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Resp > Lecture 1 and 2 - Anatomy > Flashcards

Lecture 1 and 2 - Anatomy Flashcards

1
Q

Contents of the upper respiratory tract

A

Nose
Paranasal air sinuses
Pharynx
Larynx - lower border of the cricoid cartilage

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2
Q

How does the respiratory system develop?

A

Develops as a diverticulum from the pharynx from the primitive gut tube

It then branches

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3
Q

What is the purpose of the nasal cavity? (5)

A
  1. Olfaction
  2. Produce turbulent air flow via conchae - slows speed of air entry so it can be warmed and moistened
  3. Warms and moistens inspired air (by transudation of mucous secretions)
  4. Recovers water from expired air
  5. Speech production
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4
Q

What divides the left and right nasal cavities

A

Median nasal septum

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5
Q

Transudation

A

Passage of substance through a membrane due to its hydrostatic pressure gradient

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6
Q

What is each nostril lined by?

A

Course hairs
Mucous secreting goblet cells - trap large particles in inhaled air
Cilia - waft mucous to the oropharynx where it can be swallowed

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7
Q

Which plane is the nasal cavity floor in

A

Horizontal

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8
Q

What does the pharynx and larynx do

A

Ensures food and air enter the oesophagus and trachea respectively

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9
Q

Aspiration

A

Inhalation

Of food particles and liquids which can cause aspiration pneumonia

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10
Q

Why can aspiration occur

A

The trachea and oesophagus crossover

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11
Q

4 Paranasal air sinuses

A

Ethmoidal
Frontal
Maxillary
Sphenoidal

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12
Q

Paranasal air sinuses

A

Air-filled spaces in the head which reduces the weight of the skull

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13
Q

What are paranasal air sinuses lined by?

A

Respiratory epithelium - pseudostratified ciliated columnar epithelium

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14
Q

What are conchae/turbinates?

A

3 bony projections on the lateral wall of the nasal cavity

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15
Q

Larynx

A

Links the pharynx to the trachea
Contains the vocal cords - guards tracheal inlet
Prevents aspiration
Cough reflex

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16
Q

Glottis

A

Vocal cords and aperture between the cords

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17
Q

What happens to the larynx during swallowing?

A
  • Laryngeal inlet narrows
  • Epiglottis folds down over the laryngeal inlet
  • Vocal cords adduct - closing the laryngeal inlet
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18
Q

What adducts the vocal cords?

A

Intrinsic laryngeal muscles

Supplied by the recurrent laryngeal nerve

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19
Q

What can damage the left recurrent laryngeal nerve?

A

Aortic aneurysm
Pancoast tumour

  • Presents with a hoarse voice as the left vocal cord is paralysed
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20
Q

Cough reflex

A

Vocal cords close - increased intrathoracic pressure in early stage of cough reflex

Sudden opening of the vocal cords causes air to be expelled at a high velocity

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21
Q

Conducting airways

A

Do not take part in gas exchange

Trachea
Primary bronchi  - main
Secondary bronchi - lobar
Tertiary bronchi - segmental 
Bronchioles
Terminal bronchioles

1- 16 divisions

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22
Q

Why is the trachea horseshoe shaped?

A

Prevents compression of the oesophagus

Allows the oesophagus to bulge during the passage of a bolus

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23
Q

How many secondary bronchioles does the right and left lung have?

A

Right - 3

Left - 2

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24
Q

What do the ribs articulate with?

A

Anteriorly - costal cartilage

Posteriorly - vertebral column

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25
Q

Sternal angle

A

Transverse ridge on palpation
Between the manubrium and sternal body
Indicates 2nd rib

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26
Q

What does the tubercle of the rib articulate with?

