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Respiratory Anatomy Flashcards

(45 cards)

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1
Q

List the components that make up the bony skeleton of thorax and the function of thorax.

A

Ribs 1-12, sternum, vertebrae T1-12, joints

Function: protection, muscle attachment, assisting respiratory movement

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2
Q

Describe the characteristic feature of cervical, thoracic and lumbar vertebrae.

A

Cervical- foramen transversus for vertebral arteries, veins and sympathetic nerves
Thoracic- 3 hemi facets for ribs attachment: transverse, superior and inferior costal facets
Lumbar- large vertebral body

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3
Q

List the 3 components of sternum/ breastbone and describe their articulations.

A

(rib 2 connected to manubriosternal joint/ sternal angle)
Manubrium- clavicle, rib 1&2, mesosternum
Mesosternum- manubrium, ribs 2-7, xiphisternum
Xiphisternum/ Xiphoid process (inferior)

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4
Q

Describe the level of angle of louis and list the key structures passing through.

A

T4/5

  • inferior aspect of concave aorta arch
  • trachea bifurcation (carina)
  • pulmonary trunk bifurcation
  • azygos vein entering SVC
  • ligamentum arteriosum
  • cardiac plexus
  • thoracic duct
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5
Q

What ribs are true, false and floating?

A

True- Ribs 1-7
False- Ribs 8-12
Floating- Ribs 11-12

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6
Q

What does the head and tubercle of a typical rib articulate with?

A

Head- body of own vertebrae and the one above, IV disc via crest
Tubercle- transverse process of own vertebrae and non articula part for costotransverse ligament

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7
Q

What is the costal angle and costal groove?

A

Costal angle- most curved part of rib

Costal groove- internal inferior part of rib body that protects intercostal vessels and nerves

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8
Q

What is atypical about rib 1, 2, 10, 11 & 12?

A

Rib 1- single facet on head that articulates with T1, no subcostal groove, grooves for subclavian vessels on superior surface, scalene tubercle
Rib 2- tuberosity for serratus ant, (rough area on top surface)
Rib 10- single facet on head
Rib 11 & 12- single facet on head, short with no neck or tubercle, free end in abdominal musculature
12- no subcostal groove or angle

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9
Q

Describe the 3 intervertebral joints.

A

1) intervertebral disc- fibrocartilagenous joint
2) zygapophyseal joint- synovial joint between articular facets
3) sup & inf costal facets- synovial joint for head of rib (shouldn’t it be a costovertebral joint

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10
Q

Describe the costovertebral joint.

A

(for the sup inf facets?)articulation between rib and the vertebrae of its own and the level above, encapsulated in joint capsule with intra-articular ligament separating into 2 joint space.
For costotransverse joint, costotransverse ligament between transverse process and rib for stabilisation and support.

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11
Q

Describe the sternocostal joints

A

Rib 1- fibrocartilagenous
Rib 2-7- synovial plane joints
Intercondral joints- synovial plane joints
manubriosternal joint- fibrocartilagenous joint

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12
Q

What are the two types of chest wall deformities?

A

Pectus excavatum(caved in) and pectus carinatum (angle out)

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13
Q

What defines the boundaries of the superior thoracic aperture?

A

T1 vertebrae body, Rib 1 and manubrium (superior aspect)

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14
Q

What is an important structure we need to be aware of that passes through the superior thoracic aperture?

A

Apex of lungs

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15
Q

What are the 3 layers of muscle found in the thorax and their fibre direction + starting and ending along the intercostal space?

A

External intercostal- inferomedial/superolateral (end at junction between rib and costal cartilage anteriorly)
Internal intercostal + Innermost intercostal- inferolateral/superomedial) end just before vertebral body

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16
Q

What are the rib movements for upper and lower ribs?

A

Upper ribs- (transverse process is) more lateral axis: pump handle (swings out anteriorly and laterally) sternum acts like a lever to lift the front of ribcage up
Lower ribs- more posterior axis: bucket handle (swings up laterally)

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17
Q

What is the origin of anterior intercostal arteries and which muscle do they run deep to?

A

1-6 Originates from internal thoracic artery, 7-9 by musculophrenic artery and runs deep to transversus thoracis (horizontal fibres, from sternum)

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18
Q

What is the origin of the posterior intercostal arteries?

A

[DNK]
1&2 from supreme intercostal artery (branch of costocervical trunk from subclavian artery)
3-11 and subcostal from thoracic aorta

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19
Q

Describe the venous drainage of the thoracic wall.

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A

anterior intercostal veins –> internal thoracic vein

posterior intercostal veins –> azygos/hemiazygos venous system

20
Q

what and where are the two important dermatomes found?

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A

T4- nipple line

T10- umbilicus

21
Q

Describe the blood supply and drainage system of breast.

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A

Arterial supply: lateral mammary branches from lateral thoracic artery(from axillary artery) + medial mammary branches from internal thoracic artery
Venous drainage: medial and lateral mammary veins

22
Q

Describe the lymphatic drainage of the breast.

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A

Most lymph (>75%) drains to axillary nodes, remainder to parasternal nodes (some may also drain to abdominal nodes- inf breast)

23
Q

What are the three divisions of the thoracic cavity?

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A

Left and right hemi-thorax, mediastinum

24
Q

List the layers from outer to inner of the thoracic wall to lung.

