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Duke-NUS MS1 > RA16 Thorax Breast Lungs Anatomy > Flashcards

RA16 Thorax Breast Lungs Anatomy Flashcards

1
Q

Upper respiratory tract

Anatomy

A

Nose to larynx:
- Nasal cavity
- Pharynx
- Larynx

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2
Q

Lower respiratory tract

Anatomy

A

Trachea to lungs/alveoli:
- Trachea
- Bronchi
- Lungs

Contains conducting and respiratory zones

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3
Q

Conducting zone
- Structures
- Function

Anatomy

A

Structures:
- Trachea
- Bronchi
- Bronchioles
- Terminal bronchioles

Function:
- Air conduction (get air to alveoli)
- Air condition (warm the air)
- Air filtration (remove/trap particles)

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4
Q

Respiratory zone
- Structures
- Function

Anatomy

A

Structures:
- Respiratory bronchioles
- Alveolar sacs

Function:
- Gas exchange

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5
Q

Layers of trachea and bronchi

Histology

A

From luminal surface downwards:
- Mucosa: ciliated pseudostratified columnar epithelium -> lamina propria (cellular CT)
- Submucosa: denser CT, contains seromucous glands
- Hyaline cartilage
- Adventitia: dense irregular CT

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6
Q

Trachea:
- Epithelium? Ciliated?
- Secretory cell?
- Cartilage?
- Smooth muscle?
- Glands?

Histology

A
  • Pseudostratified columnar ciliated
  • Goblet cells
  • C-shaped cartilage
  • Trachealis smooth muscle connecting the ends of the C-shaped cartilage
  • Serous + mucous glands
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7
Q

Bronchi:
- Epithelium? Ciliated?
- Secretory cell?
- Cartilage?
- Smooth muscle?
- Glands?
- Others?

Histology

A
  • Pseudostratified columnar ciliated
  • Goblet cells
  • Pieces of cartilage
  • Smooth muscle encircles lumen; between cartilage and epithelium
  • Serous + mucous glands
  • Surrounded by lung tissue (vs trachea: not surrouded by lung tissue)
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8
Q

Bronchioles (first to terminal):
- Epithelium? Ciliated?
- Secretory cell?
- Cartilage?
- Smooth muscle?
- Glands?

Histology

A
  • Simple columnar ciliated
  • Goblet cells; club cells in terminal bronchioles
  • No cartilage
  • Thick circular smooth muscle
  • No glands
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9
Q

Respiratory bronchioles:
- Epithelium? Ciliated?
- Secretory cell?
- Cartilage?
- Smooth muscle?
- Glands?
- Others?

Histology

A
  • Simple cuboidal, some cilia
  • Club cells
  • No cartilage
  • Knobs of smooth muscle
  • No glands
  • Alveoli in walls (vs bronchioles: no alveoli in walls)
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10
Q

Alveolar ducts:
- Epithelium? Ciliated?
- Secretory cell?
- Cartilage?
- Smooth muscle?
- Glands?

Histology

A
  • Simple squamous, no cilia
  • No secretory cells
  • No cartilage
  • Smooth muscle may or may not be present
  • No glands
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11
Q

Alveoli
- Epithelium? Ciliated?
- Secretory cell?
- Cartilage?
- Smooth muscle?
- Glands in connective tissue?

Histology

A
  • Simple squamous, no cilia (type 1 and 2 pneumocytes)
  • Type 2 pneumocytes
  • No cartilage
  • No smooth muscle
  • No glands
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12
Q

Type 1 vs type 2 pneumocytes (in alveoli)
- Structure
- Function
- % of total alveolar area
- % of total number of cells

Histology

A

Type 1:
- Structure: simple squamous cells, close to capillaries
- Function: gas exchange
- 95% of total alveolar area
- Least number of cells

Type 2:
- Structure: bulges out into alveolar air space
- Function: secrete surfactant -> reduces surface tension -> prevents alveolar collapse
- 5% of total alveolar area
- 60% of total number of cells

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13
Q

What are lamella bodies?

