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Anatomy class > Unit 13: The airways > Flashcards

Unit 13: The airways Flashcards

1
Q

What makes up the laryngeal skeleton?

A

The hyoid bone
Thyroid cartilage
The cricoid cartilage

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2
Q

Describe the shape of the cricoid cartilage

A

A complete signet shaped ring with a broad aspect posteriorly

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3
Q

Describe the anatomical location of the cricoid cartilage relevant to other structures

A

In adult male cricoid cartilage is found midway (3-4cm) between the hyoid bone and the tracheal notch

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4
Q

What is the role of the cricothyroid joints?

A

Contracts to allow the cricoid cartilage and the thyroid cartilage to move independently and as a unit.

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5
Q

What is the role of the cricothyroid muscle?

A

Pull the thyroid inferior and anterior relative to the cricoid
This elongates the vocal cords

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6
Q

What si the cricothyroid membrane/ligament?

A

Attaches anteriorly in the midline, connects the cricoid and thyroid cartilages
Also attaches to the vocal process at the arytenoid cartilage, has a free thickened upper border which forms the vocal ligament and contributes to the vocal cords

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7
Q

What are some of the internal structures found in the larynx?

A

The epiglottis
Arytenoid cartilages
Cuneiform cartilage
Corniculate cartilage
Vocal cords.

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8
Q

What is the epiglottis?

A

Curved and leaf-shaped in structure
Folds over the glottis
Directs food and liquid into the oesophagus by closing over the larynx.

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9
Q

Where are the arytenoid cartilages found?

A

On the upper posterior rim of the cricoid cartilage

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10
Q

What is the purpose of the cuneiform and corniculate cartilage?

A

Found on top of the arytenoid cartilage - adds shape and bulk to mucosal folding

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11
Q

What are the vocal folds?

A

Ligaments from arytenoid to inside mid point of thyroid cartilages, ligaments can be tensed by muscles to open and close.

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12
Q

When do the vocal cords tend to move?

A

Open on inspiration
Close on expiration and when protecting the larynx
Vibration of the cords - produces sound
Change in thickness or tension of the cords alters pitch

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13
Q

What is the glottis?

A

The opening between the vocal folds in the larnyx
Passage between the lungs and the mouth.

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14
Q

What makes up the nasal cavity?

A

We have two separate cavities - separated by the nasal septum
Each cavity contains a superior, middle and inferior nasal conchae called turbinate bones.
The spaces between these bones makes up the sphenoidethmoid recess, superior meatus, middle meatus and the inferior meatus.

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15
Q

What is the purpose of the conchae in the nose?

A

Where air is swirled, warmed, filtered and humidified - part of the conducting system.

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16
Q

What is the different neurovascular content in the nasal cavity?

A

CN1 - the olfactory nerve
CN5 - general sensation

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17
Q

What is the role of CN1 in the nasal cavity?

A

Branch into the nasal septum and the lateral nasal wall
Provides sense of smell.
Olfactory nerves in the cavity communicate with the olfactory nerve which project to the brain via the olfactory tract.
Cass through the cribriform foramen in the ethmoid bone in order to get into the nasal cavity.

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18
Q

What are the different boundaries of the nasal cavity?

A

Anteriorly - the nares (or nasal vestibule)
Posteriorly - the choanae - gives rise to the nasopharynx in direct communication to the oropharynx.
Superiorly - parts of the frontal, ethmoid and sphenoid bones - separate from the cranial cavity
Inferiorly - the hard palate, division from the oral cavity

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19
Q

What are the different paranasal sinuses?

A

The frontal
The maxiallary
Sphenoidal
Ethmoid cells
2x of each

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20
Q

What are the different regions of the nasal cavity?

A

The olfactory (superior)
THe respiratory resgion (bulk of body)
The vestibule (opening at the nostrils)

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21
Q

What is the role of trigeminal nerve in the nasal cavity?

A

Provides general sensation - pain, temp, touch
Branches into nasal lateral wall, nasal septum and the hard palate
Enters the nasal cavity through the maxillary sinus.

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22
Q

What is the role of the nasolacrimal duct?

A

Lacrimal gland - tears into eye
Excess tear drain into the lacrimal canaliculi in the medial corner of the eye, drains into lacrimal sac then lacrimal duct - this empties into the inferior meatus in the nasal cavity.
Bilateral structure - one for each eye.

