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Year 1 - Anatomy - Term 2 > The Respiratory System 2 > Flashcards

The Respiratory System 2 Flashcards

1
Q

How does the sternum articulate with the manubrium?

A

At its superolateral angles.
At the clavicular notches.

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2
Q

What is the suprasternal notch?

A

The median notch is formed by the superior border of the manubrium.

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3
Q

Name different joints in the thorax.

A

Costovertebral and costotransverse - synovial plane.
Sternoclavicular - synovial saddle.
Xiphisternal and costochondral - primary cartilaginous.

Sternocostal (rib 1) - primary cartilaginous.
Sternocostal (ribs 2-7) - synovial plane.

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4
Q

What does the costal cartilage of rib 2 articulate with?

A

The manubrium.
The sternal body.

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5
Q

What is the sternal angle used to locate?

A

Bifurcation of the trachea.
Start and end of the arch of aorta.
Division of the pulmonary trunk.
Azygos vein, joining the SVC.
Loop of the recurrent laryngeal nerve.

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6
Q

Define costal margin and subcostal angle.

A

CM - the lower edge of the chest, formed by the bottom edge of the ribcage.
SA - the angle between the xiphoid process and the costal margin.

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7
Q

What are the most common chest injuries?

A

Rib fractures.
Ribs 5-10 are the most common, as they are the most exposed and fixed.
Accompanied by severe localised pain through the intercostal nerves above and below, as well as difficulty breathing.

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8
Q

What are the different types of ribs?

A

Typical - 3-9.
True - 1-7.
False - 8-10.
Floating - 11-12.

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9
Q

What occurs in ~0.5% of the population?

A

An additional cervical rib develops.
Usually from the transverse process of C7.

Can compress the lower trunk of the brachial plexus, causing paraesthesia of the medial side of the upper limb, and wasting of the small muscles of the hand.

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10
Q

What do the capitulum and head of the rib articulate with?

A

C - Demi-facets on the vertebral body.
H - costal facet on the tip of the vertebral transverse process.

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11
Q

What is Thoracic Outlet Syndrome?

A

When the brachial plexus, the subclavian artery and the subclavian vein become compressed by structures (such as lung tumours between the first rib and clavicle).

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12
Q

Describe breathing in newborns.

A

Ribs do not lie obliquely in an anteroinferior plane, so volume increase is less in the thoracic cavity. The anterior scalene muscle is primarily used for breathing.

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13
Q

What do the paired intercostal spaces contain?

A

Three layers of intercostal muscles.
Nerve, posterior and anterior intercostal artery and vein.
The number of each space accords with the number of the rib lying superior.

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14
Q

What muscles can act as accessory respiratory muscles in forced expiration and inspiration?

A

Upper limb, back, and abdominal muscles which have attachment to the ribs.

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15
Q

Describe the orientation of external and internal intercostal muscles.

A

At right angles to each other.
Provides strength to the muscle layers.

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16
Q

Where is the neurovascular bundle located?

A

Between the internal and innermost intercostal muscles, lodged in the costal grooves.

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17
Q

How can a chest drain cause damage?

A

If it is inserted into the pleural space too close to the inferior border of the rib, the nerve can be liable to damage.

Insert into the pleural cavity below the inferior border to avoid the main intercostal nerve.

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18
Q

What do the intercostal muscles do?

A

Contribute to respiratory movements.
Prevents the lungs and pleura from ballooning out between the ribs during these movements.

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19
Q

What are collateral branches?

A

Branches of a neuromuscular bundle.
Runs just above the top of each rib to supply the pleura and periosteum of the ribs, which is smaller than the main nerve.

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20
Q

What do dermatomes of the chest wall correspond with?

A

The intercostal spaces at and below the T2 dermatome.
Nerves from T7-T12 project serially onto the anterior abdominal wall.

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21
Q

What dermatomes are at the sternal angle?

A

C4, immediately above T4.
The C5-T1 dermatomes create the brachial plexus and are found in the arms.

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22
Q

What are the main lymph node groups?

A

Axillary - root of the upper limb.
Superficial and deep inguinal - root of the lower limb.
Pectoral - around the pectoralis major muscle and breast.
Tracheobronchial - bifurcation of trachea in thorax.
Bronchomediastinal - the hilum of the lungs.
Lumbar and pelvic - around the root of arteries in the abdomen and pelvis.
Superficial and deep cervical - in the head and neck.

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23
Q

How are lymph nodes found in the body?

A

Clustered around large veins.
Lymph channels connect these nodes with each other, as well as nodes of surrounding areas.

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24
Q

Where are axillary lymph nodes found?

A

They lie in relation to the axillary vein and its branches in the axilla.
This includes the anterior, posterior, apical, central, and lateral groups.

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25
Q

Why does the breast need good lymphatic drainage?

A

It is made of glandular tissue surrounded by extensive adipose tissue.

26
Q

Where does most lymph in the breast drain to?

A

+75% of breast lymph drains to the anterior group of axillary lymph nodes first (the sentinel nodes) as its lies in close proximity to these nodes.

27
Q

What is the axillary tail?

A

Penetrates the floor of the axilla.
Lies in close proximity to other groups of axillary lymph nodes.

28
Q

Why is the right dome of the diaphragm situated superior to the left dome?

A

The liver is located immediately inferior to the right dome.

29
Q

Why does the caval hiatus increase in size during inspiration?

