SFP: trachea, bronchi, lungs, pleura

Question 1

Where does the trachea begin?

Answer 1

Lower border of larynx at the cricoid cartilage at C6

Question 2

Where does the trachea bifurcate?

Answer 2

At the sternal angle

Question 3

The trachea bifurcates into ___

Answer 3

The right and left primary bronchi

Question 4

Describe the general structure of the trachea

Answer 4

About ¾ of the diameter is composed of U-shaped bars of hyaline cartilage. The area not composed of cartilage is closed by the trachealis muscle.

Question 5

What structures are anterior to the trachea?

Answer 5

Arch of aorta, brachiocephalic trunk, common carotid, left brachiocephalic vein, thymus

Question 6

What structures are posterior to the trachea?

Answer 6

Right and left recurrent laryngeal nerves, esophagus, and vertebral column.

Question 7

What is on the right side of the trachea?

Answer 7

Azygous vein, right vagus nerve, and pleura

Question 8

What is on the left of the trachea?

Answer 8

Arch of aorta, left common carotid, left subclavian artery, left vagus nerve, left phrenic nerve, pleura

Question 9

Compare the right and left primary bronchi

Answer 9

The right is wider, shorter, and more vertical; foreign objects are often aspirated into the right bronchus.

Question 10

What is the carina?

Answer 10

Keel-shaped cartilage at tracheal bifurcation

Question 11

The right primary bronchus divides ___ entering the hilum, while the left primary bronchus divides ___ entering the hilum

Answer 11

Before; after

Question 12

The right primary bronchus branches into…

Answer 12

Superior secondary bronchus and intermediate bronchus

Question 13

The left primary bronchus branches into…

Answer 13

The superior and inferior secondary bronchi

Question 14

The intermediate bronchus divides into…

Answer 14

Middle and inferior secondary bronchus

Question 15

Bronchi ultimately divide into ___

Answer 15

Terminal bronchioles

Question 16

The lungs are separated by ___

Answer 16

The mediastinum

Question 17

What are the lobes of the left lung?

Answer 17

Superior and inferior

Question 18

The hilum of the lung allows for passage of…

Answer 18

Left pulmonary artery, left primary bronchus, and left pulmonary veins

Question 19

What is the lingula?

Answer 19

Structure at lower tip of the superior lobe of the left lung

Question 20

What are the lobes of the right lung?

Answer 20

Superior, middle, and inferior

Question 21

What fissures are present in the right lung?

Answer 21

Oblique and horizontal

Question 22

What is the difference between structures in the right and left lung in the hilum?

Answer 22

In the right lung, the pulmonary artery is anterior to the bronchus, while it is superior to the bronchus in the left lung. The primary bronchus divides before entering the hilum in the right lung and after entering the hilum in the left.

Question 23

What makes bronchopulmonary segments anatomical units of the lung?

Answer 23

They each receive a branch of pulmonary artery, lymphatic vessels, and autonomic nerve supply.

Question 24

What is the functional and surgical unit of the lung?

Answer 24

Bronchopulmonary segments

Question 25

Bronchopulmonary segments are ventilated by ___

Answer 25

Tertiary bronchi

Question 26

As we move along bronchi, what happens to cartilage rings?

Answer 26

They become cartilage plates

Question 27

Describe cartilage in the bronchioles

Answer 27

It's absent

Question 28

What kind of epithelium is in the bronchioles?

Answer 28

Ciliated epithelium

Question 29

What are the levels of bronchioles from most proximal to most distal?

Answer 29

1. Terminal bronchiole 2. Respiratory bronchiole 3. Alveolar ducts

Question 30

Where do alveoli first appear?

Answer 30

Respiratory bronchioles

Question 31

Describe the flow of blood through the lungs

Answer 31

1. Lungs receive deoxygenated blood from the right side of the heart through pulmonary artery 2. Deoxygenated blood makes it to capillary beds at alveolar walls and gas exchange occurs 3. Oxygenated blood enters pulmonary veins to be delivered to the left heart

Question 32

What supplies blood to the lung tissue itself?

Answer 32

Bronchial arteries that branch from the descending aorta

Question 33

What drains the lungs?

Answer 33

Bronchial veins

Question 34

Bronchial veins drain to ___ on the right and ___ on the left

Answer 34

Azygous vein; hemiazygos vein

Question 35

The superficial plexus in the lungs drains to ___ nodes

Answer 35

Bronchopulmonary

Question 36

Deep plexus lymphatic vessels in the lungs drain to __ nodes

Answer 36

Pulmonary then bronchopulmonary nodes

Question 37

After the hilar nodes, describe the drainage of lymph in the lungs

Answer 37

1. Tracheobronchial nodes 2. Paratracheal nodes 3. Broncho mediastinal trunks 4. Brachiocephalic veins directly or indirectly

Question 38

How does the pleura come to be during development?

Answer 38

The lungs grow into a structure that will eventually have a visceral and parietal layer

Question 39

Where do the visceral and parietal pleura meet?

