Anatomy Flashcards
(160 cards)
1
Q
Upper Respiratory Tract
A
Nasal cavities, oral cavity, pharynx, larynx
2
Q
Lower Respiratory Tract
A
Trachea, right & left main bronchus, lobar bronchi, segmental bronchi, bronchioles, alveoli
3
Q
Where does the larynx become the trachea?
A
At the level of C6 verterbrae
4
Q
Where does the pharynx become the oesophagus?
A
At the level of C6 verterbrae.
5
Q
Lobar Bronchi
A
1 lobar bronchus for each of the 5 lung lobes.
6
Q
Segmental Bronchi
A
1 segmental bronchus for each of the 10 bronchopulmonary segments
7
Q
Lobes of the right lung
A
Upper, middle and lower
8
Q
Lobes of the left lung
A
Upper and lower
9
Q
Lung lobe
A
Area of the lung that each lobar bronchi supply with air
10
Q
Bronchopulmonary segement
A
Area of lung lobe that each segmental bronchi supply with air
11
Q
Fissures
A
Deep crevices that separate the lobes from each other
12
Q
Lining on inside of bronchial tree (except for distal bronchioles & alveoli)
A
Respiratory epithelium
13
Q
Respiratory Epithelium
A
Contain:
- Mucous glands secrete mucous onto epithelial surface.
- Cilia beat to sweep mucous + any foreign bodies stuck in the mucous superiorly, toward the pharynx.
14
Q
Mucociliary Escalator
A
Cilia beat to sweep mucous _ any foreign bodies stuck in the mucous superiorly, toward the pharynx.
15
Q
What interferes with normal beating of cilia?
A
Cooling/drying of mucosa & toxins in cigarette smoke.
16
Q
Hyaline cartilage
A
Supports the walls of the trachea & all the bronchi & assists with maintaining airway patency
17
Q
Do alveoli have cartilage?
A
No
18
Q
Do alveoli have smooth muscle?
A
No
19
Q
Why don’t alveoli have smooth muscle or cartilage?
A
Alveolar walls have to be extremely thin as smooth muscle and cartilage would impact on diffusion.
20
Q
Cartilage in the respiratory tree
A
Cartilage gradually reduces distally in the respiratory tree
21
Q
Smooth muscle in the respiratory tree
A
Smooth muscle becomes progressively more prominent distally in the respiratory tree
22
Q
Bronchioles: smooth muscle
A
Smooth muscle is the most prominent feature of bronchioles => bronchioles can constrict or dilate
23
Q
Requirements for gas transfer between air in alveoli & blood in pulmonary capillaries
A
- Sufficient functioning lung tissue.
- Sufficient O2 in inspired air.
- No CO2 in inspired air.
- Minimal thickness of walls of alveoli.
- Minimal tissue fluid in tissue spaces around the alveolar capillaries.
24
Q
Dangers to respiratory tract
A
- Resp tract may become narrowed: Bronchiole constriction, swelling of mucosa/overproduction of mucous, growing tumour may compress tract.
- Foreign bodies being inhaled into resp tract.
25
What separates the 2 nasal cavities
Nasal septum
26
Nasal septum
- Bony Part (Posterior): Ethmoid bone & vomer.
| - Cartilaginous Part (Anterior)
27
Skeleton of larynx
Epiglottis, thyroid cartilage, cricoid cartilage, 2 arytenoid cartilages
28
Functions of larynx
1. Cartilages help to maintain patency of URT.
2. Helps prevent entry of foreign bodies into the LRT (vocal cords)
3. Produces sounds (vocal sounds)
29
Trachea
Inferior continuation of larynx
30
Narrowest part of the larynx
Rima glottidis
31
Function of Vocal cords
1. Airway protection.
| 2. Voice production
32
Voice Production
- Phonation: Expire air across vocal cords, cords vibrate to produce sound.
- Articulation: Sound is modified in nose or mouth to produce vowels and consonants.
