Respiratory system Flashcards
1
Q
What type of joint is the sternoclavicular joint?
A
Synovial saddle
2
Q
At what vertebral level is the xiphoid process?
A
T9
3
Q
At what vertebral level is the sternomanubrial joint?
A
T4 (sternal notch)
4
Q
With the bodies of which thoracic vertebrae will the head of rib 7 articulate with?
A
T6 and T7
5
Q
What structures lie in the costal grooves of the ribs?
A
Intercostal blood vessels and nerves
6
Q
Which ribs are true ribs (vertebrosternal)?
A
Ribs 1-7 (costal cartilage attached to sternum directly)
7
Q
Which ribs are false ribs (vertebrochondral)?
A
Ribs 8-10 (costal cartilage attaches to preceding costal cartilages)
8
Q
Which ribs are floating ribs?
A
Ribs 11 + 12 (sometimes 10)
9
Q
On rib 1, what vessel runs anterior to the scalene tubercle?
A
subclavian vein
10
Q
On rib 1, what vessel runs posterior to the scalene tubercle?
A
subclavian artery
11
Q
What % of the population develop an additional “rib” which grows from the transverse process of C7?
A
0.5%
Can result in compression of the brachial plexus, paraesthesia of the medial side of the upper limb and wasting of the small muscles of the hands
12
Q
What shape is the body of thoracic vertebra?
A
Heart shaped
13
Q
What structures pass through the vertebral foramen?
A
Spinal cord surrounded by the 3 meninges - dura, arachnoid and pia matter
14
Q
What structures pass through the intervertebral notches?
A
Spinal nerve roots
15
Q
What do the facets on the transverse processes of vertebrae articulate with?
A
Tubercules of the ribs
16
Q
Describe thoracic spinous processes
A
Long
Slender
Downwards pointing
Non-bifid
17
Q
Which two parts of the vertebrae form the neural/vertebral arch (parts of vertebrae which enclose the spinal cord)?
A
Pedicle
Lamina
18
Q
Describe what makes up the thoracic inlet
A
T1
1st rib
Superior border of manubrium
19
Q
What makes up the thoracic outlet?
A
T12 vertebrae
Posterolaterally by 11th and 12th ribs
Costal cartilages of ribs 7-10 anterolaterally
Xiphosternal joint
20
Q
Which ribs/costal cartilages make up the costal margin?
A
Ribs 7-10
21
Q
Which muscle is primarily used for breathing in the newborn?
A
Diaphragm
22
Q
Describe the orientation of the muscle fibres in the external intercostal muscle
A
Infero-anteriorly
23
Q
Describe the orientation of the muscle fibres in the internal intercostal muscle
A
Infero-posteriorly
24
Q
Between which two intercostal muscles are the neuromuscular bundles located?
A
Internal and innermost intercostal muscles
Each are found lining either side of rib
25
From superior to inferior, which structures are in the neuromuscular bundles found between the intercostal muscles?
Vein
Artery
Nerve
26
Where are the neuromuscular bundles found?
Inferior to each rib, in the costal grooves, between internal and innermost intercostal muscles
27
Where does the external intercostal muscles become the external intercostal membrane?
Anterior of the thorax
28
Where does the internal intercostal muscles become the internal intercostal membrane?
Posterior of the thorax
29
What does the innermost intercostal muscle become anteriorly and posteriorly?
Anteriorly - transversus thoracis muscle
| Posteriorly - subcostalis muscle
30
Which nerves innervate the diaphragm?
C3-5
| Phrenic nerves
31
Where are chest drains usually inserted?
5th intercostal space in mid axillary line
| aim just above 6th rib to avoid neurovascular bundle
32
What makes up the brachial plexus?
C5-T1
33
What dermatome is the sternal angle in?
T2
34
What dermatome are the nipples in?
T4
35
What dermatome is the umbilicus in?
T10
36
What dermatome is the inguinal region in?
L1
37
What can be a useful sign when diagnosing shingles?
Shingles - herpes viral infection of a nerve and its root. Manifests as rash on skin corresponding to the dermatome of the nerve affected, useful in diagnostics
38
Where in the body does not have lymphatic drainage?
Cartilage
inner ear
brain
spinal cord
39
Where are the major groups of lymph nodes?
