Thorax 1 (Respiratory System) - part 1 Flashcards by David Brennan

What does the thoracic wall enclose?

Left and right pleural cavities (containing the lungs)

Mediastinum

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What is the function of the thoracic wall?

Protect the contents inside the pleural and percardial cavities

Permits movement associated with respiration

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What is the thoracic wall composed of laterally?

Ribs 1-12

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What is the thoracic wall composed of anteriorly?

Sternum

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What is the thoracic wall composed of posteriorly?

Vertebrae 1-12

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What bones articulate with the manybrium at its superolateral angle?

First ribs

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What is the name given to the joint between the superolateral angle of the manubrium and the first ribs?

Sternocostal joint

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What is the name given to the notch formed by the superior border of the manubrium?

Jugular notch

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At what vertebrae level is the xiphoid process (xiphisternum) located?

T10

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At what vertebrae level is the sternomanubrial joint located?

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What component part of the sternum do the facets for the 2nd costal cartilage articulate?

Manubrium sterno joint

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What is A?

Jugular notch

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What is B?

Clavicular notch

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What is C?

Manubrium

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What is D?

Sternal angle

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What is E?

Body

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What is F?

Xiphoid process

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What ribs are known as typical ribs?

Ribs 3-9

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What are ribs 3-9 known as?

Typical ribs

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Where does the head of the typical rib articulate?

T2 and

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Where does the tubercle of a rib articulate?

Transerve process of vertebrae

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What structures lie in the costal grove of a rib?

Intervostal vein, artery and nerve

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What ribs are the true ribs?

Ribs 1-7

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What ribs are false ribs?

Ribs 8-10

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What ribs are floating ribs?

11-12

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What are true ribs?

Ones which attatch directly to the sternum

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What are false ribs?

Connect to the costal cartilage of the rib above

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What are floating ribs?

Connect only to the vertebrae

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What is A?

Head

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What is B?

Neck

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What is C?

Tubercle

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What is D?

Angle

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What is E?

Costal grove

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Why is the first rib an ‘atypical’ rib?

It is short and wide and flat, only articulating with a single vertebrae (T1)

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What vertebrae does rib 1 articulate?

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Which of the subclavien artery and subclavien vein lies anterior and posterior to the scalene tubercle?

Anterior - subclavien vein

Posterior - subclavien artery

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What supplies the chief blood supply to the upper limbs?

Subclavien artery and vein

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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

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What is A?

Subclavian artery grove

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What is B?

Scalene tubercle

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What is C?

Subclavian vein grove

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What shape is the body of a thoracic vertebra?

Heart

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Compared to a cervical and lumbar vertebrae, is the size of thoracic larger, smaller or intermediate?

Intermediate

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What structures pass through the vertebral foramen of a vertebrae?

Spinal cord

Meninges (dura, arachnoid, pia)

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What structures pass through the intervertebral foramen of a vertebrae?

Spinal nerve

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What part of a rib articulates with the transverse process of a vertebrae?

Tubercle

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How would you describe the spinous process of thoracic vertebrae?

Long

Slender

Sloped downwards

Non bifid

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What does bifid mean?

Splits into 2

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What two parts of the vertebrae form the neral (vertebral) arch, ie, parts that enclose the spinal cord?

Lamina and the body

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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

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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

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What bones form the boundaries of the thoracic inlet?

Lateral - first rib

Anterior - manubrium

Posteriorly - vertebrae

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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

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Which ribs/costal cartilages form the costal margin (subcostal angle)?

Costal cartilage of ribs 7 to 10

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What costal cartilages are directly attached to the sternum?

From ribs 1 to 7

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What costal cartilages indirectly attach to the sternum through attachment to preceding costal cartilages?

8-10

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What muscle is primarily used for breathing in a new born?

Diaphragm

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What do the intercostal spaces contain?

3 layers of intercostal muscle

An intercostal nerve

A posterior and anterior intercostal artery and vein

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How is the number of intercostal space given?

From the rib superior to it

(intercostal space 4 is below rib 4)

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What muscle is found superficial in the intercostal space?

External intercostal

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What is the direction of the external intercostal muscle?

Antero-medial

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What muscle lies intermediate in the intercostal space?

Internal intercostal

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What is the direction of the internal intercostal muscle?

Posteo-lateral

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What muscle lies deep in the intercostal space?

Innermost intercostal muscle

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What is A?

External intercostal muscle

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What is B?

Internal intercostal muscle

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What is C?

Innermost intercostal muscle

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What is D?

Costal groove

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What is E?

Intercostal vein

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What is F?

Intercostal artery

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What is G?

Intercostal Nerve

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Between which two intercostal muscles is the neurovascular bundle located?

Internal intercostal muscle and innermost intercostal muscle

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What superior to inferior, what structures comprise the neurovascular bundle?

Intercostal vein

Intercostal artery

Intercostal nerve

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In what area of the rib is the neurovascular bundle located?

Costal grove

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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

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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

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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

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What is A?

Body of thoracic vertebrae

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What is B?

Intervertebral disk

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What is C?

Internal intercostal membrane

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What is D?

Rib

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What is E?

Internal intercostal muscles

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What is F?

External intercostal muscles

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What is G?

Costal cartilage

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What is H?

External intercostal membrane

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What is I?

External intercostal muscle

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What is A?

Transverse thoracis

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What is B?

Subcostalis muscle

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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

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What does each structure forming the neurovascular bundle give of above each rib?

Small collateral branch

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What is A?

External intercostal muscle

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What is B?

Internal intercostal muscle

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What is C?

Collateral branch of neurovascular bundle

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What is D?

Intercostal vein

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What is E?

Intercostal artery

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What is F?

Intercostal nerve

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What is F?

Innermost intercostal muscle

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What is the normal location of a chest drain?

5th intercostal space in the mid-axillary line

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Where in the intercostal space should a chest drain needle be inserted?

Above the rib to avoid damaging the neurovascular structures

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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)

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What do extrapulmonary tubes refer to?

Outside of the lung, such as trachea and bronchi

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What is the structure from the lumen to the outside of extrapulmonary tubes?

Mucosa

Submucosa

Cartilage

Adventitia

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What is the mucosa of extrapulmonary tubes composed of?

2 layers:

epithelium

lamina propria (thin loose connective tissue layer)

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What kind of tissue is the lamina propria?

Thin loose connective tissue layer

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The picture is of the extrapulmonary tube, what is A?

Mucosa

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The picture is of the extrapulmonary tube, what is B?

Submucosa

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What is C?

Cartilaginous layer

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What is D?

Adventitia

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What kind of cartilage is found in the respiratory tract?

Hyaline

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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?

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?

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:

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?