Resp Flashcards
1
Q
What does the thoracic wall enclose?
A
Right and left pleural cavities (containing the lungs
2
Q
What is located between the lungs?
A
Mediastinum (including the heart)
3
Q
What kind of cavity is the pleural cavity?
A
Closed sac
4
Q
What is the function of the thoracic wall
A
To protect the content of its sacs and permit the movement associated with respiration
5
Q
What does the thoracic wall comprise of anteriorly?
A
Sternum
6
Q
What does the thoracic wall comprise of posteriorly?
A
Vertebrae T1-T12
7
Q
What does the thoracic wall comprise of laterally?
A
ribs 1 - 12
8
Q
What bones articulate with the manubrium ai its superolateral angles?
A
First ribs
9
Q
What is the name given to the joint between the superolateral angle of the manubrium and the first ribs?
A
Sternocostal joint
10
Q
What type of joint is the sternocostal joint?
A
Cartilaginous (synchondroses)
11
Q
What is the name given to the notch formed by the superior border of the manubrium?
A
Jugular notch
12
Q
At what vertebral level is the xiphoid process located?
A
T10
13
Q
At what vertebral level is the sternomanubrial joint located?
A
T4
14
Q
What component part of the sternum do the facets for the 2nd costal cartilage articulate?
A
Manubrium
15
Q
What are the typical ribs?
A
Ribs 3-9
16
Q
The head of rib 5 articulates with the bodies of which vertebrae?
A
T4 & T5
17
Q
Where does the tubercle of a rib articulate?
A
Transverse costal facet (transverse process) of vertebrae.
18
Q
What structures lie in the costal grove of a rib?
A
Intercostal vein, intercostal artery, intercostal nerve
19
Q
What ribs are true ribs?
A
Ribs 1 -7
20
Q
What ribs are false ribs?
A
Ribs 8 - 10
21
Q
What ribs are floating ribs?
A
Ribs 11 - 12
22
Q
Why is the 1st rib an atypical rib?
A
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.
23
Q
What does the 1st rib form?
A
It forms one of the superior boundaries of the bony thorax.
24
Q
Where does the groove for the subclavian artery lie on the scalene tubercle?
A
Posterior
25
Where does the groove for the subclavian vein lie on the scalene tubercle?
Anterior
26
What attaches to the scalene tubercle?
The anterior scalene muscle of the neck (an accessory muscle in forced inspiration.)
27
What shape is the thoracic vertebrae?
Heart shaped
28
What part of the rib articulates with the demi-facets?
Head of the rib (one at the same level and one above)
29
What part of the rib articulates with the costal facet?
Tubercle of the rib (one on the same level)
30
A single typical rib articulates with how many vertebral bodies?
2 (same level and one above)
31
How many vertebral transverse process does a single rib articulate?
1 (same number as rib)
32
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.
33
Where does this extra cervical vertebrae develop?
Transverse process of C7
34
Which ribs are most commonly fractured and why?
Ribs 5 - 10 because they are more exposed and fixed.
35
What can a fractured rib cause?
They perforate the pleura resulting in a pneumothorax.
36
What is a pneumothorax accompanied by?
Severe localised pain mediated through the intercostal nerves located above and below and concomitant dyspnoea (difficulty in breathing)
37
What forms the superior thoracic aperture posteriorly?
Body of T1
38
What forms the superior thoracic aperture laterally?
Medial margin of the 1st rib
39
What forms the superior thoracic aperture anteriorly?
Manubrium
40
What forms the inferior thoracic aperture anteriorly?
Costal margins
41
What forms the inferior thoracic aperture laterally?
Distal tip of rib 11 and rib 12
42
What forms the inferior thoracic aperture posteriorly?
Body of T12
43
What closes of the inferior thoracic aperture?
Diaphragm
44
What is the thoracic inlet?
Superior thoracic aperture
45
What is the thoracic outlet?
Inferior thoracic aperture
46
Which costal cartilages form the costal margin?
7 - 10
47
Which costal cartilages form the subcostal angle?
7 - 10
48
Which costal cartilages are directly attached to the sternum?
1 - 7
49
Which costal cartilages are indirectly attached to the sternum through attachment to preceeding costal cartilages?
8 - 10
50
What makes up the thoracic cavity posteriorly?
T1 - 12
51
What bones make up the lateral side of the thorax?
12 ribs
52
What makes up the anterior aspect of the thorax?
Costal cartilages and sternum
53
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.
54
What muscle is primarily used for breathing in a new born?
Diaphragm
55
How are the rib angles positioned with respect to the spinous processes?
