Respiratory Flashcards
Haemoptosis
Coughing up Blood
Which thoracic vertebrae are typical?
T2-T8
Which ribs are typical
3-9
Intervertebral Joint
Secondary cartilaginous, articulations are the superior and inferior facets of the vertebrae
Costovertebral Joint
synovial plane, head of ribs and bodies of the thoracic vertebrae
Costotransvere Joint
synovial plane, facet of rib tubercles and transverse vertebral processses
Sternocostal Joint
synovial plane (synchondrosis for 1st), rib and sternal body
Sternoclavicular Joint
synovial plane, medial clavicle and manubrium
Costochondral Joint
primary cartilaginous, ribs and costal cartilage
Interchondral Joint
synovial, (6th-10th rib cartilages)
Manubriosternal Joint
secondary cartilaginous, manubrium and sternal body
Xiphisternal Joint
primary cartilaginous, sternal body and xiphoid process
What does the internal thoracic artery supply
anterior chest wall and breasts
Where does the internal thoracic artery arise from
the subclavian artery
Where are intercostal nerves made from
The ventral rami of thoracic spinal nerves
What is shingles caused by
human herpesvirus-3 (hhv-3)
What passes through diaphragm at T8
Caval opening- IVC, right phrenic nerve
What passes through diaphragm at T10
Oesophageal hiatus- oesophagus, anterior and posterior vagal trunks. Passes through left of central tendon
What passes through diaphragm at T12
Aortic hiatus- aorta, azygous vein, thoracic duct, L + R splanchnic nerves. Passes behind diaphragm
Proportions of diaphragmatic Hernia’s
85% posterolateral, 5% anterior (Morgani’s)
Acquired hernias
adjacent to oesophageal opening, associated with symptoms of acid reflux
Parietal Pleura innervation
somatic, by intercostal and phrenic nerves
Visceral Pleura innervation
autonomic innervation
Mesothelioma
SOB from reduction of space for lung to expand, compression by tumour and fluid. Asbestos major RF
Tension Pneumothorax
Injury to chest wall, acts like a valve. Air drawn in on inspiration and can’t escape. Mediastinal shift away from injury, IVC can become compressed.
Tension Pneumothorax decompression
large needle into midclavicular 2nd intercostal space, later chest drain to midaxillary 5th intercostal space. Insertions along superior borders of ribs
Bones of nasal cavity
ethmoid, vomer, lacrimal, palatine, maxillary
Nasal Septum
perpendicular plate of the ethmoid, vomer and septal cartilage
Paranasal sinuses
frontal, sphenoid, maxillary and ethmoid
maxillary sinus innervation
anterior, middle and alveolar nerve- branches of maxillary of trigeminal
Nasal cavity obstruction
polyp, inflammation, deviated septum, foreign body
pharynx obstruction
foreign body, tonsilar (eg adenoid), obstructive sleep apnoea
larynx obstruction
foreign body, epiglottis, vocal chords (eg recurrent laryngeal nerve trauma)
stertor
snoring/gasping, usually pharyngeal blockage
stridor
scraping sound, normally children, usually laryngeal blockage
Nasopharynx
nasal cavity to soft palate (base to c1). Contains pharyngeal tonsil
Oropharynx
soft palate to superior epiglottis border (c1-c3). Contains posterior tongue, palatine and lingual tonsils, super constrictor muscles
Laryngopharynx
superior epiglottis border to inferior cricoid cartilage. Contains middle and inferior pharyngeal constrictors and vocal cords
Waldeye’s ring
ring of lymph tissue around the pharynx formed by tonsils
Vascular supply to the pharynx
network of arteries- branches of facial, maxillary, laryngeal and lingual arteries. Drains into the IJV
Lymph drainage of the pharynx
retropharyngeal and then deep cervical nodes
Nervous supply of the pharynx
Mainly from pharyngeal plexus- sensory = glossopharyngeal, motor = vagal
Extrinsic muscles of larynx
move the larynx as a whole
Subhyoid group
extrinsic muscles, raise the whole larynx
Infrahyoid group
extrinsic muscle, depresses the whole larynx (includes thyrohyoid)
Intrinsic muscles of the larynx
move parts of the larynx
Cricothyroid muscles
Intrinsic muscles. Lengthen and tense the vocal cords. External branch of superior laryngeal nerve.
Posterior cricoarytenoids
the ONLY ABDUCTORS of the vocal cords. Vagus/RLN
Lateral cricoarytenoids
adduct and internally rotate. Vagus/RLN
Thyroarytenoids
sphincter of vestibule, narrow the inlet and shorten the voca lcords- lower the voice
Oblique arytenoids
narrow the inlet, adducting vocal cords. Vagus/RLN
Transverse arytenoids
adduct the arytenoid cartilages, adducting the vocal cords. Vagus/RLN
What is the innervation of the mucosa above the vocal cords
Internal branch of superior laryngeal nerve
Surgical airway
through cricothyroid membrane to avoid vocal cords
Where does the thyroid lie
anterior to trachea at 2nd and 3rd tracheal cartilage
What does the carotid sheath contain
common carotid arteries, IJV and vagus nerves
Where does the trachea bifurcate
Carina- sternal angle, T4/T5
What is “lingular bronchus”
middle secondary on LHS
How many bronchopulmonary segments are on each side
10, each supplied by a tertiary bronchus and a branch of pulmonary artery and lymphatics and autonomic nerves
Venous drainage of the bronchi?
pulmonary veins run between segments
Which bronchus is more likely to be obstructed by a foreign body?
Right- is straighter and shorter
Polyphonic wheeze
multiple tubes- asthma/COPD
Hilum organisation
bronchi lie posteriorly, arteries lie superiorly
Black lymph nodes in lungs
anthracosis
Lung blood supply
bronchial arteries, branches of descending aorta. Drain to the azygos and hemiazygous veins
Lung lymph drainage
drains to bronchopulmonary lymph nodes at the hilum –> tracheobronchial nodes in mediastinum –> nodes in trachea
Lung + visceral pleura innervation
Autinomically by sympathetic trunks and vagus nerves via the pulmonary plexus.
What effect does PSNS stimulation have on the bronchioles?
Constricts
What effect does SNS stimulation have on the bronchioles?
Dilation
Pleural effusion exam
central trachea, stony dull percussion, reduced breath, increased vocal resonance
Lobar Pneumonia exam
central trachea, dull percussion, bronchial breathing, increased vocal resonance
Lung Collapse exam
deviated trachea towards site, dull percussion, reduce breath, reduced vocal resonance
Pneumothorax exam
central trachea, hyper-resonant percussion, reduced breath sounds, reduced vocal resonance
Tension pneumothorax exam
deviated trachea away from site, hyper-resonant percussion, reduced breath sounds, reduced vocal resonance
