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1 MBChB Anatomy > Thorax 1 (Respiratory System) - part 2 > Flashcards

Thorax 1 (Respiratory System) - part 2 Flashcards

1
Q

What do dermatomes correspond with on the chest wall?

A

Intercostal spaces

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2
Q

What is a dermatome?

A

Area of skin supplied by a single spinal nerve

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3
Q

At the sternal angle, dermatome C4 lies immediately above T2 instead of C5, why is this?

A

C5-T1 supplies the arms

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4
Q

What dermatome is overlying the sternal angle?

A

T2

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5
Q

What dermatome is overlying the nipple area?

A

T4

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6
Q

What dermatome is overlying the umbilicus?

A

T10

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7
Q

What dermatome is overlying the inguinal region?

A

L1

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8
Q

What is the purpose of the lymphatic system?

A

Return lymph to the circulatory system

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9
Q

What is lymph?

A

Essentially plasma that has leaked from capillary beds due to hydrostatic pressures

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10
Q

What organs do not have lymphatic drainage?

A

Cartilage

Eyes

Inner ear

Brain

Spinal cord

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11
Q

What are the major groups of lymph nodes?

A

Axillary

Superficial and deep inguinal

Pectoral

Tracheobronchial

Lumbar/pelvis

Superficial cervical and deep cervical

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12
Q

Where are the axillary lymph nodes?

A

Root of the upper limbs

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13
Q

Where are the superficial and deep lymph nodes?

A

Root of the lower limbs

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14
Q

Where are the pectoral lymph nodes?

A

Around the pectoralis major muscle

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15
Q

Where are the tracheobronchial lymph nodes?

A

Bifurcation of trachea in thorax

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16
Q

Where are the lumbar/pelvic lymph nodes?

A

Around root of arteries in the abdomen and pelvis

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17
Q

Where are the superficial and deep cervical lymph nodes?

A

Head and neck

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18
Q

What is A?

A

Cervical lymph nodes

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19
Q

What is B?

A

Infraclavicular lymph nodes

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20
Q

What is C?

A

Axillary lymph nodes

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21
Q

What is D?

A

Para-aortic lymph nodes

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22
Q

What is E?

A

Inguinal lymph nodes

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23
Q

What is F?

A

Pelvic lymph nodes

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24
Q

What is G?

A

Spleen

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25
Q

What is H?

A

Mediastinal lymph nodes

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26
Q

What is I?

A

Supraclavicular lymph nodes

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27
Q

Where do lymph nodes tend to be clustered around?

A

Large veins

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28
Q

What do the axillary lymph nodes lie in relation to?

A

Axillary vein and its branches in the axilla

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29
Q

What are examples of axillary nodes?

A

Anterior (pectoral) group

Posterior group

Apical group

Central group

Lateral groups

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30
Q

What is A?

A

Axillary vein

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31
Q

What is B?

A

Central axillary nodes

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32
Q

What is C?

A

Lateral axillary nodes

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33
Q

What is D?

A

Posterior axillary nodes

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34
Q

What is E?

A

Subscapular vein

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35
Q

What is F?

A

Pectoralis minor

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36
Q

What is G?

A

Anterior axillary nodes

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37
Q

What is H?

A

Apical axillary nodes

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38
Q

Where does most of the lymph of the breast drain to?

A

Anterior (pectoralis) lymph nodes

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39
Q

Where is the base (glandular part) of the breast located?

A

Between ribs 2 to 6 and between the lateral border of the sternum and the midaxillary line

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40
Q

What is the glandular part of the breast divided into?

A

16-20 lobes and smaller lobules

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41
Q

What is the glandular part of the breast surrounded by?

A

Adipose (fatty) tissue

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42
Q

Where does the axillary tail of the breast extend?

A

Uperolaterally to penetrate the floor of the axilla

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43
Q

Which dome of the diaphragm is more superior?

A

Right

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44
Q

Why is the right dome of the diaphragm more superior than the left?

A

Left needs to make room for the heart

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45
Q

What level is this CT scan taken at?

A

T4

Trachea has just bifurcated, as has the pulmonary artery

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46
Q

What colour do the lungs and respiratory passages appear in a CT scan?

A

Black

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47
Q

Why do respiratory passages and the lungs appear black in CT images?

A

Air filled spaces

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48
Q

How does one view a CT scan by clinical convention?

A

Feet up

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49
Q

What is the relative position of the oesophagus to the trachea at all points along their length?

A

Posterior

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50
Q

Is their cartilage in a bronchiole?

A

No

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51
Q

How does the trachea branch?

A

Trachea - primary bronchi - secondary bronchi - tertiary (segmental) bronchi - bronchioles - terminal bronchioles - respiratory bronchioles - alveoli

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52
Q

What bronchus is extrapulmonary?

