Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Anatomy Course > 10. Breathing and Respiratory Tract > Flashcards

10. Breathing and Respiratory Tract Flashcards

1
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the three diameters of the ribcage.

A
  • Anteroposterior diameter:
    • Extends between the manubrium and the vertebral column.
  • Transverse diameter:
    • Extends between the lateral-most parts of the ribs.
  • Vertical diameter:
    • Extends from the suprapleural membrane superiorly to the diaphragm inferiorly.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the movements of the ribcage during respiration.

A
  • Lower 6 ribs:
    • “Bucket-handle” movement
    • Increase the transverse diameter of ribcage
  • Upper 6 ribs:
    • “Pump-handle” movement
    • Increase the anteroposterior and transverse diameters (slightly)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What increases the vertical diameter of the ribcage during respiration?

A

Diaphragm, innervated by the phrenic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the innervation of the diaphragm.

A
  • Motor supply = Right and left phrenic nerves (C3-C5).
  • Sensory to central diaphragm = Phrenic nerves.
  • Sensory to peripheral diaphragm = Intercostal nerves.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Summarise the apertures of the diaphragm.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Summarise the different intercostal muscles.

A
  • External intercostal muscles (most superficial):
    • Run inferomedially from the rib above to the rib below.
    • Most active during inspiration.
  • Internal intercostal muscles (middle):
    • Fibres run inferolaterally from the rib above to the rib below.
    • Most active during expiration.
  • Innermost intercostal muscles (deepest):
    • Similar to the internal intercostal muscles, but separated from middle layer by the intercostal nerves and vessels.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the accessory muscles of respiration?

A
  • Sternocleidomastoid -> Elevates the thoracic cage, promoting inhalation.
  • Scalene muscles -> Elevates the thoracic cage, promoting inhalation.
  • Abdominal wall muscles -> Reduce volume of thoracic cavity, promoting exhalation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the position of the intercostal neurovascular bundle.

A

Between the internal and innermost layers of the intercostal muscles, running along the costal groove of the superior rib of each space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe what makes up each intercostal neurovascular bundle.

A

From superior to inferior:

  • Intercostal vein
  • Intercostal artery -> Either posterior (from thoracic aorta) or anterior (from internal thoracic artery)
  • Intercostal nerve -> The ventral primary rami of spinal nerves T1 through T11.

Remember the order “VAN”.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What intercostal nerve root innervates the sternal angle and xiphisternum?

A
  • Sternal angle = T2
  • Xiphisternum = T6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where should chest drains be inserted relative to the ribs?

A

Whenever inserting a needle into the intercostal space, it is important to appreciate the anatomy. Needles should always be inserted immediately above the inferior rib of a space, in order to avoid damage to the neurovascular bundle within the costal groove of the superior rib. Damage to the intercostal artery can cause significant haemorrhage, whilst damage to the intercostal nerve can cause intercostal muscle paralysis and chest wall paraesthesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the lymphatic drainage of the chest wall and breast.

A
  • The parasternal lymph nodes, located along the course of the internal thoracic artery, drain lymph from the medial part of the breast tissue, intercostal spaces and diaphragm.
  • These nodes drain into the junction of the internal jugular and subclavian veins.
  • Lymph from the more lateral parts of breast tissue (75% of total) drain to the anterior axillary and pectoral groups of lymph nodes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does the thoracic skeleton consist of?

A
  • 12 pairs of ribs and costal cartilages
  • 12 thoracic vertebrae
  • Sternum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the articulations of the ribs.

A

Articulations with sternum:

  • 1st-7th ribs attach directly to the sternum via costal cartilages.
  • 8th-10th rib costal cartilages are connected to the cartilage of the rib above them, so connect to the sternum indirectly.
  • 11th and 12th ribs do not connect to the sternum, and are thus referred to as “floating”.

Articulations with vertebrae:

  • All other ribs articulate with two vertebrae (at the costal hemifacets) by way of two facets on their head.
  • Ribs also articulate with vertebrae via the articular part of the tubercle, which forms a separate joint with the vertebral transverse process.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Draw the structure of an average rib.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which rib is unusual and why?

