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YEAR 1 - Organisation of the Body (Anton) > 8. Breathing and Circulation (HT) > Flashcards

8. Breathing and Circulation (HT) Flashcards

1
Q

The valves in the heart surround which chambers?

A

Ventricles

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2
Q

Describe the different structures in the heart and their function.

A
  • Double pump:
    • Right side -> pulmonary circulation at low resistance; pressure 20mmHg
    • Left side -> systemic circulation at high, variable resistance; pressure 130mmHg
  • Valves:
    • Atrioventricular to prevent reflux from ventricle during contraction
    • Outflow to prevent reflux from circulation into ventricles during relaxation
  • Muscle: to provide motor power. Wall of left ventricle becomes thicker than that of right
  • Vascular system to provide oxygen, nutrition to cardiac muscle: coronary arteries
  • Pacemaker: to initiate contraction
  • Conducting system: to ensure optimal expulsive contraction of ventricular muscle
  • Fibrous skeleton: non-conducting separation of atria & ventricles; support for valves
  • Autonomic innervation: to vary rate & force of contraction depending on demand; sensory
  • Pericardial cavity: to allow friction-free contraction within the chest
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3
Q

What are the principle venous structures draining into the heart?

A
  • Superior + Inferior venae cavae (into RA)
  • Pulmonary veins (into LA)
  • Coronary sinus (into RA)
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4
Q

What are the principle arterial structures leaving the heart?

A
  • Aorta (leaving LV)
  • Pulmonary trunk (leaving RV)
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5
Q

What are some important landmarks that can be palpated on the front of the chest?

A
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6
Q

What is the sternal angle and what is its importance?

A

It is the manubriosternal joint:

  • At the height of the point of articulation of 2nd rib with manubrium -> So ribs can be counted from this point
  • Also marks the sternal plane, which aligns with the T4 vertebrae and is the height at which the trachea bifurcates
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7
Q

Describe the basic position of the heart in the chest.

A
  • In the middle mediastinum
  • Enclosed in a sac of fibrous and serous pericardium.
  • Lies obliquely behind the sternum and adjoining parts of the rib cage, one third to the right of the midline and two thirds to the left
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8
Q

What are the base and apex of the heart?

A
  • The apex is the pointy part that points downwards
  • The base is the surface opposite that, composed of the two atria mostly
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9
Q

When viewed anteriorly, what are the 4 borders of the heart and what makes up each?

A
  • Right border formed by the right atrium
  • Inferior border formed largely by the right ventricle, with the left ventricle at the apex
  • Left border formed almost entirely by the left ventricle (the auricle of the left atrium overlaps its upper end)
  • (Upper border is usually concealed by vessels, so not usually considered, but is formed by the atria)
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10
Q

What is the position of the apex of the heart and the borders of the heart in surface anatomy?

A

Note: These are the corners, so the borders are between these points.

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11
Q

What is situs inversus? What are the causes and effects?

A
  • A congenital condition in which the major visceral organs are reversed or mirrored from their normal positions.
  • If the heart is swapped to the right side of the thorax, it is known as “situs inversus with dextrocardia” or “situs inversus totalis”.
  • It is an autosomal recessive condition, and about 25% of cases are caused by a dysfunction of the cilia that manifests itself in the embryo.
  • Generally, patients will experience no symptoms, although there may be an increased risk of heart problems and respiratory problems, especially if present alongside a different condition.
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12
Q

What is the pericardium?

A
  • The pericardium (a.k.a. pericardial sac) is a double-walled sac containing the heart and the roots of the great vessels.
  • It encloses the pericardial cavity which contains pericardial fluid.
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13
Q

What are the two layers of the pericardium?

A

A serous layer and a fibrous layer.

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14
Q

Describe where the pericardium ends.

A

It is attached below to the central tendon of the diaphragm and above to the aorta, pulmonary trunk, and great veins.

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15
Q

What is the function of the pericardium?

A

It protects and stabilises the heart within the thoracic cavity and limits the excursions of the diaphragm. It prevents acute over-distension of the heart (e.g. during exercise) but, if the volume of the heart is consistently increased, will grow to accommodate it.

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16
Q

Give an example of a condition relating to the pericardium.

A
  • Pericarditis
  • Inflammation of the pericardium (pericarditis) can cause an effusion of fluid to collect in the pericardial cavity. If a significant amount of fluid accumulates, the fibrous pericardium becomes distended and the action of the heart becomes less efficient because its venous filling is impeded (‘cardiac tamponade’).
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17
Q

Describe the parts of the heart that can be seen from the anterior view.

A
  • The majority of the anterior aspect of the heart comprises:
    • Right atrium
    • Right ventricle
    • Left ventricle
  • Left atrium is situated on the posterior aspect of the heart
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18
Q

What is the right and left auricle?

A

A small, cone-shaped pouch which comes out from the upper and front part of the atrium and overlaps the root of the aorta.

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19
Q

Describe the major veins flowing into the heart and what they form from.

A
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20
Q

Describe the major arteries flowing out of the heart and what they divide into.

A
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21
Q

Draw a diagram showing an anterior view of the heart with the major vessels.

A
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22
Q

Describe the structure of the aorta and what is flows to.

A
  • Ascending aorta goes up from left ventricle
  • First gives off coronary artery
  • Aortic arch bends over the pulmonary veins
  • First gives off brachiocephalic artery, then left common carotid and left subclavian arteries
  • Descending aorta runs down posterior to the heart -> At first, it is the thoracic aorta, then the abdominal aorta begins at the level of the diaphragm, crossing it via the aortic hiatus, technically behind the diaphragm, at the vertebral level of T12.
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23
Q

What is an aortic aneurysm? What are the causes and effects?

A
  • An enlargement (dilatation) of the aorta to greater than 1.5 times normal size.
  • Can occur as a result of trauma, infection, or, most commonly, from an intrinsic abnormality in the elastin and collagen components of the aortic wall.
  • Increases the risk of aortic rupture. When rupture occurs, massive internal bleeding results and, unless treated immediately, shock and death can occur.
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24
Q

Describe the structure of the vena cava and what it drains.

A
  • Superior vena cava drains the head and upper limbs
    • Drains the right brachiocephalic and left brachiocephalic veins, which each drain their corresponding internal jugular and subclavian veins
  • Inferior vena cava drains the abdomen, pelvis and lower limbs
    • Drains multiple tributaries, including the common iliac veins
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25
Q

Describe the structure of the common iliac arteries and veinsand what is flows to/from.

A
  • Bifurcation of the aorta and inferior vena cava, respectively
  • External arteries/veins go to lower limb
  • Internal arteries/veins go to pelvis, buttock and perineum
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26
Q

What is the carotid bifurcation?

A
  • It is the point where the common carotid artery divides into the internal and external carotid arteries
  • This usually occurs at the upper border of the thyroid cartilage, at around the level of the C4.
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27
Q

Describe the structure of the pulmonary artery and what it flows to.

A
  • Flows from the right atrium
  • Splits into the right and left pulmonary artery
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28
Q

How many pulmonary veins are there?

A

4 -> There are 2 from each lung that drain into the left atrium

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29
Q

What is the ligamentum arteriosum and how is it formed?

A
  • A ligament that is between the top of the left pulmonary artery and the proximal descending aorta
  • It is a remanant of the ductus arteriosus, which is a blood vessel in the developing fetus connecting the trunk of the pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus’s fluid-filled non-functioning lungs. Upon closure at birth, it becomes the ligamentum arteriosum.
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30
Q

What are the different types of small muscles in the chambers of the heart?

A

In atria:

  • Pectinate muscles (musculi pectinati)

In ventricles:

  • Papillary muscles
  • Trabeculae carnae
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31
Q

What are the pectinate muscles?

A
  • Small parallel ridges on the wall of the right atrium (and to a lesser extent in the left atrium)
  • Do not extent into the vena cava
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32
Q

What is the crista terminalis?

A

The smooth border that divides the right atrium into the rough anterior (pectinate muscles) and smooth posterior (fossa ovalis and coronary sinus). It is where the pectinate muscles attach.

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33
Q

What are the papillary muscles?

A
  • The papillary muscles are muscles located in the ventricles of the heart.
  • They attach to the cusps of the atrioventricular valves (also known as the mitral and tricuspid valves) via the chordae tendineae and contract to prevent inversion or prolapse of these valves on systole (or ventricular contraction).
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34
Q

What are the trabeculae carnae?

A

Rounded or irregular muscular columns which project from the inner surface of the right and left ventricle of the heart.

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35
Q

What is the fossa ovalis?

A
  • A depression in the right atrium of the heart, at the level of the interatrial septum, the wall between right and left atrium.
  • The fossa ovalis is the remnant of a thin fibrous sheet that covered the foramen ovale during fetal development.
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36
Q

Name all of the valves of the heart and their positions.

A
  • Atrioventricular valves:
    • Tricuspid -> Right AV valve
    • Bicuspid/Mitral -> Left AV valve
  • Outflow valves:
    • Pulmonary -> Right SL valve
    • Aortic -> Left SL valve
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37
Q

Describe the structure of the atrioventricular valves.

A
  • Mitral (bicuspid) valve
    • Between left atrium and ventricle
    • Has two leaflets (or “cusps”)
    • Connected to papillary muscles via cordae tendinae
  • Tricuspid valve
    • Between right atrium and ventricle
    • Has three leaflets (or “cusps”)
    • Connected to papillary muscles via cordae tendinae
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38
Q

Describe the structure of the outflow valves of the heart.

A
  • Pulmonary valve
    • Between the right ventricle and the pulmonary artery
    • Has three semilunar cusps
  • Aortic valve
    • Between the left ventricle and the aorta
    • HAs three semilunar cusps
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39
Q

What supplies blood to the heart?

A

Coronary arteries

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40
Q

Where do coronary arteries arise from?

A

Aortic sinuses just above the aortic valve.

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41
Q

Describe the blood supply to the heart by coronary arteries.

A

Right coronary artery and the left coronary artery pass around the atrioventricular groove, forming an incomplete arterial ‘ring’. Branches arise from these towards the apex.

  • Left coronary artery
    • Left anterior descending artery -> Between the ventricles on the anterior side
    • Left circumflex artery + Left marginal artery -> Supply left side of heart
    • Posterior descending artery (only sometimes, usually supplied by the right coronary artery)
  • Right coronary artery
    • Right marginal artery -> Supplies right side of heart
    • Posterior descending artery (usually, unless supplied by left CA)
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42
Q

Do coronary arteries flow into any vessels?

