Vertebral Column and Respiratory System Flashcards
How many bones in the vertebral column of a fetus?
33 vertebrae
How many bones in the vertebral column of an adult?
26 vertebrae
what are the vertebrae of an adult and where do they differ from those of a fetus?
7 cervical
12 thoracic
5 lumbar
1 sacrum (5 fused)
1 coccyx (4 fused)
What are the curves of the spine?
laterally, initially a fetus only has 1 curve
at 3 months of age, when an infant starts to hold their head their cervical curve changes
later, when the infant begins to sit up and walk the lumbar curve changes
What are the primary curves of an adult spine?
thoracic and sacrum/coccyx
Kyphotic curves
convex posteriorly
What are the secondary curves of an adult spine?
the curves that develop as a fetus - toddler
cervical and lumbar
lordotic curves
What is the reason for the curvature of an adult spine?
increase the strength of vertebral column
helps maintain balance by distributing weight
helps absorb shock
helps protect the vertebrae from fractures
What are three abnormal curves of the spine?
Kyphosis (can’t have without lordosis)
Lordosis (can’t have without kyphosis)
Scoliosis
What is kyphosis?
exaggeration of the normal kyphotic curve
Only in the thoracic region since the coccyx is fused
commonly in elderly women due to osteoporosis
What is lordosis?
Exaggeration of the normal lordotic curve
Cervical and lumbar spines
common in pregnant women
What is the typical makeup of a vertebrae?
vertebral body
vertebral arch
vertebral foramen
- opening within the arch
- where the spinal cord passes through
What is the vertebral body?
majority is trabecular bone (red bone marrow) surrounded by a thin layer of cortical bone
bounded by anterior and posterior longitudinal ligaments
separated by intervertebral discs
weight-bearing part of the vertebrae
what is the vertebral arch?
consists of 2 pedicles and 2 laminae
what is a pedicle?
- project posteriorly from the body
- vertebral notches are on the inferior and superior surfaces
- form the intervertebral foramina - where the spinal nerves enter and exit
what is a laminae?
continue from the pedicles and unite posteriorly to form the spinous process
What forms the intervertebral foramina?
the inferior vertebral notch of the superior vertebrae and the superior intervertebral notch of the inferior vertebrae
what process come off the arch?
7 processes
- 2 superior articular processes
- 2 inferior articular processes
- 2 transverse processes - roughly where the pedicle and laminae meet
- 1 spinous process - posteriorly at the union of the laminae
what are the 2 typical vertebral joints?
intervertebral discs
zygapophyseal joints
What are intervertebral discs?
C2/3 to L5/S1
account for 25% of the height of the vertebral column
- annulus fibrosus - outer fibrous ring
- nucleus pulposus - soft, highly elastic
What are zygopophyseal joints?
articulations between the superior and inferior articular processes of adjacent vertebrae
often referred to as facet joints
where we get our movement from
What are the 7 cervical vertebrae?
C3-C6 are typical
C1, C2 and C7 are atypical
C1 is the atlas
C2 is the axis
C7 is the vertebra prominens
what are the characteristics of the atlas?
atlas has no body
what happens to body size of cervical vertebrae? Which vertebrae have smaller bodies?
The size of the bodies increase from C2-C7
only the coccygeal vertebrae have smaller bodies
What vertebral section have the largest vertebral foramina?
the cervical vertebrae
- cervical enlargement of the spinal cord
What spinous processes are bifid (in 2 parts) and short?
