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154 Cards in this Set

  • Front
  • Back
Diameter of the trachea at birth? in adults?
- 3 mm
- 12 mm
Length of the trachea
- 10-12 cm
Where does the trachea begin and end on the vertebrae?
- begins at CV6
- ends at TV5
Describe the cartilage of the trachea
- 16-20 C-shaped
- last cartilage: carina
- deficient in back (near esophagus)
What is the subcarinal angle?
- 62 degrees
What is the transition angle into the right bronchus? the left bronchus?
- 25 degrees
- 37 degrees
Describe the right primary bronchus and where it enters the right lung
- wide, short (2.5 cm), more vertical than left
- enters at TV5
Describe the left primary bronchus and where it enters the left lung
- long (5 cm), narrow, less vertical than right
- enters at TV6
Where does the apex of the lung end?
above the clavicle but below the neck of the first rib
What does the base of the lung rest on?
- diaphragm
What does the hilus contain?
- root of each lung, pulmonary ligaments, pulmonary arteries/veins, bronchi, lymph nodes, and bronchial vessels
How many lobes does the right lung have? Name them
-3
- upper love
- middle lobe
- lower lobe
What is the name of the bronchi that feed into the individual lobes of the lung?
- secondary (lobar) bronchi
How many segments are in the upper lobe of the right lung? Name them
- 3
- apical, posterior, anterior
How many segments are in the middle lobe? Name them
-2
- lateral and medial
How many segments are in the lower lobe? Name them
- 5
- superior, medial basal, anterior basal, lateral basal, and posterior basal
What is the name of the bronchi that feed into the segments of the lobes of the lung?
- Tertiary (segmental) bronchi
How many segments are there in the right lung? left lung?
- 10
-8 to 9
What are the 3 surfaces of the lung called?
- costal
- mediastinal
- diaphragmatic
Name the 3 borders of the lung
- anterior (mediastinal and costal)
- inferior (costal and diaphragmatic)
- posterior (mediastinal and costal)
What nerve runs anterior to the lung root?
- phrenic nerve
What nerve runs posterior the lung root?
- vagus nerve
What is the pulmonary ligament?
- folds of pleura that project from the root to the mediastinum
How many fissures does the right lung have? Name them
- 2
- oblique and horizontal
What does the oblique fissure separate and where is it located?
- separates upper/middle lobes from lower lobe
- starts at 5th rib and follows 6th rib to reach diaphragmatic border
What does the horizontal fissure separate and where is it located?
- separates middle from upper lobe
- begins at 6th rib in mid-axillary line and ends at 4th rib behind sternum
How many lobes does the left lung have? Name them
- 2
- upper and lower
How many segments does the upper lobe of the left lung have? Name them
- 4
- apico-posterior, anterior, superior lingular, inferior lingular
How many segments does the lower lobe of the left lung have? Name them
- 5
- superior, medial basal, anterior basal, lateral basal, posterior basal (BUT anterior basal and medial basal may come from same bronchus)
What 2 things does a bronchopulmonary segment contian?
- 1 segmental bronchus (tertiary)
- 1 segmental artery
What is the most posterior structure in the hilum?
- primary bronchi
What is a bronchopulmonary segment?
- smallest, functionally independent region
What are the names of the 3 arteries that supply the lungs?
- right pulmonary artery
- left pulmonary artery
- bronchial arteries
Where is the right pulmonary arteries/where does it travel?
- root of lung
- anterior and inferior to primary bronchus
- passes between upper and middle lobe bronchi
- ends posterolateral to stem bronchus
Where is the left pulmonary artery located and where does it travel?
- root of lung
- anterior and superior to primary bronchus
- passes above upper lobe bronchus
- ends posterolateral to stem bronchus
How many bronchial arteries are there?
- 3
- 2 left and 1 right
Where does the left bronchial arteries come from?
- directly off aorta
Where does the right bronchial artery come from?
- off intercostal OR one of left branches
What are the names of the 2 left bronchial arteries?
- superior and inferior
What is the name of the right bronchial artery?
- Right third intercostal artery
OR
- Left superior bronchial artery
How many pulmonary veins are there?
- 2 (superior and inferior) for each lung
- 4 total
Where do the pulmonary veins lie?