A

No, they are functional end arteries.

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43
Q

What is unusual about when coronary arteries supply blood to the heart? Why?

A

The flow in the arteries occurs mainly during diastole because, during systole, contraction of ventricular muscle compresses the capillaries.

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44
Q

What is angina?

A
  • Chest pain or pressure, usually due to not enough blood flow to the heart muscle.
  • Angina is usually due to obstruction or spasm of the coronary arteries. Other causes include anemia, abnormal heart rhythms and heart failure.
  • The main mechanism of coronary artery obstruction is atherosclerosis as part of coronary artery disease.
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45
Q

What is the difference between myocardial ischaemia and angina?

A

Angina is the symptom that arises due to myocardial ischaemia.

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46
Q

Describe the venous drainage from the heart tissue.

A
  • Coronary sinus drains blood back into the right atrium
  • A small amount of the venous blood drains directly into the right atrium via venae cordis minimae
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47
Q

Describe the position of the SAN.

A
  • In the right atrium wall
  • Positioned just above the crista terminalis, near the opening of the superior vena cava
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48
Q

Describe the position of the AVN.

A

Lower back section of the interatrial septum near the opening of the coronary sinus,

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49
Q

What is the atrioventricular bundle?

A

It is the atrioventricular bundle of His.

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50
Q

Describe briefly the innervation of the heart.

A
  • A cardiac plexus which receives nerves from both the sympathetic and parasympathetic (vagus) systems is located beneath the arch of the aorta
  • Sympathetic fibres innervate both the SAN and AVN, and also the cardiac muscle. Sympathetic activation causes an increase in heart rate and force of contraction.
  • (Parasympathetic) Vagal fibres end primarily on the SAN and cause slowing of the heart.
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51
Q

What is referred pain?

A

Pain perceived at a location other than the site of the painful stimulus.

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52
Q

Where may pain from the heart (e.g. angina) be referred to?

A
  • Central chest
  • Neck
  • Left arm (male)
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53
Q

Where may pain from the diaphragm be referred to?

A

Shoulder (C4)

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54
Q

What is the mediastinum and what does it contain?

A
  • The central compartment of the thoracic cavity surrounded by loose connective tissue.
  • The mediastinum contains:
    • Heart and its vessels
    • Oesophagus
    • Trachea
    • Phrenic and cardiac nerves
    • Thoracic duct
    • Thymus
    • Lymph nodes of the central chest
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55
Q

Describe the divisions of the mediastinum.

A
  • Mediastinum is divided into the superior and inferior region
  • Inferior region is then subdivided into the anterior, middle (heart) and posterior compartments
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56
Q

In which part of the mediastinum is the heart?

A

Middle mediastinum

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57
Q

Remember to add flashcards about the blood supply to the head, etc.

A

Do it.

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58
Q

Name briefly what is found in the superior mediastinum.

A
  • Oesophagus
  • Trachea
  • Major great vessels supplying the head and neck: brachiocephalic arteries, carotid and subclavian arteries.
  • Vagus nerve
  • Left recurrent laryngeal nerve
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59
Q

Draw the position of all of the structures in the superior mediastinum.

A
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60
Q

Name briefly what is found in all of the compartments of the inferior mediastinum.

A

Inferior anterior mediastinum:

  • Lymph nodes

Inferior middle mediastinum:

  • Heart (in pericardium)
  • Major vessels: Ascending aorta, superior vena cava and pulmonary trunk
  • Phrenic nerves (on outside of pericardium)

The inferior posterior mediastinum:

  • Descending aorta, hemi-azygos veins, azygos veins
  • Thoracic duct
  • Oesophagus
  • Vagus nerve
  • Sympathetic trunks
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61
Q

Draw the position of all of the structures in the inferior mediastinum.

A
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62
Q

What is the division between the superior and inferior mediastinum?

A

Sternal angle (at the T4 level)

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63
Q

What does the phrenic nerve innervate?

A

The diaphragm.

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64
Q

What is the hilum of the lung and what important structures may be found near there?

A
  • It is the side of the lung where the nerves, vessels and bronchii enter the lungs.
  • Lymph nodes are at the hilum of the lungs.
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65
Q

What is the thoracic duct and what does it drain into?

A
  • The largest lymph duct in the body, originating from about the T12 level.
  • Drains into the left subclavian vein.
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66
Q

What are the two components of the circulatory system?

A
  • Blood vascular system (cardiovascular system)
  • Lymphatic vascular system
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67
Q

What is the function of the lymphatic system?

A

Collects lymph (excess extracellular tissue fluid) and delivers it back to the cardiovascular system.

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68
Q

What are the two portal systems?

A
  • Hepatic portal system
  • Hypothalamic-pituitary portal
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69
Q

Explain the difference between microvasculature and macrovasculature.

A
  • Macrovasculature
    • Vessels > 0.1 mm in diameter
      • Arteries
      • Veins
  • Microvasculature
    • Vessels < 0.1 mm
      • Arterioles
      • Capillaries
      • Venules
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70
Q

What are the layers of a blood vessel called?

A

Tunics

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71
Q

What are the names of the different layers of blood vessels? What is each?

A
  • Tunica intima -> Endothelium
  • Tunica media -> Muscle or elastic
  • Tunica adventitia -> Connective tissue
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72
Q

Describe the composition of the different layers of the blood vessels.

A
  • Tunica intima (innermost):
    • Single layer of flattened squamous epithelial cells & basal lamina
    • Sub-endothelial connective tissue
    • Internal elastic lamina
  • Tunica media:
    • Smooth muscle cells orientated concentrically around lumen
    • Replaced by elastic in elastic arteries (larger vessels)
    • External elastic lamina in large vessels
  • Tunica adventitia:
    • Fibroelastic connective tissue arranged longitudinally with adipose tissue
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73
Q

What are the different laminas in blood vessel walls?

A
  • Basal lamina -> In tunica intima, just outside the epithelial layer
  • Internal elastic lamina -> In tunica intima, thin band of elastic fibres just inside the smooth muscle layer
  • External elastic lamina -> In tunica media, band of elastic fibres just outside the smooth muscle layer

(i.e. the elastic lamina tend to sandwich the smooth muscle layer)

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74
Q

Compare how well-developed the internal and external elastic lamina are in arteries.

A
  • Internal elastic lamina is well-developed
  • External elastic lamina is not distinguishable in all arteries
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75
Q

Draw the layers of an artery, capillary and vein.

A
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76
Q

Draw the diameter and wall thickness for the aorta, arteries, arterioles, capillaries, venules, veins and vena cava.

A
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77
Q

In which vessel type are the tunica intima and tunica media more developed?

A
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78
Q

Describe the structure and function of the tunica intima.

A

Structure:

  • Simple squamous endothelium
  • Loose connective tissue
  • Internal elastic lamina

Function:

  • Endothelium regulates blood clotting and vascular tone and flow by secreting various substances
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79
Q

What does the tunica intima secrete/produce?

A
  • Secretes:
    • Collagens -> strength
    • Lamin -> attachment
    • Endothelin -> vasoconstrictor
    • Nitric oxide -> vasodilator
    • Von Willebrand factor -> clotting protein
  • Also possess membrane bound enzymes:
    • In lung, angitoensin converting enzyme (ACE) -> Converts Angiotensin I to Angiotensin II Vasoconstrictor
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80
Q

What is Von Willebrand Factor and what does a lack of it result in?

A
  • Clotting factor produced by the endothelium
  • Genetic disease where VWF is not produced -> Problems with blood clotting. Binds FVIII, gets degraded in absence.
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81
Q

What are ACE inhibitors?

A
  • Angiotensin-converting-enzyme inhibitors are a class of medication used primarily for the treatment of high blood pressure and heart failure.
  • They work by causing relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart.
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82
Q

Describe the structure and function of the tunica media.

A

Structure:

  • Concentric cell layers comprise helically arranged smooth muscle cells (elastic in elastic arteries)
    • Elastic fibres
    • Type III collagen
    • Proteoglycans interspersed within layers
  • Larger arteries have external elastic lamina

Function:

  • Collagen -> Provides restraint
  • General protective role

(NOTE: Capillaries and post-capillary venules do not have tunica media)

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83
Q

Give an example of a disorder that affects the tunica media.

A
  • Ehlers-Danlos syndrome (EDS) Type IV (vascular type)
  • Mutation in COL3A1 gene -> Coding for Type III collagen
  • Autosomal dominant
  • Increases the chance of aneurysm
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84
Q

Describe the structure and function of the tunica adventitia.

A

Structure:

  • Fibroblasts
  • Type I collagen fibers
  • Elastic fibers
  • Small blood vessels
  • Adipose tissue

Function:

  • Blends into surrounding connective tissue
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85
Q

What are vasa vasorum?

A
  • “Vessels of vessels”
  • These are small arteries that supply the walls (tunica media and adventitia) of large veins and arteries
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86
Q

What are the different types of arteries?

A

From largest to smallest:

  • Elastic (Conducting)
  • Muscular (distributing)
  • Arterioles
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87
Q

Describe some structural adaptations of arteries.

A
  • In elastic arteries concentric layers of elastic occupy most of tunica media
  • Muscular arteries have thick tunica media composed mostly of smooth muscle
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88
Q

Compare elastic and non-elastic arteries.

A
  • Larger arteries (e.g. aorta) are elastic, while smaller arteries are non-elastic
  • Tunica intima is thinner and internal elastic lamina is more prominent in non-elastic arteries
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89
Q

In what blood vessels does atherosclerosis most commnoly occur?

A

Arteries

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90
Q

What is atherosclerosis?

A
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91
Q

Describe the development of atherosclerosis.

A
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92
Q

Describe a novel treatment for stroke.

A
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93
Q

Describe an aneurysm and what causes it.

A
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94
Q

What cells support microvasculature?

A
  • Smooth muscle cells (discontinuous) -> Surround arterioles and small veins
  • Pericytes -> support vessels, but can differentiate into:
    • Fibroblasts
    • Smooth muscle cells
    • Macrophages
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95
Q

What are pericytes?

A
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96
Q

What processes are pericytes important in?

A
  • Wound healing -> By differentiating into fibroblasts, smooth muscle cells, macrophages and other cell populations
  • Angiogenesis (formation of new blood vessels)
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97
Q

What innervates arterioles?

A

Sympathetic nerves

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98
Q

What determines the flow in capillaries?

