Mediastinum, Pleura and Organs of Respiration (Part 2) Flashcards
1
Q
The mediastinum, though thick, is a movable partition that extends where? (borders)
A
Superior - thoracic outlet and root of the neck
Inferiorly - diaphragm
Anterior - sternum
Posterior - vertebral column
2
Q
What does the mediastinum contain?
A
(10) remnants of thymus heart and large blood vessels trachea and esophagus thoracic duct and lymph nodes vagus and phrenic nerves sympathetic trunks
3
Q
The divisions of the mediastinum
A
Superior
Inferior
- Middle
- Anterior
- Posterior
4
Q
What divides the superior and inferior mediastinum?
A
by an imaginary plane passing from:
- anteriorly: sternal angle - posteriorly: T4 vertebra lower border
5
Q
It consists of the pericardium and heart
A
middle mediastinum
6
Q
a space between the pericardium and the sternum
A
anterior mediastinum
7
Q
lies between the pericardium and the vertebral column.
A
posterior mediastinum
8
Q
What does potential space contain and what for?
A
minimal fluid presence to prevent too much friction
9
Q
What are the borders of superior mediastinum?
A
superiorly - oblique plane of the first rib
inferiorly - imaginary line running from the sternal angle to the intervertebral disk between T4 and T5 vertebra
10
Q
What contains the superior mediastinum?
A
(10) superior vena cava (SVC), and brachiocephalic veins arch of the aorta thoracic duct trachea esophagus vagus nerve left recurrent laryngeal nerve phrenic nerve thymus
11
Q
Where is the site at which immature lymphocytes develop into T lymphocytes and secretes thymic hormones?
A
Thymus
12
Q
What does secretion of thymic hormones cause?
A
cause T lymphocytes to gain immunocompetence
13
Q
Where is thymus prominent in children?
A
at lower mediastinum (looking like a boat/ sail sign)
14
Q
Lies anterior to the pericardium and posterior to the sternum and the transverse thoracic muscles
A
Anterior Mediastinum
15
Q
What does the Anterior Mediastinum contain?
A
(4) remnants of the thymus gland lymph nodes fat connective tissue
16
Q
Lies between the right and left pleural cavities
A
Middle Mediastinum
17
Q
What does Middle Mediastinum contain?
A
(6) heart pericardium phrenic nerves roots of the great vessels (aorta, pulmonary arteries and veins, and vena cavae) arch of the azygous vein main bronchi.
18
Q
Lies posterior to the pericardium between the mediastinal pleurae
A
Posterior Mediastinum
19
Q
What contains the Posterior Mediastinum?
A
(8) esophagus thoracic aorta azygos and hemiazygos veins thoracic duct vagus nerves sympathetic trunk splanchnic nerves
20
Q
Where is the recurrent branch of left laryngeal nerve?
A
arch on the arch of the aorta
21
Q
Where is the recurrent branch of right laryngeal nerve?
A
arch through brachiocephalic artery
22
Q
What are the boundaries of the inferior mediastinum?
A
Anterior: body of sternum
Posterior: vertebra
Inferior: diaphragm
23
Q
Begins at the inferior border of the cricoid cartilage as a continuation of the larynx and ends by bifurcating into the right and left main stem bronchi at the level of the sternal angle
A
Trachea
24
Q
At what level is the cricoid cartilage?
A
C6
25
At what level is the hyoid bone?
C2
26
At what level is the thyroid cartilage?
C4
27
Trachea is approximately 12 cm in length and what does it have that open posteriorly toward the esophagus and prevent the trachea from collapsing?
16 to 20 incomplete hyaline cartilaginous rings
28
It may be compressed by an aortic arch aneurysm, a goiter, or thyroid tumors, causing dyspnea
Trachea
29
What does the trachea have which is a downward and backward projection of the last tracheal cartilage, which lies at the level of the sternal angle and forms a keel-like ridge separating the openings of the right and left main bronchi?
carina
30
It is the internal landmark where trachea bifurcates into right and left mainstem bronchi
carina
31
What surgical procedure requires carina to be known?
Bronchoscopy
32
Carina may be distorted, widened posteriorly, and immobile in the presence of a?
bronchogenic carcinoma
33
What is one of the most sensitive areas of the tracheobronchial tree and is associated with the cough reflex?
The mucous membrane over the carina
34
Where is the direct origin of inferior thyroid artery?
thyrocervical trunk
35
What supplies blood in the upper trachea?
inferior thyroid artery
36
What supplies blood in the lower part of trachea?
Branches of the bronchial artery
37
Where is the venous drainage of trachea?
Inferior thyroid venous plexus
38
It is the shorter, wider and more vertical bronchus.
