Anatomy Flashcards
list the parts of the upper respiratory tracts in the correct order
r + l nasal cavities,
oral cavity,
naso-, oro-, laryngo- pharynx,
larynx
list the parts of the lower respiratory tracts in the correct order
trachea, r + l main bronchi, (within lungs); lobar bronchi segmental bronchi bronchioles alveoli
what happens at C6 vertebra (2)
the larynx becomes the trachea,
the pharynx becomes the oesophagus
what does the chest cavity consist of?
mediastinum and right and left pleural cavities
what does pleural fluid do?
lubricates and provides surface tension
what are the functions of the chest walls
protect heart and lungs and make the movements of breathing
what are the pleural cavities
thin fluid filled spaces that occupy the area between the two pulmonary pleurae
what is the parietal pleura
outer membrane that is attached to the inner surface of the thoracic cavity
what is the visceral pleura
the delicate serous membrane that covers each lung and dips into the fissures between lobes
what is the clinical significance of the sternal angle (6)
marks level in between thoracic vertebra T4 and T5, location of second rib, beginning and end of aortic arch, boundary between inferior and superior mediastinum, location of bifurcation of the trachea, highest point of pericardial sac
what is the clinical significance of the costal margin (2)
lower edge of chest, above spleen, exaggerated movement during breathing could show hoovers sign of pulmonary disease
what is the clinical significance of the xiphoid process
one of many origins of the diaphragm, don’t put pressure on during CPR
describe the three places that a rib articulates
rib articulates with sternum via costal cartilage, head of rib articulates with body of vertebrae of same number + vertebrae superior, rib tubercle articulates with the transverse process of the vertebrae of the same number
list the joints of breathing (3)
sternocostal joints (synovial), costochondral joints, costovertebral joints,
what are the muscles of breathing (4)
external, internal and innermost intercostal muscles, diaphragm
what nerve supply provides the intercostal muscles
anterior ramus of the spinal nerve (intercostal nerve)
what nerve supplies the diaphragm
phrenic nerves (anterior rami of cervical spinal nerves C3,4,5 )
describe the blood supply of the posterior intercostal spaces
thoracic aorta and azygous vein
describe the blood supply of the anterior intercostal spaces
internal thoracic artery and vein
describe the duality of the lungs blood supply
pulmonary arteries and their branches (oxygenation of blood for systemic circulation) and bronchial arteries (provide oxygenated blood to the lung tissue)
what happens to the diaphragm during inspiration
contracts and descends
what does the mechanics of the diaphragm do to the chest
increases the vertical dimension of the chest
what is the action of the intercostal muscles during inspiration and what does it result in
contract, elevating ribs and increase AP and lateral chest dimensions
what does AP dimension stand for
anterior-posterior
how do the lungs expand
parietal pleura stuck to chest walls via vacuum which pulls visceral pleura and therefor lungs with the chest walls as they expand
what must happen for air to flow into the lungs
negative pressure created in lungs by increasing lung volume
what is the action of the diaphragm during expiration and what does it result in
relaxes and rises decreasing the vertical thoracic dimension
what is the action of the intercostal muscles during expiration and what does it result in
relax lowering ribs and decrease AP and lateral chest dimensions
what happens to the lungs during expiration
elastic tissue recoils and air flows out
list the 5’lines’ of the chest
midsternal (median), r + l midclavicular, mid-posterior and anterior axillary
what can the sternal angle be used to locate
level of second rib and second costal cartilage
what are the four quadrants of the female breast
superolateral (upper outer), superomedial (upper inner), inferolateral (lower outer), inferiomedial (lower inner)
what quadrant of the female breast is the axillary tale located in
superolateral
describe the lymph supply to the lateral quadrants of the breast
unilateral drainage to the axillary nodes
describe the lymph supply to the medial quadrants of the breast
bilateral drainage to parasternal nodes
describe the blood supply to the breast
subclavian and inter-thoracic artery and vein
list the 6 things that lie below the breasts in order
pectoral (deep) fascia, pectoralis major, pectoralis minor, ribs, intercostal muscles, parietal pleura
where is the cephalic vein located
in delto-pectoral groove
what does the serratus anterior do
anchors scapula to ribs
what nerve supplies the serratus anterior
the long thoracic nerve
