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FM 1030 > A L5 > Flashcards

A L5 Flashcards

1
Q

at what level is the larynx continuous with the trachea?

A

C6

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2
Q

The trachea is continuous with the larynx at the level of vertebra _____. It lies _______ to the oesophagus.
It passes _________ in the midline of the neck and enters the ___________. It descends through
the __________ slightly to the ________ of the midline.

A

The trachea is continuous with the larynx at the level of vertebra C6. It lies anterior to the oesophagus.
It passes inferiorly in the midline of the neck and enters the superior mediastinum. It descends through
the superior mediastinum slightly to the right of the midline.

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3
Q

In the mediastinum, the trachea is crossed by the ___________ on the left side and by the
___________ on the right side. The trachea divides into the right and left primary bronchi
(main bronchi) at the level of the _________ i.e. at the level of the _____ intervertebral disc, at
the junction between the ___________ and __________.

A

In the mediastinum, the trachea is crossed by the arch of the aorta on the left side and by the
arch of the azygos vein on the right side. The trachea divides into the right and left primary bronchi
(main bronchi) at the level of the sternal angle i.e. at the level of the 4th intervertebral disc (T4/T5), at
the junction between the superior mediastinum and inferior mediastinum.

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4
Q

The ________ is the ridge
separating the primary bronchi at the bifurcation of the trachea.

A

CARINA

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5
Q

Clinical relevance of carina?

A

displacement of carina may indicate disease

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6
Q

The primary bronchi extend from the _________ to the ___________.

A

Tracheal bifurcation to the hilum of the lungs

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7
Q

Does the trachea travel to the right or the left of the midline in the superior mediastinum?

A

To right of it

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8
Q

If you inhale a foreign body - where is it most likely to go and why?

A

It’s most likely to enter the right primary bronchi
It is more vertical, wider and shorter than the left main/primary bronchus.

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9
Q

List the branching of the bronchi

A

Trachea –> Main/primary bronchi –> Lobar/secondary bronchi (one to each lobe of the lung) –> Segmental/tertiary bronchi (one to each bronchopulmonary segment) –> bronchioles –> terminal bronchiole –> respiratory bronchiole –> alveolar duct –> alveolar sacs

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10
Q

Describe the difference in lobar bronchi branching in Left and right lungs

A

Right
– 3 lobar branches (for the 3 lobes of the lung)
– The lobar bronchus to the R. upper lobe (EPARTERIAL BRONCHUS) branches off outside the lung and then enters the hilum.

Left
– 2 lobar branches (for the 2 lobes of the. lung)
– All of them branch within the lung after passing thru the hilum

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11
Q

The left primary bronchus passes ______ to the left atrium of the heart.

A

posterior

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12
Q

The lobar / secondary bronchi terminate by dividing into _______

A

segmental/ tertiary bronchi,

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13
Q

What are the smallest functional units of the lung?

A

The bronchopulmonary segments

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14
Q

How many bronchopulmonary segments in each lung? What shape? Which bronchi feed into these? How many veins and arteries per each?

A

There are 10 segments usually. BUT sometimes in the left lung some may fuse to give 8 segments

Pyramid shaped
– Apex points toward the hilum of the lung
– Base towards the lung surface

One tertiary/ segmental bronchi per bronchopulmonary segment

1 pulm. A branch and 1. Bronchial A. branch per segment of the lung

1 vein per segment HOWEVER multiple veins pass intersegmentally ( can help differentiate during surgical procedures)

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15
Q

Bronchoscopy - procedure and purpose?

A

A tube known as the bronchoscope is passed down into the respiratory tree

Used to:
- Examine the internal surface of the trachea and major bronchi (to look for polyps, tumors, infections etc.)
- Take biopsies to aid diagnosis
- Remove inhaled foreign bodies from the bronchi

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16
Q

Where is the apex of the lung vulnerable to injury? Why? How can it be injured?

A

The apex of the lung projects into the root of the neck

– It projects above the 1st ribs and the clavicle – thus no protection from any bones – thus its vulnerable to injury over here

– It may thus be damaged by stab wounds to the neck.

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17
Q

What are the surfaces of the lung?

