The tracheobronchial tree and larynx Flashcards
At the lower border of what cartilage does the trachea arise
cricoid cartilage - ring of hyaline that site inferior to the thyroid gland
at what vertebral level does the larynx lie
C3-C6
at what level does the trachea bifurcate
T4-T5 - level of the sternal angle
The thyroid cartilage is the largest of the laryngeal cartilages. It is formed by a right and a left lamina that are separated posteriorly and joined together at an acute angle in the anterior midline forming what prominence known as the Adams apple
laryngeal prominence
At what vertebral level is the thyroid cartilage found
C4-C5
what cells line the tracheal lumen
ciliated pseudostratified columnar and goblet cells that create the tracheal mucosa
what nerve innervates the trachealis muscle ( that allows the trachea to constrict and dilate
recurrent laryngeal nerve/ inferior laryngeal nerve ( same thing) branch of the vagus nerve
what vertebral level does the trachea extend from
C6-T4/T5
In a tension pneumothorax tracheal deviation can occur and the mediastinum to shift to the other side- compressing the vena cava and opposite lung - what major problem can occur if this goes untreated
cardiac arrest
Sx of pneumothorax
none
sudden onset dyspnoea ( difficulty or laboured breathing)
pleuritic chest pain
asymmetrical chest expansion
Tnesion P - can look blue or ashen skin anxiety and rapid hr
what is pleuritic chest pain
Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. It is exacerbated by deep breathing, coughing, sneezing, or laughing.
what is the difference between a pneumothorax and a tension pneumothorax
Pneumothorax (air in the pleural cavity) is classified as open (external wound) or closed. The pleural pressure equilibrates with atmospheric pressure, resulting in lung collapse. Tension pneumothorax develops when air continuously enters the chest without evacuation ( valve)
if inserting an IV canula into the lungs to drain fluid where do you insert it
2nd intercostal space ( above or below) in mid clavicular line - audible hiss
what are the two arteries that supply the trachea in the neck and chest region respectively
neck - inferior thyroid arteries
chest- branches of bronchial arteries
what vein drains the trachea
brachiocephalic vein
where both the pleura connect and where vessels are airways can only enter the lungs - what is this point called and at what vertebral level
hilum
T5-T7
the trachea bifurcates into the right and left bronchus - following the right lung the bronchus bifurcates into the superior lobar bronchus and the what ? that leads on to split into the middle and inferior lobar bronchi
bronchus intermedius
why is the left lung lower than the right
The left lung is a little smaller than the right lung because it shares space in the left side of the chest with the heart.
cardiac notch
the main bronchi branch into the lobar bronchi then the segmental bronchi
the lobar bronchi supply what generically
lobes of the lung
3 on right 2 on left
what do each of the tertiary bronchi supply
bronchopulmonary segment ( separated by connective tissue) 10 in right 8 in left ish
what can be found within each bronchopulmonary segment
lobules of lungs segmental bronchus segmental branches from pulmonary arteries branches of bronchial artery pulmonary vein and lymphatic margin
what are club cells
major secretory cell in the small airway epithelium occupying anywhere between 5% and 20% of total cells and secrete an array of bioactive compounds into the airway surface liquid (ASL) that protect the epithelium from damage
surfactant lipoprotein
bronchioles –> conducting bronchioles –> terminal –> respiratory –> alveolar duct –> alveolar sacs –> ?
alveoli
what cells make up respiratory bronchioles
simple squamous
in acute asthma allergen causes constriction of what vessels
bronchioles - through bronchospasm
What is bronchitis and what are the Sx
Bronchitis is an infection of the bronchi, causing them to become irritated and inflamed. mucus hyper secretion Sx Cough yellow-grey mucus (phlegm) sore throat wheezing
Rx COPD
what is bronchiolitis
much like bronchitis but affects the bronchioles and more common in younger children
a high temperature (fever) a dry and persistent raspy cough. difficulty feeding. difficulty breathing or fast breathing. noisy breathing (wheezing)
can exercise increase bronchodilation and why
increased sympathetic activity so adrenaline released which relaxes smooth muscle in the bronchioles
the bronchial arteries supply the roof of the lungs and visceral pleura the 1 right bronchial artery comes from the thoracic aorta where does the 2 left bronchia arteries come from
thoracic artery
what does the prefix para mean
alongside or adjacent to
what does the prefix pre mean
before or infront of
bronchopulmonary nodes to trachea bronchial nodes to paratracheal nodes to bronchomediastinal lymph trunk tp the thoracic duct
true or false
true
functions of the larynx
phonation
cough reflex
protection of LRT
the internal cavity of the larynx is divided into 3 what are these called
supra glottis - unstoppable inferior epiglottis
glottis - contains vocal cords
subglottis - vocal folds to the trachea
what is the opening between the vocal cords called?
