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Flashcards in Respiratory Anatomy Deck (76):
1

Features of thoracic vertebrae

Heart shaped body
Round vertebral foramen
Long, downward facing spinous process

2

Articulations of thoracic vertebrae

Transverse costal facet - tubercle of rib
Superior costal facet - head of rib
Inferior costal facet - top of head of the rib below

Costal groove (on rib) - intercostal vein, artery and nerve VAN

3

Atypical ribs

T1,2,11 and 12

4

1st rib

Short, wide
Only one facet on head for articulation (no thoracic vertebrae above)
Superior surface is lumpy - has two grooves for subclavian vein and artery

5

2nd rib

Longer and thinner than 1st rib
Roughened area on superior surface where serratus anterior attaches

6

11th and 12th ribs

No neck (like less curved typical ribs)
Only one facet for articulation with corresponding vertebrae

7

Vagus and phrenic in thoracic inlet

Vagus more medial, by trachea
Phrenic next to, but more lateral

(2 of each)

8

Intervertebral joints

Secondary cartilaginous
Between vertebral bodies and intervertebral discs

9

Costovertebral joints

Synovial plane
Head of rib to SCF and ICF

10

Costotransverse joints

Synovial plane
Tubercle of rib to transverse process

11

Costochondral joints

Primary cartilaginous
Costal cartilage to sternal end of rib

12

Interchondral joints

Synovial plane
Between costal cartilages of 6-9th ribs

13

Sternocostal joints

1st - primary cartilagenous - costal cartilage to manubrium
2nd-7th - synovial plane - costal cartilage to sternum

14

Sternoclavicular joints

Synovial saddle
Clavicle to manubrium of sternum and 1st costal cartilage

15

Manubriosternal joints

Secondary cartilaginous
Manubrium to body of sternum

16

Xiphisternal joint

Primary cartilaginous
Xiphoid process to body of sternum

17

Vessels of thoracic wall

Aorta, posterior intercostal artery arises from here
Continues to front (lateral cutaneous branches off) to become anterior intercostal artery to join upward chain internal thoracic artery

VAN order (veins at top)

18

Nerves of thoracic wall

Innermost, internal then external intercostal nerves

19

Sympathetic trunk

Lies to right of aorta
Runs with azygous vein

(Thoracic duct to left, with hemiazygous vein)

20

Shingles

Caused by human herpes virus-3 (HHV-3)
Primary infection in childhood -> chickenpox
Then virus lies dormant in dorsal root ganglia of sensory nervous system
Then will flare up in single dermatome segment, usually on chest wall

21

Primary muscle of respiration

Diaphragm
External intercostal (hands in pockets)
Internal intercostal (opposite)
Innermost intercostal (all directions, cross multiple rib spaces)

22

Accessory muscles of repiration

Sternocleidomastoid
Anterior, middle and posterior scalenes
Pectoralis major and minor
Erector spinae
Quadratus lumborum
Latissimus dorsi
Trapezius

- only if respiratory requirements increased, normal breathing just diaphragm

23

Surface anatomy of lungs

Apex 2cm above clavicle
Lower margin 2 ribs above pleural limit - 6th rib in midclavicular line, 8th in midaxillary, 10th at angle of ribs (back)

24

Oblique and horizontal fissures, surface anatomy

Oblique from spine of T4 to 6th rib in midclavicular line
Horizontal (only right) from 5th rib in midaxillary line to 4th costal cartilage at sternum

25

Surface anatomy of pleura, lower margin

Extend down to 8th rib in midclavicular line, 10th in midaxillary, 12th at angle of ribs

26

Structures passing through diaphragm at T8

Inferior vena cava (8) and phrenic nerves

- tendinous, or IVC would be compressed

27

Structures passing through diaphragm at T10

Oesophagus (10) and vagus, and oesophageal branch of left gastric vessels

- muscular, as helps peristalsis and stops reflux as aperture acts as sphincter

28

Structures passing through diaphragm at T12

Aorta and splanchnic nerves, and thoracic duct, azygous and hemiazygous veins

- behind diaphragm, or would be compressed through muscle

29

Diaphragmatic hernias

CONGENITAL
- when diaphragm not formed properly
- usually posterolateral, sometimes anterior

HIATUS
- acquired hernia, when oesophagus goes above diaphragm, rolls or slides
- acid reflux symptoms
- caused by excess strain on diaphragm or weakness

30

Pleural effusion - procedure

Pleural tap / chest drain to remove liquid
To prevent recurrence, can use a chemical powder to stick pleura together, prevent fluid build up

31

Pleura and innervation

Mesothelial membranes that line thoracic cavity and enclose pleural space (potential only)
Contain small amount of pleural fluid, to lubricate lung movements in breathing

PARIETAL
Costal - intercostal nerve
Diaphragmatic - phrenic nerve
Mediastinal - phrenic nerve