A
  • Apical surface (projects into the root of the neck)
  • Mediastinal surface (faces the mediastinum)
  • Diaphragmatic surface (lies on the diaphragm)
  • Costal surface ( lies against the thoracic wall)
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18
Q

What is the hilum?

A

Its an area on the medial aspect of the lungs thru which structures enter and leave from the lungs

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19
Q

what forms the root of the lung?

A

The structures entering and leaving the hilum of the lung forms the root of the lung.

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20
Q

What are the structures that are a part of the root of the lung?

A
  • Right main bronchi (eparterial and intermediate bronchi)
  • Pulmonary and bronchial arteries
  • Pulmonary and bronchial veins
  • Lymph nodes
  • pulmonary plexus of the ANS
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21
Q

Which lung is larger and why?

A

the right lung – due to the position of the heart – the heart is located more towards the left side of the body and thus takes up more space on the left side

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22
Q

What are fissures? Name the ones in the right and left lungs and what they separate.

A

They’re deep crevices in the lungs divide the lungs into lobes

Right lung has 3 lobes – superior, middle and inferior
Separated by 2 fissures::
—- Horizontal fissure : between superior and middle lobe
—- Oblique fissure: between middle and inferior lobe

Left lung has 2 lobes – superior and inferior
Separated by 1 fissure::
—- Oblique fissure: Btwn the superior and inferior lobe

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23
Q

Lobectomy?

A

Surgical removal of a single lobe due to a tumor/pus and pathogens limited to a single lobe.

24
Q

What are the structures on the mediastinal surface of right lung?

A
  • Azygos vein and arch
  • Superior and inferior vena cavae
  • Oesophagus
  • Phrenic nerve anterior to root of lung
  • Vagus nerve posterior to root of lung
25
Q

What is the cardiac notch? where?

A

Left lung possesses a deep notch formed by the heart called the cardiac notch

26
Q

What is the projection of the left lung that passes over the cardiac impression? Which lobe does it arise from?

A

Lingula
From the upper lobe of the left lung

27
Q

Structures related to the mediastinal surface of the left lung?

A
  • Heart
  • Arch of aorta and descending aorta
  • L. subclavian A.
  • Phrenic n. anterior to root of lung
  • Vagus n. posterior to root of lung
28
Q

Where is the diaphragm located during normal quiet resp. on each side?

A

Right dome – 5th rib
Left dome – 5th intercostal space

29
Q

Approximate position of both oblique fissures during quiet resp.?

A

a curved line from approximately the spinous process of vertebra T4 posteriorly, crossing the 5th intercostal space laterally and following the contour of rib 6 anteriorly.

30
Q

approximate position of the right horizontal fissure during quiet resp?

A

a horizontal line following the 4th costal cartilage and 4th rib from the sternum, until it meets the oblique fissure over the 5th rib the mid-axillary line.

31
Q

Which artery do the bronchial arteries usually arise from?

A

The thoracic aorta or one of its branches

32
Q

Blood vessels within the lungs?

A

The pulm trunk divides into R+L pulm arteries
–> bring deoxy blood from heart to lungs

Bronchial A. –> carry O2 and nutrients to bronchial walla and glands

Bronchial V. –> drain into pulm. and azygos veins (azygos on right hemi on left)

33
Q

Intersegmental veins

A

multiple veins run between segments in the lungs
They help identify the boundaries of the segment during surgical resection (removal of segment)

34
Q

Surgical resection

A

removal of a segment

35
Q

What is the parietal pleura attached to?

A

thoracic wall, diaphragm and mediastinum

36
Q

Where are the parietal and visceral pleura continuous?

A

At the root of the lung

37
Q

What keeps the surface of the lung in contact with the thoracic wall,

A

surface tension of pleural fluid

38
Q

Parts of the parietal pleura?

A
  • Costal part (lines thoracic wall)
  • Mediastinal part (lateral surface of mediastinum)
  • Diaphragmatic part (pleura on upper surface of diaphragm)
  • Cervical pleura/dome of pleura/pleural cupola (pleura extending into the root of the neck - rises along with the apex of the lung above the level of the 1st rib and medial 1/3rd of clavicle– like the lung can be damaged to stab wound to neck)
39
Q

Recesses of the pleura? Define? Names?

