Lungs And Pleura

Question 1

The pleurae and lungs lie on either side of the———within the chest cavity

Answer 1

The pleurae and lungs lie on either side of the mediastinum within the chest cavity

Question 2

Pleura
——membrane that covers the ——,——,—— and the ——.

Answer 2

Serous membrane that covers the lung parenchyma, mediastinum, diaphragm and the rib cage.

Question 3

Each pleura has two parts:

Answer 3

Each pleura has two parts:

➢Parietal layer
➢Visceral

Question 4

Parietal Layer
➢It lines the ——wall

➢Covers the —— surface of the —— and the lateral aspect of the ——

➢Extends into the —— of the neck to line the undersurface of the —— at the ——

Answer 4

Parietal Layer
➢It lines the thoracic wall

➢Covers the thoracic surface of the diaphragm and the lateral aspect of the mediastinum

➢Extends into the root of the neck to line the undersurface of the suprapleural membrane at the thoracic outlet

Question 5

Parts of parietal pleura
•The parietal pleura, though a ——sheet, is given different names according to the parts it covers. It is therefore divided into ——, ——, ——, and ——— pleura

Answer 5

Parts of parietal pleura
•The parietal pleura, though a continuous sheet, is given different names according to the parts it covers. It is therefore divided into costal, mediastinal, diaphragmatic, and cervical pleura

Question 6

Cervical pleura
–“pleural ——” or dome of pleura.
➢It extends from the superior———into the —— of neck, forming a — shaped pleural dome over the — of lung.

➢It reaches a level — to — cm above the ——- of the clavicle

Answer 6

Cervical pleura
–“pleural capula” or dome of pleura.
➢It extends from the superior thoracic aperture into the root of neck, forming a cup shaped pleural dome over the apex of lung.

➢It reaches a level 2.5 to 4 cm above the medial third of the clavicle

Question 7

Costal pleura
The costal pleura covers the internal surfaces of the ——, ——, ——, —— and the sides of ——— , separated from all these structures by a thin layer of loose connective tissue called the ———

Answer 7

Costal pleura
The costal pleura covers the internal surfaces of the sternum, costal cartilages, ribs, intercostal muscles and the sides of thoracic vertebrae, separated from all these structures by a thin layer of loose connective tissue called the endothoracic fascia

Question 8

Mediastinal pleura
–It covers the —— aspects of the mediastinum.
–It is attached to blood vessels and bronchi that constitute the —— root.
–it is continuous —— and —— with the costal pleura Visceral pleura

Answer 8

Mediastinal pleura
–It covers the lateral aspects of the mediastinum.
–It is attached to blood vessels and bronchi that constitute the lung root.
–it is continuous anteriorly and posteriorly with the costal pleura

Question 9

Diaphragmatic pleura
•Inferiorly, the mediastinal pleura is continuous with the———pleura that covers the ——— surface of the diaphragm while superiorly it is continuous with the——pleura

Diaphragmatic pleura :
➢Covers the superior or thoracic surface of———— on each side of mediastium.
➢In quiet respiration, the ——and the ———pleura are in apposition to each other.
➢They separate in ——inspiration.

Answer 9

Diaphragmatic pleura :
➢Covers the superior or thoracic surface of diaphragm on each side of mediastium.
➢In quiet respiration, the costal and the diaphragmatic pleura are in apposition to each other.
➢They separate in deep inspiration.

Question 10

Visceral Layer
–Covers the lung ——, not only at its point of contact with chest wall, diaphragm and the mediastinum but also in the ——- fissures.
–It apposed to lungs and cannot be ——from the surface.

the visceral pleura of ——lobes lie in contact with each other.

Answer 10

Visceral Layer
–Covers the lung parenchyma, not only at its point of contact with chest wall, diaphragm and the mediastinum but also in the interlobar fissures.
–It apposed to lungs and cannot be dissected from the surface.
the visceral pleura of adjacent lobes lie in contact with each other.

Question 11

Visceral pleura
• Endo pleura :
􏰀 Most —— layer
􏰀 Composed of a continuous layer of ———cells
▪ External elastic layer (——layer)
􏰀 Consist of thin layer of dense —-
and — tissue
􏰀 Responsible for——-
▪ Vascular layer (——layer)
􏰀 Consist of connective tissue containing —— and —-.
􏰀 Continuous with the ——tissue of the interlobular septa and directly overlies the ——membrane.

Answer 11

Visceral pleura
• Endo pleura :
􏰀 Most superficial layer
􏰀 Composed of a continuous layer of mesothelial cells
▪ External elastic layer (chief layer)
􏰀 Consist of thin layer of dense collagen
and elastic tissue
􏰀 Responsible for pleural mechanical stability

▪ Vascular layer (interstitial layer)
􏰀 Consist of connective tissue containing
lymphatic and blood vessels.
􏰀 Continuous with the interstitial tissue of the interlobular septa and directly overlies the lobular-limiting membrane.

