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ACRS > Respiratory System 4: Lungs and Pleurae > Flashcards

Respiratory System 4: Lungs and Pleurae Flashcards

1
Q

What do the right and left pulmonary cavities contain?

A

The lungs.

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2
Q

What lines the pulmonary cavities?

A

A pleural membrane (parietal pleura).

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3
Q

What does the parietal pleura reflect onto and cover?

A

The external surface of the lungs, forming the visceral pleura.

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4
Q

What is the difference between the parietal pleura and the visceral pleura?

A

The parietal pleura lines the pulmonary cavity, while the visceral pleura covers the external surface of the lungs.

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5
Q
A
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6
Q

What is the main function of the lungs?

A

To oxygenate the blood by bringing inhaled air into close relation with the venous blood in the pulmonary capillaries.

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7
Q

What is the texture and size of the lungs in living people?

A

They are light, soft, spongy, and fully occupy the pulmonary cavities.

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8
Q

How do the lungs change when the thoracic cavity is opened?

A

They recoil to approximately one-third of their size.

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9
Q

Where do the apices of the lungs extend?

A

(apices = 2 apex’s = the top of lungs)

Above the level of the first rib into the root of the neck.

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10
Q
A
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11
Q

Name the lobes of the right lung.

A

Superior lobe, middle lobe, and inferior lobe.

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12
Q

Name the lobes of the left lung.

A

Superior lobe and inferior lobe.

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13
Q

What separates the lobes of the right lung?

A

The horizontal fissure and the oblique fissure.

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14
Q

What separates the lobes of the left lung?

A

The oblique fissure.

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15
Q

What unique feature does the left lung have at its inferior aspect?

A

The lingula.

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16
Q

What part of the lung contains many impressions from neighboring structures?

A

The mediastinal surface of the lung.

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17
Q

What does the mediastinal surface include?

A

The hilum.

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18
Q

What is the function of the impressions on the mediastinal surface?

A

They are grooves created by neighboring structures resting on the lung’s surface.

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19
Q

What is the cardiac notch?

A

An indentation on the left lung caused by the apex of the heart.

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20
Q

What does the cardiac notch shape?

A

It shapes the most inferior and anterior part of the superior lobe into a tongue-like lingula.

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21
Q

What is the lingula

A

A tongue-like projection of the superior lobe of the left lung

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22
Q
A
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23
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A
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24
Q

What is the hilum of the lung?

A

The doorway through which the root of the lung passes.

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25
Q

What structures make up the roots of the lungs?

A

Main bronchi and associated bronchial vessels

Pulmonary arteries

Superior and inferior pairs of pulmonary veins

Pulmonary plexuses of nerves

Lymph nodes (not all visible on specimens)

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26
Q

What is the pulmonary ligament?

A

A structure formed by the continuity between the parietal and visceral pleurae inferior to the root of the lung.

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27
Q
A
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28
Q

What is the general arrangement of the main bronchus at the hilum of the right lung?

A

Posterior

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29
Q

What is the general arrangement of the pulmonary veins at the hilum of the right lung?

A

Anteriormost and inferiormost

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30
Q

What is the general arrangement of the pulmonary artery at the hilum of the right lung?

A

Positioned between the main bronchus and superior pulmonary vein

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31
Q

What is the general arrangement of the main bronchus at the hilum of the left lung?

A

Posterior

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32
Q

What is the general arrangement of the pulmonary veins at the hilum of the left lung?

A

Anteriormost and inferiormost

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33
Q

What is the general arrangement of the pulmonary artery at the hilum of the left lung?

A

Superiormost

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34
Q

What is the pleural cavity?

A

The potential space between the two layers of pleura containing serous pleural fluid, which lubricates the pleural surfaces and allows smooth sliding during respiration.

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35
Q

What role does surface tension of pleural fluid play?

A

It provides the cohesion that keeps the lung surface in contact with the thoracic wall, allowing the lung to expand and fill with air when the thorax expands.

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36
Q

What does the visceral pleura cover?

A

It covers and adheres to the surfaces of the lungs, including those within the horizontal and oblique fissures.

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37
Q

whats the order of the lining of the cavities and lungs, from outside to inside

A
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38
Q

What is the relationship between the parietal pleura and visceral pleura?

A

The visceral pleura is continuous with the parietal pleura at the hilum of the lung, where structures such as the bronchi and pulmonary vessels enter and leave the lungs.

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39
Q

What 3 places does the parietal pleura line?

A

The parietal pleura lines the thoracic wall, mediastinum, and diaphragm.

