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239 Cards in this Set
- Front
- Back
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what forms the pleura?
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a layer of supporting tissue and a layer of: flat cells and mesothelium
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The pleura is divided into two major types based on location. Name them-
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1. Parietal PLEURA
2. Visceral PLeura |
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What is the pleura cavity?
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A potential space enclosed between the visceral and parietal pleura.
contains serous fluid that allows each pleura on either side of it slide smoothly against each other. |
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List all the names of the Parietal Pleura
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1. costal part
2. diaphragmatic 3. mediastinal 4. cervial pleura (cupola) |
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What is seen at t5 - t7
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mediastinal pleura reflects off and forms the root of the lung
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When is the mediastinal pleura continuous with visceral pleura?
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when the root joins the hilum of the lung
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Where can fluids be aspirated from the lungs?
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potential spaces
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The largest and clinically most important lung recessess are called:
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costodiaphragmatic recessess
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When are costodiaphragmatic recessess deepest or most shallow?
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They are deepest after forced expiration and more shallow after forced inspiration
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Discribe the movement of the inferior margin of the lung during quiet inspiration
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- crosses rib 6 on the midclavicular line
- rib 8 in the midaxillary line - then horiztonaly to vertebral collum at T10 |
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What do the pulmnonary arteries deliver?
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deoxygenated blood to the lungs from the right ventricle
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which lung is larger?
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RIGHT
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What marks the apex of the lung?
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first rib and root of neck
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The root of the lung is a -
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short tubular collection of structures that attach the lung to the mediastinum
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A thin blade like fold of pleura peojects inferiorly from the root of the lung and extends from the hilum to the mediastinum. This structure is called?
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pulmonary ligament
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Purpose of the pulmonary ligament?
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- stablizes position of the inferior lobe
- accomodate down-up trnaslocation of structures in the root during breathing. |
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In the mediastinum what pass immediatly posterior to the root of the lungs?
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Vagus Nerve
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In the mediastinum what passes immediatly anterior to the root of the lungs?
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Phrenic Nerve
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Within each root and located in the hilum are:
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1. pulmonary artery
2. two pulmonary veins 3. Main bronchus 4. bronchials vessels 5. nerves 6. lymphatics |
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Generally __________ is superior at the hilum, _______ is inferior and _______ is somewhat posterior
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pulmonary artery
pulmonary veins bronchi |
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Explain the lobar bronchis (superior) in each lung-
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RIGHT- lobar branch (going to superior lobe) branches from the in main bronchus IN the root
LEFT - it branches within the lung itself and is superior to pulmonary artery |
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How many lobes and fissures does the RIGHT LUNG have?
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3 lobes
2 fissures |
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What makes it possible for the lung lobes to move freely against each other?
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invaginations of the visceral pleura
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Name and locate the fissures of the RIGHT LUNG
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1. oblique = seperates inf lobe from superior lobe and middle lobe
2. Horizontal = seperates superior lobe from middle lobe |
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How can you mark the oblique fissure on a patient during quiet respiration?
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- cruved line on the thoracic wall, that begins at spinous process of T4. crosses 5th interspace laterally and then follows the contour of rib 6 anteriorly.
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The horizontal fissure follows the fourth intercostal space from the sternum until??
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it meets the oblique fissure as it crosses rib 5
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Where should clinicians listen for lung sounds from each lobe?
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orientations of the oblique and horizontal fissures
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The LEFT lung as 2 lobes seperated by?
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oblique fissure (which is more oblique then the right lung, hell yeah baby)
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During quiet respiration, where is the position of the left lung oblique fissure?
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between spinou sprocesses of t3 and t4 across the 5th interspace laterally to rib 6 anteriorly
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What projects over the heart bulge?
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Lingula
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Where is the lingula?
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on the anterior surface of the lower part of the superior lobe (left lung) projecting over the heart bulge
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The medial surface of the LEFT lung, lies adjacent to?
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heart
arch thoracic aorta esophagus |
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______ are related to the superior lobe of ht eleft lung as they pass over the dome of the cervial pleura and into the axilla
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left subclavian artery and vein
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Trachea extends from what to what?
