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CRRAB Week 2 > Pleura and Lungs > Flashcards

Pleura and Lungs Flashcards

1
Q

Each pleural cavity is. .

A

. .a closed and separate space.

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2
Q

Visceral pleura

A

Serous membrane on surface of the lungs

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3
Q

Parietal pleura

A

Lines the walls of the thoracic cavity.

-The visceral and parietal pleura are continuous with one another at the root of the lung

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4
Q

What is the potential space between the parietal and visceral pleura called?

A

Pleural cavity

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5
Q

What system do the lungs develop from?

A

GI tract

  • Start as components o fhte rostral GI tract
  • Common precursor = endodermal tube/primitive foregut
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6
Q

What does the splanchnic mesoderm give rise to?

A

Visceral pleura

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7
Q

What does the somatic mesoderm give rise to?

A

Parietal pleura

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8
Q

When do lung buds develop?

A

5th week

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9
Q

What nerves carry sensation from the parietal pleura?

A

Phrenic & Intercostal Nerves

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10
Q

What are the four regions of the parietal pleura?

A
  1. Costal pleura
  2. Mediastinal pleura
  3. Diaphragmatic pleura
  4. Cervical pleura or pleural cupola (over apex of lung)
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11
Q

What nerves carry sensation from the visceral pleura?

A

None! Visceral pleura is insensitive

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12
Q

Where is the pulmonary ligament and what is it?

A

It drapes below the root of the lung, the thickened fusion of the visceral and parietal pleura.

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13
Q

How many/what lobes does the left lung have?

A

2

Superior & Inferior

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14
Q

How many/what lobes does the right lung have?

A

3

Superior, Middle & Inferior

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15
Q

Where is the costodiaphragmatic recess? What is it?

A
  • Between costal pleura and diaphragmatic pleura of parietal pleura
  • These are areas where lung tissue does not extend fully into pleural space except at full inspiration
  • Potential space where abnormal fluid will accumulate
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16
Q

Where is the costomediastinal recess?

A

-Between costal pleura and mediastinal pleura of parietal pleura

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17
Q

Where are the phrenic nerves carried?

A

Between the heart and lungs in the serous coverings. They are carried in the pleuropericardial folds.

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18
Q

What lies anterior to the root of the lung?

A
  • Phrenic nerve

- Pericardiacophrenic vessels (pericardiophrenic artery)

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19
Q

What lies posterior to the root of the lung?

A

-Vagus nerve

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20
Q

What is the pericardiophrenic artery a branch of?

A

Internal thoracic artery

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21
Q

What supplies ALL motor innervation and PART of sensory output from diaphragm?

A

C345 keeps the diaphragm alive! (ventral rami)

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22
Q

What does the phrenic nerve supply?

A
  • Motor innervation to the diaphragm

- Sensation from central area of diaphragm

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23
Q

What carries sensory information from the peripheral portion of the diaphragm?

A

Intercostal nerves

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24
Q

What are the two fissures of the right lung? What do they lie between?

A

Superior, Middle, Inferior

  • Horizontal between superior and middle
  • Oblique between middle and inferior
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25
Q

What is the fissure of the left lung?

A

Oblique - lies between superior and inferior

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26
Q

Bc the apex of the lung extends above the clavicle. . .

A

. . .it is at risk of traumatic injuries to the neck such as gunshots and stabbing

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27
Q

What does the lingua do during respiration?

A

Lingua of superior lobe of left lung sides in an out of the costomediastinal recess during respiration

28
Q

What are Pancoast tumors?

A

(Superior sulcus tumors)
-Unique lung carcinomas located specifically in apex of lung and invade through tissue contiguity the apical chest wall and the structures of the thoracic inlet (parietal pleura, 1st & 2nd ribs/vertebral bodies, lower roots of brachial plexus, upper sympathetic chain, subclavian vein and artery)

29
Q

What symptoms are caused by pancoast tumors?

A
  • Pain/numbness in arm & hand
  • Horner’s syndrome
  • Compression of neck structures (brachiocephalic vein, subclavian artery, phrenic nerve, vagus and recurrent laryngeal nerves)
  • Bone destruction from chest wall invasion
30
Q

Where does the lingual develop from?

A

The tongue

31
Q

Why is the right lung shorter and wider?

A

Liver!

32
Q

What are unique parts of the left lung?

A

Cardiac notch, lingula (anatomic equivalent of L middle lobe), oblique fissure

33
Q

What does RALS tell us?

A

Relationship between pulmonary artery and main bronchus

-Right anterior, left superior

34
Q

Where does the pulmonary artery lie on the right lung?

A

Pulmonary artery lies anterior to primary bronchus (RA of RALS)

35
Q

What will you see at the branch of the right lung?

A
  • R Lobar bronchi
  • R Pulmonary artery
  • R Superior pulmonary veins
  • Hilar lymph node
  • R Inferior pulmonary vein
36
Q

What impressions will you see on the right lung?

A
  • Esophagus
  • Trachea
  • SVC
  • Esophagus
  • Arch of Azygous
  • Cardiac impression
37
Q

Where does the pulmonary artery lie on left lung?

A

RALS - LS

On left lung, pulmonary artery lies superior to the primary bronchus

38
Q

What will you see at the branch of the left lung?

A
  • L pulmonary artery
  • L main bronchus
  • L superior pulmonary veins
  • Hilar lymph nodes
  • L Inferior pulmonary vein
39
Q

What impressions will you see on the left lung?

A
  • Aorta
  • Heart
  • Esophagus
40
Q

How does the trachea split?

