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Respiratory: Anatomy > Anatomy of Coughing > Flashcards

Anatomy of Coughing Flashcards

1
Q

What are 2 steps of a cough reflex?

A

1) Stimulation of sensory receptors in the airway mucosa
2) CNS response

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2
Q

What are the 2 components of the cough reflex?

A

* Sensory component

* Motor component

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3
Q

Explain the first, sensory stage of the cough reflex

A

Stimulation of sensory receptors in the mucosa of the:-

* Oropharynx

* Laryngopharynx

* Larynx

* Respiratory tree (trachea to bronchioles)

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4
Q

Explain the second, motor stage of the cough reflex

A

The CNS responds to sensory stimulation by rapidly coordinating the following:
* a DEEP inspiration using the diaphragm (phrenic nerves), intercostal muscles (intercostal nerves) & “accessory muscles of inspiration”
* adduction of the vocal cords to close the rima glottidis (vagus nerves)
* contraction of the anterolateral abdominal wall muscles (intercostal nerves) to build up intra-abdominal pressure - pushes the diaphragm superiorly and builds up pressure in the chest/respiratory tree inferior to the adducted vocal cords
* the vocal cords suddenly abduct to open the rima glottides (vagus nerves)
* the soft palate tenses (CN V) and elevates (vagus nerves) to close off the entrance into the nasopharynx and direct the stream of air (at ~100mph!!) through the oral cavity as a cough rather than through the nasal cavity as a sneeze!

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5
Q

What sensory receptors are stimulated in sneezing?

A

* CN V

* CN IX

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6
Q

What sensory receptors are stimulated in coughing?

A

* CN IX

* CN X

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7
Q

Name cranial nerves labelled A-D

A

A - CN V1 (trigeminal)

B - CN V2 (trigenimal)

C - CN IX (glossopharyngeal)

D - CN X (vagus nerve)

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8
Q

What are carotid sheaths?

A

Protective “tubes” of cervical (neck) deep fascia

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9
Q

Where to carotid sheaths start and end?

A

* Attaches superiorly to the bones of the base of the skull

* Blends inferiorly with the fascia of the mediastinum

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10
Q

What do the carotid sheaths contain?

A

* the vagus nerve

* the internal carotid artery

* the common carotid artery

* the internal jugular vein

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11
Q

What does the internal jugular vein do?

A

It drains blood from the brain and cranium to the heart

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12
Q

How do visceral pleura and respiratory tree visceral afferents connect with the CNS? (stimulation of lower respiratory tract’s respiratory mucosa)

A

* The pulmonary visceral afferents travel from visceral pleura & respiratory tree to the pulmonary plexus then follow the vagus nerve to the medulla of the brainstem

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13
Q

What is contained within the pulmonary plexus of the vagus nerve?

A

* sympathetic axons

* parasympathetic axons

* visceral afferents

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14
Q

How do motor nerves supply mucous glands and bronchial smooth muscles?

A

They travel from the tracheal bifurcation (pulmonary plexus) along the branches of the respiratory tree to supply all mucous glands and bronchiolar smooth muscles

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15
Q

Are sympathetic and parasympathetic axons sensory?

A

No, they are both motor (efferent)

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16
Q

Explain the mechanics of inspiration

A

* Diaphragm contracts abd descends (increases vertical chest dimension)

* Intercostal muscles contract elevating ribs (increases A-P and lateral chest dimensions)

* The chest walls pull the lungs outwards with them due to pleura (Air flows into the lungs due to -ve pressure)

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17
Q

What is the main muscle of quiet respiration?

A

Diaphragm

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18
Q

What nerves supply the diaphragm?

A

Phrenic nerves - anterior rami of C3, 4, 5 cervical spinal nerves

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19
Q

Where are phrenic nerves found in the neck?

A

Anterior surface of scalenus anterior muscle

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20
Q

Where are phrenic nerves found in the chest (thorax)?

A

Descending over the lateral aspects of the fibrous pericardium anterior to the lung root (hilum)

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21
Q

What is the function of phrenic nerves?

A

Supplies somatic sensory and sympathetic axons to the diaphragm & fibrous pericardium

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22
Q

How do phrenic nerves generate a deep, forced inspiration?

