Bony Thorax pt. 3

Question 1

Lines the lungs, has a frosty appearance. Spongy.
-Think like Pia Mater. Directly applied to the lungs

Answer 1

Visceral Pleura

Question 2

Lines the chest wall anteriorly around the area of the lungs.
Divided into 4 parts:
-Costal Pleura: largest; lines chest wall all the way around the chest.
-Diaphragmatic Pleura: portion underneath the lungs that lines the diaphragm
-Cervical Pleura: Lies on the apex of the lung
-Mediastinal Pleura: Lines medial aspect of the lungs, looks into the space created between the two lungs on either side.

Answer 2

Parietal Pleura

Question 3

Covered tightly by parietal pleura (derived from scalene fascia)
-Cervical Pleura

Answer 3

Apex of the Lung

Question 4

Ends above the end of the pleura, creating a space called the costodiaphragmatic recess. Allows room for the lungs to expand, prevents restrictive breathing.
-With inflammation/infection, fluid collects here due to gravity.
-Pleura ends about 2 rib spaces below the end of the lungs.

Answer 4

Base of lungs

Question 5

Base of lungs: MCL to the 6th rib; MAL to the 8th rib; PVL to the 10th rib
Parietal Pleura: MCL to the 8th rib; MAL to the 10th rib; PVL to the 12th rib

Answer 5

Ending Locations

Question 6

Where do you insert the needle for a thoracentesis?

Answer 6

At the 10th ICS or below (no lung present)
-Go over the top of the rib to avoid the IC artery, nerve, etc.
-Slide needle over the 11th rib

Question 7

Healthy lungs should be about ____ in above the clavicle

Answer 7

1 in

Question 8

-Radiolucent (Dark)
-Normal vessel cloudiness
-Heart shadow
-Aortic Knuckle/Arch of the aorta
-Clavicles
-Lungs above the clavicles by about 1 in

Answer 8

Healthy Lungs CXR

Question 9

Where the blood vessels and airway come and go.

Answer 9

Hilum

Question 10

Found below the hilum. Formed by two layers of parietal pleura coming together

Answer 10

Pulmonary Ligament

Question 11

In the right lung, the bronchus is ______.
-Airway lies behind and slightly above the artery.

Answer 11

Epiarterial

Question 12

In the left lung, the bronchus is ______.
-Airway lies below the pulmonary artery.

Answer 12

Hypoarterial

Question 13

Contains:
-Aortic Impression (Groove for the Aortic Arch): Large impression that curves and runs posteriorly.
-Cardiac impression: hole for the heart
-Cardiac notch: Interruption in the impression (on the side)
-Lingula: residual 3rd lobe, projection off of the upper lobe

Answer 13

Left Lung

Question 14

Contains:
-Esophageal Impression: Indentation for the esophagus
-Impression Arch - Azygos Vein

Answer 14

Right Lung

Question 15

A large vein that bypasses some of the load of blood volume to get it back to the heart. Terminates in the SVC. Typically found on the right side.

Answer 15

Azygos Vein

Question 16

Subdivisions of the lungs separated by fissures.

Answer 16

Lobes

Question 17

Subdivisions of the lobes, each are separated by a fibrous septum.

Answer 17

Bronchopulmonary Segments

Question 18

Fissure that separates the upper and middle lobes of the right lung

Answer 18

Horizontal fissure

Question 19

Fissure that separates the middle and lower lobes of the right lung.

Answer 19

Oblique Fissure

Question 20

Fissure that separates the upper and lower lobes of the left lung.

Answer 20

Oblique Fissure

Question 21

The right lung has _____ Bronchopulmonary Segments

Answer 21

10

Question 22

The left lung has _____ Bronchopulmonary Segments

Answer 22

8

Question 23

Bronchopulmonary segments of the right upper lobe

Answer 23

Apical, Posterior, and Anterior

Question 24

Bronchopulmonary segments of the right middle lobe

Answer 24

Lateral and Medial

Question 25

Bronchopulmonary segments of the right lower lobe

Answer 25

Superior, Anterior Basal, and Lateral Basal

Question 26

Bronchopulmonary segments of the right lower lobe (medial view)

