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Flashcards in PosteriorMediastinum & Respiratory Deck (63):
1

Lymph nodes can be found in which mediastinal compartment(s)?
Anterior
Middle
Posterior
All of the above
None of the above

All of the above!

2

Which structure contains postganglionic sympathetic fibers?
greater thoracic splanchnic nerve
recurrent larygneal nerve
white ramus communicans
ulnar nerve
vagus nerve

Ulnar Nerve

3

The aorta is located in which mediastinal compartment(s)?
Anterior only
Anterior and middle
Middle only
Middle and posterior
Posterior only

Middle & Posterior

4

While performing transesophageal echocardiography on a patient, the posterior wall of the esophagus, immediately behind the left atrium, was punctured from within. The patient subsequently developed an infection in the space around the esophagus at this point, namely the:
Anterior mediastinum
Middle mediastinum
Posterior mediastinum
Superior mediastinum

The correct answer is: posterior mediastinum
The esophagus is in the posterior mediastinum, along with the descending aorta, thoracic duct, and azygos system.

5

Patient's right sympathetic trunk was accidentally severed just cranial to the level of spinal nerve T1. Which function would be left intact in the affected region?
Arrector pili muscle activity
Dilation/constriction of blood vessels
Sweat production
Voluntary muscle activity

Voluntary Muscle

6

An enlarging lymph node gradually constricts the flow of blood in the azygos venous arch. Which vessel would enlarge as a result of collateral drainage?
Superior vena cava
Inferior vena cava
Internal thoracic vein
Right brachiocephalic vein
Superior epigastric vein

Internal Thoracic

7

A cancerous growth from the body of the 9th thoracic vertebra exerts pressure anterolaterally. Which structure lies in direct contact with this growth?
Right vagus nerve
Right phrenic nerve
Right sympathetic trunk
Right greater thoracic splanchnic nerve
Right 9th intercostal nerve

Right Greater Thoracic Splanchnic

8

A frail, elderly man, suspected of having widespread cancer of the lungs and bronchi, is brought in for bronchoscopic examination. The instrument is inserted into the airway, where it accidentally punctures the thin, brittle posterior wall of the diseased right main bronchus. A sudden gush of blood immediately indicates that the instrument has also torn the wall of the blood vessel immediately behind the right main bronchus, i.e., the:
Azygos vein
Left brachiocephalic artery
Pericardiacophrenic artery
Right pulmonary vein
Superior vena cava

Azygos Vein

9

What is special about the Great Splanchnic Nerve? Where is it found? Does it increase or slow down digestion?

Splanchnic --> do not synapse in the sympathetic chain but synapse in the CELIAC GANGLION

- T5-T9
-pierces the diaphragm
- works to SLOW digestion

10

Posterior Intercostal Artery branch off of the ______. Its Left or right arteries are longer?

AORTA

- RIGHT are longer since AORTA is skewed left

11

The azygos veins drain into the Inferior Vena Cava. True or False?

FALSE

Superior Vena Cava!

12

What large vein drains the intercostal spaces?

AZYGOS Vein --> found to the right of the vertebral bodies

13

The horizontal & oblique fissures are found in which lung?

RIGHT LUNG -- more complex (heart is more left so left lung is simpler)

3 lobes*

14

What is LABV and BAV?

LABV =
Left Lung
Artery
Bronchus
Vein
(order in the HILUM)

BAV
Right Lung
BRONCHUS
Artery Vein

15

What is the largest lymphatic system in the thorax?

THORACIC DUCT

16

The esophagus is found between what two structures?Is the left Vagus in front or behind the esophagus?

Aorta and Lungs

left vagus = FRONT of esophagus

17

The ligament arteriosum is what remnant of fetal circulation?

Ductus Arteriosus

18

What two structures does the moderator band connect?

Anterior Papillary Muscles and the septum

- conduction
-prevents the valve tricuspid from prolapsing

19

What is ASD?

Atrial Septal Defect --> fossa ovalis didnt close

20

If the left ventricle is HUGE what is the cause?