rima glottis
the epiglottis is the posterior root of the tongue and flattens during swallowing to close the larynx - what gland does it attach to
thyroid
The thyroid cartilage -two hyaline laminae from Adams apple - connect to hyoid bone and circoid cartilage - but at what vertebral level can you find the thyroid cartilage
C4-C5
croup causes a characteristic barking cough - epiglottis can be infected by bacteria what are the 4Ds
dysphagia, dysphonia, drooling, and distress
the cricoid cartilage is found just inferior to the thyroid at what level can you find this
C6
the arytenoid cartilage attaches to the vocal ligaments and the aryepiglottic fold true or false ( cuniform Cartilage is within this )
true
where do you find the corniculate cartilage
apex of arytenoid cartilages
what nerve is sensory to the supra glottis and motor to the cricothyroid muscles
superior laryngeal nerve
the inferior laryngeal nerve is sensory to the infra glottis and motor to all the internal muscles of the larynx except what
cricothyroid
what structure does the right recurrent laryngeal nerve ( branch of right vagus ) loop under
right subclavian artery
what structure does the left recurrent laryngeal nerve loop under
arch of the aorta
How can damage be causes to the laryngeal nerves and what is more prone
left more prone as longer course
due to surgery to remove apical lung tumours , thyroid cancers or aortic aneurysms
Sx of unilateral nerve palsy
hoarseness and increased risk of aspiration
A breathy quality to the voice. Hoarseness. Noisy breathing. Loss of vocal pitch. Choking or coughing while swallowing food, drink or saliva. The need to take frequent breaths while speaking. Inability to speak loudly. Loss of your gag reflex.
Bilateral more cords adducted and stridor and phonation cannot occur
what intrinsic laryngeal ligament terminates superior and forms the vocal ligaments
cricothyroid ligaments
what ligament/membrane spans from the arytenoid cartilage to epiglottis and lower margin of the vestibular ligaments.folds
quadrangular membrane
extrinsic - external
intrinsic hold cartilages together
what happens in a cricothyroidectomy
depression below thyroid cartilage can be palpated - incision made here and an ET tube is inserted into the airway
what artery supplies the internal surface of the larynx
superior laryngeal artery ( sup thyroid then external carotid)
what after supplies the mucous membranes and muscles of inferior larynx
inferior laryngeal artery ( inf thyroid then thyrocervical trunk)
do the veins follow the arteries and what do the veins drain into
yes
sup and inf laryngeal veins - internal jug on right and left goes into brachiocephalic vein via inferior thyroid
what sets of lymph nodes drain the larynx and where do they travel to
superior of the vocal cords you find the superior deep cervical lymph nodes
and inferior to the vocal cords you find the pretacheal-para and inferior deep cervical lymph nodes
what is a temporary nasopharyngeal airway called
airway adjust
what is a temporary orophayngeal airway called
guedel and also LMA
what do the extrinsic laryngeal muscles do
elevate or depress the larynx and involved in swallowing - split into supra hyoid ( above) and stylopharyngeus - elevate - and infra hyoid( below) - depress
what do the intrinsic laryngeal muscles do
involved in breathing and phonation and control the shape of the rim glottis.
tongue and lips are secondary closure sites of airspace and produce constant sound
true
the cricothyroid muscle ( intrinsic) attaches to cricoid cartilage and thyroid cartilage what nerve innervates it and what does it do
the external laryngeal nerve - branch of sup. laryngeal nerve
the posterior ( I) cricoarytenoid muscle attaches to cricoid cartilage and arytenoid cartilage and is the only muscle to do what? and what nerve innervates it?
abduct the vocal cords
inferior laryngeal nerve
the arytenoid muscle(I) is composed of transverse and oblique fibres attach to opposite ends of the arytenoid and do what and innervated by what nerve
adduct the arytenoid cartilages/ vocal folds and narrow the rima glottis
inferior laryngeal nerve
lateral cricoarytenoid also does this
which intrinsic muscle attached to thyroid cartilage and arytenoid cartilage relaxes the vocal ligaments and is innervated by the inferior laryngeal nerve
thyroarytenoid muscle ( intrinsic as well )
the stylohyoid muscle attaches to the styloid process and hyoid bone what nerve innervates this muscle and what is it function
facial nerve
elevates and retracts the hyoid bone
what muscle attaches to the manubrium and medial end of clavicle and the body of the hyoid bone and depresses the hyoid bone and larynx after swallowing
sternohyoid
C1-C3 ansa cervicalis
the sternothyroid connects to manubirum and thyroid lamina ( C2-C3 innervation- ansa cervicalis) what does it do
depresses the larynx and thyroid cartilage during swallowing
what muscle attaches to the manubirum and the medial third of clavicle and inserts on the mastoid process of occipital bone
sternocleidomastoid
what innervates the sternocleidomastoid muscle
Cranial nerve 11
and C2-3 spinal root
what is the main action of the sternocleidomastoid
tilts head to one Side i.e. laterally flexes and rotates head so face turned to opposite side
