Pleurae, Lungs, And Tracheobronchial Tree Blue Boxes

Question 1

Which structures project through the superior thoracic aperature, formed by inferior slope of 1st ribs, what structures are prone to injury?

Answer 1

Cervical pleura and the apex of the lung, posterior to sternocleidomastoid muscles.

Question 2

Wounds to the base of the neck can result in the presence of air in the pleural sac is called?

Answer 2

Pneumothorax

Question 3

An abdominal incision can enter the pleural sac in which three areas?

Answer 3

Right part of the infrasternal angle area, right and left areas of costovertebral angles. Areas at costovertebral inferomedial to 12th rib and posterior to superior poles of kidneys. Pneumothorax can occur here during kidney surgery.

Question 4

Differentiate between primary atelectasis and secondary atelectasis.

Answer 4

Primary is the failure of the lung to inflate at birth, secondary is the failure of lung after previously inflated.

Question 5

Describe how the lungs remain inflated in terms of visceral and parietal pleura and pleural fluid?

Answer 5

Normal lungs remain distended even when the airway passages are open due to the visceral pleura, parietal pleura, and pleura fluid. Visceral pleura(outer surface of lungs) adheres to inner surface of thoracic wall(parietal pleura) due to surface tension by the pleural fluid.

Question 6

Describe the lungs if penetrated in regards to pressure.

Answer 6

Elastic recoil of the lungs causes the pressure in pleural cavities to be sub-atmospheric(normally -2mmhg, drops to -8mmhg). Penetration of thoracic wall or lung–>air sucked into pleural cavity due to negative pressure. Surface tension will be broken, lung collapses, air expelled due to elastic recoil.

Question 7

Following lung collapse, describe the affect to the pulmonary cavity.

Answer 7

Pulmonary cavity may decrease in size during inspiration. Evident radiographically on the affected side due to elevation of diaphragm, intercostal space narrowing, and mediastinal shift and air filled trachea toward affected side. Collapsed lung appears more dense.

Question 8

Open chest surgery requires what to operate the lungs?

Answer 8

Maintained by intubating the trachea with a cuffed tube and using positive pressure pump, varying the pressure to inflate and deflate the lungs.

Question 9

Describe a potential complication of a bronchopulmonary fistula or a fractured rib.

Answer 9

Bronchopulmonary fistula or fractured rib, a result of a rupture of a pulmonary lesion into the pleural cavity, can result in a collapsed lung.

Question 10

Pleural effusion can lead to what?

Answer 10

Pleural effusion, the escape of fluid into the pleural cavity, can lead to hydrothorax, the accumulation of fluid in the pleural cavity. If blood, described as a hemothorax.

Question 11

Hemothorax is a common result during injury to which structures?

Answer 11

Chest would, or injury to the intercostal or internal thoracic vessel.

Question 12

If air and fluid fill the pleural space, what can be seen.

Answer 12

An air fluid level or interface, that is horizontal and a sharp line.

Question 13

Describe a thoracentesis generally?

Answer 13

Inserting a hypodermic needle through an intercostal space into the pleural cavity to obtain sample or remove fluid. If patient upright, obtain fluid through the 9th intercostal space at the MAL during expiration.

Question 14

Precautions of a thoracentesis in regards to nerve and vessels?

Answer 14

Needle inserted superior to the rib, high enough to avoid the collateral branches and intercostal nerves. Also, remember VAN within intercostal spaces.

Question 15

Where does fluid accumulate in an upright position?

Answer 15

The costodiaphragmatic recess.

Question 16

Where and how to insert the needle during thoracentesis.

Answer 16

Inserted into the 9th intercostal space in the midaxillary line during expiration. Needle angled upward to avoid the deep side of recess( thin layer of diaphragmatic parietal pleura and liver)

Question 17

The purpose of an insertion of a chest tube?

Answer 17

To remove air, blood, serous fluid, pus in the pleural cavity, to reinflate lung as well.

Question 18

Location of chest tube insertion.

Answer 18

In he he 5th or 6th intercostal space in the midaxillary line, basically nipple level.

Question 19

Directions chest tube insertion can take.

