Respiratory system

Question 1

What are the functions of the respiratory organs?

Answer 1

• gas exchange
• protection of resp. apparatus
• phonation
• olfactory perception

Question 2

Which organs belong to the upper, which to the lower airways?

Answer 2

upper airways: head → larynx

• nasal cavities
• paranasal sinuses
• pharynx

lower airways: larynx → pleural cavity

• larynx
• trachea
• bronchial tree (lung)

Question 3

Which bones and cartilages form the skeletal framework of the external nose?

Answer 3

BONES:

• 2 ossa nasalia
• 2 procc. frontales maxillae

⇒ apertura piriformis

CARTILAGES:

• 2 procc. laterales ⇒ dorsum
• parts of nasal septum
• cartilago alaris major (on each side)
  
  • ⇒ crus laterale/crus mediale
    ⇒ apex nasi
• 3-4 cartilagines alares minores

Question 4

How do you call the hairs inside the nose?

Answer 4

vibrissae

Question 5

Which vessels supply, drain the external nose, resp.?

Which nerves are responsible for the sensory and motor innervation?

Answer 5

supply:

• a. facialis → a. angularis
• a. ophtalmica → a. dorsalis nasi
• a. maxillaris → a. infraorbitalis

drainage:

• v. facialis → v. ophtalmica superior

innervation: _{(cf. supply)}

• sensory: n. opthalmicus, n. maxillaris
• motor: n. facialis via rr. buccales

Question 6

What may cause a venous sinus thrombosis and how?

Answer 6

vv. draining into v. facialis/ophtalmica anastomose btw medial angle of the eye and the root of the nose

in case of inflammation involving lat. part of face + external nose bacteria can reach deep venous sinuses → venous sinus thrombosis

Question 7

1 - 5

Answer 7

1) sinus frontalis
2) os nasale
3) proc. lateralis
4) cartilago alaris major, crus laterale
5) limen nasi

Question 8

6 - 10

Answer 8

6) vestibulum nasi
7) concha nasalis media
8) cellula ethmoidalis post.
9) concha nasalis sup.
10) sinus sphenoidalis

Question 9

11 - 17

Answer 9

11) n. nasopalatinus
12) concha nasalis inferior
13) maxilla
14) os frontale
15) tonsilla pharyngea
16) palatum molle
17) palatum durum

Question 10

Label the access routes to the 3 nasal meatus.

Which structure is located posteriorly behind the superior nasal meatus?

Answer 10

⇒ olfactory organ

• dark blue**: sinus sphenoidalis

meatus nasi superior

• yellow: post. ethmoidal air cells

meatus nasi medius

• green: sinus frontalis
• light blue: ant. + med. ethmoidal air cells
• red: sinus maxillaris

meatus nasi inferior

• purple: ductus nasolacrimalis

Question 11

Which vessels supply, drain the nasal cavity, resp.?

Which nerves are responsible for the sensory innervation?

Answer 11

supply:

• ant. 1/3: a. ophthalmica → a. ethmoidalis
• post. 2/3: a. maxillaris → a. sphenopalatina (aa. nasales post. lateral. + rr. septales post.)

drainage:

• ant: v. facialis, vv. ethmoidales → v. ophthalmica sup.
• post: vv. ethmoidales → plexus pterygoideus

​innervation: _{(cf. supply)}

• sensory: n. trigeminus
  
  • ​ant. 1/3: n. ophthalmicus
  • post. 2/3: n. maxillaris

Question 12

What is the most frequent site for epistaxis (= nose bleeding)?

Answer 12

plexus cavernosus conchae (= Kiesselbach’s plexus, locus Kiesselbachi, esp. a. sphenopalatina) on middle and inferior concha

Question 13

Explain how nasal sprays work.

Answer 13

• PNS → swelling of plexus cavernosus conchae
• SNS → detumescing of plexus cavernosus conchae

⇒ nasal sprays bind to α-adrenoreceptors → activation of SNS → vasoconstriction

Question 14

What are the 4 paranasal sinuses?

