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Anatomy: Respiratory > Anatomy of Coughing > Flashcards

Anatomy of Coughing Flashcards

1
Q

The sensory receptors that can stimulate a cough/sneeze are located in the mucosa of which areas of the respiratory tract?

A

Oropharynx

Laryngopharynx

Larynx

All of lower respiratory tract

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2
Q

What are the basic steps involved in a cough/sneeze?

A

Stimulation of sensory receptors

Deep inspiration using all muscles of inspiration

Adduction of the vocal cords to close rima glottidis

Contraction of anterolateral abdominal wall muscles to increase intra-abdominal pressure

Pushes diaphragm superiorly which increases thoracic pressure

Increased thoracic pressure increases respiratory tract pressure beneath rima glottidis

Vocal cords abduct to open rima glottidis which expels air through either oral cavity (cough) or nasal cavities (sneeze)

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3
Q

Which sensory nerves stimulate a sneeze?

A

CN V1

CN V2

CN IX

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4
Q

Which sensory nerves stimulate a cough?

A

CN IX

CN X

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5
Q

Name the nerve which provides sensory innervation in each of the numbered regions

A
  1. CN V1
  2. CN V2
  3. CN IX
  4. CN X
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6
Q

What are the carotid sheaths?

A

Protective tubes of cervical deep fascia in the neck which contain the vagus nerve, the common carotid artery, internal carotid artery and the internal jugular vein

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7
Q

What structures are contained within the carotid sheaths?

A

Vagus nerve

Common carotid artery

Internal carotid artery

Internal jugular vein

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8
Q

Where does the carotid sheath attach to superioely and inferiorly?

A

Superiorly- bones of the base of the skull

Inferiorly - blends into mediastinal fascia

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9
Q

Name the bilateral structure the arrows are pointing at

A

Carotid sheath

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10
Q

How does sensory information from the lower respiratory tract reach the brain?

A

Information passes from the visceral pleura/respiratory tree to the pulmonary plexus

The vagal branches of the pulmonary plexus join the vagus nerve

Information then ascends the vagus nerve in the carotid sheath to the medulla

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11
Q

What nerve supplies the respiratory tree and the visceral pleura with sensory fibres?

A

CN X

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12
Q

What is the pulmonary plexus?

A

A plexus of nerves innervating the visceral pleura and the respiratory tree. It is formed of sympathetic fibres from the sympathetic trunk and parasympathetic fibres from the vagus nerve

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13
Q

Where do the motor axons innervating the lungs travel?

A

From tracheal bifurcation along branches of respiratory tree to mucous glands/brobchiolar smooth muscle

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14
Q

What are the basic mechanics of inspiration?

A

Diaphragm contracts which increases the vertical dimension of the lung

Intercostal muscles contract which increases the anteroposterior and lateral dimensions of the lung

This increases the volume of the lungs and therefore reduces the pressure in the lungs

Air flows into the low pressure of the lungs along its concentration gradient

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15
Q

What innervates the diaphragm?

A

Combined anterior rami of C3, C4 and C5

(phrenic nerve)

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16
Q

Where is the phrenic nerve found in the neck?

A

Anterior surface of scalenus anterior muscle

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17
Q

Where can the phrenic nerve be found in the thorax?

A

Descending over the lateral borders if the fibrous pericardium anterior to the lung root

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18
Q

What does the phrenic nerve supply the diaphragm with?

A

Motor function

Sensory

Sympathetic axons

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19
Q

What does the phrenic nerve supply the fibrous pericardum with?

A

Sensory fibres

Sympathetic axons

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20
Q

What does a normal contraction of the diaphragm do to its shape?

A

Flattens it

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21
Q

What does a strong contraction of the diaphragm (deep inspiration) do its shape?

A

Descends it maximally

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22
Q

What are the three layers of intercostal muscle from superficial to deep?

A

External intercostal muscle (superficial)

Internal intercostal muscle

Innermost intercostal muscle (deep)

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23
Q

What are the intercostal nerves?

A

Anterior rami of T1-T11

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24
Q

What are the muscles of quiet respiration?

A

Diaphragm

Intercostal muscles

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25
Q

What are the accessory muscles of inspiration?

A

Pectoralis major

Pectoralis minor

Sternocleidomastoid

Scalenus anterior

Scalenus medius

Scalenus posterior

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26
Q

Where does the pectoralis major muscle attach?

A

On the sternum/ribs and humerus

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27
Q

How can use of the pectoralis major aid respiration?

A

If the upper limb position is fixed, it can pull the ribs upwards/outwards

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28
Q

What does the pectoralis major muscle do?

A

Adducts humerus

Medially rotates humerus

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29
Q

How can use of pectoralis minor aid respiration?

A

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

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30
Q

Where does the sternocleidomastoid muscle attach?

A

Mastoid process of temporal bone

Sternum

Clavicle

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31
Q

Where do scalenus anterior, medius and posterior attach?

A

Between cervical vertebrae and ribs 1/2

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32
Q

What does use of the accessory muscles of breathing suggest?

A

Patient is dyspnoeic

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33
Q

What motor nerve causes adduction of the rima glottidis?

34
Q

What muscles does the vagus nerve stimulate to cause adduction of the rima glottidis?

A

Intrnsic muscles of the larynx

35
Q

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

36
Q

How does contraction of the intrinsic muscles of the larynx close the rima glottidis?

A

Moves the associated cartilages which moves the vocal cords

37
Q

What do the intrinsic muscles of the larynx attach to?

A

Cartilages

38
Q

Is the vagus nerve sensory, motor or mixed?

