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Anatomy > Resp > Flashcards

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
Q

Describe the anatomy of the female breast (Blood supply and drainage)

A

Blood supply by branches off subclavian and internal thoracic artery
Blood drainage by branches off subclavian and internal thoracic vein

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26
Q

Describe the anatomy of the female breast (Lympatics)

A

Bilateral drainage from medial quadrants to parasternal nodes
Unilateral drainage from lateral quadrants to axillary nodes

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27
Q

Layers of the anterolateral chest wall

A

Skin, superfical fascia with adipose tissue, nerves, deep fascia then muscles

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28
Q

What is the nervous innervation of the anterolateral chest wall

A

The intercostal nerves

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29
Q

Where is the pectoralis major muscle

A

From sternum and clavicle to humerus

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30
Q

Innervation of pectoralis major

A

Lateral and medial pectoral nerves

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31
Q

Where is the pectoralis minor muscle

A

Connection from coracoid process of scapulae to 3rd, 4th and 5th rib

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32
Q

Innervation of pectoralis minor

A

Medial pectoral nerve

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33
Q

Identify the deltoid

A

The large overriding muscle of the shoulder

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34
Q

Where is the cephalic vein

A

In the delto-pectoral groove, between the deltoid and pectoralis major muscle

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35
Q

Where is the serratus anterior

A

Multi segmented on the lateral aspect of the chest wall

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36
Q

Identify the long thoracic nerve

A

Proximal branch of the brachial plexus that runs along the anterolateral aspect of the chest wall across seratus anterior

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37
Q

Latissimus dorsi

A

Large flat muscle of the back (looks like a free dive flight suit)
Extends from spine to humerus

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38
Q

Winged scapula

A

The paralysis of serratus anterior, often due to injury of long thoracic nerve

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39
Q

Relationship of clavicle to subclavian vein and arteries along with the brachial plexus

A

The brachial plexus and subclavians sit posterior to the clavivle

40
Q

What do the subclavian vessels become and at which point

A

The subclavian vessels become the axillary vessels at the first rib

41
Q

Relationship of scalenus anterior to the subclavian vessles

A

The subclavian vessels run posterior to the scalenus anterior

42
Q

Explain the costodiaphragamatic recess

A

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
Q

Explain costophrenic angle

A

The lowest point of the costodiaphragomatic recess

With fluid in an upright patient these angles fill and become blunted

44
Q

List the structures of the lung roots

A 
1 main bronchus
1 pulmonary artery
2 pulmonary veins
Assorted lymphatics
Visceral afferents
Sympathetic nerves
Parasympathetic nerves
45
Q

List the lung fissures

A

Right lung: oblique and middle

Left lung: oblique

46
Q

Surface markings of the oblique fissure

A

Ends at rib 6 anteriorly
(lateral to medial 4-6)
Starts at T3 posteriorly

47
Q

Surface markings of the horizontal fissure

A

Rib 4

48
Q

Auscultation of the middle lobe

A

Between ribs 4 and 6

49
Q

Auscultation of the lung apex

A

Superior to the medial 1/3rd of the clavicle

50
Q

Auscultation of the lung bases

A

Mid-scapular line at T11

51
Q

Explain the process of coughing

A

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
Q

What innervated the vocal cords

A

Vagus nerve

53
Q

What innervated the muscles of the abdominal wall

A

Intercostal nerves

54
Q

What innervates the soft palate

A

CNV

55
Q

What is the carotid sheath

A

A protective tube of cervical deep fascia

Connects to the base of the skull and blends inferiorly with the mediastinal fascia

56
Q

What is contained within the carotid sheath

A

Vagus nerve
Internal carotid artery
Common carotid artery
Internal jugular vein

57
Q

What cranial nerves are stimulated in sneezing

A

CNV or VNIX

58
Q

What cranial nerves are stimulated in coughing

A

CNIX or CNX

59
Q

What level does the lower respiratory tract stop being lined with respiratory mucosa

A

Terminal bronchioles/alveolar junction

60
Q

What are the muscles of forced inspiration

A

Pectoralis major
Pectoralis minor
Sternocleidomastoid
Scalenus: anterior, medius and posterior

61
Q

What is the connection of the sternocleidomastoid

A

Sternum and mastoid process of temporal bone

62
Q

What is the connection of the scalenus muscles

A

Cervical vertebrae and the first and second ribs

63
Q

Describe the muscles of the larynx

A

All skeletal muscles
Attach between larynx cartillages
Move the cartillages resulting in movement of the vocal cords
All supplied by the CNX

