The Thoracic Cage, Pleura and Lungs (CV2) Flashcards
what does the intercostal space contain
3 layers of intercostal muscle
neuromuscular bundle bundle
What are the constituents of the neurovascular bindle
intercostal Vein
intercostal Artery
intercostal nerve
External intercostal is most superficial. Its fibres are orientated ______ ______
Antero inferiorly
The external intercostal muscle is most active in
A)Inspiration
B)expiration
inspiration
Internal intercostal muscle run ______ _____
posterio inferiorly
which direction does the internal intercostal run in comparison to external intercostal
A) parallel
B) perpendicular
B
the internal intercostal is most active in
A)Inspiration
B)Expiration
B
the innermost intercostal runs _____ _____
posterio inferior
which direction does the innermost intercostal run to the internal intercostal
A)parallel
B)perpendicular
parallel
what lies deep to the innermost intercostal
endothoracic fascia
what lies deep to the endothoracic fascia
parietal pleura
where on the rib does the neurvascular bundle lie
Inferior border od the rib, superior to the costal space
Coastal groove
the anterior intercostal arteries are branches of the ______ _______ ______
Internal thoracic artery (ITA)
the posterior intercostal arteries are branches of the _____ _____
Descending aorta
Anterior intercostal veins drain into the _______ ______ _____
Internal thoracic vein
posterior intercostal veins drain into the _____ _____
azygous system
The intercostal nerves are somatic and contain ______ & _______ fibres
Sensory
Motor
intercostal nerves are
A)sympathetic
B)parasympathetic
C)Somatic
c
what does the pleura cover
Lungs
structures passing in and out the lungs
what lies between the parietal and visceral pleura
pleural space
which pleura is visible
parietal
The diaphragmatic pleura lies adjacent to the
diaphragm
The mediastinal pleura lies adjacent to the
heart
The costal pleura lies adjacent to the
ribs
The cervical pleura covers the
apex of lungs
what is the costodiaphragmatic recess
sharp gutter at the junction of costal and diaphragmatic pleurae
potential space that the lungs expand into during deep inspiration.
what is the costomediastinal reces
lies at the junction of the costal and mediastinal pleura.
potential space that the lungs expand into during deep inspiration.
what nerve innervates the parietal pleura
phrenic and intercostal nerves that innervate the overlying skin of the chest wall
these nerves contain somatic sensory fibres
what nerve innervates the visceral pleura
purlamanory plexus visceral afferents (autonomic sensory)
why is the visceral pleura insensitive in comparison to pain felt in the parietal pleura
visceral pleura contains visceral afferent fibres which are autonomic this this does reach conscious perception and only detects stretch
Parietal pleura is highly sensitive to pain due to somatic sensory fibres
how many lobes in L and R lungs
L 2
R 3
what is the name of the anterior
extension of the superior lobe of the lung that extends over the heart called
the lingula
how many fissures does the R lung have and name them
2
Oblique and horizontal
many fissures does the L lung have on them and name them
1
oblique
What are the 3 surfaces of the lungs
costal
mediasternal
diaphragmatic
what are the 3 borders of the lungs
anterior
posterior
inferior
what is the root of the lung comprised of
pulmonary artery,
pulmonary veins,
main bronchus
what is the hilum of the lung
region on the mediastinal surface of the lung where pulmonary artery, pulmonary veins and main bronchus enter and exit the lung
At the hilum of the right lung, the main bronchus lies ______ to the pulmonary artery
A)Anterior
B)Posterior
A
in the hilum of right lung where does the main branches lie to the pulmonary artery
Anterior
At the hilum of the left lung, the main bronchus lies ________ to the pulmonary artery.
A)superior
B)inferior
inferior
The trachea bifurcates into the left and right main bronchi at the level of the _____ _____
sternal angle/angle of Louis
describe the difference between the main L and R bronchus
The right main bronchus is shorter, wider and descends more vertically than the left main bronchus
A foreign body entering the trachea is more likely to descend through the right main bronchus than the left main bronchus – what is the anatomical explanation for this?
The right main bronchus is wider and more vertical than the left.
Each main bronchus divides into _____ bronchi
lobar
how many lobar bronchi go into each lung and why
L 2
R 3
1 lobar bronchi for each lobe of each corresponding lung
lobar bronchi divide into
semental bronchi
how many segments bronchi per lung
10
why is there 10 segmental bronchi per lung
each one supplies 1 of the 10 functionally independent segments of the lung called bronchopulmonary segments
what do segmental bronchi break into
bronchioles
The walls of the trachea and bronchi contain _______ muscle and cartilage
A)circular
B) cardiac
C)skeletal
D)smooth
D
Contraction and relaxation of the smooth muscle is under _____ control.
