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General > Respiratory Anatomy and Dissection > Flashcards

Respiratory Anatomy and Dissection Flashcards

1
Q

List, in the correct order, the names of the parts of the upper and lower respiratory tracts.

A

Upper respiratory tract:

  1. R&L nasal cavities/Oral cavity
  2. Naso-/Oro- pharynx
  3. Laryngopharynx
  4. Larynx

LRT:

  1. Trachea
  2. R&L main bronchi
  3. Lobar bronchi
  4. segmental bronchi
  5. Bronchioles
  6. Alveoli
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2
Q

State the body regions the URT is located in.

A

Head and neck.

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3
Q

State the vertebral level at which the upper respiratory tract becomes the lower respiratory tract.

A

C6 vertebra:
larynx becomes trachea.
Pharynx becomes oesophagus.

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4
Q

State the vertebral level at which the lower respiratory tract begins.

A

C6

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5
Q

State the body region the LRT is located in.

A

Thorax

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6
Q

Define the “chest walls”.

A

The chest walls contain the chest cavity.

They are made out of the rib cage, muscle, skin and fascia.

They protect the heart and lungs, and enable movements of breathing.

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7
Q

Define chest cavity.

A

Chest cavity is the space within the chest walls. It contains vital organs/viscera.

It also contains major vessels and nerves.

It consists of the mediastinum, and the R & L pleural cavities.

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8
Q

Define mediastinum.

A

The mediastinum is the area that lies in between the lungs.

It is divided into a superior and inferior mediastinum.

The inferior mediastinum is further divided into: anterior, middle, and posterior.

The heart is located in the middle mediastinum.

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9
Q

Define the pleural cavities.

A

The pleural cavities contain the right and left lungs.

They are made from the parietal pleura lining the chest walls, and visceral pleura which line the lungs. The pleural cavities are the space between these.

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10
Q

What is pleural fluid?

A

The pleurae secrete pleural fluid into the pleural cavity: a lubricant & provides surface tension.

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11
Q

Identify the bones of the chest wall.

A 
Bones:
12 pairs of ribs.
Costal margin.
12 thoracic vertebrae.
Clavicle and scapula.
Sternum: manubrium, body, xiphoid, sternal angle.
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12
Q

Identify the joints of the chest wall.

A

Joints:
Rib articulates with sternum via costal cartilage (synovial sternocostal joints).
Costochondral joints.

COSTOVERTEBRAL JOINTS:
Head of the rib articulates with body of corresponding vertebrae.
Rib tubercle articulates with transverse process of corresponding vertebrae.

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13
Q

Define and explain the clinical significance of the sternal angle.

A

The sternal angle can be palpated at the level of costal cartilage 2/ rib 2.

Enables finding of intercostal spaces for auscultation.

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14
Q

Define and explain the clinical significance of the costal margin.

A

Used as a palpable anatomical landmark, it divides the upper and lower chest.
It marks the location of the diaphragm.

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15
Q

Define and explain the clinical significance of the xiphoid process.

A

Used as a palpable anatomical landmark.

Lies at the level of the 10th rib.

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16
Q

List and identify the “muscles of breathing”.

A

3 layers of skeletal muscle located between the ribs and within the intercostal spaces.
1. external intercostal muscles
2. internal intercostal muscles
3. innermost intercostal muscles.
These make the chest wall expand during breathing by pulling adjacent ribs upwards and outwards.

The diaphragm.

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17
Q

List, identify, describe and give the nerve supply to the muscles of (normal) breathing.

A

Intercostal spaces carry neurovascular bundle between the internal and innermost muscle layers.
Nerve supply is via the anterior ramus of the spinal nerve - the intercostal nerve.

Diaphragm is supplied via the phrenic nerve: combined anterior rami of C3, 4 and 5. These can be found in the neck on the anterior surface of the scalenus anterior muscle, and in the thorax descending over the lateral aspects of the heart.

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18
Q

Detail the anatomy of an intercostal space including its blood and nerve supplies.

A

Intercostal spaces lie between the ribs, there are 11 pairs.

Each carries a neurovascular bundle of a vein, artery and nerve (VAN), between the internal and innermost intercostal muscles.

Intercostal nerve from the anterior ramus of spinal nerve.

Posterior spaces:
thoracic aorta and azygous vein.

Anterior spaces:
Internal thoracic artery and internal thoracic vein.

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19
Q

The lungs have a dual blood supply. Name them and describe the blood they carry, and why.

A

Pulmonary arteries: L&R carry venous blood to be oxygenated for the systemic circulation.

