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ESA 3 Callum's Cards > Respiratory S2 (Done) > Flashcards

Respiratory S2 (Done) Flashcards

(64 cards)

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1
Q
A
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2
Q

Label the boxes from top down

A

Jugular notch

Clavicle

Sternal angle

Costal margin

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3
Q

Describe the anterior associations of the ribs and their costal cartilages

A

Ribs 1-7:

Connected by costal cartilages directly to sternum

Ribs 8-10:

Connected by costal cartilage to the costal cartilage above

Ribs 11-12:

Free floating, no connection to sternum/cartilage

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4
Q

Label this diagram from top down

A

The typical rib:

Head

Neck

Shaft

2 articular facets separated by crest

Tubercle (Top = articular, Bottom = non-articular)

Costal groove

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5
Q

What ribs are considered typical?

A

Ribs 3 to 9

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6
Q

Label each of these ribs with their number and features that make them ‘atypical’

A

Top to bottom:

Rib 1:

shortest, broadest, most curved, only has 1 facet on head

Rib 2:

Poorly marked costal groove

Ribs 11 + 12:

Floating

Single facet on head

No tubercle

Tapering anterior end

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7
Q

Label the boxes

A

First set of boxes

Participants in joint of head of rib:

Body of vertebra superior to rib

Intervertebral disk

Body of vertebrae same number as rib

Second set of boxes

Costo-transverse joint:

Transverse process of vertebra of same number as rib

Tubercle of rib

Axis of rib rotation

Movements (the arrows):

Elevation

Depression

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8
Q

Label the black and red boxes

A

Black, top left clockwise:

Axis of movement

Axis of movement

Increase in sagittal diameter

Increase in transverse diameter

Neck of rib

Red, left to right:

Lower rib

Upper rib

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9
Q

What are the three layers of intercostal muscle

Give a brief description of each

A

External intercostals:

Fibre direction is posterior to anterior from the inferior border of the superior rib to the superior border of the inferior rib

Outermost

Internal intercostals:

Fibre direction is anterior to posterior from the inferior border of the superior rib to the superior border of the inferior rib

Middle layer

Innermost intercostals:

Run from the inferior border of the superior rib to the superior border of the inferior rib

Innermost layer

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10
Q

Label the boxes top to bottom

A

External intercostal muscles

Internal intercostal muscles

Innermost intercostal muscles

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11
Q

Describe the actions of the external intercostal muscles

A

Elevation of the upper ribs in a ‘pump handle’ movement to increase A-P diameter of thorax

Elevation of lower ribs in a ‘bucket handle’ movement increasing the lateral diameter of the thorax

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12
Q

Describe the actions of the internal and innermost intercostal muscles

A

Depress the ribs during forced expiration

Reduces A-P and lateral diameter

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13
Q

What muscles are responsible for passive expiration?

A

No muscles, passive process driven by elastic recoil of lungs and chest wall

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14
Q

What structures are labelled here?

A

Two neurovascular bundles

Main bundle includes intercostal vein, artery and nerve and runs in costal groove of superior rib

Collateral bundle runs along the superior border of the inferior rib

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15
Q

Describe the 12 intercostal nerves

A

Course:

Appear from the anterior rami of thoracic spinal nerves (T1 - T12)

Run between internal and innermost intercostal muscles

Supply:

Intercostal muscles in corresponding space

Parietal pleura

Overlying skin

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16
Q

Label the boxes from top left clockwise

A

Paravertebral chain

Intercostal nerve

Posterior intercostal artery

Anterior intercostal artery

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17
Q

What is supplied by the intercostal arteries?

A

Intercostal muscles

Parietal pleura

Overlying skin

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18
Q

Label boxes in two rows, Left row then right row, top to bottom

A

Left:

Superior vena cavae

Azygous vein

Hemiazygous

IVC

Right:

Anterior intercostal vein

Internal thoracic vein

Posterior intercostal veins

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19
Q

From where do the posterior and anterior intercostal arteries arise?

A

Anterior:

Internal thoracic artery (branch of the subclavian)

Posterior:

Thoracic aorta

Superior intercostal artery (From the costo-cervical traunk, a branch of the subclavian)

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20
Q

Describe the venous drainage of the chest wall

A

Primarily into the Azygous system —> SVC

Some drainage into internal thoracic vein

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21
Q

Describe the structure of the diaphragm

A

Central tendon + Peripheral uscle

Peripheral muscle areas:

Sternal - Arising from xiphisternum

Costal - Arising from inner aspects of the 7-12 costal cartilages

Vertebral - Arising from arcuate ligaments (thickenings of fascia over the posterior abdominal wall muscles) + crura

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22
Q

Label black boxes from top left clockwise

A

IVC opening

Central tendon

Oesophaseal opening

Aortic hiatus w/median ligament overlying

Left crus

Right crus

Lateral arcuate ligament

Medial arcuate ligament

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23
Q

Give the vertebral level of the openings in the diaphragm and attachment sites of the right and left crus

A

**Oesophagus: **

T10

Vena cava:

T8

Aortic Hiatus:

T12

Right crus:

L4

Left crus:

L3

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24
Q

What is the function of the diaphragm in relation to breathing?

