Pleura ( Handout ) Flashcards by J Santisteban

Inner membrane of the lung
A. Parietal
B. Visceral

B. Visceral

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Outer membrane of the lung
A. Visceral
B. Parietal

B. Parietal

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Insensitive to pain because it receives no nerves of general sensation

Visceral pleura

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Visceral pleura receives an autonomic nerve supply from

Pulmonary plexus

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3 compartments of the thoracic cavity

R pulmo cavity
L pulmo cavity
Mediastinum

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Closely covers the lungs including the fissures

Visceral pleura

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Adheres firmly to the lungs and provides the lungs with smooth slippery surface

Visceral pleura

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Lines the pulmonary cavities

Parietal pleura

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Pleura that is thicker than the other

Parietal thicker than visceral

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Continuous with the parietal pleura at the hilum of the lung

Visceral pleura

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Sensitive to pain, touch, and pressure

Parietal pleura

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Nerves of the parietal pleura

Intercostal nerves

Phrenic nerve

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Innervates the costal pleura and the peripheral part of the diaphragmatic pleura

Intercostal nerves

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Innervates the mediastinal pleura and the central part of the diaphragmatic pleura

Phrenic nerve

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Parts of the parietal pleura

Costal
Mediastinal
Diaphragmatic
Cervical

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Parietal pleura: covers the internal surfaces of the thoracic wall
A. Costal
B. Mediastinal
C. Diaphragmatic
D. Cervical

A. Costal

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The costal pleura is separated from the internal surfaces of the thoracic wall by?

Endothoracic fascia

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Parietal Pleura: covers and forms the lateral boundary of the mediastinum
A. Costal
B. Mediastinal
C. Diaphragmatic
D. Cervical

B. Mediastinal

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Parietal Pleura: continuous with the visceral pleura at the hilum of the lung
A. Costal
B. Mediastinal
C. Diaphragmatic
D. Cervical

B. Mediastinal

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Parietal Pleura: covers the thoracic surface of the diaphragm
A. Costal
B. Mediastinal
C. Diaphragmatic
D. Cervical

C. Diaphragmatic

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Connects the diaphragmatic pleura with the muscle fibers of the diaphragm

Phrenicopleural fascia

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Parietal Pleura: dome-shaped cap that covers the apex of the lungs
A. Costal
B. Mediastinal
C. Diaphragmatic
D. Cervical

D. Cervical

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The summit of the cervical pleura is ________ inches superior to the level of medial third of clavicle

1-1.5 inches

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The cervical pleura is reinforced by

Sibson’s fascia or suprapleural membrane

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Where the parietal pleura abruptly changes direction

Lines of pleural reflection

What are the lines of pleural reflection?

Anterior / sternal Inferior / costal Posterior / vertebral

Where costal pleura becomes continuous with the mediastinal pleura anteriorly A. Sternal line B. Costal line C. Vertebral line

A. Sternal line

Where the costal pleura becomes continuous with the diaphragmatic pleura inferiorly A. Sternal line B. Costal line C. Vertebral line

B. Costal line

Passes obliquely at the 8th rib (MCL), 10th rib (MAL), and 12th rib at its neck A. Sternal line B. Costal line C. Vertebral line

B. Costal line

Where the costal pleura becomes continuous with the mediastinal pleura posteriorly A. Sternal line B. Costal line C. Vertebral line

C. Vertebral line

Parallel the vertebral column running in the paravertebral plane from T1 to T12 A. Sternal line B. Costal line C. Vertebral line

C. Vertebral line

Potential spaces of the lungs

Costodiaphragmatic recess | Costomediastinal recess

Slit-like space between the costal and diaphragmatic pleura A. Costodiaphragmatic recess B. Costomediastinal recess

A. Costodiaphragmatic recess

Located at the most inferior limits of the parietal pleura A. Costodiaphragmatic recess B. Costomediastinal recess

A. Costodiaphragmatic recess

Slit-like spaces between the mediastinal and costal pleura A. Costodiaphragmatic recess B. Costomediastinal recess

B. Costomediastinal recess

Located posterior to the sternum A. Costodiaphragmatic recess B. Costomediastinal recess

B. Costomediastinal recess

What is larger, the left or the right costomediastinal recess?

Left recess is larger

Potential space between the layers of the pleura

Pleural cavity / pleural space

Condition that increases the production of fluid or impairs the drainage of fluid

Pleural effusion

Pleural effusion can be detected clinically when ________ ml of fluid is contained in the costodiaphragmaticnrecess

300ml

What are the conditions that can increase the production of pleural fluid

Inflammation Malignancy CHD

Condition that impairs drainage of fluid in the pleural cavity

Collapsed lung

Decreased lung expansion Decreased breath sounds Dullness on percussion - all are clinical signs of what condition?

Pleural effusion

Condition wherein blood is present in the pleural cavity

Hemothorax

An injury to intercostal or internal thoracic vessel will result to what condition

Hemothorax

Entry of air in pleural cavity will result to what condition

Pneumothorax

A penetrating wound or fractures ribs will result to what condition A. Hemothorax B. Pneumothorax

B. Pneumothorax

Sudden entry of air in pleural cavity due to a ruptured bulla (bleb) will result to what condition

Spontaneous pneumothorax

What is the clinical condition? Air + serous fluid A. Hydropneumothorax B. Pyopneumothorax C. Hemopneumothorax D. Empyema

A. Hydropneumothorax

What is the clinical condition? Air + pus A. Hydropneumothorax B. Pyopneumothorax C. Hemopneumothorax D. Empyema

B. Pyopneumothorax

What is the clinical condition? Air + blood A. Hydropneumothorax B. Pyopneumothorax C. Hemopneumothorax D. Empyema

C. Hemopneumothorax

What is the clinical condition? Pus - air (without air) A. Hydropneumothorax B. Pyopneumothorax C. Hemopneumothorax D. Empyema

D. Empyema

When a lung collapses, the pleural cavity becomes a real space. This condition is called

Atelectasis

Amount of ______ and ______ determines the extent of pulmonary collapse

Blood and air

Atelectasis: failure of a lung to inflate birth A. Primary B. Secondary

A. Primary

Atelectasis: collapse of a previously inflated lung A. Primary B. Secondary

B. Secondary

Vulnerable to injury during infancy and childhood

Cervical pleura

Inflammation of pleura secondary to inflammation of lung

Pleuritis

S/s: (+) pleural rub | sharp stabbing pain

Pleuritis

Common causes of pleuritis

TB Pneumonia Lung abscess

Presence of white tumor nodules due to exposure to asbestos that may arise from either the visceral or parietal pleura

Mesothelioma

S/s: (+) pleural rub Chest pain Dyspnea Pleural effusion Gross: (+) pleural adhesion

Mesothelioma

In performing thoracentesis in an upright position, the needle is inserted where?

9th ICS MAL

Diagnostic an therapeutic procedure wherein small incision is made into the pleural cavity

Thoracoscopy

Where do you insert a chest tube?

5th - 6th ICS in MAL

Insertion of chest tube is directed towards what pleura? Or to what recess?

Cervical pleura | Costodiaphragmatic recess