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C6 to T4/5
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Where does the trachea bifuracate?
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at T4/5
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What does the trachea bifuracate into-
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left and right bronchius
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The posterior part of the trachea is composed mainly of-
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smooth muscle
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Discribe the coure of the RIGHT BRONCHI
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wide and verticle course through the root and hilum (which is why things tend to get stuck in here)
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The main bronchus devides in each lung into___ and then into______
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lobar bronchi (secondary)
segmentla bronchi (tertiary) |
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The segmental Bronchi supply ____ ?
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bronchopulminary segments
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Where do the bronchioles come from?
btw- the bronchioles dont have cartilege like the rest do |
segmental bronchi
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What is a bronchopulmonary segment?
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- area of lung supplied by a segmental bronchus and its accompanying pulmonary artery branch
- smallest functionally independant region of a lung and the smallest area of lung that can be isolates and removed without affecting adjadcent regions |
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The tributaries of the pulmonary vein pass intersegmentally _________________
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between and around the margins of the segments
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How many Bronchopulmonary segments are there in each lung?
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10 ( and in the left lung some tend to fuse)
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The pulmonary arteries bring deoxygenated blood to the lungs from the
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right ventrical
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Where does the bifurcation of the pulmonary trunck occur?
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left of the midline inferior to T4/5 and anterinferioly to the left of the bifurcation pf the trachea
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Which is the longest pulmonary artery?
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RIGHT
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Cool things about Right Pulmonary artery
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- inferior to tracheal bifurcation
- enters root of lung and gives off a branch to superior lobe - after it passes through the hilum it gives off another recurrent branch to the superior lobe |
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Cool things about LEFT pulmonary artery
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- anterior to decending aorta
- branches all in the lung |
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The pulmonary veins drains into the ____ of the heart
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left atrium
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What constitues the nutritive vascular system of the pulmonary tissues?
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bronchial arteries and veins
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What are the pulmonary tissues?
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- bronchial walls and glands
- walls of large vessels - vesceral pleura |
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What do the bronchial arteries and veins connect with?
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pulmonary ariteries and veins inside the lung
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Where do the bronchail arteries orignate from?
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- thoracic aorta and one of its branches
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The bronchial Vein drains into...
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1. pulmonary veins
2. left atrium 3. Ayogos vein (RT) 3. Hemiazygos vein (LFT) |
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The visceral pleura and other structure of the lung are supplied by ? (nervly)
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visceral afferents and efferents (distributed through the anterior pulmonary plexus and posterior pulmonary plexus)
from spynpathetic trunk and vegas nervre |
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What constrict the bronchioles?
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vegas NERVE
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What dialates the bronchioles?
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sympathetic system
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What seperates the Mediastinum into superior and inferior parts?
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A horizontal plane passing through the sternal angle and the intervertebral disc between T4/5
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The inferior part of the mediastinum is further devided by ?
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pericardium
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What constitues the medial mediastinum?
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heart and pericardium
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Air enters and leaves the lungs via
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main bronchi
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The mediastinum extends from ____ and from ____
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1. sternum to vertebral bodies
2. superior thoracic aperture to the diaphram |
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The mediastinum contains....
and serves as a passage way for..... |
thymus gland
pericardial sac heart trachea major arteries and veins - esophagus - thoraacic duct - and some NS components |
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The pericardium lining consists of two components
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- fiberous pericardium
- serous pericardium |
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What adheres to the heart and forms its outer covering?
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visceral layer of the serous pericardium (epicardium)
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What shape is the zone of reflection?
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J shape
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The zone of reflection forms a culdesac posterior to the left atrium called-
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oblique pericardial sinus
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What sinus lies posterior to the ascending aorta and pulomonary trunk, anterior to superior vena cave and superior to the left atrium?
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Transverse Pericardial Sinus
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In surgery, a finger is placeed _________ to seperate arteries from veins
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Transverse Pericardial Sinus
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How do you touch the oblique sinus?
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place hand under apex of the heart and move it superiorly
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What arteries supply the pericardium?
