Airway

Question 1

What is the only bone in the larynx?

Answer 1

Hyoid bone

Question 2

What are the single cartilages in the larynx?

Answer 2

thyroid
cricoid
epiglottic

Question 3

What are the paired cartilages in the larynx?

Answer 3

corniculate
arytenoid
cuneiform

Question 4

What is the valleculae?

Answer 4

Space on the other side of the epiglottis where you can put the MAC blade

Question 5

What is the epiglottis?

Answer 5

fibrous cartilage with mucous membrane covering that reflects up to the paryngeal surface of the tongue and makes the glossoepiglottic fold, its at base of tongue and separates hypopharynx from the larynx and hangs over the laryngeal opening

prevents against aspiration by covering glottis during swallowing

Question 6

Is the epiglottis a vascular area?

Answer 6

Yes, very vascular area and can be traumatized and swell incredibly

Question 7

What are the components of the upper airway?

Answer 7

Nose
Mouth
Pharynx
Hypopharynx
Larynx

Question 8

What are the components of the lower airway?

Answer 8

Trachea
Bronchi
Bronchioles
Terminal Bronchioles
Respiratory Bronchioles
Alveoli

Question 9

Where is gas warmed and humidified?

Answer 9

Nose

Question 10

What is the primary pathway for normal breathing?

Answer 10

Nose, unless there is an obstruction, polyps, or upper respiratory infection

Resistance is almost 2 times that of mouth breathing

Mouth breathing is utilized with high flow rates such as that seen with exercise

Question 11

What are the 3 compartments of the pharynx?

Answer 11

Nasopharynx
Oropharynx
Hypopharynx

Question 12

Where does the pharynx extend?

Answer 12

extends from posterior aspect of nose to the level of the cricoid cartilage

Question 13

Where is the nasopharynx?

Answer 13

Anterior to C1, bound superiorly by base of skull and inferiorly by soft palate

Question 14

What structures are in the nasopharynx?

Answer 14

nasal septum, turbinates, and adenoids

Question 15

Where is the oropharynx?

Answer 15

Lies at C2-C3

Bound superiorly by soft palate and inferiorly by epiglottis

Question 16

What is a major source of obstruction in the oropharynx?

Answer 16

Tongue due to decreased genioglossus muscle tone with anesthesia

Question 17

Where is the hypopharynx?

Answer 17

Bound by superior border of epiglottis and inferior border of the cricoid cartilage at C5-C6

Lies posterior to the larynx and leads to the esophagus

Question 18

What lies at the lower edge of the hypopharynx and acts as a barrier to regurgitation in the conscious patient?

Answer 18

Upper esophageal sphincter, closes when swallowing and opens when breathing

Question 19

What is Waldeyer’s Tonsillar Ring?

Answer 19

lymphoid tissue ring in the pharynx that is at high risk for bleeding, especially with nasal intubation

Question 20

What makes up the Waldeyer’s Tonsillar Ring?

Answer 20

Pharyngeal tonsils (adenoids) in nasopharynx, palatine tonsils (oropharynx), lingual tonsils (located at base of tongue)

Question 21

Where is the larynx?

Answer 21

Lies at C3-C6 in adults

Lies at C2-C4 in infants and descends to C4-C5 by age of 5

Question 22

What is the organ of phonation and serves as a valve to protect the lower airways?

Answer 22

larynx

Question 23

Where does the larynx extend?

Answer 23

Extends from epiglottis to lower level of cricoid cartilage and sits at the junction of the airway and the esophagus

Attached anteriorly by the epiglottis, posteriorly by the mucous membrane which extends between the arytenoid cartilage and laterally by the aryepiglottic folds (false vocal cords)

Question 24

What is the most commonly seen paired cartilages in laryngoscopy?

Answer 24

arytenoids

Question 25

What are narrow bands of fibrous tissue one each side of the larynx that are found first inside the laryngeal cavity opening?

Answer 25

vestibular folds aka false vocal cords

Question 26

What are pale, white, ligamentous structures that attach to the thyroid anteriorly and the arytenoids posteriorly?

Answer 26

true vocal cords

Question 27

What is the triangular fissure between the vocal cords?

Answer 27

glottic opening

Question 28

Where is the narrowest portion of an adult airway and what is its average width?

Answer 28

Glottic opening, width of 6-9 mm (can be stretched to 12 mm)

Question 29

What is the largest cartilage of the larynx?

Answer 29

Thyroid cartilage

Question 30

What is the only complete ring in the upper airway and where is it?

Answer 30

cricoid cartilage, sits at C6, narrowest part of the airway in a child

Question 31

Where is the site for Selleck's Maneuver?

Answer 31

cricoid cartilage

Question 32

How much pressure is needed for Selleck's Maneuver?

Answer 32

6.6-8.8 lbs

Question 33

What connects the thyroid cartilage with the hyoid bone?

Answer 33

thyrohoid

Question 34

Is the cricothyroid membrane vascular or avascular?

Answer 34

avascular

Question 35

Where is the site for translaryngeal injection and emergency airway?

Answer 35

cricothyroid membrane

Question 36

Where does the trachea begin and end?

Answer 36

Begins at C6 at the inferior border of the cricoid cartilage and extends to the carina

Question 37

About how long is the trachea?

Answer 37

10-15 cm in length

Question 38

Where do the left and right mainstem bronchus bifurcate?

Answer 38

level of T5

Question 39

What angle does the right bronchus bifurcate?

Answer 39

25-30 degree angle | Shallow and favors intubation

Question 40

What angle does the left bronchus bifurcate?

