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1.4 Flashcards

1
Q

Which ribs are the true ribs and why?

A

1-7

Because they attach to the sternum via their own costal cartilage

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2
Q

Which ribs are the false ribs?

A

8-12

Because they attach to sternum via fused costal cartilage of rib 7

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3
Q

Out of the false ribs, which ribs are known as floating ribs?

A

11 and 12 because they do not attach to sterum

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4
Q

Name the 3 parts that make up the sternum.

A

Manubrium
Body
Xiphoid

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5
Q

On CXR, are the posterior or anterior bits of the ribs more horizontal?

A

Posterior

The anterior part looks curved downwards slightly and they aren’t seen as clearly as the back bits

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6
Q

From deep to superficial, list the muscles of the ribs and include where the neurovascular bundle lies.

A 
(parietal pleura)
Innermost intercostals
- Neurovascular bundle
Inner intercostal muscles
External intercostal muscles
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7
Q

Which intercostal muscles are used in expiration?

A

Inner intercostal muscles

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8
Q

Which intercostal muscles are used in inspiration?

A

External intercostal muscles

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9
Q

What movement does the contraction of the 3 different intercostal muscles do?

A

The contraction of the external intercostal muscles causes an elevation of the ribs (inspiratory breathing muscles) whereas both the internal and innermost intercostal muscles lower the ribs (expiratory breathing muscles)

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10
Q

Name the accessory muscles of respiration

A

Sternocleidomastoid
Scalene
Trapezius
Rectus abdominus

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11
Q

Name the primary muscles of respiration

A

Inspiration: external intercostals, diaphragm

Expiration: internal intercostals, intercostalis intimi, subcostals

The muscles of inspiration elevate the ribs and sternum, and the muscles of expiration depress them.

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12
Q

List the accessory muscles of inspiration..

A

Accessory inspiratory muscles:

  • Sternocleidomastoid,
  • Scalenus anterior medius, and posterior
  • Pectoralis major and minor
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13
Q

List the accessory muscles of expiration.

A

Accessory expiratory muscles:

- Abdominal muscles: rectus abdominis (especially), external oblique, internal oblique and transversus abdominis

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14
Q

Innervation of the diaphragm

A

R and L phrenic nerve (C3-5)

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15
Q

Name the structures that pass through the gaps of the diaphragm.

A

T8 = IVC and R phrenic nerve

T10 = Oesophagus and vagus nerves (R+L)

T12 = Aorta, azygous vein and thoracic duct

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16
Q

As you move posteriorly, which direction does the diagram also move?

A

Inferiorly

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17
Q

From top to bottom, how are the structure within the neurovascular bundle of the ribs relative to one another?

A

VAN - from superior to inferior

  • Vein
  • Artery
  • Nerve
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18
Q

Which arteries supply the neurovascular bundle of the ribs?

A

An anastomosis of the anterior and posterior intercostal arteries

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19
Q

Where is the anterior intercostal artery derived from?

A

Internal thoracic artery (from subclavian)

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20
Q

Where is the posterior intercostal artery derived from?

A

Thoracic aorta

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21
Q

Where does the ribcage drain?

A

Drain into azygous and internal thoracic veins

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22
Q

Is the horizontal fissure of the right lung superior or inferior to the oblique fissure?

A

Superior

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23
Q

Which fissure separates the inferior lobe from the superior lobe of the right lung?

A

Oblique fissue

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24
Q

Which fissure separates the inferior lobe from the middle lobe of the right lung?

A

Horizontal fissue

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25
Q

Which fissure separates the superior lobe from the middle lobe of the right lung?

A

Oblique fissue

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26
Q

What happens to the parietal and visceral pleura at the hilum of lungs?

A

They meet

They are continuous with one another with pleural fluid in the potential space between them

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27
Q

Most of the anterior lobe of the chest is formed by which lung lobe?

A

Superior on L side

Superior (majority) and middle on R side

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28
Q

Most of the posterior lobe of the chest is formed by which lung lobe?

A

Inferior lobes

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29
Q

The tracheal bifurcates at which vertebral level?

A

T4/5 (at carina)

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30
Q

Which airway division has the highest density of smooth muscle?

What does this allow?

