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Block 2; Week 6 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

The superior thoracic aperture is open/closed at the top of the _____.

A

Open.

Neck

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2
Q

The inferior thoracic aperture is open? Closed? Where?

A

Closed at the diaphragm.

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3
Q

What are the 3 basic spaces of the chest?

A

left & right pulmonary cavities & the mediastinum.

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4
Q

What do the pulmonary cavities contain?

A

The lungs & the pleural sacs

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5
Q

What does the pleura sac contain?

A

nothing! maybe a little serous fluid

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6
Q

What are the layers of the pleural sac?

A

outer layer: parietal layer

inner layer: touching the lung–visceral layer (an invagination of the parietal layer)

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7
Q

Where are the left & right phrenic nerves located?

A

in b/w the fibrous layer of the pericardium & the parietal pleura of the lung.

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8
Q

“C3, C4, & C5 keeps the patient alive.” What does this mean?

A

These are the cranial nerves that control the diaphragm.

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9
Q

T/F Like spinal nerves, phrenic nerves are not autonomic and carry no sympathetic fibers.

A

False.
Phrenic nerves ARE like spinal nerves in that they are NOT autonomic.
They DO carry sympathetic fibers, however.

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10
Q

What do the sympathetic fibers of the phrenic nerve supply?

A

the blood vessels of the diaphragm.

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11
Q

What do the motor nerves of the phrenic nerve supply?

A

the skeletal muscle of the diaphragm

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12
Q

What do the sensory nerves of the phrenic nerve supply?

A

diaphragmatic pleura

the pleura that sits next to the pericardial sac

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13
Q

What type of info does the sensory nerve carry?

A

sends the CNS info of pain

some stretch receptors too

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14
Q

What part of the mediastinum do the phrenic nerves pass thru?

A

middle mediastinum

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15
Q

Which part of the parietal pleura isn’t entirely filled with lung?

A

costodiaphragmatic recess

costmediastinal recess

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16
Q

What happens when you puncture the parietal pleura of the lung?

A

The lung collapses

the pressure inside the cavity becomes more positive.

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17
Q

What are the 5 parts of the lung pleura?

A 
Cervical Pleura
Costal Pleura
Mediastinal Pleura
Diaphragmatic pleura
Visceral Pleura
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18
Q

How close are the lungs to the parietal pleura?

A

Very close anteriorly.

Just not close inferiorly b/c of the recess.

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19
Q

If one lung collapses, will the other lung necessarily collapse?

A

no.

b/c the 2 pleural cavities aren’t connected.

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20
Q

If you blunt the costodiaphragmatic recess…what happens?

A

its angle becomes more obtuse

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21
Q

If you get air in your lung–where will it go?

A

To the top of the pleural cavity.

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22
Q

if you get blood or fluid in your lung–where will it go?

A

To the bottom of the pleural cavity–at the costodiaphragmatic recess…

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23
Q

How far down do the lungs extend during normal breathing? How about the parietal pleura?
This is from the perspective of the midclavicular line…

A

Lungs extend down to the 6th rib

Parietal Pleura extends down to the 8th rib

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24
Q

How far down do the lungs extend during normal breathing? How about the parietal pleura?
This is from the perspective of the midaxillary line…

A

Lungs extend down to the 8th rib

Parietal Pleura extends down to the 10th rib

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25
Q

How far down do the lungs extend during normal breathing? How about the parietal pleura?
This is from the perspective of the paravertebral line…

A

Lungs extend down to the 10th rib

Parietal Pleura extends down to the 12th rib.

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26
Q

Where is the diaphragm attached to the ribs? At the front & back?

A

Front: 6th, 8th, 10th ribs
Back: 12th rib

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27
Q

How far down do the lungs extend during normal breathing? How about the parietal pleura?
This is from the perspective of the parasternal line…

A

Lungs extend to the 4th rib
Parietal Pleura extends to the 6th rib
**Sievert doesn’t like this
**doesn’t apply to the right side….only left b/c of the dicrotic notch

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28
Q

With the parasternal, midaxillary etc lines…what position is the patient in? Why is this knowledge helpful?

A

The person is lying down.

Helps you to know where you can puncture the lung.

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29
Q

What’s the deal w/ pleural recesses?

A

They can be blunted or extended with certain pathology.

With certain pathologies, they can be filled with blood, air or water.

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30
Q

T/F the hilum & the root of the lung are the same thing

A

False.

Hilum is where the vessels actually enter the parenchyma of the lung.

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31
Q

What is contained in the root of the lung?

