1
Q
Branches of anterior ethmoidal artery
A
- External nasal
- Septal branch
2
Q
Branch of posterior ethmoidal artery
A
Septal branch
3
Q
Branch of sphenopalatine artery
A
Septal branch
4
Q
Most commonly ruptured artery in nose bleeds
A
Sphenopalatine
5
Q
Where does the nasal vein run
A
- In foramen caecum (behind frontal sinus)
- Drainage to pterygoid plexus in infratemporal fossa
- No venous valves
- Potential route for infection intra-cranially, especially cavernous sinus
6
Q
Innervation of the posterior 1/3rd of the tongue
A
Taste and general sensation by the CN IX - glossopharyngeal
7
Q
Innervation of the anterior 2/3rds of the tongue
A
- Innervation for TASTE by CN VII (facial) via chorda tympani
- General sensation via lingual (of trigeminal nerve)
- Motor innervation by CN XII (hypoglossal)
8
Q
laryngeal mucosa
A
- Lined with respiratory epithelium
- Lamina propria loose connective tissue
- Glands open onto mucosal surface
9
Q
Epithelium of vocal folds
A
- Stratified squamous non-keratinised
- Lamina propria = dense and elastic
- No glands
10
Q
Squamous metaplasia
A
- Phenomenon that occurs @ junction between squamous and non-squamous
- Hot-spot for cancer development
- With smoking, respiratory epithelium is replaced by squamous epithelium becuase it’s resistant to abrasion
11
Q
Laryngeal innervation
A
- Superior laryngeal nerve (inferior ganglion of VAGUS - CN X)
- Travels in carotid sheath, behind, carotid artery
- Exits sheath and divides into:
- INTERNAL LARYNGEAL - general sensation to epiglottis and supraglottic region
- EXTERNAL LARYNGEAL - motor to cricothyroid
12
Q
Where does the recurrent laryngeal ascend
A
In the groove between the trachea and oesophagus
Pierces the inferior constrictor to enter posterior of larynx
13
Q
Difference in innervation of recurrent laryngeal nerve
A
- MOTOR to intrinsic muscles of larynx except cricothyroid
- SOMATIC SENSORY to infraglottic region
14
Q
Vasculature of larynx
A
- External carotid -> superior thyroid -> superior laryngeal
Supplies structures in supraglottic region
- Thyrocervical trunk -> inferior thyroid -> inferior laryngeal
Supplies structures in infraglottic region
15
Q
Vertebral level of beginning and end of trachea
A
- Starts at C6
- Ends at T4/T5
- 10 - 11 cm long
- 15 - 20 C shaped cartilage rings
16
Q
Boundaries of triangle of auscultation
A
- SUPERIOR - inferolateral trapezius
- FLOOR - serratus anterior
- INFERIOR - superior border of latissimus dorsi
- LATERAL - medial border of scapula
17
Q
Transverse thoracic plane
A
Sternal angle
T4-T5 IV disc
18
Q
Xiphisternal plane
A
Xiphoid process
Lower border of T9
19
Q
Superior vs inferior aperture of thorax
A
- Superior aperture is open and continuous with the neck
- Inferior aperture is closed by the diaphragm
20
Q
Histology of pleura
A
Squamous mesothelial cells
21
Q
histology of visceral pleura
A
Low cuboid mesothelial cells
22
Q
Histology of parietal pleura
A
Squamous mesothelial cells
Secretes pleural fluid
(capillary transudate - 0.25 ml/kg)
23
Q
Transudative
A
Caused by systemic factors
24
Q
Exudative
A
Caused by local factors (e.g. inflammation)
25
Highest point of lung - associated with cervical pleura
Cupola
2-3 cm above medial 1/3 of clavicle
26
Action of external ICs
Elevate ribs
Aponeurotic anteriorly
27
Internal ICs
Depress ribs (expiration)
28
Subcostal muscles
* Internal posterior wall of thorax
* Lower 6 ribs
* Span 2-3 ribs
* Partially aponeurotic
* Depress lower ribs - forced expiration
29
Transversus thoracis muscle
* ORIGIN lower 1/3 sternal body, xiphoid process, costal cartilages
* INSERTION costochondral junctions ribs 3-6
* ACTION depress CCs to which they are attached
30
What passes through the oesophageal hiatus
Vagus
R phrenic nerve
31
What passes through the aortic hiatus
Thoracic duct
Greater splanchnic nerve
Azygos nerve
32
Contents of sternocostal triangle/triangle of morgagni
Superior epigastric artery
Lymphatics
33
Relation of medial arcuate ligament
Sympathetic trunk