A
  • A ring of muscle surrounding a blood vessel at the junction between an arteriole and capillary (pre-capillary sphincter)
  • Dilation & constriction of resistance vessels (arterioles)
  • Controlled by factors which reflect tissue metabolism
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99
Q

What is the length and width of capillaries?

A
  • Length = Approx. 50 micrometers
  • Diameter = Approx. 8-10 micrometers
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100
Q

What are the different types of capillary?

A
  • Fenestrated
  • Continuous
  • Sinusoidal
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101
Q

Describe the structure and function of continuous capillaries.

A
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102
Q

Describe the structure and function of fenestrated capillaries.

A
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103
Q

Describe the structure and function of sinusoidal capillaries.

A
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104
Q

Describe how capillary beds may be bypassed and where this is used in the body.

A
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105
Q

What are the different types of vein?

A

Veins are classified on the basis of their diameter and wall thickness:

  • Small
  • Medium
  • Large
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106
Q

Describe the defining structural features of veins.

A
  • Same 3 layers as arteries but muscular and elastic layers not as well developed
  • Connective tissue components more pronounced than arteries
  • Boundary between tunica intima and tunica media not clear
  • Medium size veins have valves to assist blood flow
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107
Q

What are some specific functions of small veins?

A
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108
Q

What are some specific functions of medium veins?

A
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109
Q

What are some specific functions of large veins?

A
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110
Q

Give 3 examples of venous disease.

A
  • Varicose veins
  • Deep vein thrombosis (DVT)
  • Vasculitis
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111
Q

What are varicose veins? What are the causes and effects?

A
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112
Q

What is DVT? What are the causes, effects and treatment?

A
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113
Q

What is vasculitis? What are the causes, symptoms and treatments?

A
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114
Q

Compare a typical artery with a typical vein.

A
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115
Q

Name three important blood vessel specialisations.

A
  • Blood Brain barrier
  • Blood air barrier
  • Kidney filtration barrier
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116
Q

Describe the structure of the blood brain barrier.

A
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117
Q

Describe the structure of the kidney filtration barrier.

A
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118
Q

What are some methods of imaging the circulation?

A
  • Plain films
  • CT
  • Ultrasound
  • Angiography
  • MRI
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119
Q

Describe how the circulatory system may be imaged using plain film slides.

A
  • X-rays are produced by bombarding a tungsten anode with electrons at high voltage.
  • The anode beam is directed so that the x-rays pass through the patient.
  • Emerging radiation is then detected by the digital detector plate.
  • The degree of exposure corresponds to how much of the beam has passed through the patient and how much has been absorbed by the different tissues of the body.
  • Air is radiolucent (black) and bone and metal are radiopaque (white)
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120
Q

Describe some important structures and pathologies of the circulatory system that may be seen on a plain film x-ray.

A
  • Aortic knuckle or knob -> May be enlarged in pathology such as thoracic aortic aneurysm; or may be reversed in dextrocardia.
  • Right heart border -> Made up predominantly by the right atrium
  • Left heart border -> Made up of the left ventricle.
  • Superior vena cava -> Only major venous structure drianing into heart that is seen on plain x-ray.
  • Pulmonary arteries + Thoracic aorta
  • Lymph nodes drain to the hilar and mediastinal nodes -> May become enlarged in infection or tumour.
  • Relationship of the subclavian artery to the clavicle, which may be damaged in trauma.
  • Relationship of the subclavian vein to the first rib, which may be compressed, causing venous thrombosis.
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121
Q

Draw the normal arrangement of the major vessels leaving the superior side of the heart.

A
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122
Q

Give the Hounsfield untis for these:

  • Air
  • Fat
  • Water
  • Soft tissue
  • Bone
A
  • Air: -1000 HU
  • Fat: -100 HU
  • Water: 0 HU
  • Soft tissue: 30 HU
  • Bone: 700 HU
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123
Q

What makes imaging the circulatory system using X-rays difficult? How is this overcome?

A
  • When we are looking at blood vessels on CT, the absorption is the same as for many other soft tissues.
  • To highlight vessels on CT imaging, we falsely increase the absorption of vessels compared to soft tissue by injecting an intravenous contrast agent.
  • This is an iodine-based contrast agent, with a high atomic number.
  • The contrast agent is injected intravenously, passes through the system veins to the right side of the heart, then to the pulmonary circulation, and finally to the left side of the heart and the systemic circulation.
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124
Q

What is the phase of a CT scan with a contrast?

A
  • The timing of the taking of the CT scanrelative to when the contrast is injected
  • This is critical to ensure the contrast is in the vessel of interest (for example, in acquiring a CT of the pulmonary arteries, the radiographer will commence the scan earlier than for a CT of the aortic arch).
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125
Q

Give some examples of uses of ultrasound in the circulatory system.

A
  • Estimation of flow rates in the carotid arteries -> Used to assess risk of stroke
  • Estimation of flow in peripheral veins, both in the deep venous system for diagnosing deep vein thrombosis, and the superficial venous system for assessing patients with varicose veins.
  • Because ultrasound imaging is real-time imaging, this allows the radiologist to perform image guided treatments and biopsies, using the ultrasound to guide placement of the needle.
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126
Q

Describe the principle of using digital subtraction angiography in imaging the circulatory system.

A
  • Goal is to produce images of contrast-filled vessels in isolation from other tissues, whilst using the minimum amount of contrast agent.
  • Images of the same region are taken in rapid succession (2-6 frames per second), before and after direct injection of contrast medium into the vessel, minimizing patient movement.
  • The image without contrast (from just before injection) is then subtracted digitally from the post contrast images, to give an image of the vessel alone (bone and soft tissue removed).
  • DSA is used for imaging the peripheral venous and arterial systems as well as abdominal vessels and cerebral vessels, but cannot be used for cardiac imaging due to cardiac motion. Instead, higher frame rates are used (up to 10 frames per second), and non-subtracted angiograms are acquired.
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127
Q

Describe the principle of using MRI to image the circulatory system.

A
  • Relies on the fact that blood is fast flowing.
  • A radiofrequency current is applied to a single slice of the patient, which flips the spins in the protons in the slice selected. The RF current is then turned off.
  • When the slice is imaged a fraction of time later, fresh blood has passed into the vessels, and the protons in the fresh blood have not been exposed to the radiofrequency current.
  • So they emit a different signal from the tissues in the original slice and can therefore be detected.
  • Gadolinium is used as a contrast agent. The gadolinium itself is not actually visualised on the MRI but it alters the magnetic properties of the adjacent tissues, so that they emit different signals. This eliminates the need to rely on blood flow to create an image of a vessel and allows imaging in any plane. This is particularly useful for cerebral imaging where the vessels are very small and tortuous.
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128
Q

What are anastamoses?

A

A connection between two blood vessels, such as between arteries (arterio-arterial anastomosis), between veins (veno-venous anastomosis) or between an artery and a vein (arterio-venous anastomosis).

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129
Q

Where are anastamoses common in the circulatory system?

A
  • Nearly all small arteries form anastomoses with neighbouring vessels.
  • Around all joints small arterial branches form anastomoses which link the major vessels above and below a joint. These are particularly important in the lower limb.
  • The degree of anastomosis is very variable.
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130
Q

What are anatomical and functional end arteries?

A
  • An anatomical end artery is one that is the only supply of oxygenated blood to a portion of tissue. Arteries which do not anastomose with their neighbors are called end arteries.
  • Functional end arteries occur when the degree of anastomosis is insufficient, particularly as we age.
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131
Q

Describe the general anatomy of veins in the limbs.

A
  • In the limbs veins form two important groups, lying superficial and deep to the deep fascia.
  • Understanding this is critical in the lower limb.
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132
Q

Are lymphatics visible and do they anastamose? Why do we study them?

A
  • No, they are not typically visible in DR
  • They have many anastamoses
  • We study them due to their importance in cancer spread
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133
Q

Describe briefly the innervation of the circulatory system.

A
  • Ateries -> Post-ganglionic sympathetic fibres control arterial flow and pressure, especially through the diameter of arterioles and alpha receptors
  • Veins -> Constriction increases venous return to the heart (and therefore pre-load).
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134
Q

Name some adult remanants of foetal structures in the circulatory system.

A
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135
Q

Describe the organisation of major arteries in the thorax and abdomen.

A

THORACIC AORTA:

  • Ascending aorta gives off:
    • Right and left coronary arteries, which go to the heart
  • Aortic arch gives off:
    • The brachiocephalic artery, which gives off:
      • Right subclavian artery (to head) and right common carotid artery (to upper limbs, neck and thorax)
    • Left common carotid artery
    • Left subclavian artery

Subclavian arteries each give off a thoracic artery that gives off anterior inctercostal arteries. They also give off the vertebral arteries, that are the major arteries of the neck.

  • Descending thoracic aorta
    • Bronchial + Oesophagal arteries
    • Posterior intercostal arteries (to body wall)

Anastomoses between anterior and posterior intercostal arteries in chest wall.

ABDOMINAL AORTA:

  • Midline branches to gastrointestinal tract and derivatives
  • T12: Coeliac artery to foregut (oesophagus to mid duodenum)
  • L1: Superior mesenteric artery to midgut (mid-duodenum to colon splenic flexure
  • L3: Inferior mesenteric to hindgut (splenic flexure to recto-anal junction)
  • Paired branches to paired organs:
    • Musculophrenic arteries
    • Adrenal/Suprarenal arteries
    • Renal arteries (L1)
    • Gonadal arteries (L2)
  • Paired lumbar arteries (to posterior abdominal wall)

COMMON ILIAC ARTERIES:

  • External iliac arteries (to lower limbs via femoral artery)
  • Internal iliac arteries (to pelvic organs and gluteal region)

Anastamoses: Trochanteric anastomosis (supplies the head of the femur), Cruciate anastomosis in thigh, anastomoses for knee, ankle, foot

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136
Q

At what level does the descending aorta pass the diaphragm?

A

It passes BEHIND the crura of the diaphragm at T12.

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137
Q

What branches does the abdominal aorta give off?

A

The paired arteries are in descending order:

  • The musculophrenic to supply the diaphragm
  • The suprarenal to the adrenal glands
  • The renal to the kidney
  • The gonadal to the ovary or testes (note that relatively cranial postion at which the gondal arteries arise reflects their embryonic origins)

The unpaired arteries are:

  • The coeliac trunk that supplies the foregut, which includes the stomach, liver, and upper parts of duodenum and pancreas
  • The superior mesenteric artery which supplies the midgut, which includes the lower parts of the duodenum and pancreas, the entire small bowel (jejunum and ileum) the caecum, ascending colon and transverse colon.
  • The inferior mesenteric artery which supplies the hindgut, including the descending colon, the sigmoid colon, and upper parts of the rectum.

