Resp Flashcards
What does the thoracic wall enclose?
Right and left pleural cavities (containing the lungs
What is located between the lungs?
Mediastinum (including the heart)
What kind of cavity is the pleural cavity?
Closed sac
What is the function of the thoracic wall
To protect the content of its sacs and permit the movement associated with respiration
What does the thoracic wall comprise of anteriorly?
Sternum
What does the thoracic wall comprise of posteriorly?
Vertebrae T1-T12
What does the thoracic wall comprise of laterally?
ribs 1 - 12
What bones articulate with the manubrium ai its superolateral angles?
First ribs
What is the name given to the joint between the superolateral angle of the manubrium and the first ribs?
Sternocostal joint
What type of joint is the sternocostal joint?
Cartilaginous (synchondroses)
What is the name given to the notch formed by the superior border of the manubrium?
Jugular notch
At what vertebral level is the xiphoid process located?
T10
At what vertebral level is the sternomanubrial joint located?
T4
What component part of the sternum do the facets for the 2nd costal cartilage articulate?
Manubrium
What are the typical ribs?
Ribs 3-9
The head of rib 5 articulates with the bodies of which vertebrae?
T4 & T5
Where does the tubercle of a rib articulate?
Transverse costal facet (transverse process) of vertebrae.
What structures lie in the costal grove of a rib?
Intercostal vein, intercostal artery, intercostal nerve
What ribs are true ribs?
Ribs 1 -7
What ribs are false ribs?
Ribs 8 - 10
What ribs are floating ribs?
Ribs 11 - 12
Why is the 1st rib an atypical rib?
It is short, wide and flat from top to bottom, and it articulates with only a single vertebrae (T1) and it onyl has one articular facet.
What does the 1st rib form?
It forms one of the superior boundaries of the bony thorax.
Where does the groove for the subclavian artery lie on the scalene tubercle?
Posterior
Where does the groove for the subclavian vein lie on the scalene tubercle?
Anterior
What attaches to the scalene tubercle?
The anterior scalene muscle of the neck (an accessory muscle in forced inspiration.)
What shape is the thoracic vertebrae?
Heart shaped
What part of the rib articulates with the demi-facets?
Head of the rib (one at the same level and one above)
What part of the rib articulates with the costal facet?
Tubercle of the rib (one on the same level)
A single typical rib articulates with how many vertebral bodies?
2 (same level and one above)
How many vertebral transverse process does a single rib articulate?
1 (same number as rib)
What happens when an extra cervical rib develops?
This can result in compression of the lower trunk of the brachial plexus, parasthaesia of
the medial side of the upper limb, and wasting of the small muscles of the hand.
Where does this extra cervical vertebrae develop?
Transverse process of C7
Which ribs are most commonly fractured and why?
Ribs 5 - 10 because they are more exposed and fixed.
What can a fractured rib cause?
They perforate the pleura resulting in a pneumothorax.
What is a pneumothorax accompanied by?
Severe localised pain mediated through the intercostal nerves located above and below and concomitant dyspnoea (difficulty in breathing)
What forms the superior thoracic aperture posteriorly?
Body of T1
What forms the superior thoracic aperture laterally?
Medial margin of the 1st rib
What forms the superior thoracic aperture anteriorly?
Manubrium
What forms the inferior thoracic aperture anteriorly?
Costal margins
What forms the inferior thoracic aperture laterally?
Distal tip of rib 11 and rib 12
What forms the inferior thoracic aperture posteriorly?
Body of T12
What closes of the inferior thoracic aperture?
Diaphragm
What is the thoracic inlet?
Superior thoracic aperture
What is the thoracic outlet?
Inferior thoracic aperture
Which costal cartilages form the costal margin?
7 - 10
Which costal cartilages form the subcostal angle?
7 - 10
Which costal cartilages are directly attached to the sternum?
1 - 7
Which costal cartilages are indirectly attached to the sternum through attachment to preceeding costal cartilages?
8 - 10
What makes up the thoracic cavity posteriorly?
T1 - 12
What bones make up the lateral side of the thorax?
12 ribs
What makes up the anterior aspect of the thorax?
Costal cartilages and sternum
What is thoracic outlet syndrome?
The brachial plexus (C5-T1), the subclavian artery and vein become compressed by structures such as tumours of the lung between the first rib and clavicle, as they enter the upper limb, with resultant limb clinical signs.
What muscle is primarily used for breathing in a new born?
Diaphragm
How are the rib angles positioned with respect to the spinous processes?
