SDL Worksheet - Upper Respiratory Tract and Chest Wall Flashcards
Differentiate between the upper and lower respiratory tract
Upper –> Nasal cavity, pharynx, larynx Lower –> Conducting and respiratory airways
Differentiate between the conducting and respiratory portions of the respiratory tract
Conducting –> Trachea, main bronchi, bronchioles Respiratory –> Smaller bronchioles and alveoli
Define the boundaries of the nasal cavity
Roof, floor, medial and lateral walls Roof is curved and narrow (except at posterior end) and divided into 3 parts: frontonasal, ethmoidal, sphenoidal (named from the bones forming each part)
What are functions of conchae?
Increase SA, air turbulence (slows air down so more time to be conditioned)
What is function of nasolacrimal duct?
Carries tears from lacrimal sac of eye into nasal cavity
Function of paranasal sinuses and what are they?
Air filled spaces in skull –> humidify inhaled air, reduce weight of skull, contribute to voice resonance
- Frontal
- Ethmoidal
- Sphenoid
- Maxillary
What is clinical importance of inflammation of paranasal sinuses?
Paranasal sinuses joined to nasal cavity. Become blocked in allergic inflammation/swelling in nasal lining with a cold. Normal drainage of mucus within sinuses is disrupted. Could cause tooth infection (maxillary posterior teeth)
What are the 3 divisions of the pharynx?
- Nasopharynx
- Oropharynx
- Laryngopharynx
Define the boundaries of the nasopharynx
Posterior to nasal cavity to the sphenoid, and superior to the level of the soft palette
Define boundaries of oropharynx
Extends from soft palate to upper border of epiglottis
Define boundaries of laryngopharynx
Extends from epiglottis (oropharynx) to oesophagus
What is the function of the auditory (Eustachian tube)?
Connects each middle ear to the throat. Important in maintaining equal air pressure on both sides of eardrum, necessary for normal hearing
Locate the pharyngeal, palatine and lingual tonsils
Identify which tonsils are indicated by red pin
Pharyngeal tonsils
What is the main function of tonsils?
Trap germs (bacteria and viruses) which you may breathe in. Proteins called antibodies produced by the immune cells in the tonsilshelp to kill germs and help to prevent throat and lung infection
What is primary function of larynx?
Protect the lower airway by closing abruptly upon mechanical stimulation, thereby halting respiration and preventing the entry of foreign matter into the airway.
Describe the anatomical features of the larynx associated with its role as a sphincter to protect the respiratory tract during swallowing
During swallowing, the rima glottidis, rima vestibuli, and vestibule are closed. The backward motion of the tongue forces the epiglottis over the opening of the glottis to cover the laryngeal inlet and prevent aspiration of swallowed material into the lungs. The larynx also moves upward and forward, which helps to open the esophagus for the passage of the swallowed material.
Outline mechanism of sound production by larynx
During phonation, the vocal cords and arytenoid cartilages are adducted. When air is forced through the closed rima glottidis, the vocal cords vibrate against one another to produce sounds.
Describe and identify characteristic features of typical thoracic vertebra
The thoracic vertebrae have four features which distinguish them from other vertebrae:
- Vertebral body is heart shaped.
- Presence of demi-facets on the sides of each vertebral body – these articulate with the heads of the ribs.
- Presence of costal facets on the transverse processes – these articulate with the tubercles of the ribs. They are present on T1-T10 only.
- The spinous processes are long and slant inferiorly. This offers increased protection to the spinal cord, preventing an object such as a knife entering the spinal canal.
Describe a typical rib
A typical rib consists of a head, neck and body:
- The head is wedge shaped, and has two articular facets separated by a wedge of bone. One facet articulates with the numerically corresponding vertebrae, and the other articulates with the vertebrae above.
- The neck contains no bony prominences, but simply connects the head with the body. Where the neck meets the body there is a roughed tubercle, with a facet for articulation with the transverse process of the corresponding vertebrae.
- The body, or shaft of the rib is flat and curved. The internal surface of the shaft has a groove for the neurovascular supply of the thorax, protecting the vessels and nerves from damage
Describe the sternum
The sternum is a long, flat bone, forming the middle portion of the front of the chest. The top of the sternum supports the clavicles and its edges join with the costal cartilages of the first seven pairs of ribs. The inner surface of the sternum is also the attachment of the sternopericardial ligaments. Its top is also connected to the sternocleidomastoid muscle. The sternum consists of three main parts:
- Manubrium
- Body
- Xiphoid process
What is the autditory/eustachain tube?
- Opens into nasopharynx at level of the inferior meatus
- Canal that connects the middle ear to the nasopharynx (equalise pressure)
What are the tonsils?
