Snell's Clinical Anatomy Chapter 5 - Thorax Part II (Thoracic Cavity)
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Questions and Answers

What happens to the lower margins of the lungs during expiration?

  • They collapse completely
  • They ascend towards the apex (correct)
  • They descend into the recesses
  • They remain unchanged

    • Which nerves supply the periphery of the diaphragmatic pleura?

  • Thoracic duct
  • Sympathetic trunk
  • Visceral afferent nerves
  • Intercostal nerves (correct)

    • What is a characteristic of the visceral pleura?

  • Insensitive to stretch
  • Sensitive to stretch (correct)
  • Sensitive to pain
  • Sensitive to touch

    • Where are the costomediasinal recesses located?

    <p>Along the anterior margins of the pleura</p> Signup and view all the answers

    Which structure runs in company with autonomic nerves from the pulmonary plexus?

    <p>Visceral afferent nerves</p> Signup and view all the answers

    What layer separates the costal and mediastinal parietal pleurae?

    <p>Pleural fluid</p> Signup and view all the answers

    What role does the diaphragm play during inspiration?

    <p>It contracts to increase thoracic volume</p> Signup and view all the answers

    What is the function of the thoracic duct?

    <p>To drain lymph from the thoracic cavity</p> Signup and view all the answers

    What is the costodiaphragmatic recess?

    <p>A slitlike space between the costal and diaphragmatic pleurae</p> Signup and view all the answers

    Which nerve supplies the mediastinal pleura?

    <p>Phrenic nerve</p> Signup and view all the answers

    During quiet inspiration, what happens to the lungs in relation to the pleural cavity?

    <p>The lungs do not fully occupy the pleural cavities at certain sites.</p> Signup and view all the answers

    What type of nerves innervate the parietal pleura?

    <p>Somatic afferent nerves</p> Signup and view all the answers

    Where do the parietal and visceral layers of pleura become continuous?

    <p>At the hilum of the lung</p> Signup and view all the answers

    What are the costs mediastinal recesses?

    <p>Recesses at the junction of costal and mediastinal pleura</p> Signup and view all the answers

    What is primarily responsible for the supply of the costal pleura?

    <p>Intercostal nerves</p> Signup and view all the answers

    Which of the following describes the pleural cavities when the lungs are fully expanded?

    <p>The lungs fill the pleural cavities.</p> Signup and view all the answers

    What do the recesses in the pleura primarily allow for?

    <p>Lung movement during respiration</p> Signup and view all the answers

    Which statement is correct about the innervation of the pleura?

    <p>Parietal pleura is more sensitive to sensation than visceral pleura.</p> Signup and view all the answers

    What is the primary function of the bronchial arteries in the thoracic cavity?

    <p>Provide blood supply to the lower third of the trachea</p> Signup and view all the answers

    Which structure is a more direct continuation of the trachea?

    <p>Right main bronchus</p> Signup and view all the answers

    Where does lymph drainage from the principal bronchus primarily occur?

    <p>Pretracheal and paratracheal lymph nodes</p> Signup and view all the answers

    Which nerve carries signals to the lung regions for respiratory function?

    <p>Vagus nerve</p> Signup and view all the answers

    What is the role of the respiratory bronchioles in the mechanics of respiration?

    <p>Facilitate gas exchange in the alveoli</p> Signup and view all the answers

    What condition results from the collection of pus in the pleural cavity?

    <p>Empyema</p> Signup and view all the answers

    Which structure serves as the main artery supplying blood to the thoracic cavity?

    <p>Aorta</p> Signup and view all the answers

    What happens to the mediastinum during a hemopneumothorax?

    <p>It is displaced to the left</p> Signup and view all the answers

    What structures are included in the lower respiratory tract?

    <p>Bronchi and bronchioles</p> Signup and view all the answers

    What is the primary function of the thoracic duct?

    <p>To drain lymphatic fluid</p> Signup and view all the answers

    How is fluid in the pleural cavity typically drained?

    <p>Using a wide-bore needle</p> Signup and view all the answers

    Which of the following structures is primarily responsible for the nerve supply to the heart?

    <p>Cardiac plexus</p> Signup and view all the answers

    During respiration, which structure expands to create a sub-atmospheric pressure in the thoracic cavity?

    <p>Diaphragm</p> Signup and view all the answers

    At which anatomical landmark does the trachea begin?

    <p>Lower border of the cricoid cartilage</p> Signup and view all the answers

    Which of the following is a result of trauma to the chest in hemopneumothorax?

    <p>Bleeding from lacerated lung</p> Signup and view all the answers

    What does the term 'mediastinum' refer to in the thoracic cavity?

    <p>The space between the lungs</p> Signup and view all the answers

    What is the primary drainage vein for the heart?

    <p>Coronary sinus</p> Signup and view all the answers

    What happens to breath sounds over a compressed lung?

    <p>They are absent</p> Signup and view all the answers

    Which type of nerve fibers in the thorax primarily increase heart rate during stress?

    <p>Sympathetic fibers</p> Signup and view all the answers

    Which anatomical structure connects the larynx to the bronchi?

    <p>Trachea</p> Signup and view all the answers

    What structure is primarily affected by the mechanics of respiration related to airflow?

    <p>Bronchi</p> Signup and view all the answers

    What type of fluid is described as serous fluid in the pleural cavity?

    <p>Pleural effusion</p> Signup and view all the answers

    What reflects the arrangement of the respiratory tract structure for air passage?

    <p>Trachea to alveoli</p> Signup and view all the answers

    Which lymphatic vessel is responsible for draining the right upper quadrant of the body?

    <p>Right lymphatic duct</p> Signup and view all the answers

    The fibrous pericardium primarily serves what purpose?

    <p>To protect the heart from mechanical injury</p> Signup and view all the answers

    Which bronchus is wider, shorter, and more vertical than the other?

    <p>Right principal bronchus</p> Signup and view all the answers

    What is the medical term for a collection of pus without air in the pleural cavity?