A

Bronchioles

Therefore allows regulation over airway diameter and resistance

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31
Q

Name given to last part of the conducting system.

A

Terminal bronchioles (gaseous exchange doesn’t happen until the respiratory bronchioles which have thinner walls)

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32
Q

Blood supply to lungs comes from which arteries?

A

Bronchial arteries - supply the conducting airways

Pulmonary arteries have deoxygenated blood going to respiratory zone in lungs for oxygenation and waste gas removal

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33
Q

How does lymph drain in lungs?

A

From plerua to hila then up towards neck

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34
Q

Name the 4 things found at hila

A

Pulmonary veins
Pulmonary artery
Lymphatics
Bronchi

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35
Q

How do the pulmonary artery and bronchi lie relative to one another in general, at the hila?

A

Pul artery superiorly

Bronchi posteriorly

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36
Q

Describe the respiratory epithelium

A

Pseudostratified columnar, ciliated (motile cilia usually which waft stuff up)

With mucus glands formed of goblet cell

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37
Q

How does the respiratory epithelium change in response to smoke?

A

Undergoes metaplasia and becomes squamous epithelium

This can then undergo malignant change and this will lead to squamous cell carcino

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38
Q

Which type pneumocytes are more abundant?

A

Type 1 (not the surfactant secreting type 2)

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39
Q

How are the basement membranes of the type 1 pneumocytes and pulmonary capillary endothelial cells related?

A

The basement membrane of both cell types are fused together to give shortest diffusion barrier possible

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40
Q

Epithelium of nose and nasal septum (upper airways)

A

Initially keratinised then respiratory epithelium

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41
Q

Which bones and cartilage form the septum?

A

The nasal septum is composed of 5 structures:

  • perpendicular plate of ethmoid bone
  • vomer bone
  • septal nasal cartilage
  • crest of the maxillary bone
  • crest of the palatine bone
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42
Q

How many paranasal air sinuses are there?

A

8 in total (4 paired)

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43
Q

Name the air sinuses and state their function

A

Frontal x2

Ethmoidal x2 (more like a bunch of tiny sinuses)

Maxillary x2

Sphenoidal x2

Make skull lighter, vocalisation

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44
Q

Via what do air sinuses drain into nasal meatuses?

A

Ostia

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45
Q

Name the 5 key vessels of the nasal septum.

A 
Anterior ethmoidal arteries
Posterior ethmoidal a.
Sphenopalatine a.
Greater palatine a.
Superior labial a.

They anastomosis at little’s area (Kiesselbach’s plexus)

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46
Q

What is the pharynx above soft palate known as?

  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
A

Nasopharynx

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47
Q

What is the pharynx between soft palate and hyoid bone known as?

  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
A

Oropharynx

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48
Q

What is the pharynx behind the larynx (from epiglottis to C5 (cricoid)) known as?

  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
A

Laryngopharynnx

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49
Q

Sequential nasopharyngeal contraction of the constrictor muscles of the pharynx is important in which reflex?

A

Swallowing - closes soft palate

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50
Q

Which structure joins the nasopharynx to the middle ear?

A

Eustachian tube (aka pharyngotympanic tubule)

51
Q

The pharynx is a key site of lymphatic tissue. Name them.

A 
Pharyngeal tonsils (adenoids)
Palatine tonsils
52
Q

Describe the pharynx gag reflex

A

Stimulated by touching the posterior pharyngeal wall

Sends nerve impulses along CN IX (glossopharyngeal afferents)

Reach brainstem and activate bilateral vagal efferents

Via vagus nerve (CN X) pharyngeal contraction occurs along with elevation of soft palate and uvula

53
Q

List the key structures of the larynx

A
  • Hyoid bone (sesamoid)
  • [Thyrohyoid membrane]
  • Thyroid cartilage (adam’s apple in men)
  • [Cricothyroid membrane]
  • Cricoid cartilage (posterior part wider than anterior part)
  • Arytenoid cartilages (sit on cricoid cartilage)
  • Cuneiform and corniculate cartilages(even smaller than arytenoid)
54
Q

Which sesamoid bone sits superiorly to the thyroid cartilage?

