Lungs & Pleura

Question 1

What are the most anterior and inferior structures in the hilum?

Answer 1

Pulmonary veins

Question 2

Pain referred from autonomic structures is

Answer 2

Dull, non-severe, poorly located

e.g. ANS innervation to peridardium, pleura, peritoneum

Question 3

Pain referred from somatic structures is

Answer 3

Sharp, severe, well-located

e.g. somatic innervation of the parietal pleura and pericardium is of the structures they line (mediastinum, diaphragm, intercostals)

Question 4

What is the path of the trachea?

Answer 4

• begins at C6
• divides at T4/T5 (manubriosternal junc’n, angle of Louis) into main bronchi
• R main bronchus is shorter, wider, more vertical
  
  • happy target for stray peanuts etc.
• main bronchi divde @ hilum into lobar bronchi (bronchiole tree in each lung)
• lobar bronchi divide into segmental bronchi
  
  • aerate bronchopulmonary segments (10 in each lung)
    
    • also have ind arteries and veins
  • important one is apical segment of the lower lobe

Question 5

What is the clinical significance of auscultation on the apical segment of the lower lobe?

Answer 5

• first posterior branch of the bronchii come off here
• tf aspirated vomit/fluid when lying on back will end up in this lobe
• esp in R main bronchus

Question 6

What is the anatomy of the R lung?

Answer 6

3 lobes

2 fissures:

hz: separates upper & middle (more anterior, superior)
oblique: separates more posterior lower lobe from upper & middle lobes

Question 7

What is the anatomy of the L lung?

Answer 7

2 lobes

1 fissure

oblique separating anterosuperior upper from posteroinferior lower lobe

lingula medially, in front of cardiac notch

Question 8

What are the four structures of the hilum?

Answer 8

• bronchioles
• vasculature
• nerves
• lymphatics

Question 9

What are the vascular elements of the hilum?

Answer 9

• pulmonary artery
• bronchial arteries
• pulmonary veins
• bronchial veins

Question 10

Pulmonary arterial structures are typically found

Answer 10

anterior and/or superior to the bronchial tree (lobar)

(and pulmonary veins)

Question 11

What is unique about the R bronchus at the hilum?

Answer 11

It gives off the R upper lobe bronchus before it enters the R lung

continues on as bronchus intermedius to the middle and lower lobar branches inside the lung

Question 12

The pulmonary arteries of the R lung lie

Answer 12

anterior to the R upper lobe bronchus and bronchus intermedius

posterior to the anterior pulmonary vein

Question 13

Answer 13

Question 14

In the L hilum, the pulmonary artery sits

Answer 14

Superior to the left main bronchus

posterior to the anterior pulmonary vein

Question 15

Question 16

Nerve supply to the lungs is

Answer 16

Autonomic: SNS & PNS

regulates mucous production and bronchiole diameter