C2 to C6
Each transverse process (unique to cervical spine) has a?
transverse foramen - vertebral artery, vein, and nerve pass-through
each transverse process arises from the pedicle and body (rather than the pedicle/laminae)
What features of the cervical spine are seen in a lateral view?
articular pillars
- between superior and inferior articular processes of the same vertebra
zygapophyseal joints
- between adjacent articular pillars
should be open on a true lateral
what is the position of the vertebral foramina?
open anteriorly - 45 to the midsagittal plane - also projected 15 inferiorly
to image - LPO 45 with 15 cephalad angle demonstrates right intervertebral foramina (RAO would need 15 caudad)
C1 (Atlas)
lacks a body and spinous process
anterior arch - articulation for odontoid
posterior arch
Lateral masses - articular pillars of C1
- superior articular process forms atlantooccipital joint (articulate with occipital condyles
- permits the motion of “YES”
- inferior articular process articulates with C2 to form the atlantoaxial joint
C2 (Axis)
odontoid process or Dens
Blunt spinous process
Atlante-axial joints permits rotation of the head to say “NO”
Bifid
What is a Jefferson’s fracture?
acquired by head first impact
axial load from top of head
C1 is wider than C2
C7 - cervical vertebrae
vertebra prominens
useful external landmark
has a long, non-bifid spinous process
What are the thoracic vertebrae?
vertebral bodies get larger from 1-12
- upper bodies 1-4 resemble cervical
- lower bodies 9-12 resemble lumbar
spinous processes are long and project inferiorly
What are the transverse processes of the thoracic spine?
transverse processes are large and are at the junction of the pedicle and lamina
it is at the pedicle and body in the C-spine
What is the major distinguishing feature of the T-spine?
the facets for articulations with the ribs
What is the costovertebral joint?
the head of the rib sits between the rib and vertebral body
What is the costotransverse joint?
between tubercle of rib and transverse process of vertebrae
Costovertebral joint of T-spine articulations with ribs?
head of rib articulates with the posterolateral part on vertebral body
whole facet if head of rib only articulates with 1 body
demi facet (half facet) if head of rib articulates with 2 vertebral bodies
How do different vertebrae articulate with the ribs?
T1 has a whole facet on the superior border for articulation with 1st rib
T1 has a demi facet on its inferior border for articulation with 2nd rib
T2-T8 have demi facets on upper and lower borders
T9 has only a superior demifacet
T10-T12 have a single whole facet on the superior border
Thoracic vertebrae articulation with ribs?
costotransverse joints
tubercle of the rib articulates with the transverse process of the vertebra
T1-T10
What are the articulations of the 7th rib?
tubercle of the 7th rib articulates with the transverse process of T7
the superior half of the head of the rib articulates with the inferior demi facet of T6
the inferior half of the head of the rib articulates with the superior demi facet of T7
Thoracic vertebrae intervertebral foramina and zygapophyseal joints?
Intervertebral foramina is demonstrated on a true lateral
Zygapophyseal is demonstrated by a steep oblique (15-20) from a true lateral position
What is the lumbar vertebrae?
largest vertebral bodies of all vertebrae (L5 is largest)
Compensate for more weight
Bodies are taller anteriory compared to posteriorly
bodies are concave anteriorly and laterally
spinous processes are thick, blunt and project horizontally
transverse processes are smaller compared to thoracic
spinal cord ends at the disc between L1 and L2 in adult patient
What is an indication of a compression fracture?
in the inferior vertebral body is smaller than the superior
What is the Pars interarticularis of the Lumbar vertebrae?
part of the lamina that is located between the superior and inferior articular processes
clinically very significant
“neck” of the scotty dog on oblique lumbar spine images
What is spondylolysis?
fracture of pars interarticularis
What is spondylolisthesis?
both pars fractured on the same vertebrae
What are the parts of the scotty dog?
Ear - superior articular process
Nose - transverse process
Eye - pedicle
Neck - pars interarticularis
the scotty dog demonstrares zygopophyseal joints
The dog faces the same way the patient is facing
what is the intervertebral foramen of the lumbar vertebrae?
formed by the superior and inferior vertebral notch
best seen on a lateral projection
zygapophyseal joints of the lumbar spine?
rotate patient an average of 45
RPO/LAO demonstrates right zygapophyseal or facet joints and right pars interarticularis
What is the sacrum?
triangular shaped bone
base is superior
apex is inferior
adult has 5 fused vertebrae (begins to fuse at 16-18)
concave curve anteriorly - varies on sex of individual - females have a greater curve
Anterior view of the sacrum?
