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Respiratory > Anatomy > Flashcards

Anatomy Flashcards

1
Q

list the parts of the upper respiratory tracts in the correct order

A

r + l nasal cavities,
oral cavity,
naso-, oro-, laryngo- pharynx,
larynx

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2
Q

list the parts of the lower respiratory tracts in the correct order

A 
trachea,
r + l main bronchi,
(within lungs);
lobar bronchi 
segmental bronchi 
bronchioles 
alveoli
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3
Q

what happens at C6 vertebra (2)

A

the larynx becomes the trachea,

the pharynx becomes the oesophagus

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4
Q

what does the chest cavity consist of?

A

mediastinum and right and left pleural cavities

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5
Q

what does pleural fluid do?

A

lubricates and provides surface tension

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6
Q

what are the functions of the chest walls

A

protect heart and lungs and make the movements of breathing

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7
Q

what are the pleural cavities

A

thin fluid filled spaces that occupy the area between the two pulmonary pleurae

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8
Q

what is the parietal pleura

A

outer membrane that is attached to the inner surface of the thoracic cavity

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9
Q

what is the visceral pleura

A

the delicate serous membrane that covers each lung and dips into the fissures between lobes

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10
Q

what is the clinical significance of the sternal angle (6)

A

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

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11
Q

what is the clinical significance of the costal margin (2)

A

lower edge of chest, above spleen, exaggerated movement during breathing could show hoovers sign of pulmonary disease

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12
Q

what is the clinical significance of the xiphoid process

A

one of many origins of the diaphragm, don’t put pressure on during CPR

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13
Q

describe the three places that a rib articulates

A

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

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14
Q

list the joints of breathing (3)

A

sternocostal joints (synovial), costochondral joints, costovertebral joints,

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15
Q

what are the muscles of breathing (4)

A

external, internal and innermost intercostal muscles, diaphragm

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16
Q

what nerve supply provides the intercostal muscles

A

anterior ramus of the spinal nerve (intercostal nerve)

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17
Q

what nerve supplies the diaphragm

A

phrenic nerves (anterior rami of cervical spinal nerves C3,4,5 )

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18
Q

describe the blood supply of the posterior intercostal spaces

A

thoracic aorta and azygous vein

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19
Q

describe the blood supply of the anterior intercostal spaces

A

internal thoracic artery and vein

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20
Q

describe the duality of the lungs blood supply

A

pulmonary arteries and their branches (oxygenation of blood for systemic circulation) and bronchial arteries (provide oxygenated blood to the lung tissue)

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21
Q

what happens to the diaphragm during inspiration

A

contracts and descends

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22
Q

what does the mechanics of the diaphragm do to the chest

A

increases the vertical dimension of the chest

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23
Q

what is the action of the intercostal muscles during inspiration and what does it result in

A

contract, elevating ribs and increase AP and lateral chest dimensions

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24
Q

what does AP dimension stand for

A

anterior-posterior

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25
Q

how do the lungs expand

A

parietal pleura stuck to chest walls via vacuum which pulls visceral pleura and therefor lungs with the chest walls as they expand

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26
Q

what must happen for air to flow into the lungs

A

negative pressure created in lungs by increasing lung volume

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27
Q

what is the action of the diaphragm during expiration and what does it result in

A

relaxes and rises decreasing the vertical thoracic dimension

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28
Q

what is the action of the intercostal muscles during expiration and what does it result in

A

relax lowering ribs and decrease AP and lateral chest dimensions

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29
Q

what happens to the lungs during expiration

A

elastic tissue recoils and air flows out

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30
Q

list the 5’lines’ of the chest

A

midsternal (median), r + l midclavicular, mid-posterior and anterior axillary

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31
Q

what can the sternal angle be used to locate

A

level of second rib and second costal cartilage

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32
Q

what are the four quadrants of the female breast

A

superolateral (upper outer), superomedial (upper inner), inferolateral (lower outer), inferiomedial (lower inner)

