Anatomy 2 - Anatomy of a Cough Flashcards
Where are the sensory receptors that are stimulated in order to cause a cough? (4)
Oropharyngeal mucosa (CN IX)Laryngopharyngeal mucosa (CN X)Laryngeal mucosa (CN X)Lower respiratory tract’s respiratory mucosa (Visceral afferents)
What nerves supply sensory receptors in the nasal cavity?
CN V1 and CN V2
What nerve supplies sensory receptors in the nasal/ oropharynx?
CN IX
What nerve supplies sensory nerve receptors in the laryngopharynx and larynx?
CN X
What is the carotid sheath?
A protective “tube” of cervical deep fascia which attaches superiorly to the bones of the base of the skull and blends inferiorly with the fascia of the mediastinum
What does the carotid sheath contain? (4)
The vagus nerveThe internal carotid arteryThe common carotid arteryThe internal jugular vein
How does the vagus nerve descend to the mediastinum?
Within the carotid sheath
Stimulation of what 2 sensory nerves causes sneezing? (don’t both need to be stimulated)
CN V or CN IX
Stimulation of what 2 sensory nerves in the URT causes coughing?
CN IX or CN X
What part of the respiratory tract does the term “respiratory/ bronchial tree” describe?
LRTTrachea to alveoli
What type of nerves does the pulmonary plexus contain?
Sympathetic axonsParasympathetic axonsVisceral afferents
Where do the motor axons from the tracheal bifurcation travel and what do they supply (2)?
Branches of the respiratory treeAll mucous glands and all bronchiolar smooth muscles
Where do pulmonary visceral afferents innervate?
Visceral pleura and respiratory tree
Where does the pulmonary visceral afferents from the visceral pleura and respiratory tree travel?
To the plexus and then they follow the vagus nerve to the medulla of the brainstem
What nerve supplies the parasympathetic supply to the visceral pleura and respiratory tree?
The vagus nerve (CN X)
The CNS response to cough sensory receptors being stimulated by causing?
A deep (forced) inspiration using the diaphragm (phrenic nerve), intercostal muscle (intercostal nerves) and accessory muscles pf inspiration
What structures does the phrenic nerve supply somatic sensory and sympathetic axons to? (4)
The fibrous pericardiumMediastinal parietal pleuraDiaphragmatic parietal pleuraDiaphragmatic parietal peritoneum
Where does the phrenic nerve supply somatic motor axons to?
Diaphragm
What are the intercostal nerves?
The anterior rami of spinal nerves T1 - T11
What are the 4 accessor muscles of deep (forced) inspiration?
Pectorals majorPectoralis minorSternocleidomastoidScalenus anterior, medius and posterior
Where does the pectoralis major attach between?
Sternum/ ribs and humerus
What can the pectorals minor do in terms of inspiration?
Pull ribs 3-5 superiorly towards the coracoid process of the scapula
Where does the sternocleidomastoid muscle attach between?
Sternum/calvicle and mastoid process of temporal bone
Where do scaliness anterior, medius and posterior attach between?
Cervical vertebrae and ribs 1 and 2
What is the recruitment of accessory muscles an important clinical sign of?
Dsypnoea
What is the next stage of coughing after rapid inhalation?
Adduction of the vocal cords to close the rim glottidis
Which nerve controls the movement of the intrinsic muscles of the larynx?
Vagal nerves (somatic motor branches)
What muscles adduct the vocal cords during the cough reflex?
The intrinsic muscles of the larynx
Are the vagal nerves mixed, motor or sensory?
Mixed
Where does the vagal nerves connect with the CNS?
At the medulla (Oblongata) of the brainstem
Where does the vagal nerve pass out of the base of the skull?
Jugular foramen
In what ways does the vagal nerve supply the larynx?
Supplies somatic sensory innervation to the mucosa lining of the larynxSupplies somatic motor axons to the intrinsic muscles of the larynx
Where does the vagus nerves descend in comparison to the lung roots in the chest?
Posterior to lung root
What does the vagal nerve supply in the chest?
Provides parasympathetic axons to the chest organs (including the lungs via the pulmonary plexus)
What happens to the vagus nerve after the chest?
Passes through the diaphragm on the oesophagusOn the surface of the stomach they finally divide into many parasympathetic branches to the foregut and midgut organs
What happens after the abduction of the vocal cords in order cause a cough?
Contraction of the anterolateral abdominal wall muscles (intercostal nerves) to build up intra-abdominal pressure which pushes the diaphragm superiorly and builds up pressure in the chest/ respiratory tree inferior to the adducted vocal cords
What happens during forced expiration in terms of the abdomen?
Diaphragm relaxesRight and left anterolateral abdominal wall muscles contract forcefully increasing intra-abdominal pressureThe diaphragm is forced superiorly by the compressed abdominal contents Intra-thoracic pressure increases increasing the pressure within he respiratory tree inferior to the vocal cords
What are the anterolateral abdominal wall muscles?
Rectus abdominis External obliqueInternal obliqueTransversus abdominus(one of each on each side)
What anterolateral abdominal wall muscles have an aponeurosis?
External oblique (right and left joined by this)Internal obliqueTransversus abdominas
What is the midline at which the aponeuorisis of the left and right obliquez blend with each other?
Linea alba
In terms of the aponeurosis of the external obliques, what is the line called where the muscle fibres end and the aponeurosis begins?
Linea semilunaris
Where does the right external oblique attach to?
Superiorly to the superficial aspects of the lower libsInferiorly to the anterior part of the iliac breast and the pubic tubercle
Attachment points of the right internal oblique?
Attaches superiorly to the inferior border of the lower ribsAttaches inferiorly to the iliac crest and the thoracolumbar fascia
What is the direction of the fibres of the internal oblique?
Same as internal intercostal muscles (from lateral to medial diagonally upwards)
Where does the transverses abdomeninus attach?
Deep aspects of the lower ribs superiorly and the iliac crest and thoracolumbar fascia of the power back inferiorly
What does the combination of the aponeuroses of the transfer abdominis, internal and external oblique form?
The rectus sheath
What divides the rectus abdominis from 2 long flat muscles into 3 or 4 smaller quadrate muscles?Why?
Tendinous intersectionsFor improved mechanical efficiency
What are the somatic motor, somatic sensory and sympathetic nerve axons supplying the structures (including the muscles) of the abdominal part of the soma conveyed within?
Thoracoabdominal nervesSubcostal nerveIliohyogastric nerveIlioinguinal nerve
What are the thoracoabdominal nerves formed from?
7th to 11th intercostal nerves travel anteriorly then their terminal branches leave the intercostal spaces, int he plane between the internal oblique and the transverses abdominus, as the thoracoabdominal nerves
What is the subcostal nerve formed from?
T12 anterior ramus
What is the iliohypogastric nerve formed from
Half of L1 anterior ramus
What is the ilioinguinal nerve formed from?
The other half of L1 anterior ramus
What are the functions of the abdominal muscles? (6)
To maintain posture (tonic contractions)To support the vertebral column (tonic contractions)To produce movements of the vertebral column To “guard” protecting the abdominal visceraTo contract increasing the intra-abdominal pressure to assist defecation, micturation and labourTo contract aiding forced expiration
