Respiratory system Flashcards

1
Q

What type of joint is the sternoclavicular joint?

A

Synovial saddle

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2
Q

At what vertebral level is the xiphoid process?

A

T9

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3
Q

At what vertebral level is the sternomanubrial joint?

A

T4 (sternal notch)

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4
Q

With the bodies of which thoracic vertebrae will the head of rib 7 articulate with?

A

T6 and T7

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5
Q

What structures lie in the costal grooves of the ribs?

A

Intercostal blood vessels and nerves

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6
Q

Which ribs are true ribs (vertebrosternal)?

A

Ribs 1-7 (costal cartilage attached to sternum directly)

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7
Q

Which ribs are false ribs (vertebrochondral)?

A

Ribs 8-10 (costal cartilage attaches to preceding costal cartilages)

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8
Q

Which ribs are floating ribs?

A

Ribs 11 + 12 (sometimes 10)

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9
Q

On rib 1, what vessel runs anterior to the scalene tubercle?

A

subclavian vein

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10
Q

On rib 1, what vessel runs posterior to the scalene tubercle?

A

subclavian artery

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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

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12
Q

What shape is the body of thoracic vertebra?

A

Heart shaped

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13
Q

What structures pass through the vertebral foramen?

A

Spinal cord surrounded by the 3 meninges - dura, arachnoid and pia matter

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14
Q

What structures pass through the intervertebral notches?

A

Spinal nerve roots

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15
Q

What do the facets on the transverse processes of vertebrae articulate with?

A

Tubercules of the ribs

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16
Q

Describe thoracic spinous processes

A

Long
Slender
Downwards pointing
Non-bifid

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17
Q

Which two parts of the vertebrae form the neural/vertebral arch (parts of vertebrae which enclose the spinal cord)?

A

Pedicle

Lamina

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18
Q

Describe what makes up the thoracic inlet

A

T1
1st rib
Superior border of manubrium

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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

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20
Q

Which ribs/costal cartilages make up the costal margin?

A

Ribs 7-10

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21
Q

Which muscle is primarily used for breathing in the newborn?

A

Diaphragm

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22
Q

Describe the orientation of the muscle fibres in the external intercostal muscle

A

Infero-anteriorly

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23
Q

Describe the orientation of the muscle fibres in the internal intercostal muscle

A

Infero-posteriorly

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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

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25
Q

From superior to inferior, which structures are in the neuromuscular bundles found between the intercostal muscles?

A

Vein
Artery
Nerve

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26
Q

Where are the neuromuscular bundles found?

A

Inferior to each rib, in the costal grooves, between internal and innermost intercostal muscles

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27
Q

Where does the external intercostal muscles become the external intercostal membrane?

A

Anterior of the thorax

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28
Q

Where does the internal intercostal muscles become the internal intercostal membrane?

A

Posterior of the thorax

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29
Q

What does the innermost intercostal muscle become anteriorly and posteriorly?

A

Anteriorly - transversus thoracis muscle

Posteriorly - subcostalis muscle

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30
Q

Which nerves innervate the diaphragm?

A

C3-5

Phrenic nerves

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31
Q

Where are chest drains usually inserted?

A

5th intercostal space in mid axillary line

aim just above 6th rib to avoid neurovascular bundle

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32
Q

What makes up the brachial plexus?

A

C5-T1

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33
Q

What dermatome is the sternal angle in?

A

T2

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34
Q

What dermatome are the nipples in?

A

T4

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35
Q

What dermatome is the umbilicus in?

A

T10

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36
Q

What dermatome is the inguinal region in?

A

L1

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37
Q

What can be a useful sign when diagnosing shingles?

A

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

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38
Q

Where in the body does not have lymphatic drainage?

A

Cartilage
inner ear
brain
spinal cord

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39
Q

Where are the major groups of lymph nodes?

A

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

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40
Q

Where do lymph nodes tend to be found?

A

Near large veins

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41
Q

Between what ribs is the base/glandular part of the breasts located?

A

Ribs 2 and 6 and between lateral border of the sternum and the midaxillary line

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42
Q

Which dome of the diaphragm lies more superior during normal expiration?

A

Right - presence of liver

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43
Q

What cardiac feature is attached to the central tendon of the diaphragm?

A

Pericardium

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44
Q

To which vertebra are the right and left crura attached to?

