W1D1 - Gross Anatomy - Thorax

Front 1

What bones comprise the thoracic skeleton?

Back 1

12 thoracic vertebrae and intervertebral cartilages, 12 pairs of ribs, and costal cartilages, and the sternum. also(ligaments)

Front 2

What are true ribs?

Back 2

Attach directly to the sternum through their own costal cartilage (Ribs 1-7)

Front 3

What are false ribs?

Back 3

Have cartilages that are joined to the cartilage of the rib just superior to them thus connected to the sternum indirectly. (Ribs 8-10)

Front 4

What are floating ribs?

Back 4

Have rudimentary cartilages that do not connect to the sternum in any way. They end of the posterior abdominal musculature. (Ribs 11-12)

Front 5

name the specific parts of a typical rib?

Back 5

(ribs 3-9)
Head(articulating facets, and crest of head), neck, tubercle, angle, costal groove, body

Front 6

What is the head of the rib, where is it found and what is it's purpose/attachment?

Back 6

wedge shaped by 2 facets that are separated by a crest. The facets articulate with the vertebrae superior and inferior to the rib.

Front 7

What is the tubercle, where is it found and what is it's attachment?

Back 7

is found at the junction of the head and body. The tubercle includes a smooth articulating part that articulates with the transverse process of thoracic vertebrae and a rough nonarticular part used for attachment of the costotransverse ligament.

Front 8

T/F the tubercle includes a articulating process and non-articulating process.

Back 8

true, non articulating process attached by ligament thus is rough from tension.

Front 9

What is the costal groove and where is it found? what is it's purpose?

Back 9

A concave internal border on the internal inferior part of the rib, it houses the "VAN" - intercostal artery, vein and nerve.

Front 10

What is the body of the rib?

Back 10

– is thin flat and curved with a concave internal surface found at the inferior boarder called a Costal Groove that protects the intercostal nerve and vessels. also curves around bodY:angle

Front 11

What type of bone is the rib composed of?

Back 11

It is composed of Compact bone exteriorly and has bone marrow inside (hematopoietic tissue).

Front 12

Where does the body of the vertebrae attach to the rib and where does the transverse process of the vertebrae attach to the rib?

Back 12

body: demifacet for articulation with head
transverse process: facet for articulation with tubercle

Front 13

Identify the areas where most ribs typically articulate with the vertebral column

Back 13

1. Costovertebral joint
2. Costotransverse joint

Front 14

What is occurring at the costovertebral joint? what is joining what?

Back 14

Superior and inferior costal demi facets articulate with head facets of a rib. (Synovial plane joint) (Superior demi facet on same level as rib while the Inferior demi facet is one level up)
ex: majority of rib 2 articulates with superior demifacet on thoracic vertebrae 2

Front 15

What are the parts of the thoracic vertebrae?

Back 15

Body: Where superior and inferior demifacets are found
Spinous Process: extends inferiorly and posteriorly
transverse process: facet for articulation with the tubercle of rib

Front 16

Identify the parts of the sternum?

Back 16

Manubrium, body, and xiphoid process
Manubrium is the (shield) that has the jugular notch found superiorly.
Where the manubrium and body meet is called the sternal angle, going inferiorly you find the xiphoid process.

Front 17

What is the manubrium and what connects here?

Back 17

Superior part of the sternum is roughly trapezoidal in shape lying at the level of the bodies of T3 and T4 vertebrae. Its thick superior boarder is indented and called the jugular notch (suprasternal notch). At the lateral boarders of the jugular notch are the clavicular notches for articulation with the sternal end of the clavicle. At the lateral boarder of the manubrium the first rib fuses with its vertical surface.

Front 18

What is the body of the sternum and what connects there?

Back 18

– is longer, narrower, and thinner than the manubrium. Costal cartilages 3-6 fuse with the body and partly fuse with costal cartilages 2 and 7 on its lateral boarders.

Front 19

What is the xiphoid process, where is it found and what does it do?

Back 19

at T10 vertebral level is the smallest part of the sternum at the inferior boarder. It varies from person to person in form and is cartilaginous in young people but ossified in adults older than 40 years. It is a midline marker for the superior level of the liver, central tendon of the diaphragm, and the inferior border of the heart.

