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Contents

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

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CardiopulmonaryPracticalExamITables

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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

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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

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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

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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