The abdominal aorta divides into the common iliac arteries which in turn divide into the external and internal iliac arteries.

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138
Q

Describe the arterial and venous blood supply of the head.

A

Arterial:

  • Each common carotid artery splits (at the carotid sinus) into:
    • Internal carotid artery
      • Supplies brain, eyes and forehead through the carotid canal in the skull
    • External carotid artery
      • Supplies areas of the head and neck that are exterior to the cranium
      • Gives off 6 branches: Superior thyroid artery, Lingual artery, Facial artery, Ascending pharyngeal artery, Occipital artery, Posterior auricular artery
  • Each subclavian artery gives off a vertebral artery that converge and supply the brain

Venous:

  • Internal jugular veins
    • Drain the brain and parts of the face
    • Drain INTO the subclavian veins, forming brachiocephalic veins
  • External jugular veins
    • Drain the superficial tissues of the skull and the posterior and deep parts of the face
    • Drain INTO the subclavian veins (before they join with the internal jugular veins)
  • Anterior jugular veins
    • Drain the neck
    • Drain INTO the external jugular vein just before they enter the subclavian veins
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139
Q

What is the carotid sinus?

A

A dilated area at the base of the internal carotid artery just superior to the bifurcation of the internal carotid and external carotid at the level of the superior border of thyroid cartilage.

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140
Q

At what level do the common carotid arteries bifurcate?

A

At the thyroid cartilage.

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141
Q

Describe the organisation of major veins in the thorax and abdomen.

A
  • Superior vena cava:
    • Confluence of right and left brachiocephalic veins, which are confluences of:
      • Internal jugular veins (drain head) and subclavian veins (drain external jugular veins and upper limb)
    • Drain the azygos vein just before the SVC enters the right atrium
      • Intercostal veins drain into the azygos vein on the right and the hemi-azygos veins on the left side of the thorax. The hemi-azygous veins drain into the azygous vein.
  • Coronary sinus drains heart
  • Inferior vena cava:
    • Drains the hepatic portal vein, which drains liver and alimentary tract (indirectly, via the hepatic portal veins)
    • Drains the adrenals, kidneys, gonads, pelvic organs (corresponding veins to arteries)
    • Drains the common iliac veins
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142
Q

Which veins in the body tend to have valves?

A

Veins below the level of the heart and outside the thorax and abdomen (extra-abdominal).

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143
Q

Which have more anastomoses: arteries or veins?

A
  • Veins are more variable and have more anastomoses than arteries
  • Important anastomoses connect the superficial and deep veins of the lower limb
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144
Q

Describe the innervation of the major veins in the body.

A

The large veins are also innervated by postganglionic sympathetic nerves which control their capacity.

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145
Q

Describe the organisation of the lymphatic system.

A
  • Lymph returns to blood vascular system at the junction of the subclavian and jugular veins (differences on R and L sides)
  • Lymphatics that drain directly into the venous confluence:
    • Head (jugular lymph trunks)
    • Upper limb (subclavian lymph trunks)
    • Bronchi & mediastinum (broncho-mediastinal lymph trunks) join venous confluence.
  • Lymphatics that drain into the cisterna chyli, which is emptied into the confluence of the left internal jugular and subclavian veins by the thoracic duct:
    • Lower limb & pelvis (external and internal iliac lymph trunks)
    • Posterior abdominal wall (via para-aortic nodes to cisterna chyli)
    • G-I tract (via midline pre-aortic nodes to cistern)
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146
Q

Describe the properties of the lymphatic system in terms of:

  • Valves
  • Innervation
  • Contraction
A
  • More valves than veins
  • Not innervated
  • Intrinsic contractile properties + compressed by arterial pulsations
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147
Q

At what level do these structures pass through the diaphragm:

  • Vena cava
  • Oesophagus
  • Aorta
A
  • Vena cava - T8 (8 letters)
  • Oesophagus - T10 (10 letters)
  • Aorta - T12
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148
Q

Describe the arterial blood supply of the upper limb.

A
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149
Q

Does the radial artery go through the palmar side of the wrist?

A

No, the artery winds laterally around the wrist, passing through the anatomical snuff box and between the heads of the first dorsal interosseous muscle.

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150
Q

What are the three types of veins in the limbs?

A
  • Deep veins run deep, and tend to run alongside an artery of the same name
  • Superficial veins run close to the skin
  • These two types are joined by communicating veins
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151
Q

Describe the venous drainage of the upper limb. [EXTRA]

A
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152
Q

Which are the deep and which are the superficial veins in the upper limb?

A

Deep:

  • Brachial
  • Ulnar
  • Radial

Superficial:

  • Basilic
  • Cephalic
  • Median cubital
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153
Q

In what direction does blood flow through communicating veins?

A

From superficial to deep

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154
Q

How does the organisation of lymphatic drainage relate to other circulation?

A

In the limbs, lymphatic drainage follows venous drainage.

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155
Q

Describe the lymphatic drainage of the upper limb.

A
  • Lymphatics run along veins
  • Superficial nodes drain to deep nodes
  • Drainage occurs via progressively more central nodes
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156
Q

What do the axillary lymph nodes drain? [IMPORTANT]

A
  • Breast (important in sentinel node biopsy)
  • Upper limb
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157
Q

Describe the arterial blood supply to the lower limb.

A

Note: The popliteal is on the posterior side, which is because the femoral winds medially from the anterior to the posterior side as is gets more distal.

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158
Q

At what point does the external iliac artery become the femoral artery?

A

At the inguinal ligament.

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159
Q

In order to enter the popliteal fossa, what does the femoral artery do?

A

Passes through a hiatus in the largest adductor muscle (adductor magnus).

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160
Q

What artery supplies most of the thigh?

A

Deep femoral (profunda femoris)

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161
Q

In the lower limb, where do arteries run relative to the deep fascia? What is the relevance of this?

A
  • Arteries run deep to the deep fascia
  • This can constrict the blood supply if there is swelling in the compartment, for example as a result of a fracture and bleeding. This constricts the venous return which makes the problem worse and leads to a ‘compartment syndrome’.
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162
Q

What is the dorsalis pedis artery?

A

A blood vessel of the lower limb that carries oxygenated blood to the dorsal surface of the foot.

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163
Q

In the limbs, arterial anastamoses occur…

A

Around joints

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164
Q

Name some arterial anastamoses in the lower limb.

A
  • Femoral circumflex artery wraps around the head of the femur
  • It is at risk in fractured neck of femur as it runs along the neck of the femur from the trochanteric anastomosis.
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165
Q

Describe the venous drainage of the lower limb.

A

Superficial veins:

  • Great saphenous vein
    • Drains blood from dorsal arch of the foot
    • Along medial side of leg, passing anterior to medial malleolus but posterior to medial condyle at the knee
    • Drains into the femoral artery, just inferior of the inguinal ligament
  • Small saphenous vein
    • Drains blood from dorsal arch of the foot and dorsal vein of little toe
    • Along posterior side of the leg, passing posterior to the lateral malleolus and along the calcaneal tendon. Passes between the two heads of the gastrocnemius muscle.
    • Then empties into the popliteal vein in the popliteal fossa.

Deep veins (run along arteries):

  • Posterior tibial + Fibular vein
    • Arise from the plantar veins (lateral and medial)
  • Popliteal vein
  • Anterior tibial vein
  • Femoral vein
  • Profunda femoris
  • External iliac vein

Communicating veins drain the superficial veins into the deep veins.

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166
Q

What is another name for communicating veins?

A

Perforating veins

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167
Q

Give some clinical relevance of the veins in the lower limb.

A
  • Deep veins -> Deep vein thrombosis
  • Superficial veins -> Varicose veins
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168
Q

What are varicose veins and what causes them? What are the symptoms and treatment?

A
  • Buldging and twisting veins, just deep to the skin (i.e. affects superficial veins)
  • Occur due to the pooling of blood in superficial veins, which is commonly a result of reduced venous retunr to the heart
  • Example causes:
    • Pregnancy, obesity and abdominal straining may place pressure on the abdomen
    • Incompetent valves can allow backflow
  • Symptoms: Pain, inability to stand for long periods, ulcers, severe bleeding upon trauma, skin conditions and clotting
  • Treatment is typically conservative (e.g. elevating legs and using medicine), but surgical approaches may also be used
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169
Q

What is deep vein thrombosis (DVT) and what causes it? What are the symptoms and treatment?

A
  • The formation of a blood clot inside deep veins of the lower limb
  • 3 major risk factors:
    • Slow blood flow
    • High coaguability of blood
    • Damage to endothelium
  • Symptoms:
    • Pain
    • Swelling
    • Discolouration
    • Cyanosis
  • Serious risk of pulmonary embolism
  • Treatments include use of anticoagulants, compression socks and removal of the clot
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170
Q

What is lymphoedema?

A

Swelling of the lower limbs caused by filarial parasites blocking the superficial lymphatics.

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171
Q

Show the major arterial pulse points on the body.

A
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172
Q

Describe the name for how muscles aid with venous return.

A
  • A skeletal-muscle pump is a collection of skeletal muscles that aid the heart in the circulation of blood.
  • It is especially important in increasing venous return to the heart.
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173
Q

What are some techniques that can be used to image respiration?

A
  • Plain Film/x-ray
  • Ultrasound
  • Nuclear Medicine
  • MRI
  • CT
  • PET/CTMRI
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174
Q

What are the two main directions in which imaging of the respiratory system may be done?

A
  • Anteroposterior
  • Posteroanterior

(The direction refers to the direction of travel of the x-rays, etc.)

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175
Q

Describe posteroanterior (PA) imaging of the respiratory system.

A
  • Film-Focus Distance 2m
  • Scapulae rotated away from lungs
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176
Q

Describe anteroposterior (AP) imaging of the respiratory system.

A
  • Film-Focus distance 1m
  • Scapulae projected over lungs
  • Low kV only
  • Suboptimal inspiration
  • Often semi-erect
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177
Q

What sort of respiratory system imaging technique is this?

A

Plain film x-ray

178
Q

What are some pros and cons of x-ray imaging of the respiratory system?

