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coughing Flashcards

1
Q

what sensory receptor receptors are simulated in sneezing?

A

CN V and CN IX

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2
Q

what sensory receptors are simulated in coughing?

A

CN IX and CN X

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3
Q

what is the carotid sheath?

A
  • bilateral
  • toilet roll tube
  • protective tubes of cervical deep fascia
  • attaches superiorly to bones of the skull base
  • blends inferiorly with the fascia of the mediastinum
  • it contains the vagus nerve, the internal carotid artery, the common carotid artery and the internal jugular vein
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4
Q

where do all motor axons travel from and what do they do?

A
  • from the tracheal bifurcation along the branches of the resp tree to supply all mucous glands and all bronchiolar smooth muscle
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5
Q

what does the pulmonary plexus contain?

A
  • sympathetic axons
  • parasympathetic axons
  • visceral afferents
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6
Q

where do the pulmonary visceral afferents travel from?

A

visceral pleural and resp tree to the plexus then follow the vagus nerve to the medulla of the brain stem

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7
Q

what are the inspiration mechanisms?

A
  1. diaphragm contracts and descends = increases vertical chest dimension
  2. intercostal muscle contract elevating ribs = increases A-P and lateral chest dimension
  3. the chest wall pulls the lungs outwards with them (pleura) = air flows into the lungs , negative pressure
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8
Q

phrenic nerves and diaphagm

A
  • main muscle of quiet respiration
  • supplied by anterior rami pf C3, 4 and 5
  • found in the neck on the anterior surface of scalneus anterior muscle
  • found in the chest descending over the lateral aspects of the fibrous pericardium anterior to the lung root
  • ## supplies somatic motor axons to the diaphragm
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9
Q

when does the diaphragm flatten?

A
  • in a deep inspiration
  • a greater outflow of action potential of lunger duration, via phrenic nerve occurs causing the diaphragm to flatten then descend maximally
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10
Q

what are the muscles of normal, quiet inspiration?

A
  1. external intercosal muscles
  2. internal intercostal musces
  3. innermost intercostal muscles
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11
Q

what happenns in a deep forced inspiration?

A

the intercostal muscles contract forcefully and raise the ribs maximally

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12
Q

what is the pectoralis major?

A
  • attaches between sternum/ribs and humerus
  • adducts and medially rotates humerus if the upper limb postition is fixed
  • this muscle can pull the ribs upwards
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13
Q

what is the pectoralis minor?

A

can pull ribs 3-4 superiorly towards the caracoid process of the scapula

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14
Q

where does the sternocleidomastoid attach?

A

between stenum/clavical and mastoid process of temporal bone

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15
Q

where do the slaneus anteroir, medius and posterior attach?

A

between cervical vertebrae and ribs 1&2

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16
Q

what are the intrinsic muscles of the larynx?

A
  • all skeletal (voluntary) muscles
  • attach between the cartilages
  • movethe cartilages resulting in the movement of the vocal cords
  • all supplied by somatic motor, branches of the vagus nerve CN X
  • they adduct the vcal cords during the cough reflex
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17
Q

is the nerve is behind the root of the lung, what is it?

A

the vagus nerve

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18
Q

what do the right and left vagus nerves do?

A

connect with the CNS at the medulla of the brainstem

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19
Q

what are the expiration mechanisms?

A
  1. diaphragm relaxes and rises = decreses vertical thoracic dimension
  2. intercostal muscles rela lowing ribs = decreases A-P and lateral chest dimension
  3. elastic tissue of lungs recoils =air flows out of the lungs
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20
Q

what are the 3 flat muscle layers?

A

external oblique
internal oblique
transversus abdominus

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21
Q

what are the thoracoabdominal nerves?

A

they somatic mototr, somatic sensory and sympahetic nerve fibres suppling the structure of the abdominal part of the body wall are conveyed within the thoracoabdominal nerves

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22
Q

what is a small/large pneumothorax?

A
  • when a small/large amount of air enters the pleural caivuty via penetrating injury to the prtietal pleural or rupture of the visceral pleural
  • the vaccum is lost, the elastic lung tissue recoils towards the lung root and a small pnuemothorac results (<2cm gap between lung and pariteal pleura)
23
Q

how is pneumothorax diagnosed?

A
  1. history
  2. exmaination = reduced ipsilateral chest expansion, reduced ipsilateral breath sounds, hypper-resonance on percussion
  3. investigation (CXR) = absent lung markings peripherally, lung edge visable
24
Q

what is tension pneumothorax?