Question 12

List the two layers of the visceral pluera

Answer 12

Endo pleura
External elastic layer
Vascular layer

Question 13

Pleural Cuff
􏰀 The two layers continuous with one another by means of a ——
􏰀 This cuff surrounds the structures entering and leaving the lung at the ——of each lung
􏰀 Pleural cuff hangs down as a loose fold called the ——

Answer 13

Pleural Cuff
􏰀 The two layers continuous with one another by means of a cuff of pleura
􏰀 This cuff surrounds the structures entering and leaving the lung at the hilum of each lung
􏰀 Pleural cuff hangs down as a loose fold called the pulmonary ligament

Question 14

Pulmonary ligament
▪At the root of the lung, the mediastinal pleura passes —— forming a sleeve that encloses the structures at the lung root

▪ Inferior to the lung root the sleeve of the mediastinal pleura is too big for the contained structures forming a double layer called the ——

Answer 14

At the root of the lung, the mediastinal pleura passes laterally forming a sleeve that encloses the structures at the lung root

Inferior to the lung root the sleeve of the mediastinal pleura is too big for the contained structures forming a double layer called the pulmonary ligament

Question 15

Pulmonary ligament
▪ If you pinch together the cuffs of a jacket below your wrist, you will understand how the lower part of the sleeve at the hilum forms a double layer i.e. the ———

▪ The pulmonary ligament is an ill‐chosen name (a——),
▪ it has nothing to do with the lung since it is ——-

in addition, the pulmonary ligament is not a ligament in the correct sense of the meaning, it is a double fold of pleura that hangs down below the ——— as an empty fold

Answer 15

Pulmonary ligament
▪ If you pinch together the cuffs of a jacket below your wrist, you will understand how the lower part of the sleeve at the hilum forms a double layer i.e. the pulmonary ligament

Pulmonary ligament
▪ The pulmonary ligament is an ill‐chosen name (a misnomer),
▪ it has nothing to do with the lung since it is pleura

in addition, the pulmonary ligament is not a ligament in the correct sense of the meaning, it is a double fold of pleura that hangs down below the lung root as an empty fold

Question 16

Function of the pulmonary ligament
▪ The function of the pulmonary ligament is to provide a ——space into which the —— descends with descent of the ———.

More important is that pulmonary veins (contained in the lung root) can expand during periods of increased ———from the lungs as in exercise (remember that the pulmonary veins carry oxygenated blood from the lungs to the heart)

It is interesting to note that the two pulmonary veins at each root lie at the ———part of the root just above the pulmonary ligament

Answer 16

Function of the pulmonary ligament
▪ The function of the pulmonary ligament is to provide a dead space into which the lung root descends with descent of the diaphragm.

More important is that pulmonary veins (contained in the lung root) can expand during periods of increased venous return from the lungs as in exercise (remember that the pulmonary veins carry oxygenated blood from the lungs to the heart)

It is interesting to note that the two pulmonary veins at each root lie at the lower part of the root just above the pulmonary ligament

Question 17

At the lung hilum the uppermost structure is the ——
while the main bronchus is situated more ——
In front and below are the ——

Answer 17

At the lung hilum the uppermost structure is the pulmonary artery (artery above)
while the main bronchus is situated more posteriorly (bronchus behind).
In front and below are the pulmonary veins

Question 18

▪ in many regions of the body, large veins always have a dead space nearby to allow for their dilation during times of ——
▪ Veins can dilate since they consist of —— wall unlike the arteries

Answer 18

▪ in many regions of the body, large veins always have a dead space nearby to allow for their dilation during times of increased venous return.
▪ Veins can dilate since they consist of thin wall unlike the arteries
Eg, The femoral vein i

Question 19

Pleural Cavity
􏰀 The parietal and visceral layers are separated from one another by a slitlike space called——
􏰀 Clinicians use the term ——instead of the anatomic term ——
􏰀 Pleural cavity contains thin film of tissue fluid called ——
􏰀 Fluid permits the two layers to move on each other with the minimum of friction

Answer 19

Pleural Cavity
􏰀 The parietal and visceral layers are separated from one another by a slitlike space called pleural cavity
􏰀 Clinicians use the term pleural space instead of the anatomic term pleural cavity
􏰀 Pleural cavity contains thin film of tissue fluid called pleural fluid
􏰀 Fluid permits the two layers to move on each other with the minimum of friction

Question 20

There are two folds or recesses of parietal pleura which acts as reserve space for the lung to ——during deep inspiration.which are?

Answer 20

There are two folds or recesses of parietal pleura which acts as reserve space for the lung to expand during deep inspiration.
􏰀 Costomediastinal recesses
􏰀 Costodiaphragmatic recesses

Question 21

Costodiaphragmatic recesses
􏰀 Are slitlike spaces between the ——-and ——- parietal pleurae
􏰀 Separated only by a capillary layer of ———
􏰀 During inspiration, the lower margins of the ——descend
into the recesses
􏰀 During expiration, the lower margins of the lungs ——so that the costal and diaphragmatic pleurae come together again

Answer 21

Costodiaphragmatic recesses
􏰀 Are slitlike spaces between the costal and diaphragmatic parietal pleurae
􏰀 Separated only by a capillary layer of pleural fluid
􏰀 During inspiration, the lower margins of the lungs descend
into the recesses
􏰀 During expiration, the lower margins of the lungs ascend so that the costal and diaphragmatic pleurae come together again

Question 22

Costomediastinal Recesses
􏰀 Are situated along the ——-margins of the pleura
􏰀 They are slitlike spaces between the ——-and the ———
parietal pleurae
􏰀 Separated by a capillary layer of ——-
􏰀 During inspiration and expiration, the ———-borders of the lungs slide in and out of the recesses

Answer 22

Costomediastinal Recesses
􏰀 Are situated along the anterior margins of the pleura
􏰀 They are slitlike spaces between the costal and the mediastinal
parietal pleurae
􏰀 Separated by a capillary layer of pleural fluid
􏰀 During inspiration and expiration, the anterior borders of the lungs slide in and out of the recesses

