Thorax Part 2

Question 1

What does the thoracic cavity include?

Answer 1

2 pulmonary cavities – lungs and pleura with one central compartment of the mediastinum

Question 2

Where is the mediastinum?

Answer 2

T4/T5 (sternal angle)

Question 3

What does the mediastinum divide into?

Answer 3

superior and inferior parts

Question 4

What is located in the superior mediastinum?

Answer 4

4 arteries: arch of aorta, brachiocephalic, left common carotid, left subclavian

4 nerves: R&L vagus and phrenic nerves

3 veins: R&L brachiocephalic, SVC
trachea & esophagus, thymus, thoracic duct

Question 5

What is the inferior mediastinum divided into?

Answer 5

MAP - middle, anterior, posterior

Question 6

What is in the posterior mediastinum?

Answer 6

4th-12th thoracic vertebrae, includes descending aorta, axygos0hemiazygos veins, lymphnodes, thoracic duct

Question 7

What is in the anterior mediastinum?

Answer 7

thymus and lymph nodes

Question 8

What are the boundaries of the anterior mediastinum?

Answer 8

superior horizontal plane, inferior diaphragm, anterior body & xiphoid process, posterior heart

Question 9

What is included in the middle mediastinum?

Answer 9

heart, pericardium, ascending aorta, L&R main bronchi, tracheal bifurcation , vena cava, R&L pulmonary veins and phrenic nerves, lymph nodes

Question 10

What is the steps of surface to deep of the thoracic duct?

Answer 10

thymus -> veins -> arteries -> nerves -> trachea -> esophagus -> thoracic duct

Question 11

What does the vagus nerve branch off into?

Answer 11

left recurrent laryngeal nerve

Question 12

Where is a mediastinoscopy?

Answer 12

superior and middle mediastinum staging

Question 13

What are the two pleural layers with a cavity in between?

Answer 13

visceral (can’t differentiate), parietal (sensitive to pain, temp, touch, adhering to mediastinum versus not). Parietal attaches to chest wall and visceral is against organs

Question 14

What is the pleural cavity?

Answer 14

between parietal and visceral layers; contains pleural fluid for lubrication of lungs to inhale and exhale

Question 15

What are recesses?

Answer 15

area between visceral and parietal where lungs can expand

Question 16

How many lobes does the right lung have?

Answer 16

3. larger.

Question 17

How many lobes does the left lung have?

Answer 17

2, cardiac notch, lingula - tongue like process off left

Question 18

What divides the lungs into lobes?

Answer 18

fissures

Question 19

What is the pulmonary innervation?

Answer 19

cardiac plexus and vagus nerve

Question 20

How are the lungs nerve supplied?

Answer 20

pulmonary plexi

Question 21

Where is the sympathetic innervation of the thorax?

Answer 21

T1-L2/L3
gray – to spinal cord
white – from spinal cord

Question 22

Where is the parasympathetic innervation?

Answer 22

cranial and S2-S4; rest and digest…key=R&L vagus nerves

Question 23

What does the parasympathetic stimulation cause?

Answer 23

vasodilation and bronchoconstriction

Question 24

How many pulmonary veins are there?

Answer 24

2 on each side for 4 total

Question 25

Where does the pulmonary artery deliver blood to?

Answer 25

lungs

Question 26

Where does the pulmonary veins deliver blood to?

Answer 26

heart

Question 27

What is the hilum?

Answer 27

pulmonary blood vessels enter and leave through here, with a primary bronchus on each side. Two pulmonary arteries, four pulmonary veins

Question 28

What is a pulmonary embolus?

Answer 28

DVT travels to the heart lodging itself in the pulmonary arteries; FATAL issue

Question 29

Where is the carina of the bronchi?

Answer 29

at sternal angle

Question 30

What is the bronchial's blood supply?

Answer 30

left bronchial arises from thoracic aorta right bronchial arises from posterior intercostal arteries (5/6 posterior intercostal artery)

Question 31

How does the bronchi drain?

Answer 31

right vein = azygous left vein = hemi-azygous vein deep = deep lung parenchyma and drain into pulmonary veins

Question 32

Where is the azygous vein?

Answer 32

Deep on right side of body, originates at 12th thoracic vertebrae and branches over hilum and joins SVC

Question 33

What is the azygous vein's job?

Answer 33

transports deoxygenated blood from posterior thorax and abdomen into superior vena cava

Question 34

Where is the hemiazygos?

Answer 34

T9 from left renal

Question 35

Where is the accessory hemazygous?

Answer 35

T8 drains into azygous, drains left superior hemithorax

Question 36

What is the drainage process of the azygos venous process?

Answer 36

hemiazygous-->azygous--> SVC, entering through the aortic hiatus

Question 37

What is an azygous lobe?

Answer 37

during embryo development, M>F, 1% of people have an extra little lobe with displaced azygous vein that creates another fissure (no bronchus though)

Question 38

What are types of alveoli?

Answer 38

type I 95% and type II 5% (infants need extra of this pulmonary surfactant to keep tension and alveolis from collapsing)

Question 39

What is respiratory distress syndrome?

Answer 39

apnea, cyanosis, grunting, inspiratory stridoer, nasal flaring, poor feeding....common in preterm neonates, prevents alveoli collapse with pulmonary surfactant

Question 40

What is the blue bloater?

Answer 40

chronic bronchitis common with overweight, cyanotic, edema, wheezing, smokers

Question 41

What is the pink puffer?

Answer 41

old and thin, dyspnea, quiet chest

Question 42

What is the innervation of the middle mediastinum?

Answer 42

pericardiacophrenic artery and phrenic nerve c3-c5, vagus nerve

Question 43

What is the pericardium?

Answer 43

very thick sack that makes up two layers that surround the heart

Question 44

What are the layers of the pericardium?

Answer 44

fibrous (anchor, prevents heart from filling with excess blood) and serous (inner layer)

Question 45

What are the three heart layers?

Answer 45

epicardium (outer/visceral), myocardium (muscular wall of the heart), endocardium (covers inner surface of heart)

Question 46

What is a cardiac tamponade?

Answer 46

emergency medical condition fluid buildup of pericardial sac that prevents refilling of ventricles

Question 47

What is Beck's triad for a cardiac tamponade?

Answer 47

hypotension, jugular venous distension, muffled heart sounds. Treated with needle asperation along left sternal border of 5th intercostal space

Question 48

This is a reminder to review your heart anatomy ! What is the flow?

Answer 48

SVC/IVC -> right atrium -> tricupsid valve -> right ventricle -> pulmonary valve -> pulmonary artery -> lungs -> left atrium -> bicupsid/mitral valve-> left ventricle -> aortic valve -> aorta -> rest of body

Question 49

What is the patent foramen ovale?

Answer 49

hole between right and left atrium while in womb..this and ductus arteriosus will close normally after birth (bypassing lungs, using mom's body)

Question 50

What are the five fetal adaptions?

Answer 50

umbilical vein (placenta O2 rich blood --> liver --> IVC) ductus venosus (umbilical vein to IVC) patent foramen ovale (hole RA->LA) ductus arteriosus (direct connection between pulmonary and aorta) umbilical arteries (blood leaves aorta, majority diverted back to placenta)