Anatomy of coughing

Question 1

How does coughing occur?

Answer 1

1. Sensory receptors of the oro-/laryngo-pharync, larync or respiratory tree are stimulated.
2. A rapid deep inspration
3. The rima glottidis is closed by adducting the vocal cords.
4. Rima glottidis rapidly opens (vocal cord abduction)
5. Entrance into the nasopharynx is closed off by tensing and elevating the soft palate.
6. Stream of air is expelled through the oral cavity.

Question 2

What sensory nerves are stimulated in coughing?

Answer 2

CN IX (Glossopharyngeal) - oropharynx
CN X (Vagus) - larynx

Question 3

What is found in the carotid sheaths?

Answer 3

Vagus nerve
Internal carotid artery
Common carotid artery
Internal jugular vein

Question 4

Muscles of normal/quite inspiration?

Answer 4

1. external intercostal
2. internal intercostal
3. innermost intercostal

Supplied by anterior rami of spinal nerves T1-T11

Question 5

Accessory muscles of deep inspiration?

Answer 5

1. pectoralis major (sternum->humerus)
2. pectoralis minor (ribs 3-5 -> coracoid process)
3. sternocleidomastoid (sternum->temporal bone)
4. Scalanus anterior, medius and posterior

Question 6

Intrinsic muscles of the larynx?

Answer 6

Adduct the vocal cords during the cough reflex.

Cupplied by vagus (CN X)

Question 7

What are the accessory muscles of deep/forced expiration?

Answer 7

The anterolateral abdominal wall muscles:

• rectus abdominis
• external oblique
• internal oblique
• transversus abdominis

Question 8

Flattened tendons into which the oblique muscles ‘blend’ into in the midline?

Answer 8

aponeurosis

Question 9

Rectus sheath is made of…

Answer 9

3 aponeuroses of the internal and external obliques and the transversus abdominis.

Question 10

The right and left rectus abdominis muscles are separated in the midline by…

Answer 10

the linea alba

Question 11

What muscles supply the abdominal body wall?

Answer 11

Thoracoabdominal nerves:

• subcostal nerve (T12)
• iliohypogastric nerve (L1)
• ilioinguinal (L1)

Question 12

The internal thoracic artery is a branch of the…

Answer 12

subclavian artery

-it supplies intercostal spaces

Question 13

Where are the inguinal ligament located?

Answer 13

-between anterior superior iliac spine (ASIS) and the pubic tubercle

It forms the inguinal canal

Question 14

Ilioinguinal nerve?

Answer 14

• branch of L1 spinal nerve

- sensory innervation of the inguinal region

Question 15

Types of inguinal herniae?

Answer 15

-direct and indirect

Question 16

Direct inguinal hernia?

Answer 16

• emerges through the superficial ring of the inguinal canal ONLY
• occlusion of the deep ring by palpation does not stop it re-emerging on coughing

Question 17

Indirect inguinal hernia?

Answer 17

• through both the deep and superficial rings of the inguinal canal
• coughing does not make it emerge when the deep ring is occluded with palpation

Question 18

Contents of the spermatic cords?

Answer 18

vas deferens
testicular artery and vein
genitofemoral nerve
ANS fibres
lymphatics

-round ligament of the uterus (F)