Question 23

Histology of Pleura
• Grossly, normal pleura is a ——,——, ——membrane.
• Light microscopy, pleural consist of five layers :
–
–
–
-
-

Answer 23

Histology of Pleura
• Grossly, normal pleura is a smooth, glistening, semitransparent membrane.
• Light microscopy, pleural consist of five layers :
– Mesothelial layer
– Connective tissue layer
– Superficial elastic layer

– Loose subpleural connective tissue layer (rich in ——, ——and ——).
– Deep fibroelastic layer (in continuity with the parenchymal structures of lung, diaphragm or the thorax)

Question 24

Histology of pleura
– Loose subpleural connective tissue layer (rich in ——, ——and ——)
▪ In ———, connective tissue is arranged in a coarse, basket weave pattern and contains only a few capillaries.
– Deep fibroelastic layer (in continuity with the ———structures of lung, diaphragm or the thorax)

Answer 24

– Loose subpleural connective tissue layer (rich in vessels , nerves and lymphatics)
▪ In pleural fibrosis connective tissue is arranged in a coarse, basket weave pattern and contains only a few capillaries.
– Deep fibroelastic layer (in continuity with the parenchymal structures of lung, diaphragm or the thorax)

Question 25

Mesothelial layer
• —— cell layer
• Different shaped cells – —— or —— or ——
• — - —μm thickness
• —— present to decrease friction

Mesothelial layer
• —— present between the mesothelial cells that communicate directly with —— .
• Capable of transformation into ——.
• In a rheumatoid pleuritis, normal mesothelial cell covering ——, instead there is ——— layer of —— cells that focally forms ——cells .

Answer 25

Mesothelial layer
• Single cell layer
• Different shaped cells – flattend or
cuboidal or columnar
• 6-12μm thickness
• Microvillae present to decrease friction

Mesothelial layer
• Stomata present between the mesothelial cells that communicate directly with lymphatic lacunaes.
• Capable of transformation into macrophages.
• In a rheumatoid pleuritis, normal mesothelial cell covering absent, instead there is pseudostratified layer of epitheloid cells that focally forms multinucleated giant cells .

Question 26

Blood supply
•Arterial supply :
– Parietal pleura
• Costal pleura :
• Mediastinal pleura :
• Diaphragmatic pleura :

Answer 26

Blood supply
•Arterial supply : – Parietal pleura :
• Costal pleura : small branches of intercostal arteries
• Mediastinal pleura : supplied by pericardio phrenic artery
• Diaphragmatic pleura : supplied by superior phrenic and musculophrenic artery.

Question 27

Blood supply
– Visceral pleura :

Answer 27

Bronchial artery : supplies visceral pleura facing the mediastinum, pleura covering the interlobular surface and part of the diaphragmatic surface.
• Pulmonary artery : supplies remaining portion

Question 28

Venous drainage :
􏰀 Parietal pleura
■ Through the ——veins which empty into —— or ——trunk.
􏰀 Visceral pleura
■ Through ——veins.
❖ Applied anatomy : Aspiration of any fluid from the pleural cavity is called ————.
❖ It is usually done in the —th intercostal space in the —— line.
❖ The needle is passed through the lower part of the space to avoid injury to the neurovascular bundle.

Answer 28

Venous drainage :
􏰀 Parietal pleura
■ Through the intercostal veins which empty into inferior venacava or brachio-cephalic trunk.
􏰀 Visceral pleura
■ Through pulmonary veins.
❖ Applied anatomy : Aspiration of any fluid from the pleural cavity is called paracentesis thoracis.
❖ It is usually done in the 6th intercostal space in the midaxillary line.
❖ The needle is passed through the lower part of the space to avoid injury to the neurovascular bundle.

Question 29

Nerve supply
• Parietal pleura :
– Sensitive to pain, temperature, touch and pressure.
▪ Costal pleura : innervated by ———nerves.
▪ Peripheral part of diaphragmatic pleura : innervated by —— nerves.
❖ pain is perceived in —— chest wall.
▪ Central portion of diaphragmatic pleura and mediastinal pleura :
- innervated by —— nerve.
▪ Pain is perceived in —— shoulder.

Answer 29

Nerve supply
• Parietal pleura :
– Sensitive to pain, temperature, touch and pressure.
▪ Costal pleura : innervated by segmental intercostal nerves.
▪ Peripheral part of diaphragmatic pleura : innervated by lower 6 intercostal nerves.
❖ pain is perceived in adjacent chest wall.
▪ Central portion of diaphragmatic pleura and mediastinal pleura :
▪ innervated by phrenic nerve.
▪ Pain is perceived in ipsilateral shoulder.

Question 30

Nerve supply

Visceral pleura :
– Insensitive to common sensation such as pain and
touch.
– Sensitive to stretch.
– Innervated by autonomic nerves from the spinal segments — and —.
• Presence of ——chest pain indicates inflammation or irritation of parietal pleura.
❖ Applied anatomy :
❖ —— :it is infusion of small volume of local anaesthetic agent into the intrapleural space through catheter. It diminish the pain sensation from the area by action on intercostal nerves, indicated in thoracotomy and insertion of chest drainage

Answer 30

Visceral pleura :
– Insensitive to common sensation such as pain and
touch.
– Sensitive to stretch.
– Innervated by autonomic nerves from the spinal segments T4 and T5.
• Presence of pleuritic chest pain indicates inflammation or irritation of parietal pleura.
❖ Applied anatomy :
❖ Intrapleural anaesthesia :it is infusion of small volume of local anaesthetic agent into the intrapleural space through catheter. It diminish the pain sensation from the area by action on intercostal nerves, indicated in thoracotomy and insertion of chest drainage

Question 31

Lymphatic drainage
• Parietal pleura :
– Costal pleura :
• Ventrally :——.
• Dorsally :——
– Mediastinal pleura :
• Drain to ——.
– Diaphragmatic pleura :
• Drain to——.