A

They are spaces in the pleural cavity which the lungs dont fill in normal quiet breathing and only fill during full inspiration.

Costomediastinal recess
Costodiaphragmatic recess

40
Q

What is the pleural cupola strengthened by?

A

The pleural cupola/cervical pleural/dome of pleura is strengthened by the suprapleural membrane.

41
Q

Where does the suprapleural membrane extend from?

A

It extends from the transverse processes of C7 vertebra to the 1st rib

42
Q

What structures pass over the dome of the cervical pleura and where do they pass from and towards?

A

The subclavian artery and vein arch up and laterally cross the dome
Pass from the thorax to the axilla and upper limb

43
Q

Which side is the costomediastinal recess larger on? why?

A

On the left side of the heart in the area overlying the heart.

44
Q

______ are potential sites for the accumulation of fluid in the lungs and from which fluids can be removed (aspirated)

A

Recesses

45
Q

What accumulates in the following:
pneumothorax:
pyothorax:
haemothorax:
chylothorax:

A

pneumothorax: air in the pleural cavity
pyothorax: pus in the pleural cavity
haemothorax: blood in the pleural cavity
chylothorax: lymph in the pleural cavity

46
Q

What does an increase in the size of the pleural cavity lead to?

A
  • It can reduce the volume of the lung on which side the substance has accumulated.
  • It can also push the mediastinum to the opposite side reducing the volume of the opposite, unaffected lung
  • Both of these can result in respiratory incapacity and severe shortness of breath.
47
Q

SURFACE PROJECTIONS OF PLEURA AND LUNGS DURING QUIET RESPIRATION? (as in where do the INFERIOR margin of the lungs and pleura cross?)

A

Lung:
- Midclavicular line at rib 6
- Midaxillary line at rib 8
- Vertebral column at T10 vertebra

Pleura:
- Midclavicular line at rib 8
- Midaxillary line at rib 10
- Vertebral column at T12 vertebra

48
Q

The parietal pleura is innervated by _______ and the visceral pleura is innervated by the ______

A

somatic nerves
Autonomic nervous system

49
Q

What are the innervations of the different parts of the parietal pleura?

A

Costal - Intercostal nerves
Mediastinal - phrenic nerve (C3, C4, C5)
Diaphragmatic :::
—> Peripheral: Lower 5 intercostal nerves
—> Central: phrenic nerves (C3, C4, C5)

50
Q

Describe referred pain from the diaphragmatic pleura

A

Pain originating from the central diaphragmatic pleura can be referred to the shoulder tip dermatome supplied by the same nerve – the phrenic nerve (C3, C4, C5)

51
Q

Nerve supply of visceral pleura? What sensation?

A

Autonomic nervous system (pulmonary plexus)

Detects stretch sensations but not pain sensations

52
Q

How many layers thick is the respiratory membrane involved in gas exchange?

A

2 cells thick
– Alveolar epithelium (1 cell)
– Capillary endothelium (1 cell)

53
Q

What are the layers that gas needs to go through for gas exchange?

A
  • Layer of fluid lining alveolus (surfactant)
  • Alveolar epithelium (1 cell)
  • Thin interstitial space
  • Capillary endothelium (1 cell)
54
Q

What are the mediastinal lymph nodes? Where are they located? what do they drain into?

A
  • Hilar –> Around the root of the lung
  • Bronchial –> Around the primary/main bronchi
  • Tracheal –> Around the trachea
    ———— All these drain into the ——————————–tracheobronchial lymph nodes —————

Tracheobronchial lymph nodes –> around bifurcation of the trachea
—-> They drain into the right and left bronchomediastinal lymph trunks which drain into the circulation at the junction between the subclavian and Internal jugular veins.

55
Q

Explain how the mediastinal lymph nodes can spread infection? and what structures can it obstruct if enlarged?

A

They may be involved in the spread of infection/carcinomas from the thoracic and upper abdominal viscera.

Lymph nodes are located near the mediastinal viscera – If they enlarge - viscera may be affected and can result in obstruction of trachea/oesophagus/SVC

FM 1030 (18 decks)

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