Answer 26

Medial Basal and Posterior Basal

Question 27

Bronchopulmonary segments of the left upper lobe

Answer 27

Apico-Posterior, Anterior, Superior, and Inferior (Lingula)

Question 28

Bronchopulmonary segments of the left lower lobe

Answer 28

Superior, Antero-Medial Basal, and Lateral Basal

Question 29

Bronchopulmonary segments of the left lower lobe (medial view)

Answer 29

Posterior Basal

Question 30

Arteries that supply the lung tissue. -1 on the right (off of the 3rd Post. IC artery) -2 on the left (Aortic Arch) -Run and subdivide with the airways out to the bronchial capillaries -Can have variations of normal

Answer 30

Bronchial Arteries

Question 31

Variable, but run retrograde with the bronchial arteries. -Drain into the Accessory Hemiazygos Vein and the Left Superior Intercostal Vein

Answer 31

Left Bronchial Veins

Question 32

Variable, but run retrograde with the bronchial arteries. -Drain into the Azygos Vein

Answer 32

Right Bronchial Veins

Question 33

Some Bronchial Veins may form cross-anastomoses with Pulmonary veins, resulting in _______ _____________. -Inability for SpO2 to naturally register as 100% due to this physiologic mixing of blood.

Answer 33

Venous Admixture

Question 34

The Trachea is about ___ in long in total. About ___ in in the neck (Cervical part), and about ____ in in the thorax (thoracic part). -Has about ____ C-Shaped Rings

Answer 34

4; 2; 2. 20 C-shaped rings

Question 35

Muscle that gives the esophagus the flexibility to expand and contract. Prevents the esophagus from hitting against hard cartilage. Smooth muscle. Covers the incomplete back of the trachea.

Answer 35

Trachealis Muscle

Question 36

Provide stability to the tracheal wall while you breathe due to changing pressures. Gives the trachea a "Skeleton" that prevents it from expanding/contracting as you breathe. -Provides integrity to the trachea and bronchial systems.

Answer 36

C-Shaped Cartilaginous Rings

Question 37

The Trachea bifurcates at the _____________________.

Answer 37

Sternal Angle of Louis (Manubrio-sternal Joint)

Question 38

From Right to Left MS Bronchi is ______ degrees -Right down is _____ degrees -Left down is ______ degrees

Answer 38

62; 25; 37

Question 39

Bronchus that is longer, smaller in diameter, and more horizontal

Answer 39

Left Mainstem Bronchus

Question 40

Bronchus that is shorter, larger in diameter, and more vertical (Steeper angle)

Answer 40

Right Mainstem Bronchus

Question 41

Mainstem Bronchus divide in the Lobar Bronchi, named for each of the lobes of the lung (3 on the R and 2 on the L). The Lobar Bronchi divide into the Bronchopulmonary Segments. Each Bronchopulmonary Segment has its own Segmental Bronchus. (R: 10 BP segments, so 10 segmental bronchi). Segmental Bronchi form Subsegmental Bronchi, getting smaller and smaller. From there, divide into Bronchioles

Answer 41

Airway Progression

Question 42

By the time you get down to the ______, you have lost the cartilaginous rings, but you keep the cartilaginous plates that help to protect the airway and keep it from collapsing.

Answer 42

Subsegmental Bronchi

Question 43

Less than 1 mm in Diameter. -No cartilage -Smooth muscle tubes that keep the airways open. -Muscle & Epithelium -Terminate in the Alveoli

Answer 43

Bronchioles

Question 44

Exchange O2 and CO2 with the blood in the alveolar capillaries via a very small membrane

Answer 44

Alveoli

Question 45

Which is more difficult to diffuse, O2 or CO2?

Answer 45

O2 is more difficult. -Increased thickness of the alveolar-capillary membrane makes it difficult for gases to absorb.

Question 46

Has several layers: -Surfactant: on the alveolar side. Layer of moisture that lines mucus membranes -Alveolar epithelium -Alveolar Basement Membrane: connecting tissue that alveoli sits on -Interstitial Space -Capillary Basement Membrane -Capillary Epithelium -RBC

Answer 46

Alveolar-Capilary Membrane