    <p>Empyema</p> Signup and view all the answers

    What is the function of the bronchial arteries in the blood supply system of the lungs?

    <p>Supply oxygenated blood to the bronchi</p> Signup and view all the answers

    What causes the mediastinum to be displaced during hemopneumothorax?

    <p>Blood collection from chest vessels</p> Signup and view all the answers

    Where does the lymph from the principal bronchus primarily drain?

    <p>Pretracheal and paratracheal lymph nodes</p> Signup and view all the answers

    What feature of the trachea is notable at its bifurcation?

    <p>Carina</p> Signup and view all the answers

    Which part of the respiratory system does the trachea directly connect to?

    <p>Larynx</p> Signup and view all the answers

    During auscultation in cases of hemopneumothorax, which findings would be expected over the compressed lung?

    <p>Absent breath sounds</p> Signup and view all the answers

    Which arteries supply the upper two thirds of the trachea?

    <p>Inferior thyroid arteries</p> Signup and view all the answers

    What type of fluid is typically involved in pleural effusion?

    <p>Serous fluid</p> Signup and view all the answers

    Which structure separates the thorax from the abdominal cavity?

    <p>Diaphragm</p> Signup and view all the answers

    What is the term for the narrowing of bronchi in response to lung compression?

    <p>Bronchoconstriction</p> Signup and view all the answers

    At what cervical vertebra level does the trachea begin?

    <p>C6</p> Signup and view all the answers

    What is the primary reason for the need for a needle thoracostomy?

    <p>To relieve excess pressure from fluid or air</p> Signup and view all the answers

    Which structures are included in the lower respiratory tract?

    <p>Bronchi, bronchioles, and alveoli</p> Signup and view all the answers

    What is the main function of the visceral pleura?

    <p>To cover the lungs and reduce friction during movement</p> Signup and view all the answers

    In which order are the major mediastinal structures arranged from anterior to posterior?

    <p>Anterior mediastinum, Middle mediastinum, Posterior mediastinum</p> Signup and view all the answers

    What happens to the coelomic cavity as the lungs grow?

    <p>It reduces to form the pleural cavity</p> Signup and view all the answers

    What is indicated about the observer's view of the thorax in cross-sectional anatomy?

    <p>The observer's right corresponds to the subject's left</p> Signup and view all the answers

    What structure primarily lines the thoracic wall?

    <p>Parietal pleura</p> Signup and view all the answers

    What is the main division of the mediastinum known as the middle mediastinum primarily associated with?

    <p>The heart and its major vessels</p> Signup and view all the answers

    Which of the following accurately describes the nature of the pleural cavity?

    <p>A slit-like space between the visceral and parietal pleura</p> Signup and view all the answers

    What do the oblique fissures separate in the lungs?

    <p>The upper lobe from the lower lobe of the same lung</p> Signup and view all the answers

    Which nerve is located posterior to the esophagus?

    <p>Left recurrent laryngeal nerve</p> Signup and view all the answers

    Which artery is found on the left side of the thorax in relation to the esophagus?

    <p>Left carotid artery</p> Signup and view all the answers

    Which structure is described as a more direct continuation of the trachea?

    <p>Right main bronchus</p> Signup and view all the answers

    What nerve is associated with the diaphragm?

    <p>Right phrenic nerve</p> Signup and view all the answers

    Which structure runs alongside the right vagus nerve?

    <p>Azygos vein</p> Signup and view all the answers

    Which vein is located in the right mediastinum?

    <p>Right brachiocephalic vein</p> Signup and view all the answers

    What is the role of the pleura mentioned in relation to the thorax?

    <p>Aids in lung expansion</p> Signup and view all the answers

    Which artery branches off the aorta in the left thorax?

    <p>Left pulmonary artery</p> Signup and view all the answers

    Which structure does the left phrenic nerve innervate?

    <p>Diaphragm</p> Signup and view all the answers

    Which of the following statements is true regarding the lung structure?

    <p>Right main bronchus is a more direct continuation of the trachea</p> Signup and view all the answers

    What happens to the lower margins of the lungs during inspiration?

    <p>They descend into the recesses.</p> Signup and view all the answers

    What is the sensitivity status of visceral afferent nerves supplying the visceral pleura?

    <p>Sensitive to stretch but insensitive to pain.</p> Signup and view all the answers

    What anatomical feature separates the costal and mediastinal parietal pleurae?

    <p>A capillary layer of pleural fluid.</p> Signup and view all the answers

    In what way do the costomediasinal recesses function during respiration?

    <p>They allow for expansion of the lungs.</p> Signup and view all the answers

    Where are the costomediasinal recesses primarily located?

    <p>Along the anterior margins of the pleura.</p> Signup and view all the answers

    Which structures are primarily responsible for supplying the periphery of the diaphragmatic pleura?

    <p>Lower intercostal nerves.</p> Signup and view all the answers

    During expiration, what happens to the lower margins of the lungs?

    <p>They ascend and the pleurae come together.</p> Signup and view all the answers

    Which region of the pleura is sensitive to stretch?

    <p>Visceral pleura.</p> Signup and view all the answers

    What type of fluid is present in the pleural cavity?

    <p>Serous fluid.</p> Signup and view all the answers

    Which structure runs along with autonomic nerves from the pulmonary plexus?

    <p>Visceral afferent nerves supplying the pleura.</p> Signup and view all the answers

    What symptom did the patient NOT report during the examination?

    <p>Pain down the arms</p> Signup and view all the answers

    What was the preliminary diagnosis made for the patient's condition?

    <p>Aortic dissection</p> Signup and view all the answers

    What could explain the discrepancy in blood pressure between the right and left arms?

    <p>Partial blockage of the left subclavian artery</p> Signup and view all the answers

    Which symptom is most characteristic of myocardial infarction compared to aortic dissection?

    <p>Referred pain down the inner arm</p> Signup and view all the answers

    Which nervous system pathway is involved in the referral of pain from the aorta?

