Unit 2 Lungs And Pleura

Front 1

What are the two pleural recesses?

Back 1

1. left/rt. costodiaphragmatic-site of fluid accumulation
2. costomediastinal-part of the pleura cavity on the left side between the mediastinal pleura and the costal pleura, insignificant on the right side, note this is the side of access when the pericardial cavity must be penetrated by a needle

Front 2

Where would you aim a needle if you needed to access the pericardial cavity in order to reduce the risk of pneumothorax

Back 2

On the left side into the costomediastinal recess

Front 3

The peripheral diaphragmatic pleura is innervated by the lower intercostal nerves. Where is refered pain from pleural irritation likely to be felt

Back 3

lateral thoracic and anterior abdominal walls because they are also innervated by the lower intercostal nerves

Front 4

The central diaphgramatic pluera and mediastinal pleura are innervated by the phrenic nerves. Where is refered pain from this region likely to be felt

Back 4

neck and shoulder (heart attack)

Front 5

Where are the pulmonary ligaments? How are they formed

Back 5

The ligaments run from the hilus of the lung to the base (diaphragmatic suface) along the mediasinal surface of each lung. They are formed where the parietal pleura of teh anterior and posterior walls of the thoracic cavity is reflected off teh medaistinal wall toward the lungs

Front 6

What is the intrathoracic cavity. What is the significance of this space.

Back 6

The intrathoracic cavity is the potential space between the visceral and parietal pleura. Introduction of air, blood, or fluid into this space results in pneumothorax, hemotorax, or hydrothorax

Front 7

What is the purpose of pleural fluid

Back 7

-prevents friction between the visceral and parietal pleura
-provides surface tension between the layers to keep the lung inflated (water drop on microscope slide)

Front 8

What two "forces" hold the lung against the thoracic wall?

Back 8

1. negative intrathoracic pressure relative to the atmosphere
2. surface tension supplied by pleural fluid

Front 9

How does an open pneumothorac occur? Which side of the chest is expanded and what happens to the mediastinum?

Back 9

An open pneumothorax occurs when air enters and leaves the pleural cavity. There is hyperexpansion of the chest wall on the normal side and a mediastinal flutter (shift to normal side during inspiration and toward injured side during expiration)

Hint: As you breath in the air follows the path of least resistance so if fills the gap where the damaged lung is. This air pushes the mediastinum towards the health side.

Front 10

How does a tension pneumothorac occur? Which side of the chest is expanded and what happens to the mediastinum?

Back 10

A tension pneumothorax occurs if the wound acts as a check valve that lets air in but not out. The increase in intrathoracic pressure foces the mediastinal contenst towrad the normal side (no flutter) and reduces the vital capacity of the normal lung

Front 11

Which is worse an open or tension pneumothroax

Back 11

A tension pneumothorax is wose because the air cannot escape. Intrathoracic pressuere continues to build and the vital capacity of the uninjured lung is decreased.The mediastinal flutter associated with an open penumothorax does decrease gas exchange in the normal lung but not to the same extent

Front 12

To avoid injury to neurovascular bundles, pleural tap should be preformed in what location relative to the ribs

Back 12

Halfway between the two ribs because the neurvascular bundles run on the inferior aspect of the ribs

Front 13

Why is the right lung shorter and wider than the left

Back 13

it is shorter because of the liver but wider because the heart is offeset to the left

Front 14

What structures enter or leave the lung at the hilus

Back 14

1. main stem bronchus
2.pulmonary artery
3. pulmonary veins
4. brochial lymphatics and hilar lymph nodes

Front 15

What divides the lungs into lobes

Back 15

fissures of the visceral pleura

Front 16

A tumor in the upper lobe of the lung can compress several vital structures. List some structures that could be compressed and the sxs assocaited

Back 16

1. subclavian/ brachiocephalic vein =>edema of face and arm on one side
2. subclavian artery=>dimished pulse in extremity
3.phrenic nerve=> paralysis of hemidiaphragm
4. recurrent laryngeal nerve=> vocal hoarseness
5. sympathetic chain=> HOrner's syndrome

Front 17

What and where is the carnia

Back 17

The carnia/ septum is the bifurcation of teh trachea into the main stem bronchi. This occurs behind the sternal angle at T5

Front 18

Compare the shapes of the right and left main stem bronchi

Back 18

right: wider, shorter, and more verticle
left: narrower, longer, and more horizontal (because of the heart)

Front 19

An aspirated object is most likley to rest in which main stem bronchi

Back 19

The right because it is wider and more verticle than the left

Front 20

What are the two separate arterial vessels that supply the lungs? What is their fxn?

Back 20

1. Pulmonary trunk: brings deoxygenated blood from the right ventricle to the lungs
2. bronchial arteries: supply the lung tissue with oxygenated blood

Front 21

What is the anatomical relationship of the pulmonary arteries to the bronchi

Back 21

Right pulmonary artery is anterior to the right main stem bronchus, left is superior
remeber: RAiLS

Front 22

What is the ligamentum arteriosum

Back 22

Connects the left pulmonary artery to the arch of the aorta. It is a remnant of the ductus arteriosus that shunted blood from the pulmonary trunk to the aortic arch in order to bypass the pulmonary system.

Front 23

A patient presenting with mild pain, pleurisy, and hemoptysis should be suspected of having...

Back 23

a pulmonary embolus

Front 24

In general, how main veins from the lungs enter the left atrium

Back 24

There are usually four, a superior and inferior from both the left and the right. Note that there can be variation with three, four, or five openings into the LA

Front 25

GVA and GVE innervation to the lungs is supplyed by branches from...

Back 25

thoracic sympathetic chain and the vagus nerve

Front 26

T/F the trachea and bronchi are important for gas exhange

Back 26

False, this section is part of the conducting portion that omves the air into the respiratory portion

Front 27

Which lung structures comprise the respiratory portion?

Back 27

respirtory bronchioles, alveolar ducts, alveolar sac, and alveoli

Front 28

The sternal angle is loacted at the T4/T5 levels and second costal cartilage. What important structures occur here

Back 28

1. the trachea bifurcates
2. the aorta ascends and desecends
3. the azygous vein drains into the SVC

Front 29

The groove for the aorta is found on the ___lung and the groove for they azygous vein is found on the __ lung

Back 29

Groove for aorta is on the left lung, groove for azygous is on the right lung ( so is groove for esophagus)

Front 30

T/F the lungs are attached to the cehst wall

Back 30

false, they stick becuase of the pleural fluid providing surface tension between the parietal and visceral pleura

Front 31

When the phrenic nerve is injured half of the diphragm is paralyzed. How will the paralyzed half move during inspiration.

Back 31

The paralyzed dome will will not descend upon inpsiration and will be forced superiorly by an increase in intrabdoinal pressure (the healthy side moves down and pressure decrease because volume increases)