A

Pros:

  • Quick
  • Cheap
  • Readily available
  • Fast to interpret by non-specialists

COns:

  • Radiation (some)
  • Poor sensitivity
  • Poor tissue characterisation
  • 3D structure on 2D image
179
Q

What sort of respiratory system imaging technique is this?

A

Ultrasound

180
Q

What are some pros and cons of ultrasound imaging of the respiratory system?

A

Pros:

  • Quick
  • Cheap (ish)
  • High sensitivity
  • No radiation - safe

Cons:

  • Cannot look through air or bones
  • Very user-dependent – most useful in hands of specialists
  • Needs bed-site clinician
181
Q

What sort of respiratory system imaging technique is this?

A

Nuclear medicine

182
Q

What are some pros and cons of nuclear medicine imaging of the respiratory system?

A

Pros:

  • Physiological test
  • High sensitivity and specificity

Cons:

  • Radiation (to patient and environment)
  • Need for radio-isotopes
  • More limited clinical use (answer ‘one question’)
183
Q

What sort of respiratory system imaging technique is this?

A

MRI

184
Q

What are some pros and cons of MRI imaging of the respiratory system?

A

Pros:

  • No radiation
  • Very good tissue characterisation
  • Very high sensitivity
  • Cross-sectional imaging technique

Cons:

  • Strong magnets
  • Heating effects
  • Long time in the scanner
  • Needs specialist to interpret
  • Expensive, not readily available
185
Q

What sort of respiratory system imaging technique is this?

A

CT

186
Q

What sort of respiratory system imaging technique is this?

A

CT

187
Q

What sort of respiratory system imaging technique is this?

A

CT

188
Q

What are some pros and cons of CT imaging of the respiratory system?

A

Pros:

  • Quick – ideal for emergencies
  • Cheap(ish) – readily available around the clock
  • Extremely good images of most tissues, high sensitivity/specificity

Cons:

  • High radiation dose
  • Often need for IV contrast
  • Needs specialist to interpret
189
Q

What some of respiratory system imaging technique is this?

A

PET/CT

190
Q

What are some pros and cons of PET/CT imaging of the respiratory system?

A

Pros:

  • Physiological test – biologic activity
  • High sensitivity

Cons:

  • Relatively low specificity
  • Radiation (to patient and environment)
  • Need for radio-isotopes
  • Very expensive
191
Q

Name some medical interventions on the respiratory system.

A
  • Pleural biopsy
  • Lung biopsy
  • Drain insertion
  • Tumour ablation
192
Q

What is this medical intervention?

A

Pleaural biopsy

193
Q

What is this medical intervention?

A

Lung biopsy

194
Q

What is this medical intervention?

A

Drain insertion

195
Q

What is this medical intervention?

A

Tumour ablation

196
Q

Label this.

A
197
Q

Label this.

A
198
Q

Draw the position of the sternum in the human body.

A
199
Q

What are the 3 parts of the sternum? [EXTRA]

A

From superior to inferior:

  • Manubrium
  • Body of sternum
  • Xiphoid process
200
Q

What are the major landmarks of the sternum and at what vertebral level are they?

A
201
Q

What is the sternal plane, at what vertebral level is it and what does it mark?

A
  • The plane that passes through the sternal angle
  • It is at the level of the T4 vertebra
  • It marks the bifurcation of trachea
202
Q

How many pairs of ribs are there?

A

12

203
Q

Label this rib.

A
204
Q

What do the different ribs attach to anteriorly? What is the name for this?

A
  • 1-7 -> Attach to sternum via a costal cartilage (vertebrosternal)
  • 8-10 -> Attach to the costal cartilage above (vertebrocostal)
  • 11-12 -> No anterior attachment (floating)
205
Q

Draw how ribs attach to vertebrae.

A

There are two points of attachment.

206
Q

What are two important structures of the diaphragm? Draw the structure.

A
  • Central tendon
  • Crura
207
Q

Describe the attachments of the diaphragm. [IMPORTANT]

A
208
Q

How does diaphragm contraction involved in breathing?

A

Contraction during inspiration increases thoracic cavity volume.

209
Q

Where do the right and left crura of the diaphragm attach?

A
  • Right crura: L1, 2, 3 vertebrae
  • Left crura: L1 & 2 vertebrae
210
Q

At what level does the oesophagus cross the diaphragm?

A

T10

211
Q

At what level does the aorta cross the diaphragm?

A

T12

212
Q

At what level does the IVC cross the diaphragm?

A

T8

213
Q

At what level does the vagus nerve cross the diaphragm?

A

T10

214
Q

What are some easy ways to remember the level at which these structures cross the diaphragm:

  • Vena cava
  • Aorta
  • Vegus nerve
  • Oesophagus
A
  • Vena cava -> T8 -> There are 8 letters in vena cava
  • Aorta -> T12 -> Idk good luck
  • Vagus nerve -> T10 -> There are 10 letters in vagus nerve and it is the 10th cranial nerve
  • Oesophagus -> T10 -> There are 10 letters in oesophagus
215
Q

What are the arcuate ligaments?

A

Read up on this.

216
Q

What nerves innervate the diaphragm?

A
  • Motor and sensory -> Phrenic nerve
  • Sensory -> Intercostal nerves
217
Q

Where can pain from the diaphragm be referred to?

A
  • Right shoulder (phrenic n.)
  • Right hypochondrium (intercostal n.)

(Hypochondrium = Just below the rib cage)

218
Q

What nerve roots innervate the diaphragm?

A

C3, C4, C5 keep the diaphragm alive.

219
Q

Draw the different layers of intercostal muscles.

A
220
Q

What is the direction and function of external intercostal muscles?

A

Function: Inspiration

221
Q

What is the direction and function of internal intercostal muscles?

A

Function: Expiration

222
Q

What is the function of innermost intercostal muscles?

A

Assist the internal intercostal muscles.

223
Q

Draw how the upper ribs move during inspiration and expiration.

A
224
Q

Draw how the lower ribs move during inspiration and expiration.

A
225
Q

Where are the intercostal nerves and vessels found? What is the clinical relevance of this?

A
  • The main neurovascular bundles lie in the costal groove of the costal groove above this
  • Chest drain insertion in lower part of the intercostal space: Avoid damage to the main neurovascular bundle
226
Q

Draw the order of the nerve and blood vessels in the intercostal neurovascular bundle.

A
227
Q

Draw the structure of an intercostal nerve.

A
228
Q

What phenomenon occurs with rib fractures? What are the symptoms of this?

A

Flail chest -> The rib cage moves upon breathing.

229
Q

Describe the aortic supply of the thoracic cage.

A
  • Each subclavian arteries give off the internal thoracic arteries that run down the anterior side of the thorax
  • The internal thoracic arteries give off the anterior intercostal arteries
  • The descending aorta gives off the posterior intercostal arteries
230
Q

What arteries supply the lungs?

A

Bronchial arteries

231
Q

Describe the venous drainage of the thoracic cage.

A
  • Posterior intercostal veins drain into the azygos, hemiazygos and accessory hemiazygos veins
  • The hemiazygos and accessory hemiazygos veins drain into the azygos veins
  • The azygos vein drains into the superior vena cava
232
Q

Describe the lymphatic drainage of the thoracic wall.

A
233
Q

Where does the symphatic chain run in the thorax and what is the clinical relevance of this?

A
234
Q

What are the two pleura in the thoracic cavity?

A
  • Parietal pleura -> Outer membrane which is attached to the inner surface of the thoracic cavity. It also separates the pleural cavity from the mediastinum.
  • Visceral pleura -> Inner membrane that covers the surface of each lung.
235
Q

What does the parietal pleura line?

A
  • Thoracic cage (costal pleura)
  • Mediastinum
  • Part of cervical region
  • Diaphragm
236
Q

What is the pleural cavity?

A

The space in the thorax between the pleural and visceral membranes.

237
Q

Draw the different parts of the parietal pleura.

A
238
Q

What is the costodiaphragmatic recess and what is the clinical relevance?

A
  • It is a recess formed by the parietal pleura into which the lung can expand into during deep inspiration
  • Region for potential fluid accumulation: pleural effusion
239
Q

How low can the costodiaphragmatic recess reach?

A

Below the 12th rib.

240
Q

What is pneumothorax?

A
  • A pneumothorax is a collapsed lung.
  • It occurs when air leaks into the space between your lung and chest wall.
  • This air pushes on the outside of your lung and makes it collapse.
241
Q

What is tension pneumothorax?

A

It is a special case of penumothorax where the pressure of the air trapped in the pleural cavity continues to increase due to a one way valve in the chest wall. It is more dangerous.

242
Q

What are the symptoms of tension pneumothorax? [EXTRA]

A
243
Q

What are the three levels of bronchi?

A
  • Main (primary) bronchi
  • Lobar (secondary) bronchi
  • Segmental (tertiary) bronchi

i.e. The main bronchi divide into lobar bronchi, which divide into segmental bronchi.

244
Q

Draw a diagram to show how the trachea divides into narrower airways.

A
245
Q

Is an inhaled foreign object more likely to pass into the right or left main bronchus? Why?

A
  • Rght main bronchus
  • Due to its wider lumen & more vertical orientation
246
Q

Draw the structure and position of the three levels of bronchi.

A
247
Q

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

A

3 lobes:

  • Upper lobe
  • Middle lobe
  • Lower lobe
248
Q

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

A

2 lobes:

  • Upper lobe
  • Lower lobe
249
Q

How many bronchopulmonary segments are in each of the right lung lobes?

A
  • Upper lobe -> 3 BP segments (1-3)
  • Middle lobe -> 2 BP segments (4-5)
  • Lower lobe -> 5 BP segemnts (6-10)
250
Q

How many bronchopulmonary segments are in each of the left lung lobes?

A
  • Upper lobe -> 5 BP segments (1-5)
  • Lower lobe -> 5 BP segments (6-10)
251
Q

What is the cardiac notch of the lungs?

A

The cardiac notch is the lateral deflection of the anterior border of the left lung. It is produced to accommodate the space taken up by the heart.

252
Q

What is the lingula of the lungs?

A
253
Q

What is the apex of the lungs?

A

The most superior point on each lung.

254
Q

What are the different fissures of the two lungs?

A

Right lung:

  • Horizontal fissure
  • Oblique fissure

Left lung:

  • Oblique fissure
255
Q

Draw the different bronchopulmonary segments of the right lung. [EXTRA]

A
256
Q

Draw the different bronchopulmonary segments of the left lung.

