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Physiology > The tracheobronchial tree and larynx > Flashcards

The tracheobronchial tree and larynx Flashcards

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1
Q

what level is the suprasternal notch?

A

T2/3

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2
Q

what level is the sternal angle?

A

T4/5

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3
Q

what level is the inferior angle of the scapula?

A

T8

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4
Q

what level is the xiphisternum?

A

T9

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5
Q

what level is the lowest part of the costal margin - 10th rib?

A

L3

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6
Q

how many ribs are there?

A

12

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7
Q

connections of the ribs

A

the first 7 are connected via costal cartilages to sternum
8-10 are articulated with the rib above
11 and 12 are free

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8
Q

what is the role of the thoracic cage?

A

protection of the thoracic and abdominal organs
resists negative intrathoracic pressure of lung recoil can change shape for respiration
attachment and movement of upper limbs

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9
Q

naming of intercostal spaces

A

named after the rib above the space

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10
Q

what is the role of pleural fluid?

A

creates surface tension which keeps lung surface in contact with thoracic wall while still allowing sliding of surfaces

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11
Q

what is the root of the lungs?

A

the structures that pass to or from the hilum
bronchus
bronchial arteries and veins
pulmonary artery and veins

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12
Q

trachea

A

11-12cm long and 2.5cm wide
fibrocartilagenous tube supported by cartilage rings
extends from the larynx at the level of C6 to T5 (sternal angle)

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13
Q

what are the layers of the trachea?

A

mucosa - pseudostratified ciliated columnar epithelium
submucosa - areolar connective tissue with seromucous glands and ducts
C shaped ring of hyaline cartilage - completed by trachealis smooth muscle and connective tissue
adventitia - made of areolar connective tissue

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14
Q

where does the trachea bifurcate?

A

carina

level of sternal angle

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15
Q

main bronchi

A

enter lungs at hilum
right is wider, shorter and more vertical and the left is inferior to the aortic arch and anterior to esophagus and descending thoracic aorta .

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16
Q

what is the largest subdivision of the bronchial tree?

A

bronchopulmonary segments

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17
Q

bronchopulmonary segments

A

largest subdivision of lung
pyramidal shape, apex at hilum
discrete anatomical and functional units separated by connective tissue.
surgically resectable

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18
Q

blood supply and drainage of bronchopulmonary segments

A

supplied by segmental bronchi, pulmonary and bronchial arteries centrally
venous and lymphatic drainage at edges
drain adjacent segments

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19
Q

how many bronchopulmonary segments are there in the left lung?

A

8-10, 4-5 per lobe

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20
Q

how many bronchopulmonary segments are there in the right lung?

A

10
3 superior
2 middle
5 inferior

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21
Q

what comes from secondary bronchi?

A

segmental bronchi / tertiary

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22
Q

segmental bronchi

A

divide into conducting bronchioles that end as terminal bronchioles

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23
Q

bronchioles

A

transport air, no alveoli
bronchioles lack cartilage
terminal bronchioles divide into respiratory bronchioles

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24
Q

respiratory bronchioles

A

outpouchings - alveoli
structural unit of gas exchange
involved in transport and gas exchange
divide into alveolar ducts (2-11)

