Unit 2- Larynx And Thorax Flashcards
What structure connects the lower part of the pharynx to the trachea?
Larynx
What does the larynx connect?
Lower part of the pharynx to the trachea
What is the larynx primarily made up of?
Cartilage
What are three functions of the larynx?
- Prevent passage of food into the airway during swallowing 2. Regulate flow of air into the lungs 3. Vocalization
About how long is the larynx in an adult?
5 cm
Between what cervical vertebral does the larynx lie?
Between CV3 and CV 6
How many cartilages make up the larynx?
6
List the 6 cartilages of the larynx.
- Thyroid 2. Cricoid 3. Epiglottic 4. Arytenoid 5. Corniculate 6. Cuneiform
T/F. The thyroid cartilage of the larynx is a single cartilage.
True
The thyroid cartilage of the larynx presents what 7 structures?
- Superior thyroid notch 2. Inferior thyroid notch 3. Laryngeal prominence 4. Superior horn (attached to greater horn of hyoid bone) 5. Inferior horn (articulates with cricoid cartilage) 6. Laminae 7. Oblique Line
The oblique line located on the external surface of the lamina provides attachment for what three muscles?
- Inferior constrictor 2. Sternothyroid 3. Thyrohyoid muscles
What does cricoid mean in Greek?
Ring
T/F. The Cricoid Cartilage is the most superior of the laryngeal cartilages.
False; most inferior (CV 6)
T/F. The cricoid cartilage consists of a narrow anterior arch and a broad, posterior lamina.
True
The epiglottic cartilage is a single spoon shaped cartilage that lies where?
Behind the root of the tongue and body of the hyoid bone
The lower end of the epiglottic cartilage is attached to the back of the laryngeal prominence of the thyroid cartilage via what structure?
Thyroepiglottic ligament
T/F. The arytenoid cartilage is a single cartilage.
False; paired and pyramidal in shape
The bases of the arytenoid cartilage articulate with what other laryngeal cartilage?
Cricoid cartilage
Each arytenoid cartilage presents what two structures?
- Vocal process 2. Muscular process
The corniculate cartilages are paired cartilages and are closed within what structure?
Aryepiglottic folds
T/F. The cuneiform cartilages are paired cartilages which lie in the aryepiglottic folds posterior to the corniculate cartilages.
False; anterior
From a clinical standpoint, the corniculate and cuneiform cartilage can ossify and also be mistaken for _________.
A fracture
There are two joints of the larynx. What are they and what are their classifications?
- Cricothyroid joint 2. Cricoarytenoid joint
Synovial joints
What type of synovial joint is the cricothyroid joint?
Hinge
Where is the location of the cricothyroid joint?
Between the side of the cricoid cartilage and the inferior horn of the thyroid cartilage
What type of motion does the cricothyroid joint permit?
Rotation of the thyroid cartilage around the horizontal axis
What type of synovial joint is the cricoarytenoid joint?
Planar, arthroidial
Where is the location of the cricoarytenoid joint?
Between the upper border of the cricoid cartilage and the base of the arytenoid cartilage
What motion does the cricoarytenoid joint permit?
Gliding and rotation of the arytenoid cartilage on the cricoid cartilage
List the 5 ligaments of the larynx.
- Thyrohyoid membrane 2. Median cricothyroid ligament 3. Vocal ligament 4. Conus Elasticus 5. Quadrangular membrane
The thyrohyoid membrane extends from the thyroid cartilage to the hyoid bone and is pierced on each side by what two structures?
Internal laryngeal nerve and superior laryngeal vessels
The median cricothyroid ligament extends from what two cartilages?
Arch of the cricoid cartilage to the thyroid cartilage
Since the vocal ligament extends from the thyroid cartilage in front to the vocal process of the arytenoid cartilage behind, it is considered the ________ vocal cord.
True vocal cord
Where is the location of the conus elasticus?
Extending upward from the cricoid cartilage to the vocal ligament
What ligament forms the free edge of the conus elasticus?
Vocal ligament
What does the quadrangular membrane connect?
Epiglottic cartilage to the arytenoid cartilage
What do the superior and inferior margins of the quadrangular membrane form?
S- aryepiglottic ligament within the aryepiglottic fold
I- vestibular ligament within the vestibular fold
Name the two pairs of folds that the larynx contains.
- Vestibular folds (false vocal cords)
2. Vocal folds (true vocal cords)
The vocal folds contain the vocal ligament and what muscle? (This muscle forms the bulk of the vocal fold)
Vocalis muscle
What is the name of the space between the vestibular folds (false vocal cords)?
Rima Vestibuli
What is the name of the space between the vocal folds (true vocal cords)?
Rima Glottidis
T/F. The Rima Vestibuli is the narrowest part of the laryngeal cavity.
False; Rima Glottidis
T/F. The Glottis includes the Rima Glottidis and vocal folds.
True
What are the names of the three cavities in which the larynx is divided into?
- Laryngeal Vestibule
- Laryngeal Ventricle
- Infraglottic Cavity
Which cavity of the larynx extends from the vocal folds to the inferior border of the cricoid cartilage?
Infraglottic cavity
Which cavity of the larynx lies between the false and true vocal cords?
Laryngeal ventricle
Which cavity of the larynx extends from the laryngeal inlet to the false vocal cords?
Laryngeal vestibule
What structure contains glands that lubricate the vocal folds (aka “oil can” of the vocal cords)?
Laryngeal saccule
Which laryngeal fold is responsible for initiating the cough reflex?
False vocal cord
Do the intrinsic or extrinsic muscles of the larynx move the larynx as a whole? What two categories can they be divided into?
Extrinsic
Depressors and elevators
What are the six elevators of the larynx?