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1. internal thoracic
2. pericardiophrenic 3. musculophrenic 4. inferior phrenic arteries 5. thoracic aorta |
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What nerves supply the pericardium?
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1. vagus
2. sympathetic trunk 3. phrenic nerves |
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What carries pain (somatic sensation) from the parietal pericardium?
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phrenic nerves
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Pain related to t a pericardial problem may be refferred to as
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supraclavicular region of the shoulder
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The base of the heart consists of-
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left atrium
little bit of right atrium proximal parts of the great veins |
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Great veins enter ____ of the heart
the pulomonary veins enter.. venae cavas enter... |
base of heart
right and left sides of the left atrium up and lower ends of right antrium |
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When standing, the base of the heart is opposite
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T6-T9 when standinf
T5-T8 while not standing |
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Esophagis lies immediatly ______ to the ____ of the heart
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posterior to the base of the heart
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What is positioned deep to the left of the 5th intercostal space?
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Apex of heart (left ventricle)
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The coronary sinus does what?
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returns blood to the heart from the wall of the heart
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How does blood get between the right atrium and the right ventricle?
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right atrioventricular orifce
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What closes the right atrioventroicular orfice?
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closed by the tricuspid valve during ventricle contraction
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What externally indicates the division of the right atrium into two continous spaces?
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sulcus terminalis cordis (a shallow vertical groove)
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What soace is posterior to the crista terminalis?
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sinus of vena cavea
(which is derived embriologically from the right horn of the sinus venous) |
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What is somtimes referred to as the atrium proper?
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The right auricle (which is anterior to the crista terminales)
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What fans out from the crista like teeth of comb?
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musculi pectiniati
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Where do the floating ribs end?
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posterior abdominal musculature
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What externally indicates the division of the right atrium into two continous spaces?
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sulcus terminalis cordis (a shallow vertical groove)
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What soace is posterior to the crista terminalis?
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sinus of vena cavea
(which is derived embriologically from the right horn of the sinus venous) |
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What is somtimes referred to as the atrium proper?
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The right auricle (which is anterior to the crista terminales)
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What fans out from the crista like teeth of comb?
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musculi pectiniati
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Where do the floating ribs end?
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posterior abdominal musculature
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supernumary rib =
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- an extra cervical rib by C7 may compress C8 or T1, compressing inferior trunk of brachail plexus and subclavian nerve
extra lumbar ribs are less common but can cuase diagnostic flase positives |
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The grooves in the 1st rib are seperated by
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scalene turbucle and ribs
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How many intercostal spaces are there and how man intercostal nerves are there?
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11 spaces
11 nerves |
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what is the nerve for the 12th subcostal space?
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spinal nerve T12 is the intercostal nerve
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3 pertinant part of the sternum?
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manubrium
body xiphoid |
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do ribs have bone marrrow?
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yepperdoody
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What forms the sternal angle of Louis?
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the manubrium and body of the sternum coming together
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Angle of Louis is located opposite to ....
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the 2nd pair of costal cartiledge
AT the level of the 4th disc between T4/5 vertibrae. |
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what vertibrae level is the xiphoid process at?
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T10
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What vertibral level is the ody of the sternum at?
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T5-T9
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what would a person have if they were missing a xiphoid process?
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pectum excavatum
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What is a median sternotomy?
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when the thoracic cavity is opened for heart surgery the mediastinum is split in the a median plane and a retracted plane.
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when the sternum fuses it causes a
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pectum carinatum
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the inferior thoracic aperture is also known as the
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anatomic thoracic outlet
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What bounds the inferior thoracic aperture?
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1. T12
2. 11 and 12 rib pairs 3. costal margin of ribs 7-10 4. xiphisternal joint |
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Symptoms of costalclavicular syndrome are:
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- pallor and coldness of the skin of upper limb
- diminished radial pulse |
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What is slipping Rib syndrome?
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displsacement of a costal cartiledge from the sternum
- severe pain in repisratory movements - lump like deformity at site |
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What is a rib SEPERATION?
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dislocation of a costo chondrial junction bewteen the rib and its costal catiledge.
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What might occur with seperation of the 3-10 ribs?
