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Y1 Respiratory Anatomy > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What makes up the upper respiratory tract?

A

Right & left nasal cavities
Oral cavity
Naso-/Oro-/Laryngo- pharynx
Larynx

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2
Q

What makes up the lower respiratory tract?

A 
Trachea
Right & left main bronchi
Lobar bronchi
Segmental bronchi
Bronchioles 
Alveoli
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3
Q

What is the division between the URT and LRT?

A

The trachea

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4
Q

At which level does the larynx (URT) become the trachea (LRT)?

A

C6 vertebrae

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5
Q

The trachea can be palpated at the ________

A

Jugular notch of the manubrium

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6
Q

The isthmus of the thyroid gland is anterior to the tracheal cartilages ___

A

2-4

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7
Q

What connects the right and left side of the thyroid gland (forms an H shape)

A

Isthmus

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8
Q

Where is the thorax?

A

Between the neck and the abdomen

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9
Q

What are the components of the thorax?

A

Chest walls

Chest cavity

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10
Q

What is the function of the chest wall?

A

Protection of the heart and lungs
Making the movements of tissue
Breast tissue –> lactation

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11
Q

Where is the chest cavity located?

A

Within the chest walls

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12
Q

What does the chest cavity contain?

A

Vital organs (Viscera) + major vessels and nerves

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13
Q

What does the chest cavity consist of?

A

Mediastinum & right and left plural cavities

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14
Q

What are the layers of the chest wall (superficial to deep)?

A

Skin
Fascia (Superficial then deep)
Bone / Joints
Parietal pleura

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15
Q

The chest cavity is divided into which 3 areas?

A

Left pleural cavityRight pleural cavityMediastinum (in between)

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16
Q

The pleura in contact with the chest wall is called ____ pleura

A

Parietal

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17
Q

The pleura in contact with the lungs is called ___ pleura

A

Visceral

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18
Q

What does the pleural cavity contain?

A

Pleural fluid

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19
Q

What is the function of pleural fluid?

A

Cause surface tension between parietal and visceral pleura

Acts as a lubricant

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20
Q

Each lung has __ Brunchopulmonary segments

A

10

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21
Q

How many lobes does the right lung contain?

A

3

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22
Q

Which lung contains 2 lobes?

A

Left lung

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23
Q

Does each bronchopulmonary segment have its own blood supply?

A

Yes

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24
Q

What defines a true rib?

A

Attach via their costal cartilage to the sternum via a single bar or cartilage

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25
Q

What defines a false rib?

A

Attach via costal cartilage above to the sternum (via common costal cartilage = costal margin)

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26
Q

What defines floating ribs?

A

No attachment to the sternum

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27
Q

Which are the true ribs?

A

1-7

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28
Q

Which are the false ribs?

A

8-10

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29
Q

Which are the floating ribs?

A

11-12

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30
Q

How many intercostal spaces are there?

A

11

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31
Q

What makes up the sternum?

A

Manubrium
Body
Xiphoid
Sternal angle

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32
Q

What are the joints of breathing and where are they found?

A

COSTOVERTEBRAL: Between ribs and vertebrae
COSTOCHONDRAL: Between ribs and costal cartilage
STERNOCOSTAL: Between the sternum and the costal cartilage

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33
Q

Which layers of skeletal muscle are located between the ribs & within the intercostal spaces (superficial to deep)?

A

External intercostal muscles
Internal intercostal muscles
Innermost intercostal muscles

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34
Q

Where do the layers of intercostal muscles attach?

A

Between adjacent ribs

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35
Q

How do the intercostal muscles make the chest wall expand during breathing?

A

By pulling adjacent ribs upwards and outwards

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36
Q

What is the main skeletal muscle of breathing?

A

The diaphragm

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37
Q

What does each intercostal space carry? Where is this located?

A

A neuro-vascular bundle between internal and innermost intercostal muscle layers

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38
Q

What constitutes a neuro-vascular bundle?

