ANAT Clinical Anatomy of Lungs, Pleura & Spaces - Week 1 & 2 (incl. ANAT Workbook)

Question 1

At an embryological level, union of visceral & parietal pleura =

Answer 1

Mesentery

Question 2

What pleura receives somatic innervation?

Answer 2

Parietal

Question 3

What happens to the pleura at the lung hilum?

Answer 3

Pulmonary ligament is site where parietal pleura folds back onto itself to form visceral pleura…

Question 4

How many lobes in right lung? Left lung?

Answer 4

3. 2.

Question 5

Which lung has lingula?

Answer 5

Left - because of heart.

Question 6

Fissures on left and right lungs?

Answer 6

R - oblique & horizontal.
L - oblique.

Question 7

What part of the heart is most anterior?

Answer 7

Right ventricle.

Question 8

Where should a needle be inserted to release pneumothorax?

Answer 8

Intercostal space in the mid-axillary line - immediately superior (usually to the 6th rib). Anatomically safe because vein, artery, nerve run under rib in costal groove.
Remember VAN.

Question 9

Cardiac notch location for pt w situs inversus.

Answer 9

Anterior, R lung.

Question 10

Difference btw R & L primary bronchi

Answer 10

R - wider & shorter w 3 branches
L - thinner & longer w 2 branches

Question 11

Once inhaled, a foreign object, if small enough, is most likely to enter which part of the lungs first?

Answer 11

R inferior lobe - as R main bronchus is wider & steeper than L.

Question 12

Atelectasis

Answer 12

Internal lung collapse (not caused by penetrating injury)
Primary - newborns
Secondary - non-newborns

Question 13

Atelectasis. Mention difference btw primary & secondary.

Answer 13

Internal lung collapse (not caused by penetrating injury).
Primary - newborns
Secondary - non-newborns

Question 14

Where is the parietal pleura particular vulnerable to a penetrating injury?

Answer 14

Apex (due to protrusion out of 1st rib).

Question 15

Drainage for R side of body

Answer 15

1/4 -> lymphatic duct.

Question 16

Drainage for L side of body

Answer 16

3/4 -> thoracic duct.

Question 17

Metastasis to which lymph nodes @ carina can cause an increase in angle and be observed on bronchoscopy.

Answer 17

Tracheobronchial.

Question 18

At what level does the trachea bifurcate?

Answer 18

T4 @ carina.

Question 19

Describe the anatomy of the respiratory tree from the trachea to the alveoli

Answer 19

Trachea -> L&RMB -> Secondary bronchi -> Tertiary bronchi -> Bronchioles -> Terminal bronchioles (end of conducting, start of respiring) -> Respiratory bronchioles -> Alveolar ducts -> Alveolar sacs/alveoli

Question 20

Why might cardiac and oesophageal pain mimic each other?

Answer 20

Oesophagus innervated by spinal nerve T1-10 of cervical/thoracic symp. trunk & heart innervated by T2-5 segments of symp. trunk.
Thus, shared nerves may explain shared pain.

Question 21

Define aortic dissection

Answer 21

Tear in inner layer of aorta -> blood may rush through this tear causing inner & middle layer of the aorta to split/dissect.

Question 22

Autonomic innervation of the heart

Answer 22

Symp: symp. trunk -> increases HR
Parasymp: vagus nerve -> decreases HR

Question 23

Consequences of denervation of the autonomic nervous system for the heart

Answer 23

For example, immediately following heart transplant -> impaired cardiac function during exercise (low HR), but higher HR at rest. Reduced chest pain - may cause delayed response in cases of myocardial infarction. This is due to myogenic contraction of heart at 80-90bpm unaffected by activity levels, B blockers, anti-arrhythmias until nerve regrowth complete.

Question 24

Which vessel - aorta or pulmonary trunk - is more anterior at their origins?

Answer 24

Pulmonary trunk (from R ventricle - more ant. than left).

Question 25

Embryological basis for position of the left & right recurrent laryngeal nerves.

Answer 25

L recurrent loops around arch of aorta. Embryologically, right also did the same - as we developed initially with 2 aorta. However, signalling lead to loss of 2nd aorta and R recurrent thus attached to closest other artery - subclavian.

Question 26

Which nerve passes immediately posterior to the hilum of the lung?

Answer 26

Vagus nerve.

Question 27

Bronchopulmonary segments are supplied by

Answer 27

Tertiary/segmental bronchi.

Question 28

What dermal layer is the embryological origin of the trachea?

Answer 28

Endoderm.

Question 29

What dermal layer is the embryological origin of the pleura?

Answer 29

Mesoderm.

Question 30

What vessel is most anterior in the lung hilum?

Answer 30

Pulmonary vein/s (Vein, Artery, Bronchus in order from Ant->Post).

Question 31

Symptoms of R sided heart failure

Answer 31

Syncope during activity, chest discomfort, chest pain, ankle oedema, symptoms of lung disorders (i.e., wheezing, coughing, phlegm production), cyanosis, raised JVP.

Question 32

Symptoms of L sided heart failure

Answer 32

Cough, SOB with walking/bending over, PND or orthopnoea, ankle oedema, reduced pulse, reduced perfusion, crackles on auscultation.

Question 33

Which sided heart failure -> contralateral sided heart failure?

Answer 33

L is most common cause of RHF.

Question 34

In what pts is a spontaneous pneumothorax common?

Answer 34

Tall, thin, adolescent males.