A33 - Larynx

Question 1

where is the larynx enclosed?

Answer 1

visceral layer of the pre tracheal fascia

Question 2

what lies anterior to the visceral layer?

Answer 2

muscular layer

Question 3

what is the location of the larynx?

Answer 3

Found anterior to the laryngopharynx

Between the carotid sheath structures

Between C4-C6 vertebral levels

Question 4

what is the borders laryngopharynx?

Answer 4

region of the pharynx from the epiglottis to the oesophagus

Question 5

what is the most important part of the Upper Respiratory Tract?

Answer 5

larynx

Question 6

where does the larynx communicate?

Answer 6

oropharynx and nasopharynx above via the oral and nasal cavity and the trachea below

Question 7

at vertebral level C6 what happens to the larynx?

Answer 7

becomes the trachea

Question 8

at vertebral level C6 what happens to the pharynx?

Answer 8

becomes the oesophagus

Question 9

what does patent mean?

Answer 9

keep the respiratory tract open

Question 10

what is the skeleton of the larynx composed of?

Answer 10

cartilages suspended from the hyoid bone

Question 11

what is the functions of the larynx?

Answer 11

• maintaining patency of URT
• help prevent entry of foreign bodies into LRT
• produce sound

Question 12

how is the thyroid cartilage connected to the hyoid bone?

Answer 12

thyrohyoid membrane

Question 13

how many types of cartilage is there in total in larynx?

Answer 13

9 in total

• 3 pairs (6)
• 3 individual

Question 14

what is an important feature of the cricoid cartilage?

Answer 14

in a cross section all cartilages are C shaped whereas this is completely enclosed - D shaped

Question 15

what type of cartilage is the larynx made of? and what is the exception to this rule?

Answer 15

hyaline

- epiglottis which is elastic

Question 16

what is located between the arch of the cricoid cartilage and the thyroid cartilage?

Answer 16

cricothyroid membrane

Question 17

what is the clinical importance for the cricothyroid membrane ?

Answer 17

access point for a cricothyroid puncture to gain access to airways

Question 18

what is the “c –shaped” anterior rings of hyaline cartilage maintain patency?

Answer 18

tracheas

Question 19

what smooth msucle completes the posterior wall of the trachea?

Answer 19

trachealis

Question 20

what are the two horns of the thyroid cartilage?

Answer 20

superior and inferior

Question 21

what is the anterior prominence on the thyroid cartilage?

Answer 21

laryngeal prominence

Question 22

the cricid cartilage becomes broader and thicker at the back to form what?

Answer 22

lamina of cricoid

Question 23

what is the synovial joint between the thyroid and cricoid cartilage?

Answer 23

cricothyroid joint

Question 24

what is the movement of the cricothyroid joint ?

Answer 24

nodding movement

Question 25

what is the way into the larynx?

Answer 25

laryngeal inlet

Question 26

what are the paired cartilages superior to the lamina of the cricoid cartilage?

Answer 26

arytenoid cartilages

Question 27

what is the separate point on the arytenoid cartilage?

Answer 27

corniculate cartilages

Question 28

where do the vocal cords attach?

Answer 28

thyroid cartilage | vocal processes of arytenoid cartilages

Question 29

what are the two vocal processes on the arytenoid cartilage?