- Thyrohyoid
- Stylohyoid
- Mylohyoid
- Digastric
- Stylopharyngeus
- Palatopharyngeus
What are the three depressors of the larynx?
- Omohyoid
- Sternohyoid
- Sternothyroid
What is the origin and insertion of the cricothyroid muscle?
O: cricoid cartilage
I: inferior horn and lower lamina of thyroid cartilage
What is the nerve supply to the cricothyroid muscle?
External laryngeal nerve
What is the function of the cricothyroid muscle?
Tilts thyroid cartilage downward or cricoid cartilage upward thereby tensing the vocal cords
What is the origin and insertion of the posterior cricoarytenoid muscle?
O: posterior surface of lamina of cricoid cartilage
I: muscular process of arytenoid cartilage
What is the nerve supply to the posterior cricoarytenoid muscle?
Recurrent laryngeal nerve
What is the function of the posterior cricoarytenoid muscle?
Abducts the vocal folds
What is the origin and insertion of the Lateral Cricoarytenoid Muscle?
O: arch of cricoid cartilage
I: muscular process of arytenoid cartilage
What is the nerve supply to the Lateral Cricoarytenoid Muscle?
Recurrent laryngeal nerve
What is the action of the Lateral Cricoarytenoid Muscle?
Adducts the vocal cords (whispering)
What is the origin and insertion of the Transverse Arytenoid Muscle?
O: posterior surface of arytenoid cartilage
I: posterior surface of opposite arytenoid cartilage
What is the nerve supply to the Transverse Arytenoid Muscle?
Recurrent laryngeal nerve
What is the action of the Transverse Arytenoid Muscle?
Adducts the vocal folds (coughing)
What is the origin and insertion of the Oblique Arytenoid Muscle?
O: muscular process of arytenoid cartilage
I: apex of opposite arytenoid cartilage
What is the nerve supply to the Oblique Arytenoid Muscle?
Recurrent laryngeal nerve
What is the action of the Oblique Arytenoid Muscle?
Adducts the vocal folds (coughing)
What intrinsic laryngeal muscle(s) function in coughing? Whispering?
Coughing: Transverse and Oblique Arytenoid
Whispering: Lateral Cricoarytenoid
What is the origin and insertion of the Aryepiglottic Muscle?
O: apex of arytenoid cartilage
I: side of epiglottic cartilage
What is the nerve supply to the Aryepiglottic Muscle?
Recurrent laryngeal nerve
What is the action of the Aryepiglottic Muscle?
Closes the laryngeal inlet
What muscle is a continuation of the oblique arytenoid and lies within the aryepiglottic fold?
Aryepiglottic Muscle
What is the origin and insertion of the Thyroepiglottic Muscle?
O: inner surface of thyroid lamina
I: lateral margin of epiglottis
What is the nerve supply to the Thyroepiglottic Muscle?
Recurrent laryngeal nerve
What is the action of the Thyroepiglottic Muscle?
Opens the laryngeal inlet
The Thyroepiglottic Muscle is the antagonist muscle to which muscle?
Aryepiglottic Muscle
What is the origin and insertion of the Thyroarytenoid Muscle?
O: inner surface of thyroid lamina
I: arytenoid cartilage
What is the nerve supply to the Thyroarytenoid Muscle?
Recurrent laryngeal nerve
What is the action of the Thyroarytenoid Muscle?
Shortens and relaxes vocal folds by drawing the arytenoid cartilages forward (decreases the pitch of voice)
What is the origin and insertion of the Vocalis Muscle?
O: inner surface of thyroid lamina
I: vocal process of arytenoid cartilage
What is the nerve supply to the Vocalis Muscle?
Recurrent laryngeal nerve
What is the action of the Vocalis Muscle?
Adjusts tension on the vocal cords during phonation (fine tuning of vocal cord)
All of the intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve except ________.
Cricothyroid Muscle (external laryngeal nerve)
What folds are important in phonation because they control the stream of air passing through the rima glottidis?
Vocal Folds
The Vocal Folds are important in phonation because they control the stream of air passing though which space?
Rima Glottidis
What are the shapes of the Rima Glottidis during inspiration and then expiration/phonation?
Inspiration- wide
Expiration/Phonation- narrow and wedge shaped
To raise the pitch of the voice, what muscle will have increased tension?
Cricothyroid Muscle
To lower the pitch of the voice, tension will be decreased on what muscle(s)?
Thyroarytenoid and Vocalis muscles
Voice dimorphism is determined by what three factors?
- length of vocal cords
- size of resonating chamber
- thickness of vocal cords- respond to androgens
What nerve is the motor nerve to all of the intrinsic muscles of the larynx except the cricothyroid?
Recurrent laryngeal nerve
The recurrent laryngeal nerve is sensory to what to what structure?
Mucosa of the larynx below the vocal fold
The internal laryngeal nerve is a branch of what nerve?
Superior laryngeal nerve
The internal laryngeal nerve is sensory to what structures?
- Mucosa of the larynx above the vocal folds
2. Superior laryngeal artery as it pierces the thyrohyoid membrane to enter the larynx
The external laryngeal nerve is a branch of what nerve?
Superior laryngeal nerve
The external laryngeal nerve is motor to what muscle(s)?
- Cricothyroid
2. Inferior constrictor muscles
What are the two arteries that supply the the larynx? What artery do they branch from?
Arteries- Superior and Inferior laryngeal artery
Branch:
S- superior thyroid artery
I- inferior thyroid artery
What are the three main function of the lymphatic system (of the head and neck)?
- Picks up protein molecules from tissue fluid which are too large to pass through capillaries and transports them to the bloodstream
- Returns excess tissue fluid to the bloodstream
- Produces lymphocytes
What is the term for the swellings found along the lymphatic system?