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33
Q

what quadrant of the female breast is the axillary tale located in

A

superolateral

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34
Q

describe the lymph supply to the lateral quadrants of the breast

A

unilateral drainage to the axillary nodes

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35
Q

describe the lymph supply to the medial quadrants of the breast

A

bilateral drainage to parasternal nodes

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36
Q

describe the blood supply to the breast

A

subclavian and inter-thoracic artery and vein

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37
Q

list the 6 things that lie below the breasts in order

A

pectoral (deep) fascia, pectoralis major, pectoralis minor, ribs, intercostal muscles, parietal pleura

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38
Q

where is the cephalic vein located

A

in delto-pectoral groove

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39
Q

what does the serratus anterior do

A

anchors scapula to ribs

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40
Q

what nerve supplies the serratus anterior

A

the long thoracic nerve

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41
Q

describe winged scapula

A

paralysis of serratus anterior usually due to injury of long thoracic nerve

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42
Q

what does the apex of the lung lie immediately posterior to

A

the clavicle, rib one, (subclavian and axillary vein and artery, brachial plexus), scalenus anterior

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43
Q

what does the scalenus anterior muscle span

A

cervical vertebrae to 1st rib

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44
Q

what is the right subclavicular vein anterior to

A

scalenus anterior

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45
Q

what is the right subclavicular artery posterior to

A

scalenus anterior

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46
Q

what is the brachial plexus posterior to

A

artery

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47
Q

when do subclavian blood vessels become axillary blood vessels

A

when they are lateral to the lateral border of the 1st rib and therefore within the axilla

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48
Q

what is the most inferior part of the pleural cavity

A

costodiaphragmatic recess

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49
Q

where is the costaldiaphragmatic recess located

A

between diaphragmatic and costal parietal pleura

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50
Q

what is laterally the most inferior part of the pleural cavity

A

costophrenic angle

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51
Q

what drains into recesses of pleural cavity (when the patient is upright)

A

abnormal fluid in the pleural cavity

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52
Q

what may abnormal fluid result in

A

blunting of the costophrenic angle

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53
Q

what are the different regions of the parietal pleura

A

cervical, costal, mediastinal and diaphragmatic

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54
Q

list the 7 structures that pass through the lung root

A

1 main bronchus, 1 pulmonary artery, 2 pulmonary veins, lymphatics, visceral afferents, sympathetic and parasympathetic nerves

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55
Q

what is the difference between lung lobes and bronchopulmonary segments

A

lobes- area of lung that lobar bronchi supply with air

b.p segments- supplied with segmental bronchi (10 in each lung)

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56
Q

what happens to the mediastinal parietal pleura at the lung root

A

is reflected onto the lung as visceral pleura

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57
Q

where should you place a stethoscope to auscultate the lungs

A

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),

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58
Q

stimulation of sensory receptors in where causes coughing

A

(respiratory mucosa) oropharyngeal mucosa, laryngopharyngeal mucosa, laryngeal mucosa

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59
Q

what sensory receptors are stimulated during sneezing

A

CN V, CV IX

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60
Q

what sensory receptors are stimulated during coughing

A

CN IX, CN X

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61
Q

what do the carotid sheaths attach to

A

superiorly to bones of the base of the skull, blends inferiorly to the fascia of the mediastinum

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62
Q

what do the carotid sheaths contain

A

vagus nerve, internal carotid artery, common carotid artery, internal jugular vein

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63
Q

what is the lower respiratory tract

A

trachea to bronchioles

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64
Q

what is CN X

A

the vagus nerve

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65
Q

where are the preganglionic cells of sympathetic nervous system located in the spinal chord