Answer 31

Lymphatic drainage
• Parietal pleura :
– Costal pleura :
• Ventrally : towards nodes along the internal thoracic artery.
• Dorsally : towards the intercostal lymph nodes.
– Mediastinal pleura :
• Drain to tracheobronchial and mediastinal nodes.
– Diaphragmatic pleura :
• Drain to parasternal, middle phrenic and posterior mediastinal nodes.

Question 32

Lymphatic drainage
• Lymphatic vessels in parietal pleura are in communication with the pleural space by means of ——.
• Stomata :
– — to — μm in diameter
– Round or — - like opening
– Found mostly on the —— and on the
——
– More stoma in the area where the mesothelial cells are —— rather then —.

Answer 32

Lymphatic drainage
• Lymphatic vessels in parietal pleura are in communication with the pleural space by means of stomata.
• Stomata :
– 2-6 μm in diameter
– Round or slit like opening
– Found mostly on the mediastinal pleura and on the
intercostal surfaces.
– More stoma in the area where the mesothelial cells are cuboidal rather then flat.

Question 33

Lymphatic drainage
• Lacunaes :
– Lymphatic vessels in parietal pleura have many branches, some submesothelial branches have dilated lymphatic space called ——.
• —— are found only over lacunae.
• Significance : Stomatas with their associated lacunaes and lymphatic vessels are main pathway for elimination of particulate matter from pleural space.

Lacunaes :
– This transport system may provide a mechanism for migration of malignant cell to distant organs in patients with positive pleural lavage cytology.

Answer 33

Lymphatic drainage
• Lacunaes :
– Lymphatic vessels in parietal pleura have many branches, some submesothelial branches have dilated lymphatic space called lacunaes.
• Stomatas are found only over lacunaes.
• Significance : Stomatas with their associated lacunaes and lymphatic vessels are main pathway for elimination of particulate matter from pleural space.

Lacunaes :
– This transport system may provide a mechanism for migration of malignant cell to distant organs in patients with positive pleural lavage cytology.

Question 34

Lymphatic drainage
• Visceral pleura :
– They have abundant lymphatic vessels.
– Lymphatics form a plexus of ———that run over the surface of lung towards the hilum.
– It also penetrate the lungs to join the ——-vessels.
– Lymphatic vessel in visceral pleura have one way ——, directing flow towards the hilum of lung.
– No —— are seen in visceral pleura.

Answer 34

Lymphatic drainage
• Visceral pleura :
– They have abundant lymphatic vessels.
– Lymphatics form a plexus of inter communicating vessels that run over the surface of lung towards the hilum.
– It also penetrate the lungs to join the bronchial lymph vessels.
– Lymphatic vessel in visceral pleura have one way valves, directing flow towards the hilum of lung.
– No stomas are seen in visceral pleura.

Question 35

Pleural fluid
▪ Fluid present between the parietal and visceral pleura, the pleural space is called ——fluid.
▪ Fluid act as ——and allows the visceral pleura covering the lung to slide along the parietal pleura lining the thoracic cavity during respiratory movements.
▪ Volume :
􏰀 Mean amount of fluid in right pleural space in normal
individual is —— +/- —— ml.
􏰀 Normally the volume of fluid in right and left pleural space is ——.

  ▪ Thickness : 􏰀 Pleural space slightly more narrow near the top(—μm) than at bottom(—μm). 􏰀 pleural space width in recess such as costodiaphragmatic recess reaches — to — mm. ⚫ Cells : 􏰀 Mean WBC count – ——cells/mm3 􏰀 Mean RBC count – —— cells/mm3 􏰀 Macrophages – —% 􏰀 Lymphocytes – — % 􏰀 Mesothilial, neutrophils, eosinophils ( < — % each ) 􏰀 Eosinophil > — % -- drug reaction, asbestosis, parasitic infection, churg-strauss syndrome

Apperance : normally —— and ——

Answer 35

Pleural fluid
▪ Fluid present between the parietal and visceral pleura, the pleural space is called pleural fluid.
▪ Fluid act as lubricant and allows the visceral pleura covering the lung to slide along the parietal pleura lining the thoracic cavity during respiratory movements.
▪ Volume :
􏰀 Mean amount of fluid in right pleural space in normal
individual is 8.4 +/- 4.3 ml.
􏰀 Normally the volume of fluid in right and left pleural space is equal.

