Resp HARC Booklet

Question 1

a. Epiglottis
b. Thyroid cartilage
c. Cricoid cartilage
d. Arytenoid cartilages
e. Corniculate cartilages
f. Cuneiform cartilage

Which are the paired and unpaired cartilages?

Answer 1

UnPaired: Epiglottis, thyroid and cricoid cartilage

Paired: Arytenoid, corniculate and cuneiform cartilages

Question 2

The cuneiform cartilages are contained within which soft tissue of the larynx?

Answer 2

Quadrangular membrane

Question 3

What is the relationship between the cricothyroid ligament and the true vocal folds?

Answer 3

The thickened upper edge of the cricothyroid ligament is the true vocal fold on each side.

Question 4

Answer 4

Question 5

Answer 5

Question 6

Answer 6

Question 7

Answer 7

Question 8

What is the rima glottidis?

Answer 8

The space between the two true vocal folds. The glottis includes this space and the vocal folds.

Question 9

What is the function of the majority of muscles on the Rima glottidis?

Answer 9

Adduction of the vocal folds closing the rima glottidis

Question 10

What does muscles on the Rima glottidis tell us about the primary function of the larynx?

Answer 10

Sphincter of the upper respiratory tract

Question 11

Answer 11

Question 12

True vocal ligament: thickened upper margin of _______ ______ _______

False vocal (vestibular) ligament: thickened inferior margin of ___________ _______

Answer 12

True vocal ligament: thickened upper margin of lateral cricothyroid ligament

False vocal (vestibular) ligament: thickened inferior margin of quadrangular membrane

Question 13

How would you describe the attachments of the quadrangular membrane?

Answer 13

Superior attachment at the lateral edge of the epiglottis and inferior edge at the arytenoid cartilages.

Question 14

What is the lateral outpouching called that is found between the true and false vocal ligament?

Answer 14

Laryngeal ventricle which is lined with muscosa for lubrication of the vocal folds.

Question 15

Answer 15

Question 16

Answer 16

Question 17

Answer 17

Question 18

Answer 18

Question 19

Answer 19

Question 20

What are the function of nasal sinuses?

Answer 20

The sinuses are air filed spaces within the skull which serve several different functions. These include adding resonance to the voice, decreasing the weight of the skull and producing mucus into the nasal cavity for protection and air conditioning.

Question 21

Using your knowledge of the sinuses, explain why someone suffering from infection of both maxillary sinuses will roll from side to side during the night.

Answer 21

To attempt to shift the fluid from one side of the skull to the other to balance out the feeling of heaviness unilaterally. Due to the opening of the maxillary sinus being relatively high up on the lateral wall of the nasal cavity, they are unable to drain when we are standing up. However, when we are lying on our side, all of the excess fluid produced will pool in the maxillary sinus on that side and be unable to drain back out unless we turn over

Question 22

What is the purpose of the meatuses?

Answer 22

They are airway passages within the nasal cavity, created by the conchae and located inferiorly to them. They receive drainage from the paranasal sinuses and the nasolacrimal duct.

Question 23

Answer 23

Question 24

What is the area of anastomosis in the nasal cavity known as?

Answer 24

Kiesselbach’s plexus or Little’s area

Question 25

What is its clinical significance of Kiesselbach’s plexus or Little’s area?

Answer 25

Common site for epistaxis (nose bleeds) – 90% occurring in this area

Question 26

Answer 26

Question 27

The visceral and parietal pleural membrane .Where are these continuous with each other?

Answer 27

The hilum (specifically the lung root)

Question 28

What is the pleural ligament?

Answer 28

The pleural or pulmonary ligament is a downwards extension of the parietal pleura surrounding the lung root.

Question 29

A chest drain needs to be passed superior to the rib (at the appropriate level). Why is this?

Answer 29

This avoids the intercostal vessels running in the costal groove on the inferior surface of the ribs

Question 30

What is the clinical significance of bronchopulmonary segmentation?

Answer 30

They are discrete functional and anatomical areas. This means that they can be removed surgically without affecting another BPS.

Question 31

The pump handle movement increases the thoracic diameter in the anteroposterior dimension. Which ribs are involved in the pump handle movement?

Answer 31

Ribs 2-6 (specific action at the costovertebral joints)

Question 32

The bucket handle movements increase the thoracic diameter in a transverse direction. Which ribs are involved in the bucket handle movement?

Answer 32

Ribs 7-10 (specific action at the costovertebral joints)

Question 33

What structure increases the superior/inferior dimensions?

Answer 33

Respiratory diaphragm

Question 34

Accessory muscles When not contributing to the movement of the thorax what do these muscles do?

Answer 34

Pectoralis major acts on the shoulder joint to produce a range of movements including medial rotation, adduction and flexion The scalene muscles laterally flex the neck and act unilaterally. There are many other accessory muscles of respiration with an extensive list\* below: serratus anterior, pectoralis major and pectoralis minor, trapezius, latissimus dorsi, erector spinae, iliocostalis, quadratus lumborum, serratus posterior superior, serratus posterior inferior, levatores costarum, transversus thoracis and subclavius \*this does not need to be learnt in detail, the key point is that essentially any muscle attaching around the rib cage can have an effect on respiration.

Question 35

What is the function of external intercoastal muscles?

Answer 35

Being one of the accessory respiratory muscles, the external intercostals elevate ribs during forced inspiration. This increases the transverse and anteroposterior diameter of the lungs, which in turn decreases the intrapleural pressure. This process expands the lungs and facilitates the entry of air into them.

Question 36

What is the function of internal intercoastal muscles?

Answer 36

nternal intercostal muscles are the accessory respiratory muscles. Together with innermost intercostals, they enable forced expiration by depressing the ribs, thus shrinking the diameter of the thoracic cavity and pushing the air out of the lungs.

Question 37

What is the function of innermost intercostal muscle?

Answer 37

The functions of the innermost intercostals are similar to those of internal intercostals; they assist breathing by depressing the ribs and support the integrity of the thoracic cage.

Question 38

External intercostal for \_\_\_\_\_\_, internal and innermost intercostals for \_\_\_\_\_\_\_

Answer 38

External intercostal for **inspiration**, internal and innermost intercostals for **expiration**

Question 39

What is a flail chest?

Answer 39

Flail chest is a condition which is characterised by paradoxical thoracic cage movements.

Question 40

What causes flial chest

Answer 40

It requires a specific set of injuries, which usually occur during trauma: fracture of at least 2 consecutive ribs in at least 2 places, e.g. diagram (right). This creates a free section of the thoracic cage which is not articulating with the sternum or vertebral column.

Question 41

How would you expect the thoracic cage to move during inspiration?

Answer 41

Up and out as a result of increasing the anteroposterior, superoinferior and transverse dimensions. Muscle contraction from primary and accessory respiratory muscles are the cause

Question 42

How would you expect the thoracic cage to move during expiration?

Answer 42

Down and in as a result of decreasing the anteroposterior, superoinferior and transverse dimensions. Muscle relaxation, elastic recoil and internal/innermost intercostal mm. contraction are the cause

Question 43

Answer 43

Question 44

What structures are most likely to be affected by the presence of a cervical rib?

Answer 44

Subclavian vessels and brachial plexus

Question 45

Subclavian vessels and brachial plexus can affected by the presence of a cervical rib What condition might this lead to?

Answer 45

Thoracic outlet syndrome – Arterial, venous or neurogenic (this is the most common)

Question 46

Answer 46