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Anatomy (Respiratory) Flashcards

1
Q

What makes up the upper respiratory tract (URT)?

A

Right and left nasal cavities, oral cavity, naso-, oro- and laryngo-pharynx and the larynx.

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2
Q

What makes up the lower respiratory tract (LRT)?

A

Trachea, right and left main bronchi, lobar bronchi, segmental bronchi, bronchioles and alveoli.

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3
Q

In the respiratory tract, what occurs at the level of the C6 vertebrae?

A

The larynx becomes the trachea and the pharynx becomes the oesophagus.

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4
Q

What is the isthmus of the thyroid gland anterior to?

A

Tracheal cartilages 2-4.

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5
Q

What are the lung lobes?

A

Right: upper, middle and lower lobes. Left: upper and lower lobes.

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6
Q

What is a bronchopulmonary segment and how many does each lung have?

A

The area of lung lobe that each one of the segmental bronchi supply with air. 10.

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7
Q

Name the parts of the sternum going from superior to inferior.

A

Jugular notch, manubrium, sternal angle, body, xiphoid process.

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8
Q

What will the head of a rib articulate with and what will the tubercle articulate with?

A

Head: Vertebral body of the same number and the one above. Tubercle: Transverse process of the same vertebra number.

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9
Q

Where is the costal groove and what will be in it?

A

Inferiorly on deep surface of the ribs, the intercostal neurovascular bundle (NVB).

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10
Q

What are the joints of the thoracic skeleton and what type are they?

A

Sternocostal (between sternum and costal cartilage, synovial), costochondal (between rib and costal cartilage, primary cartilaginous) and costovertebral (between rib and vertebra, synovial).

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11
Q

What are the 3 layers of intercostal muscle and how do they make the chest wall expand during breathing?

A

External, internal and innermost. By pulling adjacent ribs upwards and outwards.

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12
Q

Where is the neurovascular bundle of each intercostal space located?

A

Between internal and innermost intercostal layers.

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13
Q

What are the nerve and blood supplies of the intercostal spaces?

A

Nerve: anterior ramus of spinal nerve (intercostal nerve). Blood: posterior arterial supply is thoracic aorta and venous drainage is azyous vein. Anterior is internal thoracic artery and vein.

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14
Q

What are some of the anterior branches of the thoracic aorta?

A

Bronchial arteries (arterial blood for lung tissue).

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15
Q

What does the muscular part of the diaphragm attach peripherally to?

A

The sternum, the lower 6 ribs and costal cartilages and the L1-L3 vertebral bodies.

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16
Q

What nerve supplies the diaphragm and what is this made up from?

A

The phrenic nerve and C3, 4 and 5 anterior rami.

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17
Q

Where is the phrenic nerve found and what does it supply?

A

Neck: anterior surface of scalenus anterior muscle. Chest: descending over lateral aspects of the heart. Supplies somatic sensory and sympathetic axons to diaphragm and fibrous pericardium. Supplies somatic motor axons to diaphragm.

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18
Q

What are the 4 quadrants of the breast and what must a complete examination of the breast include?

A

Superolateral, superomedial, inferolateral, inferomedial. All 4 quadrants, nipple, areola, axillary tail and the regional lymphatics.

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19
Q

What is the blood supply and lymphatic drainage of the breast?

A

Subclavian and internal thoracic artery and vein. Unilateral drainage from lateral quadrants to axillary nodes, bilateral drainage from medial quadrants to parasternal nodes.

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20
Q

What is the function and nerve supply of the serratus anterior?

A

Anchors scapula to ribs, long thoracic nerve.

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21
Q

What is the innervation of the pectoralis major and minor muscles?

A

Major: Lateral and medial pectoral nerves. Minor: medial pectoral nerve.

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22
Q

What are the attachments of the pectoralis major?

A

Proximal: clavicular head (anterior surface of medial half of clavicle), sternocostal head (anterior surface of sternum, superior 6 costal cartilages, aponeurosis of external oblique muscle). Distal: Lateral lip of intertubercular sulcus of humerus.

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23
Q

What are the attachments of the pectoralis minor?

A

Proximal: 3rd-5th ribs near their costal cartilages. Distal: medial border and superior surface of carocoid process of scapula.

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24
Q

What is the serratus anterior muscle innervated by?

A

The long thoracic nerve.