A

Nerve, Artery &Vein

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39
Q

What is the nerve supply to the intercostal spaces?

A

Anterior rams of spinal nerve (aka intercostal nerve)

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40
Q

What is the posterior arterial supply to the intercostal spaces?

A

Thoracic aorta

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41
Q

What is the anterior arterial supply to the intercostal spaces?

A

Internal thoracic artery

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42
Q

What is the posterior venous drainage of the intercostal spaces?

A

Azygous vein

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43
Q

What is the anterior venous drainage of the intercostal spaces

A

Internal thoracic vein

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44
Q

The intercostal spaces have ___ arterial and venous supply

A

Dual

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45
Q

Which arteries supply the chest wall?

A

Bilateral posterior intercostal arteries

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46
Q

The bronchial arteries are branches from the anterior surface of the ______

A

Thoracic aorta

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47
Q

The thoracic duct accompanies the ____ through the diaphragm

A

Aorta

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48
Q

What forms the floor of the chest cavity?

A

Diaphragm

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49
Q

What forms the roof of the abdominal cavity?

A

Diaphragm

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50
Q

The diaphragm has _____ to allow structures to pass

A

opening

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51
Q

What type of muscle is the diaphragm?

A

Skeletal muscle with central tendon

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52
Q

Why is the right dome of the diaphragm normally more superior than the left?

A

Because of the presence of the liver inferiorly

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53
Q

The muscular part of the diaphragm attaches peripherally to (anterior to posterior)?

A
  1. Sternum
  2. Lower 6 ribs & costal cartilage
  3. L1-L3 vertebral bodies
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54
Q

What is the nerve supply of the diaphragm?

A

Phrenic nerve

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55
Q

Where does the phrenic nerve originate from?

A

C3,4 & 5 anterior rami

keep the diaphragm alive

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56
Q

The phrenic nerve is found on the anterior aspect of the ______ muscle and descends over the _____ aspects of the heart

A

Scalenus anterior

Lateral

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57
Q

The phrenic nerves supply the _____ and ______ axons to the diaphragm & ______

A

Somatic sensory
Sympathetic
Fibrous pericardium

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58
Q

The phrenic nerve supplies somatic _____ axons to the diaphragm

A

Motor

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59
Q

What are the 3 steps of inspiration mechanics?

A

Diaphragm contracts and descends
Intercostal muscles contract and elevate ribs
Chest walls pull the lungs outwards with them (parietal pleura)

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60
Q

What does the diaphragm contracting do to the vertical chest dimension?

A

Increases it

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61
Q

Which chest dimensions are increased by the intercostal muscles contracting?

A

A-P and lateral

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62
Q

What effect does the chest wall pulling the lungs outwards have?

A

CREATES NEGATIVE PRESSURE

Air flows into the lungs

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63
Q

What are the 3 steps of expiration mechanics?

A

Diaphragm relaxes and rises
Intercostal muscles relax lowering ribs
Elastic tissue of lungs recoils

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64
Q

The lateral quadrants to axillary nodes in the breast show _____ drainage

A

Unilateral

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65
Q

The medial quadrants to parasternal nodes show _____ drainage

A

Bilateral

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66
Q

Where does blood supply to the breast come from?

A

Internal thoracic artery which comes from the subclavian vein

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67
Q

What is the groove in between the pectorals major and deltoid called?

A

Deltopectoral groove

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68
Q

Which vein drains the upper limb and drains into deeper veins in the neck?

A

Cephalic vein

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69
Q

Where is the costodiaphragmatic recess located?

A

Between the diaphragmatic parietal pleura and the costal parietal pleura

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70
Q

What is the most inferior region of the costodiaphragmatic recess, laterally?

A

The costophrenic angle

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71
Q

Abnormal fluid in the pleural cavity drains into the _______

A

Costodiaphragmatic recess

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72
Q

What is auscultation

A

Listening to the sound of air moving through the larynx

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73
Q

Which parts of the lung need to be auscultated during an exam?

