Lecture 8 - Respiratory Flashcards
Which vertebrae does the trachea span? How many cartilages are there
C6-T5
16-20
The trachea has cartilages posteriorly, true or false?
False
What is the posterior surface of the trachea flattened by
Oesophagus
What are the anterior relations of the trachea? (5)
Fascia, muscles of neck, manubrium, braciocephalic and common carotid arteries
What is lateral to the trachea?
Lungs
What do the trachea branch into and in turn?
Principle bronchi, then lobar bronchi
The right bronchi is longer and thinner than the left, true or false?
False
The right bronchi gives rise to 3 lobar bronchi true or false?
True
The right superior lobar bronchus arises within the substance of the lung, true or false?
False
Where does the right superior lobar bronchus enter the substance of the lung?
Hilum of the lung posterior to the pulmonary artery at T5
Where does the remaining right principle bronchus enter?
Posteroinferior to the artery and just below superior lobar bronchus
Where does the left principal bronchus enter the hilum
At T6
The left principal bronchus enters the hilum branched, true or false?
True
Where does the left principal bronchus enter the hilum?
Below the artery
What do the lobar bronchi divide into?
Segmental bronchi
At what point does the cartilage disappear in the branching?
When the diameter is smaller than 1mm and these are called bronchioles
What do bronchioles open into?
Alveolar ducts which then open into alveoli
What does the lining of alveoli consist of?
Type 1 cells which participate in the blood-air barrier along with numerous capillaries
Type 2 cells which produce surfactant
Wandering macrophages
How do you identify the surface anatomy of the trachea?
Identify C6 below prominent spine of C7 and T5 is just below sternal angle
How many pleural cavities are there?
2, one for each lung
How would you describe how the lungs invaginate the closed cavities?
Like a fist in a balloon
Name the two pleura
Visceral and parietal
What does the visceral pleura cover?
The outer surface of the lungs including the fissure
What is the loose sleeve called that is formed by the parietal pleura adjacent to the medial surface of each lung?
Pulmonary ligament
What does the pleural space contain?
A film of serous fluid which allows the pleura to slide over each other
What is the root of lung
Structures that enter and leave the lung
What is the purpose of the root of the lung?
Only attachment of the lungs so they can stretch and recoil freely
What are pleural recesses?
Regions where parietal pleura are in contact
Where is the costodiaphragmatic recess?
The angle between thoracic cage and diaphragm
Where is the costomediastinal recess?
Medially between ribcage and mediastinum
The visceral pleura is sensitive to pain, true or false
False
Why is the parietal pleura pain sensitive? (which nerves supply it)
Branches of the intercostal and phrenic nerves
What is the anterior border of each lung shaped by?
The costodiaphragmatic recess
What is the posterior border of the lung shaped by?
The vertebral column and is rounded
Why do the two lungs differ in shape and size?
The heart protrudes more into the left pleural cavity
What impressions are on the medial surface of the right lung
Azygos, right subclavian artery, SVC, heart (right atrium)
Which fissure does the left lung usually have
oblique
What does the lower anterior border of the left lung also have
cardiac notch above a tongue of superior lobe tissue, the lingula
What impressions are on the medial surface of the left lung
aorta, left subclavian, left common carotid, heart (left and right ventricles)
How can the lobes be further divided?
Into the branches of the lobar bronchi
What comprises the root of lung
pulmonary arteries and veins, bronchial arteries and veins, lymph vessels, bronchi and nerves
What happens to the pleura at the hilum?
The parietal pleura is reflected to cover the lung as visceral pleura
What do large hilar lymph nodes contain?
Dark particles in old people or those exposed to contaminated air
What is the surface anatomy of the apex of each lung
Supraclavicular region - level of the clavicle and lateral to sternocleidomastoid
What vessels are involved with the trachea
Inferior thyroid vessels
Which lymph nodes are associated with the trachea and where do they drain?
Pretracheal, paratracheal which drain into the deep cervical nodes
What provides the oxygenated supply of blood to the lungs and where do they originate?
Small bronchial arteries from the descending aorta
What vessels drain the lungs and into what major vein?
Bronchial veins into either pulmonary veins or azygos system
What is the lymph drainage of the lung
2 networks of vessels, subpleural and deep
What does the deep lymph drainage follow?
Blood vessels and bronchi
Where are the lymph nodes of the bronchi concentrated?
Bifucations
What is the path of lymph drainage
Along the bronchi to hilus, receiving subpleural and ultimately to the bronchomediastinal trunks
What forms the pulmonary plexus
Vagus and sympathetic trunk
What are the major muscles of inspiration
Diaphragm and external intercostals
What are the major muscles of expiration
Internal, innermost intercostals and muscles of the abdominal wall
What direction are the ribs pulled in during quiet inspiration and why?
Upwards and outwards due to contraction of the external intercostal muscles and contraction/downward movement of the diaphragm.
Why does air flow into lungs
Pressure reduction due to enlargement of pleural cavity
What other muscles are recruited during deep inspiration
neck muscles (sternocleidomastoid and scalene), muscles of upper limb (pectoralis major & minor, serratus anteiror) and quadratus lumborum
What motion do the external intercostals and diaphragm perform during quiet expiration
Relax and move upwards
What else enhances the upward movement of the diaphragm
Pressure from abdominal viscera which are forced upwards by abdominal muscles
What extra muscles are recruited during forced expiration
internal and immernost intercostal muscles, abdominal muscles (anterolateral abdominal wall -external oblique, internal oblique and transversus abdominus).
How are the anterolateral abdominal wall muscles attached to the ribcage
Superiorly to the lower part of the ribcage and inferiorly to the pelvic bone
What is the external nose comprised of?
Bony and cartilaginous framework covered with skin and muscle
How many conchae are on the internal lateral wall of each nostril?
3 with the superior one being the smallest
What are the posterior openings of the nose into the nasopharynx called?
Choanae
What do the paranasal sinuses drain into?
Nasal cavity
Where does air pass through in the upper respiratory system
Nasopharynx into oropharynx and laryngopharynx
Where do the nasolacrimal ducts drain tears from and to?
From the medial corner of the eye to an opening under the inferior concha
Where do the auditory tubes open into?
The lateral walls of the nasopharynx and they connect to the air filled middle ear and mastoid process
What is the lowest part of the pharynx and where does it become the oesophagus?
laryngopharynx and at C6
What determines where air flow in the larynx goes?
Epiglottis and vocal folds
When does the epiglottis close?
During swallowing
What nerves control the movement of the laryngeal muscles?
Recurrent laryngeal branches of the vagus
What are the three tonsils of the upper respiratory passage and what are they associated with
pharyngeal tonsil - posterior wall of the nasopharynx
lingual tonsil - posterior tongue
palatine tonsils - paired in oral cavity
What lymphatic tissue do the upper respiratory tonsils form
gut associated lymphatic tissue
What nerve is associated with the trachea?
Vagus
