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Introduction to medicine (Year 1) > Introduction to the Respiratory system > Flashcards

Introduction to the Respiratory system Flashcards

1
Q

What is the function of the thoracic wall?

A
  • Protect heart and lungs
  • Make the movements of breathing
  • Breast tissue - lactation
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2
Q

Describe the thoracic cavity

A
  • Within chest walls
  • Contains viscera (vital organs)
  • Contains major vessels and nerves
  • Consists of mediastinum and right + left cavities
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3
Q

Describe the skeleton of the thoracic wall

A
  • 12 pairs of ribs:
    • True ribs - 1 → 7 (attach via their costal cartilage directly to sternum)
    • False ribs - 8 → 10 (attach via their costal cartilage to ribs number 7, which is directly attached to the sternum)
    • Floating ribs - 11 & 12 (not attached to sternum at all)
  • Intercostal spaces - spaces between the ribs
  • Costal margin - formed by lower border or ribs, forms a triangular shape
  • 12 thoracic vertebrae
  • Clavicle and scapula (these are not part of the thoracic cavity, but are connected via ligaments and muscles)
  • Sternum
    • Manubrium
    • Sternal body
    • Xiphoid (this is the little thing sticking out underneath the sternum, it’s the arrow with no label in the diagram)
    • Angle of louis (sternal angle) - this is at the level of T4 vertebrae
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4
Q

What is the function of the intercostal spaces?

A

Each intercostal space contains intercostal muscles which help to move the ribs during breathing/changing the volume within the thoracic cavity during respiration

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5
Q

Describe the external intercostal muscle

A

Most superficial layer of intercostal muscle

Runs from rib above to superior border of rib below

Function is to elevate the ribs in inhalation, increasing the diameter of the thoracic wall

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6
Q

Describe the internal intercostal muscles

A
  • Middle layer of intercostal muscle
  • Only function in forced exhalation
  • Brings the ribs closer together
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7
Q

Describe the innermost intercostal muscles

A
  • Deepest layer of intercostal muscle
  • Separated from the other 2 layers of muscle by the neurovascular bundle
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8
Q

Describe the neurovascular supply to intercostal space

A
  • Each intercostal space has a separate blood + nervous supply bundle (neurovascular bundle)
  • Bundle runs along inferior aspect of rib in the costal groove
  • Run anteriorly from the spinal column to the sternum
  • Always in arrangement superior -> inferior:

Intercostal vein
Intercostal artery
Intercostal nerve

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9
Q

What is the upper respiratory tract comprised of?

A
  • Nose
  • Nasal passages
  • Paranasal sinuses
  • Pharynx
  • Portion of larynx above the vocal cords
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10
Q

What is the lower respiratory tract comprised of?

A
  • Larynx below vocal cords
  • Trachea
  • Bronchi
  • Bronchioles
  • Lungs
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11
Q

Describe the nasal cavity

A

Air enters via nasal cavity

Nasal cavity is entered anteriorly through anterior nares (nostrils)

It opens posteriorly into the nasopharynx through the choanae (posterior nares)

Mucosa lines the nasal cavity, except for the nasal vestibule, which is lined with skin

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12
Q

Describe the epithelium lining the nasal cavity

A
  • Majority of nasal cavity lined by ‘respiratory epithelium’
  • Small part of nasal cavity lined by stratified squamous epithelium (nasal vestibule)
  • Respiratory epithelium is pseudostratified columnar ciliated epithelium (with goblet cells)
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13
Q

Describe the paranasal sinuses

A
  • Cavities within skull filled with air
  • Lined by ciliated pseudostratified columnar epithelial cells
  • Connected to the lateral walls of the nasal cavity

Function:

  • Lighten skull
  • Increase resonance of voice
  • Humidify inspired air

Innervated by trigeminal nerve (CN V)

Blood supplied by external carotid artery

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14
Q

Describe the oral cavity

A
  • Acts as an air inlet
  • Anteriorly - oral fissure
  • Posteriorly - Oropharynx
  • Laterally - Cheeks
  • Superiorly - palate (hard and soft)
  • Inferiorly - muscular floor and tongue
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15
Q

