Respiratory system Flashcards
What are the functions of the respiratory organs?
- gas exchange
- protection of resp. apparatus
- phonation
- olfactory perception
Which organs belong to the upper, which to the lower airways?
upper airways: head → larynx
- nasal cavities
- paranasal sinuses
- pharynx
lower airways: larynx → pleural cavity
- larynx
- trachea
- bronchial tree (lung)
Which bones and cartilages form the skeletal framework of the external nose?
BONES:
- 2 ossa nasalia
- 2 procc. frontales maxillae
⇒ apertura piriformis
CARTILAGES:
- 2 procc. laterales ⇒ dorsum
- parts of nasal septum
-
cartilago alaris major (on each side)
- ⇒ crus laterale/crus mediale
⇒ apex nasi
- ⇒ crus laterale/crus mediale
- 3-4 cartilagines alares minores
How do you call the hairs inside the nose?
vibrissae
Which vessels supply, drain the external nose, resp.?
Which nerves are responsible for the sensory and motor innervation?
supply:
- a. facialis → a. angularis
- a. ophtalmica → a. dorsalis nasi
- a. maxillaris → a. infraorbitalis
drainage:
- v. facialis → v. ophtalmica superior
innervation: (cf. supply)
- sensory: n. opthalmicus, n. maxillaris
- motor: n. facialis via rr. buccales
What may cause a venous sinus thrombosis and how?
vv. draining into v. facialis/ophtalmica anastomose btw medial angle of the eye and the root of the nose
in case of inflammation involving lat. part of face + external nose bacteria can reach deep venous sinuses → venous sinus thrombosis
1 - 5
1) sinus frontalis
2) os nasale
3) proc. lateralis
4) cartilago alaris major, crus laterale
5) limen nasi
6 - 10
6) vestibulum nasi
7) concha nasalis media
8) cellula ethmoidalis post.
9) concha nasalis sup.
10) sinus sphenoidalis
11 - 17
11) n. nasopalatinus
12) concha nasalis inferior
13) maxilla
14) os frontale
15) tonsilla pharyngea
16) palatum molle
17) palatum durum
Label the access routes to the 3 nasal meatus.
Which structure is located posteriorly behind the superior nasal meatus?
⇒ olfactory organ
- dark blue**: sinus sphenoidalis
meatus nasi superior
- yellow: post. ethmoidal air cells
meatus nasi medius
- green: sinus frontalis
- light blue: ant. + med. ethmoidal air cells
- red: sinus maxillaris
meatus nasi inferior
- purple: ductus nasolacrimalis
Which vessels supply, drain the nasal cavity, resp.?
Which nerves are responsible for the sensory innervation?
supply:
- ant. 1/3: a. ophthalmica → a. ethmoidalis
- post. 2/3: a. maxillaris → a. sphenopalatina (aa. nasales post. lateral. + rr. septales post.)
drainage:
- ant: v. facialis, vv. ethmoidales → v. ophthalmica sup.
- post: vv. ethmoidales → plexus pterygoideus
innervation: (cf. supply)
- sensory: n. trigeminus
- ant. 1/3: n. ophthalmicus
- post. 2/3: n. maxillaris
What is the most frequent site for epistaxis (= nose bleeding)?
plexus cavernosus conchae (= Kiesselbach’s plexus, locus Kiesselbachi, esp. a. sphenopalatina) on middle and inferior concha
Explain how nasal sprays work.
- PNS → swelling of plexus cavernosus conchae
- SNS → detumescing of plexus cavernosus conchae
⇒ nasal sprays bind to α-adrenoreceptors → activation of SNS → vasoconstriction
What are the 4 paranasal sinuses?
What is their function?
- cellulae ethmoidales
- sinus maxillaris
- sinus frontalis
- sinus sphenoidalis
⇒ lightweight construction of head + resonance to voice
What are the boundaries of sinus frontalis?
- ant. - post.
- roof - floor
- med.
Access route to nasal cavity via .. ?
- ant.: arcus superciliaris
- med.: septum
- roof + post.: anterior cranial fossa
- floor: orbit
⇒ can be accessed via meatus nasi med.
What are characteristics unique to ethmoidal air cells?
What are their boundaries?
- med. - lat.
