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Respiratory > Anatomy > Flashcards

Anatomy Flashcards

0
Q

What are the layers of the chest wall, superficial to deep?

A 
Skin
Fascia
Skeletal muscle
Bone/joints
Parietal pleura
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1
Q

What happens at the level of C6 vertebra?

A

The larynx becomes the trachea

The pharynx becomes the oesophagus

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2
Q

What are the functions of the chest wall?

A

Protect internal organs
Make the movements of breathing
Breast tissue for lactation

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3
Q

What makes up the chest cavity?

A

Left and right pleural cavity and the mediastinum

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4
Q

What are the two layers of the pleura in the chest and what do they adhere to?

A

Parietal pleura adheres to the mediastinum and the chest wall

Visceral pleura - inside

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5
Q

What are the names of the lung fissures and what do each separate?

A

Horizontal is right lung only and separates superior lobe from middle lobe.
Oblique is both right and left and separates inferior from middle (right) and superior (left)

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6
Q

What are the bronchopulmonary segments?

A

The areas of lung lobe supplied by each of the segmental bronchi.
Each lung has 10.

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7
Q

How are the ribs named and which ones fit in each category?

A

1-7 true ribs
8-10 false ribs
11-12 floating ribs

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8
Q

What are the three aspects of the sternum?

A

Manubrium
The body
The xiphoid

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9
Q

What are the aspects of the ribs from sternum to body of the vertebra?

A 
Costal cartilage
Rib angle - common site of fracture
The body/shaft of the rib
The rib tubercle
The neck of the rib
The head of the rib
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10
Q

How do the ribs articulate with the vertebrae and the sternum?

A

With the sternum via its costal cartilage

The head of the rib articulates with the body of the vertebra of the same number and body of the vertebra superiorly

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11
Q

What are the costal grooves?

A

Inferior indent on surface of ribs for the intercostal neurovascular bundle to run along

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12
Q

What joints are involved in breathing an where are they?

A

Costovertebral - rib to vertebra

Costachondral - rib to costal cartilage

Sternocostal - sternum to costal cartiliage

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13
Q

What are the layers of skeletal muscle located between the ribs and within intercostal spaces and what direction do they run?

A

External intercostals - hands in pockets, downwards and inwards
Internal intercostals - 90 degrees, horizontal
Innermost intercostals - 90 degrees, horizontal

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14
Q

Other than the intercostals what other muscle is essential for breathing?

A

The diaphragm

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15
Q

What arteries supply the intercostal spaces and where?

A

Thoracic aorta - posterior part of the intercostal spaces

Internal thoracic artery - anterior parts of the intercostal spaces, runs vertically either side of the deep side of the sternum

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16
Q

What veins drain the intercostal spaces and where?

A

The azygous vein - drains posterior intercostal spaces

Internal thoracic veins (2 either side of deep sternum) - drain the anterior intercostal spaces

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17
Q

Describe the nerve supply to the intercostal spaces.

A

The anterior ramus at that vertebral level and it’s lateral and anterior cutaneous branches supply all the layers in that intercostal space enabling breathing

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18
Q

What nerve supplies the diaphragm and where does it originate?

A

The phrenic nerve from C3,4 and 5 anterior rami.

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19
Q

Where does the diaphragm attach to in the chest cavity?

A

The sternum
The lower 6 ribs and costal cartilages
L1-L3 vertebral bodies

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20
Q

Where does the phrenic nerve run?

A

Starts at combined anterior rami C3,4,5 and is found in the neck on the anterior surface of scalenus anterior. It is then found in the chest on the lateral aspect of the fibrous pericardium.

21
Q

What does the phrenic nerve supply?

A

Somatic sensory and sympathetic axon of diaphragm and fibrous pericardium.

Somatic motor axons to the diaphragm

22
Q

What happens in inspiration anatomically?

A

The diaphragm contracts and descends
The intercostal muscles contract pulling ribs out and up
Chest wall pulls the lungs outwards due to the surface tension created by the parietal pleura and visceral pleura.
Lungs expand

23
Q

What happens in expiration anatomically?

A

All the muscles involved in inspiration relax causing elastic recoil

24
Q

Where are the four areas that stimulation of sensory receptors in the mucosa can cause cough?