Answer 19

Suerpiorly towards the cervical pleura for air removal, or inferiorly toward costodiaphragmatic recess for fluid drainage. Suction can be used to prevent air from being sucked back into pleural cavity.

Question 20

Failure to remove fluid from pleural cavity can lead to?

Answer 20

The development of a resistant fibrous covering that inhibits expansion unless peeled off (lung decortication).

Question 21

What can cause obliteration of the pleural cavity?

Answer 21

By disease, as in pleuritis (inflammation of pleura) or during surgery with a pleurectomy, an excision of a part of the pleura.

Question 22

Possible functional defects of loss of a pleural cavity.

Answer 22

No functional deficits, but pain during exertion.

Question 23

Describe a pleurodesis.

Answer 23

Covering the apposing layers of pleura with an irritating powder or sclerosing agent to induce the adherence of the parietal and visceral layers of pleura.

Question 24

Purpose of a pleurectomy or pleurodesis?

Answer 24

Both are performed to prevent recurring spontaneous secondary atelectasis caused by chronic pneumothorax or malignant effusion resulting from lung disease.

Question 25

What is a thoracoscopy procedure?

Answer 25

A diagnostic procedure in which the pleural cavity is examined with a scope.

Question 26

What condition might be detectable based on lung sounds, related to the pleura.

Answer 26

The sliding of the smooth and moist pleurae make no detectable sounds during auscultation of the lungs. Pleuritis can lead to friction, a pleural rub, that is detectable with a stethoscope.

Question 27

What is pleural adhesion?

Answer 27

The parietal and visceral layers of pleura adhering together, can occur with pleuritis.

Question 28

Symptoms of acute peluritis?

Answer 28

Acute pleuritis is marked by sharp, stabbing pain especially during extertion.

Question 29

Possible variations of lung fissures?

Answer 29

Oblique and horizontal fissures may be incomplete or absent, resulting in changes to the lobes. Extra fissure dividing the lung, examples including three lobes in left lung, two lobes in right lung.

Question 30

Possible variations of lung lobes?

Answer 30

Superior left lobe may not feature a lingula. A common accessory lobe known as the azygos lobe may appear in the right lung, located superior to the hilum and separated by the deep groove containing the arch of azygos vein. Large azygos lobe may appear as bifurcated apex.

Question 31

Appearance of lungs in children, adults, and urban locations.

Answer 31

Light pink in healthy children and non smokers in clean environments. Darker and mottled in adults living in urban or agricultural areas due to accumulation of carbon and dust.

Question 32

Lungs defense to particulate matter?

Answer 32

Lungs can accumulate carbon by containing phagocytes to remove carbon that deposit in inactive connective tissue or in lymph nodes.

Question 33

What are the sound types when performing percussion of the thorax.

Answer 33

Air filled, resonant soundFluid filled, dull soundSolid, flat sound

Question 34

What is meant when auscultating the base of the lung?

Answer 34

The inferoposterior part of the inferior lobe, apply a stethoscope to the posterior thoracic wall of the 10th thoracic vertebra level.

Question 35

Which bronchus is most likely to have foreign objects lodged within and why.

Answer 35

The right main bronchus due to being wider and shorter and running more vertically.

Question 36

What is the Carina and where is it located?

Answer 36

The Carina is a cartilaginous projection of the last tracheal ring that is observed between the orifices of the right and left main bronchi.

Question 37

What is clinically useful of the Carina?

Answer 37

Tracheobronchial lymph nodes in the angle between the main bronchi are enlarged because of cancer, the carina is distorted, widened posteriorly, and immobile.

Question 38

What reflex does the Carina contain induce.

Answer 38

The mucous membrane over the carina is sensitive, and associated with the cough reflex. It will only reflex when in contain with fluid or object.

Question 39

Describe the difference between pneumonectomy, lobectomy, or segmentectomy.

Answer 39

Pneumonectomy is defined as the removal of a whole lung.Lobectomy is defined as the removal of a lobe. Segmentectomy is defined as the removal of a bronchopulmonary segment.

Question 40

Bronchial and pulmonary disorders are often localized where?

Answer 40

Localized in the bronchopulmonary segment which can be treated with any -ectomy.

Question 41

Describe segmental atelectasis.