33
Airway Protection by Vocal Cords
Vocal cords can approximate in the midline, closing the rima Glottidis & preventing a foreign body inhaled into the trachea => stimulates cough reflex to expel foreign body via pharynx and oral cavity.
34
Heimlich manoeuvre
Raises abdominal pressure, forces diaphragm superiorly, raises pressure in chest & lungs, forces air from lungs into trachea, forces air through rima glottidis to expel foreign body out of URT.
35
Dangers of breathing in cold/dry air
Cooling & drying out of respiratory tract => damages the mucocili]ary escalator & predisposes to infection.
36
Dangers of breathing in unclean air
Breathing in infected foreign bodies or bacteria/viruses etc. => infection.
37
How do we warm air?
Respiratory mucosa lining the walls of the nasal cavities has a very good arterial blood supply providing warmth
38
How to de humidity air?
Respiratory mucosa produces mucous providing moisture
39
How do we clean air?
Sticky mucous traps potentially infected particles & tonsils produce white blood cells in defence against infection.
40
Chest wall
- Skin & Fascia.
- Bones.
- Skeletal muscles.
- Diaphragm.
- Parietal pleura.
41
Thoracic Skeleton
- 12 Pairs of Ribs (True 1-7, False 8-10, Floating 11-12)
- Intercostal spaces
- Costal margin.
- 12 thoracic vertebrae.
- clavicle & scapula
- sternum
42
Bones of chest wall
- Sternoclavicular joint.
- Sternocostal articulation with costal cartilage of rib 1
- Manubrium
- Sternal angle (at level of rib 2)
- Body
— Xiphoid process
43
Joints of thoracic skeleton
Sternocostal joints & costochondral joints
44
Sternocostal joints
Synovial
45
Costovertebral joints
Limited movement at these joints
46
Muscles of breathing
- Intercostal muscles: make chest wall expand during breathing by pulling adjacent ribs upwards and outwards.
- Diaphragm.
47
Intercostal muscles
3 layers of skeletal muscles are located between ribs in intercostal spaces:
- external intercostal muscles.
- Internal intercostal muscles.
- innermost intercostal muscles.
48
Parietal pleura
Internal lining of the chest wall
49
Visceral pleura
Skin attached lung lobes
50
Pleural cavity
Space that surrounds the lung in 3D apart from where main bronchus enters it
- Between parietal & visceral layers of pleura
51
At level of C6 vertebrae
Larynx becomes trachea & pharynx becomes oesophagus.
52
Where can you palpate the trachea
At the jugular notch of the manubrium
53
Isthmus of thyroid gland
Anterior to tracheal cartilages 2-4.
54
2 parts of Thorax
Chest walls & chest cavity
55
Function of chest walls
- Protect heart & lungs.
- Make movements of breathing.
- Breast tissue: lactation.
56
Chest cavity
Within chest wall, consists of mediastinum & right & left pleural cavities, contains vital organs, major vessels and nerves.
57
Lung development
Embryo: Lung bud pushes out from mediastinum, covered in pleura.
Adults: Pleural cavity: potential space, pleural fluid.
Both: Parietal pleura on wall, visceral pleura on lungs, reflect at lung roots.
58
Pleural fluid
Lubricant that provides surface tension - secreted by pleurae into pleural cavity.
59
Intercostal spaces
11 pairs, each carrying a neuro-vascular bundle between internal and innermost intercostal muscle layers.
60
Diaphragm
- Forms floor of chest cavity & roof of abdominal cavity.
- Contains openings to permit structures to pass between the 2 cavities.
- Skeletal muscle with unusual central tendon.
- Left and right domes, right more superior due to presence of liver.
- Muscular part attaches peripherally to: Sternum, lower 6 ribs, costal cartilages & L1-L3 vertebral bodies.
- Muscle part supplied by phrenic nerve.
61
What is supplied by phrenic nerve (C3, 4 & 5 anterior rami)
Muscular part of diaphragm
62
Why is the right dome of diaphragm higher?
Presence of liver inferiorly.
63
What does the muscular part of the diaphragm attach peripherally to?
