Respiratory: Anatomy of Coughing

Question 1

What does the (right) carotid sheath contain?

Answer 1

the vagus nerve
internal carotid artery
common carotid artery
internal jugular vein

Question 2

what sensory receptors are stimulated in coughing?

Answer 2

CN 9 = glossopharyngeal

CN X = vagus

Question 3

what does the pulmonary plexus consist of?

Answer 3

sympathetic axons
parasympathetic axons
visceral afferents

Question 4

what do the motor axons supply?

Answer 4

supplies all the mucous glands and all bronchiolar smooth muscles

Question 5

where do the pulmonary visceral afferents travel?

Answer 5

visceral pleura -> respiratory tree -> plexus -> vagus nerve to the brainstem via medulla

Question 6

what does the CNS co-ordinate rapidly when coughing?

Answer 6

A DEEP inspiration using the diaphragm (phrenic nerves), intercostal muscles (intercostal nerves), and accessory muscles of inspiration

Question 7

How do the chest walls pull the lungs outwards?

Answer 7

1. surface tension between the parietal and visceral pleurae created by the pleural fluid.
2. the potential vacuum in the pleural cavity becomes an actual vacuum.
3. This vacuum ‘sucks’ the visceral pleura towards the moving parietal pleura.
4. Air flows into the lungs down a pressure gradient (atmosphere and lungs)

Question 8

What supplies the diaphragm?

Answer 8

spinal nerves 3,4,5

Question 9

Where are the spinal nerves which innervate diaphragm located?

Answer 9

found on the anterior surface of scaliness anterior

Question 10

Where does the Pectoralis major?

Answer 10

attaches between sternum/ribs and the humerus

Question 11

What does the Pectoralis minor?

Answer 11

can pull 3-5 ribs superiorly towards the coracoid process of the scapula

Question 12

Where does the sternocleidomastoid?

Answer 12

this attaches between sternum and mastoid process/temporal bone

Question 13

what do the intrinsic muscles of the larynx do during a cough reflux?

Answer 13

they adduct the vocal chords

Question 14

Route of the vagus nerve?

Answer 14

1. connect to the medulla of the brain stem
2. base of the skill part of the course is the jugular foramen
3. descends through the neck within the carotid sheath
4. in the chest they descend posterior to the lung root
5. pass through the diaphragm on the oesophagus
6. on the surface of the stomach they finally divide into many parasympathetic braces for the foregut and midgut organs

Question 15

where are the accessory muscles of DEEP expiration?

Answer 15

the right and left anterolateral abdominal wall muscles contract forcefully increasing intra-abdominal pressure

Question 16

where does the right and left external oblique/right and left internal oblique aponeurosis blend in at?

Answer 16

linea alba

Question 17

where does the right external oblique attach to?

Answer 17

superficial aspects of the lower ribs and the anterior part of the iliac breast and the pubic tubercle

Question 18

where does the right internal oblique attach to?

Answer 18

inferior border of the lower ribs and interiorly the iliac crest and the thoracolumbar fascia of the lower back

Question 19

what are the thoracoabdominal nerves?

Answer 19

the 7th to the 11th intercostal nerves travel anteriorly then their terminal braces leave the intercostal spaces, in the plane between the internal oblique and the transverse abdominus as thoracoabdominal nerves

Question 20

where is the subcostal nerve found?

Answer 20

T12 anterior ramus

Question 21

where is the iliohypogastric nerve?

Answer 21

half of the L1 anterior ramus

Question 22

where is the ilioinguinal nerve?

Answer 22

the other half of the L1 anterior ramus