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Anatomy Week 8 > Lungs and Posterior Mediastinum > Flashcards

Lungs and Posterior Mediastinum Flashcards

1
Q

Where does the trachea begin and end?

A

Begins at the inferior border of the larynx and end at the bifurcation into the primary bronchi at the sternal angle

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2
Q

What prevents the trachea from collapsing under normal conditions?

A

The C-shaped cartilages

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3
Q

What happens to the C-shaped cartilages as you move toward the bronchi?

A
  • They lose their c-shape and become plates of cartilage
  • These still serve to keep the lumen of the air tube open
  • no longer called C-shape cartilages once you get to the bronchi
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4
Q

Where is the cough reflex stimulated?

A

At the mucosa covering the carina

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5
Q

What is the carina?

A

Name of the final tracheal cartilage located at the tracheal bifurcation (at the sternal angle)

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6
Q

If you choke, which bronchus are the food particles most likely to end up in and why?

A

Right because it straighter, larger, and a more direct continuation of the trachea

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7
Q

What effect does the presence of the heart and great vessels have on the morphology of the left broncus?

A

they make it course at a sharper angle

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8
Q

What happens to the cartilage as you move from primary bronchi to segmental and subsegmental bronchi?

A

Loss of cartilage as the branching gets more extensive

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9
Q

What keeps the subsegmental bronchii from collapsing past the point where the rings of cartilage end (bronchioles)?

A

Negative pressure acts to keep the lumen of the bronchioles open

Note: smooth muscle fibers and elastic fibers regulate the size of this lumen

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10
Q

What makes up the walls of the bronchioles?

A

Mucosa, submucosa, elastic fibers, and smooth muscle

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11
Q

What differentiates a bronchiole from a respiratory bronchiole?

A

The presence of isolated alveoli along the walls of the bronchioles

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12
Q

List the structures that lead from the respiratory bronchiole to an alveolar sac.

A

Respiratory bronchioles
Alveolar ducts
Atrium
Alveolar sacs (clustered around atrium)

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13
Q

What structural changes are caused by edema fibrosis?

A

Increased distance between RBCs in the alveolar capillaries and the air in the alveolar space

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14
Q

What is pneumothorax?

A

The presence of air in the cavity between the lungs and chest wall causing lung collapse

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15
Q

What is the cause of lung collapse observed in pneumothorax?

A

Elastic and smooth muscle that are present to help regulate lumen size collapse when the negative pressure in the pleural cavity is lost

NOTE: this is the basis of collapse anytime there is fluid in the pleural cavity

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16
Q

T or F: everything until you get to the respiratory bronchioles, where alveoli start to appear is called dead space

A

True

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17
Q

Where can gas exchange take place in the respiratory system?

A

Only between the respiratory membrane in the alveolus

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18
Q

T or F: to maintain sufficient O2 and CO2 levels the lungs must only take in more air than the volume of the dead space

A

True

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19
Q

T or F: increased distance of diffusion across the respiratory membrane has a greater affect on CO2 than oxygen?

A

False, CO2 moves 10x faster across the membrane so any increase in distance will be more devastating to O2 diffusion

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20
Q

What 4 common processes that impair lung function by increasing diffusion distance?

A

Smoking - accumulation of particles
Fibrosis - too much CT in lungs
Edema - more fluid to diffuse across
Infections - bacterial accumulation or secretions

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21
Q

What barriers must O2 cross in order to enter an alveolar capillary in a normal lung?

A
  1. Surfactant
  2. Alveolar epithelial cells
  3. capillary endothelium
  4. plasma inside capillary

**note there is a basal lamina and CT associated with 2 and 3.

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22
Q

What would you expect to happen to the heart as a result of pulmonary embolism?

A

Increased pressure on the right side as it tries to push blood past the occlusion

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23
Q

What is a bronchopulmonary segment and what does it consist of?

A

Bronchopulmonary segment contains several components and occurs on the tertiary branches of the bronchi

Associated structures:

  1. Pulmonary Artery (deoxgenated blood)
  2. Bronchial Artery (oxygenated blood)
  3. Pulmonary vein (oxygenated blood)
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24
Q

Compare the bronchial and pulmonary arteries

A

Bronchial - High pressure, Low Flow

Pulmonary - Low Pressure, High Flow

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25
Q

What are the locations of the veins and arteries in the bronchiole pulmonary segment?

