The tracheobronchial Tree and Larynx

Question 1

suprasternal notch

Answer 1

T2/3

Question 2

sternal angle of Louis

Answer 2

T4/5(2nd rib ends)

Question 3

inferior angle of scapula

Answer 3

T8

Question 4

Xiphisternum

Answer 4

T9

Question 5

lowest part of the costal margin

Answer 5

10th rib L3

Question 6

pleural fluid

Answer 6

creates surface tension which keeps lung surface in contact with thoracic wall while still allowing sliding of surfaces

Question 7

trachea

Answer 7

extends from the larynx at the level of C6 to T5

Question 8

levels of the trachea

Answer 8

mucosa(pseudostratified ciliated columnar epithelium)
submucosa(areolar connective tissue with seromucous glands and ducts)
C-shaped ring of hyaline cartilage(completed posteriorly by the tracheal smooth muscle and connective tissue)
Adventitia(made of areolar connective tissue)

Question 9

tracheal bifurcation

Answer 9

carina

level of sternal angle

Question 10

secondary lobar bronchi

Answer 10

plates of hyaline cartilage

Question 11

tertiary segmental bronchi

Answer 11

pseudo stratified ciliated

columnar epithelium

Question 12

smaller bronchi

Answer 12

reduced or no plates of hyaline cartilage

Question 13

bronchioles

Answer 13

simple ciliated columnar/cuboidal epithelium

no cartilage ,more smooth muscles

Question 14

Terminal bronchioles

Answer 14

simple cuboidal epithelium

no goblet cells and underlying mucous glands

Question 15

respiratory bronchioles

Answer 15

simple squamous epithelium

Question 16

blood supply of the trachea

Answer 16

neck-inferior thyroid arteries

chest-branches from the bronchial arteries

Question 17

blood supply of lung

Answer 17

each lung has a pulmonary artery
divers alongside the bronchial tree
carry low O2 ‘venous blood’ to lungs for oxygenation

Question 18

venous supply of lungs

Answer 18

2 pulmonary veins
-superior and inferior
-right middle lobe to superior
carry oxygen rich ‘arterial blood’ to left heart
independent of bronchial tree and pulmonary arteries
except centrally visceral pleura and bronchial venous blood drain into pulmonary veins

Question 19

bronchial arteries

Answer 19

supply blood for nutrition to the lungs, structures of the root of the lungs and visceral pleura
two left bronchial arteries
-directly from the thoracic aorta
single right bronchial artery
-may arise directly from the thoracic aorta or indirectly from one of the three posterior intercostal arteries or the left superior bronchial artery
parietal pleura supplied and drained by thoracic wall vessels

Question 20

in exercise

Answer 20

-increased sympathetic activity
-relase of adrenaline and noradrenaline by the adrenal gland
-relaxation of the smooth muscles in the bronchiole
increase lung ventilation

Question 21

histamine

Answer 21

parasympathetic activities
contract the bronchiolar smooth muscles
decrease lung ventilation

Question 22

surface anatomy of trachea

Answer 22

midline
-from laryngeal prominence (C4-C5 vertebral level)
immediately posterior to suprasternal notch
bifurcates at sternal angle

Question 23

tension pneumothorax

Answer 23

medical emergency
insert large bore cannula-mid clavicular line 2nd intercostal space
positive intrapleural pressure collapses lung and eventually causes mediastinal shift to the opposite side
as this happens it can cause kinking of the vena cava resulting in :
no venous returns heart=no cardiac output=risk of cardiac arrest

Question 24

chest tube

Answer 24

incision is made in the 5th and 6th intercostal space in the midaxillary line
the tube may be directed superiorly toward the cervical pleura for removal of airier inferiorly toward the costodiaphragmatic recess for fluid drainage

Question 25

larynx

Answer 25

suspended from the hyoid bone
C3-C6
laterally-thyroid gland
posteriorly oesophagus

Question 26

thyroid

Answer 26

C4
laryngeal prominence
superior and inferior horns
thyrohyoid membrane attaches to hyoid

Question 27

cricoid

Answer 27

ring
crocothyroid joints
change length of vocal folds

Question 28

epiglottis

Answer 28

posterior to root of tongue

Question 29

extrinsic laryngeal muscles

Answer 29

elevate or depress the larynx during swallowing

Question 30

intrinsic laryngeal muscles

Answer 30

move the individual components of the larynx, for breathing and phonation

Question 31

blood supply of the larynx

Answer 31

superior laryngeal artery-a branch of the superior thyroid artery
inferior laryngeal artery-a branch of the inferior thyroid artery

Question 32

venous drainage of larynx

Answer 32

the superior laryngeal vein drains to the internal jugular vein via the superior thyroid
the inferior laryngeal vein drains to the left brachiocephalic vein via the inferior thyroid vein

Question 33

nervous innervation of the larynx

Answer 33

vagus nerve
inferior laryngeal nerve-sensory to infra glottis and motor of internal muscles
superior laryngeal nerve-sensory to supra glottis and motor to cricothyroid

Question 34

recurrent laryngeal nerve palsy

Answer 34

apical lung tumour 
thyroid cancer
aortic aneurysm 
cervical lymphadenopathy 
iatrogenic (thyroid surgery)
-leads to hoarseness of voice due to paralysis of the vocal fold.

Question 35

unilateral rln palsy

Answer 35

• hoarseness

- increased risk of aspiration

Question 36

bilateral rln palsy

Answer 36

• cords adducted
• breathing impaired (stridor, snoring)
• phonation cannot occur

Question 37

left recurrent laryngeal nerve

Answer 37

• long course

- down into chest and loops under aortic arch up to larynx

Question 38

right recurrent laryngeal nerve

Answer 38

shorter and loops around subclavian artery

Question 39

cricoid pressure

Answer 39

• during intubation pressure can be applied to the cricoid cartilage of the larynx
• this occludes the oesophagus-preventing gastric regurgitation