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
2
Q
List the parts of the lower respiratory tract.
A
trachea right and left main bronchus lobar bronchi segmental bronchi bronchioles alveoli
3
Q
What vertebral level does the upper respiratory tract become the lower?
A
C6
4
Q
Define the chest walls.
A
Skin Fascia Skeletal muscle Bone/joints Parietal pleura
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
6
Q
What is the parietal pleura adherent to?
A
The inside of the chest wall and the structures of the mediastinum
7
Q
What is the function of pleural fluid?
A
Lubricant
provides surface tension
8
Q
What is the line at the lower costal cartilages called
A
costal margin
9
Q
What is the clinical significance of the xiphoid process?
A
Land mark for CPR
10
Q
What does the head of the rib articulate with
A
Vertebral body
11
Q
What does the rib tuberical articulate with
A
transverse process
12
Q
What are the joints of breathing?
A
Sternocostal
Costochondral
Costovertebral
13
Q
What innervates the diaphragm?
A
Phrenic nerve- combined anterior rami of spinal nerves C3, 4, 5
14
Q
What innervates the intercostal spaces?
A
eg. T4 anterior ramus or 4th intercostal nerve and its branches
15
Q
What are the branches of an intercostal nerve?
A
Lateral cutaneous branch
Anterior cutaneous branch
16
Q
What supplies the anterior parts of the intercostal spaces?
A
Internal thoracic artery
17
Q
What drains the anterior aspect of the intercostal spaces?
A
Internal thoracic vein
18
Q
What supplies the posterior part of the intercostal space?
A
thoracic aorta
19
Q
What drains the posterior intercostal spaces?
A
azygous vein
20
Q
What branches of the thoracic aorta supply the intercostal spaces?
A
The posterior intercostal arteries (Bilateral)
21
Q
What branches of the thoracic aorta supply the lung tissue?
A
Bronchial arteries (from lateral aspect)
22
Q
Where does the diaphragm attach?
A
sternum
lower 6 ribs
L1-3 vertebral bodies
23
Q
Where is the phrenic nerve found in the neck?
A
Anterior surface of the scalenus anterior
24
Q
Where is the phrenic nerve found in the chest?
A
Descends over the lateral aspect of the fibrous pericardium
25
What does the phrenic nerve supply?
Diaphragm
| Fibrous pericardium
26
What happens to the pleural cavity during inspiration
Becomes a vacuum
27
How would you locate rib two
by palpating the sternal angle
28
What are the four quadrants of the breast?
Superolateral
Superomedial
Inferolateral
Inferomedial
29
What are the significant features of the breast?
Axillary tails
nipple
areola
30
What is the blood supply and veinous drainage to the breast?
Subclavian
| internal thoracic artery and veins
31
What is the lymphatic drainage to the breast?
Unilateral drainage of lateral quadrants to axillary nodes
| Bilateral drainage from medial quadrants to parasternal nodes
32
Where can you palpate the trachea?
Jugular notch of the manubrium
33
Where is the cephalic vein located?
In the delto-pectoral groove
34
What is the long thoracic nerve and where does it supply?
Branch of the brachial plexus
| Supplies serratus anterior
35
What causes a winged scapula?
Paralysis of the serratus anterior due to an injured long thoracic nerve
36
Where does the serratus anterior attach?
Medical border of the scapula to ribs 1-8
37
When does the subclavian vessels become the axillary vessels?
Lateral to the lateral border of rib 1
38
Where does the scalenus anterior attach to
Rib 1
39
Where is the subclavian artery located in relationship to the muscles?
Posterior
40
Where is the brachial plexus located in relationship to the arteries
Posterior
41
Where is the apices of the lung located?
superiorly to rib 1 in the root of the neck
42
What is the pleura called at the apex
cervical parietal pleura
43
What is the pleura inferior to rib one called
the costal parietal pleura
44
What is the pleural at the diaphragm called
the diaphramatic parietal pleur
45
What is the pleura that attaches to the mediastinal structures called?
Mediastinal parietal pleura
46
What is the most inferior part of the costodiaphragmatic recess?
costophrenic angles
47
What is the costodiaphragmatic recess?
Located between the diaphramatic parietal pleura and the mediastinal parietal pleura
48
What are the structures of the lung root?
```
1 main bronchus
1 pulmonary artery
2 pulmonary veins
lymphatics
visceral afferents
sympathetic and parasympathetic nerves
```
49
What is the lungula of the lungs?
The 'tongue' of the superior lobe
50
Where do you auscultate the lung apex?
Superior to the medial third of the clavicle
51
Where do you ausculate the middle lobe of the right lung?
Between ribs 4 and 6
| Midclavicular line and middle axillary line
52
Where is the location of the horizontal fissure?
rib 4
53
Where is the location of the oblique fissures
ribs 6- rises to T3 level posteriorly
54
Where do you ausculate the lung base?
