Thorax 1 (Respiratory System) - part 1 Flashcards
What does the thoracic wall enclose?
Left and right pleural cavities (containing the lungs)
Mediastinum
What is the function of the thoracic wall?
Protect the contents inside the pleural and percardial cavities
Permits movement associated with respiration
What is the thoracic wall composed of laterally?
Ribs 1-12
What is the thoracic wall composed of anteriorly?
Sternum
What is the thoracic wall composed of posteriorly?
Vertebrae 1-12
What bones articulate with the manybrium at its superolateral angle?
First ribs
What is the name given to the joint between the superolateral angle of the manubrium and the first ribs?
Sternocostal joint
What is the name given to the notch formed by the superior border of the manubrium?
Jugular notch
At what vertebrae level is the xiphoid process (xiphisternum) located?
T10
At what vertebrae level is the sternomanubrial joint located?
T4
What component part of the sternum do the facets for the 2nd costal cartilage articulate?
Manubrium sterno joint
What is A?
Jugular notch
What is B?
Clavicular notch
What is C?
Manubrium
What is D?
Sternal angle
What is E?
Body
What is F?
Xiphoid process
What ribs are known as typical ribs?
Ribs 3-9
What are ribs 3-9 known as?
Typical ribs
Where does the head of the typical rib articulate?
T2 and
Where does the tubercle of a rib articulate?
Transerve process of vertebrae
What structures lie in the costal grove of a rib?
Intervostal vein, artery and nerve
What ribs are the true ribs?
Ribs 1-7
What ribs are false ribs?
Ribs 8-10
What ribs are floating ribs?
11-12
What are true ribs?
Ones which attatch directly to the sternum
What are false ribs?
Connect to the costal cartilage of the rib above
What are floating ribs?
Connect only to the vertebrae
What is A?
Head
What is B?
Neck
What is C?
Tubercle
What is D?
Angle
What is E?
Costal grove
Why is the first rib an ‘atypical’ rib?
It is short and wide and flat, only articulating with a single vertebrae (T1)
What vertebrae does rib 1 articulate?
T1
Which of the subclavien artery and subclavien vein lies anterior and posterior to the scalene tubercle?
Anterior - subclavien vein
Posterior - subclavien artery
What supplies the chief blood supply to the upper limbs?
Subclavien artery and vein
Where does the subclavien artery and vein pass relative to the first rib?
Pass from the neck to the axialla, sandwiched between the clavicle and the first rib
What is A?
Subclavian artery grove
What is B?
Scalene tubercle
What is C?
Subclavian vein grove
What shape is the body of a thoracic vertebra?
Heart
Compared to a cervical and lumbar vertebrae, is the size of thoracic larger, smaller or intermediate?
Intermediate
What structures pass through the vertebral foramen of a vertebrae?
Spinal cord
Meninges (dura, arachnoid, pia)
What structures pass through the intervertebral foramen of a vertebrae?
Spinal nerve
What part of a rib articulates with the transverse process of a vertebrae?
Tubercle
How would you describe the spinous process of thoracic vertebrae?
Long
Slender
Sloped downwards
Non bifid
What does bifid mean?
Splits into 2
What two parts of the vertebrae form the neral (vertebral) arch, ie, parts that enclose the spinal cord?
Lamina and the body
What vertebrae numbers does a typical rib articular?
Vertebrral body of the same number and one immediately above
ie, rib 4 articulates to vertebrae T3 and T4
What is the thorax bounded by:
Anteriorly
Posteriorly
Superiorly
Inferiorly
Laterally
Anteriorly - sternum and costal cartilages
Posteriorly - vertebrae 1 to 12
Superiorly - thoracic inlet
Inferiorly - diaphragm
Laterally - ribs 1 to 12
What bones form the boundaries of the thoracic inlet?
Lateral - first rib
Anterior - manubrium
Posteriorly - vertebrae
What bones/costal cartilages form the boundaries of the thoracic outlet?
Anterior - costal cartilages 7 to 12 and xiphisternal joint
Posterior - vertebrae 12
Lateraly - ribs 11 and 12
Which ribs/costal cartilages form the costal margin (subcostal angle)?
Costal cartilage of ribs 7 to 10
What costal cartilages are directly attached to the sternum?
From ribs 1 to 7
What costal cartilages indirectly attach to the sternum through attachment to preceding costal cartilages?
8-10
What muscle is primarily used for breathing in a new born?
Diaphragm
What do the intercostal spaces contain?
3 layers of intercostal muscle
An intercostal nerve
A posterior and anterior intercostal artery and vein
How is the number of intercostal space given?
From the rib superior to it
(intercostal space 4 is below rib 4)
What muscle is found superficial in the intercostal space?
