Lecture 8 pt 2

Question 1

Normally lungs are radio_________ and vessels will be more radio________

Answer 1

radiolucent; radiopaque

Question 2

1) What are the bronchopulmonary segments shaped like?
2) Where are the apex and base of the lungs?

Answer 2

1) Pyramid shaped
2) Apex toward hilum (superior), base at pleural surface (inferior)

Question 3

What supply each segment of the lungs with air, blood to oxygenate, and drainage of blood?

Answer 3

1) Segmental bronchus (air)
2) Tertiary branch of pulmonary artery (blood)
3) Intersegmental parts of pulmonary vein (blood drainage)

Question 4

What are the bronchopulmonary segments important for?

Answer 4

Lung segment resection (cancer, copd, etc)

Question 5

What part of the lungs can you find superior to the clavicle?

Answer 5

Cervical pleura and apices of lungs

Question 6

1) List how many costal cartilages there are on the right side
2) List how many there are on the left side

Answer 6

1) 2-6 on right
2) 2-4 on left

Question 7

1) Where does the lung extend to at the mid clavicular line on both sides of the thorax?
2) Where does the lung extend to at the mid axillary line on both sides of the thorax?
3) Where does the lung extend to at the scapular line on both sides of the thorax?

Answer 7

1) 8th rib mid clavicular line (lungs are variable depending on inflation but sometimes here)
2) 10th rib mid axillary line (pleura extends here anteriorly and laterally)
3) 12th rib scapular line (pleura extends here posteriorly)

Question 8

1) What fissure does the right lung have that the left doesn’t?
2) Where is it?

Answer 8

1) Horizontal fissure
2) Extends from oblique fissure along 4th rib and costal cartilage anteriorly

Question 9

Where is the oblique fissure?

Answer 9

SP T2; 6th costal cartilage

Question 10

What are the two main vessels involved in pulmonary circulation?

Answer 10

1) Pulmonary artery
2) Pulmonary vein

Question 11

1) What does the pulmonary artery arise from?
2) What does it divide into within each lung?
3) What does that divide into after that?
4) What kind of blood does it carry?

Answer 11

1) Pulmonary trunk (left and right)
2) Lobar arteries
3) Segmental arteries
4) Poorly oxygenated blood

Question 12

What is the organization of the lungs?

Answer 12

1) Left and right lungs
2) Lobes (3 on left, 2 on right)
3) Segments

Question 13

What do the pulmonary veins convey?

Answer 13

Oxygenated blood to LV (left ventricle)

Question 14

Describe the route of the right pulmonary artery

Answer 14

Passes underneath aortic arch and posterior to SVC

Question 15

How are lung resections for cancer/disease often localized?

Answer 15

Often localized to lung, lobe, or segments

Question 16

Types of lung resections:
1) What is a pneumonectomy?
2) What is a lobectomy?
3) What is a segmentectomy?

Answer 16

1) Whole lung
2) Entire lobe
3) One or more segments

Question 17

1) What pleura is insensitive?
2) What pleura is sensitive? What condition is this associated with?

Answer 17

1) Viscera pleura
2) Parietal pleura very sensitive to pain; “pleuritis”

Question 18

1) What arteries supply the lung tissues and structures?
2) Is the blood deoxygenated or oxygenated?
3) Where does the left one arise from?
4) Where does the right one arise from?

Answer 18

1) Bronchial arteries
2) Oxygenated
3) Aorta
4) Right varies

Question 19

What are the two main types of veins that drain the lungs?

Answer 19

Bronchial and pulmonary veins

Question 20

1) What do bronchial veins drain? Where do they drain into?
2) What do pulmonary veins drain?

Answer 20

1) Only proximal parts [of lungs] into azygos vein
2) More distal tissue

Question 21

1) What level does the trachea bifurcate at? What are the two parts?
2) What part of the lungs do they enter?

Answer 21

1) At level of sternal angle ~ (T5); right and left main stem bronchi
2) Hila(root) of the lungs

Question 22

Which main stem bronchi (left or right) is wider, shorter and more vertical?

Answer 22

Right

Question 23

What is the significance of one main stem bronchi being shorter and wider than the other? (2 reasons)

Answer 23

1) Right main stem is a common place for foreign body or GI aspiration
2) Right main E-tube placement

Question 24

slide 68

Question 25

Most post ganglionic sympathetic nerves are ______adrenergic/ cholinergic__________

Answer 25

adrenergic (relating to epinephrine)

Question 26

Most pre ganglionic neurons are ______adrenergic/ cholinergic__________

Answer 26

cholinergic (relating to acetylcholine)

Question 27

1) What is the primary muscle of respiration?
2) Which part descends during respiration?
3) Which part is higher on one side than the other?
4) How many openings does it have?

