Resp Flashcards
Order for parts of the resp tract
Oral/Nasal cavity, pharynx, trachea, main bronchus, lobar bronchi, segmental bronchi, terminal bronchioles and alveolar
The upper respiratory tract transition level
C6
Define lower respiratory tract
The trachea to the alveoli
Define the chest wall
The body wall structures that form the chest cavity
Skin, fat, fascia, ribs, intercostal muscles
Define the chest cavity
The space formed by the chest wall
Define the mediastinum
Space between the 2 chest cavities
Define the pleural cavity
The potential fluid filled space between the visceral and parietal pleura
Define parietal pleura
The pleural layer sat on the body wall
Define visceral pleura
The pleural layer on the organs (viscera)
Define pleural fluid
Fluid within the plural cavity that prevents friction and holds the layers together by surface tension
Clinical significance of sternal angle
Palpation point for second intercostal space
Clinical significance of costal margin
Palpation for lower thoracic border
Clinical significance of the xiphoid process
Landmark for CPR
Landmark for pericardiocentesis
List and identify the joints of breathing
Sternocostal joints (sternum and cartilage) Costocondral joints (cartilage and ribs) Costoverberal joint (rib tubercle and transverse costal facet, rib and superior + inferior costal facets)
List, describe and give nervous innervation of the muscle of respiration
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
Describe the anatomy of the intercostal space
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.
Describe the blood supply to the lungs
Dual blood supply
Pulmonary from the right ventricle to be oxygenated
Bronchial from the thoracic aorta to supply the lung cells with oxygen themselves.
Describe the basic anatomy and innervation of the diaphragm.
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.
Describe and explain the mechanics of breathing (Inspiration)
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
Describe and explain the mechanism of breathing
Expiration
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
Identify the lines of the chest
Midsternal (median) line
Right and level midclavicular lines
Anterior, mid and posterior axillary lines
Identify the palpable areas of the chest surface anatomy
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
Describe the anatomy of the female breast (Quadrants)
4 quadrants: Superolateral (contains the tail), Superomedial, inferolateral, inferomedial
Describe the anatomy of the female breast (Fascia relationship)
Sits anterior to the pectoral fascia (deep fascia)
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
Describe the anatomy of the female breast (Lympatics)
Bilateral drainage from medial quadrants to parasternal nodes
Unilateral drainage from lateral quadrants to axillary nodes
Layers of the anterolateral chest wall
Skin, superfical fascia with adipose tissue, nerves, deep fascia then muscles
What is the nervous innervation of the anterolateral chest wall
The intercostal nerves
Where is the pectoralis major muscle
From sternum and clavicle to humerus
Innervation of pectoralis major
Lateral and medial pectoral nerves
Where is the pectoralis minor muscle
Connection from coracoid process of scapulae to 3rd, 4th and 5th rib
Innervation of pectoralis minor
Medial pectoral nerve
Identify the deltoid
The large overriding muscle of the shoulder
Where is the cephalic vein
In the delto-pectoral groove, between the deltoid and pectoralis major muscle
Where is the serratus anterior
Multi segmented on the lateral aspect of the chest wall
Identify the long thoracic nerve
Proximal branch of the brachial plexus that runs along the anterolateral aspect of the chest wall across seratus anterior
Latissimus dorsi
Large flat muscle of the back (looks like a free dive flight suit)
Extends from spine to humerus
Winged scapula
The paralysis of serratus anterior, often due to injury of long thoracic nerve
Relationship of clavicle to subclavian vein and arteries along with the brachial plexus
The brachial plexus and subclavians sit posterior to the clavivle
What do the subclavian vessels become and at which point
The subclavian vessels become the axillary vessels at the first rib
Relationship of scalenus anterior to the subclavian vessles
The subclavian vessels run posterior to the scalenus anterior
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
Explain costophrenic angle
The lowest point of the costodiaphragomatic recess
With fluid in an upright patient these angles fill and become blunted
List the structures of the lung roots