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23
Q

What are paranasal sinuses?
What is their function?

A

Hollow chambers in the skull
Increase sound resonance
Reduce weight of skull
Humidify and heat inspired air
Help protect from rapid temperature changes in the nose
Buffer aginst facial trauma.

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24
Q

Label the different paranasal sinuses.

A

Green - frontal
Blue - ethmoidal
Purple - maxillary
Red - sphenoidal.

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25
Q

Label the different paranasal sinuses on the x-ray?

A

Yellow - frontal
Green - ehtmoidal
Red - sphenoid
Yellow - maxillary
Blue - nasal cavity

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26
Q

What nerve innervates the paransal sinus?

A

Trigeminal nerve mainly V1 and V2.

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27
Q

What is the role of the pharnygotympanic tube related to nasal cavity?

A

Located in nasopharynx - links nasopharynx to middle ear, typically opened during swallowing.
Aerates middle ear and clears any mucus into the nasopharynx from the ear
However in children allows infection spread from nasal cavity to middle ear as more horizontal in shape and tend to lye on back a lot.

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28
Q

Label the following image

A

Inferior conchae
Soft palate
Nasopharynx
Opening of the pharyngotympanic tube
Middle concha
Superior concha

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29
Q

Where do the different paranasal sinuses drain into the nasal cavity?

A
  1. Sphenoidal sinus - into sphenoethmoidal recess
  2. Posterior ethmoidal cells into superior meatus
  3. Middle ethmoidal cells in ethmoidal bulba in middle meatus
  4. Anterior ethmoidal cells and frontal sinus - into infundibulum - frontonasal duct - middle meatus
  5. Maxillary sinus into the middle meatus in the floor of the semilunar hiatus.
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30
Q

What structure is the continuation of the larynx?

A

The trachea

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31
Q

What are the different divisions after the trachea?

A

Primary bronchi
Lobal bronchi - righ tlung has 3 left only has 2
Tertiary or segmental bronchi

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32
Q

What is the mediastinum?

A

Central chest - between the pleural cavtities, continas the heart in the pericardium.

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33
Q

What is the role of the pleura?

A

Reduce friction
Protection
Aid ventialtion - creates surface tension to move lungs with ribs.

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34
Q

What is the relationship between the root of the lungs and the hilum?

A

Hilum is the door
Root is the structures going in and out.

35
Q

What are the different regional names of the pleura?

A

Cervical
Mediastinal
Diaphragmatic
Costal.

36
Q

What is the cardiac notch on the left lung?

A

The anterior region of the cardiac impression.

37
Q

What features of the left main bronchus means it is less likely to be obstructed?

A

Smaller in diameter and more horizontally orientated.

38
Q

Describe the innervation of the diaphragm.

A

Motor - via the left and right phrenic nerve respectively, originating from C3,4,5 in the cervical plexus, descend through the thorax.
Sensory - central tendinous part phrenic nerves, peripheral muscular portions 6th to 11th intercostal nerves.

39
Q

What are the different attachments of the diaphragm?

A

Right crus (L1 to L3) and left crus (L1 to L2) attach to the vertebrae posteriorly
Muscle fibres combine centrally to form a central tendon to fuse with inferior surface of pericardium.
Attaches anteriorly to the xiphoid process and the costal margin.

40
Q

What are the different serous covering of the diaphragm?

A

The diaphragmatic parietal plerua - covers the superior surface of the diaphragm.
The diaphragmatic peritoneum covers the inferior surface of the diaphragm

41
Q

What is the surface anatomy of the heart and great vessels?

A

3rd rib right of sternum
5th rib right of sternum
2nd ICS left hand side just off sternum
4th rib left mid calvicualr line
5th ICS left midclav line

42
Q

What is the origin and coarse of the phrenic nerves?

A

Roots C3,C4,C5, from the anterior surface of the anterior scalene muscles.
Descend anteriorly into the middle mediastinum and pass the hilum of the lungs anteriorly

43
Q

What is the origin and course of the vagus nerve?

A

Right vagus nerve - parralel to the trachea, posteroir to the SVC and PT.
Gives off the right recurrent larnygeal nerve branch which loops behind the right subclavian artery to the larynx
Left vagus nerve - enters between the left common carotid and the left subclavian, travels anteriorly to the aortic arch, then posteriorly to the bronchus.
The left vagus nerve divides into the left recurrent laryngeal nerve as it passes through the aortic arch, travels to the left of the ligamentun arteriosum, then in the tracheal oesophageal groove. to the larynx.