- anterior and inferior to other structures within the hilus
What is the superficial plexus located with or near?
- visceral pleura
Does the superficial plexus contains its own nodes? Name them
- No, empties into hilar nodes
What are the nodes of the deep plexus?
- pulmonary nodes
- bronchopulmonary nodes
- tracheobronchial nodes
- Paratracheal nodes
Where are the pulmonary nodes located?
- bronchopulmonary segments
- interface between lung and bronchi
Where are the bronchopulmonary nodes located?
- near lobar bronchi (where comes of primary bronchi)
Where are Paratracheal nodes located?
- around the trachea
What are the 2 types of tracheobronchial nodes?
- superior
- inferior
Where are superior tracheobronchial nodes located?
- where primary and lobar bronchi meet, closer to primary
Where are inferior tracheobronchial nodes located?
- under carina cartilage
Where is the thymus located?
- in front of great vessels
- behind sternum
Where is the left brachiocephalic vein located?
- in front of arteries
- joins right vein and forms superior vena cava
Where is the aortic arch located?
- begins anteriorly/slightly right
- goes in front of trachea
- passes over left primary bronchus
- ends posteriorly and left to TV4 body
Where do the branches of the aortic arch enter the neck?
- sides of the trachea
The trachea is in front/behind esophagus
- in front
Where is the thoracic duct located in relation to the esophagus?
- left side
What does the left recurrent laryngeal nerve run between on the left side?
- trachea and esophagus
Where does the esophagus begin and end?
- CV6 (pharynx)
- to TV11 (abdome at the stomach)
Describe the route the esophagus takes until it ends at teh abdomen
- travels slightly to left of TV1
- slightly right at TV5
- through diaphragm to the left of TV10
What does the anterior portion of the esophagus interact with?
- trachea and pericardium
What does the posterior portion of the esophagus interact with?
- vertebrae and thoracic aorta
What does the right portion of the esophagus interact with?
- parietal pleura
What does the left portion of the esophagus
- parietal pleura (and aorta in middle)
How many layers of the esophageal wall are there? Name them
- 4
- tunica adventitia
- tunica muscularis
- tunica submucosa
- tunica mucosa
What is associated with the tunica adventita?
- related to esophageal plexus of nerves
- contains plexus of veins
What does the tunica muscularis layer of the esophagus contain?
- nerve plexus (with sympathetic and parasympathetic fibers as well as postganglionic parasympathetic cell bodies)
What does the tunica submucosa layer of the esophagus contain?
- nerve plexus (with sympathetic and parasympathetic fibers as well as postganglionic parasympathetic cell bodies)
- venous plexus
What does the tunica mucosa layer of the esophagus contain?
- stratified squamous epithelium with tunica propria
What is the name of the artery that supplies the upper esophagus?
- inferior thyroid arteries
What is the name of the arteries that supply the middle esophagus? What structure do they come off of?
- off of the aorta
- bronchial, esophageal, mediastinal arteries
What is the name of the artery that supplies the lower esophagus?
- esophageal branch of the left gastric artery
The upper veins of the esophagus drain into ??? via which 3 veins?
- drain into the superior vena cava
- get to superior vena cava via inferior thyroid vein, azygos veins, and left brachiocephalic vein
The lower veins of the esophagus drain into ???? via which branches?
- drain into portal system
- via esophageal branches of left gastric vein
The venous plexus of the middle and lower thirds of the esophagus is part of?
- the port-caval anastomose
What is the main nerve supply called for the esophagus?
- esophageal plexus
What 2 branches/nerves from the esophageal plexus?
- vagus nerves
- splanchnic branches from sympathetic trunk
What does to vagus nerves contribute to the esophageal plexus?
- preganglionic parasympathetic fibers
- sensory fibers
What do the splanchnic branches from the sympathetic trunk contribute to the esophageal plexus?
- postganglionic fibers
- sensory fibers
What is the path of the thoracic aorta?
- begins to the left of the body of the TV4
- moves medially as it descends
- ends at the mid-line of TV12
- when enters the abdominal cavity through the diaphragm it is called the abdominal aorta
What is the left of the thoracic aorta?
