Flashcards in Thorax (Test III) Deck (124):
What makes up the thoracic cage?
Ribs and costal cartilages, sternum, thoracic vertebrae, and the diaphragm (as the floor).
What are the three compartments of the thoracic cavity?
The mediastinum and left and right pulmonary cavities.
What is the vertebrae levels of the sternum?
What is the level of the sternal angle (the angle of Lewis)?
What is the level of the xiphoid process?
How many true ribs are there?
What are the false ribs?
What are the floating ribs?
What is the thoracic inlet bounded by?
(Anteriorly) superior border of the manubrium
(Laterally) 1st ribs and their cartilages
(Posteriorly) T1 vertebrae
What is the thoracic outlet bounded by?
(Anteriorly) costal cartilages of ribs #7-10 and the xiphsternal joint
(Posterior-Laterally) 11th and 12th ribs
(Posteriorly) T12 vertebrae
What travels into the thoracic inlet?
What travels through the thoracic outlet?
Inferior vena cava
What level is the jugular notch at?
What are the levels of the scapula (include those for the superior angle, base of the spine and the inferior angle?
Superior angle= T2-T3 and the 2nd posterior intercostal space
Base of spine= T4-T5 and the 4th posterior intercostal space
Inferior angle= T7-T8 and the 7th posterior intercostal space
Name the structures of a rib running posterior to anterior.
Head (with two articular facets for demi facets of vertebrae)
Tubercle (with articular facets for transverse processes of vertebrae)
Angle (where rib changes direction)
What is the subcostal groove?
A groove running on the inferior aspect of a rib. It is for the subcostal vein, artery, and nerve to run.
How are ribs orientated? What does this allow for?
Inferiorly to superiorly. This allows for the pump-handle movement during deep respiration.
Does the external intercostal muscle end anteriorly or posteriorly as the external intercostal membrane?
How does the internal intercostal muscle end?
Posteriorly as the internal and innermost intercostal membrane.
What artery runs on both sides of the sternum?
Internal thoracic (mammillary) artery.
What does the internal thoracic (mammillary) artery give off?
The anterior intercostal artery for spaces #1-6 and the pericardioacophrenic artery.
What does the pericardioacophrenic artery run with?
The phrenic nerve.
When does the internal thoracic (mammillary) artery divide? What does it divide into?
At the 6th intercostal space;
Superior epigastric artery and musculophrenic artery.
What does the superior epigastric artery (medial portion) supply?
Where do the anterior intercostal arteries for spaces #7-10 come off?
The musculophrenic artery (what the internal thoracic artery divides into at the level of the 6th intercostal space).
Where do the intercostal neves arise from?
The ventral primary rami of the thoracic levels.
Where do the posterior intercostal arteries of spaces 3-11 come from?
Off the descending aorta.
Where do the posterior intercostal arteries of spaces 1-2 come from?
Off the supreme intercostal artery (comes from the costocervical trunk)
What comes off the sympathetic trunk?
Gray and white communicans.
Of the gray and white communicans, which is more medial and which is more lateral? Which one is pre-ganglionic fibers and which is post-ganglionic fibers?
Gray= more medial and post-ganglionic fibers
White= more lateral and pre-ganglionic fibers
During inspiration, what happens to the interthoracic and interpulmonary pressures?
What are the muscles of inspiration?
Diaphragm and external intercostal.
What innervates the diaphragm?
The phrenic nerve (C3-C5)
What are the muscles of forced inspiration? (X5)
Sternocleidomastoid, levator costarum, anterior/middle/posterior scalene, pectoralis major, and serratus posterior superior.
What are the muscles of expiration?
Relaxation of the diaphragm
What are the muscles of forced expiration?
Abdominals, transverse thoracis, and the serratus posterior inferior.
What happens to the intrathoracic and intrapulmonary pressure during expiration?
What does the intercostal vein, artery, and nerve run between?
Between the innermost and internal intercostal muscles.
How does the innermost intercostal muscle end?
Anteriorly as the innermost intercostal membrane.
True or false:
The diameter of the throrax increases with inspiration.
True. The thorax expands during inspiration.
The superior/inferior axis of the thorax increases during quiet breathing because of the:
The anterior/posterior axis of the thorax increases during breathing because of:
The intercostals and scalene muscle
What creates the "pump-handle" movement during breathing?
The ribs rotating around a transverse axis at the costovertebral and costotransverse joints. This occurs mainly at the upper ribs)
What creates the "bucket-handle" movement during breathing?
The ribs rotating one degree around an anterior/posterior axis at the sternocostal joints. This happens mainly at the middle ribs.
Where does the apical portion if the lungs lie?
Above the clavicle and 1st rib
What separates the superior and middle lobes of the lungs?