39
Q

Where does the vagus nerve connect with the CNS?

A

Medulla oblongata

40
Q

What cranial foramen does the vagus nerve pass through?

A

Jugular foramen

41
Q

In what structure does the vagus nerve pass through the neck?

A

Carotid sheath

42
Q

What nerve fibre does the vagus nerve supply the laryngeal mucosa with?

43
Q

What nerve fibre does the vagus nerve supply the muscles of the larynx with?

44
Q

Does the vagus nerve descend posteriorly or anteriorly to the lung root?

A

Posteriorly

45
Q

Does the vagus nerve descend posteriorly or anteriorly to the lung root?

A

Anteriorly

46
Q

What structure does the vagus nerve pass into the abdominal cavity on?

A

Oesophagus

47
Q

What happens to the vagus nerve on the surface of the stomach?

A

It divides into many parasympathetic branches supplying the foregut and midgut organs

48
Q

Describe the basic mechanism of expiration

A

Diaphragm and intercostal relaxes

The elastic tissue in the lungs restores the shape, lower volume and higher pressure of the lungs which expels air

49
Q

What are the accessory muscles of forced expiration?

A

Anterolateral abdominal wall muscles

50
Q

What are the anterolateral abdominal wall muscles?

A

Right and left rectus abdominus

Right and left external oblique

Right and left interal oblique

Right and left transversus abdominus

51
Q

Name the numbered muscles

A
  1. Rectus abdominus
  2. External oblique
  3. Internal oblique
  4. Transversus abdominus
52
Q

What is an aponeurosis?

A

A flattened tendon

53
Q

What is the name of the line where the aponeuroses of the right and left external oblique muscles blend together?

A

Linea alba

54
Q

What is the name of the junction between the external oblique and its aponeurosis?

A

Linea semilunaris

55
Q

Name the numbered structures

A
  1. Aponeurosis of the right external oblique muscle
  2. Linea alba
  3. Right and left linea semilunaris
  4. Left external oblique muscle
56
Q

Where does the external oblique muscle attach?

A

Superior attachment - superficial aspects of lower ribs

Inferior attachment - anterior paet of iliac crest and pubic tubercle

57
Q

What anterolateral abominal wall muscle’s fibres face in the same direction as the external intercostal muscles fibres?

A

External oblique muscle

58
Q

What is the name of the line where the aponeuroses of the right and left internal oblique muscles blend together?

A

Linea alba

59
Q

What are the attachments of the internal oblique muscle?

A

Superior attachment - inferior border of the lower ribs

Inferior attachment - iliac crest and thoracolumbar fascia of the lower back

60
Q

What anterolateral abdominal wall muscle’s fibres run in the same direction as the fibres of the internal intercostal muscle?

A

Internal oblique

61
Q

What is the name of the line where the aponeuroses of the right and left transversus abdominus muscles blend together?

A

Linea alba

62
Q

What makes up the rectus sheath?

A

The aponeuroses of the external oblique, intenal oblique and transversus abdominus

63
Q

What are the attachments of the transversus abdominus?

A

Superior attachment - deep aspects of lower ribs

Inferior attachment - iliac crest and thoracolumbar fascia of the lower back

65
Q

What does the rectus sheath contain?

A

The rectus abdominus

66
Q

What divides the 2 long flat rectus abdominus muscles into 6 or 8 smaller quadrate muscles?

A

Tendinous intersections

67
Q

What muscle forms the ‘6 pack’?

A

Left and right rectus abdominus

68
Q

Why do tendinous intersections divide the rectus abdominus?

A

Improves their mechanical efficiency

69
Q

Name the numbered structures

A
  1. Linea alba
  2. Left rectus abdominus
  3. Rectus sheath
  4. Apeneurosis of the external oblique
  5. Aponeurosis of the internal oblique
  6. Aponeurosis of the abdominus transversus
70
Q

What is the name of the hole in the diaphargm which the aorta passes through?

A

Aortic hiatus

71
Q

What nerve fibres do the thoracoabdominal nerves carry and to where?

A

Somatic motor

Somatic sensory

Sympathetic

Structures of the abdominal wall

72
Q

Which intercostal nerves eventually become the thoracoabdominal nerves?

A

Intercostal nerves 7-11

73
Q

Thoracoabdominal nerves travel inferiorly in between which anterolateral abdominal wall muscles?

A

Between the internal oblique and the transversus abdominus

74
Q

When do the intercostal nerves become the thoracoabdominal nerves?

A

After they leave the intercostal spaces

75
Q

Which anterior ramus is the subcostal nerve derived from?

76
Q

Which anterior ramus in the iliohypogastric nerve derived from?

A

Half of L1

(the half not supplying the ilioinguinal nerve)

77
Q

Which anterior ramus is the ilioinguinal nerve derived from?

A

Half of L1

(half not supplying the iliohypogastric nerve)

78
Q

What are the main functions of the anterolateral abdominal wall muscles?

A

Contractions aid forced expiration

Tonic contractions maintain posture and support vertebral column

Contractions move the spine

Guarding protects the abdominal viscera

Contractions increase intraabdominal pressure

  • vomiting, defecation, micturition and labour
79
Q

What is the name of the hole in the diaphragm which the oesophagus passes through?

A

Oesophageal hiatus

80
Q

What is the name of the hole in the diaphragm which the inferior vena cava passes through?

A

Caval opening

81
Q

Name the numbered structures and what passes through them

A
  1. Aortic hiatus - aorta
  2. Oesophageal hiatus - oesophagus
  3. Caval opening - inferior vena cava

Anatomy: Respiratory (3 decks)

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