1
Q
What are the functions of the respiratory organs?
A
- gas exchange
- protection of resp. apparatus
- phonation
- olfactory perception
2
Q
Which organs belong to the upper, which to the lower airways?
A
upper airways: head → larynx
- nasal cavities
- paranasal sinuses
- pharynx
lower airways: larynx → pleural cavity
- larynx
- trachea
- bronchial tree (lung)
3
Q
Which bones and cartilages form the skeletal framework of the external nose?
A
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
- ⇒ crus laterale/crus mediale
- 3-4 cartilagines alares minores
4
Q
How do you call the hairs inside the nose?
A
vibrissae
5
Q
Which vessels supply, drain the external nose, resp.?
Which nerves are responsible for the sensory and motor innervation?
A
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
6
Q
What may cause a venous sinus thrombosis and how?
A
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
7
Q
1 - 5
A
1) sinus frontalis
2) os nasale
3) proc. lateralis
4) cartilago alaris major, crus laterale
5) limen nasi
8
Q
6 - 10
A
6) vestibulum nasi
7) concha nasalis media
8) cellula ethmoidalis post.
9) concha nasalis sup.
10) sinus sphenoidalis
9
Q
11 - 17
A
11) n. nasopalatinus
12) concha nasalis inferior
13) maxilla
14) os frontale
15) tonsilla pharyngea
16) palatum molle
17) palatum durum
10
Q
Label the access routes to the 3 nasal meatus.
Which structure is located posteriorly behind the superior nasal meatus?
A
⇒ 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
11
Q
Which vessels supply, drain the nasal cavity, resp.?
Which nerves are responsible for the sensory innervation?
A
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
12
Q
What is the most frequent site for epistaxis (= nose bleeding)?
A
plexus cavernosus conchae (= Kiesselbach’s plexus, locus Kiesselbachi, esp. a. sphenopalatina) on middle and inferior concha
13
Q
Explain how nasal sprays work.
A
- PNS → swelling of plexus cavernosus conchae
- SNS → detumescing of plexus cavernosus conchae
⇒ nasal sprays bind to α-adrenoreceptors → activation of SNS → vasoconstriction
14
Q
What are the 4 paranasal sinuses?
What is their function?
A
- cellulae ethmoidales
- sinus maxillaris
- sinus frontalis
- sinus sphenoidalis
⇒ lightweight construction of head + resonance to voice
15
Q
What are the boundaries of sinus frontalis?
- ant. - post.
- roof - floor
- med.
Access route to nasal cavity via .. ?
A
- ant.: arcus superciliaris
- med.: septum
- roof + post.: anterior cranial fossa
- floor: orbit
⇒ can be accessed via meatus nasi med.
16
Q
What are characteristics unique to ethmoidal air cells?
What are their boundaries?
- med. - lat.
- floor - roof
Access route to nasal cavity via .. ?
A
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.
17
Q
What are the boundaries of sinus maxillaris?
- roof - floor
- dorsal - ventral
- med.
Why are they clinically relevant?
Access route to nasal cavity via .. ?
A
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.
18
Q
Any characteristics unique to sinus sphenoidalis?
What are its boundaries?
- vent. - caud.
- lat.
Why are they clinically important?
Access route to nasal cavity via .. ?
A
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
19
Q
On which vertebral level can we find the larynx?
Where does it open into?
A
- newborns: C2-4
- adults: C5-7 (in men lower than in women)
⇒ opens into hypgopharynx AKA laryngopharynx
20
Q
What are the 2 main functions of the larynx?
A
closure of lower airways during swallowing
larynx retracted below corpus adiposum preepiglotticum
phonation
- closure + tension of vocal folds
- 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
21
Q
1 - 5
A
1) epiglottis
2) hyoid bone
3) cartilago thryoidea
4) trachea
5) arcus cart. cricoideae
22
Q
6 - 10
A
6) lig. thyrohyoideum lat.
