Respiratory Flashcards
Lines walls of the thoracic cavity
Parietal pleura
Lines surface of the lung
Visceral pleura
Space between the visceral and parietal pleura
Pleural space
Located inferior to the root of the lung, area of fusion between the parietal and visceral pleura
Pulmonary ligament
What are the 4 parts of the parietal pleura?
Cervical
Costal
Diaphragmatic
Mediastinal
To what landmarks does the parietal pleural layer extend to at mid respiration?
Anterior down to rib 8
Laterally down to rib 10
Posteriorly down to T12
To what landmarks does the visceral pleural layer extend to at mid respiration?
Anterior down to rib 6
Laterally down to rib 8
Posteriorly down to T10
Which nerve(s) innervate the parietal pleura?
Intercostal nerve
Phrenic nerve
What are the lateral inferior corners of the thoracic cavity called?
Costodiaphragmatic recess
Inflammation of the pleural layers
Pleurisy
Build up of fluid in the pleural cavity (give two examples)
Pleural effusion
Ex. Hydrothorax, hemothorax
Between what intercostal spaces should you aim for during a thoracentesis? Why?
Intercostal spaces 8-10 at the midaxillary line in order to avoid hitting lung
What is an sign of a severe pneumothorax that can be seen without imaging?
A shifted trachea from midline
Collapsed lung
Pneumothorax
At what level will you find the horizontal fissure of the right lung?
4th intercostal space
At what level will you find the oblique fissures on the left and right lungs?
T4-T6 intercostal spaces
What does the horizontal fissure separate in the lung?
Superior lobe from middle lobe on RIGHT lung
What does the oblique fissure separate in the lungs?
The inferior lobes from the middle (right lung) or superior (left lung) lobes
Where is the apex of the lung located?
Above the 1st rib
What part of the lung makes room for the heart?
The cardiac notch in the left lung
What part of the lung sticks out under the cardiac notch?
Lingula
What impressions can be found in the right lung?
Superior vena cava Inferior vena cava Azygos vein Esophagus Brachiocephalic vein
What impressions can be found in the left lung?
Subclavian artery
Aortic arch
Esophagus
What is the order of the pulmonary arteries in the hilums of the right and left lungs?
RALS: Right Anterior, Left Superior
Right PA is anterior to the bronchus, Left PA is superior to the bronchus
Where does cartilage in the bronchial system end?
Alveoli/capillary beds
At what level does the trachea bifurcate? What is this bifurcation called?
T4/T5 (sternal angle)
Carina
Where does choking mostly occur? Why?
In the right main bronchus because it is wider, shorter, and more vertical. “Inhale a bite, goes down the right”
What is the order of the bronchial tree after the trachea?
Main bronchus —> lobar bronchus (secondary) —> segmental bronchi (tertiary)
How many lobar bronchi does each lung have?
Left: 2
Right: 3
How many bronchopulmonary segments are in each lung? What are they separated by?
10
Fibrous septa
A hydrophobic substance secreted by Type II alveolar cells that repels from water and keeps lungs from collapsing
Surfactant
What arteries and veins supply the lung tissue?
Bronchial arteries
Bronchial veins
Where do the left and right bronchial arteries arise from?
Left: thoracic aorta
Right: right 3rd intercostal artery (which comes off the aorta)
Where do the right and left bronchial veins drain into?
Right: azygos vein
Left: accessory hemiazygos vein
What part of the pulmonary plexus provides parasympathetic pulmonary innervation? What do they do?
Left and right vagus nerves (CN X)
Cause bronchoconstriction and vasodilation
What part of the pulmonary plexus provides sympathetic pulmonary innervation? What do they do?
Nerves from the sympathetic trunk
Cause bronchodilation and vasoconstriction
What is the pathway for pulmonary lymph drainage, starting from the right pulmonary lymph?
Right pulmonary lymph —> right tracheobronchial nodes —> right bronchomediastinal trunk —> right lymphatic duct —> right venous angle
What is the tendon of the diaphragm called?
Central tendon
Where does the innervation of the diaphragm originate?
C3/C4/C5
Where does the diaphragm attach?
Xiphoid
Costal margin
Ribs 11-12
Lumbar vertebrae (L/R crura)
What are the 3 openings of the diaphragm and at what level are they located?
Caval opening: T8
Esophageal hiatus: T10
Aortic hiatus: T12
What nerves innervate the diaphragm?
Phrenic nerves (bilaterally)
Intercostal nerves (peripherally)
What is unique about lung innervation?
The left and right halves are independently innervated
What muscles are responsible for expiration?
Internal intercostals
What muscles are responsible for inspiration?
External intercostals