Answer 29

``` muscular process (posterior) vocal process (lateral) ```

Question 30

what attaches to the vocal processes?

Answer 30

vocal cords

Question 31

what attaches to the muscular processes?

Answer 31

muscles that move the vocal cords

Question 32

where to the vocal cords attach to the thyroid cartilage?

Answer 32

anteriorly to the internal aspect of the thyroid cartilage

Question 33

what is the thickened elastic tissue between arytenoid and thyroid cartilage?

Answer 33

vocal cord/ligament

Question 34

where are the cuneiform & corniculate cartilages are located?

Answer 34

deep to the laryngeal mucosa

Question 35

what is the role of the cuneiform & corniculate cartilages?

Answer 35

support the laryngeal inlet but play no part in moving the vocal cords

Question 36

what mucosa lines the larynx?

Answer 36

respiratory epithelium

Question 37

what is the mucosa of the vocal cords?

Answer 37

stratified squamous epithelium

Question 38

what secretes mucous onto epithelial surfaces?

Answer 38

mucous glands

Question 39

what is the mucociliary escalator?

Answer 39

cilia beat to sweep the mucous superiorly, towards the pharynx, to be swallowed

Question 40

wha divides internal larynx?

Answer 40

vocal cords

Question 41

what are the false vocal folds?

Answer 41

superior vestibular folds

Question 42

what are the true vocal cords?

Answer 42

inderior vocal folds

Question 43

what is the difference between vocal folds and vocal cords?

Answer 43

vocal folds are covered in mucosa vocal cords are not

Question 44

what is the space between the vocal cords?

Answer 44

rima glottidis

Question 45

what is the motor and sensory innervation supply of all laryngeal muscles?

Answer 45

CN X

Question 46

what branch of CNX supplies superior to vocal fold?

Answer 46

internal laryngeal branches of superior laryngeal branch of CN X

Question 47

what branch of CNX supplies inferiro to vocal fold?

Answer 47

inferior recurrent laryngeal branches of CN X

Question 48

what is the pathway of the vagus nerve to supply the larynx?

Answer 48

1. the vagus nerve passes through the jugular foramen 2. the vagus nerve descends through the neck within the carotid sheath 3. inferior laryngeal nerve (continuation of recurrent laryngeal) 4. recurrent laryngeal nerve (branches off CN X in the mediastinum

Question 49

where are the extrinsic muscles originate?

Answer 49

outwith larynx

Question 50

what is the role larynx?

Answer 50

move the whole hyoid

Question 51

what are the extrinsic muscles of the larynx?

Answer 51

Suprahyoid muscles | and Infrahyoid muscles

Question 52

what type of muscle are the intrinsic muscles of the larynx?

Answer 52

skeletal muscles

Question 53

where do the intrinsic muscles attach?

Answer 53

between the cartilages

Question 54

what do the intrinsic muscles of the larynx do?

Answer 54

move the cartilages which then move the vocal cords

Question 55

what are the intrinsic muscles of the larynx?

Answer 55

- tensors (of the vocal cords) - relaxers(of the vocal cords) - adductors (of the vocal cords) - abductors (of the vocal cords)

Question 56

what are the intrinsic muscles innervated by?

Answer 56

motor branches of CN X

Question 57

what muscles tense the vocal cord?

Answer 57

cricothyroid muscles

Question 58

what stretches the vocal cord?

Answer 58

‘nodding’ the thyroid cartilage anteriorly at the cricothyroid joints,

Question 59

what muscles relax the vocal cords and pull the he arytenoid cartilages towards the thyroid cartilage?

Answer 59

thyro-arytenoid muscles

Question 60

where do the thyro-arytenoid muscles attach?

Answer 60

thyroid at front an arytenoid muscles at the back

Question 61

what is the muscles between the thyro-arytenoid and the vocal cord and makes minute variations on the voice

Answer 61

vocalis muscle

Question 62

what muscle attaches between the cricoid and arytenoid cartilage?

Answer 62

lateral crico-arytenoid muscles

Question 63

what is the action of the lateral crico-arytenoid muscles?

Answer 63

- adduct the vocal cords | - rotate the arytenoid cartilages so that the vocal processes of the cartilages come together in the midline

Question 64

what are the two types of the arytenoid muscles?

Answer 64

transverse and oblique arytenoids

Question 65

what is the role of the arytenoid muscles?

Answer 65

adduct the vocal cords assist the lateral cricoarytenoids to gently close the rima glottidis sphincter function

Question 66

what muscle - abduct the vocal cords - rotate the arytenoid cartilages so that the vocal processes of the cartilages move laterally - widens the rima glottidis

Answer 66

posterior crico-arytenoid muscles

Question 67

what muscle is involved in the normal resting position of the rima glottidis?

Answer 67

laryngeal muscles relaxed

Question 68

what muscle is involved in the forced resprtaion of the rima glottidis?

Answer 68

posterior crico-arytenoids contract

Question 69

what muscle is involved in the phonation of the rima glottidis?

Answer 69

arytenoids contract assist lateral crico-arytenoids

Question 70

what muscle is involved in the whispering of the rima glottidis?

Answer 70

lateral crico-arytenoids contract

Question 71

how do u produce sound?

Answer 71

vibration of the air moving over vocal points

Question 72

what muscles involved in inspiration?

Answer 72

diaphragm and/or intercostal muscles

Question 73

what is phonation?

Answer 73

producing a sound in the larynx

Question 74

what is articulation?

Answer 74

producing a recognisable sound within the oral or nasal cavities

Question 75

what causes oral sound?

Answer 75

- soft palate tenses (CN V3) and elevates (CN X) to close off entrance into nasopharynx - directs stream of air through oral cavity - sound interrupted by the tongue (CN XII) and the teeth/lips (CN VII) to - produce most vowels and consonants in English language

Question 76

what causes nasal sounds?

Answer 76

- soft palate tenses (CN V3) and descends (CN X) to close off entrance into oropharynx - directs stream of air through nasal cavities - produces one of three sounds: “m”, “n” or “ing” - depending on position of tongue (CN XII), teeth and lips (CN VII).

Question 77

how is the vagus nerve tested clinically?

Answer 77

listen to patient speak ask patient to swallow small sip of water ask patient to cough

Question 78

describe that anatomy of coughing?

Answer 78

breathe in using the diaphragm (phrenic nerves) close the vocal ligaments (CN X) contract the abdominal wall to build up pressure beneath the closed vocal ligaments suddenly open the vocal ligaments (CN X) tense (CN V3) and raise (CN XI) the soft palate to direct the stream of air through the mouth

Question 79

what is the most protective reflex in humans?

Answer 79

cough relax

Question 80

what is aspiration?

Answer 80

Inhalation of liquid or solid into the lungs

Question 81

what can effect function of the cranial nerve?

Answer 81

brainstem stroke

Question 82

what causes brainstem stroke?

Answer 82

bleeding from, or blockage of, branches from the vertebral arteries or basilar artery which also supply the cranial nerves attaching to the brainstem

Question 83

a patient with damage to CN X might have?

Answer 83

a hoarse voice abnormal swallow weak cough

Question 84

what is Cricothyroid puncture?

Answer 84

Emergency airway management