A

Primary bronchi

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53
Q

What bronchus is intrapulmonary?

A

Secondary and tertiary bronchus

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54
Q

What is tertiary bronchi also known as?

A

Segmental bronchi

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55
Q
A
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56
Q

What are the 2 portions of the branches from the trachea known as?

A

Conducting portion (no gas exchange)

Respiratory portion (gas exchange)

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57
Q

What is the last component of the conducting system of the respiratory system?

A

Terminal bronchioles

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58
Q

What is the beginning of the respiratory portion of the respiratory system?

A

Respiratory bronchioles

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59
Q

What is A?

A

Trachea

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60
Q

What is B?

A

Main bronchus

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61
Q

What is C?

A

Segmental bronchus

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62
Q

What is D?

A

Bronchioles

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63
Q

What is E?

A

Terminal bronchioles

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64
Q

What is F?

A

Respiratory bronchioles

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65
Q

How do you known this is a bronchus?

A

Presence of hyaline cartilage plates

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66
Q

What is A?

A

Hyaline cartilage plates

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67
Q

What is the diameter of a bronchioles?

A

1mm or less

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68
Q

What things are not present in bronchioles compared to trachea and larger bronchi?

A

Cartilage

Glands

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69
Q

This a slide of a bronchioles, what is A?

A

Terminal bronchioles

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70
Q

This is a slide of a bronchioles, what is B?

A

Respiratory bronchioles

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71
Q

What does this slide show?

A

Bronchioles

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72
Q

What is still present in the terminal bronchioles that is present in larger airways?

A

Some cilia and smooth muscle

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73
Q

What is the classification of the epithelium of terminal bronchioles?

A

Columnar or cuboidal

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74
Q

What is A?

A

Blood vessels

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75
Q

What is B?

A

Bronchiole

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76
Q

What is C?

A

Blood vessel

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77
Q

What is D?

A

Alveolar duct

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78
Q

Alveolus

A
79
Q

What two connective tissue fibres are found in the alveolar walls?

A

Elastin

Reticulin

80
Q

What 3 cells are found in the wall of an alveolus?

A

Type 1 pneumocyte

Type 2 pneumocyte

Macrophage

81
Q

What is the function of a type 1 pneumocyte?

A

Permit gas exchange to take place

82
Q

What is the function of a type 2 penumocyte?

A

Secrete pulmonary surfactant

83
Q

What is the function of a macrophage?

A

Digest forign bodies

84
Q

What is A?

A

Type II pneumocyte

85
Q

What is B?

A

Macrophage

86
Q

What is C?

A

Type I pneumocyte

87
Q

What is the pleura?

A

Double layer of serous membranes that surround each lung

88
Q

What does the pleura consist of?

A

Outer parietal layer (lining the inner wall of the chest cavity)

Inner visceral layer (adherent to the lung tissue)

Pleural space (or cavity, which is the space between these two membranes)

89
Q

Which of the parietal and visceral layer of the pleura is outer and inner?

A

Parietal is outer (lines chest wall)

Visceral is inner (lines lungs)

90
Q

What is A?

A

Trachea

91
Q

What is B?

A

Pleura (lung lining)

92
Q

What is C?

A

Lung

93
Q

What is D?

A

Pleural space

94
Q

How would you describe the relationship between the parietal and visceral layers of the pleura?

A

Continuous to each other

95
Q

Which layer of the pleura enters and lines the fissures of the lungs?

A

Visceral

96
Q

Which layer of the pleura is sensitive to pain?

A

Parietal

97
Q

What nerves supplies pain sensation to the pleura?

A

Phrenic nerve

Intercostal nerves

98
Q

What is the parietal pleura also named according to?

A

Its location within the thoracic cavity:

mediastinal pleura

diaphragmatic pleura

costal pleura

apical pleura

99
Q

Where does the mediastinal pleura line?

A

The structures situated between the two pleural cavities (mediastinum)

100
Q

Where does the diaphragmatic pleura line?

A

Superior surface of the diaphragm

101
Q

Where does the costal pleura line?

A

Inner surfaces of the ribs and sternum

102
Q

Where does the apical pleura line?

A

Apex of the lungs in the root of the neck

103
Q

What is the apical pleura also known as?

A

Cervical pleura

104
Q

What lies immediately above the apical pleura?

A

A fascial membrane known as the suprapleural membrane

105
Q

What is A?

A

Apical/cervical pleura

106
Q

What is B?

A

Costal pleura

107
Q

What is C?

A

Mediastinal pleura

108
Q

What is D?

A

Diaphragmatic pleura

109
Q

What is the presence of air within the pleural space known as?

A

Pneumothorax

110
Q

What occurs at the reflections within the pleura?