Cardiac Hypertrophy

- calcification in the Aortic Semilunar Valve --> cusps fused together, heart must work to pump harder

21

The trachea begins at _____ vertebral level.
It bifurcates at ______ level. What is located at the bifurcation?

1. C6
2. T4/T5 - STERNAL ANGLE OF LOUIS
3. CARINA at the bifurcation!

22

Which bronchus is:
1. Shorter
2. More vertical
3. LARGER in diameter

RIGHT main bronchus - since trachea is pushed right

23

Which bronchus has the EPARTERIAL bronchus?

epi= above, arterial (before the arteries)
--> supplies the UPPER LOBE

RIGHT MAIN BRONCHUS

24

What is the blood supply to the bronchus?

Aorta & Pulmonary Intercostal Arteries

25

The right lung has _____ lobes.
It has _______ bronchopulmonary segments
It is grooved by what 3 structures?

What is found on the right lung that is not found on the left?

1. 3 lobes (superior, middle , inferior)
2. 10 bronchopulmonary segments
3. Grooved by:
Inferior Vena Cava - T8
Trachea - T10
Esophogus - T12

I ATE TEN EGGS AT NOON** I8 10 Eggs at Noon

- FIND HORIZONTAL FISSURE + 3 lobes

26

The left lung has ______ lobes and how many fissures?
It has ______ bronchopulmonary segments.
Is grooved by what two major structures?

What 2 structures are found on the left lung that are not found on the right?

1. 2 lobes (superior/inferior)
2. 8 brochopulmonary segments
3. Grooved by:
- Aorta
- Left Subclavian ARTERY

* has a LINGULA & and CARDIAC NOTCH on left lung (level of 4th rib)

27

What separates the superior and middle lobe of the right lung? The middle and inferior?

1. Horizontal Fissure
2. Oblique fissure

28

The blood supply to the LUNGS is from the _______ arteries which carry oxygenated or deoxygenated blood?

BRONCHIAL ARTERIES

- oxygenated blood

(unlike pulmonary arteries which carry deoxygenated blood)

29

Describe the lymphatic drainage.

Pulmonary nodes --> tracheobronchial nodes --> bronchiomediastinal trunks

30

What is found adherent to lung tissue and continuous with the parietal pleura at the HILUM of the lung?

VISCERAL PLEURA

31

What are the surface projections of the visceral pleura?

Midline --> rib 2
Cardiac Notch(left) --> 4th rib
MID- CLAVICULAR line --> 6th rib
MID - AXILLARY line --> 8th rib
Posteriorly --> 10th rib

32

What are the three surfaces of the PARIETAL pleura?

1. Costal
2. Diaphragmatic
3. Mediastinal

33

What are the surface projections of the PARIETAL pleura?

midline --> 2nd rib
BARE AREA --> 4th rib
Costal arch --> 6th rib
MID-CLAVICULAR --> 8th rib
MID-AXILLARY* --> 10th rib
Posteriorly --> 12th rib

34

What is found 2 ribs higher, the visceral or parietal pleura?

VISCERAL PLEURA

35

What is the name of the structure that extends into the ROOT of the neck and is suspended by Sibson's Fascia?

CUPOLA

- parietal pleura can be punctured at the CUPOLA

36

What is the main recess of the pleural cavity? What is the purpose of this recess?

COSTODIAPHRAGMATIC RECESS

- potential space that allows the lungs to fill to their maximum expansion

37

What separates the lungs?

Mediastinum

38

What structures are found within the posterior mediastinum?

ALL the GOOSES*

1. Azygos Vein (& hemiazygos)
2. Vagus
3. Descending AORTA***
4. Esophogus
5. Thoracic splanchninc Nerve
6. Thoracic Duct ** - between azygos and esophagus

39

Can children move the ribs up or down?

No, they have limited lung displacement

40

What extends all the way to T12? To L2?

T12 = Parietal Pleura (forms costodiaphragmatic recess)

L2 = Diaphragm

41

What connects the medial lung surface to the trachea and heart?

the root

42

What 4 structures do both lungs have?

Both lungs have an
1. apex
2. base
3. root
4. hilum

43

What surrounds the root?

