week 1 tutorial - surface marking of pleural cavity & lung

Question 1

what is each lunch surrounded by?

Answer 1

2 layers of pleura:

parietal pleura & visceral pleura

Question 2

what does the parietal pleura line?

Answer 2

the bony thoracic cage (costal surface), diaphragm & mediastinal surface which makes up walls of each hemi thorax

Question 3

what is the parietal pleura continuous with? where?

Answer 3

continuous at the root (hilum) of the lung with the visceral pleura

Question 4

what does the visceral pleura line?

Answer 4

adherent to the surface of the lung and extends between the lobes of the lung

Question 5

what is the potential space between the 2 layers of pleura?

Answer 5

the pleural cavity

Question 6

what are the lines of pleural reflection?

Answer 6

the abrupt lines along which the parietal pleura changes direction from its costal surface t the diaphragmatic and mediastinal surfaces

Question 7

what are the pleural reflection used for?

Answer 7

used to surface mark the extent of the pleural cavity

Question 8

what are the landmarks of the surface marking of the pleural cavity?

Answer 8

ribs 2,4,6,8,10,12 and their costal cartilages (cc)

Question 9

where is the apex of the lung and pleural cavity?

Answer 9

extends about 3cm above the medial 1/3rd of the clavicle, into the root of the neck

Question 10

what is the apical pleura (lung apex) covered by?

Answer 10

by a fascia (the suprapleural membrane) - which is attached to the inner border of the first rib

Question 11

from the apex, where does the line of pleural reflection from each side travel?

Answer 11

the line of pleural reflection on each side slopes down behind the sterno-clavicular joints to meet each other near the midline, behind the sternal angle (the 2 pleural cavities are virtually touching)

Question 12

what is the sternal angle?

Answer 12

synarthrotic joint formed by articulation of manubrium and body of sternum

Question 13

what articulates together at the level of the sternal angle?

Answer 13

the 2nd costal cartilage articulates with the sternum

Question 14

what happens from the sternal angle?

Answer 14

both pleural reflections pass vertically down behind the sternum to the 4th costal cartilage

Question 15

what happens at the 4th costal cartilage to the left pleura?

Answer 15

the left pleura deviates laterally (due to presence of heart) to the edge of the sternum and descends lateral to the sternum down to the 6th cc

Question 16

what happens at the 4th costal cartilage to the rightpleura?

Answer 16

the pleura continues vertically behind the sternum to the 6th cc

Question 17

at the 6th cc, what happens to the line?

Answer 17

pleura on both sides turn laterally to pass around the chest wall crossing:
8th rib at the mid clavicular line
10th rib at mid axillary line
12th rib at scapular line to lateral edge of paravertebral muscles

Question 18

where is the scapular line?

Answer 18

medial border of the scapular

Question 19

what happens to the medial border of the pleural cavity?

Answer 19

ascends vertically along the lateral border of the paravertebral muscles, up to the apex

Question 20

what are the landmarks of the surface markings of the lung?

Answer 20

ribs 2,4,6,8,10 NOT 12

Question 21

what is different about the surface markings of the lungs from the pleural cavity?

Answer 21

same as pleural cavity, except inferiorly and at cardiac notch

Question 22

what happens inferiorly?

Answer 22

the lower border of the lung lies abut 2 ribs higher than the pleura

Question 23

what does the lower border of the lung lies abut 2 ribs higher than the pleura mean?

Answer 23

crosses 6th rib at mid-clavicular line
8th rib at mid axillary line
10th rib at scapular line & lateral edge of paravertebral muscles

Question 24

what is the inferior part of the pleural cavity not occupied by lung (extra 2 ribs) known as?

Answer 24

costodiaphragmatic recess

Question 25

what happens to the cardiac notch in lung surface marking?

Answer 25

the cardiac notch of the lung curves further laterally than the pleural reflection - it moves from 4th costal cartilage to the 5th IC space just medial to mid clavicular line

Question 26

where does the oblique fissure on either side extend from to?

Answer 26

extend from process of T2 vertebral posteriorly to the 6th costal cartilage anteriorly

Question 27

where is the horizontal fissure and what is it’s function?

Answer 27

only present on the right side from the mid axillary line anteriorly along the 4th rib, to the anterior edge of the lung, separating the right and middle lobes

Question 28

what shape is the diaphragm?

Answer 28

dome shape

Question 29

where is the right dome of the diaphragm?

Answer 29

lies at the level of the 5th rib (liver pushes up)

Question 30

where is the left dome of the diaphragm?

Answer 30

slightly lower at the level of 5th IC space

Question 31

when does the sound change when percussing over the lung? why?

Answer 31

the resonant percussion changes to a dull note below the 5th rib due to presence of liver
which is overlapped only by a thin rim of lung and costodiaphragmatic recesses

Question 32

what is resonance below the 5th rib a sign of?

Answer 32

hyper inflated lungs in COPD

Question 33

what is the costodiaphragmatic recesses?

Answer 33

the pleural-lined gutters that surround the upward convexity of the diaphragm