Answer 40

45 degree angle

Question 41

How is the pediatric airway different than the adult airway?

Answer 41

larynx positioned higher in the neck tongue larger relative to mouth size epiglottis larger, stiffer, angled more posteriorly head and occiput larger relative to body size short neck narrow nares cricoid ring is narrowest region

Question 42

What is the purpose of muscles in the airway?

Answer 42

Adduct, abduct, regulate tension, or physically move the larynx

Question 43

What is the role of intrinsic muscles?

Answer 43

responsible for opening, closing, and controlling tension of the vocal cords

Question 44

What is the role of extrinsic muscles?

Answer 44

connect the larynx with the hyoid bone and other structures and serve to move the larynx as a whole (elevating and depressing) during phonation, swallowing, and breathing

Question 45

What does the posterior cricoarytenoid muscle do?

Answer 45

abducts (opens) the vocal cords and opens the glottis | intrinsic muscle

Question 46

What does the lateral cricoarytenoid muscle do?

Answer 46

adducts (closes) the vocal cords | intrinsic muscle

Question 47

What do the arytenoid muscles do?

Answer 47

adducts the vocal cords | intrinsic muscle

Question 48

What does the cricothyroid muscle do?

Answer 48

produces cord tension, closure, and elongates the vocal cords can result in total and profound glottic closure, called laryngospasm intrinsic muscle

Question 49

What does the thyroarytenoid muscle do?

Answer 49

shortens and relaxes the vocal cords | intrinsic muscle

Question 50

What does the sternohyoid muscle do?

Answer 50

Draws hyoid bone inferiorly | Extrinsic muscle

Question 51

What does the sternothyroid muscle do?

Answer 51

Draw thyroid cartilage caudad (toward feet) | Extrinsic muscle

Question 52

What does the thyrohyoid muscle do?

Answer 52

Draws hyoid bone inferiorly | Extrinsic muscle

Question 53

What does the omohyoid muscle do?

Answer 53

Draws hyoid bone caudad | Extrinsic muscle

Question 54

What does the stylohyoid muscle do?

Answer 54

Elevates larynx | Extrinsic muscle

Question 55

What does the mylohyoid muscle do?

Answer 55

Elevates larynx | Extrinsic muscle

Question 56

Which cranial nerves innervate the upper airway?

Answer 56

trigeminal - nasopharynx glossopharyngeal - oropharynx vagus - hypopharynx

Question 57

What nerve innervates the anterior septum and lateral walls of the nose?

Answer 57

ophthalmic division of trigeminal nerve or more specifically the anterior ethmoidal nerve

Question 58

What nerve innervates the posterior septum of nerve?

Answer 58

maxillary division of trigeminal nerve | more specifically nasopalatine nerves and sphenopalatine ganglion

Question 59

What does sympathetic stimulation do to the nose?

Answer 59

vasoconstriction and shrinkage of nasal tissue

Question 60

What does parasympathetic stimulation do to the nose?

Answer 60

engorgement of blood vessels and increases likelihood of bleeding with airway manipulation (seen with general anesthesia) nasal airway could cause significant nose bleed

Question 61

What is the sensory innervation of tonsils, roof of pharynx, and underside of soft palate?

Answer 61

glossopharyngeal nerve

Question 62

What nerve innervates anterior 2/3 of tongue?

Answer 62

lingual nerve (mandicular dicision of trigeminal nerve)

Question 63

What nerve innervates posterior 1/3 of tongue?

Answer 63

glossopharyngeal nerve

Question 64

What areas does the facial nerve (CNVII) innervate?

Answer 64

supplies muscles of facial expression taste to anterior 2/3 of tongue small amount of afferent conduction to oropharynx motor control of stylohyoid laryngeal muscle salivary glands (parasympathetic stimulation increases saliva production)

Question 65

What does the hypoglossal nerve (CNXII) do?

Answer 65

- provides motor innervation to most muscles of the tongue | - damage to the hypoglossal nerve can relax the tongue, causing it to fall back and cause airway obstruction

Question 66

What area does the vagus nerve (CNX) innervate?

Answer 66

airway below the epiglottis

Question 67

What branch of vagus nerve provides sensation to larynx from epiglottis to vocal cords (sensation above vocal cords)?

Answer 67

internal superior laryngeal nerve (SLN) | internal = SENSORY

Question 68

What does the external branch of the SLN do?

Answer 68

provides motor innervation to cricothyroid muscle | External = MOTOR

Question 69

What nerve provides sensation to larynx below the vocal cords and innervates all muscles of the larynx except for the cricothyroid muscle?

Answer 69

recurrent laryngeal nerve (RLN)

Question 70

What happens with a vagal nerve injury?

Answer 70

affects both SLN and RLN | bilateral vagal denervations produces flaccid, midpositioned cords, resulting in aphonia

Question 71

What occurs with unilateral superior laryngeal nerve injury?

Answer 71

minimal effects

Question 72

What occurs with bilateral superior laryngeal nerve injury?

Answer 72

hoarseness, vocal tiring

Question 73

What occurs with unilateral recurrent laryngeal nerve damage?

Answer 73

Hoarseness

Question 74

What happens with bilateral recurrent laryngeal nerve damage?

Answer 74

Acute: stridor, respiratory distress from unopposed tension of the cricothyroid muscle Chronic: aphonia

Question 75

What area does the superior laryngeal artery (SLA) provide blood to?

Answer 75

- supraglottic laryngeal structures | - carotid to the superior thyroid artery to SLA