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Anatomy Exam 2 > Lungs & Associated Structures > Flashcards

Lungs & Associated Structures Flashcards

1
Q

What is the pleura?

A

Serous membrane that produces fluid that allows for lubrication and attaches lungs to inner surface of thoracic cage
**A dysfunctional pleura: stiffened pleura doesn’t allow lungs to expand –> no oxygen –> difficulty breathing (pneumothorax, hemothorax etc.)

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2
Q

Pleura is made up of how many parts?

A

3 parts form an envelope between lungs and the chest wall.

1) “Parietal pleura”: lines inside chest wall and part of diaphragm
2) “Visceral pleura”: lines lungs and adherent to all its surfaces
3) “Pleural space”: between visceral and parietal, also known as the “pleural cavity” containing the pleural fluid

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3
Q

Describe the lungs?

A

Paired, cone-shaped organs in the thoracic cavity

  • Separated by the heart and other mediastinum structures
  • Extend from diaphragm inferiorly to just above clavicles superiorly
  • *In COPD, emphysema, or uncontrolled asthmatics -> lungs are hyperinflated/hyperextended superiorly above clavicles (when you put a needle in subclavian line you can puncture the lung)
  • *Clavicle fractures can also injure the lung
  • Anterior, lateral and posterior boundaries of the lung: pleura, muscles, and ribs of the thoracic cage
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4
Q

What is the hilum?

A

The medial root of the lung where the airway, blood vessels and lymphatic enter the lung

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5
Q

What is the anterior border of the apex of the lung?

A

3-4 cm above the inner 1/3 of clavicles

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6
Q

How many lobes does each lung have? How many fissures separate each?

A
  • Right lung: 3 lobes (upper, middle, lower); shorter due to liver, 2 fissures separate the lobe areas (oblique and horizontal fissures)
  • Left lung: 2 lobes (upper and lower); narrower due to heart; 1 fissure (oblique fissure)
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7
Q

Where are the lungs best auscultated?

A
  • Better auscultated posteriorly, but right middle lobe is not auscultated posteriorly
  • Base areas: T10
  • “Diaphragmatic excursion”: area between T10 and T12; listening for hollow sound (telling you there’s air between cavity) -> percuss for hollow sound lower down so you can see how far down the diaphragm pulls that lung on deep inspiration
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8
Q

When auscultating the anterior chest what lung sounds will you hear? What areas will you auscultate?

A

Anterior has mostly upper lobe and very little lower lobe (and middle lobe from right lung)

  • RUL and LUL apex just superior to clavicle
  • RUL base at medial horizontal fissure @ 4th rib and lateral horizontal fissure/lateral oblique fissure @ 5th rib midaxillary line
  • Right medial oblique fissure (between bases of RML and RLL) @ 6th rib midclavicular line
  • Left oblique fissure (between bases of LUL and LLL) @ 6th rib midclavicular line
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9
Q

When auscultating the posterior chest what lung sounds will you hear? What areas will you auscultate?

A

Posterior has mostly lower lobe (no right middle lobe)

  • RUL and LUL oblique fissures at T3
  • RLL and LLL at T10-T12
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10
Q

Where will you auscultate laterally?

A
  • RUL: spinous process of T3
  • RML: 5th rib midaxillary extending anterior-laterally to 4th rib
  • RLL: 6th rib midclavicular line
  • LUL: spinous process of T3
  • LLL: 6th rib midclavicular line
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11
Q

How are the lungs supplied with blood?

A

Dual supply:

1) Bronchial supply: arises from superior thoracic aorta or aortic arch -> supplies bronchi, airway walls and pleura
2) Pulmonary supply: enter at hila & branch with airways

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12
Q

What is the trachea? What is alveoli and what does it do?

A
  • Trachea connects the larynx to 2 principle bronchi (left and right bronchus)
  • Alveoli: terminal branches of 2 bronchioles, within it is the capillary system (where gas exchange occurs)
  • *if airway constricted the quickest way to open up bronchiole trees is through inhalation therapy
  • *inhaled objects generally found in RT-bronchus due to straighter pathway (listen to LT first for comparison, if decreased breath sounds do not ask pt. to breathe deeply)
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13
Q

Describe the lower respiratory tract.

A

Intralobular bronchiole -> terminal bronchiole -> respiratory bronchiole -> alveolus -> alveolar duct -> alveolar sac -> alveoli

  • contains a lot of smooth muscle
  • *any disease of smooth muscle (stiffening) -> bronchiole tree will be constricted -> can’t expand -> less airflow
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14
Q

What kinds of respiratory tract infections occur in our population?

A

175 episodes of respiratory infection

  • URT (59.4%) -> lungs CLEAR (common cold/rhinitis, acute otitis media, tonsillitis, sudden rash)
  • LRT (40.6%) -> lungs will have wheezing/rhonchi, rales (wheezing in asthma & cardiac problems, pneumonia, bronchiolitis/secondary pneumonia, atelactasis-affects alveoli and seen on x-ray as skinny white line extending across lung, whooping cough-paroxysmal cough that is highly contagious and has extremely high morbility)
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15
Q

Where does the trachea begin and where is it located?

