Respiratory - Working Deck

Question 1

How many ribs are there?

Answer 1

There are 12 pairs of ribs (one for each thoracic vertebrae): 7 true, 3 false, 2 floating

Question 2

How do the ribs articulate with the sternum?

Answer 2

Via intercostal cartilage

Question 3

What encloses the thoracic outlet and inlet?

Answer 3

Outlet: Xiphoid process, costal margins, 12th rib and vertebrae
Inlet: Manubrium, first rib and vertebrae

Question 4

Describe the structural properties of a typical rib.

Answer 4

Head (posteriorly): two articulating facets for first costovertebral joint
Neck: flat, lateral extension, with tubercle on its posterior, for second costotransverse joint
Body/shaft: with inferior costal groove for vessel protection (VAN)

Question 5

What is the size difference between the cervical, thoracic and lumbar vertebral bodies?

Answer 5

Get larger as you go down the spine

Question 6

Describe the bodies of the cervical, thoracic and lumbar vertebrae.

Answer 6

Cervical: bifid
Thoracic: long and pass downwards
Lumbar: short and blunt

Question 7

What are differences in vertebral foramina?

Answer 7

Cervical vertebrae have transverse foramina for the vertebral arteries

Question 8

Describe the transverse processes of the cervical, thoracic and lumbar vertebrae.

Answer 8

Cervical: has transverse foramina
Thoracic: long and thick, with facets for rib articulation
Lumbar: long and slender

Question 9

Which vertebrae have unique articular processes?

Answer 9

Cervical vertebrae, superior and inferior processes are fused, faces face up/down, forming articular pillar

Question 10

What features are unique to the first rib?

Answer 10

Short, thick, only 1 articular facet and a scalene tubercle for scalene muscle attachment

Question 11

What are the muscles of the intercostal muscles, from superficial to deep?

Answer 11

External, internal and innermost

Question 12

What is the direction of intercostal muscles?

Answer 12

External: hands in pockets (medially as downwards)
Internal: hands on chest (lateral as downwards)
Innermost: vertical

Question 13

What is the function of the intercostal muscles?

Answer 13

External: inhalation
Internal: exhalation, and forced inhalation by elevating ribs
Innermost: insignificant

Question 14

When does a membrane replace the intercostal muscles?

Answer 14

External intercostal: replaced anteriorly

Internal intercostal: replaced posteriorly

Question 15

What nerves and blood vessels occupy the intercostal space?

Answer 15

Intercostal, lateral intercostal branch, anterior intercostal and anterior cutaneous

Question 16

Where do the intercostal VANs lie, and where do the collateral branches lie?

Answer 16

Intercostal: in the intercostal groove (superior)
Collateral: in the inferior intercostal space

Question 17

What supplies the intercostal arteries?

Answer 17

Anterior: internal thoracic artery
Posterior: subclavian artery and thoracic aorta

Question 18

Where do the intercostal veins drain to?

Answer 18

Anterior: Internal thoracic vein
Posterior: azygos, hemiazygos, accessory azygos and to the brachiocephalic veins

Question 19

What is the route of the internal thoracic artery?

Answer 19

Arise from subclavian artery, runs down side of the sternum, divides into the superior epigastric and musculophrenic artery

Question 20

What are the divisions of the mediastinum?

Answer 20

Above sternal angle: superior mediastinum
In front of the pericardium: anterior inferior mediastinum
Pericardium: middle inferior mediastinum
Behind pericardium: posterior inferior mediastinum

Question 21

Which arteries arise from the aorta?

Answer 21

Right: brachiocephalic trunk
Left: Left common carotid and left subclavian arteries

Question 22

What is the structural organisation of the trachea and oesophagus?

Answer 22

Trachea is anterior. Oesophagus passes posterior to the left bronchus

Question 23

What level does the trachea bifurcate?

Answer 23

Carina is at T4/5, the sternal angle?

Question 24

What are the limits to the arch of the aorta?

Answer 24

T4/5, sternal angle

Question 25

What is significant about the structure of the brachiocephalic veins?

Answer 25

The left vein is longer, and passes to the right, fusing with the right vein to form the vena cava

Question 26

Give the structure and pathway of the thoracic duct

Answer 26

Cisterna Chyli at base, passes superiorly through aortic hiatus, between the azygos vein and thoracic aorta, curves left draining in the venous angle (subclavian and internal vein)

Question 27

Give the path of the azygos vein system.

Answer 27

Accessory hemiazygos vein drains superior left intercostal veins (not uppermost), into the azygos.
Hemiazygos vein drains inferior left intercostal veins, into the azygos.
Azygos vein drains the right intercostal veins. Passes along the right of the vertebral column, over the right main bronchus, and into the superior vena cava

Question 28

What innervates the lungs?

Answer 28

Parasympathetic vagus nerve

Sympathetic nerves

Question 29

Describe the path of the left vagus nerve

Answer 29

Enter thorax between common carotid and subclavian arteries. Cross left side of the aorta. Here it gives rise to the left recurrent laryngeal branch, which hooks around the aorta and ascends in the groove between the trachea and oesophagus
Through the oesophagus plexus and pulmonary plexus, then to trunk

Question 30

Describe the path of the right vagus nerve.

Answer 30

Gives rise to recurrent laryngeal nerve at level of subclavian artery, which hooks around subclavian and passes up the groove between trachea and oesophagus.
Then continues posterior to the superior vena cava and right main bronchus.
Through the oesophagus plexus and pulmonary plexus, then to trunk

Question 31

What is the stellate ganglion?

Answer 31

Inferior cervical ganglion fused with first thoracic ganglion

Question 32

What arises from the upper thoracic ganglia?

Answer 32

Postganglionic neurones which form the cardiac, pulmonary and oesophageal plexuses
Cardiopulmonary splanchnic nerves which supply the aorta and main artery channels

Question 33

Give the pathway of thoracic splanchnic nerves

Answer 33

Arise from sympathetic ganglia (5-12), passing inferiorly (medial to sympathetic chain), piercing diaphragm to innervate the abdomen.

Question 34

What is the location of the thoracic lymph nodes?

Answer 34

Bronchopulmonary: in the hilum of the lung
Tracheobronchial: around the carina of the trachea
Paratracheal: either side of the trachea

Question 35

What are the impressions found on the right lung medial surface?

Answer 35

Superior vena cava, Right Brachiocephalic vein, and Azygos Vein
Right Subclavian Artery
Trachea
Oesophagus

Question 36

What are the impressions on the medial surface of the left lung?

Answer 36

Left Brachiocephalic Vein
Aortic Arch and Left Subclavian artery
Oesophagus

Question 37

Where does the pulmonary trunk bifurcate?

Answer 37

Level with the middle of T6 vertebrae

Question 38

What is the lingular of the lung?

Answer 38

Tongue like structure at base of left lungs upper lobe, it is superior to the oblique fissure