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SMP - Cardiopulmonary Lab Practical > Dissection of the Pleural Cavities and Lungs > Flashcards

Dissection of the Pleural Cavities and Lungs Flashcards

1
Q

What are the pleurae?

A

Serous sacs surrounding the lungs

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2
Q

During breathing, what 3 thoracic dimensions vary? What is each due to?

A
  1. Vertical: diaphragm
  2. Lateral: intercostal muscles moving the shafts of the ribs
  3. Anteroposterior: intercostal muscles moving the sternum
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3
Q

Are the anterior ends of the ribs superior or inferior to the posterior ends?

A

Inferior

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4
Q

How does the sternum moves when the ribs elevate?

A

Upward and forward

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5
Q

How does the sternum moves when the ribs depress?

A

Downward and backward

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6
Q

Level of shaft of ribs compared to anterior and posterior ends?

A

Slightly inferior

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7
Q

Borders of pleural cavities?

A
  1. Superiorly: root of neck 3-4 cm above costal cartilage of rib 1 but not higher than its neck
  2. Inferiorly: just above the costal margin
  3. Medially: mediastinum
  4. Anteriorly: posterior portion of sternum but in the inferior portion the left one does not come as close as the right one because mediastinum bulges to the left
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8
Q

Composition of pleura?

A
  1. Single layer of flat mesothelial cells

2. Layer of supportive connective tissue

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9
Q

2 types of pleura? Based on what?

A

Based on location:

  1. Parietal: associated with walls of pleural cavity
  2. Visceral: reflected from medial wall onto and adheres to surface of lung
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10
Q

4 parts to the parietal pleura?

Describe each.

A
  1. Costal: related to ribs and intercostal spaces
  2. Diaphragmatic: covering diaphragm
  3. Mediastinal: covering mediastinum
  4. Cervical pleura: dome shaped lining the cervical extension of the pleural cavity
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11
Q

2 other names for cervical pleura?

A
  1. Dome of pleura

2. Pleural cupola

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12
Q

What is the suprapleural membrane? What is it attached to? What muscle fibers does it receive?

A

Dome-like layer of fascia covering the cervical pleura

Attached to medial margin of 1st rib and to transverse process of C7

Receives scalene muscles from the neck

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13
Q

Can you see visceral pleura on a cadaver?

A

NOPE

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14
Q

At which point do the visceral and parietal pleurae become continuous?

A

At the hilum of the lung

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15
Q

Vertebral level of hilum of the lung?

A

T5 to T7

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16
Q

What is the root of the lung?

A

The hilum of the lung and the structure it contains

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17
Q

Innervation of parietal pleura? Where would pain be felt for each?

A

Somatic afferent nerves:

  1. Costal: branches of intercostal nerves (pain in thoracic wall)
  2. Diaphragmatic: phrenic nerves (pain in C3-C5 dermatomes = lateral neck and supraclavicular region of shoulder) and lower intercostal nerves
  3. Mediastinal: phrenic nerves (pain in C3-C5 dermatomes = lateral neck and supraclavicular region of shoulder)
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18
Q

Describe in painful detail the inferior margin of the parietal pleura.

A

Margin is just above the costal margin

  1. Midclavicular line: rib 8
  2. Midaxillary line: rib 10
  3. More laterally: horizontal margin crossing ribs 11 and 12 to reach T12
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19
Q

Innervation of visceral pleura? Where is pain felt?

A

Autonomic nerves accompanying bronchial vessels

No pain felt, only stretch

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20
Q

What sensations is the parietal pleura sensitive to?

A
  1. Pain
  2. Touch
  3. Temperature
  4. Pressure
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21
Q

What are pleural recesses?

A

Areas where 2 layers of parietal pleura become opposed

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22
Q

Do the lungs completely fill the pleural cavities? What does this mean?

A

Nope, not in the anterior or posterior inferior regions

BUT these spaces fill during FORCED inspiration

=> potential spaces where fluid can accumulate

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23
Q

What are the 2 types of pleural recesses? Which are more clinically significant? Which are larger?

A
  1. Costomediastinal recesses

2. ***Costodiaphragmatic recesses

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24
Q

Describe the costomediastinal recesses. Larger right or left one?

A

Costal pleura and mediastinal pleura oppose anterior to the heart and inferior to the lung

Larger on left side overlying the heart

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25
Q

Describe the costodiaphragmatic recesses.

A

Costal pleura and diaphragmatic pleura oppose between inferior margin of lung and pleural cavity

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26
Q

When are pleural processes deepest?