Right main (Primary) Bronchus
39
Runs under the arch of the azygos vein and divides into 3 lobar or secondary bronchi and finally into 10 segmental bronchi
Right main (Primary) Bronchus
40
The right superior lobar (secondary) bronchus is known as?
eparterial (above the artery) bronchus
41
All other types of secondary bronchus are?
hyparterial (below artery) bronchi.
42
What are the 3 lobar bronchus of right main bronchi?
superior, middle, and inferior
43
Runs inferolaterally inferior to the arch of the aorta, crosses anterior to the esophagus and thoracic aorta, and divides into 2 lobar or secondary bronchi, the upper and lower, and finally into 8 to 10 segmental bronchi.
Left Main (Primary) Bronchus
44
Which main bronchi are more foreign bodies likely to enter through the trachea?
Right main (Primary) Bronchus
45
Longer, narrower, and more angulated bronchus
Left Main (Primary) Bronchus
46
What does the left main bronchus crosses superiorly on its proximal and distal parts respectively?
Proximal: arch of the aorta
Distal: left pulmonary artery
47
Chronic obstruction of airflow through airways and lungs
Chronic obstructive pulmonary disease (COPD)
48
inflammation of airways, resulting to excessive mucus production that plugs up airways
Chronic bronchitis
49
accumulation of air in the terminal bronchioles and alveolar sacs
Emphysema
50
chronic inflammation of bronchi that causes swelling and narrowing of airways
Asthma
51
general term for chronic dilation of bronchi and bronchioles
Bronchiectasis
52
A thin serous membrane that consists of a parietal pleura and a visceral pleura
Pleura
53
Lines the inner surface of the thoracic wall and the mediastinum and has costal, diaphragmatic, mediastinal, and cervical parts.
Parietal Pleura
54
The dome of the pleura, projecting into the neck above the neck of the first rib
cervical pleura (cupula)
55
What reinforced the cupula?
Sibson fascia/ suprapleural membrane
56
What innervates parietal pleura?
intercostal nerves
| phrenic nerves
57
What supplies the parietal pleura?
branches of the internal thoracic (1)
| superior (2), phrenic (3), posterior intercostal artery (4), and superior intercostal artery (5)
58
What do the veins of parietal pleura join?
systemic veins
59
What does the parietal pleura form, which is a two-layered vertical fold of mediastinal pleura, which extends along the mediastinal surface of each lung from the hilus to the base and ends in a free falciform border?
pulmonary ligament
60
Intimately invests the lungs and dips into all of the fissures
Visceral pleura (Pulmonary Pleura)
61
What supplies visceral pleura?
bronchial arteries
62
What drains the venous blood of visceral pleura?
pulmonary veins
63
Which pleura is sensitive to pain and which is sensitive to stretch?
pain: parietal pleura
stretch: visceral pleura
64
It contains vasomotor fibers and sensory endings of vagal origin, which may be involved in respiratory reflexes
Visceral pleura (Pulmonary Pleura)
65
lower border of lung midclavicular lines, midaxillary lines, and sides of vertebral column (paravertebral line) respectively?
midclavicular: 6th rib
midaxillary: 8th rib
paravertebral: 10th rib
66
lower border of pleura midclavicular lines, midaxillary lines, and sides of vertebral column (paravertebral line) respectively?
midclavicular: 8th rib
midaxillary: 10th rib
paravertebral: 12th rib
67
• A potential space between the parietal and visceral pleurae
• Represents a closed sac with no communication between right and left parts
Contains a film of fluid that lubricates the surface of the pleurae and facilitates the movement of the lungs
Pleural Cavity
68
* Pleural recesses formed by the reflection of the costal and diaphragmatic pleurae
* Can accumulate fluid when in the erect position
* Allow the lungs to be pulled down and expanded during inspiration
Costodiaphragmatic Recesses
69
Are part of the pleural cavity where the costal and mediastinal pleurae meet
Costomediastinal Recesses
70
accumulation of air in the pleural cavity, the lung collapses because the negative pressure necessary to keep the lung expanded has been eliminated.
Pneumothorax
71
Can be treated by draining the pleural air collection by simple aspiration using an intravenous catheter or chest tube thoracostomy (needling)
Pneumothorax
72
abnormal accumulation of fluid in the pleural cavity
Pleural effusion
73
Usually seen in car accidents, blunt trauma to the thorax
Pneumothorax
74
clear watery fluid
Transudate
75
cloudy viscous fluid
Exudate
76
How is pleural effusion treated?
thoracentesis
77
A surgical puncture of the thoracic wall into the pleural cavity for aspiration of fluid
Thoracentesis (pleuracentesis or pleural tap)
78
Where are the ideal sites in thoracentesis?