A

Transverse process of corresponding vertebrae

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27
Q

Describe the head of the ribs T3-9

A

They have 2 articular facets
Articulate with the corresponding and above vertebrae
e.g third rib articulates with T2 and T3

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28
Q

Bony thorax

A

Sternum
Ribs
Thoracic vertebrae
Costovertebral joints

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29
Q

Describe the structure of a rib

A

Head with 2 facets articulates with the vertebrae
Neck connects head and shaft
Tubercle articulates with the transverse process of vertebrae
Shaft - external surface
The internal surface contains a costal groove
Costal cartilage

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30
Q

Describe the thoracic vertebrae

A 
Superior articular facets (2)
Inferior articular facets (2)
Superior costal facet (2) [demifacet]
Inferior costal facet (2) [demifacet]
Transvere costal facet (2)

Heart shaped vertebral body
Inferiorly slanted spinous processes

31
Q

Mediastinum

A

Midline structure that separates the lungs

The sternal angle T4/ T5 separates the superior and inferior mediastinum

32
Q

What nerve innervates the intercostal muscles

A

Intercostal nerve

33
Q

External intercostal muscle

A

Most superficial
30% of chest expansion during quiet inspiration
Contraction elevates the ribs in a bucket handle type motion
Increases thoracic volume and decreases pressure

34
Q

Internal intercostal muscles

A

Muscle fibres are perpendicular to the external intercostal muscles
Pulls ribs down from chest expansion during FORCED expiration

35
Q

Quiet expiration

A

Passive process

Due to the elastic recoil of the alveoli

36
Q

Innermost intercostal muscles

A

Less well developed

Support inner intercostal muscles

37
Q

The costotransverse ligament

A

Connects the anterior surface of the transverse ligament to the neck of the rib
Lateral costotransverse ligament connects the tip of the transverse process to the tubercle of the rib

38
Q

Movement of chest wall during inspiration

A

RIbs move laterally up and out

Sternum moves forward due to rib elevation

39
Q

Diaphragm

A

70% of chest expansion during quiet inspiration
Dome shape
Bulges into the thorax

Origin: lower margin of thoracic cavity
Insertion: Central tendon
Innervation: C3,4,5
Action: Contract moving the diaphragm down to decrease pressure in the thoracic cavity

Relaxation on exhalation moves the diaphragm up by 2 intercostal spaces

40
Q

Damage to phrenic nerves

A

C3,4,5,
Paralysis of the diaphragm on the affected side
Elevated hemidiaphragm on CXR
- Breathless

41
Q

Openings to the diaphragm

A

Vena cava T8
Oesophagus T10
Aortic hiatus T12

42
Q

Which diaphragmatic dome is higher?

A

Right due to the liver (5th rib)

Left dome - lower at the 5th intercostal muscle

43
Q

How does the movement of the ribs cause movement of air into the lungs?

A

The ribs move up and out, increasing intrathoracic volume.
Decreases intrathoracic pressure creating negative pressure.
Air is drawn in

44
Q

Where are the major neurovascular bundles located in the thorax?

A

Just below the rib at the inferior margin

Therefore when inserting tubes, go superior to the rib

45
Q

Accessory muscles of inspiration

A

SCM
Pectoralis major when arms are fixed
Serratous anterior
Scalene muscles

46
Q

Accessory muscles of expiration:

A

Internal intercostal muscles
Innermost intercostal muscles
Abdominal muscles - Rectus abdominis + EO + IO

47
Q

Sternum

A

Manubrium
Sternal angle
Sternal body
Xiphisternum

48
Q

Neurovasculature of the thorax

A

Intercostal artery, vein and nerve

Supply and drain the:

  • Intercostal muscles
  • Parietal pleura
  • Overlying skin

The intercostal arteries are posterior and the internal thoracic arteries are anterior

49
Q

Specialised draining system of the thorax

A

Azygous veins - unpaired (no associated artery)

Right - azygous veins - required for intercostal muscles at the level of the heart and drain into the IVC

Left - Accessory hemiazygous vein

50
Q

Referred pain to shoulder in pericardium defect

A

The pericardium is supplied by C3, 4 and 5

Therefore pain in the shoulder due to irritation of the pericardium will be referred to the C3,4, 5 dermatome

51
Q

Liver biopsy

A

Needle introduced below the 5th intercostal space

52
Q

Trachea

A

Commences at the lower margin of the cricoid cartilage of the larynx and terminates by dividing into primary bronchi at the sternal angle

53
Q

Carina

A

Angle between the right and left bronchi

54
Q

Bronchopulmonary segment

A

Area of the lung supplied by a segmental (tertiary) bronchiole and the accompanying segmental branch of the pulmonary artery.
Drained by a segmental pulmonary vein.