Front 20

The ___________ also known as the manubriosternal joint is the interface between the manubrium and the body and is a palpable clinical landmark opposite the 2nd pair of costal cartilages at the level of vertebral disk IV between T4 and T5.

Back 20

sternal angle

Front 21

___________ is the joint between the body and the xiphoid process. In elderly people, this joint may fuse.

Back 21

xiphisternal joint

Front 22

What type of joints occur at the manubrium and along the body of the sternum?

Back 22

– Costal cartilage from the anterior proximal end of the rib and the body of the sternum are connected by a synovial plane joint. The cartilage of the 1st rib and the manubrium form a cartilaginous joint.

Front 23

What injuries may result from a comminuted sternal fracture?

Back 23

Injuries that may result from comminuted(multi-fragmentary fractures (formerly called comminuted) involve the bone splitting into multiple pieces) sternal fracture – Heart and pulmonary injury; because the pieces are free to severe other organs within the body cavitiy

Front 24

What aperatures or (inlets and outlets) exist in the thorax?

Back 24

the Superior thoracic aperature
the Inferior thoracic aperature

Front 25

identify and describe the structures that border the superior thoracic aperatures or (thoracic inlet)

Back 25

the opening at the top of the thoracic cage bounded by
1.Posteriorly by T1 vertebra
2.Laterally by the 1st pair of ribs and their costal cartilages
3.Anteriorly by the superior border of the manubrium
the trachea, esophagus, vessels, and nerve run throught this aperature.

Front 26

identify and describe the structures that border the inferior thoracic aperatures or (thoracic outlet)

Back 26

the opening at the bottom of the thoracic cage bounded by
1.Posteriorly by T12 vertebra
2.Posterolaterally, by the 11th and 12th pairs of ribs
3.Anterolaterally, by the joined costal cartilages of ribs 7-10, forming the costal margin.
4.Anteriorly, by the xiphisternal joint
Structures that pass through: IVA, esophagus or aorta

Front 27

Where are these joints found and what bones comprise them?
i. Costovertebral –
ii. Costotransverse –
iii. Sternocostal –
iv. Costochondral –
v. Sternoclavicular –

Back 27

i. head of rib - articulation with body of vertebra
ii. tubercle of rib articulation with transverse process of vertebra
iii. in sternum and rib (Costal cartilage from the anterior proximal end of the rib and the body of the sternum are connected by a synovial plane joint.)
iv. articulation of lateral end of costal cartilage with sternal end of rib (Primary cartilaginous joint)
v. Sternal end of the clavicle with the manubrium (at clavicular notch) and 1st rib costal cartilage (Saddle type of synovial joint) - fibrocartilagenous disk between sternum and clavicle - similar to TMJ.

Front 28

What is a landmark to find 1st rib and 2nd rib?

Back 28

1st rib is bound to the lat. border of manubrium and
2nd rib is bound to the sternum at the sternal angle.

Front 29

At what joint do most dislocation occur in children in relation to the thoracic cage?

Back 29

At the Costochondral joint.

Front 30

T/F the xiphoid process is usually fused in adults(old people0

Back 30

true

Front 31

What comprises the costal margin/

Back 31

the cartilage connection of false ribs to cartilage of true ribs - where you find the internal thoracic artery splitting into musculophrenic and epigastric - also found at the attachment of the diaphragm

Front 32

What is the movement of the thoracic wall during inspiration? Does an increase or decrease of pressure occur because of this? Does the Volume increase or decrease?

Back 32

The thoracic wall expands by outward motion of sternum and elevation of the ribs during inspiration causing a decrease of pressure within the thoracic cavity. (increase in volume) This draws air into the lungs to equalize the pressure.

Front 33

What is the movement of the thoracic wall during EXpiration? Does an increase or decrease of pressure occur because of this? Does the Volume increase or decrease?

Back 33

The thoracic wall contracts by inward motion of the sternum and depression of the ribs during expiration causing an increase of pressure within the thoracic cavity. This expels air out of the lungs to equalize the pressure. (decrease in volume)

Front 34

What would be the anatomical effect of unilateral paralysis of the diaphragm?

