Flashcards in PosteriorMediastinum & Respiratory Deck (63):
Lymph nodes can be found in which mediastinal compartment(s)?
All of the above
None of the above
All of the above!
Which structure contains postganglionic sympathetic fibers?
greater thoracic splanchnic nerve
recurrent larygneal nerve
white ramus communicans
The aorta is located in which mediastinal compartment(s)?
Anterior and middle
Middle and posterior
Middle & Posterior
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:
The correct answer is: posterior mediastinum
The esophagus is in the posterior mediastinum, along with the descending aorta, thoracic duct, and azygos system.
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
Voluntary muscle activity
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
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
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:
Left brachiocephalic artery
Right pulmonary vein
Superior vena cava
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
-pierces the diaphragm
- works to SLOW digestion
Posterior Intercostal Artery branch off of the ______. Its Left or right arteries are longer?
- RIGHT are longer since AORTA is skewed left
The azygos veins drain into the Inferior Vena Cava. True or False?
Superior Vena Cava!
What large vein drains the intercostal spaces?
AZYGOS Vein --> found to the right of the vertebral bodies
The horizontal & oblique fissures are found in which lung?
RIGHT LUNG -- more complex (heart is more left so left lung is simpler)
What is LABV and BAV?
(order in the HILUM)
What is the largest lymphatic system in the thorax?
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
The ligament arteriosum is what remnant of fetal circulation?
What two structures does the moderator band connect?
Anterior Papillary Muscles and the septum
-prevents the valve tricuspid from prolapsing
What is ASD?
Atrial Septal Defect --> fossa ovalis didnt close
If the left ventricle is HUGE what is the cause?
- calcification in the Aortic Semilunar Valve --> cusps fused together, heart must work to pump harder
The trachea begins at _____ vertebral level.
It bifurcates at ______ level. What is located at the bifurcation?
2. T4/T5 - STERNAL ANGLE OF LOUIS
3. CARINA at the bifurcation!
Which bronchus is:
2. More vertical
3. LARGER in diameter
RIGHT main bronchus - since trachea is pushed right
Which bronchus has the EPARTERIAL bronchus?
epi= above, arterial (before the arteries)
--> supplies the UPPER LOBE
RIGHT MAIN BRONCHUS
What is the blood supply to the bronchus?
Aorta & Pulmonary Intercostal Arteries
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
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:
- Left Subclavian ARTERY
* has a LINGULA & and CARDIAC NOTCH on left lung (level of 4th rib)
What separates the superior and middle lobe of the right lung? The middle and inferior?
1. Horizontal Fissure
2. Oblique fissure
The blood supply to the LUNGS is from the _______ arteries which carry oxygenated or deoxygenated blood?
- oxygenated blood
(unlike pulmonary arteries which carry deoxygenated blood)
Describe the lymphatic drainage.
Pulmonary nodes --> tracheobronchial nodes --> bronchiomediastinal trunks
What is found adherent to lung tissue and continuous with the parietal pleura at the HILUM of the lung?
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
What are the three surfaces of the PARIETAL pleura?
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
What is found 2 ribs higher, the visceral or parietal pleura?
What is the name of the structure that extends into the ROOT of the neck and is suspended by Sibson's Fascia?
- parietal pleura can be punctured at the CUPOLA
What is the main recess of the pleural cavity? What is the purpose of this recess?
- potential space that allows the lungs to fill to their maximum expansion
What separates the lungs?
What structures are found within the posterior mediastinum?
ALL the GOOSES*
1. Azygos Vein (& hemiazygos)
3. Descending AORTA***
5. Thoracic splanchninc Nerve
6. Thoracic Duct ** - between azygos and esophagus
Can children move the ribs up or down?
No, they have limited lung displacement
What extends all the way to T12? To L2?
T12 = Parietal Pleura (forms costodiaphragmatic recess)
L2 = Diaphragm
What connects the medial lung surface to the trachea and heart?
What 4 structures do both lungs have?
Both lungs have an
What surrounds the root?
The reflection of the PARIETAL to VISCERAL pleura
What is found within the Hilum?What is continuous at the hilum?
PLEURA IS CONTINUOUS AT THE HILUM
What is the double layer of parietal pleura in the lung called? Is it visible in both lungs?
- more prominent in the LEFT lung
Wound at the apex could damage what structure?
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
What vessels bring blood to the lungs to be oxygenated?
What happens during systole? Where does blood travel?
(diastole --> blood is filling*)
- blood moves from RIGHT ventricle to the Pulmonary trunk
***The lungs are vascularized by what two blood vessels? Do they both carry oxygenated blood?
1. Pulmonary Arteries (deoxygenated blood)
2. Bronchial Arteries (oxygenated)
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)
Why do lungs appear anthracotic?
DARK --> from living in an urban environment
The pulmonary plexus comprises parasympathetic (C.N. X) and sympathetic components. True or False?
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*
On full Inhalation, what recess can the lung expand to? What is it formed by?
-Pleural recesses are formed between the parietal and visceral pleura -->potential spaces
-allowing maximum expansion of the lung during forced ventilation.
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
mid-c, mid-ax, posterior
What is found to the right of the thoracic duct?
Sympathetic Chain Ganglia
What nerve travels with the esophagus?
Azygos veins are found on which side of the body? Where do they drain into?
- drain into the SUPERIOR vena Cava
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
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
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 *