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Physiology > The tracheobronchial tree and larynx > Flashcards

The tracheobronchial tree and larynx Flashcards

1
Q

what level is the suprasternal notch?

A

T2/3

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2
Q

what level is the sternal angle?

A

T4/5

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3
Q

what level is the inferior angle of the scapula?

A

T8

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4
Q

what level is the xiphisternum?

A

T9

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5
Q

what level is the lowest part of the costal margin - 10th rib?

A

L3

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6
Q

how many ribs are there?

A

12

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7
Q

connections of the ribs

A

the first 7 are connected via costal cartilages to sternum
8-10 are articulated with the rib above
11 and 12 are free

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8
Q

what is the role of the thoracic cage?

A

protection of the thoracic and abdominal organs
resists negative intrathoracic pressure of lung recoil can change shape for respiration
attachment and movement of upper limbs

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9
Q

naming of intercostal spaces

A

named after the rib above the space

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10
Q

what is the role of pleural fluid?

A

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

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11
Q

what is the root of the lungs?

A

the structures that pass to or from the hilum
bronchus
bronchial arteries and veins
pulmonary artery and veins

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12
Q

trachea

A

11-12cm long and 2.5cm wide
fibrocartilagenous tube supported by cartilage rings
extends from the larynx at the level of C6 to T5 (sternal angle)

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13
Q

what are the layers of the trachea?

A

mucosa - pseudostratified ciliated columnar epithelium
submucosa - areolar connective tissue with seromucous glands and ducts
C shaped ring of hyaline cartilage - completed by trachealis smooth muscle and connective tissue
adventitia - made of areolar connective tissue

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14
Q

where does the trachea bifurcate?

A

carina

level of sternal angle

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15
Q

main bronchi

A

enter lungs at hilum
right is wider, shorter and more vertical and the left is inferior to the aortic arch and anterior to esophagus and descending thoracic aorta .

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16
Q

what is the largest subdivision of the bronchial tree?

A

bronchopulmonary segments

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17
Q

bronchopulmonary segments

A

largest subdivision of lung
pyramidal shape, apex at hilum
discrete anatomical and functional units separated by connective tissue.
surgically resectable

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18
Q

blood supply and drainage of bronchopulmonary segments

A

supplied by segmental bronchi, pulmonary and bronchial arteries centrally
venous and lymphatic drainage at edges
drain adjacent segments

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19
Q

how many bronchopulmonary segments are there in the left lung?

A

8-10, 4-5 per lobe

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20
Q

how many bronchopulmonary segments are there in the right lung?

A

10
3 superior
2 middle
5 inferior

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21
Q

what comes from secondary bronchi?

A

segmental bronchi / tertiary

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22
Q

segmental bronchi

A

divide into conducting bronchioles that end as terminal bronchioles

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23
Q

bronchioles

A

transport air, no alveoli
bronchioles lack cartilage
terminal bronchioles divide into respiratory bronchioles

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24
Q

respiratory bronchioles

A

outpouchings - alveoli
structural unit of gas exchange
involved in transport and gas exchange
divide into alveolar ducts (2-11)

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25
Q

alveolar ducts

A

give rise to alveolar sacs (5-6)

multiple alveoli clusters open

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26
Q

how many alveoli are there?

A

300 million

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27
Q

what is a bronchopulmonary segment?

A

part of lung supplied by a tertiary/ segmental bronchus and arteries

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28
Q

what is there within each bronchopulmonary segment?