A

Main stem bronchi, pulmonary arteries, pulmonary veins, lymphatics, bronchial arteries
**basically: anything that enters or leaves the lungs

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32
Q

What is the difference b/w the bronchi of the left & right roots of the lung?

A

Left Root: primary bronchus enters the parenchyma & then splits
Right Root: primary bronchus divides before it enters the root of the lung

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33
Q

What is the difference b/w the L & R sides in the position of the pulmonary artery with respect to the main stem bronchus?

A

RALS
Right Side: the pulmonary artery is anterior to the main stem bronchus.
Left Side: the pulmonary artery is superior to the main stem bronchus.

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34
Q

What is the positional relationship b/w the vagus nerves & the root of the lung?

A

Vagus nerves travel posterior to the root of the lung.

**The vagus nerve has to be able to gain access to the esophagus.

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35
Q

What is the positional relationship b/w the phrenic nerves & the root of the lung?

A

The phrenic nerves travel anterior to the root of the lung.

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36
Q

T/F The trachea is in both the superior & inferior mediastinum.

A

False.

It is only in the superior mediastinum. This is where it bifurcates

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37
Q

Where are the veins of the lungs found?

A

always in the inferior anterior margin

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38
Q

Which lung has 3 lobes & what are they?

A

Right lung…has superior, inferior, middle

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39
Q

What separates the superior & inferior lobes of the lung?

A

Oblique fissure

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40
Q

What separates the middle & inferior lobes of the lungs?

A

An extension of the oblique fissure

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41
Q

What separates the superior & the middle lobes of the lung?

A

the horizontal fissure

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42
Q

Which of the lobes of the lungs can you percuss posteriorly & which can you not?

A

Superior & inferior can be percussed posteriorly.

The middle lobe can’t be percussed posteriorly b/c it doesn’t extend to the posterior thoracic wall.

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43
Q

What are the lobes of the left lung? Fissures?

A

Superior & Inferior

Separated by the oblique fissure

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44
Q

What is the pulmonary ligament?

A

It is an artifact of development.
It is the joining of the 2 parietal pleura.
It can be found near the hilum of the lung.

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45
Q

Which lung is smaller? How does this relate to the bronchopulmonary segments?

A

The left lung is smaller b/c of the dicrotic notch.
It has 8-10 bronchopulmonary segments.
However, the right lung has 10 bronchopulmonary segments.

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46
Q

What does the primary bronchus supply?

A

The lobe of the lung

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47
Q

What does the tertiary bronchus supply?

A

the bronchopulmonary segment

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48
Q

What supplies the bronchopulmonary segments?

A

tertiary bronchus

pulmonary artery branch

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49
Q

What is the supply called that goes to the bronchopulmonary segment?

A

intrasegmental

**tertiary bronchus & pulmonary artery branch

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50
Q

What is intersegmental supply?

A

pulmonary veins in the lungs

**this drains more than just one bronchopulmonary segment

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51
Q

What happens if you compress the pulmonary artery that follows the tertiary bronchus?

A

You will block the blood supply & that segment will die.

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52
Q

Why is performing a segmentectomy so difficult?

A

b/c the venous drainage isn’t intrasegmental.

You have to close off all the little venous tributaries. This is why it is more common to remove an entire lobe.

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53
Q

What airway supplies the middle lobe?

A

The middle bronchus…it branches off of the inferior bronchus

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54
Q

What is the carina?

A

It is the branching of the primary bronchus

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55
Q

Which bronchus is more likely to have things get stuck?

A

the right bronchus, b/c it is more vertical

56
Q

Where does the trachea divide?

A

@ the superior mediastinum. This is its end point.

57
Q

What all happens @ the superior mediastinum?

A

the trachea divides
the aorta attaches to the aortic arch
the pericardial sac attaches @ this point

58
Q

The pulmonary arteries are nestled in which structure?

A

the arch of the aorta

59
Q

T/F a part of the pulmonary arteries can be considered a part of the superior mediastinum.

A

True.

60
Q

Describe the nerve innervation of the lung.

A

Vagus: R & L branch into the cardiac plexus (cervical & thoracic)
Sympathetics: 2 types: off the chain & inferior cervical ganglion–>cardiac plexus
Pulmonary Plexus–>extension of the cardiac plexus

61
Q

T/F The parietal pleura of the lung does NOT feel pain, but the visceral pleura of the lung DOES.

A

False.
Parietal pleura does feel pain.
Visceral pleura does not feel pain.

62
Q

T/F the pain felt by the parietal pleura of the lung is carried by the same set of nerves

A

False.
It is carried by various sets of nerves.
Even pain in the same area may be carried by several sets b/c of the segmental innervation.