7th, 8th, or 9th intercostal space, inserted above the superior margin of a rib
79
What sites are avoided during thoracentesis?
lung, spleen, liver, diaphragm
| intercostal neurovascular bundle
80
Essential organs of respiration and are attached to the heart and trachea by their roots and the pulmonary ligaments
Lungs
81
What nourishes and drains nonrespiratory tissues respectively?
nourished by: bronchial arteries
drained by: bronchial veins for the larger subdivisions of the bronchi
pulmonary veins for the smaller subdivisions of the bronchial tree
82
Parasympathetic indication of lungs
bronchoconstrictor and secretomotor
83
Sympathetic indication of lungs
bronchodilator and vasoconstrictor
84
Have some sensory endings of vagal origin, which are stimulated by the stretching of the lung during inspiration and are concerned in the reflex control of respiration
Lungs
85
Larger and heavier but is shorter and wider
Right lung
86
Why is the right lung shorter and wider?
because of the liver presence in the diaphragm
87
Right lung has 3 lobes which are divide by?
oblique and horizontal (accessory) fissures
88
usually begins at the head of the fifth rib and follows roughly the line of the sixth rib.
oblique fissure
89
runs from the oblique fissure in the midaxillary line at the sixth rib level and extends forward to the fourth costal cartilage level
horizontal fissure
90
How many is the bronchial artery of right lung?
1
91
Has 3 lobar (secondary) bronchi and 10 segmental (tertiary) bronchi
Right lung
92
Has grooves for various structures (e.g., SVC, arch of azygos vein, esophagus)
Right lung
93
What divides the left lung?
an oblique fissure
94
Where is an oblique fissure usually more vertical?
Left lung
95
a tongue-shaped portion of the upper lobe that corresponds to the middle lobe of the right lung
lingula
96
Contains a cardiac impression, a cardiac notch (a deep indention of the anterior border of the superior lobe of the left lung), and grooves for various structures (e.g., aortic arch, descending aorta, left subclavian artery)
Left lung
97
Has 2 lobar (secondary) bronchi and 8 to 10 segmental bronchi
Left lung
98
The anatomic, functional, and surgical unit (subdivision) of the lungs
Bronchopulmonary Segment
99
What consists the Bronchopulmonary Segment?
segmental (tertiary or lobular) bronchus
segmental branch of the pulmonary artery
segment of the lung tissue
100
Refers to the portion of the lungs supplied by each segmental bronchus and segmental artery. The pulmonary veins are said to be intersegmental.
Bronchopulmonary Segment
101
What drains the Bronchopulmonary Segment?
intersegmental part of the pulmonary vein
102
What does the intersegmental pulmonary veins form which allows the removal of a bronchopulmonary segment without seriously disrupting the surrounding lung tissue and major blood vessels?
surgical landmarks
103
What are the main bronchopulmonary segments of the right lung?
Superior lobe: apical, posterior, anterior
Middle lobe: lateral, medial
Inferior Lobe: superior (apical), medial basal, anterior basal, lateral basal, posterior basal
104
What are the main bronchopulmonary segments of the left lung?
Superior: apical, posterior, anterior, superior lingular, inferior lingular
Inferior lobe: superior (apical), medial basal, anterior basal, lateral basal, posterior basal
105
Includes the nasal cavity, nasopharynx, larynx, trachea, bronchi, bronchioles (possess no cartilage), and terminal bronchioles
Conducting Portion
106
Includes the respiratory bronchioles, alveolar ducts, atria, and alveolar sacs.
respiratory portion
107
Vital exchange of oxygen and carbon dioxide that occurs in the lungs.
Respiration
108
What does the air-blood barrier contain?
alveolar type I cells,
basal lamina, and
capillary endothelial cells
109
What does The alveolar type II cells secrete?
Surfactant
110
When is the surfactant completed?
34 weeks
111
What does the surfactant do?
Increases surface tension of lungs
112
Occurs when the ribs and sternum (or thoracic cage) are elevated by the following muscles: diaphragm; external, internal (interchondral part), and innermost intercostal; sternocleidomastoid; levator costarum; serratus anterior; scalenius; pectoralis major and minor; and serratus posterior superior muscles.
Inspiration
113
Pulls the dome inferiorly into the abdomen, thereby increasing the vertical diameter of the thorax
Contraction of the Diaphragm
114
Reduces the intrapulmonary pressure (creates a negative pressure), thus allowing air to rush into the lungs passively because of atmospheric pressure
Enlargement of the Pleural Cavities and Lungs
115
Involves contraction off the intercostal muscles and elevation of ribs (superolateral movement), with the sternum moving anteriorly like a bucket handle. (When the handle is raised, the convexity moves laterally)
Forced Inspiration
116
Results in increased transverse and anteroposterior diameters of the thoracic cavity. The abdominal volume is decreased with an increased abdominal pressure
Forced Inspiration
117
What is the primary muscle of inspiration and its innervation?
