Final Exam Thoracic Cavity Flashcards
How many true ribs are there? What makes them true?
7 true ribs because they directly articulate with the sternum
What is the classification of rib 9? Why?
false rib because it indirectly articulates with the sternum
What does rib 4 articulate with?
T3 and T4 vertebral bodies and the articular facets of transverse process of T4
What does rib 1 articulate with?
T1 vertebral body
What does rib 11 articulate with?
only the body of T12 (do not have tubercle)
Why is rib 1 unique?
has grooves for subclavian a. and v.
What is the intercostal space between ribs 4 and 5 called?
4th intercostal space
What is the space below the 12th rib called?
subcostal space
How many intercostal spaces are there?
11
What are the borders of the superior thoracic aperature?
T1, rib 1, and manubrium
What structures run through the superior thoracic aperature?
esophagus, trachea, neurovasculature that supply head and upper limbs
What are the borders of the inferior thoracic aperature?
T12, ribs 11 & 12, costal cartilages of ribs 7-10, and xiphisternal joint
What does the diaphragm attach to?
xyphoid process, ribs, and lumbar vertebrae
What innervates the diaphragm?
phrenic nerve
What passes through the diaphragm at T8?
inferior vena cava
What passes through the diaphragm at T10?
esophagus
What passes through the diaphragm at T12?
aorta
What direction is the diaphragm pulled with inspiration?
down
During expiration, the intrathoracic pressure _____.
increases
A fracture of middle ribs can lead to..
pneumothorax, lung or spleen injuries
What causes flail chest?
multiple rib fractures
What muscles assist with inspiration?
external intercostals
What muscles assist with expiration?
internal intercostals
What are the muscles that overlie the costal cartilage of ribs 2- by the sternum?
transversus thoracis
Where do the first 2 posterior intercostal arteries branch from?
supreme intercostal artery
Where do the posterior intercostal arteries branch from (other than the first 2)?
directly branch from the thoracic aorta
What is the 12th posterior intercostal artery called?
subcostal artery
Where do the upper 6 anterior intercostal arteries branch from?
internal thoracic arteries
Where do the anterior intercostal arteries 7-9 branch from?
musculophrenic arteries
Where do the last 2 intercostal spaces get their blood supply from?
posterior intercostal arteries
The internal thoracic arteries divide into…
superior epigastric and musculophrenic arteries before 7th rib
Where do the posterior intercostal veins drain into?
azygos
Where do the anterior intercostal veins drain into?
internal thoracic veins
How many posterior intercostal veins are there? Why?
11 with 1 subcostal vein due to there only being 12 ribs
What innervates the muscles of the intercostal spaces?
Ventral rami of T1-T11
What is the T12 intercostal nerve called?
subcostal nerve
What branches off of the intercostal nerves?
lateral and anterior cutaneous branches
Where are the “VAN”s of each intercostal space located?
in the costal groove of each rib sandwiched between the innermost and internal intercostal muscles
If a blockage occurs and blood cannot flow through the posterior intercostal artery of an intercostal space, how will the muscles receive oxygenated blood?
via the anterior intercostal arteries because they form anastomoses with the posterior intercostal arteries
What are the 3 compartments of the thoracic cavity?
2 lateral pleural cavities and 1 central mediastinal cavity
What pleura covers the lungs?
visceral pleura
What are the 4 parietal pleura of the pleural cavities?
cervical, costal, diaphragmatic, and mediastinal
What is found between the parietal and visceral pleura?
serous fluid
What keeps lungs from collapsing with each breath?
surface tension from pleural fluid
A penetrating wound through the thoracic cavity could cause ____ pressure and the lung to collapse.
negative
Where are the visceral and parietal pleura continuous?
hilum of the lung
What innervates the cervical and costal pleura?
intercostal nerves
What innervates the diaphragmatic pleura?
phrenic and intercostal nerves
What innervates the mediastinal pleura?
phrenic nerve
What are the 2 recesses found in the pleural cavities?
costomediastinal recess and costodiaphragmatic recess
Where does fluid collect in the pleural cavity when a person is upright?
costodiaphragmatic recess
What is a hemothorax?
blood in the pleural cavity
What is pleural effusion?
fluid in the pleural space
Where is the best place to perform a thoracentesis? Why?
in the 7-9th intercostal space because it avoids the lung and diaphragm
If performing a thoracentesis in the 9th intercostal space, what pleural layers will the needle pass through?
only the costal parietal pleura
Where does the trachea begin?
