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2nd Year - systems 2 > Respiratory Anatomy > Flashcards

Respiratory Anatomy Flashcards

1
Q

Features of thoracic vertebrae

A

Heart shaped body
Round vertebral foramen
Long, downward facing spinous process

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2
Q

Articulations of thoracic vertebrae

A

Transverse costal facet - tubercle of rib
Superior costal facet - head of rib
Inferior costal facet - top of head of the rib below

Costal groove (on rib) - intercostal vein, artery and nerve VAN

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3
Q

Atypical ribs

A

T1,2,11 and 12

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4
Q

1st rib

A

Short, wide
Only one facet on head for articulation (no thoracic vertebrae above)
Superior surface is lumpy - has two grooves for subclavian vein and artery

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5
Q

2nd rib

A

Longer and thinner than 1st rib

Roughened area on superior surface where serratus anterior attaches

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6
Q

11th and 12th ribs

A 
No neck (like less curved typical ribs)
Only one facet for articulation with corresponding vertebrae
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7
Q

Vagus and phrenic in thoracic inlet

A

Vagus more medial, by trachea
Phrenic next to, but more lateral

(2 of each)

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8
Q

Intervertebral joints

A

Secondary cartilaginous

Between vertebral bodies and intervertebral discs

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9
Q

Costovertebral joints

A

Synovial plane

Head of rib to SCF and ICF

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10
Q

Costotransverse joints

A

Synovial plane

Tubercle of rib to transverse process

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11
Q

Costochondral joints

A

Primary cartilaginous

Costal cartilage to sternal end of rib

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12
Q

Interchondral joints

A

Synovial plane

Between costal cartilages of 6-9th ribs

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13
Q

Sternocostal joints

A

1st - primary cartilagenous - costal cartilage to manubrium

2nd-7th - synovial plane - costal cartilage to sternum

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14
Q

Sternoclavicular joints

A

Synovial saddle

Clavicle to manubrium of sternum and 1st costal cartilage

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15
Q

Manubriosternal joints

A

Secondary cartilaginous

Manubrium to body of sternum

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16
Q

Xiphisternal joint

A

Primary cartilaginous

Xiphoid process to body of sternum

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17
Q

Vessels of thoracic wall

A

Aorta, posterior intercostal artery arises from here
Continues to front (lateral cutaneous branches off) to become anterior intercostal artery to join upward chain internal thoracic artery

VAN order (veins at top)

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18
Q

Nerves of thoracic wall

A

Innermost, internal then external intercostal nerves

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19
Q

Sympathetic trunk

A

Lies to right of aorta
Runs with azygous vein

(Thoracic duct to left, with hemiazygous vein)

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20
Q

Shingles

A

Caused by human herpes virus-3 (HHV-3)
Primary infection in childhood -> chickenpox
Then virus lies dormant in dorsal root ganglia of sensory nervous system
Then will flare up in single dermatome segment, usually on chest wall

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21
Q

Primary muscle of respiration

A 
Diaphragm
External intercostal (hands in pockets)
Internal intercostal (opposite)
Innermost intercostal (all directions, cross multiple rib spaces)
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22
Q

Accessory muscles of repiration

A 
Sternocleidomastoid
Anterior, middle and posterior scalenes
Pectoralis major and minor
Erector spinae
Quadratus lumborum
Latissimus dorsi
Trapezius
  • only if respiratory requirements increased, normal breathing just diaphragm
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23
Q

Surface anatomy of lungs

A

Apex 2cm above clavicle
Lower margin 2 ribs above pleural limit - 6th rib in midclavicular line, 8th in midaxillary, 10th at angle of ribs (back)

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24
Q

Oblique and horizontal fissures, surface anatomy

A

Oblique from spine of T4 to 6th rib in midclavicular line

Horizontal (only right) from 5th rib in midaxillary line to 4th costal cartilage at sternum