Answer 27

1) Diaphragm
2) Central portion
3) Right dome higher than left dome
4) 3 hiatal openings

Question 28

slide 71
1) Where is the muscular portion of the diaphragm? What is the central part?
2) What nerve innervates the diaphragm? What type of innervation is this?

Answer 28

1) Muscular portion peripheral (radial projections), tendon is central
2) Phrenic nerve; motor and sensory

Question 29

What are the 3 openings in the diaphragm? List their locations.

Answer 29

1) Caval opening (in central tendon)
2) Esophageal hiatus (right crus forming sphincter)
3) Aortic hiatus (posterior to diaphragm)

Question 30

1) Where is the caval opening?
2) What adheres to the opening?
3) What nerve is here?

Answer 30

1) Right of median plan in central tendon
2) Inferior vena cava (IVC) adheres
3) Right phrenic nerve’s terminal branch.

Question 31

1) What 3 things go through the esophageal hiatus?
2) Where is it?

Answer 31

1) Vagus nerve trunks, esophageal vessels, & lymphatics
2) In right crus (forming sphincter) at about T10 level

Question 32

What two things go through the aortic hiatus posterior to diaphragm?

Answer 32

Azygos vein & thoracic duct

Question 33

True or false: the pleura extend far past the inferior portion of the lungs

Answer 33

True

Question 34

Describe the organization of the trachea from largest to smallest parts

Answer 34

1) Trachea
2) Tracheal bifurcation (carina)
3) Secondary/ lobar bronchi
4) Tertiary/ segmental bronchi
5) 20 generations of increasingly small bronchi
6) Respiratory bronchioles
7) Alveolar ducts
8) Alveolus with alveolar sacs

Question 35

Where does gas exchange occur?

Answer 35

The last 3 parts of the trachea:
1) Bronchioles
2) Alveolar ducts
3) Alveolar sacs

Question 36

Pulmonary lymphatics are concentrated where?

Answer 36

Towards the midline/ hilum of the lungs

Question 37

1) What is a SABA and LABA?
2) Give an example of this in medication
3) What do they act on? Agonist or antagonist?
4) Sympathetic or parasympathetic?

Answer 37

1) Short acting beta agonist and long acting beta agonist
2) Asthma and COPD Rx
3) Adrenergic receptor agonist
4) Sympathetic

Question 38

1) What is a SAMA and LAMA?
2) Give an example of this in medication
3) What do they act on? Agonist or antagonist?
4) Sympathetic or parasympathetic?

Answer 38

1) Short acting and long acting muscarinic antagonists
2) COPD and Asthma Rx; blocks muscarinic receptors
3) ACH receptors antagonist
4) Parasympathetic; dilates

Question 39

__________ is slightly on left side of vertebral bodies, __________ is on the right side.

Answer 39

Aorta; SVC

Question 40

There’s a gap in the diaphragm for what muscle?

Answer 40

Psoas

Question 41

1) What is just inferior to the aortic hiatus?
2) What’s just inferior to that?

Answer 41

1) Celiac trunk
2) Superior mesenteric artery

Question 42

Where is the top of the diaphragm? How far down does the diaphragm extend?

Answer 42

About T6-7 top of dome; down to 11 rib

Question 43

1) Where does the phrenic nerve primarily come from? Where else?
2) Where does it provide motor innervation?
3) Where does it provide sensory innervation?
4) What does this nerve receive?

Answer 43

1) C4 spinal nerve & C3 and C5
2) Sole motor to diaphragm
3) Sensation to central diaphragm, mediastinal pleura, and pericardium
4) Sympathetic fibers from cervical sympathetic ganglia

Question 44

1) What muscle does the phrenic nerve cross over?
2) Where does it go after the diaphragm?

Answer 44

1) Anterior scalene m.
2) Enters thorax anterior to subclavian artery and posterior to subclavian vein

Question 45

Where are the phrenic nerves when they’re in the mediastinum?

Answer 45

1) Right phrenic n:
-Runs posterior to subclavian vein and anterior to subclavian artery.
-Then runs medially to (small) right pericardiophrenic vein while hugging the lateral aspect of the SVC. Runs down right side of heart.
2) Left phrenic n:
-Runs posterior to subclavian v. and anterior to subclavian artery
-Then runs anterior to descending aortic arch, anterior to LPA (left pulmonary artery), and down left side of heart.

Question 46

1) How does the vagus nerve traverse the mediastinum?
2) Besides the phrenic and vagus nerves, name 2 more nervous system structures in the mediastinum

Answer 46

1) Travels posterior to LBV (left brachiocephalic vein), then anteriorly to top of aortic arch and posteriorly to the LPA (left pulmonary a)
2) Recurrent laryngeal n. and sympathetic trunk

Question 47

Why do we care about the phrenic innervation of the diaphragm?

Answer 47

Right phrenic nerve may be responsible for paralysis of right hemidiaphragm

*might be on quiz