HARC - Respiratory Flashcards
1
Q
Name the missing parts?
A
2
Q
Name the missing parts?
A
3
Q
Name what is in the Upper and Lower respiratory tract?
A
4
Q
Anatomy of the upper respiratory tract
A
5
Q
Anatomy of the upper respiratory tract
A
6
Q
Anatomy of the sinuses
A
7
Q
Anatomy of the pharynx
A
8
Q
Anatomy of the larynx: Name the 3 large unpaired cartilages
A
9
Q
Anatomy of the larynx: Name the 3 small unpaired cartilages
A
10
Q
The larynx – blood supply :
A
11
Q
The larynx – blood supply:
A
12
Q
The larynx – innervation:
A
13
Q
Anatomy of the lower respiratory tract: (properties)
A
14
Q
Anatomy of the alveoli
A
15
Q
Anatomy – The hilum of the lungs
A
16
Q
Anatomy – The hilum of the lungs (left)
A
17
Q
Anatomy – The hilum of the lungs (right)
A
18
Q
Anatomy of the lungs
A
19
Q
Anatomy of the diaphragm
A
20
Q
Anatomy of the Mediastinum
A
21
Q
Breathing mechanics – Active vs Passive
Inspiration
A
22
Q
Breathing mechanics – Active vs Passive
Expiration
A
23
Q
Innate and adaptive response
A
24
Q
Innate and adaptive response
A
25
Identify the 3 main regions of the nose (A - C)
A – Nasal vestibules
B – Respiratory region
C – Olfactory region
26
The nasal cavity has 3 distinct epithelial areas which correspond to three distinct areas of the nasal cavity.
What are the names and functions of these three areas?
Nasal vestibule - is lined by skin and contains hair which filter dust and other matter from the air being breathed in.
Respiratory region - has a rich blood supply and a large surface area owing to the turbinates/conchae. This allows warming of air being breathed in. Mucous cells are also present here providing a method for capturing foreign material. The mucous is moved posteriorly by cilia on the epithelial cells in the nasal cavities.
Olfactory region – A small region lined by olfactory epithelium which contains the olfactory receptors for smell.
27
Identify the defining characteristics of the lateral wall of the nasal cavity:
3 conchae (superior, middle and inferior) and the 4 recess (the 3 meatuses and the sphenoethmoidal recess).
28
What are the functions of each of the characteristics of the lateral wall of the nasal cavity?
To warm and humidify air by causing turbulence in the pathway of air (which is why the conchae are also called the turbinate’s) to increase their contact area with the thick vascular supply of the nose. Most openings drain from the paranasal sinuses here
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Ethmoid Bone
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Ethmoid Bone:
31
Identify the main features of the external nose listed from A-F in the diagram below:
A – Nasal bone
B – Lateral process of septal cartilage
C – Superior margin of septal cartilage
D – Major alar cartilage
E – Septal cartilage
F – Minor alar cartilag
32
The nasal cavity is supplied by __ main arteries and they meet in an anastomosis called _________ \_\_\_\_\_\_
4
Kiesselbach’s plexus
33
Identify the main arteries of the nasal cavity and why is this area important in epistaxis?
Site of anastomosis of 4/5 arteries supplying the nose. Prone to epistaxis, particularly in little toddlers picking their nose.
34
Put these statements in the correct order
* Sphenoidal sinus opens into the sphenoethmoidal recess (above superior concha)
* Anterior ethmoid air cells drain into middle meatus
* Frontal sinuses drain into frontonasal duct (which opens into anterior part of hiatus semilunaris in middle meatus)
* Middle ethmoid air cells drain into the bulla ethmoidalis (middle meatus)
* Nasolacrimal duct opens into the inferior meatus
* Posterior ethmoid air cell opens into the superior meatus
* Maxillary sinus opens into floor of hiatus semilunaris (middle meatus)
1. Sphenoidal sinus opens into the sphenoethmoidal recess (above superior concha)
2. Posterior ethmoid air cell opens into the superior meatus
3. Middle ethmoid air cells drain into the bulla ethmoidalis (middle meatus)
4. Frontal sinuses drain into frontonasal duct (which opens into anterior part of hiatus semilunaris in middle meatus
5. Maxillary sinus opens into floor of hiatus semilunaris (middle meatus)
6. Anterior ethmoid air cells drain into middle meatus
7. Nasolacrimal duct opens into the inferior meatus
35
Note that most of the paranasal sinuses drain inferiorly, assisted by gravity. However, the opening of the largest sinus (the maxillary sinus) is at the roof of the sinus cavity - therefore how does this drain?
It drains from the roof of the maxillary sinus.
It is poorly situated in bipedal humans when we are standing upright but not so bad when we lay down to sleep. Particularly evident when you have a bad cold and you move from side to side and only one nostril opens up. Also maxillary sinus is not so badly situated in quadrupeds
36
Paranasal sinuses:
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I'll be impressed if you know this one.
(probs won't know it)
38
How is smell transmitted to the olfactory bulb (Cranial Nerve I) from what you smell?