What is their function?

Answer 14

• cellulae ethmoidales
• sinus maxillaris
• sinus frontalis
• sinus sphenoidalis

⇒ lightweight construction of head + resonance to voice

Question 15

What are the boundaries of sinus frontalis?

• ant. - post.
• roof - floor
• med.

Access route to nasal cavity via .. ?

Answer 15

• ant.: arcus superciliaris
• med.: septum
• roof + post.: anterior cranial fossa
• floor: orbit

⇒ can be accessed via meatus nasi med.

Question 16

What are characteristics unique to ethmoidal air cells?

What are their boundaries?

• med. - lat.
• floor - roof

Access route to nasal cavity via .. ?

Answer 16

can be grouped into ant./med./post. ethmoidal air cells

⇒ biggest: bulla ethmoidalis

BORDERS

• medially: upper part of nasal cavity
• laterally: orbit
• roof: anterior cranial fossa
• floor: maxillary sinus

⇒ can be accessed via meatus nasi sup./med.

Question 17

What are the boundaries of sinus maxillaris?

• roof - floor
• dorsal - ventral
• med.

Why are they clinically relevant?

Access route to nasal cavity via .. ?

Answer 17

​biggest paranasal sinus (12 - 15 ml)

• roof: orbita
• ventrally: facial surface of maxilla
• dorsally: tuber maxillae
• medially: nasal cavity
• floor: dental arch of maxilla ⇒ inflammation can cause toothache, ALSO: extraction of teeth can cause infection of sinus max.

⇒ can be accessed via meatus nasi med.

Question 18

Any characteristics unique to sinus sphenoidalis?

What are its boundaries?

• vent. - caud.
• lat.

Why are they clinically important?

Access route to nasal cavity via .. ?

Answer 18

divided into right and left sinuisoidal sinus by a septum

• anteriorly: ethmoidal air cells, canalis opticus
• posteriorly: fossa hypophysialis ⇒ used for access to pituitary gland in case of tumors
• laterally: sulcus caroticus (a. carotis int., sinus cavernosus)

⇒ can be accessed via rec. sphenoethmoidalis

Question 19

On which vertebral level can we find the larynx?

Where does it open into?

Answer 19

• newborns: C2-4
• adults: C5-7 (in men lower than in women)

⇒ opens into hypgopharynx AKA laryngopharynx

Question 20

What are the 2 main functions of the larynx?

Answer 20

closure of lower airways during swallowing

larynx retracted below corpus adiposum preepiglotticum

phonation

1. closure + tension of vocal folds
2. expirational pressure → vibration of vocal folds

• pitch depends on tension of vocal folds:
  the more tense, the higher the tone
• loudness depends on volume + velocity of exhaled air

Question 21

1 - 5

Answer 21

1) epiglottis
2) hyoid bone
3) cartilago thryoidea
4) trachea
5) arcus cart. cricoideae

Question 22

6 - 10

Answer 22

6) lig. thyrohyoideum lat.
7) lig. thyrohyoideum medianum
8) lig. cricotracheale
9) membrana thyrohyoidea
10) cart. triticea

Question 23

11 - 14

What are the 2 parts of #11?

Another name for #12.

Answer 23

11) m. cricothyorideus (pars recta + pars obliqua)
12) lig. cricothryoideum medianum (= lig. conicum)
13) n. laryngeus sup. r. int.
14) a. laryngea sup.

Question 24

1 - 5

Another name for #4.

Answer 24

1) lig. hyoepiglotticum
2) lig. thyrohyoideum medianum
3) lig. thyroepiglotticum
4) lig. cricothryoideum medianum (= lig. conicum)
5) membrana triangularis

Question 25

#6 - 10

Answer 25

6) membrana quadrangularis 7) plicae vocales 8) plicae vestibularis 9) plica aryepiglottica 10) cart. cuneiformis

Question 26

#11 - 16 No #12.