Lymph nodes
What are the functions of lymph nodes?
- Produce lymphocytes
2. Act as filters for the lymph, preventing foreign bodies from entering the bloodstream
What lymph vessel drains lymph to a node?
Afferent
What lymph vessel drains lymph from a node?
Efferent
How is lymph moved?
Skeletal muscle contraction
T/F. Exercise clears toxins from tissues.
True
What are the superficial nodes of the head?
- Occipital
- Mastoid
- Parotid
Lymph nodes contain what type of tissue?
Reticular tissue
What are the superficial nodes of the neck?
- Submandibular
- Submental
- Anterior cervical
- Superficial cervical
T/F. The superficial cervical chain of nodes can be located on the external surface of the platysma.
False; external surface of the sternocleidomastoid
The superficial cervical nodes of the neck follow the course of what vein?
External jugular vein
T/F. The deep cervical nodes are located within the carotid sheath, and follow the course of the internal jugular vein.
True
Name the two largest deep cervical nodes.
- Jugulodigastric Node
2. Jugulo-omohyoid Nodes
The two largest deep cervical nodes drain what structure?
The tongue
Match the location to the node.
A. Jugulodigastric Node
B. Jugulodigastric-omohyoid Node
- Intermediate tendon of the onto hyoid
- Posterior belly of the digastric muscle
A. 2
B. 1
The jugulodigastric node and what tonsil drain the tongue?
Palatine tonsil
During tonsillitis, what deep cervical node is enlarged?
Jugulodigastric Node
T/F. Efferents of the deep cervical nodes form the superior and inferior jugular trunks.
False; right and left jugular trunks
The right jugular trunk of the deep cervical nodes drains into the junction of what two veins?
Internal jugular and subclavian veins
The left jugular trunk of the deep cervical nodes drains into what structure?
Thoracic duct
With clinical considerations in mind, what is the lymphatic system very important for?
Tracking the spread of cancer cells
The Submental nodes drain what three structures?
- Lower lip
- Floor of the mouth
- Tip of the tongue
The Submandibular nodes drain what 6 structures?
- Cheek
- Side of the nose
- Upper lip
- Lateral part of the lower lip
- Gums
- Margin of the tongue
What is the term for the spread of cancer via the lymphatic system.
Lymphogenous Metastasis
What is the name of an enlarged supraclavicual are node, usually on the left side?
Signal (sentinel) Node
What is a Signal (sentinel) Node usually the 1st indication of?
Visceral tumor of thorax/abdomen
What is the name of the primary tumor of the lymph nodes?
Lymphoma
What are two types of lymphoma? Which one has a poorer prognosis?
- Hodgkin’s Disease
2. Non-Hodgkin’s Lymphoma- poorer prognosis
A tender or painful enlarged lymph node usually indicates ______.
Infection
A hard and painless enlarged lymph node usually indicates _________ or _________.
Cyst development or cancer
What is the term for parasitic infection of the lymphatic system (worms)?
Filariasis
T/F. The great is an epidermally derived structure which consists of mammillary glands, fat, and fibrous tissue.
False; mammary glands*
The breast is located between what two ribs?
Second and Sixth rib
What is the name of vertical line dividing the armpit into anterior and posterior halves?
Midaxillary Line
The nipple I’d usually located at the level of what intercostal space?
Fourth
What is the term for the ring of pigmented skin which surrounds the nipple?
Areola
What is the term for the portion of the breast which extends back into the armpit and is a frequent site for cancer?
Axillary Process (Tail)
What ligaments support the breast and runs through the breast from the skin to the deep layer of superficial fascia?
Suspensory Ligaments of Breast
T/F. The mammary gland is a modified sweat gland located in the superficial fascia.
True
Each mammary gland has how many lobes of glandular tissue?
15-20 lobes
Each lobe of glandular tissue of a mammary gland opens onto the tip of the nipple though what structure?
Lactiferous Duct
What is the term for an expansion of the lactiferous duct, which serves as a reservoir for milk during lacation?
Lactiferous Sinus
What are the four arteries that supply blood to the breast?
- Internal thoracic artery
- Thoracoacromial artery
- Lateral thoracic artery
- Intercostal arteries
T/F. 75 % of the lymph from the breast drains to the parasternal nodes.
False; the axillary nodes
What is the most common type of cancer in women?
Breast cancer
T/F. Breast cancer spreads to the bloodstream 1st before entering the lymphatics.
False; spreads to the lymphatics 1st before entering the blood stream
The posterior intercostal veins drain to ______ and _________ systems.
Azygos and Hemiazygos
T/F. Connections to the vertebral venous plexus allows spread of breast cancer to vertebral column and brain.
True
What are the three clinical signs for breast cancer?
- Dimpling (due to invasion of suspensions ligament)
- Inverted nipple (due to invasion of lactiferous duct)
- Leathery thickening of skin (like orange due to invasion of dermis and lymphatics)
Breast cancer is one cause of A. Upper B. Mid C. Low thoracic pain in females.
B. Mid thoracic
What bone contains bone marrow and is a major site for RBC formation?
Sternum
What are the three parts of the sternum?
- Manubrium
- Body
- Xiphoid process
What part of the sternum is the widest and thicket part?
Manubrium
The upper border of the manubrium forms the ___________.
Jugular notch
The body of the sternum articulates with what 2 coastal cartilages?
Second and Seventh
The costal cartilage of the second rib articulates directly with what joint?
Manubriosternal Joint
T/F. The Xiphoid process is cartilaginous at birth and rapidly ossifies to support the rib cage.
False; slowly ossifies throughout life.
What part of the sternum is sometimes broken during CPR?