7) lig. thyrohyoideum medianum
8) lig. cricotracheale
9) membrana thyrohyoidea
10) cart. triticea
23
Q
11 - 14
What are the 2 parts of #11?
Another name for #12.
A
11) m. cricothyorideus (pars recta + pars obliqua)
12) lig. cricothryoideum medianum (= lig. conicum)
13) n. laryngeus sup. r. int.
14) a. laryngea sup.
24
Q
1 - 5
Another name for #4.
A
1) lig. hyoepiglotticum
2) lig. thyrohyoideum medianum
3) lig. thyroepiglotticum
4) lig. cricothryoideum medianum (= lig. conicum)
5) membrana triangularis
25
#6 - 10
6) membrana quadrangularis
7) plicae vocales
8) plicae vestibularis
9) plica aryepiglottica
10) cart. cuneiformis
26
#11 - 16
No #12.
11) cart. corniculata
13) m. arytenoideus transversus
14) m. cricoarytenoideus lat.
15) m. cricoarytenoideus post.
16) hyoid bone
27
#17 - 22
17) epiglottis
18) cart. thyroidea
19) cart. cricoidea
20) ventriculus larnygis
21) m. thyroarythenoideus
22) m. arytenoideus obliquus
28
What are the parts of cavitas laryngis?
* *sup.:* **vestibulum laryngis** → plicae vestibulares
* *med.:* **ventriculus laryngis** → plicae vocales
* *inf.:* **cavitas infraglottica** → trachea
29
Which structures form the glottis AKA **rima glottidis**?
What are its parts?
plicae vocales
* *ant. part:* **pars intermembranacea**
* *post. part:* **pars intercartilaginea**
30
Which muscles cause an elevation or depression of the larynx?
**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
31
Which cartilages make up the laryngeal skeleton?
What happens to them at the end of puberty?
* cartilago thyroidea
* cartilago cricoidea
* cartilago arytenoidea
* epiglottis
⇒ **ossify** at the end of puberty (except epiglottis bc elastic, not hyaline cart.!!)
32
#1 - 6
Another name for #6.
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**)
33
#1 - 7
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**
34
#8 - 13
#9 refers to 2 terms.
8) collicus
9) **proc. vocalis; lig. vocale**
10) crista arcuata
11) fovea triangularis
12) **proc. muscularis**
13) fovea oblonga
35
What are the names of the small cartilages located in the larynx in craniocaudal direction?
* **cart. triticea** (in lig. thyrohyoideum lat.)
* **cart. cuneiformis** (in plica aryepliglottica)
* **cart. corniculata** (sitting on apex of cart. arytenoida)
36
#1 - 2
1) cartilago epiglottica (= **epiglottis**)
2) petiolus epiglottidis
37
What are the 2 laryngeal joints?
* art. cricothyroidea
* art. cricoarytenoidea
38
Describe art. cricothyroidea.
* *type:* bilateral **ginglymus**
* *articulating surfaces:*
* **cornu inferius** of thyroid cart.
* **lamina** of cricoid cart.
⇒ regulation of **length/tension of ligg. vocalia**
39
Describe art. cricoarytenoidea
* *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
40
The submucosal conn. tissue of the larynx forms special structures, which?
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
41
Explain the process of voice break.
* *growth of vocal ligg. + larynx** → deeper voice
* (in males more than in females obv)*
42
Why is lig. conicum clinically important?
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
43
What is a laryngeal edema?
What could be possible causes?
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
44
What is to note when using a laryngoscope?
image is inverted
45
Which muscles act upon the rima glottidis?
**_open rima glottidis_** = abduction
* m. cricoarytenoideus posterior (!!)
**_close rima glottidis_** = adduction
* m. cricoarytenoideus lateralis
* m. (inter)arytenoideus transversus
* m. arytenoideus obliquus
* m. vocalis
46
_m. circothyroideus_ (pars recta + pars obliqua)
* ORIGIN: cricoid cart.
* INSERTION: cornus inf. of thyroid cart.