Answer 26

11) cart. corniculata 13) m. arytenoideus transversus 14) m. cricoarytenoideus lat. 15) m. cricoarytenoideus post. 16) hyoid bone

Question 27

#17 - 22

Answer 27

17) epiglottis 18) cart. thyroidea 19) cart. cricoidea 20) ventriculus larnygis 21) m. thyroarythenoideus 22) m. arytenoideus obliquus

Question 28

What are the parts of cavitas laryngis?

Answer 28

* *sup.:* **vestibulum laryngis** → plicae vestibulares * *med.:* **ventriculus laryngis** → plicae vocales * *inf.:* **cavitas infraglottica** → trachea

Question 29

Which structures form the glottis AKA **rima glottidis**? What are its parts?

Answer 29

plicae vocales * *ant. part:* **pars intermembranacea** * *post. part:* **pars intercartilaginea**

Question 30

Which muscles cause an elevation or depression of the larynx?

Answer 30

**ELEVATION** _suprahyoid mm._ * m. digastricus * m. stylohyoideus * m. mylohyoideus * m. geniohyoideus _add:_ * m. thyrohyoideus * m. palato-, stylopharyngeus * m. constrictor pharyngis inf. **DEPRESSION** _{(infrahyoid mm., exc. thyrohyoideus)} * m. sternohyoideus * m. omohyoideus * m. sternothyroideus

Question 31

Which cartilages make up the laryngeal skeleton? What happens to them at the end of puberty?

Answer 31

* cartilago thyroidea * cartilago cricoidea * cartilago arytenoidea * epiglottis ⇒ **ossify** at the end of puberty (except epiglottis bc elastic, not hyaline cart.!!)

Question 32

#1 - 6 Another name for #6.

Answer 32

1) incisura thyroidea superior/inferior 2) **lamina dextra/sinistra** 3) tuberculum thyroideum superius 4) cornu superius/inferius 5) linea obliqua 6) prominentia laryngea (= **Adam's apple**)

Question 33

#1 - 7

Answer 33

1) **cartilago corniculata** 2) **proc. muscularis** 3) facies articularis thyroidea 4) lig. cricoarytenoideum posterius 5) **lamina cartilaginis cricoideae** 6) **cartilago arytenoidea** 7) **arcus cartilaginis cricoideae**

Question 34

#8 - 13 #9 refers to 2 terms.

Answer 34

8) collicus 9) **proc. vocalis; lig. vocale** 10) crista arcuata 11) fovea triangularis 12) **proc. muscularis** 13) fovea oblonga

Question 35

What are the names of the small cartilages located in the larynx in craniocaudal direction?

Answer 35

* **cart. triticea** (in lig. thyrohyoideum lat.) * **cart. cuneiformis** (in plica aryepliglottica) * **cart. corniculata** (sitting on apex of cart. arytenoida)

Question 36

#1 - 2

Answer 36

1) cartilago epiglottica (= **epiglottis**) 2) petiolus epiglottidis

Question 37

What are the 2 laryngeal joints?

Answer 37

* art. cricothyroidea * art. cricoarytenoidea

Question 38

Describe art. cricothyroidea.

Answer 38

* *type:* bilateral **ginglymus** * *articulating surfaces:* * **cornu inferius** of thyroid cart. * **lamina** of cricoid cart. ⇒ regulation of **length/tension of ligg. vocalia**

Question 39

Describe art. cricoarytenoidea

Answer 39

* *type:* bilateral **trochoginglymus** with add. **sliding** * *articulating surfaces:* * **base of arytenoid cart.** * **lamina** of cricoid cart * *ligaments:* **lig. cricoarytenoideum** ⇒ **opening and closure of rima glottidis** (for forced inhalation, phonation), only pars intercartilaginea open during normal breathing

Question 40

The submucosal conn. tissue of the larynx forms special structures, which?