A

This encourages venous return of blood to the heart through the IVC.

30
Q

What is a hiatus hernia?

A

An abnormal protrusion of a structure.
The structures of the abdomen can enter the thorax through a weakness in the diaphragm.
Caused by frequent hard coughing, heavy lifting, etc.

31
Q

What structures form the URT?

A

Nasal cavity, pharynx and larynx.
In the head and neck.

32
Q

What is the larynx?

A

A set of cartilages, membranes and ligaments that make sound from expired air.
Protects the inlet to the respiratory system.
Continuous inferiorly with the trachea at C6.
Anterior to the pharynx.

33
Q

What structures form the LRT?

A

The trachea, the bronchi and their branches, the bronchioles and the alveoli.
Almost entirely located in the thorax.

34
Q

What is the innervation of the LRT?

A

Motor - sympathetic fibres originating in the upper thoracic spinal levels, via pulmonary plexuses at the termination of the bronchi; parasympathetic fibres via the vagus nerve.

Sensory - fibres reach the spinal cord via both sympathetic and parasympathetic nerves.

35
Q

What is the trachea?

A

The inferior continuation of the larynx at C6.
Inferior to the cricoid cartilage.
Continues through the thoracic inlet to T4 (the sternal angle), where it bifurcates.

36
Q

What are the important features of the trachea?

A

Has 16-20 cartilaginous rings.
The tracheal muscle completes the tracheal ring posteriorly.
The tracheal carina is a keel-shaped cartilage ring at the bifurcation.

37
Q

What structures surround the trachea?

A

Oesophagus - posterior.
Common carotid arteries - lateral (neck).
Vagus nerve - lateral.
Tracheo-oesophageal grooves - between the trachea and oesophagus, both left and right.

38
Q

What is the function of the tracheo-oesophageal grooves?

A

Lodges the recurrent laryngeal nerves (branches of vagus) that innervate the larynx, both with motor and sensory fibres.

39
Q

What are the branches of the right main bronchus?

A

Superior lobar bronchus or eparterial bronchus - superior, branches before entering the lung.
Hyparterial bronchus - inferior.

40
Q

What are the tracheobronchial LNs?

A

Lies alongside and in the cleft between the two main bronchi.
Lymph from the trachea, bronchi and lungs drain here, and thence to the thoracic duct or right lymphatic duct.
Plays a role in the secondary spread of lung and breast cancer.

41
Q

What LNs lie at the hilum of the lungs?

A

The bronchomediastinal LNs.

42
Q

What are the bronchioles?

A

Small air tubes (<1mm in diameter) that control airflow.
No cartilage or glands.
Increased smooth muscle and elastic fibre.

43
Q

How can you locate the 2nd right intercostal space?

A

When the patient is lying down.
Right from the sternal angle.
A gap between the ribs.

44
Q

How can you locate the apex beat of the heart?

A

In the 5th intercostal space.
In the midclavicular line.
Palpate by placing your fingers horizontally across the chest.

45
Q

How can you determine hyperinflation on a CXR?

A

> 6 ribs seen anteriorly, or 10 ribs posteriorly.

46
Q

What is an arcuate ligament?

A

An arch shaped band in the chest that presses on the artery and sends blood to the upper abdomen.

47
Q

Where do clinicians perform a pleural aspiration?

A

Above the level of the 10th rib in the midaxillary line, to avoid the spleen and liver.

48
Q

Where does the diaphragm develop from?

A

The cervical myotome.
It moves down the thorax during development.

49
Q

What is immediately anterior to the left main bronchus?

A

The right pulmonary arteries.

50
Q

What is immediately posterior to the left main bronchus?

A

The oesophagus and descending thoracic aorta.

51
Q

What is immediately lateral to the left main bronchus?

A

Left - left pulmonary artery.
Right - right main bronchus.

52
Q

What anatomical structures are found in the superior mediastinum?

A

Trachea.
SVC.
Thoracic duct.
Arch of aorta.
Oesophagus.
Vagus nerve.
Phrenic nerve.
Recurrent laryngeal nerve.

53
Q

What anatomical structures are found in the anterior mediastinum?

A

Thymus.
Lymph nodes.
Recurrent laryngeal nerve.

54
Q

What anatomical structures are found in the middle mediastinum?

A

Heart.
Pericardium.
Roots of the great vessels (aorta, pulmonary trunk, pulmonary veins, vena cava).

55
Q

What anatomical structures are found in the posterior mediastinum?

A

Oesophagus.
Thoracic aorta.
Azygos veins.
Hemizygos veins.
Thoracic duct.
Vagus nerve.
Sympathetic trunk.

56
Q

Where are the main thoracic nerves in relation to the hila?

A

Vagus - posterior.
Phrenic - anterior.

57
Q

What is the area of cardiac dullness?

A

The area of the heart not covered by lung.
Pericardiocentesis (collecting pericardial fluid) is taken from this site.

58
Q

What is the endothoracic fascia?

A

A layer of loose CT between the inner aspect of the chest wall and the costal parietal pleura.

59
Q

What is paradoxical movement?

A

When the phrenic nerve is paralysed on one side, the diaphragm only moves on one side.

60
Q

How do the different quadrants of the breast have different drainage?

A

Lateral - axillary.
Medial - parasternal.
Lower - abdominal.

Lower inner quadrant - sub-diaphragmatic lymphatics.

Year 1 - Anatomy - Term 2 (16 decks)

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