  ▪ Thickness : 􏰀 Pleural space slightly more narrow near the top(18.5μm) than at bottom(20.3μm). 􏰀 pleural space width in recess such as costodiaphragmatic recess reaches 1 to 2 mm. ⚫ Cells : 􏰀 Mean WBC count – 1,716 cells/mm3 􏰀 Mean RBC count – 700 cells/mm3 􏰀 Macrophages – 75 % 􏰀 Lymphocytes – 25 % 􏰀 Mesothilial, neutrophils, eosinophils ( < 2 % each ) 􏰀 Eosinophil > 10 % -- drug reaction, asbestosis, parasitic infection, churg-strauss syndrome

Apperance : normally light yellow and clear

Question 36

Appearance Underlying disaese
Pale yellow ———-
Turbid. ———
Pus. ———
Haemorrhagic. ——, ——
Milky fluid. ———
Brown. ————
Black. ———
Yellow to green. ———

Answer 36

Appearance Underlying disaese
Pale yellow Transduates
Turbid. Inflammatory exudates
Pus. Empyema
Haemorrhagic. Trauma, malignancy
Milky fluid. Chylothorax
Brown. Amoebic liver abscess
Black. Fungal infection
Yellow to green. Rheumatoid pleurisy

Question 37

Pleural Fluid Formation
▪ Sources:.

Answer 37

Pleural Fluid Formation
▪ Sources
􏰀 pleural capillaries,
􏰀 interstitial spaces of the lung, 􏰀 intrathoracic lymphatics,
􏰀 intrathoracic blood vessels,
􏰀 peritoneal cavity.

Question 38

The movement of fluid between the pleural capillaries and the pleural space governed by —— law

Answer 38

The movement of fluid between the pleural capillaries and the pleural space governed by Starling’s law of transcapillary exchange.

Question 39

Pleural Fluid
▪ More fluid formation across the parietal pleura over the —compared with ——.
▪ Pleural fluid absorption more over —- than over —
▪ More fluid formation over the — ribs than over the — ribs.
▪ Increase in——results in more fluid formation.

Answer 39

Pleural Fluid
▪ More fluid formation across the parietal pleura over the ribs compared with intercostal spaces.
▪ Pleural fluid absorption more over intercostal spaces than over ribs.
▪ More fluid formation over the caudal ribs than over the cranial ribs.
▪ Increase in breathing frequency results in more fluid formation.

Question 40

Nerve supply
▪ The nerve supply of the visceral pleura as in the lung is autonomic through nerves that accompany the —— arteries, these are ——.
▪ The visceral pleura is thus insensitive to ordinary stimuli as — and —.

Answer 40

Nerve supply
▪ The nerve supply of the visceral pleura as in the lung is autonomic through nerves that accompany the bronchial arteries, these are vasomotor.
▪ The visceral pleura is thus insensitive to ordinary stimuli as pain and touch.

Question 41

Nerve supply
▪ The parietal pleura as part of the chest wall is supplied by somatic nerves namely —— and —— nerves.

Answer 41

Nerve supply
▪ The parietal pleura as part of the chest wall is supplied by somatic nerves namely intercostal and phrenic nerves.

Question 42

Nerve supply
Parietal pleura
▪ The —— branches of —— nerves segmentally supply the costal pleura and the peripheral part of the diaphragmatic pleura

Answer 42

Nerve supply
▪ The collateral branches of intercostal nerves segmentally supply the costal pleura and the peripheral part of the diaphragmatic pleura

Question 43

Nerve supply
Parietal pleura
▪ The central part of the diaphragmatic pleura and the mediastinal pleura are supplied by the —— nerves.
▪ The parietal pleura is thus sensitive to ——

Answer 43

Nerve supply
▪ The central part of the diaphragmatic pleura and the mediastinal pleura are supplied by the phrenic nerves.
▪ The parietal pleura is thus sensitive to pain.

Question 44

Refered pleural pain
▪ Irritation of the — and — part of the diaphragmatic pleura by disease causes local pain and referred pain i.e. pain referred or seems to be arising frown regions supplied by the same intercostal nerves that supply the pleura. Thus pain is referred to the chest and abdominal walls, both are supplied by intercostal nerves

Answer 44

Refered pleural pain
▪ Irritation of the costal and peripheral part of the diaphragmatic pleura by disease causes local pain and referred pain i.e. pain referred or seems to be arising frown regions supplied by the same intercostal nerves that supply the pleura. Thus pain is referred to the chest and abdominal walls, both are supplied by intercostal nerves

Question 45

Referred pleural pain
▪ Irritation of the —— or —— part of the diaphragmatic pleura supplied by the —— nerve is referred to the tip of the shoulder where the dermatome there is that of C— since the root value of the phrenic nerve is C3, 4, and 5 mainly C—

Answer 45

Referred pleural pain
▪ Irritation of the mediastinal or central part of the diaphragmatic pleura supplied by the phrenic nerve is referred to the tip of the shoulder where the dermatome there is that of C4 since the root value of the phrenic nerve is C3, 4, and 5 mainly C4

Question 46

Referred pleural pain
▪ Irritation of the —— peritoneum below the diaphragm (which is also supplied by the phrenic nerve) is also referred to the tip of the ——

Answer 46

Referred pleural pain
▪ Irritation of the parietal peritoneum below the diaphragm (which is also supplied by the phrenic nerve) is also referred to the tip of the shoulder

Question 47

Clinical conditions associated
with pleura
• ———— : This is the inflammation of the pleura. Acute—- is marked by sharp, stabbing pain, especially on exertion.
• ———— : Presence of air in the pleural cavity. Entry of air into the pleural cavity, resulting from a penetrating wound of the parietal pleura or rupture of a lung results in partial collapse of the lung.

• ———— : Presence of blood in the pleural cavity. It results more often from injury to a major intercostal vessel than laceration of lung.
• ———— : presence of both fluid and air in the pleural cavity.
• ————: presence of pus in pleural cavity.

