Lungs and Diaphragm

Question 1

What structures make up the thoracic inlet?

Answer 1

The manubrium (anteriorly), first ribs (laterally), and T1 (posteriorly)

Question 2

Describe the relative location of the thoracic cavity using anatomical terms and structures

Answer 2

Inferior to the thoracic inlet, superior to the diaphragm

Question 3

What structure is noted as the inferior margin/boarder of the thoracic cavity?

Answer 3

The diaphragm

Question 4

Define serous sacs

Answer 4

Continuous, dual layered sacs that form a membrane AROUND organs (the organs are not inside the serous sacs, they are surrounded by it as if you were to push your fist into a balloon)

Question 5

What 2 layers make up a serous sac?

Answer 5

Visceral and parietal layers

Question 6

Which layer of serous sacs is responsible for being in physical contact with organs? (visceral or parietal)

Answer 6

Visceral

Question 7

The visceral layer of serous sacs receives what type of nerve innervation?

Answer 7

Visceral sensory innervation (sensations of stretch and ischemia)

Question 8

Which layer of serous sacs comes into contact with the body wall?

Answer 8

Parietal layer

Question 8

The parietal layer of serous sacs receives what type of nerve innervation?

Answer 8

Somatic sensory innervation (pain, temperature, touch)

Question 9

What is the serous cavity?

Answer 9

The potential space between the parietal and visceral layers of serous sacs

Question 9

What is the primary function of serous fluid within serous sacs?

Answer 9

Facilities the movement of organs (allows for frictionless movement of structures like the lungs in the thoracic cavity)

Question 10

Define pleurae

Answer 10

The pair of serous sacs that surround the lungs

Question 11

What is the pericardial sac?

Answer 11

The serous sac that surrounds the heart

Question 12

What is the peritoneal sac?

Answer 12

The serous sacs that surrounds the abdominopelvic organs

Question 13

What is the parietal pleura?

Answer 13

The inner layer of a pleural sac that lines the deep surface of the thoracic wall (comes into contact with thoracic wall)

Question 14

Which nerves are responsible for the somatic sensory innervation received by the parietal pleura?

Answer 14

Intercostal nerves (peripherally, laterally in particular) and the phrenic nerve (medially, particularly the surface that comes into contact with the pericardium)

Question 15

What is the visceral pleura?

Answer 15

The outer layer of a pleural sac that lines the surface of the lungs

Question 16

Pleurae are continuous at what structure?

Answer 16

The root of the lung

Question 17

Define hydrothorax

Answer 17

An abnormal accumulation of fluid within the pleural cavity (nonspecific fluid, word can be used to describe any type of fluid)

Question 18

Define hemothorax

Answer 18

An abnormal accumulation of blood within the pleural cavity

Question 19

Define pneumothorax

Answer 19

An abnormal accumulation of air within the pleural cavity

Question 20

Define pleurisy

Answer 20

Somatic pain from inflammation of the parietal pleura

Question 21

How does an abnormal accumulation of fluid or air within the pleural cavity cause a problem?

Answer 21

A buildup of fluid or air within the pleural cavity adds pressure to surrounding tissue (the lungs), which decreases the lungs ability to fully inflate, making it difficult to breathe.

Question 22

What is a thoracentesis?

Answer 22

A procedure used to drain fluid from the costodiaphragmatic process of the pleural cavity

Question 23

What is the costodiaphragmatic recess?

Answer 23

The corners at the junction of costal and diaphragmatic pleura. These corners can be found laterally and posteriorly on the inferior portion of the thorax, where the diaphragm meets the thoracic cage

Question 24

Assuming a patient is sitting upright, the pathological accumulation of fluid within the pleural space accumulates where?

Answer 24

Costodiaphragmatic recess

Question 25

During a thoracentesis, the needle being used to drain the fluid is typically inserted where (Assuming no ultrasound is used)?

Answer 25

The posterior side of intercostal spaces 7-9

Question 26

Generally speaking, the apex of an organ is defined as what?

Answer 26

The narrowest surface (most pointy)

Question 27

Generally speaking, the base of an organ is defined as what?

Answer 27

The broadest surface

Question 28

Describe the root of the lung (also known as the hilum)

Answer 28

The area on the medial surface of each lung where bronchi and vessels enter and exit (ONLY place where structures enter and exit the lung)

Question 29

What does the costal surface of the lungs face?

Answer 29

The ribs

Question 30

Name the lobes of the right lung from superior to inferior

Answer 30

Superior lobe, middle lobe, inferior lobe

Question 31

Describe the location of the oblique fissure of the right lung

Answer 31

Between the inferior lobe and superior and middle lobes

Question 32

What are the 2 types of fissures of the right lung called?

Answer 32

Oblique fissure and horizontal fissure

Question 33

Describe the location of the horizontal fissure of the right lung

Answer 33

Between the superior lobe and middle lobe

Question 34

Describe the location of the oblique fissure of the left lung

Answer 34

Between the inferior lobe and superior lobe

Question 35

Why is the left lung smaller/have less lobes than the right?

