Lungs, Pleura, Superior and Posterior Mediastinum

Question 1

There are essentially 3 spaces in the chest. What are they?

Answer 1

Right and left pulmonary cavities and the mediastinum

Question 2

The inferior thoracic aperture is closed by this structure

Answer 2

The diaphragm

Question 3

Two things enclosed in the pulmonary cavity

Answer 3

The lungs and the pleural sacs

Question 4

The (blank) lines the chest wall, and adheres to the contours of the chest wall all the way to the diaphragm

Answer 4

parietal pleura

Question 5

Which lung has three lobes?

Answer 5

The right lung

Question 6

What is the name of the fissure that divides the superior lobe from the middle lobe?

Answer 6

Horizontal fissure

Question 7

What is the name of the fissure that divides the inferior lobe from the superior lobe?

Answer 7

Oblique fissure

Question 8

What kind of nerve is the phrenic?

Answer 8

Just a basic spinal nerve.

Question 9

Do the phrenic nerves have sympathetic fibers?

Answer 9

Yes. They DO have sympathetic fibers on them, because the phrenic nerve goes to the diaphragm and the diaphragm has blood vessels, which need sympathetic innervation.

Question 10

Which layer of pleura, visceral or parietal, can feel pain?

Answer 10

Parietal

Question 11

The phrenic nerve is sandwiched between which two structures?

Answer 11

Parietal pleura and fibrous pericardium of the pericardial sac

Question 12

Where is the costal part of the parietal pleura?

Answer 12

Along the intercostal muscles (laterally)

Question 13

This is the space where the lung does not fill the entire parietal pleura

Answer 13

Costodiaphramatic recess

Question 14

If you peel the parietal pleural away from the fibrous layer of the pericardial sac, you will find the phrenic nerves, which are passing down from the spinal cord at what level?

Answer 14

C3-C5 (“C 3, 4, and 5 keep the person alive)

Question 15

Are there somatomotor and sensory fibers on the phrenic nerves?

Answer 15

Yes

Question 16

The lung does not expand all the way out to the midline border of the mediastina. What is the extra space called?

Answer 16

costomediastinal recess

Question 17

At the midclavicular line, how low do the lungs (visceral pleura) extend during quiet respiration? How about the parietal pleura?

Answer 17

6th rib; 8th rib

Question 18

At the mid-axillary line, how low do the lungs (visceral pleura) extend during quiet respiration? How about the parietal pleura?

Answer 18

8th rib; 10th rib

Question 19

At the paravertebral line (posteriorly), how low do the lungs (visceral pleura) extend during quiet respiration? How about the parietal pleura?

Answer 19

10th rib; 12th rib

Question 20

Potential spaces which can fill with blood, air and water in pathological states. The spaces can be blunted or increased depending on the pathology.

Answer 20

Pleural recesses

Question 21

Consists mainly of pulmonary arteries, bronchi and pulmonary veins, but anything entering or leaving the lung could also be considered part of this.

Answer 21

Root of the lung

Question 22

On which side does the primary bronchus enter the hilum?

Answer 22

Left side

Question 23

On which side do the secondary bronchi for upper and lower lobes enter the hilum?

Answer 23

Right side

Question 24

Phrenic runs (blank) to the hilum, while the vagus runs (blank) to the hilum.

Answer 24

anterior; posterior

Question 25

The superior vena cava branches to become the

Answer 25

Right and left brachiocephalic vein

Question 26

On the right side, the pulmonary arteries lie (blank) to the bronchi and the pulmonary veins lie (blank) and (blank) to all other structures in the root

Answer 26

anterior; inferior and anterior

Question 27

On the left side the pulmonary arteries lie (blank) to the bronchi and the pulmonary veins lie (blank) and (blank) to all other structures in the root

Answer 27

superior; inferior and anterior

Question 28

the most anterior and most inferior major structures in the hilum of both lungs

Answer 28

Branches of the pulmonary vein

Question 29

In the right (R) lung, the artery is (blank) to the airway. In the left (L) lung, the artery is (blank) to the airway

Answer 29

anterior; superior

Question 30

The unit of lung supplied by one tertiary (segmental) bronchus and its accompanying artery

Answer 30

bronchopulmonary segments

Question 31

In relation to bronchopulmonary segments, the pulmonary arteries are considered (blank), while the pulmonary veins are considered (blank).

Answer 31

intrasegmental; intersegmental

Question 32

How many segments are there in the right lung? Left lung?

Answer 32

10; 8-10

Question 33

What airway supplies each bronchopulmonary segment?

Answer 33

A tertiary bronchus supplies each segment.

Question 34

Each lung segment and each tertiary bronchus is paired up with a branch of the pulmonary artery. So, the pulmonary artery and the tertiary bronchi travel side by side. Their supplies are considered (blank).

Answer 34

Intrasegmental

Question 35

Which main bronchus is more vertical and wider, which allows for aspirated objects to get lodged more readily?

Answer 35

Right primary bronchus

Question 36

On which side does the main stem bronchus divide before entering the lung?

Answer 36

The right side

Question 37

What is the name for the point where the main stem bronchus bifurcates?

Answer 37

Carina

Question 38

Where does the trachea divide into primary bronchi?

