Anatomy of Coughing

Question 1

What sensory receptors are stilumated in coughing

Answer 1

1. Oropharyngeal mucousa
2. Laryngopharyngeal mucousa
3. Laryngeal mucousa
4. Lower respiratory tracts - respiratory mucousa

Question 2

What is the nerve supply to the sensory receptors in sneezing

Answer 2

CNV or CN IX

Question 3

What is the nerve supply to the sensory receptors in Coughing

Answer 3

CNIX and CNX

Question 4

What are carotid sheeths

Answer 4

• Protective tubes of Cervical deep fascia
• Attach supperiorly - bones of basel skull
• Inferiorly - blends with the fascia of the mediastinum

Question 5

What do the carotid sheeths contain

Answer 5

1. Vagus nerve
2. Internal carotid artery
3. Common carotid arery
4. Internal juglular vien

Question 6

What does the Pulmonary plexus contain

Answer 6

1. Sympathetic nerves- motor
2. Parasympathetic nerves - motor
3. Visceral afferents - Sensory

Question 7

how do pulmonary visceral afferents take impluses to the brainstem

Answer 7

Travel form visceral pleura and the respiratory tree to the plexus and then followe the vagus nerve to the medulla

Question 8

How do the motor (sympathetic and parasympathetic) supply the repsiratory tree and mucousal glands

Answer 8

All motor neurons travel along the bifurcaiton of the trachea along the branches to supply all Mucousal glands and all the Bronchiole smooth muscle

Question 9

How does the diaphragm carry out deep inspiration

Answer 9

greater outflow of longer duration of action potentials via the phrenic nerve

• causes diapragm to flatten out then descend maximally

Question 10

What are the muscles of normal quite breathing

Answer 10

1. internal intecostal
2. external intercostal
3. inner most intercostal

(diaphragm)

Question 11

What is the nerve supply to the inntercostal muscles

Answer 11

Intercosral nerves

• Anterior rami of spinal nerves
• T1-T11

Question 12

How do the intercostal muscles carry out deep forceful inspiration

Answer 12

in a deep forceful inspiration the intercostal muscles contract forcefully and elevate the ribs maximally

Question 13

What are the Accessory muscles of Deep forced inspiration

Answer 13

• pectoralis major
• pectoralis minor
• Scalanous anterior, Medius and posterior
• Sternocleidomastoid

Question 14

What is the attachment, function and innervation of pectoralis muscle

Answer 14

Attachment

• ​between sternum/ribs and humerus ​

Function

• Adducts and medially rotates the humerus
• If upper-limb position is fixed
• pull ribs upwards and outwards

​Innervation

• Brachail plexus - medial and lateral pectoral nerves

Question 15

What is the function of the pectoralis minor muscle

Answer 15

Can pull ribs 3-5 supeirorly towards the coricoid process of the scapula

Question 16

What are the attachments of the sternocliedomastoid muscle

Answer 16

Attachment

• Between sternum/clavical and mastoid process of the temporal bone

Question 17

What are the attachments of the scalenus anterior, medus and posterior

Answer 17

• cervical vertebrae
• rib 1 and 2

Question 18

what is the anatomy of the larnyx

Answer 18

Question 19

What are the vocal cords and the Rima glottis

Answer 19

• supperior parts of the larnxny
• Rima glottis is the space between the vocal cords
• The vocal cords can aapproximate in the midline closing the rima glotttis

Question 20

What are the intrinsic muscles of the larnyx

Answer 20

• Skeletal muscle attach between the cartilageous
• Move the cartilageous resulting in the movement of the vocal cords

Innervation

• supplied by somatic motor
• Branches from vagus nerve - CNX

These muscles adduct the vocal cords during cough relflex

Question 21

What is the anatomy of the right and left vagus nerves

Answer 21

• They are mixed cranial nerves
• connect with the CNS at the medulla
• Base of skeleton part of the course = jugular foramen
• Descends through the neck witihn the carotid sheath

Question 22

Function of vagus nerve in coughing

Answer 22

Supply somatic sensory and motor axons to the larynx ​

• Seconsry = Muscosa of larynx
• Motor = intrinsic muscles of larynx

Question 23

Vagus supply to the Chest organs

Answer 23

• Descends posteiror to the root of the lungs
• Parasympathetic supply to chest organs

