Resp Flashcards
Describe how the structure of the nose is conducive to warming, humidifying and filtering/trapping particles in inspired air
Warming:
- Good blood supply close to the mucosal membrane
- Conchae cause turbulence and slow down airflow.
Humidifying:
- Mucous and blood keeps the area warm
- Conchae cause turbulence and slow down airflow.
Filtering/ trapping particles:
- Hairs
- Mucous
Describe how the structure of the paranasal sinuses are conducive to warming, humidifying and filtering/trapping particles in inspired air
Warming:
-Good blood supply
Humidifying:
-Goblet cells produce mucous
Filtering/trapping particles:
-Mucous traps particles
Name the paranasal sinuses?
Maxillary
Ethmoidal
Frontal
Sphenoidal
What is the name of the muscle that connects the two cartilaginous rings together of the trachea and what is the function?
Trachealis muscle
Pull the rings together to constrict the trachea to increase the air pressure in the lungs for example during a cough
The airways are separated into two areas, what are they called?
Conducting airway and respiratory airways
What is included in the conducting airways?
Trachea Primary Bronchi Secondary Bronchi - lobar bronchi Tertiary bronchi - segmental bronchi Bronchioles Terminal bronchioles
What is included in the respiratory airways?
Respiratory bronchioles
Alveolar ducts
Alveoli
What part of the respiratory system is extrapulmonary and intrapulmonary?
Extrapulmonary: Nasal Cavity Pharynx Larynx Trachea Primary bronchi
Intrapulmonary: Secondary bronchi - lobar bronchi Tertiary bronchi - segmental bronchi Bronchioles Terminal bronchioles Respiratory bronchioles Alveolar ducts Alveoli
Explain why hoarseness of voice/ voice change may be a sign of intra-thoracic disease?
Left recurrent laryngeal nerve innervates the intrinsic laryngeal muscles except cricothyroid.
The route of the recurrent laryngeal nerve is:
Originates from the left vagus nerve as it passes over the arch of the aorta inferior to the left superior intercostal vein. It passes medially and posteriorly deep to the ligamentum arteriosum before curving inferior to the arch of the aorta. It then passes superiorly over the left main bronchus to ascend in the groove between the left side of the trachea and the anterior of the oesophagus.
Branches: mucosa of upper oesophagus, inferior thyroid artery, inferior thyroid veins. Paratracheal lymph nodes, parathyroid glands, lateral lobe of thyroid gland, cardiac and tracheal branches.
At the level of the thyroid gland it passes beneath the inf border of cricopharyngeus to run deep to it and sup towards the pharynx and larynx.
If there is pathology in any of the areas of the route of travel then there could be effects seen in the terminal branches of the larynx.
Describe the structure of the bony thorax?
12 Thoracic vertebrae 12 ribs:1-7 attached ribs 8-12 false ribs 11-12 floating ribs 1 sternum
Superior thoracic aperture is where the lungs stick out of the top of the ribs.
Inf thoracic aperture is the location of the diaphragm
Sternum:
Manubrium
Body
Xiphoid process
Costal cartilage connect the rib bones to the sternum.
Parts of the rib post to ant:
Head -> Neck
Costal groove on the inside separate the sup and inf part of the rib.
Crest separates the facet joints of the head of the rib.
Joints: Thoracic vertebrae: Demifacets on each. Sup demifacet of T2 and Inf demifacet of T1 will articulate with Rib 1 etc. Articular facet of rib articulates with transverse costal facet of the vertebrae.
Thoracic vertebrae is connected with a rib by superior costotransverse ligament and lateral costotransverse ligament.
Describe rib movements during respiration?
Bucket handle movement.
During inspiration:
Ribs move up and out to increase thoracic volume and decrease pressure. Lateral and anterior dimensions increase.
During expiration:
Ribs move down and in to decrease thoracic volume
Describe the intercostal muscles, their nerve supply and actions in respiration?
3 layers of intercostal muscles:
External intercostal membrane above the muscles.
External m. - direction of fibres: obliquely, inferiorly, post to ant
Action: inspiration - contraction brings ribs up and out. Expiration - relaxed.