44
Q

Where is referred pain from the lungs felt?
What underpins this?

A

Felt in the neck and shoulders (As is the diaphragm) as parietal pleura innervated by phrenic and intercostal nerves
Phrenic nerve routes C3,4,5 corresponds to shoulder and neck

45
Q

What is the innervation of the pleura?

A

Parietal - phrenic and intercostal - sensitivie to pressure, pain and temperature, well localised

Visceral - sensory only detects stretch - ANS from the pulmonary plexus including vagus nerve.

46
Q

What is the function of the larynx?

A

Part of the respiratory tract - protects the lower respiratory tract
Phonation (speach/sound)
Cough reflex

47
Q

What are the unpaired cartilages found in the larynx?

A

Epiglottis
Thyroid
Cricoid cartilages

48
Q

What is the thryoid cartialge?

A

Large more visible in adult males
Two lamniae which join anteriroly to form the laryngeal prominence
Each laminea projects inferior to form the inferior and superior hornes
Inferior horn connect to the cricoid cartilage
Superior horn connect to the hyoid bone via the lateral thyrohyoid ligament.

49
Q

What is the importance of the circoid cartilage?

A

Completely encircles airway marking inferiorly border of larynx at C6
During emergency intubation - pressure can be applied to occlude oesophagus preventing regurgiation from gag reflex.

50
Q

What is the role of the epiglottis>

A

Is elastic cartilage
Marks the entrance to the larynx
Attaches to back of anterior aspect of thyroid cartilage via the thyro-epiglottic ligament
Flattens and moves posteriorly when swallowing to close off the larynx and prevent aspiration.

51
Q

What are the three paired cartilages in the larynx?

A

Arytenoid cartilages
Cornicular cartilage
Cuneiform cartilages
Note these are all bilateral.

52
Q

What is the purpose of the arytenoid cartilages?

A

Pyramidal in shape site on the cricod cartilage
Made from apex - articular with corniculate cartilage
Base - to cricoid
Vocal process - to attach with vocal ligament
Muscular process - for cricoarytenoid muscles to attach

53
Q

What is the purpose of the cornicular catilages?

A

Articular with apices of arytenoid cartilages
Supports vocal folds by folding mucosa

54
Q

What is the purpose of the cuneiform cartilages?

A

Located in aryepiglottic folds
No direct attachment but strengthen the fold.
Supports vocal folds

55
Q

Label the different cartilages in the larynx.

A

Green - epiglottis
Red - thyroid
Blue - arytenoid
Purple - corniculate
Yellow - cricoid

56
Q

Label the cartilage in the image

A

Cuneiform cartilages
Corniculate cartilages

57
Q

What are the different extrinsic ligaments of the larynx?

A

Thyrohyoid membrane - from superior thyroid to hyoid bone
Hypo-epiglottic ligament 0 midline of epiglottis, anterior superiorly to the body of the hyoid bone
Cricotracheal ligament - lower corbed of cricoid cartilage to the adjacent upper border of the first tracheal cartilage

58
Q

Label the different structures of the larynx

A

Hypo-epiglottic ligament
Lateral thryohyoid ligaments
Thyrohyoid membrane
Cricotracheal ligament

59
Q

What are the different intrinsic laryngeal membrane?

A

Cricothyroid ligament
Quadrangular membrane

60
Q

What is the cricothyroid ligament?

A

Also called circovocal membrane or cricothyroid membrane
Extends from arch of cricoid superior to enf ina free upper margin with the space created by the thyroid cartilage
On upper free margin attaches to thyroid cartilage anteriorly and thevocal processes of the arytenoid cartilages posteriorly.
Free margin is thickened to form the vocal ligament the true vocal cord.

61
Q

What is the quadrangular membrane of the larynx?

A

Bilateral
Runds from lateral margin of epiglottis to arytenoid and corniculate cartilage
Also contains the cuneiform cartilage.

62
Q

What are the different borders of the quadrangular membrane and their function?

A

Free upper margin - between epiglottis and the corniculate cartilage - allows passage of air into the larynx
Lower margin between thyroid and arytenoid cartilage - thickens to form the vestibular ligament - false vocal cord of larynx.

63
Q

What makes up the medial border of the nasal cavity?