    <p>Sympathetic nerves</p> Signup and view all the answers

    What vital sign measurement was notably different between the patient's arms?

    <p>Blood pressure</p> Signup and view all the answers

    What aspect of the patient's pain was crucial for determining the diagnosis?

    <p>Radiation of pain to the back</p> Signup and view all the answers

    What is the most immediate concern for an emergency physician when evaluating chest pain?

    <p>Determining the cause of the pain</p> Signup and view all the answers

    What is the main function of the U-shaped tracheal rings?

    <p>To provide structural support and maintain patency</p> Signup and view all the answers

    During what respiratory activity does the bifurcation of the trachea rise?

    <p>Expiration</p> Signup and view all the answers

    Which anatomical structure is located anteriorly to the trachea in the thorax?

    <p>Thymus</p> Signup and view all the answers

    How long is the trachea in adults?

    <p>4 1/2 inches</p> Signup and view all the answers

    What happens to the trachea during deep inspiration?

    <p>It lowers to the level of the sixth thoracic vertebra</p> Signup and view all the answers

    What happens to the lung on the side of a pneumothorax?

    <p>The lung collapses immediately</p> Signup and view all the answers

    Which structures are found in the superior mediastinum?

    <p>Thymus and large veins</p> Signup and view all the answers

    What can cause the left recurrent laryngeal nerve to be compressed?

    <p>Enlarging tumor or organ in the mediastinum</p> Signup and view all the answers

    What bounds the inferior mediastinum in front?

    <p>Body of the sternum</p> Signup and view all the answers

    What is the effect of an enlarging tumor in the mediastinum on the esophagus?

    <p>It causes distension as food boluses pass</p> Signup and view all the answers

    Which of the following structures is associated with the inferior mediastinum?

    <p>Thymus</p> Signup and view all the answers

    How is the mediastinum described in a cadaver?

    <p>Inflexible and fixed</p> Signup and view all the answers

    What typically happens to the mediastinum during a pneumothorax?

    <p>It displaces to the opposite side</p> Signup and view all the answers

    What is a main characteristic of the pleurae surrounding the lungs?

    <p>It is highly mobile in a living person</p> Signup and view all the answers

    Which structure is located at the hilum of each lung?

    <p>Pulmonary veins</p> Signup and view all the answers

    What is the primary function of the pleural membranes surrounding each lung?

    <p>To create independent cavities for each lung</p> Signup and view all the answers

    Which structures are found within the mediastinum?

    <p>Trachea and esophagus</p> Signup and view all the answers

    What separates the anterior mediastinum from the posterior mediastinum?

    <p>Pericardium</p> Signup and view all the answers

    What defines the boundaries of the mediastinum?

    <p>Sternum and pleural cavities</p> Signup and view all the answers

    Which of the following pairs of structures serve as key landmarks at the thoracic cavity?

    <p>T4 intervertebral disc and bifurcation of the trachea</p> Signup and view all the answers

    What additional structures does the inferior mediastinum contain?

    <p>Heart and large blood vessels</p> Signup and view all the answers

    What is the function of the pleural cavities?

    <p>To minimize friction during lung expansion</p> Signup and view all the answers

    How is the inferior mediastinum subdivided?

    <p>Into anterior, middle, and posterior mediastinum</p> Signup and view all the answers

    Which anatomical landmarks are used as references within the thoracic cavity?

    <p>T4 intervertebral disc and left primary bronchus</p> Signup and view all the answers

    What is located between the lungs and the thoracic wall?

    <p>Pleural cavity</p> Signup and view all the answers

    What happens to the costal and diaphragmatic pleurae during expiration?

    <p>They come together again.</p> Signup and view all the answers

    Which nerves are responsible for supplying the visceral pleura?

    <p>Visceral afferent nerves.</p> Signup and view all the answers

    How are the costomediasinal recesses formed?

    <p>By the capillary layer of pleural fluid between the pleurae.</p> Signup and view all the answers

    Which characteristic is true regarding the visceral pleura?

    <p>It is sensitive to stretch.</p> Signup and view all the answers

    What anatomical feature separates the costal and mediastinal pleurae?

    <p>A capillary layer of pleural fluid.</p> Signup and view all the answers

    What role do the lower intercostal nerves play?

    <p>They supply the periphery of the diaphragmatic pleura.</p> Signup and view all the answers

    Which nerves accompany the visceral afferent nerves from the pulmonary plexus?

    <p>Autonomic nerves.</p> Signup and view all the answers

    Where are the pleural recesses primarily located?

    <p>Along the anterior margins of the pleura.</p> Signup and view all the answers

    What type of fluid is present in the pleural cavity and serves to reduce friction?

    <p>Serous fluid.</p> Signup and view all the answers

    What happens to the lungs and pleura during the act of inspiration?

    <p>Both lungs and pleurae expand simultaneously.</p> Signup and view all the answers

    Which structure is found posterior to the left recurrent laryngeal nerve?

    <p>Esophagus</p> Signup and view all the answers

    Which arteries are associated with the left side of the thoracic cavity?

    <p>Left common carotid and left subclavian arteries</p> Signup and view all the answers

    What is the orientation of the right main bronchus compared to the left main bronchus?

    <p>Wider and a more direct continuation of the trachea</p> Signup and view all the answers

    Which nerve is positioned alongside the azygos vein on the right side of the thoracic cavity?

    <p>Right vagus nerve</p> Signup and view all the answers

    What structure is commonly dissected to reveal the bronchi within the lung tissue?

    <p>Trachea</p> Signup and view all the answers

    What separates the mediastinum from the pleural cavities?

    <p>The pleural membranes</p> Signup and view all the answers

    Which structure is located posteriorly to the mediastinum?

    <p>The vertebral column</p> Signup and view all the answers

    The pleural cavities are formed by what type of membranes?

    <p>Serous membranes</p> Signup and view all the answers

    What contents are found in the superior mediastinum?