They are level
56
What is contained in the paired intercostal spaces?
- 3 layers of intercostal muscles, intercostal nerves and a posterior and anterior artery and vein.
57
What is the origin and insertion of the intercostal muscles?
Origin: inferior border of the rib above
Insertion: superior border of the rib below
58
What is the direction of the fibres of the external intercostal muscles?
Antero-medial
59
What is the direction of the fibres of the internal intercostal muscles?
Posteo-lateral
60
What does the number of each intercostal space accord with?
The number of the rib lying superior to it.
61
What number of rib accords with the number of intercostal nerve, artery and vein?
The rib above.
62
Where is the innermost intercostal muscle located?
Posteriorly behind the two ribs
63
In between which muscles do the intercostal vein, artery and nerves run?
They run between the internal intercostal muscle and the innermost intercostal muscle.
64
What is the most superficial intercostal muscle called?
External intercostal muscle
65
What is the intermediate intercostal muscle called?
Internal intercostal muscle
66
What is the deepest intercostal muscle called?
Innermost intercostal muscle
67
In which part of the rib is the neurovascular bundle lodged?
Costal groove
68
What can happen if the chest drain is inserted to close to the inferior border of the rib?
The intercostal nerve can be damaged
69
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.
70
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.
71
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
72
What does each structure forming the neurovascular bundle give of above each rib?
Small collateral branch
73
What is the normal location of a chest drain?
5th intercostal space in mid axillary line
74
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
75
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)
76
What do dermatomes correspond with on the chest wall?
Intercostal spaces
77
What is a dermatome?
Area of skin supplied by a single spinal nerve
78
At the sternal angle, dermatome C4 lies immediately above T2 instead of C5, why is this?
C5 - T1 supplies the arms
79
What dermatome is overlying the sternal angle?
T2
80
What dermatome is overlying the nipple area?
T4
81
What dermatome is overlying the umbilicus?
T10
82
What dermatome is overlying the inguinal region?
L1
83
What is lymph?
Plasma that has leaked from the capillary beds due to high hydrostatic pressures.
84
What is the function of the lymphatic system?
Return lymph to the circulatory system, also plays a role in immunity and cancer spreas.
85
What organs dont have lymphatic drainage?
Cartilage, eyes, inner ear, brain and spinal cord
86
What are the main groups of lymph nodes?
```
Axillary
Superficial and deep inguinal
Pectoral
Tracheobronchial
Bronchomediastinal
Lumbar/pelvic
Superficial cervical and deep cervical
```
87
Where are the axillary lymph nodes?
Root of the upper limb
88
Where are the superficial and deep inguinal lymph nodes?
Root of the lower limb
89
Where are the pectoral lymph nodes?
Around the pectoralis major muscle
90
Where are the tracheobronchial lymph nodes?
Bifurcation of the trachea in the thorax
91
Where are bronchomediastinal lymph nodes?
The hilum of the lungs
92
Where are the lumbar/pelvic lymph nodes?
Around the root of the arteries in the abdomen and pelvis
93
Where are the superficial and deep cervical lymph nodes found?
Head and neck
94
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
95
Where do lymph nodes tend to be clustered?
Around large veins
96
Where do the axillary lymph nodes lie?
In relation to the axillary vein and its branches in the axilla.
97
What are examples of axillary node?
Anterior, posterior, apical, central and lateral groups.
98
What connects axillary nodes together?
Lymph channels
99
What is the composition of the breast?
Glandular surrounded by extensive adipose tissue.
100
Where does most of the breast lymph drain to?
anterior (pectoral) group of axillary lymph nodes
101
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
102
What is the glandular part of the breast divided into?
16-20 lobes and smaller lobules
103
Where does the axillary tail of the breast penetrate?
Into the floor of the axilla
104
What are the 4 attachments of the diaphragm?
Lumbar vertebrae
Arcuate ligaments
Costal cartilages
Sternum
105
What are the 3 main openings of the diaphragm?
Caval hiatus
Oesephageal hiatus
Aortic Hiatus
106
What level is the vena cava opening at?
T8
107
What level is the oesophagus opening at?
T10
108
What level is the aortic hiatus at?
T12
109
What structures do the vena caval opening have?
Inferior vena cava and terminal branches of the phrenic nerve
110
What structures do the oesophageal opening have?
Oesophagus, right and left vagus nerves, Oesophageal branches of left gastric artery/vein.
111
What structures do the aortic hiatus have?
Aorta, thoracic duct and azygous vein
112
What do the hiatuses of the diaphragm permit?
They permit structures to pass through the abdomen and the thorax.
113
What are the main functions of the diaphragm?
