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?
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?
Where in the right lung root does the veins lie?
Where in the left lung does the main bronchus lie?
Where in the left lung root does the pulmonary artery lie?
In the lung root what type of blood do the pulmonary veins carry?
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
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
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
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)