Resp System and Posterior Mediastinum

Question 1

Components of the Respiratory System

Answer 1

Nasal cavity, nasopharynx, larynx, trachea, bronchi, bronchioles, lungs

Question 2

Carina

Answer 2

Bump/ring where the trachea divides to form the bronchi.

Question 3

Differences between the Right and Left Bronchi

Answer 3

RIGHT: Shorter, more vertical, larger diameter (because right lung is larger)

LEFT: Longer (further to travel), more horizontal (arch of the aorta goes over the left main bronchus), smaller diameter (left lung is smaller to accommodate the heart).

Question 4

Eparterial bronchus

Answer 4

Goes to superior lobe on the right side and is branch of the right bronchus. OFTEN TAGGED

Question 5

Branching of the right bronchus

Answer 5

Branches into the:

• eparterial bronchus (branch to the upper lobe)
• bronchus intermedius aka hyparterial (branch to the middle/lower lobes)

Question 6

Basic anatomical features of the lungs

Answer 6

Both lungs have an apex, base, root and hilum

Question 7

What is the hilum of the lungs? What are the roots?

Answer 7

These terms are often interchangeable.

HILUM- structures that come and go from the lungs (pulmonary veins/arteries, bronchial vessels, nerves, lymphatics etc.)

ROOT- the lung tissue where these structures enter in

Question 8

The parietal and visceral layers of the pleura are continuous where?

Answer 8

The Root

Question 9

Distinct characteristics of the Left Lung

Answer 9

• 2 lobes (superior and inferior– divided by the oblique fissure)
• Lingula (tongue like extension of the superior lobe)
• The pulmonary artery is above (superior to) the bronchus

Question 10

What divides the superior and inferior lobes of the left lung?

Answer 10

-The oblique fissure

Question 11

Pulmonary ligament

Answer 11

A fold at the root of the lung which is composed of a double layer of parietal pleura which is extending towards the hilum.

Question 12

Most vessels are Posterior or Anterior to the Bronchus?

Answer 12

Anterior

Question 13

Pulmonary trunk/arteries are Inferior or Superior to the pulmonary veins?

Answer 13

Superior. The veins are mostly in back of the heart, on the posterior side.

Question 14

Distinct characteristics of the Right Lung

Answer 14

• 3 lobes (superior, middle and inferior)
• 2 fissures (oblique, horizontal)
• The pulmonary artery is NOT superior to the bronchus– they are at the same level, because the eparterial bronchus branches high.

Question 15

Oblique fissure

Answer 15

Divides the superior from inferior (posteriorly)

Question 16

Horizontal fissure

Answer 16

Separates the superior from the middle

Question 17

Projection of lungs anteriorly

Answer 17

• Apex of lung extends into the roof of the neck anteriorly
• Medially, both come close to the sternum
• Cardiac notch on left side to accommodate the heart (4th rib)
• Oblique fissures intersect around 6th rib anteriorly and the 2nd rib posteriorly (towards the midline)
• Horizontal fissure intersects 4th rib (towards the midline)

Question 18

Describe the vascularization of the lungs

Answer 18

• Pulmonary and Bronchial vessels (bronchial arteries contain oxygenated blood. Pulmonary arteries do not)
• During systole, the blood in the right ventricle enters the pulmonary trunk
• Bronchial arterial branches move in association with the bronchi
• Pulmonary veins run in the fascia between bronchopulmonary segments

Question 19

Anthracotic structures

Answer 19

Dark particulate matter found in adult lymph nodes near the lungs

Question 20

The two types of lymph nodes in the lungs

Answer 20

• Bronchopulmonary (root of the lung)

- Tracheobronchial (tracheal termination and two main stem bronchi)

Question 21

Innervation of the Lungs

Answer 21

Both parasympathetic (CN X) and sympathetic supply. Both are from plexuses which are along the great vessels of the heart.

Question 22

Basics of adult respiration

Answer 22

• Normal respiration is diaphragmatic
• Ribs are raised when more oxygen is needed
• Anterior (upper) thoracic wall moves anteriorly
• Lower (lateral) thoracic wall moves laterally
• Accessory muscles (mostly serratus anterior) can help increase thoracic wall size

Question 23

Extension of the parietal layer surface area does what?

Answer 23

Increases the surface area of the visceral layer because it is a closed space, so the lungs expand.

Question 24

Surfaces of the Parietal Pleura

Answer 24

Costal: associated with ribs
Mediastinal
Diaphragmatic
Cupola: Parietal part of lung which extends into the neck to cover the apex of lung (suspended by Sibson’s fascia which holds it in place so it isn’t sucked back into the thorax)

Question 25

How far does the parietal pleura extend? The diaphragm?

Answer 25

- Parietal (T12) | - Diaphragm (L2)

Question 26

Define a pleural recess. What are the two most important ones?

Answer 26

Pleural recesses are spaces formed between the parietal and visceral pleura, allowing for maximum expansion of the lungs during forced inhalation. Two main ones: - costodiaphragmatic recess(lowest one and most important) - costomediastinal recess

Question 27

The two most important lines when projecting the lungs onto the body surface

Answer 27

- Midclavicular | - Midaxillary (lateral view)

Question 28

The parietal pleural projections

Answer 28

- (2) Cupola meets midline at second rib - (4) Cardiac deviation of left lung is at the fourth rib - (6) Deviation of the right lung - (8) The parietal pleura intersects at the mid-clavicular line at the eighth rib - (10) The parietal pleura intersects at the mid-axillary line at the tenth rib - (12) The parietal pleura intersects posteriorly at the twelfth rib

Question 29

Difference between where the parietal pleura project on chest wall and where the visceral pleura/lungs project.

Answer 29

There is a 2 rib difference (visceral hits mid-clavicular, mid-axillary and the posterior two ribs earlier)

Question 30

What does the Posterior Mediastinum contain?

Answer 30

a. aorta b. esophagus c. vagus n. d. azygos and hemiazygos v. e. thoracic duct f. sympathetic chain

Question 31

3 main structures which pass through the diaphragm.

Answer 31

(1) Inferior Vena Cava- T8 (2) Esophagus- T10 (3) Aorta- T12 I ate 10 Eggs At Noon

Question 32

Main channel which accepts blood from the posterior intercostal veins.

Answer 32

Azygus. It tends to be on the right side. It then drains into the superior vena cava.

Question 33

Which splanchnic is often tagged?

Answer 33

Greater

Question 34

Which Bronchi will you first look for aspirated foreign bodies?

Answer 34

Right main Bronchus. It is larger in diameter and more vertical.

Question 35

Trachea divides at which intercostal space?

Answer 35

The second (above the third rib)