The reflection of the PARIETAL to VISCERAL pleura

44

What is found within the Hilum?What is continuous at the hilum?

main bronchus
pulmonary artery/veins
bronchial vessels
nerves and
lymphatics

PLEURA IS CONTINUOUS AT THE HILUM

45

What is the double layer of parietal pleura in the lung called? Is it visible in both lungs?

Pulmonary Ligament

- more prominent in the LEFT lung

46

Wound at the apex could damage what structure?

PLEURA

47

The oblique fissures intersect at ____ rib.

The horizontal fissure of the right lung is close to ____ rib

1. 6th rib!! (from 2nd to 6th)

2. 4th rib

48

What vessels bring blood to the lungs to be oxygenated?

Pulmonary Arteries

49

What happens during systole? Where does blood travel?

Cardiac contraction
(diastole --> blood is filling*)

- blood moves from RIGHT ventricle to the Pulmonary trunk

50

***The lungs are vascularized by what two blood vessels? Do they both carry oxygenated blood?

1. Pulmonary Arteries (deoxygenated blood)
2. Bronchial Arteries (oxygenated)


TEST!!!

51

Bronchopulmonary nodes are in the ____ of the lung.

& Tracheobronchial lymph nodes are near the _____ termination.

1. ROOT of the lung

2. TRACHEAL termination (at the two main stem bronchi)

52

Why do lungs appear anthracotic?

DARK --> from living in an urban environment

53

The pulmonary plexus comprises parasympathetic (C.N. X) and sympathetic components. True or False?

TRUE

54

If you fix what bone of the back, will this increase or decrease the volume of the lungs?

Fix the SCAPULA with serratus anterior

- INCREASE volume of the lungs

Raise intercostals = increase the volume of the thoracic space & air gets sucked in

WHY: pleural cavity has negative pressure within it --> so SUCK IN AIR when increase space*

55

On full Inhalation, what recess can the lung expand to? What is it formed by?

Costodiaphragmatic Recess

-Pleural recesses are formed between the parietal and visceral pleura -->potential spaces

-allowing maximum expansion of the lung during forced ventilation.

56

What are the 3 area to perform Thoracentesis (insert needle to drain fluid from pleural cavity?

insert into COSTODIAPHRAGMATIC RECESS

1. above 7th rib (midclavicular line), 2. above 9th rib (midaxillary line)
3. or above 11th rib (scapular line) to avoid lungs and intercostal vessels

- 7,9,11
mid-c, mid-ax, posterior

57

What is found to the right of the thoracic duct?

Sympathetic Chain Ganglia

58

What nerve travels with the esophagus?

Vagus Nerve

59

Azygos veins are found on which side of the body? Where do they drain into?

RIGHT side
- drain into the SUPERIOR vena Cava

60

1. A mother brings a 5 year old to the ER who has aspirated a marble. You suspect that the object most likely entered the:

A: Right Main Bronchus
B: Left Main Bronchus

A: Right Main Bronchus - more verticle, larger in diameter

61

Radiologist informs you that tumor of the lower esophogus is compressing part of the lobe of the lung. This would most likely be:

A: Inferior Lobe of right lung
B: Superior Lobe of right lung
C: Inferior Lobe of left lung
E: Superior Lobe of left lung

impression of the esophagus is on the RIGHT lung

A: inferior lobe of the right lung

62

Your patient has developed a hemothorax (blood into the pleural cavity). Where could you insert your needle to withdraw fluid without injuring the lung?

A: 2nd intercostal
B: 4th intercostal in midclavicular
C: 6th intercostal of midclavicular
D: 7th intercostal space of midclavicular line
E: 8th intercostal space in the midaxillary line

D: 7th intercostal of midclavicular *

7,9,11
midclavicular
midaxillary
posteriorly

63

You patient has large lipoma that is compressing the trachea where it divides into the bronchi. You decide to resect it via a lateral approach. Which intercostal space would you enter?

A: 1st
B: 2nd
C: 3rd
D: 4th
E: 5th

A: 1st

Trachea divides at STERNAL ANGLE
(2nd rib --> so the space above is the 1st intercostal space)