Respiration and raising intra-abdominal pressure during coughing, vomiting and defecation.
114
Which dome of the diaphragm is more superior?
Right
115
Why is the right dome of the diaphragm more superior than the left?
Left needs to make more room for heart
116
What cardiac structure is firmly attached to the central tendon?
Fibrous pericardium
117
At which vetebrae are the left and right crura attached?
Left - L1 - L2
| Right - L1 - L3
118
What is the crura of the diaphragm?
Tendinous structures that extend below the diaphragm to the vertebral column, forming a muscular tether for contraction.
119
Which membrane covers the superior surface of the diaphragm?
Parietal
120
When the diaphragm contracts, do the domes ascend or descend?
Descend
121
What is the shape of the central tendon?
Clover
122
What tendon is the diaphragm attached to?
Central tendon
123
What costal cartilages is the diaphragm attached to?
7 - 10
124
What part of the sternum is the diaphragm attached to?
Xiphoid process
125
What vertebrae is the diaphragm attached to?
L1 - L3
126
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
127
Through which part of the diaphragm does the inferior vena cava pass?
Tendinous
128
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
129
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
130
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
131
What type of supply does the diaphragm get?
• Motor and sensory supply on its left, right, superior and inferior parts
132
What type of supply does the phrenic nerve supply to the diaphragm?
Motor and sensory nerves
133
What type of supply does the lower intercostal nerve provide to the diaphragm?
• Sensory to the peripheral parts of the diaphragm (T7 - T12)
134
What are the spinal root values of the phrenic nerve?
• C3-5
135
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.
136
Damage to the phrenic nerve can lead to which dome being damaged?
• Ipsilateral dome
137
How is respiratory function maintained when one lobe is paralysed?
• this is done by the intercostal muscles and nerves
138
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
139
What does the upper respiratory tract consist of?
• Nasal cavity, pharynx and larynx
140
Where is the URT located?
• head and neck
141
What is the larynx composed of?
• Set of carilages, membranes and ligaments
142
What does the larynx do?
* Produces sound from expired air
| * Protect the inlet to the respiratory system
143
What is found superiorly to the larynx?
• hyoid bone
144
What is found inferiory to the larynx?
• Trachea
145
What is the larynx related to anteriorly?
Pharynx
146
What cartilage forms the laryngeal prominence?
• Thyroid cartilage
147
What structure prevents solids and liquids from entering the laryngeal inlet?
• Epiglottis
148
What cartilages are attached to the vocal cords?
• Arytenoid
149
What kinds of cartilage is all of the cartilage of the larynx?
• hyaline, except epiglotttis which is elastic
150
What kind of cartilage is the epiglottis?
• Elastic cartilage
151
What does the LRT consist of?
• trachea, bronchi, bronchioles and alveoli
152
Where is the LRT located?
• mostly in the thorax
153
What does the lower respiratory tract recieve its nerve innervation by?
* Sympathetic fibres originating in the upper thoracic spinal level via pulmonary plexuses located at the termination of the main bronchi
* Parasympathetic fibres from the vagus nerve
* both of the above are motor.
154
How does the lower respiratory tract recieve its arterial supply?
• Via the bronchial arteries arising from the thoracic aorta and intercostal arteries
155
What veins supply the lower respiratory tract?
• Bronchial veins drain to the azygos veinous system and accessory hemiazygous vein
156
Where does the venous supply from the lower respiratory tract drain to?
• Azygos venous system
157
What vertebrae levels does the trachea being and end?
* Begins at C6 (inferior to the cricoid cartilage)
| * Ends at T4
158
What structure is present at T4?
• Sternal angle (carina)
159
What happens to the trachea at T4?
• Bifurcates in to the primary left and right brinchi
160
What vertebrae level does the trachea bifurcate into the left and right main bronchi?
• T4
161
How many hyaline cartilage rings are in the trachea?
• 16 - 20
162
What is the muscle called that completes the tracheal rings of cartilage?
• Trachealis
163
What is the final keel-shaped cartilage ring at the bifurcation of the trachea called?
• Carina
164
What is the tubular organ lying immediately posterior to the trachea?
• Oesophagus
165
What are the arteries called lying immediately lateral to the trachea in the neck?
• common carotid arteries
166
Where do the common carotid arteries in the neck lie relative to the trachea?
• Lateral
167
What is the nerve called lying immediately lateral to the trachea at both sides?
• Vagus nerve
168
Where does the vagus nerve lie relative to the trachea?
• Lateral at both sides
169
What are the groves called that lie between the trachea and oesophagus on both sides?