Answer 38

At the junction of the ascending aorta and the arch

Question 39

Trachea is limited to the (blank), but many structures traverse the superior and some component of the inferior.

Answer 39

superior mediastina

Question 40

The (blank) pleura doesn’t feel pain whereas the mediastinal, costal and diaphragmatic plurae do

Answer 40

visceral

Question 41

Most lung tissues get their nutrients from the pulmonary circulation but structures comprising the root and supporting tissues get nutrients from (blank)

Answer 41

the bronchiole arteries

Question 42

The subpleural plexus drains the parenchyma and drains to the (blank)

Answer 42

bronchopulmonary nodes

Question 43

Explain the pathway that lymph takes in the lungs.

Answer 43

All lymph drains back to bronchopulmonary lobes, and then it passes from there up to the tracheobronchial nodes, the paratracheal nodes, and ultimately drains back to the thoracic duct on the left side or lymphatic duct on the right side

Question 44

Things in the superior mediastinum

Answer 44

``` Aortic arch and roots of its three superior branches (B,C,S) some pulmonary trunk with left and rt. arteries, some SVC with the arch of azygos draining in rt. and lt. brachiocephalic veins phrenic and vagus nerves lt. recurrent laryngeal trachea esophagus some thymus. ```

Question 45

Which brachiocephalic vein is more vertical? Which is more transverse?

Answer 45

right; left

Question 46

Five layers of superior mediastinum from superficicial to deep

Answer 46

``` Glandular (thymus) Venous Arterial (arch of the aorta and the great vessels BCS) Respiratory (trachea) Digestive (esophagus) ```

Question 47

The esophagus travels (post) to the root of the lung

Answer 47

Posterior

Question 48

The vagus nerves on both sides both contribute to the (blank).

Answer 48

esophageal plexus

Question 49

Phrenics pass (blank) to the root of the lung.

Answer 49

anterior

Question 50

What vertebrae mark the boundaries of the posterior mediastinum?

Answer 50

T5-T12

Question 51

Contents of the posterior mediastinum

Answer 51

Thoracic descending aorta and its branches esophagus and esophageal plexus azygos and hemi azygos system of veins thoracic duct and associated lymph nodes greater, lesser and least thoracic splanchnic nerves (sympathetic chain)

Question 52

Is the trachea found in the posterior mediastinum?

Answer 52

No, because it has already bifurcated.

Question 53

What is the main job of the azygos system?

Answer 53

Azygos main job is to drain the body wall. For example, in the region of the thorax, the intercostal veins have no place to drain. So, they drain to the azygos before entering the SVC.

Question 54

T/F: Technically, the sympathetic trunk and the roots of the splanchnic nerves are not in the posterior because they lie along side the vertebrae

Answer 54

True

Question 55

What happens to the left and right vagus nerves after they reach the esophageal plexus?

Answer 55

The fibers reconvene on their way to the stomach as the anterior and posterior VAGAL TRUNKS.

Question 56

The esophageal plexus also receives (blank) from thoracic splanchnics

Answer 56

sympathetics

Question 57

The right vagus contributes mostly to the (blank) esophageal plexus

Answer 57

posterior

Question 58

Important branches of the thoracic aorta

Answer 58

``` esophageal arteries bronchial arteries posterior intercostal arteries superior phrenic arteries two subcostal arteries ```

Question 59

Three things that the azygos system drains

Answer 59

the body wall, esophagus and bronchial veins

Question 60

The azygos system connects to the (blank) indirectly through the esophageal venous plexus

Answer 60

portal system

Question 61

Both the azygos and hemiazygos veins communicate with the abdominal cavity via direct connection to (blank)

Answer 61

the ascending lumbar veins

Question 62

Plexus of veins close to the internal surface of the esophagus

Answer 62

esophageal venous plexus

Question 63

Arch of azygos runs (blank) to the root of the lung on the (blank) side

Answer 63

superior; right

Question 64

Where is the thoracic duct located?

Answer 64

It lies between the esophagus and the thoracic aorta

Question 65

How is flow in the thoracic duct facilitated?

Answer 65

By pressure changes created through respiration

Question 66

The thoracic duct ultimately receives lymph from...

Answer 66

The entire body, except for upper right quadrant of the chest and the right side of the head

Question 67

At what rib can the oblique fissure be found in both lungs?

Answer 67

6th rib

Question 68

The horizontal fissure of the right lung can be found between which two ribs?

Answer 68

3rd and 4th

Question 69

Describe the pathway lymph takes from the lungs to its final destination.

Answer 69

subpleural lymph plexus-->pulmonary nodes-->bronchiopulmonary nodes-->tracheobronchial nodes-->paratracheal nodes-->right lymphatic duct or left thoracic duct

Question 70

At what level should a chest tube be entered for a pneumothorax? For a hemothorax?

Answer 70

2nd or 3rd intercostal space at midclavicular line (higher for pneumothorax because air rises); 5th intercostal space at midaxillary line

Question 71

With chest tube insertion, you want to insert the tube at an angle to avoid hitting the (blank) or (blank)

Answer 71

diaphragm or liver

Question 72

In the superior mediastinum, the esophagus is the most (blank) structure. However, in the inferior mediastinum, it lies (blank) to the aorta.

Answer 72

posterior; anterior and medial