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Flashcards in Respiratory Deck (51):

names the components of the upper and lower respiratory tracts?


Oral cavity/ nasal cavity
Nasopharynx, oropharynx, laringopharynx, larynx



At which vertebral level does the upper respiratory tract become the lower resp tract?


Where the larynx becomes the trachea and the pharynx becomes the oesophagus


What are the two types of pleura in the thoracic space? How are they defined?

Parietal - touching body wall
Visceral- touching organ


What is the clinical significance of the sternal angle, costal margin and xiphoid process?

Sternal angle signifies attachments of rib 2

Xiphoid process acts as an origin for diaphragm muscles and important in emergency as it is used for cardiopulmonary resuscitation

Costal margin allows attachment of the false ribs


What are the ‘joints of breathing’

Costovertebral joint; between ribs and vertebrae (rib head articulates with the transverse process)

Costochondral joints; between ribs and cartilage to bind to the sternum


What muscles are involved in ‘normal’ breathing?

Intercostal muscles;
1. External intercostals (hands front pockets)
2. Internal intercoastals (hands on chest)
3. Innermost intercostals (horizontal)



What is the innervation of the muscles of breathing?

Anterior rami of C3,4,5 keeps the diaphragm alive


Describe the blood supply to the intercostal muscles

- internal thoracic artery
- internal thoracic vein

- thoracic aorta
- azygous vein


What is the innervation of the intercostal muscles?

Anterior ramus of spinal nerve


Describe the anatomy the female breast (quadrants, realtion with pectroal fasic, muscles, blood and lymph supplies)

Four quadrants (superior lateral -> inferior medial)

Attaches to the pectoral fascia

Venous drainage into the subclavian vein

Arterial supply from the internal thoracic artery (branch of the subclavian artery)

Lymph drainage from medial sectors into the parasternal nodes (side of the sternum)
From lateral sectors into the axillary nodes


What arteries supply the lung itself with oxygenated blood?

The unilateral branch of the thoracic aorta


How is negative pressure created in the lungs allowing air to enter?

By diaphragm contracting and descending and the intercostal muscles contracting and lifting the ribs increasing the chest dimesions


What is the function of the muscle serratus anterior? What is its innervation? Where is it located/ what look like?

To anchor the scapula to the thoracic cavity, located laterally on chest and looks like feathers.

Innervated by the long thoracic nerve


What is the attachments of the pectoralis minor?

Coracoid process of the scapula and ribs 3-5


What is the function of the scalenus anterior, what muscle does it lie deep to

To lift the first rib and to allow the neck to tilt to the side, lies deep to the sternoclamastoid muscle


Where in the right lung root does the main bronchus lie?

Posteriorly superior


Where in the right lung root does the veins lie?

Most anteriorly


Where in the left lung does the main bronchus lie?

Posteriorly medial


Where in the left lung root does the pulmonary artery lie?

Most superiorly


In the lung root what type of blood do the pulmonary veins carry?

Oxygenated blood


In the lung root what type of blood do the pulmonary arteries carry?



Describe the process of coughing including nerves

Sensory receptors in mucosa of oral cavity stimulated (vagus or glossopharyngeal)

This causes deep inspiration using diaphragm (phrenic nerve), intercostal muscles (intercostal nerves) and accessory muscles of inspiration

Adduction of vocal cords closing rima glottidis (vagus)

(Causes incresed pressure then SUDDENLY)

Vocal cords abduct, soft palate tenses and elevates (vagus) and coughing occurs


What are the nerve supplies to the nasal cavity?

Trigeminal nerve V1 (opthalmic) and V2 (maxillary)


What structures do the carotid sheaths enclose? What is its function

The vagus nerve
Internal carotid artery
Common carotid artery
Internal jugular vein

To protect them from damage


What is the nerve supply to the bronchioles?

The pulmonary plexus which is composed of sympathetics and parasympathetics (vagus nerve) and visceral afferents


What is the course of the phrenic nerve in the thorax?

Moves anterior to the lung root


What nerves innervate the intercostal muscles?