A

Main muscle of inspiration

Contraction causes descent of diaphragm, expanding the thoracic cavity

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25
Describe the nerve supply of the diaphragm Include any additional innervation of that nerve
**Phrenic nerve** **Roots:** C3 - 5 (3-4-5 keep you alive) **Motor innervation:** Diaphragm **Sensory innervation:** Pericardium Mediastinal and diaphragmatic portions of parietal pleura Both surfaces of diaphragm
26
What muscles/actions are involved in inspiration? What are the results of these muscle actions?
**External intercostals:** Elevation of ribs **Contraction of diaphragm:** Descent **Sternocleidomastoids:** Elevates sternum **Scalenes:** Elevate and fix upper ribs **Results:** Increased transverse and A-P diameter Increase in vertical dimension
27
Describe the process of expiration in regards to actions/muscles involed
Quiet expiration: No muscles, just elastic recoil **Forced expiration:** Internal and innermost intercostals Rectus abdominus External and internal obliques Transversus abdominus **Results of either passive or forced:** Decrease in AP and transverse diameter Decrease in the vertical dimension
28
What is the involvement of the pleura in respiration? Briefly describe how this works
As muscle action expands the thorax and the parietal pleura the pleural seal ensures that the visceral pleura and hence the lung also expand The pleural seal is formed from surface tension between fluid molecules of the serous secretions in the pleural cavity
29
What is the clinical relevance of the pleural seal?
Puncture of the parietal pleur breaks the pleural seal, allowing the visceral and parietal pleura to separate, this is a pneumothorax (lung collapse)
30
Decribe the nerve supply of the pleura
**Parietal:** Somatic innervation (including pain) and autonomic **Visceral:** Only autonomic
31
Describe the blood supply of the pleura
**Parietal:** Intercostal arteries and internal thoracic artery Corresponding veins drain **Visceral:** Bronchial arteries Bronchial veins
32
Describe the anatomical location and important features of the trachea
Extends from the lower border of the cricoid cartilage to the division od bronchi at the **carina** (Spinal level T4/5) Fibro-cartilagenous tube 18-22 U shaped cartilage rings Trachealis muscle posteriorly
33
What is the clinical relevance of the angle of tracheal bifurcation?
If angle is wider than normal this indicates swollen tracheo-bronchial lymph nodes
34
What is a broncho-pulmonary segment and what is the clinical relevance?
**Broncho-pulmonary segment:** Area of lung supplied by its own segmental bronchus and segmental branches of pulmonary arteries and veins Pyrimidal in shape, apex towards hilum, base towards lung surface **Clinical:** Segment can be isolated and removed with little damage to others (E.g. removal of small primary or metastatic tumours)
35
What is the apex of the lung and why is it clinically relevant?
**Apex:** Superior portion of the lung extending superiorly through the superior thoracic inlet and to the base of the neck **Clinical:** Apical lung tumours can compress structures in root of neck (E.g. brachial plexus, subclavian vessels, sympathetic trunk) Subclavian vein cannulation can lead to pleural puncture (pneumothorax)
36
What structures pass throught the lung Hilum?
Pulmonary and bronchial arteries and veins Bronchi
37
From where do the bronchial arteries arise? where do they supply? What is the role of the bronchial arteries in venous drainage of the lungs?
**Arteries:** Arise from aorta on left and 3rd intercostal on right Supply bronchial tree from the carina to the respiratory bronchioles, visceral pleura and connective tissue **Veins:** Most drainage is via pulmonary veins rather than bronchial Superifical bronchial veins drain the visceral pleura and bronchi in the hilar region into the azygous vein on the right and hemiazygous vein on the left Deep group drain the deeper bronchi into the pulmonary vein
38
Label the black boxes and identify each lung
**Lung pictured left, boxes from top to bottom, left to right:** Right lung Pulmonary arteries Bronchus Pulmonary veins Pulmonary ligament **Lung pictured right, boxes from top to bottom:** Left lung Pulmonary artery Bronchus Pulmonary veins
39
PIctured are the right and left mediastinal spaces with lungs removed, identify the structures labelled
**Left picture, top to bottom:** Sympathetic chain Vagus nerve Phrenic nerve **Right picture, top to bottom:** Reccurent larangeal nerve (branch of vagus) Vagus nerve Phrenic nerve Aorta
40
Label the boxes and identify the borders of each mediastinal space
Boxes, top to bottom, left to right: **Anterior** Body of sternum Fibrous pericardium **Superior** Thoracic inlet Plane passing throught sternal angle and lower border of T4 **Middle** Between anterior and posterior **Posterior** Fibrous percardium Vertebral bodies