Root of upper limb - axillary
root of lower limb - superficial + inguinal
around pectoralis major - pectoral
bifurcation of trachea - tracheobronchial
root of arteries in abdomen - lumbar/pelvic
head and neck - superficial and deep cervical
40
Where do lymph nodes tend to be found?
Near large veins
41
Between what ribs is the base/glandular part of the breasts located?
Ribs 2 and 6 and between lateral border of the sternum and the midaxillary line
42
Which dome of the diaphragm lies more superior during normal expiration?
Right - presence of liver
43
What cardiac feature is attached to the central tendon of the diaphragm?
Pericardium
44
To which vertebra are the right and left crura attached to?
Right - L1-3
| Left - L1-2
45
To which costal cartilages is the diaphragm attached?
ribs 7-10
46
At what vertebral level is the opening for the vena cava in the diaphragm?
T8
47
At what vertebral level is the opening for the oesophagus in the diaphragm?
T10
48
At what vertebral level is the opening for the aorta in the diaphragm?
T12
49
What spinal nerves make up the phrenic nerves?
C3-5
50
What nerves supply the diaphragm?
Phrenic nerves to central part (s+m)
| Lower intercostal nerves to periphery (s)
51
How can you distinguish between the vagus nerves and the phrenic nerves?
Vagus nerves are thicker, lie more medially and soon pass posteriorly in the thorax behind the oesophagus
Phrenic nerves are thinner and are relatively anterior and visible throughout their course to the diaphragm
52
Where can the upwards arch of the diaphragmatic domes be found during quiet expiration?
Rib 5
| take care if there is a puncture wound below the nipples at intercostal space 4 as it could damage the diaphragm
53
At what vertebral level is the aortic arch seen in scans?
T4
54
What does the upper respiratory tract consist of?
Nasal cavity
Pharynx
Larynx
55
What cartilage forms the laryngeal prominence?
Thyroid cartilage
56
What type of cartilage makes up the cartilage of the larynx?
Hyaline
57
What type of cartilage makes up the epiglottis?
Elastic
58
What makes up the lower respiratory tract?
```
Trachea
Main bronchi
Bronchioles
Alveoli
Lungs
Pleurae
```
59
When does the larynx become the trachea?
C6 - just inferior to the cricoid cartilage and when tracheal cartilage starts
60
When does the trachea bifurcate?
T4
61
How many incomplete tracheal cartilage rings are there?
15-20
62
What muscle fills the gap between the cartilage rings on the posterior of the trachea?
Trachealis muscle
63
What is the final keel shaped cartilage ring found where the trachea bifurcates called?
Carina
64
What are the three vessels that leave the aortic arch, in order of exit?
1st - brachiocephalic artery (right sub and CC)
2nd - left common carotid artery
3rd - left subclavian artery
65
Which of the two main bronchi is shorter, wider and more vertical?
Right bronchus
66
What two vessels arch over the left bronchi anteriorly?
Left pulmonary artery
| Aortic arch
67
What is the branch of the right bronchi that branches before the right bronchi enters the lung called?
Eparterial/superior lobar bronchus
Main bronchi is then called hyparterial
68
What group of lymph nodes are found near the hilum of the lung?
Bronchomediastinal lymph nodes
69
Which lung has the:
- cardiac impression
- aortic impression
- cardiac notch
- lingula
Left lung
70
On which lung surface is the hilum found?
Mediastinal surface
71
What 4 structures constitute the root of the lungs?
Bronchi
Pulmonary artery
Superior pulmonary vein
Inferior pulmonary vein
72
What fascial membrane covers the apex of the lung?
Suprapleural membrane
73
What is a bronchopulmonary segment?
Segment of lung supplied by a tertiary bronchus and an accompanying branch of the pulmonary artery and bronchial artery and vein
74
How many bronchopulmonary segments are in each lung?
Right - 10 segments
| Left - 8 or 9 segments
75
What is the most superior vessel in the hilum of the lung?
Superior pulmonary vein
76
What is the most inferior vessel in the hilum of the lung?
Inferior pulmonary vein
77
What is the most anterior vessel in the hilum of the lung?
Pulmonary artery
78
What is the most posterior vessel in the hilum of the lung?
Bronchi
79
What is situated above the pulmonary artery in the right lung?
Eparterial bronchus (branch off main bronchi)
80
What are the names of the two lung pleura?