A

Trachea –> primary bronchi –> Lobar bronchi –> Segmental bronchi (~10 for each lung)

41
Q

Where does the trachea split into the primary bronchi?

A

Around T4-5 (lying down)

T6 standing up

42
Q

Where is the carina?

A

-Keel-shaped cartilaginous ridge at bifurcation of trachea

43
Q

Bronchopulmonary segment:

A

That portion of lung supplies by a segmental bronchus and pulmonary artery branch

44
Q

What is the significance of the trachealis muscle?

A
  • Trachea is supported by C-shaped cartilaginous rings, open at the back
  • Opening in back is filled by trachealis muscle
  • As you descend, cartilage replaces the rings
45
Q

What does deviation in the position of the carina indicate?

A

It may indicate metastasis of bronchogenic carcinoma into the tracheobronchial lymph nodes

46
Q

What is the typical area in the airway where a foreign body will lodge?

A

Right airway

  • Shorter in length
  • Wider in diameter
  • More vertical
47
Q

Obstruction of a bronchus is the primary cause of…

A

Atelectasis = A collapsed and airless state of a lung. It may be acute or chronic, and may involve all or part of a lung
-Collapse of significant amount of lung may lead to mediastinal shift toward side of the collapse

48
Q

What is a bronchopulmonary segment?

A

Smallest, functionally independent region of a lung and the smallest area of lung that can be isolated and removed without affecting other regions.

  • Arteries run with Airways!
  • Veins and lymphatics will drain intersegmentally around the edges
  • Segments separated by connective tissue
49
Q

What direction are chest radiographs typically taken?

A

PA

AP only if patient can’t stand

50
Q

What is the difference between primary and secondary atelectasis?

A

Primary - failure of lung to inflate at birth

Secondary - collapse of previously inflated lung

51
Q

How does inspiration causing a decrease in intra-thoracic pressure?

A

Normal inspiration:

  • Contraction of diaphragm extends the vertical dimension of the thoracic cavity
  • External intercostals widen and expand the lateral dimension while the sternum also elevates and moves anteriorly
  • Increase in volume of the thoracic cavity causes a decrease in the intra-thoracic pressure
52
Q

How do the pleural cavities expand during inspiration?

A

They experience a decrease in pressure was they expand to fill void.
-Lungs expand to fill the vacuum of the pleural cavities, and since they are open to atmospheric pressure, air moves into the lungs along its pressure gradient

53
Q

What happens during expiration?

A
  • The diaphragm relaxes, elastic recoil of the chest wall and lungs occurs.
  • The volume of thoracic cavity decreases
  • Increased pressure on the pleural cavities and lungs expels air
54
Q

What is normal intra-pleural pressure? What does it do?

A

4 mmHg below atm pressure

-Acts like suction to keep alveoli inflated

55
Q

What is a pneumothorax?

A

Entry of air into the pleural cavity is called a pneumothorax.
-As a result of air entering the cavity, pressure in the pleural cavity increases, the lung collapses and the pleural cavity becomes a real space.

56
Q

What causes pneumothorax?

A 
Traumatic punctures (bullet, stab wounds) that penetrate the thoracic wall and parietal pleura; ruptures of the lung parenchyma and visceral pleura. 
-Note that the pleural cavities extend into the neck
57
Q

What causes a spontaneous pneumothorax?

A

Can be due to a rupture of a bleb or bulla on lung surface.

  • Typically patient with no known lung disease
  • Can occur secondary to diseases of lung
  • Tall men at risk due to rapid growth spurts
  • Once one has ruptured, 60% chance another will
  • Some genetic predisposition
58
Q

What is the common presentation of a simple/sponteneous pneumothorax?

A
  • Tall, thin male teenager (20-40)
  • Abrupt onset dyspnea
  • Chest pain
  • Hyperresonant percussion (exaggerated hollow sound) on affected side
  • Breath sounds diminished
59
Q

What is open pneumothorax?

A

May be caused by stab wounds often.

  • Air flows easily in and out of the open wound.
  • Mediastinal structures are pushed to the opposite side with inspiration but return with expiration
60
Q

What is a tension pneumothorax?

A

Injury may be to the thoracic wall or lung tissue -Wound is covered by skin, muscle or clothing.

  • Air becomes trapped in the pleural space and mediastinal structures are pushed to the opposite side
  • One lung is collapsed and the other is compressed
  • Trachea deviates away from the lesion
61
Q

What are the clinical signs of tension pneumothorax?

A

Distended neck veins, shifted trachea, decreased breath sounds in both lungs, hypotension, agitation

62
Q

What are the classic signs of tension pneumothorax?

A
  1. Deviation of trachea away from side of tension
  2. Shift in mediastinum
  3. Depression of hemidiaphragm
    - Cardiovascular function compromised due to venous obstruction of heart
63
Q

What is tube thoracostomy?

A
  • Used for open & closed pneumothorax if large
  • Chest tube inserted into 4th or 5th intercostal space in midaxillary line
  • Tube is attached to suction device, allows lungs to re-expand
  • Local anesthesia used
  • Chest tube left in place until lung leak seals on its own, usually within two to five days
64
Q

Where is a needle inserted to remove blood or other fluids?

A

Through intercostal space in the costodiaphragmatic recess

  • Between 9th and 10th rib
  • Needle must be placed above diaphragm and avoid liver and spleen
65
Q

What is pleural effusion?

A

Increase of fluid in the pleural space

66
Q

What is hemothorax?

A

Blood entering the pleural space e.g. from a chest wound

67
Q

What location is the safest to perform a pleural tap?

A

9th intercostal space, mid-axillary line

CRRAB Week 2 (9 decks)

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