* ACTION: **most important tensor of vocal cords** → pitch
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**
48
_m. cricoarytenoideus lateralis_ (lateralis)
* ORIGIN: arch of cricoid cart.
* INSERTION: proc. muscularis of arytenoid cart. on same side
* ACTION: **closure of pars intermembranacea**
49
_m. (inter)arytenoideus transversus_
* ORIGIN: post. surface of arytenoid cart.
* INSERTION: same spot on 2nd arytenoid cart.
* FUNCTION: **closure of pars intercartilaginea**
50
_m. arytenoideus obliquus_
* ORIGIN: proc. muscularis of arytenoid cart.
* INSERTION: apex of 2nd arytenoid cart.
* ACTION: **closure of pars intercartilaginea**
51
+ all parts
_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
52
Which nn. are responsible for sensory and motor innervation of the larynx?
_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
53
Why is the innervation of the larynx clinically important?
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
54
Which vessels supply, drain the larynx, resp.?
_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
55
How long is the trachea?
Where does it start, where does it end?
What are its 2 parts?
* 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**
56
How do you call the structure btw the cartilagines tracheales?
How do you call the non-cartilaginous part?
**ligg. annularia**
**paries membranaceus**
57
What is important mention abt the tracheal bifurcation?
Clinical relevance?
* 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**
58
Which vessels supply, drain the trachea, resp.?
Which nerves are responsible for the innervation?
_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
59
What might be the effect of a goiter (swelling of thyroid gland)?
= struma
→ can cause compression of trachea → suffocation (= **asphyxia**)
60
What happens in case of smoking to the cilia in the trachea?
* transition from resp. epithelium to str. squamous epithelium (= **squamous metaplasia**)
* adherence + immobility of cilia → removal of pollutants impaired (= impairance of **mucociliar clearance**)
61
What is the shape of the lung?
Volume?
Surface area?
* half cone shape
* total volume 2 - 3l, after max. inhalation 5 - 8l
* *left: 10 - 20 % less**
* total surface area: 70 - 140 m2
62
#1 - 5
1) impression for a. subclavia dex.
2) impression for esophageus
3) impression for v. azygos + IVC
4) fissura obliqua
5) fissura horizontalis
63
#6 - 10
6) impression for a. subclavia sin.
7) impression for aorta / arcus aorticus
8) impressio cardiaca
9) lingula pulmonis sinistri
10) vv. pulmonales
64
#11 - 17
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
65
Which impressions can you find on which lung?
_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
66
How do you call the 3 surfaces of the lung?
* facies costalis (= biggest)
* facies mediastinalis
* facies diaphragmatica
67
In which position are the bronchi of the right and left lung?
* right main bronchus in **eparterial** position
= sup. to a. pulmonalis
* left main bronchus in **hyparterial** position
= inf. to a. pulmonalis
68
How do you call all vessels + nn. in the hilum?
radix pulmonis
69
What can possible cause a pneumothorax?
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
70
Explain the segmentation of the lungs.
_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:_ 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)
- right hand: 3 fingers (1st) + 2 fingers (2nd) = 5 fingers (3rd)
- left: 9 (total) - right hand (1st) = 4 (2nd)
71
Explain the structure of a lung lobules
= 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)
72
Why is the segmentation of the lung clinically important?
* **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
73
Which vessels supply, drain the lungs, resp.?
Which nerves are responsible for the innervation?
What is the action of sympathetic and parasympathetic innervation?
_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
74
Differentiate btw nutritive vessels of the lung
* **vasa publica:** pulmonary circulation → reoxygenate blood
* **vasa privata:** systemic circulation → supply/drain lung
75
Explain the structure of the pleura.
How do you call the upper apex?
* 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**
76
Which recessus are formed by the pleura?
What is their function?
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
77
Which vessels supply, drain the pleura?
Innervated by.. ?
Clinical relevance?
_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!)
78
Compare the surface projections of lungs and pleura.
exc. at sternal line pleural borders = lung borders + 1
Anatomy II
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