Back 34

i. By noting paradoxical movement since each half of the diaphragm is supplied by its own phrenic nerve.
ii. The paralyzed diaphragm dome will move in opposite direction of the active diaphragm dome.
1. Inspiration
a. Active diaphragm dome depresses.
b. Paralyzed diaphragm dome elevates due to abdominal viscera being compressed by the active side.
2. Expiration
a. Active diaphragm dome elevates
b. Paralyzed diaphragm dome depresses from the increased pressure in the lungs.

Front 35

What effect do the movement (inspiration and expiration have on intrathoracic volume and pressure?)

Back 35

i. The volume increases causing a decrease in pressure on inspiration.
ii. The volume decreases causing an increase in pressure on expiration.

Front 36

T/F the heart sits atop the diaphragm

Back 36

true

Front 37

An increase in volume results in an _______ in pressure.

Back 37

decrease and vice versa, this is why the increased space in the lungs during inspiration causes the air to flow in and equilibriate the pressure

Front 38

________ regulate the volume of thoracic cage.

Back 38

muscles: diaphragm, external and internal intercostals, etc...

Front 39

Identify the three dimensions of the thorax that change with breathing.

Back 39

i. Vertical dimension
ii. Anteroposterior dimension
iii. Transverse dimension

Front 40

In the Vertical dimension, during inspiration and expiration what is occurring? How is it measured and what muscle is responsible for it's movement?

Back 40

– (height of center part of thoracic cavity) increases during inspiration and decreases during expiration from activity of the diaphragm.

Front 41

In the Antero posterior dimension, what is included in the dimension and what movement does it make during inspiration and expiration and what muscles are responsible for it's movemnt.

Back 41

(distance from the vertebral column to the sternum) Increases during inspiration and decreases during expiration because of the intercostals muscles contraction and relaxation respectively.

Front 42

In theTransverse dimension, what is included in the dimension and what movement does it make during inspiration and expiration and what muscles are responsible for it's movemnt.

Back 42

(distance between lateral boards of the rib) increases during inspiration and decreases during expiration because of the intercostals muscles contraction and relaxation respectively.

Front 43

How are these dimensional changes (vertical, anteroposterior, and transvers) related to the “pump-handle” and “bucket-handle” actions described in the text?

Back 43

i. Pump-handle – The sternum moves like a pump handle with the hinge point considered as 1st rib attachment to the manubrium. The Xiphoid process is the point on the handle of greatest motion.
ii. Bucket-handle – Each rib is like a bucket handle that pivots at the vertebral column at one end and the sternum at the other end. On inspiration, the lateral part of the rib moves up as it pivots on the costovertebral joint and the sternocostal joint.

Front 44

What is the attachment and action of the external intercostal muscles? also, what is the innervation?

Back 44

External Intercostal;
Superior Attachment: Inferior border of ribs
Inferior Attachment:Superior border of ribs
Innervation: Intercostal nerve (from ant. rami)
Function: Elevate ribs during forced inspiration

Front 45

What is the attachment and action of the internall intercostal muscles? also, what is the innervation?

Back 45

External Intercostal;
Superior Attachment: Inferior border of ribs
Inferior Attachment:Superior border of ribs
Innervation: Intercostal nerve (from ant. rami)
Function: Elevate ribs during forced inspiration

Front 46

What is the attachment and action of the innermost intercostal muscles? also, what is the innervation?

Back 46

Innermost intercostals;
Superior Attachment: Inferior border of ribs
Inferior attachment: superior border of ribs
Innervation: intercostal nerve. (off of ant. rami)
Function: elevation of ribs during forced inspiration

Front 47

What is the attachment and action of the transversus thoracis (transverse thoracic) muscles? also, what is the innervation?

Back 47

Transverse Thoracic;
Superior Attachment: Internal surface of costal cartilages 2-6
Inferior attachment: Posterior surface of lower sternum
Innervation: intercostal nerve. (off of ant. rami - segmental innervation)
Function: Weakly depresses ribs

Front 48

What is the attachment and action of the Serratus Posterior Superior muscle? also, what is the innervation?

Back 48

Serratus Posterior Superior;
Superior attachment: Nuchal ligament, spinous processes of C7-T3 vertebrae
Inferior Attachment:Superior borders of 2nd-4th ribs
Innervation:2nd-5th intercostals nerves
Function: Elevate Ribs

Front 49

What is the attachment and action of the Serratus Posterior Inferior muscle? also, what is the innervation?

