HS2-15 Lungs and Pleura

Question 1

Describe the process of gas exchange in the lungs.

Answer 1

deoxygenated blood from heart enters lungs via pulmonary trunk + pulmonary arteries

oxygenated blood flows from lungs to heart via pulmonary vein

Question 2

Compare the size and weight of the two lungs.

Answer 2

right lung is wider and heavier than left

Question 3

What fissures are found on the right lung?

Answer 3

oblique

horizontal

Question 4

What lobes are found in the right lung?

Answer 4

superior

middle

inferior

Question 5

Which lung is taller?

Answer 5

left lung

Question 6

What fissures are found on the left lung?

Answer 6

only oblique fissure

Question 7

What lobes are found on the left lung?

Answer 7

superior (featuring cardiac notch + lingula)

inferior

Question 8

Impressions on the lung are found on which lung?

Answer 8

left lung (cardiac + aortic impressions)

Question 9

What structures are found in the hilum, the root of the lung? (5)

Answer 9

bronchi

pulmonary arteries/veins

bronchial arteries/veins

pulmonary plexus

lymph vessels/nodes

Question 10

Describe the arrangement of structures in the left lung hilum. Draw a diagram.

Answer 10

1 pulmonary artery superior to 1 main bronchus

pulmonary veins anterior and inferior to bronchus and artery

Question 11

Describe the arrangement of structures in the right lung hilum. Draw a diagram.

Answer 11

1 lobar bronchus superior to main bronchus

2 pulmonary arteries, one slightly superior and anterior to each bronchus

pulmonary veins anterior and inferior to bronchi and arteries

Question 12

What is the hierarchy of bronchi?

Answer 12

principal = main

secondary = lobar

tertiary = segmental

Question 13

Why are inhaled objects more likely to get stuck in the right bronchus?

Answer 13

because the right bronchus is wider, shorter, and more vertically oriented

Question 14

How many secondary/lobar bronchi are there?

Answer 14

2 left

3 right

Question 15

What is the function of bronchial arteries?

Answer 15

supply oxygenated blood to lung tissue

Question 16

How many bronchial arteries are there?

Answer 16

2 from thoracic aorta (supply left lung)

1 from first intercostal artery -or- superior left bronchial artery (supplies right lung)

Question 17

What is the function of the bronchial veins?

Answer 17

drain deoxygenated blood from lung tissue

Question 18

The bronchial veins drain into

Answer 18

azygos vein (right)

hemiazygos vein (left)

Question 19

What are the two layers of pleura?

Answer 19

parietal

visceral

Question 20

The parietal pleura covers

Answer 20

parts of the thoracic wall, and some of the thoracic contents

Question 21

What are the subtypes of parietal pleura found in the thoracic cavity? (4)

Answer 21

costal

mediastinal

diaphragmatic

cervical (a.k.a. cupola)

Question 22

Describe the features of cervical pleura. (3)

Answer 22

covers apex of lung

extends an inch above clavicle, therefore reaching into neck

also called the cupola

Question 23

The visceral pleura covers

Answer 23

lungs

Question 24

The visceral pleura is continuous with

Answer 24

the parietal pleura at the root of the lung

Question 25

What is the pleural cavity?

Answer 25

space between parietal and visceral pleura

Question 26

What is the function of the pleural fluid found in the pleural cavity? (2)

Answer 26

reduces friction produces surface tension that keeps parietal and visceral pleural stuck to each other

Question 27

What are lines of pleural reflection?

Answer 27

where one type of parietal pleura becomes continuous with another (ie. changes surfaces)

Question 28

What are pleural recesses?

Answer 28

areas where two layers of parietal pleura are not separated by lung during quiet respiration

Question 29

What are the three functionally significant pleural recesses?

Answer 29

right costodiaphragmatic recess left costodiaphragmatic recess left costomediastinal recess

Question 30

What is the significance of the right and left costodiaphragmatic recesses?

Answer 30

can accommodate inferior margins of lungs

Question 31

What is the significance of the left costomediastinal recess? (2)

Answer 31

exists due to leftward bulge of heart accommodates lingula of left lung

Question 32

What is the innervation to the visceral pleura?

Answer 32

_autonomic_ innervation from vagus + sympathetic trunk

Question 33

(T/F) The visceral pleura are insensitive to pain.

Answer 33

**True**

Question 34

What is the innervation to the parietal pleura? (1, +2)

Answer 34

_somatic innervation:_ costal pleura = intercostal nerves diaphragmatic + mediastinal pleura = phrenic nerve

Question 35

Describe how the vertical plane of the thorax changes during respiration.

