Pleura and Lungs

Question 1

What are the boundaries of the thoracic inlet?

Answer 1

The manubrium, rib 1 (+ its costal cartilage), and the body of vertebra T1.

Question 2

What are the boundaries of the thoracic outlet?

Answer 2

The body of T12, the costal margin and the xiphisternal joint.

Question 3

What is the suprapleural membrane?

Answer 3

A dome-shaped thickening of the endothoracic fascia over the thoracic inlet occupied by the cupola of each lung.

Question 4

What serous membrane lines each thoracic cavity?

Answer 4

The pleural membrane (parietal pleura).

Question 5

What are the various division of the parietal pleura?

Answer 5

Costal, mediastinal, diaphragmatic and cervical pleura.

Question 6

How does parietal pleural differ from visceral with regard to innervation?

Answer 6

Parietal pleura is highly innervated, visceral pleura is not innervated.

Question 7

Where does parietal pleura become visceral pleura?

Answer 7

Where it reflects off the mediastinum (as the mediastinal division of parietal pleura) onto the surface of the lung at the root of the lung.

Question 8

What is the pulmonary ligament?

Answer 8

A cuff-like extension of this reflection of parietal/visceral pleura at the root of the lung inferiorly along the mediastinum.

Question 9

What attaches the costal pleura to the back of the thoracic cage?

Answer 9

Endothoracic fascia.

Question 10

What is a pleural recess?

Answer 10

A reflection of parietal pleura off one aspect of the body wall onto another forming a thin slit-like serous lined region into which the sharp borders of the lung rarely insert - even during deep inspiration.

Question 11

What is the function of the pleural recesses?

Answer 11

A region for expansion of the lung duyng deep inspiration.

Question 12

Name two pleural recesses.

Answer 12

Costodiaphragmatic and costomediastinal.

Question 13

Which specific aspect of the lung would insert into each recess?

Answer 13

The sharp anterior border of the lung slips into the costomediastinal recess; the sharp inferior border of the lung inserts down into the costodiaphragmatic recess.

Question 14

Cite a clinical implication of these recesses.

Answer 14

Fluid accumulates in these regions (specifically the costodiaphragmatic) in pathological conditions. It is generally removed from these regions by thoracocentresis so that the lung is not pierced by the needle withdrawing the fluid.

Question 15

What is meant by negative pressure of the thoracic cavity?

Answer 15

It keeps the moist visceral pleura of the lung adherent to the moist parietal pleura of the thoracic wall. Movement of the wall pulls the lung with it - inspiration and expiration.

Question 16

What causes the visceral pleura to adhere to the parietal pleura?

Answer 16

A thin layer of pleural fluid and the negative pressure.

Question 17

What is a pneumothorax?

Answer 17

Air enters the pleural cavity causing the two pleural layers to separate (and the lung to collapse).

Question 18

What is a hemothorax?

Answer 18

Blood enters the pleural cavity and forces the two pleural layers apart.

Question 19

Be able to label a diagram of the anatomical surface features of the lungs.

Answer 19

The diagrams on page 156 have been used on the exam before as well as being tested on the practical.

Question 20

Which aspect of the thorax would apply the stethoscope to in order to listen to the airways in the upper lobe of each lung?

Answer 20

To listen to the airway sounds in the upper lobe of either lung, you would place the stethescope on the anterior thoracic wall.

Question 21

Which aspect of the thorax would you apply the stethoscope to in order to listen to the airways in the lower lobe of each lung?

Answer 21

On the posterior thoracic wall.

Question 22

Which aspect of the thorax would you apply the stethoscope to in order to listen to the airways in the apical region?

Answer 22

in the thoracic inlet

Question 23

Which aspect of the thorax would you apply the stethoscope to in order to listen to the airways in the middle lobe of the right lung?

Answer 23

on the lateral thoracic wall

Question 24

What vessels supply lung tissue with oxygenated blood?

Answer 24

the bronchial arteries

Question 25

From where do the vessels that supply lung tissue arise?

Answer 25

off the aorta

Question 26

What is the relationship between bronchi and pulmonary arteries?

Answer 26

The pulmonary aa. follow the bronchial tree - most commonly above it.

Question 27

What is the relationship between bronchi and pulmonary veins?

Answer 27

Pulmonary vv. lie below the bronchi at the hilus/root of the lung.

Question 28

Which main bronchus is longer and why?

Answer 28

The left is longer and more horizontal as it passes over the heart.

Question 29

Which main bronchus is explored first when objects are aspirated? Why?

Answer 29

The right bronchus is always explored first with the bronchoscope. Because it is more vertical and in-line with the trachea so objects tend to enter it rather than the more horizontal left main bronchus.

Question 30

What does a main (primary) bronchus supply?

Answer 30

a lung

Question 31

What does a secondary bronchus supply?

Answer 31

a lobe

Question 32

What does a tertiary bronchus supply?

Answer 32

A bronchopulmonary segment (BPS).

Question 33

What is a bronchopulmonary segment?

Answer 33

The smallest surgically resectable portion of a lung.

Question 34

How many BPS’s are found in each lung?

Answer 34

There are 10 BPS in each lung.

Question 35

What is the clinical implication of BPS’s?

Answer 35

They are the smallest surgically resectable portion of a lung as well as the knowledge of their position in the lung is important for positioning the patient for postural drainage.

Question 36

What clinical implication does the autonomic innervation of the lungs have?

Answer 36

The parasympathetic innervation (vagus nerve) constricts the smooth muscle in the walls of the bronchioles - asthma (highly atypical as the sympathetic division normally constricts smooth muscle).

Question 37

To what notes do the superficial and deep lymphatics of the lung drain?

Answer 37

The bronchopulmonary nodes.

Question 38

Where are these nodes located?

Answer 38

at the root of the lung

Question 39

From here the lymph passes to what other groups located along the bronchus and trachea?

Answer 39

To the tracheobronchial and paratracheal nodes respectively.