Back 49

Serratus Posterior Inferior;
Superior attachment: Spinous processes of T11-T12 vertebrae
Inferior Attachment:inferior borders of 8th-12th ribs near their angles
Innervation:9th-11th intercostals nerves subcostal (T12) nerve
Function: Depress Ribs

Front 50

What is the attachment and action of the Levator Costarum muscle? also, what is the innervation?

Back 50

Levator Costarum;
Superior attachment: Transverse processes of T7-T11
Inferior Attachment:Subjacent ribs between tubercle and angle
Innervation:POSTERIOR rami of C8-T11 nerves
Function: Elevates Ribs

Front 51

Where are subcostal muscles found?

Back 51

overlying the ribs on the inner surface of the thoracic cage.

Front 52

Describe the origin and course of a typical intercostal nerve.

Back 52

1. Begins as Anterior rami of T1-T11 run along intercostals space
2. Run initially along the posterior aspects of the intercostals spaces between the parietal pleura and the internal intercostals membrane.
3. Near the angles of the rib, the nerves pass between the internal intercostals and innermost intercostals muscles and into the costal grooves inferior to the intercostals vein.

Front 53

T/F the transversus thoracis is in the same plane as the innermost intercostals.

Back 53

true

Front 54

How many intercostals nerves are there?

Back 54

11 (T1-T11)
Subcostal nerve is T12

Front 55

Are there any collateral branches associated with the intercostal nerves?

Back 55

4. Collateral branches arise at the angle and near the sternum while the intercostals nerve.
a. Lateral cutaneous branches arise at the angle of the ribe at the midaxillary line and runs on the anterior surface of the internal intercostals muscle.
b. Anterior cutaneous branches near the sternum as it turns anteriorly, passing between the costal cartilages and entering the subcutaneous tissue.

Front 56

T/F the innermost intercostal muscles are found only at the lateralmost parts of the intercostal spaces.

Back 56

treu

Front 57

The anterior rami of the t1 - t11 segments form what nerves?

Back 57

intercostal nerves that run along the extent of the intercostal spaces.

Front 58

The anterior rami of the t12 nerve, inferior to the 12th ribs, form the ________ nerves.

Back 58

subcostal

Front 59

Where do the lateral cuteaneous branches come from?

Back 59

a. Lateral cutaneous branches arise at the angle of the ribe at the midaxillary line and runs on the anterior surface of the internal intercostals muscle.

Front 60

Where do the anterior cuteaneous branches come from?

Back 60

b. Anterior cutaneous branches near the sternum as it turns anteriorly, passing between the costal cartilages and entering the subcutaneous tissue.

Front 61

What is the subcostal nerve?

Back 61

The anterior rami of the T12 nerves inferior to the 12th ribs

Front 62

How are the intercostals nerves involved in the innervations of the muscles in this region?

Back 62

Muscular branches arise all along the course of the intercostals nerves to supply the intercostals, subcostal, transverse thoracic, and serratus posterior muscles.

Front 63

Describe the contents of a typical intercostals space.

Back 63

1.Vein – Intercostal vein in costal groove most superior
2.Artery – Intercostal artery in costal groove between V and N.
3.Nerve – Intercostal nerve in costal goove most inferior
4.Space between nerves
5.Nerve – Collateral branch of intercostal nerve at superior boarder of rib
6.Artery – Collateral branch of intercostal artery at superior border of rib between V and N
7.Vein – Collateral branch of intercostal artery at superior boarder of rib below the artery

Front 64

What is the relationship of the neurovascular bundle(intercostal VAN) to the muscles of the intercostal space?

Back 64

They lie between the internal and the innermost intercostals muscles. laterally.

Front 65

How are the anterior and lateral cutaneous branches related to their intercostal nerve of orgin?

Back 65

They have branched off of their respective intercostal nerve arising off of the anterior rami.
1. Anterior cutaneous branches arise near the sternum
2. Lateral cutaneous branches arise near the rib angle

Front 66

3.What is the cutaneous distribution of these branches? Define a “dermatome”

Back 66

Dermatomes and myotomes of the trunk run in bands around the body at each vertebral level. The dermatome is the sensory innervations that feed into the dorsal root at a particular vertebral level.

Front 67

Explain the anatomical basis for shingles.