A
  • Secretory organelles in type II pneumocytes in alveoli
  • Stores phosphotidylcholine, a component of surfactant
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14
Q

Club cells
- Location
- Structure
- Function

A
  • Location: terminal and respiratory bronchioles
  • Structure: cuboidal, non-ciliated
  • Function: secrete surfactant components, degradation of toxins, regenerate into bronchiolar epithelium (stem cell properties)
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15
Q

Function of alveolar macrophages

A
  • Phagocytose foreign materials
  • Initiate immune response by releasing cytokines
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16
Q

Epithelium of false vocal cord (vestibular fold)

A

Ciliated pseudostratified columnar

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17
Q

Epithelium of true vocal cord (vocal fold)

A

Stratified squamous

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18
Q

What is the space between the true and false vocal cords?

A

Ventricle

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19
Q

Stages of lung development (5)

Embryology: lung development

A
  1. Embryonic (4-9 weeks): trachea and bronchi develop
    -> Error leads to tracheoesophageal fistula/esophageal atresia
  2. Pseudoglandular (5-18 weeks): bronchioles and terminal bronchioles develop
    -> Fetus unable to survive if born
  3. Canalicular (16-26 weeks): respiratory bronchioles develop
    -> Limited respiration possible starting around week 24
    -> Surfactant production begins aroud week 22, but insufficient to prevent airway collapse (atelactasis)
  4. Saccular (26 weeks - birth): alveolar ducts develop
    -> Surfactant production is sufficient to prevent atelactasis around week 36
    -> Premature babies can survive
  5. Alveolar (36 weeks - 8 years): alveolar sacs develop

EPCSA: Every Pulmonologist Can See Alveoli

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20
Q

Error in embryonic stage of lung development leads to what disorder?
- Prenatal and postnatal complications?

Embryology: lung development

A

Tracheoesophageal fistula and/or esophageal atresia - due to incomplete separation of trachea and esophagus (typically around 4th-8th weeks)

Prenatal complications:
- Polyhydramnios - excess amniotic fluid due to inability to swallow

Postnatal complications:
- Regurgitation - immediate coughing and choking upon feeding
- Pneumonitis (inflammation) / pneumonia (infection) - gastric contents reflux intro trachea and lungs

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21
Q

What defects are tracheoesphageal fistula associated with?

Embryology: lung development

A

VACTERL:
- Vertebral anomalies
- Anal atresia
- Cardiac defects
- Tracheoesophgeal fistula
- Esophageal atresia
- Renal atresia
- Limb defects

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22
Q

When does surfactant production begin?

Embryology: lung development

A

Week 22

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23
Q

Respiratory distress syndrome
- Cause?

Embryology: lung development

A
  • Surfactant production begins around week 22
  • Affects premature babies with surfactant deficiency -> increased surface tension of alveoli -> alveolar collapse
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24
Q

What develops into the following parts of the diaphragm?
- Central tendon
- Membranous part
- Muscular part
- Crura

Embryology: diaphragm development

A
  • Septum transversum -> central tendon
  • Pleuroperitoneal membrane -> membranous part
  • Somites C35 -> muscular part
  • Mesentary of esophagus -> crura
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25
Q

Which somites do the muscles of the diaphragm arise from?

Embryology: diaphragm development

A

C3-5

C3, 4, 5 keep the diaphragm alive

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26
Q

How does the diaphragm develop?

Embryology: diaphragm development

A
  • Septum transversum grows from anterior to posterior, stopping at the gut tube
  • Leaves 2 pleuropertioneal canals at the left and right sides
  • Pleuropertioneal canals are closed off by the growth of pleuroperitoneal membranes (arise from posterior body wall)
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27
Q

What do defects in the development of pleuroperitoneal membranes lead to?

Embryology: diaphragm development

A

Congenital diaphragmatic hernia
- Pleuroperitoneal canals fail to close off -> hole in diaphragm
- Abdominal contents herniate into pleural cavities
- Associated with pulmonary hypoplasia (can’t develop lungs)

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28
Q

What are the main components of the thoracic skeleton?

Anatomy

A
  • 12 pairs of ribs and costal cartilages
  • 12 thoracic vertebrae and intervertebral discs
  • Sternum
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29
Q

What are the 3 classes of ribs?

Anatomy

A

True (vertebrosternal) ribs
- Ribs 1-7
- Attached directly to sternum anteriorly

False (vertebrochondral) ribs
- Ribs 8-10
- Attached indirectly to sternum at the costal margin via fused costal cartilages

Floating (free) ribs
- Ribs 11 and 12 (sometimes 10)
- Not attached to sternum

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30
Q

Which ribs are the typical and atypical ribs?