They are level
What is contained in the paired intercostal spaces?
- 3 layers of intercostal muscles, intercostal nerves and a posterior and anterior artery and vein.
What is the origin and insertion of the intercostal muscles?
Origin: inferior border of the rib above
Insertion: superior border of the rib below
What is the direction of the fibres of the external intercostal muscles?
Antero-medial
What is the direction of the fibres of the internal intercostal muscles?
Posteo-lateral
What does the number of each intercostal space accord with?
The number of the rib lying superior to it.
What number of rib accords with the number of intercostal nerve, artery and vein?
The rib above.
Where is the innermost intercostal muscle located?
Posteriorly behind the two ribs
In between which muscles do the intercostal vein, artery and nerves run?
They run between the internal intercostal muscle and the innermost intercostal muscle.
What is the most superficial intercostal muscle called?
External intercostal muscle
What is the intermediate intercostal muscle called?
Internal intercostal muscle
What is the deepest intercostal muscle called?
Innermost intercostal muscle
In which part of the rib is the neurovascular bundle lodged?
Costal groove
What can happen if the chest drain is inserted to close to the inferior border of the rib?
The intercostal nerve can be damaged
What is another function of the intercostal muscles other than contributing to the respiratory movements of the chest?
Preventing the lungs and the pleura from ballooning out between the ribs during the movement of the chest wall.
How do the external and internal intercostal muscles not occupy the entire length of the intercostal space?
They become aponeurotic at one end, called the intercostal membrane.
How much of the intercostal space does the innermost intercostal muscles fill?
Half, the other half is completed anteriorly by the transversus thoracis muscles and posteriorly by the subcostalis muscles
What does each structure forming the neurovascular bundle give of above each rib?
Small collateral branch
What is the normal location of a chest drain?
5th intercostal space in mid axillary line
Where in relation to the upper and lower borders of a rub do you think a chest drain needle should be inserted into the pleural cavity to avoid damaging the intercostal nerves?
Above the superior border
What are the tissues of the chest wall that a chest drain needle will need to pass from superficial to deep?
Skin
Superficial fascia
Deep fascia
External intercostal muscle
Internal intercostal muscle
Innermost intercostal muscle
Parietal pleura of the lung
Pleural cavity
(after this is visceral pleura then the lung which the needle should not reach)
What do dermatomes correspond with on the chest wall?
Intercostal spaces
What is a dermatome?
Area of skin supplied by a single spinal nerve
At the sternal angle, dermatome C4 lies immediately above T2 instead of C5, why is this?
C5 - T1 supplies the arms
What dermatome is overlying the sternal angle?
T2
What dermatome is overlying the nipple area?
T4
What dermatome is overlying the umbilicus?
T10
What dermatome is overlying the inguinal region?
L1
What is lymph?
Plasma that has leaked from the capillary beds due to high hydrostatic pressures.
What is the function of the lymphatic system?
Return lymph to the circulatory system, also plays a role in immunity and cancer spreas.
What organs dont have lymphatic drainage?
Cartilage, eyes, inner ear, brain and spinal cord
What are the main groups of lymph nodes?
Axillary Superficial and deep inguinal Pectoral Tracheobronchial Bronchomediastinal Lumbar/pelvic Superficial cervical and deep cervical
Where are the axillary lymph nodes?
Root of the upper limb
Where are the superficial and deep inguinal lymph nodes?
Root of the lower limb
Where are the pectoral lymph nodes?
Around the pectoralis major muscle
Where are the tracheobronchial lymph nodes?
Bifurcation of the trachea in the thorax
Where are bronchomediastinal lymph nodes?
The hilum of the lungs
Where are the lumbar/pelvic lymph nodes?
Around the root of the arteries in the abdomen and pelvis
Where are the superficial and deep cervical lymph nodes found?
Head and neck
How does lymphatic fluid get from the lymph nodes back to the venous circulation?
Efferent lymphatic vessels arise which lead to the thoracic duct or right lymphatic duct
Where do lymph nodes tend to be clustered?
Around large veins
Where do the axillary lymph nodes lie?
In relation to the axillary vein and its branches in the axilla.
What are examples of axillary node?
Anterior, posterior, apical, central and lateral groups.
What connects axillary nodes together?
Lymph channels
What is the composition of the breast?
Glandular surrounded by extensive adipose tissue.
Where does most of the breast lymph drain to?
anterior (pectoral) group of axillary lymph nodes
Where is the base (glandular part) of the breast located?