• Trachea-oesophageal grooves
170
What lodges into the Trachea-oesophageal grooves?
• Recurret laryngeal nerve
171
What do the recurrent laryngeal nerves supply?
• they supply motor and sensory innervation to the larynx
172
Which of the two main bronchi is shorter, wider and more vertical?
• Right
173
In which bronchi are accidentally aspirated objects more likely to pass?
• right because it is shorter and less wide
174
What two main arteries arch above the left bronchus?
• Aorta and pulmonary artery
175
Above which bronchus does the aorta and pulmonary artery arch above?
• Left
176
What is the main difference between the branches of the left and right bronchus?
* Left main bronchus enters the lung before giving off branches
* Right main bronchus gives off a superior branch just before entering the lung
177
Once the right bronchus splits just before entering the lung, what is the superior and inferior component called?
* Superior - superior lobar bronchus
| * Inferior - hyparterial bronchus
178
What do bronchi lose as they branch?
• cartilage, cilia, glands and smooth muscle
179
What increases in bronchi as they branch?
• Elastic fibre content
180
Where does lymph draining from the trachea, bronchi and lungs go to?
• Tracheobronchial lymph nodes
181
Where are the tracheobronchial lymph nodes relative to the bronchi?
• Lie alongside as well as in the cleft between the two main bronchi
182
Where do the traheobronchail lymph nodes drain to?
• Thoracic duct or right lymohatic duct
183
What is the role of tracheobronchial lymph nodes?
• They have a role in secondary spread of lung and breast cancer
184
Other than the tracheobronchial lymph nodes, what other lymph nodes do the lungs drain to?
• Bronchomediastinal lymph nodes
185
Where are the bronchomediastinal lymph nodes found?
• hilum of the lungs
186
What are brinchioles responsible for?
• control of airflow
187
What increases in bronchioles as they branch?
• Elastic fibre content and smooth muscle content
188
What does the left lung posses that the right lung does not?
Cardiac impression
Aortic impression
Cardiac notch
Lingula
189
What does the right lung possess that the left lung does not?
* Middle lobe
* Transverse fissure
* Superior lobar bronchus
190
What is the hilum?
• an area on the medial surface if the lung through which structures enter or leave the lung
191
What ia the root?
• the structures which enter and leave the lung at the hilum
192
What are the 4 structures that constitutes the root of the lung?
* Pulmonary artery
* Superior pulmonary vein
* Inferior pulmonary vein
* Primary bronchi
193
What fascial membrane covers the apex of the lung?
Suprapleural membrane
194
What is a fascia?
• Band or sheet of connective tissue, primarily collagens
195
Do the lungs extend above the first rib?
• yes
196
Why is it clinically important that the lungs extend above the first rib?
• They are unprotected
197
Which lung is shorter and more broader?
• Right lung because it needs to make more spcae for the liver
198
What is the function of the fascial membrane?
• it provides rigidity to the thoracic inlet and prevents distortion due to changes in intrathoracic pressure during respiration
199
What features of an isolated lung should you use to 'side' them?
• Apex/base, orientation, lobes
200
Explain the entire process of the lymphatic drainage of the lungs?
1) Lungs and visceral pleura drain into bronchopulmonary lymph nodes at the bifurcation of the large bronchi at the lung hilia
2) Lymphatics pass to tracheobronchial nodes
3) Drain into the thoraic duct (left) and right lymphatic duct (right)
201
What is the advantage of lungs having bronchopulmonary segments?
• Each lung segment has its own blood and air supply which allows a surgeon to remove that particular segment without adversely affecting any neighbouring segments
202
How many bronchopulmonary segements does each lung have?
* Right - 10
| * Left - 8 or 9
203
What is a bronchopulmonary segment of a lung?
• Segment of lung supplied by a tertiary (segmental) bronchus and an accompanying branch of the pulmonary artery and bronchial artery and vein
204
What are the different bronchopulmonary segments of the lung seperated by?
• Layers of connective tissue
205
What structures present in the bronchial wall enables its definitive identification as a bronchus?
• Hyaline cartilage
206
What is the pulmonary circulation?
• Portion of the circulatory system that carries deoxygenated blood away from the right ventricle of the heart to the lungs, and returns oxygenated blood to the left atrium of the heart
207
What are the vessels of the pulmonary circulation?
• Pulmonary veins and arteries
208
Where does the bronchial circulation arise?
• Aorta and 3rd posterior intercostal artery
209
What supplies oxygen to the lung tissue and larger airways?
• Bronchial circulation
210
What does the bronchial circulation supply blood to?
