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Respiratory > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Branches of the bronchi

A

Right and left bronchi, lobar, segmental bronchi

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2
Q

What level does the larynx become trachea and pharynx become oesophagus

A

C6

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3
Q

What does the chest cavity contain

A

Mediastinum and right and left pleural cavity

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4
Q

Function of pleural fluid

A

Lubrication and provide surface tension

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5
Q

What causes the visceral and parietal pleura to stick together

A

Surface tension

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6
Q

What are lung lobes

A

Area of lung that each lobar bronchi supply with air
Right side - Upper, middle and lower
Left - Upper and lower

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7
Q

What are bronchopulmonary segments

A

Area of lung that each of the segmental bronchi supply with air. 10 in each lung

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8
Q

What fissues seperated the lobes

A

Horizontal fissure (only right side) and oblique fissures

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9
Q

Classification of the ribs

A

True (1-7), false (8-10) and floating ribs (11-12)

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10
Q

Where does the head of the rib articulate

A

Head of the rib articulates with the body of vertebrae of same number and superior body

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11
Q

Where does the rib tubercle articulate

A

Articulates with transverse process of vertebrae of same number

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12
Q

Joints of thoracic skeleton

A

Sternocoastal joint, Costochondral joint, Costovertebral

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13
Q

Skeletal muscles between ribs and intercoastal space

A

External, internal and innermost intercoastal muscles

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14
Q

How many intercoastal spaces

A

11

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15
Q

Nerve supply to intercoastal space

A

Anterior rami of spinal nerve, intercoastal nerve

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16
Q

Blood supply to posterior intercoastal space

A

Thoracic aorta and drained by Azygous vein

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17
Q

Blood supply to anterior intercoastal space

A

Internal thoracic artery and internal thoracic vein

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18
Q

What forms the intercoastal artery

A

Anastomose between thoracic aorta posteriorly and inner thoracic artery anteriorly

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19
Q

Where do bronchial arteries arise from

A

Anterior branches of thoracic aorta

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20
Q

Why is right dome of diaphragm higher

A

Due to presence of liver

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21
Q

What vertebral bodies diaphragm attaches to

A

L1 to L3 vertebral bodies

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22
Q

Nerve supply to diaphragm

A

Phrenic nerve, C3, 4 and 5 anterior rami

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23
Q

Route of Phrenic nerve to diaphragm

A

C3, 4 and 5 anterior rami. Anterior surface of scalenus anterior muscle. Lateral aspect of the heart supplying somatic sensory and sympathetic axons to diaphragm and fibrous pericardium, somatic motor to diaphragm

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24
Q

What innervates the nipples and umbilicus

A

Nipples - T4, Umbilicus - T10

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25
Q

What quadrants can the breast be divided into

A

Superolateral, superomedial

Inferolateral, inferomedial

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26
Q

Lymph drainage of breasts

A

Unilateral drainage from lateral quadrants to axillary nodes. Bilateral drainage from medial quadrants to parasternal nodes

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27
Q

What level is sternal angle

A

Coastal cartilage 2, T4 vertebrae

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28
Q

What vein can be found in the delto-pectoral groove

A

Cephalic vein

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29
Q

Function of superficial fascia

A

Fatty tissue, provide insulation

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30
Q

Function deep fascia

A

Fibrous, tough and protective in nature

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31
Q

What causes winged scapula

A

Paralysis of serratus anterior often due to injury to the long thoracic nerve

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32
Q

Where does the pectoralis minor attach

A

Coracoid process and ribs 3-5

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33
Q

Where does fluid from haemothorax or pleural effusion generally drain to

A

Costodiaphragmatic or costophrenic recess

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34
Q

Where can the apex of lung be auscultated for

A

Superior to medial 1/3rd of clavicle

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35
Q

Level of horizontal fissures

A

Rib 4

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36
Q

Level of oblique fissures

A

Rib 6

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37
Q

Auscultation of middle lobe

A

Between ribs 4 and 6, midclavicular and midaxillary line

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38
Q

Auscultation of lung base

A

T11 scapular line

39
Q

Origin of pectoralis major

A

Clavicular head originates on the clavicle, sternocoastal head on the sternum and costal cartilage 1 to 6. This inserts into the intertubercular groove of humerus.

