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Respiratory System > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What does the upper respiratory tract include?

A
  • The right and left nasal cavities
  • The oral cavity
  • The naso- oro- and laryngo- pharynx
  • The larynx
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2
Q

What does the lower respiratory tract include?

A
  • Trachea
  • Right and left main bronchi
  • Lobar bronchi (located within the lungs)
  • Segmental bronchi (located within the lungs)
  • Bronchioles (located within the lungs)
  • Alveoli (located within the lungs)
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3
Q

Where is the transition point where the larynx becomes the trachea?

A

The C6 vertebra

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4
Q

Describe the pleural cavity

A
  • Pleural cavity is the space surrounding each lung.
  • In adult lung visceral (in contact with lungs) pleura and parietal (in contact with body wall) pleura.
  • The space between is filled with pleural fluid, this causes the two layers to stick together.
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5
Q

What are the lobes of the left and right lung?

A
  • The Right lung has three lobes: Superior, inferior and middle.
  • The Left lung has two lobes: Superior and inferior. The absent middle lobe is thought to be due to the presence of the heart.
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6
Q

What are bronchopulmonary segments?

A

the area of lung lobe that each one of the segmental bronchi supply with air, each lung has 10 bronchopulmonary segments
• Each segment own blood supply, venous drainage, lymphatic drainage etc. All segments can be isolated surgically if required.

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7
Q

What are the major muscles involved in inspiration that contract every inspiration and relaxation causes passive expiration?

A

External intercostal muscles and the diaphragm

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8
Q

What is contained within intercostal spaces?

A

Each intercostal space carries a neuro-vascular bundle containing a nerve, artery and a vein. (going vein, artery nerve from superior to inferior). The neuromuscular bundle is between the internal intercostals and the innermost intercostals and lie in the subcostal groove under the rib.

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9
Q

Describe the origins of nerves, arteries and veins from the intercostal spaces

A
  • Intercostal nerve of the intercostal space is coming from single origin anterior ramus of spinal nerve.
  • Arteries and vein have dual anterior and posterior origins.
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10
Q

Describe the nerve supply of the diaphragm

A
  • Diaphragm nerve supply is the phrenic nerve
  • Phrenic nerve is produced by multiple spinal nerve anterior rami.
  • The muscular part of the diaphragm is supplied by the C3,4 and 5 anterior rami (phrenic nerve)
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11
Q

Describe inspiration mechanics

A
  1. Diaphragm contracts and descends which increases vertical chest dimension
  2. Intercostal muscles contract elevating ribs which increases anterior to posterior and lateral chest dimensions
  3. The chest walls pull the lungs outwards with them (pleura) and air flows into the lungs
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12
Q

Describe expiration mechanics

A
  1. Diaphragm relaxes and rises which decreases vertical thoracic dimension
  2. Intercostal muscles relax lowering ribs which decreases anterior to posterior and lateral chest dimensions
  3. Elastic tissue of lungs recoils and air flows out of lungs
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13
Q

What are the muscles of active expiration?

A

Abdominal muscles

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14
Q

What are the accessory muscles of inspiration that contract only during forceful inspiration?

A

Internal intercostals, pectoralis minor and major, scalenus muscles and the sternocleidomastoid

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15
Q

What surface anatomy is used to auscultate the lung apex?

A

Auscultate superior to the medial third of the clavicle

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16
Q

What rib does the horizontal fissure follow?

A

Rib 4

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17
Q

Where does the obique fissure follow?

A

Rib 6 anteriorly rising to T3 posteriorly

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18
Q

Where should you auscultate the middle lobe?

A

Between ribs 4 and 6 in the mid clavicular and mid auxiliary lines ON THE RIGHT HAND SIDE

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19
Q

What is the carina and what level is it at.

A

Ridge of cartilage in the trachea that occurs between division of two main bronchi. Level of rib 2

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20
Q

What is the site used in depressing a tension pneumothorax?

A

The 2nd intercostal space

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21
Q

Where do bronchial arteries arise from?

A

The thoracic aorta usually.

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22
Q

Where is the visceral pleura continuous with the parietal pleura?

A

At the hilum of the lung

23
Q

Describe the tracheobronchial tree?

A

Trachea bifurcates at the level of the sternal angle into main bronchi one to each lung. Each main bronchus divides into secondary lobar bronchi which each supply a lobe of the lung. Each lobar bronchi divides into segmental bronchi that supply the bronchopulmonary segments. These segmental bronchi divide into conducting bronchioles, then terminal bronchioles then respiratory bronchioles that end in alveoli. Bronchioles lack cartilage in their walls.

24
Q

What two cranial nerves are stimulated in coughing?

A

Cranial nerves 9 (glossopharyngeal) and 10 (vagus)

25
Q
  • Carotid sheath are protective tubes of ____1____ deep fascia
  • It contains the _____2___ nerve
  • Vagus nerve travels ____3____ carotid sheath but ______4____ nerve on surface.
A

cervical
vagus
within
glossopharyngeal

26
Q

Where are the nerves from the lung and visceral pleura derived from?

A

Pulmonary plexuses

27
Q

The ___1____ is narrowest part of the airway and the intrinsic muscles of the larynx ____2____ the vocal cords during the cough reflex

A

Rima glottidis

Adduct

28
Q

Phrenic nerve is ______ and made by coming together of __________ Phrenic nerve passes _____ to the root of the lung

A

Bilateral
C3,4 and 5
Anterior

29
Q

One function of vagus nerves important to coughing is to supply ________ and ______ axons to the larynx. Vagus nerve is ______ to the root of the lung.

