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Respiratory System > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Upper Respiratory Tract

A

Nasal cavities, oral cavity, pharynx, larynx

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2
Q

Lower Respiratory Tract

A

Trachea, right & left main bronchus, lobar bronchi, segmental bronchi, bronchioles, alveoli

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3
Q

Where does the larynx become the trachea?

A

At the level of C6 verterbrae

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4
Q

Where does the pharynx become the oesophagus?

A

At the level of C6 verterbrae.

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5
Q

Lobar Bronchi

A

1 lobar bronchus for each of the 5 lung lobes.

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6
Q

Segmental Bronchi

A

1 segmental bronchus for each of the 10 bronchopulmonary segments

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7
Q

Lobes of the right lung

A

Upper, middle and lower

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8
Q

Lobes of the left lung

A

Upper and lower

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9
Q

Lung lobe

A

Area of the lung that each lobar bronchi supply with air

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10
Q

Bronchopulmonary segement

A

Area of lung lobe that each segmental bronchi supply with air

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11
Q

Fissures

A

Deep crevices that separate the lobes from each other

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12
Q

Lining on inside of bronchial tree (except for distal bronchioles & alveoli)

A

Respiratory epithelium

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13
Q

Respiratory Epithelium

A

Contain:

  • Mucous glands secrete mucous onto epithelial surface.
  • Cilia beat to sweep mucous + any foreign bodies stuck in the mucous superiorly, toward the pharynx.
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14
Q

Mucociliary Escalator

A

Cilia beat to sweep mucous _ any foreign bodies stuck in the mucous superiorly, toward the pharynx.

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15
Q

What interferes with normal beating of cilia?

A

Cooling/drying of mucosa & toxins in cigarette smoke.

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16
Q

Hyaline cartilage

A

Supports the walls of the trachea & all the bronchi & assists with maintaining airway patency

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17
Q

Do alveoli have cartilage?

A

No

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18
Q

Do alveoli have smooth muscle?

A

No

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19
Q

Why don’t alveoli have smooth muscle or cartilage?

A

Alveolar walls have to be extremely thin as smooth muscle and cartilage would impact on diffusion.

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20
Q

Cartilage in the respiratory tree

A

Cartilage gradually reduces distally in the respiratory tree

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21
Q

Smooth muscle in the respiratory tree

A

Smooth muscle becomes progressively more prominent distally in the respiratory tree

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22
Q

Bronchioles: smooth muscle

A

Smooth muscle is the most prominent feature of bronchioles => bronchioles can constrict or dilate

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23
Q

Requirements for gas transfer between air in alveoli & blood in pulmonary capillaries

A
  1. Sufficient functioning lung tissue.
  2. Sufficient O2 in inspired air.
  3. No CO2 in inspired air.
  4. Minimal thickness of walls of alveoli.
  5. Minimal tissue fluid in tissue spaces around the alveolar capillaries.
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24
Q

Dangers to respiratory tract

A
  1. Resp tract may become narrowed: Bronchiole constriction, swelling of mucosa/overproduction of mucous, growing tumour may compress tract.
  2. Foreign bodies being inhaled into resp tract.
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25
Q

What separates the 2 nasal cavities

A

Nasal septum

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26
Q

Nasal septum

A
  • Bony Part (Posterior): Ethmoid bone & vomer.

- Cartilaginous Part (Anterior)

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27
Q

Skeleton of larynx

A

Epiglottis, thyroid cartilage, cricoid cartilage, 2 arytenoid cartilages

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28
Q

Functions of larynx

A
  1. Cartilages help to maintain patency of URT.
  2. Helps prevent entry of foreign bodies into the LRT (vocal cords)
  3. Produces sounds (vocal sounds)
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29
Q

Trachea

A

Inferior continuation of larynx

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30
Q

Narrowest part of the larynx

A

Rima glottidis

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31
Q

Function of Vocal cords

A
  1. Airway protection.

2. Voice production

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32
Q

Voice Production

A
  • Phonation: Expire air across vocal cords, cords vibrate to produce sound.
  • Articulation: Sound is modified in nose or mouth to produce vowels and consonants.
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33
Q

Airway Protection by Vocal Cords

A

Vocal cords can approximate in the midline, closing the rima Glottidis & preventing a foreign body inhaled into the trachea => stimulates cough reflex to expel foreign body via pharynx and oral cavity.