A

T1 to L2

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66
Q

what is the pulmonary plexus made of

A

sympathetic axons, parasympathetic axons, visceral afferents

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67
Q

where do all motor axons travel

A

from tracheal bifurcation along the branches of the respiratory tree

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68
Q

what do the motor axons supply

A

all mucous glands and all bronchiolar smooth muscle

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69
Q

where do the pulmonary visceral afferents travel

A

from visceral pleura and respiratory tree to the pulmonary plexus where it follows vagus nerve to the medulla of the brainstem

70
Q

what do sensory neuron axons connect

A

sensory receptors to the CNS

71
Q

how do sensory neurons initially react to the stimulation of the sensory receptors in the mucosa

A

rapidly coordinate a deep inspiration

72
Q

what is involved in the deep inspiration

A

diaphragm, phrenic nerves, intercostal muscles, intercostal nerves, accessory muscles of inspiration

73
Q

where is the phrenic nerves located in relation to the scalenus anterior muscle

A

on the anterior surface

74
Q

describe the position of the phrenic nerves in the chest/ thorax

A

descending over the lateral aspects of the fibrous pericardium anterior to the lung root

75
Q

what do the phrenic nerves supply specifically

A

supplies somatic sensory and sympathetic axons to the diaphragm and fibrous pericardium- and somatic motor axons to the diaphragm

76
Q

what is the difference or nerve actions during normal inspiration and a deep forced inspiration

A

greater outflow of action potentials of longer duration via phrenic nerve causing the diaphragm to flatten and descend maximally

77
Q

describe the action of the intercostal muscles during forced inspiration

A

contract forcefully to raise the ribs maximally

78
Q

where does the pectoralis major attach to

A

between sternum/ribs and humerus

79
Q

what is the action of the pactoralis major

A

adducts and medially rotates humerus

80
Q

what are the accessory muscles of deep forced inspiration

A

pectoralis major, pectoralis minor, sternocleidomastoid, scalenus anterior, medius and posterior

81
Q

how does the pectoralis major aid forced inspiration

A

can pull the ribs upwards and outwards if the limb is fixed

82
Q

how does the pectoralis minor aid forced inspiration

A

can pull ribs 3-5 superiorly towards the coracoid process of the scapula

83
Q

what is the recruitment of accessory muscles a clinical sign of

A

dyspneoa

84
Q

what role do the vocal chords play in coughing

A

adduct to close the rima glottidis (vagus nerves)

85
Q

what type of muscle are the intrinsic muscles of the larynx

A

all skeletal

86
Q

where do the intrinsic muscles of the larynx attach to

A

between the cartilage

87
Q

what are the intrinsic muscles of the larynx supplied by

A

somatic motor and vagus nerves

88
Q

what adducts the vocal chords

A

the intrinsic muscles of the larynx

89
Q

describe the path of the left and right vagus nerves

A

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

90
Q

what is the role of the anterolateral abdominal wall muscles on coughing

A

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

91
Q

what happens to the diaphragm during deep forced expiration

A

relaxes and then is forced superiorly by the compressed abdominal contents

92
Q

what are the other (excluding the diaphragm) accessory muscles in deep forced expiration and their role

A

r + l anterolateral abdominal wall muscles contract forcefully increasing intra-abdominal pressure

93
Q

the somatic motor, somatic sensory and sympathetic nerve fibres supplying the structures of the abdominal part of the body wall are conveyed within the…

A

thoracoabdominal nerves

94
Q

describe the route of travel of the 7th to the 11th intercostal nerves

A

anteriorly then their terminal branches leave the intercostal spaces in the plane between the internal oblique and the transverse abdominus as the thoracoabdominal nerves

95
Q

what is the subcostal nerve

A

T12 anterior ramus

96
Q

what is the iliohypogastric nerve

A

half of the L1 anterior ramus

97
Q

what is the ilioinguinal nerve

A

the other half of the L1 anterior ramus

98
Q

describe tonic compressions and what they do

A

continuous low level, maintain posture and support vertebral column

99
Q

what do guarding contractions do

A

protect the abdominal viscera

100
Q

what is the role of the soft palate in coughing

A

tenses and elevates to close off the entrance into the nasopharynx and direct the stream of air through the oral cavity

