How do we cough

Question 1

Give a brief summary of the anatomy of coughing.

Answer 1

1. stimulation of sensory receptors in the mucosa o the oropharynx, laryngopharynx, larynx or resp tree.
2. deep inspiration using the diaphragm, IC muscles ad accessory muscles of inspiration
3. adduction of vocal cords to close rima glottidis
4. contraction of anterolateral abdo wall muscles
5. vocal cords suddenly abduct to open rima glottidis
6. soft palate tenses and elevates to close off the entrance to the nasopharynx and direct stream of air out as a cough

Question 2

What are the accessory muscles of inspiration?

Answer 2

pec major, pec minor, sternocleidomastoid & anterior medius and posterior scalenus muscles

Question 3

What happens at the level of C6 vertebra?

Answer 3

larynx becomes trachea

pharynx becomes oesophagus

Question 4

Which cranial nerves are stimulated in coughing?

Answer 4

CNIX or CNX

Question 5

Which cranial nerves are stimulated in sneezing?

Answer 5

CNV or CNIX

Question 6

Which is higher up, the rima glottidis or the epiglottis?

Answer 6

epiglottis

Question 7

What is the carotid sheath and what does it contain?

Answer 7

a protective tube of cervical deep fascia 
contains the vagus nerve
the internal carotid artery 
the common carotid artery 
the internal jugular vein

Question 8

Where in the brain are the cough or sneeze receptors recieved?

Answer 8

medulla

Question 9

What do lobar bronchi supply?

Answer 9

one lung lobe - 5 in total

Question 10

What specifically does “respiratory tree” describe?

Answer 10

anatomy of the LRT airways from trachea to alveoli

Question 11

What kinds of nerve are in the pulmonary plexus and where is it found?

Answer 11

sympathetic axons, parasympathetic axons and visceral afferents
found at the tracheal bifurcation on the anterior surface

Question 12

What does recruitment of the accessory muscles of inspiration suggest?

Answer 12

dysponea

Question 13

What do motor axons of the pulmonary plexus supply?

Answer 13

all mucous glands and bronchiolar smooth muscles of the respiratory tree

Question 14

Where in the chest are the phrenic nerves found?

Answer 14

descending over the lateral aspect of the fibrous pericardium anterior to the lung root

Question 15

What happens to the diaphragm and intercostal muscles in a deep (forced) inspiration?

Answer 15

diaphragm - flattens then descends maximally

IC muscles - contract forcefully and raise the ribs maximally

Question 16

What are the intercostal nerves?

Answer 16

anterior rami of spinal nerves T1-11

Question 17

What kind of muscle are the intrinsic muscles of the larynx and what are they innervated by?

Answer 17

skeletal (voluntary) muscle

somatic motor branches of the vagus nerve

Question 18

What does the vagus nerve supply that is important to coughing?

Answer 18

To supply somatic sensory to the mucosa lining the larynx and somatic motor to the intrinsic muscles of the larynx

Question 19

In relation to the lung root, where do the vagus nerves descend?

Answer 19

posterior

Question 20

What are the accessory muscles of deep (forced) expiration?

Answer 20

right and left anterolateral abdominal wall muscles (external oblique, internal oblique, transversus abdominus and rectus abdominus)

Question 21

What is an aponeurosis?

Answer 21

flattened tendon

Question 22

What is the linea alba?

Answer 22

where right and left aponeurosis join at the midline

Question 23

What is the linea semilunaris?

Answer 23

where the muscle fibres end and the aponeurosis begins

Question 24

Where does the external oblique attach?

Answer 24

superficial aspect of the lower ribs superiorly and anterior part of iliac crest and public tubercle inferiorly

Question 25

Where does the external oblique attach?

Answer 25

inferior border of lower ribs superiorly
and
iliac crest and the thoracolumbar fascia of the lower back inferiorly

Question 26

Where does the transversus abdominus attach?

Answer 26

deep aspect of the lower ribs superiorly and

iliac crest and thoracolumbar fascia of the lower back inferiorly

Question 27

What is a tendinous intersection?

Answer 27

divide each of 2 long flat muscles of the rectus abdominus into 3 or 4 smaller quadrate muscles for improved mechanical efficiency

Question 28

What are the functions of the anterolateral abdominal wall muscles?

Answer 28

• maintain posture
• support the vertebral column and contractions produce movement of the vertebral column
• guarding
• increase intra-abdominal pressure
• forced expiration

Question 29

What are the thoracoabdominal nerves?

Answer 29

the 7th to the 11th intercostal nerves travel anteriorly then their terminal branches leave the intercostal spaces, in the plane between the internal oblique & the transversus abdominus

Question 30

What is the Subcostal nerve?

Answer 30

T12 anterior ramus

Question 31

What is the Iliohypogastric nerve?

Answer 31

half of L1 anterior ramus

Question 32

What is the Ilioinguinal nerve?

Answer 32

other half of L1 anterior ramus

Question 33

What is needle cricothyrotomy?

Answer 33

temporary emergency procedure performed in cases of URT obstruction. Needle is inserted at or above the level of the vocal cords