Answer 47

Clinical conditions associated
with pleura
• Pleuritis or pleurisy : This is the inflammation of the pleura. Acute pleuritis is marked by sharp, stabbing pain, especially on exertion.
• Pneumothorax : Presence of air in the pleural cavity. Entry of air into the pleural cavity, resulting from a penetrating wound of the parietal pleura or rupture of a lung results in partial collapse of the lung.
• Hemothorax : Presence of blood in the pleural cavity. It results more often from injury to a major intercostal vessel than laceration of lung.
• Hydropneumothorax : presence of both fluid and air in the pleural cavity.
• Empyema : presence of pus in pleural cavity.

Question 48

• Lungs are a pair of respiratory organs situated in the thorax. The right and left lungs are separated by the ———
• Texture: ——
• Color: Young- —-
• Adult-molted —— due to deposition of ——- particles
•Weight: right- ——gram left- —- gram

Answer 48

• Lungs are a pair of respiratory organs situated in the thorax. The right and left lungs are separated by the mediastinum
• Texture: Spongy
• Color: Young- Brown
• Adult-molted black due to deposition of carbon
particles
•Weight: right- 600gram left- 550 gram

Question 49

Each lung has the following features:
• It is ——- in shape.
• It has an apex, a base and
How many surfaces.
• The costal surface of each lung borders the ribs (front and back).
• On the medial (mediastinal) surface, the bronchi, blood vessels, and lymphatic vessels enter the lung at the ——.

Answer 49

Each lung has the following features:
• It is conical in shape.
• It has an apex, a base and
2 surfaces.
• The costal surface of each lung borders the ribs (front and back).
• On the medial (mediastinal) surface, the bronchi, blood vessels, and lymphatic vessels enter the lung at the hilum.

Question 50

LUNGS
• Apex: projects into root of the —- (—- inch above the ——- of the clavicle).
It is covered by —— pleura.
It is grooved anteriorly by —— artery.
• Base: (inferior= ——- surface) is (is it concave or convex?) and sits on the diaphragm.

Answer 50

LUNGS
• Apex: projects into root of the neck (one inch above the medial 1/3 of the clavicle).
It is covered by cervical pleura.
It is grooved anteriorly by subclavian artery.
• Base: (inferior= diaphragmatic surface) is concave and sits on the diaphragm.

Question 51

Borders:
• ——- border : is sharp, thin and overlaps the heart.
• Anterior border of left lung
presents a —— notch at its lower end + thin projection called the —— below the cardiac notch.
• ——- border : is rounded, thick and lies beside the ——.

Answer 51

Borders: Anterior & Posterior
• Anterior border : is sharp, thin and overlaps the heart.
• Anterior border of left lung
presents a cardiac notch at its lower end + thin projection called the lingula below the cardiac notch.
• Posterior border : is rounded, thick and lies beside the vertebral column.

Question 52

Surfaces:
• Costal surface:
• Convex or concave??.
• Covered by —— pleura which separates lung from: ribs, costal cartilages & intercostal muscles.
• Medial surface:
• It is divided into 2 parts:
• ——— (mediastinal) part:
• Contains a —- in the middle (it is a depression in which bronchi, vessels, & nerves forming the root of lung).
• —— (vertebral) part:
• It is related to: bodies of thoracic vertebrae, intervertebral discs, posterior intercostal vessels & sympathetic trunk.

Answer 52

Surfaces: Costal & Mediastinal
• Costal surface:
• Convex.
• Covered by costal pleura which separates lung from: ribs, costal cartilages & intercostal muscles.
• Medial surface:
• It is divided into 2 parts:
• Anterior (mediastinal) part:
• Contains a hilum in the middle (it is a depression in which bronchi, vessels, & nerves forming the root of lung).
• Posterior (vertebral) part:
• It is related to: bodies of thoracic vertebrae, intervertebral discs, posterior intercostal vessels & sympathetic trunk.

Question 53

RIGHT LUNG ROOT
• how many bronchi lie (posterior or anterior ).
• Pulmonary artery
is superior T or F
• how many Pulmonary veins are —— and—— .

LEFT LUNG ROOT
• how many bronchus
lies posterior T or F
• Pulmonary artery
is ——-
• how many Pulmonary veins

Answer 53

RIGHT LUNG ROOT
• 2 bronchi lie posterior.
• Pulmonary artery
is superior
• 2 Pulmonary veins are inferior and anterior.

LEFT LUNG ROOT
• One bronchus
lies posterior
• Pulmonary artery
is superior
• 2 Pulmonary veins are i

Question 54

Right lung
• Larger & shorter than left lung. T or F
• Divided by how many fissures (— & ___) into 3 lobes (__, ___ and ___ lobes).

Left Lung
• Divided by one oblique fissure into -how many lobes, —— and ——- lobes.
• There is No ——- fissure.
• It has a cardiac notch at lower part of its ——- border.

Answer 54

Right lung
• Larger & shorter than left lung.
• Divided by
2 fissures (oblique & horizontal) into 3 lobes (upper, middle and lower lobes).

Left Lung
• Divided by one oblique fissure into -2 lobes, Upper and lower.
• There is No horizontal fissure.
• It has a cardiac notch at lower part of its anterior border.