- floor - roof
Access route to nasal cavity via .. ?
can be grouped into ant./med./post. ethmoidal air cells
⇒ biggest: bulla ethmoidalis
BORDERS
- medially: upper part of nasal cavity
- laterally: orbit
- roof: anterior cranial fossa
- floor: maxillary sinus
⇒ can be accessed via meatus nasi sup./med.
What are the boundaries of sinus maxillaris?
- roof - floor
- dorsal - ventral
- med.
Why are they clinically relevant?
Access route to nasal cavity via .. ?
biggest paranasal sinus (12 - 15 ml)
- roof: orbita
- ventrally: facial surface of maxilla
- dorsally: tuber maxillae
- medially: nasal cavity
- floor: dental arch of maxilla ⇒ inflammation can cause toothache, ALSO: extraction of teeth can cause infection of sinus max.
⇒ can be accessed via meatus nasi med.
Any characteristics unique to sinus sphenoidalis?
What are its boundaries?
- vent. - caud.
- lat.
Why are they clinically important?
Access route to nasal cavity via .. ?
divided into right and left sinuisoidal sinus by a septum
- anteriorly: ethmoidal air cells, canalis opticus
- posteriorly: fossa hypophysialis ⇒ used for access to pituitary gland in case of tumors
- laterally: sulcus caroticus (a. carotis int., sinus cavernosus)
⇒ can be accessed via rec. sphenoethmoidalis
On which vertebral level can we find the larynx?
Where does it open into?
- newborns: C2-4
- adults: C5-7 (in men lower than in women)
⇒ opens into hypgopharynx AKA laryngopharynx
What are the 2 main functions of the larynx?
closure of lower airways during swallowing
larynx retracted below corpus adiposum preepiglotticum
phonation
- closure + tension of vocal folds
- expirational pressure → vibration of vocal folds
- pitch depends on tension of vocal folds:
the more tense, the higher the tone - loudness depends on volume + velocity of exhaled air
1 - 5
1) epiglottis
2) hyoid bone
3) cartilago thryoidea
4) trachea
5) arcus cart. cricoideae
6 - 10
6) lig. thyrohyoideum lat.
7) lig. thyrohyoideum medianum
8) lig. cricotracheale
9) membrana thyrohyoidea
10) cart. triticea
11 - 14
What are the 2 parts of #11?
Another name for #12.
11) m. cricothyorideus (pars recta + pars obliqua)
12) lig. cricothryoideum medianum (= lig. conicum)
13) n. laryngeus sup. r. int.
14) a. laryngea sup.
1 - 5
Another name for #4.
1) lig. hyoepiglotticum
2) lig. thyrohyoideum medianum
3) lig. thyroepiglotticum
4) lig. cricothryoideum medianum (= lig. conicum)
5) membrana triangularis
6 - 10
6) membrana quadrangularis
7) plicae vocales
8) plicae vestibularis
9) plica aryepiglottica
10) cart. cuneiformis
11 - 16
No #12.
11) cart. corniculata
13) m. arytenoideus transversus
14) m. cricoarytenoideus lat.
15) m. cricoarytenoideus post.
16) hyoid bone
17 - 22
17) epiglottis
18) cart. thyroidea
19) cart. cricoidea
20) ventriculus larnygis
21) m. thyroarythenoideus
22) m. arytenoideus obliquus
What are the parts of cavitas laryngis?
- sup.: vestibulum laryngis → plicae vestibulares
- med.: ventriculus laryngis → plicae vocales
- inf.: cavitas infraglottica → trachea
Which structures form the glottis AKA rima glottidis?
What are its parts?
plicae vocales
- ant. part: pars intermembranacea
- post. part: pars intercartilaginea
Which muscles cause an elevation or depression of the larynx?
ELEVATION
suprahyoid mm.
- m. digastricus
- m. stylohyoideus
- m. mylohyoideus
- m. geniohyoideus
add:
- m. thyrohyoideus
- m. palato-, stylopharyngeus
- m. constrictor pharyngis inf.
DEPRESSION (infrahyoid mm., exc. thyrohyoideus)
- m. sternohyoideus
- m. omohyoideus
- m. sternothyroideus
Which cartilages make up the laryngeal skeleton?