base
- Sacral Ala - fused transverse processes of S1 - auricular surface is on the lateral edge of sacrum and forms SI joint
- Sacral promontory
- 2 superior articular processes - articular with inferior articular processes of L5
4 pairs of sacral foramina
Apex - articulates with coccyx
Posterior view of the sacrum?
convex surface
Median sacral crest - fused spinous processes
Lateral sacral crest - fused transverse processes
4 pairs of posterior sacral foramina
Sacral hiatus - Lamina of S5 (sometimes S4 too) fail to meet
Sacral cornu - adjacent to sacral hiatus, inferior articular oricess of S5
What does the sacral canal house?
spinal nerves
What is the coccyx?
triangular shaped
Base is superior and articulates with sacrum
apex is inferior and at the level of the symphysis pubis (greater trochanter)
Fusion of 4 rudimentary vertebrae typically (20-30 years of age)
What is the thoracic cage composed by and its purpose?
thoracic vertebrae
ribs
sternum
encloses and protects the organs and vessels in the thoracic and upper abdominal cavities
What is the sternum?
flat bone - red bone marrow
Anterior connection for ribs
1. manubrium
2. body
3. xiphoid process
segments fuse by 25
What is the manubrium?
jugular notch - disc space between T2 and T3
Clavicular notch - superior, lateral border, forms SC joint
1st rib (costocartilage) attaches just below the SC joint
Sternal angle is the junction between the manubrium and body of the sternum
What is the body of the sternum?
sternal angle
- 2nd rib attaches here (attaches to both manubrium and body)
- disc space between T4 and T5 - good landmark for the start of the aortic arch (top of heart)
ribs 3-7 also attach directly to the body of the sternum
What is the xiphoid process?
T10
good landmark for the bottom of heart or (anterior/superior part) diaphragm
get patient to show where their ribs come together
How many ribs are there?
12 pairs, numbered 1-12 starting with the most superior
What are ribs obliquity?
slant anterior and inferior
Anterior part is 3-5 inches inferior to vertebral or posterior part
Where do the ribs attach?
anterior part of the rib attaches to costocartilage
What is the space between the ribs called?
intercostal spaces
What is the costal groove?
a groove on the inferior surface of the rib that houses arteries, veins and nerves
If assessing a full respiration on a PA patient, what do you need to be able to see?
10 posterior ribs above the diaphragm on the left side, as the left diaphragm is lower than the right due to the liver
What are the parts of a typical rib?
vertebral end (Head, Neck and Tubercle), shaft or body and sternal end (attaches to costocartilage)
What is the vertebral end of the rib?
Head - articulates with the vertebral body
Neck
Tubercle - articulates with the transverse process
What are the true ribs?
ribs 1-7
attach directly to sternum via costocartilage
What are false ribs?
ribs 8-12
What are floating ribs?
Ribs 11 and 12 do not attach anteriorly to anything
What are the functions of the respiratory system?
exchange of gases - intake of oxygen, removal of carbon dioxide
HELPS REGULATE BLOOD PH
Sense of Smell
Filters warm and inhaled air
produces voice
excretes small amount of water and heat
what are the cavities of the respiratory system?
nasal, oral and thoracic
What is the thoracic cavity?
lungs, heart, thymus gland
Separated from the abdominal cavity by the diaphragm
Mediastinum
Why is it important to denote if you do a chest image AP?
the heart and mediastinum will appear enlarged, making the radiologist believe there is a pathology
What is the mediastinum?
area between the lungs
heart
aorta
SVC and IVC (superior or inferior vena cava)
Trachea
Esophagus
Thymus
What are the 3 separate cavities within the thoracic cavity?