Back 67

The herpes virus invades a spinal ganglion and is transported along the axon to the skin where it produces an infection that causes sharp burning pain in the dermatome supplied by the involved nerve. A few days later, blisters or rashes appear on specific dermatome.

Front 68

The intercostal nerve communicate with the sympathetic trunk via _________ ________.

Back 68

rami communicantes

Front 69

What are the specific arterial branches that supplky the thoracic wall?

Back 69

Posterior intercostals
Anterior intercostals
Internal thoracic
Subcostal

Front 70

The innervation of the levator costarum is from the ________

Back 70

posterior primary rami of C8 - T11

Front 71

What is the origin of the anterior and posterior rami embryologically?

Back 71

anterior rami: ventral hypomere
posterior rami: dorsal epimere - somites give rise to spinal nerve

Front 72

epimeric vs. hypomeric muscles would be found where in an adult body?

Back 72

epimeric muscles are posterior
hypomeric muscles are anterior

Front 73

How are the veins, arteries and nerve arranged in the costal groove?

Back 73

Vein, Artery, nerve (VAN) Superior to Inferior

Front 74

The veins drain into the _____ system.

Back 74

azygous

Front 75

What fascia lies over the innermost intercostals?

Back 75

endothoracic fascia

Front 76

what artery does the supreme intercostal branch off of and what does it supply?

Back 76

off of the subclavian arteries, and goes to rib1 and2

Front 77

Thorax is supplied by arteries fom 3 sources:

Back 77

Thoracic aorta,
subclavian artery
axillary artery

Front 78

What artery branches directly off of the thoracic aorta?

Back 78

posterior intercostal arteries

Front 79

What two branches come of the subclavian artery and supply the upp ribes and anterior aspect to anastamose with posterior intercostals?

Back 79

Internal thoracic - does down anterior aspect of thoracic cage and has anterior intercostal arteries branching off to anastomose with posterior intercostal a.
Supreme intercostal also branches of and supplies the uppermost ribs because arch of aorta doesn't go that high.

Front 80

What does the lat. thoracic branch off of?

Back 80

the axillary artery, also the thoracoacromial branches of superiorly to the lat. thoracic.
lat. thoracic is found lateral to the pect. m.

Front 81

What are the veins of the thoracic wall?

Back 81

Right brachiocephalic vein comes off SVC, and has internal thoracic branch which has several other branches
1.supreme intercostal branch
2.anterior intercostal

Also have azygous vein along the spinal vertebrae in the back (where everything drains) and has posterior intercostal veins branching off of it.

Front 82

2.What are where are the azygos and hemiazygos veins? What do they do?

Back 82

a.Function: Drain blood from the posterior walls of the thorax, abdomen, and the mediastinal viscera
b.Azygos – forms a collateral pathway between the superior vena cava and the inferior vena cava. It courses on each anterior side of the vertebral column.
c.Hemiazygos – is the main tributary of the azygos vein. It arises from the inferior vena cava or the renal vein and joins the azygos vein around T7 or T8.

Front 83

What do the hemiazygous and accessory veins branch off of? (they are found on the LEFT side)

Back 83

the azygous vein

Front 84

What is endothoracic fascia and where is it found?

Back 84

a thin fibroareolar layer between the internal aspect of the thoracic cage and the lining of the pleural cavities (parietal pleura). This fascia invests the underlying internal and innermost intercostal and the subcostal and transverse thoracic muscles. It blends with the perichondrium of the costal cartilages.
Function: provides a cleavage plane, allowing the surgeon to separate the parietal pleura form the thoracic wall, providing access to intrathoracic structures.

Front 85

What is found between the parietal and visceral layers?

Back 85

a POTENTIAL space 'mesothelium' - produces fluid as lubricant

Front 86

Parietal pleura has regional names, name them.

Back 86

cervical, (superior
costal - lining ribes
mediastinal - toward midline
diaphragmatic - towards diaphragm

Front 87

What is a pleural reflection? There are 3 of them

Back 87

a change in direction of the membrane - sternal
- vertebral
- costal

Front 88

Where is the midsternal line, midclavicular line, an dmidaxillary lines found?

Back 88

the mid sternal line is a vertical line running down the center of the sternum, assists in finding the sternal angle as well as jugular notch
The midclavicular line is found mid-clavicle and also is vertical
The mid axillary lines runs from the center of the armpit vertically

Front 89

Where are the jugular notch, and sternal angle and infrasternal angle found?