A

Oropharynx
Laryngopharynx
Larynx
Respiratory tree

25
Q

What nerves are stimulated in coughing?

A

Oropharynx - CN IX - glossopharyngeal

Laryngopharynx and larynx - CN X - vagus

Respiratory tree - visceral afferents

26
Q

What happens after stimulation of sensory receptors in coughing?

A 
The CNS responds rapidly causing:
A deep inspiration
Adduction of the vocal cords
Contraction of abdominal wall muscles
Vocal cords suddenly abduct
Soft palate tenses and elevated
27
Q

What are the accessory muscles of deep inspiration?

A

Pectoralis major
Pectoralis minor
Sternocleidomastoid
Scalenus anterior, medius and posterior

28
Q

What muscles are involved in a deep inspiration when coughing?

A

The diaphragm
The intercostal muscles
Accessory muscles of inspiration

29
Q

What happens during adduction of the vocal cords in coughing?

A

Closure of the rima glottidis by the intrinsic muscles of the larynx which are supplied by the vagus nerve

30
Q

Where do the right and left vagus nerves connect to the brainstem?

A

The medulla oblongata through the jugular foramen

31
Q

What effect does contraction of the anterolateral abdominal wall muscles have during coughing?

A

They build up intra-abdominal pressure which pushes the diaphragm superiorly increasing pressure in the chest and respiratory tree towards the adducted vocal cords

32
Q

What accessory muscles cause deep expiration and how?

A

The diaphragm relaxes and the anterolateral abdominal wall muscles contract increasing abdo pressure and forcing diaphragm up. Increasing intra-thoracic pressure forcing air out

33
Q

What happens after the Intrathoracic pressure increase during coughing?

A

The vocal cords abduct opening the rima glottidis so air is forced out. This is done by the vagus nerve

34
Q

What happens after the vocal cords abduct in coughing?

A

The soft palate tenses (CN V) and elevates (CN X) closing off the nasopharynx directing air out of the oral cavity causing a cough rather than a sneeze

35
Q

What can stimulate the sensory receptors causing a cough?

A

Inflammatory mediators (asthma)
Irritant chemicals (smoking)
Mucus build up (asthma/infection)
Drugs (ACE inhibitors)

36
Q

What is the carina?

A

The internal aspect of the tracheal bifurcation

37
Q

What is a common pulmonary consequence of chronic cough?

A

Pneumothorax

38
Q

What are the consequences of mediastinal shift?

A

Trachea deviation

SVC compression reduces venous return to the heart cause hypotension

39
Q

How is a pneumothorax managed?

A 
Needle aspiration (thoracentesis) or
Siting of a chest drain.

Both in the 4th/5th intercostal space midaxillary line

40
Q

Why is it vital that needles or chest drains are place into the middle of intercostal spaces in pneumothorax drainage?

A

To avoid the neurovascular bundles running either side of the ribs

41
Q

What is the emergency treatment of a tension pneumothorax?

A

A large gauge cannula into the pleural cavity via the 2nd or 3rd intercostal space mid clavicular line

42
Q

What are the most likely causes of chronic cough?

A

Herniae

43
Q

What factors are needed to contribute to a hernia?

A

Weakness of one structure (usually the body wall)

Increased pressure

44
Q

Where are common sites of herniae?

A

Oesophageal hiatus
Umbilical
Inguinal

45
Q

What is ASIS short for?

A

Anterior superior iliac spine

46
Q

What makes up the spermatic cord?

A

The 3 layers of coverings gained as the testis pass through the Inguinal canal plus the structures contained within

47
Q

What structures are contained within the spermatic cord?

A 
The vas deferens (transport sperm)
Testicular artery (oxygen supply)
Pampiniform venous plexus (drains deoxygenated blood)
48
Q

What is the difference between a direct Inguinal hernia and an indirect Inguinal hernia in males?

A

Direct - peritoneum forced through posterior wall of Inguinal canal and directly out of superficial ring into scrotum

Indirect - through deep ring, along Inguinal canal and out of superficial ring

49
Q

How do you differentiate between direct and indirect Inguinal hernias clinically?

A

Reduce the hernia and occlude the deep Inguinal ring. Ask the patient to cough. If the lump reappears it is direct, if not is indirect

Respiratory (5 decks)

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