A

After forceful expiration

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27
Q

Describe in painful detail the quiet inspiration inferior margin of the lung.

A
  1. Midclavicular line: rib 6
  2. Midaxillary line: rib 8
  3. More laterally: horizontal margin to reach T10
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28
Q

How many pleural recesses total?

A

4

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29
Q

What is found between the parietal pleura and the ribs?

A

Thoracic cavity lined with endothoracic fascia

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30
Q

Which lung is bigger?

A

Right one

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31
Q

Describe the 4 characteristics of each lung.

A
  1. Base on diaphragm
  2. Apex above rib 1 into root of neck
  3. 3 surfaces
  4. 3 borders
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32
Q

Describe the 3 surfaces of the lungs.

A
  1. Costal surface
  2. Mediastinal surface against mediastinum anteriorly and vertebral column posteriorly
  3. Diaphragmatic surface
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33
Q

Which lung surface contains the hilum?

A

Mediastinal surface

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34
Q

Describe the 3 borders of the lungs.

A
  1. Inferior: sharp and separates base from costal surface

2 and 3. Anterior (sharp) and posterior (smooth) borders separate costal surface from mediastinal surface

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35
Q

What is the pulmonary ligament? Functions?

A

A thin fold of pleura projecting inferiorly from the hilum to the mediastinum

Functions:

  1. Stabilizes inferior lobe
  2. Accommodates down and up translocations of root structures during breathing
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36
Q

Location of vagus nerves in relation to roots of lungs?

A

Posterior

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37
Q

Location of phrenic nerves in relation to roots of lungs?

A

Anterior

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38
Q

6 contents of roots of lungs? Include positions.

A
  1. Pulmonary artery (superior on left and posterior on right)
  2. 2 pulmonary veins (inferior)
  3. Main bronchus (posterior on left and branched with the lobar bronchus to the superior lobe and SUPERIOR ON RIGHT)
  4. Bronchial vessels
  5. Nerves
  6. Lymphatics
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39
Q

Number of lobes of right lung?

A

3

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40
Q

Number of fissures of right lung?

A

2

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41
Q

What are lung fissures?

A

Invaginations of visceral pleura separating the lobes

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42
Q

2 fissures of right lung?

A
  1. Oblique fissure separating inferior and middle/superior lobes
  2. Horizontal fissure separating middle and superior lobes
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43
Q

Location of oblique fissure of right and left lungs in quiet respiration?

A

Curved line from spinous process of T4 to 4th and 5th intercostal space to rib 6 anteriorly

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44
Q

Location of horizontal fissure of right lung in quiet respiration?

A

4th intercostal space from sternum to the oblique fissure over rib 5

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45
Q

What do the lung fissures determine clinically?

A

Where clinicians should listen for lung sounds

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46
Q

Anterior and posterior surface projections of right superior lobe?

A

Anterior = root of neck to above rib 4

Posterior = root of neck to above rib 6

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47
Q

Anterior and posterior surface projections of right middle lobe?

A

Anterior = top of 4th rib to medial 6th rib

Posterior = top of rib 6 to top of rib 10 medially

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48
Q

Anterior and posterior surface projections of right inferior lobe?

A

Anterior = laterally over rib 6 and 5th and 6th intercostal spaces (around nipple)

Posterior = none

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49
Q

6 mediastinal structures in contact with medial surface of right lung? Which form impressions on the mediastinal surface of the right lung? Structure not part of mediastinum that also forms an impression?

A
  1. Heart***
  2. IVC
  3. SVC***
  4. Azygos vein*** (impression from arch)
  5. Esophagus***
  6. Right brachiocephalic vein***

+ 1st rib

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50
Q

Number of lobes of left lung?

A

2

51
Q

Number of fissures of left lung?

A

1

52
Q

Which is more oblique: the right or left fissure?

A

Left one

53
Q

Anterior and posterior surface projections of left superior lobe?

A

Anterior = root of neck to above 4th rib and then inverse C-shape to above rib 6

Posterior = root of neck to above rib 6

54
Q

Anterior and posterior surface projections of left inferior lobe?

A

Anterior = over lateral 6th rib and 5th and 6th intercostal spaces above and below (around nipple)

Posterior = top of rib 6 to top of rib 10 medially

55
Q

Which lung has a notched mediastinal surface? Why? What is this called? Where is it?

A

Left lung due to heart’s projection = cardiac notch on superior lobe at the anterior border

56
Q

What is the lingula of the left lung? Function?

A

Tongue-like extension of the anterior border of the lower portion of the superior lobe projecting over the heart anteriorly and bordering the left lower border of the heart

Function: increases gas exchange surface area of left lung

57
Q

5 mediastinal structures in contact with medial surface of left lung? Which 3 form impressions on the mediastinal surface of the left lung?

