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Semester 3 > Resp Session 2 > Flashcards

Resp Session 2 Flashcards

1
Q

Is breathing in active or passive?

A

Active

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2
Q

Why is breathing it passive?

A

Lungs tend to recoil to reach resting expiratory level where all forces are in balance

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3
Q

What facilitates changing lung volume by movement of the thorax?

A

Pleural seal

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4
Q

What muscles are used for inhalation in quiet breathing?

A

Diaphragm

External intercostals

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5
Q

What are the accessory muscles used for inspiration?

A

Sternocleidomastoid
Scalene
Serratus anterior
Pectoralis major

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6
Q

How does the difference between intrapleural and intrapulmonary pressures change on inspiration?

A

Becomes ore -ve as ribs pull more

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7
Q

What is found in the pleural cavity?

A

10-20 ml of pleural fluid which is similar to plasma but with less protein

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8
Q

What happens if the integrity of the pleural seal is broken?

A

Lungs tend to collapse and large space opens between the visceral and parietal pleura

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9
Q

What muscles are used in forced expiration?

A

Internal intercostals
External and internal abdominal obliques
Rectus abdominis

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10
Q

What is forced expiration?

A

When you breathe out beyond the resting expiratory level e.g. in exercise

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11
Q

What is the action of the muscles used in forced expiration?

A

Contract and flatten abdominal wall and push upper GI organs into diaphragm

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12
Q

Why is inspiration to resting expiratory volume following force expiration passive?

A

Forces on the lungs are unbalanced

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13
Q

What is lung compliance?

A

Lung stretchiness/ease of inflation measured as volume changeover unit volume

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14
Q

How is compliance of the lungs affected by emphysema?

A

Increased due to loss of elasticity so no opposing force to inflation

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15
Q

How does fibrosis affect compliance of the lungs?

A

Decreases as the lungs become stiff

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16
Q

In quiet breathing, when is most effort used?

A

To expand lungs unless the diaphragm is obstructed e.g. Pregnancy, obesity or surgical corset

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17
Q

What is the elastic recoil of the lungs due to?

A

Elastic tissue of airways and surface tension of fluid lining alveoli

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18
Q

How does the fluid lining the alveoli increase surface tension and make them harder to stretch?

A

Polar water molecules attract and interact with air –> surface resists stretching –> wants to collapse alveoli –> increases surface tension

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19
Q

Why does fluid line the alveoli if it makes them harder to inflate?

A

Needed to dissolve oxygen so it can move into the blood

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20
Q

How does surfactant decease surface tension?

A

Disrupts interactions between surface molecules

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21
Q

What produces surfactant in the lungs?

A

Type II pneumocytes

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22
Q

Why are little breaths easy when surfactant is present?

A

Surfactant is effective at low volume as there are a finite number of molecules which spread out as lung expands, therefore the less spread out they are the more surface tension is reduced

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23
Q

What does Laplace’s law state?

A

Pressure = (2xsurface tension)/radius

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24
Q

How is Laplace’s law applied to the lung?

A

Big bubble = large radius –> low pressure
Small bubble = small radius –> high pressure
If bubbles are connected then air moves from small to big bubble and this would happen in the alveoli if surfactant wasn’t present

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25
Q

Explain how surfactant is effective at keeping pressure stable inside the alveoli.

A

As radius of alveoli increases surfactant molecules spread apart which allows surface tension to rise thus keeping pressure stable

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26
Q

What is respiratory distress syndrome?

A

Surfactant levels in the lungs are disrupted impairing breathing and gas exchange

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27
Q

Why can babies born prematurely need respiratory support?

A

Respiratory system develops late so baby might have too little surfactant, stuff lungs, few and large alveoli and little muscle mass

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28
Q

What is the treatment used for babies at risk of respiratory distress syndrome due to premature birth?

A

Inject mother before birth with steroids to stimulate surfactant production and give air and surfactant after birth

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29
Q

When is respiratory distress syndrome seen in adults?

A

Major trauma –> inflammatory lung process disrupting surfactant

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30
Q

What does Poiseulle’s law state?