• Lung tissue and larger airways
211
How many bronchial arteries supply the right and left lungs?
* Right lung - 1
| * Left lung 2
212
What is pleura?
• Double layer of serous membranes that surround each lung
213
What does pleura consist of?
* Outer parietal layer (lining the inner wall of the chest cavity)
* Inner visceral layer (adherent to the lung tissue)
* Pleural space (or cavity, which is the space between these two membranes)
214
Which of the parietal and visceral layer of the pleura is outer and inner?
* Parietal is outer (lines chest wall)
| * Visceral is inner (lines lungs)
215
How would you describe the relationship between the parietal and visceral layers of the pleura?
• Continous to each other
216
Which layer of the pleura enters and lines the fissures of the lungs?
• Visceral
217
Which layer of the pleura is sensitive to pain?
• Parietal
218
What nerves supplies pain sensation to the pleura?
• Phenic nerve and intercostal nerves
219
Where does the mediastinal pleura line?
• The structures situated between the two pleural cavities (mediastinum)
220
Where does the diaphragmatic pleura line?
• Superior surface of the diaphragm
221
Where does the costal pleura line?
• Inner surfaces of the ribs and sternum
222
Where does the apical pleura line?
• Apex of the lungs in the root of the neck
223
What is the apical pleura also known as?
• Cervical pleura
224
What lies immediately above the apical pleura?
• A fascial membrane known as the suprapleural membrane.
225
What else can cause the lungs to collapse other than pneumothorax?
• inflammation/infection
226
What is the prescence of air within the pleural space called?
• Pneumothorax
227
What is the prescence of blood within the pleural space called?
• Haemothorax
228
What is a pleural reflection?
• A pleural reflection occurs where the parietal pleura lining one surface of the chest wall changes its direction to line another surface,
229
What occurs at the reflections within the pleura?
• Space between the parietal and visceral pleura is greater than normal, forming a pleural recess
230
What is each part of the pleura innervated by?
Parietal pleura - intercostal nerves and phrenic nerves, pain sensitive.
Visceral pleura - Autonomic nerves
231
What kind of innervation does the visceral pleura have?
• Autonomic innervation for stretch (pulmonary plexus)
232
Why do respiratory passages and the lungs appear black in CT images?
• air filled spaces
233
How does one view a CT scan by clinical convention?
• Feet up
234
What is the relative position of the oesophagus to the trachea at all points along their length?
• posterior
235
What rib level is the lung at in the: midclavicular line, midaxillary line, midscapular line?
* Midclavicular - rib
* Midaxillary - rib 8
* Midscapular - rib 10
236
What rib level is the parietal pleura at in the: midclavicular line, midaxillary line, midscapular line.
* Midclavicular line - rib 8
* Midaxillary line - rib 10
* Midscapular line - rib 12
237
How many intercostal spaces difference is there between the inferior border of the lung and parietal pleura at each landmark?
• 2
238
What organ occupies the notch seen in the anterior border of the left lung between ribs 4 and 6?
• heart
239
The oblique fissure follows the course of what rib?
• Rib 6
240
The horizontal fissure follows the course of what rib?
• Rib 4
241
Where does the posterior border of each lung extend from?
• C7 to T10
242
Why is pleural aspiration performed in the 9th intercostal space in the midaxillary line and not the 10th?
• Risk of penetrating the abdominal (pritoneal) cavity
243
What do extrapulmonary tubes refer to?
• Outside of the lung, such as trachea and bronchi
244
What is the structure from the lumen to the outside of extrapulmonary tubes?
* Mucosa
* Submucosa
* Cartilage
* Adventitia
245
What is the mucosa of extrapulmonary tubes composed of?
Ciliated pseudostratified columnar epithelium.
| Lamina propria - underneath the epithelium contains elastin blood vessels.
246
What kind of tissue is the lamina propria?
• Thin loose connective tissue layer
247
What kind of cartilage is found in the respiratory tract?
• Hyaline
248
What connective tissue fibre predominates in the respiratory tract?
• Elastin
249
What are the 3 kinds of connective tissue fibre?
* Collagen
* Elastin
* Reticulin
250
What are the 3 kinds of cartilage?
* Hyaline
* Fibro
* Elastic
251
What type of muscle fibres is found in the respiratory tract?.
• Smooth
252
What are the 2 types of cells found in the respiratory epithelium layer?
• Basal and goblet cells
253
What type of epithelium is found in the respiratory tract?
• pseudostratified ciliated colunar epithelium
254
What are the small, hair like structures projecting from the epithelial cells of the respiratory tract into the lumen?
Cilia
255
What substances are secreted from the glands in the submucosa?