A
  1. Heart***
  2. Aortic arch***
  3. Thoracic aorta
  4. Esophagus
  5. Left brachiocephalic vein***
58
Q

Lymphatic drainage of lungs?

A

Tracheobronchial nodes

59
Q

Where are tracheobronchial lymph nodes located?

A

Around root of lobar and main bronchi and alongside trachea

60
Q

Pathway of lung lymphatic drainage?

A

Within the lung => through hilum => posterior mediastinum => tracheobronchial nodes => lymphatic vessels in the superior mediastinum anterior to the brachiocephalic veins that also drain lymph from parasternal and brachiocephalic nodes => right and left bronchomediastinal trunks => veins at base of neck OR right lymphatic duct/thoracic duct

61
Q

Lung innervation?

A

Pulmonary plexus with branches from sympathetic trunks and vagus nerves lying anteriorly and posteriorly to tracheal bifurcation (anterior smaller than posterior)

62
Q

Vertebral borders of trachea?

A

C6 to T4/T5

63
Q

What is the carina?

A

Most inferior tracheal cartilaginous ring that is hook-shaped projecting backwards

64
Q

Do inhaled foreign bodies lodge more frequently in the right or left main bronchi? Why?

A

Right one because it is wider and takes a more vertical course through the root of the lung than the left one AND because the carina tends to block aspirated objects from going in the direction of the left primary bronchus

65
Q

What airway generation supplies per lobe?

A

Lobar bronchi

66
Q

Other name for segmental bronchi?

A

Tertiary bronchi

67
Q

What do segmental bronchi supply?

A

Bronchopulmonary segments

68
Q

What are bronchopulmonary segments?

A

Area of lung supplied by a segmental bronchus and its accompanying pulmonary artery branch

69
Q

Shape of bronchopulmonary segments?

A

Irregular cones with apex at origin of segmental bronchus and base projecting peripherally onto surface of the lung

70
Q

Smallest area of lung that can be isolated and removed without affecting adjacent regions? Why?

A

Bronchopulmonary segment because it is functionally independent

71
Q

How many bronchopulmonary segments in each lung?

A

10, but some of them fuse in the left lung

72
Q

Where are pulmonary veins found in the lungs?

A

Between margins of bronchiopulmonary segments

73
Q

Where does the bifurcation of the pulmonary trunk take place?

A

Sternal angle to the left of the bifurcation of the trachea

74
Q

Which pulmonary artery is longer: left or right one?

A

Right one

75
Q

Position of right pulmonary artery.

A
  1. Anterior to trachea and right main bronchus

2. Posterior to ascending aorta, SVC, and upper pulmonary vein

76
Q

Position of left pulmonary artery.

A
  1. Anterior to descending aorta
  2. Posterior to superior pulmonary vein
  3. Superior to left main bronchus
77
Q

Does the left pulmonary artery only branch within the lung?

A

YES

78
Q

Does the right pulmonary artery only branch within the lung?

A

TBD

79
Q

Do bronchial arteries and veins interconnect with branches of pulmonary arteries and veins within the lung?

A

YUP

80
Q

List the 3 bronchial arteries and what artery they arise from.

A
  1. Right bronchial artery from the 3rd posterior intercostal artery or superior left bronchial artery
  2. Superior left bronchial artery from the anterior surface of the thoracic aorta (at T5)
  3. Inferior left bronchial artery from the anterior surface of the thoracic aorta (inferior to left bronchus)
81
Q

On what surface of the bronchi do the bronchial arteries run?

A

Posterior

82
Q

Where do the bronchial veins drain into?

A
  1. Pulmonary veins
  2. Left atrium
  3. Azygos vein on right
  4. Superior intercostal vein on left
  5. Hemiazygos vein on left
83
Q

When is a lung cancer inoperable? What is the treatment then?

A

When the tumor has invaded structures in the mediastinum or the pleurae or has metastasized

Treatment: radiotherapy and chemotherapy

84
Q

Through what lymph nodes does lung cancer spread?

A

Lymph nodes within hila, mediastinum, and root of the neck

85
Q

Imaging techniques to assess spread of metastasized lung cancer?

A

Radiography, CT, MRI, or PET

86
Q

Do lungs appear with black spots on their visceral pleura normally?

A

YUP because of pollution

87
Q

How to differentiate the bronchus in the root of the lung?

A

It is WHITER and THICKER

88
Q

Where are lymph nodes found at the root of the lung?