101
Q

what nerve supplies the soft palate

A

CN V

102
Q

what is the difference between a cough and a sneeze

A

in a sneeze the air leaves through the nasal cavity

103
Q

what does skeletal muscle allow us to choose to do

A

breath

104
Q

where does the respiratory mucosa lining the lower respiratory tract end

A

terminal bronchioles/alveoli

105
Q

via what structures do the sensory and motor nerves supply the lungs

A

pulmonary plexus

106
Q

name the laryngeal cartilages

A

thyroid, cricoid, arytenoid

107
Q

what is the rima glottidis

A

the opening between the true vocal chords and the arytenoid cartilages of the larynx

108
Q

what is the narrowest part of the larynx

A

the rima glottidis

109
Q

what supplies the intrinsic muscles of the larynx

A

branches of the vagus nerves

110
Q

what do contractions of the intrinsic muscles of the larynx bring about

A

movements of the vocal chords (including abduction of the rima glottidis during coughing)

111
Q

what happens at the linea alba

A

the aponeurosis of the right external oblique blends with the aponeurosis of the left external oblique

112
Q

where does the external oblique attach superiorly

A

the superficial aspects of the lower ribs

113
Q

where does the external oblique attach inferiorly

A

anterior part of the iliac crest and the pubic tubercle

114
Q

what happens at the linea semilunaris

A

where the muscles fibres end and the aponeurosis begins

115
Q

what direction are the external and internal oblique muscle fibres in

A

same as intercostal

116
Q

describe the aponeurosis of the internal oblique muscles

A

right blends with left at linea alba

117
Q

where does the internal oblique lie

A

deep to external oblique

118
Q

where does the internal oblique attach superiorly

A

the inferior border of the lower ribs

119
Q

where does the internal oblique attach inferiorly

A

the iliac crest and the thoracolumbar fascia of the lower back

120
Q

describe the aponeurosis of the transverse abdominus muscles

A

right blends with left at linea alba

121
Q

where does the transverse abdominus lie

A

deep to the internal oblique

122
Q

where does the transverse abdominus attach superiorly

A

deep aspects of the lower ribs

123
Q

where does the transverse abdominus attach inferiorly

A

the iliac crest and the thoracolumbar fascia of the lower back

124
Q

what is the rectus sheath constructed from

A

the aponeurosis of the other three muscles

125
Q

what creates the 6/8 pack

A

tendinous intersections

126
Q

what can a pneumothorax and tension pneumothorax be secondary to

A

pulmonary disease and chronic cough

127
Q

what leads to alveolar air entering the pleural cavity

A

a breach in the visceral pleura

128
Q

how can asthma lead to rupture of the lung and visceral pleura

A

build up of air trapped in alveoli

129
Q

what happens when the vacuum between the parietal and visceral pleura is lost

A

pneumothorax- elastic lung tissue recoils towards lung root

130
Q

what is a large pneumothorax

A

when amount of air is greater than 2cm

131
Q

what are the features found on examination of a pneumothorax

A

reduced chest expansion and breath sounds. hyper-resonance on percussion

132
Q

what are the features found on a CXR of a pneumothorax

A

absent lung markings peripherally, lung edge visible

133
Q

can a pneumothorax be bilateral

A

yes

134
Q

what causes a tension pneumothorax

A

when torn pleura creates a valve that prevents air escaping pleural cavity during expiration

135
Q

what happens to the lung during a tension pneumothorax

A

collapses towards the root

136
Q

what happens to the mediastinal structures in a tension pneumothorax

A

air applies pressure onto them causing a mediastinal shift- heart and left lung compressed, tracheal deviation

