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Respiratory System > The Tracheobronchial Tree and Larynx > Flashcards

The Tracheobronchial Tree and Larynx Flashcards

1
Q

What is immediately posterior to the suprasternal notch?

A

Trachea

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2
Q

What is the sternal angle?

A

Where trachea ends and becomes right and left bronchus

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3
Q

What is the manubrium?

A

Massive, thickest and squarest of 3 main parts of sternum

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4
Q

What is the angle of louis?

A

Name given for sternal angle which is a palpable feature formed from manubriosternal junction

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5
Q

What are the symptoms of Tension Pneumothorax?

A 
Chest pain + tightness
Cough
Blue or ashen skin (cyanosis)
Rapid heart rate
Fatigue
Anxiety
Shortness of breath
Shallow breathing
Seen respiratory distress
Asymmetrical chest expansion
Tracheal deviation on neck palpation
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6
Q

What causes tension pneumothorax?

A

Secondary to mechanical ventilation
Ongoing air leak
Can occur after penetrating or blunt chest trauma or potentially after failed subclavian or jugular venous catheter insertion attempts

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7
Q

Mechanism behind tension pneumothorax?

A

1) Opening in the pleura acts as 1 way valve so air in on inspiration but valve closes on expiration so can’t escape
2) Positive intrapleural pressure collapses lung
3) Eventually causes mediastinal shift to opposite side (tracheal shift)
4) This happening can cause kinking of vena cava resulting in decreased or no venous return to heart
5) Compresses the opposite lung

6) If no venous return can lead to no cardiac output = Risk of cardiac arrest

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8
Q

Management of Tension Pneumothorax (non-emergency)

A

Incision made in the 5th and 6th intercostal space in midaxillary line (approx nipple line)
Tube directed superiorly toward cervical pleura for removal of air or inferiorly toward costodiaphragmatic recess for fluid drainage

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9
Q

Management of Tension pneumothorax (emergency)

A

Cannula 2nd intercostal space in mid-clavicular line then chest drain

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10
Q

Trachea extends from which spinal levels?

A

From larynx at level of C6 to T5 (sternal angle)

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11
Q

What is the carina?

Where is it?

A

Ring of cartilage that has a hook underneath it that splits it into right and left bronchus

At level of sternal angle

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12
Q

What are the layers of the trachea?

A

Mucosa includes cilia, pseudo-stratified columnar epithelium, lamina propria
Submucosa
C-shaped ring of hyaline cartilage
Adventitia

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13
Q

What is the hilum?

A

Where the bronchi and pulmonary vessels enter the lung

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14
Q

Difference between left and right bronchi?

A

Right is wider, shorter and more vertical

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15
Q

What are the lobes in the lungs? How are they separated?

A

Left lung: Upper and lower love separated by oblique fissure
Right lung: Upper lobe, lower lobe and middle lobe
Upper and middle separated by horizontal fissure and all 3 separated by oblique fissure

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16
Q

Order of the bronchial tree?

A 
Main bronchi (primary)
Lobar bronchi (secondary)
Segmental bronchi (tertiary)
Terminal bronchioles
Respiratory bronchioles
Alveolar ducts
Alveoli
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17
Q

What do the segmental bronchi (tertiary) supply?

A

bronchopulmonary segments

e.g upper, middle, lower lobes

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18
Q

What do bronchioles lack?

A

cartilage

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19
Q

Secondary (lobar) bronchi structural specialization

A

Plates of hyaline cartilage

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20
Q

Tertiary (segmental) bronchi structural specialization

A

Pseudostratified ciliated columnar epithelium

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21
Q

Terminal bronchioles structural specialization

A

Initially ciliated, then simple columnar epithelium
No cartilage, more smooth muscles
No goblet cells, no mucous

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22
Q

Respiratory bronchioles structural specialization

A

Simple squamous epithelium

Surfactant producing

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23
Q

Alveoli structural specialization

A

Single-cell layer of pneumocytes

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24
Q

Cause of acute asthma?

A

Allergen that causes sudden inflammation and contraction of bronchiole smooth muscle (bronchospasm), narrowing the airways

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25
Q

Symptoms of acute asthma

A

Difficulty breathing

Wheezing

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26
Q

What type of disease in terms of genes is cystic fibrosis?

A

Autosomal recessive

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27
Q

What is the pathophysiology of cystic fibrosis?

A

Deranged transport of chloride and other ions alters the viscocity of mucous
Makes patient more prone to infection, damaging bronchi resulting in bronchiectasis

28
Q

Symptoms of COPD

A 
Chronic bronchitis (mucus hypersecretion
Emphysema (tissue destruction)
Bronchiolitis (small airway inflammation and fibrosis)

Lead to resistance to airflow in airways
increased compliance in lungs
air trapping
Progressive airflow obstruction

29
Q

What causes COPD?