~C6 inferior to cricoid cartilage
The trachea is ____ to the esophagus.
anterior
Where does the trachea bifurcate?
sternal angle
The right primary bronchus passes under the ____.
arch of the azygos vein
The left primary bronchus passes inferior to the ___ and anterior to the _____.
aortic arch
descending aorta
Which bronchus is wider, shorter, and more vertical?
right primary bronchus
What is the section of cartilage called at the bifurcation of the trachea?
carina
How many secondary (lobar) bronchi are found in the on the right?
3
How many secondary (lobar) bronchi are found on the left?
2
How many tertiary (segmental) bronchi are found on the right?
10
How many tertiary (segmental) bronchi are found on the left?
8-10
What are the largest subdivisions of lung lobe called?
bronchopulmonary segments
Bronchopulmonary segments are separated by
tissue septa
Each bronchopulmonary segment is supplied by
a segmental bronchus, a tertiary branch of the pulmonary artery, and intersegmental parts of the pulmonary vein
What is the descending order of airflow?
trachea –> primary bronchus –> secondary (lobar) bronchus –> tertiary (segmental) bronchus –> bronchioles –> alveolar sacs –> alveoli
What is a segmentectomy?
the removal of lung segments
What is a lobectomy?
the removal of a lung lobe
What is a pneumonectomy?
removal of an entire lung
How many lobes in the right lung?
3
What lung and lobe is the lingula found?
left superior lobe
Where is the horizontal fissure of the right lung found?
parallels the 4th rib
What is the root of the lung?
collection of structures that connect the lung to the mediastinum
What is the hilum?
the doorway that all of the root structures pass through to enter the lung
The pulmonary artery carries
deoxygenated blood
The pulmonary vein carries
oxygenated blood
What supplies the lung tissues with blood?
bronchial arteries and veins
Where does the left bronchial vein drain into?
accessory hemi-azygos vein or left superior intercostal vein
Where does the right bronchial vein drain into?
azygos vein
Where does the left bronchial artery branch from?
thoracic aorta
Where does the right bronchial artery branch from?
thoracic aorta OR posterior intercostal artery (3rd) OR common trunk
What are the boundaries of the mediastinum?
superior thoracic aperture
sternum
diaphragm
vertebrae
What level is the sternal angle found?
T4/5
Where is the bifurcation of the trachea located?
sternal angle
What important structures are located in the superior mediastinum?
aortic arch superior vena cava thoracic duct thymus trachea esophagus vagus nerve phrenic nerve
After puberty, the thymus is replaced by
fat
The esophagus extend from the ____ to the ____.
pharynx to stomach
Where is the thoracic duct found?
posterior to esophagus in the superior mediastinum
Where does the thoracic duct empty into?
the venous system at the junction of the the left internal jugular and subclavian veins
What major vessels feed into superior vena cava?
brachiocephalic vein
What vessels branch off of the aortic arch?
brachiocephalic trunk
left common carotid
left subclavian
Which brachiocephalic vein in longer?
left
The superior vena cava returns all of the blood from the structures superior to the diaphragm EXCEPT
heart and lungs
Where does the superior vena cava form?
inferior border of the 1st right costal cartilage
What side of the mediastinum is the superior VC found?
right side
What part of the mediastinum is the ascending aorta?
middle mediastinum
Where does the aortic arch become the descending aorta?
below the sternal angle
What branches off of the right brachiocephalic trunk?
right common carotid
right subclavian
What does the vagus nerve supply?
parasympathetic innervation to thoracic and abdominal viscera
The vagus nerves branch into the
left and right recurrent laryngeal nerve
What is the smallest subdivision of the mediastinum?
anterior mediastinum
What division of the mediastinum is the heart in?
middle mediastinum
What are the 3 layers of the pericardium?
fibrous, parietal serous, and visceral serous
What anchors the fibrous pericardium to the central tendon?
pericardiacophrenic ligament
What innervates the fibrous pericardium?
phrenic nerve for SENSORY
vagus nerve and sympathetic trunks for MOTOR
What supplies the fibrous pericardium with blood?