A

Right - L1-3

Left - L1-2

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45
Q

To which costal cartilages is the diaphragm attached?

A

ribs 7-10

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46
Q

At what vertebral level is the opening for the vena cava in the diaphragm?

A

T8

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47
Q

At what vertebral level is the opening for the oesophagus in the diaphragm?

A

T10

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48
Q

At what vertebral level is the opening for the aorta in the diaphragm?

A

T12

49
Q

What spinal nerves make up the phrenic nerves?

A

C3-5

50
Q

What nerves supply the diaphragm?

A

Phrenic nerves to central part (s+m)

Lower intercostal nerves to periphery (s)

51
Q

How can you distinguish between the vagus nerves and the phrenic nerves?

A

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
Q

Where can the upwards arch of the diaphragmatic domes be found during quiet expiration?

A

Rib 5

take care if there is a puncture wound below the nipples at intercostal space 4 as it could damage the diaphragm

53
Q

At what vertebral level is the aortic arch seen in scans?

A

T4

54
Q

What does the upper respiratory tract consist of?

A

Nasal cavity
Pharynx
Larynx

55
Q

What cartilage forms the laryngeal prominence?

A

Thyroid cartilage

56
Q

What type of cartilage makes up the cartilage of the larynx?

A

Hyaline

57
Q

What type of cartilage makes up the epiglottis?

A

Elastic

58
Q

What makes up the lower respiratory tract?

A
Trachea
Main bronchi
Bronchioles
Alveoli
Lungs
Pleurae
59
Q

When does the larynx become the trachea?

A

C6 - just inferior to the cricoid cartilage and when tracheal cartilage starts

60
Q

When does the trachea bifurcate?

A

T4

61
Q

How many incomplete tracheal cartilage rings are there?

A

15-20

62
Q

What muscle fills the gap between the cartilage rings on the posterior of the trachea?

A

Trachealis muscle

63
Q

What is the final keel shaped cartilage ring found where the trachea bifurcates called?

A

Carina

64
Q

What are the three vessels that leave the aortic arch, in order of exit?

A

1st - brachiocephalic artery (right sub and CC)
2nd - left common carotid artery
3rd - left subclavian artery

65
Q

Which of the two main bronchi is shorter, wider and more vertical?

A

Right bronchus

66
Q

What two vessels arch over the left bronchi anteriorly?

A

Left pulmonary artery

Aortic arch

67
Q

What is the branch of the right bronchi that branches before the right bronchi enters the lung called?

A

Eparterial/superior lobar bronchus

Main bronchi is then called hyparterial

68
Q

What group of lymph nodes are found near the hilum of the lung?

A

Bronchomediastinal lymph nodes

69
Q

Which lung has the:

  • cardiac impression
  • aortic impression
  • cardiac notch
  • lingula
A

Left lung

70
Q

On which lung surface is the hilum found?

A

Mediastinal surface

71
Q

What 4 structures constitute the root of the lungs?

A

Bronchi
Pulmonary artery
Superior pulmonary vein
Inferior pulmonary vein

72
Q

What fascial membrane covers the apex of the lung?

A

Suprapleural membrane

73
Q

What is a bronchopulmonary segment?

A

Segment of lung supplied by a tertiary bronchus and an accompanying branch of the pulmonary artery and bronchial artery and vein

74
Q

How many bronchopulmonary segments are in each lung?

A

Right - 10 segments

Left - 8 or 9 segments

75
Q

What is the most superior vessel in the hilum of the lung?

A

Superior pulmonary vein

76
Q

What is the most inferior vessel in the hilum of the lung?

A

Inferior pulmonary vein

77
Q

What is the most anterior vessel in the hilum of the lung?

A

Pulmonary artery

78
Q

What is the most posterior vessel in the hilum of the lung?

A

Bronchi

79
Q

What is situated above the pulmonary artery in the right lung?

A

Eparterial bronchus (branch off main bronchi)

80
Q

What are the names of the two lung pleura?