A

Generate greater outflow of action potentials of longer duration causing the diaphragm to flatten then descend maximally

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23
Q

What are the 3 layers of intercostal muscles?

A

* external intercostal muscles

* internal intercostal muscles

* innermost intercostal muscles

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24
Q

What are intercostal nerves?

A

Anterior rami of spinal nerves T1-T11 - pass through costal grooves of ribs

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25
Q

What happens in deep (forced) inspiration?

A

* The external intercostal muscles contract forcefully and raise the ribs maximally

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26
Q

what are the accessory muscles of deep (forced) inspiration?

A

* Pectoralis major and minor

* Scalenus anterior, medius and posterior

* Sternocleidomastoid

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27
Q

Where does pectoralis major attach?

A

Attaches between sternum/ribs & humerus

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28
Q

What is the function of the pectoralis major?

A

Adducts and medially rotates humerus

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29
Q

Why do patients with COPD often hold onto the arm of a chair or the thigh to breathe?

A

Allows pectoralis major (accessory muscle of inspiration) to pull the ribs upwards/outwards

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30
Q

What is recruitment of accessory muscles an important clinical sign of?

A

Dyspnoea

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31
Q

How does pectoralis minor aid in forced inspiration?

A

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

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32
Q

Where does the sternocleidomastoid attach?

A

Attaches between sternum/clavicle & mastoid process of temporal bone

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33
Q

Where does scalenus anterior, medius and posterior attach?

A

Attach between cervical vertebrae and ribs 1 & 2

34
Q

How does sternocleidomastoid aid in forced inspiration?

A

Increases A-P diameter

35
Q

How is the rima glottidis closed?

A

The vocal cords approximate in the midline, closing the rim glottidis

36
Q

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

A

All skeletal (voluntary) muscles

37
Q

What causes the movement of the vocal cords?

A

Intrinsic muscles of the larynx

38
Q

How do intrinsic muscles of the larynx cause movement of the vocal cords?

A

They attach between the cartilages, move the cartilages resulting in the movement of the vocal cords

39
Q

What nerves supply the intrinsic muscles of the larynx?

A

Somatic motor branches of the vagus nerve (CN X)

40
Q

What is the function of the intrinsic muscles of the larynx in the cough reflex?

A

Adduct the vocal cords during cough reflex

41
Q

What is the rim glottidis?

A

Not a structure - it is a space that gets larger depending on the abduction/adduction of vocal cords

42
Q

What are right and left vagus nerves?

A

Mixed cranial nerves

43
Q

Where do the vagus nerves connect with the CNS?

A

At the medulla (oblongata) of the brainstem

44
Q

What part of skull does vagus nerve pass through?

A

Jugular foramen

45
Q

How do vagus nerves descend through the neck?

A

Within the carotid sheath

46
Q

Why is the vagus nerve important in the cough reflex?

A

Supply somatic sensor and motor axons to the larynx

47
Q

Which parts of the larynx are supplied with somatic sensory and somatic motor neurones?

A

* Sensory to the mucosa lining the larynx
* Motor to the intrinsic muscles of the larynx

48
Q

How do vagus nerves descend through the chest?

A

Posterior to the lung root (unlike phrenic nerves which descend anterior to the lung root)

49
Q

What do the vagus nerves supply the chest organs with?

A

Parasympathetic axons

50
Q

How do the vagus nerves supply parasympathetic axons to the chest organs (including the lungs)?

A

Via the pulmonary plexus

51
Q

How do the vagus nerves pass through the diaphragm?

A

With the oesophagus

52
Q

What happens once vagus nerves reach the stomach?

A

Divide into many parasympathetic branches for the foregut & midgut organs

53
Q

Explain the mechanics of expiration

A

* Diaphragm relaxes and rises (decreases vertical thoracic dimension - increases intra-thoracic pressure)
* Intercostal muscles relax lowering ribs (decreases A-P and lateral chest dimensions)
* Elastic tissue of lungs recoils (air flows out of lungs)

54
Q

What are the accessory muscles of active expiration?

