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VI.LungDissection ........................................4
VII.HeartDissection.......................................5
VIII.CoronaryVessels......................................5
IX.MediastinalDissection.............................5
I.RespiratoryHistology................................ 2
II.VascularHistology.....................................3
III.CardiacHistology.......................................3
IV.Radiology...................................................4
V.CrossSectionalAnatomy..........................4
ThisisnotexactlyacandidateforVH1sBestWeekEver.
CardiopulmonaryPracticalExamITables
Page2
TableI
RespiratoryHistology
Tissue
Images
Respiratory
epithelium
Description
Components
PCCE(ciliatedcolumnar)
Function
Epitheliallining,sweepoutparticles
Linerespiratorytract
fromnasopharynx
toterminal
bronchioles
Gobletcells
Containmucusdroplets&granules
Brushcells
Numerousmicrovilli,sensoryreceptors
Basalcells
Lieonbasallamina,mitotic
Smallgranulecells
Neuroendocrine
PCCE(ciliatedcolumnar)
Epitheliallining,sweepoutparticles
Olfactorycells
Bipolarneurons,ciliaassmellreceptors
Bowmansglands
Inlaminapropria,seroussecretions
Swellbodies(venousplexi)
Engorgeevery30m,recoverfromdesiccation
Sustentacularcells
Supportsurroundingcells
Falsevocalfolds(VF)
Upperpair,linedbyrespiratoryepithelium(L
image)
Truevocalfolds(VoF)
Lowerpair,linedbysquamousepithelium,
containvocalism.(VM,Rimage)
Cartilagerings
1620,hyalinecartilage
Fibroelasticligament
Preventsoverdistensionoftracheallumen
Trachealism.
Allowsforregulationoflumen
PCCE
Moregobletcells
Smoothmuscle
Becomesmoreprominentinsmallerbronchi
Cartilage
Becomeirregularplatesinsecondarybronchi
Simplecuboidalepithelium
Ciliated,fewtonogobletcells
Claracells
Secreteglycosaminoglycansfordetoxification
Smoothmuscle
TargetofANSstimulation
Simplecuboidalepithelium
Ciliated,fewtonogobletcells,transitionsto
simplesquamousatalveolaropenings
Claracells
Secrateglycosaminoglycansfordetoxification
Simplesquamousepithelium
Nociliaorgobletcells
Alveolarsac
Communicatebtw.ductandalveoliviaatrium
Elasticfibers
Allowexpansionandcontraction
Reticularfibers
Preventoverdistension
Simplesquamousepithelium
Nociliaorgobletcells
TypeIalveolarcells(97%)
Siteofgasexchange,desmosomes&tightjcts
TypeIIalveolarcells(3%)
Cuboid,secretesurfactant,lamellarbodies
Surfactant
Dipalmitoylphosphatidylserine,surfacetension
Basementmembrane
FusionofcapillaryendotheliumandtypeIcell
Fibroblasts,reticularfibers
Stabilizestructure
Macrophages
Eliminatesmallparticlesnottrappedbycilia
Alveolarpores
Connectadjacentalveoli,equalizepressure
Linessuperiornasal
concha
Lackgobletcells
Olfactory
epithelium
Notelackofcleargobletcells
Connectspharynxto
trachea
Hyalinecartilage
Larynx
10cmlong
Splitsintobronchiat
carina(levelof
sternalangle)
Trachea
Rbronchusis
shorter,wider,
moreverticalthanL
Secondary:3R,2L
Bronchi
Terminal
bronchioles
Lackglandsand
cartilage
Respiratory
bronchioles
Transitionbetween
conductingand
respiratoryportions
Alveoliinwalls
Alveolar
ducts
Aroundrespiratory
bronchiolewhere
alveolaropenings
areevident
Functionalunitof
respiration
Alveoli
Barrieracrosswhich
gasexchangetake
place
0.20.5mthick
Interalveolar
septum
TypeIcellsandcapillarylumen TypeII;notegranules
CardiopulmonaryPracticalExamITables
TableII
Page3
VascularHistology
Artery
Image
Description
Lackofsubendotheliallayer;theinternal
elasticlimitingmembraneisnot
apparentwiththelightmicroscope.
Oneortwolayersofsmoothmusclecells
inthemedia.