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34
Q

Heimlich manoeuvre

A

Raises abdominal pressure, forces diaphragm superiorly, raises pressure in chest & lungs, forces air from lungs into trachea, forces air through rima glottidis to expel foreign body out of URT.

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35
Q

Dangers of breathing in cold/dry air

A

Cooling & drying out of respiratory tract => damages the mucocili]ary escalator & predisposes to infection.

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36
Q

Dangers of breathing in unclean air

A

Breathing in infected foreign bodies or bacteria/viruses etc. => infection.

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37
Q

How do we warm air?

A

Respiratory mucosa lining the walls of the nasal cavities has a very good arterial blood supply providing warmth

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38
Q

How to de humidity air?

A

Respiratory mucosa produces mucous providing moisture

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39
Q

How do we clean air?

A

Sticky mucous traps potentially infected particles & tonsils produce white blood cells in defence against infection.

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40
Q

Chest wall

A
  • Skin & Fascia.
  • Bones.
  • Skeletal muscles.
  • Diaphragm.
  • Parietal pleura.
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41
Q

Thoracic Skeleton

A
  • 12 Pairs of Ribs (True 1-7, False 8-10, Floating 11-12)
  • Intercostal spaces
  • Costal margin.
  • 12 thoracic vertebrae.
  • clavicle & scapula
  • sternum
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42
Q

Bones of chest wall

A
  • Sternoclavicular joint.
  • Sternocostal articulation with costal cartilage of rib 1
  • Manubrium
  • Sternal angle (at level of rib 2)
  • Body
    — Xiphoid process
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43
Q

Joints of thoracic skeleton

A

Sternocostal joints & costochondral joints

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44
Q

Sternocostal joints

A

Synovial

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45
Q

Costovertebral joints

A

Limited movement at these joints

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46
Q

Muscles of breathing

A
  • Intercostal muscles: make chest wall expand during breathing by pulling adjacent ribs upwards and outwards.
  • Diaphragm.
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47
Q

Intercostal muscles

A

3 layers of skeletal muscles are located between ribs in intercostal spaces:

  • external intercostal muscles.
  • Internal intercostal muscles.
  • innermost intercostal muscles.
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48
Q

Parietal pleura

A

Internal lining of the chest wall

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49
Q

Visceral pleura

A

Skin attached lung lobes

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50
Q

Pleural cavity

A

Space that surrounds the lung in 3D apart from where main bronchus enters it
- Between parietal & visceral layers of pleura

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51
Q

At level of C6 vertebrae

A

Larynx becomes trachea & pharynx becomes oesophagus.

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52
Q

Where can you palpate the trachea

A

At the jugular notch of the manubrium

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53
Q

Isthmus of thyroid gland

A

Anterior to tracheal cartilages 2-4.

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54
Q

2 parts of Thorax

A

Chest walls & chest cavity

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55
Q

Function of chest walls

A
  • Protect heart & lungs.
  • Make movements of breathing.
  • Breast tissue: lactation.
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56
Q

Chest cavity

A

Within chest wall, consists of mediastinum & right & left pleural cavities, contains vital organs, major vessels and nerves.

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57
Q

Lung development

A

Embryo: Lung bud pushes out from mediastinum, covered in pleura.

Adults: Pleural cavity: potential space, pleural fluid.

Both: Parietal pleura on wall, visceral pleura on lungs, reflect at lung roots.

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58
Q

Pleural fluid

A

Lubricant that provides surface tension - secreted by pleurae into pleural cavity.

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59
Q

Intercostal spaces

A

11 pairs, each carrying a neuro-vascular bundle between internal and innermost intercostal muscle layers.

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60
Q

Diaphragm

A
  • Forms floor of chest cavity & roof of abdominal cavity.
  • Contains openings to permit structures to pass between the 2 cavities.
  • Skeletal muscle with unusual central tendon.
  • Left and right domes, right more superior due to presence of liver.
  • Muscular part attaches peripherally to: Sternum, lower 6 ribs, costal cartilages & L1-L3 vertebral bodies.
  • Muscle part supplied by phrenic nerve.
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61
Q

What is supplied by phrenic nerve (C3, 4 & 5 anterior rami)

A

Muscular part of diaphragm

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62
Q

Why is the right dome of diaphragm higher?

A

Presence of liver inferiorly.

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63
Q

What does the muscular part of the diaphragm attach peripherally to?

