CR Revision 7 Flashcards by patrick ellis

what are the nasopharynx, oropharynx and laryngopharynx innervated by?

nasopharynx: CN V₂
oropharynx: CN IX
laryngopharynx: CN X

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what happens to the epiglottis when you swallow?

larynx moves up, towards base of tongue and hyoid bone: makes the epiglottis close over the laryngeal inlet to prevent aspiration into trachea

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which ligament connect the hyoid bone and thyroid? - what is this covered by?

which ligament connects the cricoid and thyroid cartilage?

where does ithe internal laryngeal nerve and superior laryngeal artery enter larnyx?

Hyoid bone and thyroid are joined by thyrohyoid ligament, covered by a thyrohyoid membrane.

Internal laryngeal nerve and superior laryngeal artery come through this ligament/membrane

Between the cricoid and thyroid cartilages: Crico-thyroid ligament

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which nerve controls most of the muscles of larynx? - which muscle does it not innervate?

most motor to muscles controlled by the recurrent laryngeal nerve - PHONATION
sensory innervation to area below vocal cords

doesnt innervate motor control for cricothyroid (comes from superior laryngeal nerve)

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Which nerves can be damaged during laryngeal surgery? [2]

Explain the effect of each nerve damage [2]

Could be caused by surgery to the neck (particularly thyroid), Tumours (often thyroid) leading to compressing nerve, trauma or viral infection, thyroidectomy due to tumour/hyperthyroidism.

Recurrent laryngeal injury will result in paralysis of all intrinsic muscles except cricothyroid which will cause problems with phonation. Vocal cord paralysis means you will be unable to abduct laterally, leading to hoarseness (if this damage only occurs on one side) or aphonia (if the damage is bilateral).

Stridor or respiratory distress can happen if acute due to blockage of the airflow which your body is not able to adapt to. This is due to paralysis of intrinsic muscles.

External laryngeal will lead to paralysis of cricothyroid preventing higher pitched phonation. This leads to Weak voice with low pitch, reduced range so your voice easily tires

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The larynx lies in which vertebral layers? [1]

C3-C6

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The vocal cords attach anteriorly to which cartilage?

Cricoid cartilage
Cuneiform cartilage
Epiglottis
Arytenoid cartilage
Thyroid cartilage

The vocal cords attach anteriorly to which cartilage?

Cricoid cartilage
Cuneiform cartilage
Epiglottis
Arytenoid cartilage
Thyroid cartilage

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During swallowing, epiglottis [] and moves [] to close off the larynx

During swallowing, epiglottis flattens and moves posteriorly to close off the larynx to prevent aspiration of food

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Which of the following is the only complete cartilaginous ring within the upper airway?

Cricoid cartilage
Cuneiform cartilage
Epiglottis
Arytenoid cartilage
Thyroid cartilage

Which of the following is the only complete cartilaginous ring within the upper airway?

Cricoid cartilage
Cuneiform cartilage
Epiglottis
Arytenoid cartilage
Thyroid cartilage

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What does the cricoid cartilage attach to:
Anteriorly?
Posteriorly?

Anteriorly: Cricothyroid membrane
Posteriorly: Inferior horns of thyroid cartilage + paired arytenoid cartilages

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The vocal cords attach posteriorly to which of the following?

Cricoid cartilage
Cuneiform cartilage
Epiglottis
Arytenoid cartilage
Thyroid cartilage

The vocal cords attach posteriorly to which of the following?

Cricoid cartilage
Cuneiform cartilage
Epiglottis
Arytenoid cartilages
Thyroid cartilage

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What is the sensory innervation to all muscles below the vocal cords? [1]
What is the sensory innervation to all muscles above the vocal cords? [1]

What is the motor innervation to all muscles of the larynx except for the cricothryroid? [1]

What is the motor innervation for the cricothryroid? [1]

What is the sensory innervation to all muscles below the vocal cords? [1]
Recurrent laryngeal nerve

What is the sensory innervation to all muscles above the vocal cords? [1]
Internal laryngeal nerve

What is the motor innervation to all muscles of the larynx except for the cricothryroid? [1]
Recurrent laryngeal nerve

What is the motor innervation for the cricothryroid? [1]
External laryngeal nerve

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Which nerve is responsible for the opening the rima glottidis to refine sounds during phonation? [1]

Recurrent laryngeal nerve

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What are the effects of superior, internal and external branch palsies? [A&B]

A: reduced gag reflex
B: reduced range of pitch

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Palsy to which nerve causes reduced gag reflex?

Superior laryngeal nerve, external branch
Superior laryngeal nerve, internal branch
Recurrent layngeal nerve, bilateral damage
Recurrent layngeal nerve, unilateral damage

Palsy to which nerve causes reduced gag reflex?

Superior laryngeal nerve, external branch
Superior laryngeal nerve, internal branch
Recurrent layngeal nerve

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Palsy to which nerve causes reduced range of pitch?

Superior laryngeal nerve, external branch
Superior laryngeal nerve, internal branch
Recurrent layngeal nerve, bilateral damage
Recurrent layngeal nerve, unilateral damage

Palsy to which nerve causes reduced range of pitch?