pericardiacophrenic a and v
The visceral serous pericardium is also called
epicardium
What is pericardial effusion?
fluid within the pericardial cavity
What is cardiac tamponade?
rapid accumulation of fluid/blood in the pericardial cavity that compresses the heart reducing its output
Where would the needle for a pericardiocentesis be inserted?
left 5th intercostal space or infrasternal angle
What are the pericardial sinuses?
where the great vessels pierce the fibrous pericardium and serous pericardium is continuous
What are the 2 pericardial sinuses?
transverse and oblique pericardial sinuses
The right side of the heart is responsible for ____ circulation.
pulmonary
The left side of the heart is responsible for _____ circulation.
systemic
The right atrium receives ____ blood from _____.
deoxygenated blood from inferior and superior VC
The smooth walled portion in the right atrium is called the
sinus venarum
What chamber of the heart is the fossa ovalis found?
Right atrium
What is the fossa ovalis a remnant of?
foramen ovale
The right AV valve is also called the
tricuspid valve
The smooth walled portion of the right ventricle is called the
conus arterious
When blood leaves the right ventricle, where does it immediately go?
pulmonary trunk
What heart chamber receives oxygenated blood from the pulmonary veins?
left atrium
The rough walled portion of the left ventricle is called the
trabeculae carneae
Where is the common site of ventricular septal defects?
the upper membranous portion of the interventricular septum
What is a narrowing of heart valves called?
stenosis
When a valve fails to fully close causing backflow
valvular insufficiency
The cusps of the AV valves are attached to ____ by ____.
papillary muscles by chordae tendinae
What is responsible for closing the AV valves?
ventricular contraction pushing blood against them
What prevents valves from everting into atria?
papillary muscles and chordae tendinae
What is the most common type of valvular disease?
mitral valve prolapse ( a type of insufficiency)
What creates the lub sound?
closure of AV valves
When are the AV valves closed?
ventricular contraction
When is heart in systole?
ventricular contraction & AV valve closure
When is heart in diastole?
atrial contraction & semilunar valve closure
What creates the dub sound?
closure of semilunar valves
Where is the best place to listen to the aorta?
right 2nd intercostal space/ 3rd costal cartilage
Where is the best place to listen to the pulmonic valves?
left upper sternal border/ 2nd intercostal space
Where is the best place to listen for the tricuspid valve?
4th left intercostal space
Where is the best place to listen for the bicuspid valvle?
5th left intercostal space
Where is the SA node found?
superior right atria
Where is the AV node found?
inferior right atria
The right coronary artery is found in the
coronary sulcus
What coronary branch supplies the left atrium?
circumflex branch
What does the coronary sinus drain into?
right atrium
What 2 vessels merge to mark the start of the coronary sinus?
great cardiac vein and oblique vein of left atrium
What is myocardial ischemia?
insufficient blood flow to the heart muscles
What is a coronary angioplasty?
a balloon catheter inserted into a blocked coronary artery to restore blood flow
Where do most coronary blockages occur?
anterior IV branch (LAD)
What is a CABG?
coronary artery bypass graft (using healthy vessel from somewhere else)
The intraembryonic coelom divides into what 3 cavities?
pericardial, pleural, and peritoneal
What gives rise to the parietal layer of the peritoneum?
somatic mesoderm
What gives rise to the visceral layer of the peritoneum?
splanchnic mesoderm
Where is the only place the ventral mesentery remains?
caudal foregut (below diaphragm)
What is the partition between the pericardial and pleural membranes in an embryo called?
pleuropericardial membranes
The septum transversum turns into the
central tendon
What anchors the diaphragm in an embryo?
crura
What is important in embryology about C3-5 nerves?
they innervate the diaphragm
What is a congenital hiatal hernia?
herniation of part of the fetal stomach through an excessively large esophageal hiatus
What passes through the esophageal hiatus?
esophagus and vagus nerve
Why do CDHs lead to respiratory failure if not treated in utero?
lack of space for lungs to develop
What is esophageal atresia?
where esophagus ends in a blind pouch
What week does the lung bud bifurcate?
late 4th week
At what week of gestation is the conducting portion complete?
week 16
What week does surfactant begin being produced?
week 28
What type of cells produce surfactant?
type II pneumocytes
What are the 4 stages of lung maturation in order?