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tearing of the perichondrium and periosterm usually occur
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2/3 of the breasts rests on the
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pectorial fascia
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What is the beginning of the cooper ligaments?
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pectorial fascia
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what keeps boobs in place?
(what firmly ataches to the mammory gland) |
suspensory ligaments (of cooper)
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how many lobules of grandular tissue does the breast contain?
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15- 20
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What drains each breast lobule?
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lactiferous ducts
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The artierial supply of the breast is derived from
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- medial mammory branches from perforating branches
-anterior intercostal branches of the internal thoracic artery - lateral thoracic and thoracoacromial bracnhes - branches of the thoracic aorta in the intercostal spaces |
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internal thoracic artery priginates from the
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subclavian artery
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posterior intercostal arteries are found at the base of the boob which is...
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2nd to 6th intercostal spaces
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75% of breast lymph drains into the-
what about the remaining lymph |
axillary lymph nodes
the med quandrant of the booob drains into parasternal lymph nodes and the lat boob may drain into abdominal lymph nodes |
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The nerves of the breast derive from the aterior and lateral.....
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cutaneous branches of the 4th-6th intercostal nerves
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The breast tail is from__ to___
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thorax to axilla (important to know for cancers)
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Usually superonumary breasts consist of
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rudamentary nipple and areola
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The innervation of the breast and vasculture of the breast is very----
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similiar
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What forms the subcostal nerves?
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anterior rami of the T12 nerves, inferior to the 12th rib
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Does the External intercostal muscle reach the sternum?
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Noppydoppy
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Intercostal muscles, tranvserve thoracic muscles and the subcostal muscle are all inNerveated by?
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intercostal Nerve
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Levator Costarum does what is innverated by what?
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elevates ribs and inervated by posterior rami of c8 to t1
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What innvervates the surratus posterior superior? and what is its actions
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2-5th intercostal nerve and it elevates the ribs
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Name the two main branches of the ventral Rami
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1. lateral cutaneous branch
2. anterior cutaneous branch |
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Attypical intercostal nerves
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1st and 2nd
7th and 11th |
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Order of structures in the costal groove from superior to inferior
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intercostal vein
intercostal Artery Intercostal Nerve |
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What is directly superior to each rib
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collateral branches (NAV)
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what connects the intercostal and subcostal nerve to the ipsilateral symphathetic trunck?
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Rami communicantes
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How does an intercostal nerve block cause complete loss of sensation?
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two or more intercostal nerves in adjecent intercostal spaces are anesethetized (becuase dermatomes tend to have overlapping)
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What is between the internal thoracic cage amd the lining of the plerual cavitites?
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endothoracic fascia
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the first and secomd intercostal space get arteriol supply from
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superior thoracic
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3 branches from the thoracic aorta
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1. posterior intercostals
2. subcostal 3. lumbar arteries |
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what is glued to the endothoracic fascia
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parietal plEURA
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If there is too much serous pleura fluid you have-
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pleura effusion
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The root of the lung connects the lung with
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heart and trachea
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The coronary sinus is the
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major drainange of heart
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What reinforces cuspids of AV valve and the differences between sides
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papillary
RT- has 3 : ant, post, sept LEFT- has 2 : ant and post |
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Where can you only find moderator veins?
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Right ventricle ONLY
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Brachiocephalic veins are located immediatly below the-
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Thymus
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Superior Vena cava formed where the right and left....
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BRACHIOCEPHALIC VEINS join
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Superior Vena Cavea recieves ______ IMMEDIALTY before entering the pericardial sac
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Azygos vein
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what part of aorta is in superior mediastinum
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arch of aorta
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what crosses the three branches off the auperior arch of aorta?
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brachiocephalic vein
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Nerve of superior mediastinum
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Vagus
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Thoracic duct drains between
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left subclavian vein and internal jugular
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Where does the esophagus end?
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cardiac opening of the stomach
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Where does esophagus begin?
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inferior to cricoid cart
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After being crosses by aorta, the esophagus is compressed by the-____ and then passes posterior to the _____
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left main bronchus
left atrium |
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Esophageal arteries arise from:
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1. thoracic aorta
2. bronchial arteries 3. ascending branches of left gastric artery |
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When does the thoracic aorta begin?