34
Relations of left crus
Greater and lesser splanchnic nerves
Hemiazygos vein
35
Relations of right crus
Greater and lesser splanchnic nerves
36
Blood supply of superior surface of the diaphragm
Internal thoracic
* Pericardiacophrenic
* Musculophrenic
Superior phrenic
IC
37
Blood supply of inferior surface of the diaphragm
Inferior phrenic
38
Venous drainage of diaphragm on thoracic surface
* Brachiocephalic
* Azygos
39
Venous drainage of diaphragm on abdominal surface
* Inferior vena cava
* Renal
40
Lymph drainage of diaphragm
ANTERIOR
* Sternal & mediastinal
MIDDLE
* Sternal & mediastinal
POSTERIOR
* Mediastinal
41
What does the extensive capillary network of the lungs facilitate
* Filtering of small clots and gas bubbles
* Presence of ACE (conversion of Ang I -\> Ang II)
42
Bifurcation of trachea
T4/T5 // T5-T7
43
Blood supply of trachea
Inferior thyroid arteries
44
What is the trachea partially covered by
Sternothyroid and sternohyoif muscle
45
What are the 2nd-4th cartilages covered by
Thyroid isthmus
46
Main bronchi -\>
Lobar bronchi -\> segmental bronchi
47
Most inferior limit of the lung in normal respiration
Rib 8
48
Relations of right lung
1. SVC and IVC
2. Right subclavian artery and vein
3. Rib 1
4. Oesophagus
5. Azygos vein
6. Heart - mostly RA
49
Relations of left lung
1. Rib 1
2. Left subclavian artery
3. Left brachiocephalic vein
4. Arch of aorta
5. Oesophagus
6. Descending thoracic aorta
50
What nerves arc around lung root
* Anterior phrenic nerve
* Posterior vagus nerve (CN X) - PS to and sensory from viscera as far as splenic flexure of colon
51
Where do the left bronchial arteries originate from
2
Superior and inferior originate directly from aorta
52
Where do the right bronchial arteries originate from
3rd IC artery (frequently originates from left superior bronchial a.)
53
Innervation of bronchoconstriction
Vagus
54
What runs in the connective tissue between bronchopulmonary segments
Branches of pulmonary vein collecting oxygenated blood
55
Where does gas exchange take place
At respiratory bronchioles and alveoli
56
Respiratory epithelium
Pseudostratified columnar ciliated with goblet cells
Mucociliary escalator
57
Submucosa contents
* Hyaline cartilage
* Smooth muscle
* Glands
58
Primary ciliary dyskinesia/Kartageners Syndrome
* Immotile or poorly functioning cilia
* Non-functioning mucociliary escalator
* Chronic sinusitis, bronchitis, bronchiectasis
* Male infertility
* 50% - situs inversus
59
Lung secondary lobule
* Each acinus has between 1500 and 4000 alveoli
* Bounded by interstitial fibrous septa
* Thicker and most numerous at lung periphery
* Location of distal PV and lymphatics
60
What are alveoli fed by
* Respiratory bronchioles
* Alveolar ducts
* Enveloped by capillaries and some CT (elastic fibres)
61
Anatomic site of asthma
Respiratory bronchioles
* Hyper contractility of airway smooth muscle results in bronchial hyperresponsiveness, inflammation, terminal airway obstruction
62
Pores of Kohn
Pores interconnecting alveoli
63
Blood air interface from outside (air) in (IS)
1. Surfactant
2. Type I pneumocyte
3. FUsed basement membranes of type I pneumocyte and capillary endothelial cells
4. Capillary endothelial cell
64
Emphysema
Scarring of alveolar IS
* Loss of elasticity and compliance
* Alveolar thickening and reduced gas exchange
* Increase in ‘deadspace’
* Bronchiolar thickening, alveolar destruction
* Use of accessory muscles
* COPD
65
Bronchioles and lung
66
Needle thoracostomy
67
Safe triangle
68
Thoracocentesis
69
What is a cricotomy used for
Emergency, for supraglottic obstruction
70
Embryonic (3-8 weeks)
Formation of early airway branches (segmental bronchii)
71
Pseudoglandular (5-18 weeks)
formation of bronchioles
72
Canalicular (16-26 weeks)
Formation of respiratory bronchioles
73
Saccular (24-36 weeks)
Formation of alveolar ducts
74
Alveolar (36 weeks-8 yrs)
Formation and expansion of alveoli
Resp Anatomy
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