Answer 41

Blockage of a segmental bronchus will prevent air from reaching the bronchopulmonary segment. Air in blocked segment will be gradually collapse. Adjacent segments will expand to compensate for the reduced volume.

Question 42

An embolus in the pulmonary artery can be caused by,

Answer 42

Blood clot, fat globule, or air pocket. Common origins include leg, even after fractures in the leg. Embolus passes through the right side of the heart, through a pulmonary artery, forming a block known as pulmonary embolism.

Question 43

Immediate effect of pulmonary embolism.

Answer 43

The immediate result of PE is partial or complete obstruction of blood flow to the lung, losing perfusion of blood.

Question 44

Longer term effects to a PE.

Answer 44

The patient suffers acute respiratory distress due to major decrease in oxygenation of blood due to lack of blood flow to lung. The right side of the heart may become acutely dilated because the volume of blood arriving from the systemic circuit cannot be pushed through the pulmonary circuit.

Question 45

Medium embolus can lead to what.

Answer 45

Block an artery supplying a bronchopulmonary segment, resulting in an pulmonary infarct, an area of dead tissue.

Question 46

Difference between physically active and sick people and their embolism.

Answer 46

Physically active people have a collateral circulation. Anastomoses with branches of the bronchial arteries are located near terminal bronchioles.

Question 47

Complications with impaired circulation to lung, or chronic congestion.

Answer 47

PE commonly results in lung infarction, or pleuritis causing inflamed visceral pleura which can become fused to the sensitive parietal pleura.

Question 48

Pain in the parietal pleura is a result from what.

Answer 48

Pain from parietal pleura is referred to the cutaneous distribution of the intercostal nerves to the thoracic wall, or for the inferior nerves to the anterior abdominal wall.

Question 49

What is the result to the lymphatic system following a pleural adhesion.

Answer 49

If parietal and visceral pleura adhere, the lymphatic vessels in the lung and visceral pleura may anastomoses with parietal lymphatic vessels that drain into the axillary lymph nodes. Indication can be carbon particles in these nodes is indication of adhesion.

Question 50

Spitting up blood or blood stained sputum can be an indication of what.

Answer 50

Bleeding is from the branches of the bronchial arteries most likely and a result of bronchitis, lung cancer, pneumonia, bronchiectasis, pulmonary embolism, and tuberculosis.

Question 51

Describe everything about bronchogenic carcinoma or lung cancer.

Answer 51

Brochogenic carcinoma refers to any cancers now from lung. Malignant cells can be detected in sputum. Primary tumor can metastasize to the bronchopulmonary lymph nodes and subsequently to other thoracic lymph nodes.

Question 52

Common sites of hematogenous metastasis of cancer cells.

Answer 52

Brain, bones, lungs, and suprarenal glands. The tumor cells probably enter the systemic circulation by invading the wall of a sinusoid of venue in a lung. The lymph nodes above the supraclavicular lymph nodes are enlarged when bronchogenic carcinoma develops owing to metastases of cancer cells.

Question 53

Describe sentinel nodes

Answer 53

Are now known as supraclavicular lymph nodes, enlargement alerted physicians about malignant disease in thoracic or abdomenal internal organs. Now sentinel lymph node is used to describe first lymph node anywhere that receives cancer cells.

Question 54

How can lung cancer affect our breathing or voice.

Answer 54

Lung cancer involved phrenic nerve can result in paralysis of half the diaphragm. Apical Lung cancer near apex of the lung may affect the recurrent laryngeal nerve which can result in hoarseness owing to paralysis of a vocal nerve since laryngeal nerve supplies all but one laryngeal muscle.

Question 55

Describe pleural pain.

Answer 55

Visceral pleura is insensitive to pain because it receives no nerves of general sensation. Parietal pleura especially costal is extremely sensitive to pain, richly supplied by branches of intercostal and phrenic nerve. Irritation of parietal pleura may produce local or referred pain to dreamy anatomies supplied by the same spinal ganglia and segments. Irritation of the costal and peripheral parts of the diaphragmatic pleura results in local pain and referred pain to the dermatomes of thoracic and abdominal walls. Irritation of these mediastinal and central diaphragmatic areas of parietal pleura results in referred pain to the root of the hen neck and over the shoulders c3-c5 dermatomes.