Bronchial arteries, supply oxygenated blood to the lung tissue.

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20
Q

State the basic anatomy of, the function of and the nerve supply to the diaphragm.

A

diaphragm lies inferior to lungs. It forms the floor of the chest cavity, and roof of the abdominal cavity. It has openings to permit structures to pass between these two cavities.

It is a skeletal muscle important in breathing, and has an unusual central tendon. The muscular part attaches peripherally to:

  1. the sternum.
  2. the lower 6 ribs and costal cartilages.
  3. L1-3 vertebral bodies.

It is anatomically arranged as R & L domes. (Right is superior).

The muscular part is innervated by the phrenic nerve (C3, 4, 5).

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21
Q

Describe and explain the “mechanics of breathing”.

A

INSPIRATION:
Diaphragm contracts, and descends. this increases vertical chest dimension. Intercostal muscles contract to elevate ribs- increases lateral dimensions.
Chest walls pull lungs outwards, and air flows into the lungs.

EXPIRATION:
opposite of inspiration.

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22
Q

Identify the palpable features of the chest.

A 
Jugular notch.
Clavicles.
Sternum.
sternal angle.
Xiphoid process.
R&L pectoralis major muscles.
Costal margin.
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23
Q

How is rib 2 located?

A

By finding the sternal angle, and moving laterally.

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24
Q

Describe the quadrants of the female breast.

A

Superolateral (upper outer)- axillary tail.
Superomedial (upper inner).
Inferolateral (lower outer).
Inferomedial (lower inner).

The areola and nipple lies in all four quadrants.

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25
Q

List the surface anatomy of the chest.

A 
R&L midclavicular lines.
Midsternal line.
Costal margin.
R&L axilla.
Mid-, posterior-, and anterior- axillary lines.
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26
Q

Describe the relationship of the female breast to the pectoral fascia and muscles.

A

The female breast lies anteriorly to the pectoral fascia, pectoralis major and pectoralis minor.

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27
Q

Describe the blood supply to the female breast.

A

Blood is supplied via the subclavian and internal thoracic arteries and veins.

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28
Q

Describe the lymph supply to the female breast.

A

Lateral quadrants drain unilaterally to axillary nodes.

Medial quadrants drain bilaterally to parasternal nodes.

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29
Q

Describe the anatomy of the pectoral region.

A 
EXTERNAL.
Pectoral fascia.
Pectoralis major.
Pectoralis minor.
INTERNAL.
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30
Q

Describe the deltoid muscle.

A

Bilateral muscles (L&R) of the anterolateral chest wall.

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31
Q

Describe the cephalic vein.

A

The cephalic vein lies in the delto-pectoral groove.

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32
Q

Describe the serratus anterior muscle.

A

Muscle of the anterolateral chest wall, supplied by the long thoracic nerve.

It anchors the scapula to the ribs.

Paralysis results in a winged scapula.

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33
Q

Describe latissimus dorsi.

A

It is the largest muscle of the back.

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34
Q

The apex of the lungs lie in the root of the neck, immediately posterior to which structures?

A

Subclavian and axillary arteries and veins.

The brachial plexus.
The clavicle, rib 1 and scalenus anterior.

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35
Q

Define and describe the anatomy of the breastplate.

A

Breast plate is made up of the anterior ribs covering the lungs.

It may be divided medially to form hemi-breastplates.

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36
Q

What are the costodiaphragmatic recesses?

A

Recess located between the diaphragmatic parietal pleura and the costal parietal pleura.

Its most inferior region laterally is the costophrenic angle.

Abnormal fluid (e.g. pleural effusion, haemothorax) in the pleural cavity drains into the recess causing blunting of the angles and a fluid level on CXR.

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37
Q

List the structures that pass through the lung root.

A

Pulmonary arteries, main bronchi, pulmonary lymph vessels and pulmonary veins.

Also visceral afferents, sympathetic and parasympathetic nerves.

38
Q

Mediastinal parietal pleura becomes what as it is reflected onto the lung at the lung root?

A

Visceral pleura.

39
Q

Describe the anatomy of the lung root.

A

The lung roots (hilum) are the only point of contact between the lungs and the mediastinum.

They are bilateral and each contains:
1 main bronchus
1 pulmonary artery
2 pulmonary veins
lymphatics
visceral afferents
sympathetic nerves
parasympathetic nerves
40
Q

Describe the anatomy of the lung fissures and lobes.

A

The right lung has 3 lobes, the left has 2.

Both the right and left lungs have oblique fissures, between the upper and lower lobes.

