Lungs and pleura

Question 1

How many lobes does the right lung have

Answer 1

3

Question 2

How many lobes does the left lung have

Answer 2

2

Question 3

Where does the horizontal fissure (right lung) run

Answer 3

From T3 vertebra posteriorly to rib 6 anteriorly

Question 4

Where does the oblique fissure run

Answer 4

From rib 4 to horizontal fissure

Question 5

What are the surfaces of the lungs

Answer 5

Cervical surface (top)
Mediastinal surface
Diaphragmatic surface
Costal surface (side)

Question 6

What are pleural reflections

Answer 6

The lines along which the parietal pleura changes direction from one wall of pleural cavity to another

Question 7

What are the names of the pleural reflections

Answer 7

Sternaline line of pleural reflection
Vertebral line of pleural reflection
Costal line of pleural reflection

Question 8

What is the sternaline line of pleural reflection

Answer 8

When the costal pleura changes into mediastinal pleura ANTERIORLY

Question 9

What is the vertebral line of pleural reflection

Answer 9

When the costal pleura changes into mediastinal pleura POSTERIORLY

Question 10

What is the costal line of pleural reflection

Answer 10

When costal pleura changes into diaphragmatic pleura

Question 11

How does the right lung compare to the left lung and why

Answer 11

Right lung is larger and heavier than the L but shorter and wider because right dome of diaphragm is higher and heart and pericardium bulge to the left

Question 12

Which dome of the diaphragm is higher

Answer 12

Right

Question 13

What is the surface anatomy of the visceral pleura

Answer 13

2-4-6-8-10

Reflections closest at plane of sternal angle (rib 2)
Parallel down to rib 4
L indented by cardiac notch but right continues down to cc6
Cross rib 8 at midaxillary line
Cross rib 10 at lateral border of erector spinae

Question 14

What is the surface anatomy of the parietal pleura

Answer 14

2-4-6-8-10-12

Asymmetry and close behind sternal angle (rib 2)
Parallel down to rib 4
L indented but R continues down to cc6
Rib 8 at midclavicular line
Rib 10 at midaxillary line
Rib 12 at lateral border of erector spinae mm

Question 15

Which bronchus is more vertical and wider and so therefore where are foreign objects more likely to enter

Answer 15

R

Question 16

What do secondary bronchi supply

Answer 16

Lobes

Question 17

What do tertiary bronchi supply

Answer 17

Segments

Question 18

How many segments does the right lung have

Answer 18

10

Question 19

How many segments does the left lung have

Answer 19

8

Question 20

Where does fluid typically accumulate in the lung if the patient is lying on their back for extended periods of time

Answer 20

Apical and posterior segments of the inferior lobe (both lungs)

Question 21

What are the borders of the lung

Answer 21

Anterior
Posterior
Inferior

Question 22

What is the anterior border of the lung

Answer 22

Where costal and mediastinal surfaces meet anteriorly

Question 23

What is the posterior border of the lung

Answer 23

Where costal and mediastinal surfaces meet posteriorly

Question 24

What is the inferior border of the lung

Answer 24

Separates diaphragmatic surface from costal and mediastinal surfaces

Question 25

How is blood supplied to the lung

Answer 25

Pulmonary trunk --> Lobar artery --> segmental artery to each bronchopulmonary segment

Question 26

What do bronchial arteries supply

Answer 26

Blood to structures comprising the; Roots of the lungs Supporting tissues of lungs Visceral pleura

Question 27

What drains the visceral pleura

Answer 27

pulmonary veins

Question 28

What supplies the parietal pleura

Answer 28

Intercostal arteries

Question 29

How are lungs drained

Answer 29

Pulmonary veins

Question 30

How are adjacent bronchopulmonary segments drained

Answer 30

Intersegmental veins which then turn into superior pulmonary veins or inferior pulmonary veins

Question 31

Where do the pulmonary veins drain

Answer 31

Right atrium

Question 32

What is the role of the bronchial veins

Answer 32

drain part of the blood supplied to the lungs by the bronchial arteries

Question 33

What do the bronchial arteries supply

Answer 33

Visceral pleura of lungs, connective tissue of lungs, bronchi and oesophagus

Question 34

Difference between pulmonary arteries and bronchial arteries

Answer 34

Pulmonary arteries supply deoxygenated blood pumped from the right ventricle Bronchial arteries supply oxygenated blood pumped from the left ventricle

Question 35

Where does the right bronchial vein drain into

Answer 35

Azygos vein

Question 36

Where does the left bronchial vein drain into

Answer 36

Accessory hemi-azygos vein | Left superior intercostal vein (which then goes to left brachiocephalic vein)

Question 37

Where does lymphatic fluid from the lung tissue and visceral pleura drain into (sequence of events)

Answer 37

1- Superficial lymph plexus 2- bronchopulmonary (hilar) lymph nodes 3- inferior and superior tracheobronchial lymph nodes 4ai) Right bronchomediastinal lymph trunks aii- right lymph trunk (along with other lymph trunks) aiii- Terminate at venous angle 4bi)Left bronchomediastinal lymph trunks bii- terminates at thoracic duct biii- Terminates at venous angle

Question 38

Where does lymph from structures that form the root of the lung drain into

Answer 38

1) Deep lymph plexus 2) Pulmonary lymph nodes 3) these drain into bronchopulmonary (hilar) lymph nodes 4) Then follow same course as lymph fluid from lung tissue and visceral pleura

Question 39

Where does lymph from parietal pleura drain into

Answer 39

Lymph nodes of thoracic wall (intercostal, parasternal, mediastinal, and phrenic)

Question 40

Where does lymph from cervical pleura drain into

Answer 40

Axillary lymph nodes

Question 41

What is pleuritis and how is it presented

Answer 41

Inflammation of pleura so lung surfaces rub. Can be heard with stethoscope. Presented with sharp, stabbing pain when there is increased exertion (ie climbing stairs)

Question 42

When does pulmonary collapse occur

Answer 42

When there is too much air in the pleural cavity

Question 43

Which structures are affected in pulmonary collapse and how

Answer 43

- Lung - Diaphragm is elevated in elevated side - Mediastinum shifts away (can tell because trachea is displaced) - ICS narrowing - Pleural sacs are separate so they don't affect one another

Question 44

Which pleura is insensitive to pain and why

Answer 44

Visceral pleura because its innervation is autonomous (vagus nerve and sympathetic fibres)

Question 45

What is the visceral pleura innervated by

Answer 45

Vagus nerve and sympathetic fibres

Question 46

What pleura is sensitive to pain and why

Answer 46

Parietal pleura

Question 47

What is the parietal pleura innervated by

Answer 47

Intercostal nerves and phrenic nerve

Question 48

Which part of the parietal pleura is particularly sensitive to pain

Answer 48

Costal pleura

Question 49

If there is irritation of the costal and peripheral parts of diaphragmatic pleura, where would there be pain

Answer 49

Local pain and referred pain along intercostal nerves to thoracic and abdominal walls

Question 50

If there is irritation of mediastinal and central diaphragmatic areas of parietal pleura, where would there be pain

Answer 50

Pain in root of neck and over the shoulder

Question 51

What are the common pneumonia sites in the lung of patients that are confined to bed

Answer 51

Apical and posterior segments of the inferior lobe