Question 55

Mediastinal surface of right lung
• On the mediastinal surface of the right lung, you find these structures:

Mediastinal surface of left lung
• On the mediastinal surface of the left lung, you will find these structures:

Answer 55

Mediastinal surface of right lung
• On the mediastinal surface of the right lung, you find these structures:
• Azygos vein and its arch (posterior and over the root of the lung).
• Vagus nerve posterior to the root.
• Esophagus above and posterior to
the root.
• Phrenic nerve anterior to the root.
• Cardiac impression: related to right atrium.
• Below hilum and in front of pulmonary ligament:
• Groove for I.V.C.

Mediastinal surface of left lung
• On the mediastinal surface of the left lung, you will find these structures:
• Descending aorta posterior to the root.
• Vagus nerve posterior to the root.
• Arch of the aorta over the root.
• Groove for left common carotid
artery.
• Groove for left subclavian artery.
• Phrenic nerve anterior to the root.
• Cardiac impression : related to
left ventricle

Question 56

Blood supply of lung
• —— arteries (branches of descending thoracic aorta)….. supply oxygenated blood to bronchi , lung tissue & visceral pleura.
• ——- veins : drain into azygos & hemiazygos veins.
• ——- artery which carries non-oxygenated blood from right ventricle to the lung alveoli.
• 2 ——— veins : carry oxygenated blood from lung alveoli to the left atrium.

Answer 56

Blood supply of lung
• Bronchial arteries (branches of descending thoracic aorta)….. supply oxygenated blood to bronchi , lung tissue & visceral pleura.
• Bronchial veins : drain into azygos & hemiazygos veins.
• Pulmonary artery which carries non-oxygenated blood from right ventricle to the lung alveoli.
• 2 pulmonary veins : carry oxygenated blood from lung alveoli to the left atrium.

Question 57

Nerve Supply of the lung
• Pulmonary plexus :
• at the root of lung….is formed of autonomic N.S. from ——- & ——- fibres.
1- Sympathetic F. from ..sympathetic trunk broncho-——-/and vaso——-.
2- Parasympathetic F. from….Vagus nerve …. Broncho-——and secretomotor to —— glands /and vaso——.

Answer 57

Nerve Supply of the lung
• Pulmonary plexus :
• at the root of lung….is formed of autonomic N.S. from sympathetic & parasympathetic fibres.
1- Sympathetic F. from ..sympathetic trunk broncho-dilatation /and vasoconstriction.
2- Parasympathetic F. from….Vagus nerve …. Broncho-constriction and secretomotor to bronchial glands /and vasodilatation.

Question 58

Lymph drainage of the lungs
• There are 2 lymphatic plexuses…. —— & —— plexuses.
• Superficial plexus (subpleural):
lies under the —— pleura and drain to ———- nodes in the hilum of lung.
• Deep plexus:
• Lies along the —— tree & pulmonary blood vessels and drain into the ——- nodes within the lung substance.
• Then into ——- nodes in the hilum of lung.
• Then into the ——— nodes at the bifurcation of trachea , and finally into ———-lymph trunks to end in ——- (left) or in ——— (right).

Answer 58

Lymph drainage of the lungs
• There are 2 lymphatic plexuses…. superficial & deep plexuses.
• Superficial plexus (subpleural):
lies under the visceral pleura and drain to bronchopulmonary nodes in the hilum of lung.
• Deep plexus:
• Lies along the bronchial tree & pulmonary blood vessels and drain into the pulmonary nodes within the lung substance.
• Then into bronchopulmonary nodes in the hilum of lung.
• Then into the tracheo-bronchial nodes at the bifurcation of trachea , and finally into broncho-mediastinal lymph trunks to end in thoracic duct (left) or in right lymphatic duct (right).

Question 59

Bronchi
• The trachea divides into 2 main bronchi:
• Right main bronchus:
It divides before entering the hilum, it gives off ——— (secondary) bronchus. On entering hilum, it divides into —— & —— lobar bronchi.
• Left main bronchus:
On entering hilum, it divides into —— & ——- lobar bronchi.

Answer 59

Bronchi
• The trachea divides into 2 main bronchi:
• Right main bronchus:
It divides before entering the hilum, it gives off superior lobar (secondary) bronchus. On entering hilum, it divides into middle & inferior lobar bronchi.
• Left main bronchus:
On entering hilum, it divides into superior & inferior lobar bronchi.

Question 60

Bronchial Divisions
• Within the lung each bronchus divides into number of branches that can be divided into two groups:
I- ——- zone branches
Primary (main) bronchi Secondary (lobar) bronchi Tertiary (segmental) bronchi (supply the bronchopulmonary segment)
Smaller bronchi Bronchioles Terminal bronchioles

II- —— zone branches
• Respiratory bronchioles
• Alveolar ducts
• Alveolar sacs
• Alveoli

Answer 60

Bronchial Divisions
• Within the lung each bronchus divides into number of branches that can be divided into two groups:
I- Conduction zone branches
Primary (main) bronchi Secondary (lobar) bronchi Tertiary (segmental) bronchi (supply the bronchopulmonary segment)
Smaller bronchi Bronchioles Terminal bronchioles

II- Respiratory zone branches
• Respiratory bronchioles
• Alveolar ducts
• Alveolar sacs
• Alveoli

Question 61

Bronchopulmonary segments
• They are the anatomic, functional, and surgical units of the lungs.
• Each lobar (secondary) bronchus gives off —— (tertiary) bronchi.
• Each segmental bronchus
divides repeatedly into
——-.
• Bronchioles divide into ——- which show delicate outpouchings ‘the ———-’.