A

* Abdominal wall muscles
* Internal intercostal muscles

55
Q

Explain the process of deep, forced expiration in cough reflex

A

* The right & left anterolateral abdominal wall muscles contract forcefully increasing intra-abdominal pressure
* The diaphragm is forced superiorly by the compressed abdominal contents
* Intra-thoracic pressure increases, increasing the pressure within the respiratory tree inferior to the vocal cords

56
Q

Label the anterolateral abdominal wall muscles labelled A-H (pic)

A

A - left rectus abdominus
B - left external oblique
C - left internal oblique
D - left transverses abdominus
E - right transverses abdominus
F - right internal oblique
G - right external oblique
H - right rectus abdominus

57
Q

Where are axial sections viewed from?

A

The foot of the patient

58
Q

What should abdominal muscles not be confused with?

A

Intercostal muscles

59
Q

What is a useful way for remembering the direction in which the abdominal wall muscles run?

A

* External oblique - hands in pockets
* Internal oblique - hands on chest
* Transversus abdominus - perpindicular to midline
* Rectus abdominus - straight up and down

60
Q

Which direction does the external oblique run in?

A

Fibre direction the same as the external intercostal muscle (hands in pockets)

61
Q

What is an aponeurosis?

A

Flattened tendon

62
Q

Which of the abdominal muscles has an aponeurosis?

A

* External obliques * Internal obliques * Transversus abdominus

63
Q

Where does the aponeurosis of the right external oblique blend with the aponeurosis of the left external oblique?

A

At the midline (linea alba)

64
Q

Where do the external obliques attach?

A

Superiorly - the superficial aspects of the lower ribs Inferiorly - the anterior part of the iliac crest and the pubic tubercle

65
Q

What is the linea semilunaris?

A

Where the muscle fibres end and the aponeurosis begins

66
Q

Where does the aponeurosis of the right internal oblique blend with the aponeurosis of the left internal oblique?

A

The midline linea alba

67
Q

Where do the internal obliques attach?

A

* Superiorly - inferior border of the lower ribs * Inferiorly - the iliac crest and thoracolumbar fascia of the lower back

68
Q

What direction do the internal obliques run in?

A

* Opposite direction to the external obliques * Fibre direction the same as the internal intercostal muscle (hands on chest)

69
Q

Where does the aponeurosis of the right transversus abdominus blend with the aponeurosis of the left transversus abdominus?

A

At the linea alba

70
Q

Where does the transverses abdominus attach?

A

* Superiorly - deep aspects of lower ribs * Inferiorly - iliac crest and thoracolumbar fascia of the lower back

71
Q

What special features does the rectus abdominus have?

A

* Right and left rectus sheaths * Tendinous intersections

72
Q

What are the rectus sheaths composed of?

A

The aponeuroses of the other 3 muscles

73
Q

Which abdominal muscle group does not have an aponeurosis?

A

Rectus abdominus

74
Q

What do the tendinous intersections do?

A

Divide each of the 2 long flat muscles into 3 or 4 smaller quadrate muscles (“6-pack” or “8-pack”)

75
Q

What is the effect of the tendinous intersections in contraction of the abdominal muscles?

A

During contraction, allows for curved anterior aspect of the abdomen rather than completely straight

76
Q

What are the somatic motor, somatic sensory and sympathetic nerve fibres supplying the structures of the abnormal wall conveyed within?

A

The thoracoabdominal nerves

77
Q

How are the thoracoabdominal nerves formed?

A

The 7th to the 11th intercostal nerves travel anteriorly then their terminal branches leave the intercostal spaces, in the plane between the internal oblique & the transversus abdominus as the thoracoabdominal nerves

78
Q

What is the T12 anterior ramus?

A

The subcostal nerve

79
Q

What is the L1 anterior ramus?

A

* Half of the L1 anterior ramsus is Iliohypogastric nerve * Other half is ilioinguinal nerve

80
Q

What are the functions of the abdominal wall muscles?

A

* tonic (continuous low level) contractions maintain posture * tonic (continuous low level) contractions support the vertebral column * contractions produce movements of the vertebral column (spine): flexion, lateral flexion, rotations * “guarding” contractions protect the abdominal viscera * contractions increase intra-abdominal pressure to assist: defecation, micturition, labour * Contractions aid forced expiration

81
Q

Why can mechanical back pain sometimes be improved by abdominal muscle exercises?

A

Tonic contractions of the abdominal muscles support the vertebral column

Respiratory: Anatomy (4 decks)

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