VISCERAL - vagus nerve

32

Mesothelioma

Thickened, pale, cream coloured pleura all around lung and into fissures - tumorous
Nearly always from past asbestos history (can be 40 years +)
Asbestos not broken down in body so WBCs accumulate
-> breathlessness as pleura constricts lung

33

Decompression of tension pneumothorax

One way valve is created, increase intra-thoracic pressure and organs shift away - can be fatal
1) Needle to 2nd intercostal space in midclavicular line - hear hiss
2) Chest drain to 5th intercostal space in midaxillary line

MUST be along superior border of rib, as neurovascular bundle lies immediately inferior

34

Types of epithelia down airway

Trachea - pseudostratified ciliated, with goblet cells
Bronchi - columnar ciliated with goblet cells
Bronchioles - ciliated simple columnar -> ciliated simple cuboidal (with club cells throughout)
Alveoli - simple sqaumous

35

Defence in respiratory tract

Filtered in nasopharynx
Sneeze and cough reflex
Epithelial barrier
Mucociliary escalator
Immune response, as loose lymphoid tissue drains to nodules

36

Left vs right bronchus

Right
- shorter, straighter - easier flow into
- 3 secondary bronchi
- less cartilage, more smooth muscle

Left
- right angle - harder flow in
- 2 secondary bronchi
- more cartilage, less smooth muscle

37

Major differences between trachea and bronchi

Bronchi:
- cartilage not continuous, hyaline plates instead
- columnar not pseudostratified epithelia
- fewer goblet cells

38

Club cells

In terminal bronchioles instead of goblet cells
Non-ciliated dome-shaped columnar cells
Microvilli
Protective and regenerative role
May act as stem cells for repair in bronchioles
Possible secretory role - surfactant, anti-proteases, oxidases to protect

39

Respiratory vs terminal bronchioles

- respiratory have less collagen, less smooth muscle
- respiratory have squamous epithelia, terminal have cuboidal
- alveolar ducts branch off respiratory

40

Histology of lobar pneumonia

Alveoli fill with pus, cannot fill with air, less gas exchange
Stretched and inflamed alveolar walls
Mostly dead neutrophils visible, some macrophages

41

Bones of nasal septum

Septal cartilage anterior
Then perpendicular plate of ethmoid at top, vomer at bottom

42

Openings of paranasal air sinuses - under superior concha

2
Posterior ethmoid + sphenoid (further back)

43

Openings of paranasal air sinuses - under middle concha

4
Frontal, middle and anterior ethmoid, maxillary (maxillary clearest, furthest back)

44

Openings of paranasal air sinuses - under inferior concha

1
Nasolacrimal duct

- eustachian orifice doesn't open into nasal cavity, opens into nasopharynx

45

Maxillary sinus innervation

Maxillary division of trigeminal (V)
So sinusitis can be referred to upper jaw, teeth and skin of cheek

Sinusitis is an inflammation of membranous lining of sinuses -> pain, nasal discharge

46

Cranial nerves

O - olfactory
O - optic
O - occulomotor
T - trochlear
T - trigeminal
A - abducens
F - facial
V - vestibulocochlear
G - glossopharngeal
V - vagus
A - accessory
H - hypoglossal

47

Epistaxis

Nose bleeds
Usually from damage to anterior-inferior part of nasal septum vessels - arterial anastamosis here

48

Obstruction in pharynx

Due to - adenoids, palatine tonsils, obstructive sleep apnoea -> snoring
-> STERTOR - (partial airway obstruction above the level of the larynx)

49

Obstruction in larynx

-> STRIDOR - (partial airway obstruction below the level of the larynx)

50

Vocal chord paralysis

From damage to recurrent laryngeal nerve through trauma
-> HOARSENESS - if unilateral
-> BREATHING DIFFICULTIES AND APHONIA - if bilateral

51

Nasopharynx

Opens into nasal cavity
Extends from base of skull to soft palate (C1)
Contains pharyngeal tonsils, eustachian tonsils, opening of auditory tube

52

Oropharynx

Opens into oral cavity
Extends from soft palate (C1) to tip of epiglottis (C3)
Contains palatine tonsils

53

Laryngopharynx

Opens into larynx
From tip of epiglottis (C3) to cricoid cartilage (C6)
Contains NOTHING, needs to be clear for air

54

Lymph tissue in pharynx

Pharyngeal tonsils and eustachian tonsils in nasopharynx
Palatine tonsils in oropharynx
Lingual tonsils under tongue
(Waldeyer's ring)

-> drains to retropharyngeal then deep cervical nodes

55

Blood and nervous supply to pharynx

Arterial - from branches of facial, maxillary, laryngeal and lingual arteries
Veins - to internal jugular vein

