Respiratory System

Question 1

Describe the fibrocartilaginous components (trachea, bronchi, carina)

Answer 1

The trachea begins below the cricord cartilege (about C6) and divides at the sternal angle into right and left primary bronchi. The carina (radiological landmark) is the intersection of the division.

Question 2

Describe the asymmetry of the right main bronchus.
What accounts for the asymmetry and what is the clinical significance?

What is the blood supply?

Answer 2

larger diameter, more vertical, shorter than the left

has the eparterial bronchus to the upper lobe
has bronchus intermedius (hyparterial) to the middle and lower lobes

3 lobes instead of 2

• as trachea descends it is pushed to the right because aorta is coming to the left
• clinically if someone aspirates something into trachea probably will fall to right side because its larger and more vertical

right bronchi splits early so comes as 2 not as one

supply supply is from aorta and posterior intercostal a

Question 3

Describe the left main bronchus.

Answer 3

longer, smaller diameter than right, more horizontal

branches into secondary bronchi to upper and lower lobes

Question 4

Describe the bony landmarks of the back that pertain to the projection of trachea and bronchi on back.

Answer 4

scapula- superior border of T2
inferior angle- about T7
sternal angle- projects posteriorly to about T4

Question 5

What are the basic anatomical features of the lungs?

How are they divided?

What is blood supply?

What is lympathic drainage?

Answer 5

apex, base, root, hilum

each lung is divided into broncho-pulmonary segments supplied by a single artery. Pulmonary veins are located in the septa separating the broncho-pulmonary segments

blood supply is from bronchial arteries which are brancehs off the aorta and posterior intercostal a.

lymphatic drainage is from pulmonary nodes to tracheobronchial nodes to bronchomediastinal nodes

Question 6

What does the root of lung do?
What surrounds to the root?
What does the hilum contain?

Answer 6

root connects the medial lung surface to the trachea and heart. It is the part of heart where things come and go (pulmonary arteries/veins, bronchi, etc)

reflection of the parietal to the visceral pleura surrounds the root

the hilum contains the main bronchus, pulmonary artery/veins, bronchial vessels, nerves and lymphatics

Question 7

What are the three surfaces of the lungs?

Answer 7

costal surfaces- ribs
mediastinal surfaces- associated with mediastinum
diaphragmatic- associated with diaphragm

Question 8

Describe the lobes and fissures of the left lung.

Answer 8

2 lobes

superior lobe with lingula (which is inferior to cardiac notch)

inferior lobe separated by oblique fissure (starts posteriorly at T2 and intersects anteriorly at 6th costal arch…separates the lobes)

8 broncho-pulmonary segments
has cardiac notch and lingua
is grooved by aorta and left subclavian a

Question 9

Where do you auscultate the inferior and superior lobes?

Answer 9

inferior lobe- from behind

superior lobe- from anterior wall

Question 10

Describe the relationship of pulmonary arteries/veins.

Answer 10

artery is superior to veins, anterior to bronchus

vessels are anterior to trachea/bronchi

Question 11

Describe the lobes and fissures of the right lung.

Answer 11

superior lobe
middle lobe
inferior lobe

lobes separated by horizontal fissure (divides middle lobe, tracks along the 4th rib)

and oblique fissure (begins posteriorly at T2 and intersects anteriorly at 6th costal cartilage/rib

has 10 broncho-pulmonary segments
grooved by trachea, esophagus and IVC

Question 12

Where does the cardiac notch start and where does it project?

Where do the lungs project laterally?

Answer 12

4th rib
projects along costal arch (6th)

left side - T2 to 6th costal arch
right side - 4th rib, horizontal fissure projecting to 6th

Question 13

Where is the apex of the lung? What is the significance?

Answer 13

in root of neck. ribs project inferiorly back to front so can see the thoracic structures in the root of neck and if there is some penetrating wound there, could be collapsed lung..

Question 14

What are the two vascular supplies to the lungs?

Answer 14

pulmonary- airate the blood (delivered by pulmonary arteries carrying unoxygenated blood from the right side to be oxygenated)

bronchial- supply the lung tissues themselves (bronchial arteries are carrying airated blood)

Question 15

Describe the pulmonary arteries.

Answer 15

they carry most blood to the lung

they track along the fissures

Question 16

What happens during cardiac contraction (systole)?

Answer 16

The blood in the right ventricle enters the pulmonary trunk.

Question 17

Where are pulmonary arterial branches distributed?

Answer 17

in the bronchopulmonary segments in association with the bronchi

Question 18

Where are the two pulmonary venous components located?

Answer 18

they are in the supporting connective tissue between the bronchopulmonary segments

Question 19

Describe the lymphatics of the lungs.

Answer 19

bronchopulmonary nodes are in the root of the lung

tracheobronchial lymph nodes near the tracheal termination and the two main stem bronchi

Question 20

Why might adult lymph nodes in and near the lung appear dark? (What term do we use to describe this?)

Answer 20

anthracotic

-some node tissues in lungs themselves will pick up carbon particles that macrophages cannot digest - accumulate with age!

Question 21

Describe the innervation of the lungs.

Answer 21

autonomic

pulmonary plexus comprises parasympathetic (X) and sympathetic components

Question 22

Describe respiration of an adult.

Answer 22

the diaphragm moves down (primarily involves diaphragm in adults)
anterior (upper) thoracic wall moves anteriorly
lower (lateral) thoracic wall moves laterally

Question 23

Describe the respiration of a child.