- left lung
What is posterior to the thoracic aorta?
- superior: connective tissue between vertebral column and lung
- inferior: vertebral column
What is to the right of the thoracic aorta?
- Superior: vertebral column
- Middle: esophagus
- Inferior: right lung
What is anterior to the thoracic aorta?
- Superior: root of left lung
- Inferior: esophagus, then diaphragm
Which intercostal arteries branch off of the thoracic aorta?
- 3rd through 11th
How many left bronchial arteries are there? Names?
- 2
- superior and inferior
Name all of the branches off of the thoracic aorta
- 3rd-11th intercostal
- subcostal
- superior and inferior left bronchial
- esophageal
- mediastinal
- pericardial
- superior phrenic
What usually gives rise to the right bronchial artery? What else may give rise to it?
- right 3rd intercostal artery
- superior left artery
What is the path of the azygos vein proper?
- begins as right ascending lumbar vein in abdomen
- goes through aortic hiatus (diaphragm hole) goes in front of vertebral column
Where does the azygos vein proper empty?
- goes anterior and superior to right primary bronchus to empty into the superior vena cava
What veins empty into the azygos vein proper?
- right subcostal (below T12)
- lower 7 or 8 right intercostal
- hemiazygos
- accessory hemiazygos
- several esophageal
- several mediastinal
- several pericardial
- bronchial veins
- right superior intercostal veins
What is the path of the hemizaygos vein?
- begins as continuation of left ascending lumbar vein
- enters thorax through left crus of diaphragm (tendons to attach diaphragm to vertebrae)
- crosses at TV9 and empties into azygos
What veins empty into the hemiazygos vein?
- left subcostal
- 4 or 5 left posterior intercostal veins
- left ascending lumbar vein
- several esophageal
- several mediastinal
Where does the accessory hemiazygos vein cross the vertebrae to empty into the azygos vein?
- TV8
What empties into the accessory hemiazygos vein?
- 4th-8th left posterior intercostal
- left bronchial
Where does the first intercostal space (veins) drain into?
- either the brachiocephalic or vertebral vein
Where does the left superior intercostal veins drain?
- left brachiocephalic vein
What does the left superior intercostal vein cross as it travels to the left brachiocephalic vein?
- crosses aortic arch
- goes between left phrenic nerve and left vagus nerve
Where does the right superior intercostal vein drain?
- terminal portion of azygos vein
What are the 3 main parietal nodes of the thorax?
1) sternal/ parasternal/ internal thoracic nodes
2) intercostal nodes
3) phrenic nodes
Where are the sternal/parasternal/ internal thoracic nodes located?
- near internal thoracic vessels
Where are intercostal nodes located?
- near head and inferior to the neck of the ribs
Where are phrenic nodes mainly located?
- on diaphragm
What are the 3 types of phrenic nodes?
1) anterior nodes
2) lateral/middle nodes
3) posterior nodes
Where does the anterior nodes of the phrenic nodes lie?
- region of xiphoid process
Where do the anterior nodes receive lymph?
- liver
- diaphragm
- anterior abdominal wall
- middle phrenic nodes
Where do the anterior nodes drain?
- upward to sternal nodes
Where are the lateral/ middle nodes located?
- near where the phrenic nerves goe sinto the diaphragm
Where do the lateral/ middle nodes receive lymph?
- from diaphragm
- on right: from liver
Where do most middle/lateral nodes drain? the rest?
- anterior phrenic nodes
- some to posterior phrenic nodes
Where do posterior nodes lie?
- related to crura of diaphragm near thoracic aorta
Where do posterior nodes receive lymph?
- diaphragm
- middle phrenic nodes
Where do posterior nodes drain?
- posterior mediastinal nodes
What are the 3 visceral nodes?
1) anterior mediastinal lymph nodes
2) tracheobronchial nodes
3) posterior mediastinal lymph nodes
Where do the anterior mediastinal lymph nodes lie?
- near brachiocephalic veins
- within superior mediastinum
What types of nodes are included or are joined by in the anterior mediastinal lymph nodes?
- includes brachiocephalic nodes
- joined by sternal nodes
Where are the tracheobronchial nodes located?