What happens to them at the end of puberty?
- cartilago thyroidea
- cartilago cricoidea
- cartilago arytenoidea
- epiglottis
⇒ ossify at the end of puberty (except epiglottis bc elastic, not hyaline cart.!!)
1 - 6
Another name for #6.
1) incisura thyroidea superior/inferior
2) lamina dextra/sinistra
3) tuberculum thyroideum superius
4) cornu superius/inferius
5) linea obliqua
6) prominentia laryngea (= Adam’s apple)
1 - 7
1) cartilago corniculata
2) proc. muscularis
3) facies articularis thyroidea
4) lig. cricoarytenoideum posterius
5) lamina cartilaginis cricoideae
6) cartilago arytenoidea
7) arcus cartilaginis cricoideae
8 - 13
8) collicus
9) proc. vocalis; lig. vocale
10) crista arcuata
11) fovea triangularis
12) proc. muscularis
13) fovea oblonga
What are the names of the small cartilages located in the larynx in craniocaudal direction?
- cart. triticea (in lig. thyrohyoideum lat.)
- cart. cuneiformis (in plica aryepliglottica)
- cart. corniculata (sitting on apex of cart. arytenoida)
1 - 2
1) cartilago epiglottica (= epiglottis)
2) petiolus epiglottidis
What are the 2 laryngeal joints?
- art. cricothyroidea
- art. cricoarytenoidea
Describe art. cricothyroidea.
- type: bilateral ginglymus
-
articulating surfaces:
- cornu inferius of thyroid cart.
- lamina of cricoid cart.
⇒ regulation of length/tension of ligg. vocalia
Describe art. cricoarytenoidea
- type: bilateral trochoginglymus with add. sliding
-
articulating surfaces:
- base of arytenoid cart.
- lamina of cricoid cart
- ligaments: lig. cricoarytenoideum
⇒ opening and closure of rima glottidis (for forced inhalation, phonation), only pars intercartilaginea open during normal breathing
The submucosal conn. tissue of the larynx forms special structures, which?
membrana fibroelastica laryngea forms conus elasticus in cavitas infraglottica
- med. part: lig. cricothryoideum medianum (= lig. conicum)
- lower lat. part: membrana triangularis
- upper lat. part: membrana quadrangularis
- plicae vestibulares → ligg. vestibularia
- *plicae vocales** → ligg. vocalia
Explain the process of voice break.
- *growth of vocal ligg. + larynx** → deeper voice
- (in males more than in females obv)*
Why is lig. conicum clinically important?
is cut in case of conicotomy in emergency medicine if upper airways are obstructed (= coniotomy, cricothyrotomy)
⇒ prominentia laryngea (= Adam’s apple) serves as important landmark
What is a laryngeal edema?
What could be possible causes?
loose conn. tissue in mucosa of the laryngeal inlet permits build-up of considerable amounts of fluid from the vascular system
e.g. due to inflammation/insect stings → life-threatening mucosal swelling
What is to note when using a laryngoscope?
image is inverted
Which muscles act upon the rima glottidis?
open rima glottidis = abduction
- m. cricoarytenoideus posterior (!!)
close rima glottidis = adduction
- m. cricoarytenoideus lateralis
- m. (inter)arytenoideus transversus
- m. arytenoideus obliquus
- m. vocalis
m. circothyroideus (pars recta + pars obliqua)
- ORIGIN: cricoid cart.
- INSERTION: cornus inf. of thyroid cart.
- ACTION: most important tensor of vocal cords → pitch
m. cricoarytenoideus post. (posticus)
- ORIGIN: lamina of cricoid cart.
- INSERTION: proc. muscular of arytenoid cart. on same side
- ACTION: only m. that opens rima glottidis
m. cricoarytenoideus lateralis (lateralis)
- ORIGIN: arch of cricoid cart.
- INSERTION: proc. muscularis of arytenoid cart. on same side
- ACTION: closure of pars intermembranacea
m. (inter)arytenoideus transversus
- ORIGIN: post. surface of arytenoid cart.
- INSERTION: same spot on 2nd arytenoid cart.
- FUNCTION: closure of pars intercartilaginea
m. arytenoideus obliquus
- ORIGIN: proc. muscularis of arytenoid cart.