A
  • arteries are central within the segment

- veins are peripheral

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26
Q

Where do bronchial arteries end?

A
  • they stop at the respiratory bronchioles because they are no longer needed
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27
Q

What feature lies just deep to the 4th rib and follows its path from the midclavicular line to the sternum?

A

Horizontal fissure

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28
Q

Where would you place the stethoscope to listen to the sounds of the inferior lobe of the lung?

A

On the back below the 6th rib (probably on the posterior side)

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29
Q

What feature lies deep to the ribs and crosses the 5th intercostal space in the mid-clavicular line and follows the 6th rib to the sternum?

A

Oblique fissure (both R and L lungs)

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30
Q

Where would you place the stethoscope to listen to breath sounds in the middle lobe?

A

below the 4th rib

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31
Q

Where would you place the stethoscope to listen to sounds in the superior lobe?

A

Above the 4th rib

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32
Q

What feature of the left lung is comparable to the middle lobe of the right lung?

A

the linguina

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33
Q

What lung feature projects through the thoracic inlet into the root of the neck?

A

apex

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34
Q

What is the hilum?

A

Where the structures of the root of the lung leave the mediastinum and enter the substance of the lung

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35
Q

What is the lingula?

A

Inferior aspect of the left superior lobe

36
Q

T or F: the cardiac impression is a feature that can be found on both right and left lungs?

A

FALSE

37
Q

What structure(s) within the hilum are typically located posterior and superior to the pulmonary veins?

A

Secondary and primary bronchi

38
Q

Where are the pulmonary arteries located on the R and L sides?

A

Right:
anterior to the bronchi and between the bronchi and pulmonary veins (maintains anterior position to bronchi throughout course)

Left:
Up and bronchus to remain mostly in a posterior position throughout the course

39
Q

From where do the two left bronchial arteries arise?

A

Anterior aspect of the thoracic aorta near the tracheal bifurcation

40
Q

Where does the single right bronchial artery arise from?

A

the first right posterior intercostal branch of the aorta

41
Q

Where does the left bronchial vein drain?

A

Hemiazygos vein

42
Q

Where does the right bronchial vein empty?

A

azygos vein - near its junction with SVC

43
Q

How many secondary bronchi are in the right and left lungs?

A

2 in the left lung, and 3 in the right

Note: there is a secondary bronchii for each lobe

44
Q

What branches are given off from the vagus n. on the posterior side of the root of the lung, and what type of fibers are these?

A
  • Pulmonary Branches given off here

- Branches: Postganglionic, GVE, Parasympathetic

45
Q

What does Vagal motor stimulation cause in the lungs?

A

Constriction of the bronchial smooth muscle
secretion of bronchial mucus glands
Vasodilation

46
Q

What do afferent fibers from the vagus n. do in the lungs?

A
  • Detect stretching of muscle fibers in the bronchial tree

- Also contains fibers used in the COUGH reflex

47
Q

What is the affect of sympathetic stimulation on the lungs?

A
  • dilation of bronchi
  • reduction in mucous secretion
  • vasoconstriction
48
Q

Where does the thoracic duct enter venous flow?

A

at the junction of the internal jugular and subclavian veins

49
Q

What pulls lymph fluid into the venous flow?

A

Low pressure created by the flowing deoxygenated blood (Bernoulli’s principle)

50
Q

What is the consequence of a faulty lymphatic return to the venous flow?

A

Edema

51
Q

What is the thoracic duct?

A

The final lymph channel that drains 3/4 of the body (upper left quadrant and both lower quadrants)

52
Q

What drains the upper right quadrant in the lymph system?

A

Right lymphatic duct

53
Q

What is responsible for draining the right side of the head and neck?

A

Right lymphatic duct

54
Q

Where does the thoracic duct begin?

A

at the cysterna chyli (just inferior to the diaphragm at the aortic hiatus

55
Q

Where does the superficial plexus of lymphatics lie?

A

Just deep to the visceral pleura

56
Q

Where can the deep lymphatic plexus be found?

A

In the submucosa and surrounding connective tissue of the bronchi

57
Q

Where do lymphatics from both the deep and superficial plexus of lymphatics drain?

A

In the bronchopulmonary nodes

58
Q

What group of lymph nodes lie deep to the carina?