Back 89

the jugulary notch is found anteriorly at the base of the neck between the sternocleidomastoid muscle
the sternal angle is below the jugular notch and is slightly elevated on human body
the infrasternal angle is found below the xiphoid process and is the angle created by the costal margins of the ribs. (also known as the subcostal angle)

Front 90

Identify the three compartments of the thorax and the contents of each compartment

Back 90

2 – Pulmonary cavities – contain the lungs and pleurae (lining of lungs)
1 – Mediastinum cavity – contains heart, thoracic parts of the great vessels, thoracic part of the trachea, esophagus, thymus, and other structures like lymph nodes.

Front 91

What are the two main subdivisions of the pleurae?

Back 91

Visceral pleura – covers the lungs and is adherent to all its surfaces and can’t be removed from its surface. Covers organ
Parietal pleura – lines the pulmonary cavities adhering to the thoracic wall, mediastinum, and the diaphragm. Lines walls

Front 92

Identify and describe the location of the four parts of the parietal pleura.

Back 92

Cervical part – extends through the superior thoracic aperature at the level of the 1st rib making a cup-shaped dome over the lung.

Costal part – Covers the internal surface of the thoracic wall and is separated from the wall by the endothoracic fascia.

Mediastinum part – covers the lateral aspects of the mediastinum.

Diaphragmatic part – covers the superior or thoracic surface of the diaphragm on each side of the mediastinum.

Front 93

How is endothoracic fascia different from the parietal pleura?

Back 93

Endothoracic fascia invests the thoracic muscles on the internal wall of the thorax while the parietal pleura is continuous with the visceral pleura creating a space between the two pleura for movement of the lungs without excess frictional damage.

Front 94

What is a pleural line of reflection?

Back 94

Reflection is a change of the pleura direction at an angle. Sternal, vertebral, and costal reflection are made in the parietal pleura.

Front 95

What is the pulmonary ligament?

Back 95

A double fold of pleura inferior to the lung root, extends between the lungs and mediastinum

Front 96

Costodiaphragmatic recess: is what?

Back 96

Potential space created by the reflection of the ribs to the diaphragm.

Front 97

Costomediastinal recess – is what?

Back 97

Potential space created by the reflection of the ribs to the mediastinum. (seen on left side b/c potentially larger - becuase of cardiac notch)

Front 98

Where and what are the visceral pleura?

Back 98

(pulmonary pleura) - covers the lungs and is adherent to all its surfaces, i ncluding the surfaces within the horizontal and oblique fissures; it cannot be dissected from the lungs.

Front 99

T/F the Recess is the potential space created by the reflection.

Back 99

treu

Front 100

What is found in the root of the lung (what it carries)

Back 100

Pulmonary a. - 1
pulmonary v. - 2
main bronchus - 1
(with bronchial a.
nerves
lymphatics - drain excess fluids.

Front 101

Are the roots of the lungs found laterally, medial or superiioraly?

Back 101

MEDIALLY

Front 102

Describe the anatomical basis for pulmonary collapse

Back 102

Cause – when a sufficient amount of air enters the pleural cavity the surface tension adhering the visceral to the parietal pleura is broken.
Result - The potential space between the visceral and parietal pleura becomes a real space and the lungs collapse.

Front 103

What is pneumothorax?

Back 103

when air enters the pleural cavity - bad - that is between parietal and visceral

Front 104

what is hydrothorax; hemothorax?

Back 104

Hydrothorax – The accumulation of a significant amount of fluid in the pleural cavity
Hemothorax – The accumulation of blood in the pleural cavity

Front 105

When viewing the root of the lung what is it surrounded by?

Back 105

the pulmonary sleeve (continuous layer of parietal and visceral)

Front 106

What is the hilum of the lung?

Back 106

it is the area on the medial surface of the each lung, the pint at which the structure forming the root - the main bronchu, pulmonary vesels, bronchial vessels, and lymphatic vessels, and nerve enter and leave the lung

Front 107

What 'ligament' is found below the root?

Back 107

the pulmonary ligament - double layer of pleura

Front 108

What is the root of the lung?

