____
  • The developing tree elongates and undergoes repeated buddings bilaterally, yielding just over 20 generations of ____ tubes contributing to the ____ of the respiratory system
A

respiratory diverticulum
foregut
endodermal
conducting zone

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10
Q

____ and ____ are both features of the first five generations of bronchi

Bronchioles have no ____ and are surrounded instead by ____ under autonomic control

A

hyaline cartilage
elastic tissue
cartilage
smooth muscle

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11
Q

The ____, the ____, provide for intimate contact between inspired atmospheric air and pulmonary vasculature as features of the the respiratory zone of the tract

A

terminal bronchioles branching

alveoli

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12
Q

Proliferation of alveoli increases through the first decade of postnatal life until age ____

Ultimately…
the two mature lungs contain approximately ____ km.
of airways and ____ million alveoli

Gas exchange takes place as oxygen diffuses through the walls of the alveoli into the developing ____

A

8 or 9
2,400
300 to 500
capillaries

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13
Q

The ____ are found on either side of the mediastinum
in the thorax

Each cavity is filled with a ____ surrounding a lung and lining the pulmonary cavity

A

pulmonary cavities

fibroserous pleural sac

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14
Q

The two pleural sacs are ____ of each other, though they converge upon each other deep to the sternum in the ____

HOWEVER…

A

independent

anterior mediastinum

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15
Q

Along the body wall, each pulmonary cavity is lined by ____ whereas each developing lung assumes a covering of ____

As the lung buds develop from the ____ endoderm, they essentially “punch” into the ____ (or body cavity) around the lungs, which is thereafter called the ____.

A 
parietal pleura
visceral pleura
foregut
intraembryonic coelom
pulmonary cavity
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16
Q

Along the body wall, each pulmonary cavity is lined by ____ whereas each developing lung assumes a covering of ____

As the lung buds develop from the ____ endoderm, they essentially “punch” into the ____ (or body cavity) around the lungs, which is thereafter called the ____.

A 
parietal pleura
visceral pleura
foregut
intraembryonic coelom
pulmonary cavity
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17
Q

So the parietal and visceral layers of pleura are continuous with each other at the ____ (root of the lung) forming the ____

A

pulmonary hilum

pulmonary ligament

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18
Q

Between the PARIETAL and VISCERAL layers of PLEURA lies the ____, containing a capillary-thin layer of serous fluid

• Lubricates the adjacent pleural surfaces - ____
— However, a condition known as pleural friction rub will result if there is some interruption of the ____ of the lubricating fluid in the pleural cavity. Sounds like 2 pieces of leather rubbing together. Sound can result from inadequacy of ____, and can be heard after pathologies that produce ____ between visceral and parietal membranes.
• Facilitates movement of the ____
• Maintains ____ that is crucial for respiration, ensuring coincident movement of ____ pleural layers with changes in ____ and pressure

A 
pleural cavity
pleural friction rub
flow
pleural fluid
adhesions

lungs
surface tension
BOTH
thoracic volume

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19
Q

Parietal pleura receives ____ innervation

Visceral pleura does ____!

Thus pulmonary pathology (e.g. a lung tumor) will ____ include sharp, localizable pain as part of its symptomatology until…

… the pathological process erodes the ____ of the lung and its covering of visceral pleura and impinges upon the ____

A 
somatosensory
not
NOT
surface
parietal pleura
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20
Q

Top:
NO PAIN
May have ____ issues: coughing up black sputum and ____

Bottom:
PAIN
Contacting the ____ pleura lining the pulmonary cavity - stimulated ____ and producing sharp localized pain

A

respiratory
blood

parietal
somatic afferents

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21
Q

Discrete portions of the
____ PLEURA lining each pulmonary cavity may be defined

\_\_\_\_
\_\_\_\_
\_\_\_\_
\_\_\_\_
Lungs are not exclusively thoracic organs, also have some \_\_\_\_ origin
A 
parietal
costal
diaphragmatic
mediastinal
cervical
cervical
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22
Q

The ____ of each lung and the pleural membranes that surround it extend superiorly through the ____ into the root of the neck

Thus a penetrating wound to the ____ may actually violate the pleural cavity… causing a ____ as well as injure the ____ of the lung itself

The cervical pleura is also referred to as the pleura of the ____

A 
apex
superior thoracic aperture
root of the neck
pneumothorax
apex
cupola
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23
Q