A

All 5 lung lobes
Apices
Bases

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74
Q

Describe the dual blood supply to the lungs

A

OXYGENATED BLOOD
Pulmonary veins x 4
Bronchial arteries

DEOXYGENATED BLOOD
Pulmonary arteries x 2
Bronchial veins

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75
Q

What are the two types of bronchi?

A

LOBAR - provide lung lobes with air

SEGMENTAL - provide bronchopulmonary segments with air

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76
Q

The sternal angle is at what rib level?

A

Level of rib 2

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77
Q

Which area on the ribs carriers the intercostal NVB?

A

Costal groove

78
Q

Which nerve innervates serratus anterior? Injury to this nerve causes what?

A

Long thoracic nerve

Winged scapula

79
Q

What are the structures of the lung root?

A 
Main bronchus
Pulmonary veins x 2
Pulmonary artery
Lymphatics
Sensory visceral afferents
Sympathetic and parasympathetic nerves
80
Q

Coughing occurs in response to the stimulation of receptors in _______ (3)

A

Oropharyngeal mucosa
Laryngopharyngeal mucosa
Laryngeal mucosa

81
Q

From which cranial nerve will the nasopharynx and oropharynx relay action potentials from?

A

CN IX (Glossopharyngeal nerve)

82
Q

From which cranial nerve does the laryngopharynx relay action potentials from?

A

CN X (Vagus nerve)

83
Q

What are carotid sheaths?

A

Protective “tubes” of cervical deep fascia

84
Q

Where do the carotid sheets attach?

A

Superiorly to the bones of the base of the skull

Blend inferiorly with the fascia of the mediastinum

85
Q

What do the carotid sheaths (right/left) contain? (4)

A

Vagus nerve
Internal carotid artery
Common carotid artery
Internal jugular vein

86
Q

How do visceral pleura and respiratory tree visceral afferents connect with the CNS? (3)

A

Sympathetic trunk
Pulmonary plexus
Vagus nerve (in the carotid sheath)

87
Q

What is meant by “visceral afferent”?

A

Sensory nerve (that arrives) from an organ

88
Q

What does the pulmonary plexus contain? (3)

A

Sympathetic axons
Parasympathetic axons
Visceral afferents

89
Q

What is a plexus?

A

An intertwining of nerves

90
Q

The sympathetic and parasympathetic axons in the pulmonary plexus are _____ nerves that supply the _____

A

Motor

Heart

91
Q

The motor axons travel from the tracheal _____ along the branches of the _________ to supply all ____ and ______

A

Bifurcation
Respiratory tree
Mucous glands
Bronchiolar smooth muscles

92
Q

Describe the route of the pulmonary visceral afferents from the visceral pleura to the medulla

A

From visceral pleura

Respiratory tree to the plexus then follow the vagus nerve to the medulla to the brain

93
Q

Once the sensory receptors have been stimulated the CNS responds by rapidly coordinating _____

A

Deep inspiration

94
Q

Deep inspiration requires use of ___(4)

A

Diaphragm
Intercostal muscles
Accessory muscles of inspiration

95
Q

Which nerves innervate the diaphragm?

A

Phrenic nerves

96
Q

Which nerves innervate the intercostal muscles?

A

Intercostal nerves

97
Q

What is the difference between quiet and forced inspiration in terms of action potentials via the phrenic nerves?

A

In deep/forced inspiration a greater outflow of action potentials with a longer duration cause the diaphragm to flatten and descend maximally

98
Q

The intercostal nerves are the anterior rami of which spinal nerves?

A

T1-T11

99
Q

What are the accessory muscles of forced / deep inspiration?

A

Pectoralis Major
Pectoralis minor
Sternocleidomastoid
Scalenus anterior, posterior

100
Q

Where does the pectoralis major attach?