A

The septal cartilage
The ethmoid bone
Soft palate
Vomer
Nasal bone

64
Q

What is littles area in the nasal cavity?

A

Found on the anterior nasal septum
Anastamosis of 5 arteries - fragile and large blood supply
High risk of nose bleeds.

65
Q

What structure of the trachea prevents it from collapsing?

A

Hyaline C -shaped cartilage rings

66
Q

Why is the tracheal cartilage C-shaped rather than round?

A

Prevent the collapse or obstruction of tube anterirly (mainly during expiration)
Allows expansion of adjacent oesophagus posteriorly during consumption of food or liquid.

67
Q

label the following image black labels

A

Hyoid bone
Lateral thyrohyoid ligament
Superior laryngeal nerve and artery
Median thyrohydois ligament
Thyrohyoid membrane

68
Q

What are the orange labels on this image?

A

Superior horn of thyroid cartilage
Oblique line
Inferir horn of thyroid cartilage
Thyroid cartilage
Laryngeal incisure

69
Q

What are the blue labels on this image?

A

Cricothyroid muscle
Cricothyroid joint
Trachea
Cricoid cartilage
Conus elasticus
Median cricothyroid ligament

70
Q

What branch marks the border between the conducting and respiratory system in the lungs?

A

Terminal bronchioles mark the end of the conducting segment
Respiarotry bronchioles onwards are respiratory system for gas exchange.

71
Q

What are the signs and symptoms of pleural effusion?

A

SOB/dyspnea
Chest pain usually worse on cough
Cough
Fever and chills
Orthopnea
Reduced pO2
Reduced chest expansion
Dull sound on percussion over fluid.

72
Q

Where and why should a chest drain be placed?

A

4th or 5th ICS in the axilla (specifically lateral to lateral edge of pectoralis major and medial to lateral edge of latissimus dorse
Just above the rib below.
In order to avoid damage to VAN in costal groove.
Ant to mid axillary line to avoid long thoracic nerve
On side to best work alongside gravity for fluid drainage.

73
Q

How do lung function measurements tend to be affected by ostructive lung conditions?

A

Total lung capacity - normal
Forced vital capacity - normal
Expiratory flow - decreased
FEV1:FVC ratio - decreased

74
Q

What is the carina?
What vertebral level is it found?

A

Is a cartilagenous ridge separating the left and right main bronchi, formed by the inferior and posterior elongation of the most inferior tracheal ring
Found at T4/5 level

75
Q

What nerve innervates the carina?
Why is this important?

A

The vagus nerve CNX
If the sensory innervation over this area is compromised during intubation than the cough reflex will not be initiated upon aspiration.

76
Q

Which two arches create the oropharyngeal isthmus?
What muscles underline them?

A

Oropharangeal isthmus is the constriction of the anterior oropharynx that bordes the oral cavity
Formed by the palattoglossal arches and the palaotphranygeal arches and muscles respectively .

77
Q

Which two muscles form the inferior pharyngeal constrictor?

A

Thyropharyngeus
Cricopharyngeus

78
Q

What muscle opens the auditory tube?

A

Tensor veli palatine muscle

79
Q

In what situations is a nasogastric tube inserted?
When would it be unsuitable?

A

Patient unable to obtain nutrition orally themselves - stroke and difficulty swallowing, coma, eating disorders
To empty the stomach to prevent aspiration or damage from consumed toxins.
To obtain a sample of gastric content for analysis.
Unsuitable - recent oesophagal intervention, bleed or injury, uncorrected coagulation abnormalities.

80
Q

In what situations is an endotracheal airway inserted?
When is it contraindicated?

A

When patients airway is compromised, has poor respiratory drive, hypoxia and hypercapnia - keeps open for oxygen, medicine or anaesthesia - pneumonia, heart failure, collapsed lung or severe trauma.
Contrainidicated - severe trauma or obstruction does not allow safe placement, cervical spin injury requiring immobilisation or coagulopathy.

81
Q

What are the alternatives to an endotracheal airway?

A

Bag mask ventilation
Supraglottic airway - laryngeal mask airway

82
Q

What are the six accessory muscles of inspiration?

A

Sternoclaidomastoid
Scalenes - anterior, middle and posterior.
Pectoralis minor
External intercostal

83
Q

What are the 4 accessory muscles of expiration?

A

Transverse abdominus
Rectus abdominus
Internal intercostal muscles
External/internal oblique

Anatomy class (42 decks)

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