A

1st rib:

  • The broadest, shortest and most curved rib
  • The superior surface is indented by two grooves for the subclavian vessels to pass along. The grooves are separated by the scalene tubercle, into which the anterior scalene muscle inserts.
  • The 1st rib also only articulates with one vertebra (T1).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Draw the components of the sternum.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

At what height is the sternal angle?

A

T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe rib fractures.

A
  • Due to its protected position, the first rib is rarely fractured.
  • Rib fractures usually result from blunt trauma to the chest.
  • Broken parts of the rib may cause damage to internal organs, such as the lung and spleen.
  • Fractures are suspected in patients who report chest wall pain during heavy breathing, coughing and sneezing.
  • Multiple simultaneous fractures of neighbouring ribs may create a free island of rib fragments, which moves freely to the rest of the wall.
  • This segment moves paradoxically (inward on inspiration outward on expiration) and may interfere with ventilation and cause lung contusions.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the two pleura of the lungs?

A
  • Parietal pleura (outer)
  • Visceral pleura (inner)

This can seem like the wrong way round, since the pleura are invaginated during development.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What innervates each of the lung pleura?

A
  • Parietal pleura -> Innervated by the intercostal nerves and phrenic nerves, meaning this layer is sensitive to pressure, pain and temperature.
  • Visceral pleura -> Innervated by the autonomic fibres of the pulmonary plexus, and is sensitive to stretch, but not pain, temperature or touch.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is found between the two layers of pleura in the lungs?

A

Pleural cavity, which normally contains a small amount of serous fluid, allowing friction-free movement of the layers over each other.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is pneumothorax? What are the different types?

A
  • Presence of gas within the pleural cavity, which results in a loss of surface tension and hence collapse of the lung on the affected side.
  • Simple pneumothorax -> Non-expanding collection of air within the pleural space.
  • Tension pneumothorax -> Results from the formation of a one-way valve within the lung tissue, allowing gas to escape from the lung into the pleural cavity but preventing it from returning back into the lung. This causes air to progressively accumulate, which becomes a medical emergency.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does tension pneumothorax present on an X-ray?

A

Mediastinal shift -> Trachea and apex beat of the heart are both shifted away from the affected side.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is a pleural effusion?

A
  • A significant increase in the volume of fluid in the pleural cavity.
  • The fluid may cause shortness of breath, cough and pleuritic chest pain.
  • There are a range of causes, including pulmonary (such as pneumonia, lung cancer), pleural (such as mesothelioma) and extra-pulmonary (such as heart failure, cirrhosis) causes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the clinical signs of pleural effusion on auscultation, percussion and radiography?

A
  • Auscultation -> Breath sounds are diminished or absent over pleural effusions.
  • Percussion -> Dull on percussion.
  • Radiography -> Blunting of the costophrenic angle on a chest X-ray if small, and a fluid level with a meniscus obliterating the lung markings if larger.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the costo-phrenic angle? What are some other names?

A
  • A potential space in the pleural cavity at the point where the diaphragm meets the ribs
  • Also called the costo-diaphragmatic recess and costo-phrenic recess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the supra-pleural membrane?

A

A dense fascial layer that is attached to the inner border of the first rib and costal cartilage anteriorly, C7 transverse process posteriorly and to the mediastinal pleura medially.

31
Q

Describe the position of the beginning of the trachea.

A

The lower border of the cricoid cartilage, inferior to the thyroid cartilage within the neck.

32
Q

At what level does the trachea bifurcate?

A

T4 (the sternal angle)

33
Q

What supports the trachea and main bronchi?

A

Rigid, C-shaped cartilage rings

34
Q

Compare the right and left main bronchi.

A
  • The right main bronchus is wider and more vertical than the left main bronchus.
  • This means that if a foreign body is inadvertently inhaled (“aspirated”) into the lungs, it is more likely to lodge in the right lung.
35
Q

Describe when the right and left main bronchi divide further.

A
  • The right main bronchus produces a superior lobar bronchus before entering the right lung at the hilum.
  • When within the lung tissue, the left and right bronchi undergo further branching to produce lobar bronchi, each of which supply a lung lobe.
  • These lobar bronchi then divide into smaller segmental bronchi.
36
Q

Describe the cartilage in segmental bronchi and bronchioles.

