RESPIRATORY Flashcards
Where is the thorax in the body?
Between the abdomen and the neck
What is the inlet of the thorax?
The top of it
What landmarks identify the inlet?
Posteriorly where the T1
Anteriorly where the costal cartilage of the first rib and superior boarder of the manubrium is
Laterally where the first rib is
What is the outlet of the thorax?
The bottom of it
What landmarks identify the outlet?
Posteriorly where the 12th thoracic vertebrate is
Anteriorly where the costal cartilage of the 7-10th ribs and xiphisternal joint are.
Laterally where the 11th and 12th ribs are.
What are the parts of the sternum?
Manubrium
Body
Xiphoid process
What are the features of the sternum?
Jugular notch
Clavicle notch
Sternal angle
At which level is the sternal angle found
T4 and T5
At which level is the clavicle notch found?
T3
How many pairs of ribs are there?
12
What is the direction of movement in the ribs during inspiration?
Up and out
Like a bucket handle
What are the true ribs?
Rib 1-7
Directly connected to the sternum
What are the false ribs?
Rib 8-10
Indirectly connected to the sternum
What are the floating ribs?
Ribs 11 and 12
Not connected to the sternum
What are the typical ribs?
Ribs 3-9
Body
Neck
Head which has two articular facets
What is the shape of the first rib?
Broad and flat
one articular facet
Anterior grove where the subclavian vein runs
Scalene tubercle attachment site for the scalene muscles
Posterior grove where the subclavian artery runs and the lower branch of the brachial plexus
What muscles are used in inspiration?
Diaphragm
external intercostal
What muscles are used in expiration?
Nothing
If forced the internal intercostals
Describe the intercostal muscles
Run in different directions, external towards the belly button, internal away from the belly button. The innermost are vertical.
Sit in between the ribs.
VAN bundle in the costal grove of the superior rib in-between the innermost and internal intercostals.
Collateral group inferior.
How are the intercostal muscles innervated ?
Intercostal nerve which is somatic and carried sensory and motor nerves.
What is the movement of the diagram during inspiration?
Descends and flattens
Describe the shape of the diaphragm
Large muscle with a central tendon
Two domes the right of which is slightly higher than the left
Two crus which are tendon like structures attached to the vertebrate.
Has three hiatuses
Describe the left crus
L1-L2
Describe the right crus
L1-L3
Fibres wrap around the oesophageal opening and prevent reflux of gastric content
What are the three hiatuses
T8 there is a caval opening which cuts through the central tendon allowing the inferior vena cava and right phrenic nerve through.
T10 the oesophageal hiatus cuts through a muscular sling of the right curs allowing the oesophagus and vagus nerve to pass.
T12 the aortic hiatus cuts between the left and right curs allowing the aorta, azygos vein, hemiazygos vein and thoracic duct to pass.
How is the diaphragm innervated?
Phrenic nerve both motor and sensory comes from C3,4,5
Inferior = Motor
Central = Sensory
Peripheral = Intercostal
At what level is the peripheral diaphragm supplied by intercostal nerves
T7-T12
How is the diaphragm attached to the chest wall?
Arcuate ligament which attached to the lumber vertebrate
Diaphragm attached to the Xiphoid process and the costal cartilage of ribs T7-T12
Describe the lobes of the lungs
3 superior, middle and inferior in the right lung
2 superior and inferior in the left lung
Describe the fissures of the lung
Horizontal fissure superior and middle lobe and superior and inferior lobe
Oblique fissure middle and inferior lobe
Describe the surfaces of the lung
Mediastinal surface
Diaphragmatic surface
Costal surface
Describe the boarders of the lungs
Anterior (cardiac notch and lingula in the left lung)
Posterior
Inferior
At what level is the cardiac notch?
T4-T6
Draw the bronchopulmonary segments of the right lung
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Draw the bronchopulmonary segments of the left lung
-
What is a hila of the lung?
Hila is located on the medial side of the lung
where the bronchi, arteries and veins, lymphatics and nerves enter and leave the lungs.
Draw the hila of the left lung
-
Draw the hila of the right lung
-
How are the lungs innervated?
Parasympathetic - Vagus nerve
Sympathetic - T2 - T5 nerves
Where are the lungs lymphatic drainage too?
Pulmonary lymph nodes Bronchopulmonary lymph nodes tracheobronchial lymph nodes Bonchiomediatinal lymph nodes Bornchomediatinal lymph trunk
Describe the innervation of the pleura of the lungs
Visceral - Autonomic nerves (vagus) pain insensitive
Parietal - Somatic (intercostal and phrenic) pain sensitive
What are pleural reflections?