A
257
Q

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

A
  • Apical segment of the lower lobe
  • This is important because any fluid will drain there when lying down
258
Q

What arteries supply the lungs? [IMPORTANT]

A
  • Pulmonary arteries -> Supply exchange parts of the lungs
  • Bronchial arteries -> Supply non-exchange parts of the lungs (e.g. bronchi)
259
Q

What is more anterior: the oesophagus or the trachea?

A

Trachea

260
Q

How many pulmonary arteries are there?

A

2 -> A left and a right one.

261
Q

Describe the venous drainage of the lungs and bronchi.

A
  • Pulmonary veins drain the lungs -> Drain into the left atrium of the heart.
  • Bronchial veins drain the larger bronchi and structures at the roots of the lungs -> The right side drains into the azygos vein, while the left side drains into the left superior intercostal vein or the accessory hemiazygos vein.
262
Q

How many pulmonary veins are there?

A

4 -> A superior and inferior on each side.

263
Q

Label the hila of the right and left lungs.

(Right is on the left and left is on the right)

A

Note: The posterior is in the middle, the anterior is to the sides.

264
Q

Compare the structure of the left and right main bronchi and pulmonary arteries as they enter the lungs.

A
  • On the right -> The main bronchus & pulmonary arteries typically divide BEFORE entering the lung
  • On the left -> The main bronchus & pulmonary arteries typically divide AFTER entering the lung
265
Q

Draw the impressions of vessels that can be seen on the right lung.

A
266
Q

Draw the impressions of vessels that can be seen on the left lung.

A
267
Q

What do the bronchial arteries originate from?

A

Aorta

268
Q

What is the pulmonary ligament?

A

A fold of pleural membrane reflected at the junction between the parietal and visceral pleura, at the bottom of the hilum.

269
Q

Describe the lymphatic drainage of the lungs and bronchi.

A
  • Lymphatic drainage from lungs follows the tracheobronchial tree
  • Majority of lymphatic drainage is to right lymphatic duct / subclavian vein except left upper lobe
270
Q

Describe the surface position of the apex of each lung.

A

It is about 2cm above the clavicle.

271
Q

Draw the surface markings of the lungs.

A

Note: You definitely don’t need to know the surface markings of the fissures. Nothing else is mentioned in the spec, apart from the apex, but it might be worth knowing the lower boundaries of the lungs.

272
Q

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

A

12th rib

273
Q

Draw the surface markings of the pleura of the lungs.

A
274
Q

What are some reasons why you may percuss the chest wall in a clinical setting? [IMPORTANT]

A

If the sound is dull, you may be tapping the:

  • Heart
  • Liver
  • Other liquid-filled cavities

If the sound is resonant, you may be tapping:

  • Gas-filled cavity (e.g. lungs or gas in stomach)
275
Q

Define auscultation.

A

The action of listening to sounds from the heart, lungs, or other organs, typically with a stethoscope, as a part of medical diagnosis.

276
Q

Draw the positions where you have to listen to the heart in order to hear the S1 and S2 heart sounds.

A

Note that the numbers show the position of the actual valves, while the crosses show where it is best to listen for that valve.

277
Q

Describe where to listen for the aortic semilumar valve.

A

Medial right 2nd intercostal space.

278
Q

Describe where to listen for the pulmonary semilumar valve.

A

Medial left 2nd intercostal space

279
Q

Describe where to listen for the tricuspid valve.

A

Medial left 4th/5th intercostal space

280
Q

Describe where to listen for the mitral valve.

A

Left 5th intercostal space, close to the midclavicular line

281
Q

What are lung fields? [IMPORTANT]

A
  • The areas of the lungs that can be listened to using a stethoscope.
  • These are the posterior, lateral, and anterior lung fields.
282
Q

Add flashcard on auscultation of ‘breathe sounds over trachea’.

A

Do it, whatever that means.

283
Q

What are the bones that make up the skull and facial skeleton?

A

Skull:

  • Frontal
  • Parietal
  • Occipital
  • Sphenoid
  • Temporal
  • Ethmoid

Facial skeleton:

  • Maxilla
  • Mandible
  • Zygomatic
  • Nasal
  • Vomer
284
Q

How many cranial and facial bones are there?

A
  • Cranial -> 8
  • Facial -> 14

[Check this!]

285
Q

Label this.

A
286
Q

Which bones make up the base of the skull?

A
287
Q

What is the orbit and which bones surround it?

A

The orbit is the bony protective socket for the eye and is formed by the surrounding frontal, sphenoid, maxilla and zygomatic bones.

288
Q

What is the name for the bones that make up the upper and lower jaw?

A
  • Upper jaw -> Maxilla
  • Lower jaw -> Mandible
289
Q

What is the zygomatic arch and what is it made up of?

A
  • The cheekbone
  • Formed by the zygomatic process of the temporal bone and the temporal process of the zygomatic bone
290
Q

What does the mandible articulate with? What is the name of the joint?

A

The temporal bone at the temporo-mandibular joint.

291
Q

Show the location of the temporal bone and name the 3 main parts of the bone.

A
292
Q

Describe the structure of the sphenoid bone and how it appears in the skull.

A
  • Greater wings -> These are the bits that can be seen on the lateral skull wall
  • Lesser wings
  • Pterygoid plates
  • Pituitary fossa (in the body) -> Where the pituitary gland is found
  • Sphenoid sinuses (in the body)
293
Q

What bone is this? Label it.

A
  • Zygomatic bone
  • Note that the part of it that forms the zygomatic arch is called the temporal process
294
Q

What bone is this? Label it.

A

Maxilla

295
Q

What bone is this? Label it.

A

Mandible

296
Q

Describe the different types of facial fracture. [EXTRA]

A
297
Q

What structures make up the external nose?

A
  • Nasal bones
  • Lateral nasal cartilages
  • Greater alar cartilages
298
Q

What is the nasal septum formed from?

A
  • Perpendicular plate of the ethmoid
  • Vomer
  • Septal cartilage
299
Q

What bone is this? Label it.

A

Ethmoid

300
Q

Draw the position of the ethmoid bone in the skull.

A
301
Q

What are the roles of the nose? [IMPORTANT]

A
  • Olfaction
  • Warming, cleaning and humidifying inspired air
302
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.
303
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.
304
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.

305
Q

What structures in the nasal passage allow warming and humidifying of air?

A

Mucus-secreting cells and rich blood supply.

306
Q

What arteries supply the nasal mucosa?

A

Originating from the internal and external carotid supply:

  • Maxillary artery
  • Facial artery
  • Branches of the ophthalmic artery
307
Q

What is the nasal cycle?

A

The alternating blood supply to the two nostrils, meaning that only one nostril can be blocked at a time during a cold.

308
Q

What important structure is found in the upper part of the nasal cavity?

A

Specialised sensory epithelium which allows us to sense odours (olfaction).

309
Q

Describe the nerves that innervate the nasal passage.

A
  • Olfactory Nerve (I) -> Smell
  • Trigeminal Nerve (V) -> General sensory
  • Facial Nerve (VII) -> Parasympathetic supply (of mucosa)
310
Q

What are paranasal air sinuses and where do they open?

A

Air-filled spaces are lined with mucus membrane and have openings into the nasal passage, behind the conchae.

311
Q

What are some functions of paranasal sinuses?

A
  • Lightening the weight of the head
  • Humidifying and heating inhaled air
  • Increasing the resonance of speech
  • Serving as a crumple zone to protect vital structures in the event of facial trauma
312
Q

How many paranasal sinuses are there? What are their names?

A

There are 2 copies of each of these 4 types:

  • Maxillary
  • Ethmoid
  • Sphenoid
  • Frontal
313
Q

Draw a diagram to show the openings of the different paranasal sinuses.

A
314
Q

Where does the naso lacrimal duct drain to?

A

From the eye to below the inferior concha.

315
Q

What nerve are the lips innervated by?

A

Trigeminal nerve (V)

316
Q

What are the different types of teeth, how many of each are there in an adult and what is their function? [EXTRA]

A

In each quarter of the mouth:

  • 2 Incisors -> Cutting
  • 1 Canine -> Gripping
  • 2 Premolars -> Grinding
  • 3 Molars -> Grinding
317
Q

What nerve innervates the upper and lower jaw?

A

Trigeminal Nerve (V)

318
Q

What articulates at the temporomandibular joint?

A

Head of the mandible articulates with the temporal bone forming a synovial joint at the mandibular fossa.

319
Q

What are the muscles of mastication and what is the function of each?

A
  • Temporalis and masseter -> Jaw-closing muscles.
  • Medial and lateral pterygoid muscles -> Allow protrusion of the lower jaw and sideways movements involved in chewing.
320
Q

What are the muscles of mastication innervated by? [IMPORTANT]

A

Mandibular branch of the trigeminal nerve (V)

321
Q

What are the two types of muscle of the tongue?

A
  • Intrinsic
  • Extrinsic
322
Q

Describe the extrinsic muscles of the tongue.

A

They all end in glossus.

323
Q

Describe the motor and sensory innervation of the tongue. [IMPORTANT]

A

Motor:

  • Hypoglossal nerve (XII) -> All muscles (except palatoglossus X)

Sensory:

  • Trigeminal nerve (V) -> General sensation of anterior 2/3rds of tongue
  • Facial nerve (VII) -> Taste sensation of anterior 2/3rds of tongue
  • Glossopharyngeal nerve (IX) -> Both general and taste sensation of posterior 1/3rd
324
Q

What are the different salivary glands are their location?

A
325
Q

Which nerves and ganglia control the different salivary glands?

A

Parotid gland:

  • Glossopharyngeal nerve (IX) via the otic ganglia

Sub-mandibular and sublingual salivary glands:

  • Facial nerve (VII) via the sub-mandibular ganglion
326
Q

Explain briefly what the pharynx is.

A
  • It is essentially the throat -> It is a common passage for solid food, liquid and air
  • It is the muscular tube behind the mouth and nasal cavity, and above the esophagus and larynx of the trachea (the tubes going down to the stomach and the lungs).
327
Q

What are the three parts of the pharynx?

A
  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
328
Q

Does the pharynx ever enter the trachea or oesophagus?

A

The enters the start of the oesophagus, but not the trachea.

329
Q

What parts of the pharynx need to be separated during swallowing and how is this achieved? [IMPORTANT]

A

The nasopharynx and oropharynx are separated during swallowing by the elevation of the soft palate.

330
Q

What allows for equalisation of pressure during swallowing?