Nerves - from pharyngeal plexus - glossopharyngeal for sensory and vagus for motor

56

Laryngeal cartilages

Thyroid - big
Cricoid - signet ring
Epiglottis - flap
Arytenoids - move vocal chords
Cuneiforms and corniculates - in quadrangular membrane under epiglottis

57

Vocal folds

False superior (vestibular fold)
Then true vocal chords

58

Extrinsic muscles acting on larynx

Controlled by vagus
Move larynx as whole
Suprahyoid elevate for swallowing
Infrahyoid depress

59

Intrinsic muscles acting on larynx

Thyroarytenoid - relax vocal ligament
Lateral cricoarytenoid - adduct vocal folds
Cricothyroid muscle - stretch and tense vocal ligaments, needed for forceful speech
Transverse arytenoid - adduct arytenoid cartilages
Oblique arytenoid - adduct arytenoid cartilages
Posterior cricoarytenoid - abduct vocal folds

60

Nerve supply to larynx

Inferior laryngeal nerve - all intrinsic muscles (except cricothyroid), and mucosa below vocal folds
Superior laryngeal nerve - external - cricothyroid muscle, - internal - mucosa above vocal folds

- recurrent laryngeal nerve is very close to thyroid, may be damaged in surgery -> hoarseness

61

Intubation method

Stand behind patient head, extend neck fully, clear mouth
Laryngoscope lateral to tongue, tip in vallecula (above epiglottis)
Laryngoscope lifted to view vocal chords
Endotracheal tube inserted through chords into trachea
Balloon inflated to hold tube in place, ventilate
Check to ensure not in bronchus (only one lung inflating) or oesophagus

62

Cricothyroidotomy

In emergency situations
Small slit on cricothyroid membrane, insert endotracheal tube

63

Tracheostomy

For long term management
Inserted directly to trachea
Incision via anterior wall of neck in surgical procedure
To bypass air from obstruction eg laryngeal tumour
- cannot speak

64

Symptoms of lung cancer

Chronic cough
Haemoptosis
Persistent chest infections
Breathlessness
Loss of appetite, unexplained weight loss
Clubbing
Tiredness
Aches/pains when breathing or coughing

65

Relations to trachea

Anterior - thyroid isthmus at 2nd/3rd tracheal cartilage, left brachiocephalic vein
Posterior - oesophagus
Lateral - lobes of thyroid gland, carotid sheath containing common carotid artery, internal jugular vein and vagus nerve

Bifurcation (carina) at T4/5, sternal angle, plane of louis

66

Lung segments

2 primary bronchi, then left has 2 lobar, right has 3 lobar.

Then, 10 bronchopulmonary segments on each side
Each segment has a tertiary bronchus and pulmonary artery branch
Segments separated by connective tissue septa - can surgically remove one segment, and can contain disease
- pulmonary veins do not accompany bronchi, run between segments

67

Polyphonic wheeze

High pitched, expiratory
Indicative of asthma - expiratory as further decreasing airway diameter as lung collapses

68

Vessels at hilum

Left lung - clockwise to front
A
B V
V

Right lung -
A B
A B
V V
(front is right, back is left)

Veins thicker than arteries, as pulmonary veins supply oxygenated blood
Back of lung is straight , front follows curved chest wall

69

Neurovasculature of lungs

Bronchial arteries, branches of descending aorta
Bronchial veins drain to azygous and hemiazygous veins

Lymph to bronchopulmonary nodes at hilum, then tracheobronchial nodes at mediastinum, then nodes along trachea (lung cancer spreads this way)

Autonomic innervation from sympathetic trunk and vagus nerves via pulmonary plexuses
- parasympathetic constricts bronchioles, sympathetic dilates

70

Examination results - pleural effusion

Position of trachea - central
Percussion note - stony dull
Breath sounds - reduced
Vocal resonance - reduced

71

Examination results - lobar pneumonia

Position of trachea - central
Percussion note - dull
Breath sounds - reduced
Vocal resonance - increased

72

Examination results - collapsed lung (atelectasis)

Position of trachea - towards
Percussion note - dull
Breath sounds - reduced
Vocal resonance - reduced

73

Examination results - pneumothorax

Position of trachea - central
Percussion note - hyper-resonant
Breath sounds - reduced
Vocal resonance - reduced

74

Examination results - tension pneumothorax

Position of trachea - away
Percussion note - hyper-resonant
Breath sounds - reduced
Vocal resonance - reduced

75

Anterior auscultation

Apex - superior to medial third of clavicle
Superior lobe - 2nd intercostal space
Middle lobe (right) - 4th IC space
Inferior lobe - 6th IC space

76

Posterior auscultation

Apex - superior to medial third of clavicle
Superior lobe - 2nd IC space
Inferior lobe - triangle - bordered by trapezius, latissimus dorsi, medial border of scapula