    <p>Thymus and large blood vessels</p> Signup and view all the answers

    Which anatomical landmark marks the bifurcation of the trachea?

    <p>T4 vertebra</p> Signup and view all the answers

    Which area is located between the pericardium and the sternum within the mediastinum?

    <p>Anterior mediastinum</p> Signup and view all the answers

    What does the mediastinum contain?

    <p>Thymus, heart, and trachea</p> Signup and view all the answers

    Which of the following statements best describes the inferior mediastinum?

    <p>It is subdivided into anterior, middle, and posterior mediastinum.</p> Signup and view all the answers

    What is the primary function of the visceral pleura?

    <p>To facilitate movement of the lungs during respiration</p> Signup and view all the answers

    Which structure is appropriately described as surrounding the hills of each lung?

    <p>Pulmonary ligament</p> Signup and view all the answers

    How is the term 'pleural space' defined in modern clinical usage?

    <p>It indicates a potential space only under abnormal conditions</p> Signup and view all the answers

    What significant change occurs during deep inspiration with respect to the pleura?

    <p>The costal and diaphragmatic pleurae become further separated</p> Signup and view all the answers

    What is the primary difference between the parietal and visceral pleura?

    <p>The parietal pleura is thicker than the visceral pleura</p> Signup and view all the answers

    What distinctive feature is associated with the cervical pleura?

    <p>It extends beyond the clavicle</p> Signup and view all the answers

    Under normal conditions, what is the state of the pleural cavity?

    <p>It remains as a potential space</p> Signup and view all the answers

    What causes the pleura to separate during deep inhalation?

    <p>Lung expansion, causing downward movement</p> Signup and view all the answers

    Which of the following best describes the function of the costal pleura?

    <p>To line the inner surfaces of the ribs and intercostal spaces</p> Signup and view all the answers

    What anatomical feature is associated with the lower border of the lung?

    <p>It is continuous with the diaphragm's surface</p> Signup and view all the answers

    What is the primary purpose of the costodiaphragmatic recesses?

    <p>To facilitate lung expansion during deep inspiration</p> Signup and view all the answers

    Which nerves are responsible for supplying the parietal pleura?

    <p>Intercostal nerves</p> Signup and view all the answers

    How does the pleural cavity status change during quiet inspiration?

    <p>Lungs do not fully occupy the pleural cavity</p> Signup and view all the answers

    What is the anatomical relationship between the visceral and parietal pleura at the hilum of the lung?

    <p>They become continuous</p> Signup and view all the answers

    What types of sensations are transmitted by the somatic afferent nerves to the parietal pleura?

    <p>Pain, temperature, touch, and pressure</p> Signup and view all the answers

    During expiration, how do the anterior borders of the lungs behave?

    <p>They slide out of the recesses</p> Signup and view all the answers

    What is a key characteristic of the parietal pleura?

    <p>It is thicker than the visceral pleura</p> Signup and view all the answers

    What is the composition of the fluid found between the pleural layers?

    <p>A capillary layer and serous fluid</p> Signup and view all the answers

    Which of the following best describes the nerve supply to the mediastinal pleura?

    <p>The phrenic nerve supplies the mediastinal pleura</p> Signup and view all the answers

    What function does the costodiaphragmatic recess serve during respiration?

    <p>It allows for expansion and contraction of lungs</p> Signup and view all the answers

    What anatomical landmark does the bifurcation of the trachea correspond to during expiration?

    <p>Fifth thoracic vertebra</p> Signup and view all the answers

    Which of the following accurately describes the tracheal rings?

    <p>Supported by hyaline cartilage</p> Signup and view all the answers

    During deep inspiration, where does the trachea typically lower to?

    <p>Sixth thoracic vertebra</p> Signup and view all the answers

    What connects the posterior part of the trachea?

    <p>Smooth muscle</p> Signup and view all the answers

    Which artery is NOT mentioned as being anterior to the trachea?

    <p>Pulmonary artery</p> Signup and view all the answers

    What anatomical feature is highlighted at the bifurcation of the trachea?

    <p>Formation of the carina</p> Signup and view all the answers

    Why does the esophagus need to expand into the trachea during swallowing?

    <p>To facilitate food passage</p> Signup and view all the answers

    How long is the trachea in adults?

    <p>11.25 cm</p> Signup and view all the answers

    What facilitates the rise of the bifurcation of the trachea during respiratory movements?

    <p>Changes in intrathoracic pressure</p> Signup and view all the answers

    What is the diameter of the trachea in adults?

    <p>2.5 cm</p> Signup and view all the answers

    Which of the following structures is primarily responsible for the blood supply to the lungs?

    <p>Bronchial arteries</p> Signup and view all the answers

    What is the primary role of the fibrous pericardium?

    <p>Prevents over-expansion of the heart</p> Signup and view all the answers

    Which nerves are primarily responsible for increasing heart rate during periods of stress?

    <p>Sympathetic trunks</p> Signup and view all the answers

    What type of fluid is found in the pleural cavity under normal conditions?

    <p>Serous fluid</p> Signup and view all the answers

    Which structural feature of the trachea is notable at its bifurcation?

    <p>Division into primary bronchi</p> Signup and view all the answers

    The thoracic duct primarily drains lymph from which areas of the body?

    <p>Lower extremities</p> Signup and view all the answers

    What anatomical feature is responsible for the separation of the costal and mediastinal pleurae?

    <p>Pleural recesses</p> Signup and view all the answers

    What artery primarily supplies the lower third of the trachea?

    <p>Bronchial artery</p> Signup and view all the answers

    Which bronchus is more direct in continuation from the trachea?

    <p>Right main bronchus</p> Signup and view all the answers

    Which of the following correctly describes the structure responsible for heart nerve supply?

    <p>Autonomic nerve fibers</p> Signup and view all the answers

    Where do the principal bronchi primarily drain lymph?

    <p>Pretracheal lymph nodes</p> Signup and view all the answers

    What structures arise from the walls of the alveolar sacs?