• Mucous and water
256
What is the function of the posterior strip of smooth muscle found in the tracheal wall?
• Aloows the oesophagus to expand, coughing
257
In which tissue layer of the tracheal wall are the secreting glands located?
• Submucosa
258
What are the type of glands found in the submucosa of the tracheal wall?
• Seromucous glands
259
What do the seromucous glands of the tracheal wall secrete?
• Mucous and water
260
How does the trachea branch?
• Trachea - primary bronchi - secondary bronchi - tertiary (segmental) bronchi - bronchioles - terminal bronchioles - respiratory bronchioles - alveoli
261
What bronchus is extrapulmonary?
• Primary bronchi
262
What bronchus is intrapulmonary?
• Secondary and tertiary bronchus
263
What is tertiary bronchi also known as?
• segmental bronchi
264
What are the 2 portions of the branches from the trachea known as?
* Conducting portion (no gas exchange)
| * Respiratory portion (gas exchange)
265
What is the last component of the conducting system of the respiratory system?
• Terminal bronchioles
266
What is the beginning of the respiratory portion of the respiratory system?
• Respiratory bronchioles
267
What is the diameter of bronchioles?
• 1mm or less
268
What things are not present in bronchioles compared to trachea and larger bronchi?
• Cartilage and gland
269
What is still present in the terminal bronchioles that is present in larger airways?
• Some cilia and smooth muscle
270
What is the classification of the epithelium of terminal bronchioles?
ciliated cuboidal
271
What two connective tissue fibres are found in the alveolar walls?
• Elastic and reticulin
272
What 3 cells are found in the wall of an alveolus?
Type 1 and 2 pneumoncyte and macrophage
273
What is the function of a type 1 pneumocyte?
• Permit gas exchnage
274
What is the function of a type 2 penumocyte?
• Secrete pulmonary surfactant
275
What is the function of a macrophage?
• Digest foreign bodies
276
What is the surface markings of the pleura?
Starting 2.5cm above mid point of medial 1/3 of clavicle
Meet in midline at rib 2
Left side diverges at rib 4 to makr room for the heart, whilst the right continues parasternally to rib 6
Both cross rib 8 in the midclavicular line
Then rib 10 in the midaxillary line
Both reach posterior chest just below rib 12
(continuous red line)
277
What is the surface markings of the lungs?
2 rib spaces less than the pleura
| blue dotted line
278
What are the surface markings of the fissues?
Oblique - spine of T3 vertebra to rib 6 anteriorly along medial border scapula
Horizontal (on right only) - rib/costal cartilage 4 to rib 5 in midaxillary line
279
What are the surface markings of the oblique fissue?
Spine of T3 vertebrae to rib 6 anteriorly along medial border of scapula
280
What are the surface markings of the horizontal fissure?
Rib/costal cartilage 4 to rib 5 in midaxillary line
281
What two process does respiration involve?
Physical and chemical
282
What does the physical process of respiration entail?
Ventilation involves inspiratory and expiratory movements of the chest.
283
What does the chemical process of respiration involve?
The exchange of gases between air and blood takes place at the cellular level
284
What does parasympathetic innervation do in the lungs?
Bronchioconstriction, mucous secretion and vasodilatation
285
What does the sympathetic innervation do in the lungs?
Bronchodilatation
286
What is the total distance for gas to be exchanged?
0.2 micro meters
287
What happens during breathlessness?
There is fluid in the gap between the alveol and the capillary and so the distance is increased and so the gas can't diffuse properly.
288
What are the four main layers of the respiratory system?
Mucosa
Submucosa
Cartilage and supporting muscle
Adventitia
289
What consists of the mucosa?
There is a epithelium and a connective tissue layer which consists of connective tissue which is known as the lamina propria.
290
What does the sub mucosal layer have?
Seromucous glands
291
What do the seromucous glands have?
They have a duct that opens up into the lumin of the mucosa and it release mucous and serous fluids.
292
What is the adventitia?
It s the fibrous connective tissue which covers the tracheal bronchial treee.
293
What kind of cartilage makes up the rings of the trachea?
Hyaline
294
What are the gaps between the cartilage ring filled up with?
They are filled with trachealis muscle and fibroelastic tissue
295
What is the function of the respiratory mucosa and submucosal layer?
It warms and moistens the air and traps any foreign particle in the mucous
296
What cells are present in the mucosal layer?
Goblet cells
297
What cells can differentiate and act as stem cells?
Basal cells
298
What kind of cells are found in the trachea?
Pseudostratified ciliated columnar cells
299
What does the lamina propria contain?