Answer 40

membrana fibroelastica laryngea forms **conus elasticus** in cavitas infraglottica * med. part: **lig. cricothryoideum medianum** (= lig. conicum) * lower lat. part: **membrana triangularis** * ​upper lat. part: **membrana quadrangularis** * **plicae vestibulares →** ligg. vestibularia * *plicae vocales** → ligg. vocalia

Question 41

Explain the process of voice break.

Answer 41

* *growth of vocal ligg. + larynx** → deeper voice * (in males more than in females obv)*

Question 42

Why is lig. conicum clinically important?

Answer 42

is cut in case of conicotomy in emergency medicine if upper airways are obstructed (= **coniotomy**, **cricothyrotomy**) ⇒ **prominentia laryngea** (= Adam's apple) serves as important landmark

Question 43

What is a laryngeal edema? What could be possible causes?

Answer 43

loose conn. tissue in mucosa of the laryngeal inlet permits **build-up of considerable amounts of fluid from the vascular system** e.g. due to inflammation/insect stings → life-threatening mucosal swelling

Question 44

What is to note when using a laryngoscope?

Answer 44

image is inverted

Question 45

Which muscles act upon the rima glottidis?

Answer 45

**_open rima glottidis_** = abduction * m. cricoarytenoideus posterior (!!) **_close rima glottidis_** = adduction * m. cricoarytenoideus lateralis * m. (inter)arytenoideus transversus * m. arytenoideus obliquus * m. vocalis

Question 46

Answer 46

_m. circothyroideus_ (pars recta + pars obliqua) * ORIGIN: cricoid cart. * INSERTION: cornus inf. of thyroid cart. * ACTION: **most important tensor of vocal cords** → pitch

Question 47

Answer 47

_m. cricoarytenoideus post._ (posticus) * ORIGIN: lamina of cricoid cart. * INSERTION: proc. muscular of arytenoid cart. on same side * ACTION: **only m. that opens rima glottidis**

Question 48

Answer 48

_m. cricoarytenoideus lateralis_ (lateralis) * ORIGIN: arch of cricoid cart. * INSERTION: proc. muscularis of arytenoid cart. on same side * ACTION: **closure of pars intermembranacea**

Question 49

Answer 49

_m. (inter)arytenoideus transversus_ * ORIGIN: post. surface of arytenoid cart. * INSERTION: same spot on 2nd arytenoid cart. * FUNCTION: **closure of pars intercartilaginea**

Question 50

Answer 50

_m. arytenoideus obliquus_ * ORIGIN: proc. muscularis of arytenoid cart. * INSERTION: apex of 2nd arytenoid cart. * ACTION: **closure of pars intercartilaginea**

Question 51

+ all parts

Answer 51

_m. thyroarytenoideus_ * ORIGIN: inner side of thyroid cart. * INSERTION: arytenoid cart. (int. part) * ACTION: closure pars intermembranacea * INSERTION: proc. vocalis (**m. vocalis**) * ACTION: closure of vocal cords → fine tuning of tension * INSERTION: epiglottis (**m. thyroepiglotticus**) * ACTION: opens aditus laryngis

Question 52

Which nn. are responsible for sensory and motor innervation of the larynx?

Answer 52

_motor innervation:_ * **n. laryngeus sup. r. ext.** → m. cricothyroideus * n. laryngeus recurrens → **n. laryngeus inf.** → REST _sensory innervation:_ * *sup. part:* **n. laryngeus sup. r. int.** * *inf. part:* **n. laryngeus recurrens** ⇒ division sup. and inf. to rima glottidis for innervation and supply/drainage

Question 53

Why is the innervation of the larynx clinically important?

Answer 53

surgeries on thyroid gland can possibly injure **n. laryngeus recurrens** → failure of n. cricoarytenoideus post. * unilateral damage → hoarseness + paralysis of vocal cord * bilateral damage → serious breathing problems

Question 54

Which vessels supply, drain the larynx, resp.?