    <p>Alveoli</p> Signup and view all the answers

    Which factor differentiates the right principal bronchus from the left?

    <p>Width</p> Signup and view all the answers

    What is the medical term for a collection of pus in the pleural cavity?

    <p>Empyema</p> Signup and view all the answers

    Which structure does the trachea directly connect to at its upper end?

    <p>Larynx</p> Signup and view all the answers

    During a hemopneumothorax, which of the following occurs in relation to the mediastinum?

    <p>It displaces to the side of the affected lung.</p> Signup and view all the answers

    What is the function of the bronchi in the respiratory tract?

    <p>Transporting air to the alveoli</p> Signup and view all the answers

    Which type of fluid in the pleural cavity is specifically referred to as serous fluid?

    <p>Transudate</p> Signup and view all the answers

    Which anatomical structure is located at the bifurcation of the trachea?

    <p>Carina</p> Signup and view all the answers

    What is the impact of excess serous fluid in the pleural cavity on lung function?

    <p>Compresses the lung</p> Signup and view all the answers

    Where does the trachea end as it branches into the lungs?

    <p>At the main bronchi</p> Signup and view all the answers

    What can be heard during auscultation over a compressed lung?

    <p>Faint breath sounds</p> Signup and view all the answers

    What is primarily indicated by the presence of fluid in the pleural cavity?

    <p>Possible infection or injury</p> Signup and view all the answers

    What is the normal volume of pleural fluid contained in the pleural cavity?

    <p>5 to 10 mL</p> Signup and view all the answers

    What condition results from the accumulation of fluid in the pleural cavity?

    <p>Pleural effusion</p> Signup and view all the answers

    Which of the following describes a pleural rub during auscultation?

    <p>A rough sound caused by inflamed pleura rubbing</p> Signup and view all the answers

    What is the most common cause of pleurisy?

    <p>Inflation of the lung</p> Signup and view all the answers

    Which condition may result from impaired drainage of pleural fluid?

    <p>Pleural effusion</p> Signup and view all the answers

    How much pleural fluid is typically needed for clinical detection of an effusion?

    <p>300 mL</p> Signup and view all the answers

    Which of the following describes the term 'artificial pneumothorax'?

    <p>Purposeful injection of air to collapse a lung</p> Signup and view all the answers

    What is a common clinical sign of a pleural effusion?

    <p>Dullness on percussion over the effusion</p> Signup and view all the answers

    What is the role of hydrostatic and osmotic pressures in pleural fluid formation?

    <p>They stimulate the formation of pleural fluid.</p> Signup and view all the answers

    What can cause roughening of the pleural surfaces?

    <p>Fibroblast invasion of inflammatory exudate</p> Signup and view all the answers

    What anatomical feature permits the esophagus to expand into the trachea during swallowing?

    <p>Posterior discontinuity</p> Signup and view all the answers

    During deep inspiration, how far can the bifurcation of the trachea lower?

    <p>Sixth thoracic vertebra</p> Signup and view all the answers

    What is the average length of the trachea in adults?

    <p>11.25 cm</p> Signup and view all the answers

    Which of the following is not found anteriorly to the trachea?

    <p>Rib cage</p> Signup and view all the answers

    What characteristic distinguishes the right principal bronchus from the left?

    <p>It is wider and a more direct continuation of the trachea.</p> Signup and view all the answers

    What type of muscle connects the posterior aspect of the trachea?

    <p>Smooth muscle</p> Signup and view all the answers

    During expiration, how does the position of the bifurcation of the trachea change?

    <p>It rises by about one vertebral level.</p> Signup and view all the answers

    Which structure supports and maintains the patency of the trachea?

    <p>Tracheal rings</p> Signup and view all the answers

    Which vessel is located anterior to the trachea?

    <p>Brachiocephalic vein</p> Signup and view all the answers

    What is the diameter of the trachea in adults?

    <p>2.5 cm</p> Signup and view all the answers

    Study Notes

    Pleurae

    • The pleurae are membranes lining the thoracic cavity and the lungs.
    • Parietal Pleura lines the thoracic cavity and comes in three parts:
      • Costal Pleura lines the ribs
      • Diaphragmatic Pleura lines the diaphragm
      • Mediastinal Pleura lines the mediastinum
    • Visceral Pleura surrounds the lungs as a continuous layer with the parietal pleura.
    • Between the visceral and parietal pleurae, there's a potential space called Pleural Cavity.
    • The pleural cavity is a potential space where fluid fills for lubrication.
    • The parietal pleura is sensitive to pain, pressure, touch, and temperature, as it's supplied by somatic nerves.
    • The visceral pleura is insensitive to pain, touch, and pressure, but sensitive to stretch as it's supplied by visceral nerves.
    • The parietal pleura is supplied by intercostal, phrenic, and lower intercostal nerves.
    • The visceral pleura is supplied by afferent nerves that run with autonomic nerves.

    Costomediastinal Recesses

    • Costomediastinal Recesses are slit-like spaces between the costal pleura and mediastinal pleura.
    • These spaces are filled with pleural fluid and allow for lung expansion during inspiration.

    Costodiaphragmatic Recesses

    • Costodiaphragmatic Recesses are located between the costal pleura and diaphragmatic pleura.
    • During inspiration, the lungs descend into the recesses.
    • During expiration, the lungs ascend, bringing the costal and diaphragmatic pleura together.

    Trachea

    • The trachea is a mobile, cartilaginous, and membranous tube.
    • It connects the larynx to the bronchi.
    • It begins at the lower border of the cricoid cartilage at the level of the sixth cervical vertebra.
    • It runs through the superior mediastinum in the midline of the neck and thorax.
    • It ends by dividing into right and left principal bronchi at the level of the sternal angle (T4).
    • Cartilaginous rings support the trachea and prevent its collapse.

    Bronchial Tree

    • The bronchial tree is a branching system that begins with the two principal bronchi.
    • Each principal bronchus enters a lung.
    • The right principal bronchus is shorter, wider, and more vertical than the left, making it more vulnerable to aspiration.