The right lung also has a horizontal fissure between its upper and middle lobes.

The left lung’s upper lobe has a lingula (tongue).

41
Q

Describe the surface anatomy of the lungs. Where can the lungs be auscultated?

A

Lung apex can be auscultated in the root of the neck, superior to the medial 1/3 of the clavicle.

The horizontal fissure of the right lung follows the right 4th rib.

The oblique fissures can be found bilaterally at the level of the 6th rib anteriorly, and T3 vertebral posteriorly.

The middle right lobe can be auscultated between ribs 4 and 6, in the mid-clavicular and mid-axillary lines.

Lung bases can be auscultated in the scapular line at T11 vertebral level.

42
Q

Describe pectoralis major.

A

Clavicular head, sternocostal head (originates on sternum and costal cartilages 1-6.
Both heads insert onto the intertubercular groove of the humerus.

It enables adduction and medial rotation of the upper limb at the shoulder joint.

It is an accessory muscle of inspiration.

It receives nerve supply from the brachial plexus.

43
Q

Describe pectoralis minor.

A

Origin: coracoid process of scapula.
Insertion: ribs 3-5, near the midclavicular line.

Stabilises scapula, accessory muscle of inspiration.

Pectoral nerve from the brachial plexus.

44
Q

Describe serratus anterior.

A

Origin: medial border of the deep (anterior) surface of the scapula.
Insertion: ribs 1-8 near anterior axillary line.

Stabilisation and protraction of scapula.

supplied by long thoracic nerve from brachial plexus.

45
Q

Where is cricothyrotomy performed?

A

Through the cricothyroid membrane, in the midline.

46
Q

Summarise the anatomy of the steps involved in stimulating and generating a cough.

A

Sensory receptors in the mucosa of the oropharynx, laryngopharynx, larynx and respiratory tree) are stimulated.

The CNS responds by stimulating deep inspiration using the diaphragm (phrenic nerves) and intercostal muscles (intercostal nerves).

The vocal cords adduct(vagus nerves) to close the rima glottidis.

The soft palate tenses (CN V) and elevates (vagus) to close nasopharynx entrance and direct air through oral cavity as a cough.

47
Q

Summarise the sensory nerve supply to the mucosa lining the nasal cavities, pharynx and larynx.

A

Nasal cavity:
Roof = CN V1
Floor = CN V2

Pharynx: CN IX.

Larynx: CN X

48
Q

Give a basic definition of the carotid sheath and list the structures enclosed within it.

A

They are protective tubes of cervical deep that attach superiorly to the bones of the bases of the skull.

Inferiorly, they blend with the fascia of the mediastinum.

They contain the vagus nerve, internal carotid artery, common carotid artery and internal jugular vein.

49
Q

Until which level is the lower respiratory tract lined with respiratory mucosa?

A

The level of the terminal bronchioles/alveoli.

50
Q

Give a basic summary of the sensory & motor nerve supply to the lungs (via the pulmonary plexus).

A

Pulmonary plexus contains sympathetic axons, parasympathetic axons and visceral afferents.

Motor axons travel from the tracheal bifurcation along branches of the respiratory tree, to supply mucous glands and bronchiolar smooth muscles.

Pulmonary visceral afferents travel from visceral pleura and the respiratory tree, to the plexus, and follow the vagus nerve to the medulla of the brainstem.

51
Q

What muscles are involved in quiet inspiration?

A

diaphragm is the main muscle of quiet inspiration.

External, internal and innermost intercostal muscles.

52
Q

Detail the anatomical course of the phrenic nerves (including key anatomical relations). State the functions of the phrenic nerves.

A

Originate on C3,4,5.
They are found in the neck on the anterior surface of the scalenus anterior muscle.

The phrenic nerve is found in the thorax, descending over the lateral aspects of the fibrous pericardium anterior to the lung roots.

They supply somatic sensory and sympathetic axons to the diaphragm and fibrous pericardium.

They also supply somatic motor axons to the diaphragm.

53
Q

What role do phrenic nerves have in deep (forced) inspiration?

A

In deep inspiration, action potentials of longer duration and in greater outflow move through the phrenic nerve to the diaphragm, causing it to flatten and then descend maximally.

54
Q

List the accessory muscles of inspiration and be able to briefly explain their anatomy relevant to performing inspiration.

A

Pectoralis major: attaches sternum/ribs to humerus, pulls ribs up and out.

Pectoralis minor: pulls ribs 3-5 superiorly towars coracoid process of scapula.