External intercostal
What is the direction of the external intercostal muscle?
Antero-medial
What muscle lies intermediate in the intercostal space?
Internal intercostal
What is the direction of the internal intercostal muscle?
Posteo-lateral
What muscle lies deep in the intercostal space?
Innermost intercostal muscle
What is A?
External intercostal muscle
What is B?
Internal intercostal muscle
What is C?
Innermost intercostal muscle
What is D?
Costal groove
What is E?
Intercostal vein
What is F?
Intercostal artery
What is G?
Intercostal Nerve
Between which two intercostal muscles is the neurovascular bundle located?
Internal intercostal muscle and innermost intercostal muscle
What superior to inferior, what structures comprise the neurovascular bundle?
Intercostal vein
Intercostal artery
Intercostal nerve
In what area of the rib is the neurovascular bundle located?
Costal grove
How do the external and internal intercostal muscles not occupy the entire length of the intercostal space?
They become aponeurotic at one end, called the intercostal membrane
How much of the intercostal space does the innermost intercostal muscles fill?
Half, the other half is completed anteriorly by the transversus thoracis muscles and posteriorly by the subcostalis muscles
If the innermost intercostal muscles only fill the central half of the intercostal space, what is the rest filled by?
Anteriorly by transversus thoracis muscles
Posteriorly by subcostalis muscles
What is A?
Body of thoracic vertebrae
What is B?
Intervertebral disk
What is C?
Internal intercostal membrane
What is D?
Rib
What is E?
Internal intercostal muscles
What is F?
External intercostal muscles
What is G?
Costal cartilage
What is H?
External intercostal membrane
What is I?
External intercostal muscle
What is A?
Transverse thoracis
What is B?
Subcostalis muscle
What is the purpose of the intercostal muscles?
Contribute to respiratory movements of the chest wall
Prevent the lungs and pleura from balooning out between the ribs during movements
What does each structure forming the neurovascular bundle give of above each rib?
Small collateral branch
What is A?
External intercostal muscle
What is B?
Internal intercostal muscle
What is C?
Collateral branch of neurovascular bundle
What is D?
Intercostal vein
What is E?
Intercostal artery
What is F?
Intercostal nerve
What is F?
Innermost intercostal muscle
What is the normal location of a chest drain?
5th intercostal space in the mid-axillary line
Where in the intercostal space should a chest drain needle be inserted?
Above the rib to avoid damaging the neurovascular structures
What are the tissues of the chest wall that a chest drain needle will need to pass from superficial to deep?
Skin
Superficial fascia
Deep fascia
External intercostal muscle
Internal intercostal muscle
Innermost intercostal muscle
Parietal pleura of the lung
Pleural cavity
(after this is visceral pleura then the lung which the needle should not reach)
What do extrapulmonary tubes refer to?
Outside of the lung, such as trachea and bronchi
What is the structure from the lumen to the outside of extrapulmonary tubes?
Mucosa
Submucosa
Cartilage
Adventitia
What is the mucosa of extrapulmonary tubes composed of?
2 layers:
epithelium
lamina propria (thin loose connective tissue layer)
What kind of tissue is the lamina propria?
Thin loose connective tissue layer
The picture is of the extrapulmonary tube, what is A?
Mucosa
The picture is of the extrapulmonary tube, what is B?
Submucosa
What is C?
Cartilaginous layer
What is D?
Adventitia
What kind of cartilage is found in the respiratory tract?
Hyaline
What connective tissue fibre predominates in the respiratory tract?
Elastin
What are the 3 kinds of connective tissue fibre?
Collagen
Elastin
Reticulin
What are the 3 kinds of cartilage?
Hyaline
Fibro
Elastic
What type of muscle fibres is found in the respiratory tract?
Smooth
What is A?
Pseudostratified ciliated columnar epithelium
What is B?
Goblet cell
What is C?
Basal cells
What is D?
Mucous gland
What is E?
Lamina propria
What are the 2 types of cells found in the respiratory epithelium layer?
Basal and goblet cells
What type of epithelium is found in the respiratory tract?
Pseudostratified epithelium
What are the small, hair like structures projecting from the epithelial cells of the respiratory tract into the lumen?
Cilia
What substances are secreted from the glands in the submucosa?
Mucous and water
What is A?
Folded mucosa
What is B?
Thyroid gland
What is C?
Posterior cartilage
What is D?
Trachealis muscle
What is E?
Mucosa
What is F?
Submucosa
What is G?
C-shaped ring of cartilage
What is A?
Respiratory epithelium
What is B?
Lamina propria
What is C?
Mucosa
What is D?
Submucosa
What is E?
Tracheal cartilage
What structure lies immediately posterior to the trachea?