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25
Q

Surface anatomy of pleura, lower margin

A

Extend down to 8th rib in midclavicular line, 10th in midaxillary, 12th at angle of ribs

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26
Q

Structures passing through diaphragm at T8

A

Inferior vena cava (8) and phrenic nerves

  • tendinous, or IVC would be compressed
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27
Q

Structures passing through diaphragm at T10

A

Oesophagus (10) and vagus, and oesophageal branch of left gastric vessels

  • muscular, as helps peristalsis and stops reflux as aperture acts as sphincter
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28
Q

Structures passing through diaphragm at T12

A

Aorta and splanchnic nerves, and thoracic duct, azygous and hemiazygous veins

  • behind diaphragm, or would be compressed through muscle
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29
Q

Diaphragmatic hernias

A

CONGENITAL

  • when diaphragm not formed properly
  • usually posterolateral, sometimes anterior

HIATUS

  • acquired hernia, when oesophagus goes above diaphragm, rolls or slides
  • acid reflux symptoms
  • caused by excess strain on diaphragm or weakness
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30
Q

Pleural effusion - procedure

A

Pleural tap / chest drain to remove liquid

To prevent recurrence, can use a chemical powder to stick pleura together, prevent fluid build up

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31
Q

Pleura and innervation

A

Mesothelial membranes that line thoracic cavity and enclose pleural space (potential only)
Contain small amount of pleural fluid, to lubricate lung movements in breathing

PARIETAL
Costal - intercostal nerve
Diaphragmatic - phrenic nerve
Mediastinal - phrenic nerve

VISCERAL - vagus nerve

32
Q

Mesothelioma

A

Thickened, pale, cream coloured pleura all around lung and into fissures - tumorous
Nearly always from past asbestos history (can be 40 years +)
Asbestos not broken down in body so WBCs accumulate
-> breathlessness as pleura constricts lung

33
Q

Decompression of tension pneumothorax

A

One way valve is created, increase intra-thoracic pressure and organs shift away - can be fatal

1) Needle to 2nd intercostal space in midclavicular line - hear hiss
2) Chest drain to 5th intercostal space in midaxillary line

MUST be along superior border of rib, as neurovascular bundle lies immediately inferior

34
Q

Types of epithelia down airway

A

Trachea - pseudostratified ciliated, with goblet cells
Bronchi - columnar ciliated with goblet cells
Bronchioles - ciliated simple columnar -> ciliated simple cuboidal (with club cells throughout)
Alveoli - simple sqaumous

35
Q

Defence in respiratory tract

A 
Filtered in nasopharynx
Sneeze and cough reflex
Epithelial barrier
Mucociliary escalator
Immune response, as loose lymphoid tissue drains to nodules
36
Q

Left vs right bronchus

A

Right

  • shorter, straighter - easier flow into
  • 3 secondary bronchi
  • less cartilage, more smooth muscle

Left

  • right angle - harder flow in
  • 2 secondary bronchi
  • more cartilage, less smooth muscle
37
Q

Major differences between trachea and bronchi

A

Bronchi:

  • cartilage not continuous, hyaline plates instead
  • columnar not pseudostratified epithelia
  • fewer goblet cells
38
Q

Club cells

A

In terminal bronchioles instead of goblet cells
Non-ciliated dome-shaped columnar cells
Microvilli
Protective and regenerative role
May act as stem cells for repair in bronchioles
Possible secretory role - surfactant, anti-proteases, oxidases to protect

39
Q

Respiratory vs terminal bronchioles

A
  • respiratory have less collagen, less smooth muscle
  • respiratory have squamous epithelia, terminal have cuboidal
  • alveolar ducts branch off respiratory
40
Q

Histology of lobar pneumonia

A

Alveoli fill with pus, cannot fill with air, less gas exchange
Stretched and inflamed alveolar walls
Mostly dead neutrophils visible, some macrophages