Sternocleidomastoid: attaches sternum/clavicle to mastoid process of temporal bone.

Scalenus anterior, medius and posterior: attach between cervical vertebrae and ribs 1-2.

55
Q

State the names and the basic anatomy of the laryngeal cartilages.

A

thyroid, cricoid and arytenoid.

Thyroid is largest, forms adam’s apple.

Cricoid: only complete ring around trachea. Muscles, cartilage and ligaments attach here.

Arytenoid: pair of small three-sided pyramids which form part of the larynx, to which the vocal folds are attached

56
Q

Define the rima glottidis (in terms of vocal cords & arytenoid cartilages).

A

It is the opening between the vocal cors and the aretynoid cartilages.

Adduction of the vocal cords closes the rima glottidis. Abduction opens it.

It is the narrowest part of the larynx and is located within the thyroid cartilage.

57
Q

Describe the intrinsic muscles of the larynx.

A

They are skeletal muscles which attach between the cartilages of the larynx and are supplied by branches of the vagus nerves.

They move the laryngeal cartilages, moving the vocal cords.

They adduct the vocal cords during the cough reflex.

58
Q

Summarise the anatomy of the vagus nerves.

A

They are CNX.
They are mixed cranial nerves which connect with the CNS at the medulla oblongata of the brainstem.
They leave the skull through the jugular foramen, and descend through the neck within the carotid sheath.

They descend posterior to the lung root.

Pass through the diaphragm on the oesophagus

On the surface of the stomach they divide into many parasympathetic branches for the foregut and midgut organs.

59
Q

Define anterolateral abdominal wall.

A

Abdominal wall composed of muscles.

EXTERNAL.
R&L external oblique.
R&L internal oblique.
R&L transversus abdominus.
INTERNAL.

The R&L rectus abdominus lie on the anterior aspect.

60
Q

Give the functions, nerve supply, and the describe the aponeuroses of the external oblique muscles.

A

Pulls the chest downwards.
Thoracoabdominal nerves.

Vertical muscle fibres, in the same direction as external intercostal muscle. The aponeurosis of R & L blend at the midline linea alba.

61
Q

Name the 4 pairs of muscles of the anterolateral abdominal wall.

A

External oblique, internal oblique, rectus abdominus and transversus abdominus.

62
Q

Give the functions, nerve supply, and the describe the aponeuroses of the internal oblique muscles.

A

Accessory muscle of respiration, and enables rotation and side-bends of the trunk.

Supplied via intercostal, ilioinguinal and iliohypogastric nerves.

Aponeurosis blend at the midline linea alba.

Muscle fibres in the same direction as internal intercostal muscle (diagonal from medial down to lateral).

63
Q

Give the functions, nerve supply, and the describe the aponeuroses of the transversus abdominus muscles.

A

Helps compress ribs and viscera, providing stability.

Supplied by lower intercostal nerves, ilioinguinal and iliohypogastric.

Aponeuroses blend at the linea alba.

Muscle fibres are horizontal.

64
Q

Give the functions, nerve supply, and describe the rectus sheath of the rectus abdominus muscles.

A

Important in maintaining posture.

Muscles contained within a rectus sheath.

Rectus sheaths are constructed from the aponeuroses of the other 3 anterolateral abdominal muscles.

Motor supply by thoraco-abdominal nerves (T7-11).

65
Q

What are the functions of the anterolateral abdominal muscles?

A

Maintain posture, support and movement of the vertebral column.

They contract to guard abdominal viscera, and assist in defecation, micturition, forced expiration and labour.

66
Q

Define and explain the anatomy of a simple pneumothorax. How might it occur?

A

It is a non-expanding collection of air in the pleural cavity. There is no shift of the heart or mediastinal structures.

Penetrating injury to the parietal pleura or rupture of visceral pleura. Vacuum is lost, and lung tissue recoils towards the lung root.

67
Q

Define small pneumothorax.

A

A small amount of air enters the pleural cavity. There is a gap of <2cm between the lung and parietal pleura.

68
Q

Define large pneumothorax.

A

A large amount of air enters the pleural cavity. There is a gap >2cm between the lung and parietal pleura.

69
Q

How is a pneumothorax diagnosed?

A

History: trauma, breathlessness.

Examination: reduced ipsilateral chest sounds, and reduced ipsilateral breath sounds. Hyper-resonance on percussion.

Investigation: CXR will show absent lung markings peripherally and lung edge will be visible.

70
Q

Pneumothorax can occur secondary to pulmonary disease, or chronic cough. True or false?

A

True.