Xiphoid Process
T/F. The sternum can sometimes have a bifid xiphoid process or a xiphoid foramen.
True
What two parts of the sternum form the sternal angle?
Manubrium and the Body
The sternal angle is found at the level of the intervertebral disc between what two vertebrae?
TV4 and TV5
The superior thoracic aperture (thoracic inlet) is shaped like a
A. Circle
B. Triangle
C. Kidney
C. Kidney
The superior thoracic aperture is the superior opening of the thoracic cage and is bounded by what three structures?
- Manubrium
- Fist rib
- First thoracic vertebra
The inferior thoracic aperture (thoracic outlet) is the inferior opening of the thoracic cage and is bounded by what 5 structures?
- Xiphoid process
- Costal margin
- Twelfth rib
- Distal end of the 11th rib
- Twelfth thoracic vertebra
How many pairs of ribs are there? How many are true? False?
12 pairs of ribs
True: ribs 1-7
False: ribs 8-12
Why are Ribs 1-7 called true ribs?
Because they articulate with the sternum directly through their own costal cartilages
Of the false ribs, which ribs are not connected to the sternum at all and are referred to as “floating ribs”?
Ribs 11 and 12
T/F. Ribs 8-10 articulate with the sternum directly by attaching to the costal cartilage of the rib below.
False; rib above
Matching.
A. Typical
B. Atypical
- Rib 1
- Rib 2
- Ribs 3-9
- Rib 10
- Rib 11
- Rib 12
- B
- B
- A
- B
- B
- B
The typical ribs have the same morphology. Name the 6 structures that group ribs 3-9 into the typical rib category.
- Head
- Neck
- Tubercle
- Angle
- Shaft
- Costal groove
List the three functions of the thoracic cage.
- Protection of thoracic and upper abdominal organs
- Muscle attachments
- Respiration
List the 5 muscles of the thoracic wall.
- External intercostal
- Internal intercostal
- Innermost intercostal
- Transversus thoracis
- Subcostalis
What muscle of the thoracic wall is the 2nd most important muscle of inspiration?
External intercostal
What is the origin and insertion of the external intercostal muscle?
O: lower border of ribs 1-11
I: upper border of ribs 2-12
What is the nerve innervation of the external intercostal muscle?
Corresponding intercostal nerve
What is the function of the external intercostal muscle?
Elevates the ribs in inspiration
The external intercostal muscles begin at the tubercle of the rib and end at the ________ joint, where they are replaced by the external intercostal membrane.
Costochondral
What direction do the fibers of the external intercostal muscle run?
Downward and forward (“hands in pockets”)
What is the origin and insertion of the internal intercostal muscle?
O: upper border of ribs 2-12
I: lower border of ribs 1-11
What is the nerve innervation to the internal intercostal muscle?
Corresponding intercostal nerve
What is the function of the internal intercostal muscle?
Depress the ribs in forced expiration
T/F. The internal intercostal muscles begin at the sternum and end at the angle of the ribs, where they are replaced by the internal intercostal membrane.
True
What direction do the fibers of the internal intercostal muscle run?
Downward and backward (“hands in armpits”)
What is the origin and insertion of the innermost intercostal muscle?
O: upper border of ribs 2-12
I: lower border of ribs 1-11
What is the nerve innervation to the innermost intercostal muscle?
Corresponding intercostal nerve
What is the function of the innermost intercostal muscle?
Depress the ribs in forced expiration
What direction do the innermost intercostal muscles run?
Downward and backward
T/F. All intercostal muscles function to prevent the pushing in or drawing out of intercostal spaces during respiration.
True
What is the origin and insertion of the subcostalis muscle?
O: inner surface of ribs near their angles
I: muscle crosses a rib without inserting and then inserts into the rib above that
What is the nerve innervation to the subcostalis muscle?
Intercostal nerve (corresponding)
What is the function of the subcostalis muscle?
Depress the ribs in forced expiration
What is the origin and insertion of the transversus thoracis muscle?
O: posterior surface of the lower sternal body and xiphoid process
I: inner surface of costal cartilages 2-6
What is the nerve innervation to the transversus thoracis muscle?
Intercostal nerve (corresponding)
What is the function of the transversus thoracis muscle?
Depress the ribs in forced expiration
All of the muscle of the thoracic wall depress the ribs during forced expiration except ___________.
External intercostal muscle
The anterior aspect of the thoracic wall is supplied by what artery?
Internal thoracic artery and its branches
The internal thoracic artery comes from what artery?
Subclavian artery
What are the four branches of the internal thoracic artery?
- Pericardiacophrenic artery
- Anterior intercostal arteries
- Musculophrenic artery
- Superior epigastric artery
What branch of the internal thoracic artery accompanies the phrenic nerve, supplies the pleura, pericardium, and diaphragm?
Peri-cardia-cophrenic artery
What branch of the internal intercostal artery supples the upper 6 intercostal spaces, anastomose with the posterior intercostal arteries?
Anterior intercostal arteries
What branch of the internal intercostal artery is the lateral terminal branch?
Musculophranic artery
What branch of the internal intercostal artery is the medial terminal branch?
Superior epigastric artery
The posterior aspect of the thoracic wall is supplied by what three arteries?
- Supreme (superior) intercostal artery
- Third through eleventh posterior intercostal arteries
- Subcostal artery
Where does the supreme (superior) intercostal artery arise from? What does it branch into?
From the costocervical trunk
Branches into the 1st and 2nd posterior intercostal arteries
The third through eleventh posterior intercostal arteries arise directly from __________.
Thoracic aorta
Where does the subcostal artery arise from? Where does it lie?
From the thoracic aorta
Lies below the 12th rib
The anterior aspect of the thoracic wall is drained by what vein?