A

Between the sternum/ribs and humerus

101
Q

What is the function of the pectoralis major?

A

Adduction and medial rotation of the humerus

102
Q

What position must the upper limb be in so the pectoralis major can pull the ribcage upwards/outwards?

A

Upper limb position is “fixed” E.g. by holing on to the air of the chair or the thigh

103
Q

What is the recruitment of accessory muscles a clinical sign of

A

Dyspnoea?

104
Q

What is the function of the pectoralis minor in terms of deep inspiration?

A

Puling ribs 3-5 superiorly towards the coracoid process of the scapula

105
Q

Where does the sternocleidomastoid attach?

A

Between the sternum/clavicle and mastoid process of the temporal bone

106
Q

Where do the scalenus anterior, medius & posterior attach?

A

Between cervical vertebrae; ribs 1 and 2

107
Q

Which nerve stimulates the adduction of the vocal cords to close the rims glottidis during the coughing reflex?

A

CN X - Vagus nerve

108
Q

Where do the intrinsic muscles of the larynx attach?

A

Between the cartilages

109
Q

What do the intrinsic muscles of the larynx move? What does this result?

A

The cartilages - movement of the vocal cords

110
Q

What type of muscle are the intrinsic muscles of the larynx?

A

Skeletal (voluntary) muscle

111
Q

What type of nerve is CN X?

A

Mixed (sensory and motor)

112
Q

Where does the cranial nerve connect with the CNS?

A

At the medulla oblongata of the brainstem

113
Q

Through which structure do the vagus nerves (left&right) pass through the neck?

A

Within the carotid sheath

114
Q

What is the important function of CN X to coughing?

A

Supply somatic sensory and somatic motor axons to the larynx

115
Q

To which part of the larynx do the sensory parts of CNX go?

A

Mucosa lining of the larynx

116
Q

To which part of the larynx do the motor parts of CNX go?

A

Intrinsic muscles of the larynx

117
Q

In the chest, the vagus nerves descend ______ to the chest organs (including the lungs via the pulmonary plexus

A

Posterior

118
Q

The vagus nerves pass through the diaphragm on the _______

A

Oesophagus

119
Q

Where do the vagus nerves divide into many parasympathetic braches?

A

On the surface of the stomach

120
Q

Which structures do the parasympathetic branches of the vagus nerve supply? (2)

A

Foregut and Midgut organs

121
Q

Does the vagus or the phrenic nerve pass anterior to the root of the lung?

A

The phrenic nerve

122
Q

What is the purpose of anterolateral abdominal wall muscle contraction in terms of the cough reflex?

A

Raise intra-abdominal pressure

123
Q

Which muscles forcefully increase the the intra-abdominal pressure during deep expiration?

A

Right left anterolateral abdominal wall and the diaphragm

124
Q

Which muscles are involved in deep expiration? (4 - right and left of each)

A

Rectus abdominis
External oblique
Internal oblique
Transverses abdominus

125
Q

What is an aponeurosis?

A

Flattened tendon

126
Q

The aponeurosis of the right external oblique blends with the aponeurosis of the left external oblique the the midline ________

A

Linea alba

127
Q

Where does the external oblique attach superiorly?

A

Superficial aspects of the lower ribs

128
Q

Where does the eternal oblique attach inferiorly?

A

Anterior part of the iliac crest and the pubic tubercle

129
Q

The fibre direction of the external oblique is the _____ as the external intercostal muscle

A

Same

130
Q

Where is the lines semilunaris?

A

Where the muscle fibres end and the aponeurosis begins

131
Q

_____ of the right internal oblique bless with the aponeurosis of the _______ at the midline linea alba

A

Aponeurosis

Left internal oblique

132
Q

Where does the right internal oblique attach superiorly?

A

The inferior border of the lower ribs

133
Q

Where does the internal oblique attach inferiorly?