Internal m. - direction of fibres: Obliquely, inferior, ant to post
Action: forced expiration they will contract bringing ribs down and in
Innermost m. - direction of fibres: Obliquely, inferiority, ant to post
Action: forced expiration they will contract bringing ribs down and in
Nerve supply: Major bundle below costal groove -intercostal nerve between each rib bundled with intercostal artery and vein. Minor bundle (collateral branches) run slightly above the rib.
Describe the diaphragm, their nerve supply and actions in respiration?
Nerve supply: Phrenic nerve
Action is contraction to increase thoracic volume during inspiration.
Expiration relaxation
Musculophrenic artery, inferior phrenic artery, pericardiacophrenic arteries - supplies the diaphragm muscle.
Central tendon of diaphragm - is the middle portion of the diaphragm.
Describe the course of the intercostal nerves, arteries and veins
Intercostal nerve is a branch off the spinal column from the ventral ramus- sympathetic nerve.
Major branch - run beneath costal groove
Minor branch - runs above costal groove
Major and minor branches both have intercostal arteries and veins in them.
Dual blood supply to intercostal muscles therefore increasing risk of blood loss if there is damage.
Anterior perforating branches of intercostal vessels and ant. cutaneous branch of intercostal nerve cover the anterior portion of the muscle and come over to the skin.
Lateral branches of the intercostal nerve and vessels come out the sides to cover the lateral portion of the area.
Blood goes up and down the thoracic cavity in the anterior part next to the body of the sternum called internal thoracic artery and vein.
Blood goes up and down the thoracic cavity in the posterior part ant to the vertebrae called posterior intercostal artery and vein.
They vessels run between the internal and innermost intercostal muscles.
How would you insert a chest drain/ pleural tap and avoid damaging any neurovascular supply to the surrounding tissues?
Insert slightly above the rib as this is where there is a less risk of damaging important neurovascular supplies.
At what vertebral level do the following pass through the diaphragm:
Vena cava
Oesophagus
Aortic hiatus
Vena cava - T8
Oesophagus - T10
Aortic hiatus - T12
What is the venous drainage of the ribs?
Left T1 - T3 = goes into superior vena cava at T2
Left T4 - T8 = Accessory hemiazygous vein L side which then crosses over to R side into the azygous vein
Left T9-T12 = hemiazygous vein on L side then crosses at T9-T10 into the azygous vein
Right T1 - superior vena cava at T1-T2
Right T2-T4 = Into opening of the azygous vein into the SVC at T4
Right T5-T12 = Azygous vein
What nerves roots innervate the diaphragm?
C3/4/5
Keeps the diaphragm alive
What is the part of the lung called where the trachea bifurcates?
Carina
What separates the lobes of the lung?
Fissures
Right lung - Transverse fissure and oblique fissure
Left lung - oblique fissure only as there are only 2 lobes.
Describe the pleural cavity and pleura incl nerve supply and role of pleural fluid and seal in lung expansion?
2 layers of pleura: visceral pleura and Parietal pleura. It is a potential space.
Between there is 10ml of serous fluid that acts as lubricant to allow easy chest expansion. Surface tension creates a seal which ensures that when the thorax expands on inspiration the lungs expand too.
Visceral pleura is on the surface of the lung and the parietal is on the surface of the thorax. Visceral pleura has somatic innervation and so is painful to pierce or irritation occurs.
Describe the blood supply to and from the lungs
Pulmonary trunk - right and left pulmonary arteries.
Left (2) pulmonary veins
Right (3) pulmonary veins
Blood supply to the lungs for its own blood supply = Superior left bronchial artery + inferior left bronchial artery
Right bronchial artery - branch from right third posterior intercostal artery
On surface markings what is the height of the diaphragm at rest?
Right side up to 5th rib (higher) and left side up to 5th intercostal space (lower) in the mid-clavicular line
Describe in simple terms in relation to the trachea what happens in a tension pneumothorax as seen in an x-ray?
Tracheal deviation
Black areas where the lung should be - due to air entrapment
Lung would be scrunched up in the middle where the air has been removed