    Lungs

    • The right lung has three lobes—superior, middle, and inferior—separated by fissures.
    • The left lung has two lobes—superior and inferior—separated by a fissure.
    • The lungs are supplied by bronchial arteries and veins.
    • The lungs are drained by lymphatic vessels.
    • The lungs are innervated by the vagus nerve and sympathetic trunk.

    Anatomy of the Lungs

    • The lungs are cone-shaped, and their bases rest on the diaphragm.
    • The apices extend slightly above the clavicles.
    • The lungs are divided into lobes: the right lung has three lobes, and the left has two.
    • Each lobe is further subdivided into bronchopulmonary segments.

    Mechanics of Respiration

    • The muscles of respiration, such as the diaphragm and intercostals, play a crucial role in ventilation.
    • During inspiration, the diaphragm contracts, flattening and increasing the vertical dimension of the thoracic cavity.
    • The external intercostal muscles contract, lifting the ribs and increasing the anteroposterior dimension of the thoracic cavity.
    • This increase in volume reduces pressure within the thoracic cavity, drawing air into the lungs.
    • During expiration, the diaphragm and external intercostal muscles relax, returning the thoracic cavity to its original size.
    • This increase in pressure forces air out of the lungs.

    Pleural Effusion

    • Pleural Effusion is a buildup of fluid in the pleural space.
    • The fluid can be serous, blood, or pus.
    • This can lead to lung compression and difficulty breathing.
    • Needle Thoracostomy can remove fluid from the pleural space.

    Empyema

    • Empyema is a pus collection in the pleural space.
    • It commonly follows pneumonia or lung abscesses.
    • It can lead to lung compression and difficulty breathing.

    Hemopneumothorax

    • Hemopneumothorax is a combination of blood and air in the pleural cavity.
    • It results from trauma to the chest wall, blood vessels, or lung.
    • It can lead to lung collapse.

    Anatomy of the Thorax

    • The thoracic cavity is divided into the right and left pleural cavities and the mediastinum.
    • Visceral pleura covers the lungs.
    • Parietal pleura lines the thoracic wall, the diaphragm, and the mediastinum.
    • The space between the pleural membranes, pleural cavity, has a thin layer of serous fluid.

    Anatomy of the Mediastinum

    • The mediastinum is the central compartment of the thorax located between the lungs.
    • It is subdivided into three compartments: superior, middle, and inferior.
    • The major mediastinal structures are arranged from anterior to posterior.

    Lung Development

    • The lungs develop from lung buds that invaginate the wall of the coelomic cavity.
    • The lung buds grow to fill the coelomic cavity.
    • The coelomic cavity is reduced to a slitlike space called the pleural cavity.

    Lung Function

    • During inspiration, the lower margins of the lungs descend.
    • During expiration, the lower margins of the lungs ascend, bringing the costal and diaphragmatic pleurae together.
    • The costomediastinal recesses are slitlike spaces between the costal and mediastinal parietal pleurae.
    • The visceral pleura is sensitive to stretch, but insensitive to pain and touch.

    Anatomy of the Trachea

    • The trachea is a mobile cartilaginous and membranous tube.
    • It begins in the neck at the level of the sixth cervical vertebra.
    • It descends through the superior mediastinum and bifurcates into the right and left principal bronchi at the level of the fourth thoracic vertebra.

    Anatomy of the Bronchi

    • The right principal bronchus is wider, shorter, and more vertical than the left principal bronchus.
    • The bronchi divide dichotomously until they form terminal bronchioles.
    • The terminal bronchioles further divide into respiratory bronchioles which lead to alveolar ducts.

    Blood Supply to the Trachea and Bronchi

    • The inferior thyroid arteries (branches of the subclavian arteries) supply the upper two-thirds of the trachea.
    • The bronchial arteries (branches of the thoracic aorta) supply the lower third of the trachea and the bronchi.

    Lymph Drainage

    • Lymph from the trachea drains into the pretracheal, paratracheal, and deep cervical lymph nodes.

    Nerve Supply

    • The vagus and recurrent laryngeal nerves innervate the trachea.

    Pleural Effusion

    • Pleural effusion is the presence of excess serous fluid in the pleural cavity.
    • Hemopneumothorax is bleeding and air in the pleural cavity.
    • Empyema is a collection of pus in the pleural cavity.

    Bronchopulmonary Segments

    • Bronchopulmonary segments are sections of lung tissue that are supplied by a specific segmental bronchus and branch of the pulmonary artery.
    • These segments are surgically resectable.

    Chest Pain Examination

    • A 54-year-old woman presented with sudden, severe chest pain radiating to her back.
    • The pain was described as knife-like and excruciating.
    • The patient did not experience pain down her arms or neck.
    • Her blood pressure was significantly higher in her right arm (200/110 mmHg) compared to her left arm (120/80 mmHg).
    • The differential diagnosis included aortic dissection, a serious condition where the aorta tears.
    • Myocardial infarction (heart attack) can also cause referred pain, but the patient's lack of arm or neck pain made this less likely.

    Anatomy of the Thorax

    • The mediastinum is the central compartment of the chest, located between the two pleural cavities (containing the lungs) and vertebral column.
    • The mediastinum includes vital structures like the heart, great blood vessels, trachea, esophagus, and nerves.
    • The mediastinum is further divided into three sections - superior, anterior, and posterior.

    • The inferior mediastinum can be further subdivided into middle, anterior, and posterior compartments.
    • The pleura is a thin membrane that lines the lungs and thoracic wall, forming two independent sacs called the pleural cavities.
    • The arrangement of the pleura forms two independent membranous sacs, one on each side of the thorax.


    Mediastinal Tumors

    • The mediastinum is a tight space with many vital structures, so tumors or cysts can compress and impede their function.
    • A left lung tumor can spread to the mediastinal lymph nodes, which, if enlarged, might press on the left recurrent laryngeal nerve, causing vocal cord paralysis.