A
  • The segmental bronchi contain irregular islands of cartilage.
  • The loss of cartilage in the walls marks the transition from bronchi to bronchioles.
37
Q

How many lobes does the right lung have and what are they called?

A

3 lobes:

  • Upper lobe
  • Middle lobe
  • Lower lobe
38
Q

How many lobes does the left lung have and what are they called?

A

2 lobes:

  • Upper lobe
  • Lower lobe
39
Q

What are the different fissures of the two lungs?

A

Right lung:

  • Horizontal fissure
  • Oblique fissure

Left lung:

  • Oblique fissure
40
Q

What is the apex of the lungs?

A

The most superior point on each lung.

41
Q

What are lung segments?

A
  • Each lung lobe can be subdivided into bronchopulmonary segments, each of which are supplied by a segmental bronchus.
  • Segments are pyramidal in shape, with their apices facing the root of the lung.
  • Each segment is supplied by its own pulmonary artery and bronchial artery branch.
42
Q

Which bronchopulmonary segment is most inferior when lying down? What is the clinical relevance of this?

A
  • Apical segment of the lower lobe
  • This is important because any fluid will drain there when lying down
43
Q

Where height do the oblique fissures and horizontal fissure run from and to?

A
  • Oblique fissures -> From the spinous process of T3, inferiorly and anteriorly to the level of the 6th costal cartilage
  • Horizontal fissures -> From the oblique fissure in the mid-axillary line to the level of the 4th costal cartilage
44
Q

Draw the surface markings of the lungs.

A

The spec only mentions the surface markings of the apex of the lower lobe, which is just below the oblique fissure.

45
Q

Draw the surface markings of the pleura of the lungs.

A
46
Q

Along the paravertebral line, at what height is the costodiaphragmatic recess?

A

12th rib

47
Q

What blood vessels are involved in supply and drainage of the lungs?

A
  • Pulmonary artery -> Carries de-oxygenated blood from the pulmonary trunk to the lungs for gas exchange.
  • Pulmonary veins -> Variable in number (1-4), responsible for carrying newly oxygenated blood to the left atrium of the heart for systemic circulation.
  • Bronchial arteries ->Arise from the thoracic aorta, passing along the posterior aspect of the main bronchi, to supply the supporting structures of the lung (e.g. bronchi)
48
Q

What do the bronchial arteries originate from?

A

Aorta

Right bronchial artery may also arise from the right third posterior intercostal artery

(CHECK THIS)

49
Q

Describe the lymph drainage of the lungs.

A
  • The lymph from the lung parenchyma drains to the lymph nodes within the lung hila.
  • These nodes subsequently drain to the tracheobronchial nodes, before reaching the venous circulation.
50
Q

How can lung cancers affect venous drainage of the lungs?

A

Diseases of the lungs, including lung cancer and tuberculosis, can cause lymphadenopathy, which may be sufficiently large to cause an obstruction of the bronchus at the hilum and ultimately lobe collapse.

51
Q

What is the innervation of the lungs and airway?

A
  • The lung parenchyma is under autonomic nervous system control, derived from the pulmonary plexus of nerves around the lung hilum.
  • Bronchial smooth muscle contracts and mucous glands secrete under vagal stimulation, whilst other glands and blood vessels are controlled by sympathetic fibres originating from T1-T5 spinal levels.
52
Q

Draw the attachments of the diaphragm.

A
53
Q

On what side is the diaphragm higher up?

A
  • Right side
  • This is due to the liver below it
  • This also means that the lung on the right ends higher up
54
Q

Draw all the openings in the diaphragm.

A
55
Q

What is seen here?

A

Pneumothorax -> The left lung has collapsed.

56
Q

What is this?

A

Bi-hilar lymphadenopathy -> Enlargement of the hilar lymph nodes.

57
Q

What are the roles of the nose?

A
  • Olfaction
  • Warming, cleaning and humidifying air
  • Drainage of lacrimal ducts and para-nasal sinuses
58
Q

Where is the nasal cavity and what is it formed from?