137
Q

how can a pneumothorax cause hypotension

A

SVC compression reducing venous return to heart

138
Q

how is a large pneumothorax treated

A

needle aspiration

139
Q

where is a chest drain placed

A

4th or 5th intercostal space in the midaxillary line

140
Q

describe the emergency management of an tension pneumothorax

A

large guage cannula inserted into the pleural cavity via the 2nd or 3rd intercostal space in the med clavicular line

141
Q

what does the cannula/chest drain pass through

A

skin, superficial/deep fascia, 3 layers of intercostal muscles, parietal pleura

142
Q

what is a hernia and what can cause it

A

any structure passing through another- chronic cough

143
Q

what two factors are required for a hernia

A

weakness of a structure (usually body wall), increased pressure on one side of that wall

144
Q

name the for parts of the body that have normal anatomical weakness

A

(all hernia) diaphragmatic, umbilical, inguinal, femoral

145
Q

name the hernia that arises from an abnormal weakness caused by congenital abnormalities

A

congenital diaphragmatic hernia

146
Q

what hernia arises from surgical scars

A

incisional hernia

147
Q

where do diaphragmatic hernia develop

A

weaknesses at the attachment to the xiphoid (posterior attachments), oesophageal hiatus

148
Q

describe a paraoesophageal hiatus hernia

A

herniated part of stomach passes through the oesophageal hiarus to become parallel to the oesophagus in the chest

149
Q

describe a sliding hiatus hernia

A

herniated part of stomach slides through the oesophageal hiatus into the chest WITH the gastro-oesophageal junction (moves up with part of stomach)

150
Q

what forms the floors of the inguinal canals

A

medial halves of the inguinal ligaments

151
Q

what are the inguinal ligaments the inferior borders of

A

external oblique aponeurosis

152
Q

what are the inguinal canals

A

4cm long passageways through the anterior abdominal wall

153
Q

what do the inguinal canals run through

A

deep (entrance) and superficial (exit)

154
Q

where is the deep ring located

A

superior to the midpoint of the inguinal ligament

155
Q

what is the superficial ring and where is it located

A

v shaped defect in the external oblique aponeurosis that lies superolateral to the pubic tubercle

156
Q

where do inguinal hernia form

A

medial half of the inguinal region

157
Q

how is the inguinal canal originally formed

A

during the passage of the testes/round ligament of the uterus into the perineum

158
Q

what does the inguinal canal contain in adults

A

spermatic chord/round ligament of the uterus

159
Q

what can increase the intra-abdominal pressure that causes a inguinal hernia

A

chronic cough, constipation, occupational lifting of heavy weights, athletic effort

160
Q

how many coverings does the spermatic chord have

A

3

161
Q

what are the contents of the spermatic chord

A

vas deferns, testicular arteries, pampiniform, autonomic nerves, genitfemoral nerve, lymph vessels

162
Q

what do the autonomic nerves within the spermatic chord supply

A

smooth muscle of the vas deferens and arterioles

163
Q

what are the contents of the inguinal canal in females

A

ilioinguinal nerve, round ligament of the uterus

164
Q

describe a direct inguinal hernia

A

a ‘finger’ of peritoneum is forced through the posterior of the inguinal canal and directly out of the superficial ring into the scrotum

165
Q

describe an indirect inguinal hernia

A

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)

166
Q

what are the three steps in clinically differentiating a hernia

A
  1. ‘reduce the hernia
  2. obstruct deep ring with fingertip pressure
  3. ask patient to cough
167
Q

how do you tell if its an indirect or direct hernia after the 3 steps

A

direct- lump will reappear

indirect- lump will not reappear

168
Q

what forms the interlobar fissures

A

visceral pleura covering the lungs

169
Q

what does the parietal pleura cover

A

mediastinum, diaphragm, inner surface of the thorax

170
Q

why do hila have no pleural coverage (lung root)

A

as two layers (parietal and visceral pleura) combine around hila

171
Q

what do the two layers when they combine

A

pulmonary ligament

172
Q

where does the pulmonary ligament join

A

attaches the root of the lung to the diaphragm

Respiratory (26 decks)

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