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40
Q

What is the endothoracic fascia?

A

A thin layer of loose connective tissue that separates the pleura from the thoracic wall. It is not well seen in embalmed donors.

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41
Q

What does the costal part of the parietal pleura cover?

A

It covers the internal surfaces of the thoracic wall facing the ribs.

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42
Q

What does the mediastinal part of the parietal pleura cover?

A

It faces the lateral aspect of the mediastinum.

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43
Q

What does the diaphragmatic part of the parietal pleura cover?

A

It covers the superior surface of the diaphragm.

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44
Q

What does the cervical part of the parietal pleura cover?

A

It covers the apex of the lung.

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45
Q
A
46
Q

What is the costodiaphragmatic recess?

A

It is a narrow gap between the periphery of the diaphragm and the lower chest wall, forming an extension of the pleural cavity where the lungs do not occupy.

47
Q

What is another name for the costodiaphragmatic recess?

A

The phrenic angle.

48
Q

Which pleural layers are involved in forming the costodiaphragmatic recess?

A

The visceral pleura and parietal pleura.

49
Q

Why is the costodiaphragmatic recess clinically significant?

A

It is a potential site for fluid accumulation in conditions such as pleural effusion, often visible in chest X-rays.

50
Q

What is thoracocentesis?

A

A medical procedure where a needle is inserted through an intercostal space into the pleural cavity to obtain a sample of fluid.

51
Q

Where is the needle inserted during thoracocentesis?

A

Through the 9th intercostal space, between the 9th and 10th ribs, in the midaxillary line to enter the costodiaphragmatic recess.

52
Q

Why is the costodiaphragmatic recess used for thoracocentesis?

A

It is a space where fluid tends to accumulate, making it an ideal site for fluid sampling.

53
Q

How can the risk of lung injury be minimized during thoracocentesis?

A

By asking the patient to exhale, avoiding the inferior border of the lungs.

54
Q

Where do the cervical pleurae and apices of the lungs pass through?

A

Through the superior thoracic aperture deep to the supraclavicular fossae.

55
Q

How do the anterior borders of the lungs run?

A

They run parallel to the reflections of the parietal pleura between the 2nd and 4th costal cartilages.

56
Q

What happens to the left pleural margin?

A

It moves laterally and then inferiorly to reach the 6th costal cartilage.

57
Q

What is distinct about the left anterior lung border?

A

It is more deeply indented by the cardiac notch, creating a gap with the pleural margin.

58
Q

Where do the right anterior lung border and pleural margin stay parallel?

A

Until the 6th costal cartilage.

59
Q

Where do the pleural margins reach at different lines?

A

Midclavicular line (MCL): At the 8th costal cartilage.
Midaxillary line (MAL): At the 10th rib.
Scapular line (SL): At the 12th rib.

60
Q

Where do the inferior lung margins reach?

A

MCL: At the 6th rib.
MAL: At the 8th rib.
SL: At the 10th rib.

61
Q

What is auscultation in lung examination?

A

Listening to the sounds of the lungs with a stethoscope.

62
Q

What is percussion in lung examination?

A

Tapping on fingers pressed firmly on the thoracic wall over the lungs to detect underlying tissues (air-filled, fluid-filled, or solid).

63
Q

What can auscultation and percussion assess?

A

They assess airflow into the lobes of the lungs and whether tissues are air-filled, fluid-filled, or solid.

64
Q

How does the sound differ during percussion over the lung tissue versus the costodiaphragmatic recess?

A

The sounds will vary depending on whether the area is air-filled (lungs) or a space that may be filled with fluid (costodiaphragmatic recess).

65
Q

What creates the bare area of the pericardium?

A

The deviation of the left anterior lung border and pleural margin from the median plane.

66
Q

Why is the bare area of the pericardium clinically significant?

A

It allows access to the pericardial sac for needle puncture (pericardiocentesis) with less risk of puncturing the lungs or pleural cavity.

67
Q

What procedure is performed at the bare area of the pericardium?

A

Pericardiocentesis, which removes excessive fluid in the pericardial cavity to relieve cardiac tamponade.

68
Q
A
69
Q

What causes lungs to remain distended despite their elasticity?

A

Surface tension provided by pleural fluid allows the visceral pleura to adhere to the parietal pleura.

70
Q

What happens when the pleural cavity is punctured?

A

The surface tension is broken, air is sucked into the pleural cavity due to negative pressure, and the lung collapses.

71
Q

What does the pleural cavity become when the lung collapses?