PNEUMOTHORAX
lResults from introduction of air into the ____ as the result of penetrating chest trauma or a ____
l____ lung collapses as intrapleural pressure rises and increases with each breath lMediastinum shifts ____, leading to
lCompression of the ____ lung
lAs pressure builds, mediastinal and tracheal shifts are augmented, the diaphragm is ____ and venous return to the ____ is impeded

A 
pleural cavity
ruptured lung cyst
ipsilateral
contralaterally
contralateral
depressed
right atrium
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24
Q

SUPERIOR THORACIC APERTURE

INFERIOR THORACIC APERTURE is largely filled by the ____, the primary muscle of ____

A

diaphragm

respiration

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25
Q

Diaphragm

Right hemidiaphragm is always ____ than the left because of the liver

A

higher

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26
Q

The dome-shaped DIAPHRAGM forms both the ____
of the thoracic
cavity and the ____ of the abdominopelvic
cavity

A

floor

roof

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27
Q

The CENTRAL TENDON of the diaphragm receives the insertion of fibers
arising from the
circumference of
the ____ and the ____

A

thorax

upper lumbar spine

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28
Q 
COSTAL part of diaphragm
\_\_\_\_ ribs (\_\_\_\_ surface; lower margin of \_\_\_\_)

LUMBAR part of diaphragm
____ part: ____ vertebral vodies, intervertebral disk, and ____ as right and left crura

STERNAL part of diaphragm
____ (____ surface)

ALL INSERT ON THE ____

A

7th-12th
inner
costal arch

medial
L1-L3
anterior longitudinal ligament

xiphoid process
posterior
central tendon

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29
Q

There are three important apertures in the diaphragm, transmitting structures between the thoracic and abdominal cavities

CAVAL FORAMEN
____ ascends into thorax from abdomen via the caval foramen; ____ enhances flow of blood to the heart

ESOPHAGEAL HIATUS
____, vagal fibers, and vasculature supplying and draining the inferior aspect of the ____ travel through here

AORTIC HIATUS
Point of transition of ____ from thoracic to abdominal

I ATE(8) 10 EGGS AT 12

A

IVC
diaphragmatic contraction

esophagus
esophagus

descending aorta

30
Q

Recall that the fibrous pericardial sac, containing the ____, is fused to the cranial (____) surface of the
____

A

fibrous pericardial sac
superior
central tendon

31
Q

Recall that the heart
falls and rises as the diaphragm contracts and relaxes during respiration…

…as the position of the ____ changes by about ____ vertebral levels in quiet breathing

Diaphragmatic contraction also produces ____ of the base and marked distension of the ____ of each lung in inspiration

A

central tendon
two
descent
inferior lobe

32
Q

Diaphragmatic contraction ____ the volume of each ____, while ____ between the parietal and visceral pleurae causes adherence that
produces associated ____ of the lung…

A

increases
pulmonary cavity
surface tension
expansion

33
Q

Inspiration occurs when the thorax is ____ and both pleural and alveolar pressures become increasingly ____… causing air to flow into the ____.

Expiration occurs when the thorax ____ in size and alveolar pressures exceed ____ pressure… causing air to be forced out of the ____.

A

expanded
subatmospheric
lungs

diminishes
atmospheric
lungs

34
Q

With the ____ of the diaphragm in inspiration, the lungs ____ and ____ elements of the bronchial tree are physically ____ and elongated

Their ____ will contribute significantly to expiration

A 
depression
expand
elastic
stretched
recoil
35
Q

L & R PHRENIC
NERVES
descend between ____ ____ to the root of each lung

____ keep the diaphragm alive!

• A high cervical spinal cord injury, above the C4 cord segment
	○ Producing \_\_\_\_ and \_\_\_\_ paralysis reducing vital capacity and requiring a \_\_\_\_
A 
pleura
pericardium
C3, 4, 5
quadriplegia
diaphragmatic
ventilator
36
Q

The lungs and pleural cavities are ____ in quiet respiration

There is roughly a 2-rib disparity in the ____, ____ and ____ lines

A

asymmetric
mid-clavicular
midaxillary
scapular

37
Q

The costomediastinal and costodiaphragmatic recesses are formed by the acute ____ of the parietal pleura onto the ____ and ____ respectively