A

Hyoid bone

55
Q

Where does the frontal and maxillary sinuses drain?

a. Middle meatus
b. Sphenoethmoidal recess
c. Superior meatus
d. Inferior meatus

A

Frontal sinuses = middle meatus

Maxillary sinuses = middle meatus, largest sinus

56
Q

Where does the anterior and middle ethmoidal sinuses drain?

a. Middle meatus
b. Sphenoethmoidal recess
c. Superior meatus
d. Inferior meatus

A

Middle meatus

57
Q

Where does the sphenoidal sinuses drain?

a. Middle meatus
b. Sphenoethmoidal recess
c. Superior meatus
d. Inferior meatus

A

Spheno-ethmoidal recess

58
Q

Where does the anterior and middle ethmoidal sinuses drain?

a. Middle meatus
b. Sphenoethmoidal recess
c. Superior meatus
d. Inferior meatus

A

Superior meatus

59
Q

Where are tubes passed in the nose?

A

Widest part of nasal cavity = Inferior nasal meatus – therefore we pass tubes through this area.

60
Q

Major artery to nose?

A

Sphenopalatine artery

61
Q

There are 9 cartilages total that make up larynx.

Name the unpaired cartilages (bigger than paired cartilages).

A

o Thyroid (adam’s apple)
o Epiglottis
o Cricoid: round like a signet ring, more prominent at the back

62
Q

There are 9 cartilages total that make up larynx.

Name the paired cartilages (2 of each).

A

o Arytenoid – adduct the vocal cords
o Cuneiform
o Corniculate

63
Q

What do these organs have in common?

  • Stomach
  • Liver
  • Spleen
  • Jejunum, Ileum & 1st 2cm of duodenum
  • Transverse & sigmoid colon
  • Appendix
  • Upper 3rd of rectum
  • Tail of pancreas
A

They are intraperitoneal organs: completely covered in visceral peritoneum, anteriorly & posteriorly

64
Q

List retroperitoneal organs: covered by peritoneum on anterior surface (SAD PUCKER)

A
  • Suprarenal glands (adrenal)
  • Aorta/ IVC
  • Duodenum except 1st (superior) section 2cm
  • Pancreas except tail
  • Ureters
  • Colon (ascending & descending)
  • Kidneys
  • oEsophagus
  • Rectum
65
Q

Is the laryngeal inlet open or shut when breathing/speaking?

A

Open

It’s closed for swallowing

66
Q

Which muscles are involved in laryngeal elevation (which is needed for closure of epiglottis)?

A

Suprahyoid muscles

67
Q

The top edge of the cricothyroid membrane attaches to arytenoid cartilage to form which important structures?

A

True vocal cords

68
Q

Action of vocalis and thyroarytenoid muscles.

A

Loosen or tighten vocal cords

69
Q

Which arteries supply the larynx?

A

Superior and inferior laryngeal arteries

70
Q

Motor nerve supply to larynx

A

Almost entirely from the recurrent laryngeal nerve (branch of vagus nerve)

Except cricothyroid (external superior laryngeal nerve)

71
Q

Damage to recurrent laryngeal nerve can lead to palse of which muscles?

A

Intrinsic muscles of the larynx and change voice

72
Q

Sensory nerve supply to larynx

A

Above cords = superior laryngeal n.

Below cords = recurrent laryngeal n.

73
Q

Which structure closes the laryngeal inlet?

A

Epiglottis

74
Q

Afferent and efferent nerves involved in gag reflex

A

Glossopharyngeal afferent

Vagal efferents

75
Q

Name given to volume of air left in the lungs after normal expiration?

A

Functional residual capacity (not same as residual volume which is volume of air left in lungs after maximal expiration)

76
Q

What is the physiological dead space in terms of ventilation?

A

Areas of the respiratory tract with gaseous movement but no gaseous exchange occurring.

E.g. conducting airways (trachea, bronchi, bronchioles (except terminal bronchioles)

Alveolar dead space is pathological because there should be gaseous exchange in gaseous exchange zones

77
Q

Is pleural pressure always negative or positive?

A

Always negative

Because lung has an elastic inward recoil and chest has elastic outward recoil so they recoil against each other and generate a negative pressure which lower than atmospheric pressure

So air flows in

78
Q

Is the pleural pressure more negative during inspiration or expiration? Why?

