The Coughing Reflex (ANATOMY) Flashcards
Coughing occurs in response to the stimulation of receptors in _______ (3)
Oropharyngeal mucosa
Laryngopharyngeal mucosa
Laryngeal mucosa
From which cranial nerve will the nasopharynx and oropharynx relay action potentials from?
CN IX (Glossopharyngeal nerve)
From which cranial nerve does the laryngopharynx relay action potentials from?
CN X (Vagus nerve)
What are carotid sheaths?
Protective “tubes” of cervical deep fascia
Where do the carotid sheets attach?
Superiorly to the bones of the base of the skull
Blend inferiorly with the fascia of the mediastinum
What do the carotid sheaths (right/left) contain? (4)
Vagus nerve
Internal carotid artery
Common carotid artery
Internal jugular vein
How do visceral pleura & respiratory tree visceral afferents connect with the CNS? (3)
Sympathetic trunk
Pulmonary plexus
Vagus nerve (in the carotid sheath)
What is meant by “visceral afferent”?
Sensory nerve (that arrives) from an organ
What does the pulmonary plexus contain? (3)
Sympathetic axons
Parasympathetic axons
Visceral afferents
What is a plexus?
An intertwining of nerves
The sympathetic and parasympathetic axons in the pulmonary plexus are _____ nerves that supply the _____
motor
heart
The motor axons travel from the tracheal _____ along the branches of the _________ to supply all ____ & ______
bifurcation
respiratory tree
mucous glands & bronchiolar smooth muscles
Describe the route of the pulmonary visceral afferents from the visceral pleura to the medulla
From visceral pleura & respiratory tree to the plexus then follow the vagus nerve to the medulla to the brain
Once the sensory receptors have been stimulated the CNS responds by rapidly coordinating _____
Deep inspiration
Deep inspiration requires use of ___(4)
Diaphragm
Intercostal muscles
Accessory muscles of inspiration
Which nerves innervate the diaphragm?
Phrenic nerves
Which nerves innervate the intercostal muscles?
Intercostal nerves
What is the difference between quiet and forced inspiration in terms of action potentials via the phrenic via?
In deep/forced inspiration a greater outflow of action potentials with a longer duration cause the diaphragm to flatten&descend maximally
What are the muscles of normal (quiet) inspiration?
External intercostal muscles
Internal intercostal muscles
Innermost intercostal muscles
The intercostal nerves are the anterior rami of which spinal nerves?
T1-T11
What are the accessory muscles of forced / deep inspiration?
Pectoralis Major
Pectoralis minor
Sternocleidomastoid
Scalenus anterior, menus & posterior
Where does the pectoralis major attach?
Between the sternum/ribs & humerus
What is the function of the pectoralis major?
Adduction and medial rotation of the humerus
What position must the upper limb be in so the pectoralis major can pull the ribcage upwards/outwards?
Upper limb position is “fixed”
E.g. by holing on to the air of the chair or the thigh
What is the recruitment of accessory muscles a clinical sign of?
Dyspnoea?
What is the function of the pectoralis minor in terms of deep inspiration?
Puling ribs 3-5 superiorly towards the coracoid process of the scapula
Where does the sternocleidomastoid attach?
Between the sternum/clavicle & mastoid process of the temporal bone
Where do the scalenus anterior, medius & posterior attach?
Between cervical vertebrae & ribs 1&2
Which nerve stimulates the adduction of the vocal cords to close the rims glottidis during the coughing reflex?
CN X - Vagus nerve
Where do the vocal cords approximate?
Midline
Where do the intrinsic muscles of the larynx attach?
Between the cartilages
What do the intrinsic muscles of the larynx move? What does this result?
The cartilages - movement of the vocal cords
What type of muscle are the intrinsic muscles of the larynx?
Skeletal (voluntary) muscle
What type of nerve is CN X?
Mixed (sensory & motor)
Where does the cranial nerve connect with the CNS?