63
Q

Describe which nerves will send pain signals of the parietal pleura for the following areas:
Posterior Wall
Diaphragmatic Surface
Middle Mediastinum

A

Posterior Wall: intercostals
Diaphragmatic: phrenic nerve
Middle Mediastinum: Phrenic (pericardiacophrenic branches)

64
Q

What are the 2 main blood supplies of the lung?

A

Pulmonary Arteries

Bronchial Arteries

65
Q

Which of the 2 blood supplies to the lung carry deoxygenated blood & which carry oxygenated blood?

A

Pulmonary-deoxygenated

Bronchial-oxygenated

66
Q

If you have these awesome pulmonary arteries…why would you need bronchial arteries to supply the lung too?

A

b/c the main fcn of the pulmonary arteries is to facilitate gas exchange…bronchial arteries are here to maintain the workers (like giving hot cocoa to volunteers)…they mainly target the bronchi & the hilum stuff. Can’t get enough O2 thru diffusion from the pulmonary artery. Walls are too thick.

67
Q

T/F the pulmonary arteries & the bronchial arteries both follow the branching of the bronchial tree.

A

True.

68
Q

What are the main structures that the bronchial arteries target?

A

Those at the hilum of the lung.

Especially…primary, secondary, tertiary bronchi

69
Q

Where are the bronchial arteries before they enter the lungs?

A

Right Side: 1 bronchial artery. Poor guy.
This branches off of a right posterior intercostal artery.
Left Side: 2 bronchial arteries. Tough guy.
They both branch directly off the aorta.

70
Q

What is a visceral branch of the aorta? How does this relate to the bronchial arteries?

A

Visceral branch is an anterior branch that comes off the aorta & goes to an organ in the body cavity.
Example: bronchial arteries on the left side…esophageal artery

71
Q

What is a parietal branch of the aorta? How does this relate to the bronchial arteries?

A

Parietal branch is a more posterior branch that comes off the aorta & goes to a body wall structure.
Example: posterior intercostal arteries.
Note: right bronchial artery branches off a posterior intercostal artery (parietal branch off the aorta).

72
Q

Where are there NO lymphatics in the body?

A

the brain

73
Q

Describe the lymph drainage in the lungs.

A 
Subpleural lymph plexus
Bronchopulmonary nodes (hilar)
tracheobronchial nodes (superior & inferior)
paratracheal nodes (R & L)
Thoracic Duct OR R. Lymphatic Duct
74
Q

What is the general direction of lymph drainage in the lungs?

A

superiorly

75
Q

Why can cancers of the lungs spread so rapidly?

A

b/c of the extensive communication w/i the lymphatics of the lungs with other structures…

75
Q

Why can cancers of the lungs spread so rapidly?

A

b/c of the extensive communication w/i the lymphatics of the lungs with other structures…

76
Q

To review: how do you divide up the mediastinum?

A

Superior & Inferior

Inferior = Anterior, Middle, Posterior

76
Q

To review: how do you divide up the mediastinum?

A

Superior & Inferior

Inferior = Anterior, Middle, Posterior

77
Q

How do you divide the superior & inferior mediastinum?

A

sternal angle
transverse thoracic plane
posteriorly: T4 & T5

77
Q

How do you divide the superior & inferior mediastinum?

A

sternal angle
transverse thoracic plane
posteriorly: T4 & T5

78
Q

What structures are contained w/i the superior mediastinum?

A 
arch of the aorta
roots of the great vessels
esophagus
trachea
vagal, phrenic, cardiac nerves...
78
Q

What structures are contained w/i the superior mediastinum?

A 
arch of the aorta
roots of the great vessels
esophagus
trachea
vagal, phrenic, cardiac nerves...
79
Q

What structures are contained w/i the anterior portion of the inferior mediastinum?

A

fat
thymic remnant
branches of the internal thoracic artery

79
Q

What structures are contained w/i the anterior portion of the inferior mediastinum?

A

fat
thymic remnant
branches of the internal thoracic artery

80
Q

What structures are contained w/i the middle portion of the inferior mediastinum?

A 
pericardial sac
heart
ascending aorta
SVC 
pulmonary trunk
phrenic nerves
80
Q

What structures are contained w/i the middle portion of the inferior mediastinum?

A 
pericardial sac
heart
ascending aorta
SVC 
pulmonary trunk
phrenic nerves
81
Q

What structures are contained w/i the posterior portion of the inferior mediastinum?

A 
vessels of the venous system
descending aorta
Greater, Lesser, Least splanchnics
esophagus
thoracic duct
sympathetic chain**
81
Q

What structures are contained w/i the posterior portion of the inferior mediastinum?