describe winged scapula
paralysis of serratus anterior usually due to injury of long thoracic nerve
what does the apex of the lung lie immediately posterior to
the clavicle, rib one, (subclavian and axillary vein and artery, brachial plexus), scalenus anterior
what does the scalenus anterior muscle span
cervical vertebrae to 1st rib
what is the right subclavicular vein anterior to
scalenus anterior
what is the right subclavicular artery posterior to
scalenus anterior
what is the brachial plexus posterior to
artery
when do subclavian blood vessels become axillary blood vessels
when they are lateral to the lateral border of the 1st rib and therefore within the axilla
what is the most inferior part of the pleural cavity
costodiaphragmatic recess
where is the costaldiaphragmatic recess located
between diaphragmatic and costal parietal pleura
what is laterally the most inferior part of the pleural cavity
costophrenic angle
what drains into recesses of pleural cavity (when the patient is upright)
abnormal fluid in the pleural cavity
what may abnormal fluid result in
blunting of the costophrenic angle
what are the different regions of the parietal pleura
cervical, costal, mediastinal and diaphragmatic
list the 7 structures that pass through the lung root
1 main bronchus, 1 pulmonary artery, 2 pulmonary veins, lymphatics, visceral afferents, sympathetic and parasympathetic nerves
what is the difference between lung lobes and bronchopulmonary segments
lobes- area of lung that lobar bronchi supply with air
b.p segments- supplied with segmental bronchi (10 in each lung)
what happens to the mediastinal parietal pleura at the lung root
is reflected onto the lung as visceral pleura
where should you place a stethoscope to auscultate the lungs
lung apex (superior to medial 1/3rd of the clavicle), middle lobe (between ribs 4 and 6 in the mid-clavicular and mid-axillary lines), lung base (scapular line at T11 vertebral level),
stimulation of sensory receptors in where causes coughing
(respiratory mucosa) oropharyngeal mucosa, laryngopharyngeal mucosa, laryngeal mucosa
what sensory receptors are stimulated during sneezing
CN V, CV IX
what sensory receptors are stimulated during coughing
CN IX, CN X
what do the carotid sheaths attach to
superiorly to bones of the base of the skull, blends inferiorly to the fascia of the mediastinum
what do the carotid sheaths contain
vagus nerve, internal carotid artery, common carotid artery, internal jugular vein
what is the lower respiratory tract
trachea to bronchioles
what is CN X
the vagus nerve
where are the preganglionic cells of sympathetic nervous system located in the spinal chord
T1 to L2
what is the pulmonary plexus made of
sympathetic axons, parasympathetic axons, visceral afferents
where do all motor axons travel
from tracheal bifurcation along the branches of the respiratory tree
what do the motor axons supply
all mucous glands and all bronchiolar smooth muscle
where do the pulmonary visceral afferents travel
from visceral pleura and respiratory tree to the pulmonary plexus where it follows vagus nerve to the medulla of the brainstem
what do sensory neuron axons connect
sensory receptors to the CNS
how do sensory neurons initially react to the stimulation of the sensory receptors in the mucosa
rapidly coordinate a deep inspiration
what is involved in the deep inspiration
diaphragm, phrenic nerves, intercostal muscles, intercostal nerves, accessory muscles of inspiration
where is the phrenic nerves located in relation to the scalenus anterior muscle
on the anterior surface
describe the position of the phrenic nerves in the chest/ thorax
descending over the lateral aspects of the fibrous pericardium anterior to the lung root
what do the phrenic nerves supply specifically
supplies somatic sensory and sympathetic axons to the diaphragm and fibrous pericardium- and somatic motor axons to the diaphragm
what is the difference or nerve actions during normal inspiration and a deep forced inspiration
greater outflow of action potentials of longer duration via phrenic nerve causing the diaphragm to flatten and descend maximally
describe the action of the intercostal muscles during forced inspiration
contract forcefully to raise the ribs maximally
where does the pectoralis major attach to
between sternum/ribs and humerus
what is the action of the pactoralis major
adducts and medially rotates humerus
what are the accessory muscles of deep forced inspiration
pectoralis major, pectoralis minor, sternocleidomastoid, scalenus anterior, medius and posterior
how does the pectoralis major aid forced inspiration
can pull the ribs upwards and outwards if the limb is fixed
how does the pectoralis minor aid forced inspiration
can pull ribs 3-5 superiorly towards the coracoid process of the scapula