Answer 54

_supply:_ * a. carotis ext. → a. thyroidea sup. → **a. laryngea sup.** * a. subclavia → a. thyroidea inf. → **a. laryngea inf.** **​**_drainage:_ * cf. supply ⇒ division btw sup. and inf. region at rima glottidis for supply/drainage + innervation

Question 55

How long is the trachea? Where does it start, where does it end? What are its 2 parts?

Answer 55

* 10 - 13 cm, can expand up to 15 - 18 cm during deep inhalation * C7 → T4/5 * 2 parts: * **pars cervicalis**: behind thyroid gland * **pars thoracica**

Question 56

How do you call the structure btw the cartilagines tracheales? How do you call the non-cartilaginous part?

Answer 56

**ligg. annularia** **paries membranaceus**

Question 57

What is important mention abt the tracheal bifurcation? Clinical relevance?

Answer 57

* in bifurcation, spine = **carina tracheae** * angle btw main bronchi btw 55 - 65° * left angle usually: 35 - 45° * right angle usually: **15 - 25°** ⇒ aspirated foreign bodies are more likely to **enter right main bronchus**

Question 58

Which vessels supply, drain the trachea, resp.? Which nerves are responsible for the innervation?

Answer 58

_supply:_ * **a. thyroidea inf.** → rr. tracheales * **thoracic aorta** → rr. bronchiales * **a. thoracica int.** → rr. bronchiales _drainage:_ * **plexus thryoideus impar** → v. thyroidea inf. * **vv. esophageales** → v. hemi-/azygos _innervation:_ * *parasymp.:* **n. laryngeus recurrens** → rr. tracheales, **n. vagus (X)** → rr. bronchiales * *symp.:* truncus symphaticus

Question 59

What might be the effect of a goiter (swelling of thyroid gland)?

Answer 59

= struma → can cause compression of trachea → suffocation (= **asphyxia**)

Question 60

What happens in case of smoking to the cilia in the trachea?

Answer 60

* transition from resp. epithelium to str. squamous epithelium (= **squamous metaplasia**) * adherence + immobility of cilia → removal of pollutants impaired (= impairance of **mucociliar clearance**)

Question 61

What is the shape of the lung? Volume? Surface area?

Answer 61

* half cone shape * total volume 2 - 3l, after max. inhalation 5 - 8l * *left: 10 - 20 % less** * total surface area: 70 - 140 m²

Question 62

#1 - 5

Answer 62

1) impression for a. subclavia dex. 2) impression for esophageus 3) impression for v. azygos + IVC 4) fissura obliqua 5) fissura horizontalis

Question 63

#6 - 10

Answer 63

6) impression for a. subclavia sin. 7) impression for aorta / arcus aorticus 8) impressio cardiaca 9) lingula pulmonis sinistri 10) vv. pulmonales

Question 64

#11 - 17

Answer 64

11) lig. pulmonale 12) right main bronchus in **eparterial position** 13) left main bronchus in **hyparterial position** 14) a. pulmonalis dex. 15) a. pulmonalis sin. 16) incisura cardiaca pulmonis sin. 17) hilum pulmonis

Question 65

Which impressions can you find on which lung?

Answer 65

_right lung:_ * impression for a. subclavia dex. * impression for v. azygos * impression for IVC * impression for esophagus ​_left lung:_ * impression for a. subclavia sin. * impression for arcus aorticus * impression for thoracic aorta

Question 66

How do you call the 3 surfaces of the lung?

Answer 66

* facies costalis (= biggest) * facies mediastinalis * facies diaphragmatica

Question 67

In which position are the bronchi of the right and left lung?

Answer 67

* right main bronchus in **eparterial** position = sup. to a. pulmonalis * left main bronchus in **hyparterial** position = inf. to a. pulmonalis

Question 68

How do you call all vessels + nn. in the hilum?

Answer 68

radix pulmonis

Question 69

What can possible cause a pneumothorax?

Answer 69

injury / **central venous catheter** in v. subclavia → perforation of cupula pleurae → air evades through perforated lung → lung collapses due to low pressure in pleural cavity

Question 70

Explain the segmentation of the lungs.