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edge of T4
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When does thoracic aorta end?
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T12
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Azygos system arises from opposite ____ at the junction between the....
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L1, L2
riught acedning lumbar vein and right subcostal vein |
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How does the azygos system enter the thorax
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through aortic hiatus of diaphram
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hemiazygos vein arises at the junction between the...
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lwwft ascending lumbar vein and left subcostal
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How does the HEMIazygos enter the thorax?
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through left CRUS of diaphram
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How does the sympatheitc trunk leave the thorax?
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under the medial arcuate ligament or through the cura
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Innervation of various thoracic viscera?
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first 5 ganglia - postganglionic sympathetic fibers
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what forms the 3 thoracic splanic nerves?
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lower 7 ganglia
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GREATER splanchnic nerves arise from...
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5th-9/10th ganglia
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How does the greater splanchnic nerve leave the thoracix?
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crus
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Where does the greater splanchnic nerve end?
where does the lesser splanchnic nerve end? where does least splanichnic nerve end? |
celiac glanglia
aorticonel ganglia renal plexus |
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what innervates the pericardium?
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phrenic nerve and symphathetic fibers
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the adventitia of the great vessels is an one of the attachments sights for?
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fiberous pericardium
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Opening of the pericardium =
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sternocostal surface of heart
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Right main coronary artery supplies how much of the SA and AV node?
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Sa 60%
AV 80% |
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The part of the veous sinus incorporated into the primordial atrium becomes the
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smooth walled sinus venarum of the adult right atrium
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The opening of the vena cavea into the right atrium is formed by
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oval fossa and limbus of the oval fossa (surrounded by sinus venarum
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Where would you find the pectinae muscles?
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On the RIGHT heart bordering right atrium inferiorly
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What would you find inplace of the pectinate mucles on the LEFT side of the heart?
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trabeculae carneae
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The SVC and the IVC drain into the
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right atrium
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what leads blood from right ventricle to the pulmonary trunk?
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conus arteriousus
(infundibulum) |
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Interior right ventricle has irregular muscle elevations called
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trabecula carnaea
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What carries the Right bundle of the AV node from the heart to the rt ventrical papillary muscles?
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Septomarginal Trabecula (moderator Band)
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What guards the right AV orifce?
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tricuspid valve
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what prevents cusp seperation during systol?
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Tendinous cords (L. chordae tendinea)
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what chort cut facilitates conduction time?
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moderator band
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the pulmonary valve is at the level of
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3rd costal cartilage
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What prevents pulmonary cusps from sticking to the walls of the pulmonary trunck and failing to close?
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pulmonary sinuses
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What are the sinuses of valsavla?
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the three aortic sinuses. anatomic dialations right above aortic valve
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Sinus of valsavla AKA
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Aneurysm of the aortic sinus'
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discribe the openings for the coronary arteries
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in the right and left semilunar cusps ( not in the posterior semilunar cusp)
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what is the electric insulator of the heart?
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fiberous skelteton
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what is near junction of SCV and right atrium?
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SA node
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what is posterior to the interatrial septum near opening of the coronary sinus?
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AV node
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what are the great veins
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SVC and IVC
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what are the great arteries?
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pulmonary artery
aorta |
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the only bridge on conduction betweeeen the atrial and ventricular myocardium is?
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AV bundle of HIS
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The Av bundkle devides where?
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just BEFORE start of IV septum
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What carries inpulse from left anf right bundle branches to the myocardium ventricles?
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purkinje fibers
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what is associated with QRS complex?
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purkinje fibers
(they also serve as last resort if pace maker fails) |
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pain fibers are sympathetic or para?
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sympathetic
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large outlet of thoracic is closed by the
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diaphram
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what rib can you palpate the sternomanubrium joint?
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2nd rib
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what are the anterior thoracoappendicular muscles?
|
pec maj and minor
subclavious serratus anterior |
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external intercostals help with what movement?
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Elevate ribs
(inspiration) |
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Internal Intercostal mucles help with what movement?
