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Neuro Exam 1 > Larynx and Pharynx > Flashcards

Larynx and Pharynx Flashcards

1
Q

The pharynx is located posterior to the nasal cavity, mouth, and larynx. It extends from the ______ ______ to the level of cervical vertebra ____

A

Pharyngeal tubercle; 6

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2
Q

3 phases of deglutition (swallowing)

A

Oral
Oropharyngeal
Pharyngo-esophageal

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3
Q

Oral phase of deglutition

A

Mastication

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4
Q

Oropharyngeal phase of deglutition

A

Elevation of the floor of the mouth and tongue in order to push the bolus into the oropharynx

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5
Q

Pharyngoesophageal phase of deglutition

A

Oropharynx elevates and constricts around the bolus, propelling it down the esophagus

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6
Q

What reflex initially begins as a series of expiratory cough triggered by a noxious stimulus to the supraglottic laryngeal mucosa?

A

Airway protective cough reflex

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7
Q

T/F: laryngeal displacement throughout human development corresponds to high incidence of SIDS around 2-4 months of age

A

False; there is not a significant increase in the rate of laryngeal displacement around the 2-4 month age, laryngeal descent did not coincide with the epidemiological reports of the peak age of SIDS

Studies suggested that the development of the laryngeal cough reflex and its role in neurological airway protection may be more involved

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8
Q

3 divisions of the pharynx

A

Nasopharynx
Oropharynx
Laryngopharynx

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9
Q

The nasopharynx communicates with the nasal cavity via the _______, the middle ear cavity via the auditory tube, and the oropharynx via the _____ _______

A

Choanae; pharyngeal isthmus

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10
Q

3 primary structures located on the lateral wall of the nasopharynx

A

Torus tubarius

Pharyngeal opening of eustachian tube

Pharyngeal tonsil

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11
Q

The oropharynx communicates with the nasopharynx via the pharyngeal isthmus, the oral cavity via the ____ ____, and the laryngopharynx at the level of the ____ bone

A

Faucial isthmus; hyoid

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12
Q

What are the 2 primary structures on the lateral wall of the oropharynx?

A

Palatoglossal fold

Palatine tonsil

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13
Q

Almost 1/3 of congenital neck masses are remnants of branchial clefts or _____ ______

Although the prevalence varies from childhood to adults, these cysts, sinuses, or fistulae are usually related to second cleft/pouch malformation and may be distributed along the anterior border of the ______ muscle

A

Pharyngeal pouches

SCM

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14
Q

The laryngopharynx is located posterior to the larynx. It communicates with the oropharynx at the level of the hyoid; larynx via the laryngeal ______, and esophagus at the level of ____

A

Aditus; C6

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15
Q

The _____ _____ are situated posterior and lateral to the arytenoid cartilages in the laryngopharynx. The epithelium in this area is innervated by the _____ _____ n. and supplied by the superior laryngeal artery

A

Piriform recesses; internal laryngeal n.

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16
Q

Major pharyngeal mm.

A

Stylopharyngeus m.

Superior constrictor
Middle constrictor
Inferior constrictor

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17
Q

The stylopharyngeus m. arises from the styloid process and inserts on the pharyngeal wall between the superior and middle constrictors. What is the action and innervation of this m.?

A

Action: elevates pharynx during deglutition

Glossopharyngeal n. (NOTE this is the ONLY muscle innervated by the glossopharyngeal n.)

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18
Q

The horizontal fibers of the inferior constrictor m. of the pharynx comprise what muscle?

A

Cricopharyngeus m. — used during pharyngeal speech

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19
Q

Zenker’s diverticulae are frequently located at the junction of what 2 groups of musculature?

A

Cricopharyngeus and esophageal musculature

This junction is devoid of a muscular layer

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20
Q

Most esophageal diverticula result from what?

A

Abnormal luminal pressure due to a stricture, esophageal spasm, or abnormal lower esophageal sphincter functions

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21
Q

_______ fascia covers the posterior surface of the buccinator m. and the pharynx; and it forms the anterior fascial wall of the ________ space. It attaches to the pharyngeal tubercle, pterygomandibular raphe, hyoid, and the thyroid and cricoid cartilages. The _______ plexus is also embedded in the portion of the fascia covering the middle constrictor

A

Buccopharyngeal; retropharyngeal; pharyngeal

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22
Q

What named space is between the buccopharyngeal fascia and prevertebral fascia, continuous from the base of the skull to the mediastinum?

A

Retropharyngeal space

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23
Q

What is the clinical importance of the retropharyngeal space in terms of infection and surgical fusion?

A

Infections can spread from either the skull or mediastinum via the retropharyngeal space

In surgical fusion of the cervical vertebrae, the anterior bodies of the cervical vertebrae are approached via the retropharyngeal space

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24
Q

The pharynx is supplied from branches of what 2 arteries?

A

Ascending pharyngeal a.

Inferior thyroid a.

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25
Q

The pharynx is innervated by the ____ ____, which is embedded in the buccopharyngeal fascia

A

Pharyngeal plexus

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26
Q

The pharyngeal plexus receives sensory (GVA) info from the pharyngeal branch of the _____ n. and motor (SVE) fibers from the pharyngeal branch of the _______ n.

A

Glossopharyngeal; vagus

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27
Q

The GVA fibers of the pharyngeal plexus (those from the glossopharyngeal n.) contribute the afferent info for the _____ reflex

A

Gag

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28
Q

The SVE motor fibers to the pharynx and larynx originate in the _____ ______ (cranial portion of the accessory nucleus). These fibers exit the brainstem with the ____ ____ n. and at the level of the jugular foramen, join the _______ n.

A

Nucleus ambiguus; spinal accessory; vagus

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29
Q

The pharyngeal branches of the vagus n. supply motor fibers to the _____ _____, which innervates all the pharyngeal muscles except the stylopharyngeus

A

Pharyngeal plexus

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30
Q

Pharyngeal branches of the ______ n. convey the sensory (afferent) component of the gag reflex

Pharyngeal branches of the _____ n. mediate the motor (efferent) component of the gag reflex

A

Glossopharyngeal

Vagus

[in by IX, out by X]

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31
Q

The glossopharyngeal n. Passes through the interval formed by the ______ and the middle and superior constrictor mm., enters the base of the tongue, and supplies GVA and SVA fibers to the posterior _____ of the tongue, and sends a pharyngeal branch to the pharyngeal mucosa (GVA)

A

Styloglossus

1/3

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32
Q

3 branches of CN IX

A

Pharyngeal n. to pharyngeal plexus

Sensory (GVA) to mucosa of post 1/3 tongue and pharynx and sensory SVA to taste buds of post 1/3 tongue

Motor (SVE) to stylopharyngeus muscle

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33
Q

The _______ _____ slightly dilate if the patient says “a-a-a” in a low voice. Secretions may gather here, but they should disappear when swallowing. If they do not, the patient has “_____” sign, which suggests obstruction or paralysis of upper esophagus

A

Piriform recesses; pooling

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34
Q

What cartilage forms the laryngeal prominence?

A

Thyroid cartilage

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35
Q

The superior horn of the thyroid laminae (laryngeal prominence) is continuous with the _____ bone via the ______ ligament

A

Hyoid; thyrohyoid

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36
Q

The inferior horn of the thyroid laminae articulates with the ____ cartilage via the ______ joint

A

Cricoid; cricothryoid

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37
Q

T/F: after age 30, portions of the thyroid cartilage may show areas of ossification on Xray

A

True

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38
Q

General location (vertebral level) of cricoid cartilage

A

C6

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39
Q

Cricoid cartilage has “signet ring” configuration and has what 2 principle components?

A

Cricoid lamina

Cricoid arch

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40
Q

The cricoid lamina is located on the posterior aspect of the larynx, and is approximately 2-3 cm long in its vertical dimension. It articulates with the _____ cartilages. The _____ arch forms the main supporting element of the laryngeal airway

A

Arytenoid; cricoid

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41
Q

The 2 arytenoid cartilages are perched on the superior edge of the cricoid cartilage. The apex of the arytenoid cartilage articulates with the _____ cartilage

The vocal process is attached to the vocal ligament of the vocal fold. The muscular process is attached to the posterior and lateral ________

A

Corniculate

Cricoarytenoids

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42
Q

The _____ cartilages form the posterior attachment of the vocal ligaments. They are highly moile in both rotational and transverse directions. During phonation, they rotate along a vertical axis to control the tension on the vocal folds.

During respiration, they slide laterally to open the ____ ____. The aryepiglottic folds, vestibular folds, and the vocal folds are the sphincters of the larynx that protect the lower respiratory passages from foreign bodies, and help build intrathoracic pressure for coughing and other functions

A

Arytenoid

Rima glottidis

43
Q

The _____ cartilages are small rod-shaped cartilages that articulate with the apex of the arytenoid cartilages. The ______ cartilages are long rod-shaped cartilages which are embedded in the aryepiglottic folds and quadrangular membranes. These cartilages add structural support to the membranous wall

A

Corniculate; cuneiform

44
Q

The _____ is a spoon-shaped elastic cartilage located posterior to the tongue and anterior to the laryngeal aditus. It is directly connected to the tongue via _______ folds and the hyoid bone via the _____ ligament

A

Epiglottis; glossoepiglottic; hyoepiglottic

45
Q

What ligament attaches to the apex of the epiglottis to the inner surface of the thyroid cartilage?

A

Thyroepiglottic ligament

46
Q

What ligament attaches the epiglottis to the hyoid?

A

Hyoepiglottic ligament

47
Q

During deglutition, the tongue moves backwards in the mouth and pushes the ______ posteriorly to cover the laryngeal aditus. The bolus of food/fluid cascades over the lateral edges of this structure, flowing through the _____ recess, the mucosal “gutters” adjacent to the larynx in the laryngopharynx

A

Epiglottis; piriform

48
Q

The ____ ____ are cup-shaped recesses between the tongue and epiglottis

They are separated from each other by the ___ ____ ____ and bounded laterally by _____ _____ ____

A

Valleculae epiglottica

Median glossoepiglottic; lateral glossoepiglottic folds

49
Q

During intubation of a patient, the blade is often placed in the ____ _____. As the end of the blade is moved forward, so is the tongue and epiglottis. This movement opens the laryngeal aditus. To examine these structures more distinctly, the examiner asks the patient to phonate

A

Valleculae epiglottica

50
Q

T/F: large veins are frequently seen in the valleculae epiglottica; these are normal

A

True

51
Q

A fracture of the laryngeal skeleton may result from blows received during boxing, karate, or compression by a shoulder strap during an automobile accident. These fractures may lead to what complications?

A

Submucosal hemorrhage

Edema

Respiratory obstruction

Hoarseness

Dysarthria

52
Q

The ______ joint is a circular hinge type that functions during increases in pitch. The _________ n. courses posterior to this joint.

The _______ joint is a combination sliding and rotatory type of joint associated with the larynx

A

Cricothyroid; recurrent laryngeal n.

Cricoarytenoid

53
Q

The ______ membrane extend between the thyroid cartilage and the hyoid bone. It is pierced by the _______ a. and ________ n.

A

Thyrohyoid; superior laryngeal; internal laryngeal

54
Q

The _________ and __________ extend from arytenoid to the epiglottic cartilages. The cartilages are embedded in these membranous structures. The conus elasticus (cricovocal) extends from the vocal ligament to the first tracheal ring. It forms the dome of the infraglottic region

A

Aryepiglottic fold; quadrangular membrane

55
Q

The _____ ligament extends from the vocal process of the arytenoid cartilage to the inner surface of the thyroid cartilage just above the inferior thyroid notch

The _____ _____ ligament is located on the anterior side of the larynx between the cricoid and thyroid cartilages

A

Vocal ligament

Median cricothyroid ligament

56
Q

What ligament is cut during an emergency cricothyrotomy

A

Median cricothyroid ligament

57
Q

The muscle serves as the ONLY abductor of the vocal cords?

A

Posterior cricoarytenoid m.

58
Q

What muscle is located at the cricoid lamina to the muscular process of the arytenoid?

A

Posterior cricoarytenoid m.

59
Q

What muscle is on the anterior exterior surfaces of the cricoid and thyroid cartilages and when it contracts it increases the tension on the vocal cords?

A

Cricothyroid m.

60
Q

What innervates the cricothyroid m

A

External laryngeal n. of the vagus

61
Q

How can the cricothyroid m. function be tested?

A

Have the patient say “e-e-e” in a high-pitched voice. Under these conditions, the examiner can palpate the decrease in width of the cricothyroid membrane

62
Q

What muscle is located from the cricoid arch to the muscular process of the arytenoid?

A

Lateral cricoarytenoid m.

63
Q

Action of lateral cricoarytenoid m.

A

Adducts the vocal cords

64
Q

What muscle is found between the arytenoid cartilages?

A

Arytenoideus

65
Q

The arytenoideus makes up the _____ sphincter

A

Laryngeal

66
Q

The _____ muscle is located lateral and parallel to the vocal ligaments

A

Thyroarytenoid

67
Q

The thyroarytenoid m. is subdivided into what 2 muscles?

A

Vocalis m. (Medial)

Thyroepiglottic m.

68
Q

What muscle extends superior and anterioly from the inner surface of the thyroid cartilage to the epiglottis and quadrangular membrane, serving as an important sphincter of the laryngeal aditus?

A

Thyroepiglottic m.

69
Q

The ______ m. lies immediately adjacent and parallel to the vocal ligament. When it contracts, it decreases the tension on the vocal ligament

A

Vocalis m.

70
Q

The action of the vocalis m. is opposed by what m.?

A

Cricothyroid m.

71
Q

T/F: the cricothyroid m. increases vocal fold tension by tilting the thyroid cartilage forward

A

True

72
Q

What muscle(s) serve as abductor(s) in the larynx?

A

Posterior cricoarytenoid only

73
Q

What muscle(s) serve as adductor(s) in the larynx?

A

Lateral cricoarytenoid m.

Arytenoideus m.

74
Q

What muscles alter the tension on the vocal cords?

A

Cricothyroid - increases tension

Vocalis - decreases tension

75
Q

The vagus n. exits the ______ foramen and gives of the pharyngeal branch (motor to the pharyngeal muscles except the _________), and superior laryngeal nerve. Just posterior to the _____ artery, the superior laryngeal n. bifurcates into internal and external branches

A

Jugular; stylopharyngeus; internal carotid a.

76
Q

The internal branch of what nerve pierces the thyrohyoid membrane along with the superior laryngeal a.?

A

Internal branch of superior laryngeal n. (ibSLN)

77
Q

What is the chief sensory nerve to the interior of the larynx?

A

The internal branch of the superior laryngeal n. (ibSLN)

As such, it supplies GVA sensory fibers to the interior of the larynx, and it is involved in the cough reflex. It also supplies parasympathetic fibers (GVE) to the saccule glands of the larynx such as the saccule

78
Q

The laryngeal receptors and afferent fibers of the internal branch of the superior laryngeal n. represent the afferent component of what reflex?

A

Laryngeal expiratory reflex (LER)

[if the ibSLN is not functional during the initiation of the protective cough reflex, the protective value of the LER is compromised, and there is an increased risk of developing aspiration pneumonia in neurologically impaired patients]

79
Q

What nerve innervates the cricothryoid m.?

A

External branch of superior laryngeal n.

80
Q

After the _____ ______ n. crosses the cricothyroid joint and enters the larynx, it is called the inferior laryngeal n. It conveys SVE fibers to the laryngeal mm., except the _______ m. These fibers originate from the nucleus ______

A

Recurrent laryngeal; cricothyroid; nucleus ambiguus

81
Q

Lesions or paralysis of recurrent laryngeal n. may lead to what effects?

A

Hoarseness
Dysphagia

May also be coughing or choking d/t collapse of aryepiglottic fold and subsequent drainage of fluids into larynx

82
Q

What are the 2 major vessels supplying the larynx?

A

Superior and inferior laryngeal aa.

83
Q

The superior laryngeal a. is a branch of the ______ a.

The inferior laryngeal a. is a branch of the ________ a.

A

Superior thyroid

Inferior thyroid

84
Q

The superior and inferior laryngeal veins drain the larynx.

The superior laryngeal v. drains into the ______v.

The inferior laryngeal v. drains into the _______ v.

A

Superior laryngeal

Inferior laryngeal

85
Q

The _______ nerve, originating from the superior laryngeal n., is the chief sensory nerve to the interior of the larynx and piriform recess

A

Internal laryngeal n.

