Lecture - Resp (Yusuf Mechanics)

Question 1

Development of the pleura:

1. In fetal evelopment, the lungs grow and push into sac-like structures which is the _______ _______ and what’re the two types of pleura?
2. Okay so the visceral pleura lies on the organ and the parietal lies on the body wall. Do you feel pain in both the visceral and parietal membrane? What do you feel at each?
   - Explain in terms of the nerve supply

Answer 1

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Question 2

Alright, so we’ve established that the parietal pleura lies on the body wall - what are the four attachments of it, though?

-tell me the names of the things it’s attached to and the name of the lines of the paretal pleura that attach there

Answer 2

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Question 3

The pleural cavity

1. SO the visceral and parietal pleura are continuous with one another at what part of the lung?
2. What is the potential space between the visceral and the parietal pleura called?
3. How are the surfaces of the pleura moistened?
4. What is the function of this secreted fluid?

Answer 3

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Question 4

Surface markings of the pleura:

1. On the anterior side, what are the lowest borders of the visceral and parietal pleura and on what line?
2. On the lateral side, what are lowest borders and on what line?
   - what does the technique of percussion have to do with this?
3. What about the borders on the posterior side and which line are we talking?

Answer 4

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Question 5

Plaural recesses

1. What are the names of the two recesses?
2. These two are the partof the pleural cavity in the angle of reflection of what two pleura and borders respectively?
3. What happens with these recesses during forced inspiration?
4. If you have an x-ray and you can’t see the costodiaphragmatic recess, is it of much use?
   - if you see white stuff in this recess (aka fluid/pus) in the recess on the xray - what does this mean?
5. If you want to remove fluid from the costodiaphragmatic recess, what should you make sure to do?

Answer 5

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Question 6

Innervation of the pleura

1. Is the visceral pleura sensitive to pain? What can it sense?
2. Parietal pleural is extremely sensitive to pain - why?
   - what nerves are we talking about that innervate the different surfaces?

Answer 6

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Question 7

What three things is the thoracic skeleton made up of?

Answer 7

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Question 8

Thoracic bones:

1. What are the three parts of the sternum?
2. There are three types of ribs - what are they, why are they and how many are they?
   - what’re their colloquial names?
3. What is the joint between the manubrium and the body of the sternum called and why is it significant? Slide 26
4. Why does a typical rib look like a women doing yoga?

Answer 8

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Question 9

A typical rib joints

1. Posteriorly, the rib is joined to the vertebra:
   - what does the head of the rib attach to? What are these joints called and what type of joints are they?
   - what does the tubercle of the rib articulate with and what are these joints called and what type of joints are they?
2. Anteriorly, the rib is joined to the sternum
   - what’re these joints made up of? What are they called and what type of joints are they?
   - so what ribs actually make up the sternocostal joints?
3. Why are there demifacets on the body of a vertebra?

Answer 9

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Question 10

Diameters of the thoracic cavity:

1. What are the three diametes of the thoracic cavity?
   - Imagine what they look like
2. What two things does the elevation of the ribs by inspiration muscles cause? (it looks like your arms when they elevate for the chicken dance)…….we’re talking in terms of the diameters
3. What does the contraction of the diaphragm cause an increase in what diameter?

Answer 10

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Question 11

“Pump-handle” movements of the ribs

1. In the pumo-handle movements, what two things act as a single structure?
2. Alright so how do the sternum and the ribs move? What diameter mostly changes?
3. In this movement, “rotation” takes place about an axis passing through the what?
4. Is there any movement in the sternocostal joint?
5. Why do the upper ribs undergo more of a “pump-handle” movement than the lower ribs?

Answer 11

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Question 12

“Bucket-handle” movement

1. In this movement, rotation occurs about an acis through the what?
2. Is there rotation in the costotransverse joints?
   - what kind of movement occurs here then?
   - why does this movement occur?
   - where mostly does the bucket handle movement occur (oppsite to the pump handle)
3. So how do the LOWER RIBS spread? What diameter increases?
4. What muscle is this movement mainly produced by?
5. So is there movement at the sternocostal joint?