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25
What is the innervation of the latissimus dorsi?
Thoracodorsal nerve.
26
List these structures from anterior to posterior: brachial plexus, right axillary/subclavian vein, right axillary/subclavian artery.
Vein, artery, plexus.
27
What are the 4 parts of the parietal pleura?
Cervical, costal, diaphragmatic and mediastinal.
28
What is the costodiaphragmatic recess and where is it located?
The most dependent part of the pleural cavity and located between the diaphragmatic parietal pleura and the costal parietal pleura.
29
Describe the structures of the right hilum.
Most posterior are main bronchi, most anterior/inferior are pulmonary veins, superomedial parts are pulmonary arteries. Bronchopulmonary lymph nodes is inferior to the main bronchi.
30
Describe the structures of the left hilum.
Pulmonary artery most superior, main bronchi most posterior, 1 pulmonary vein most inferior and 1 pulmonary artery most inferior. Bronchopulmonary lymph node is in the middle.
31
Where would you auscultate the lung apex and the right middle lobe?
Apex: superior to the medial 1/3rd of the clavicle. Middle: between ribs 4 and 6 in the mid clavicular and midaxillary lines.
32
Where do the oblique fissures go?
Level of rib 6 anteriorly rising to T3 vertebral level posteriorly.
33
At what rib level is the horizontal fissure?
4
34
Where would you auscultate the lung base?
In the scapular line at T11 vertebral level (most inferior/dependent part of the inferior lobe).
35
What are the surface markings of the right lung?
Cardiac impression, groove for superior vena cava, groove for arch of azygous vein and groove for oesophagus.
36
What are the surface markings of the left lung?
Groove for arch of aorta, groove for 1st rib, cardiac impression, groove for descending aorta and groove for subclavian artery.
37
What is the lingula and what notch causes it?
The most inferior and anterior part of the left superior lobe. A thin, tongue-like process which extends below the cardiac notch.
38
Where can stimulation of sensory receptors in the mucosa cause a cough?
Oropharynx, laryngopharynx, larynx, respiratory tree (trachea to bronchioles).
39
What areas does each of the cranial nerves supply for sneezing and coughing?
CN V1 - superoanterior nasal cavity. CN V2 - posteroinferior nasal cavity. CN IX - asopharynx and most of oropharynx. CN X - laryngopharynx and larynx.
40
What cranial nerve sensory fibres are stimulated in sneezing and coughing?
Sneezing - CN V or IX. Coughing - CN IX or X.
41
What are the carotid sheaths?
Protective tubes of cervical (neck) deep fascia.
42
Where do the carotid sheaths attach inferiorly and superiorly?
Inferiorly - blend with the fascia of the mediastinum. Superiorly - attach superiorly to the bones of the base of the skull.
43
What do the carotid sheaths contain?
The vagus nerve, internal carotid artery, common carotid artery, internal jugular vein.
44
What type of nerves does the pulmonary plexus contain?
Sympathetic axons, parasympathetic axons and visceral afferents.
45
Describe the path of travel of all motor axons to the lungs.
Travel from the tracheal bifurcation along the branches of the respiratory tree to supply all mucous glands and all bronchiolar smooth muscles.
46
Describe the path of travel of the pulmonary visceral afferents.
Travel from visceral pleura and respiratory tree to the plexus then follow the vagus nerve to the medulla of the brainstem.
47
What is the phrenic nerve activity like in a deep forced inspiration?
A greater outflow of action potentials of longer duration, causing the diaphragm to flatten then descend maximally.
48
When can the pectoralis major muscle pull the ribs upwards and outwards?
If the upper limb position is fixed.
49
What are the accessory muscles of deep (forced) inspiration?
Pectoralis major, pectoralis minor, sternocleidomastoid, scalenus anterior, medius and posterior.
50
What ribs can the pectoralis minor muscle pull and to where?
Ribs 3-5 superiorly towards the coracoid process of the scapula.
51
Where do the scalenus anterior, medius and posterior attach?
Between cervical vertebrae and ribs 1 and 2.
52
Where does the sternocleidomastoid muscle attach?
Between sternum/clavicle and the mastoid process of the temporal bone.
53
What types of muscles are the intrinsic muscles of the larynx and where do they attach?
Skeletal, attach between the cartilages.
54
What nerves are the intrinsic muscles of the larynx supplied by?
Somatic motor nerves and branches of the vagus nerve (CN X).
55
What do the intrinsic muscles of the larynx do to the vocal cords during the cough reflex?
Adduct them.
56
Where do the right and left vagus nerves connect with the CNS?
The medulla oblongata of the brainstem.
57
Where does the vagus nerve supply sensory and motor axons in the larynx?
Sensory - mucosa lining the larynx. Motor - intrinsic muscles of the larynx.
58
Describe the path of the vagus nerves through the chest and abdomen.
Descend posterior to lung root, pass through diaphragm on oesophagus, on surface of stomach finally divide into many parasympathetic branches for the foregut and midgut organs.
59
What are the accessory muscles of deep (forced) expiration and how do they do this?
The anterolateral abdominal wall muscles by contracting forcefully to increase intra-abdominal pressure.
60
In what directions do the intercostal muscles run?
External - inferoanteriorly. Internal - inferoposteriorly. Innermost - same as internal.
61
What are the anterolateral abdominal wall muscles from superficial to deep?
External oblique, internal oblique, transversus abdominus.
62
What are the most anterior abdominal muscles called?
Rectus abdominus.