1 pericardial cavity - space between visceral and parietal layers around the heart
2 pleural cavities - space between the visceral and parietal layers around the lungs
What is the pleura?
double walled serous membrane
made up of the parietal pleura, visceral pleura and pleural cavity
What is the parietal pleura?
lines the superior portion of diaphragm and chest wall
- outer part
What is the visceral pleura?
clings to the surface of the lungs
- inner part
What is the pleural cavity?
in between visceral and parietal pleura
Negative pressure (potential space)
Contains a small amount on lubricating fluid (serous fluid) - reduces friction (should be painless)
What does the respiratory system consist of?
nose, nasal cavity, pharynx, larynx, trachea, bronchi and lungs
What are the structural classifications of the respiratory system?
upper respiratory system - nose, nasal cavity and pharynx
Lower respiratory system - larynx, trachea, bronchi and lungs
What are the functional classifications of the respiratory system?
conducting zone and respiratory zone
What is the conducting zone?
Series of connecting cavities and tubes
Nose, nasal cavity, pharynx, larynx, trachea, bronchi, bronchioles, terminal bronchioles
Filter, warm, moisten and conduct air to and from the lungs
What is the respiratory zone?
tubes and tissues within the lungs where gas exchange occurs
respiratory bronchioles, alveolar ducts, alveolar sacs and alveoli
What is the nasal cavity?
external nares (nostrils) to internal nares
between nasal bones and cartilage to hard palate
What are the 3 functions of the nasal cavity?
- warm, filter and moisten incoming air
- detect olfactory stimuli
- modify speech as they pass through conchae and sinuses
Pharynx
internal nares to level of cricoid cartilage (most inferior cartilage of the larynx)
mucus escalator
1. nasopharynx
2. oropharynx
3. laryngopharynx
Nasopharynx
posterior to nasal cavity to soft palate where it becomes oropharynx
has 2 eustachian tubes or auditory tubes (connect middle ear to equalize pressure)
has 1 pharyngeal tonsil or adenoid (immune response)
Oropharynx
extends from the soft palate to the hyoid bone (starts at the fauces or the opening to oral cavity)
has both respiratory and digestive functions
common passageway for food and air
lingual and palatine tonsils are located in oropharynx
vallecula is superior to epiglottis
laryngopharynx
from level of hyoid to esophagus
has both respiratory and digestive functions
connects directly to larynx and esophagus
larynx
voice box
connects laryngopharynx to trachea
Anterior esophagus from C4 to C6
wall is composed of 9 cartilages
9 cartilages of the larynx
thyroid cartilage (adam’s apple) is a landmark for C5 - connected to hyoid
Cricoid cartilage forms the inferior wall and attached to trachea (C6)
eppiglottis is a leaf-shaped - “stem of leaf” is attached to the thyroid cartilage, “broad leaf” is freely moveable
- during swallowing, the epiglottis covers the glottis (opening of the larynx) to prevent aspiration)
glottis
consists of a pair of folds or mucous membrane
has vestibular folds (false vocal cords) and vocal cords (true vocal cords)
vestibular folds (false vocal cords)
superior pair
important part of valsalva maneuver
vocal cords (true vocal cords)
inferior pair
sound is produced by vibrations of the vocal cords
higher pitch occur when the cords are pulled tight
volume is controlled by force of air against the cords
Trachea
C6 to T5 (carina)
anterior to esophagus
formed by 16-20 c-shaped cartilages stacked on top of one another
semi-rigid support that prevents trachea from collapsing down
C opens posteriorly
midline, but may shift to right by the aortic arch
Bronchi
at Carina (T5), trachea splits into right and left main stem bronchi
right main stem bronchus is more vertical, shorter and wider compared to left (important because most aspirated object go into the right lung)
most aspirated objects or misplaced feeding tubes go into right lung
T5 is the level of the?
carina
Bronchial tree
trachea -> main stem bronchi -> lobar bronchi (secondary) -> segmental bronchi (tertiary) -> bronchioles -> terminal bronchioles -> lung lobule (over 100,000) -> respiratory bronchioles
right lung
right main stem bronchus
3 lobar bronchi
10 segmental bronchi - 10 bronchopulmonary segments - many lobules
left lung
left main stem bronchus
2 lobar bronchi
10 segmental bronchi - 10 bronchopulmonary segments - many lobules
what are lung lobules?