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Depress ribs
(expiration) (inner most also do this) |
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Subcostal muscle movement-
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Elevates ribs
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what artery supplies first and second intercostals?
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axillary artery
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What 3 things branch from the internal thoracic artery and giev blood to the diaphram?
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pericardiophrenic
musculophrenic superior phrenic arteries |
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what innervates the diaphram?
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phrenic Nerve (c3-c5)
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what are lines of pleura reflection?
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areas where pleura linging sharply change direction
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what structures are between the esophagus, aorta, and symphathteic trunk?
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1. thoracic duct
2. azygos vein 3. splechnic nerve |
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do bronchial arteries go to respirotry tissue?
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no the pulmonary arteries do
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pulmonary arteries anastamos with
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bronchi arteries
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most of the blood supplied by the bronchialarteries is returned by
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pulmonary veins (DVT)
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pulmonary arteries supply while the bronchialarteries supply-
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deoxygenated blood from the right ventricle (pulmonary circuation)
supplies oxygenated blood pumped from the left ventricle (systemic ciruclation) |
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altogether there are __ pulmonary arteries and ____ pulmonary veins
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2
4 |
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RALS
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the way pulmonary artery goes in the lung w/r/t bronchi
Right Anterior Left Superior |
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The splanchnic nerves are paired nerves that
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innervate the viscera, carrying fibers of the autonomic nervous system (visceral efferent fibers) as well as sensory fibers from the organs (which are also known as visceral afferent fibers). All carry sympathetic fibers except for the pelvic splanchnic nerves, which carry parasympathetic fibers.
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Thoracic splanchnic nerves arise from the
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the sympathetic trunk in the thorax and travel inferiorly to provide sympathetic innervation to the abdomen. The nerves contain preganglionic sympathetic and visceral afferent fibers.
greater is under t10 and lesser is under t11 |
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T8
T10 T12 |
- venacavae
- esophagus - aorta |
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During inspiration the diaphragm contracts causing the
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central tendon to be drawn inferiorly which partially flattens the domes. The result is an enlargement of thoracic cavity and reduction in intra-thoracic pressure
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hemiazygos drains beneath the
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2nd intercostal space
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Widows Artery (LAD) =
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anterior interventricular artery
- most deadly with infarction supplied more blood to myocardium then any other artery |
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What lung is the lingula in?
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LEFT
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Lingula of left lung
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However, the term lingula is used to denote a projection of the upper lobe of the left lung that serves as the homologue, and some sources define this as a distinct lobe.
There are two bronchopulmonary segments of the lingula: Superior and inferior. It is thought that the lingula of the left lobe is the remnant of the right lobe of the lung, which has been lost from the left through |
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what is the arch of the azygos vein?
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azygos vein arches over the root of the right lung to join the superior vena cava
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Middle mediastinum contains??
(a lot of stuff!!) |
- pericardium
- heart - ascending aorta - pulmonary trunk - SVC - arch of azygos - main bronchi |
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The right recurrent laryngleal nerve curves right B4...
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superior mediastinum
where as the left is IN the superior mediastinum |
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epicardium gets blood from
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coronary artery
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Thrombus clots can from in the
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right auricle of right atrium
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compare the fiberous ring of the pulmonary trunk with the fiberous ring of the aorta
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a
lr lr p |
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what does the aortic sinus have that the pulmonary sinus lacks?
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holes for cornoary artery
(osteum = hole) |
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All heart veins drain into ____
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right atrium
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The coronary sinus is between
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left atrium and left ventricle
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where does RIGHT vagas nerve enter the thorax?
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anterior to the right subclavian artery/ not part of the superior mediastinum
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waht is from when the imbulical cord is clamped?
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ligamentum anterioseum
(attaches aortic arch and pulmonary trunk) |
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discribe innervation of esophagus?
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1/3 skelital muscle
2/3 smooth muscle |
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what atrium does the sophagus run behind?
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Left
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Lymph system below the diaphram is called?
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chyle cistern
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Esophagus is compressed by three structures
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1. left main bronchi
2. aortic arch 3. diaphram |
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when does the thoracic duct cross torwards the left?
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t4-t6
and then empties at the left venous angle |