Collections of lymphoid tissue located in the pharynx
First line of defence against pathogens entering naso/oropharynx
- Lingual - posterior 1/3
- Pharyngeal/adenoid - roof of naso
- Palatine - ‘the tonsils’, ‘tonsilitis’
What level does the trachea bifurcate?
At carina, T4/5 level
What are the 3 surfaces and borders of the lungs?
Surfaces - Mediastinal, costal and diaphragmatic
Borders - Anterior, inferior and posterior
RALS - right anterior left superior
Relationship of pulmonary artery and bronchi
How do all 12 ribs articulate posteriorly with the vertebrae of the spine?
Each rib forms 2 joints: costotransverse joint and costovertebral joint
- Costotransverse joint – Between the tubercle of the rib, and the transverse costal facet of the corresponding vertebrae
- Costovertebral joint – Between the head of the rib, superior costal facet of the corresponding vertebrae, and the inferior costal facet of the vertebrae above
What are the 5 muscles of the thoracic wall?
Intercostals (external, internal, innermost)
Subcostals
Transversus thoracis
What are the intercostal spaces? How are they numbered?
Anatomic space between 2 ribs. 11 intercostal spaces, each numbered to rib superior to it.
What is the order in the neurovascular bundle?
V-A-N (vein-artery-nerve)
Where do the intercostal nerves and blood vessels run?
Between the internal intercostal muscle layer and the innermost intercostal muscle layer
What are internal thoracic arteries a branch of?
Subclavian artery. It travels downard on the inside of the ribcage, approx a cm from sides of the sternum, medial to the nipple. It is accompanied by an internal thoracic vein.
What do the internal thoracic arteries supply?
The anterior chest wall and breasts. It is a paired artery, with one running round each side of the sternum
What lies immediately superior to the roof of the nasal cavity?
The frontal sinus within frontal bone
Diagram of the conchae
How is the membrane lining the nasal cavity adapted for its role in the conditioning and filtering of inspired air?
- Moist membrane
- Pseudostratified columnar ciliated respiratory epithethelium (respiratory/olfactory)
What are nasal polyps?
Overgrowths of nasal mucosa
Which of the paranasal sinuses is most prone to infection in adults? Why?
Maxillary - due to its poor communication with the nasal cavity
Why does infection in the maxillary sinus comomonly give rise to toothache?
The roots of the teeth are located on the floor of the maxillary sinus, separated only by a thin membrane. Infection of the sinus can irritate the roots, leading to toothaches
What does the nasolacrimal duct do? What happens if this duct is blocked?
Drain excess tears from the lacrimal gland. Tears spill over the eyelid and eyes stream if blocked.
What structure separates the nasopharynx from the oropharynx?
The uvula
What structure separates the oropharynx from the laryngopharynx?
The epiglottis
What structure(s) are connected to the pharynx by the auditory tube? What is its function?
Middle ear –> equalises pressure between this space and the external environment
Where does the pharyngeal/adenoid tonsil lie?
In the roof of the nasopharynx, superior to the opening of the auditory tube in children but becomes much smaller with age
What is the pharyngeal made up of?
A mass of lymphoid tissue - a specialised region which filters lymph, contains white blood response which can be released to fight infection
What is the function of the tonsils?
First line of defence by the immune system – associated deployment of white blood cells and antigen detection (look at IMS)
What is tonsilitis?
Inflammation of the tonsils either via a bacterial or viral infections
What are 2 functions of the larynx?
Enable the articulation of speech
Protect food passing in to the trachea
What forms the anterior boundary of the inlet to the larynx?
The epiglottis
What defines the lateral borders of the laryngeal inlet?
Two folds of mucous membrane, the aryepiglottic folds, extend from the sides of the epiglottis downwards and backwards (to the paired arytenoid cartilages of the larynx)
What regions of the respiratory tract are “closed off” during swallowing?
Larynx and trachea
Which structure closes off the respiratory tract superiorly during swallowing?
Oesophagus
What occurs during swallowing?
Narrowing of the laryngeal inlet during swallowing is achieved by contraction of laryngeal muscles, causing the two aryepiglottic folds to move towards the midline. In addition, the tip of the epiglottis is briefly tilted downwards, like a trapdoor, over the laryngeal inlet, protecting the inlet while food/fluid passes into the oesophagus.
What are the vestibular folds and vocal folds?
Two further pairs of mucosal folds that stretch across the cavity of the larynx inferior to the aryepiglottic folds. These are the upper pair of vestibular folds and the lower pair of vocal folds.
Which pair of folds is used in sound production?
Vocal folds - these cover the vocal cords
How is sound produced by the vocal folds?
Tensing the folds in the airstream during expiration causes them to vibrate, producing sound. Pitch is controlled by altering the length and tension of the folds, loudness by the force of the air passed over them
What is the rima glottidis?
Space between the 2 vocal cords