Diaphragm
| Innervated by C2-C4
118
Involves the following muscles: muscles of the anterior abdominal wall, internal intercostal (costal part) muscles, and serratus posterior inferior muscles
Expiration
119
Involves relaxation of the diaphragm, the internal intercostal muscles (costal part), and other muscles; decrease in thoracic volume; and increase in the intrathoracic pressure.
Overall Process
120
What happens to the abdominal pressure and position of ribs in expiration?
abdominal pressure - decreased
| ribs - depressed
121
Produces a subatmospheric pressure in the pleural cavities. Thus, much of the air is expelled.
Elastic Recoil of the Lungs
122
A passive process caused by the elastic recoil of the lungs
Quiet expiration
123
It results from contraction of the diaphragm
quiet inspiration
124
Requires contraction of the anterior abdominal muscles and the internal intercostals (costal part)
Forced Expiration
125
What is the primary muscle of expiration?
No primary muscle, because it is a passive process
126
Drain the bronchial tree, pulmonary vessels, and connective tissue septa
Lymphatic Vessels of the Lungs
127
Direction of drainage in the bronchiole and bronchi
```
bronchopulmonary nodes
tracheobronchial nodes
tracheal nodes
bronchomediastinal nodes
thoracic duct on the left and right lymphatic duct on the right
```
128
Extends upward from the conus arteriosus of the right ventricle of the heart and carries poorly oxygenated blood to the lungs for oxygenation
Pulmonary Trunk
129
Passes superiorly and posteriorly from the front of the ascending aorta to its left side for approximately 5 cm and bifurcates into the right and left pulmonary arteries within the concavity of the aortic arch at the level of the sternal angle
Pulmonary Trunk
130
Has much lower blood pressure than that in the aorta and is contained within the fibrous pericardium
Pulmonary Trunk
131
Serves as landmark to distinguish eparterial and hyparterial bronchi
Pulmonary Trunk
132
Carries deoxygenated blood to the left lung, is shorter and narrower than the right pulmonary artery, and arches over the left primary bronchus
Left Pulmonary Artery
133
Connected to the arch of the aorta by the fibrous remains of the ductus arteriosus called?
ligamentum arteriosum
134
Runs horizontally toward the hilus of the right lung under the arch of the aorta behind the ascending aorta and SVC and anterior to the right bronchus
Right Pulmonary Artery
135
- Carry oxygenated blood from the respiratory part (alveoli) of the lung
- Intersegmental in drainage
- only four veins enter the left atrium
Pulmonary Veins
136
Arise from the thoracic aorta; usually there is one artery for the right lung and two for the left lung
Bronchial Arteries
137
Supply oxygenated blood to the nonrespiratory conducting tissues of the lungs and the visceral pleura.
Bronchial Arteries
138
Receive blood from the bronchi and empty into the azygos vein on the right and in accessory hemiazygos vein or the superior intercostal vein on the left
Bronchial Veins
139
May receive twigs (small vessels) from the tracheobronchial lymph nodes
Bronchial Veins
140
An obstruction of the pulmonary artery or one of its branches by an embolus (air, blood clot, fat, tumor cells, or other foreign material)
Pulmonary embolism (pulmonary thromboembolism)
141
Bed-ridden people and people with varicose veins are at risk to this
Pulmonary embolism (pulmonary thromboembolism)
142
Receives afferent and efferent (parasympathetic preganglionic) fibers from the vagus nerve, joined by branches (sympathetic postganglionic fibers) from the sympathetic trunk and cardiac plexuses
Pulmonary Plexus
143
What are the two divisions of Pulmonary Plexus?
anterior pulmonary plexus
| posterior pulmonary plexus
144
Arises from the third through fifth cervical nerves (C3-C5) and lies in front of the anterior scalene muscle
Phrenic Nerve
145
It supplies the central diaphragm, mediastinal pleura, and pericadium.
Phrenic Nerve
146
What part of diaphragm is supplied by the 6th to 12tg intercostal nerves
Peripheral diaphragm
147
The conducting (airway) system through the terminal bronchioles develops. Respiration is not possible
Glandular Period (Prenatal Weeks 5 to 17)
148
Luminal diameter of the conducting system increases, and respiratory bronchioles, alveolar ducts, and terminal sacs begin to appear. Premature fetuses born before week 20 rarely survive
Canalicular Period (Prenatal Weeks 13 to 25)
149
More terminal sacs form, and alveolar type I cells and surfactant-producing alveolar type II cells develop. Respiration is possible, and premature infants can survive with intensive care
Terminal Sac Period (Prenatal Weeks 24 to Birth)
150
Respiratory bronchioles, terminal sacs, alveolar ducts, and alveoli increase in number
Alveolar Period (Late Fetal Stage to 8 Years)