It contains areolar connective tissue which has elastine and also blood vessels. (there might also be some macrophages and immune cells.)
300
Where do the pseudostratified ciliated cells start and where do they end?
It starts at the nose and finishes at the level of the terminal bronchiole
301
What type of cells starts from the terminal bronchiole?
Non-ciliated columnar single layer cells.
302
What kind of tissue makes up the lamina propria?
Loose connective tissue
303
What is in between the submucosal layers?
Elastic fibres
304
What is found in the perichondrium?
Cartilage
305
What is the function of the adventitia?
It connects and supports the trachea to the surrounding tissue. It also contains nerves, vessels and adipose tissue.
306
What two groups can we divide the bronchi into?
Intrapulmonary bronchi and extrapulmonary bronchi
307
What is the histology of the extrapulmonary bronchi?
They represent the histology of the trachea.
308
What is the histology of the intrapulmonary bronchi?
They have less cartilage and it does not completely encircle the lumen and there are layers of smooth muscle between the mucosa and sub-mucosa.
309
What is the diameter of a bronchiole?
less than 1mm
310
What are bronchioles covered in?-
Ciliated columnar epithelium (however in the smaller bronchioles it is non-ciliated)
311
What is different about the histology of bronchioles?
Smooth muscle increases, Clara cells are present which secrete surfactant, no goblet cells, no ciliated cells, no submucosal glands, no cartilage,
Pseudostratified columnar epithelium
312
What type of cells make up the respiratory bronchioles?
Ciliated cuboidal epithelium
313
What are alveolar ducts surrounded by?
Collagen, elastin and smooth muscle
314
What surrounds the alveoli and the alveolar sacs?
by blood vessels and pulmonary capillaries
315
What surrounds the alveoli and the alveolar sacs?
by blood vessels and pulmonary capillaries
316
What type of epithelium makes up the bronchioles?
Simple epithelium wth few cilia
317
How many glands are in the lamina propria in the bronchioles?
None
318
How does the smooth layer in the broncholes compare to that of the bronchi?
It is thicker.
319
Describe the alveolar-capillary interface.
Gaseous exchange takes place through the endothelial cell of the capillary, basement membrane and type I pneumocyte
The walls of the capillary endothelial cell is fused to that of the alveolar cell, there is only a very thin basement membrane between these two cells.
320
What is correct about the club cells (Clara cells)?
Protect airways, regenerate bronchiolar epithelium, produce surfactant.
321
Which is bigger: superior thoracic aperture or inferior thoracic aperture?
inferior thoracic aperture
322
What is on the interior of each rib?
It is a spongy anterior containing bone marrow which forms blood cells§
323
What does a tubercle correspond with?
Transverse process
324
How is the 1st rib different?
It is broad, it is the shortest and most sharply curved. It also articulates with rib T1.
325
How is the 2nd rib different?
It is thinner, it is also twice the length of the 1st rib.
326
What is different about ribs 10 - 12?
They only have one facet on their heads., The 11th and 12th are short and have no necks or tubercles.
327
Where is the subcostal space located?
Under rib 12
328
What makes up the subcostal nerve?
Anterior ramus of the spinal nerve T12.
329
At what vertebral level does the manubrium lie?
T3 - T4
330
What ligament joins the ribs and the vertebral bodies?
Costotransverse bodies
331
What kind of joint is the intervertebral joint?
Symphysis (secondary cartilaginous joint)
332
What kind of joint is the costovertebral joints of the head of the ribs?
Synovial plane
333
What kind of joint is the costotransverse joint?
Synovial plane
334
What kind of joint is the 1st sternocostal joint ?
Primary cartilaginous joint
335
What kind of joint are the rest of the sternocostal joints?
Synovial plane joints
336
What type of joint is the sternoclavicular joint?
Saddle
337
What type of joint is the costochrondral joint?
Primary cartilaginous
338
What kind of joint is the interchondral joint?
Synovial plane joint
339
What is the costochondral joint?
It is the joint between the costal cartilages and the ribs
340
What kind of joint is the manubriosternal joint?
Symphysis
341
What kind of joint is the xiphisternal joint?
Synchondroses
342
What level is the xiphisternal joint?
T9
343
Where is the weakest part of the rib?
Just anteriorly to its angle
344
What is flail chest?
A sizeable segment of the anterior and/or lateral thoracic wall moves freely because of of multiple rib fractures
345
What can a cervical rib cause and where is it normally found?
It articulates with the C7 vertebra and can compress spinal nerves C8 to T1 or the inferior trunk of brachial plexus supplying upper limb. They can also compress subclavian artery.