what is the recruitment of accessory muscles a clinical sign of
dyspneoa
what role do the vocal chords play in coughing
adduct to close the rima glottidis (vagus nerves)
what type of muscle are the intrinsic muscles of the larynx
all skeletal
where do the intrinsic muscles of the larynx attach to
between the cartilage
what are the intrinsic muscles of the larynx supplied by
somatic motor and vagus nerves
what adducts the vocal chords
the intrinsic muscles of the larynx
describe the path of the left and right vagus nerves
connect with CNS at medulla, jugular foramen, descend through neck in carotid sheath, descend posterior to lung root, pass through diaphragm, divide into parasympathetic branches
what is the role of the anterolateral abdominal wall muscles on coughing
contract and build up intra-abdominal pressure which pushes the diaphragm superiorly and and builds up pressure in the chest/ respiratory tree inferior to the adducted vocal chords
what happens to the diaphragm during deep forced expiration
relaxes and then is forced superiorly by the compressed abdominal contents
what are the other (excluding the diaphragm) accessory muscles in deep forced expiration and their role
r + l anterolateral abdominal wall muscles contract forcefully increasing intra-abdominal pressure
the somatic motor, somatic sensory and sympathetic nerve fibres supplying the structures of the abdominal part of the body wall are conveyed within the…
thoracoabdominal nerves
describe the route of travel of the 7th to the 11th intercostal nerves
anteriorly then their terminal branches leave the intercostal spaces in the plane between the internal oblique and the transverse abdominus as the thoracoabdominal nerves
what is the subcostal nerve
T12 anterior ramus
what is the iliohypogastric nerve
half of the L1 anterior ramus
what is the ilioinguinal nerve
the other half of the L1 anterior ramus
describe tonic compressions and what they do
continuous low level, maintain posture and support vertebral column
what do guarding contractions do
protect the abdominal viscera
what is the role of the soft palate in coughing
tenses and elevates to close off the entrance into the nasopharynx and direct the stream of air through the oral cavity
what nerve supplies the soft palate
CN V
what is the difference between a cough and a sneeze
in a sneeze the air leaves through the nasal cavity
what does skeletal muscle allow us to choose to do
breath
where does the respiratory mucosa lining the lower respiratory tract end
terminal bronchioles/alveoli
via what structures do the sensory and motor nerves supply the lungs
pulmonary plexus
name the laryngeal cartilages
thyroid, cricoid, arytenoid
what is the rima glottidis
the opening between the true vocal chords and the arytenoid cartilages of the larynx
what is the narrowest part of the larynx
the rima glottidis
what supplies the intrinsic muscles of the larynx
branches of the vagus nerves
what do contractions of the intrinsic muscles of the larynx bring about
movements of the vocal chords (including abduction of the rima glottidis during coughing)
what happens at the linea alba
the aponeurosis of the right external oblique blends with the aponeurosis of the left external oblique
where does the external oblique attach superiorly
the superficial aspects of the lower ribs
where does the external oblique attach inferiorly
anterior part of the iliac crest and the pubic tubercle
what happens at the linea semilunaris
where the muscles fibres end and the aponeurosis begins
what direction are the external and internal oblique muscle fibres in
same as intercostal
describe the aponeurosis of the internal oblique muscles
right blends with left at linea alba
where does the internal oblique lie
deep to external oblique
where does the internal oblique attach superiorly
the inferior border of the lower ribs
where does the internal oblique attach inferiorly
the iliac crest and the thoracolumbar fascia of the lower back
describe the aponeurosis of the transverse abdominus muscles
right blends with left at linea alba
where does the transverse abdominus lie
deep to the internal oblique
where does the transverse abdominus attach superiorly
deep aspects of the lower ribs
where does the transverse abdominus attach inferiorly
the iliac crest and the thoracolumbar fascia of the lower back
what is the rectus sheath constructed from
the aponeurosis of the other three muscles
what creates the 6/8 pack
tendinous intersections
what can a pneumothorax and tension pneumothorax be secondary to
pulmonary disease and chronic cough
what leads to alveolar air entering the pleural cavity
a breach in the visceral pleura
how can asthma lead to rupture of the lung and visceral pleura
build up of air trapped in alveoli
what happens when the vacuum between the parietal and visceral pleura is lost