Describe the pharynx

A

Divided into 3 parts:

  • Nasopharynx - Posterior to nasal cavities and above soft palate
  • Oropharynx - Posterior to oral cavity, inferior to the level of the soft palate, superior to the upper margin of the epiglottis
  • Laryngopharnyx - Extends from the superior margin of the epiglottis to the top of the oesophagus
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16
Q

Describe the tonsillar region

A
  • Waldeyer’s tonsillar ring/pharyngeal lymphoid ring is a group of lymphoid tissues in the pharynx:
    • Pharyngeal tonsil (Adenoids)
    • Tubal tonsils (x2)
    • Palatine tonsils (x2)
    • Lingual tonsil
  • The first line of defence against pathogens entering through the nasopharynx or oropharynx
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17
Q

Describe the larynx

A
  • Voice box
  • Vocal cords - sound created by forcing air through vocal folds of larynx which vibrate to make noise
  • Air travels through larynx into trachea. There are a few cartilage structures surrounding the larynx, keeping it patent and protected
18
Q

Describe the trachea

A
  • Air travels through larnyx into trachea, which is the tube through which air is transported to the lungs
  • It runs from the level of the lower border of the cricoid cartilage C6/C7 to T4/T5 vertebral level
  • Here it bifurcates into the left and right primary (main) bronchi
  • Trachea formed of ‘horse shoe’ or ‘c’ shaped rings of hyaline cartilage, held together by dense connective tissue
  • Posteriorly, at the junction where the trachea is in contact with the oesophagus the trachea has a membrane void of cartilage and covered in smooth muscle, the trachealis muscle
19
Q

What lies at the bifurcation of the trachea?

A
  • The carina, a ridge that can be seen on a bronchoscopy
  • Carina is a key landmark in determining pathologies. Widening/distortion of the carina can often indicate cancer in the lymph nodes that lie just inferior to the carina. The name of these lymph nodes in inferior tracheobronchial lymph nodes
20
Q

Describe a bronchoscopy

A
  • Bronchoscope travels down trachea to enter a main bronchus
  • Bronchoscope must move around the carina to get to the bronchus
  • The inferior tracheobronchial lymph nodes can blunt the carina when enlarged → indicating pathology
21
Q

Describe the bronchi

A
  • Trachea bifurcates into left and right primary (main) bronchi
  • Bronchi have hyaline cartilage rings supporting them
  • Right bronchi is wider, shorter and lies at a steep vertical angle, so more likely for foreign objects to become lodged here
  • Left bronchi is narrower and more horizontal
  • This is important as inhaled foreign objects are more likely to get lodged in the right side of the bronchus
22
Q

Describe the secondary bronchi

A
  • Left and right primary (main) bronchi divide into secondary (lobar) bronchi
  • 2 secondary (lobar) bronchi on left
  • 3 secondary (lobar) bronchi on right
  • Secondary bronchi further divide to give tertiary (segmental) bronchi; usually 10 for each lung
23
Q

Describe the terminal bronchioles

A
  • Each tertiary bronchi gives rise to many terminal bronchioles - these differ in structure as they no longer have hyaline cartilage in their walls
  • Respiratory bronchioles branch from these terminal bronchioles
  • Each respiratory bronchiole ends in an acinus of clustered alveoli
24
Q

Describe the lungs

A
  • Lungs functional organs of respiration
  • 2 lungs- either side of mediastnium, protected by rib cage
  • Diaphragm lies inferior to lungs which separates the thoracic cavity from the abdominal cavity
  • Function of lungs is to oxygenate blood
  • Achieve this by bringing inhaled air into close contact with oxygen-poor blood in pulmonary capillaries
  • Can expand down to lower border of ribs; costal margin and extend as far up as the root of the neck. Above the first rib.
25
Q

How are the lungs divided?