41
Describe the nerve supply of the lungs
Lung recieves innervation from differnt nerves all via the pulmonary plexuses at each lung hilum **Vagus Efferent:** Parasympathetic nerves provide motor innervation to bronchial smooth muscle (constriction) Pulmonary vasoldilation Secretomotor innervation to mucous glands **Vagus afferent:** cough reflex Subserving pain **Sympathetic trunk:** Bronchodilation Vasoconstriction
42
Describe the lymphatic drainage of the lungs
**Superficial sub-pleural lymphatic plexus:** Lies deep to visceral pleura Drains lung parenchyma and visceral pleura Drain into hilar lymph nodes at each lung hilum **Deep broncho-pulmonary lymphatic plexus:** Lies in the submucosa of bronchi and peribronchial tissue Drain into the hilar nodes
43
What si the normal composition of alveolar air? Give partial pressures
pO2 = 13.3kPa pCO2 = 5.3kPa
44
Give the normal gaseous content of mixed venous blood returning to the lungs
pO2 = 6kPa pCO2 = 6.5kPa Can vary with metabolism
45
Identify the direction of gas gradients across the alveolar membrane and hence give direction of movement of each gas
**pO2:** 13.3kPa \> 6.0kPa Therefore O2 moves into alveolar capillaries **pCO2:** 5.3kPa \< 6.5kPa Therefore CO2 diffuses into alveoli
46
Aside from gradient what factors influence diffusion of gases across the alveolar membrane?
Surface area (Ideally large) Diffusion resistance (Ideally low)
47
What factors influence diffusion resistance?
Nature of gas Nature of barrier
48
Describe the diffusion barrier in the lungs
Diffusion occurs across alveolar wall and into RBCs therefore barrier made up of: Epithelium of alveolus Tissue fluid Endothelial cells of capillary Plasma Red cell membrane **Total = 0.6um**
49
Which diffuses faster, Co2 or O2? Why?
**CO2 (x21):** Gases diffuse at rate proportional to solubility Therefore CO2 faster
50
Apart from solubility what other feature of gases goes towards determining diffusion rate?
**Molecular weight:** Gases diffuse at rate inversely proportional to molecular weight
51
Houw long does it take for partial pressures of alveolar gases and blood gases to equilibrate in the lung? How long do blood cells spend in the alveolar capillaries and why is this relevant?
0.5s 1s **Relevance:** Plenty of leeway, diffusion not limiting on lung function
52
What are the partial pressures of gases in blood leaving the alveolar capillaries?
**pO2 = **13.3kPa **pCO2 = **5.3kPa
53
Describe the process of ventilation and what it achieves
Expansion of the lungs increasing the volume of respiratory bronchioles and alveolar ducts, drawing air into them Air is not drawn directly into alveoli, fresh air is an incorrect mix Raises pO2 and lowers pCO2 in alveoli
54
Label the boxes and define the terms
Top to bottom **Inspiratory reserve:** Extra volume that can be breathed in over that inspired at rest **Tidal volume:** Volume in and out with each breath at rest **Expiratory reserve volume:** Extra volume that can be breathed out over that expired at rest
55
Label the box and define Give how this volume is measured
**Residual volume:** Volume left in lungs at maximal expiration Measured with a helium dilution test
56
Label the box, define it and give it's typical value
**Vital capacity:** Measured from maximal inspiration to maximal expiration About 5L in typical adult Cn be altered by disease
57
Label the box, define it and give it's typical value
**Inspiratory capacity:** Measured from resting expiratory level to maximal inspiration Typically 3L
58
Label the box, define it and give typical value
**Functional residual capacity:** Volume of air in lungs at resting expiratory level (Expiratory reserve + Residual volume) Typically 2L
59
Define ventilation rate
Volume of air moved into and out of a space (lungs) per minute Product of volume per breath and resp rate
60
Give the exquation of pulmonary ventilation rate and the typical values
Tidal volume x resp rate Typically 8L.min-1 Can exceed 80L.min-1 in exercise
61
How does alveolar ventilation rate differ from pulmonary ventilation rate?
Discounts volume of air only moved into dead spaces in the lung where no gas exchange occurs (bronchi etc)
62
# Define 'serial dead space' How is it measured? Give a typical value
Volume of the airways Used to be known as 'anatomical dead space' Measured via nitrogen washout test Typically 0.15L
63
# Define 'distributive dead space' and 'physiological dead space' Give typical values
**Distributive:** Parts of the lungs that do not support gas exchange but are not airways, including: - Dead or damaged alveoli - Alveoli with poor P/V ration **Physiological:** Distributive + Serial dead space to give total 'dead space' Typically 0.17L
64

ESA 3 Callum's Cards (55 decks)

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