41
Q

Bones of nasal septum

A

Septal cartilage anterior

Then perpendicular plate of ethmoid at top, vomer at bottom

42
Q

Openings of paranasal air sinuses - under superior concha

A

2

Posterior ethmoid + sphenoid (further back)

43
Q

Openings of paranasal air sinuses - under middle concha

A

4

Frontal, middle and anterior ethmoid, maxillary (maxillary clearest, furthest back)

44
Q

Openings of paranasal air sinuses - under inferior concha

A

1
Nasolacrimal duct

  • eustachian orifice doesn’t open into nasal cavity, opens into nasopharynx
45
Q

Maxillary sinus innervation

A

Maxillary division of trigeminal (V)
So sinusitis can be referred to upper jaw, teeth and skin of cheek

Sinusitis is an inflammation of membranous lining of sinuses -> pain, nasal discharge

46
Q

Cranial nerves

A 
O - olfactory
O - optic
O - occulomotor
T - trochlear
T - trigeminal
A - abducens
F - facial
V - vestibulocochlear
G - glossopharngeal
V - vagus
A - accessory
H - hypoglossal
47
Q

Epistaxis

A

Nose bleeds

Usually from damage to anterior-inferior part of nasal septum vessels - arterial anastamosis here

48
Q

Obstruction in pharynx

A

Due to - adenoids, palatine tonsils, obstructive sleep apnoea -> snoring
-> STERTOR - (partial airway obstruction above the level of the larynx)

49
Q

Obstruction in larynx

A

-> STRIDOR - (partial airway obstruction below the level of the larynx)

50
Q

Vocal chord paralysis

A

From damage to recurrent laryngeal nerve through trauma

  • > HOARSENESS - if unilateral
  • > BREATHING DIFFICULTIES AND APHONIA - if bilateral
51
Q

Nasopharynx

A

Opens into nasal cavity
Extends from base of skull to soft palate (C1)
Contains pharyngeal tonsils, eustachian tonsils, opening of auditory tube

52
Q

Oropharynx

A

Opens into oral cavity
Extends from soft palate (C1) to tip of epiglottis (C3)
Contains palatine tonsils

53
Q

Laryngopharynx

A

Opens into larynx
From tip of epiglottis (C3) to cricoid cartilage (C6)
Contains NOTHING, needs to be clear for air

54
Q

Lymph tissue in pharynx

A

Pharyngeal tonsils and eustachian tonsils in nasopharynx
Palatine tonsils in oropharynx
Lingual tonsils under tongue
(Waldeyer’s ring)

-> drains to retropharyngeal then deep cervical nodes

55
Q

Blood and nervous supply to pharynx

A

Arterial - from branches of facial, maxillary, laryngeal and lingual arteries
Veins - to internal jugular vein

Nerves - from pharyngeal plexus - glossopharyngeal for sensory and vagus for motor

56
Q

Laryngeal cartilages

A 
Thyroid - big
Cricoid - signet ring
Epiglottis - flap
Arytenoids - move vocal chords
Cuneiforms and corniculates - in quadrangular membrane under epiglottis
57
Q

Vocal folds

A 
False superior (vestibular fold)
Then true vocal chords
58
Q

Extrinsic muscles acting on larynx

A

Controlled by vagus
Move larynx as whole
Suprahyoid elevate for swallowing
Infrahyoid depress

59
Q

Intrinsic muscles acting on larynx

A

Thyroarytenoid - relax vocal ligament
Lateral cricoarytenoid - adduct vocal folds
Cricothyroid muscle - stretch and tense vocal ligaments, needed for forceful speech
Transverse arytenoid - adduct arytenoid cartilages
Oblique arytenoid - adduct arytenoid cartilages
Posterior cricoarytenoid - abduct vocal folds

60
Q

Nerve supply to larynx

A

Inferior laryngeal nerve - all intrinsic muscles (except cricothyroid), and mucosa below vocal folds
Superior laryngeal nerve - external - cricothyroid muscle, - internal - mucosa above vocal folds