A

Sternum, lower 6 ribs &costal cartilages & L1-L3 vertebral bodies

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64
Q

Phrenic nerves

A

Combined anterior rami of cervical spinal nerves C3, 4 & 5.

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65
Q

Where is phrenic nerve found?

A
  • Neck: On anterior surface of scale us anterior muscle.

- Chest (Thorax): Descending over lateral aspects of the heart.

66
Q

What does the phrenic nerve supply?

A

Somatic sensory & sympathetic axons to diaphragm & fibrous pericardium & somatic motor axons to the diaphragm.

67
Q

Inspiration mechanics

A
  1. Diaphragm contracts & descends.
  2. Intercostal muscles contract elevating ribs.
  3. Chest walls pull the lungs outwards with them (pleura)
68
Q

Expiration Mechanics

A
  1. Diaphragm relaxes & rises.
  2. Intercostal muscles relax, lowering ribs.
  3. Elastic tissue of lungs recoils.
69
Q

Anatomy of Breast

A

Pectoral fascia, pectoralis Major, pectoralis minor, ribs, intercostal muscles, parietal pleura, subclavian & internal thoracic artery & vein.

70
Q

Unilateral drainage

A

From lateral quadrants to axillary nodes

71
Q

Bilateral drainage

A

From medial quadrants to parasternal nodes

72
Q

Superficial fascia

A

Adipose tissue, insulation

73
Q

Deep fascia

A

Fibrous, tough, protection

74
Q

Muscles of chest wall

A

Pectoralis major, lattimus dorsi, serratus anterior, deltoids, pectoralis minor.

75
Q

Cervical parietal pleura

A

Above rib 1

76
Q

Costal parietal pleura

A

From rib 1 to lung base

77
Q

Diaphragmatic parietal pleura

A

Spans area where lung & diaphragm meet.

78
Q

Mediastinal parietal pleura

A

Spans area where lung & mediastinum meet

79
Q

Costophrenic angle

A

Where costal pleura & diaphragmatic pleura meet.

80
Q

Costodiaphragmatic recess

A

Inferior part of pleural cavity, located between diaphragmatic and costal parietal pleura.

81
Q

Where does abnormal fluid in pleural cavity drain?

A

Into costodiaphragmatic recess

82
Q

What does abnormal fluid in costodiaphragmatic recess cause?

A

Blunting of angles & fluid level seen on CXR

83
Q

Root of the lung

A
  • 1 main bronchus.
  • 1 pulmonary artery.
  • 2 pulmonary veins.
  • Lymphatics, visceral afferent, sympathetic nerves & parasympathetic nerves.
84
Q

Afferent nerves

A

Sensory -> CNS

85
Q

Efferent nerves

A

CNS -> Muscle

86
Q

Right Lung: Surface markings

A

Root of lung, azygous vein, phrenic nerve, superior vena cava, heart, diaphragm, inferior vena cava

87
Q

Hilum of Lung

A

Main bronchi, pulmonary arteries, pulmonary lymph nodes (black), pulmonary veins

88
Q

Left Lung: Surface Markings

A

Aorta, heart, diaphragm, root of lung, phrenic nerve, common carotid artery.

89
Q

Auscultation

A

Anterior: Lung apex (superior to clavicle), Middle lobe (between ribs 4&6).
Posterior: Lung base (Level of T11 vertebrae)

90
Q

What level is the horizontal fissure of Right Lung?

A

Follows right rib 4

91
Q

What level is the oblique fissures?

A

Level of rib 6 anteriorly rising to T3 vertebral level posteriorly.

92
Q

Coughing

A

Stimulation of sensory receptors in:

  1. Oropharyngeal mucosa.
  2. Laryngopharyngeal mucosa.
  3. Laryngeal mucosa.
93
Q

What sensory receptors are stimulated in sneezing?

A

CNV or CNIX

94
Q

What sensory receptors are stimulated in coughing?

A

CNIX or CNX

95
Q

Carotid sheaths

A

Protective tubes of cervical deep fascia.

96
Q

What does the carotid sheath attach superiorly to?

A

Bones of the base of the skull.

97
Q

What does the carotid sheath contain?

A

Vagus nerve, internal carotid artery, common carotid artery & internal jugular vein

98
Q

What does the carotid sweat blend inferiorly with?

