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Resp Flashcards

1
Q

Order for parts of the resp tract

A

Oral/Nasal cavity, pharynx, trachea, main bronchus, lobar bronchi, segmental bronchi, terminal bronchioles and alveolar

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2
Q

The upper respiratory tract transition level

A

C6

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3
Q

Define lower respiratory tract

A

The trachea to the alveoli

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4
Q

Define the chest wall

A

The body wall structures that form the chest cavity

Skin, fat, fascia, ribs, intercostal muscles

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5
Q

Define the chest cavity

A

The space formed by the chest wall

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6
Q

Define the mediastinum

A

Space between the 2 chest cavities

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7
Q

Define the pleural cavity

A

The potential fluid filled space between the visceral and parietal pleura

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8
Q

Define parietal pleura

A

The pleural layer sat on the body wall

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9
Q

Define visceral pleura

A

The pleural layer on the organs (viscera)

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10
Q

Define pleural fluid

A

Fluid within the plural cavity that prevents friction and holds the layers together by surface tension

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11
Q

Clinical significance of sternal angle

A

Palpation point for second intercostal space

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12
Q

Clinical significance of costal margin

A

Palpation for lower thoracic border

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13
Q

Clinical significance of the xiphoid process

A

Landmark for CPR

Landmark for pericardiocentesis

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14
Q

List and identify the joints of breathing

A 
Sternocostal joints (sternum and cartilage)
Costocondral joints (cartilage and ribs)
Costoverberal joint (rib tubercle and transverse costal facet, rib and superior + inferior costal facets)
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15
Q

List, describe and give nervous innervation of the muscle of respiration

A 
Diaphragm, skeletal muscle with an unusual central tendon and 2 openings. Innervated by the phrenic nerve
Intercostal muscle (external), down and in
Intercostal muscle (internal), up and out
Intercostal mucle (innermost), vertically
All intercostals are supplied by the intercostal nerves
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16
Q

Describe the anatomy of the intercostal space

A

The intercostal space contains the muscles
A neurovascular bundle sits on the posteroinferior aspect of each rib.
The neurovascular bundle is vein, artery nerve from superior to inferior.
The NVB supplied the intercostal space.

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17
Q

Describe the blood supply to the lungs

A

Dual blood supply
Pulmonary from the right ventricle to be oxygenated
Bronchial from the thoracic aorta to supply the lung cells with oxygen themselves.

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18
Q

Describe the basic anatomy and innervation of the diaphragm.

A

A large flat skeletal muscle with a central tendon.
Has 2 openings (third from its posterior opening)
Innervated by the phrenic nerve
Blood supply from: superior phrenic artery from the thoracic aorta, lower internal intercostal arteries and branches from the internal thoracic aorta.

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19
Q

Describe and explain the mechanics of breathing (Inspiration)

A

Diaphragm contacts and descends (increases the vertical chest dimensions)
Intercostal muscles contract elevating the ribs (Increases the A-P chest dimension and lateral chest dimension)

The chest wall movement moves the lungs outwards by the transmural pressure gradient and pleural fluid adhesion

This reduces the pressure of the lungs so air moves in

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20
Q

Describe and explain the mechanism of breathing

Expiration

A

Diaphragm relaxes and rises (decreasing the vertical chest dimension)
Intercostal muscles relax lowering the ribs(Decreasing the A-P chest dimension and lateral chest dimension)

Elastic tissues of the lung recoil

This increases the pressure within the lungs so air moves out

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21
Q

Identify the lines of the chest

A

Midsternal (median) line
Right and level midclavicular lines
Anterior, mid and posterior axillary lines

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22
Q

Identify the palpable areas of the chest surface anatomy

A

The jugular notch just superior to the manibrium (tracheal palpation is here)
Clavicles are palpable (apex of the lung sits superior to the clavicles)
The sternal angle between manibrium and sternal body (At the level of rib 2)
Xiphoid process (site of pericardialcentesis and CPR land mark)
Costal margin

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23
Q

Describe the anatomy of the female breast (Quadrants)

A

4 quadrants: Superolateral (contains the tail), Superomedial, inferolateral, inferomedial

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24
Q

Describe the anatomy of the female breast (Fascia relationship)

A

Sits anterior to the pectoral fascia (deep fascia)