- INSERTION: apex of 2nd arytenoid cart.
- ACTION: closure of pars intercartilaginea
+ all parts
m. thyroarytenoideus
- ORIGIN: inner side of thyroid cart.
- INSERTION: arytenoid cart. (int. part)
- ACTION: closure pars intermembranacea
- INSERTION: proc. vocalis (m. vocalis)
- ACTION: closure of vocal cords → fine tuning of tension
- INSERTION: epiglottis (m. thyroepiglotticus)
- ACTION: opens aditus laryngis
Which nn. are responsible for sensory and motor innervation of the larynx?
motor innervation:
- n. laryngeus sup. r. ext. → m. cricothyroideus
- n. laryngeus recurrens → n. laryngeus inf. → REST
sensory innervation:
- sup. part: n. laryngeus sup. r. int.
- inf. part: n. laryngeus recurrens
⇒ division sup. and inf. to rima glottidis for innervation and supply/drainage
Why is the innervation of the larynx clinically important?
surgeries on thyroid gland can possibly injure n. laryngeus recurrens → failure of n. cricoarytenoideus post.
- unilateral damage → hoarseness + paralysis of vocal cord
- bilateral damage → serious breathing problems
Which vessels supply, drain the larynx, resp.?
supply:
- a. carotis ext. → a. thyroidea sup. → a. laryngea sup.
- a. subclavia → a. thyroidea inf. → a. laryngea inf.
drainage:
- cf. supply
⇒ division btw sup. and inf. region at rima glottidis for supply/drainage + innervation
How long is the trachea?
Where does it start, where does it end?
What are its 2 parts?
- 10 - 13 cm, can expand up to 15 - 18 cm during deep inhalation
- C7 → T4/5
- 2 parts:
- pars cervicalis: behind thyroid gland
- pars thoracica
How do you call the structure btw the cartilagines tracheales?
How do you call the non-cartilaginous part?
ligg. annularia
paries membranaceus
What is important mention abt the tracheal bifurcation?
Clinical relevance?
- in bifurcation, spine = carina tracheae
- angle btw main bronchi btw 55 - 65°
- left angle usually: 35 - 45°
- right angle usually: 15 - 25°
⇒ aspirated foreign bodies are more likely to enter right main bronchus
Which vessels supply, drain the trachea, resp.?
Which nerves are responsible for the innervation?
supply:
- a. thyroidea inf. → rr. tracheales
- thoracic aorta → rr. bronchiales
- a. thoracica int. → rr. bronchiales
drainage:
- plexus thryoideus impar → v. thyroidea inf.
- vv. esophageales → v. hemi-/azygos
innervation:
- parasymp.: n. laryngeus recurrens → rr. tracheales, n. vagus (X) → rr. bronchiales
- symp.: truncus symphaticus
What might be the effect of a goiter (swelling of thyroid gland)?
= struma
→ can cause compression of trachea → suffocation (= asphyxia)
What happens in case of smoking to the cilia in the trachea?
- transition from resp. epithelium to str. squamous epithelium (= squamous metaplasia)
- adherence + immobility of cilia → removal of pollutants impaired (= impairance of mucociliar clearance)
What is the shape of the lung?
Volume?
Surface area?
- half cone shape
- total volume 2 - 3l, after max. inhalation 5 - 8l
- *left: 10 - 20 % less**
- total surface area: 70 - 140 m<span>2</span>
1 - 5
1) impression for a. subclavia dex.
2) impression for esophageus
3) impression for v. azygos + IVC
4) fissura obliqua
5) fissura horizontalis
6 - 10
6) impression for a. subclavia sin.
7) impression for aorta / arcus aorticus
8) impressio cardiaca
9) lingula pulmonis sinistri
10) vv. pulmonales
11 - 17
11) lig. pulmonale
12) right main bronchus in eparterial position
13) left main bronchus in hyparterial position
14) a. pulmonalis dex.
15) a. pulmonalis sin.
16) incisura cardiaca pulmonis sin.
17) hilum pulmonis
Which impressions can you find on which lung?
right lung:
- impression for a. subclavia dex.
- impression for v. azygos
- impression for IVC
- impression for esophagus
left lung:
- impression for a. subclavia sin.