63
What are the fibre directions of the anterolateral abdominal wall muscles?
External and internal - same as intercostals. Transversus abdominus - anteriorly.
64
What are the attachments of the external oblique?
Superiorly - the superficial aspects of the lower ribs. Inferiorly - the anterior part of the iliac crest and the public tubercle.
65
What are the attachments of the internal oblique?
Superiorly - the inferior border of the lower ribs. Inferiorly - the iliac crest and thoracolumbar fascia of the lower back.
66
What are the attachments of the transversus abdominus?
Superiorly - deep aspects of the lower ribs. Inferiorly - the iliac crest and the thoracolumbar fascia of the lower back.
67
What are the aponeuroses of the anterolateral abdominal wall muscles and where is the midline of them?
Flattened tendon, at the linea alba.
68
What is the linea semilunaris?
Where the muscle fibres end and the aponeurosis begins.
69
What does the rectus sheath cover and what is it composed of?
The right and left rectus abdominus muscles. It is composed of the aponeuroses of the other 3 muscles.
70
What divides the rectus abdominus muscles and why?
Tendinous intersections to improve mechanical efficieny.
71
Describe the path of the 7th to 11th intercostal nerves as they become the thoracoabdominal nerves?
Travel anteriorly then their terminal branches leave the intercostal spaces in the plane between the internal oblique and the transversus abdominus.
72
Name the nerves that the somatic motor, somatic sensory and sympathetic nerve fibres supplying the structures of the abdominal wall come from.
Thoracoabdominal nerves, subcostal nerve (T12 anterior ramus), iliohypogastric nerve (half of L1 anterior ramus), ilioinguinal nerve (other half of L1 anterior ramus).
73
Name the functions of the anterolateral abdominal wall muscles.
Tonic contractions maintain pressure and support the vertebral column. Contractions produce movement of the vertebral column (flexion, lateral flexion, rotation). Guarding contractions protect the abdominal viscera. Contractions increase intra-abdominal pressure to assist defection, micturition and labour. Contractions aid forced expiration.
74
Describe the stages of a cough.
1. deep inspiration. 2. adduction of vocal cords to close the rima glottidis. 3. contraction of anterolateral abdominal wall muscles (builds up intra-abdominal pressure). 4. Vocal cords suddenly abduct to open rima glottidis. 5. Soft palate tenses and elevates to close off entrance into nasal pharynx and direct air through the oral cavity.
75
Where would you either perform needle aspiration (thoracentesis) or place a chest drain in management of a large pneumothorax.?
4th or 5th intercostal space in the midaxillary line.
76
What is a hernia?
Any structure passing through another so ending up in the wrong place.
77
What 2 factors are usually required for the development of a hernia?
1. Weakness of one structure; commonly a part of the body wall. 2. Increased pressure on one side of that part of the wall.
78
What parts of the body wall have a normal anatomical weakness and what types of herniae does this cause?
Diaphragm (diaphragmatic), umbilicus (umbilical), inguinal (inguinal), femoral (femoral).
79
What other things can cause a weakness in a body wall?
Congenital abnormalities e.g. congenital diaphragmatic hernia. Surgical scars e.g. incisional hernia.
80
Why may chronic cough produce a hernia?
Produces repeated bouts of increased intra-abdominal pressure so structures are pushed through the wall to produce a hernia.
81
Where are the normal anatomical weaknesses of the diaphragm?
The attachments to the xiphoid and the posterior attachments.
82
What are the openings/hiatuses of the diaphragm?
The caval opening (IVC), the aortic hiatus and the oesophageal hiatus (hiatus herniae are common).
83
Describe a paraoesophageal hiatus hernia.
Herniated part of the stomach passes through the oesophagus to become parallel to the oesophagus in the chest.
84
Describe a sliding hiatus hernia.
Herniated part of the stomach slides through the oesophageal hiatus into the chest with the gasto-oesophageal junction.
85
What is the inguinal region?
From the anterior superior iliac spine (ASIS) to the pubic tubercle. The groin.
86
Where do the inguinal ligaments attach and what do their medial halves form the floors of?
The ASIS and pubic tubercle. The inguinal canals.
87
What are the inguinal ligaments the inferior borders of?
The external oblique aponeuroses.
88
Describe the superficial and deep rings of the inguinal canal.
Superficial - v shaped defect in the external oblique aponeurosis that lies superolateral to the pubic tubercle. Deep ring - located superior to midpoint of inguinal ligament.
89
What does the inguinal canal contain in adults?
Spermatic cord or the round ligament of the uterus.
90
What can cause inguinal herniae?
Chronic cough, chronic constipation, occupational lifting of heavy weights, athletic effort.
91
Before the balls have dropped, where is the vas deferens located?
Attached inferiorly in the pelvis in the region of the developing prostate gland.
92
What accompanies the testis when it first begins to move
The processus vaginalis (an outpouching of parietal peritoneum).
93
What is the internal spermatic fascia made from?
A covering of transversalis fascia.
94
What is the cremasteric fascia?
A covering of skeletal muscle fibres from the internal oblique.
95
What is the external spermatic fascia made from?
A covering of external oblique aponeurosis.
96
What is contained in the spermatic cord?
Vas deferens, testicular artery and pampiniform plexus of veins.

Respiratory (30 decks)

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