Answer 35

diaphgram contracts and moves inferiorly

Question 36

Describe how the transverse plane of the thorax changes during respiration. (2)

Answer 36

ribs 2-10 elevate in bucket handle motion lateral edges of ribs move away from midline

Question 37

Describe how the anteroposterior plane of the thorax changes during respiration.

Answer 37

sternum moves superiorly in pump handle motion anterior ends of ribs 2-6 elevate

Question 38

What are the muscles associated with quiet inspiration?

Answer 38

diaphragm

Question 39

What are the muscles associated with forced inspiration? (1 +3, 1 +3)

Answer 39

primary = external intercostals, scalenes, sternocleidomastoid secondary = pectoralis major/minor, serratus anterior, serratus posterior superior/inferior

Question 40

What are the muscles associated with quiet expiration? (2)

Answer 40

relaxation of diaphragm elastic recoil of lung tissue

Question 41

What are the muscles associated with forced expiration?

Answer 41

contraction of internal + innermost intercostal muscles

Question 42

Describe the mechanism of forced expiration.

Answer 42

contraction of internal and innermost intercostal muscles pulls ribs and sternum inferiorly increase in abdominal pressure causes diaphragm to move superiorly

Question 43

What are the three common views of chest x-rays?

Answer 43

PA (posterior anterior) = frontal view, standing lateral = lateral view, standing AP (anterior posterior) frontal view, supine

Question 44

How is the heart imaged in the AP view?

Answer 44

because the heart is positioned further from the director, it is artifically magnified in size

Question 45

What is echocardiography?

Answer 45

ultrasound of the heart

Question 46

What is mammography?

Answer 46

specialized radiographic technique used to image the breast

Question 47

What are the bronchi?

Answer 47

main two stems of the trachea

Question 48

What is the carina?

Answer 48

branching point of main stem bronchi

Question 49

What is main stem bronchus intubation?

Answer 49

placement of an endotracheal tube that preferrably ends up in the mid trachea, proximal to the carina

Question 50

Where do malpositioned endotracheal tubes most commonly end up?

Answer 50

right main stem bronchus (for the same reason that inhaled objects tend to end up in the right main stem bronchus)

Question 51

How can a right main stem bronchus intubation affect the *left* lung?

Answer 51

can cause left lung collapse due to lack of ventilation on the left side caused by malpositioned tube in right side

Question 52

Differentiate between the left and right hilums in chest radiography.

Answer 52

left hilum is *slightly higher* than right hilum on chest x-ray

Question 53

Describe the visualization of right middle lobe pneumonia on chest x-ray.

Answer 53

abnormal, triangularly-shaped opacity that demonstrate's the right middle lobe's characteristic triangular shape

Question 54

Which type of chest x-ray is best for visualizing right middle lobe pneumonia?

Answer 54

lateral CXR

Question 55

What is pneumothorax?

Answer 55

presence of air in pleural space

Question 56

What is the effect of pneumothorax on the visceral and parietal pleura?

Answer 56

air occupies pleural space and pushes visceral pleura away from parietal pleura

Question 57

(T/F) In its normal state, the visceral pleura is visualizable on CXR.

Answer 57

**False**. That's why if you do actually see the visceral pleura on CXR, something is *not* normal (such as pneumothorax).

Question 58

Where on a CXR is pneumothorax most easily visualized?

Answer 58

in the superior thorax/apical region

Question 59

In what patient position is pneumothorax most easily visualized on CXR?

Answer 59

patient in upright position

Question 60

Write out a table that shows where the lungs and parietal pleura end at the midclavicular, midaxillary, and midscapular lines.

Answer 60

Question 61

Where does the costodiaphragmatic recess extend to, posteriorly?

Answer 61

12th rib @ midscapular line

Question 62

Where does the costodiaphragmatic recess extend to, laterally?

Answer 62

extends to 10th rib @midaxillary line

Question 63

Where does the costodiaphragmatic recess extend to, anteriorly?

Answer 63

extends to 8th rib @ midclavicular line

Question 64

Which of the costodiaphragmatic recesses are best seen on CXR?

Answer 64

lateral and posterior

Question 65

Where does fluid preferentially accumulate in the pleural cavity of the thorax?

Answer 65

the lateral and posterior costodiaphragmatic recesses, because they are the most inferior regions of the thorax

Question 66

How is pleural fluid typically seen on CXR?

Answer 66

homogeneous opacity that "blunts" the typical costodiaphragmatic angle and has a concave meniscus

Question 67

Describe the movement of air after the trachea.

Answer 67

trachea ↓ principal/main bronchi ↓ secondary/lobar bronchi ↓ tertiary/segmental bronchi ↓ bronchopulmonary segments