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25
alveolar ducts
give rise to alveolar sacs (5-6) | multiple alveoli clusters open
26
how many alveoli are there?
300 million
27
what is a bronchopulmonary segment?
part of lung supplied by a tertiary/ segmental bronchus and arteries
28
what is there within each bronchopulmonary segment?
``` lobules of the lung segmental bronchus segmental branches from pulmonary artery branches of bronchial artery pulmonary vein and lymphatics at margin ```
29
branches of bronchial tree
``` secondary/ lobar bronchi tertiary/ segmental bronchi smaller bronchi bronchioles terminal bronchioles respiratory bronchioles ```
30
secondary bronchioles
aka lobar | plates of hyaline cartilage
31
tertiary bronchi
aka segmental | pseudostratified ciliated columnar epithelium
32
smaller bronchi
reduced or no plates of hyaline cartilage
33
bronchioles
simple ciliated columnar/ cuboidal epithelium | no cartilage, more smooth muscles
34
terminal broncioles
simple cuboidal epithelium | no goblet cells and underlying mucous glands
35
respiratory bronchioles
simple squamous epithelium
36
blood supply to trachea
neck - inferior thyroid arteries | chest - branches from bronchial arteries
37
blood supply of lungs
each lung has a pulmonary artery and 2 pulmonary veins (superior and inferior)
38
pulmonary artery
divides alongside the bronchial tree | carry low O2 blood to lungs for oxygenation
39
pulmonary veins
right middle to superior lobe carries oxygen rich blood to the left of heart independent of bronchial tree and pulmonary arteries
40
bronchial arteries
supply blood for nutrition to the lungs, structures of the root of the lungs and visceral pleura
41
where do the left bronchial arteries come from?
2 from thoracic aorta
42
right bronchial artery
1 from thoracic aorta or from one of the 3 upper posterior intercostal arteries or left superior bronchial artery
43
blood supply to parietal pleura
supplied and drained by thoracic wall vessels
44
emphysema
lung tissue destruction and reduced airflow
45
chronic bronchitis
inflammation and scarring and narrowed airways
46
asthma attack
smooth muscle spasms occur at bronchiolar level of bronchial tree and closes off airways as there is no cartilage
47
what happens during exercise?
increased sympathetic activity release of adrenaline and noradrenaline by the adrenal gland relaxation of smooth muscles of bronchiole bronchodilator increase lung ventilation
48
what happens at rest/ in allergies
parasympathetic activity allergic mediators released - histamine contracts the bronchiolar smooth muscles - bronchoconstriction decrease lung ventilation
49
where is laryngeal prominence
C4-5
50
trachea surface anatomy
midline from laryngeal prominence immediately posterior to suprasternal notch bifurcates at sternal angle
51
tracheal deviation
caused by tension pneumothorax
52
symptoms of tension pneumothorax
``` tracheal deviation chest pain shortness of breath rapid heart rate shallow breathing anxiety blue or ashen skin kinking of vena cava causing no venous return to heart, no cardiac output, risk of cardiac arrest ```
53
how does a tension pneumothorax form?
opening in pleura acts as 1 way valve so air comes in on inspiration but the valve closes on expiration and the air cannot escape positive intrapleural pressure collapses the lung and eventually causes mediastinal shift to the opposite side
54
treatment for tension pneumothorax
medical emergency | insert large bore cannula to mid clavicular line 2nd intercostal space
55
chest tube
incision is made in the 5th and 6th intercostal space in the midaxillary line (nipple level) directed superiorly to cervical pleura to remove air or inferiorly to remove fluid
56
Larynx
anterior neck
57
functions of larynx
phonation cough reflex protection of lower respiratory tract
58
structure of larynx
primarily cartilaginous skeleton - 9 cartilages ligaments and membranes laryngeal muscles move components of the larynx for phonation and breathing
59
anatomy of larynx
``` suspended from hyoid bone C3-6 below pharynx and above trachea behind infrahyoid muscles in front of oesophagus and medial to thyroid gland ```
60
subdivisions of larynx
internal cavity divided into 3 supraglottis glottis subglottis/ infraglottis
61
supraglottis
from inferior surface of epiglottis to vestibular folds
62
glottis
vocal apparatis contains false and true vocal cords laryngeal ventricle - lateral recess between vestibular and vocal folds
63
rima glittidis
opening between vocal cords, size altered by muscles of phonation
64
subglottis
from vocal folds to trachea
65
laryngeal cartilages
unpaired and paired
66
unpaired laryngeal cartilages
thyroid cricoid epiglottis
67
thyroid cartilage
laryngeal prominence superior and inferior horns thyrohyoid membrane attaches to hyoid
68
cricoid cartilage
``` ring cricothyroid joints changes length of vocal folds cricothyroid ligament cricotracheal ligament ```
69
epiglottis
posterior to root of tongue
70
paired laryngeal cartilage
arytenoid corniculate cuneiform
71
vocal folds
under control of muscles of phonation vocal ligament vocalis muscle
72
what is the space between the vocal folds called?
rima glottidis
73
vestibular folds
``` false vocal cords lie superiorly to the true vocal cords consist of vestibular ligament fixed folds provide protection to larynx ```
74
laryngeal muscles
extrinsic and intrinsic
75
extrinsic laryngeal muscles
elevate or depress the larynx during swallowing larynx suspended from hyoid infrahyoid muscles depress suprahyoid muscles elevate
76
intrinsic laryngeal muscles
``` move the individual components of the larynx for breathing and phonation control shape of rima glottidis adductors abductors sphincters tensors relaxers vocalis muscles ```
77
innervation of intrinsic laryngeal muscles
inferior laryngeal nerve from recurrent laryngeal nerve
78
innervation of cricothyroid
superior laryngeal nerve
79
laryngeal ligaments
extrinsic | intrinsic
80
extrinsic laryngeal ligaments
attach larynx to external structures
81
intrinsic laryngeal ligaments
hold cartilages of the larynx together as one functional unit internally cricothyroid and quadrangular membrane
82
appearance of false and true vocal cords
false/ vestibular folds = covered by mucous membrane, are pink true vocal folds = avascular so appear white
83
blood supply of larynx
superior and inferior laryngeal artery
84
superior laryngeal artery
branch of superior thyroid artery | supplies internal surface
85
inferior laryngeal artery
branch of inferior thyroid artery | supplies mucous membranes and muscles of inferior larynx
86
venous drainage of larynx
superior and inferior laryngeal veins
87
superior laryngeal vein
drains to internal jugular vein
88
inferior laryngeal vein
drains to left brachiocephalic vein
89
lymphatic drainage of larynx
superior to vocal folds = superior deep cervical lymph nodes | inferior to vocal folds = pretracheal and paratracheal lymph nodes - inferior deep cervical lymph nodes
90
innervation of larynx
motor and sensory from vagus nerve, via superior and inferior laryngeal nerve
91
inferior laryngeal nerve
continuation of recurrent laryngeal nerve sensory to infraglottis motor to all internal muscles except cricothyroid
92
superior laryngeal nerve
sensory to supraglottis | motor to cricothyroid muscle
93
what causes a recurrent laryngeal nerve palsy?
``` apical lung tumour thyroid cancer aortic aneurysm cervical lymphadenopathy iatrogenic ```
94
symptoms of recurrent laryngeal nerve palsy
hoarse voice due to paralysis of vocal fold weak voice bovine cough
95
unilateral RLN palsy
hoarseness | increased risk of aspiration
96
bilateral RLN palsy
cords adducted breathing impaired - stridor, snoring phonation cannot occur
97
cricoid pressure
during intubation pressure can be applied to cricoid cartilage of larynx and occludes the oesophagus preventing gastric regurgitation

Physiology (46 decks)

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