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B2 > Pulmonary Anatomy > Flashcards

Pulmonary Anatomy Flashcards

1
Q

The inferior thoracic aperture is closed by the ________

A

diaphragm

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2
Q

What are the three spaces in the chest that make up the thoracic structures?

A

left pulmonary cavity, right pulmonary cavity, and mediastinum

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3
Q

In the thorax, the blood supply (aorta, vena cava), nerve supply (vagus nerve), thoracic duct and esophagus all penetrate the __________

A

diaphragm

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4
Q

The superior thoracic aperture has a lot of blood vessels due to vasculature to what three areas?

A

head, neck, upper extremities

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5
Q

________ results from compression of vasculature and nerve supply penetrating superior thoracic aperture

A

thoracic outlet syndrome

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6
Q

What does the independence of pulmonary cavities signify?

A

You can have problems on one side but still maintain respiration on the other.

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7
Q

What two structures are contained within the pulmonary cavities?

A

Lungs and pleural sacs

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8
Q

The space inside the pleural sac is called the _________ and is empty

A

pleural cavity

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9
Q

The _______ is space sandwiched in between pleura on both sides

A

Mediastinum

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10
Q

The ______ pleural lines the lung whereas the ______ lines the body wall

A

visceral, parietal

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11
Q

What is found within the pleural space?

A

A tiny bit of fluid that allows the lung to slide back and forth as it expands and deflates

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12
Q

True/False: It is necessary to have positive pressure inside the lung during inspiration

A

FALSE, negative pressure to draw air in passively

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13
Q

True/False: In COPD, airflow in is compromised

A

False, can get air in, but can’t get it back out

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14
Q

The ___________ is where the parietal pleura extends further down than the inflated lung. The normal space is about 2 ribs.

A

costodiaphragmmatic recess

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15
Q

What kind of nerve is the phrenic nerve?

A

Somatic (that’s why we can control breathing!) with some autonomic fibers

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16
Q

The phrenic nerve is found sandwiched in between what two structures?

A

Parietal pleura and fibrous pericardium

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17
Q

Phrenic nerve comes from what vertebral levels?

A

C3-C5 [C3,4,5 keeps the person alive!]

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18
Q

Posteriorly (paravertebrally), the lungs (visceral pleura) go to above vertebral level of ____ whereas the parietal pleura go to vertebral level of ___

A

10, 12

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19
Q

Anteriorly, when looking at mid-clavicular level, the lungs (visceral pleura) go to about vertebral level of ____ and the parietal pleura to ___

A

6, 8

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20
Q

If looking from a mid-axillary viewpoint, the lungs (visceral pleura) go to about vertebral level of ___ and the parietal pleura to ____

A

8, 10

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21
Q

True/False: The cardiac notch has pleura over it and the lung continues into it

A

FALSE - the lung does not continue into the cardiac notch (does have pleural however)

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22
Q

Why is it important that patient raises their arms for CXR?

A

to get scapula out of the way

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23
Q

If looking along parasternal line, the lungs (visceral pleural) go to vertebral level of about ___, whereas the parietal pleura go to vertebral level of _____

A

4, 6

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24
Q

________ are potential spaces which can fill with blood, air and water in pathological states.

A

Pleural Recesses

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25
Q

This area of the lung consists of mainly pulmonary arteries, bronchi and pulmonary veins but anything entering or leaving the lung could also be considered part of this.

A

The root

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26
Q

The point where the arteries, bronchi, and pulmonary veins enter the lung is the ______

A

hilum

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27
Q

Describe the differences in bronchi on each side of the hilum

A

On the left side. the primary bronchus enters. On the right side, the secondary bronchi for upper and lower lobes enter.

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28
Q

Describe where the phrenic and vagus run in respect to the hilum

A

The phrenic runs anterior to the hilium and the vagus runs posterior

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29
Q

How many secondary bronchi are there?

A

2 on right, 3 on left

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30
Q

_______ enter the lobe whereas ______ enter the bronchopulmonary segments

A

secondary bronchi, tertiary bronchi

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31
Q

The main contribute to the esophageal plexus is the ______

A

vagus nerve

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32
Q

In the root of the lung, where do the pulmonary arteries lie in relation to the bronchi?

A

On the right side, the artery lies anterior to the bronchi. On the left side, the pulmonary arteries lie superior to the bronchi (RALS)

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33
Q

In the root of the lung, where do the pulmonary veins lie in relation to the other structures in the root?

A

anterior and inferior

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34
Q

The branches of the ________ are the most anterior and inferior major structures in the hilum of both lungs

A

pulmonary vein

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35
Q

What defines a bronchopulmonary segment in a lung?