What separates the middle lobe from the inferior lobe of the right lung and the superior lobe from the middle lobe of the left lung?
Where will blood acculumate in the event of a hemothorax?
The costodiaphragmatic recess. (It's where there is no lung tissue in he pleural cavity).
True of false:
The dome of the diaphragm sits higher on the left side.
False. It sits higher on the right because of the liver.
What helps to adhere the parietal pleura to different structures such as the rib cage and mediastinum?
What do the lung buds develop into?
The pleura (a serous membrane that is one cell layer thick).
What occurs when air gets into the pleural cavity? When blood gets in?
What is the pulmonary ligament?
A vertical fold of the mediastinum pleura extending from the hilus of the lung to the diaphragm.
What are the parts of the parietal pleura?
Cervical (cupola) pleura
Mediastinal parietal pleura
Costal parietal pleura
Diaphragmatic parietal pleura
What is the esophageal ligament?
A double fold of the mediastinal pleura behind the esophagus.
How many pulmonary arteries come off the pulmonary trunk of the heart? What is unique about them?
2- a right and left pulmonary artery. They are the only arteries in the body that carry deoxygenated blood.
How many pulmonary veins are the returning blood to the heart from the lungs? What is unique about them?
4-- a left, right, superior, and inferior. They are the only veins in the body that carry oxygenated blood.
True or false:
The arch of the aorta is superior to the left primary bronchi.
What is interesting about the orientation of the right primary bronchus?
It has a wider diameter and is more vertical, allowing of the possibility of food to fall down into it.
How many lobes are there in the right lung? The left lung?
3 in the right--superior, middle, and inferior lobes.
2 in the left--superior and inferior.
Which border of the lung is sharp and which is rounded?
Sharp is the anterior border and rounded is the posterior border.
Describe the bronchi branching sequence of the right lung.
Primary bronchi-> superior lobar -> apical segmental (S1), posterior segmental (S2), and anterior segmental (S3)
-> middle lobar -> medial segmental (S4) and lateral segmental (S5)
-> inferior lobar -> superior segmental (S6), medial basilar (S7), anterior basilar (S8), lateral basilar (S9), posterior basilar (S10)
Describe the branching sequence of the bronchi of the left lung.
Primary bronchi-> superior lobar -> apical/posterior segmental (S1/2), anterior segmental (S3), lingular superior (S4), and lingular inferior (S5)
-> inferior lobar -> superior basilar (S6), anterior/medial basilar (S7/8), lateral basilar (S9), posterior basilar (S10)
What is found in the hillus of the lung?
Pulmonary artery, primary bronchus, and two pulmonary veins.
True or false:
In the hilus of the lung, the pulmonary artery is superior to the primary bronchus.
Grooves for what vessels are found on the left lung?
Descending aorta, aortic arch, and cardiac impression.
Grooves for what vessels are found on the right lung?
Superior vena cava, esophagus, trachea, and brachiocephalic vein
True or false:
The pulmonary artery sits more anterior than the primary bronchus.
What is the smooth muscle of the bronchial tree innervated by during vasodilation?
The sympathetic nervous system.
What is the smooth muscle of the bronchial tree innervated by during constriction?
Parasympathetic nervous system.
How far down does the smooth muscle of the bronchial tree extend?
To the level of the alveoli
Where do the bronchioles begin in the bronchial tree?
Where the hyaline cartilage ends.
Where does respiration begins?
In the terminal branches (also with the alveoli for gas exchange)
What do the terminal branches of the bronchial tree give rise to? What occurs here?
Respiratory bronchioles. This is where CO2 and O2 is exchanged.
What is the branching sequence of the lungs? (Bronchial tree)
Trachea- primary bronchi- secondary (lobar) bronchi- tertiary (segmental bronchi)- bronchioles- terminal branches- respiratory branches and acinus.
What makes up the acinus?
The alveolar ducts, sacs, and alveoli.
What mediates the exchange of gas in the lungs?
The partial pressure of CO2 (PCO2).
Where are the chemoreceptors that monitor PCO2 levels?
In the carotid body (located in the carotid sinus).
Of the respiratory reflex, what is the afferent limb mediated by?
Glossopharyngeal N (CN XI)
Of the respiratory reflex, what is the efferent limb mediated by?
(Sympathetic) GVE fibers
(Parasympathetic) Vagus Nerve
How many bronchial arteries supply the lung? Where do they come from?
Three--2 left bronchial arteries off the descending thoracic aorts and one right bronchial artery off the 3rd right posterior intercostal artery
When do the bronchial arteries become bronchiole arteries? What do they supply?
After the bronchi tree--they supply the lobar and teritary segements.
What supplies esophagus?