346
What can compression of spinale nerves C8 - T1 cause?
Tingling and and numbness may occur along the medial border of the forearm.
347
What can compression of subclavian artery cause?
Ischemic muscle pain which is caused by poor blood supply.
348
What is thoracotomy?
Surgical creation of an opening through the thoracic wall to enter a pleural cavity.
349
What is anterior thoracotomy?
It involves making H-shaped cuts through the perichondrium of one or more costal cartilages and then shelling out segments of costal cartilage to gain entrance to the thoracic cavity.
350
How does the breast lymph drain to the central and apical axillary nodes?
Via Infraclavicular and pectoral nodes
351
Where do the internal thoracic arteries arise from?
Subclavian artery
352
Where do the intercostal arteries supply?
The 1st six intercostal spaces
353
What is the arterial supply of the thoracic wall?
Posterior intercostal arteries, anterior descending arteries, branches of axillary artery.
354
What are the posterior intercostal arteries a branch of?
Descending thoracic aorta
355
What are the anterior thoracic arteries a branch of?
internal thoracic artery
356
What is the venous drainage of the thoracic wall?
Azygous, hemiazygous, accessory hemiazygous vein, internal thoracic vein.
357
where does the left side of the chest drain to?
Thoracic duct which drains to left subclavian vein.
358
Where does the right side of the chest wall drain to?
Right lymphatic duct which drains to the right subclavian vein.
359
What is the lymphatic drainage of the lungs?
pulmonary LN, Bronchopulmonary LN, Tracheobronchial LN, Bronchomedistinal LN,
360
What is the parasympathetic innervation of the lungs?
Vagus nerve
361
What is the sympathetic innervation of the lungs?
T2-5
362
What are the gaps between the c shaped cartilages of the trachea filled with?
Trachealis muscle and fibroelastic tissue.
363
Which pair of costal cartilages attach to the sternum at the sternomanubrial joint?
a. 1st
b. 2nd
c. 3rd
d. 4th
e. 5th
B
364
2. Which part of a rib articulates with the transverse process of a thoracic vertebra?
a. tubercle
b. neck
c. crest
d. angle
e. costal groove
A
365
3. The head of rib 5 articulates with which of the following vertebrae?
a. T5
b. T4
c. T5 and T6
d. T6
e. T4 and T5
e
366
4. The intercostal vessels and nerve are situated:
a. between the innermost intercostal muscle and the parietal pleura
b. between the external and internal intercostal muscles
c. between the external intercostal muscle and the fascia covering the chest wall
d. between the internal and innermost intercostal muscles
e. inside the innermost intercostal muscle
D
367
5. The inferior vena cava passes through the diaphragm at which vertebral level?
```
A. T10
B. T12
C. T8
D. T6
E. T9
```
C
368
The oblique fissure of the lung corresponds to which of the following ribs?
a. rib 2
b. rib 4
c. rib 6
d. rib 8
e. rib 10
C
369
7. The inferior border of the lung corresponds to which rib in the midaxillary line?
```
A. rib 4
B. rib 6
C. rib 8
D. rib 10
E. rib 12
```
C
370
The nerve supplying the central tendon of the diaphragm carries which fibres?
```
A. sensory
B. motor
C. parasympathetic
D. sensory and motor
E. sympathetic
```
D
371
The cardiac notch indicated by the arrow lies between which ribs?
```
A. 3-5
B. 5-8
C. 7-9
D. 4-6
E. 6-8
```
D
372
The bifurcation of the trachea indicated by the arrow occurs at which vertebral level?
```
A. T1-T2
B. T2-T3
C. T3-T4
D. T4-T5
E. T5-T6
```
D
373
4. What structure is located at the bifuraction of the trachea?
```
A. arena
B. marina
C. serena
D. larina
E. carina
```
E
374
11. The inferior border of the parietal pleura corresponds to which rib in the paravertebral line?
```
A. rib 4
B. rib 6
C. rib 8
D. rib 10
E. rib 12
```
E
375
The trachea:
a) contains rings of fibrocartilage
b) lies posterior to the oesophagus
c) bifurcates into the main bronchi at vertebral level T2
d) is completed posteriorly by a band of skeletal muscle
e) has the carina situated at its bifurcation
e
376
The lungs are dissimilar in their gross anatomical features. The right lung is characterised by:
a) a transverse fissure situated between the middle and lower lobes
b) an oblique fissure situated between the upper and lower lobes
c) two fissures and 2 lobes
d) a transverse fissure situated between the upper and middle lobes
e) an oblique fissure situated between the upper and middle lobes
d