A

Inspiration

Because as you breath in the chest expands and pulls out and pulls the lungs outwards and downwards along with it (imagine a vacuum like suction)

79
Q

What does decreased elasticity of respiratory structures do to compliance?

A

Decreases compliance

Compliance is also affected by alveolar surface tension

80
Q

Define elasticity

A

Resistance to deformation

81
Q

Role of surfactant

A

Detergent that decreases surface tension in alveoli which reduces collapsing radial forces (that would cause lung (alveolar) collapse of unopposed)

It INCREASES lung compliance and makes it easier for lungs to expand

82
Q

Where in the airways is resistance greater?

A

Large airways - resistance greater because of low total cross-sectional area and due to turbulent air flow within the large lumen (diameter), higher velocity of air flow and branching causing high resistance

Trachea, bronchi and larger bronchioles

83
Q

How is bronchial diameter controlled?

A

Bronchoconstriction via parasympathetic autonomic NS (vagus) and via low airway CO2, leukotrienes, distamine, bradykinin

Bronchodilation via sympathetic (beta-2-adrenoreceptor ligation)

84
Q

What causes bronchoconstriction (contraction of bronchial smooth muscle)?

A 
Low airway CO2
Leukotrienes, histamine, bradykinin
Vagus nerve stimulation
Increased mucus
Some rest tone
85
Q

What is salbutamol an example of?

A

B2-adrenoreceptor agonist used for bronchodilation in asthma and COPD (obstructive airways diseases)

86
Q

Limitation to air flow from exciting alveoli causes restrictive or obstructive airway disease?

A

Obstructive

During expiration pressure is highest in alveoli and lowest at mouth so should go towards mouth but when airway obstructed (at large airways) the airway pressure drops at site of constriction so air doesn’t want to flow out

Causes a wheeze

87
Q

COPD causes expiratory limitation due to increased or decreased resistance?

A

Increased

88
Q

Are O2 and CO2 diffusion or perfusion limited gases?

A

Perfusion - less than half way along the pulmonary capillary the oxygen and carbon dioxide in the blood and alveoli are at equilibrium so gaseous exchange doesn’t occur anymore

CO is diffusion limited

89
Q

Why is equilibrium achieved during gaseous exchange in alveoli/pulmonary capillaries very quickly for O2 and CO2 but slowly for CO?

A

O2 and CO2 have low solubility and no binding in blood so readily move in and out of pulmonary capillaries - they exert high partial pressure in blood

CO is highly soluble in blood and has high haemoglobin affinity (and other proteins) so it binds really strongly and doesn’t except a high partial pressure in blood

90
Q

When inspired O2 levels are low, will oxygen be perfusion or diffusion limited?

A

Diffusion limited because O2 won’t reach equilibrium within capillary and alveoli

91
Q

How does anaemia affect blood oxygen content?

A

Lack of haemoglobin leads to less blood oxygen content although the haemoglobin saturation can be 100%

Tissues get a normal proportion of oxygen delivery because the O2 partial pressures and Hb saturation curve maintains sigmoidal shape

92
Q

In which state is most of CO2 carried in blood?

A

HCO3- (bicarbonate) using carbonic anhydrase

93
Q

What is the Bohr effect?

A

Reduced Hb affinity for oxygen due to increased CO2

so in high CO2 environments (respiring tissues) oxygen dissociates from haemoglobin more readily

94
Q

Does O2 of CO2 diffuse more easily?

A

CO2 - but both are perfusion limited gases (normally)

95
Q

What does reducing the CO2 partial pressure do to O2 partial pressure?

A

Increases it

96
Q

Respiratory failure is defined as:

  1. PaCO2 <8 kPa
  2. PaO2 <8 kPa
  3. PaO2 >8 kPa
  4. PaCO2 >8kPa
A
  1. PaO2 <8 kPa

10. 5 to 13.5 kPa is normal

97
Q

Type 1 respiratory failure is defined as:

  1. PaCO2 <6kPa
  2. PaCO2 >6 kPa
  3. PaO2 >8 kPa
A
  1. PaCO2 <6kPa

Respiratory failure with normal or low CO2

(5.1 to 5.6 kPa is normal)

98
Q

Type 1 respiratory failure is defined as:

  1. PaCO2 <6kPa
  2. PaCO2 >6 kPa
  3. PaO2 >8 kPa
A
  1. PaCO2 >6 kPa

Respiratory failure with a raised CO2

99
Q

Normal oxygen partial pressure?