A

Inferiorly and anteriorly

89
Q

Location of azygos vein in relation to the right lung hilum?

A

Superior

90
Q

Location of right brachiocephalic vein in relation to the right lung hilum?

A

Anterior

91
Q

Location of SVC in relation to the right lung hilum?

A

Anterior and inferior

92
Q

Location of esophagus in relation to the right lung hilum?

A

Posterior

93
Q

What does the parietal pleura look like on a cadaver?

A

Transparent/whitish

94
Q

Stethoscope placement to listen to apex of lung?

A

Right above medial clavicle

95
Q

Stethoscope placement to listen to middle lobe of right lung?

A

Middle of 4th intercostal space

96
Q

Stethoscope placement to listen to superior lobe of lung?

A

Middle of 2nd intercostal space

97
Q

Stethoscope placement to listen to inferior lobe of lung?

A

Lateral portion of 6th intercostal space

98
Q

Which intercostal spaces to the left of the sternum are not left lung?

A

4-6th intercostal spaces are the heart!

99
Q

Posterior surface projection of the top of the oblique fissure?

A

T4

100
Q

Surface projection of left costomediastinal recess?

A

4th and 5th ICS further than 3.5 inches from midline

101
Q

Anterior and posterior surface projections of left and right costodiaphragmatic recesses?

A

Anterior = medial 6th ICS to lateral 8th ICS

Posterior = T10 to T12

102
Q

How does the parietal pleural adhere to the endothoracic fascia? How does this contribute to respiration?

A

By surface tension

During inspiration, when the thoracic cage expands, the parietal pleura expands, which allows the lungs to expand also

103
Q

What lung lobes comprise most of the anterior surface of the thorax?

A

Superior lobe of both lungs + middle lobe of right lung

104
Q

What is the right main bronchus referred to? Why?

A

Eparterial bronchus because it is located superior to the right pulmonary artery in the root of the right lung

105
Q

Technically are the lungs within the pleural cavity?

A

Although clinically the lungs are often considered to be within the pleural cavity, technically they are outside the pleural cavity

106
Q

What is a hemothorax?

A

Blood in pleural cavity

107
Q

What are lines of pleural reflection?

A

Places where pleura turns to change from one surface to another

108
Q

Other name for costodiaphragmatic recess?

A

Costophrenic recess

109
Q

Procedure to drain fluid out of pleural cavity? What must first be done? Where is it typically performed?

A

Pleural tap = thoracocentesis

First, anesthetize the rib by infiltration to rib and space above and below because the periosteum is extremely sensitive

Lower ICS 4 or 5 between midaxillary lines and anterior axillary lines

110
Q

What muscles can help the diaphragm during forced expiration?

A

Abdominal muscles

111
Q

Right lung bronchi: once the right upper lobar bronchus has branched off, what do you call the remaining right bronchus?

A

Interlobar bronchus or bronchus intermedius

112
Q

If veins are dilated on both sides of the neck, what would this indicate regarding the location of lung cancer?

A

Near SVC in right lung

113
Q

If patient is having difficulty breathing, what would this indicate regarding the location of lung cancer?

A

Phrenic nerve is affected

114
Q

2 most common causes of a pneumothorax?

A
  1. Rib fractures

2. Positive pressure ventilation lung damage

115
Q

Diseases associated with pleural effusion?

A
  1. Lung infection
  2. Cancer
  3. Abdominal sepsis
116
Q

Cause of hemopneumothorax?

A

Severe chest trauma

117
Q

What do you risk if you insert a needle below the 5th ICS?

A

Placing needle in liver or spleen (L or R)

118
Q

Why are upper lobe pneumonias unusual?

A

Because most patients develop gravity-dependent infections

119
Q

What 2 infections are common in upper and middle lung lobes?

A
  1. Tuberculosis (bacteria)

2. Histoplasmosis (fungus living in soil)

120
Q

Auscultation sign of pneumonia?

A

Decreased breath sounds which are hoarse in nature = bronchial breathing

121
Q

Percussion sign of pneumonia?

A

Dull percussion sound

122
Q

How do the lungs become surrounded by pleura?

A

During development they grow out of the mediastinum

123
Q

What lies on each side of the superior thoracic aperture?

A

Axillary inlets

124
Q

What is each axillary inlet formed by?

A
  1. Superior margin of scapula posteriorly
  2. Clavicle anteriorly
  3. Lateral margin of rib 1 medially
  4. Medial margin of coracoid process superiorly
  5. Triangular opening inferiorly

SMP - Cardiopulmonary Lab Practical (11 decks)

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