Answer 12

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Question 13

Fill in this table

Answer 13

Question 14

Thoracic apetures (‘openings’)

1. What are the two apetures of the thorax called?
2. What is the superior thoracic apeture bound by anteriorly, laterally and posteriorly?
3. What is the inferior thoracic apeture bound by anteriorly, laterally and posteriorly?

Answer 14

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Question 15

Contents of the thoracic apetures

1. The superior thoracic provides a way for strucutres to run between what two things?
   - What things pass through this apeture?
2. The inferior thoacic apeture provides a way for strcutures to run between what two things?
   - What things pass throguh this apeture?
   - It is closed by a musculotendinous sheet called…..? SO how do these things get through the apeture?

Answer 15

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Question 16

What is the difference between the anatomical “thoacic inlet” and “thoracic outlet” and the clincian’s definition of those terms?

Answer 16

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Question 17

What is thoracic outlet syndrome?

Answer 17

Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed.

Question 18

Why are the scalane muscles important?

-where are they?

Question 19

The diaphragm:

1. Each half of the muscular part of the diaphragm is divided into 3 parts which are inserted into the central tendon. What are these three parts called?
2. For each of the parts, where do they arise from?
3. So the lumbar part of the diaphragm forms two muscular _______ that asend to the central tendon. Where do they both arise from?

Answer 19

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Question 20

Why are the psoas major and quadratus lumborum important?

Answer 20

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Question 21

For each of these, tell me what vertebra level they pirece the diaphragm

1. Inferior vena cava
2. Esophagus
3. Aorta

Answer 21

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Question 22

What diameter does the contraction of the diaphragm increase?

Answer 22

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Question 23

What is the trendelenburg’s position and why is it liked by surgeons doing abdominal surgeries?

Answer 23

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Question 24

Respiration basics

1. Okay, so muscles of respiration cause an increase in the diameters of the thoracic cavity (because it’s expanded)
   - cause an increase in the _____ of the thoracic cavity
   - what about intrathoracic pressure?
   - what happens to the air and the lungs?
2. Muscles of expiration cause a decease in the diameters of the thoracic cavity (since it’s contracted)
   - causes a decrease in the _____ of the thoracic cavity
   - what about intrathoracic prressure?
   - what happens to the air and the lungs?

Answer 24

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Question 25

Muscles of respiration

1. What are the two groups of muscles that are involved?
2. In what situations do these two groups work?
3. Can you pls give examples of the primary and secondary muscles

Answer 25

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Question 26

The intercostal muscles

The muscles which fill an intercostal space are arranged in 3 planes

• what are the three layers?
• what muscles are in each layer?
• in an intercostal space, the muscle fibres are attached to what?

Answer 26

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Question 27

Okay so with the intercostal muscle layers - what two muscle form membranes and whereabouts do they form the membranes?

Answer 27

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Question 28

Why does the deep layer in the intercostal muscles have three muscles as opposed to one?

Answer 28

Slide 54

Question 29

Actions of the intercostal muscles

1. The muscles can be distinguished by what?
2. What are the directions of the fibres of:
   - external intercostal m.
   - internal intercostal m.
   - innermost intercostal m.
3. SO knowing the directions of the fibres, what action do they perform and during when? (Inspiration/expiration)

Answer 29

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Question 30

What’re the analogies on slide 59 that he gave for the directions of the fibres of the external and internal (+innermost) intercostal muscles and their actions?

So just remember that the external intercostal m. is a rib elevator and the others are all rib depressors

Question 31

Clinical vignette:

How are you meant to position to needle in the intercostal space to get to the pleural cavity and why?

Answer 31

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Question 32

On slide 62, there are the secondary muscles listed - maybe just have a good look at them and let one or two get stuck in your head

Remember the psoas and quadratus lumborum annnnd scalane

Answer 32

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Question 33

Secondary muscles of respiration do forced inspiration, remember that!

1. What sort of pateitns need to do forced inspiration?
2. SO what muscle in the neck do they use to lift the upper ribs as high as they can to increase lung capacity?
3. They also use their rhomboid and pec m_____ muscles to shift what?
4. Of course, they use their psoas major and quadratus lumborum muscles to do what?
5. Abdomical muscles like ____ _____ is used to what during when?

Answer 33

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Question 34

Actually memorise this: