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Anatomy > Respiratory > Flashcards

Respiratory Flashcards

1
Q

List in correct order the name of the parts of the upper respiratory tract?

A

Nasal cavities
Oral cavity
Naso, oro, laryngo- pharnyx
larynx

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2
Q

List the parts of the lower respiratory tract.

A 
trachea
right and left main bronchus
lobar bronchi
segmental bronchi
bronchioles
alveoli
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3
Q

What vertebral level does the upper respiratory tract become the lower?

A

C6

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4
Q

Define the chest walls.

A 
Skin
Fascia
Skeletal muscle
Bone/joints
Parietal pleura
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5
Q

Define the chest cavity

A

Located within the chest walls
Contains organs, great vessels and nerves
Mediastinum and the right and left pleural cavities

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6
Q

What is the parietal pleura adherent to?

A

The inside of the chest wall and the structures of the mediastinum

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7
Q

What is the function of pleural fluid?

A

Lubricant

provides surface tension

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8
Q

What is the line at the lower costal cartilages called

A

costal margin

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9
Q

What is the clinical significance of the xiphoid process?

A

Land mark for CPR

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10
Q

What does the head of the rib articulate with

A

Vertebral body

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11
Q

What does the rib tuberical articulate with

A

transverse process

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12
Q

What are the joints of breathing?

A

Sternocostal
Costochondral
Costovertebral

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13
Q

What innervates the diaphragm?

A

Phrenic nerve- combined anterior rami of spinal nerves C3, 4, 5

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14
Q

What innervates the intercostal spaces?

A

eg. T4 anterior ramus or 4th intercostal nerve and its branches

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15
Q

What are the branches of an intercostal nerve?

A

Lateral cutaneous branch

Anterior cutaneous branch

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16
Q

What supplies the anterior parts of the intercostal spaces?

A

Internal thoracic artery

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17
Q

What drains the anterior aspect of the intercostal spaces?

A

Internal thoracic vein

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18
Q

What supplies the posterior part of the intercostal space?

A

thoracic aorta

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19
Q

What drains the posterior intercostal spaces?

A

azygous vein

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20
Q

What branches of the thoracic aorta supply the intercostal spaces?

A

The posterior intercostal arteries (Bilateral)

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21
Q

What branches of the thoracic aorta supply the lung tissue?

A

Bronchial arteries (from lateral aspect)

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22
Q

Where does the diaphragm attach?

A

sternum
lower 6 ribs
L1-3 vertebral bodies

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23
Q

Where is the phrenic nerve found in the neck?

A

Anterior surface of the scalenus anterior

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24
Q

Where is the phrenic nerve found in the chest?

A

Descends over the lateral aspect of the fibrous pericardium

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25
Q

What does the phrenic nerve supply?

A

Diaphragm

Fibrous pericardium

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26
Q

What happens to the pleural cavity during inspiration

A

Becomes a vacuum

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27
Q

How would you locate rib two

A

by palpating the sternal angle

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28
Q

What are the four quadrants of the breast?

A

Superolateral
Superomedial
Inferolateral
Inferomedial

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29
Q

What are the significant features of the breast?

A

Axillary tails
nipple
areola

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30
Q

What is the blood supply and veinous drainage to the breast?

A

Subclavian

internal thoracic artery and veins

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31
Q

What is the lymphatic drainage to the breast?

A

Unilateral drainage of lateral quadrants to axillary nodes

Bilateral drainage from medial quadrants to parasternal nodes

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32
Q

Where can you palpate the trachea?

A

Jugular notch of the manubrium

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33
Q

Where is the cephalic vein located?

A

In the delto-pectoral groove

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34
Q

What is the long thoracic nerve and where does it supply?

A

Branch of the brachial plexus

Supplies serratus anterior

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35
Q

What causes a winged scapula?

A

Paralysis of the serratus anterior due to an injured long thoracic nerve

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36
Q

Where does the serratus anterior attach?

A

Medical border of the scapula to ribs 1-8

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37
Q

When does the subclavian vessels become the axillary vessels?

A

Lateral to the lateral border of rib 1

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38
Q

Where does the scalenus anterior attach to

A

Rib 1

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39
Q

Where is the subclavian artery located in relationship to the muscles?

A

Posterior

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40
Q

Where is the brachial plexus located in relationship to the arteries

A

Posterior

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41
Q

Where is the apices of the lung located?

