applied anatomical concepts

Question 1

what is the difference between breathing and inspiration

Answer 1

Breathing – inspiration and expiration

Respiration – o2 conveyed to tissues and cells and the oxidation products co2 and water given off (gaseous exchange)

Question 2

what are the phases of breathing

Answer 2

Phases 
Inspiration and expiration 
Areas 
Thoracic and abdominal 
Types
Quiet and forced

Question 3

what is Boyle’s law

Answer 3

Dec in vol – inc in pressure and vice versa

Question 4

how does inspiration work

Answer 4

Inc in intrathoracic vol – dec in intrathoracic pressure
Parietal pleura pulled with movement of ribs and diaphragm
Visceral pleura moves with parietal pleura (surface tension)
Lung vol inc
Air moves into lungs towards lower pressure

Question 5

how does expiration work

Answer 5

Visceral pleura moves with elastic recoil of lungs
Parietal pleura moves with the ribs and diaphragm as they return to rest
Surface tension between pleura stops collapse
Lung vol dec so air moves out

Question 6

what dimension changes occur in breathing

Answer 6

Thoracic breathing
Lateral/transverse diameter
Anteroposterior diameter

Abdominal breathing
Vertical diameter

Question 7

how does the Lateral diameter of thorax (thoracic) change in breathing

Answer 7

Lateral edges of ribs are elevated supero-laterally during inspiration and the lateral diameter of thoracic cavity increases
Results in an increase in the transverse/lateral diameter of chest cavity
Aka bucket handle movement

Question 8

how does the anteroposterior diameter of the thorax change in breathing (thoracic)

Answer 8

Anterior ends of ribs raised during inspiration
Elevation causes sternum to also be raised
Movement facilitated by costal cartilages
Increase in anteroposterior diameter if chest cavity
Aka pump handle movement

Question 9

how does the vertical diameter of the thorax change in breathing (abdominal)

Answer 9

via diaphragm which forms floor of thoracic cavity
Resting position of the diaphragm is domed
Upon contraction the diaphragm descends 5-10cm compressing abdominal organs
Increases vertical diameter of thorax

Question 10

what is quiet breathing

Answer 10

Quiet inspiration
Extend intercostals, scalene muscles (cervical spine, insert onto 1st and 2nd ribs) and diaphragm
Quiet expiration
Normally a passive process, elastic recoil lungs

Question 11

what is forced inspiration

Answer 11

(e.g. during exercise)

Muscles used in quiet expiration + pectoral muscles, sternocleidomastoid and latissimus dorsi

Question 12

what is forced expiration

Answer 12

Eg coughing or playing wind instruments

Internal intercostals, oblique and transverse abdominal muscles, quadratus lumborum

Question 13

what makes up the diaphragm

Answer 13

Sheet of skeletal muscle with a central tendon
Pericardium attached to middle of tendon on its superior surface
Diaphragmatic (parietal) pleura lines its superior surface

Question 14

what is the origin and insertion of the diaphragm

Answer 14

Origin has 3 parts
1 sternal (xiphoid process), 2 costal (costal cartilages ribs 7-10, ribs 11 and 12), 3 lumbar (medial and lateral arcuate ligaments and lumbar vertebral bodies 
Insertion – central tendon

Question 15

what makes up the lumbar attachments of the diaphragm

Answer 15

Lumbar part of diaphragm arises from medial and lateral arcuate ligaments and from the lumbar vertebral bodies via right and left crura
The right and left crura meet to form medial arcuate ligament and form aortic hiatus
Fibres of right crus pass around the oesophagus to form oesophageal hiatus

Question 16

what are the openings of the diaphragm

Answer 16

inferior vena cava T8
Oesophageal hiatus T10
Aortic Hiatus T12
the thoracic duct and azygous vein also pass through the aortic hiatus 
I ate 10 oranges at 12

Question 17

what is the blood supply to the diaphragm

Answer 17

superior and inferior phrenic arteries

Question 18

what are the actions of the diaphragm

Answer 18

Alters vol of thorax
Quiet inspiration descends approx. 2cm, forced inspiration descends approx. 710cm, aids venous return, hiccups
Alters vol of abdomen
Urinating and defecation
Lifting heavy objects (braces vertebral column)
Child birth

Question 19

what is the phrenic nerve

Answer 19

Arises from ventral rami of C3, 4, 5 and passes anterior to main bronchi/root of lung
Enters superior mediastinum lateral to the vagus nerve
Phrenic passes over pericardium

Question 20

what does the phrenic nerve do

Answer 20

Motor – diaphragm (sole supply)
Sensory:
Pericardium 
Parietal pleura (mediastinal and central part of diaphragmatic)
Parietal peritoneum 
Central region of diaphragm

Question 21

what is a pancoast tumour

Answer 21

Is a cancer located at apex of lung, if on left side can compress recurrent laryngeal nerve compression, vocal cord paralysis – hoarseness

Question 22

what are issues with coronary circulation dominance

Answer 22

Blockage of main right or left coronary artery will have different outcomes depending on dominance
Important when planning coronary artery bypass graft
Arteriograms are used to determine coronary artery dominance