1. Pulmonary and Lower Respiratory Anatomy Flashcards by J L

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

nose

pharynx

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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 ____

c-shaped cartilaginous rings
transverse
trachealis

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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

steady state
constant
cervical spine

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

deep neck

superior mediastinum

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

trachea

superior and inferior mediastinum

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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

left and right primary bronchi
left
right

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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!

shorter
vertical
aspirated foreign objects
lung abscesses
microbial infection

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Repeated branchings of the ____ and the associated

____ form the substance of the lungs

bronchi

blood vessels

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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

respiratory diverticulum
foregut
endodermal
conducting zone

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

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

hyaline cartilage
elastic tissue
cartilage
smooth muscle

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

terminal bronchioles branching

alveoli

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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 ____

8 or 9
2,400
300 to 500
capillaries

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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

pulmonary cavities

fibroserous pleural sac

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

HOWEVER…

independent

anterior mediastinum

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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 ____.

parietal pleura
visceral pleura
foregut
intraembryonic coelom
pulmonary cavity

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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 ____.

parietal pleura
visceral pleura
foregut
intraembryonic coelom
pulmonary cavity

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

pulmonary hilum

pulmonary ligament

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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

pleural cavity
pleural friction rub
flow
pleural fluid
adhesions

lungs
surface tension
BOTH
thoracic volume

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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 ____

somatosensory
not
NOT
surface
parietal pleura

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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

respiratory
blood

parietal
somatic afferents

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

\_\_\_\_
\_\_\_\_
\_\_\_\_
\_\_\_\_
Lungs are not exclusively thoracic organs, also have some \_\_\_\_ origin

parietal
costal
diaphragmatic
mediastinal
cervical
cervical

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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 ____

apex
superior thoracic aperture
root of the neck
pneumothorax
apex
cupola

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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

pleural cavity
ruptured lung cyst
ipsilateral
contralaterally
contralateral
depressed
right atrium

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SUPERIOR THORACIC APERTURE

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

diaphragm

respiration

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

higher

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

floor | roof

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

thorax | upper lumbar spine

``` 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 ____

7th-12th inner costal arch medial L1-L3 anterior longitudinal ligament xiphoid process posterior central tendon

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

IVC diaphragmatic contraction esophagus esophagus descending aorta

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

fibrous pericardial sac superior central tendon

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

central tendon two descent inferior lobe

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

increases pulmonary cavity surface tension expansion

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 ____.

expanded subatmospheric lungs diminishes atmospheric lungs

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

``` depression expand elastic stretched recoil ```

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 ____

``` pleura pericardium C3, 4, 5 quadriplegia diaphragmatic ventilator ```

The lungs and pleural cavities are ____ in quiet respiration There is roughly a 2-rib disparity in the ____, ____ and ____ lines

asymmetric mid-clavicular midaxillary scapular

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

reflection fibrous pericardial sac diaphragm

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 ____

``` extend accessing thoracentesis pleural effusion expiring ```

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

contraction surface tension pleural recesses

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

costal fissures lobes

LEFT LUNG * ____ lobes * ____ (oblique) fissure Each conical lung presents with three surfaces: • ____ • ____ • ____ ____ overlies apex of heart during life and is unique to the ____ lung

``` two one costal mediastinal diaphragmatic lingula left ```

RIGHT LUNG • ____ lobes • Two fissures: ○ ____ ○ ____ In the depths of the fissures, ____ covers the ____ surfaces

two oblique horizontal visceral pleura interlobar

The ____ surface of each lung preserves impressions of adjacent features of the ____ LEFT: - ____ impression - ____ impression - ____ impression RIGHT: - ____ impression - ____ impression - ____ impression

mediastinal middle and posterior mediastinum aortic arch aortic cardiac cardiac azygos arch esophageal

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

pericardial sac

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

pulmonary vessels primary bronchi hilum

LEFT HILUM - branches of ____. - ____ bronchi - branches of ____ - ____

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

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 ____

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

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

left and right pulmonary arteries | pulmonary veins

``` Pulmonary arterioles are continuous with a ____ in intimate contact with the alveoli that is in turned drained by tributaries of the ____ ```

capillary network | pulmonary veins

"RALS" ``` LEFT HILUM RIGHT HILUM Note too: • ____ • ____ ```

bronchial vessels | bronchopulmonary (hilar) lymph nodes

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

parenchymal | bronchial tree

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

bronchial arteries | pulmonary veins

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.

bronchial veins | azygos sytem

Broncho-pulmonary (Hilar) lymph nodes …drain to ____ ... Which in turn drain to ____

tracheobronchial (carinal) nodes paratracheal nodes

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 ____

venous sytem ipsilateral metastatic lung cancer

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

ten tertiary broncus PA

The bronchopulmonary segments are, in fact, the ____ | units of each lung

anatomical bronchovascular

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

auscultation percussion air vs. fluid content

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 ____

``` segment VI superior segmental bronchus bronchus intermedius inferior lobar bronchus aspiration pneumonia ```

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 ____

segment or a lobe | segmental or lobar resections

PULMONARY PLEXUS Target: bronchial muscles Sympathetic: ____ Parasymp: ____ Target: pulmonary vessels Sympathetic: ____ Parasymp: ____ Target: secretory cells of alveoli Sympathetic: ____ Parasymp: ____

inhibitory (bronchodilation) motor (bronchoconstriction) motor (vasoconstriction) inhibitory (bronchodilation) secretomotor inhibitory

Sympathetic inputs to pulmonary plexus produce ____… … as well as secretion of ____ by alveolar cells

bronchodilation | pulmonary surfactant

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

``` contracting constricts mucous glands innate dust ```

Deep breathing requires ____ as well as ____ movement

thoracic | diaphragmatic

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

head thoracic vertebra joint tubercle transverse costotransverse

These COSTOVERTEBRAL JOINTS are ____ joints ... ... that permit movements of the ribs necessary for ____

plane synovial | deep breathing

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

``` oblique ventral sternal true and false inferior ```

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

``` width coronal depth sagittal maximum airflow ```

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

upper anteroposterior pump handle effect

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

lower laterally transverse bucket-handle effect

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

vertical | deep or forced inspiration

``` 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 ____ ```

``` expiration gravity elastic recoil elastic rebound abdominal musculature ```