A
  • Into lobes:
    • 2 lobes on left: Superior and inferior divided by oblique fissure
    • 3 lobes on right: Superior, middle and inferior divided by oblique fissure and horizontal fissure
26
Q

Describe the hilum of the lungs

A
  • Located on medial aspect of each lung, it’s the site where the bronchi, arteries, veins & nerves enter/exit the lung
  • The pleura (visceral and parietal) join together on the hila of the lungs
  • Plural is hilia
27
Q

What is the order of bronchus, vein, artery from the anterior to posterior of the hilia of the lungs?

A

Anterior → Posterior = Vein, Artery, Bronchus

Pulmonary artery is superior to the pulmonary veins

28
Q

What does the diaphragm form?

A

Floor of the chest cavity and forms roof of the abdominal cavity

29
Q

What do the ‘openings’ of the diaphragm permit?

A

Structures to pass between the 2 cavities (thoracic and abdominal)

30
Q

What type of muscle is the diaphragm?

A

Skeletal

31
Q

Where does the muscular part of the diaphragm attach, and what is the muscular part supplied by?

A
  • The sternum
  • Lower 6 ribs & costal cartilages
  • L1-L3 vertebral bodies

Supplied by:

  • Phrenic nerve (C3,4 & 5 anterior rami)
32
Q

How is the diaphragm anatomically arranged?

A
  • Into right and left ‘domes’
    • Right dome normally more superior (due to presence of liver inferiorly)
33
Q

What are the 3 major openings of the diaphragm, and at what point do they pass through?

A
  • Inferior vena cava - Passes through at T8 level
  • Oesophagus - Passes through at T10 level
  • Aorta - passes through at T12 level
34
Q

In what 3 planes is thoracic volume increased during inspiration? Describe them

A
  • Anteroposterior - Increase illustrated with pump handle movement
  • Transverse - Increase illustrated with lifting handle of bucket, which is like raising right and left ribs at the costovertebral and costosternal joints
  • Vertical - Increased by downward pull of diaphragm- When diaphragm contracts it pushes down on the abdominal viscera and increases the vertical dimension of the thoracic cavity. This reduces the pressure in the thoracic cavity
35
Q

What happens to the diaphragm during inspiration?

A
  • When thoracic wall and diaphragm move during inhalation, they increase the intrathoracic wall and the diameter
  • This reduce intrathoracic pressure, allowing air to move from the atmosphere into the lungs through the upper and lower respiratory tracts
  • The movement of the thoracic wall, diaphragm and intercostal muscles increases the capacity of the thoracic wall during inhalation, making it easier for air to flow into the lungs
36
Q

What happens to the diaphragm during relaxed inhalation?

A
  • Diaphragm contracts
  • External intercostals elevate thoracic cavity
37
Q

What happens during relaxed exhalation?

A
  • External intercostal muscles above diaphragm relax
  • Allows lungs to recoil, push air out, as the pressure is now high
38
Q

Describe the pleura

A
  • Each lung contained within a serous membrane called a pleural sac
  • Pleural sacs flank both sides of heart, occupy most of the thoracic cavity
  • Each pleural sac composed of 2 serous layers - called parietal pleural and visceral pleura
  • Thin space between 2 layers called pleural cavity.
  • Thin pleural cavity contains thin layer of liquid called pleural fluid - provides lubrication between 2 layers of pleura as lungs expand which helps prevent friction
39
Q

Describe the parietal pleura

A
  • Lines internal surface of thoracic cavity
  • Named differently depending on area it is lining
    • Diaphragmatic parietal pleura - lines superior surface of diaphragm
    • Mediastinal parietal pleura - lines lateral surface of mediastinum (which contains the heart)
    • Costal parietal pleura - lines internal surface of ribs
    • Cervical parietal pleura - extends above rib 1 to the root of the neck
40
Q

Describe the visceral pleura

A
  • Surrounds and is intimately attached to each lung
  • Following the contour of the lobes
  • Visceral pleura is contiguous with the parietal pleura at the hilum of each lung

Introduction to medicine (Year 1) (55 decks)

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