Places at which the parental pleura changes it direction
What are pleural recesses?
Increased space between the layers of the pleura occurring at pleural reflections
What are the names of the recesses ?
Costodiphragmatic and costomediastinal
What are the anterior joints of the thorax?
Sternocostal joints (Ribs and sternum). Rib 1 forms a primary cartilaginous joint. Xiphisterna joint (body and Xiphoid process) Manubrial sternal joint (manubrium and sternum) is a primary cartilaginous joint
What are the posterior joints of the thorax?
Synovial plane joints formed between the articular facets of the ribs and vertebral body. Also called the costovertebral joint.
Synovial plane joint formed between the costal facet on the transverse process of the vertebra and the tubercle of the neck of the rib. Also called the costotransverse joint.
Secondary cartilaginous joint forms the intervertebral joints
Describe the arteries of the thorax
Descending thoracic aorta branches at each intercostal level to form the posterior intercostal arteries.
Left and right Subclavian arteries have a branch to form the left and right Internal thoracic artery and descends branching at each intercostal level to form the anterior intercostal arteries.
The anterior and posterior intercostal artery anastomose to from one artery.
Some of the chest wall is also supplied by branches of the axillary artery.
Describe the veins of the thorax
Posterior Intrathoracic veins pick up the deoxygenated blood. 1 drains directly into the brachiocephalic vein. The left once’s drain into the azygous. The right once’s drain into the hemiazygos or hemiazygos accessory and then into the azygous vein.
Anterior thoracic veins 1-6 drain into the internal thoracic vein. 7-9 drain into the musculophrenic vein which then drains into the internal thoracic vein.
Lymphatics: Where does the left side of the chest wall drain into?
Thoracic duct and then left subclavian
Where does the right side of the chest wall drain into?
Right lymphatic duct and then right subclavian vein
Where does the breast tissue drain to?
Axillary lymph nodes
Parasternal lymph nodes
Abdominal lymph nodes
What is the role of the respiratory system?
Moving air in (Ventilation) and out of the lungs
What is the upper respiratory tract?
Nose
Pharynx
Larynx
What is the lower respiratory tract?
Trachea
Bronchi (primary (extrapulmonary) secondary (intrapulmonary) and tertiary (intralobar))
Bronchioles
Alveoli
What is the conducting portion of the lung?
Nose Pharynx Larynx Trachea Bronchi Bronchioles
What is the role of the conducting portion of the lung?
Warms, moistens and cleans the air
What is the respiratory portion of the lungs ?
Respiratory bronchioles
Alveolar ducts
Alveolar sacs
Alveoli
Where is the trachea in the body ?
Starts at the larynx
bifurcates at the carina T4
Where does the inferior boarder of the lungs cross what lines?
Mid clavicular line T6
Mid axillary line T8
paravertebral line T10
Where does the inferior boarder of the pleura cross what lines?
Mid clavicular T8
Mid axillary T10
Paravertebral T12
What are the four layers of the airways walls?
Mucosa - Epithelium with supporting laminae
Sub mucosa - seromucous glands containing a duct
Cartilage or smooth muscle
Adventitia - Fibrous connective tissue
What is the structure of the trachea walls ?
Wide flexible tube
Mucous is made up of ciliated pseudostratified columnar epithelium which contains goblet cells which secret mucous.
Lamina propria
Submucosa layer contains seromucous gland which have watery secretions which moisten the airways.
There are C shaped rings of cartilage (20 of them) the gap of which is filled with the trachealis muscle and fibroelastic tissue.
The adventitia layer support and connects it to other structures.
What is the structure of the bronchi walls?
Mucous is made up of ciliated pseudostratified columnar epithelium which contains goblet cells which release mucous.
lamina propria
Extra smooth muscle layer.
Submucous layer which does still contain some seromucous gland but not as many as the trachea.
Cartilage pates but not rings (decrease in size as you move down)
Adventitia
What is the structure of the bronchiole walls?
Mucous is made up of ciliated simple columnar epithelium (no cilia in terminal bronchioles) no goblet cells
Sub mucosa no seromucous glands,
Smooth Muscle but no cartilage
What is the structure of the alveoli?
Blood vessels
Type I pneumocyte (oval nucleus)
Type II pneumocyte (round nucleus)
Macrophages