A

superiorly to rib 1 in the root of the neck

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42
Q

What is the pleura called at the apex

A

cervical parietal pleura

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43
Q

What is the pleura inferior to rib one called

A

the costal parietal pleura

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44
Q

What is the pleural at the diaphragm called

A

the diaphramatic parietal pleur

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45
Q

What is the pleura that attaches to the mediastinal structures called?

A

Mediastinal parietal pleura

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46
Q

What is the most inferior part of the costodiaphragmatic recess?

A

costophrenic angles

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47
Q

What is the costodiaphragmatic recess?

A

Located between the diaphramatic parietal pleura and the mediastinal parietal pleura

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48
Q

What are the structures of the lung root?

A 
1 main bronchus
1 pulmonary artery
2 pulmonary veins
lymphatics
visceral afferents
sympathetic and parasympathetic nerves
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49
Q

What is the lungula of the lungs?

A

The ‘tongue’ of the superior lobe

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50
Q

Where do you auscultate the lung apex?

A

Superior to the medial third of the clavicle

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51
Q

Where do you ausculate the middle lobe of the right lung?

A

Between ribs 4 and 6

Midclavicular line and middle axillary line

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52
Q

Where is the location of the horizontal fissure?

A

rib 4

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53
Q

Where is the location of the oblique fissures

A

ribs 6- rises to T3 level posteriorly

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54
Q

Where do you ausculate the lung base?

A

Scapular line at T 11

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55
Q

What stimulates a cough?

A

Stimulation of sensory nerves in the mucosa of the oropharynx, laryngopharynx, larynx and respiritory tree and fires action potentials to CNS

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56
Q

What are series of events that produce a cough?

A

Deep inspiration
Adduction of the vocal cords closing the rima glottidis
Contraction of anterolateral abdominal wall
Adbuction of vocal cords
opening of rima glottidis
Soft palate tenses and elevates to direct air away from nasal cavity into oral cavity

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57
Q

What cranial nerves are stimulated during sneezing?

A

CN V and IX

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58
Q

What cranial nerves are stimulate during coughing?

A

CN IX and X

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59
Q

How does the vagus nerve descend into the mediastinum?

A

Via the carotid sheeth

60
Q

What is contained within the carotid sheath?

A

Vagus nerve
Internal carotid artery
Common carotid artery
Internal jugular vein

61
Q

Define the carotid sheath?

A

Cervical deep fascia
attaches superiorly to the bones of the base of the skull
blends inferiorly with the fascia of the mediastinum

62
Q

What cranial nerves supply the nasal cavities?

A

V1 and V2

63
Q

What cranial nerve supplies the pharynx?

A

CN IX

64
Q

What cranial nerve supplies the larynx?

A

CN X

65
Q

What part of the respiratory tract are lined with respiratory mucosa?

A

Trachea to bronchioles

66
Q

How do motor axons and visceral afferents connect with the CNS?

A

via the pulmonary plexus

67
Q

Where is the pulmonary plexus located?

A

at the bifurcation of the trachea

68
Q

Where is the phrenic nerve in relation to the lung root?

A

Anterior

69
Q

Where does the phrenic nerve supply somatic sensory and sympathetic axons to?

A

fibrous pericardium

parietal pleura

70
Q

Where does the phrenic nerve supply motor axons?

A

Diaphragm

71
Q

What are the accessory muscles of breathing?

A

Pectoralis major
Pectoralis minor
SCM
Scalenus anterior, medius and posterior

72
Q

Where does the pec major attach?

A

Sternum/ribs and humerous

73
Q

Where does the pectoralis minor attach?

A

ribs 3-5 and the coracoid process of the scapula

74
Q

Where does the SCM attach?

A

Sternum, clavicle and mastoid process of the temporal bone

75
Q

Where does the scalenus attach?

A

Cervical vertebrae and ribs 1 and 2

76
Q

What is the function of the intrinsic muscle of the larynx?

A

Skeletal muscles that adduct the vocal cords resulting in closure of the rima glotidis during the cough reflex

77
Q

Where are the intrinsic muscles of the larynx?

A

Attach between the cartilages of the larynx

78
Q

What cranial nerve supplies the intrinsic muscles of the larynx?

A

CN X or vagus

79
Q

What type of cranial nerve is the vagus nerve?

A

MIxed

80
Q

Where does the vagus nerve connect with the CNS?

A

Medulla oblongata of the brainstem

81
Q

Which foramen does the vagus nerve run through?