Sternum, lower 6 ribs &costal cartilages & L1-L3 vertebral bodies
64
Phrenic nerves
Combined anterior rami of cervical spinal nerves C3, 4 & 5.
65
Where is phrenic nerve found?
- Neck: On anterior surface of scale us anterior muscle.
| - Chest (Thorax): Descending over lateral aspects of the heart.
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What does the phrenic nerve supply?
Somatic sensory & sympathetic axons to diaphragm & fibrous pericardium & somatic motor axons to the diaphragm.
67
Inspiration mechanics
1. Diaphragm contracts & descends.
2. Intercostal muscles contract elevating ribs.
3. Chest walls pull the lungs outwards with them (pleura)
68
Expiration Mechanics
1. Diaphragm relaxes & rises.
2. Intercostal muscles relax, lowering ribs.
2. Elastic tissue of lungs recoils.
69
Anatomy of Breast
Pectoral fascia, pectoralis Major, pectoralis minor, ribs, intercostal muscles, parietal pleura, subclavian & internal thoracic artery & vein.
70
Unilateral drainage
From lateral quadrants to axillary nodes
71
Bilateral drainage
From medial quadrants to parasternal nodes
72
Superficial fascia
Adipose tissue, insulation
73
Deep fascia
Fibrous, tough, protection
74
Muscles of chest wall
Pectoralis major, lattimus dorsi, serratus anterior, deltoids, pectoralis minor.
75
Cervical parietal pleura
Above rib 1
76
Costal parietal pleura
From rib 1 to lung base
77
Diaphragmatic parietal pleura
Spans area where lung & diaphragm meet.
78
Mediastinal parietal pleura
Spans area where lung & mediastinum meet
79
Costophrenic angle
Where costal pleura & diaphragmatic pleura meet.
80
Costodiaphragmatic recess
Inferior part of pleural cavity, located between diaphragmatic and costal parietal pleura.
81
Where does abnormal fluid in pleural cavity drain?
Into costodiaphragmatic recess
82
What does abnormal fluid in costodiaphragmatic recess cause?
Blunting of angles & fluid level seen on CXR
83
Root of the lung
- 1 main bronchus.
- 1 pulmonary artery.
- 2 pulmonary veins.
- Lymphatics, visceral afferent, sympathetic nerves & parasympathetic nerves.
84
Afferent nerves
Sensory -> CNS
85
Efferent nerves
CNS -> Muscle
86
Right Lung: Surface markings
Root of lung, azygous vein, phrenic nerve, superior vena cava, heart, diaphragm, inferior vena cava
87
Hilum of Lung
Main bronchi, pulmonary arteries, pulmonary lymph nodes (black), pulmonary veins
88
Left Lung: Surface Markings
Aorta, heart, diaphragm, root of lung, phrenic nerve, common carotid artery.
89
Auscultation
Anterior: Lung apex (superior to clavicle), Middle lobe (between ribs 4&6).
Posterior: Lung base (Level of T11 vertebrae)
90
What level is the horizontal fissure of Right Lung?
Follows right rib 4
91
What level is the oblique fissures?
Level of rib 6 anteriorly rising to T3 vertebral level posteriorly.
92
Coughing
Stimulation of sensory receptors in:
1. Oropharyngeal mucosa.
2. Laryngopharyngeal mucosa.
3. Laryngeal mucosa.
93
What sensory receptors are stimulated in sneezing?
CNV or CNIX
94
What sensory receptors are stimulated in coughing?
CNIX or CNX
95
Carotid sheaths
Protective tubes of cervical deep fascia.
96
What does the carotid sheath attach superiorly to?
Bones of the base of the skull.
97
What does the carotid sheath contain?
Vagus nerve, internal carotid artery, common carotid artery & internal jugular vein
98
What does the carotid sweat blend inferiorly with?
Fascia of the mediastinum
99
Affect of stimulation of sensory receptors in LRT respiratory mucosa
1. Motor axons travel from tracheal bifurcation along branches of resp tree to supply all mucous glands & all bronchiolar smooth muscles.