A

unit of lung supply by one tertiary (segmental) bronchus and its accompanying artery; each segment separated by connective tissue layer

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36
Q

The tertiary bronchus and its accompanying artery are _____ whereas the pulmonary vein that drains each bronchopulmonary segment is ______

A

intrasegmental, intersegmental

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37
Q

Pulmonary veins drain intersegmentally. What is the significance of this in terms of loss of blood flow?

A

One pulmonary vein drains multiple bronchopulmonary segments - so if blood flow obstructed, will affect multiple. When removing a segment, must tie off the tributaries to that vein.

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38
Q

Which primary bronchi is more vertical and wide and what is the significance of this?

A

The one on the right side. Aspirated objects tend to lodge in the right main or inferior lobar.

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39
Q

At what point does the trachea divide into the primary bronchi?

A

At the junction of the ascending aorta and the arch.

40
Q

True/False: The trachea passes from the superior mediastinum to the inferior mediastinum.

A

FALSE - only superior

41
Q

Which pleura feel pain?

A

mediastinal, costal, cervical, and diaphragmmatic. VISCERAL DOES NOT.

42
Q

True/False: The nerve supply to the lung comes from the same source as the heart and continues into the cardiopulmonary plexus

A

True

43
Q

On the costal pleura, where do the pain fiber originate?

A

intercostal nerves

44
Q

On the mediastinal pleura, where do the pain fibers originate?

A

Phrenic nerve

45
Q

True/False: All lung tissues get their nutrients from the pulmonary circulation

A

FALSE - structures comprising the root and supporting tissues get nutrients from bronchiole arteries

46
Q

How many bronchiole arteries are there?

A

generally two on left and one on right

47
Q

Why is the pulmonary circulation insufficient to perfuse structures of the root?

A

Structure is deep in the lung and the fusion across membranes of the lungs is not enough to give these cells nourishment and oxygen

48
Q

In regards to lymphatics of the lung, the _______ drains the parenchyma and drains to the bronchopulmonary nodes

A

subpleural plexus

49
Q

The _______ contains portions of the great vessels, esophagus, trachea, vagus, phrenic and cardiac nerves, thoracic duct and thymus.

A

superior mediastinum - begins at angle of louis

50
Q

The inferior mediastinum is divided into what three sections?

A

anterior, middle, posterior

51
Q

The ________ contains the heart and ascending aorta, pulmonary trunk and some superior vena cava [everything in pericardial sac]

A

middle mediastinum

52
Q

The _______ contains mostly fat, branches of internal thoracic artery and some thymus in children

A

anterior mediastinum

53
Q

What are the three superior branches of the aortic arch?

A

brachiocephalic artery, common carotid artery, subclavian artery

54
Q

Where does the arch of azygos drain into?

A

superior vena cava

55
Q

The right and left brachiocephalic veins, phrenic and vagus nerves, recurrent laryngeal nerves, trachea, esophagus and some thymus are part of the _________. Also includes the extra pericardial part of the pulmonary trunk and right and left pulmonary arteries.

A

superior mediastinum

56
Q

Describe the 5 layers of the superior mediastinum from anterior to posterior

A

glandular, venous (containing brachiocephalic veins), arterial (containing brachiocephalic artery, common carotid, and subclavian), respiratory (including trachea), and digestive (including esopohagus)

57
Q

The vagus courses onto the esophagus and passes ______ to the root of the lung

A

posterior

58
Q

The phrenic nerve runs ______ to the hilum of the lung

A

anterior

59
Q

The posterior mediastinum is the area anterior to the vertebral column between levels __ and ____.

A

T5 and T12

60
Q

The esophagus and its plexus, the thoracic descending aorta, the azygos system of veins and the greater, lesser, and least thoracic sphlancnic nerves are found in the _______

A

posterior mediastinum

61
Q

Between what two structures is the thoracic duct located?

A

esophagus and aorta

62
Q

What part of the mediastinum are the sympathetic trunk and roots of the sphlancnic nerves considered to be?

A

posterior mediastinum - not technically tho

63
Q

What vertebral levels do the a) greater thoracic splanchnic; b) lesser thoracic splanchnic; c) least thoracic splanchnic

A

a) t5-t9; b) lesser t10-11; c) least 12

64
Q

The thoracic duct is sandwiched between esophagus, aorta, and azygos vein on the right and ultimately hooks over to get into the junction of the ________ and _______

A

internal jugular, subclavian vein

65
Q

What are the sources of the anterior esophageal plexus? Where do the fibers travel past the this plexus?

A

The vagus nerves and thoracic sphlancnincs. The left vagus contributes mostly to the anterior esophageal plexus but there is a mixing of fibers from right and left vagus nerves. The fibers then reconvene into the anterior and posterior vagal trunk.