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25
Describe the anatomy of the female breast (Blood supply and drainage)
Blood supply by branches off subclavian and internal thoracic artery Blood drainage by branches off subclavian and internal thoracic vein
26
Describe the anatomy of the female breast (Lympatics)
Bilateral drainage from medial quadrants to parasternal nodes Unilateral drainage from lateral quadrants to axillary nodes
27
Layers of the anterolateral chest wall
Skin, superfical fascia with adipose tissue, nerves, deep fascia then muscles
28
What is the nervous innervation of the anterolateral chest wall
The intercostal nerves
29
Where is the pectoralis major muscle
From sternum and clavicle to humerus
30
Innervation of pectoralis major
Lateral and medial pectoral nerves
31
Where is the pectoralis minor muscle
Connection from coracoid process of scapulae to 3rd, 4th and 5th rib
32
Innervation of pectoralis minor
Medial pectoral nerve
33
Identify the deltoid
The large overriding muscle of the shoulder
34
Where is the cephalic vein
In the delto-pectoral groove, between the deltoid and pectoralis major muscle
35
Where is the serratus anterior
Multi segmented on the lateral aspect of the chest wall
36
Identify the long thoracic nerve
Proximal branch of the brachial plexus that runs along the anterolateral aspect of the chest wall across seratus anterior
37
Latissimus dorsi
Large flat muscle of the back (looks like a free dive flight suit) Extends from spine to humerus
38
Winged scapula
The paralysis of serratus anterior, often due to injury of long thoracic nerve
39
Relationship of clavicle to subclavian vein and arteries along with the brachial plexus
The brachial plexus and subclavians sit posterior to the clavivle
40
What do the subclavian vessels become and at which point
The subclavian vessels become the axillary vessels at the first rib
41
Relationship of scalenus anterior to the subclavian vessles
The subclavian vessels run posterior to the scalenus anterior
42
Explain the costodiaphragamatic recess
The space of the pleural cavity not containing the lungs in the most inferior is the costodiaphragomatic recess Formed of the costal cartilages and the diaphragm
43
Explain costophrenic angle
The lowest point of the costodiaphragomatic recess | With fluid in an upright patient these angles fill and become blunted
44
List the structures of the lung roots
``` 1 main bronchus 1 pulmonary artery 2 pulmonary veins Assorted lymphatics Visceral afferents Sympathetic nerves Parasympathetic nerves ```
45
List the lung fissures
Right lung: oblique and middle | Left lung: oblique
46
Surface markings of the oblique fissure
Ends at rib 6 anteriorly (lateral to medial 4-6) Starts at T3 posteriorly
47
Surface markings of the horizontal fissure
Rib 4
48
Auscultation of the middle lobe
Between ribs 4 and 6
49
Auscultation of the lung apex
Superior to the medial 1/3rd of the clavicle
50
Auscultation of the lung bases
Mid-scapular line at T11
51
Explain the process of coughing
Stimulation of sensory receptors in the mucosa of: oropharynx, laryngopharynx and larynx CNS responds rapidly to co-ordinate a deep inspiration using the diaphragm, intercostal muscles and accessory muscles Vocal cords abduct to close the rima glottids Anterolateral abdo wall contracts to raise intra adopressure to increase intra thoracic pressure Vocal cords abduct suddenly to open the rima glottides Soft palate tenses and elevated to close nasopharynx Air is forcefull expelled through mouth
52
What innervated the vocal cords
Vagus nerve
53
What innervated the muscles of the abdominal wall
Intercostal nerves
54
What innervates the soft palate
CNV
55
What is the carotid sheath
A protective tube of cervical deep fascia | Connects to the base of the skull and blends inferiorly with the mediastinal fascia
56
What is contained within the carotid sheath
Vagus nerve Internal carotid artery Common carotid artery Internal jugular vein
57
What cranial nerves are stimulated in sneezing
CNV or VNIX
58
What cranial nerves are stimulated in coughing
CNIX or CNX
59
What level does the lower respiratory tract stop being lined with respiratory mucosa
Terminal bronchioles/alveolar junction
60
What are the muscles of forced inspiration
Pectoralis major Pectoralis minor Sternocleidomastoid Scalenus: anterior, medius and posterior
61
What is the connection of the sternocleidomastoid
Sternum and mastoid process of temporal bone
62
What is the connection of the scalenus muscles
Cervical vertebrae and the first and second ribs
63
Describe the muscles of the larynx
All skeletal muscles Attach between larynx cartillages Move the cartillages resulting in movement of the vocal cords All supplied by the CNX
64
Intrinsic muscles of the larynx
Intrinsic muscles of the larynx adduct the vocal cords during coughing
65
Where does the vagus nerve pass through the diaphragm