A
  • Anterior to esophagus, 10-11 cm long
  • Begins at cricoid cartilage
  • Bifurcates just below sternal angle into RT-main stem bronchus (shorter and straighter, where you place an intubation) and LT-main stem bronchus
  • Trachea and bronchi provide passage for air to get into lungs from environment
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16
Q

What is the cardiac notch?

A

The indentation in the medial part of the left lung to accommodate the heart

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17
Q

What is the anterior border of the base of the lung?

A

Rests on the diaphragm at the level of the 6th rib at mid-clavicular line

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18
Q

What is the lateral borders of the lungs?

A

Extend from the apex of the axilla to the 7th-8th ribs

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19
Q

What is the posterior borders of the lungs?

A

Apex is at C7 and the base is at T10 (T12 on deep inspiration)

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20
Q

Where would you listen to lung sounds on a patient with CHF?

A

Posteriorly and B/L -you can hear fluid best in the posterior regions. You will often hear bibasilar rales or absent lung sounds in the lung bases when fluid is present. Important to ausculate B/L because B/L-pleural effusion is common

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21
Q

What is a possible respiratory complication of an enlarged heart?

A

Pneumonia - due to the decreased air exchange that an enlarged heart causes

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22
Q

How many lobar bronchi does the right lung contain?

A

3 - right superior, right middle and right inferior lobar bronchi (for each lobe)

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23
Q

How many lobar bronchi does the left lung contain?

A

2 - left superior and left inferior lobar bronchi (for each lobe)

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24
Q

What is the trachea?

A

10-11 cm long tube anterior to esophagus, that connects to the two principal bronchi

25
Q

Where does the trachea begin and bifurcate?

A

Begins at cricoid cartilage and bifurcates just below sternal angle

26
Q

What is the function of the trachea and bronchial tree?

A

Provide passage for air to get into lungs from environment

27
Q

What is dead space?

A

The part of tidal volume that is not involved in gas exchange (around 150 mL in a healthy person); excess capacity for lungs to inflate

28
Q

What are the 4 functions of the respiratory system?

A

1) Supplies oxygen for energy production
2) Removes CO2 and waste products for energy production
3) Homeostasis (acid-base of arterial blood)
4) Heat exchange

29
Q

How does respiration maintain pH of blood?

A

Supplying O2 and removing CO2

30
Q

What are normal ranges of arterial blood gases?

A 
pH = 7.34-7.45
pCO2 = 35-45 mmHg
pO2 = 80-100 mmHg
SaO2 = 94-98%
31
Q

How do lungs adjust the amount of CO2 in the body?

A

Respiratory rate: hypoventilation (shallow/slower breathing) and hyperventilation (faster breathing)

  • hyperpnea = increased depth and rate of breathing
  • tachypnea = shallow, increased rate of breathing
  • hypopnea = shallow breathing
  • bradypnea = slow breathing
32
Q

What should you do when someone is hyperventilating due to anxiety?

A

Give them a paper bag to breathe into and allow them to recycle their own CO2, since they will be blowing off too much CO2
-CO2 controls respiration!

33
Q

Where does control of respiration come from?

A

The pons and medulla of the brainstem

34
Q

What is the stimulus to breathe in a normal person?

A

Hypercapnia - an increase in the level of CO2 in the blood and CSF

35
Q

What are the muscles of inspiration?

A
  • External intercostal muscles: elevate the ribs and expand the width of the thoracic cavity (in quiet and forced inspiration)
  • Interchondral part of the internal intercostal muscles: elevates the ribs
  • Diaphragm: domes descend, increasing length of thoracic cavity; elevates lower ribs
  • Accessory/secondary muscles: sternocleidomastoid (elevates sternum), scalenes (elevate and fix 1st and 2nd ribs), trapezius, serratus anterior, pectoralis major/minor, latissmus dorsi
36
Q

What are the muscles of inspiration?

A
  • External intercostal muscles: elevate the ribs and expand the width of the thoracic cavity (in quiet and forced inspiration)
  • Interchondral part of the internal intercostal muscles: elevates the ribs
  • Diaphragm: domes descend, increasing length of thoracic cavity; elevates lower ribs
  • Accessory muscles: sternocleidomastoid (elevates sternum), scalenes (elevate and fix 1st and 2nd ribs), trapezius, serratus anterior, pectoralis major/minor, latissmus dorsi
37
Q

What are the muscles of expiration?

A
  • Quiet breathing: expiration results from passive recoil of lungs and rib cage
  • Active breathing: Internal intercostal muscles (except interchondral part) lowers ribs and decrease width of thoracic cavity; Abdominal muscles (rectus abdominis, internal/external obliques, transverse abdominis) depress lower ribs and compress abdominal contents, thus pushing up diaphragm
38
Q

What happens when the diaphragm contracts?

A

The superior-inferior dimension of the thoracic cavity is increased

39
Q

What is pectus excavatum?