pneumothorax- elastic lung tissue recoils towards lung root
what is a large pneumothorax
when amount of air is greater than 2cm
what are the features found on examination of a pneumothorax
reduced chest expansion and breath sounds. hyper-resonance on percussion
what are the features found on a CXR of a pneumothorax
absent lung markings peripherally, lung edge visible
can a pneumothorax be bilateral
yes
what causes a tension pneumothorax
when torn pleura creates a valve that prevents air escaping pleural cavity during expiration
what happens to the lung during a tension pneumothorax
collapses towards the root
what happens to the mediastinal structures in a tension pneumothorax
air applies pressure onto them causing a mediastinal shift- heart and left lung compressed, tracheal deviation
how can a pneumothorax cause hypotension
SVC compression reducing venous return to heart
how is a large pneumothorax treated
needle aspiration
where is a chest drain placed
4th or 5th intercostal space in the midaxillary line
describe the emergency management of an tension pneumothorax
large guage cannula inserted into the pleural cavity via the 2nd or 3rd intercostal space in the med clavicular line
what does the cannula/chest drain pass through
skin, superficial/deep fascia, 3 layers of intercostal muscles, parietal pleura
what is a hernia and what can cause it
any structure passing through another- chronic cough
what two factors are required for a hernia
weakness of a structure (usually body wall), increased pressure on one side of that wall
name the for parts of the body that have normal anatomical weakness
(all hernia) diaphragmatic, umbilical, inguinal, femoral
name the hernia that arises from an abnormal weakness caused by congenital abnormalities
congenital diaphragmatic hernia
what hernia arises from surgical scars
incisional hernia
where do diaphragmatic hernia develop
weaknesses at the attachment to the xiphoid (posterior attachments), oesophageal hiatus
describe a paraoesophageal hiatus hernia
herniated part of stomach passes through the oesophageal hiarus to become parallel to the oesophagus in the chest
describe a sliding hiatus hernia
herniated part of stomach slides through the oesophageal hiatus into the chest WITH the gastro-oesophageal junction (moves up with part of stomach)
what forms the floors of the inguinal canals
medial halves of the inguinal ligaments
what are the inguinal ligaments the inferior borders of
external oblique aponeurosis
what are the inguinal canals
4cm long passageways through the anterior abdominal wall
what do the inguinal canals run through
deep (entrance) and superficial (exit)
where is the deep ring located
superior to the midpoint of the inguinal ligament
what is the superficial ring and where is it located
v shaped defect in the external oblique aponeurosis that lies superolateral to the pubic tubercle
where do inguinal hernia form
medial half of the inguinal region
how is the inguinal canal originally formed
during the passage of the testes/round ligament of the uterus into the perineum
what does the inguinal canal contain in adults
spermatic chord/round ligament of the uterus
what can increase the intra-abdominal pressure that causes a inguinal hernia
chronic cough, constipation, occupational lifting of heavy weights, athletic effort
how many coverings does the spermatic chord have
3
what are the contents of the spermatic chord
vas deferns, testicular arteries, pampiniform, autonomic nerves, genitfemoral nerve, lymph vessels
what do the autonomic nerves within the spermatic chord supply
smooth muscle of the vas deferens and arterioles
what are the contents of the inguinal canal in females
ilioinguinal nerve, round ligament of the uterus
describe a direct inguinal hernia
a ‘finger’ of peritoneum is forced through the posterior of the inguinal canal and directly out of the superficial ring into the scrotum
describe an indirect inguinal hernia
a ‘finger’ of peritoneum is first forced through the deep ring into the inguinal canal and then out of the superficial ring into the scrotum (follows canal)
what are the three steps in clinically differentiating a hernia
- ‘reduce the hernia
- obstruct deep ring with fingertip pressure
- ask patient to cough
how do you tell if its an indirect or direct hernia after the 3 steps
direct- lump will reappear
indirect- lump will not reappear
what forms the interlobar fissures
visceral pleura covering the lungs
what does the parietal pleura cover
mediastinum, diaphragm, inner surface of the thorax
why do hila have no pleural coverage (lung root)
as two layers (parietal and visceral pleura) combine around hila
what do the two layers when they combine
pulmonary ligament
where does the pulmonary ligament join
attaches the root of the lung to the diaphragm