A 
lobules of the lung
segmental bronchus
segmental branches from pulmonary artery
branches of bronchial artery 
pulmonary vein and lymphatics at margin
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29
Q

branches of bronchial tree

A 
secondary/ lobar bronchi
tertiary/ segmental bronchi
smaller bronchi
bronchioles
terminal bronchioles
respiratory bronchioles
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30
Q

secondary bronchioles

A

aka lobar

plates of hyaline cartilage

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31
Q

tertiary bronchi

A

aka segmental

pseudostratified ciliated columnar epithelium

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32
Q

smaller bronchi

A

reduced or no plates of hyaline cartilage

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33
Q

bronchioles

A

simple ciliated columnar/ cuboidal epithelium

no cartilage, more smooth muscles

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34
Q

terminal broncioles

A

simple cuboidal epithelium

no goblet cells and underlying mucous glands

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35
Q

respiratory bronchioles

A

simple squamous epithelium

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36
Q

blood supply to trachea

A

neck - inferior thyroid arteries

chest - branches from bronchial arteries

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37
Q

blood supply of lungs

A

each lung has a pulmonary artery and 2 pulmonary veins (superior and inferior)

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38
Q

pulmonary artery

A

divides alongside the bronchial tree

carry low O2 blood to lungs for oxygenation

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39
Q

pulmonary veins

A

right middle to superior lobe
carries oxygen rich blood to the left of heart
independent of bronchial tree and pulmonary arteries

40
Q

bronchial arteries

A

supply blood for nutrition to the lungs, structures of the root of the lungs and visceral pleura

41
Q

where do the left bronchial arteries come from?

A

2 from thoracic aorta

42
Q

right bronchial artery

A

1 from thoracic aorta or from one of the 3 upper posterior intercostal arteries or left superior bronchial artery

43
Q

blood supply to parietal pleura

A

supplied and drained by thoracic wall vessels

44
Q

emphysema

A

lung tissue destruction and reduced airflow

45
Q

chronic bronchitis

A

inflammation and scarring and narrowed airways

46
Q

asthma attack

A

smooth muscle spasms occur at bronchiolar level of bronchial tree and closes off airways as there is no cartilage

47
Q

what happens during exercise?

A

increased sympathetic activity
release of adrenaline and noradrenaline by the adrenal gland
relaxation of smooth muscles of bronchiole
bronchodilator
increase lung ventilation

48
Q

what happens at rest/ in allergies

A

parasympathetic activity
allergic mediators released - histamine
contracts the bronchiolar smooth muscles - bronchoconstriction
decrease lung ventilation

49
Q

where is laryngeal prominence

A

C4-5

50
Q

trachea surface anatomy

A

midline from laryngeal prominence
immediately posterior to suprasternal notch
bifurcates at sternal angle

51
Q

tracheal deviation

A

caused by tension pneumothorax

52
Q

symptoms of tension pneumothorax

A 
tracheal deviation
chest pain
shortness of breath
rapid heart rate
shallow breathing
anxiety
blue or ashen skin
kinking of vena cava causing no venous return to heart, no cardiac output, risk of cardiac arrest
53
Q

how does a tension pneumothorax form?

A

opening in pleura acts as 1 way valve so air comes in on inspiration but the valve closes on expiration and the air cannot escape
positive intrapleural pressure collapses the lung and eventually causes mediastinal shift to the opposite side

54
Q

treatment for tension pneumothorax

A

medical emergency

insert large bore cannula to mid clavicular line 2nd intercostal space

55
Q

chest tube

A

incision is made in the 5th and 6th intercostal space in the midaxillary line (nipple level)
directed superiorly to cervical pleura to remove air or inferiorly to remove fluid

56
Q

Larynx

A

anterior neck

57
Q

functions of larynx

A

phonation
cough reflex
protection of lower respiratory tract

58
Q

structure of larynx

A

primarily cartilaginous skeleton - 9 cartilages
ligaments and membranes
laryngeal muscles move components of the larynx for phonation and breathing

59
Q

anatomy of larynx

A 
suspended from hyoid bone
C3-6
below pharynx and above trachea
behind infrahyoid muscles
in front of oesophagus and medial to thyroid gland
60
Q

subdivisions of larynx

A

internal cavity divided into 3
supraglottis
glottis
subglottis/ infraglottis

61
Q

supraglottis

A

from inferior surface of epiglottis to vestibular folds

62
Q

glottis

A

vocal apparatis
contains false and true vocal cords
laryngeal ventricle - lateral recess between vestibular and vocal folds