Anatomy

A

Typical ribs: 3-9
Atypical ribs: 1-2, 10-12

31
Q

What are the parts of a typical rib? (4)

Anatomy

A
  • Head: inferior facet articulates with numerically coresponding vertebra; superior facet articulates with superior vertebra
  • Neck: connects head and body of rib
  • Tubercle: articulates with transverse process of corresponding vertebra
  • Body: internal surface contains the costal groove, which contains the intercostal veins, arteries, and nerves
32
Q

What does the costal groove (in intercostal space) contain, from superior to inferior?

Anatomy: neurovasculature of intercostal space

A

VAN:
- Intercostal vein
- Intercostal artery
- Intercostal nerve

33
Q

The neurovasculature of the intercostal space is located between which muscles?

Anatomy: neurovasculature of intercostal space

A

Between the internal and innermost intercostal muscles

34
Q

Veins in intercostal space

Anatomy: neurovasculature of intercostal space

A
  • Posterior and anterior intercostal veins
  • Subcostal vein
35
Q

Pathway of posterior intercostal veins

Anatomy: neurovasculature of intercostal space

A

Posterior intercostal veins -> azygos vein -> superior vena cava

36
Q

Arteries in intercostal space and their origin

Anatomy: neurovasculature of intercostal space

A
  • Posterior and anterior intercostal arteries
  • Collateral branches

Mostly derived from thoracic aorta

37
Q

Nerves in intercostal space and their origin

Anatomy: neurovasculature of intercostal space

A
  • Intercostal nerves: anterior rami of T1-T11
  • Subcostal nerves: anterior rami of T12 (supplies subcostal space below T12)
38
Q

Where should one insert the needle during thoracentesis (inserting a needle through the intercostal space to remove fluid/air from the lungs)?

A

Superior to the rib (but not right above) in order to avoid damaging the collaterals

39
Q

Muscles for quiet and forced inspiration

Anatomy: muscles for respiration

A

Quiet inspiration:
- Diaphragm
- External intercostal muscles

Forced inspiration:
- Accessory muscles: scalene, sternocleidomastoid, pectoralis major and minor, serratus anterior, latissimus dorsi, trapezius

40
Q

Muscles for quiet expiration and forced expiration

Anatomy: muscles for respiration

A

Quiet expiration:
- Main driver is elastic recoil of lungs

Forced expiration:
- Internal intercostal muscles
- Innermost intercostal muscles
- Subcostal muscles
- Transversus thoracis
- Anterior abdominal wall muscles

41
Q

Inspiratory muscles (…) the ribs while expiratory muscles (…) the ribs

Anatomy: muscles for respiration

A

Inspiratory muscles elevate the ribs while expiratory muscles depress the ribs

42
Q

How does the thoracic wall move during inspiration?
- Muscles and diaphragm?
- Diaphragm moves?
- Vertical dimension?
- AP dimension?
- Transverse dimension?
- Intrathoracic diameter?
- Intrathoracic volume?
- Intrathoracic pressure?
- Air flow direction?
- Intra-abdominal pressure?
- Abdominal viscera?

Anatomy: movement of thoracic wall

A
  • Muscles and diaphragm: contract
  • Diaphragm moves: down
  • Vertical dimension: increase
  • Anteroposterior dimension: increase
  • Transverse dimension: increase (during forced inspiration)
  • Intrathoracic diameter: increase
  • Intrathoracic volume: increase
  • Intrathoracic pressure: decrease
  • Air flow direction: into lungs
  • Intra-abdominal pressure: increase
  • Abdominal viscera: compress
43
Q

How does the thoracic wall move during expiration?
- Muscles and diaphragm?
- Diaphragm moves?
- Vertical dimension?
- AP dimension?
- Transverse dimension?
- Intrathoracic diameter?
- Intrathoracic volume?
- Intrathoracic pressure?
- Air flow direction?
- Intra-abdominal pressure?
- Abdominal viscera?