A

reflection
fibrous pericardial sac
diaphragm

38
Q

Pleural recesses
the areas of the pleural space into which the lungs do not ____ in quiet respiration

They are crucial for ____ the pleural cavity without injuring the lungs… as in ____ to drain a ____

When inserting the tube, you will have the patient ____

A 
extend
accessing
thoracentesis
pleural effusion
expiring
39
Q

TO SUMMARIZE:
• Diaphragmatic
____ increases the volume of the pleural cavity
• ____ between parietal and visceral pleurae causes adherence that produces associated expansion of the lung…

… including expansion into the ____ at full inspiration

A

contraction
surface tension
pleural recesses

40
Q

The ____ SURFACE of the embalmed lung preserves the impressions of the adjacent ribs in addition to demonstrating the ____ separating the ____

A

costal
fissures
lobes

41
Q

LEFT LUNG

* \_\_\_\_ lobes
* \_\_\_\_ (oblique) fissure

Each conical lung presents with three surfaces:
• ____
• ____
• ____

____ overlies apex of heart during life and is unique to the ____ lung

A 
two
one
costal
mediastinal
diaphragmatic
lingula
left
42
Q

RIGHT LUNG

• \_\_\_\_ lobes
• Two fissures:
	○ \_\_\_\_
	○ \_\_\_\_

In the depths of the fissures,
____ covers the
____ surfaces

A

two
oblique
horizontal

visceral pleura
interlobar

43
Q

The ____ surface of each lung preserves impressions of adjacent features of the ____

LEFT:

  • ____ impression
  • ____ impression
  • ____ impression

RIGHT:

  • ____ impression
  • ____ impression
  • ____ impression
A

mediastinal
middle and posterior mediastinum

aortic arch
aortic
cardiac

cardiac
azygos arch
esophageal

44
Q

With the ____ and its contents removed, the structures effectively suspending each lung from the mediastinum may be observed

A

pericardial sac

45
Q

____ and ____ enter each lung at the ____ or ROOT on the MEDIASTINAL SURFACE

A

pulmonary vessels
primary bronchi
hilum

46
Q

LEFT HILUM

  • branches of ____.
  • ____ bronchi
  • branches of ____
  • ____
A

left pulmonary a.
superior and inferior lobar
left pulmonary vv.
pulmonary ligament

47
Q

RIGHT HILUM

  • ____
  • branches ____
  • ____(common origin)
  • branches of ____
  • pulmonary ligament

The superior lobar (eparterial) bronchus branches off the ____ prior to its passage through the hilum of the lung

The bronchus intermedius (interlobar bronchus) gives rise to the ____

A

superior lobar bronchus
right pulmonary a.
inferior and middle lobar bronchi
right pulmonary vv.

main bronchus
middle and inferior lobar bronchi

48
Q

CARDIOPULMONARY CIRCULATION

The functional segmentation of each lung is reflected in the branching of the ____ and the formation of the paired ____ draining each organ

A

left and right pulmonary arteries

pulmonary veins

49
Q 
Pulmonary
arterioles
are continuous with a
\_\_\_\_ in intimate contact with the alveoli that is in turned drained by tributaries of the
\_\_\_\_
A

capillary network

pulmonary veins

50
Q

“RALS”

LEFT HILUM
RIGHT HILUM
Note too:
	• \_\_\_\_
	• \_\_\_\_
A

bronchial vessels

bronchopulmonary (hilar) lymph nodes

51
Q

Bronchial Arteries

provide an oxygenated blood supply to the ____ of the lung, ramifying along the ____

A

parenchymal

bronchial tree

52
Q

85% of the blood the ____ deliver to the lungs leaves those organs with the newly oxygenated blood in the ____

A

bronchial arteries

pulmonary veins

53
Q

The remainder returns via ____ to the
____

Responsible for draining the remaining 15%: small bronchial veins that drain the lung into Azygos system (venous system), which is responsible for draining posterior thoracic wall and posterior mediastinal viscera like esophagus.