40
Q

What nerve supplies pectoralis major

A

Pectoral nerve from brachial plexus

41
Q

Actions of pectoralis major

A

Adduction and medial rotation of upper limb at shoulder joint. Accessory muscle of inspiration

42
Q

Origin of pectoralis minor

A

Coracoid process of scapula

43
Q

Insertion of pectoralis minor

A

Ribs 3-5 midcalvicular line

44
Q

Actions of pectoralis minor

A

Stabilize scapula, accessory muscle of inspiration

45
Q

Nerve supply of pectoralis minor

A

Pectoral nerve from brachial plexus

46
Q

Origin and insertion of serratus anterior

A

Origin on ribs 1-8 anterior axillary line and inserts in the medial border of deep (anterior) surface of scapula

47
Q

Main actions of serratus anterior

A

Stabilize and protraction of scapula

48
Q

Nerve supply of serratus anterior

A

Long thoracic nerve from brachial plexus

49
Q

CNS coordination of coughing

A

Deep inspiration using diaphragm (phrenic nerve C3,4,5), intercostal muscles (intercostal nerves) and accessory muscles on inspiration
Adduction of vocal cords to close rima glottidis (vagus nerve)
Contraction of anterolateral abdominal wall (intercostal nerve) to build-up abdominal pressure which pushes diaphragm up and builds pressure in the chest inferior to adducted vocal cords. The vocal cords suddenly abduct to open rima glottidis (vagus nerve).
The soft palate (CN V - Trigeminal) and elevates (Vagus nerve) to close off the entrance into nasopharynx and direct stream of air through oral cavity rather than nasal cavity as a sneeze

50
Q

What nerves are involved in sneezing

A

CN V - Trigeminal and CN IX - Glossopharyngeal

51
Q

What nerves are involved in coughing

A

CN IX - Glossopharyngeal and CN X - Vagus nerve

52
Q

What are the carotid sheaths

A

Protective deep fascia that contains the vagus nerve, internal carotid artery, common carotid artery and internal jugular vein

53
Q

Route of Phrenic nerve to diaphragm

A

Anterior rami of C 3,4,5. Anterior surface of scalenus anterior muscle. In the thorax descending over lateral aspect of fibrous pericardium anterior to lung root

54
Q

Muscles of quiet inspiration

A

External, internal and innermost intercoastal muscles

55
Q

Accessory muscles of inspiration

A

Pectoralis major and minor, Sternocleidomastoid, Scelenus anterior, middle and posterior

56
Q

What ribs do Pectoralis minor pull

A

Ribs 3-5 superiorly towards the coracoid process of scapula

57
Q

Where does the sternocleidomastoid attach

A

Sternum/clavicle and mastoid process of temporal bone

58
Q

What supplies the vocal cords

A

Somatic motor nerves part of CN X - Vagus nerve

59
Q

Vagus nerve connections in brainstem

A

Medulla oblongata at brainstem. Exit cranium at jugular foramen

60
Q

Location of vagus nerve at root lung

A

Posterior to root lung whereas Phrenic nerve is anterior to lung root

61
Q

Where does the aponeurosis of left and right external oblique meet

A

Linea alba

62
Q

Where does external oblique attach inferiorly

A

Iliac crest and pubic tubercle

63
Q

What is the attachment of muscle fibre to aponeurosis called

A

Linea semilunaris

64
Q

Inferior attachment of internal obliques

A

Iliac crest and thoracolumbar fascia of lower back

65
Q

Inferior attachment of transverse abdominus

A

Iliac crest and thoracolumbar fascia

66
Q

What do the tendinous intersections of rectus abdominus do

A

Divide the 2 long flat muscles into 3 or 4 quadrate muscles

67
Q

How is the thoracoabdominal nerve formed

A

7 to 11 intercoastal nerve travel anteriorly then their terminal branches leave the intercoastal space in plane between transverse abdominus and internal oblique muscles as thoracoabdominal nerve

68
Q

What nerve arises from T12 anterior ramus

A

Subcostal nerve

69
Q

What nerve arises from one half of L1 anterior ramus

A

Iliohypogastric nerve and Ilioinguinal nerve from the other half

70
Q

Openings of diaphragm

A

Caval opening for SVC, oesophageal hiatus and aortic hiatus

71
Q

What makes up the rectus sheath

A

Aponeuroses of transverse abdominus, internal and external obliques

72
Q

What happens when air enters pleural cavity

A

Vacuum is lost and elastic lung recoil towards lung root making expiration harder.