A

Iliac crest and thoracolumbar fascia of the lower back

134
Q

Does the internal oblique have the same/opposite fibre direction as the internal intercostal muscles?

A

Same

135
Q

Where does aponeurosis of the right transverses abdomens blend with the aponeurosis of the left transversus abdomens?

A

Linea alba

136
Q

Where does the transversus abdominus attach superiorly?

A

Deep aspects of the lower ribs

137
Q

Where does the transversus abdominus attach inferiorly?

A

Iliac crest and thoracolumbar fascia of the lower back

138
Q

What encapsulates the rectus abdominus?

A

Internal oblique
External oblique
Skin
Transversus abdominis

139
Q

Where does the the rectus abdominis attach superiorly?

A

Xiphoid process

Costal margin

140
Q

Where does the rectus abdominis attach inferiorly?

A

Pubis bone

Pubic symphysis

141
Q

The somatic motor, somatic sensory and sympathetic nerve fibres supplying the structures of the abdominal part of the body wall (soma) are convey within the _____

A

Thoracoabdominal nerves

142
Q

The 7th-11th intercostal nerves travel ______ then their terminal branches leave the _________ in which plane?

A

Anteriorly
Intercostal spaces
In the plane between the internal oblique and transversus abdominus

143
Q

What is the name of the nerves in the plane between the internal oblique and transversus abdominus?

A

Thoracoabdominal nerves

144
Q

What innervates the upper part of the abdominal wall?

A

Thoracoabdominal nerves

145
Q

What innervates the area below T12?

A

Subcostal nerve

146
Q

What does the iliohypogastric nerve innervate?

A

Half of L1 anterior ramus

147
Q

What does the ilioinguinal nerve innervate?

A

Half of L1 anterior ramus

148
Q

What are the functions of tonic (continuous low level) contractions of anterolateral abdominal muscles?

A

Maintain posture

Support the vertebral column

149
Q

What are the function of contractions of the anterolateral abdominal muscles?

A

Movements of the vertebral column (flexion; lateral flexion; rotations)
Guarding - protect the abdominal viscera
Increase intra-abdominal pressure (to assist defecation; micturition; labour)
Aid forced expiration

150
Q

What is a pneumothorax?

A

Alveolar air in the pleural cavity

151
Q

How can dynamic airway compression in asthma lead to a pneumothorax?

A

Expiration is difficult and the build-up of air trapped in alveoli can lead to rupture of lung and visceral pleura

152
Q

By which mechanism is a pneumothorax developed?

A

Penetrating injury to parietal pleura or rupture of visceral pleura; loss of vacuum; elastic recoil of lungs towards lung root

153
Q

What classifies a small pneumothorax?

A

2 cm between lungs and parietal pleura

154
Q

What classifies a large pneumothorax?

A

> 2 cm between lungs and parietal pleura

155
Q

How is a pneumothorax diagnosed by examination?

A

Reduced ipsilateral chest expansion
Reduced ipsilateral breath sounds
Hyper-resonance on percussion

156
Q

How can a pneumothorax be diagnosed by investigation via a CXR?

A

Absent lung markings peripherally

Visible lung edge

157
Q

How does a tension pneumothorax develop?

A

Torn pleura creating a one-way valve allowing air to enter pleural cavity on inspiration but not expiration

158
Q

What consequence can follow a tension pneumothorax?

A

Mediastinal shift

159
Q

How can mediastinal shift, and therefore a tension pneumothorax, be diagnosed?

A

Deviation of the trachea - palpable on jugular notch

160
Q

What is the consequence of mediastinal shift?

A

SVC compression reduces venous return to the heart causing hypotension

161
Q

How is a large pneumothorax managed (2)?

A 
Needle aspiration (thoracentesis)
Sitting of chest drain
162
Q

Where should the needle enter to relieve a large pneumothorax?

A

4th or 5th intercostal space in the mid-axilliary line

163
Q

How would you emergency manage a tension pneumothorax?