64
Q

Intrinsic muscles of the larynx

A

Intrinsic muscles of the larynx adduct the vocal cords during coughing

65
Q

Where does the vagus nerve pass through the diaphragm

A

The oesophageal hiatus at T10

66
Q

What is the motor supply to the lung

A

Motor axons travel from pulmonary plexus on the tracheal bifrication

67
Q

What is the visceral supply from the lung

A

Visceral afferants travel from the visceral pleura and resiratory tree to the plexus and follow the vagus nerve

68
Q

Where is the phrenic nerve in the neck

A

Anterior surface of the scalenus anterior

69
Q

Where is the phrenic nerve in the thorax

A

Descening over the lateral aspect of the fibrous pericardium anterior to the lung root

70
Q

What are intercostal nerves

A

The anterior rami of the T1 to T11 spinal nerves

71
Q

What does the pectoralis major muscle do to assist respiration

A

If the upper limb is fixed the muscle can pull the ribs up and out

72
Q

What does the pectoralis minor muscle do to assist respiration

A

Can pull ribs 3-5 superiorly towards to coracoid process

73
Q

What are the 3 basic areas of the laryngeal cartilages

A

Thyroid, cricoid and arytenoid

74
Q

What is the relation of the 3 laryngeal cartilages

A

Thyroid superior
Cricoid inferiorly
Arytenoid posterior to the thyroid

75
Q

Where does the vagus leave the skull

A

Jugular foramen

76
Q

How does the vagus descend through the neck

A

In the carotid sheath

77
Q

How does the vagus nerve run through the thorax

A

Descend posterior to the lung root

78
Q

Where does the vagus nerve divide

A

The vagus nerve branches on the stomach surface

Divide into parasymapthetic branches of the foregut and midgut

79
Q 
Describe the external oblique
Superior attachment
Inferior attachment
Orientation
Aponeurosis
A

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
Q 
Describe the internal oblique
Superior attachment
Inferior attachment
Orientation
Aponeurosis
A

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
Q 
Describe the transversus abdominus
Superior attachment
Inferior attachment
Orientation
Aponeurosis
A

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
Q

Describe the rectus abdominis
Possition
Intersections

A

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
Q

Describe the rectus sheath

A

The 3 aponeurosis join to form the rectus sheath the rectus abdominus passes through

84
Q

How do you diagnose a pneumothorax

A

History suggestive
Reduced chest expansion ipsilaterally
Reduced breath sounds ipsilaterally
CXR showing visible absent of lung marking

85
Q

What is the triangle of safety in a chest drain

A

Anterior border of latissimus dorsi
Posterior border of pectoralis major
Axial line superior to the nipple

86
Q

Define a hernia

A

Protrusion of the inferior diaphragmatic contence back through
Paraoesophageal
Sliding

87
Q

State common hernia positions due to chronic cough

A 
Hiatus
Inguinal
Ubmbilical
Incisional
Femoral
88
Q

Describe areas of weakness in diaphragm

A

The hiatus of the diaphragm are weak points

89
Q

Position of inguinal ligament

A

Anterior superior illiac spine and pubic tubercle

90
Q

Position of the inguinal canals

A

The inguinal ligaments are the inferior borders of the external oblique aponeuroses

91
Q

Describe the inguinal canal

A

Passage way from anterior abdominal wall in the inguinal regions
Running through the deep ring (entrance) and a superficial ring (exit)

92
Q

List the path of the descending testis

A

Transversalis fascia, transversus abdominus, internal oblique, deep ring of inguinal ligament, superficial fascia of the scrotum and the scrotal skin

93
Q

List the layers surrounding the testis

A

Internal spermatic fascia
Cremasteric fascia
External spermatic fascia
Tunica vaginalis within due to reminant of processus vaginalis

94
Q

List the contence of the spermatic cord

A 
Vas deferens (transports sperm)
Testicular artery (carries oxygenated blood to the testis)
Pampiniform plexus (carries deoxygenated blood from the testis)
95
Q

Explain the path of a direct inguinal hernia

A

Through the posterior wall of the inguinal canal and out the superficial ring

96
Q

Explain the path of an indirect inguinal hernia

A

Through the deep ring thought the inguinal canal.

Through the superficial ring into the scrotum

97
Q

Explain how to clinically differentiate between a direct and indirect inguinal herniae

A 
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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