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Respiratory I > Anatomy of respiration > Flashcards

Anatomy of respiration Flashcards

1
Q

What rib do the scalene muscles attach to?

A

To the first rib at the scalene tubercle (first rib is pulled up during forced inspiration).

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2
Q

At what vertebral level is the suprasternal/jugular notch of the manubrium located?

A

At T2/T3

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3
Q

At what vertebral level is the sternal angle located?

A

At T4/T5

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4
Q

What structures are located at the T4/T5 vertebral level?

A

T4/T5 is where the trachea bifurcates and the arch of the aorta begins. Additionally, it marks the border between the superior and inferior mediastinum.

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5
Q

What rib is attached lateral to the sternal angle, and what is its clinical significance?

A

The second rib, which is an important landmark for rib counting.

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6
Q

What type of joint is the first sternocostal?

A

A synchondrosis.

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7
Q

What type of joints are the 2nd-7th sternocostal joints?

A

Synovial plane joints.

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8
Q

What type of joints are the costochondral joints?

A

Synchondrosis type.

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9
Q

What type of joints are the costovertebral and costotransverse joints?

A

Synovial joints.

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10
Q

What are the articulate surfaces of the costovertebral joints?

A

Between the head of the rib and the vertebral bodies/IV disk.

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11
Q

What are the articulate surfaces of the costotransverse joints?

A

Between the rib tubercle and the vertebral transverse process.

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12
Q

What ribs articulate with contiguous vertebrae at the costovertebral joints?

A

Ribs 2-9 articulate with two vertebral bodies.

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13
Q

What ligament limits movement of the costovertebral joint?

A

The intra-articular ligament, which extends from the head of the rib to the IV disk.

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14
Q

What ribs articulate only with they body of the same numbered vertebrae?

A

Ribs 1 and 10-12 articulate with only one vertebral body.

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15
Q

What joint is damaged in a rib separation?

A

The costochondral joint (between the ribs and the costal cartilage).

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16
Q

What ribs do not have costotransverse joints?

A

Ribs 11 and 12.

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17
Q

What is the role of the external intercostal muscles?

A

Elevate the ribs during inspiration.

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18
Q

What is the role of the internal and innermost intercostal muscles?

A

Depress the ribs during expiration.

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19
Q

What is the role of the subcostal muscles?

A

Depress the ribs during expiration.

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20
Q

What is the innervation of the intercostal muscles?

A

The intercostal nerves.

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21
Q

What is the role of the serratus posterior inferior?

A

Assists with inspiration by depressing ribs 10-12 to help the diaphragm move inferior (as opposed to the other ribs which are elevated).

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22
Q

What is the innervation of the serratus posterior inferior?

A

Intercostal nerves 9-12.

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23
Q

What do the anterolateral abdominal muscles assist with ?

A

Expiration.

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24
Q

What does the quadratus lumborum muscle assist with?

A

Inspiration by depressing the lower ribs to help the diaphragm create a more negative intra-thoracic pressure (just like the serratus posterior inferior).

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25
Q

What do the pectoralis major and minor muscles assist with?

A

Inspiration.

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26
Q

Where does the neurovascular bundle travel in the intercostal space?

A

In the inferior surface of the rib (costal groove). As such, the intercostal space should be accessed at the superior surface of the rib.

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27
Q

What is the orientation of the neurovascular bundle in the intercostal space?

A

Vein superior, artery middle, and nerve inferior (VAN)

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28
Q

How many pairs of intercostal nerves are there?

A

11 pairs

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29
Q

How many pairs of subcostal nerves are there?

A

1 pair.

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30
Q

What are the intercostal and subcostal nerves derived from?

A

The ventral rami of the 12 pairs of thoracic spinal nerves.

31
Q

What does being derived from thoracic ventral rami mean about the intercostal and subcostal nerves?

A

That their branches include white and grey communicantes to the sympathetic chain.

32
Q

What are the branches of the intercostal and subcostal nerves?

A

Muscular branches, lateral cutaneous branches, anterior cutaneous branches, collateral branches, and rami communicantes to the sympathetic chain.

33
Q

What is the intercostal nerve that doesn’t give off lateral or anterior cutaneous branches?

A

The 1st intercostal nerve (the T1 dermatome is instead on the arm).

34
Q

What does the right crus of the diaphragm attach to?

A

L1-L3 (larger than the left crus)

35
Q

What does the left crus of the diaphragm attach to?

A

L1-L2

36
Q

What is the median arcuate ligament?

A

A tendinous arch between the left and right crua. The aortic hiatus is within it.

37
Q

What vertebral level is the caval hiatus at?

A

T8. It is located in the central tendon of the diaphragm, and transmits the IVC and right phrenic nerve.

38
Q

What vertebral level is the esophageal hiatus at?

A

T10. It passes through the right crus, and transmits the esophagus and vagal trunks.

39
Q

What vertebral level is the aortic hiatus at?

A

T12. It passes between the left and right crus, and transmits the aorta and thoracic duct.