A

Insert large gauge cannula into pleural cavity via 2nd or 3rd intercostal space in the mid-clavicular line on the side of the tension pneumothorax

164
Q

What is a hernia?

A

Any structure passing through another (i.e. ending up in the wrong place)

165
Q

What is required for a hernia to develop?

A

Weakness of one structure (normal/congenital/surgical scar) + increased pressure on one side of that part of the wall

166
Q

Why can a chronic cough cause a hernia?

A

Regular increase in intra-abdominal pressure on diaphragm, anterolateral abdominal walls (including inguinal region + femoral triangle)

167
Q

Where do diaphragmatic hernia tend to develop?

A

Xiphoid attachment
Posterior attachments
Oesophageal hiatus

168
Q

What distinguishes a paraoesophagheal hiatus hernia?

A

Herniated pert of stomach passes through oesophageal hiatus to become parallel to the oesophagus in the chest - Gastro-oesophageal junction doesn’t move

169
Q

What distinguishes a sliding hiatus hernia?

A

Herniated part of the stomach slides through oesophageal hiatus into the chest with the gastro-oesophageal junction

170
Q

Where do inguinal hernias occur?

A

Uni-/bilateral

Medial halves of inguinal region

171
Q

What weakness and which pressure cause inguinal hernias?

A 
Weakness = presence of inguinal canal 
Pressure = intra-abdominal
172
Q

What can cause an inguinal hernia?

A

Chronic cough or constipation
Occupational heavy lifting
Athletic effort

173
Q

Where is the inguinal canal?

A

Between deep ring and superficial ring

174
Q

Where is the inguinal region?

A

Between anterior superior iliac spine and pubic tubercle

175
Q

What guides the testicle from its origin point in the abdomen down through the abdominal wall into the scrotum?

A

The gubernaculum

176
Q

How does the testicle descend from the abdomen to the scrotum?

A

Testicle starts to push into transversalis fascia (drags some with its)
Bypasses transverse abdominus
Crosses internal oblique (drags some with)
Passes through superficial ring of pubic tubercle
Passes through superficial fascia (drags some with)

177
Q

What does the layer of transversals fascia become known as when covering the testis?

A

Internal spermatic fascia

178
Q

What does superficial fascia become known as later on when it covers the testis?

A

External spermatic fascia (covering of external oblique aponeurosis)

179
Q

What does the internal oblique become known as later on when it covers the testis?

A

Cremasteric fascia

180
Q

The structures that the testes dragged with it become known as the ____

A

Spermatic cord

181
Q

Small part of peritoneum remained in scrotum after descending of testis becomes known as the ______

A

Tunica vaginalis

182
Q

The point between the deep and superficial ring is the _____

A

Inguinal canal

183
Q

The deep ring is where the the testes pushed into the ________

A

Transversals fascia

184
Q

The superficial rings is where the testes pushed into the _______ of the scrotum

A

Superficial fascia

185
Q

What does the spermatic cord contain?

A

Vas deferens
Testicular artery
Pampiniform plexus of veins

186
Q

What is the function of the vas deferens?

A

Transports sperm

187
Q

What are the boundaries of the femoral canal?

A 
Anterior =  inguinal ligament 
Medial = lacunar ligament 
Lateral = femoral vein
Posterior = pectinate ligament
188
Q

What is a direct inguinal hernia?

A

Finger of peritoneum is forced through posterior wall of inguinal canal and directly out of superficial ring into the scrotum

189
Q

What is an indirect inguinal hernia?

A

Finger of peritoneum is forced through the deep ring into the inguinal canal, then out of the superficial ring into the scrotum

190
Q

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

A
  1. Reduce hernia
  2. Occlude deep ring with fingertip pressure
  3. Ask patient to cough
    If direct, lump will reappear
    If indirect, lump will not reappear

Y1 Respiratory Anatomy (2 decks)

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