Answer 39

The hilum (root)

Question 40

Describe the visceral pleura

Answer 40

It covers the outer surfaces of the lung and extends into the interlobar fissures

Question 41

Describe the parietal pleura

Answer 41

Covers the thoracic wall, surface of mediastinum, and into the root of the lung

Question 42

What is the pleural reflection?

Answer 42

The point at the hilum of the lung where a pleural cuff forms (visceral and parietal pleura join)

Question 43

What is the pulmonary ligament?

Answer 43

Loose fold that hangs below the cuff and allows for movement of pulmonary vessels and bronchi during inspiration

Question 44

Describe the cervical pleura

Answer 44

Portion of parietal pleura that covers the apex and extends up into the neck

Question 45

Describe the costal pleura

Answer 45

Portion of the parietal pleura that lines the inner surface of the ribs, costal cartilages, intercostal spaces, sides of vertebral bodies, and back of the sternum

Question 46

Describe the diaphragmatic pleura

Answer 46

Portion of the parietal pleura that covers the thoracic surface of the diaphragm

Question 47

Describe the mediastinal pleura

Answer 47

Portion of the parietal pleura that covers the lateral border of the mediastinum

Question 48

What are recesses?

Answer 48

Portions where the pleura/lung extend into during inspiration; there is a Costodiaphragmatic recess and costomediastinal recess

Question 49

The pleura extends ___ rib levels lower than the lung

Answer 49

2

Question 50

At the mid-clavicular line, the lungs extend to the __ rib, and the pleura extends to the __ rib

Answer 50

6; 8

Question 51

At the mid-axillary line, the lung extends to the __ rib while the pleura extends to the __ rib

Answer 51

8; 10

Question 52

At the mid scapular line, the lung extends to the __ rib while the pleura extends to the __ rib

Answer 52

10; 12

Question 53

Where does the pulmonary nerve plexus distribute?

Answer 53

Trachealis muscle, mucous membrane of trachea and airways, and blood vessels

Question 54

What is the function of afferent fibers in the lungs?

Answer 54

They carry information from mucous membranes and alveolar stretch receptors to the CNS

Question 55

The parietal pleura is sensitive to…

Answer 55

Pain, temperature, touch, pressure

Question 56

The visceral pleura is sensitive to…

Answer 56

Stretch

Question 57

What are the main innervation methods of the parietal pleura?

Answer 57

Phrenic nerve and intercostal nerves

Question 58

Describe the phrenic nerve in relation to the pleura

Answer 58

Innervates the mediastinal pleura as well as the dome of the diaphragmatic pleura

Question 59

Describe the intercostal nerves in relation to the pleura

Answer 59

Segmental intercostal nerves innervate the costal pleura segmentally and the lower 6 intercostal nerves innervate the periphery of the diaphragm

Question 60

Describe the innervation of the visceral pleura

Answer 60

Autonomic innervation from pulmonary plexuses at the tracheal bifurcation and main bronchi

Question 61

Describe the phrenic nerves

Answer 61

They descend anterior to the root of the lungs between the pericardium and pleura. They’re distributed to the mediastinal pleura and dome of diaphragm

Question 62

Which nerves provide motor innervation to the diaphragm?

Answer 62

Phrenic nerve

Question 63

The right phrenic nerve descends to the right side of…

Answer 63

R brachiocephalic vein, SVC, R atrium, IVC

Question 64

The left phrenic nerve descends to the left side of…

Answer 64

The aortic arch

Question 65

The right vagus nerve is between ____

Answer 65

Brachiocephalic vein and brachiocephalic trunk

Question 66

The left vagus nerve runs across the ___

Answer 66

Left side of the aortic arch

Question 67

The vagus nerve runs ___ to the root of the lung, while the phrenic nerve runs ___ to the root of the lung

Answer 67

Posterior; anterior

Question 68

How do we increase thoracic volume during inspiration?

Answer 68

Raising the sternal ends of the ribs to increase anteroposterior diameter and raising the ribs at the costo-vertebral joints to increase the transverse diameter

Question 69

What happens to the diaphragm during inspiration?

Answer 69

It contracts, causing it to flatten

Question 70

What happens to the trachea during inspiration?

Answer 70

The bifurcation can move downward by 2 levels

Question 71

What is used during quiet inspiration?

Answer 71

Diaphragm and external intercostals

Question 72

What is used during forced inspiration?

Answer 72

SCM, scalene, muscles that stabilize the scapula

Question 73

What muscles are used in quiet expiration?

Answer 73

Passive; the muscles relax

Question 74

What muscles are used in forced expiration?

Answer 74

Internal intercostals, abdominal muscles, and quadratus lumborum

Question 75

When the patient holds their arms with their hands behind their heads, how does this show surface projections?

Answer 75

The scapula rotates superiorly, causing its medial border to be parallel to the oblique fissure from T4

Question 76

When the patients hold their arm straight up, how does this show surface projections?

Answer 76

The horizontal fissure will cross the 5th rib at the mid axillary line and cross the 4th intercostal space. The oblique fissure will be at the spine of 4th thoracic vertebra. As it descends toward the anterior portion of the body, it crosses the 4th rib, 4th intercostal, 5th intercostal and midaxillary line, and follows the 6th rib anteriorly