where the actual gas exchange occurs
what do lung lobules contain?
lymphatic vessel
arteriole
venule
branch from a terminal bronchiole - further divide into respiratory bronchioles - (around 300 million alveoli) - extremely thin membrane for rapid diffusion of gases
Type 1 cells of the alveoli
main site of gas exchange
Type 2 cells of the alveoli
secrete surfactant which lowers surface tension and therefore reduces the tendency for alveoli to collapse
What are the parts of the lung?
lung parenchyma
apex or apices
bases
costophrenic angles
hilum
cardiac notch
What is the lung parenchyma?
highly elastic and spongy
What is the apex or apices?
top portion of lungs
Goes to T1 - make sure vertebra pominens is in the light field
What are the bases?
concave bottom that rests on the diaphragm
lungs extend lower posteriorly and laterally because of diaphragm - drop bucky 1” for lateral
What are the costophrenic angles?
extreme outermost lower corner of each lung
What is the Hilum?
also known as the root of the lung
main stem bronchi, pulmonary blood vessels, lymphatic vessels, and nerves
What is the cardiac notch?
only on left lung where the heart sits
Right Lung
typically shorter than left (liver pushes hemi-diaphragm up) but wider because no heart
1. Upper (superior) lobe - horizontal fissure
2. Middle lobe - oblique fissure
3. Lower (inferior) lobe
Left Lung
Typically longer and narrower than the right
Has cardiac notch
Upper (superior) lobe
Lower (inferior) lobe
Blood supply for the lungs
Right and left pulmonary arteries
Bronchial arteries
Pulmonary Veins (4)
Right and left pulmonary arteries
carry deoxygenated blood from the right side of the heart to the capillaries surrounding the alveoli
bronchial arteries
Arise from the aorta (left side of the heart) and carries oxygenated blood to supply the muscular walls of the bronchi and bronchioles
pulmonary veins (4)
carry oxygenated blood from the capillaries surrounding the alveoli back to the left side of the heart
respiration
process of gas exchange on the body
requires 3 seperate processes
1. pulmonary ventilation
2. external or pulmonary respiration
3. internal or tissue respiration
pulmonary ventilation
exchange of air between atmosphere and alveoli
inhalation (inspiration) and exhalation (expiration)
External or pulmonary respiration
exchange of gases between alveoli and surrounding capillaries
Internal or tissue respiration
exchange gases between blood in systemic capillaries and tissues
the process of pulmonary ventilation
in between breaths, the pressure inside the lungs is equal to the atmosphere
Inspiration
Expiration
Forced Expiration
What is inspiration
pressure inside must be less than atmosphere
- diaphragm muscle contracts (dome flattens down) - responsible for 75% of the air entering the lungs during quiet breathing
- external intercostal muscles contract elevating ribs - responsible for 25% of the air entering the lungs during quiet breathing
actions of these muscles increase the volume and the lungs and decrease the pressure according to Boyle’s law
contractions of the muscles requires energy
Expiration
normal expiration during quiet breathing is a passive process (does not require energy)
elastic recoil of the lungs (spring back after they have been stretched)
relaxation of the diaphragm and external intercostal muscles - decrease the vertical, lateral and AP diameters of the thoracic cavity - decreases lung volumes
Forced expiration
playing a wind instrument or during exercise
becomes an active process
contraction of the abdominal muscles and intercostal muscles aid in forced expirations
Old McDonald Had a Farm
External
Intercostal
Elevate
Inspiration
Oh!
Respiratory center
Located in the brain stem (pons and medulla)
Monitors and controls respiratory rate by stimulating muscle contractions
Chemoreceptors monitor levels of CO2 and O2 in blood - located in aortic and carotid bodies
What is Boyle’s Law?
pressure is inversely proportional to volume
What is Dalton’s law?
Air we breathe
20.9% oxygen
0.04% carbon dioxide
Dalton states that the partial pressure of O2 and CO2 determines their movement - from higher partial pressure to lower partial pressure