Olfactory epithelium transmits the signal through the bipolar cells which are traversing the cribiform plate of the ethmoid to synapse in the olfactory bulb of cranial nerve I
39
What is another name for pharynogtympanic tube?
Eustachian tube
40
What does the pharyngotympanic tube (or Eustachian tube) do?
links the nasopharynx to the middle ear and allows for equalisation of air pressure between the middle ear cavity (which is normally closed off) and the air pressure in the nasopharynx (or atmosphere).
41
How specifically does the pharyngotympanic tube equalise the air oressure between the middle ear cavoty and nasopharynx/atomosphere?
A small muscle attached to the tube from the nasopharynx can contract to open it to equalise this pressure so therefore activities that utilise the pharynx such as swallowing or yawning can make this muscle contract. This is what happens when your “ears pop” on an airplane or ascending to high altitudes (where atmospheric pressure decreases).
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Pharynx muscles:
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What is directly anterior to the laryngopharynx?
The larynx – The larynx is in front of the pharynx and therefore the trachea is always in front of the oesophagus
46
Do the valleculae have a function?
Yes – they act to guide food but particularly water away from the laryngeal opening but diverting it laterally
47
If a fish bone scratches the mucosal wall of the piriform fossa, which nerve (reflex) will it activate?
Vagus nerve and cough reflex
48
All three of the constrictors of the pharynx are arranged as 3 overlapping muscles, meet posteriorly and unite in a special tendon called the _______ \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_
median pharyngeal raphe
49
A muscle called \_\_\_\_\_\_\_\_\_\_\_is part of the inferior constrictor that forms a sphincter at the level of the cricoid cartilage (vertebral level C6).
cricopharyngeus
50
In addition to the constrictors the pharynx is made up of 3 longitudinal muscles. What are they?
stylopharyngeus, the palatopharyngeus and the stylopharyngeus
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What are the different functions of the constrictor muscles and the longitudinal muscles? How do they work together to aid swallowing?
Longitudinal muscles elevate pharynx to shorten it and get food into oesophagus. Constrictor muscles create a peristaltic ridge behind bolus of food to push it down.
53
What is the difference of the musculature of the pharynx compared to the musculature of the rest of the digestive system?
Skeletal muscles so can be voluntary. Also, more advance, the longitudinal muscle is interior to the circular muscle. It is the opposite in the rest of the alimentary tract
54
As what structure does the pharynx continue inferiorly?
Oesophagus
55
The constrictor muscles of the pharynx are supplied by which plexus?
the pharyngeal plexus
56
Location of pharyngeal plexus?
sits on the lateral surface of the muscles and is formed by pharyngeal branches of the vagus nerve, the glossopharyngeal nerve and sympathetic nerves from the superior cervical ganglion.
57
Identify the tonsils on the diagram below and describe the regions in which you would have the followings tonsils (making up Waldeyer’s ring):
58
Name the labels:
A - Epiglottis
B - Hyoid bone
C - Thyroid cartilage
D - Cricoid cartilage
E - Arytenoid cartilages
59
. At what vertebral levels would you find B, C and D on the diagram, below?
Hyoid = C2 Upper border
Thyroid cartilage = C3
Vocal Folds = C4
Lower border of thyroid cartilage = C5
Cricoid cartilage = C6
60
Name the nerves below:
A – Superior laryngeal n.
B – Internal laryngeal n.
C – External laryngeal n.
D – Vagus n.
E – Recurrent laryngeal n.
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Which foramen of the skull does the vagus nerve exit the cranial cavity?
Jugular foramen
64
Cross section of the neck (level C5)
Identify the labels A – I on the diagram
A = Internal Jugular vein
B = SCM
C = Thyroid gland
D = Larynx at the level of thyroid cartilage
E = Carotid Sheath
F = Common carotid artery
G = Oesophagus
H = Anterior Scalene
I = Trapezius
65
What is the action of the cricothyroid muscle on:
* thyroid cartilage
* vocal folds
* As it contracts it pulls the thyroid cartilage downwards
* The vocal folds increase the length of the vocal folds thereby increasing the pitch of your voice
66
At what point (and vertebral level) does the larynx become the trachea?
C6
67
What shape are the cartilaginous tracheal rings and why is this important?
C shaped and incomplete posteriorly to allow for the expansion of the oesophagus when passing a bolus of food. It is completed posteriorly by the trachealis muscle
68
. If the trachea wasn’t in the midline with the suprasternal notch – what might be happening?
Either a tumour which is pulling the trachea off centre or a pneumothorax/haemothorax which is pushing the trachea off centre
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The area below the bifurcation is occupied by a group of lymph nodes called ______________________________ which are often involved in **malignant disease** which can make carina **look less sharp and blunt**
tracheobronchial lymph nodes
72
The right main bronchus is slightly larger in size that the left, and runs more vertically – What can this lead to?
this can lead to inhaled foreign bodies often passing into the right main bronchus.
73
1. Why is the right main bronchus more vertical than the left main bronchus?
Because the heart gets in the way on the left
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75
Which organs cause the indentations found on the base of the right lung versus the base of the left lung?