2. Pulmonary visceral afferent travel from visceral pleura & resp tee to plexus then follow vagus nerve to medulla of brainstem
100
Where do motor axons, that supply mucous glands & bronchiolar smooth muscle, travel from?
Tracheal bifurcation, along branches of resp tree
101
Where to pulmonary visceral afferents travel form to reach the medulla of the brain stem?
Visceral pleura & resp tree to plexus and then follow vagus nerve to medulla
102
What nerve do pulmonary visceral afferents follow to the medulla from plexus?
Vagus
103
Coughing involves stimulation of sensory receptors in the mucosa of what?
Respiratory tree
104
What muscles are used in a deep inspiration?
Diaphragm, intercostal muscles & accessory muscles of inspiration
105
How does the CNS co-ordinate a deep inspiration?
- Diaphragm: Phrenic nerve supplies greater outflow of action potentials of longer duration causes diaphragm to flatten and then descend maximally.
- Intercostal muscles contract forcefully & raise ribs maximally: Intercostal nerves.
106
Intercostal nerves
Anterior rami of spinal nerves T1-T11
107
Accessory muscles of forced inspiration
Pectoralis major, pectoralis minor, sternocleidomastoid, scalenus anterior, medius & posterior.
108
Pectoralis Major
- Attaches between sternum/ribs & humerus.
- Adducts & medically rotates humerus.
- Upper limb position fixed.
- Muscle can pull ribs upwards/outwards.
109
Pectoralis Minor
- Can pull ribs 305 superiorly towards coracoid process of the scapula.
110
Clinical sign suggestive of dyspnoea?
Recruitment of accessory muscles.
111
Sternocleidomastoid
- Attaches between sternum/clavicle & mastoid process of temporal bone.
112
Scalenus anterior, medius & posterior
Attach between cervices vertebrae & ribs 1 & 2.
113
What does adduction of the vocal cords cause?
Closure of rima glottidis.
114
Where do intrinsic muscles attach between?
Cartilages of larynx
115
What does movement of cartilages in larynx cause?
Movement of vocal cords
116
Affect of cough reflex on intrinsic muscles of larynx?
Causes intrinsic muscles of larynx to adduct the vocal cords
117
What nerve supplies the intrinsic muscles of the larynx?
All supplied by (somatic) motor nerve - branches of the vagus nerve (CN X)
118
What type of muscle is the intrinsic muscles of the larynx?
All skeletal (voluntary) muscles.
119
Where do the right and left vagus nerves connect with the CNS?
At the medulla (oblongata) of the brainstem
120
What type of nerve is the vagus nerves?
Both sensory & motor nerve
121
Function of vagus nerves in neck
- Supply somatic sensory axons to the muscles a lining of the larynx.
- Supply somatic motor axons to the intrinsic muscles of the larynx.
122
Function of vagus nerves in chest
Supply parasympathetic axons to chest organs
123
Route of vagus nerves
Medulla of brainstem -> jugular foramen -> descend through neck within carotid sheath -> descent posterior in chest to lung root -> pass through diaphragm on the oesophagus -> divide into many parasympathetic branches on surface of stomach for the foregut & midgut organs.
124
Accessory muscles of forced expiration
Abdominal wall muscles
125
How does CNS coordinate deep expiration?
Intercostal nerves stimulate contraction of right & left anterolateral abdominal wall muscles to build up intra-abdominal pressure which pushes the diaphragm superiorly & builds up pressure in the chest/resp tree inferior to the adducted vocal cords
126
Anterolateral abdominal wall muscles
Right & left rectus abdominis, right & left external oblique, right & left internal oblique, right & left transversus abdominus.
127
Where does aponeurosis of right & left external oblique blend?
Midline linea alba
128
What attaches to the right external oblique superiorly?
Superficial aspects of lower ribs
129
What attaches to the right external oblique inferiorly?
Anterior part of iliac crest & pubic tubercle
130
Linea semilunaris
Where muscle fibres end & aponeurosis begins
131
What attaches to right internal oblique superiorly?