  • recurrent laryngeal nerve is very close to thyroid, may be damaged in surgery -> hoarseness
61
Q

Intubation method

A

Stand behind patient head, extend neck fully, clear mouth
Laryngoscope lateral to tongue, tip in vallecula (above epiglottis)
Laryngoscope lifted to view vocal chords
Endotracheal tube inserted through chords into trachea
Balloon inflated to hold tube in place, ventilate
Check to ensure not in bronchus (only one lung inflating) or oesophagus

62
Q

Cricothyroidotomy

A

In emergency situations

Small slit on cricothyroid membrane, insert endotracheal tube

63
Q

Tracheostomy

A

For long term management
Inserted directly to trachea
Incision via anterior wall of neck in surgical procedure
To bypass air from obstruction eg laryngeal tumour
- cannot speak

64
Q

Symptoms of lung cancer

A 
Chronic cough
Haemoptosis
Persistent chest infections
Breathlessness
Loss of appetite, unexplained weight loss
Clubbing
Tiredness
Aches/pains when breathing or coughing
65
Q

Relations to trachea

A

Anterior - thyroid isthmus at 2nd/3rd tracheal cartilage, left brachiocephalic vein
Posterior - oesophagus
Lateral - lobes of thyroid gland, carotid sheath containing common carotid artery, internal jugular vein and vagus nerve

Bifurcation (carina) at T4/5, sternal angle, plane of louis

66
Q

Lung segments

A

2 primary bronchi, then left has 2 lobar, right has 3 lobar.

Then, 10 bronchopulmonary segments on each side
Each segment has a tertiary bronchus and pulmonary artery branch
Segments separated by connective tissue septa - can surgically remove one segment, and can contain disease
- pulmonary veins do not accompany bronchi, run between segments

67
Q

Polyphonic wheeze

A

High pitched, expiratory

Indicative of asthma - expiratory as further decreasing airway diameter as lung collapses

68
Q

Vessels at hilum

A

Left lung - clockwise to front
A
B V
V

Right lung - 
  A  B
  A  B
  V     V
(front is right, back is left)

Veins thicker than arteries, as pulmonary veins supply oxygenated blood
Back of lung is straight , front follows curved chest wall

69
Q

Neurovasculature of lungs

A

Bronchial arteries, branches of descending aorta
Bronchial veins drain to azygous and hemiazygous veins

Lymph to bronchopulmonary nodes at hilum, then tracheobronchial nodes at mediastinum, then nodes along trachea (lung cancer spreads this way)

Autonomic innervation from sympathetic trunk and vagus nerves via pulmonary plexuses
- parasympathetic constricts bronchioles, sympathetic dilates

70
Q

Examination results - pleural effusion

A

Position of trachea - central
Percussion note - stony dull
Breath sounds - reduced
Vocal resonance - reduced

71
Q

Examination results - lobar pneumonia

A

Position of trachea - central
Percussion note - dull
Breath sounds - reduced
Vocal resonance - increased

72
Q

Examination results - collapsed lung (atelectasis)

A

Position of trachea - towards
Percussion note - dull
Breath sounds - reduced
Vocal resonance - reduced

73
Q

Examination results - pneumothorax

A

Position of trachea - central
Percussion note - hyper-resonant
Breath sounds - reduced
Vocal resonance - reduced

74
Q

Examination results - tension pneumothorax

A

Position of trachea - away
Percussion note - hyper-resonant
Breath sounds - reduced
Vocal resonance - reduced

75
Q

Anterior auscultation

A

Apex - superior to medial third of clavicle
Superior lobe - 2nd intercostal space
Middle lobe (right) - 4th IC space
Inferior lobe - 6th IC space

76
Q

Posterior auscultation

A

Apex - superior to medial third of clavicle
Superior lobe - 2nd IC space
Inferior lobe - triangle - bordered by trapezius, latissimus dorsi, medial border of scapula

2nd Year - systems 2 (7 decks)

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