A

somatic sensory
somatic motor
posterior

30
Q

What is the linea alba?

A

Midline where aponeurosis of right and left blend together

31
Q

Consequence of chronic cough?

A

Pneumothorax

Hernia

32
Q

What is the difference between a small and large pneumothorax?

A

Small has < 2cm gap between lung and parietal pleura

A large pneumothorax results in > 2cm gap between lung and parietal pleura.

33
Q

What happens in a tension pneumothorax?

A
  • The torn pleura can create a one-way valve that permits air to enter the pleural cavity on each inspiration but prevents air escaping again on expiration
  • With each inspiration more air enters the pleural cavity
  • The pneumothorax expands and the lung collapses towards its root
  • Eventually the build-up of air in the pleural cavity applies tension (pressure) to the mediastinal structures
34
Q

The trachea will deviate away or towards the pneumothorax and where is this palpable?

A

Away from the pneumothorax and this is palpable at the jugular notch.

35
Q

Describe the safe triangle and management of a large pneumothorax.

A
  1. Needle aspiration (thoracentesis)
  2. The siting of a chest drain

Both these procedures are done by 4th or 5th intercostal space in the midaxillary line

The “safe triangle”:

  • The anterior border of latissimus dorsi
  • The posterior border pectoralis major
  • Axial line superior to the nipple
  • Need to be in middle of intercostal space to avoid arteries, nerves and veins.
36
Q

Describe emergency management of a tension pneumothorax

A

Large gauge cannula inserted into pleural cavity via the 2nd or 3rd intercostal space in the midclavicular line of the side of the tension pneumothorax using sternal angle (level of rib 2) as a guide.

37
Q

What are hernia? And two causes?

A

Hernia are any structure passing through another, ending up in the wrong place.
• Hernia can form where there may be weakness of one structure
• Another cause is repeated bouts of increased intra-abdominal pressure on the diaphragm and the anterolateral abdominal wall (including the inguinal region/femoral triangle) as then structures are pushed through the wall to produce a hernia.

38
Q

What direction does the external oblique run in ?

A

Superolateral to inferomedial direction

39
Q

What direction does the internal oblique run in?

A

Superomedial to inferolateral

40
Q

What direction does the transversus abdominus run in?

A

across

41
Q

What are all the anterolateral abdominal muscles innervated by?

A

Thoracoabdominal nerves

42
Q

External intercostals ______ extend anteriorly as far as the sternum but internal intercostals ___ extend anteriorly all the way to the sternum

A

do not

do

43
Q

Findings on examination of pneumothorax?

A
  • reduced ipsilateral chest expansion
  • reduced ipsilateral breath sounds
  • hyper-resonance on percussion
44
Q

Describe the two types of diaphragmatic hernia?

A

Paraoesophageal hiatus hernia
The herniated part of the stomach passes through the oesophageal hiatus to become parallel to the oesophagus and in the chest

Sliding hiatus hernia
The herniated part of the stomach slides through the oesophageal hiatus into the chest with the gastro-oesophageal junction

45
Q

What is the weakness in the inguinal area caused by and what are the two types of hernia you can get?

A

Weakness due to the inguinal canal

Direct inguinal hernia
A “finger” of peritoneum is forced through the posterior wall of the inguinal canal and directly out of the superficial ring into the scrotum

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

46
Q

How do you differentiate between the two types of inguinal hernia?

A
  1. ‘reduce’ the hernia
  2. occlude the deep ring with fingertip pressure
  3. ask the patient to cough

if it is a direct hernia, the lump will reappear
if it is an indirect hernia, the lump will not reappear

47
Q

5 types of hernia associated with chronic cough?

A

1) Diaphragmatic herniae (e.g. paraoesophageal & sliding hiatus herniae)
2) Umbilical herniae (congenital & acquired)
3) Incisional herniae (any surgical incision of the abdominal wall is vulnerable)
4) Inguinal herniae (direct & indirect - see later in this session)
5) Femoral herniae (in the femoral triangle of the proximal anterior thigh - more in Year 2)

48
Q

Describe the route of the inguinal canal starting at the deep ring in males

A 
transversalis fascia
transversus abdominus 
internal oblique
external oblique aponeurosis 
deep fascia
superficial fascia
scrotal skin
49
Q

What are the boundaries of the inguinal canal?

A

Floor = inguinal ligament
Anterior wall = external oblique aponeurosis
Posterior wall = transversalis fascia (lateral) and conjoint tendon (medial)
Roof = transversus abdominis and internal oblique

50
Q

What are the contents of the inguinal canal?

A

Spermatic cord in males or round ligament of the uterus in females. Also contains blood and lymphatic vessels as well as the ilio-inguinal nerve and the genital branch of the genitofemoral nerve.

51
Q

The aponeuroses of internal oblique and transversus abdominis join to form the conjoint tendon ______

A

Medial to the deep inguinal ring.

52
Q

What nerve provides motor innervation to the soft palate and intrinsic laryngeal muscles

A

Vagus nerve

53
Q

Lymphatic drainage of the lungs?

A

Tissue- bronchopulmonary- tracheobronchial (superior and inferior) and then into the bronchomediastinal trunk which drains into the venous angles

54
Q

Which bronchus has a higher rate of inhalation of foreign material?

A

The right

Respiratory System (16 decks)

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