Internal thoracic vein (into the brachiocephalic vein)
The posterior aspect of the thoracic wall is drained by what vein?
Azygos system of veins
What does Azygos mean in Greek?
Unpaired or unyoked
T/F. The 1st posterior intercostal of the Azygos system drains into the brachiocephalic vein on both the right and left side.
True
On the right side, the 2nd and 3rd posterior intercostal veins join together to form what vein? What does it drain into?
Superior intercostal vein
Drains into the Azygos vein
On the right side, the 4th through 11th posterior intercostal veins and the ________ vein drain directly into the Azygos vein.
Subcostal vein
On the left side, the 2nd and 3rd posterior intercostal veins join together to form what vein? Where does it drain into?
Superior intercostal vein
Drains into left brachiocephalic vein
On the left side, The 4th through 8th posterior intercostal veins join together to form what vein? Where does it drain?
Accessory Hemiazygos vein
Drains into the Azygos vein
On the left side, The 9th through 11th posterior intercostal veins and the subcostal vein join to form what vein? Where does it drain?
Hemiazygos vein
Drains into the Azygos vein
T/F. On the left side, the Azygos and the Hemiazygos veins represent the thoracic continuation of the right and left ascending lumbar veins.
True
What nerve is the anterior primary rami of the first 11 thoracic spinal nerve?
Intercostal nerves
What nerve is the anterior primary ramus of the 12th thoracic spinal nerve?
Subcostal nerve
Name the 12 layers of the thoracic wall.
- Skin
- Superficial fascia
- Deep fascia
- Serratus anterior
- External intercostal muscle
- Internal intercostal muscle
- Innermost intercostal muscle
- Endothoracic fascia
- Parietal pleura
- Pleura cavity
- Visceral pleura
- Lung
What is the function of the endothoracic fascia?
Prevent the innermost intercostal muscle from rubbing against the parietal pleura
What is the term for the thickening of the fascia over the apex of the lung?
Suprapleural membrane
What three structures will be found in a typical intercostal space?
- Intercostal vein
- Intercostal artery
- Intercostal nerve
The intercostal vein, artery, and nerve lie within the costal groove on the lower, internal surface of each rib and are sandwiched between what two muscles?
Internal and Innermost intercostal muscles
T/F. The thoracic cavity is subdivided into two smaller cavities.
False; three smaller cavities
What are the three smaller cavities in which the thoracic cavity is divided into? What do they contain?
2 pleura cavities- each of which surrounds a lung
1 mediastinum- area between the two pleura cavities which contains the hearts, great vessels, trachea, esophagus, etc.
What is the term for a thin membrane which lines the inner surface of the thoracic cavity and covers the surface of the lung?
Pleura
What type of pleura lines the inner surface of the thorax?
Parietal pleura
What type of pleura intimately invests the lung?
Visceral pleura
The parietal pleura reflects back to become the visceral pleura at what part of the lung?
Root of the lung
Is the pleural cavity a real or potential space between the parietal and visceral pleura?
Potential space
T/F. Parietal fluid lubricates the pleurae to minimize friction between the parietal and visceral layers, facilitating movement of the lungs.
False; pleural fluid
The parietal pleura consists of 4 parts. What are they?
- Costal pleura
- Mediastinal pleura
- Diaphragmatic pleura
- Cervical pleura
What is the term for the spaces found between two folds of parietal pleura? What are their functions?
Pleural recesses
Fxn: allow expansion of the lung during inspiration
Which pleural recess is located at the midaxillary line?
Costodiaphragmatic recess
Where is the costodiaphragmatic recess formed?
Where the costal and diaphragmatic pleurae meet
Where is the costomediastinal recess formed?
Where the costal and mediastinal pleurae meet
Fluid tends to accumulate in the costodiaphragmatic recess. How can it be removed?
By thoracentesis at intercostal space 9 during expiration
What artery supplies the parietal pleura?
Intercostal arteries, internal thoracic artery, and superior phrenic artery
What artery supplies the visceral pleura?
Bronchial artery
T/F. The visceral pleura is sensitive to pain while the parietal pleura is insensitive to pain.
False; parietal pleura= sensitive to pain, visceral pleura= insensitive to pain
What nerve(s) innervate the parietal pleura?
Intercostal nerves, subcostal nerve, and phrenic nerve
What nerve(s) innervate the visceral pleura?
NONE (no sensory innervation)
What are the three causes of pneumothorax?
- Trauma (sucking chest wound)
- Disease (bronchitis, emphysema, TB)
- Congenital weak spot (tall people)
T/F. Pneumothorax occurs when pleural cavities fill with air.
True
In tension pneumothorax, instead of a hole, a _______ is present on visceral pleura.
Flap
T/F. In pneumothorax, air enters the pleural cavity on inspiration, but cannot exit on expiration.
True
How does hemothorax differ from pneumothorax?
Hemothorax- pleural cavity fills with blood
Pneumothorax- pleural cavity fills with air
T/F. Hemothorax and pneumothorax- both conditions are present, simultaneously.
True
Hemothorax and pneumothorax will result in ________.
Atelectasis (lung collapse)
Define pleuritis.
Inflammation of pleura
What does pleuritis lead to?
Adhesions between parietal and visceral pleura
What pleura causes pain in pleuritis?
Parietal pleura
Pain in pleuritis is often refer to the shoulder via the _______ nerve (C3,4,5).
Phrenic nerve
During pleuritis, pain radiates along distribution of ________ nerves (C3,4).
Supraclavicular
Pleuritis produces a sound known as _________, which can be heard on auscultation.
Pleural friction rub
What is the space between the pleural cavities?
Mediastinum
The mediastinum contains all of the structures of the thorax except _______ and ________.
