Intro to Cardioresp Workbook

Question 1

Describe the anatomy of cartilage in the neck

Answer 1

Thyroid cartilage lies over the larynx and above the thyroid gland in two halves that come together to form th laryngeal prominence (Adams apple)
Below this (C6 level) is cricoid cartilage and below again is tracheal cartilage covering the trachea 
In gap between cricoid and thyroid is cricothyroid ligament where cricothyrotomy occurs due to airway obstruction

Question 2

How many pairs of ribs do we have?

Answer 2

12

Question 3

Where is the jugular notch?

Answer 3

Visible dip between the neck and the clavicle

Question 4

Where is the sternal angle?

Answer 4

Visible ridge (Angle of Louis) - T4/T5 vertebral level 
Laterally is where the costal cartilage of the second rib attaches to the sternum

Question 5

What lies at the level of the 4th rib?

Answer 5

horizontal fissure of the right lung - nipple lies at the level of the 4th intercostal space in men

Question 6

What is the significance of the sternal angle?

Answer 6

This is where the trachea bifurcates and the aortic arch becomes the thoracic aorta

Question 7

Describe where the heart lies in the chest

Answer 7

Heart lies In the thoracic cavity behind the sternum and in between the two lungs - 2/3 of the heart lies over the midline to the left hand side and extends to the midclavicular line crossing the 5th intercostal space

Question 8

Where do you hear the aortic valve sound?

Answer 8

2nd intercostal space at the right sternal margin

Question 9

Where would you hear the pulmonary valve sound?

Answer 9

2nd intercostal space at the left sternal margin

Question 10

Where would you hear the tricuspid valve sound?

Answer 10

Right sternal margin in the 5th intercostal space

Question 11

Where would you hear mitral valve sound?

Answer 11

over the heart apex in line with the middle clavicle in the 5th intercostal space

Question 12

How many lobes does the right and left lung have?

Answer 12

Right lung has three lobes (horizontal and oblique fissure) and the left lung has 2 lobes (Oblique fissure)

Question 13

Where does the oblique fissure lie?

Answer 13

Start at the 4th rib at the back and travel deep to the 5th rib and end at the 6th costal cartilage

Question 14

Where do the lungs lie in relation to the ribs?

Answer 14

Inferior extent of the lungs is at the 6th rib anteriorly, 8th rib laterally and 10th rib posteriorly - lung extends above the clavicle into the base of the neck

Question 15

Why is bronchoconstriction useful?

Answer 15

When asleep it reduces the volume of air that needs to be breathed into the lungs and reduces the effort needed to breathe

Question 16

What is the arterial blood supply of the lungs?

Answer 16

Bronchial artery from the thoracic aorta supplying OXYGENATED BLOOD
2x Pulmonary arteries from the right ventricle providing DEOXYGENATED BLOOD

Question 17

Describe the venous drainage of the lungs

Answer 17

Bronchial veins draining DEOXYGENATED BLOOD to the azygous vein
Pulmonary veins x4 draining OXYGENATED BLOOD

Question 18

Describe the pleurae of the lungs

Answer 18

Inner surface of the chest wall is covered in parietal pleura which comes into contact with the visceral pleurae which covers the lungs - between the two layers is the parietal cavity which contains serous fluid which sticks the lung to the inside of the chest wall

Question 19

Describe the mechanism of inspiration

Answer 19

Lung pressure must be lower than atmospheric pressure for air to be drawn in
Ribs are angled forwards and downwards and moved upwards and laterally (Pump and bucket handle) to increase the thoracic volume
Diaphragm contracts and moves downwards creating a negative pressure in the thorax resulting in air being drawn into the lungs –> Abdominal breathing

Question 20

How does the mechanism of breathing change during exercise and pregnancy when increased gas exchange is required?

Answer 20

Contraction of the external intercostal muscles pulls the ribs closer together increasing the lateral and anterior-posterior diameters of the chest –> Thoracic breathing

Question 21

Describe the mechanism of expiration

Answer 21

Normally a passive process (Diaphragm and external intercostals relax) with no muscular contraction of the intercostal muscles or the diaphragm except in active or forced expiration where internal intercostals and abdominals contract

Question 22

When do the coronary arteries fill with oxygenated blood?

Answer 22

Fill during diastole when the ventricular wall is relaxed so a reduction in diastolic filling time will reduce the perfusion of cardiac tissue

Question 23

Where does the coronary sinus drain into?

Answer 23

Right atrium

Question 24

Define heart failure and list the three different type

Answer 24

HF is a syndrome of signs and symptoms where the heart is unable to pump sufficient blood - can be caused by structural or functional abnormalities

1. Left ventricular failure
2. Right ventricular failure
3. Biventricular failure (Congestive cardiac failure)

Question 25

What are the causes of heart failure

Answer 25

1. Failure of heart valves
   - Narrowed valve that restricts blood (increases strain on cardiac muscle
   - Leaky valve allowing flow back into chamber
2. Increased demands on heart to circulate blood
   - Anaemia - body needs to circulate more blood due to low Hb
   - pregnancy - increased volume of blood and demands on the body
   - High blood pressure - has to pump against higher resistance
3. Failure due to damage itself
   - Coronary artery disease - insufficient blood reaching heart muscle - heart attack
   - Cardiomyopathy - muscle is diseased

Question 26

Effects of Heart Failure

Answer 26

Blood returning to the ventricle is not pumped out effectively so blood back log forms
In left ventricle this develops in the lungs = breathlessness
In the right ventricle blood back log develops in bodily tissues leading to leg oedema and prominent veins in the neck