At the medulla oblongata of the brainstem
Through which structure do the vagus nerves (left&right) pass through the neck?
Within the carotid sheath
What is the important function of CN X to coughing?
Supply somatic sensory & somatic motor tons to the larynx
To which part of the larynx do the sensory parts of CNX go?
Mucosa lining of the larynx
To which part of the larynx do the motor parts of CNX go?
Intrinsic muscles of the larynx
In the chest, the vagus nerves descend ______ to the chest organs (including the lungs via the pulmonary plexus)
posterior
The vagus nerves pass through the diaphragm on the _______
oesophagus
Where do the vagus nerves divide into many parasympathetic braches?
On the surface of the stomach
Which structures do the parasympathetic branches of the vagus nerve supply? (2)
Foregut & Midgut organs
Does the vagus or the phrenic nerve pass anterior to the root of the lung?
The phrenic nerve
What is the purpose of anterolateral abdominal wall muscle contraction in terms of the cough reflex?
Raise intra-abdominal pressure
Which muscles forcefully increase the the intra-abdominal pressure during deep expiration?
Right & left anterolateral abdominal wall and the diaphragm
Which muscles are involved in deep expiration? (4 - right & left of each)
Rectus abdominis
External oblique Internal oblique
Transverses abdominus
What is an aponeurosis?
Flattened tendon
The aponeurosis of the right external oblique blends with the aponeurosis of the left external oblique the the midline ________
Linea alba
Where does the external oblique attach superiorly?
Superficial aspects of the lower ribs
Where does the eternal oblique attach inferiorly?
Anterior part of the iliac crest & the pubic tubercle
The fibre direction of the external oblique is the _____ as the external intercostal muscle
same
Where is the lines semilunaris? (right and left)
Where the muscle fibres end and the aponeurosis begins
_____ of the right internal oblique bless with the aponeurosis of the _______ at the midline linea alba
Aponeurosis
Left internal oblique
Where does the right internal oblique attach superiorly?
The inferior border of the lower ribs
Where does the internal oblique attach inferiorly?
Iliac crest & thoracolumbar fascia of the lower back
Does the internal oblique have the same/opposite fibre direction as the internal intercostal muscles?
same
Where does aponeurosis of the right transverses abdomens blend with the aponeurosis of the left transversus abdomens?
Linea alba
Where does the transversus abdominus attach superiorly?
Deep aspects of the lower ribs
Where does the transversus abdominus attach inferiorly?
Iliac crest & thoracolumbar fascia of the lower back
What encapsulates the rectus abdominus?
Internal oblique
External oblique
Skin
Transversus abdominis
Where does the the rectus abdominis attach superiorly?
Xiphoid process
Costal margin
Where does the rectus abdominis attach inferiorly?
Pubis bone
Pubic symphysis
The somatic motor, somatic sensory and sympathetic nerve fibres supplying the structures of the abdominal part of the body wall (soma) are convey within the _____
thoracoabdominal nerves
The 7th-11th intercostal nerves travel ______ then their terminal branches leave the _________ in which plane?
anteriorly
intercostal spaces
In the plane between the internal oblique & transversus abdominus
What is the name of the nerves in the plane between the internal oblique & transversus abdominus?
Thoracoabdominal nerves
What innervates the upper part of the abdominal wall?
Thoracoabdominal nerves
What innervates the area below T12?
Subcostal nerve
What does the iliohypogastric nerve innervate?
Half of L1 anterior ramus
What does the ilioinguinal nerve innervate?
Half of L1 anterior ramus
What are the functions of tonic (continuous low level) contractions of anterolateral abdominal muscles?
Maintain posture
Support the vertebral column
What are the function of contractions of the anterolateral abdominal muscles?
Movements of the vertebral column (flexion; lateral flexion; rotations)
Guarding - protect the abdominal viscera
Increase intra-abdominal pressure (to assist defecation; micturition; labour)
Aid forced expiration