Scapular line at T 11
55
What stimulates a cough?
Stimulation of sensory nerves in the mucosa of the oropharynx, laryngopharynx, larynx and respiritory tree and fires action potentials to CNS
56
What are series of events that produce a cough?
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
57
What cranial nerves are stimulated during sneezing?
CN V and IX
58
What cranial nerves are stimulate during coughing?
CN IX and X
59
How does the vagus nerve descend into the mediastinum?
Via the carotid sheeth
60
What is contained within the carotid sheath?
Vagus nerve
Internal carotid artery
Common carotid artery
Internal jugular vein
61
Define the carotid sheath?
Cervical deep fascia
attaches superiorly to the bones of the base of the skull
blends inferiorly with the fascia of the mediastinum
62
What cranial nerves supply the nasal cavities?
V1 and V2
63
What cranial nerve supplies the pharynx?
CN IX
64
What cranial nerve supplies the larynx?
CN X
65
What part of the respiratory tract are lined with respiratory mucosa?
Trachea to bronchioles
66
How do motor axons and visceral afferents connect with the CNS?
via the pulmonary plexus
67
Where is the pulmonary plexus located?
at the bifurcation of the trachea
68
Where is the phrenic nerve in relation to the lung root?
Anterior
69
Where does the phrenic nerve supply somatic sensory and sympathetic axons to?
fibrous pericardium
| parietal pleura
70
Where does the phrenic nerve supply motor axons?
Diaphragm
71
What are the accessory muscles of breathing?
Pectoralis major
Pectoralis minor
SCM
Scalenus anterior, medius and posterior
72
Where does the pec major attach?
Sternum/ribs and humerous
73
Where does the pectoralis minor attach?
ribs 3-5 and the coracoid process of the scapula
74
Where does the SCM attach?
Sternum, clavicle and mastoid process of the temporal bone
75
Where does the scalenus attach?
Cervical vertebrae and ribs 1 and 2
76
What is the function of the intrinsic muscle of the larynx?
Skeletal muscles that adduct the vocal cords resulting in closure of the rima glotidis during the cough reflex
77
Where are the intrinsic muscles of the larynx?
Attach between the cartilages of the larynx
78
What cranial nerve supplies the intrinsic muscles of the larynx?
CN X or vagus
79
What type of cranial nerve is the vagus nerve?
MIxed
80
Where does the vagus nerve connect with the CNS?
Medulla oblongata of the brainstem
81
Which foramen does the vagus nerve run through?
Jugular
82
Where does the vagus nerve pass throught the diaphragm?
on the oesophagus
83
What happens to the vagus nerve in the adbdominal cavity?
on the surface of the stomach they finally divide into many parasympathetic branches for the foregut & midgut organs
84
What are the accessory muscles of deep expiration?
Anterolateral abdominal wall muscles
| diaphragm
85
What is the linea alba?
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
What is the linea semilunaris?
Where the muscle fibres of the external obliques end and the aponeurosis begins
87
Where does the external oblique attach?
Superior aspect of the ribs
| Anterior part of the iliac crest and pubic tubercle
88
Where does the internal obliques attach?
Inferior border of the lower ribs
| Illiac crest and thoracolumbar fascia
89
Where does the transvesus abdominus attach?
Deep aspects of the lower ribs
| Iliac crest and the thoracolumbar fascia of the lower back
90
What is the rectus sheath?
Combination of the aponeurosis of the three anterolateral abdominal wall muscles
contains rectus abdominus
91
How are the rectus abdominus muscles divided?
Each of 2 long flat muscles divided by tendinous intersections into quadrate muscles 'six pack'
92
What set of nerves supply the abdominal soma?
Thoracoabdominal nerves
93
What are the thoracoabdominal nerves made up of?
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
Name the three thoracoabdominal nerves
Subcostal
Iliohypogastric
Ilioinguinal
95
What anteriorramus makes up the subcostal nerve?
T12
96
What anterior ramus makes up the iliohypogastric nerve?
first half of L1
97
What anterior ramus makes up the ilioinguinal nerve?
second half of L1
98
What are the functions of the anterolateral abdominal wall muscles?
```
Maintain posture
Support spine
Movements of veretebral column
Guarding of abdomnal viscera
Increase intra abdominal pressure- defecation, labout etc
Aids forced expiration
```
99
Where is the likeliest location for a foreign body to be inhaled into in the lung when the patient is upright?
Inferior lobe of the right lung
100
What is the carina?
Internal aspect of the tracheal bifurcation
101
What are the possible pulmonary consequences of chronic cough?
Dynamic airway compression in asthma- makes expiration difficult
Build up of trapped air can lead to rupture of lung and visceral pleura
102
What is a pneumothorax?