Back 108

is formed by the structures entering and emerging from the lung at its hilum

Front 109

Describe the function and the surfaces of each lung

Back 109

Function: oxygenate the blood by bringing inspired air into close relation with the venous blood in the pulmonary capillaries. They are very elastic and shrink to about 1/3rd their size when the thoracic cavity is opened.

ii. Surfaces:
Costal surface – adjacent to the sternum, costal cartilages, and ribs
Mediastinal surface – includes the hilum of the lung and related medially to the mediastinum and posterior sides of the vertebrae
Diaphragmatic surface – resting on the convex dome of the diaphragm.

Front 110

Identify and describe the lobes and fissures of the lungs

Back 110

Right lung has three lobes
Superior – superior lobe of lung
Middle – lobe between superior and inferior lobes of lung
Inferior – inferior lobe of lung
Right lung has two fissures that divide the lobes
Horizontal fissure – separates the superior from the middle lobes
Oblique fissure – separates the middle from the inferior lobe

Left lung has two lobes
Superior lobe – superior lobe of lung
Inferior lobe – inferior lobe of lung
Left lung has one fissure which is called the Oblique fissure that separates the superior from the inferior lobe.

Front 111

Describe how the right and left lung differ from each other.

Back 111

Lobes: The right lung has 3 lobes while the left has two lobes
Size: the right lung is heavier and larger than the left, but it is horter and wider because th right dome of the diaphragm is higher and the heart and pericardium bulge more to the left.
Medial border: the left lung has a relatively straight medial border while the left lung has the cardiac notch for the heart.

Front 112

What is the arrangement of the vessels in the hilum?

Back 112

1. Pulmonary artery is most superior on left lung and may be on the right lung if the if the superior lobar bronchus isn’t
2. Superior and inferior pulmonary veins are most anterior and inferior respectively
3. Bronchus is against and approximately in the middle of the posterior boundary with the bronchial vessels immediately surrounding it.

Front 113

What is the lingula?

Back 113

A thin tongue-like process of the superior lobe in the left lung that extends below the cardiac notch and slides in and out of the costomediastinal recess during respiration

Front 114

Is a cardiac notch found on both lungs?

Back 114

no, only on the left above the lingula

Front 115

Describe the position of the lung relative to the skeleton of the thorax

Back 115

The cervical pleurae and paices of he lung pass through the thoracic inlet and into the root of the neck superior and posterior to the clavicles
Anterior borders of the lung – are adjacent to the anterior line of the reflection of the parietal pleura between the 2nd and the 4th costal cartilages.
Inferior borders of lung – lateral border of lung to the 8th rib

How far inferiorly do the pleural cavities project? They reach the 12th rib at the scapular line

Front 116

Describe the course of the trachea in the thorax

Back 116

Primary bronchi run from the trachea to the lung at the level of the sternal angle at the hilum of the lungs.
1. The right primary bronchus is wider, shorter, and runs more vertically than the left primary bronchus. (Aspiration typically effects the right lung)
2. The left primary bronchus runs inferior to the arch of the aorta and anterior to the esophagus and thoracic aorta.

Front 117

a. Where is the trachea in relation to the esophagus? .

Back 117

The trachea runs anterior to the esophagus

Front 118

c. How is the lumen of the trachea kept patent (open)?

Back 118

It is held open by C-shaped hyaline cartilage in segments along the trachea.

Front 119

d. Identify the surface landmark for the bifurcation of the trachea in to the two primary bronchi.

Back 119

The level of the sternal angle

Front 120

e. Explain the pattern formed by branching into the lobar bronchi.

Back 120

The branching from the primary bronchi forms what is called a bronchial tree as the bronchi course into smaller and smaller branches toward the alveoli

Front 121

f. Where do the tertiary bronchi direct air?

Back 121

Into the segments of each lobe

Front 122

g. Be able to ID the trachea, primary, secondary, and tertiary bronchi on a PA radiograph. What does PA mean?

Back 122

The x-rays enter the posterior of the patient with the film on the patients anterior side.

Front 123

The lobar bronchus divides into ________- brohnchi.

Back 123

segmental (tertiary) these deliver air to the bronchopulmonary segments

Front 124

If you aspirate a foreign body what will happend?

Back 124

aspirated foreign bodies are more likely to lodge in the right bronchus be cause of it's size and shape. A potential hazard encountered by DENTISTS is an aspirated foreign body, such as a piece of tooh, filling material or small instrument. - will enter R bronchus

Front 125

Describe the pulmonary arteries and veins. Describe the function and origin and course of each pair. Which has blood of higher oxygen tension?