A

Space between the parietal and visceral pleura is greater than normal, forming a pleural recess

111
Q

What can occur in a pleural recess?

A

Accumulation of fluid

112
Q

What is 1?

A

Costodiaphragmatic recess and reflection

113
Q

What is 2?

A

Costomediastinal recess and reflection

114
Q

What is each part of the pleura innervated by?

A

Phrenic nerve - mediastinal adn diaphragmatic parietal pleura

Intercostal nerves - remainder of parietal pleura

115
Q

What kind of innervation does the visceral pleura have?

A

Autonomic innervation for stretch

116
Q

What is the surface markings of the pleura?

A

Starting 2.5cm above mid point of medial 1/3 of clavicle

Meet in midline at rib 2

Left side diverges at rib 4 to makr room for the heart, whilst the right continues parasternally to rib 6

Both cross rib 8 in the midclavicular line

Then rib 10 in the midaxillary line

Both reach posterior chest just below rib 12

(continuous red line)

117
Q

What is the surface markings of the lungs?

A

2 rib spaces less than the pleura

(blue dotted line)

118
Q

What are the surface markings of the fissues?

A

Oblique - spine of T3 vertebra to rib 6 anteriorly along medial border scapula

Horizontal (on right only) - rib/costal cartilage 4 to rib 5 in midaxillary line

(purple dotted lines)

119
Q

What are the surface markings of the oblique fissue?

A

Spine of T3 vertebrae to rib 6 anteriorly along medial border of scapula

(purple dotted lines)

120
Q

What are the surface markings of the horizontal fissure?

A

Rib/costal cartilage 4 to rib 5 in midaxillary line

(dotted purple line)

121
Q

What fissure(s) are present on the left lung?

A

Oblique fissure

122
Q

What fissure(s) are present on the right lung?

A

Oblique

Horizontal

123
Q

What rib level is the lung at in the:

midclavicular line

midaxillary line

midscapular line

A

Midclavicular - rib 6

Midaxillary - rib 8

Midscapular - rib 10

124
Q

What rib level is the parietal pleura at in the:

midclavicular line

midaxillary line

midscapular line

A

Midclavicular line - rib 8

Midaxillary line - rib 10

Midscapular line - rib 12

125
Q

How many intercostal spaces difference is there between the inferior border of the lung and parietal pleura at each landmark?

A

2

126
Q

What organ occupies the notch seen in the anterior border of the left lung between ribs 4 and 6?

A

Heart

127
Q

What space does the heart occupy?

A

Ribs 4 to 6

128
Q

The oblique fissure follows the course of what rib?

A

Rib 6

129
Q

The horizontal fissure follows the course of what rib?

A

Rib 4

130
Q

Where does the posterior border of each lung extend from?

A

C7 to T10

131
Q

Why is pleural aspiration performed in the 9th intercostal space in the midaxillary line and not the 10th?

A

Risk of penetrating the abdominal (pritoneal) cavity

132
Q

What is the diaphragm?

A

Sheet of skeletal muscle that forms the boundary between the thoracic and abdominal cavities

133
Q

How many attachments does the diaphragm have?

A

4

134
Q

How many hiatuses (openings) does the diaphragm have?

A

3 major and a number of minor

135
Q

What do the hiatuses (openings) in the diaphragm permit?

A

Structures to pass between the thorax and abdomen

136
Q

What is the purpose of the diaphragm?

A

Main muscle for respiration

Assists in raising inta-abdominal pressure during coughing, vomiting and defaecation

137
Q

What is the main muscle of respiration?

A

Diaphragm

138
Q

What are hiatuses?

A

Openings

139
Q

Which of the left or right dome of the diaphragm lies more superior during normal expiration and why?

A

Right as the heart pushes down on the left

140
Q

What cardiac structure is firmly attached to the central tendon?

A

Fibrous pericardium

141
Q

At which vetebrae are the left and right crura attached?

A

Left - L1-L2

Right - L1-L3

142
Q

What is the crura of the diaphragm?

A

Tendinous structures that extend below the diaphragm to the vertebral column, forming a muscular tether for contraction

143
Q

Which membrane covers the superior surface of the diaphragm?

A

Parietal membrane

144
Q

What is A?

A

Central tendon of diaphragm

145
Q

What is B?

A

Opening for inferior vena cava

146
Q

What is C?

A

Diaphragm

147
Q

What is D?

A

Central tendon

148
Q

What is E?

A

Medial arcuate ligament

149
Q

What is F?

A

Left crus of diaphragm

150
Q

What is G?

A

Aorta

151
Q

What is H?

A

Diaphragm

152
Q

What is I?

A

Oesophagus

153
Q

What is J?

A

Right crura of diaphragm

154
Q

When the diaphragm contracts, do the domes ascend or descend?