The esophogeal arteries
What feeds into the esophogeal arteries that supply the esophagus?
The descending aorta and bronchial arteries.
Lymphatic vessels drain the bronchial tree. What do the pulmonary vessels drain into?
The pulmonary and bronchopulmonary lymph nodes.
What do the pulmonary and bronchopulmonary lymph nodes drain into?
The traceobronchial and paratracheal lymph nodes.
What do the trachobronchial and paratracheal lymph nodes drain into?
The thoracic duct or bronchomediastinal lymphatic duct.
Describe the lymphatic system of the lungs.
Pulmonary vessels-> pulmonary and bronchopulmonary lymph nodes -> tracheobronchial and paratracheal nodes -> thoracic duct or bronchomediastinal lymphatic duct.
What is the mediastinum?
A midline "wall of structures" between the two pleural cavities.
What is the mediastinum bounded laterally by?
The medistinal parietal pleura.
What constitues the superior mediastinum?
The plane connecting the sternal angle to the level of T4-T5 vertebre.
What are the major structures of the superior mediastinum?(x10)
Superior vena cava, brachiochephalic vein, aortic arch, trachea, esophagus, remnents of the thymus gland, phrenic nerve, vagus nerve, left recurrent laryngeal nerve, and the thoracic duct.
What are the three divisions of the inferior mediastinum?
Anterior, middle, and posterior.
What constitutes the area of the anterior mediastinum?
Anterior to the heart
What constitutes the area of the middle mediastinum?
The pericardium and heart--it is bounded laterally by the parietal pleura.
What are the major strucutues of the anterior mediastinum?
Remnants of the thymus gland, parasternal lymph nodes, and superficial fat and connective tissue.
What structures can be seen in the right lateral view of the posterior mediastinum? (x6)
Esophagus, azygos vein, right vagus nerve, sympathetic trunk, thoracic splanchnic nerves, and the thoracic duct.
What structures can be seen in the left lateral view of the posterior mediastinum? (x6)
Thoracic aorta, accessory hemaxygos vein, left vagus nerve, sympathetic trunk, throacic splanchnic nerves, and the thoracic duct.
At what cord level is the foramen of the IVC found in the diaphragm?
Where in the diaphragm does the IVC pass through? What also runs with the IVC through this?
Foramen of the IVC (level of T8) in the central tendon of the diaphgram. It runs with the right phrenic nerve.
At what cord level is the esophageal hiatus? Where is this found?
T10; muscular right crus
What passes through the esophageal hiatus?
Esophagus, and the anterior and posterior vagal trunks.
Where is the aortic hiatus located?
Between the right and left crus
What passes through the aortic hiatus? (x4)
Aorta, thoracic duct, greater thoracic splanchnic nerve, and azygos vein.
What are the three diaphramatic foramen?
IVC, esophageal hiatus, and the aortic hiatus.
At what level is the aortic hiatus?
What is the sympathetic nervous system distribution?
Thoracolumbar outflow (T1-L2)
What innervates the heart and lungs?
The pulmonary and cardiac plexuses. (and the cervical--cardiopulmonary) splanchnic nerves)
What innervates the foregut?
Greater splancnic nerve
What levels is the greater thoracic splancnic nerve?
What innervates the midgut?
Lesser thoracic splancnic nerve
What levels is the lesser thoracic splancnic nerve?
What innervates the hindgut?
Least thoracic splancnnic nerve and the lumbar splancnic nerve
What level is the least thoracic splancnic nerve?
What innervates the pelvis and perineum?
Sacral splancnic nerve
What constitues the area of the posterior mediastinum?
The area posterior to the heat--it is bounded posteriorly by the vertebrae.
What is included in the middle medistinum?
Heart, pericardium, primary bronchi, bases of SVC, IVC, aorta, pulmonary arteries and veins, phrenic nerve, and the azygos vein.
What is included in the posterior mediastinum?
Esophagus, descending aorta, azygos system, vagus nerve, thoracic splanchnic nerves, sympathetic trunk, and thoracic duct.
What does the phrenic nerve innervate? What are it's cord levels?
Diaphragm--C3, C4, C5
True or false:
The phrenic nerve passes posterior to the root of the lung.
False--it passes anterior as it runs with the pericardiophrenic artery.
True or false: the vagus nerve passes posterior to the root of the lung`
True--it passes posterior to the root of the lung and the heart.
What is the level of the vagus nerve? What does it innervate?
Cranial nerve 10--it innervates the heart, lungs, and the esophagus and provides parasympathetic innervation to the thoracic organs.
What does the left recurrent laryngeal nerve come off of? Where is it? What does it do?
It comes off the vagus nerve around the ligamentum arteriosus --it give parasympthetic innervation going back to the neck.