respiratory Flashcards
1
Q
Which bones articulate with the manubrium at its superolateral angles?
A
clavicles and 1st rib
2
Q
What is the name given to abovementioned joints?
A
costaclavicular and costamanubrium
3
Q
What type of joint is the abovementioned
A
synovial plane
4
Q
What is the name given to the notch formed by the superior border of the manubrium?
A
suprasternal notch
5
Q
At what vertebral level is the xiphoid process located?
A
t10
6
Q
Sternomanubrial joint. At what vertebral level is the sternomanubrial joint found?
A
t4
7
Q
Head. With the bodies of which thoracic vertebrae will the head of rib 7 articulate?
A
t6 and t7
8
Q
Tubercle. With which thoracic vertebral structure does this articulate?
A
transverse process
9
Q
Costal sulcus/groove. Which structures lie in the costal groove?
A
intercostal nerves vessels
10
Q
Which ribs are true ribs (vertebrosternal)? Ribs
A
1-7
11
Q
Which ribs are false ribs (vertebrochondral)? Ribs
A
8-10
12
Q
Which ribs are floating ribs (vertebral)? Ribs
A
10-12
13
Q
A
14
Q
Articulate a typical rib with the vertebra and determine what part of the rib articulates with this facet
A
tubercle of ribs
15
Q
Which two parts of the vertebra form the neural (vertebral) arch, ie. parts of the vertebra that enclose
the spinal cord?
A
The posterior surface of vertebral body encloses the neural arch which is created by fusion of two pedicles and 2 laminae
16
Q
Which bones form the boundaries of the thoracic inlet?
A
1st thoracic vertebrae, 1st ribs internally, superior border of manubrium
17
Q
Which bones/costal cartilages form the boundaries of the thoracic outlet?
A
12 thoracic vertebrae posteriorly, 11th and 12th rib laterally, costal cartilage of 7-10 ribs anterioly and xiphersternal angle.
18
Q
Which ribs/costal cartilages form the costal margin (subcostal angle)?
A
formed by 7-10 ribs
19
Q
Which costal cartilages (cc.) are:
a) directly attached to the sternum?
b) indirectly attached to the sternum through attachment to preceding costal cartilages?
A
1-7
8-10
20
Q
which muscle is primarily used for breathing in the newborn?
A
diaghram
21
Q
Between which two intercostal muscles is the neurovascular bundle located?
A
Between internal and innermost intercostal muscle.
22
Q
From superior to inferior, which structures comprise the neurovascular bundle?
A
vein-artery-nerve
23
Q
In which area of the rib is the neurovascular bundle located?
A
inferior area of rib
24
Q
Where in the intercostal space do you think a chest drain needle should be inserted to avoid damaging the neurovascular structures?
A
upper border of the rib belows
25
What is a dermatome?
Skin applied by one spinal nerve
26
What is the dermatome overlying the:
* sternal angle?
* nipple area?
* umbilicus?
* inguinal region (groin)?
T2
T4
T10
L1
27
Which of the left or right dome lies more superior during normal expiration? Why?
Right dome- because the liver pushes it up the diaghram
28
What cardiac structure is firmly attached the central tendon? Fibrous
pericardium
29
to which vertebrae are the left and right crura attached?
left l1-l2
right l1-l3
30
Which membrane covers the superior surface of the diaphragm? Parietal
pleura
31
When the diaphragm contracts, do the domes ascend or descend?
Descend
32
Opening for the inferior cava. Occurs at vertebral level
T8
33
Opening for the oesophagus. Occurs at vertebral level
T10
34
Opening for the aorta. Occurs at vertebral level
T12
35
Through which part of the diaphragm does the inferior cava pass – the central tendinous part or the muscular part? How does this assist venous return to the heart?
Tendinous-because muscle contract and restrict flow while tedons dont, so it doesnt restrict flow
36
What vertebral levels of the spinal cord contribute to the phrenic nerves?
C3-4-5
37
What structure prevents solids and liquids entering the laryngeal inlet?
