Kyle's Questions for Microscopic and Gross Flashcards
What are the outer and inner layers of the pleura called? Name all four subspaces of the outer pleura. What space lies between them?
Outer- Parietal; Inner- visceral. Parietal is made of the costal (lateral), cervical (superior), mediastinal (medial), and diaphragmatic (inferior). Space between is called the pleura cavity.
What connects the heart to the diaphragm? What hole is present in the structure and what runs through it?
The central tendon. The caval opening is a hole through it. The inferior vena cava and phrenic nerve run through it.
How far does the pleural cavity extend on the lateral and medial portions of the lung?
Medially, lung extend to 6th rib but pleural space extends to 8th. Laterally, lung extends to 10th rib but pleura extends to 12th rib
What sensory nerves innervate the parietal pleura? When do patients feel pain and how is pain felt?
Intercostal nerves. Patients feel pain when parietal and visceral adhere to one another as can happen during inflammation of the pleura (known as pleuritic). Pain feels stabbing. Diaphragmatic pleura is innervated by sensory fibers from phrenic nerve (C3-C5). If patient has inflammation of the diaphragmatic pleura, pain can be felt as radiating over the shoulder due to cervical origins of the phrenic nerve. Phrenic nerve also contains the motor fibers for the diaphragm.
What is the branching pattern of the respiratory tree?
Trachea -> principle bronchi -> secondary (lobar) bronchi (three on right, two on left) -> tertiary (segmental) bronchi -> terminal bronchiole -> respiratory bronchiole -> alveolar duct -> alveolar saccules
Which side is aspirated objects more likely to be found on and why?
Right side of the pulmonary tree because the primary bronchi is shorter and more vertical on the right side as compared to the left
How do adjacent alveoli communicated?
Pores of Kohn – provide avenues for collateral air flow
What is the pattern and location of the respiratory blood flow?
Pulmonary artery -> pulmonary arteries (follow branching pattern of bronchial tree) -> capillary plexus (surround each alveolus) -> intersegmental pulmonary veins (run on the outside of bronchioles – in connective tissue septa between bronchopulmonary segments) -> come together at hilum and form superior and inferior pulmonary veins.
What are symptoms of enlarged lymph nodes in the bronchial tree? What diseases are associated with each of these symptoms?
Enlargement can lead to occlusion of a part of the bronchial tree leading to dyspnea. This can occur as a result of lung cancer (sometimes otherwise clinically silent). Increase in bronchopulmonary or tracheobronchial nodes can cause deviation of the trachea. Localized on the left side may lead to compression of the left recurrent laryngeal nerve (aka inferior laryngeal nerve) (X) causing hoarseness – may be first clinical sign of lung cancer.
What types of nerves innervate the lungs? What are their branching patterns? Where do each originate? What information do they carry?
Generally, all visceral plexi contain postganglionic sympathetic fibers, preganglionic parasympathetic fibers, and visceral afferent fibers (2 types). Fibers of the anterior and posterior pulmonary plexi follow the pulmonary arteries/ branching pattern of the bronchiole tree.
Sympatheric fibers – originate from T1-T5. Bronchodilation and control blood flow through pulmonary vessels.
Preganglionic parasympathetic fibers – part of vagus nerve (Cn. X) synapse on ganglion near or within lung. Lead to bronchoconstriction and initiate glandular secretions.
Visceral afferent (monitoring) fibers – part of vagus nerve
Mucosa of bronchi – initiate cough
Muscle of the bronchi – respond to stretch
Connective tissue of interalveolar septae – control inspiration/ respiratory excursions
Pulmonary arteries – pressorreceptors (blood pressure)
Pulmonary veins – chemoreceptors (blood gas levels)
Visceral Afferent (pain) fibers follow the sympathetics. Pain is referred over dermatomes T1-T5. However, very limited number.
Somatic Afferent (pain) – fibers from the parietal pleura is transmitted by intercostal and phrenic nerves. Source of most pain
What arteries supply the external nose? What part of the nose does the maxillary artery supply? What are the branches off the maxillary that supplies the nose? What foramen does they enter through?
External nose is supplied by the ophthalmic artery. The maxillary artery supplies the alar, lower portion of the nasal septum, and most of the naval cavities. The sphenopalatine artery is the branch that supplies most of the blood to the nose and enters via the sphenopalatine foramen (connects the pterygopalatine fossa with the nasal cavity). The nasopalatine artery breaks off the sphenopalatine and supplies the septum. The descending palatine artery is a branch off the maxillary artery originating in the pterygopalatine fossa, and runs through the ptergopalatine canal, divides into the greater and lesser palatine artery. The greater palatine artery runs the length of the hard palate and ends by passing through the incisive foramen to supply the anterior portion of the septum.