    Mediastinal Deflection

    • The position of the mediastinum can shift depending on the pressure within the pleural cavities.
    • In pneumothorax (air in the pleural cavity), the lung on that side collapses, and the mediastinum shifts to the opposite side.
    • The mediastinum moves rhythmically during breathing due to the pulsation of the heart, lungs, and large arteries.
    • The esophagus expands during swallowing to accommodate food boluses.

    Trachea

    • The trachea is a tube that carries air to the lungs.
    • In adults, the trachea is about 4 1/2 inches long and 1 inch in diameter.
    • The trachea is supported by C-shaped hyaline cartilage rings.
    • The trachealis muscle connects the posterior aspect of the cartilage rings.
    • The trachea bifurcates into the right and left main bronchi at the level of the sternal angle (T4-T5 vertebral disc).
    • The trachea is positioned close to various structures in the neck and superior mediastinum, including the sternum, thymus, large veins, large arteries, and the arch of the aorta.

    Pleura

    • The visceral pleura covers the lungs, while the parietal pleura lines the thoracic wall.
    • The costomediastinal recesses are slit-like spaces between the costal and mediastinal parietal pleurae, separated by a thin layer of pleural fluid.
    • The visceral pleura is sensitive to stretch but insensitive to pain and touch.

    Blood Pressure Discrepancy

    • The patient's lower blood pressure reading in the left arm was likely due to a partial blockage of the left subclavian artery by the aortic dissection.
    • The left subclavian artery arises from the aortic arch, just above the beginning of the descending thoracic aorta.

    T4 Vertebra

    • The level of the T4 vertebra is a significant landmark in the thorax, marking several key structures.
    • Structures at the T4 level:
      • Joint between the manubrium and body of the sternum.
      • Second costosternal joint.
      • Demarcation between the ascending aorta and the aortic arch.
      • Demarcation between the aortic arch and the descending thoracic aorta.
      • Bifurcation of the trachea.
      • Level of the left primary bronchus
      • T4 intervertebral disc.

    The Pleura

    • Covers each lung and the inner surface of the thoracic wall
    • Forms two independent membranous sacs called the pleural cavities
    • Each pleural cavity is a potential space located between the lungs and the thoracic walls.

    The Mediastinum

    • The area between the sternum, the two pleural cavities, and the vertebral column
    • Extends superiorly to the thoracic outlet and the root of the neck, and inferiorly to the diaphragm
    • Extends anteriorly to the sternum and posteriorly to the vertebral column
    • Contains the thymus, heart and large blood vessels, trachea and esophagus, thoracic duct and lymph nodes, vagus and phrenic nerves, and sympathetic trunks.

    Pleural Layers

    • Visceral Pleura: Outer surface of the lung, extends into the interlobar fissures.
    • Parietal Pleura: Lines the inside of the thoracic wall, covers the thoracic surface of the diaphragm and the lateral aspect of the mediastinum
    • The two layers are continuous with one another via a cuff of pleura that surrounds the structures entering and leaving the lung at the hilum of each lung.

    Pleural Cavities

    • Space between the parietal and visceral layers of pleura.
    • Normally a potential space filled with a thin layer of fluid.

    Divisions of Parietal Pleura

    • Cervical pleura: Extends up into the neck, lining the undersurface of the suprapleural membrane.
    • Costal pleura: Lines the inner surfaces of the ribs, costal cartilages, intercostal spaces, sides of the vertebral bodies, & the back of the sternum.
    • Diaphragmatic pleura: Covers the thoracic surface of the diaphragm.

    Costal and Diaphragmatic Pleura

    • They are in apposition to each other below the lower border of the lung during quiet respiration.
    • They separate during deep inspiration as the margins of the base of the lung descend.

    Costodiaphragmatic Recess

    • Lower area of the pleural cavity into which the lung expands on inspiration.

    Mediastinal Pleura

    • Covers and forms the lateral boundary of the mediastinum.
    • Continuous with the visceral pleura around the vessels and bronchi at the hilum of the lung.

    Movements of the Lungs

    • During full inspiration, the lungs expand and fill the pleural cavities.
    • During quiet inspiration, the lungs do not fully occupy the pleural cavities at four sites: the right and left costodiaphragmatic recesses and the right and left costomediastinal recesses.

    Recesses of the Pleural Cavity

    • Costodiaphragmatic Recesses: Slitlike spaces between the costal and diaphragmatic parietal pleurae.
    • Costomediastinal Recesses: Slitlike spaces between the costal and mediastinal parietal pleurae.

    Nerve Supply of the Pleura

    • Parietal Pleura: Supplied by somatic afferent nerves, which are sensitive to pain, temperature, touch, and pressure.
    • Costal Pleura: Supplied by the intercostal nerves segmentally.
    • Mediastinal Pleura: Supplied by the phrenic nerve.
    • Diaphragmatic Pleura: Supplied by the phrenic nerve.

    Trachea

    • A tubular structure composed of U-shaped bars of hyaline cartilage that extend from the larynx to the carina.
    • Extends from the larynx inferiorly to the level of the sternal angle (opposite the disc between the fourth and fifth thoracic vertebrae)
    • The trachealis muscle, a smooth muscle, connects the posterior ends of the cartilaginous rings of the trachea.
    • Bifurcates at approximately the level of the T4 intervertebral disc into right & left main bronchi.

    Relations of the Trachea

    • In the neck, the trachea lies anterior to the esophagus.
    • In the superior mediastinum, the trachea is:
      • Anteriorly: Sternum, thymus, left brachiocephalic vein, origins of the brachiocephalic and left common carotid arteries, and the arch of the aorta.
      • Posteriorly: Esophagus, and the left recurrent laryngeal nerve.
      • Right side: Azygos vein, right vagus nerve, and the pleura.
      • Left side: The arch of the aorta, the left common carotid and left subclavian arteries, the left vagus and left phrenic nerves, and the pleura.