Answer 23

the major component consists of the diaphragm moving down

the ribs in the child are nearly horizontal and thus the rib displacement is limited

Question 24

Describe why runners might grasp knees when gasping for breath.

Answer 24

the serratus anterior stabilizes the scapula

runners might hold knees to reverse the role of serratus anterior, stabilize the scapula through upper limb and use serratus anterior to expand chest wall even more

(gasping for air- neck muscles straining to lift first rib so other follow and increase the volume of the thoracic cavity)

Question 25

Describe the pleural cavity as a closed sac with its two layers.

What can from as a result of bad cold-like infection?

Answer 25

two layers- visceral layer (inside) and parietal layer (outside) between the two is a potential space with just a little serous fluid for lubrication

as lung expands and contracts visceral and parietal layers slide

adhesions can form - connective tissue that forms between visceral and parietal pleura “stitch” is a sharp pain when breathing that breaks the small adhesions

Question 26

What is the pleural cavity?

Answer 26

a potential space (not a true space)
normally contains a thin layer of serous fluid

pneumothorax- air in there, collapsed lung
hemathorax- if full of blood or something else

Question 27

Describe the pleural sac.

Answer 27

(membrane) that surrounds each lung

parietal pleura lines the interior surface of the thoracic wall
(surface projectsions: 2-midline,4(L)-bare area,6-costal arch,8-midclavicular line,10-midaxillary line,12-posteriorly)

visceral pleura covers the complete surface of the lung. It is adherent to lung tissue and continuous with parietal pleura at hilum of lung
(surface projectsion: 2-midline, 4(L)cardiac notch, 6-mid-clavicular, 8-mid-axillary, 10-posteriorly)

parietal pleura must be anchored firmly to chest wall on the inside… necessary for respiration to occur!. visceral pleura dragged along passively and then because of the vacuum we have exhalation, an elastic rebound

Question 28

What are the 4 components included in the parietal pleura?

Answer 28

costal- all inner thoracic surfaces including the thoracic vertebrae

mediastinal
diaphragmatic
cupola

Question 29

Describe the cupola

Answer 29

part of parietal pleura
extends into root of the neck, suspended by Sibson’s fascia

refers to parietal layer in the root of neck, (visceral lining- apex of lung)

runs along the sternal angle to midsternal line

Question 30

Describe the extensions of the diaphragm, parietal pleura, thorax.

Answer 30

thorax and parietal pleural extend to T12 posteriorly because that’s the end of the thorax

parietal pleura extends but the lung does not

diaphragm is domed and projects inferiorly to L2

Question 31

What are the two pleural recesses that form between the parietal and visceral pleura? What is their purpose?

Answer 31

they form potential spaces that allow for maximum expansion of the lung during forced ventilation

costodiaphragmatic recess
costomediastinal recess

Question 32

Why might a chest x-ray technician ask a patient to take a deep breath and hold it?

Answer 32

the inferior border of the diaphragm is a gutter into which the lung can expand and if you take a breath there is a space for viceral/pleura/lung to expand

take breath and hold it to expand all the way to the costodiaphragmatic recess, by filling lung in this recess you can see if anything is in there because gravity would bring it down and if anything got into pleural cavity it would go into the recess

Question 33

What is the costomediastinal recess?

Answer 33

it is pleura coming around the ribs posteriorly and reflects along the mediastinal border and changes direction and the recess is there, another area you can expand tissue upon deep inhalation

Question 34

Where does the pleura intersect inferiorly?

Answer 34

8th rib at midclavicular line , then laterally to mid axillary line where the 10th rib is intersected

Question 35

Where do the visceral and parietal pleura intersect at midclavicular line and midaxillary line?

Answer 35

2 rib difference w visceral vs parietal

at midclavicular- pareital pleura at 8, visceral at 6

midaxillary- parietal intersects chest wall at 10, visceral at 8th and so forth

(costodiaphragmatic recess as it goes front to back)

Question 36

Describe the 3 main tubes of posterior mediastinum.

Answer 36

3 tubes pass through diaphragm at levels T8, 10, 12
(I ate 10 eggs at noon.)

inferior vena cava - at T8 passes through to heart
esophagus - at T10 esophagus passes through diaphragm
aorta- at T12 passes through diaphragm

thorax ends at T12 because that’s as far as parietal pleura will go, muscles of diaphragm to go L2.

Question 37

What is in the posterior mediastinum ?

Answer 37

the aorta, esophagus, vagus, azygos and hemiazgos veins, thoracic duct, sympathetic chain

Question 38

Describe:
azygos and hemiazgos veins

thoracic duct

sympathetic chain

Answer 38

azygos and hemiazgos veins- venous system accepting posterior intercostal veins from posterior mediastinum

thoracic duct - main channel for lymphatic system drainage except upper right quadrant

sympathetic chain- within posterior mediastinum

Question 39

Where does the vagus nerve go?

Answer 39

goes into diaphragm by following esophagus

Question 40

Describe the pulmonary artery in the hilum.

Answer 40

right -anterior

left- superior

Question 41

What is in the posterior mediastinum?

Answer 41

descending aorta
azygos and hemiazygos v
esophagus
vagus n. (L vagus becomes ant. esophageal)
thoracic splanchnic n.
thoracic duct