63
Q

rima glittidis

A

opening between vocal cords, size altered by muscles of phonation

64
Q

subglottis

A

from vocal folds to trachea

65
Q

laryngeal cartilages

A

unpaired and paired

66
Q

unpaired laryngeal cartilages

A

thyroid
cricoid
epiglottis

67
Q

thyroid cartilage

A

laryngeal prominence
superior and inferior horns
thyrohyoid membrane attaches to hyoid

68
Q

cricoid cartilage

A 
ring 
cricothyroid joints
changes length of vocal folds
cricothyroid ligament
cricotracheal ligament
69
Q

epiglottis

A

posterior to root of tongue

70
Q

paired laryngeal cartilage

A

arytenoid
corniculate
cuneiform

71
Q

vocal folds

A

under control of muscles of phonation
vocal ligament
vocalis muscle

72
Q

what is the space between the vocal folds called?

A

rima glottidis

73
Q

vestibular folds

A 
false vocal cords
lie superiorly to the true vocal cords
consist of vestibular ligament
fixed folds
provide protection to larynx
74
Q

laryngeal muscles

A

extrinsic and intrinsic

75
Q

extrinsic laryngeal muscles

A

elevate or depress the larynx during swallowing
larynx suspended from hyoid
infrahyoid muscles depress
suprahyoid muscles elevate

76
Q

intrinsic laryngeal muscles

A 
move the individual components of the larynx for breathing and phonation
control shape of rima glottidis 
adductors
abductors
sphincters
tensors
relaxers
vocalis muscles
77
Q

innervation of intrinsic laryngeal muscles

A

inferior laryngeal nerve from recurrent laryngeal nerve

78
Q

innervation of cricothyroid

A

superior laryngeal nerve

79
Q

laryngeal ligaments

A

extrinsic

intrinsic

80
Q

extrinsic laryngeal ligaments

A

attach larynx to external structures

81
Q

intrinsic laryngeal ligaments

A

hold cartilages of the larynx together as one functional unit internally
cricothyroid and quadrangular membrane

82
Q

appearance of false and true vocal cords

A

false/ vestibular folds = covered by mucous membrane, are pink
true vocal folds = avascular so appear white

83
Q

blood supply of larynx

A

superior and inferior laryngeal artery

84
Q

superior laryngeal artery

A

branch of superior thyroid artery

supplies internal surface

85
Q

inferior laryngeal artery

A

branch of inferior thyroid artery

supplies mucous membranes and muscles of inferior larynx

86
Q

venous drainage of larynx

A

superior and inferior laryngeal veins

87
Q

superior laryngeal vein

A

drains to internal jugular vein

88
Q

inferior laryngeal vein

A

drains to left brachiocephalic vein

89
Q

lymphatic drainage of larynx

A

superior to vocal folds = superior deep cervical lymph nodes

inferior to vocal folds = pretracheal and paratracheal lymph nodes - inferior deep cervical lymph nodes

90
Q

innervation of larynx

A

motor and sensory from vagus nerve, via superior and inferior laryngeal nerve

91
Q

inferior laryngeal nerve

A

continuation of recurrent laryngeal nerve
sensory to infraglottis
motor to all internal muscles except cricothyroid

92
Q

superior laryngeal nerve

A

sensory to supraglottis

motor to cricothyroid muscle

93
Q

what causes a recurrent laryngeal nerve palsy?

A 
apical lung tumour
thyroid cancer
aortic aneurysm 
cervical lymphadenopathy 
iatrogenic
94
Q

symptoms of recurrent laryngeal nerve palsy

A

hoarse voice due to paralysis of vocal fold
weak voice
bovine cough

95
Q

unilateral RLN palsy

A

hoarseness

increased risk of aspiration

96
Q

bilateral RLN palsy

A

cords adducted
breathing impaired - stridor, snoring
phonation cannot occur

97
Q

cricoid pressure

A

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

Physiology (46 decks)

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