Chronic cough may cause a build up of air trapped in lung alveoli, leading to rupture of lungs and visceral pleura.

71
Q

Define tension pneumothorax.

A

Torn pleura creates a one way valve, permitting air entry into the pleural cavity, but prevents exit,

With each inspiration more air enters the pleural cavity.

Pneumothorax expands and the lung collapses towards its hilum.

Pressure is applied to mediastinal structures, and may cause mediastinal shift causing tracheal deviation.

They may be bilateral.

72
Q

How will the trachea deviate in a unilateral tension pneumothorax? How can this be determined?

A

Trachea will deviate away from the side of the tension pneumothorax, and is palpable in the jugular notch.

73
Q

How is a large pneumothorax treated?

A
  1. needle aspiration (thoracocentesis).
  2. Chest drain.

Both via the 4/5th intercostal space in the midaxillary line, in the MIDDLE of the ICS.

74
Q

How is a tension pneumothorax treated?

A

Clinical emergency.

A large gauge cannula is inserted into the pleural cavity via the 2/3rd ICS in the midclavicular line, on the side of the tension pneumothorax.

75
Q

How might recurrent pneumothorax be treated?

A

pleurodesis.

76
Q

Define hernia.

A

Any structure passing through another, and ending up in the wrong place.

77
Q

What two factors are usually required for hernia formation?

A
  1. Weakness of one structure, commonly the body wall, e.g. umbilicus, inguinal canal, femoral canal. surgical scars.
  2. increased pressure on the body wall in an area of weakness.
78
Q

How might a chronic cough contribute to hernia formation?

A

Chronic cough causes repeated episodes of increased intra-abdominal pressure, and may push structures through the abdominal wall to produce a hernia.

79
Q

What herniae are associated with chronic cough?

A

Umbilical, diaphragmatic, incisional, inguinal and femoral.

80
Q

Describe the anatomy of the diaphragm and its normal areas of “weakness”

A

Normal anatomical weaknesses at its attachments to the xiphoid.
Posterior attachments.
(hiatus herniae are common).

81
Q

Describe the anatomy of the 2 types of hiatus hernia

A

Paraoesophageal hiatus hernia: stomach herniates through the oesophageal hiatus, to become parallel to the oesophagus in the chest.

Sliding hiatus hernia: Gastro-oesophageal junction, and part of the stomach slide through the oesophageal hiatus into the chest.

82
Q

Describe the anatomy of the inguinal regions.

A

Inguinal regions lie within the groin, from the anterior superior iliac spine to the pubic tubercle.

83
Q

Describe the anatomy of the inguinal ligaments.

A

The inguinal ligaments attach between the ASIS and pubic tubercle. They are the inferior borders of the external oblique aponeuroses.

84
Q

Describe the anatomy of the inguinal canals.

A

4cm long passageways through the anterior abdominal wall in the inguinal region.

The medial halves of the inguinal ligaments form the floors of the inguinal canals.

85
Q

Describe the anatomy of the inguinal rings (deep and superficial).

A

The deep ring is the entrance to the inguinal canal, and the midpoint of the inguinal ligament.

The superficial ring is the exit of the canal. It is a v-shaped defect in the external oblique aponeurosis. It lies superolateral to the pubic tubercle.

86
Q

Describe the anatomy of the ilioinguinal nerve.

A

Runs in the inguinal canal, but external to the spermatic cord.

87
Q

Describe the route of descent of the testis to the scrotum (& round ligament of the uterus to the labia).

A

Testes descend from the abdomen to the scrotum via the inguinal canal.

The round ligament of the uterus descends to the labia.

88
Q

Describe the anatomy of the spermatic cord and list all its contents (in the male).

A

The spermatic cord contains the Vas Deferens, testicular artery and pampiniform plexus.

It also contains autonomic nerves, genitofemoral nerve and lymphatics.

89
Q

Define direct inguinal herniae.

A

Peritoneum is forced through the posterior wall of the inguinal canal, and directly out of the superficial ring into the scrotum.

90
Q

Define indirect inguinal herniae.

A

Peritoneum is first forced out through the deep ring into the inguinal canal, and then out of the superficial ring into the scrotum.

91
Q

How do you differentiate clinically between direct and indirect inguinal herniae?

A
  1. reduce the hernia.
  2. occlude deep ring with fingertip.
  3. ask the patient to cough.

If it is direct, it will reappear, if not it is indirect.

92
Q

Where does the internal thoracic/mammary artery originate? What is its clinical application?

A

It is a branch of the subclavian artery.

May be used in CABG

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