A

Small tubes have high flow resistance

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31
Q

Considering Poiseulle’s law, why is flow resistance highest in the trachea and lowest in the small airways?

A

Despite having narrower lumen the bronchial tree branches providing parallel pathways thus compensating for increased flow resistance with more possible pathways

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32
Q

Is the respiratory systems usually a high or low resistance system in quiet respiration?

A

Generally low

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33
Q

How does flow resistance change in forced expiration?

A

Small airways are narrowed by external pressure therefore resistance increases dramatically as there is no cartilage to keep them open

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34
Q

What is the result of pressure changes during forced expiration in the lungs?

A

Air is trapped in alveoli but in healthy individual there is usually enough resilience to overcome this

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35
Q

Why does obstructive airways disease lead to hyperinflation of the lung?

A

Small airways are already narrowed so in expiration resistance increases much earlier –> breathing out very difficult and more air is trapped in the lungs –> hyperinflation

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36
Q

What forms the bony thorax?

A

12 thoracic vertebrae
Sternum
12 ribs and their cartilages
11 intercostal spaces

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37
Q

Where are the thoracic outlet and inlet found?

A

Thoracic outlet = aperture formed by first ribs and superior surface of sternum
Thoracic inlet = aperture formed by 12th ribs

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38
Q

Lost the parts of the sternum superior to inferior.

A

Manubrium
Sternal angle (manubrio-sternal joint)
Sternal body
Xiphoid process

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39
Q

Does the xiphoid process remain cartilaginous throughout life?

A

No, only until mid 30s to 40s when it begins to calcify

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40
Q

Which ribs are ‘typical’ ribs?

A

3-9

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41
Q

What is the costo-transverse joint made by a typical rib?

A

Traverse process of vertebra + rib tubercle

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42
Q

What does the crest of a typical rib separate?

A

Articulating surface with corresponding vertebra above rib level and articulating surface with corresponding vertebra to rib level (e.g. Rib 7 = C7)

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43
Q

What runs in the costal groove of a typical rib?

A

Vein
Artery
Nerve

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44
Q

Which ribs are atypical?

A

1, 2, 10, 11 and 12

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45
Q

Describe the structure of rib 1.

A

Shortest, broadest, most curved and head with one facet. Has a groove for subclavian artery and vein

46
Q

Why is rib 2 said to be atypical?

A

Has poorly marked costal groove

47
Q

Describe the structure of ribs 11 and 12.

A

‘Floating’ ribs with single facet on head, no tubercle an taper at the anterior end

48
Q

What forms the axis of rib rotation?

A

Imaginary line running through 2 costovertebral joints

49
Q

How do the upper ribs move to alter thoracic volume?

A

Increase sagittal diameter by pushing sternum forward thus increasing A-P diameter

50
Q

How do the lower ribs move to alter the thoracic volume?

A

Increase transverse diameter thus increasing lateral diameter

51
Q

Where are the intercostal muscles found?

A

Each intercostal space

52
Q

List the intercostal muscles from superficial to deep.

A

External intercostal
Internal intercostal
Innermost intercostal

53
Q

How are the fibres of each type of intercostal muscle arranged?

A

External: fibres run inferiorly and anteriorly (hands in pockets)
Internal: fibres run inferiorly and posteriorly
Innermost: fibres run inferiorly and posteriorly

54
Q

How are the intercostal muscles attached to the sternum?

A

By a membrane as fibres do not reach

55
Q

What is the result of external intercostal muscle contraction?

A

Ribs move superiorly

56
Q

When are internal and innermost intercostal muscles used?

A

Forced expiration to decrease A-P and lateral diameters of eh chest by moving ribs inferiorly

57
Q

Between internal and innermost intercostals at lower border of rib therefore insert a needle at the upper border of the rib below to avoid damage

A

Where does the neurovascular bundle run in relation to the intercostal muscles and what is its clinical relevance?

58
Q

Describe the neural supply of the muscles in the corresponding intercostal space, parietal pleura and overlying skin of each rib.