A

Posterior depression of the sternum and costal cartilage due to overgrowth of the costal cartilage
**3.5 : 1 male-to-female ratio

40
Q

Are other thoracic structures affected with pectus excavatum?

A

No - the 1st, 2nd ribs and manubrium are in the normal position

41
Q

What are the musculoskeletal abnormalities associated with pectus excavatum?

A

Scoliosis, kyphosis, myopathy, Marfan’s syndrome, Cerebral palsy

42
Q

What are the symptoms of pectus excavatum?

A 
Decreased exercise tolerance
Fatigabilitiy
Dyspnea on exertion
Sternal pain
Multiple URIs
Palpitations
**most common complaint is cosmetic
43
Q

What is pectus carinatum?

A

Anterior protrusion of the sternum

  • “pigeon chest”
  • less common that pectus excavatum
44
Q

What is Poland’s syndrome?

A

Congenital absence of pectoralis major/minor muscles, ribs, breast abnormality, chest wall depression and syndactylyl (2 or more digits fused together), brachydactylyl (shortening of fingers and toes due to unusually short bones, usually 4th digit; inherited condition–what you see in hands you see in feet), or absence of phalanges

45
Q

What is the thoracic outlet?

A

The space through which the subclavian artery, subclavian vein and the brachial plexus pass to the upper limb

  • boundaries: 1st rib, clavicle, scalene muscles
  • sx develop when these structures are compressed at the outlet
46
Q

What is a cervical rib?

A

An accessory rib which is not normally present - when present, it can cause compression of important structures in the thoracic outlet

47
Q

What are the neurogenic symptoms of a cervical rib in TOS?

A

95% incidence - ulnar nerve C7-T1 usually affected

  • Sympathetic -> Raynaud’s phenomenon (usually B/L because it is systemic, if unilateral suspect TOS)
  • Peripheral -> pain, paresthesias, motor weakness
48
Q

What are the vascular symptoms of a cervical rib in TOS?

A

5% incidence - prolonged compression and trauma

  • Subclavian vein -> edema, venous distention, Paget-Schroetter syndrome -> UE DVT in the axillary/subclavian veins
  • Subclavian artery -> intimal injury -> stenosis, thrombosis -> post-stenotic dilation/aneurysm -> distal micro-embolisation
49
Q

Which ribs are most commonly injured?

A

5th-9th rib (anterior and lateral)

50
Q

How do rib fractures present?

A
  • History of single traumatic blow
  • Pain over fx site (pinpoint pain; diffuse pain would be a pulmonary problem)
  • Pain with deep inspiration, coughing, sneezing, movement of torso
51
Q

What is subcutaneous emphysema?

A

Pockets of air over fractured areas directly under the skin (feels like wax paper, when you touch the area crackles); seen with blunt force trauma

52
Q

What is the most common cause of chest pain?

A

Tietze syndrome = costochondritis (inflammation of costochondral cartilage where ribs join sternum); referred pain midclavicular line 3rd and 4th ribs down to back
-MOI: hyperflexion, horizontal abduction

53
Q

What is a pneumothorax?

A

Accumulation of air in the pleural cavity

  • Must evaluate because lung cannot expand
  • Treatment: put in chest tube
  • Clinical signs: apprehension/agitation, cyanosis, diminished breath sounds, distended neck veins/tracheal deviation
  • Palpation: trauma induced -> point tenderness
  • Vital signs: labored, shallow respirations, BP decreases rapidly
54
Q

What is a spontaneous pneumothorax?

A

ATRAUMATIC lung rupture -> air within pleural cavity -> pressure increases

  • Re-inflate lung via chest tube to get air and fluid out to create negative pressure so the lungs can expand
  • Diagnosis dependent on signs/symptoms = rare (SOB)
  • Contributing factors = tall/thin, family hx, sports related, weight lifting, football injuries, simple jogging
  • Localized (side of affected lung and can radiate to shoulder, neck and back)
55
Q

What is primary and secondary spontaneous pneumothorax?

A
  • Primary spontaneous pneumothorax = bleb (outpocket of air in lungs bursts especially in smokers, COPD)
  • Secondary spontaneous pneumothorax = subcutaneous emphysema
56
Q

What is a tension pneumothorax?

A

TRAUMATIC; one way valve is created from blunt or penetrating trauma

  • Air can enter but cannot leave pleural space –> increases intrathoracic pressure –> lung collapses –> increases pressure on mediastinum
  • Pressure will eventually collapse superior and inferior vena cava –> loss of venous return –> decreased BP
  • Stabilize by ecclusive closing dressing so air cannot get in
57
Q

What is a hemothorax?

A

Blood enters pleural space –> lung on affected side compressed

  • Causes: infection, trauma, loss of blood due to blunt injury
  • Secondary complications: mediastinal shift, compressions of superior and inferior vena cava
  • Sx/signs: anxiety, depression, hypovolemic shock
58
Q

What is a massive hemothorax?

A

1500cc blood loss into thoracic cavity

Anatomy Exam 2 (5 decks)

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