pseudoglandular stage
canalicular stage
terminal sac stage
alveolar stage
What are the 3 layers of the heart wall?
endocardium, myocardium, and epicardium
Cardiac muscle cells are
involuntary, mononucleated, striated and elongated/branched
What is considered the pace maker of the heart?
the SA node
What type of cells make up the endocardium?
simple squamous
The cardiac skeleton is made of
dense irregular CT
What type of cells make up the epicardium?
simple squamous/cuboidal mesothelium
What delivers the purkinje fibers from the interventricular septum to the papillary muscles of the RIGHT ventricle?
moderator band
What are the purkinje fibers full of?
glycogen
What are the 3 layers of a vessel from external to internal?
tunica adventitia –> tunica media –> tunic intima
What vascular layer is much thicker in an artery than a vein?
tunica media
What do arterial tunica media have more of?
elastic fibers
What vascular layer is thicker in veins?
tunica adventitia
What are the 2 layers of a capillary?
basement membrane and endothelium
What are the elastic arteries?
aorta, pulmonary trunk
What is distinct in elastic arteries?
internal elastic lamina
What are vasa vasorum?
small vessels that provide blood to larger vessels with thick walls
What are arterioles lacking?
elastic lamina
What is the most common type of capillary?
continuous capillaries
What type of capillaries have a discontinuous basement membrane?
sinusoidal capillaries
What is a portal system?
one capillary bed drains into a vein which branches into another capillary system
What allows for a bypass of capillary beds?
arteriovenous shunts
What are vein valves composed of?
folds of intima
What are the ventilation components of the respiratory system?
diaphragm
rib cage
intercostal muscles
abdominal muscles
What are the conduction components of the respiratory system?
nasal cavity sinuses larynx trachea bronchi bronchioles terminal bronchioles
What are the respiratory components of the respiratory system?
respiratory bronchioles
alveolar ducts
alveolar sacs
What are the common components of the conduction airways?
mucosa
smooth muscle
submucosa
adventitia
Between what 2 layers is smooth muscle found in the bronchi and bronchioles?
mucosa and submucosa
What type of epithelium is in the respiratory tract?
pseudostratified ciliated columnar epithelium (PCCE)
What respiratory cells produce mucus?
goblet cells
What cell type has the function of chemo receptors in the respiratory tract?
brush cells
What are the neuroendocrine cells of the respiratory epithelium?
kulchitsky cells
What are the stem cells that replenish the cells of the respiratory tract?
basal cells
Smoking cause a transition of respiratory epithelium from _____ to _____.
PCCE to NKSSE
What are the 4 layers that surround the lumen of the trachea?
mucosa
submucosa
cartilage
adventitia
What is the order of the bronchial tree from largest to smallest?
primary bronchi secondary (lobar) bronchi tertiary (segmental) bronchi bronchioles terminal bronchioles respiratory bronchioles alveolar ducts alveolar sacs alveoli
What are the differences in the bronchi vs the trachea
- bronchi have spiral bands of smooth muscle in the submucosa
- smaller diameter
- bronchi are surrounded by lung tissue
Primary bronchi have ____ cartilage
C-ring
Secondary bronchi have ____ cartilage
plates of
The bronchioles have what kind of epithelium?
larger bronchioles have PCCE
smaller and terminal bronchioles have ciliated cuboidal or ciliated columnar
What are goblet cells replaced with in terminal bronchioles?
club or clara cells
What is the function of club/clara cells?
- secrete surfactant
- detoxification via enzymes
- antimicrobial peptides and cytokines
Terminal bronchioles have an incomplete
circular layer of smooth muscle
Parasympathetic motor branches are responsible for ______ of bronchioles
constriction
Sympathetic branches are responsible for bronchiole _______
dilation
What is the transition point between the conducting and respiratory portions of the respiratory system?
respiratory bronchioles
What type of epithelium is found in the alveoli?
simple squamous
What type of cells are the majority of alveolar cells?
type II pneumocytes
What type of cells make up the majority of the surface of alveoli?
type I pneumocytes
What is the shape of type I pneumocytes?
flat
What is the shape of type II pneumocytes?
cuboidal
During ARDS, what happens to the alveoli?
- alveolar edema
- epithelial necrosis
- formation of hyaline membranes