A

Long term exposure to harmful particles and gases causing abnormal inflammatory response
Smoking major cause

30
Q

Which arteries supply the lungs and visceral pleura?

A

Bronchial arteries
2 left bronchial arteries
single right bronchial artery

31
Q

What vessels supply the parietal pleura?

A

Thoracic wall vessels

32
Q

The lymphatic drainage steps for lungs

A

1) Bronchopulmonary nodes
2) Tracheobronchial nodes
3) Pratracheal nodes
4) Bronchomediastinal lymphatic trunks
5) Thoracic duct

33
Q

Where is the larynx located?

A

In anterior neck

34
Q

Functions of larynx ?

A

Phonation- production of vocal sound + speech
Cough reflex
Protection of the lower respiratory tract

35
Q

How is the larynx interior surface lined?

A

Pseudostratified ciliated columnar epithelium except for vocal cord which stratified squamous epithelium

36
Q

Larynx spinal root position

A

C3-C6

37
Q

What is above and below the larynx

A

Superior pharynx

Inferiorly trachea

38
Q

3 parts of the larynx

A

Supraglottis
Glottis- contains false and true vocal cords
Subglottis/infraglottis- vocal folds to trachea

39
Q

Name 3 laryngeal cartilages (unpaired)

A

Epiglottis- flattens during swallowing
Thyroid (C4)
Cricoid (C6)- can be compressed during emergency intubation to stop regurgitation of stomach content

40
Q

Name 3 paired laryngeal cartilages

A

Arytenoid
Corniculate
Cuneiform

41
Q

What do vocal folds do?

A

produce speech
protect airway from choking from material in throat
regulate flow of air into lungs

42
Q

What is Reinke’s space?

A

In true vocal cords. Watery layer. Due to fluidity, epithelium able to vibrate freely above it to create sound

43
Q

What is Rima Glottidis?

A

Space between vocal cords

44
Q

Difference between true and false vocal cords?

A

True: non-keratinized stratified squamous epithelium
False: vestibular ligament covered by mucous membrane

45
Q

Similarities between true and false vocal cords?

A

Protection to larynx

46
Q

What nerve innervates the larynx?

A

Vagus nerve (Motor and sensory)

47
Q

What branch of the vagus nerve supplies the supraglottis?

A

Internal branch of superior laryngeal nerve

48
Q

What branch provides innervation to infraglotttis?

A

Inferior laryngeal nerve (continuation of recurrent laryngeal nerve)

49
Q

Which is more prone to palsy right or left recurrent laryngeal nerve?

A

Left as has a longer course- loops under aortic arch

50
Q

Damage of RLN causes

A

Apical lung tumour
Thyroid cancer
etc.

51
Q

Symptoms of Unilateral RLN palsy (recurrent laryngeal nerve)

A

Hoarseness
Increased risk of aspiration
Bovine cough

52
Q

Symptoms of bilateral RLN palsy

A

Cords adducted
Breathing impaired (stridor, snoring)
Phonation cannot occur

53
Q

What do the extrinsic laryngeal muscles do?

A

Elevate/superiorly or depress/inferiorly the larynx during swallowing

54
Q

What do the intrinsic laryngeal muscles do?

A

Move individual components of larynx for breathing and phonation

55
Q

What do the suprahyoid muscles do? (extrinsic)

A

Elevate the larynx

56
Q

What do the infrahyoid muscles do?

A

Depress the larynx

57
Q

How do the vocal cords produce sound?

A

Adduction of arytenoids and elongation of vocal folds closes the airway

58
Q

What do extrinsic laryngeal ligaments do?

A

attach larynx to external structures?

59
Q

What do intrinsic laryngeal ligaments do?

A

Hold cartilages of the larynx together as one functional unit

60
Q

What is cricothyroidotomy

A

Emergency procedure that provides a temporary airway in situations where there is obstruction at or above the larynx

(facial trauma, oedema, foreign body)

61
Q

How to do a cricothyroidotomy

A

1) Depression below thyroid cartilage can be palpated
2) Incision made here
3) ET tube inserted to secure airway

62
Q

Vein drainage

A

Superior laryngeal vein draining to internal jugular vein and inferior laryngeal veins draining to left brachiocephalic vein

63
Q

What lymph nodes are superior to vocal folds?

A

Superior deep cervical lymph nodes

64
Q

What lymph nodes are inferior to vocal folds?

A

Pretracheal and paratracheal lymph nodes

Inferior deep cervical lymph nodes

65
Q

What does the inferior laryngeal nerve innervate?

A

Sensory innervation to Infraglottis

Motor innervation to all internal muscles of larynx except cricothyroid

66
Q

What does the superior laryngeal nerve innervate?

A

Sensory innervation to supraglottis

Motor innervation to cricothyroid

67
Q

lung blood supply

A

1 pulmonary artery
2 pulmonary veins
2 left brachial arteries
1 right brachial artery

Respiratory System (19 decks)

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