Lungs and pleurae
Topographically, the sternal angle is an important landmark because it indicates the level of what 5 structures?
- Boundary between the superior and inferior mediastinum
- Articulation of the second rib with the sternum
- Aortic arch
- Bifurcation of the trachea into the left and right main bronchi
- Upper border of the pulmonary trunk
What are the contents of the superior mediastinum? (10)
- Superior vena cava
- Brachiocephalic veins
- Arch of the aorta (and its branches)
- Thoracic duct
- Trachea
- Esophagus
- Thymus
- Vagus nerve
- Left recurrent laryngeal nerve
- Phrenic nerve
What are the subdivisions of the inferior mediastinum?
- Anterior mediastinum
- Middle mediastinum
- Posterior mediastinum
T/F. The anterior mediastinum lies anterior to the pericardial sac and posterior to the sternum.
True
What are the contents of the anterior mediastinum?
- Thymus
- Lymph nodes (parasternal)
- Sternopericardial ligaments
What lymph nodes in the anterior mediastinum drain breast and lung cancer?
Parasternal nodes
What is the middle mediastinum bounded by?
Pericardial sac
What are the contents of the middle mediastinum?
- Heart
- Pericardium
- Roots of the Great Vessels
- Main bronchi
- Phrenic nerve
The posterior mediastinum lies posterior to the pericardial sac and anterior to what thoracic vertebrae?
TV 5 through 12
What are the contents of the posterior mediastinum?
- Esophagus
- Thoracic aorta
- Azygos Vein
- Hemiazygos vein
- Thoracic duct
- Vagus nerve
- Splanchnic nerves (from sympathetic trunk)
The trachea begins at the inferior border of what cartilage?
Cricoid cartilage (CV6)
The trachea consists of how many c-shaped cartilaginous rings?
15-20
The c-shaped cartilaginous rings of the trachea open anteriorly or posteriorly to prevent the trachea from collapsing?
Posteriorly
What muscle spans the posterior gap of the cartilaginous rings of the trachea? Is it skeletal or smooth muscle?
Trachealis muscle
Smooth muscle
T/F. The trachea is 9-15 cm in length.
True
Where does the trachea bifurcate into the right and left main bronchi?
At the level of the sternal angle (intervertebral disc between TV 4 and 5)
What is the term for a prominent ridge located within the trachea at its bifurcation, which separates the openings of the right and left main bronchi?
Carina
Why does the trachea deviate to the right just before its bifurcation at the sternal angle?
For passage of aortic arch
Of the two main bronchi, which is shorter, wider, and more vertical?
Right
The right main bronchus passes under what vein?
Azygos vein
T/F. The right main bronchus gives off the superior lobar bronchus within the hilum of the lung.
False; before entering the hilum of the lung
T/F. The right main bronchus divides into the middle and inferior lobar bronchi within the hilum.
True
The 3 lobar bronchi of the right main bronchus divide into how many segmental bronchi?
10
Of the two main bronchi, which one is longer, narrower, and more horizontal?
Left main bronchus
Does the left main bronchus divide into superior and inferior lobar bronchi before entering the hilum or within the hilum of the lung?
Within the hilum of the lung
The 2 lobar bronchi of the left main bronchus divide into how many segmental bronchi?
10
T/F. It is not that common for a child to aspirate a small object such as a peanut or button.
False; it is common
When an object is aspirated, what primary bronchus will the object enter? Why?
Right main bronchus
Due to its wide, short, vertical arrangement
When an object is aspirated, what will mechanically initiate the cough reflex?
Carina (covered with a sensitive mucous membrane)
What two arteries supply the trachea?
- Inferior thyroid artery
2. Bronchial arteries
What two nerves innervate the trachea?
- Vagus nerve (parasympathetic and pain fibers)
2. Sympathetic trunk
What are the three surfaces of the lungs?
- Costal
- Mediastinal
- Diaphragmatic
What are the three borders of the lungs?
- Anterior
- Posterior
- Inferior
The hilum, which is an opening through which the vessels, nerves, and bronchi pass, is on what surface of the lung?
Mediastinal
The root of the lung is formed by the structures which pass through the hilum. What are the structures?
- Bronchi (posterior)
- Pulmonary vessels (arteries and veins)
- Bronchi vessels
- Nerves
- Lymphatics
T/F. The root of the lung connects the lung to the heart and trachea.
True
The root of the lung is covered with pleura, which is prolonged downward as a double layered membrane called the ____________.
Pulmonary ligament
Each lung has how many bronchopulmonary segments?
10
How many fissures does the right lung have? Name them.
- Oblique
2. Horizontal
How many lobes does the right lung have? Name them.
- Superior lobe
- Middle lobe
- Inferior lobe
Right Lung Matching
- Superior Lobe
- Middle Lobe
- Inferior Lobe
A. Between the horizontal and oblique fissure
B. Above the horizontal fissure
C. Below the oblique fissure
- B
- A
- C
Each lobe of the right lung is supplied by what kind of bronchus?
Corresponding lobar bronchus
T/F. The corresponding lobar bronchus divide into segmental bronchi, each of which supplies a bronchopulmonary segment.
True
How many fissures does the left lung have? Name them.
- Oblique
How many lobes does the left lung have? Name them.
- Superior lobe
2. Inferior lobe
Match the lung to the characteristic. A. Right B. Left
- Groove for the Azygos vein
- Cardiac impression (shallow)
- Cardiac impression (deep)
- Lingula
- Groove for the esophagus
- Groove for the aorta
- Groove for right brachiocephalic vein
- Groove for superior vena cava
- Cardiac notch
- Groove for left subclavian artery
- A
- A
- B
- B
- A
- B
- A
- A
- B
- B
What are the functional units of the lung?