Poorlydevelopedorabsentadventitia
andnoexternalelasticlimiting
membrane.
Functionascontrolvalvesoncapillary
bedsautonomicnervousinnervation
andassistsincontrolofbloodpressure.
Arterioles
Morethantwolayersofsmoothmuscle
cells.
Mayhaveaninternalelasticlimiting
membrane.
Assistinthecontrolofbloodpressure.
Small
arteries
Medium
(muscular)
arteries
Large
(elastic)
arteries
Allcoatswelldefined.
Mediaisprominentwithupto40
smoothmusclelayers.
Bothinternalandexternalelasticlimiting
membranespresent.
Intimacomposedofendothelium,athin
connectivetissuelayerandaprominent
internalelasticlimitingmembrane.
Thickmediawithabundantelasticfibers
arrangedinfenestratedlaminae.
Theadventitiaiscomposedofelastic
connectivetissueandiswell
vascularizedwithsmallarteriesand
veins;vasavasorum.
Vein
Image
Description
Venules
Characterizedbyanendotheliallining,anabsent
mediaandadelicatecollagenousadventitia.
Functionsincellandfluidegress,i.e.released
histaminecausestheendothelialcellstoseparate
exposingthebasallamina.Neutrophilsattachand
crossthebasementmembranetoenterthe
connectivetissue.Histaminealsocausesarteriole
contraction,therebyincreasingvenousbloodpressure
andsoincreasingfluidsmovingintotheconnective
tissue.
Small
veins
Similartovenulesbutlargerwithmediaandadventitia
Medium
veins
Circularlyarrangedsmoothmuscleintheirmediaand
longitudinallyarrangedsmoothmuscleintheir
adventitia.
Themediaofmediumveinsismuchthickerrelativeto
thesizeofthelumenthanisthemediaofthelarge
vein.
Valvesmaybepresent.
Adventitiaismostprominentandcontainsnumerous
longitudinallyarrangedbundlesofsmoothmuscle.
Circularlyarrangedsmoothmuscleinnarrowmedia.
Vasavasorumpresentinadventitia.
Valvesgenerallypresent
Large
veins
Capillary
Locations
Continuous
muscle,connectivetissue,CNS,gonads,skinandformthebloodbrainbarrier
Fenestrated
gastrointestinaltract,endocrineglandsandinrenalglomeruli
Discontinuous
spleen,bonemarrowandliver
Description
Singlelayer ofendotheliumrolledbackuponitselftoform atube
Celljunctionsandabasallaminaarepresent.
Pores orfenestraeintheendothelialcellwall
Sometimescoveredbyathindiaphragm
Discontinuityorgapintheendothelialcelllining
Basallaminaisincompleteormissing
TableIII
Tissue
CardiacHistology
Images
Endocardium
Description
Composedofanendotheliallining,basallaminaandsubendocardiallayerof
connectivetissue
Veins,nerves,andtheimpulseconductingsystemarepresentinthe
subendocardialregion
Coverscuspsofheartvalves
Purkinjecellsaregenerally,largerthancardiacmusclecells,andcontainhigh
levelsofglycogen
Myocardium
Cardiacmusclefibers
Epicardium
Serouscoveringofmesotheliumandalooseconnectivetissuesubepicardial
layer
CardiopulmonaryPracticalExamITables
Page4
TableIV
Radiology
TableV
CrossSectionalAnatomy
TableVI
Lung
LungDissection
MedialImage
LateralImage
Left
Right
Landmark
Bronchus
Description
Inbetweenpulmonaryvessels
Pulmonaryartery
Mostsuperiorhilaropening
Pulmonaryvein
Mostinferiorhilaropening
Hilus
Areaofattachmenttolungroot,containsbronchus&pulmonaryvessels
Cardiacimpression
Onmedialsurface
Cardiacnotch
Atanteromedialedge
Lingula
Mostinferiorprocessoflung
ObliqueFissure
Separatessuperiorandinferiorlobes
Grooveforaorticarch
Apparentonmedialaspect
Bronchus
Eparterial:mostsuperiorofhilaropenings
Pulmonaryartery
Inbetweenbronchusandpulmonaryvein
Pulmonaryvein
Mostinferiorhilaropening
Obliquefissure
Separatesinferiorfrommiddleandsuperiorlobes
Horizontalfissure
Separatessuperiorfrommiddlelobe,endsatobliquefissure
CardiopulmonaryPracticalExamITables
TableVII
Page5
HeartDissection
Chamber
Images
Landmarks
Coronarysinus
Sinoatrialnode
Atrioventricularnode
Rightatrium
Fossaovalis
Rightauricle
Pectinatemm.