    Bronchi

    • The trachea bifurcates at the carina into the right and left principal bronchi.
    • Right Principal Bronchus: Wider and more direct continuation of the trachea than the left.
    • Left Principal Bronchus: Passes horizontally to the left, below the arch of the aorta, and passes into the root of the left lung.

    Tracheobronchial Tree

    • The trachea bifurcates to give rise to the right & left main bronchi.
    • The right and left main bronchi enter the right and left lungs, respectively.
    • Each main bronchus branches into lobar bronchi (e.g. 3 right lobar bronchi, 2 left lobar bronchi).
    • Lobar bronchi divide into segmental bronchi.
    • Segmental bronchi continue to branch into smaller and smaller bronchi until they reach the smallest air passageways called the bronchioles.

    Pulmonary Arteries

    • From the pulmonary trunk, the right and left pulmonary arteries arise.
    • The pulmonary trunk divides into the right and left pulmonary arteries, with each artery branching into lobes and segments, generally accompanying the bronchi of the lung.

    Pulmonary Veins

    • The pulmonary veins drain deoxygenated blood from the lungs and carry it to the left atrium of the heart.
    • There are two pulmonary veins from each lung: a superior pulmonary vein and inferior pulmonary vein.

    Thoracic Cavity Overview

    • Consists of chest wall, mediastinum, and lungs
    • Serves as a protective chamber for vital organs
    • Crucial for respiratory function

    Osteology

    • Thoracic cage, a bony framework, encases the thoracic cavity
    • Comprises 12 thoracic vertebrae, 12 pairs of ribs, and the sternum
    • Ribs have a costal angle for muscle attachment and articulation

    Thoracic Wall

    • Formed by the thoracic cage, muscles, and skin
    • Facilitates breathing with its ability to expand and contract

    Mediastinum

    • Centrally located within the thoracic cavity
    • Houses heart, great vessels, trachea, esophagus, thymus, and lymphatic structures

    Pleurae

    • Serous membrane that lines the thoracic cavity
    • Consists of two layers: parietal pleura lining the cavity and visceral pleura covering the lungs
    • Pleural cavity, the space between these layers, contains a thin film of lubricating fluid

    Lower Respiratory Tract

    • Includes trachea, bronchi, and bronchioles, responsible for air transport to the lungs
    • Trachea:
      • Cartilaginous and membranous tube connecting the larynx to the bronchi
      • Supported by C-shaped hyaline cartilage rings, allowing for expansion during swallowing
      • Located in the midline of the neck and descends through the superior mediastinum
    • Bronchi:
      • Bifurcate from the trachea at the level of the sternal angle (T4-T5)
      • Right principal bronchus: wider, shorter, and more vertical than the left
      • Left principal bronchus: narrower, longer, and more horizontal

    Lungs

    • Two cone-shaped organs, located in the thoracic cavity, separated by the mediastinum
    • Right lung: 3 lobes, lobes divided by fissures
    • Left lung: 2 lobes, smaller to accommodate the heart
    • Bronchopulmonary segments: functional units of the lung, each supplied by a tertiary bronchus and a pulmonary artery

    Pericardium

    • Fibrous sac that encases the heart, providing protection and support
    • Consists of two layers: fibrous pericardium (outermost layer) and serous pericardium (innermost layer)
    • Serous pericardium:
      • Parietal layer: lines the fibrous pericardium
      • Visceral layer: adheres to the heart surface
      • Pericardial cavity: space between the parietal and visceral layers, containing pericardial fluid for lubrication

    Heart

    • Four-chambered organ, located in the mediastinum
    • Responsible for circulation and oxygenation of the blood

    Large Thoracic Arteries

    • Aorta, carrying oxygenated blood from the left ventricle
    • Pulmonary trunk, carrying deoxygenated blood from the right ventricle

    Large Thoracic Veins

    • Superior vena cava: drains deoxygenated blood from the head, neck, upper limbs, and thorax
    • Inferior vena cava: drains deoxygenated blood from the lower limbs, abdomen, and pelvis
    • Pulmonary veins: carry oxygenated bood from the lungs to the left atrium

    Thymus

    • Located in the superior mediastinum, crucial for T-cell development during childhood
    • Slowly regresses with age

    Esophagus

    • Muscular tube, connecting the pharynx to the stomach
    • Descends through the posterior mediastinum, located in the thoracic cavity
    • Its expansion into the trachea is facilitated by the posterior discontinuity of the tracheal rings during swallowing

    Thoracic Duct

    • Largest lymphatic vessel, draining lymph from the left side of the body
    • Empties into the left subclavian vien

    Right Lymphatic Duct

    • Smaller lymphatic vessel, draining lymph from the right side of the body
    • Empties into the right subclavian vein

    Thoracic Nerves

    • Phrenic nerves (C3-C5): innervate the diaphragm, crucial for breathing
    • Vagus nerves (cranial nerve X): carry parasympathetic fibers to the heart and lungs
    • Sympathetic trunks: sympathetic innervation to the heart and lungs, regulate heart rate and breathing

    Mechanics Of Respiration

    • Inhalation: air drawn into the lungs, diaphragm contracts and descends, intercostal muscles elevate the ribs
    • Exhalation: air expelled from the lungs, diaphragm relaxes and ascends, intercostal muscles depress the ribs
    • Breathing is controlled by the medulla oblongata in the brainstem

    Clinical Significance

    • Pleurisy (inflammation of the pleura): often caused by pneumonia, chest pain, and friction rub on auscultation
    • Pneumothorax (air in the pleural cavity): can be caused by trauma or disease, resulting in collapsed lung
    • Pleural effusion (fluid in the pleural cavity): caused by various conditions, manifested by decreased breath sounds and dullness on percussion

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    Test your knowledge on the anatomy and functions of the pleurae. This quiz covers key aspects such as the differences between parietal and visceral pleura, their innervation, and the significance of the pleural cavity. Perfect for students of anatomy and physiology!

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