A

Inferior tracheobronchial nodes

59
Q

Where does lymph from the lungs ultimately drain the majority of the time?

A

Right thoracic duct for both lungs

60
Q

Describe the path of the esophagus?

A
  • Enters superior mediastinum at the midline and is just anterior to the thoracic vertebral bodies and continues downward until it makes a left turn around T10 to enter the stomach
61
Q

Describe the innervation and musculature of the esophagus.

A

Upper 1/3:
GSE in the recurrent layngeal nn.
Striated muscle

Lower 2/3:
GVE in the vagus n.
Smooth muscle

62
Q

What is the most superior sphincter in the esophagus and what is its job?

A
  • The upper esophageal sphincter

- opens during the swallowing reflex and closes to minimize regurgitation

63
Q

What is the most inferior esophageal sphincter and what is its job?

A
  • lower esophageal sphincter

- keeps stomach contents from refluxing back toward the larynx

64
Q

Aside from the upper and lower esophageal sphincters, what is another point in the esophagus where constrictions could occur?

A
  • Where the trachea passes deep to the tracheal bifurcation, the left bronchus can press on the trachea causing constriction
65
Q

Why are esophageal sphincters important?

A
  • several pathologies can arise at these point

E.g.
Sphincter dysfunction and the formation of diverticula that can trap food and become infected

66
Q

What are some of the effects diverticula in the esophagus?

A
  • they can get infected
  • can cause regurgitation
  • bad breath
  • aspiration pneumonia
67
Q

What two two nerves divide to make the parasympathetic portion of the esophageal plexus?

A

right and left vagal nerves

68
Q

How do nerves of the esophageal plexus enter the abdomin?

A

Through the esophageal hiatus in the diaphragm around T10

69
Q

T or F: splanchnic nerves arise from the sympathetic trunk

A

True

70
Q

T or F: splanchnic nerves typically contain post-ganglionic fibers

A

False - always preganglionic because they still need to synapse in the collateral ganglia

71
Q

From what chain ganglia do the greater, lesser, and least splanchnic nerve arise?

A

T5-T9 ganglia (greater)
T10-T11 ganglia (lesser)
T12 ganglion (least)

72
Q

At what vertebral level does the thoracic aorta descend into the abdominal cavity and what structure must it pass through to get there?

A

T12

-Must pass through the aortic hiatus in the diaphragm

73
Q

What gives rise to the intercostal arteries?

A

1-2 originate from the subclavian a.

3-11 branch from the thoracic aorta

74
Q

From major artery do the bronchial and esophageal arteries branch from?

A

Aorta

75
Q

What veins drain the posterior mediastinum?

A

azygos system of veins:

azygos
hemiazygos
accessory hemiazygos

76
Q

What two veins come together to pierce the diaphragm as the azygos vein and what is the area where this vein pierces?

A

Right ascending lumbar vein
Right subcostal vein

azygos passes through the aortic hiatus

77
Q

T or F: the azygos vein can be found on the left side of the vertebral column, and it drains the left anterior intercostal veins

A

FALSE, it is found on the RIGHT side of the vertebral column and drains the RIGHT POSTERIOR intercostal veins

78
Q

How does azygos receive blood from posterior intercostal spaces 2-4?

A

These drain into the right superior intercostal vein which drains into azygos

79
Q

How are the left posterior intercostals drained?

A

Rib 1-3: Right superior intercostal vein
Rib 4-8: accessory hemiazygos vein
Rib 9-12: hemiazygos vein

80
Q

What venous system in the thorax is incredibly important for collateral circulation and has very few valves?

A

Azygos

81
Q

What vein might become enlarged from an occlusion in the superior vena cava?

A

azygos

82
Q

What three major hiatuses exist in the diaphragm?

A

IVC hiatus T8
esophageal hiatus T10
Aortic hiatus T12

83
Q

Which hiatus in the diaphragm pierces the central tendon?

A

IVC hiatus

84
Q

What hiatus in the diaphragm is bounded on the right and left sides by the crura of the diagphragm?

A

aorta hiatus

85
Q

How does the relationship of the esophagus to the aorta change as you descend into the diaphragm.

A

aorta L and esophagus R to aorta posterior and esophagus anterior

Anatomy Week 8 (15 decks)

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