Answer 35

To accommodate the heart

Question 36

What are bronchopulmonary segments?

Answer 36

A portion of lung divided/defined by thin connective tissue septa

Question 37

Define segmental bronchus

Answer 37

The respiratory tube (bronchi) that supplies air to each of the bronchopulmonary segments (each bronchopulmonary segment has its own segmental bronchus)

Question 38

Define segmental artery

Answer 38

The pulmonary arteries of each of the bronchopulmonary segments (each bronchopulmonary segment has its own segmental artery)

Question 39

How many bronchopulmonary segment can be found in the left lung?

Answer 39

10

Question 40

How many bronchopulmonary segment can be found in the right lung?

Answer 40

10

Question 41

How do branches of the pulmonary vein run in the lungs?

Answer 41

Intersegmentally, so in between bronchopulmonary segments (bronchopulmonary segments do NOT have their own pulmonary vein like they do with the bronchi and the pulmonary arteries)

Question 42

Bronchopulmonary segments each have their own of which of the following? (Chose 2) A) Bronchi B) Arteries C) Veins

Answer 42

A and B

Question 43

Define the margins of the bronchial tree

Answer 43

Extends from the larynx superiorly, through the thorax, and into each lung

Question 44

What structure makes up the largest portion of the bronchial tree?

Answer 44

The trachea

Question 45

What structure is immediately posterior to the trachea?

Answer 45

The esophagus

Question 46

What occurs to the trachea at the level of the sternal angle (Between the manubrium and the body of the sternum, or at the level of the T4/T5 vertebral disc)?

Answer 46

It bifurcates into the right main bronchi and left main bronchi

Question 47

What is the name of the internal ridge structure at the bifurcation of the trachea?

Answer 47

The carina (car-eye-na)

Question 48

Where do the left and right main bronchi extend from and to?

Answer 48

They extend from the trachea and into the lungs

Question 49

Why are the left and right main bronchi known as extrapulmonary structures?

Answer 49

Because they remain outside of the lungs

Question 50

What do the left and right main bronchi divide into?

Answer 50

lobar bronchi

Question 51

How many lobar bronchi are in the left lung?

Answer 51

2

Question 52

How many lobar bronchi are in the right lung?

Answer 52

3

Question 53

Why are lobar bronchi known as intrapulmonary structures?

Answer 53

Because they reside within the lung tissue

Question 54

What do lobar bronchi divide into?

Answer 54

Segmental bronchi

Question 55

How many segmental bronchi are there in the left lung?

Answer 55

10 (one for each bronchopulmonary segment)

Question 56

How many segmental bronchi are there in the right lung?

Answer 56

10 (one for each bronchopulmonary segment)

Question 57

What is meant when it is said that segmental bronchi are intrasegmental?

Answer 57

It means they reside in the center of bronchopulmonary segments)

Question 58

Why is the an aspirated object more likely to end up in the right main bronchus than the left main bronchus?

Answer 58

Because it is shorter, wider, and more vertical than the left main bronchus

Question 59

If an object is aspirated on, which of the main bronchi is it more likely to end up in?

Answer 59

The right main bronchus

Question 60

Describe the role of the pulmonary arteries

Answer 60

Carry DEOXYGENATED blood from the heart (via the pulmonary trunk) to the lungs for oxygenation

Question 61

Define arteries

Answer 61

Blood vessels that carry blood AWAY from the heart

Question 62

Define veins

Answer 62

Blood vessels that carry blood towards the heart

Question 63

What chamber of the heart does the pulmonary trunk arise from?

Answer 63

The right ventricle

Question 64

The pulmonary trunk divides into terminal branches known as what?

Answer 64

The left and right pulmonary arteries

Question 65

In the lungs, pulmonary arteries divide into what?

Answer 65

Lobar arteries

Question 66

How many lobar arteries are found in the left lung?

Answer 66

2

Question 67

How many lobar arteries are found in the right lung?

Answer 67

3

Question 68

Lobar arteries branch/divide into what?

Answer 68

Segmental arteries

Question 69

What are pulmonary veins?

Answer 69

Small vessels that converge to drain away from the lungs that carry oxygenated blood back towards the heart (2 pulmonary veins enter each lung, so there are 4 total)

Question 70

Why are pulmonary veins known are intersegmental rather than intrasegmental?

Answer 70

Because they run between bronchopulmonary segments rather than to the middle of them like segmental pulmonary arteries and segmental bronchi

Question 71

What chamber of the heart do the pulmonary veins enter into?

Answer 71

The left atrium

Question 72

What are bronchial vessels?

Answer 72

Systemic vessels used to bring oxygen and nutrients to lung tissues that are too far away from alveolar spaces to rely on direct gas exchange as their source for oxygen and nutrients

Question 73

Where do bronchial arteries arise from?