40
Q

Where do the anterior and posterior pulmonary plexuses travel?

A

Along the primary bronchi.

41
Q

Where do the preganglionic cell bodies of the sympathetic innervation of the lungs arise?

A

In the T2-T6 lateral horns.

42
Q

Where are the postganglionic cell bodies of the sympathetic innervation to the lungs located?

A

In the upper thoracic and cervical sympthetic chain ganglia

43
Q

What do the sympathetic efferents of the lungs do?

A

Vasoconstriction, bronchodilation, inhibit gland secretion.

44
Q

Where do the preganglionic cell bodies of the parasympathetic innervation of the lungs arise?

A

In the brain stem. They travel with the vagus nerve (CN X).

45
Q

Where are the parasympathetic post-synaptic fibers found in the lungs?

A

Within the walls of the airways.

46
Q

What do the parasympathetic efferents to the lungs do?

A

Vasodilation, bronchoconstriction, increase gland secretions.

47
Q

What do the parasympathetic afferents transmit?

A

Reflexive information (from bronchial mucosa for cough reflex, stretch of bronchial muscle, baroreceptors, chemoreceptors)

48
Q

What do the sympathetic afferents transmit?

A

Nocireceptive (acute pain)

49
Q

What is an increase in A-P (anterior-posterior) diameter of the thorax called?

A

Pump handle motion (the sternum is like the handle to a water pump).

50
Q

What is an increase in transverse diameter of the thorax called?

A

Bucket handle motion (the ribs are like bucket handles).

51
Q

What causes the thoracic vertical diameter increase?

A

Constriction/flattening of the diaphragm.

52
Q

What is the lumbocostal triangle?

A

The lumbocostal triangle is an area of muscular weakness between the costal and lumbar portions of the diaphragm,. It is a common site for abdominal herniation into the thorax.

53
Q

What is the arterial supply to the diaphragm?

A

The pericardiophrenic and musculophrenic arteries, the superior phrenic artery, and the inferior phrenic artery.

54
Q

What do the pericardiophrenic and musculophrenic arteries arise from?

A

The internal thoracic artery.

55
Q

What does the superior phrenic artery arise from?

A

The thoracic aorta.

56
Q

What does the inferior phrenic artery arise from?

A

The abdominal aorta.

57
Q

What is the lymphatic drainage of the diaphragm?

A

The superior diaphragmatic (phrenic) LN drain to the mediastinal LN. Additionally, the inferior diaphragmatic vessels drain into the superior diaphragmatic LN or the lumbar LN.

58
Q

What does the sternocleidomastoid muscle assist with?

A

Forced inspiration.

59
Q

What do the first through third posterior intercostal veins drain into?

A

They fuse to form the superior intercostal vein, which drains into the azygous vein on the right and the brachiocephalic vein on the left.

60
Q

What do the rest of the posterior intercostal veins drain into?

A

The azygous system of veins.

61
Q

What do the anterior intercostal veins drain into?

A

The internal thoracic vein.

62
Q

What is the venous drainage of the diaphragm?

A

The superior phrenic vein, the pericardiaphrenic and musculophrenic veins, and the inferior phrenic veins.

63
Q

What does the superior phrenic vein drain onto?

A

The inferior vena cava.

64
Q

What do the pericardiaphrenic and musculophrenic veins drain into?

A

The internal thoracic vein.

65
Q

What does the inferior phrenic vein drain into?

A

The inferior vena cava on the right. On the left it merges with the suprarenal vein which drains into the left renal vein.

66
Q

Where does the musculophrenic artery travel?

A

Along the costal margin.

67
Q

Where does the internal thoracic artery travel?

A

Along the deep surface of the anterior chest wall, lateral to the sternum.

68
Q

Where does the internal thoracic artery branch into the musculophrenic and superior epigastric arteries?

A

Near the 6th or 7th costal cartilages.

69
Q

Where do the anterior intercostal arteries arise from?

A

The first 6 arise directly from the internal thoracic artery, while the 7-9th anterior intercostal arteries arise from the musculophrenic artery (branch of the internal thoracic).

70
Q

Where do the posterior intercostal arteries arise from?

A

The first two arise from the supreme intercostal artery (a branch off the costocervical trunk). The rest (along with the subcostal artery) arise from the thoracic aorta.

71
Q

What does the transverse thoracic assist with?

A

It helps with expiration, and is innervated by intercostal nerves 2-6.

72
Q

What does the levator costarum assist with?

A

It assists with inspiration, and is innervated by the ventral rami of C8-T1.

73
Q

What are the five accessory muscles of inspiration?

A

The scalene muscles, the sternocleidomastoid, the pectoralis major/minor, the serratus anterior, and the quadratus lumborum.

74
Q

What is one of the roles of the endothoracic fascia?

A

It adheres the parietal pleura to the thoracic wall. It is a clinically relevant cleavage plane between the thoracic wall and the pleura for surgeries.

Respiratory I (6 decks)

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