Pick best answer
A)sympathetic
B)parasympathetic
C)autonomic
D)somatic
A
what is the blood supply of the lungs
pulmonary arteries
bronchial arteries
what innervates the lungs autonomic or somatic
autonomic
in the ANS, parasympathetic fibres stimulate what in the lungs
constricting bronchial smooth muscle
bronchial tree gland section
in the ANS, sympathetic fibres stimulate what in the lungs
relaxing bronchial smooth muscle
inhibiting bronchial tree gland secretion
Lymph from the lungs ultimately drains into the venous system via the ______ duct or right ________ duct.
thoracic
lymphatic
describe where inferior border of the lungs lies anteriorly, posteriorly, laterally at rib levels
Ant=6th rib
Lat=8th rib
Post=10th rib
describe where parietal pleura extends anteriorly, posteriorly, laterally at rib levels
ant= 8
lat=10
post=12
what rib/costal cartilage level does oblique fissures on both lung extend from posteriorly
4 rib to 6 costal
Horizontal fissure in lung Runs horizontally from the sternum, at the level of the ____ rib, to meet the oblique fissure.
3rd
4th
5th
6th
4th
describe the diaphragm with accordance to the following bullet points
-thickness
-shape
-what its made out of
thin
domed
skeletal muscle
what are the 3 foramen in the diaphragm
aortic hiatus
oesophageal hiatus
caval foreman
what innervates the diaphragm
phrenic never from C3,4,5
what places is diaphragm attached to
xiphoid process
costal margin
tips 11-12 ribs
lumbar vertebrae
the diaphragm contracts during ________
A)inspiraation
B)expiration
inspiration
describe what happens to diaphragm during inspiration and the intrathoracic volume
diaphragm contracts
muscles fibres are pulled towards their peripheral attachments
dome flattens
intre-thoracic vol increases
what is the central, fibrous part of the diaphragm called
central tendon
describe what happens to diaphragm during expiration and the intrathoracic volume
diaphragm relaxes
diaphragm domes superiorly
During ventilation, the dimensions of the thoracic cavity change in which three planes
vertically
laterally
anteroposteiorly
The pleural fluid creates s______ t______ between the parietal pleura lining the thoracic cavity and the visceral pleura on the surface of the lung.
surface tension
If the surface tension is ‘broken’ (e.g. by a penetrating injury of the chest that punctures the parietal pleura and introduces air into the pleural cavity - pneumothorax) what happens
ventilation may become dysfunctional
explain inspiration with reference to
-diaphragm
-intercostal muscles
-ribs
-intrathoracic volume
-lungs expansion, pressure and volume
diaphragm and external intercostals contract which increases intrathoracic volume
ribs pull sternum superorly and anteriorly
lungs expand due to increases volume
pressure in lungs decreases below atm pressure and air is drawn into the lung
explain expiration with reference to
-diaphragm
-intercostal muscles
-ribs
-intrathoracic volume
-lungs expansion, pressure and volume
diaphragm and external intercostals relax
internal intercostals contract
intrathoracic vol decreases
internal intercostals pull ribs inferiorly and posteriorly
lung vol decreases
pressure in lungs increases above atm pressure and air is expelled from the lungs.
what are the muscles used In normal, quiet breathing
diaphragm for inspiration and expiration is passive
describe Pleuritic chest pain
when pleura has become inflamed/injured sharp pain can be pinpointed and is worst non inspiration
describe the differences and similarities between Pneumothorax and haemothorax
pneumothorax is air in the pleural cavity vs haemothorax is blood in pleural cavity
pneumothorax occurs due to trauma causing a tear in the pleura (e.g fractured rib) and air rapidly enters that lung and compresses the lung, heart, great vessels and the other lung
Haemothorax is a collection of blood in the pleural cavity and occurs after trauma when blood vessels are torn or cut.
both are disturbances to pleural cavity
describe pleural perfusion and how to fix it, also why you must be careful while attempting to fix it
excess fluid in pleural cavity
can be removed with a chest drain by making am incision in lower part of chosen intercostal space, to avoid the neurovascular bundle
surface anatomy of the heart and lungs must be considered to ensure the tip of the drainage tube doesnt injure them
what is mesothelioma
malignancy in the pleura
injury to the phrenic nerves could cause
consider ipsilateral and bilateral injury
ipsilateral may go innoticed since only paralyses 1 side
bilateral paralysis will need ventilatory support
Which nerves carry sensation from the parietal and visceral pleura?
parietal- intercostal nerves
visceral-visceral afferent fibres
What is a bronchopulmonary segment?
anatomically and functionally separate segment of the lung of which there are 10 of
has a feeding artery and bronchus running through centre of segment
draining being run along surface
What structures pass through the hilum of the lung?
pulmonary artery
2 pulmonary veins
main bronchus
Lymphatic vessels
Branches of the vagus nerve and sympathetic nerves.
how does contraction of the diaphragm assist in returning blood to the heart?
Contraction of diaphragm decreases intra-thoracic pressure and
increases intra-abdominal pressure
blood therefor flows form abdomen to chest
What is the sensory and motor nerve supply to the diaphragm?
phrenic