- impression for arcus aorticus
- impression for thoracic aorta
How do you call the 3 surfaces of the lung?
- facies costalis (= biggest)
- facies mediastinalis
- facies diaphragmatica
In which position are the bronchi of the right and left lung?
- right main bronchus in eparterial position
= sup. to a. pulmonalis - left main bronchus in hyparterial position
= inf. to a. pulmonalis
How do you call all vessels + nn. in the hilum?
radix pulmonis
What can possible cause a pneumothorax?
injury / central venous catheter in v. subclavia → perforation of cupula pleurae → air evades through perforated lung → lung collapses due to low pressure in pleural cavity
Explain the segmentation of the lungs.
right lung: main bronchi → 3 lobar bronchi:
- sup. lobar bronchus → 3 segmental bronchi
- mid. lobar bronchus → 2 segmental bronchi
- inf. lobar bronchus → 5 segmental bronchi
⇒ 10 segmental bronchi
left lung: main bronchi → 2 lobar bronchi:
- sup. bronchus → 5 segmental bronchi
- inf. bronchus → 4 segmental bronchi
⇒ 9 segmental bronchi (7th missing due to incisura cardiaca)
REMEMBER HAND RULE: know that right lobe 10 seg./3 bronchi, left 9/2 <br></br>- right hand: 3 fingers (1st) + 2 fingers (2nd) = 5 fingers (3rd)<br></br>- left: 9 (total) - right hand (1st) = 4 (2nd)
Explain the structure of a lung lobules
= subunit of branchopulmonary segment
- supplied by bronchiole
→ divides 3-4 times → terminal branches that bear alveoli (= acinus pulmonis) - mainly on surface of lungs (0.3 - 5cm polygonal regions)
Why is the segmentation of the lung clinically important?
- pneumonia can only affect one lobe
- relevant for bronchoscopies: in which segment was biopsy taken?
- in case of lung metastasis: surgical removal of entire segments
- in case of lung carcinomas: removal of entire lobe
Which vessels supply, drain the lungs, resp.?
Which nerves are responsible for the innervation?
What is the action of sympathetic and parasympathetic innervation?
supply:
- aa. pulmonales (vasa publica)
- rr. bronchiales of thoracic aorta (+ 3./4. a. intercostales) (vasa privata)
!!! aa. pulmonales carry DEOXYGENATED blood
drainage:
- vv. pulmonales (vasa publica)
- vv. bronchiales → v. azygos, v. hemiazygos (vasa privata)
!!! vv. pulmonales carry OXYGENATED blood
innervation:
- sensory + parasymp: n. vagus (X) → n. laryngeus recurrens → rr. bronchiales
- sensory + symp: truncus symphaticus → rr. bronchiales
⇒ together: plexus pulmonalis
⇒ para: bronchospasm (= constriction of bronchi)
⇒ symp: bronchorelaxation via β-receptors
Differentiate btw nutritive vessels of the lung
- vasa publica: pulmonary circulation → reoxygenate blood
- vasa privata: systemic circulation → supply/drain lung
Explain the structure of the pleura.
How do you call the upper apex?
- pleura parietalis + visceralis (reflection of pl. parietalis) enclose cavitas pleuralis filled with a few ml of serous fluid
- according to surfaces of lung:
- pars mediastinalis
- pars costalis
- pars diaphragmatica
- cupula pleurae extends apertura thoracica by 5cm
- forms recessus
Which recessus are formed by the pleura?
What is their function?
lungs expand into recessus during deep inhalation
recessus costodiaphragmaticus
- lateral btw ribs + diaphragm
recessus costomediastinalis
- ventral behind sternum
recessus phrenicomediastinalis
- dorsal btw diaphragm + mediastinum
recessus vertebromediastinalis
- dorsal next to spine
Which vessels supply, drain the pleura?
Innervated by.. ?
Clinical relevance?
supply:
- aa. intercostales
- vasa pericardiaco-/musculophrenica
drainage:
- cf. supply
innervation: (sensory)
- nn. intercostales
- n. phrenicus
⇒ only pleura periatalis innervated nociceptively (no pain in case of lung tumors!)
Compare the surface projections of lungs and pleura.
exc. at sternal line pleural borders = lung borders + 1
