EXAM #1: ANATOMY Flashcards
Relate the apex of the lung to the bony anatomy.
- Apex extends above the clavicle
- Lateral to C7
What is the rule of two’s for the visceral pleura of the lung?
The visceral pleura extends to the following ribs, in the following planes:
Mid-clavicular= 6th rib
Mid-axillary= 8th rib
Paraverteral= 10th rib
What is the rule of two’s for the parietal pleura of the lung?
The parietal pleura extends to the following ribs, in the following planes, and generally is 2x ribs below visceral pleura*
Mid-clavicular= 8th rib Mid-axillary= 10th rib Paraverteral= 12th rib
What is the best place to listen to the middle lobe of the right lung?
Between 4th and 6th intercostal space in the mid-clavicular line
What is the best way to access a pleural effusion? Why?
Posterior b/c:
- Deep posterior gutter
- Wider intercostal spaces vs. anterior approach
- NV bundle is closer to the inferior margin
What is the superior pulmonary sulcus?
- This is a posterior concave region of the thoracic wall
- Groove is formed by the subclavian artery as it curves in front of the pleura
*Associated with T3
What cancer progresses along the superior pulmonary sulcus?
Pancoast tumor
What structures can be affected by a pancoast tumor?
Brachial plexus components:
- C8/T1– claw hand
- SNS– Horner’s Syndrome
What is the mnemonic to remember the sx. of Horner’s Syndrome?
PAM is horny
P= ptosis A= anhidrosis M= miosis
How many lobes does the left lung have?
2
How many lobes does the right lung have?
3
What lung/lobe is the lingula associated with?
Left lung, superior lobe
How many bronchopulmonary segments does the right lung have?
10
How many bronchopulmonary segments does the left lung have?
8
What is the hilum of the lung?
Doorway into/out of the lung
What is the mnemonic to remember the features/ relationships in the hilum of the right and left lungs?
RALS
- Right= pulmonary a. ANTERIOR
- Left= pulmonary a. SUPERIOR
*In relationship to the bronchus
Describe the branching of the airway from the trachea to the bronchioles.
1) Trachea
2) Primary bronchi
3) Secondary (lobar) bronchi*
4) Tertiary (segmental) bronchi**
5) Many divisions
6) Bronchioles
- Primary
- Terminal
- Respiratory
- Equal to the number of lobes per lung
- *Equal to the number of bronchopulmonary segments
In relationship to the vertebral column, where does the trachea begin and where does it divide at the carina?
C6= beginning T4= end
Note that the trachea is ~10cm long
What is unique about the respiratory bronchioles?
These are the bronchioles that are associated with the alveolar ducts/ alveoli
What type of epithelium is associated with the true vocal fold? Why?
Stratified squamous epithelium to protect against the vibratory stress
What is Reinke’s Space?
Space between:
1) Epithelium of the vocal fold lamina propria
2) Vocal ligament
What is the general histological “theme” in the airway?
- Larger airways have more diversity
- Smaller airways have much less diversity
Describe the epithelium of the respiratory tract, and the various transitions that occur from proximal to distal.
1) Anatomic dead space i.e. to terminal bronchioles= pseudostratified ciliated columnar epithelium
2) Respiratory bronchioles= cuboidal cells, no cilia
3) Alveoli= simple squamous cells, no cilia
Are there normally goblet cells in the bronchioles?
No
*Note that there ARE in smokers
What are the basal cells of the airway?
Stem cells/ regenerative cells
What is the name of the neuroendocrine cells in the airway?
Cells of Kolchinsky
What are the brush cells in the airway?
Sensory receptors of the airway
What major differences are there between the intrapulmonary bronchi and the more superior bronchi?
The intrapulmonary bronchus has:
1) Smooth muscle
2) Glandular secretions
What are the components of the glandular secretions in the intrapulmonary bronchi?
1) Mucus
2) Lactoferrin (bactericidal)
3) Lyzozyme (bactericidal)
4) IgA
5) Alpha-1 antitrypsin
How is the respiratory wall modified in asthma?
1) Increased mucus
2) Increased thickness of the basal lamina
3) Increased thickness of the lamina propria
- Edema
- Leukocytes
4) Increased thickness of the muscularis
5) Increased glands in the mucosa
What is the Reid index used to diagnose?
Chronic bronchitis
What is the Reid Index?
Gland thickness/ airway wall thickness
*In the ppt diagram, this is “bc/ad”
What is the normal Reid Index?
Less than 0.4
What is a Reid index that is positive for chronic bronchitis?
Greater than 0.5
gland is bigger relative to the wall
Where do the majority of lung cancers originate?
First three divisions of the airway
- Primary
- Secondary
- Tertiary
Bronchi
How do bronchioles differ from the bronchi?
1) No cartilage
2) No submucosa
3) Goblet cells only in large bronchioles
What are club/ clara cells? What are their functions?
These are cells found in terminal and respiratory bronchioles that:
1) Secrete a surfactant-like substance
2) Represent a stem-cell population
3) Degrade toxins
What is a Type I pneumocyte?
Squamous cells (small) in the alveoli that function as the location of gas exchange
*Make up 97% of the surface area of the alveoli
What is a Type II pneumocyte? What are the major functions of the Type II penumocytes?
Larger cells in the alveoli that:
1) Secrete surfactant
2) Function as stem cells i.e. can replace Type I pneumocytes
3) Secrete alpha-1 antitrypsin
What are heart failure cells?
Macrophages that are breaking down RBCs