A
  • the torn pleural creases a one way valve that allow s air to enter th epleural cavity on each inspiration but prevents air eescaping on expiration
  • the pneumothorax expands and the lung collapses towards its root
  • eventuallt tension is applied to the medialstinal structures = causing a medialstinal shift
25
Q

what are the consequences of a mediastinal shift?

A
  • tracheal deviation = away from the side of the unilateral tension pneumothorax
26
Q

how do you manage a large pneumothorax?

A
  1. needle aspiration
  2. the sitting of a chest drain
    both via the 4th or 5th intercostal space in the mixaxillary line to avoid intercostal nerves/arteries/veins
27
Q

how do you manage tension pneumothorax in an emergency situation?

A
  • insert large gauge cannula into the pleural cavity via the 2nd or 3rd intercostal space in the midclavicular line on the side of the tension pneumothorax
28
Q

in emergency management on tension pneumothorax, what will the cannula pass through?

A
  • skin
  • superficial/deep fascia
  • 3 layers of intercostal muscles
  • pariteal pleura
29
Q

what is a herniae?

A

any structure passing through another and ending up in the wrong place

30
Q

what factors are required for the development of a hernia?

A
  1. weakness of one structure

2. increased pressure on one side of that part of the wall

31
Q

what is a paraoesophageal hiatus hernia?

A

the herniated part of the stomach passes through the oesophageal hiatus to become parallel to the oesophagus and in the chest

32
Q

what is a sliding hiatus hernia?

A
  • the herniated part of the stomach slides through the oesophageal hiatus into the chest with the gastoro-oesophageal junction
33
Q

what are the inguinal ligaments?

A
  • they attach between the ASIS and pubic tubercle
  • their medial halves form the floor of the inguinal canals
  • the inguinal ligaments are the inferior borders of the external oblique aponeuroses
34
Q

what are inguinal canals?

A
  • 4cm long passageways through the anterior abdominal wall in the inguinal regions
  • each canal floor is the medial half of the inguinal ligament
  • each canal runs between a deep rings and a superficial ring
35
Q

what is the superficial ring?

A

v shaped above the pubic tubercle

36
Q

what is an inguinal herniae?

A
  1. the weakness is the presence of the inguinal canal
  2. the increased pressure is intra-abdominal and due to
    - chronic cough
    - chronic constipation etc
37
Q

what are the layers of the anterolateral abdominal wall in the inguinal region?

A

(from outside to inside)

  • scrotal skin
  • superficial fascia of scrotum
  • deep fascia
  • inguinal ligament
  • lower border of the internal oblique
  • lower border of transversus abdominis
  • transversalis fascia
  • partietal perinoneum
  • visceral peritoneum
  • testicular vein
  • testicular artery
38
Q

what does the gubenaculum do?

A

pulls in the scrotum

39
Q

name changes

A
  • transversalis fascia = the processus vaginails
  • transverusus abdomnins = the internal spermaatic fascia
  • internal oblique = the cremasteric fascia
  • the inguinal ligament = v shaped defect in the medial end
  • superficial fascia = he external spermatic fascia
40
Q

what is the tunica vaginalis?

A

the remains of the processus vaginalis

41
Q

what are the components of the testis and spermatic cord?

A
  • the right vas deferens
  • the right testicular artery
  • the right pampiniform venous plexus
42
Q

what is a direct inguinal hernia?

A

a finger of peritoneum is forced through the posterior wall of the inguinal canal and directly out of the superficial ring into the scrotum

43
Q

what is an indirect inguinal hernia?

A

a “finger” of peritoneum is first forced through the deep ring into the inguinal canal and then out of the superficial ring into the scrotum

44
Q

how does the rima glottidis close?

A

the vocal cords approximate in the midline

45
Q

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

A
  • pectoralis major
  • pectoralis minor
  • sternocleidomastoid
  • salcenus anterior, medius, posterior
46
Q

what happens in deep (forced) expiration?

A
  • diaphragm relaxes
  • right and 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 with in the resp tree inferior to the vocal cords
47
Q

what are the anterolateral abdominal wall muscles?

A
  • rectus abdominis (6 pack)
  • external oblique
  • internal oblique
  • transversus abdominus
48
Q

what is found in the external oblique?

A
  • aponeurosis
  • the linea semilunaris
  • serratus anterior
49
Q

what direction are the fibres in the external oblique?

A

medially and inferiorly

same direction as external intercostal muscle

50
Q

what is found in the internal oblique?

A

aponeurosis

51
Q

what direction are the fibres in the internal oblique?

A

laterally and inferiorly

same direction as internal intercostal muscle

52
Q

what is the linea alba?

A

a white line in the midline that blends with the aponeurosis

53
Q

what direction are the fibres in the transversus abdominus?

A

medially

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