The oesophageal hiatus at T10
66
What is the motor supply to the lung
Motor axons travel from pulmonary plexus on the tracheal bifrication
67
What is the visceral supply from the lung
Visceral afferants travel from the visceral pleura and resiratory tree to the plexus and follow the vagus nerve
68
Where is the phrenic nerve in the neck
Anterior surface of the scalenus anterior
69
Where is the phrenic nerve in the thorax
Descening over the lateral aspect of the fibrous pericardium anterior to the lung root
70
What are intercostal nerves
The anterior rami of the T1 to T11 spinal nerves
71
What does the pectoralis major muscle do to assist respiration
If the upper limb is fixed the muscle can pull the ribs up and out
72
What does the pectoralis minor muscle do to assist respiration
Can pull ribs 3-5 superiorly towards to coracoid process
73
What are the 3 basic areas of the laryngeal cartilages
Thyroid, cricoid and arytenoid
74
What is the relation of the 3 laryngeal cartilages
Thyroid superior Cricoid inferiorly Arytenoid posterior to the thyroid
75
Where does the vagus leave the skull
Jugular foramen
76
How does the vagus descend through the neck
In the carotid sheath
77
How does the vagus nerve run through the thorax
Descend posterior to the lung root
78
Where does the vagus nerve divide
The vagus nerve branches on the stomach surface | Divide into parasymapthetic branches of the foregut and midgut
79
``` Describe the external oblique Superior attachment Inferior attachment Orientation Aponeurosis ```
Superior attachment to the lower ribs Inferior attachment to the anterior part of the iliac crest and pubic tubercle Orientated down and in Forms an aponeurosis to the central linea alba
80
``` Describe the internal oblique Superior attachment Inferior attachment Orientation Aponeurosis ```
Superior attachment to inferior border of lower ribs Inferior attachment to iliac crest and thoracolumbar fascia of the lower back Orientation up and out Aponeurosis blends with the aponeurosis of the oposing internal oblique at the linea alba
81
``` Describe the transversus abdominus Superior attachment Inferior attachment Orientation Aponeurosis ```
Superior attachment to the deep aspect of the lower ribs Inferior attachment to the iliac crest and thoracolumbar fascia Orientation is horizontal medial to lateral Aponeurosis blends with the opposing aponeurosis to form the linea alba
82
Describe the rectus abdominis Possition Intersections
Sits within the internal oblique aponeurosis | The rectus abdominus has multiple tendinous intersections to divide into 3 or 4 smaller quadrate muscles (6 or 8 pack)
83
Describe the rectus sheath
The 3 aponeurosis join to form the rectus sheath the rectus abdominus passes through
84
How do you diagnose a pneumothorax
History suggestive Reduced chest expansion ipsilaterally Reduced breath sounds ipsilaterally CXR showing visible absent of lung marking
85
What is the triangle of safety in a chest drain
Anterior border of latissimus dorsi Posterior border of pectoralis major Axial line superior to the nipple
86
Define a hernia
Protrusion of the inferior diaphragmatic contence back through Paraoesophageal Sliding
87
State common hernia positions due to chronic cough
``` Hiatus Inguinal Ubmbilical Incisional Femoral ```
88
Describe areas of weakness in diaphragm
The hiatus of the diaphragm are weak points
89
Position of inguinal ligament
Anterior superior illiac spine and pubic tubercle
90
Position of the inguinal canals
The inguinal ligaments are the inferior borders of the external oblique aponeuroses
91
Describe the inguinal canal
Passage way from anterior abdominal wall in the inguinal regions Running through the deep ring (entrance) and a superficial ring (exit)
92
List the path of the descending testis
Transversalis fascia, transversus abdominus, internal oblique, deep ring of inguinal ligament, superficial fascia of the scrotum and the scrotal skin
93
List the layers surrounding the testis
Internal spermatic fascia Cremasteric fascia External spermatic fascia Tunica vaginalis within due to reminant of processus vaginalis
94
List the contence of the spermatic cord
``` Vas deferens (transports sperm) Testicular artery (carries oxygenated blood to the testis) Pampiniform plexus (carries deoxygenated blood from the testis) ```
95
Explain the path of a direct inguinal hernia
Through the posterior wall of the inguinal canal and out the superficial ring
96
Explain the path of an indirect inguinal hernia
Through the deep ring thought the inguinal canal. | Through the superficial ring into the scrotum
97
Explain how to clinically differentiate between a direct and indirect inguinal herniae
``` Reduce the hernia Occlude the deep ring with a fingertip pressure Ask the patient to cough - If direct will reappear - If indirect will remain absent ```

Anatomy (6 decks)

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