Anatomy: movement of thoracic wall

A
  • Muscles and diaphragm: relax
  • Diaphragm moves: up
  • Vertical dimension: decrease
  • Anteroposterior dimension: decrease
  • Transverse dimension: decrease (during forced expiration)
  • Intrathoracic diameter: decrease
  • Intrathoracic volume: decrease
  • Intrathoracic pressure: increase
  • Air flow direction: out of lungs (due to increase in intrathoracic pressure and elastic recoil of lungs)
  • Intra-abdominal pressure: decrease
  • Abdominal viscera: decompress
44
Q

What nerve innervates the diaphragm?
Which spinal root(s) does it originate from?

A

Phrenic nerve (C3-C5)

45
Q

What structures perforate the diaphragm?
- Aperture
- Location in diaphragm
- Vertebral level
- Structures passing through

A

T8:
- Caval opening
- Central tendon
- Inferior vena cava, right phrenic nerve

T10:
- Esophageal hiatus
- Right crus
- Esophagus, vagus nerve

T12:
- Aortic hiatus
- Between left and right crura
- Aorta, azygos vein, thoracic duct

I 8 (ate) 10 eggs at 12

46
Q

What are the 3 routes of metastasis in breast cancer?

Anatomy

A
  1. To lungs: via lympathic channels (axillary lymph nodes) -> liver, CNS endocrine system, appendicular skeleton
  2. To liver: via abdominal lympathic system
  3. To vertebrae: via intercostal veins -> azygos/hemiazygos veins -> vertebral venous plexus of Batson
47
Q

Transverse thoracic plane
- What does it separate?
- Between which vertebrae?
- Marked by what structure?

A
  • Separates superior and inferior medistinum
  • Located between T4 and T5
  • Marked by sternal angle (at manubriosternal joint)
48
Q

Structures in transverse thoracic plane

A
  • T4 and T5 IV disc
  • Start and end of aortic arch
  • Bifurcation of trachea (carina)
  • Bifurcation of pulmonary trunk
  • Ascending thoracic duct
49
Q

Parietal pleura
- Location
- Sections (4)
- Arteries
- Innervation (nervous system + nerves)
- Sensitive to?

A
  • Covers internal surface of thoracic cavity
  • Cervical (superior), costal (inner surface of thoracic wall), mediastinal (lateral surface of mediastinum), diaphragmatic (superior surface of diaphragm) pleura
  • Intercostal arteries
  • Somatic nervous system: intercostal nerves (lateral wall) + phrenic nerve (diaphragmatic surface)
  • Sensitive to pain, temperature, touch
50
Q

Visceral pleura
- Location
- Arteries
- Innervation (nervous system)
- Sensitive to?

A
  • Covers the lungs
  • Bronchial arteries
  • Autonomic nervous system
  • Sensitive to stretch only
51
Q

What is the space between the parietal and visceral pleura?

A

Pleural cavity

52
Q

The parietal and visceral pleura are continous at the (…)

A

The parietal and visceral pleura are continous at the hilum (site of entry of root of lung)

53
Q

Pleural reflections

A

The lines along which the parietal pleura changes direction as it passes from one wall of the pleural cavity to another

54
Q

What are the 3 types of plerual reflection?
- View
- Line
- Inferior margin of lung vs parietal pleura

A

Sternal reflection:
- Anterior view
- Midclavicular line
- 6th vs 8th rib

Costal reflection:
- Lateral view
- Midaxillary line
- 8th vs 10th rib

Vertebral reflection:
- Posterior view
- Scapular line
- 10th vs 12th rib

55
Q

The pleura descends below the costal margin at the (…) and (…)

A

The pleura descends below the costal margin at the costovertebral angles and right infrasternal angles

56
Q

Pleural recess

A

Spaces where the pleural cavity is not completely filled by the lungs
- Formed by opposing parietal pleura
- Filled with pleural fluid

57
Q

What are the 2 types of pleural recesses?

A
  1. Costodiaphragmatic recess: between costal and diaphragmatic pleura
  2. Costomediastinal recess: between costal and mediastinal pleura, behind the sternum
58
Q

What do pleural injuries lead to?

A

Pneumothorax: air from lungs leaks into the plerual cavity (the space between visceral and parietal pleura)

59
Q

Possible sites of pleural injury (3)

  • What injuries are they susceptible to?
A
  1. Cervical pleura: suscpetible to injuries at base of neck
  2. Right infrasternal angle: susceptible to abdominal incision injury
  3. Left and right costovertebral angles: susceptible to abdominal incision injury
60
Q

Relationship of pulmonary artery and bronchi

A
  • Right lung: pulmonary artery anterior to bronchi
  • Left lung: pulmonary artery superior to bronchi

RALS: Right Anterior Left Superior

61
Q

How many lobes does the right lung have? What are they?