A
  • Passes from the nostrils to the nasopharynx
  • Formed by:
    • Nasal cartilage and bone
    • Cribriform plate of the ethmoid
    • Hard palate
    • Sphenoid bone
    • Alar cartilages.
59
Q

What structures make up the external nose?

A
  • Nasal bones
  • Lateral nasal cartilages
  • Greater alar cartilages
60
Q

What is the nasal septum formed from?

A
  • Perpendicular plate of the ethmoid
  • Vomer
  • Septal cartilage
61
Q

What bone is this? Label it.

A

Ethmoid

62
Q

Draw the position of the ethmoid bone in the skull.

A
63
Q

What are conchae and meati in the nose and what is their role?

A

Conchae:

  • Bony ridges in the nasal passage.
  • Act to increase the surface area of the nasal passages -> For warming, cleaning and humidifying inspired air.

Meati:

  • The spaces created by the conchae through which air can flow.
64
Q

How many conchae and meati are there? What are their names? Draw their positions.

A

3 Conchae:

  • Inferior concha
  • Middle concha
  • Superior concha

4 Meati:

  • Inferior meatus –> Between the inferior concha and floor of the nasal cavity.
  • Middle meatus -> Between the inferior and middle concha.
  • Superior meatus -> Between the middle and superior concha.
  • Spheno-ethmoidal recess -> Superiorly and posteriorly to the superior concha.
65
Q

What bones form each of the 3 conchae in the nasal passage?

A

The middle and upper conchae are part of the ethmoid bone, whilst the inferior concha is a separate bone.

66
Q

What structures drain into each of the meati of the nasal cavity?

A
  • Frontal, maxillary and ethmoidal sinuses -> Middle meatus.
  • Nasolacrimal duct -> Inferior meatus.
  • Eustachian tube [EXTRA] -> Drains into nasopharynx at the level of the inferior meatus.
67
Q

What nerves innervate the nasal cavity?

A
  • Smell -> Olfactory nerve (via cribriform plate)
  • General sensation -> Ophthalmic and maxillary nerves (CN V).
  • Secretomotor to nasal mucous glands and lacrimal glands -> Parasympathetic branches of facial nerve (CN VII)
68
Q

The nasal mucous and lacrimal glands are supplied by the facial nerve (CN VII). What ganglion is this via?

A

Pteryogopalatine

69
Q
A
70
Q

Describe sinusitis and the possible routes of infection.

A
  • Due to the communication between the nasal cavity and para-nasal air sinuses, an upper respiratory tract infection can extend to the mucosa of the sinuses.
  • Additionally, sinusitis may develop if the normal drainage of mucus from the sinuses is disrupted, for example by allergic inflammation.
  • Infection may also originate from the maxillary posterior teeth, which subsequently extends into the maxillary sinus.
  • Inflammation results in pain and swelling within the sinuses. Since the maxillary branch of the trigeminal nerve innervates the maxillary sinus and maxillary teeth, inflammation within the maxillary sinus can present as toothache.
71
Q

What is the relation between the teeth and maxillary antrum?

A
  • There can be spread of infection from the maxillary posterior teeth into the maxillary sinus
  • Since the maxillary branch of the trigeminal nerve innervates the maxillary sinus and maxillary teeth, inflammation within the maxillary sinus can present as toothache.
72
Q

What forms each of the walls of the nasal cavity?

A
  • Roof -> Nasal cartilage and bone, the cribriform plate of the ethmoid, and the sphenoid.
  • Floor -> Upper surface of the hard palate formed from the maxilla and palatine bones.
  • Lateral walls -> Formed anteriorly by alar cartilages around the nostrils and more posteriorly by the medial surface of the maxillary and ethmoid air sinuses and the medial pterygoid plate of the sphenoid.
  • Medial wall -> Ethmoid, vomer and septal cartilage.
73
Q

Describe blood supply to the nose.

A
  • Maxillary artery -> Main supply
  • Ophthalmic artery -> Supply to ethmoid air cells in the upper and anterior part of the nose
  • Facial artery -> Supply the vestibule.
74
Q

What is Little’s area?

A
  • An area of anastamosis of the main arteries supplying the nose.
  • It is found in the cartilaginous part of the nasal septum.
  • It is a common site for nosebleeds.

Clinical Anatomy Course (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions