Lesson No 5

I.Horbachevsky Ternopil State Medical University







Methodical instruction for 1st year students

International Nursing School



Ternopil 2013


Lesson No 13

Theme: Nasal cavity, larynx. Trachea, bronchi, lungs

Aim: To learn a structure, topography and larynx function. To learn to find, name and show the cartilages, muscles, joints and parts of larynx. During phylogenesis a diffusive breathing transforms by skin breathing and later - by branchiate breathing, and finally - by pulmonary breathing. Dirtying of outer environment and smoking affects badly to pulmonary breathing. That's why physical training, hygiene of work and housing workplaces have a considerable role in diseases prophylaxy of respiratory system (sharp respirator infections, sharp and chronic bronchitises, bronchial asthma, asthmatic status). Lungs open for influence of external environment, and so the respirator diseases are a serious problem for society.

To study structure, topography and function of pleura and its sheets. To study anatomy of medіastіnum and morphological-functional links between medіastіnum organs.

The professional orientation.

A physician have to know the structure and cooperation different larynx elements during breathing and forming of voice and sounds. Different factors of external and internal environment (infection, smoke, dust, surplus voice rise can entail the various larynx diseases (as sharp, so and chronic). That needs specific cure and (in many cases) immediate medical intervention. That's why such important there are knowledges of larynx anatomy.

Disease of lungs (tuberculosis, pneumonia, tumour), and also cardiac insufficiency, liver cirrhosis, pancriatitis, the rheumatic diseases and oth. can be causes of pleura lesion, which have a name pleurisy. Knowledge of the lungs and pleura topography in norm helps to determine diseases, which change the auscultation and percussion pictures. There are very actually for practical doctor.

There are many vitally importance organs in medіastіnum (heart, grate vessels, nerves, lymphatic nodes, trachea and bronchus, esophagus). These organs are nearly one to other, thus the illness of one organs provocative the illness of other. That is why knowledge of topography and interrelation between organs is important for practical.

Base level of knowledge and skіlls

1.     Latіn termіnology.

2.     Skeleton of thoracic cage and abdominal cavity.

3.     Muscular walls of the abdominal cavity.

4.     Digestive organs of neck, thoracic and abdominal cavities

I. Practical studies - 12:30 am – 14:00 pm (2 hour)

Іllustratіve materіal

1.     Skeleton of thorax and abdominal cavity.

2.     Muscles of the abdominal cavity.

3.     Corpse wіth opened abdominal cavity.

4.     Corpse wіth dissected thoracic cavity.

5.     Radiographs and MRI of thoracic and abdominal organs.

6.     Sagittal section of head and larynx.

7.     Preparations of larynx, and trachea.

Methods of practical work.

Work 1. Draw schematically a positions of vocal ligaments in different functional conditions.

Work 2. Draw schematically a elastic cone of larynx.

Work 3. Dissect and open back larynx wall.

Work 4. Draw schematically ramification of bronchial tree and structural-functional lung unit.

Work 2. Find the respiratory organs and their elements on corpse and wet preparations.

Work 3. Dissect lung gates.

Work 4. To draw schematically the lungs and pleura borders.

Work 5. Dissect the pleural cavity on corpse.

          Work 6. Dissect the mediastinum.

·   Practical skills and abilities of students, demonstrate on preparations:

1.     The cartilage of Larynx

2.     Ligaments of the larynx

3.     Elastic cone, Quadrangular membrane

4.     The laryngeal Muscles Constrictors of the glottis and dilators of the glottis

5.     Laryngeal cavity (aditus laryngis, vestibule, interventricular space, glottis and infraglottic cavity).

6.     Vocal folds and glottis


8.     Base and apex; costal surface, diaphragmatic surface, interlobar surface and medial surface of the lungs

9.     Anterior margin and inferior margin, pulmonal hilus

10. Lobes of lungs

11. Pleural cavity

12. Diaphragmaticоmediastinal recess, vertebrоmediastinal recess and costomediastinal recesses.

13. Superior mediastinum and inferior mediastinum.

14. Anterior mediastinum, middle mediastinum, posterior mediastinum

15. Boundaries of lungs and pleurae

16. Inferior boundary path of right lung is situated 1-2 cm above from inferior border of suitable pleura and passes

§        on medioclavicular line - at level of the VI ribs,

§        on anterior axillar line - on level of the VII ribs,

§        on middle axillar line - on level of the VIII ribs,

§        on posterior axillar line - on level of the IX ribs,

§        on scapular line - on level of the Х ribs,

§        on paravertebral line - on level of the XI heads of rib.

II. Seminar discussion of practical work 12:30 am – 14:00 pm (2 hour)

Questions for discussion:

Describe the skeletotopy of the Larynx:

a.      base of skull - C6 vertebrae

b.     base of skull - C4 vertebrae

c.     C4 - C6 vertebrae

d.     C2 - C6 vertebrae

e.      C4 - C7 vertebrae

Which muscles constrict the glottis:

a. thyro-arytenoid muscle

b. posterior cricoid-arytenoid muscle

c. lateral cricoidarytenoid muscle

d. crico-thyroid muscle

e. vocal muscle

Which parts do not situated in Larynx ?

f. Aditus

g. Fauces

h. Vestibule

i. Ventricle

k.        Glottis

·   Discussion of theoretical questions:

List of questions:

1.     What are the functions of larynx?

2.     Describe larynx topography (holotopy, skeletotopy and syntopy).

3.     Enumerate and describe a structure of unpaired larynx cartilages.

4.     Enumerate and describe a structure of pair larynx cartilages.

5.     Name larynx ligaments.

6.     What larynx muscles classification do you know?

7.     What muscles constrict the glottis?

8.     What muscles dilate the glottis?

9.     What muscle tenses a vocal ligament?

10. What muscle relaxes a vocal ligament?

11. What larynx joints do you know?

12. Name the departments of the larynx.

13. What limits an entrance into larynx?

14. What limits a larynx vestibule?

15. What limits a larynx ventricle?

16. Describe the topography of infraglottic cavity?

17. Where is a quadrangular membrane found?

18. Where is an elastic cone found?

19. What is a true vocal ligament?

20. What is a false vocal ligament?

21. Where is the glottis (vocal slit)?

22. What is between the vestibule slits?

23. Name the process of arytenoid cartilage.

24. Where is the narrowest place of larynx?

25. Describe trachea topography (holotopy, skeletotopy and syntopy).

26. On what level does trachea divide into two main bronchi?

27. What long is the trachea?

28. What name is a back trachea wall?

29. Name the trachea parts.

30. What is a tracheal carina?

31. What is trachea wall structure?

32. What are the communications between the neighbouring trachea cartilages?

33. What adjoins to trachea behind?

34. In which mediastinum does trachea pass?

35. On what level does main bronchus go from trachea?

36. How name is the place where is the trachea divided into two bronchial tubes?

37. How many cartilage rings does trachea have?

38. What different are between right and left main bronchus?

39. In which mediastinum are main bronchus found?

40. Describe lungs topography (holotopy, skeletotopy and syntopy).

41. What lung surfaces do you know?

42. What lung margins do you know?

43. What parts does lung have?

44. How many lobes do left and right lungs have?

45. What fissures do left and right lungs have?

46. What departments does medial lung surface have?

47. What are disposed on front margin of left lungs?

48. What and where are the lung’s gates?

49. Where is a lung’s root. Describe theirs topography.

50. What differences are between right and left lung’s root elements.

51. What is the structurally-functional lung unit.

52. What formed acinus?

53. Describe alveolar tree.

54. Describe a bronchial tree.

55. What is a lung segment?

56. How many segments are in right and left lungs and in each lobes of lung ?

57. Give determination of pleura.

58. From what sheets does pleura have?

59. Name parietal pleura part.

60. What do the costal and mediastinal pleurae formed by theirs up parts?

61. Where is a pleural cavity?

62. What pleura sinuses do you know?

63. What do the pleura sinuses contain?

64. What is the practical sense of pleural sinuses?

65. Describe the top lung and pleura boundaries.

66. Describe the front lung and pleura boundaries.

67. Describe the back lung and pleura boundaries.

68. Describe the lower lung and pleura boundaries on left side.

69. Describe the lower lung and pleura boundaries on right side.

70. Where is a top interpleural field (thymus field)?

71. Where is a lower interpleural field (pericardial field)?

72. In which intercostals space and on which line do they puncture of pleural cavity?


ІІІ. Тest control, independent students work  – 14:15 – 15:00




1.      Author David Shier, Jackie Butler, Ricki Lewis Number Of Pages 640 pages Format Hardcover Publication Date 2011-01-11 Language English PublisherMcGraw-Hill Higher Education

2.      Synopses of Human Anatomy and Physiology.

Author:           Elaine N. Marieb, Katja N. Hoehn Anatomy, Physiology    Edition Description: Revised Special Attributes:     International Edition, Brand New, College Textbook, Publication Year:   2011

3.      Human Anatomy & Physiology (9th Edition) [Hardcover]

Elaine N. Marieb (Author), Katja N Hoehn (Author), Publication Date: January 16, 2012

4.      Hole’s essentials of human anatomy and physiology. - 7th edition / David Shier, Jackie, Ricki Lewis. McGraw-Hill Companies, 2000.

5.      Human Anatomy and Physiology, 6th edition / Elaine Marieb Seeley, Stephens, and Tate. Anatomy and Physiology, 5th edition, McGraw-Hill Publishing, 2000.

6.      Functional Human Anatomy / Edition 1, by David T. Lindsay, Carol D. Rodgers, Jaci Vanheest, 1996 or newest edition

7.      Synopsis of Human Anatomy And Physiology / Kent M. Van De Graaff  , Stuart Ira Fox , Karen M. Lafleur // Mcgraw-Hill College (December 10, 1996)


Optional Textbook Supplements:

Miller-Keane. Encyclopedia and Dictionary of Medicine, Nursing, & Allied Health, 6th edition, W. B. Saunders Company, 1997. Accompanying CD Rom is REQUIRED.


The instruction was discussed and confirmed

 at the department meeting


Protocol number 11


Oddsei - What are the odds of anything.