What is Kiesselbach’s area?
Site of anastomosis (coming together) of branches of internal and external carotid arteries. The anterior and posterior ethmoid arteries (branches of IC), the nasopalatine, greater palatine, and superior labial arteries (all EC) all join. 90% of nose bleeds occur in the Kiesselbach’s area others more posterior in the sphenopalatine artery can be more serious.
What nerves innervate the nose and what parts of the nose do they innervate?
Infratrochlear, supratrochlear, and external branch of anterior ethmoidal nerve (V1) supply superior aspects of the nose to the tip. Infraorbital nerve (V2) branches supply inferior and lateral aspects of nose, nares, up to lower eyelids. Nasopalatine supplies the septum. The anterior ethmoidal nerve (branch of V!) supplies general sensory anterosuperior aspects of lateral nasal wall and portions of nasal septum. Postganglionic parasympathetic and sympathetic fibers to nasal mucosa travel with branches of V2 (which enters cavity via foramen rotundum). Preganglionic parasympathetic arise from greater petrosal nerve (from CN VII) arrive at pterygopalatine ganglion – postganglionic travel with V2. Postganglionic sympathetic arise from cervical ganglion gain access to cranial cavity with internal carotid, and nerves destined for face join the deep petrosal nerve in the ptergoid canal and form the Vidian nerve goes to zygomatic nerve to communicating branches which vasoconstricts lacrimal.
Name the bones and cartilage of the nose and their location.
Bones of the nose are the nasal bone (superior portion) and the frontal portion of the maxillary bone (lateral portion). Cartilage of the bone includes the alar (wing) of the nose.
What are the boundaries to the naval cavity?
Superiorly: the cribiform plate; inferiorly: the palantine process of the maxilla and the horizontal plate of the palatine bone; laterally: superior and middle conchae (part of the ethmoid) and inferior concha (portion of the lacrimal); the bony septum makes up the medial extent
What bones make up the nasal septum?
Superiorly, the vomer and inferiorly the perpendicular plate of the ethmoid bone
What is the name of the strucutres that allow ventilation to the sinuses?
Ostia
Name the structures that drain the sinuses
Frontonasal duct – Drains the frontal sinus into middle meatus
Ethmoidal bulla – drains the middle ethmoid air cells
Hiatus semilunar- drains the anterior ethmoid air cells and maxillary sinus to middle meatus
Posterior ethmoid cells drain into superior ethmoid air cells
Spenoethmoidal recess – Drains sphenoid sinus
Nasolacrimal drains into inferior meatus
Ostiomeatal complex – Drainage pathways going into middle meatus, has the tendency to blockage.
What are the branches of the vagus nerve, where do they innervate, and what information do they carry?
Two branches, the superior and inferior laryngeal nerve
Superior broken into external and internal laryngeal nerve.
External has solely a motor function for cricothyroid muscles. Damage leads to monotone and deep voice.
Internal laryngeal nerve – General sensory fibers to mucosa above vocal cords, special sensory fibers to taste buds of the root of the tongue, preganglionic parasympathetic fibers that are secretory motor to mucosa above vocal cords. Internal laryngeal nerve enters inner larynx through piercing the thyrohyoid membrane traveling with the superior laryngeal artery. Severing cord leads to loss of cough reflex and objects may pass through trachea.
Inferior laryngeal nerve – motor fibers to all intrinsic muscles of the larynx. Sensory and preganglionic parasympathetic fibers that are secretomotor to the mucosa below the vocal cords. Severing cord leads to hoarseness and difficulty breathing/ swallowing.
What is the site in the trachea that can be used to insert a tube for airway?
The cricothyroid ligament/ membrane.
What lies between true and false vocal cords
Ventricle
Name and describe muscles that function to widen/ narrow larynx and their mechanism.
Cricothyroid muscles draws the thyroid cartilage forward and down lengthening and adducting the vocal cords. Lateral cricoarytenoid and arytenoid muscles aid in adducting vocal cords. Aryepiglottic muscles works with thyroarytenoid muscle to act as sphincter, protecting airway. Posterior cricoarrtenoid muscle is the only one that abducts vocal cords. If recurrent inferior laryngeal nerve is comporomised, breathing will be difficult.
Name the two arteries that supply the blood to the larynx, their origin, and where they enter.
Superior laryngeal artery- branch of the superior thyroid artery (from EC), enters through the thyrohyaline membrane.
Inferior laryngeal artery – branch of the interior thyroid artery (from thyrocervical trunk/ subclavian artery). Enters larynx with inferior laryngeal nerve, in groove between the trachea and esophagus.