Anterior rami of spinal nerves T1-T11


What is the origin and insertion of the pectoralis major muscle? What is its function?

Sternum and ribs/ humerus

If upper limbs are fixed the muscle can pull the ribs up and outwards


Name the accessory muscle of deep inspiration

Pectoralis major
Pectoralis minor
Scalenus anterior, medius and posterior


Describe the larynx in terms of muscle type, innervation and function


Move cartilage rings allowing movement of vocal cords

Supplied by vagus nerve


Describe the course of the vagus nerve from brain to lungs

Bound at the medulla oblongata of the brainstem

Then descend through the jugular foramen

Descending posterior to the lung roots

Right and left converge to form the pulmonary plexus


Describe the abdominal wall muscle layers

The external oblique
Internal oblique
Transversus abdominus

These sit laterally

Then medially is the right and left rectus abdominus


What is the attachments of the external oblique?

Superiorly to the lower ribs and inferiorly to the anterior iliac crest and pubic tubercle


What is the midline referred to as in the aponeurosis between the external obliques?

The line alba


What is the attachments of the internal oblique and transversus abdominus?

Superiorly to the lower ribs and inferiorly to the iliac crest and the thoracolumbar fascia


What nerves make the thoracoabdominal nerve that supply the abdominal body wall

The 7th to 11th intercostal nerves


Name some of the functions of the abdominal muscles

Maintain posture

Support vertebral column

Facilitate movements of the spine

Guarding to protect the abdominal viscera

Increase intraabdominal pressure aiding defecation, micturition (urination) and labour


Describe how someone can develop a simple pneumothorax (2cm gap or less between lung and parietal pleura)

In asthma where expiration can be difficult there is a build of air and pressure in alveoli which can lead to the rupture of a lung. This means the vacuum is lost so pressure is lost and the lung tissue recoils. (


What is defined as a large pneumothorax

More than a 2cm gap between lung and parietal pleura


Summarise the process for diagnosing a pneumothorax


Reduced Ipsilateral chest expansion

Reduced ipsilateral breath sounds

Hyper resonance on percussion

CXR with lung edge visible


What are the treatment options for a large pneumothorax, using what anatomical landmarks

Needle aspiration (thoracentesis)

Sitting of a chest drain in the 4th or 5th intercostal space midaxillary line


What is the treatment for an emergency tension pneumothorax

Large gauge cannula inserted into pleural cavity via 2/3rd intercostal space midclavicular line


What is a hernia? Requirments for its formation?

Any structure passing thorugh another ending up in the wrong place

1. Weakness of commonly the body wall
2. Increased pressure on one side of the wall


What are some common hernias formed due to chronic cough?



Describe the anatomy of the diaphragm

Dome shape with a caval opening allowing passage of the IVC, oesophagus and aorta


What is the difference between a paraoesophageal hiatus hernia and a sliding hiatus hernia?

Para; where part of stomach moves superiorly through the hiatus to become paralell to the chest

Sliding; where part of stomach moves through the oesophageal hiatus to bulge out including the gastro-oesophageal junction


Describe the anatomy of the inguinal canals

Contain inguinal ligaments providing the bottom part of the tube which attach between the ASIS (iliac spine) and the pubic tubercle

Contains an entrance known as the deep ring and the exit known as the superficial ring (made from the external oblique aponeurosis)


How are the inguinal canals formed?

From the descent of the primary sex organs into the perineum e.g testes or round ligament of the uterus


How do you differentiate between a direct and indirect herniae

A direct herniae; is when the inguinal canal wall is breached and periotneum exits via the superficial ring

An indirect herniae is when the periotenum enters the deep ring and exits the superficial ring

Push herniae back in body wall, occlude deep ring with hand, ask patient to cough;
1. If herniae reappears then direct
2. If herniae doesnt reappear then indirect


Describe the anatomy of the spermatic cord

Contains the vas deferens

Right testicular artery (branch of abdo aorta)

Papniform plexus of veins (drains into ivc)

Autonomic nerves


What is the vertebral level of the sternal angle?