Lungs and Diaphragm Anatomy

Question 1

Innervation to parietal pleura

Answer 1

intercostal to costal part
phrenic to diaphragmatic and mediastinal parts

Question 2

Innervation of visceral pleura

Answer 2

autonomic

Question 3

contents of lung root

Answer 3

Pulmonary artery
2 pulmonary veins
Main bronchus
Bronchial vessels
Pulmonary nerve plexus
Lymphatics

Question 4

Orientation at the hilum

Answer 4

artery superior
veins inferior
bronchus posterior

Question 5

Relevance of bronchopulmonary segments

Answer 5

smallest functionally independent lung units
each segment has its own blood supply and segmental bronchus.
Can resect one without effecting the function of the rest of the lung

Question 6

What is the lingular

Answer 6

left lung
cuff of lung tissue that overlies the indentation made by the heart

Question 7

Where does the trachea bifurcate

Answer 7

T4/5

Question 8

what is the trachea made of

Answer 8

hyaline cartilage
15-20 c-shaped

Question 9

level of cricoid carticlage

Answer 9

c6

Question 10

length of the trachea

Answer 10

10cm
c6 to t4/5

Question 11

where does the pulmonary truk bifurcate

Answer 11

t4/5
into right and left pulmonary arteries

Question 12

where do bronchial arteries orginate

Answer 12

thoracic aorta

Question 13

where do bronchial veins drain to

Answer 13

azygos or pulmonary veins

Question 14

lymph drainage of the lung

Answer 14

bronchopulomary nodes at hilum
to bronchotracheal nodes around carina
then to broncho mediastinal nodes

Question 15

what are the accessory respiratory muscles

Answer 15

external intercostals, scalene, sternocleidomastoid

Question 16

what does the diaphragm originate from

Answer 16

crura and arcuate ligaments

right crus - l1-3
left crus - L1/2
median arcuate ligement - psoas major fascia
lateral arcuate ligament - quadratus lumborum fascia

sternum
lower 6 costal cartilages

Question 17

blood supply to diaphragm

Answer 17

branches of the internal thoracic artery (musculophrenic) and aorta
(superior and inferior phrenic, intercostals)

majority is inferior phrenic

Question 18

right crus and oesophagus

Answer 18

oesophagus at T10
some fibres wrap around oesophagus acting as sphincter
crura are tendinous

Question 19

central tendon

Answer 19

right and left muscle fibres of diaphrgam meet and fuse with pericardium

Question 20

paralysis of diaphragm

Answer 20

interruption of nerve supply

brainstem, spinal cord, phrenic erve

c3,4,5,

normally phrenic nerve injury

• Mechanical trauma: ligation or damage to the nerve during surgery.
• Compression: due to a tumour within the chest cavity.
• Myopathies: such as myasthenia gravis.
• Neuropathies: such diabetic neuropathy.

Question 21

path of phrenic nerve

Answer 21

c3,4,5
through superior thoracic aperture
anterior to the lung roots

Question 22

vagus nerve and lung root

Answer 22

vagus is posterior and gives off RCLN

Question 23

congenital diaphragmatic hernia

Answer 23

bochdalek - posterior/left. most common

morgagni - rare foramen of morgagni - costal cartilage and xiphoid junction. right sided.

Question 24

acquired diaphragmatic hernia

Answer 24

sliding - oesophagogastric junction slides up into the thorax

rolling - part of the stomach is in the thorax but junction remains in the abdomen

Question 25

openings of the diaphragm

Answer 25

T8 - central tendon - IVC and right phrenic nerve T10 - Right crus - Oesophagus, vagus T12 - Behind median arcuate ligament - Aorta, azygos, thoracic duct

Question 26

insertion of diaphragm

Answer 26

central aponeurotic tendon

Question 27

action of the diaphragm

Answer 27

inspiration and forced expiration

Question 28

innervation of diaphragm

Answer 28

phrenic nerve c234

Question 29

blood supply diaphragm

Answer 29

inferior phrenic artery

Question 30

identify structures passing through the hilum of the lung

Answer 30

pulmonary artery and vein (most anterior) right and left main bronchus (most posterior) bronchial artery and vein lymph nodes autonomic nerves

Question 31

what is the pulmonary ligament

Answer 31

pleural fold that separates the mediastinal surface of the lung and the pericardium to allow expansion of the pulmonary veins with increased blood flow

Question 32

surface anatomy apex of lung

Answer 32

3cm above clavicle between median and middle third

Question 33

surface anatomy anterior boarder lung

Answer 33

SCJ to xiphistermun left lung deviates at 4th costal caritlage for cardiac notch

Question 34

inferior border of lung surface anatomy

Answer 34

6th, 8th, 10th ribs ant, lat, post

Question 35

posterior border of the lung surface naatomy

Answer 35

C7 - T10

Question 36

vertebral level of lung hilum

Answer 36

T5/6/7

Question 37

vertebral level carina

Answer 37

T4

Question 38

how many bronchopulmonary segments in each lung

Answer 38

10

Question 39

nerves related to the hilum of the mung

Answer 39

anterior = phrenic posterior = sympathetic chain

Question 40

describe the course of a clot from deep veins of the calf to pulmonary artery

Answer 40

popliteal vein, femoral vein, EIV, CIV, IVC, right atrium, AV valve pulmonary valve pulmonary artery

Question 41

nerve supply of intercostal muscles

Answer 41

intercostal nerves

Question 42

branches of the aortic arch

Answer 42

brachiocephalic - right subclavian, right common carotid left common carotid left subclavian

Question 43

subclavian steal syndrome

Answer 43

retrograde flow of blood to the vertebral artery due to sternoocculusive disease in the subclavian artery proximal to the vertebral artery. will lead to brainstem ischaemia on arm exercise

Question 44

thoracic outlet syndrome

Answer 44

compression of the subclavian artery and rbachial plexus between scalene medium and anterior - neurologial and vascular symptoms in the arm

Question 45

where to put a chest drain

Answer 45

5th ICS mid axillary line

Question 46

why would someone get bradycardia after a chest tube insertion

Answer 46

irritation of the vagus nerve

Question 47

boundaries of the posterior mediastinum

Answer 47

anterior - pericardium, vertical part of diaphragm posterior - lower 8 thoracic vertebrae each side - mediastinal pleura

Question 48

contents of posterior mediastinim

Answer 48

oesophagus thoracic aorta azygos vein thoracic duct vagus nerve sympathetic nerve trunks splanchnice nerves

Question 49

superior mediastinum contents

Answer 49

SVC brachiocephalic veins arch aorta thoracic duct trachea oesophagus thymus vagus nerve left recurrent laryngeal nerve phrenic nerve

Question 50

anterior mediastinum

Answer 50

thymic remnants lymph nodes fat

Question 51

middle mediastinum

Answer 51

pericardium herat aortic root arch of azygos vein main bronchi