A

Jugular

82
Q

Where does the vagus nerve pass throught the diaphragm?

A

on the oesophagus

83
Q

What happens to the vagus nerve in the adbdominal cavity?

A

on the surface of the stomach they finally divide into many parasympathetic branches for the foregut & midgut organs

84
Q

What are the accessory muscles of deep expiration?

A

Anterolateral abdominal wall muscles

diaphragm

85
Q

What is the linea alba?

A

The point at which the aponeurosis of the left external and internal obliques and transvesus abdominus blends with the aponeurosis of the right side at the midline

86
Q

What is the linea semilunaris?

A

Where the muscle fibres of the external obliques end and the aponeurosis begins

87
Q

Where does the external oblique attach?

A

Superior aspect of the ribs

Anterior part of the iliac crest and pubic tubercle

88
Q

Where does the internal obliques attach?

A

Inferior border of the lower ribs

Illiac crest and thoracolumbar fascia

89
Q

Where does the transvesus abdominus attach?

A

Deep aspects of the lower ribs

Iliac crest and the thoracolumbar fascia of the lower back

90
Q

What is the rectus sheath?

A

Combination of the aponeurosis of the three anterolateral abdominal wall muscles
contains rectus abdominus

91
Q

How are the rectus abdominus muscles divided?

A

Each of 2 long flat muscles divided by tendinous intersections into quadrate muscles ‘six pack’

92
Q

What set of nerves supply the abdominal soma?

A

Thoracoabdominal nerves

93
Q

What are the thoracoabdominal nerves made up of?

A

7th to 11th intercostal nerves travel anteriorly then their terminal branches leave the intercostal spaces in the plane between the internal oblique and the transversus abdominus

94
Q

Name the three thoracoabdominal nerves

A

Subcostal
Iliohypogastric
Ilioinguinal

95
Q

What anteriorramus makes up the subcostal nerve?

A

T12

96
Q

What anterior ramus makes up the iliohypogastric nerve?

A

first half of L1

97
Q

What anterior ramus makes up the ilioinguinal nerve?

A

second half of L1

98
Q

What are the functions of the anterolateral abdominal wall muscles?

A 
Maintain posture
Support spine
Movements of veretebral column
Guarding of abdomnal viscera
Increase intra abdominal pressure- defecation, labout etc
Aids forced expiration
99
Q

Where is the likeliest location for a foreign body to be inhaled into in the lung when the patient is upright?

A

Inferior lobe of the right lung

100
Q

What is the carina?

A

Internal aspect of the tracheal bifurcation

101
Q

What are the possible pulmonary consequences of chronic cough?

A

Dynamic airway compression in asthma- makes expiration difficult
Build up of trapped air can lead to rupture of lung and visceral pleura

102
Q

What is a pneumothorax?

A

Air in the pleural cavity

103
Q

What is a small pneumothorax?

A

less than 2cm gap between the lung and the parietal pleura

104
Q

What can cause a pneumothorax?

A

Penetration of parietal pleura

Rupture of the visceral pleura

105
Q

What is a large pneumothorax

A

Larger than 2cm

106
Q

What will a pneumothorax show on examination?

A

Reduced ipsilateral chest expansion
Reduced ipsilateral breath sounds
Hyper resonance on percussion

107
Q

What will a pneumothorax show in a CXR?

A

Absent lung markings

Lung edge visable

108
Q

What is a tension pneumothorax?

A

One way valve created
Air leaks into the pleural cavity on inspiration but cannot escape on expiration
Pneumothorax expands
Tension on mediastinal structures eventually

109
Q

What are the consequences of a tension pneumothorax?

A

Mediastinal shift

110
Q

What are the consequences of a mediastinal shift?

A

Tracheal deviation away from the side of a unilateral tension pneumothorax
SVC compression- decreased venous return- hypotension

111
Q

How is a large pneumothorax managed?

A

Needle aspiration (thoracentesis)

112
Q

Where is a chestdrain inserted?

A 
'safe triange' :
Anterior border of latussimus dorsi
Posterio border or pectoralis major
4th of 5th intercostal space
midaxillary line
axial line superior to the nipple
113
Q

What is the emergency management of a tension pneumothorax?

A

large gauge cannula (grey/orange) intot he pleural vavity

114
Q

Where is a large gauge cannula inserted?

A

2nd or 3rd intercostal space, midclavicular line

on the same side as pneumothorax

115
Q

What is the treatment for recurrent pneumothoraces?