Bronchopulmonary segments
Each bronchopulmonary segment consists of what four structures?
- Segmental bronchus
- Branch of the pulmonary artery
- Segments of lung tissue
- Surrounding septum
T/F. Bronchopulmonary segments can be surgically removed without affecting the functioning of adjacent segments.
True
What arteries supply the lungs? Veins?
Bronchial arteries (from the thoracic aorta) Bronchial veins (drains to the Azygos and accessory Hemiazygos veins)
Trachea rocha Tree matching (primary tissue to structure)
- Trachea
- Main bronchi
- Lobar bronchi
- Segmental bronchi
- Bronchioles
- Alveoli
A. Cartilage rings
B. Cartilage plates
C. Smooth muscle
D. Membrane
- A
- A
- B
- C
- C
- D
What three structures of the tracheobronchial tree can result in inflammation?
Segmental bronchi, bronchioles, alveoli
The anterior and posterior pulmonary plexuses that innervate the lungs are formed by fibers from what two nerves?
- Vagus (parasympathetic and sensory)
2. Sympathetic trunk (T2 to T5, sympathetic and sensory)
Sympathetic activation of the lungs will produce bronchial ______ and _________.
Will it increase or decrease glandular secretion?
Dilation and vasoconstriction
Decrease
Parasympathetic activation of the lungs will produce bronchial ______ and _______.
Will it increase or decrease glandular secretion?
Constriction and vasodilation
Increase glandular secretion
What is the pathology described as an obstructive airway characterized by coughing, wheezing, and difficulty breathing?
Asthma
What is asthma caused by?
Spasms of smooth muscle which lies in the segmental bronchi and bronchioles; accompanied by excessive secretion of mucus
What are the two types of asthma?
- Extrinsic
2. Intrinsic
What type of asthma is triggered by allergens?
Extrinsic
What is intrinsic asthma triggered by?
Non allergenic stimuli- cold, stress, exercise
T/F. Chiro clinicians have noted that asthma is often associated with upper thoracic subluxation.
True
What thoracics supply the adrenal medulla? What does the adrenal medulla secrete?
T9-11
Epinephrine (bronchodilator)
T/F. There has been chiro research that demonstrates a positive effect for the adjustment on asthma symptoms.
False; has NOT demonstrated a positive effect
Lymph from the lungs drains into what two nodes? Where are the located?
Pulmonary and bronchopulmonary nodes, which drain into the tracheobronchial nodes
Located in the hilum
What structure moves mucus and dirt through the larynx?
Mucocillary clearance
What is the term for the primary tumor of the bronchi?
Bronchogenic Carcinoma
T/F. Bronchogenic carcinoma is indirectly related to cig. Smoking and air pollution.
False; directly related
Lung cancer (bronchogenic carcinoma) may effect what two nerves? What does it result in?
- Phrenic nerve- resulting in paralysis of 1/2 diaphragm
2. Recurrent laryngeal nerve- at the apex of lung resulting in paralysis of 1/2 larynx
Why is the right dome of the diaphragm slightly higher than the left dome?
Because it overlies the liver
What are the two parts of the diaphragm?
- Muscular part
2. Central tendon
T/F. The muscular part of the diaphragm takes origin from a number of bony sources, and inserts into the central tendon.
True
What are the three points of origin of the muscular part of the diaphragm?
- Sternal: from the xiphoid process
- Costal: from the lower 6 costal cartilages
- Lumbar: from lumbar vertebrae 1-3 and the medial and lateral arcuate ligaments
Match the level to the opening.
- Caval opening
- Esophageal hiatus
- Aortic hiatus
A. TV 10
B. TV 12
C. TV 8
- TV 8
- TV 10
- TV 12
The caval opening is within the central tendon and transmits what two structures?
Inferior vena cava
Right phrenic nerve
The esophageal hiatus transmits what structures?
Esophagus and the anterior and posterior vagal trunks
What structures does the aortic hiatus transmit?
Aorta, thoracic duct, Azygos vein
What four arteries supply the diaphragm?
- Musculophrenic artery
- Pericardiacophrenic artery
- Superior phrenic artery
- Inferior phrenic artery
What is the motor supply as a whole and central part to the diaphragm?
Phrenic nerve
What is the sensory innervation to the peripheral part of the diaphragm?
Intercostal nerves
What injury is due to a weakness in the diaphragmatic wall around the esophageal hiatus?
Hiatal hernia
T/F. The upper part of the stomach of a person 50+ years old slides up into the thoracic cavity through the opening during a Hiatal Hernia.
True
What injury is a major cause of gastroesophageal reflux? Symptoms include belching and epigastric pain.
Hiatal hernia
What technique could help a hiatal hernia?
Part of SOT technique
What are the three major movements during inspiration that take place within the thorax and result in an increase in intrathoracic volume and a decrease in intrathoracic pressure?
- Piston movement
- Bucket handle movement
- Pump handle movement
What movement during inspiration, will result in an increase in the vertical diameter of the thorax?
Piston movement
What movement during inspiration will increase the transverse diameter of the thorax?
Bucket Handle Movement
What movement during inspiration will result in an increase in the anterior-posterior diameter of the thorax?
Pump handle movement
The elevation of the ribs in both bucket handle (7-10) and pump handle (2-6) is due to the contraction of what muscles?
External intercostal muscles
During forced expiration, what muscles contract?
During normal expiration, what muscles contract?
Forced: Internal intercostals, innermost intercostals, muscles of the anterior abdominal wall
Normal: none, diaphragm and external intercostal muscles relax
T/F. Contraction of the diaphragm during inspiration has the opposite effect on the abdomen that is has on the thorax. (Abdominal volume is decreased while intra-abdominal pressure is increased)
True
What are hiccups a result of? What nerve is irritated?