Epiglottis
38
The incomplete hyaline cartilage rings. +/- how many rings comprise the trachea?
15-20
39
The muscle completing the tracheal rings posteriorly. Name this muscle
trachealis
40
The final keel-shaped cartilage ring at the bifurcation of the trachea called the
carina
41
The tubular organ lying immediately posterior to the trachea is the
oesophagus
42
At what vertebral level does the trachea divide into the two main bronchi?
T4
43
Which of the two main bronchi is the shorter, wider and more vertical?
Note: This is the bronchus into which an accidentally aspirated object is more likely to pass.
Right
44
Identify two major arteries arching over the left main bronchus
Left pulmonary vein and Aorta
45
On which lung surface is the hilum found?
medial/saggital
46
What is the hilum of the lung?
47
What is the root of the lung?
48
Which 4 structures constitute the root of the lung?
pulmonary artery, pulmonary vein, bronchi
49
What fascial membrane covers the apex of the lung?
pleural membrane
50
Do the lungs extend above the 1st rib and clavicle? Why is this of clinical importance?
yes, need to be careful not to rupture the lungs
51
Which lung is the shorter and broader of the two? Which abdominal organ gives rise to this asymmetry?
right lung, due to liver
52
What structures present within the bronchial wall enable its definitive identification as a bronchus?
cartiligeous plates
53
situated above the artery in the hilum of the right lung is the
hypercarteriam bronchus
54
The thoracic wall
* The thoracic wall encloses the left and right pleural cavities (containing the lungs). Between these is the mediastinum (the structures **“standing in the middle”)**, including the heart within the pericardial cavity.
* Each of these cavities is a closed sac.
55
The function of the thoracic wall is
To protect the **contents** of the sacs, yet permit the **movements** associated with respiration.
56
The thoracic wall comprises
The sternum anteriorly, vertebrae **T1-T12** posteriorly, and ribs **1-12** laterally.
57
1st rib
The first rib is an **atypical**, t**rue rib**: It is short and wide and flat and it articulates with **only** a single vertebra
58
subclavian artery and veins
* These two vessels are the **chief** blood supply to and from the **upper limb** and pass from the neck to the axilla, sandwiched between the clavicle and first rib.
* The subclavian vein lies s**uperficial (anterior)** to the subclavian artery.
59
A typical rib articulates with
**Two v**ertebral bodies.
## Footnote
These are:
1. The vertebral body of the **same number** as the rib
2. The vertebral body i**mmediately above**
60
Boundaries of the Thoracic Cage
* The thorax is bounded superiorly by the thoracic inlet,
* Inferiorly by the **thoracic outlet,**
* Anteriorly by the **sternum and costal cartilages,**
* Posteriorly by vertebrae **T1-T12,**
* Laterally by ribs **1-12**
* Inferiorly by the **diaphragm.**
61
Intercostal space, muscles and nerves
The paired intercostal spaces each contain **3 layers of intercostal muscles,** an **intercostal nerve,** and a **posterior and anterior intercostal artery and vein.**
The number of each space accords with the number of the rib **lying superior** to it.
Upper limb and back muscles which have attachment to the ribs can act as **accessory respiratory** muscles in forced inspiration and expiration.
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Intercostal muscles
The intercostal muscles, whilst contributing to respiratory movements of the chest wall, also assist in **preventing** the lungs and pleura from **ballooning out** between the ribs during these movements.
Each structure forming the intercostal neurovascular bundle in a particular intercostal space gives off a **small collateral branch** which is located just above the top of each rib.
63
Dermatomes of the chest wall and Lymphatics
On the chest wall dermatomes correspond with the intercostal spaces.
The nerves from the **lower 6 i**ntercostal spaces (**T7-12)** project serially onto the anterior abdominal wall creating the correspondingly named dermatomes there.
64
The Diaphragm and respiratory movements
The diaphragm is a sheet of skeletal muscle that forms the boundary between the thoracic and abdominal cavities.
It has **4 attachments**, and **3 major** and a number of **minor hiatuses** (openings) which permit structures to pass between thorax and abdomen.