Parasympathetic supply to the lungs via pulmonary plexus

Question 24

Other functions of the vagus nerve

Answer 24

On surface of the stomach divid into many parasymthetic branches ​

• For the fore-gut and mid-gut organs

Question 25

How does the vagus nerve pass through the diaphragm

Answer 25

on the **oesophgus**

Question 26

what is the action of the accessory muscle of **deep forced Expiration**

Answer 26

* Diaphragm relaxes * right and left **anteriolateral abdominal** wall muscles **contract forcefully** * this increases **intra-abdominal pressure** * **compressed abdominal contents** push the diaphragm forcefully superiorly * Intra-thoracic pressure increases * this i**ncreases pressure within the respiratory tree** inferior to the vocal cords

Question 27

What are the muscle of the anteriolateral abdominal wall

Answer 27

* **rectus abdominus** * **External oblique** * **Internal oblique** * **Transvere abdominus**

Question 28

What is the **Linea alba (**white line**)**

Answer 28

the aponeurosis of the right external oblique (and the internal oblique and the transverse oblique) blends with the aponeurosis of the left external oblique (and internal and transverse) at the midline

Question 29

What are the attachments of the of the **external oblique muscles**

Answer 29

**_Superiorly_** * superficial aspects of the lower ribs **_Inferiorly_** * Anterior part of the **illiac crest and pubic tubercle**

Question 30

What is the **Linea semilunaris** (located on the right and left)

Answer 30

* Where the **muscle fibres end** and **aponeurosis begins**

Question 31

What are the attachments of the **internal oblique muscle**

Answer 31

**_Superiorly_** * Inferior boarder of the lower ribs **_Inferiorly_** * **Illiac crest** and **thoracolumbar fascia** of lower back **Fibre direction** = Same as the internal interscostal muscles

Question 32

What are the attachments of the **transverse abdominus muscle**

Answer 32

**_Superiorly_** * deep aspects of the lower back **_inferiorly_** * **illiac Cresnt and thoracolumbar fascia**

Question 33

What is the anatomy of the **retus abdominis muscle**

Answer 33

* Vertically running muscle * contained within the **rectus sheeth** (tendenous muscle envolope)- formed from the aponeurosis of the 3 muscles **_origin_** * 5-7 costal cartilages and xiphiod prosses **_inseriton_** * pubis - between **pubic tubercle and symphysis**

Question 34

What are **tendinous intersections**

Answer 34

* fibrous bands that cross the 2 rectus abdominus muscles * divide the muscles into **3-4 smaller quadrate muscles** * **6 pack**

Question 35

What is the nerve supply to the abdominal muscles carrying **somatic sensory, motor and sympathetic** nerve fibres

Answer 35

**Thoracoabdominal Nerves** * **7-11 intercostal nerves** * travel anteriorly then their terminal branches leve the **intercostal spaces** * leave space in the **plane** between the **internal oblique** and **transverse abdominis** as **thoracoabdolimnal nerves**

Question 36

What are other nerve supply to the abdominal wall carrying **somatic motor, sensory and sympathetic** nerve fibres

Answer 36

* **Subcostal nerve - T12** anterior ramus * **Illiohypogastric nerve -** half of **L1** anterior ramus * **Ilioinguinal nerve -** other half of **L1**

Question 37

Function of anteriolateral abdominal muscles

Answer 37

* **Maintain posture -** tonic (continous low level) contraction * **Support vertebral column -** Tinoc contraction * **movement of vertebral column -** flextion, lateral flexion and rotation * **Gaurding -** protect **abdominal viscera via** contraction * **increasing intra- abdominal pressure-** defecation, micturition and labour * **Forced expiration**

Question 38

Cough reflex

Answer 38

A.stimulation of sensory receptors in the mucosa of the: 1. oropharynx 2. laryngopharynx 3. larynx 4. respiratory tree (trachea to bronchioles) B.the CNS responds by rapidly coordinating the following: 1. a DEEP inspiration using the diaphragm (phrenic nerves), intercostal muscles (intercostal nerves) & “accessory muscles of inspiration” 2. adduction of the vocal cords to close the rima glottidis (vagus nerves) 3. contraction of the anterolateral abdominal wall muscles (intercostal nerves) to build up intra-abdominal pressure which pushes the diaphragm superiorly and builds up pressure in the chest/respiratory tree inferior to the adducted vocal cords 4. the vocal cords suddenly abduct to open the rima glottides (vagus nerves) 5. 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!