• The respiratory bronchioles end by branching into ——— which lead into ———.
• The alveolar sacs consist of several —-, each alveolus is surrounded by a network of blood capillaries for ——-

Answer 61

Bronchopulmonary segments
• They are the anatomic, functional, and surgical units of the lungs.
• Each lobar (secondary) bronchus gives off segmental (tertiary) bronchi.
• Each segmental bronchus
divides repeatedly into
bronchioles.
• Bronchioles divide into terminal bronchioles, which show delicate outpouchings ‘the respiratory bronchioles’.

• The respiratory bronchioles end by branching into alveolar ducts, which lead into alveolar sacs.
• The alveolar sacs consist of several alveoli, each alveolus is surrounded by a network of blood capillaries for gas exchange

Question 62

Characteristics of Bronchopulmonary segments
• It is a subdivision of a lung lobe.
• It is —— in shaped, its apex lies toward the —-, while its base lies on the —-.
• It is surrounded by ——-septa.
• It has a segmental bronchus, a segmental artery, lymph vessels, and autonomic nerves.
• The segmental vein lies in the —- septa between the segments.
• A diseased segment can be removed surgically, because it is a —- unit.

Answer 62

Characteristics of Bronchopulmonary segments
• It is a subdivision of a lung lobe.
• It is pyramidal in shaped, its apex lies toward the root, while its base lies on the lung surface.
• It is surrounded by connective tissue septa.
• It has a segmental bronchus, a segmental artery, lymph vessels, and autonomic nerves.
• The segmental vein lies in the inter- segmental C.T. septa between the segments.
• A diseased segment can be removed surgically, because it is a structural unit.

Question 63

Changes In Airway
As you go further down into the bronchial tree of each lung, changes in the airway occur:
▪ increased number of airways (how many primary; — or — secondary; how many tertiary bronchi; how many terminal bronchioles; how many of alveolar ducts)
▪ decreased or increased diameter of each airway?
▪ decreased or increased amount of cartilage in the airways? (no cartilage
at all by terminal bronchioles T or F)
▪ increased amount of ——- (relative to diameter)
▪ lining epithelium changes from —— to ——-. epithelium (in alveoli)

Answer 63

Changes In Airway
As you go further down into the bronchial tree of each lung, changes in the airway occur:
▪ increased number of airways (1 primary; 2 or 3 secondary; 10 tertiary bronchi; 6000 terminal bronchioles; millions of alveolar ducts)
▪ decreased diameter of each airway
▪ decreased amount of cartilage in the airways (no cartilage
at all by terminal bronchioles)
▪ increased amount of smooth muscle (relative to diameter)
▪ lining epithelium changes from PSCC 􏰀 simple squamous epithelium (in alveoli)

Question 64

Relationship of Airways & Pulmonary Vessels
▪ As airways branch within lungs, they are accompanied by branches of the —— artery (carrying de-oxygenated blood into the lungs), & branches of the ——- veins (carrying oxygenated blood out of the lungs)
▪ As the alveolar ducts expand to form alveoli, ——— will branch to form a network of pulmonary capillaries, surrounding the alveoli

Answer 64

Relationship of Airways & Pulmonary Vessels
▪ As airways branch within lungs, they are accompanied by branches of the pulmonary artery (carrying de-oxygenated blood into the lungs), & branches of the pulmonary veins (carrying oxygenated blood out of the lungs)
▪ As the alveolar ducts expand to form alveoli, pulmonary arterioles will branch to form a network of pulmonary capillaries, surrounding the alveoli

Question 65

Alveoli
▪ Alveoli are expanded chambers of epithelial tissue that are the —— surfaces of the lungs
▪ There are about —— million alveoli in each lung
▪ Multiple alveoli usually share a common —— duct, creating “alveolar sacs”

Answer 65

Alveoli
▪ Alveoli are expanded chambers of epithelial tissue that are the exchange surfaces of the lungs
▪ There are about 150 million alveoli in each lung
▪ Multiple alveoli usually share a common alveolar duct, creating “alveolar sacs”

Question 66

Alveoli Cells
There are three types of cells found within alveoli:
1. —— epithelial (aka “type —”) cells – primary cells making up the wall of the alveoli
2. —- (aka “type —”) cells – sectrete “surfactant” to reduce surface tension which prevents alveoli from sticking together & allows for easier gas exchange

3. ——- (aka “—- cells”) – phagocytic cells that remove dust, debris & pathogens

Answer 66

Alveoli Cells
There are three types of cells found within alveoli:
1. Alveolar Squamous epithelial (aka “type I”) cells – primary cells making up the wall of the alveoli
2. Septal (aka “type II”) cells – sectrete “surfactant” to reduce surface tension which prevents alveoli from sticking together & allows for easier gas exchange

3. Alveolar macrophages (aka “dust cells”) – phagocytic cells that remove dust, debris & pathogens

Question 67

Gas “exchange” occurs across the —— membrane – the fused membranes of the alveolar epithelium & the pulmonary capillary endothelium

Answer 67

Gas “exchange” occurs across the Respiratory membrane – the fused membranes of the alveolar epithelium & the pulmonary capillary endothelium

Question 68

Gas “exchange” occurs across the Respiratory membrane – the fused membranes of the ——- epithelium & the ——-endothelium

Answer 68

Gas “exchange” occurs across the Respiratory membrane – the fused membranes of the alveolar epithelium & the pulmonary capillary endothelium