86
Q

The _______ a, originating from the superior thyroid a., distributes to the interior of the larynx

A

Superior laryngeal

87
Q

The ______ n., originating from the superior laryngeal n., innervates the cricothyroid m.

A

External laryngeal

88
Q

The ________ a, originating from the external carotid a., supplies the lobes of the thyroid gland

A

Superior thyroid

89
Q

The _______ a., originating from the inferior thyroid a., supplies the thyroid gland and parathyroids

A

Inferior laryngeal a.

90
Q

The larynx primarily drains into what general group of lymph nodes?

A

Deep cervical nodes

91
Q

The superior half of the larynx drains into the _______ and superior deep cervical nodes

The inferior half of the larynx drains into the _____, _____, and ______ LNs

A

Infrahyoid

Prelaryngeal, pretracheal, paratracheal

92
Q

The ______ LNs, located on the midline of the thyrohyoid membrane, become enlarged with thyroid carcinoma and subacute thyroiditis

A

Delphian

93
Q

The 3 regions of the interior larynx are demarcated by the vestibular and vocal folds. What are these 3 regions?

A

Vestibule

Ventricle

Infraglottic regions

94
Q

_______is a triangular shaped opening between the laryngopharynx and larynx. During deglutition, it collapses inward and is covered by the epiglottis

A

Laryngeal aditus

95
Q

Define the vestibule of the larynx

A

Cavity located between the laryngeal aditus (opening) and the vestibular folds — it is continuous with the laryngopharynx superiorly and the ventricle inferiorly

96
Q

The ____ ____, or false vocal cords, lie directly above and slightly lateral to the true vocal folds

Although they do not normally produce sound, they can act as laryngeal sphincters. Ordinarily they appear dull pink in color and thicker than the vocal cords. _____ _____ is the elliptical shaped opening formed by the free edge of the vestibular folds

A

Vestibular folds

Rima vestibularis

97
Q

During laryngoscopy, the vocal folds reflect light and therefore appear white and sharp-edged — however, their color is not white and the edges are rounded

Anteriorly the cords meet at the midline where they are attached to the ____ cartilage. This area is difficult to see by indirect laryngoscopy. Posteriorly, they are attached to the vocal processes of the _______ cartilages. The anterior attachment is fixed, but the posterior attachment is mobile and allows the cords to open and close during respiration and phonation

A

Thyroid; arytenoid

98
Q

The _____ is a slit-like cavity located between the vestibular and vocal folds. It is continuous with the larynx superiorly and inferiorly, and the saccule drains into it laterally. Some of the ventricle can be seen during indirect laryngoscopy by having the patient tilt his or her head sideways

A

Ventricle

99
Q

The ______ is a mucous secreting gland located superolateral to the ventricle; it drains into the ventricle and onto the vocal cords. Dilations of the this structure (laryngocele) may occur due to prolonged periods of intralaryngeal pressure; this condition may occur in musicians (horns) and singers and is generally non-pathological

A

Saccule

100
Q

What are the superior and inferior boundaries of the infraglottic region? What forms the walls?

A

Extends from the vocal folds to the first tracheal ring

Its walls are formed by the conus elasticus (cricovocal membrane)

101
Q

What happens if one of the vocal folds is paralyzed?

A

It remains fixed while the other moves in and out. In elderly patients, the vocal folds frequently do not completely adduct during phonation

102
Q

Tumors of the vocal folds result in hoarseness, or _______, which can be detecte early. Therefore, they have a more favorable dx and prognosis. Mucous on the vocal folds can be confused with tumors. However, coughing will remove the mucous

A

Dysphonia

103
Q

Describe potential effects of inhalation of sharp foreign bodies

A

Results in choking, sharp pain, and progressive obstruction to breathing d/t inflammation of the larynx and edema of the glottis

Edema does not extend inferior to the vocal folds. The vocal folds are extremely sensitive and contact with a foreign body produces immediate explosive coughing

Aspiration of a foreign object such as food into the larynx causes the laryngeal mm. to spasm and closes the rima glottidis. The airway is thereby completely blocked until the object is directly or indirectly removed, or bypassed by cricothyrotomy

Neuro Exam 1 (17 decks)

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