66
Q

Past the esophageal plexus, the vagal trunks provide parasympathetic innervation to the GI tract as far as the _________

A

left colic flexure [past this the pelvic sphlancnics take over]

67
Q

The left vagus gives off the ______ whereas the right hooked behind the ________

A

recurrent laryngeal nerve; subclavian artery

68
Q

The ______ contributes mostly to the posterior esophageal plexus [ but there are mixing of fibers from right and left vagal nerves.

A

right vagus

69
Q

What happens to the fibers after the posterior esophageal plexus?

A

reconvene on their way to the stomach as the anterior and posterior vagal trunks

70
Q

Name the important branches of the thoracic aorta (5)

A

esophageal arteries, bronchial arteries, posterior intercostal arteries, superior phrenic arteries, subcostal arteries

71
Q

What three structures does the azygos system drain?

A

body wall, esophagus, and bronchial veins

72
Q

How does the azygos drain into the SVC?

A

arches over the right of the lung on the right

73
Q

How do the azygos and hemiazygos veins communicate with the abdominal cavity? [major venous connection]

A

via direct connection to the ascending lumbar veins

74
Q

The azygos system connects to the portal system indirectly through the __________

A

esophageal venous plexus

75
Q

The hemiazygos system usually reached a vertebral level of ____ whereas the accessory hemi reaches ___ [there are a lot of variabilities from person to person however]

A

T8, T6.

76
Q

How does liver cirrhosis affect the esophageal plexus?

A

There is a backup of blood into the portal vein which will head back towards the stomach and esophageal plexus. There is a direction connection with the azygos system. Dump lots of blood into azygos when its not designed to take that much blood

77
Q

Ruptured vessels in the plexus of veins close to the internal surface of the esophagus can become dilated from ________ and can be ruptured easily and bleed extensively

A

portal hypertension

78
Q

If the posterior mediastinum is viewed from the right, the arch of the azygos is found where in relation to the root of the lung

A

superior

79
Q

On which side does the diaphragm protrude more highly and why?

A

on right side because of liver

80
Q

The thoracic duct receives the lymph from the entire body except where?

A

the upper right quadrant of the chest and the right side of the head

81
Q

The thoracic duct passes just inferior to the diaphragm to its point of emptying into the venous system at what junction?

A

left internal jugular and left subclavian vein

82
Q

How is flow through the thoracic duct facilitated?

A

pressure changes during respiration

83
Q

True/False: Flow through the thoracic duct goes in both directions

A

FALSE - has valves so that flow only goes in one direction

84
Q

The thoracic duct passes behind the ______ brachiocephalic vein

A

right

85
Q

The oblique fissure runs from what vertebral level? What are the differences between sides? Is it found in the superior or inferior mediastinum?

A

Starts at T4/T5 and runs anteriorly to pass through hilum. The left is steep than the right. This would be the inferior mediastinum (T4-T9)

86
Q

The right horizontal fissure runs from the hilum anteriorly. How does the left horizontal fissure run?

A

trick question there is no left horizontal fissure HAHAHA

87
Q

Describe tension pneumothorax.

A

Tension pneumothorax is caused by a wound that creates a “flap” so that air can come in but then flap closes and air cannot escape. This causes a shift of the heart, aorta, and trachea.

88
Q

What is the biggest issue with tension pneumothorax?

A

Cardiac output compromised due obstruction of flow to heart

89
Q

On which view will a tension pneumothorax be better visualized: inspiratory or expiratory and why?

A

Expiratory because lung naturally pulled back from chest wall

90
Q

True/False: A silhouette sign can be normal or pathologic and generally refers to the border between lung tissue and any other neighboring tissue (usually the heart)

A

TRUE

91
Q

What is a normal silhouette sign?

A

Heart obscures anterior part of left hemi-diaphragm in lateral film or anterior part of PA film

92
Q

Rank in terms of most radiolucent to least radiolucent: water and most tissues, spongy bone, fat, air, compact bone

A

Air, fat, water and most tissues, spongy bone, compact bone

93
Q

True/False In the costodiaphragmmatic recess, an air fluid level can be normal or pathologic

A

FALSE - pathologic

94
Q

On an x-ray, a breast overlapping with the diaphragm would produce a ______

A

summation shadow

95
Q

What do the black hole on the chest x-ray signify? Where are the pulmonary arteries in relation?

A

THe black hole is the left upper lobe bronchus. The left pulmonary artery will be above and the right pulmonary artery will be anterior.

96
Q

True/False: Posteroinferior lower lobes can only be seen on lateral films

A

TRUE - diaphragm obscures on PA

B2 (15 decks)

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