Oesophagus
What is the name of the smooth muscle that is in the posterior wall of the trachea?
Trachealis muscle
What is the function of the posterior strip of smooth muscle found in the tracheal wall?
Allows oesophagus to expand
Coughing
What type of cartilage is found in the trachea wall?
Hyaline
In which tissue layer of the tracheal wall are the secreting glands located?
Submucosa
What are the type of glands found in the submucosa of the tracheal wall?
Seromucous glands
What do the seromucous glands of the tracheal wall secrete?
Mucous and water
What is A?
Hyaline cartilage
What is B?
Trachealis muscle
What does the upper respiratory tract consist of?
Nasal cavity
Pharnx
Larynx
Where is the upper respiratory tract located?
In the head and neck
What is the larynx composed of?
Set of carilages, membranes and ligaments
What does the larynx do?
Produces sound from expired air
Protect the inlet to the respiratory system
What is found superiorly and inferiorly to the larynx?
Superior - hyoid bone (attached to)
Inferior - trachea (continuous from C6)
What nerves supply the larynx?
Branches of the vasgus nerve for both motor and sensory innervation
What is the pharynx otherwise known as?
Throat
What is A?
Nasal cavity
What is B?
Pharynx
What is C?
Larynx
What is D?
Trachea
What is E?
Primary bronchi
What is F?
Lungs
What is A?
Hyoid bone
What is B?
Thyroid cartilage
What is C?
Cricoid cartilage
What is D?
Tracheal cartilages
What is E?
Laryngeal prominence (Adam’s apple)
What is F?
Epiglottis
What is A?
Aperture for internal branch of superior laryngeal nerve and associated artery
What is B?
Thyrohyloid membrane
What is C?
Corniculate cartilage
What is D?
Arytenoid cartilage
What is E?
Cricoid cartilage
What is F?
Trachea
What is G?
Thyroid cartilage
What is H?
Hyoid bone
What is I?
Epiglottis
What cartilage forms the layngeal prominence?
Thyroid cartilage
What is the laryngeal prominance otherwise known as?
Adam’s apple
What structure prevents solids and liquids from entering the laryngeal inlet?
Epiglottis
What cartilages are attached to the vocal cords?
Arytenoid
What kinds of cartilage is all of the cartilage of the larynx?
Hyaline, except the epiglottish which is elastic
What kind of cartilage is the epiglottis?
Elastic cartilage
What does the lower respiratory tract consist of?
Trachea
Primary bronchi and their branches
Lungs
Pleurae
Where is the lower respiratory tract located?
Almost entirely in the thorax
What does the lower respiratory tract recieve its nerve innervation by?
Sympathetic fibres originating in the upper thoracic spinal level via pulmonary plexuses located at the termination of the main bronchi
Parasympathetic fibres from the vagus nerve
both of the above are motor, sensory reach the spinal cord via both of which
How does the lower respiratory tract recieve its arterial supply?
Via the bronchial arteries arising from the thoracic aorta and intercostal arteries
What veins supply the lower respiratory tract?
Bronchial veins drain to the azygos veinous system
Where does the venous supply from the lower respiratory tract drain to?
Azygos venous system
What vertebrae levels does the trachea being and end?
Begins at C6 (inferior to the cricoid cartilage)
Ends at T4
What happens to the trachea at T4?
Bifurcates into the left and right main bronchi
What vertebrae level does the trachea bifurcate into the left and right main bronchi?
T4
How many hyaline cartilage rings are in the trachea?
16-20
What is the muscle called that completes the tracheal rings of cartilage?
Trachealis
What is the final keel-shaped cartilage ring at the bifurcation of the trachea called?
Carina
What is the tubular organ lying immediately posterior to the trachea?
Oesophagus
Where does the oesophagus lie relative to the trachea?
Posterior
What are the arteries called lying immediately lateral to the trachea in the neck?
Common carotid arteries
Where do the common carotid arteries in the neck lie relative to the trachea?
Lateral
What is the nerve called lying immediately lateral to the trachea at both sides?
Vagus
Where does the vagus nerve lie relative to the trachea?
Lateral at both sides
What are the groves called that lie between the trachea and oesophagus on both sides?
Trachea-oesophageal grooves
What is A?
Primary bronchi
What is B?
Carina
What is C?
Primary bronchi
What is A?
Right upper bronchus
What is B?
Right primary bronchus
What is C?
Trachea
What is D?
Left primary bronchus
What is E?
Left pulmonary artery
What is F?
Pulmonary trunk
What is G?
Right pulmonary artery
At what vertebral level does the trachea divide into the two main bronchi?
T4
Which of the two main bronchi is shorter, wider and more vertical?
Right
In which bronchi are accidentally aspirated objects more likely to pass?