Back 125

i. Pulmonary arteries – originate from the right ventricle and carry deoxygenated blood to the lungs, tey give off a branch to the superiro lobe before entering teh hilum, each artery then enters and divides and supplies a bronchopulmonary segment of the lung (anterior aspect)
ii. Pulmonary veins – originate at the hilum of the lungs and enter the left atrium of the heart with oxygenated blood. begin in pulmonary capillaries, veins unit into larger and larger vessels (veins from parietal pleura join the systemic veins in adjacent parts of the thoracic wall. The veins from the visceral pleura drain into the pulmonary veins.)

Front 126

Identify the surface landmark for the origin of the pulmonary arteries (pulmonary trunk)

Back 126

at the sternal angle

Front 127

Trace the sequence of arteries that branch from pulmonary aa to eventually reach the bronchopulmonary segment.

Back 127

Pulmonary artery -> lobar artery -> segmental artery -> bronchopulmonary segment

Front 128

Describe the general drainage pattern of the veins. How does this differ from the pattern of arteries?

Back 128

Intrasegmental veins drain blood from adjacent bronchopulmonary segments into teh intersegmental veins in the septa, which separate the segments. A main vein drains each bronchopulmonary segment, usually on the anterior surface of the corresponding bronchus

4 Pulmonary veins enter the heart while only one pulmonary artery trunk leaves the heart.

Front 129

Describe the function, origin, and course of the bronchial arteries.

Back 129

Function: supply blood to the structures making up the root of the lungs, supporting tissues of the lungs and the visceral pleura

Origin:
1.Left bronchial arteries arise from the thoracic aorta
2.Right bronchial arteries arise from the
a.Superior posterior intercostals artery
b.Common trunk from the thoracic aorta with the right 3rd posterior intercostals artery
c.Left superior bronchial artery

Course:
1.Provide the superior esophagus and then pass along the posterior aspects of the main bronchi supplying branches to respiratory bronchioles.
2.Distal branches anastomose with branches of the pulmonary arteries in the walls of the bronchioles and the visceral pleura.

Front 130

Describe the function, course and termincations of the bronchial veins.

Back 130

the bronchial veins drain only parth of the blood supplied to the lungs by the bronchial arteries, primarily that distributed to or near the more proximal part of the root of the lungs. The remainder of the blood is drained by the pulmonary veins. The right bronchial vein drains into the azygous vein, and the left bronchial vein drains into the accessory hemiazygous vein or the left superior intercostal vein.

Front 131

Describe the lymphatic drainage of the lung.

Back 131

Pulmonary nodes -> Bronchopulmonary nodes -> Superior & inferior trachea-bronchial nodes -> Right & left bronchomediastininal lymph trunks -> Right lymphatic duct or thoracic duct respectfully

Front 132

What autonomic innervation does the lung receive, from what nerve?

Back 132

vagus nerve

Front 133

What is the function of the sympathetic and parasympathetic innervations of the lungs.

Back 133

Innervations is from the Vagus nerve

Sympathetic: Inhibitory to the bronchial muscles (bronchodilator) and motor to the pulmonary vessels (vasoconstrictor) and inhibitory to the alveolar glands of the bronchial tree

Parasympathetic: Motor to the smooth muscles of the bronchial tree (bronchoconstrictor) inhibitory to the pulmonary vessels (vasodilator) and secretory to the glands of the bronchial tree (secretomotor)

Front 134

How would you feel pain from the surface of the lungs?

Back 134

Visceral pleura are insensitive to pain since innervation is autonomic by the Sympathetic trunk.

Parietal pleura is richly supplied by branches of somatic intercostals and phrenic nerves.
1.Irritation of the costal and peripheral parts of the diaphragmatic pleura results in local pain and referred pain along the intercostals nerves to the thoracic and abdominal walls.
2.Irritation of the mediastinal and central diaphragmatic areas of the parietal pleura results in pain that is referred to the root of the neck and over the shoulder (C3-5 dermatomes)

Front 135

Is the sympathetic an activator or inhibitor of glands of the bronchial tree?

Back 135

Inhibitory to alveolar glands of bronchial tree