Air in the pleural cavity
103
What is a small pneumothorax?
less than 2cm gap between the lung and the parietal pleura
104
What can cause a pneumothorax?
Penetration of parietal pleura
| Rupture of the visceral pleura
105
What is a large pneumothorax
Larger than 2cm
106
What will a pneumothorax show on examination?
Reduced ipsilateral chest expansion
Reduced ipsilateral breath sounds
Hyper resonance on percussion
107
What will a pneumothorax show in a CXR?
Absent lung markings
| Lung edge visable
108
What is a tension pneumothorax?
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
What are the consequences of a tension pneumothorax?
Mediastinal shift
110
What are the consequences of a mediastinal shift?
Tracheal deviation away from the side of a unilateral tension pneumothorax
SVC compression- decreased venous return- hypotension
111
How is a large pneumothorax managed?
Needle aspiration (thoracentesis)
112
Where is a chestdrain inserted?
```
'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
What is the emergency management of a tension pneumothorax?
large gauge cannula (grey/orange) intot he pleural vavity
114
Where is a large gauge cannula inserted?
2nd or 3rd intercostal space, midclavicular line
| on the same side as pneumothorax
115
What is the treatment for recurrent pneumothoraces?
VATS- video assisted thorascopic surgery
116
What can be done durin a thoracoscopy?
Suturing pleural perforations
pleural biopsy
Pleurectomy
Chemical pleurodesis
117
What are the other most likely consequences of a chronic cough?
Herniae
118
What is a hernia?
any structure passing through another and so ending up in the wrong place
119
What two factors make a hernia more likely?
Weakness of the body wall eg normal, congenital or surgical (inscisional hernia)
Increased pressure on body wall eg chronic cough
120
Where are the areas of natural weaknesss in the body wall where hernias are likely?
Diaphragm
Umbilicus
Inguinal canal
Femoral canal
121
Where do diaphragmatic herniae typically develop?
Attachment to the xiphoid and posterior attachments- normal areas of weaknes
Oesophageal hiatus
Aortic hiatus
Hiatus hernias are common
122
What is a paraoesophageal hiatus hernia?
The herniated part of the stomach passes through the oesophageal hiatus to become parallel to the oesopahgus and chest wall
123
What is a sliding hiatus hernia?
The herniated part of the stomach slides through the oesophageal hiatus into the chest with the gastrooesophageal junction
124
What are umbilical herniae?
Common in babies
125
Where do inguinal hernias commonly form?
The medial half of the inguinal region- may be unilateral or bilateral
126
Where do the inguinal ligaments attach
Between the ASIS and pubic tubercle
127
What forms the floor of the inguinal canals?
Medial half of the inguinal ligaments
128
How is the inguinal canal formed?
Embryologically during the passage of the testes or the round ligament of the uterus into the perineum
129
What is contained in the inguinal canal in the adult?
Spermatic cord
| or the round ligament of the uterus
130
Where is the superficial ring located?
In the external oblique lying superolateral to the pubic tubercle
131
Where is the deep ring located?
Superior to the midpoint of the inguinal ligament
132
What is the processus vaginalis?
An outpouching of the parietal peritoneum
133
What is the internal spermatic fascia?
A covering of the trasversalis fascia
134
What is the cremasteric fascia?
A covering of skeletal muscle fibres from the internal oblique around the testicle
135
What is the external spermatic fascia?
A covering of the external oblique aponeurosis
136
What is the conjoint tendon?
the medial end of the combined aponeuroses of internal oblique and transversus abdominis
137
What is the function of the conjoint tendon?
anchors the internal oblique and the transversus abdominus muscles inferiorly to the pubic bone
138
What three layers of facia is contained in the spermatic cord?
Internal spermatic fascia
Cemasteric facia
External spermatic fascia
+structures contained within
139
What structures are contained within the spermatic cord?
Vas defrens
Testicular artery
Pampiniform venous plexus
140
Where is the ilioinguinal nerve loaced in relation to the inguinal canal and spermatic cord?
It is in the inguinal canal but external to the spermatic cord
141
Where does the round ligaments of the uterus pass through?
The inguinal canals into the labium majus
142
What is a direct inguinal hernia?
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
What is an indirect inguinal hernia?
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
How do you differentiate clinically between a direct and indirect herniae?
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
What blood vessels enter the rectus sheeth posterior to the rectus abdminis?
Inferior epigastric artery and vein
| indirect inguinal hernias pass lateral to these
146
Where is a direct inguinal hernia forced through?
Anterior abdominal wall via the inguinal or Hesselbacks triangle
147
What is hesselbacks triangle?
between teh inguinal ligament inferiorly and the inferior epigastic vessels laterally and the rectus abdominis medially