It is the main muscle of respiration, but also assists in raising intra-abdominal pressure during coughing, vomiting and defaecation.
65
The external and internal intercostal muscles
Do not occupy the entire length of the intercostal space, rather they become tendinous and develop into a thin **aponeurosis** (a flat tendon) called an intercostal membrane.
66
External intercostal muscles
Filll the intercostal space as far as the costochondral junction anteriorly.
The remaining part of the space up to the sternum is completed by the external intercostal membrane.
67
Internal intercostal muscles
# Fill the intercostal space from the sternum to the costal angles posteriorly.
The remaining part of the space up to the thoracic vertebrae is completed by the **internal intercostal membrane.**
68
The innermost intercostal muscles
**Only** fill the central half of the space.
The remainder of the space is completed anteriorly by the t**ransversus thoracis muscles** and posteriorly by the **subcostalis muscles.**
69
Hiatuses
The major structures traverse the diaphragm through the major hiatuses (openings), while smaller structures can pass along with the major structures through the major hiatuses or pass through a **minor hiatus by themselves.**
70
The URT consists of the
Nasal cavity, pharynx and larynx, and is located in the h**ead and neck.**
71
Larynx:
Is a set of cartilages, membranes and ligaments which produce sound from expired air and protects the inlet to the respiratory system.
It is attached to the **hyoid bone** superiorly and is continuous inferiorly with the trachea at **C6**.
It is supplied almost entirely by branches of the **vagus nerve** for **both** motor and sensory innervation.
It is anteriorly related to the pharynx (=“throat”).
72
Lower Respiratory Tract
Consists of the trachea, the main (principal/primary bronchi and their branches), the lungs and pleurae
The LRT is receives motor innervation through **sympathetic fibres** originating in the **upper thoracic spinal levels**, via pulmonary plexuses located at the **termination** of the main bronchi, and parasympathetic fibres from the vagus nerve.
Sensory fibres reaches the spinal cord via **both** the sympathetic and parasympathetic nerves.
Arterial supply is via the **bronchial** arteries arising from the thoracic aorta and intercostal arteries, while the bronchial veins drain to the a**zygos venous system**.
73
Trachea
Is the inferior continuation of the larynx at **C6** (just inferior to the cricoid cartilage), through the thoracic inlet, to vertebra **T4 (sternal angle**), where i**t bifurcates** into the left and right main bronchi.
74
left and right main bronchus
While the left main bronchus enters the lung before giving off its branches, the right main bronchus gives off **a superior branch** just before entering the right lung.
This branch is known as the **eparterial or superior lobar bronchus** (the main bronchus then being called the hyparterial bronchus).
The bronchi ramify in the lungs to become secondary, tertiary, terminal and respiratory bronchioles, and alveoli, gradually losing their cartilage and increasing their elastic fibre content.
75
Hilum
This is the **_area_** on the medial surface of the lung through which structures enter or leave the lung.
Root: The **_structures_** which enter and leave the lung at the hilum are known collectively as the root of the lung. The structures of the root have constant relative positions within the hilum.
76
Pulmonary circulation
The pulmonary circulation is the portion of the circulatory system which carries **deoxygenated** blood **away f**rom the **right ventricle** of the heart, to the lungs, and returns **oxygenated** blood to the **left atrium** and ventricle of the heart.
77
Bronchial circulation
Supplies blood to the tissue of the larger airways of the lung.
78
Pulmonary circuit
Deoxygenated blood leaves through the right ventricle through the pulmonary artery.
From the right atrium, the blood is pumped through the tricuspid valve (or right atrioventricular valve), into the right ventricle.
Blood is then pumped from the right ventricle through the pulmonary valve and into the main pulmonary artery.
79
Pleura
A double layer of serous membranes that surround each lung.
The space between the 2 membranes is known as the **pleural space or cavity**. This space is the true pleural cavity and should not be confused with the cavity in the chest occupied by the lung and its surrounding pleura – also usually termed the **“pleural cavity”** by clinicians.
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