A

VATS- video assisted thorascopic surgery

116
Q

What can be done durin a thoracoscopy?

A

Suturing pleural perforations
pleural biopsy
Pleurectomy
Chemical pleurodesis

117
Q

What are the other most likely consequences of a chronic cough?

A

Herniae

118
Q

What is a hernia?

A

any structure passing through another and so ending up in the wrong place

119
Q

What two factors make a hernia more likely?

A

Weakness of the body wall eg normal, congenital or surgical (inscisional hernia)
Increased pressure on body wall eg chronic cough

120
Q

Where are the areas of natural weaknesss in the body wall where hernias are likely?

A

Diaphragm
Umbilicus
Inguinal canal
Femoral canal

121
Q

Where do diaphragmatic herniae typically develop?

A

Attachment to the xiphoid and posterior attachments- normal areas of weaknes
Oesophageal hiatus
Aortic hiatus
Hiatus hernias are common

122
Q

What is a paraoesophageal hiatus hernia?

A

The herniated part of the stomach passes through the oesophageal hiatus to become parallel to the oesopahgus and chest wall

123
Q

What is a sliding hiatus hernia?

A

The herniated part of the stomach slides through the oesophageal hiatus into the chest with the gastrooesophageal junction

124
Q

What are umbilical herniae?

A

Common in babies

125
Q

Where do inguinal hernias commonly form?

A

The medial half of the inguinal region- may be unilateral or bilateral

126
Q

Where do the inguinal ligaments attach

A

Between the ASIS and pubic tubercle

127
Q

What forms the floor of the inguinal canals?

A

Medial half of the inguinal ligaments

128
Q

How is the inguinal canal formed?

A

Embryologically during the passage of the testes or the round ligament of the uterus into the perineum

129
Q

What is contained in the inguinal canal in the adult?

A

Spermatic cord

or the round ligament of the uterus

130
Q

Where is the superficial ring located?

A

In the external oblique lying superolateral to the pubic tubercle

131
Q

Where is the deep ring located?

A

Superior to the midpoint of the inguinal ligament

132
Q

What is the processus vaginalis?

A

An outpouching of the parietal peritoneum

133
Q

What is the internal spermatic fascia?

A

A covering of the trasversalis fascia

134
Q

What is the cremasteric fascia?

A

A covering of skeletal muscle fibres from the internal oblique around the testicle

135
Q

What is the external spermatic fascia?

A

A covering of the external oblique aponeurosis

136
Q

What is the conjoint tendon?

A

the medial end of the combined aponeuroses of internal oblique and transversus abdominis

137
Q

What is the function of the conjoint tendon?

A

anchors the internal oblique and the transversus abdominus muscles inferiorly to the pubic bone

138
Q

What three layers of facia is contained in the spermatic cord?

A

Internal spermatic fascia
Cemasteric facia
External spermatic fascia
+structures contained within

139
Q

What structures are contained within the spermatic cord?

A

Vas defrens
Testicular artery
Pampiniform venous plexus

140
Q

Where is the ilioinguinal nerve loaced in relation to the inguinal canal and spermatic cord?

A

It is in the inguinal canal but external to the spermatic cord

141
Q

Where does the round ligaments of the uterus pass through?

A

The inguinal canals into the labium majus

142
Q

What is a direct inguinal hernia?

A

a “finger” of peritoneum is forced through the posterior wall of the inguinal canal and directly out of the superficial ring into the scrotum

143
Q

What is an indirect inguinal hernia?

A

a “finger” of peritoneum is first forced through the deep ring into the inguinal canal and then out of the superficial ring into the scrotum

144
Q

How do you differentiate clinically between a direct and indirect herniae?

A
  1. reduce the hernia
  2. occlude the deep ring with fingertip pressure
    3 ask patient to cough
    Direct- lum will reappear
    Indirect- lump will not reappear
145
Q

What blood vessels enter the rectus sheeth posterior to the rectus abdminis?

A

Inferior epigastric artery and vein

indirect inguinal hernias pass lateral to these

146
Q

Where is a direct inguinal hernia forced through?

A

Anterior abdominal wall via the inguinal or Hesselbacks triangle

147
Q

What is hesselbacks triangle?

A

between teh inguinal ligament inferiorly and the inferior epigastic vessels laterally and the rectus abdominis medially

Anatomy (7 decks)

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