A 
vessels of the venous system
descending aorta
Greater, Lesser, Least splanchnics
esophagus
thoracic duct
sympathetic chain**
82
Q

T/F The intercostal nerves are considered a part of the posterior mediastinum.

A

False.

82
Q

T/F The intercostal nerves are considered a part of the posterior mediastinum.

A

False.

83
Q

Why is it that the sympathetic chain isn’t technically considered a part of the posterior mediastinum?

A

b/c it lies lateral to the vertebrae, not anterior to them…

83
Q

Why is it that the sympathetic chain isn’t technically considered a part of the posterior mediastinum?

A

b/c it lies lateral to the vertebrae, not anterior to them…

84
Q

What vertebrae does the posterior mediastinum extend to posteriorly?

A

the 12th thoracic vertebrae

84
Q

What vertebrae does the posterior mediastinum extend to posteriorly?

A

the 12th thoracic vertebrae

85
Q

What generally defines the boundaries of the posterior mediastinum?

A

anterior to the vertebrae
posterior to the heart
b/w the parietal pleura of both lungs…

85
Q

What generally defines the boundaries of the posterior mediastinum?

A

anterior to the vertebrae
posterior to the heart
b/w the parietal pleura of both lungs…

86
Q

What is significant about the the fibrous pericardium that lies on top of parts of the aorta & SVC?

A

This marks the boundary b/w the inferior & superior mediastinum. Specifically middle & superior. Therefore, there is no fibrous pericardium in the superior mediastinum.

87
Q

Aside from the 5 layers that make up the superior mediastinum…what other structures are found here?

A

Pulmonary Trunk
Vagus, Phrenic, & Cardiac nerves
**left recurrent laryngeal nerve (a branch of the vagus)

88
Q

What is the difference in appearance of the R & L brachiocephalic veins…something helpful w/ CT reading?

A

R brachiocephalic vein is shorter & more vertical

L brachiocephalic vein is longer & more transverse

89
Q

What are the branches that come off of the aortic arch?

A

BCS (from right to left)
B: brachiocephalic artery
C: Common carotid (left)
S: subclavian artery (left)

90
Q

What are the branches that come off of the brachiocephalic artery?

A

The R common carotid & the R subclavian.

91
Q

What drains into the SVC? Sorta branches…

A

The R & L brachiocephalic veins.

92
Q

What’s something else that’s special & drains into the SVC?

A

the azygos vein

93
Q

What are the 5 layers that compose the superior mediastinum? Superficial–>Deep

A 
Glandular--Thymus
Venous--Brachiocephalics
Arterial--Aortic Arch
Respiratory--Trachea
Digestive--Esophagus
94
Q

Explain the path of the vagus nerves (especially w/ respect to the lungs).

A

The vagus nerves pass posterior to the root of the lungs & contribute to the esophageal plexus.
The left vagus nerve gives off the branch of the left recurrent laryngeal nerve that hooks around the ligamentum arteriosium.

95
Q

Explain the path of the phrenic nerves (especially w/ respect to the lungs).

A

These pass in front of the hilum of the lung & run alongside the pericardial sac. After they are done being in the superior mediastinum they are in the middle mediastinum.

96
Q

Let’s go thru this again in more detail…what structures are contained w/i the posterior mediastinum?

A 
Descending Aorta
Esophagus
Esophageal Plexus
Azygos & Hemiazygos System of Veins
Thoracic Duct & lymph nodes
Greater, lesser, least thoracic splanchnics
Sympathetic Chain**
97
Q

When are the greater, lesser, & least thoracic splanchnics considered a part of the posterior mediastinum?

A

When they pass in front of the vertebrae…anterior to them…

98
Q

T/F The SVC & IVC are important parts of the venous drainage of the posterior mediastinum.

A

False.

The SVC & IVC are NOT contained w/i the posterior mediastinum.

99
Q

T/F The trachea is NOT considered a part of the posterior mediastinum, but terminates after the superior mediastinum.

A

True.
The trachea bifurcates at the transition from the superior to the inferior mediastinum. Therefore, it is NOT considered a part of the posterior mediastinum.

100
Q

What is the span of vertebrae that make up the posterior mediastinum?

A

T5-T12

101
Q

Explain the azygos venous drainage system found in the posterior mediastinum.

A

R side: Main azygos vein.

L Side: accessory hemiazygos vein & hemiazygos vein.

102
Q

What is the main function of the azygos venous drainage?