Answer 73

The thoracic aorta

Question 74

Where do bronchial veins drain into?

Answer 74

The azygous system/azygous vein

Question 75

What specific blood vessels carries oxygenated blood to lung tissues that aren't passively oxygenated?

Answer 75

The bronchial arteries

Question 76

The azygous vein drains into what structure?

Answer 76

The superior vena cava (SVC)

Question 77

Sympathetic innervation of the lungs follows which sympathetic pathway?

Answer 77

The thoracic viscera pathway

Question 78

What nerves are responsible for supplying sympathetic innervation to the lungs?

Answer 78

Pulmonary splanchnic nerves

Question 79

Sympathetic and parasympathetic innervation of the lungs acts upon what type of muscle?

Answer 79

Smooth muscle

Question 80

What is the outcome of sympathetic innervation of the lungs?

Answer 80

Bronchodialation

Question 81

The trachea divides into the left and right main bronchi at what level?

Answer 81

The level of T4/T5

Question 82

The lungs receive parasympathetic innervation via what nerve?

Answer 82

The vagus nerve (cranial nerve X/10)

Question 83

What is the outcome of parasympathetic innervation of the lungs/bronchi?

Answer 83

Bronchoconstriction

Question 84

The primary muscle of respiration is knows as what?

Answer 84

The diaphragm

Question 85

The diaphragm is composed of what type of muscle fibers?

Answer 85

Skeletal

Question 86

Describe the differences between the right and left hemidiaphragms

Answer 86

The right hemidiaphragm is situated higher than the left, as the liver is located directly inferior to it

Question 87

Describe the nerve innervation of the right and left hemidiaphragms

Answer 87

They are independently innervated

Question 88

What are the points of attachment for the diaphragm?

Answer 88

The costal margin, ribs 11 and 12, the xiphoid process (at anterior midline) and the lumbar vertebrae (at posterior midline)

Question 89

From superior to inferior, name the various openings in the diaphragm

Answer 89

Caval opening (T8), esophageal hiatus (T10), and the aortic hiatus (T12)

Question 90

Describe the relative location of the caval opening

Answer 90

Located at the level of T8, is the most superior and anterior of the 3 openings in the diaphragm

Question 91

What structure(s) does the caval opening transmit?

Answer 91

The inferior vena cava (IVC)

Question 92

Describe the relative location of the esophageal hiatus

Answer 92

Located at the level of T10, is inferior and slightly posterior to the caval opening

Question 93

What structure(s) does the esophageal hiatus transmit?

Answer 93

The esophagus and the vagal trunks (of both vagus nerves)

Question 94

Describe the relative location of the aortic hiatus

Answer 94

At the level of T12, is the most inferior and posterior of the 3 openings in the diaphragm

Question 95

What structure(s) does the aortic hiatus transmit?

Answer 95

The thoracic aorta (becomes the abdominal aorta), the azygous vein, and the thoracic duct (part of the lymphatic system)

Question 96

At what point does the thoracic aorta become the abdominal aorta?

Answer 96

After passing through the aortic hiatus

Question 97

Explain the process of inhalation

Answer 97

The diaphragm contracts, flattening the hemidiaphragm domes, which creates negative pressure and causes air to flow in

Question 98

Explain the process of expiration

Answer 98

The diaphragm relaxes, allowing the hemidiaphragm domes to re-shape, which creates positive pressure and causes air to be pushed out

Question 99

Expiration is primarily due to what (other than the relaxation of the diaphragm)?

Answer 99

Elastic recoil

Question 100

What occurs during forced inhalation?

Answer 100

The upper limb part of the muscle becomes fixed, and the chest wall part becomes free/not fixed.

Question 101

What muscle largely contributes to the process of forced inhalation?

Answer 101

Pectoralis major

Question 102

What occurs during forced exhalation?

Answer 102

The abdominal muscles contract, compressing abdominal contents upwards, reducing the thoracic volume

Question 103

How do accessory muscles move the sternum?

Answer 103

Anteriorly and superiorly (known as a pump handle motion)

Question 104

How do accessory muscles move the ribs?

Answer 104

Laterally and superiorly (known as a bucket handle motion)

Question 105

The diaphragm receives somatic motor innervation from what nerve?

Answer 105

The phrenic nerve

Question 106

Describe the origins of the phrenic nerve

Answer 106

From C3 to C5

Question 107

How does the phrenic nerve run down the left side of the body in relation to the heart and lungs?

Answer 107

In between the heart and lungs, anterior to the hilum

Question 108

The phrenic nerve provides somatic sensory innervation to what structures?

Answer 108

The central part of the diaphragm and some of the parietal pleura

Question 109

What nerve(s) are responsible for providing somatic sensory innervation to parts of the parietal pleura, as well as the peripheral aspects of the diaphragm?

Answer 109

The intercostal nerves

Question 110

The intercostal nerves provide motor innervation to what muscles?

Answer 110

The intercostal muscles