A

Descend

155
Q

What is the shape of the central tendon?

A

Clover

156
Q

What attachments does the diaphragm have?

A

1 central tendinous and 4 peripheral bony

157
Q

What tendon is the diaphragm attached to?

A

Central tendon

158
Q

What costal cartilages is the diaphragm attached to?

A

Costal cartilage 7 - 10

159
Q

What part of the sternum is thr diaphragm attached to?

A

Xiphoid process

160
Q

What vertebrae is the diaphragm attached to?

A

L1 - L3

161
Q

How do major and smaller structures pass through the diaphragm?

A

Major structures pass through the major hiatuses

Smaller structures can pass along with the major structures or pass through a minor hiatus by themselves

162
Q

What are the major structures that pass through the diaphragm?

A

Inferior vena cava

Oesophagus

Aorta

163
Q

What vertebral level is the opening for the vena cava on the diaphragm?

A

T8

164
Q

What vertebral level is the opening for the oesophagus through the diaphragm?

A

T10

165
Q

What vertebral level is the opening for the aorta through the diaphragm?

A

T12

166
Q

This shows the major structures passing through the diaphragm, what is A?

A

Sternum

167
Q

This shows the major structures passing through the diaphragm, what is B?

A

Diaphragm

168
Q

This shows the major structures passing through the diaphragm, what is C?

A

Inferior vena cava

169
Q

This shows the major structures passing through the diaphragm, what is D?

A

Oesophagus

170
Q

This shows the major structures passing through the diaphragm, what is E?

A

Aorta

171
Q

This shows the major structures passing through the diaphragm, what is F?

A

Celiac trunk

172
Q

This shows the major structures passing through the diaphragm, what is G?

A

Superior mesenteric artery

173
Q

Through which part of the diaphragm does the inferior vena cava pass?

A

Tendinous not muscular

174
Q

Why does the inferior vena cava pass through the tendinous and not muscular part of the diaphragm?

A

So it doesn’t contract and stop the blood flow

175
Q

Why do the structures that pass through the diaphragm more anteriorly also pass through it at a higher vertebral level?

A

Due to the dome shape

176
Q

What is a hiatus hernia?

A

Abnormal protrusion (herniation) of a structure into the thorax through a tear or weakness in the diaphragm caused by frequent hard coughin, heavy lifting or a number of other things

177
Q

What things could herniat in a hiatus hernia?

A

Abdominal oesophagus

Upper part of the stomach

178
Q

What kind of nervous innervation does the diaphragm recieve?

A

Motor and sensory supply on both its left, right, superior and inferior sides

179
Q

What nerves supply innervation to the diaphragm?

A

Phrenic nerves (motor and sensory)

Lower intercostal nerves (sensory to peripheral parts of the diaphragm)

180
Q

What vertebral levels of the spinal cord contribute to the phrenic nerves?

A

C3, 4 and 5

181
Q

Nervous supply to the diaphragm, what is A?

A

Phrenic nerve

182
Q

Nervous supply to the diaphragm, what is B?

A

Lower intercostal nerves

183
Q

What kind of innervation does the phrenic nerves give the diaphragm?

A

Motor and sensory

184
Q

What kind of innervation does the lower intercostal nerves give the diaphram?

A

Sensory

185
Q

What parts of the diaphragm are innervated by the lower intercostal nerves?

A

Periphery of the diaphragm

186
Q

What is required if damage to the spinal cord occurs above the level of the phrenic nerves?

A

Paralysis of the diaphragm and the need for artificial ventilation

187
Q

How can you differentiate the vagus and phrenic nerves?

A

Vagus are thicker and lie more medially, and soon pass posteriorly in the thorax out of view to lie on the oesophagus

Phrenic nerves remain relatively anterior and visible throughout their course to the diaphragm

188
Q

What is A?

A

Vagus nerve

189
Q

What is B?

A

Phrenic nerve

190
Q

How do muscles contribute to the respiratory movements of inspiration and expiration?

A

Inspiration involves active contraction of the respiratory muscles to increase volume of the chest capacity

Expiration is normally passive

191
Q

What is forced inspiration/expiration?

A

Involves the action of accessory muscles, which are ussually attached to the superior and inferior boundaries of the thoracic cavity

(such as muscles of the neck attaching to the sternum and upper ribs, and muscles of the abdoment that attach to the lower ribs)

192
Q

What happens during damage to the phrenic nerve?

A

Paralysis of ipslateral dome of the diaphragm

Intercostal muscles and nerves work to compensate and maintain some respiratory function

193
Q

When should penetrating wounds be suspected to cause damage to the diaphragm?

A

Below the nipples (intercostal space 4) due to the upwards arching of the domes in quite expiration to the rib 5 if not higher

1 MBChB Anatomy (15 decks)

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