A

Fascia of the mediastinum

99
Q

Affect of stimulation of sensory receptors in LRT respiratory mucosa

A
  1. Motor axons travel from tracheal bifurcation along branches of resp tree to supply all mucous glands & all bronchiolar smooth muscles.
  2. Pulmonary visceral afferent travel from visceral pleura & resp tee to plexus then follow vagus nerve to medulla of brainstem
100
Q

Where do motor axons, that supply mucous glands & bronchiolar smooth muscle, travel from?

A

Tracheal bifurcation, along branches of resp tree

101
Q

Where to pulmonary visceral afferents travel form to reach the medulla of the brain stem?

A

Visceral pleura & resp tree to plexus and then follow vagus nerve to medulla

102
Q

What nerve do pulmonary visceral afferents follow to the medulla from plexus?

103
Q

Coughing involves stimulation of sensory receptors in the mucosa of what?

A

Respiratory tree

104
Q

What muscles are used in a deep inspiration?

A

Diaphragm, intercostal muscles & accessory muscles of inspiration

105
Q

How does the CNS co-ordinate a deep inspiration?

A
  • Diaphragm: Phrenic nerve supplies greater outflow of action potentials of longer duration causes diaphragm to flatten and then descend maximally.
  • Intercostal muscles contract forcefully & raise ribs maximally: Intercostal nerves.
106
Q

Intercostal nerves

A

Anterior rami of spinal nerves T1-T11

107
Q

Accessory muscles of forced inspiration

A

Pectoralis major, pectoralis minor, sternocleidomastoid, scalenus anterior, medius & posterior.

108
Q

Pectoralis Major

A
  • Attaches between sternum/ribs & humerus.
  • Adducts & medically rotates humerus.
  • Upper limb position fixed.
  • Muscle can pull ribs upwards/outwards.
109
Q

Pectoralis Minor

A
  • Can pull ribs 305 superiorly towards coracoid process of the scapula.
110
Q

Clinical sign suggestive of dyspnoea?

A

Recruitment of accessory muscles.

111
Q

Sternocleidomastoid

A
  • Attaches between sternum/clavicle & mastoid process of temporal bone.
112
Q

Scalenus anterior, medius & posterior

A

Attach between cervices vertebrae & ribs 1 & 2.

113
Q

What does adduction of the vocal cords cause?

A

Closure of rima glottidis.

114
Q

Where do intrinsic muscles attach between?

A

Cartilages of larynx

115
Q

What does movement of cartilages in larynx cause?

A

Movement of vocal cords

116
Q

Affect of cough reflex on intrinsic muscles of larynx?

A

Causes intrinsic muscles of larynx to adduct the vocal cords

117
Q

What nerve supplies the intrinsic muscles of the larynx?

A

All supplied by (somatic) motor nerve - branches of the vagus nerve (CN X)

118
Q

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

A

All skeletal (voluntary) muscles.

119
Q

Where do the right and left vagus nerves connect with the CNS?

A

At the medulla (oblongata) of the brainstem

120
Q

What type of nerve is the vagus nerves?

A

Both sensory & motor nerve

121
Q

Function of vagus nerves in neck

A
  • Supply somatic sensory axons to the muscles a lining of the larynx.
  • Supply somatic motor axons to the intrinsic muscles of the larynx.
122
Q

Function of vagus nerves in chest

A

Supply parasympathetic axons to chest organs

123
Q

Route of vagus nerves

A

Medulla of brainstem -> jugular foramen -> descend through neck within carotid sheath -> descent posterior in chest to lung root -> pass through diaphragm on the oesophagus -> divide into many parasympathetic branches on surface of stomach for the foregut & midgut organs.

124
Q

Accessory muscles of forced expiration

A

Abdominal wall muscles

125
Q

How does CNS coordinate deep expiration?

A

Intercostal nerves stimulate contraction of right & left anterolateral abdominal wall muscles to build up intra-abdominal pressure which pushes the diaphragm superiorly & builds up pressure in the chest/resp tree inferior to the adducted vocal cords

126
Q

Anterolateral abdominal wall muscles

A

Right & left rectus abdominis, right & left external oblique, right & left internal oblique, right & left transversus abdominus.

127
Q

Where does aponeurosis of right & left external oblique blend?

A

Midline linea alba

128
Q

What attaches to the right external oblique superiorly?

A

Superficial aspects of lower ribs

129
Q

What attaches to the right external oblique inferiorly?

A

Anterior part of iliac crest & pubic tubercle

130
Q

Linea semilunaris

A

Where muscle fibres end & aponeurosis begins

131
Q

What attaches to right internal oblique superiorly?