A

Opening of the pharyngo-tympanic tube.

331
Q

What muscles form the pharynx?

A

The superior, middle and inferior pharyngeal constrictor muscles.

332
Q

How are the pharyngeal constrictor muscles joined?

A

The muscles are fused posteriorly as a “raphe”.

333
Q

What bone is important to the structure of the pharynx?

A

Hyoid bone

334
Q

Where is the hyoid bone found and how is it held in position?

A
  • Lies in the upper part of the neck
  • Suspended by muscles and the stylohyoid ligament
335
Q

What do each of the pharyngeal constrictor muscles attach to?

A
  • Superior constrictor -> Medial pterygoid plate of sphenoid
  • Middle constrictor -> Hyoid bone
  • Inferior constrictor -> Thyroid cartilage and the cricoid cartilage (parts of the larynx)
336
Q

What are the pharyngeal constrictor muscles innervated by?

A

Pharyngeal plexus

337
Q

What is the name for the sphincter between the pharynx and the oesophagus?

A

Cricopharyngeus

338
Q

What are the hard and soft palate?

A

They are the two parts of the roof of the mouth. The hard palate is the bony part at the front of the mouth, while the soft palate is the soft part at the back.

339
Q

What bones make up the hard palate? [EXTRA]

A
  • Palatine process of the maxilla
  • Paired palatine bones
340
Q

What is the function of the soft palate?

A

Facilitates speech, breathing and swallowing by making sure that the proper communication channels between the oral, pharyngeal and nasal cavities are open or closed during each of these processes.

341
Q

What is the larynx and what is its function?

A
  • Commonly called the voice box
  • It is an organ in the top of the trache
  • Involved in breathing, producing sound and protecting the trachea against food aspiration.
  • The larynx houses the vocal folds, and manipulates pitch and volume, which is essential for phonation.
342
Q

Compare the larynx and pharynx.

A

The larynx is the voice box at the top of the trachea, while the pharynx is the throat behind the mouth and nose. The pharynx essentially ends at the larynx, but goes a bit further into the oesophagus.

343
Q

What sort of tissues is the larynx made out of?

A
  • Cartilages
  • Membranes
344
Q

What are the different laryngeal cartilages?

A
  • Epiglottis -> Leaf-like cartilage which covers the opening of the larynx during swallowing
  • Thyroid cartilage -> Major cartilage of the larynx and is larger in males (Adams apple)
  • Cricoid cartilage -> Like a signet ring and lies at the top of the trachea.
  • Arytenoid cartilages -> Within the thyroid cartilage.
345
Q

Label this larynx.

A
346
Q

What is the epiglottis and what does it do?

A

The leaf-shaped covering at the top of the larynx that covers the opening during swallowing.

347
Q

What is the proper name for the Adam’s apple?

A

Thyroid cartilage

348
Q

In what organ are the vocal chords found?

A

In the larynx.

349
Q

What part of the larynx do the vocal cords attach to?

A
  • Posteriorly -> Arytenoid cartilages
  • Anteriorly -> Thyroid cartilage
350
Q

What are the arytenoid cartilage situated on and what is the implication of this?

A
  • The cricoid cartilage
  • This means that the can move freely and rotate and slide on the cricoid cartilage -> This is controlled by the vocal muscles
351
Q

How can the volume and pitch of vocal cords be controlled?

A

Note: The vocal cords are attached posteriorly to the arytenoid cartilages (on the cricoid cartilage), and anteriorly to the thyroid cartilage.

Volume control:

  • Moving the arytenoids controls the separation of the cords and therefore the volume

Pitch control:

  • The cricothyroid muscle pulls the thyroid cartilage down tensing the vocal cords -> Increases pitch
  • The thyroarytenoid muscles run in parallel with the vocal cords so slacken the cords -> Decrease pitch

[Don’t need to know named muscles]

352
Q

Label this.

A
353
Q

What protects the airway during swallowing?

A

Epiglottis (of the larynx)

354
Q

Describe the process of swallowing. [IMPORTANT]

A
  • The teeth break down the food, and the tongue mixes the food with salivary secretions to form a paste-like bolus.
  • The tip of the tongue is elevated against the hard palate and the posterior part of the tongue depressed, so the bolus moves to the oro-pharynx.
  • The sensory receptors on the posterior part of the tongue (glossopharyngeal) initiate a swallowing reflex.
  • The soft palate is tensed and elevated, sealing the nasal part of the pharynx.
  • The hyoid bone is elevated as the bolus passes to the pharynx, where the pharyngeal constrictors force the bolus down toward the oesophagus.
  • The elevation of the hyoid causes the epiglottis to cover the opening of the larynx, protecting the airway.
  • The bolus passes over the epiglottis down into the pharynx and, once past the cricopharyngeus muscle, the hyoid descends and the epiglottis flips back to reopen the airway.
355
Q

What nerves innervate the larynx?

A

Branches of the vagus nerve:

  • Recurrent laryngeal nerve -> Sensory innervation of the infraglottis, and motor innervation to all the internal muscles of larynx (except the cricothyroid).
  • Superior laryngeal nerve -> Internal branch provides sensory innervation to the supraglottis, and external branch provides motor innervation to the cricothyroid muscle.
356
Q

What nerve innervates the trachea?

A

Pulmonary plexus:

  • Recurrent laryngeal nerves (branches of the vagus) -> Parasympathetic supply
  • Sympathetic trunks -> Sympathetic supply
357
Q

What are some critical functions of the respiratory system?

A
  • Gas exchange -> O2 and CO2
  • Synthesis -> e.g. Collagen, elastin etc
  • Metabolism -> ATP production
  • Secretion -> e.g Mucus, surfactant
  • Defence -> Non-specific, specific
358
Q

What are the two main portions of the respiratory system and what is their function?

A
359
Q

What are the components of the conducting and respiratory portions of the airway?

A

Conducting portion:

  • Nasal cavity
  • Nasopharynx
  • Larynx
  • Trachea
  • Bronchi
  • Bronchioles
  • Terminal bronchioles

Respiratory portion:

  • Respiratory bronchioles
  • Alveolar ducts
  • Alveoli
360
Q

How is the conducting portion of the airways designed for its function?

A

Patency of conducting airways maintained by:

  • Rigid structural support -> Bone and cartilage
  • Flexibility and extensibility -> Elastic and collahen fibres, and smooth muscle

For protective and secretory functions:

  • A lining of epithelial cells with glands
361
Q

How is the respiratory portion of the airways designed for its function?

A
  • Thin walled pouches where gaseous exchange can take place
  • Rich capillary network and thin cellular membranes
362
Q

What lines the conducting portion of the airways?

A

Mucous membrane (mucosa)

363
Q

Describe the structure of mucous membranes. [IMPORTANT]

A

They consist of two layers:

  • Epithelial cells
  • Layer of connective tissue

Beneath the mucous membrane there is usually a submucosa and adventitia, plus maybe other layers.

364
Q

What is a mucosa, where is it found and what is its function?

A
  • It is just another name for a mucous membrane
  • It is found lining many places, including in the respiratory system, digestive system, and reproductive systems
  • Mucous membranes can contain or secrete mucus, having a protective function
365
Q

Draw the structure of the mucosa and underlying layers in the conducting portion of the airways.

A
  • Mucous membrane (mucosa) is:
    • Respiratory epithelium
    • Lamina propria
  • Submucosa and adventitia found beneath mucosa
366
Q

What are the functions of the mucous membrane of the conducting portion of the airways?

A
  • Covers and protects
  • Secretory and absorptive functions
367
Q

Where are mucous membranes found?

A

All body cavities that are in continuity with the external surface.

368
Q

What type of epithelium is the respiratory epithelium in the conducting portion of the airways?

A

Ciliated pseudostratified columnar epithelium

369
Q

What are the 5 types of cell in the mucous membrane of the respiratory epithelium (in the conducting portion of the airways)?

A
  1. Ciliated columnar cells
  2. Mucous goblet cells
  3. Basal (short) cells [EXTRA]
  4. Small granule cells (Kulchitsky or K cells) [EXTRA]
  5. Brush cells [EXTRA]
370
Q

Label the cells in this respiratory epithelium.

A
371
Q

What percentage of the respiratory epithelium do these cell types make up:

  • Ciliated columnar cells
  • Mucous goblet cells
  • Basal (short) cells
  • Small granule cells (Kulchitsky or K cells)
  • Brush cells
A
  • Ciliated columnar cells -> 30%
  • Mucous goblet cells -> 30%
  • Basal (short) cells -> 30%
  • Small granule cells (Kulchitsky or K cells) -> 3-4%
  • Brush cells -> 3%
372
Q

How many cilia are there on the apical surface of each ciliated cell in the respiratory epithelium?

A

300

373
Q

What is the normal ciliary beat frequency in the respiratory epithelium?

A

1000-1500 beats per minute

374
Q

Describe the internal structure of cilia of ciliated columnar epithelial cells in the resipratory epithelium.

A

Axoneme core:

  • 2 central microtubules
  • 9 pairs of microtubules around the outside of each cilia

Motor protein:

  • Dynein -> Enables movement
375
Q

How do cilia (on columnar epithelial cells of the respiratory epithelium) move?

A
  • Microtubules arranged longitudinally along the cilia glide past each other by ATP hydrolysis
  • Dynein (motor protein) provides the force for bending -> This is controlled by Ca2+ flux through gap junctions
376
Q

What is the function of goblet cells in the respiratory epithelium?

A

Produce mucus to trap particulate matter and pollutants.

377
Q

What does the viscosity of mucus produced by the goblet cells of the respiratory epithelium depend on?

A

Relative contributions from goblet cells and seromucus glands.

378
Q

What is metachronicity of ciliated epithelial cells and how does it happen?

A
  • Co-ordinated beating of cilia
  • Maintained by Ca2+ flux via gap junctions -> Visualised using Ca2+ sensitive dye
379
Q

What are some examples of diseases caused by faulty mucociliary function in the airways? (Aside from CF)

A
380
Q

What is respiratory epithelium?

A
  • The pseudostratified columnar epithelium that covers most of the upper respiratory tract.
  • It is a structural classification, not a functional one.
381
Q

Compare the concepts of the respiratory epithelium and mucous membrane.

A

Mucous membrane = Respiratory epithelium + Lamina Propria

382
Q

What is cystic fibrosis and what causes it?