Right due to being shorter and wider
What two main arteries arch above the left bronchus?
Aorta and pulmonary artery
Above which bronchus does the aorta and pulmonary artery arch above?
Left primary bronchus
What is the main difference between the branches of the left and right bronchus?
Left main bronchus enters the lung before giving off branches
Right main bronchus gives off a superior branch just before entering the lung
Once the right bronchus splits just before entering the lung, what is the superior and inferior component called?
Superior - superior lobar bronchus
Inferior - hyparterial bronchus
What increases in bronchi the further they branch?
Smooth muscle and elastin content
What decreases in bronchi as they branch?
Cartilage
Where does lymph draining from the trachea, bronchi and lungs go to?
Tracheobronchial lymph nodes
Where are the tracheobronchial lymph nodes relative to the bronchi?
Lie alongside as well as in the cleft between the two main bronchi
Other tahn the tracheobronchial lymph nodes, what other lymph nodes do the lungs drain to?
Bronchomediastinal lymph nodes
Where are the bronchomediastinal lymph nodes found?
Hilum of the lungs
What is A?
Apex
What is B?
Anterior border of right lung
What is C?
Cardiac notch
What is D?
Lingula
What is E?
Mediastinal surface
What is F?
Base
What is G?
Inferior border of right lung
What is H?
Costal surface
What does the left lung posses that the right lung does not?
Cardiac impression
Aortic impression
Cardiac notch
Lingula
What does the right lung possess that the left lung does not?
Middle lobe
Transverse fissure
Superior lobar bronchus
On which lung surface is the hilum found?
Medial
What is the hilum of the lung?
Gap that root goes into
What is the root of the lung?
Vessels that through the hilum into the lungs
What are the 4 structures that constitutes the root of the lung?
Pulmonary artery
Superior pulmonary vein
Inferior pulmonary vein
Primary bronchi
What fascial membrane covers the apex of the lung?
Suprapleural membrane
What is a fascia?
Band or sheet of connective tissue, primarily collagen
Do the lungs extend above the first rib?
Yes, they do so unprotected
Why is it clinically important that the lungs extend above the first rib?
They are unprotected
Which lung is shorter and more broader?
Right lung due to needing to make space for the liver
Why is the right lung shorter and more broader than the left?
It needs to make room for the liver
What features of an isolated lung should you use to ‘side’ them?
Apex/base
Orientation
Lobes
Explain the entire process of the lymphatic drainage of the lungs?
1) Lungs and visceral pleura drain into bronchopulmonary lymph nodes
2) Lymphatics pass to tracheobronchial nodes
3) Drain into the thoraic duct (left) and right lymphatic duct (right)
What is the advantage of lungs having bronchopulmonary segments?
Each lung segment has its own blood and air supply which allows a surgeon to remove that particular segment without adversely affecting any neighbouring segments
How many bronchopulmonary segements does each lung have?
Right - 10
Left - 8 or 9
What is a bronchopulmonary segment of a lung?
Segment of lung supplied by a tertiary (segmental) bronchus and an accompanying branch of the pulmonary artery and bronchial artery and vein
What are the different bronchopulmonary segments of the lung seperated by?
Layers of connective tissue
What structures present in the bronchial wall enables its definitive identification as a bronchus?
Hyaline cartilage
What structures are at the following positions of the hilum:
anterior
posterior
superior
inferior
Anterior - superior pulmonary vein
Posterior - bronchus
Superior - pulmonary artery
Inferior - pulmonary vein
What is situated above the artery in the hilum of the right lung?
Superior lobus bronchus
What is situated below the artery in the hilum of the right lung?
Hyparterial bronchus
What is clustered around the veins at the hilum?
Bronchopulmonary lymph nodes
What is the pulmonary circulation?
Portion of the circulatory system that carries deoxygenated blood away from the right ventricle of the heart to the lungs, and returns oxygenated blood to the left atrium of the heart
What are the vessels of the pulmonary circulation?
Pulmonary arteries
Pulmonary veins
What supplies oxygen to the lung tissue and larger airways?
Bronchial circulation
What does the bronchial circulation supply blood to?
Lung tissue and larger airways
What is A?
Right pulmonary artery
What is B?
Right pulmonary veins
What is C?
Right atrium
What is D?
Right ventricle
What is E?
Heart muscle
What is F?
Left ventricle
What is G?
Left atrium
What is H?
Left pulmonary veins
What is I?
Left pulmonary artery
What is A?
Right atrium
What is B?
Pulmonary valve
What is C?
Tricuspid valve
What is D?
Right ventricle
What is E?
Blood flow through heart
What is F?
Left ventricle
What is G?
Mitral valve
What is H?
Aortic valve
What is I?
Left atirum