73
Q

Small vs large pneumothorax

A

Small < 2 cm

Large > 2 cm

74
Q

What in tension pneumothorax

A

Torn pleura can create a one-way valve that permits air to enter pleura but not leave. This increases pleural pressure with every breath applying increased tension to mediastinal structures causing a mediastinal shift and decreases in lung volume of unaffected lung

75
Q

Level of sternal angle

A

T4

76
Q

How can tension pneumothorax cause hypotension

A

It can cause SVC compression, leading to decrease venous return; this causes hypotension

77
Q

Management of large pneumothorax

A

Thoracentesis/needle aspiration/pleural tap in 4th-5th intercostal space, midaxillary line

78
Q

What is a safe triangle

A

Triangular region in the axilla formed by anterior boundary of latissimus dorsi, posterior boundary of pectoralis major and axial line superior to nipples. It is a safe region for thoracentesis and chest drains. Insert the needle posterior to rib to avoid the neurovascular bundle

79
Q

Emergency management of tension pneumothorax

A

Large gauge cannulae inserted into pleural cavity via 2nd or 3rd intercoastal space, midclavicular line on side of tension pneumothorax

80
Q

What factors cause development of herniae

A

Weakness of one structure, commonly part of body wall

Chronic cough, increases ipsilateral pressure

81
Q

Paraoesophageal vs sliding hiatus hernia

A

Paraoesophageal hitus hernia - Herniated part of stomach becomes parallel to oesophagus in chest
Sliding hiatus hernia - Herniated part slides though oesophageal hiatus into chest with gastro-oesophageal junction

82
Q

Inguinal ligaments attach where

A

Between ASIS and pubic tubercle

83
Q

Describe the inguinal canals

A

4cm long passageways through anterior abdominal wall in inguinal regions. Deep ring superior to midpoint of inguinal ligament and superficial ring superolateral to pubic tubercle

84
Q

What does the inguinal canal contain in adults

A

Spermatic cord or round ligament of uterus

85
Q

Embryonic developmental outpouching of parietal peritoneum in the testes

A

Processus vaginalis

86
Q

What is the cremasteric fascia

A

Covering of skeletal muscle fibres from internal oblique

87
Q

What is the external spermatic fascia

A

Covering of external oblique aponeurosis

88
Q

What is the superficial ring of inguinal canal

A

Defect in external oblique aponeurosis where the testis pass into the superficial fascia of scrotum

89
Q

Layers the spermatic cord passes through, posterior to anterior

A

Visceral peritoneum, parietal peritoneum (processus vaginalis), transversalis fascia (internal spermatic fascia), transverse abdominus, internal oblique (cremasteric fascia), external oblique aponeurosis (external spermatic fascia)

90
Q

What is the spermatic cord

A

Vas defernece, testicular artery and pampiniform plexus, sympathetic nerves, lymphatic vessels, internal spermatic fascia, cremasteric fascia and external spermatic fascia

91
Q

Direct vs indirect hernia

A

Direct - Peritoneum is pushed though posterior wall of inguinal canal and directly out of superficial ring into scrotum
Indirect - Peritoneum is pushed through deep ring into inguinal canal and then though superficial ring into scrotum

92
Q

How to clinically differentiate direct and indirect

A

Place a finger on deep ring and ask the patient to cough. If it’s a direct hernia, the lump will reappear. It it’s indirect, won’t appear

93
Q

Significance of internal thoracic artery

A

Branch of subclavian artery
Anterior parts of intercoastal space are supplied via anterior intercoastal branches. This artery can be mobilised form its attachment to sternum, sectioned inferiorly and anastomosed to a coronary artery distal to occlusion

Respiratory (26 decks)

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