1 main bronchus 1 pulmonary artery 2 pulmonary veins Assorted lymphatics Visceral afferents Sympathetic nerves Parasympathetic nerves
List the lung fissures
Right lung: oblique and middle
Left lung: oblique
Surface markings of the oblique fissure
Ends at rib 6 anteriorly
(lateral to medial 4-6)
Starts at T3 posteriorly
Surface markings of the horizontal fissure
Rib 4
Auscultation of the middle lobe
Between ribs 4 and 6
Auscultation of the lung apex
Superior to the medial 1/3rd of the clavicle
Auscultation of the lung bases
Mid-scapular line at T11
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
What innervated the vocal cords
Vagus nerve
What innervated the muscles of the abdominal wall
Intercostal nerves
What innervates the soft palate
CNV
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
What is contained within the carotid sheath
Vagus nerve
Internal carotid artery
Common carotid artery
Internal jugular vein
What cranial nerves are stimulated in sneezing
CNV or VNIX
What cranial nerves are stimulated in coughing
CNIX or CNX
What level does the lower respiratory tract stop being lined with respiratory mucosa
Terminal bronchioles/alveolar junction
What are the muscles of forced inspiration
Pectoralis major
Pectoralis minor
Sternocleidomastoid
Scalenus: anterior, medius and posterior
What is the connection of the sternocleidomastoid
Sternum and mastoid process of temporal bone
What is the connection of the scalenus muscles
Cervical vertebrae and the first and second ribs
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
Intrinsic muscles of the larynx
Intrinsic muscles of the larynx adduct the vocal cords during coughing
Where does the vagus nerve pass through the diaphragm
The oesophageal hiatus at T10
What is the motor supply to the lung
Motor axons travel from pulmonary plexus on the tracheal bifrication
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
Where is the phrenic nerve in the neck
Anterior surface of the scalenus anterior
Where is the phrenic nerve in the thorax
Descening over the lateral aspect of the fibrous pericardium anterior to the lung root
What are intercostal nerves
The anterior rami of the T1 to T11 spinal nerves
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
What does the pectoralis minor muscle do to assist respiration
Can pull ribs 3-5 superiorly towards to coracoid process
What are the 3 basic areas of the laryngeal cartilages
Thyroid, cricoid and arytenoid
What is the relation of the 3 laryngeal cartilages
Thyroid superior
Cricoid inferiorly
Arytenoid posterior to the thyroid
Where does the vagus leave the skull
Jugular foramen
How does the vagus descend through the neck
In the carotid sheath
How does the vagus nerve run through the thorax
Descend posterior to the lung root
Where does the vagus nerve divide
The vagus nerve branches on the stomach surface
Divide into parasymapthetic branches of the foregut and midgut
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
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
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
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)
Describe the rectus sheath
The 3 aponeurosis join to form the rectus sheath the rectus abdominus passes through
How do you diagnose a pneumothorax
History suggestive
Reduced chest expansion ipsilaterally
Reduced breath sounds ipsilaterally
CXR showing visible absent of lung marking
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
Define a hernia
Protrusion of the inferior diaphragmatic contence back through
Paraoesophageal
Sliding
State common hernia positions due to chronic cough
Hiatus Inguinal Ubmbilical Incisional Femoral
Describe areas of weakness in diaphragm
The hiatus of the diaphragm are weak points
Position of inguinal ligament
Anterior superior illiac spine and pubic tubercle
Position of the inguinal canals
The inguinal ligaments are the inferior borders of the external oblique aponeuroses
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)
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
List the layers surrounding the testis
Internal spermatic fascia
Cremasteric fascia
External spermatic fascia
Tunica vaginalis within due to reminant of processus vaginalis
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)
Explain the path of a direct inguinal hernia
Through the posterior wall of the inguinal canal and out the superficial ring
Explain the path of an indirect inguinal hernia
Through the deep ring thought the inguinal canal.
Through the superficial ring into the scrotum
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