Answer 70

_right lung:_​ main bronchi → 3 lobar bronchi: * sup. lobar bronchus → **3** segmental bronchi * mid. lobar bronchus → **2** segmental bronchi * inf. lobar bronchus → **5** segmental bronchi ⇒ **10** segmental bronchi _left lung:_ main bronchi → 2 lobar bronchi: * sup. bronchus → **5** segmental bronchi * inf. bronchus → **4** segmental bronchi ⇒ **9** segmental bronchi (**7th missing due to incisura cardiaca**) __{REMEMBER HAND RULE:}_ <sub>​ know that right lobe 10 seg./3 bronchi, left 9/2
- right hand: 3 fingers (1st) + 2 fingers (2nd) = 5 fingers (3rd)
- left: 9 (total) - right hand (1st) = 4 (2nd)</sub>

Question 71

Explain the structure of a lung lobules

Answer 71

= subunit of branchopulmonary segment * supplied by **bronchiole** → divides 3-4 times → **terminal branches** that bear alveoli (= **acinus pulmonis**) * mainly on surface of lungs (0.3 - 5cm polygonal regions)

Question 72

Why is the segmentation of the lung clinically important?

Answer 72

* **pneumonia** can only affect one lobe * relevant for **bronchoscopies**: in which segment was biopsy taken? * in case of **lung metastasis**: surgical removal of entire segments * in case of **lung carcinomas**: removal of entire lobe

Question 73

Which vessels supply, drain the lungs, resp.? Which nerves are responsible for the innervation? What is the action of sympathetic and parasympathetic innervation?

Answer 73

_supply:_ * **aa. pulmonales** (vasa publica) * rr. bronchiales of **thoracic aorta** (+ 3./4. a. intercostales) (vasa privata) !!! aa. pulmonales carry DEOXYGENATED blood _drainage:_ * **vv. pulmonales** (vasa publica) * vv. bronchiales → **v. azygos, v. hemiazygos** (vasa privata) **​**!!! vv. pulmonales carry OXYGENATED blood _innervation:_ * sensory + parasymp: **n. vagus (X)** → n. laryngeus recurrens → rr. bronchiales * sensory + symp: **truncus symphaticus** → rr. bronchiales ⇒ together: **plexus pulmonalis** ⇒ para: **bronchospasm** (= constriction of bronchi) ⇒ symp: **bronchorelaxation** via β-receptors

Question 74

Differentiate btw nutritive vessels of the lung

Answer 74

* **vasa publica:** pulmonary circulation → reoxygenate blood * **vasa privata:** systemic circulation → supply/drain lung

Question 75

Explain the structure of the pleura. How do you call the upper apex?

Answer 75

* pleura parietalis + visceralis (reflection of pl. parietalis) enclose **cavitas pleuralis** filled with a few ml of serous fluid * according to surfaces of lung: * **pars mediastinalis** * **pars costalis** * **pars diaphragmatica** * **​cupula pleurae** extends apertura thoracica by 5cm * forms **recessus**

Question 76

Which recessus are formed by the pleura? What is their function?

Answer 76

lungs expand into recessus during deep inhalation **_recessus costodiaphragmaticus_** * lateral btw ribs + diaphragm **_recessus costomediastinalis_** * ventral behind sternum _recessus phrenicomediastinalis_ * dorsal btw diaphragm + mediastinum _recessus vertebromediastinalis_ * dorsal next to spine

Question 77

Which vessels supply, drain the pleura? Innervated by.. ? Clinical relevance?

Answer 77

_supply:_ * **aa. intercostales** * **vasa pericardiaco-/musculophrenica** _​drainage:_ * *cf. supply* _innervation:_ (sensory) * **nn. intercostales** * **n. phrenicus** **​** ⇒ only pleura periatalis innervated nociceptively (no pain in case of lung tumors!)

Question 78

Compare the surface projections of lungs and pleura.

Answer 78

_{exc. at sternal line pleural borders = lung borders + 1}