A

Anterior rami of thoracic spinal nerves T1-12 run in neurovascular bundle giving rise to collateral branches where needed

59
Q

Why is pain from an inflamed parietal pleura felt on the skin directly above?

A

Due to intercostal nerve supply

60
Q

How does varicella zoster give rise to a dermatomal rash that does not cross the midline?

A

Remains dormant in the dorsal root ganglion but on reactivation gives characteristic rash due to intercostal nerve supply

61
Q

What do the intercostal arteries anastomose with to provide and alternative route for bloodflow to the legs?

A

Superior epigastric artery

62
Q

Describe the arterial supply of intercostal muscles, parietal pleura and overlying skin for each rib.

A

Anterior and posterior intercostal arteries follow path of intercostal nerve in each intercostal space. Posterior comes from thoracic aorta, anterior from internal thoracic aorta

63
Q

What can anastomose with the anterior and posterior intercostal arteries in the intercostal space?

A

Each other

Mammary branches

64
Q

Where do the superior two ribs receive their arterial blood supply from?

A

Superior intercostal artery, a branch of the subclavian

65
Q

Where does the venous drainage of each intercostal space go?

A

Anterior and posterior intercostal veins in neurovascular bundles drain into the Azygos and hemiazygos veins –> SVC
Some drain into the internal thoracic vein

66
Q

Which muscle accounts for 70% of inspiration?

A

Diaphragm

67
Q

Where does the peripheral muscular part of the diaphragm arise from?

A

Lower ribs
Arcuate ligaments
R and L crus of diaphragm

68
Q

Where do the muscle fibres of the diaphragm all insert?

A

Central tendon where the pericardium attaches

69
Q

What are the arcuate ligaments?

A

Thickening of posterior abdominal muscles

70
Q

What are the openings of the diaphragm for?

A 
T8= vena cava
T10= oesophagus
T12= aorta (aortic hiatus)
71
Q

Where is the diaphragm positioned during expiration?

A

R dome reaches behind 5th rib

Left dome in the 5th ICS MCL

72
Q

Why are dullness sounds from percussion of the liver in hyperinflation lower?

A

Diaphragm is pushed down

73
Q

What gives nervous supply to the diaphragm?

A

Phrenic nerve (C3,4,5 keep you alive)

74
Q

What gives neural supply to the margins of the diaphragm?

A

Intercostal nerves

75
Q

What is the motor function of the phrenic nerve?

A

Diaphragm

76
Q

What is the sensory function of the phrenic nerve?

A

Pericardium
Mediastinal part of parietal pleura
Diaphragmatic parietal pleura
Both surfaces of the diaphragm

77
Q

Why is pain felt in the shoulder following chest surgery which affected the diaphragm?

A

Referred pain due to dermatomal distribution of C3,4,5

78
Q

Where is the median arcuate ligament found in the diaphragm?

A

Around aortic aperture

79
Q

Describe the structure of the costodaiphragmatic recess.

A

Lung doesn’t reach but pleura does and overlaps liver as it reaches down to 6th ICS

80
Q

Which three arcuate ligaments are found in the diaphragm?

A

Median
Medial
Lateral

81
Q

What would a stab wound in the 7th ICS damage?

A 
Skin
Intercostal muscles
Parietal pleura
Visceral pleura
Lung
Liver
82
Q

What does the thoracic cavity consist of?

A

2 lateral pulmonary cavities and the central mediastinum compartment

83
Q

Describe the visceral pleura.

A

Covers and adheres to lungs including horizontal and oblique fissures

84
Q

What 4 parts does the parietal pleura consist of?

A

Cervical
Mediastinal
Costal
Diaphragmatic

85
Q

Describe the distribution of each of the four parts of the parietal pleura.

A

Cervical extends into the root of the neck
Mediastinal covers lateral mediastinum
Costal covers internal surfaces of thoracic wall
Diaphragmatic covers superior diaphragm

86
Q

Where are the visceral and parietal pleura continuous?

A

Hilum

87
Q

What is the function of the film of fluid between the pleura of the lungs?