Parietal - lines body
| Visceral - lines lungs
81
Give two examples of a pleural reflection and recess
Costodiaphragmatic (costophrenic) reflection and recess
Costomediastinal recess and reflection
82
Describe the innervation of the parietal pleura
Phrenic nerve supplies mediastinal and diaphragmatic parietal pleura
Remainder innervated by intercostal nerves
83
Give an example of a site to carry out pleural aspiration/pleural tap
9th intercostal space in midaxillary line
| not 10th cause it could penetrate abdomen
84
Give an example of a site you could enter a needle to enter the heart
At cardiac notch between ribs 4 and 6 anteriorly, where the lung and parietal pleura deviate from the sternal margin
85
Where does the trachea begin and end?
C6 - start of cricoid cartilage of larynx
| T4 - bifurcation of trachea in coronal plane
86
Describe the inferior border of the lungs in the midclavicular, midaxillary and mid scapular line (with reference to ribs)
Midclavicular - 6
Midaxillary - 8
Midscapular - 10
87
Describe the inferior border of the parietal pleura in the midclavicular, midaxillary and mid scapular line (with reference to ribs)
Midclavicular - 8
Midaxillary -10
Midscapular - 12
88
Along the course of what rib does the oblique fissure follow?
6th rib
89
Along the course of what rib does the horizontal fissure follow?
4th rib
90
Describe the vertebral level of the posterior border of each lung
C7-T10
91
Describe the architecture of the extra pulmonary tubes
Mucosa (epithelium and lamina propria)
Submucosa
Cartilage
Adventitia
92
Describe the lamina propria
Thin loose connective tissue, part of mucosa
93
What type of cartilage is found in the respiratory tract?
Hyaline
94
What type of connective tissue predominates in the respiratory tract?
Elastin
95
What type of muscle is found in the respiratory tract?
Smooth
96
What is the function of the trachealis muscle?
Constrict trachea e.g. cough
| Connects free ends of cricoid cartilage
97
Describe the difference in hyaline cartilage arrangement in the trachea and the bronchi
Trachea - C shaped rings
| Bronchi - Plates
98
What is the last component of the conducting zone of the lungs?
Terminal bronchioles - these branch into respiratory bronchioles which can partake in gas exchange
99
What type of epithelium is found in the terminal bronchioles?
Ciliated columnar or cuboidal epithelium
100
The absence of which 3 features distinguishes a terminal bronchiole from a bronchus?
No cartilage, glands or goblet cells
101
What 2 connective tissue fibres predominate in the respiratory portion of the lung tissue?
Elastic fibres
| Reticular fibres
102
What dermatome is the nipple in?
T4
103
What dermatome is the xiphisternum in?
T9
104
Where is the intercostal neuromuscular bundle situated?
Between the internal and innermost intercostal muscles
105
What nerve lies posterior to the lung hilum?
Vagus nerves, carrying motor and sensory and PS signals
106
What nerve lies anterior to the lung hilum?
Phrenic nerve (C3-5), motor supply of diaphragm
107
What type of epithelium lines the trachea and primary bronchi?
Pseudostratified columnar epithelium with goblet cells and cilia
108
In what dermatome is the sternomanubrial joint found?
C4
109
What group of lymph nodes drain around the bifurcation of the trachea?
Tracheobronchial lymph nodes
110
What ribs are typical (not true) ribs?
T3-9
111
Which vertebrae have bifid spinous processes?
Early cervical vertebrae
112
Which ribs are more commonly fractured and why?
Ribs 5-10, relatively more exposed and fixed
113
What are the collateral branches?
Each intercostal neuromuscular bundle (VAN) structure in a particular IC space gives off a small collateral branch located just above the top of each rib
114
List the layers of the chest wall a chest drain needle would pass through
```
Skin
Superficial fascia
Deep fascia surrounding muscles
External intercostal muscles
Internal intercostal muscles
Innermost intercostal muscles
Parietal pleura
Pleural cavity
(Does not penetrate visceral pleura)
```
115
Into which lymph nodes does the majority of lymph, especially from the lateral quadrants, drain into?
Anterior pectoral group of axillary lymph nodes
116
How many lobes are in the glandular part of the breast?
16-20
117
What are the arteries that are found immediately lateral to the trachea in the neck?
Common carotid arteries
118
What are the nerves that are found immediately lateral to the trachea in the neck?
Vagus nerves
119
In what plane does the trachea bifurcate into the two main bronchi?
Sternomanubrial plane