Between ribs 2 to 6 and between the lateral border of the sternum and the midaxillary line
What is the glandular part of the breast divided into?
16-20 lobes and smaller lobules
Where does the axillary tail of the breast penetrate?
Into the floor of the axilla
What are the 4 attachments of the diaphragm?
Lumbar vertebrae
Arcuate ligaments
Costal cartilages
Sternum
What are the 3 main openings of the diaphragm?
Caval hiatus
Oesephageal hiatus
Aortic Hiatus
What level is the vena cava opening at?
T8
What level is the oesophagus opening at?
T10
What level is the aortic hiatus at?
T12
What structures do the vena caval opening have?
Inferior vena cava and terminal branches of the phrenic nerve
What structures do the oesophageal opening have?
Oesophagus, right and left vagus nerves, Oesophageal branches of left gastric artery/vein.
What structures do the aortic hiatus have?
Aorta, thoracic duct and azygous vein
What do the hiatuses of the diaphragm permit?
They permit structures to pass through the abdomen and the thorax.
What are the main functions of the diaphragm?
Respiration and raising intra-abdominal pressure during coughing, vomiting and defecation.
Which dome of the diaphragm is more superior?
Right
Why is the right dome of the diaphragm more superior than the left?
Left needs to make more room for heart
What cardiac structure is firmly attached to the central tendon?
Fibrous pericardium
At which vetebrae are the left and right crura attached?
Left - L1 - L2
Right - L1 - L3
What is the crura of the diaphragm?
Tendinous structures that extend below the diaphragm to the vertebral column, forming a muscular tether for contraction.
Which membrane covers the superior surface of the diaphragm?
Parietal
When the diaphragm contracts, do the domes ascend or descend?
Descend
What is the shape of the central tendon?
Clover
What tendon is the diaphragm attached to?
Central tendon
What costal cartilages is the diaphragm attached to?
7 - 10
What part of the sternum is the diaphragm attached to?
Xiphoid process
What vertebrae is the diaphragm attached to?
L1 - L3
How do major and smaller structures pass through the diaphragm?
Major structures pass through the major hiatuses
Smaller structures can pass along with the major structures or pass through a minor hiatus by themselves
Through which part of the diaphragm does the inferior vena cava pass?
Tendinous
Why does the inferior vena cava pass through the tendinous and not muscular part of the diaphragm?
So it doesn’t contract and stop the blood flow
Why do the structures that pass through the diaphragm more anteriorly also pass through it at a higher vertebral level?
because of the dome shape of the diaphragm
What is hiatus hernia?
• Abnormal protrusion (herniation) of a structure into the thorax through a tear or weakness in the diaphragm caused by frequent hard coughing, heavy lifting or a number of other things
What type of supply does the diaphragm get?
• Motor and sensory supply on its left, right, superior and inferior parts
What type of supply does the phrenic nerve supply to the diaphragm?
Motor and sensory nerves
What type of supply does the lower intercostal nerve provide to the diaphragm?
• Sensory to the peripheral parts of the diaphragm (T7 - T12)
What are the spinal root values of the phrenic nerve?
• C3-5
What happens when there is damage to the spinal cord just above the phrenic nerve spinal roots?
• Paralysis of the diaphragm and the need for artificial ventilation.
Damage to the phrenic nerve can lead to which dome being damaged?
• Ipsilateral dome
How is respiratory function maintained when one lobe is paralysed?
• this is done by the intercostal muscles and nerves
When should penetrating wounds be suspected to cause damage to the diaphragm?
• Below the nipples (intercostal space 4) due to the upwards arching of the domes in quiet expiration to the rib 5 if not higher
What does the upper respiratory tract consist of?
• Nasal cavity, pharynx and larynx
Where is the URT located?
• head and neck
What is the larynx composed of?
• Set of carilages, membranes and ligaments
What does the larynx do?
- Produces sound from expired air
* Protect the inlet to the respiratory system
What is found superiorly to the larynx?
• hyoid bone
What is found inferiory to the larynx?
• Trachea
What is the larynx related to anteriorly?
Pharynx
What cartilage forms the laryngeal prominence?
• Thyroid cartilage
What structure prevents solids and liquids from entering the laryngeal inlet?
• Epiglottis
What cartilages are attached to the vocal cords?
• Arytenoid
What kinds of cartilage is all of the cartilage of the larynx?
• hyaline, except epiglotttis which is elastic
What kind of cartilage is the epiglottis?
• Elastic cartilage