A

Partial pressure of oxygen (PaO2): 75 to 100 mm Hg (10.5 to 13.5 kPa)

100
Q

Normal carbon dioxide partial pressure?

A

Partial pressure of carbon dioxide (PaCO2): 38 to 42 mm Hg (5.1 to 5.6 kPa)

101
Q

Is type 1 or type 2 respiratory failure usually do to a failure of ventilation?

A

Type 2

102
Q

Hypercapnia and hypoxia is known as what type respiratory failure?

A

Type 2

103
Q

Hypoxia without hypercapnia is known as what type respiratory failure?

A

Type 1

104
Q

Is ventilation and perfusion greater (better) at the base or towards apex of lung?

A

Base

Perfusion more greater than ventilation great at base

105
Q

What is V/Q ratio?

A

Ventilation-perfusion ratio

106
Q

What is normal V/Q?

A

0.8

107
Q

What would the V/Q be in an area that is perfused but not ventilated?

Cause: R to L shunt

E.g. Pneumonia, COPD

A 
Perfusion = Q = 1
Ventilation = V = 0

0/1 = 0

108
Q

What would the V/Q be in an area that is ventilated but not perfused?

Cause = alveolar dead space

E.g. pulmonary embolism

A 
Perfusion = Q = 0
Ventilation = V = 1

1/0 = undefined or infinity

109
Q

In unventilated areas (e.g. pneumonia), in the airway PaO2 is low, the airway PaCO2 high which leads to a lower pH.

How does the pulmonary vasculature and bronchial smooth muscle try to correct this ventilation-perfusion mismatch?

A

Low pH (respiratory acidosis) acts on pulmonary vasculature to cause vasoconstriction to decrease perfusion

Also bronchodilation occurs to increase ventilation

110
Q

In COPD patients get chronic hypoxia. What does this do to pulmonary vasculature?

A

Chronic pulmonary vasoconstriction which increases R heart pressure and the heart work –> eventually can lead to cor pulmonale

111
Q

Which type respiratory failure would cause a respiratory acidosis and which will cause an alkalosis?

A

Type 1 = resp alkalosis

Type 2 - resp acidosis

112
Q

The base of lung receives relative more ventilation or perfusion?

A

Perfusion

113
Q

Does phrenic nerve activity mediate inspiration or expiration?

A

Inspiration

Expiration is a passive process usually but active expiration (forced) is mediated by internal intercostal nerve activity

114
Q

Which receptors mediate breathing?

A

Central chemoreceptors

115
Q

When CO2 increases why does blood become more acidic?

A

CO2 combines with H2O to form bicarbonate and H+

Increased proton level lowers pH

116
Q

Why don’t the central chemoreceptors respond to changes in pH?

A

Because H+ cannot cross blood brain barrier but CO2 can so central chemoreceptors respond to CO2 changes only

117
Q

In chronic hypercapnia, how does the metabolic system buffer the acidic CSF?

A

Slowly exports bicarbonate from blood in to of CSF in exchange for chloride.

HCO3- binds to H+ and eventually forms water and CO2

CO2 can diffuse out of CSF

118
Q

Where are peripheral chemoreceptors found?

A 
Carotid body (IX)
Aortic body (X)
119
Q

What do are peripheral chemoreceptors respond to?

A

Changes in PCO2, PO2 (key role), pH

They are sensitive to pH change not just from respiratory acidosis/alkalosis but also metabolic acidosis and alkalosis

120
Q

How is exercise detected by the body?

A

Receptors in joints (joint receptors)

Receptors in muscles (metaboreceptors)

121
Q

Central chemoreceptors respond to low CSF pH do to raised what?

A

Arterial CO2

122
Q

Peripheral chemoreceptors mainly respond to?

A

Arterial O2 and metabolic acidosis

123
Q

Aerobic exercise causes hyperpnoea. Does it change arterial blood gases?

A

No

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