Apex WB #1-Airway Anatomy

Question 1

Laryngeal muscles are classified as

Answer 1

Intrinsic or Extrinsic

Question 2

intrinsic laryngeal muscles control the

Answer 2

Tension & position of the vocal cords

Question 3

The Recurrent laryngeal nerve innervates

Answer 3

ALL the intrinsic laryngeal muscles, which are innervated by the external branch of the superior laryngeal nerve

Question 4

The posterior cricoarytenoid is responsible for

Answer 4

Opening the vocal cords

Question 5

The extrinsic laryngeal muscles support the

Answer 5

Larynx inside the neck & assist with swallowing

Question 6

All the extrinsic muscle (except the digastric) end in

Answer 6

-HYOID

Question 7

The cricothyroid____the VC

Answer 7

Elongates/Tenses

(SLN external branch)

Question 8

The Thyroarytenoid ______ the vocal folds & _____ the glottis

Answer 8

Shortens/relaxes

ADDUCTS vocal folds

Closes glottis

(RLN)

Question 9

The Vocalis causes

Answer 9

Shortening & relaxation

(RLN)

Question 10

The lateral Cricoarytenoid causes _____ of vocal folds & ____glottis

Answer 10

ADDUCTION

Closes glottis

(RLN)

Question 11

The Posterior Cricoarytenoid _____ vocal folds & _____ glottis

Answer 11

ABDUCTS

Opens glottis

(RLN)

Question 12

Muscular Innervation=

SCAR

Answer 12

Superior Laryngeal- Cricothyroid Muscle

All others- Recurrent Laryngeal

Question 13

The _____ nerve provides sensory innervation to the face & neck

Answer 13

Trigeminal

Question 14

Ophthalmic covers

Answer 14

Nares & anterior 1/3 of nasal septum

Question 15

Maxillary covers

Answer 15

Turbinates & nasal septum

Question 16

Mandibular covers

Answer 16

Anterior 2/3 of tongue (somatic)

Question 17

The Glossopharyngeal nerve (CN9) provides sensation from the

Answer 17

Oropharynx down to the anterior side of the epiglottis

Question 18

The vagus nerve (CN 10) gives rise to the

Answer 18

Superior laryngeal nerve, which divides into the internal & external branches

Question 19

The SLN internal branch provides

Answer 19

Sensory function

Posterior side of epiglottis (level of vocal cords)

Question 20

The SLN external branch provides

Answer 20

Motor function

Cricothyroid muscle (tenses VC)

Question 21

The Vagus nerve also gives rise to the

Answer 21

RLN, which provides sensation to the level of VC to the trachea

Question 22

The RLN innervates the

Answer 22

Posterior cricoarytenoid muscle

When paralyzes, the cord tensing action of the cricothyroid muscle acts unopposed

Question 23

Bilateral RLN injury (acute) will cause

Answer 23

respiratory distress

Question 24

Bilateral RLN (chronic) will cause

Answer 24

No respiratory distress

Question 25

What happens with the SLN is injured?

Answer 25

No respiratory distress, but can cause hoarseness

Question 26

What structures need to be anesthetized for an awake intubation?

Answer 26

Base of tongue Oro/Hypo pharynx Larynx

Question 27

What is the treatment for Methemoglobinemia?

Answer 27

Methylene Blue

Question 28

When should Cocaine be avoided?

Answer 28

PChE deficiency MAOI use Increase in SNS tone Hx CAD

Question 29

What 3 nerves need to be blocked for an awake intubation?

Answer 29

Glossopharyngeal (bilat) Superior laryngeal (Bilat) RLN (transtracheal)

Question 30

The adult larynx lies anterior to

Answer 30

C3-C6

Question 31

Where is the narrowest region in the adult airway

Answer 31

Glottic opening

Question 32

The pediatric larynx is shaped like a funnel when they are

Answer 32

Less than or equal to 5 years old

Question 33

What is the narrowest fixed region in the airway of a pediatric patient?

Answer 33

Cricoid Ring

Question 34

What is the narrowest dynamic region in the airway of a pediatric patient?

Answer 34

Vocal Cords

Question 35

What are the common signs of laryngospasm?

Answer 35

Inspiratory Stridor Suprasternal/Clavicular retraction during Inspiration Rocking hoarse of chest wall Increased Diaphragmatic excursion Lower Rib flailing Absent/altered EtCO2 waveform

Question 36

What are common causes of laryngospasm?

Answer 36

Less than 1 year old Active/recent respiratory infection 2nd hand smoke Reactive airway disease GERD Hypervent/Hypocapnia

Question 37

What maneuver can relieve laryngospasm?

Answer 37

Larson's Hold pressure & given 15-20cmH2O of CPAP

Question 38

In the adult, how much Succinylcholine can be given to break a laryngospasm?

Answer 38

IV 0.1-1mg/kg IM 4mg/kg

Question 39

What is the Valsalva maneuver?

Answer 39

Exhalation against a closed glottis Ex: coughing, bucking or bearing down

Question 40

What is the risk of Valsalva maneuver?

Answer 40

Increased pressure in the thorax, ABD & brain

Question 41

What is the Muller's maneuver?

Answer 41

Inhalation against a closed glottis Ex: bite ETT & takes a deep breath

Question 42

What is the risk of Muller's maneuver?

Answer 42

Sub-atmospheric pressure in the thorax, leading to negative pressure & pulmonary edema

Question 43

The bevel when placing a naso instrument should point towards the

Answer 43

Turbinates

Question 44

Anesthetic agents reduce

Answer 44

Pharyngeal delator muscle tone, leading to obstruction

Question 45

What is the most common type of airway obstruction?

Answer 45

At the level of the tongue Genioglossus muscle relaxation

Question 46

What is another location where airway obstruction can occur?

Answer 46

Level of soft palate Tensor palatine muscle relaxation

Question 47

The genioglossus muscle helps

Answer 47

Open oropharynx

Question 48

The tensor palatine muscle opens the

Answer 48

Nasoparynx

Question 49

The carina is at

Answer 49

T4-5 Angle if Louis

Question 50

What allows air movement between alveoli?

Answer 50

Pores of Kohn

Question 51

Type 1 pneumocytes participate in

Answer 51

Gas Exchange

Question 52

Type 2 pneumocytes participate in

Answer 52

Production of surfactant Resistant to O2 toxicity Produce type 1

Question 53

Type 3 pneumocytes are

Answer 53

Macrophages

Question 54

Neutrophils are present in the

Answer 54

Alveoli in smokers & patients with acute lung injury

Question 55

The SLN innervates the

Answer 55

Cricothyroid muscle Underside of the epiglottis

Question 56

What 4 structures are involved in airway innervation?

Answer 56

Trigeminal Glossopharyngeal SLN RLN

Question 57

What are the Neural pathways of the Airway

Answer 57

Trigeminal CN5 (sensory) Glossopharyngeal CN9 (afferent nerve gag reflex-soft palate stimulation) Vagus CN 10 (efferent limb-pharyngeal constriction

Question 58

Tongue movement is due to

Answer 58

CN 12