A
  • Autosomal recessive disorder
  • Caused by a mutation in the CFTR protein (cystic fibrosis transmembrane conductance regulator) -> This is a Cl- channel
  • Affects most critically:
    • Lungs
    • Pancreas, liver, and intestine
  • Mechanism:
    • Disrupts epithelial ion transport
    • Results in defective transport of Cl- and water by the submucosal glands
    • Lack of chloride transport leads to decreased water movement by osmosis
    • Cells take up extra Na+
    • Mucus becomes thick and traps bacteria
  • The thick mucus leads to lung infections
383
Q

What are basal cells in the respiratory epithelium? [EXTRA?]

A
384
Q

What are small granule cells in the respiratory epithelium? [EXTRA]

A
385
Q

What are brush cells in the respiratory epithelium? [EXTRA]

A
386
Q

In what tissue do most lung cancers start? How does this happen? [EXTRA]

A
  • The respiratory epithelium is most susceptible to damage from pollutants
  • Smoking transforms respiratory epithelium into stratified squamous epithelium -> This is the first step in differentiation into a tumour
387
Q

What is the lamina propria?

A

Connective tissue with:

  • Mucous glands
  • Serous glands

It is beneath the respiratory epithelium and supports it. Together the two make up the mucosa (mucous membrane).

388
Q

Describe the structure of the lamina propria.

A
  • Elastic connective tissue
  • Has glands:
    • Mucous glands
    • Serous glands
  • Has MALT for defence:
    • Lymphocytes
    • Plasma cells
    • Macrophages
    • Neutrophils
    • Eosinophils
  • Rich blood supply
389
Q

What are the two types of gland in the lamina propria of the mucosa in the upper respiratory tract?

A
  • Mucous glands
  • Serous glands
390
Q

What do the mucous and serous glands of the lamina propria (in the upper respiratory tract) do?

A
  • Mucous glands
    • Produce a mucus that supplements that produced by goblet cells
    • It is viscous
  • Serous glands
    • Produce a watery secretion that dilutes mucus
    • Lysosyme, lactoferrin and protease inhibitors -> Protection against bacteria
391
Q

What are the different tissues below the mucosa (mucous membrane) in the upper respiratory tract?

A
  • Submucosa -> Larger glands
  • Cartilage
  • Muscle
  • Collagenous and elastic connective tissue fibres
392
Q

What forms the border between the mucosa and submucosa in the upper respiratory tract?

A

Elastic lamina

393
Q

Describe the epithelium in the mucosa of the nasal cavity.

A

There are 3 types of epithelium:

  • Respiratory epithelium (ciliated pseudostratified columnar epithelium)
  • Stratified squamous epithelium
  • Olfactory epithelium
394
Q

What is notable about the mucosa of the nasal cavity?

A
  • Very plentiful blood supply (for warming air)
  • Vibrissae (for filtering out dust particles)
  • Higher goblet : ciliated cell ratio (than lower airways)
395
Q

Where is the olfactory epithelium found?

A

It covers the roof of the nasal cavity.

396
Q

Describe the structure of the olfactory epithelium. [EXTRA?]

A
397
Q

What type of epithelium lines the trachea?

A

Respiratory epithelium

398
Q

What are the layers of the trachea wall?

A
  • Mucosa
  • Sub-mucosa
  • Adventitia with cartliage
399
Q

What reinforces the trachea?

A
  • 10-12 C-shaped cartilage rings
  • Open on the posterior side, where the gap is bridged by smooth muscle
  • Collagenous and elastic connective tissue fibres link individual rings
400
Q

Describe the mucosa of the bronchi.

A

It is very similar to the tracheal mucosa (i.e. the archetypal respiratory epithelium, with abundant mucous and serous glands), but the underlying cartilages are more irregular and there is a criss-crossing muscle layer.

401
Q

Do bronchioles have cartilage and muscle in the walls?

A

They have muscle, but no cartilage.

402
Q

What happens to the mucosa as you go further down the bronchioles?

A
  • Decrease in glands and goblet cells
  • Epithelial cells become more cuboidal
403
Q

Describe the mucosa of bronchioles.

A

Not typical respiratory epithelium -> Lined with ciliated cuboidal cells and Club (Clara) cells

404
Q

What are Clara cells? [EXTRA]

A
405
Q

Describe the structure of terminal bronchioles (compared to earlier bronchioles).

A

Increase in smooth muscle and elastic tissue (relative to wall)

406
Q

Describe the contraction and relaxation of the smooth muscle in the terminal bronchioles.

A

Muscle contracts at end of expiration and relaxes during inspiration

407
Q

What is asthma?

A
408
Q

Describe the process underlying asthma pathology.

A
409
Q

Where is the transition between the conducting and respiratory portions of the airways?

A

Between the terminal and respiratory bronchioles.

410
Q

Describe the structure of the walls of terminal bronchioles.

A
  • Mucosa similar to terminal bronchioles except walls interrupted by saclike alveoli which increase in number
  • Smooth muscle and elastic connective tissue
  • 80% of cells are Club cells
411
Q

Draw and describe the structure of the respiratory portion of the airways.

A

Alveolar ducts are tiny ducts that connect the respiratory bronchioles to alveolar sacs, each of which contains a collection of alveoli (small mucus-lined pouches made of flattened epithelial cells).

412
Q

Describe the epithelium of alveoli and alveolar ducts.

A
  • Simple squamous epithelium
  • Alveolar ducts do not have walls of their own
413
Q

What separates adjacent alveoli?

A

Sphincter-like smooth muscle cells

414
Q

What supports the alveoli (structurally) and what is the clinical relevance of this?

A
  • A rich matrix of elastic (expansion) and reticular fibres provides the only support of the alveolar duct and alveoli
  • A loss of elasticity and breakdown of elastic fibres gives rise to emphysema
415
Q

What is emphysema and how does it occur?

A
416
Q

Describe the wall between two alveoli.

A
  • Between the two squamous epithelia lie capillaries, elastic and reticular fibres and connective tissue matrix and cells (i.e. the interstitium)
  • Richest capillary network in body
  • Pores of Kohn allow communication between alveoli
417
Q

What are the three cells types that line alveoli? Draw how they appear.

A
  • Type I pneumocytes
  • Type II pneumocytes
  • Macrophages
418
Q

Compare the number and coverage of Type I cells, Type II cells and macrophages in the alveoli.

A
  • Type I -> 90% of alveolar surfaces
  • Type II -> More numerous than Type I cells but only occupy 10% of alveolar surface
  • Alveolar macrophages -> 10% of alveolar surface
419
Q

What type of cell are type I pneumocytes in alveoli and what is their function?

A
  • Squamous epithelial cells
  • Form gas exchange surface
420
Q

Draw the appearance of type I pneumocytes and describe their adaptions to their function.

A

Adapted to gas exchange:

  • Organelles grouped round nucleus leaving cell with minimal thickness
  • Form occluding junctions with each other preventing seepage of extracellular fluid into alveolar lumen
421
Q

What are the 3 layers of the blood-air barrier in the alveoli?

A
  1. Cytoplasm of alveolar cells
  2. Cytoplasm of endothelial cells
  3. Fused basal laminae of closely apposed alveolar and endothelial cells
422
Q

What drives transport across the blood-air barrier in the alveoli?

A

It occurs by passive diffusion, which is driven by pressure difference of gases within blood and alveolar lamina.

423
Q

What type of cell are type II pneumocytes in alveoli and what is their function?

A
  • Cuboidal epithelial cells found in groups
  • They produce sufactant and can also replace both type I and II pneumocytes by mitosis
424
Q

How do type II pneumocytes appear?

A

Thery are cuboidal and found in groups. They are interspersed with type I cells.

425
Q

Are type II pneumocytes connected with type I pneumocytes?

A

Type II cells have occluding and desmosomal junctions with type I cells.

426
Q

How are pneumocytes replaced?

A

Type II pneumocytes divide by mitosis to replace their own population and also the type I population.

427
Q

What is surfactant and what is its purpose?

A

A protein lipid complex which lowers alveolar surface tension.

428
Q

Describe how type II pneumocytes secrete surfactant.

A
  • Lamellar bodies synthesize (and recycle) phospholipids, glycosaminoglycans and proteins that comprise surfactant
  • Released at apical surface of cell where it forms a broad lattice-like network known as tubular myelin
429
Q

What is respiratory distress syndrome? [EXTRA]

A
430
Q

What type of cell are alveolar macrophages?

A

Phagocytes

431
Q

How do alveolar macrophages function? [IMPORTANT]

A
  • Phagocytose particulate matter (dust and bacteria) in lumen of alveoli maintaining sterile environment within lungs
  • Produce proteolytic and lysosomal enzymes
  • Also kill bacteria through peroxide-producing oxidative mechanisms
  • Also assist type II cells in the uptake of surfactant
  • Has many psuedopods and microvilli
432
Q

Draw the appearance of alveolar macrophages on a histology slide.

A
433
Q

What are some conditions causing inflammation of the respiratory tract?

A
  • Common cold
  • Influenza
  • Croup
  • Diptheria
  • Whooping cough (pertussis)
  • Pneumonia
  • Pleurisy
  • TB
  • Sinusitis
434
Q

Name some of the defence mechanisms in the respiratory system.

A
  • Filtration
  • Sneeze and cough reflexes
  • Mucus - ‘mucociliary escalator’ moves particles up to the mouth, where they can be swallowed
  • Lysozme, lactoferrin, transferrin involved in bacterial defence
  • Opsonins, such as immunoglobulins and complement
  • Phagocytic cells, such as alveolar macrophages and neutrophils
  • Pulmonary surfactant proteins
  • Nitric Oxide – inflammatory mediator
435
Q

Describe specific immunity mechanisms in the respiratory system.

A
  • Mucosal immune system
  • Aggregates of immune tissue
    • Adenoids
    • Bronchus-associated lymphoid tissue (BALT) -> Nodules containing T and B lymphocytes
    • NALT – in nose
436
Q

Describe the surface anatomy of the diaphragm.

A
  • The posteriorinferior margin of the diaphragm is the T12 vertebra.
  • The anteroinferior margin is the costal margin.
437
Q

Label this CT.

A
438
Q

Describe the innervation of the bronchi.

A

Pulmonary branches of the vagus nerve (X).

439
Q

What are arterial anastamoses?

A

A series of anastomosing arterial arches between the arterial branches of the jejunum and ileum.

440
Q

What nervous system controls arterial supply to the gut?

A

Sympathetic

441
Q
A

YEAR 1 - Organisation of the Body (Anton) (15 decks)

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