A

Right lung has 3 lobes:
1. Upper lobe
2. Middle lobe
3. Lower lobe

62
Q

How many lobes does the left lung have? What are they?

A

Left lung has 2 lobes:
1. Upper lobe
2. Middle lobe

63
Q

What fissures separate the lobes of the right lung?

A
  • Major fissure: separates right upper and middle lobe from right lower lobe
  • Minor fissure: separates right upper lobe from right middle lobe
64
Q

What fissure separate the lobes of the left lung?

A

Major fissure: separates the left upper and lower lobes

65
Q

Pulmonary circulation of lungs
- Function
- Pathway
- Oxygen content of blood
- Pressure vs flow

A
  • Carries deoxygenated blood from heart to lungs for oxygenation
  • Right ventricle -> pulmonary trunk -> pulmonary arteries -> lungs -> pulmonary veins -> left atrium
  • Dexoygenated blood
  • Low pressure, high flow
66
Q

Bronchial circulation of lungs
- Function
- Pathway
- Oxygen content of blood
- Pressure vs flow

A
  • Supplies oxygenated blood to larger airways, hilum, and supporting tissue of lungs
  • Thoracic aorta -> bronchial arteries -> lung tissue -> bronchial vein
    1. Bronchial vein -> azygos/hemiazygos vein -> superior vena cava -> right atrium
    2. Bronchial vein -> pulmonary vein -> left atrium
  • Oxygenated blood
  • High pressure, low flow
67
Q

Branching of bronchi

A

Trachea
-> 2 main/primary bronchi (one to each lung)
-> lobar/secondary bronchi (2 on left, 3 on right; each supplies a lobe of the lung)
-> segmental/tertiary bronchi (supply bronchopulmonary segments)

[-> bronchioles -> terminal bronchioles -> respiratory bronchioles -> alveolar ducts -> alveolar sacs -> alveoli]

68
Q

Structure of right vs left main bronchus

A

The right main bronchus is wider, shorter, and runs more vertically then the left main bronchus

69
Q

Bronchopulmonary segment
- Shape
- Location of apex vs base

A
  • Pyramidal shape
  • Apex faces root of lung
  • Base at pleural surface
70
Q

Which of the following structures lie anterior to the right superior pulmonary vein?

A. Right sympathetic thoracic trunk
B. Right vagus nerve
C. Right phrenic nerve
D. Right pulmonary artery
E. Right main bronchus

RA16 Q13

A

C. Right phrenic nerve

See Moore’s essential clinical anatomy pg 209 Fig 4.18

71
Q

A 20-year-old man is being seen in the A&E for facial swelling. A CT scan of the chest demonstrates a large thymic mass. Compression of which of the following structures by the thymic mass would account for his symptoms?

A. Superior vena cava
B. Azygos vein
C. Right superior pulmonary vein
D. Right pulmonary artery
E. Ascending aorta

RA16 Q14

A

A. Superior vena cava

72
Q
A
73
Q

A swallowed coin would most likely become lodged in which lobe of the lungs?

RA16 Q16

A

Right lower lobe
- The right bronchus is wider, shorter and more vertical than left bronchus -> stuff more likely to enter right bronchus
- Gravity will pull the coin to the lower lobe

74
Q

A child diagnosed with primary ciliary dyskinesia presents with upper and lower respiratory tract infections. What is the likley pathological reason?
A. Production of thick mucin that cannot be cleared
B. Impairment of the mucociliary escalator
C. Presence of club cells in the alveoli
D. Overproduction of pulmonary surfactant
E. Tracheal aplasia

RA16 Q17

A

B. Impairment of the mucociliary escalator

  • Primary ciliary dyskinesia: cilia cannot move well or at all -> cannot propel mucus and germs out of lungs

A: Cystic fibrosis - causes thick and viscous mucus, which is a breeding ground for germs and is harder to transport out of lungs

C: Not pathological

E: Absence of trachea -> incompatible with life

Duke-NUS MS1 (12 decks)

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