A

It becomes an actual space instead of a potential space.

72
Q

What is pneumothorax?

A

The entry of air into the pleural cavity, causing lung collapse.

73
Q

What is hemothorax?

A

The entry of blood into the pleural cavity, causing lung collapse.

74
Q

How does a penetrating wound cause lung collapse?

A

By allowing air to enter the pleural cavity, disrupting the negative pressure and surface tension.

75
Q

Which fibers innervate the parietal pleura?

A

Somatic afferent fibers.

76
Q

What does the phrenic nerve supply in the parietal pleura?

A

The mediastinal and large portions of the diaphragmatic parts.

77
Q

What does the intercostal nerve supply in the parietal pleura?

A

The small portions of the diaphragmatic, costal, and cervical parts.

78
Q

How is the visceral pleura innervated?

A

By the pulmonary plexuses (parasympathetic, sympathetic, and visceral afferent fibers).

79
Q

From which plexus are the nerves of the lungs derived?

A

Pulmonary plexus.

80
Q

Where is the pulmonary plexus typically located?

A

Anterior and mainly posterior to the roots of the lungs.

81
Q

What types of fibers does the pulmonary plexus contain?

A

Parasympathetic, sympathetic, and visceral afferent fibers

82
Q

Which nerve provides parasympathetic fibers to the pulmonary plexus?

A

The vagus nerve.

83
Q

What type of fibers are the parasympathetic fibers in the pulmonary plexus?

A

Preganglionic fibers.

84
Q

What type of fibers are the sympathetic fibers in the pulmonary plexus?

A

Postganglionic fibers.

85
Q

From where does the pulmonary plexus receive sympathetic fibers?

A

The cardiac nerves.

86
Q

What supplies blood to each lung?

A

A pulmonary artery.

87
Q

How is blood drained from each lung?

A

By two pulmonary veins.

88
Q

Into what do pulmonary arteries divide?

A

Secondary lobar arteries.

89
Q

What do secondary lobar arteries further divide into?

A

Segmental arteries.

90
Q

What is the function of the superior and inferior pulmonary veins?

A

They carry oxygenated blood to the left atrium of the heart.

91
Q

Do pulmonary veins follow the bronchial tree branching pattern?

A

No, they course between bronchopulmonary segments.

92
Q

From where do pulmonary veins collect blood?

A

From within and among adjacent segments.

93
Q

What supplies blood to the bronchi and visceral pleura?

A

The bronchial arteries.

94
Q

How many bronchial arteries arise on the left side, and from where do they arise?

A

Two left bronchial arteries, arising directly from the thoracic aorta.

95
Q

How does the single right bronchial artery commonly arise?

A

From the third posterior intercostal artery.

96
Q

Into which vein do the right bronchial veins drain?

A

The azygos vein.

97
Q

Into which veins do the left bronchial veins drain?

A

The accessory hemiazygos vein or the left superior intercostal vein (if the accessory hemiazygos vein is absent).

98
Q

What does the superficial lymphatic plexus drain?

A

Lung tissues and visceral pleura.

99
Q

What does the deep lymphatic plexus drain?

A

Structures of the root of the lung.

100
Q

Where do the lymphatics of the lungs initially drain?

A

Bronchopulmonary (hilar) nodes.

101
Q

After the hilar nodes, where does lymph drain?

A

To tracheobronchial nodes.

102
Q

Where does lymph go after tracheobronchial nodes?

A

To paratracheal nodes.

103
Q

Where do the paratracheal nodes drain lymph?

A

Into the bronchomediastinal trunks.

104
Q

Where do the bronchomediastinal trunks ultimately drain?

A

Into the venous angles.

105
Q
A
106
Q

What is the first site of metastasis for primary lung tumors?

A

Bronchopulmonary lymph nodes.

107
Q

What distant lymph nodes may enlarge due to lung tumor metastases?

A

Supraclavicular (scalene) nodes.

108
Q

What does “Nx” represent in the TNM staging system?

A

Regional lymph nodes cannot be assessed.

109
Q

What does “N0” represent in the TNM staging system?

A

No regional lymph node metastasis.

110
Q

What does “N1” represent in the TNM staging system?

A

Metastasis in ipsilateral peribronchial, hilar lymph nodes, and/or intrapulmonary nodes.

111
Q

What does “N2” represent in the TNM staging system?

A

Metastasis in ipsilateral mediastinal and/or subcarinal lymph nodes.

112
Q

What does “N3” represent in the TNM staging system?

A

Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph nodes.

ACRS (9 decks)

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