A

Parietal - lines body

Visceral - lines lungs

81
Q

Give two examples of a pleural reflection and recess

A

Costodiaphragmatic (costophrenic) reflection and recess

Costomediastinal recess and reflection

82
Q

Describe the innervation of the parietal pleura

A

Phrenic nerve supplies mediastinal and diaphragmatic parietal pleura
Remainder innervated by intercostal nerves

83
Q

Give an example of a site to carry out pleural aspiration/pleural tap

A

9th intercostal space in midaxillary line

not 10th cause it could penetrate abdomen

84
Q

Give an example of a site you could enter a needle to enter the heart

A

At cardiac notch between ribs 4 and 6 anteriorly, where the lung and parietal pleura deviate from the sternal margin

85
Q

Where does the trachea begin and end?

A

C6 - start of cricoid cartilage of larynx

T4 - bifurcation of trachea in coronal plane

86
Q

Describe the inferior border of the lungs in the midclavicular, midaxillary and mid scapular line (with reference to ribs)

A

Midclavicular - 6
Midaxillary - 8
Midscapular - 10

87
Q

Describe the inferior border of the parietal pleura in the midclavicular, midaxillary and mid scapular line (with reference to ribs)

A

Midclavicular - 8
Midaxillary -10
Midscapular - 12

88
Q

Along the course of what rib does the oblique fissure follow?

A

6th rib

89
Q

Along the course of what rib does the horizontal fissure follow?

A

4th rib

90
Q

Describe the vertebral level of the posterior border of each lung

A

C7-T10

91
Q

Describe the architecture of the extra pulmonary tubes

A

Mucosa (epithelium and lamina propria)
Submucosa
Cartilage
Adventitia

92
Q

Describe the lamina propria

A

Thin loose connective tissue, part of mucosa

93
Q

What type of cartilage is found in the respiratory tract?

A

Hyaline

94
Q

What type of connective tissue predominates in the respiratory tract?

A

Elastin

95
Q

What type of muscle is found in the respiratory tract?

A

Smooth

96
Q

What is the function of the trachealis muscle?

A

Constrict trachea e.g. cough

Connects free ends of cricoid cartilage

97
Q

Describe the difference in hyaline cartilage arrangement in the trachea and the bronchi

A

Trachea - C shaped rings

Bronchi - Plates

98
Q

What is the last component of the conducting zone of the lungs?

A

Terminal bronchioles - these branch into respiratory bronchioles which can partake in gas exchange

99
Q

What type of epithelium is found in the terminal bronchioles?

A

Ciliated columnar or cuboidal epithelium

100
Q

The absence of which 3 features distinguishes a terminal bronchiole from a bronchus?

A

No cartilage, glands or goblet cells

101
Q

What 2 connective tissue fibres predominate in the respiratory portion of the lung tissue?

A

Elastic fibres

Reticular fibres

102
Q

What dermatome is the nipple in?

A

T4

103
Q

What dermatome is the xiphisternum in?

A

T9

104
Q

Where is the intercostal neuromuscular bundle situated?

A

Between the internal and innermost intercostal muscles

105
Q

What nerve lies posterior to the lung hilum?

A

Vagus nerves, carrying motor and sensory and PS signals

106
Q

What nerve lies anterior to the lung hilum?

A

Phrenic nerve (C3-5), motor supply of diaphragm

107
Q

What type of epithelium lines the trachea and primary bronchi?

A

Pseudostratified columnar epithelium with goblet cells and cilia

108
Q

In what dermatome is the sternomanubrial joint found?

A

C4

109
Q

What group of lymph nodes drain around the bifurcation of the trachea?

A

Tracheobronchial lymph nodes

110
Q

What ribs are typical (not true) ribs?

A

T3-9

111
Q

Which vertebrae have bifid spinous processes?

A

Early cervical vertebrae

112
Q

Which ribs are more commonly fractured and why?

A

Ribs 5-10, relatively more exposed and fixed

113
Q

What are the collateral branches?

A

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
Q

List the layers of the chest wall a chest drain needle would pass through

A
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
Q

Into which lymph nodes does the majority of lymph, especially from the lateral quadrants, drain into?

A

Anterior pectoral group of axillary lymph nodes

116
Q

How many lobes are in the glandular part of the breast?

A

16-20

117
Q

What are the arteries that are found immediately lateral to the trachea in the neck?

A

Common carotid arteries

118
Q

What are the nerves that are found immediately lateral to the trachea in the neck?

A

Vagus nerves

119
Q

In what plane does the trachea bifurcate into the two main bronchi?

A

Sternomanubrial plane