Cristaterminalis
Papillarymm.
Chordatetendineae
Moderatorband
Trabeculaecarnae
Rightventricle
Tricuspidvalve
Conusarteriosus
Leftheart
Description
Emptiescoronaryvv.intoRA
Pacemaker,locatedposteriorlynear
openingforsuperiorvenacava
Medialtofossaovalis,conducts
impulsestotheventricles
Remnantofforamenovale,onwall
betweenRAandLA
earshapedpouch
Parallelmusclesonauriclewall
Terminalconnectorofpectinate
mm.,unionofauricleandatrium
Controlclosingoftricuspidvalve
Connectvalveflapstopapillarymm.
Muscular,preventsoverdistension
Irregularmuscularcolumnsin
ventricularwall
Rightatrioventricularvalve,3leaves
Conicalpouchfromwhich
pulmonaryarteryarises,lacks
trabecularcarnae
Pulmonicvalve
ValvefromRVtopulmonarya.
Theleftsideisbrilliantlysimple:leftauricle,pectinatemm.,fossaovalis,openingsofpulmonaryvv.,mitralvalve
Aorta:openingsofLandRcoronaryaa.behindtherightandleftsemilunarcuspsoftheaorticvalve
TableVIII
CoronaryVessels
Vessel
Rcoronarya.
Posteriordescendinga.
Lcoronarya.circumflexbranch
Lanteriordescendinga.
Coronarysinus
Greatcardiacv.
Middlecardiacv.
Smallcardiacv.
Location
OverRatrium
Posteriorinterventriculargroove
Inferiortopulmonaryvv.
Anteriorinterventriculargroove
Inferiortopulmonaryvv.
Anteriorinterventriculargroove
Posteriorinterventricularsulcus
Rightcoronarysulcus
TableIX
Structure
Thoracicduct
Azygosv.
Accessoryhemiazygosv.
Hemiazygosv.
Brachiocephalicvv.
Superiorintercostalvv.
Sympathetictrunk
MediastinalDissection
Vagusn.(CNX)
Phrenicn.(C35)
Lrecurrentlaryngealn.
Aorticarch
Location
Lower,posterior
AlongRspine,overlungroot
MiddleLposteriormediastinum
InferiorLposteriormediastinum
Superiormediastinum
st
nd
Inbetween1 and2 ribs
Posteriormediastinum
GreaterT59,LesserT1011,
LeastT12offsympathetictrunk
Posteromedialmediastinum
Anteromedialmediastinum
Beneathligamentumarteriosum
Obvious!
Brachiocephalictrunk
Firstbranchoffaorta(BCS)
Lcommoncarotida.
L.subclaviana.
Cavalopening
Aortichiatus
Esophagealhiatus
Secondbranchoffaorta(BCS)
Thirdbranchoffaorta(BCS)
Diaphragm,Rofspine
Diaphragm,posteromedial
Diaphragm,anteromedial
Splanchnicnn.
Supply/Drainage
Ratrium
Posteriormuscle
PosterolateralLventricle,anterolateralpapillarym.
Anterolateralmuscle,apex,septum
Drainscardiacvv,emptiesintoRatrium
Anterolateralmuscle,apex,septum
PosterolateralLventricle
Ratrium,Rventricle
Function
EmptieslymphintosuperiorVC
DrainsRposteriorintercostalvv.
Drainsmiddlepost.intercostalvv.
Drainsinferiorpost.intercostalvv.
Drainintosuperiorvenacava
Drainuppertwointercostalspaces
Sympatheticfibers
Greater adrenalmedulla,Lesser
celiac,Leastrenal
Parasympatheticfibers
Innervatesdiaphragm
Innervateslarynx
Carriesblooddirectlyfromheart
BranchesintoRcommoncarotida.
andRsubclaviana.
Suppliesneckandhead
SuppliesLarm
AllowspassageofinferiorVC
Allowspassage ofaorta
Allowspassageofesophagus
Images