Base of right lung indented by liver
Base of left lung indented by spleen, stomach and sometimes the left lobe of the liver
76
Which bony structure causes the indentation around each apex of the lung?
1 st rib
77
Which bony structures cause the indentations on the posterior and lateral surfaces of the lung?
Ribs – note the downward orientation of the ribs on the surface of the lung. This orientation in used in pump handle movement. In particular, the indentations made on the posterior surface of the lung are created by the neck and angle of the ribs while the indentations on the lateral surface are created by shaft of the rib.
78
How many BP segments are on each side? Why are they important?
10 BP segments in the right lung (3 in superior, 2 in middle, 5 in inferior love.
8-10 BP segments in left (4-5 in upper, 4-5 in lower).
Because they each have their own segmental bronchus, pulmonary artery that enter through the apex of each BP segment. The pulmonary veins surround each BP unit which means that they can be isolated and excised to limit the spread of disease in the lungs. They are independent units of lung tissue that can be taken out without compromising the function of the rest of the lung tissue.
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83
. What happens if the 2 layers of pleura separate?
It will limit the expansion of the lung often causing it to collapse. This is because air or fluid has now occupied the potential space of the pleural cavity
84
What is thecondition called when layers of pleura separate and can you name 4 different types of this condition?
There are 3 main types of pleural effusion when excess fluid fills the pleural cavity. **Hydrothorax** (serous fluid), **haemothorax** (blood), **pyothorax** (pus). **Pneumothorax** (air) can also occur.
85
How would an injury such as a stab wound to the neck cause a pneumothorax?
Because the apex of the lung extends into the neck
86
What are the root values of the phrenic and vagus nerves? What is their function?
Phrenic – C3-C5 innervation of diaphragm
Vagus – Cranial nerve number 10. Lots of functions we will cover this nerver in different blocks. For respiratory innervation of larynx mainly. See Respiratory 1 and lectures.
87
What sits directly anterior to each costodiaphragmatic recess?
Kidney
88
Surface markings of the lungs and Pleura
89
The Pleura:
2 - 4 - 6 - 8 - 10 - 12
90
The Lungs:
2- 4- 6- 8 -10
91
What are the actions of the muscles mentioned?
Diaphragm
Elastic recoil
Internal/External intercostal muscle
Serratus anterior
Pectoralis major and minor
**Diaphragm** : Inspiration
**Elastic recoil**: Expiration
During forced inhalation and quiet respiration: **the external intercostal** muscles lift (bucket handle) and spread the ribs – it also causes anteroposterior volume to increase (pump handle). The ribs are fixed posteriorly to the vertebral column so contraction lifts the ribs like a bucket handle.
Deep exhalation uses the **internal intercostal muscles** to pull the ribs inferiorly, the opposite movement to the **external intercostals.**
**Innermost intercostals** work with **internal intercostal muscles** to reduce the transverse dimension of the thorax.
**Serratus anterior** holds the scapula close to the chest wall and can lift the ribs while the shoulder girdle is fixed so aids in respiration.
**Pectoralis major and minor** aid forced inhalation pulling ribcage out to expand room for lung expansion. The latter three are just some examples of accessory muscles but there are more.
92
What nerve runs on the superficial surface of serratus anterior? If this was damaged during, for example during removal of lymph nodes from the axilla, what would be the resultant effect?
Long thoracic nerve. Winging of the scapula. Because serratus anterior attached to the medial border of the scapula (not the lateral!) it will be the medial border of the scapula that will wing.
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94
At what vertebral levels do the aorta, oesophagus and inferior vena cava pass through the diaphragm? What parts of the diaphragm are involved for each structure?
T12 – aorta behind the diaphragm (aortic hiatus)
T10 – oesophagus through left muscular dome
T8 – IVC through central tendon
95
Where does the vagus nerve pass through?
T10 with the oesophagus
96
What are the attachments of the diaphragm to the vertebral column and rib cage? Are they the same on the left and right?
To vertebral column – the left and right crura.
Right crus arises from upper 3 vertebral bodies.
Left crura from the upper 2 vertebral bodies.
Median arcuate ligament between the two crura
Medial arcuate ligaments – side of body of L1 or L2 to transverse process of L1 or L2.
Lateral arcuate ligaments – tip of transverse process of L1 or L2 into 12th rib
97
What is meant by the “crus of the diaphragm”?
Crus translates as leg in latin. Crura is plural. Look at the picture below how the legs stand either side of the aorta.
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Where does the azygous vein drain?
Superior vena cava
101
Where do the left hand intercostal veins drain? Can you find it/them?
The accessory hemiazygous and hemiazygous veins
102
Note that the quite often the super intercostal veins on the left will come together to form the ____________ that drains into the \_\_\_\_\_\_\_\_\_\_\_\_\_vein. While similarly the right superior intercostal veins may join to form the\_\_\_\_\_\_\_\_\_\_\_\_ which empties into the \_\_\_\_\_\_\_\_\_
left superior intercostal vein
left brachiocephalic
right superior intercostal vein
azygous vein
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