Spasmodic contraction of the diaphragm
Phrenic nerve
What structure is a fibroserous sac that encloses the heart and great vessels? What mediastinum does it occupy?
Pericardium
Middle mediastinum
What is the strong, dense outer part of the pericardium also known as the “cardiac seatlbelt”?
Fibrous pericardium
The fibrous pericardium is continuous with what fascia?
Pretracheal fascia
The fibrous pericardium is connected to the back of the sternum by what ligaments?
Sternopericardial ligaments
What are the three layers of the serous pericardium?
- Parietal layer
- Pericardial cavity
- Visceral layer
What part of the serous pericardium lines the inner surface of the fibrous pericardium?
Parietal layer
What layer of the serous pericardium is also known as the epicardium?
Visceral layer
What layer of the heart is composed mainly of cardiac muscle fibers?
Myocardium
What layer of the heart is the smooth endothelium which lines the inside of the heart?
Endocardium
How many chambers are in the human heart?
4
In cardiac tamponade, what blood vessel is particularly vulnerable?
Superior vena cava
Since fluid is rapidly leaking into the pericardial cavity in cardiac tamponade, what vein will become prominent eventually leading to all veins of the face and neck becoming engorged?
External jugular vein
Which pericardial sinus lies posterior to the aorta and pulmonary trunk, and anterior to the superior vena cava and left atrium?
Transverse pericardial sinus
Which pericardial sinus lies posterior to the heart and is surrounded by the left and right pulmonary veins and inferior vena cava?
Oblique pericardial sinus
What four arteries supply the pericardium?
- Pericardiocophrenic artery
- Bronchial artery
- Esophageal artery
- Coronary arteries
Of the four arteries that supply blood to the pericardium, which is the main blood supply?
Pericardiacophrenic artery
What nerves innervate the pericardium?
- Phrenic nerve (sensory)
- Sympathetic trunk (vasomotor)
- Vagus
T/F. The phrenic nerve passes between the parietal pleura and fibrous pericardium.
True
T/F. The pericardium is less sensitive to pain than the pleura.
True
How would you distinguish pericardial friction rub from pleural friction rub?
Have the patient hold their breath
If sound stops: pleura
What is the pathology for an obstruction of a pulmonary artery by a blood clot?
Pulmonary embolism
During a pulmonary embolism, the embolus blocks what artery?
Pulmonary artery or one of its branches
What will a pulmonary embolism result in?
Acute respiratory distress, which leads to dilation of r-vent and r-atrium, resulting in heart failure and death can occur in minutes
Valves control the flow of blood through the heart and consist of what three structures?
- Valve orifice; surrounded by -
- Fibrous ring; to which is attached-
- Cusps: flaps which close the valve
What are the four major valves of the human heart?
- Pulmonary
- Aortic
- Mitral (bicuspid)
- Tricuspid
Where will you find the pulmonary valve? How many cusps does it have?
Between the right ventricle and pulmonary trunk 3 cusps (A, L, R)
Where will you find the aortic valve? How many cusps?
Between the left ventricle and aorta 3 cusps (L, R, P)
Where will you find the mitral (bicuspid) valve? How many cusps?
Between the left atrium and left ventricle
2 (A, P)
Where will you find the tricuspid valve? How many cusps?
Between the right atrium and right ventricle
3 (A, P, Septal)
Which two valves make up the semi-lunar valves? Atrio-Ventricular Valves?
Semi-lunar= pulmonary and aortic Atrio-Ventricular= Bicuspid and Tricuspid
The “Lub” sound of the heart is produced by the contraction of ______ and closure of the _______ and ______ valves.
Ventricles; tricuspid; mitral
The “Dup” sound is produced by the closure of the _______ and _______ valves.
Pulmonary and aortic
Match the location to the valve.
- Pulmonary valve
- Aortic valve
- Mitral valve
- Tricuspid valve
A. Behind the left half of the sternum medial to the third intercostal space
B. Behind the medial end of the third left costal cartilage
C. Behind the right half of the sternum medial to the fourth intercostal space
D. Behind the left half of the sternum medial to the fourth costal cartilage
- B
- A
- D
- C
What is the orientation of the heart in the thorax?
Oblique; forward, downward, and to the left
What forms the boundaries of the base of the heart?
Left and right atria
What forms the boundaries of the apex of the heart?
Formed by the left ventricle
What are the four surfaces of the heart? What forms them?
- Anterior (sternocostal)- right ventricle
- Diaphragmatic- right and left ventricle
- Left pulmonary- left ventricle
- Right pulmonary- right atrium
What are the 5 structures located within the chambers of the heart?
- Right auricle
- Pectinate muscles
- Crista terminalis
- Sinus of venae cavae
- Floss ovalis
What does pectinate mean in Latin?
Comblike
The crista terminalis is marked externally by a vertical groove called the _______.
Sulcus terminalis
What embryonic structure does the sinus of venae cavae represent?
Sinus venosus
The fossa ovalis is a depression which is the remnant of the _________.
Foramen ovale
What is the term of the sharp border of the fossa ovalis?
Limbus fossa ovalis
What is the pathology where the foramen ovale persists as a small opening in the superior part of the fossa ovalis?
Atrial septal defect
When the foramen ovale defect is small, what is it called?
Probe patent foramen ovale
T/F. Atrial septal defect in most cases is clinically significant.
False; not clinically significant
In atrial septal defect, blood is shunted from the left atrium to the right atrium causing dilation of what three structures?
- right atrium
- Right ventricle
- Pulmonary trunk
What are the 5 openings in the right atrium?
- Superior vena cava
- Inferior vena cava
- Coronary sinus
- Anterior veins of right ventricle
- Right ventricle