Inferior border of lower ribs
132
What attaches to right internal oblique inferiorly?
Iliac crest & thoracolumbar fascia of lower back.
133
Where does aponeurosis of right & left internal oblique blend?
Midline linea alba
134
Where does aponeurosis of right & left transverse abdominus blend?
Linea alba
135
What attaches to transversus abdominus superiorly?
Deep aspect of lower ribs.
136
What attaches to transverse abdominus inferiorly?
Iliac crest & thoracolumbar fascia of lower back.
137
Functions of anterolateral abdominal muscles
- Tonic contractions maintain posture, & support the vertebral column.
- Contractions produce movements of vertebral column.
- Guarding contractions protect abdominal viscera.
- Contractions increase intra-abdominal pressure to assist defecation, micturition & labour.
- Contractions aid forced expiration.
138
Affect of abduction of vocal cords on rima glottidis
Opens rima glottidis.
139
How does CNS direct stream of air through oral cavity as a cough rather than nasal cavity as a sneeze?
Soft palate tenses (CN V) & elevates (vagus nerves) to close of entrance into Nasopharynx & direct stream of air.
140
Complications of dynamic airway compression in asthma
- Expiration difficult.
| - Build up of air trapped in alveoli can lead to rupture of Lung & visceral pleura.
141
How does alveolar air enter the pleural cavity?
Through a breach in the visceral pleura
142
Small pneumothorax
< 2cm gap between lung and parietal pleura, when a small amount fo air enters the pleural cavity.
143
Cause of small pneumothorax
1. Penetrating injury to parietal pleura.
| 2. Rupture of visceral pleura.
144
How does injury to parietal pleura/rupture of visceral pleura cause a small pneumothorax?
Vacuum is lost, elastic lung tissue recoils towards lung root & small pneumothorax results.
145
Large pneumothorax
> 2cm gap between lung & parietal pleura, when a large amount of air enters the pleural cavity
146
What causes large pneumothorax?
1. Penetrating injury to the parietal pleura.
| 2. Rupture of visceral pleura.
147
How does injury to parietal pleura/rupture of visceral pleura cause a large pneumothorax?
Vacuum is lost, elastic lung tissue recoils towards lung root & large pneumothorax results.
148
Pneumothorax: Auscultation
Reduced ipsilateral breath sounds
149
Pneumothorax: Percussion
Hyper-resonance
150
Pneumothorax: Chest expansion
Reduces ipsilateral chest expansion
151
Pneumothorax: CXR
- Absent lung markings peripherally.
| - Lung edge visible (red arrows)
152
How does a tension pneumothorax occur?
Torn pleura can create a one-way valve that permits air to enter the pleural cavity on each inspiration but prevents air escaping again on expiration => on each inspiration more air enters pleural cavity (Increasing intrapleural pressure with each expiration) => pneumothorax expands => lung collapses towards its root => Eventually build up of air in pleural cavity applies tension to mediastinal structures.
153
In pneumothorax how does air enter pleural cavity on inspiration but air preventing from escaping on expiraton?
Torn pleura can create a one way valve
154
How does tension pneumothorax cause mediastinal shift?
Build up of air in pleural cavity applies tension to mediastinal structures => mediastinum shifted
155
What level is the superior mediastinum?
Level of Sternal angle
156
Consequences of mediastinal shift
- Tracheal deviation, away from side of unilateral tension pneumothorax, palpable in the jugular notch.
- SVC compression reduces venous return to the heart leading to hypotension.
157
Management of large pneumothorax
1. Needle aspiration.
| 2. Chest drain.
158
Safe triangle
- Anterior border of latissimus dorsi.
- Posterior border of pectoralis major.
- Axial line superior to nipple.
159
Emergency management of tension pneumothorax
Large gauge cannula inserted into pleural cavity via 2nd or 3rd intercostal space in mid-clavicular line on side of tension pneumothorax.
160
What does cannula pass through in emergency management of tension pneumothorax?
- Skin.
- Superficial/deep fascia.
- 3 layers of intercostal muscles.
- Parietal pleura.