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A

Skin> superficial fasica> external, internal, innermost intercostal musc> endothoracic fascia> parietal pleura> visceral pleura> lung

25
Describe the innervation of the visceral and parietal pleura.
Visceral-ANS ~T1-4 SNS and vagus (CNX) | Parietal- Intercostal nerve + phrenic nerve(from C3-5)
26
Describe the surface markings that define where the lung and pleura is.
In order of lung, pleura Midclavicular- rib6, 8 Midaxillary- rib8, 10 Scapular- rib10, 12
27
What are the two types of recesses in the pleura(?)?
Costomediastinal recesses and costodiaphragmatic recesses
28
Describe the orientation of the three main structures entering/exiting the hila.
Bronchus= posterior Pulmonary arteries= superior Pulmonary veins= ant & inf
29
Describe two features of the pulmonary plexus.
- ant and post plexus where post is larger - situated around carina - PSNS= Vagus nerve, SNS- T1(T2-4) ganglia
30
Describe the lymphatic drainage from right and left lung.
Pulmonary nodes--> bronchopulmonary nodes(hilar)--> carinal nodes --> paratracheal nodes -->(inferior deep cervical nodes)? --> thoracic duct (L) and right lymphatic duct (R)
31
What defines a broncho-pulmonary segment and where do the pulmonary veins go?
- segmental bronchus - pulmonary artery branch - bronchial artery branch (pulmonary veins and lymphatics drain along the edges of the segments
32
What are the names given to pleura found in the four different regions and their innervation?
Intercostal nerve: - related to ribs: costal pleura - related to apex of lung: cervical pleura Phrenic nerve: - related to diaphragm: diaphragmatic pleura - related to mediastinum: mediastinal pleura
33
What is the layer below intercostal muscles and what is it continuous with?
endothoracic fascia which adheres costal parietal pleura to thoracic wall and is continuous with suprapleural membrane that is found covering the apex of lungs (extra protection)
34
Describe the course of the right vagus nerve.
The right vagus nerve enters the superior mediastinum and lies between the right brachiocephalic vein and the brachiocephalic trunk. It descends in a posterior direction toward the trachea, crosses the lateral surface of the trachea and passes posteriorly to the root of the right lung to reach the esophagus. Just before the esophagus, it is crossed by arch of azygos vein. As the right vagus nerve passes through the superior mediastinum, it gives branches to the esophagus, cardiac plexus and pulmonary plexus.
35
Describe the course of the left vagus nerve.
The left vagus nerve enters the superior mediastinum posterior to the left brachiocephalic vein and between the left common carotid and left subclavian arteries. As it passes into the superior mediastinum, it lies just deep to the mediastinal parietal pleura and crosses the left side of the arch of the aorta. It continues to descend in a posterior direction and passes posterior to the root of the left lung to reach the esophagus in the posterior mediastinum. As it passes through sup mediastinum, it gives branches to oesophagus, cardiac plexus and pulmonary plexus. It also gives rise to the left recurrent laryngeal nerve, which arises from it at the inferior margin of the arch of the aorta just lateral to the ligamentum arteriosum. The LRLN passes inferior to the arch of the aorta before ascending on its medial surface. Entering a groove between the trachea and esophagus, LRLN continues superiorly to enter the neck and terminate in the larynx.
36
Describe the course of the right and left phrenic nerves.
Arise from cervical region C3-5 anterior rami. It runs obliquely over anterior surface of anterior scalene muscle and passes between subclavian arteries and veins(through superior thoracic aperture) into the thoracic cavity. it passes anterior to the hila of the lungs running between the pleura and fibrous pericardium. The right phrenic nerve passes through the diaphragm via the caval cavity(through central tendon) along with IVC innervating the inferior aspect of diaph. The left phrenic nerve pierces through the muscular portion of the diaph. on the left due to the apex of the heart pushing it far left.
37
What do the phrenic nerves supply?
mediastinal and diaph. parietal pleura, fibrous pericardium, peritoneum (diaph.) and central tendon (peripheral sensory by lower 6 intercostals), parietal pericardium
38
What are attachment points of the 3 ligaments in diaphragm and what do they form/ passes through them?
Arcuate ligaments - lateral: R12-L1TP (quad. lumborum) - medial: L1TP- crus (psoas) - median: L&R crura
39
What are the 3 openings in the diaphragm and what structures pass through them (at what level)?
- Caval opening (T8)- through central tendon: IVC, Right phrenic n. - Oesophageal hiatus (T10)- through muscular portion: oesophagus, vagal trunk [CNX] - Aortic hiatus (T12): aorta, thoracic duct, azygos vein
40
What are the thoracic splanchnic nerves? Describe their origin and location.
- Greater (T5-9): coeliac plexus- foregut + adrenals - Lesser (10-11): superior mesenteric plexus- midgut - Least (T12): aorticorenal plexus- kidneys, adrenals They pierces through the muscular crura - cardiopulmonary(T1-4): cardiac & pulmonary plexuses- heart and lungs
41
What are the blood supply of the diaphragm and their origin?
- MAJOR ONE: Inferior phrenic (>abdominal aorta)- - superior phrenic (>lower thoracic aorta) - musculophrenic (>internal thoracic) - pericardiacophrenic (>internal thoracic) - intercostal arteries (small branches)
42
Describe how does the intercostal nerves supply the thoracic wall.
Intercostal nerves= anterior rami. It innervates the thoracic wall segmentally according to vertebral level (?), the intercostal nerve exits the spinal cord travelling in the neuromuscular plane between the innermost and internal intercostal muscles and around the cage - sends of lateral and anterior cutaneous branch
43
What is the order of the neurovascular bundle in the costal groove?
From closes to the rib to furthest: vein, artery, nerve
44
What are white and grey rami communicans?
White- only found T1-L1/2 level, specific for sympathetic output to chain Grey- found at all levels, from chain to spinal nerve
45
Which root do afferent and efferent travel through?
Afferent- dorsal root | efferent- ventral root

Respiratory System (2 decks)

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