A

bronchial veins

azygos sytem

54
Q

Broncho-pulmonary (Hilar) lymph nodes
…drain to ____

… Which in turn drain to ____

A

tracheobronchial (carinal) nodes

paratracheal nodes

55
Q

Pulmonary lymphatic drainage is ultimately returned to the ____ in the root
of the neck…

Enlargement of
supraclavicular (inferior deep cervical) nodes may indicate ____ pulmonary pathology
including but not limited to ____

A

venous sytem
ipsilateral
metastatic lung cancer

56
Q

The BRONCHIAL TREE

Each lung features ____
functional segments - each segment is supplied by a ____ and accompanying branch of the ____

A

ten
tertiary broncus
PA

57
Q

The bronchopulmonary segments are, in fact, the ____

units of each lung

A

anatomical bronchovascular

58
Q

LEFT LUNG

Clinical assessment of the lungs relies upon techniques of ____ and ____ of the chest wall overlying specific segments in order to determine ____

A

auscultation
percussion
air vs. fluid content

59
Q

RIGHT LUNG

In the supine, bed-ridden patient, aspirated material is most likely to enter ____ via the ____, which branches posteriorly off either ____ or the ____

Aspiration of oropharyngeal contents and bacteria may lead to ____

A 
segment VI
superior segmental bronchus
bronchus intermedius
inferior lobar bronchus
aspiration pneumonia
60
Q

The segmentation of the lungs means that pulmonary pathology may be isolated to either a ____

Surgeons exploit the anatomical subdivision of the organ into lobes and segments when excising damaged tissue via ____

A

segment or a lobe

segmental or lobar resections

61
Q

PULMONARY PLEXUS

Target: bronchial muscles
Sympathetic: ____
Parasymp: ____

Target: pulmonary vessels
Sympathetic: ____
Parasymp: ____

Target: secretory cells of alveoli
Sympathetic: ____
Parasymp: ____

A

inhibitory (bronchodilation)
motor (bronchoconstriction)

motor (vasoconstriction)
inhibitory (bronchodilation)

secretomotor
inhibitory

62
Q

Sympathetic inputs to pulmonary plexus produce ____…

… as well as secretion of ____ by alveolar cells

A

bronchodilation

pulmonary surfactant

63
Q

Parasympathetic Vagal inputs:
• facilitate ____ of smooth muscle that ____ the bronchial tubes
• stimulate bronchial secretion by ____ and goblet cells
—part of the ____ defense system protecting the airways against inhaled irritants soot, ____, microbes

A 
contracting
constricts
mucous glands
innate
dust
64
Q

Deep breathing requires ____ as well as ____ movement

A

thoracic

diaphragmatic

65
Q

COSTOVERTEBRAL JOINTS
The ____ of each rib articulates with the body of at least one ____ (and often an IV disc) at a ____ of the head of the rib

The ____ articulates with
the ____ process of a single thoracic vertebra at a
____ joint

A

head
thoracic vertebra
joint

tubercle
transverse
costotransverse

66
Q

These COSTOVERTEBRAL JOINTS are ____ joints …

… that permit movements of the ribs necessary for ____

A

plane synovial

deep breathing

67
Q

Note the ____ course that each rib takes from its vertebral articulations to the ____ aspect of the body…

As a consequence, note that the ____ ends of both
the ____ ribs are ____ to the vertebral ends

A 
oblique
ventral
sternal
true and false
inferior
68
Q

Elevation of the rib cage, further increasing the vertical diameter of the thorax, also contributes to expansion of
the thorax in both…

• \_\_\_\_ (in the \_\_\_\_ plane)
• \_\_\_\_ (in the \_\_\_\_ plane) Both crucial for \_\_\_\_ into and out of the lungs
A 
width
coronal
depth
sagittal
maximum airflow
69
Q

When the ____ ribs are elevated, the ____ dimension of the thorax is increased

This is known as the ____

A

upper
anteroposterior
pump handle effect

70
Q

When the angles of
the ____ ribs are elevated, they move ____, increasing the ____ DIMENSION

The ____

A

lower
laterally
transverse
bucket-handle effect

71
Q

These movements combine with the increase in the ____ dimension of the thorax resulting from the contraction of the DIAPHRAGM to facilitate ____

A

vertical

deep or forced inspiration

72
Q 
These expanded diameters will be reduced in \_\_\_\_ by the following factors (in addition to the \_\_\_\_ of the elements of the bronchial tree):
• \_\_\_\_
• \_\_\_\_ of the
costal cartilages
• \_\_\_\_ of abdominal viscera
• If necessary, contraction of \_\_\_\_
A 
expiration
gravity
elastic recoil
elastic rebound
abdominal musculature

BS V, Module II (11 decks)

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