A

Allow them to slide over each other and prevents surfaces being pulled apart due to forces between the fluid molecules

88
Q

What divides the URT and LRT?

A

Lower border of cricoid cartilage

89
Q

Where do the L and R bronchi divide?

A

At the carina behind the sternal angle at T4/5 level

90
Q

What can be seen on bronchoscopy or bronchogram which indicates enlargement of tracheo-bronchial lymph nodes?

A

Widening of the carina

91
Q

Compare the R and L main bronchi.

A 
R= shorter, wider and more vertical
L= longer, more horizontal
92
Q

How many lobar bronchi are in the L and R lung?

A 
R = 3-upper, middle and lower
L = 2-upper and lower
93
Q

What is a bronchopulmonary segment?

A

A segment of lung with its own segmental bronchi, segmental branch of pulmonary artery and vein supply

94
Q

What is the clinical relevance of bronchopulmonary segments?

A

In surgery one segment can be removed with little damage to others and limited bleeding

95
Q

Where does the horizontal fissure run?

A

In the R lung from oblique fissure along 4th rib and cartilage border

96
Q

Where does the oblique fissure of the lung run?

A

In R lung from the spinous process of T2 to the 6th costal cartilage

97
Q

What corresponds to the R middle lobe in the L lung?

A

Lingula

98
Q

Which lobe is the lingula found in?

A

L superior

99
Q

What are the 3 surfaces of each lung?

A

Diaphragmatic
Mediastinal
Costal

100
Q

Why can subclavian vein cannulation lead to pneumothorax?

A

Apex of the lung extends into the root of the neck

101
Q

What can apical lung tumours compress?

A

Brachial plexus (esp median cord)
Subclavian vessels
Sympathetic trunk

102
Q

Describe the blood supply by the bronchial arteries.

A

From aorta bring oxygenated blood to bronchial tree up to terminal bronchioles

103
Q

What blood supply do the pulmonary arteries give?

A

Bring deoxygenated blood from the R heart to alveoli for oxygenation

104
Q

What prevents ischaemia in PE?

A

Anastomoses of the bronchial arteries

105
Q

What are the borders of the four compartments of the mediastinum?

A 
Superior = thoracic inlet --> sternal angle and lower T4 border
Anterior = body of sternum --> fibrous pericardium
Posterior = vertebral bodies --> fibrous pericardium
Middle = between anterior and posterior
106
Q

What are the contents of the superior mediastinum?

A

Thymus
Brachiocephalic veins, SVC, brachiocephalic trunk, left common carotid and left subclavian arteries
Vagus, phrenic nerves, R+LRN and cardiac plexus
Trachea
Oesophagus
Thoracic duct and lymphatic ducts

107
Q

What forms the borders of the posterior mediastinum?

A 
Lateral: mediastinal pleura
Anterior: pericardium
Posterior: T5-12
Roof: imaginary line between sternal angle and T4
Floor: diaphragm
108
Q

What is the contents of the posterior mediastinum?

A 
Thoracic aorta
Oesophagus
Thoracic duct
Azygos system of veins
Sympathetic trunks
109
Q

What forms the borders of the anterior mediastinum?

A 
Roof: superior mediastinum
Anterior: body of sternum and transversus thoracic muscle
Posterior: pericardium
Lateral: mediastinal pleura
Floor: diaphragm
110
Q

What are the contents of the anterior mediastinum?

A 
Loose CT which tethers pericardium to sternum
Fat
Lymphatic vessels and nodes
Branches of internal thoracic vessels
Thymus only in children
111
Q

What forms the borders of the middle mediastinum?

A

Superior: imaginary line between sternal angle and T4
Anterior: anterior margin of pericardium
Posterior: posterior border of pericardium
Lateral: mediastinal pleura of lungs
Inferior: diaphragm

112
Q

What are the contents of the middle mediastinum?

A 
Heart and pericardium
Tracheal bifurcation with L and R main bronchi
Great vessels of heart
Cardiac plexus
L and R phrenic nerves
Tracheobronchial lymph nodes

Semester 3 (50 decks)

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