A

Inferior border of lower ribs

132
Q

What attaches to right internal oblique inferiorly?

A

Iliac crest & thoracolumbar fascia of lower back.

133
Q

Where does aponeurosis of right & left internal oblique blend?

A

Midline linea alba

134
Q

Where does aponeurosis of right & left transverse abdominus blend?

A

Linea alba

135
Q

What attaches to transversus abdominus superiorly?

A

Deep aspect of lower ribs.

136
Q

What attaches to transverse abdominus inferiorly?

A

Iliac crest & thoracolumbar fascia of lower back.

137
Q

Functions of anterolateral abdominal muscles

A
  • Tonic contractions maintain posture, & support the vertebral column.
  • Contractions produce movements of vertebral column.
  • Guarding contractions protect abdominal viscera.
  • Contractions increase intra-abdominal pressure to assist defecation, micturition & labour.
  • Contractions aid forced expiration.
138
Q

Affect of abduction of vocal cords on rima glottidis

A

Opens rima glottidis.

139
Q

How does CNS direct stream of air through oral cavity as a cough rather than nasal cavity as a sneeze?

A

Soft palate tenses (CN V) & elevates (vagus nerves) to close of entrance into Nasopharynx & direct stream of air.

140
Q

Complications of dynamic airway compression in asthma

A
  • Expiration difficult.

- Build up of air trapped in alveoli can lead to rupture of Lung & visceral pleura.

141
Q

How does alveolar air enter the pleural cavity?

A

Through a breach in the visceral pleura

142
Q

Small pneumothorax

A

< 2cm gap between lung and parietal pleura, when a small amount fo air enters the pleural cavity.

143
Q

Cause of small pneumothorax

A
  1. Penetrating injury to parietal pleura.

2. Rupture of visceral pleura.

144
Q

How does injury to parietal pleura/rupture of visceral pleura cause a small pneumothorax?

A

Vacuum is lost, elastic lung tissue recoils towards lung root & small pneumothorax results.

145
Q

Large pneumothorax

A

> 2cm gap between lung & parietal pleura, when a large amount of air enters the pleural cavity

146
Q

What causes large pneumothorax?

A
  1. Penetrating injury to the parietal pleura.

2. Rupture of visceral pleura.

147
Q

How does injury to parietal pleura/rupture of visceral pleura cause a large pneumothorax?

A

Vacuum is lost, elastic lung tissue recoils towards lung root & large pneumothorax results.

148
Q

Pneumothorax: Auscultation

A

Reduced ipsilateral breath sounds

149
Q

Pneumothorax: Percussion

A

Hyper-resonance

150
Q

Pneumothorax: Chest expansion

A

Reduces ipsilateral chest expansion

151
Q

Pneumothorax: CXR

A
  • Absent lung markings peripherally.

- Lung edge visible (red arrows)

152
Q

How does a tension pneumothorax occur?

A

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 => on each inspiration more air enters pleural cavity (Increasing intrapleural pressure with each expiration) => pneumothorax expands => lung collapses towards its root => Eventually build up of air in pleural cavity applies tension to mediastinal structures.

153
Q

In pneumothorax how does air enter pleural cavity on inspiration but air preventing from escaping on expiraton?

A

Torn pleura can create a one way valve

154
Q

How does tension pneumothorax cause mediastinal shift?

A

Build up of air in pleural cavity applies tension to mediastinal structures => mediastinum shifted

155
Q

What level is the superior mediastinum?

A

Level of Sternal angle

156
Q

Consequences of mediastinal shift

A
  • Tracheal deviation, away from side of unilateral tension pneumothorax, palpable in the jugular notch.
  • SVC compression reduces venous return to the heart leading to hypotension.
157
Q

Management of large pneumothorax

A
  1. Needle aspiration.

2. Chest drain.

158
Q

Safe triangle

A
  • Anterior border of latissimus dorsi.
  • Posterior border of pectoralis major.
  • Axial line superior to nipple.
159
Q

Emergency management of tension pneumothorax

A

Large gauge cannula inserted into pleural cavity via 2nd or 3rd intercostal space in mid-clavicular line on side of tension pneumothorax.

160
Q

What does cannula pass through in emergency management of tension pneumothorax?

A
  • Skin.
  • Superficial/deep fascia.
  • 3 layers of intercostal muscles.
  • Parietal pleura.

Respiratory System (35 decks)

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