Segments are pyramid-shaped with the apex facing towards the segmental branches and base towards the lung face

Can be isolated and removed with limited bleeding and air leakage during surgery

55
Q

Why is food more likely to lodge in the right bronchus

A

Shorter
Wider
More vertical

56
Q

Respiratory zone

A

7 divisons 16 - 23
Where gas exchange occurs

Respiratory bronchioles
alveolar sacs
alveolar ducts

57
Q

Alveoli

A

3 million
SA = 70m^2
Surrounded by a network of pulmonary capillaries
Thin membrane

58
Q

Right lung

A

3 lobes: upper, middle and lower

Horizontal - separates lower lobe from middle
Oblique fissure - seperates upper lobe from middle

Bases- rests on the right hemidiaphragm
Rib 6 MCL
Rib 8 MAL
Rib 10 Scapula line

Apex - extends above the 1st rib level

59
Q

Horizontal fissure

A

In the midaxillary line

anterior along 4th rib to edge of lung

60
Q

Oblique fissure

A

From spinous process of T2 posteriorly to 6th intercostal cartilage anteriorly
Follows medial border of the scapula

61
Q

Mediastinal surface of the lungs

A

Contains the hilum:

  • Main bronchi
  • lymphatics
  • pulmonary veins x 2
  • pulmonary artery branches
  • pulmonary plexus
62
Q

What is the right lung adjacent to?

A 
Superior vena cava
Azygous veins
Right atrium 
Oesophagus
Phrenic nerve
Vagus nerve
Sympathetic trunk
63
Q

What is the left lung adjacent to?

A 
Heart
Aortic arch 
Descending aorta 
Left recurrent laryngeal nerve 
Phrenic nerve
Vagus nerve 
Sympathetic trunk
64
Q

Lung pathologies affecting mediastinal surfaces

A

Phrenic nerve - paralysis of the diaphragm - breathlessness

Left recurrent laryngeal nerve - paralysis of the intrinsic laryngeal muscles - hoarse voice

Superior vena cava - Obstruction - peripheral oedema

65
Q

Pleural layers

A

Visceral

Parietal

66
Q

Visceral pleura

A

Lines the outside of lungs
Extends into the fissures

Supplied by the pulmonary plexus - sensitive to distention only

67
Q

Parietal pleura

A

Lines the inside of the hemi thorax
Continous with the visceral pleura at the hilum of the lungs

Supplied by the phrenic and intercostal nerves
- sensitive to pain, pressure and temperature

68
Q

Pleural cavity

A

Potential space between the visceral and parietal pleura which contains a small amount of pleural fluid

69
Q

Pleural fluid

A

Surface tension of pleural fluid creates a seal so when the thorax expands the lungs do too.

70
Q

Costodiaphragmatic angle

A

Space in which only the parietal pleura extends around the outer edge of the diaphragm

Allows room for expansion

Rib 8 MCL
Rib 10 MAL
Rib 12 Scapular line

71
Q

Blood supply to the lungs

A

Dual blood supply:

Pulmonary arteries - Supplies alveoli with deoxygenated blood for gas exchange

Bronchial arteries - supplies parenchyma of lung and visceral pleura with oxygenated blood

Most blood drains via the pulmonary veins
Some blood drains to the azygous vein to SVC

72
Q

Lymphatic drainage

A 
Hilar node (bronchopulmonary)
Efferent lymph nodes - tracheobronchial nodes - enlarged tracheobronchial nodes can widen the carina angle
73
Q

Nerve supply of the lungs

A

Right and left vagus nerve
PS efferents - motor to smooth muscle (bronchoconstriction) and secretomotor to mucous glands

afferent - cough reflex and pain

Sympathetic trunk - efferent - bronchodilation
- afferent - vasoconstriction

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