A

Important to drain the thoracic body wall structures…especially the intercostal veins.
Who else will drain them? Not the SVC or IVC. The poor little guys are neglected.

103
Q

Where are things normally drained in the abdominal & pelvic regions?

A

Abdominal Region: IVC

Pelvic Region: Common iliac veins (branches of the IVC)

104
Q

Splanchnic nerves are ______ to the vertebrae & considered a part of the _______ mediastinum.

A

Anterior

Posterior

105
Q

What happens to the cardiac plexus? Where is it located?

A

It is located at the carina…continues onto the lungs where it is considered the pulmonary plexus.

106
Q

What are the 2 main nerve sources that contribute to the esophageal plexus?

A

Vagus nerves

Thoracic Splanchnics

107
Q

Explain the deal w/ the thoracic splanchnics that contribute to the esophageal plexus.

A

These synapsed in the sympathetic chain ganglion. They then left the chain anteriorly & went straight to the plexus. Thus, they are considered thoracic splanchnics.

108
Q

Explain the entire path of the R & L vagus nerves.

A

Brainstem
Thorax
They both merge in the esophageal plexus.
Separate out again as anterior & posterior vagal trunks
Stomach

109
Q

T/F The Anterior Vagal Trunk is made entirely of the Left Vagus Nerve & The Posterior Vagal Trunk is made entirely of the Right Vagus Nerve.

A

False.
Anterior is predominately composed of L vagus nerve. But not entirely b/c they merged.
Posterior is predominately composed of R vagus nerve. But not entirely b/c they merged.

110
Q

T/F The Right bronchial artery is considered a visceral branch of the aorta.

A

True.

It seems strange b/c it is a branch of a parietal branch, but it is true. Just accept it.

111
Q

What are the important branches of the thoracic aorta?

A 
Esophageal arteries (visceral)
Bronchial arteries (visceral)
Posterior Intercostal (parietal)
Subcostal (below the ribs)
Superior Phrenic Arteries
112
Q

Once again, what is the function of the azygos system?

A

drains body wall structures w/o using the SVC or IVC
can provide collateral flow
provides a sometimes important connection to the portal system.

113
Q

What does it mean that the azygos system is unpaired? And variable?

A

It is different on the right side than the left.

Sometimes you won’t see the structures on the left side at all!!

114
Q

Describe the azygos system on the right side.

A

Right Side:
azygos vein
drains into the arch of the azygos vein (which goes over the root of the lung on the right side) & drains into the SVC.
this isn’t really variable.

115
Q

Describe the azygos system on the left side.

A

Left Side:
Accessory Hemiazygos Vein (superior)–8th vertebrae & up
Hemiazygos Vein (inferior)–9th vertebrae & down

116
Q

What are the most notable veins that drain directly into the azygos system?

A

The posterior intercostal veins.

117
Q

What structure mirrors the azygos arch?

A

The arch of the aorta…it loops right over the root of the lung, too. It is just on the left side, whereas the azygos arch is on the right & is smaller.

118
Q

What does the body do to compensate when it is missing the hemiazygos vein or something???

A

The veins drain over the vertebrae in azygos branches (not over the esophagus)…that then drains into the azygos…
There is a lot of communication across the midline, which makes it possible to compensate for the variable left side veins.

119
Q

What are 2 things that account for the collateral flow of the azygos system?

A

Connection to the abdominal body wall…thru the ascending lumbar veins (next to the vertebrae).
Connection to the portal system (via esophageal veins that drain into the portal vein).

120
Q

Why is it helpful that there is collateral flow/connection to the portal system & the azygos system?

A

When you have portal hypertension…you can dilate the azygos blood vessel & allow them to hold more blood & alleviate the pressure in the portal system.

121
Q

What is significant about the veins of the esophageal venous plexus?

A

When they are dilated in response to portal HTN they can become overfilled & easily rupture. Then you will see extensive bleeding.

122
Q

The arch of the aorta on the ____ side & the arch of the azygos vein on the _____ side both go ____ to the root of the lung.

A

Left SIde–arch of the aorta
Right Side–azygos arch
Over/anterior to the root of the lung

123
Q

Where does the thoracic duct originate? Where does it drain? What structures is it sandwiched b/w?

A

Originates: diaphragm
Drains: @ the jcn of the left internal jugular vein & the left subclavian vein
Sandwiched: b/w the descending aorta & the esophagus…

124
Q

What parts of the body does the thoracic duct drain?

A

It drains the lymph of everything except the upper right quadrant of the body & the right side of the head…

125
Q

How is flow thru the thoracic duct facilitated?

A

thru respiration…

Block 2; Week 6 (4 decks)

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