- near where the trachea bifurcates and the hilus
Which vessels enter the tracheobronchial nodes?
- superficial: paratracheal vessels
- deep: lung vessels
Where are the posterior mediastinal lymph nodes located?
- around esophagus, aorta, soft tissues of posterior mediastinum
Where do the anterior mediastinal lymph nodes, tracheobronchial nodes, and posterior mediastinal lymph nodes drain into?
- bronchomediastinal lymph trunk
What are the 3 places that the bronchomediastinal lymph trunk drains into?
- right lymphatic duct
- thoracic duct
- into terminal part of subclavian vein
Which 2 structures joins the bronchomediastinal lymph trunk?
- jugular lymph trunk
- subclavian lymph trunk
What is the thoracic duct?
- major lymph vessel
Where does sthe thoracic duct travel?
- begins in abdominal region as cisterna chyli at LV2 level
- travels superior to right side of aorta through aortic hiatus of diaphragm at TV12 (on vertebral column)
- crosses to left at TV6
- arches over subclavian artery
- empties into where internal jugular vein and left subclavian vein join OR into subclavian vein
What does the thoracic duct drain?
- lower limbs
- abdominal viscera
- pelvic viscera
- perineum
Where is the thoracic sympathetic trunk?
- near heads/necks of rib
- extends up to cervical region
- extends down to lumbar region
Which spinal nerves contribute to the white communicating rami of the thoracic sympathetic trunk?
- 12 thoracic
- 1st and 2nd lumbar nerves
What type of fibers do white communicating rami have?
- preganglionic neurons
What do the white communicating rami (preganglionic neurons ) do?
- carry impulses from spinal nerve to the sympathetic trunk
Which spinal nerves contribute to the gray communicating rami?
- all spinal nerves
What type of fibers are in the gray communicating rami?
- postganglionic sympathetic neurons
What do the gray communicating rami (postganglionic sympathetic neurons) do?
- impulses to the smooth muscle and glands
What types of organs/ect do spinal nerves innervate?
- sweat glands
- smooth muscles
- erector pili muscles
What do visceral/splanchnic branches come off of?
- sympathetic trunk
The first 4 or 5 thoracic segments form what?
- pulmonary plexus
- cardiac plexus
- esophageal plexus
What ganglia joins the first 4 or 5 thoracic segments?
- cervical sympathetic ganglia
What types of fibers do the first 4 or 5 thoracic segments contain?
- postganglionic sympathetic fibers
What forms the greater splanchnic nerve?
- TV5- TV9
Where does the greater splanchnic nerve travel to?
- down into abdominal cavity through the crura of the diaphragm
What types of fibers does the greater splanchnic nerve contain?
- mainly preganglionic sympathetic
- some postganglionic sympathetic and sensory fibers
What branches come off of the greater splanchnic nerve and what types of fibers do they contain?
- esophageal branches
- postganglionic sympathetic fibers
Which segments form the lesser splanchnic nerve?
- TV10 and TV11
Where does the lesser splanchnic nerve travel?
- into abdominal cavity
What forms the least splanchnic nerve?
- visceral branches from TV12
Where does the right vagus nerve travel?
- enters thorax from above
- goes anterior to the subclavian artery
- behind lung roots
- joins with left to form esophageal plexus
- enters abdominal cavity as anterior/posterior vagal trunks
Where does the left vagus nerve travel?
- enters thorax from above
- anterior to aortic arch
- behind lung roots
- forms esophageal plexus
- enters abdominal cavity as anterior/posterior vagal trunks
Where does the recurrent/inferior laryngeal nerves travel?
- under right subclavian artery and aortic arch
- ascends to larynx
What type of branches come off of the recurrent/inferior laryngeal nerves
- cardiac branches
What is the pathway of the phrenic nerves? (before they differ)
- enter thorax from anterior surface of scalenus anterior muscle
- pass between subclavian artery and vein
What structure is the right phrenic nerve related to?
- superior and inferior vena cava
What structure is the left phrenic nerve related to?
- aortic arch
The phrenic nerves pass anteriorly to what structure?
- lung roots
Which 2 structures to the phrenic nerves go between?
- pericardial and pleural sacs
What do the phrenic nerves innervated
- the diaphragm