Superior laryngeal nerve, external branch
Superior laryngeal nerve, internal branch
Recurrent layngeal nerve, bilateral damage
Recurrent layngeal nerve, unilateral damage

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Palsy to which nerve causes horseness of voice?

Superior laryngeal nerve, external branch
Superior laryngeal nerve, internal branch
Recurrent layngeal nerve, bilateral damage
Recurrent layngeal nerve, unilateral damage

Palsy to which nerve causes horseness of voice?

Superior laryngeal nerve, external branch
Superior laryngeal nerve, internal branch
Recurrent layngeal nerve, bilateral damage
Recurrent layngeal nerve, unilateral damage

Palsy to which nerve causes loss of phonation?

Superior laryngeal nerve, external branch
Superior laryngeal nerve, internal branch
Recurrent layngeal nerve, bilateral damage
Recurrent layngeal nerve, unilateral damage

Palsy to which nerve causes loss of phonation?

Superior laryngeal nerve, external branch
Superior laryngeal nerve, internal branch
Recurrent layngeal nerve, bilateral damage
Recurrent layngeal nerve, unilateral damage

How do you calculate forced vital capacity? [1]

Forced vital capacity (maximum volume of air air forcibly exhaled out of your lungs after a deep full breath) = Inspiratory reserve volime + tidal volume + expiratory reserve volume

DCLO technique

Rapid inhalation of CO/Helium to TLC → Breath hold (10 sec) → unforced exhalation (< 4 sec)
Sample: exhaled breath

Explain what DCLO measures [1]

How do you calculate DCLO? [1]

What is a normal DLCO value? [1]

DCLO: a measurement to assess the ability of the lungs to transfer gas from inspired air to the bloodstream. Carbon monoxide has a high affinity for hemoglobin, and it follows the same pathway as that of oxygen to finally bind with hemoglobin. Inhaled carbon monoxide is used for this test due to its high affinity for hemoglobin (200-250 times that of oxygen).

above 75 % of predicted value

Why is DCLO raised in asthma Ptx?

Expiration is decreased, so air is trapped in the lungs.

Have a lot of blood vessel recruitment

Name 3 & explain 3 excercise tests

Assess pre-operative fitness/fitness state/extent of breathlessness/benefit of oxygen therapy

Which is the order of metabolic pathways used when undergoing exercise? [3]

1. **Phosphocreatine**: immediate energy system 2. **Anaerobic glycolysis**: Non-oxidative source 3. **Aerobic metabolism:** Aerobic system

Briefly explain how the immediate energy system works Enzyme name? [1]

**Decomposition of phosphocreatine** releases high amounts of energy which can **generate ATP**. This energy transfer occurs within a fraction of a second Enzyme: **creatine kinase**

How do you calculate VO2? [1] What is the name of the equation? [1]

Fick equation: **VO2 = Q x (CaO2-CvO2)** Q is the cardiac output of the heart (blood flow to muscle) CaO2 is the arterial oxygen content CvO2 is the venous oxygen content (CaO2 – CvO2) is also known as the arteriovenous oxygen difference.

What is VO2 max? When do you reach VO2 max?

**VO2 max:** is the **highest peak oxygen** uptake that an individual can obtain during **dynamic exercise** using large muscle groups during a few minutes performed under normal conditions at sea level **VO2 max is reached when:** O2 consumption remains at steady state despite and increase in workload

Explain how increase muscle blood flow occurs during exercise [Local control & Systemic control?] I.e. which molecules are the mediators of local vasodilation [7] and what conditions does this occur at [1] Name the two ways that systemic regulation of vasodilation occurs [2]

Regional muscle vasodilation achieved by: **Local control:** * Vasoactive substrates and products of muscle metabolism (CO2, Lactate, K+) * Muscle hypoxia * Vasoactive mediators released by the endothelium (Nitric Oxide, ATP, Adenosine and prostaglandins) **Systemic regulation:** * Adrenergic receptor activation (β2R --> Vasodilation) AND **Vasoconstriction of other vascular beds which redirects blood flow**

Explain how cardiac output is increased during exercise? [2] What is relationship between HR and SV as they both increase? [1]

Achieved by **increasing HR and SV.** - HR increase due to: **more adrenaline on B1 adrenoreceptors** AND **decrease parasympathetic NS**. - SV: increase preload, decrease afterload, and increase contractility However! **SV starts to drop after a while**: as HR increases, **diastolic time decreases**, so get reduced blood out.

What are the increases in sympathetic outflow that occur due to exercise that contribute to increased skeletal and cardiac muscle blood flow ? [3] What are the local responses that occur due to exercise? [1]

**Sympathetic**: - Increase HR: increased CO - Constriction of aterioles (splachnic and renal) - Constrictio of veins: increase in venous return **Local response:** - Increase in vasodilator metabolites: decrease in SVR AND **Decreased parasympathetic output**

If during exercise SVR / Total peripheral resistance decreases, how come systolic BP increases? [1]

SVR reduces, but SV and MAP increases. **CO increases in greater magnitude than TPR decreases**

What is resting CO like in atheletes vs non atheletes? Explain your answer

Resting CO in athletes is **identical to non-athletes** due an **increased resting stroke volume and a compensatory** bradycardia. They have a **increased resting end diastolic volume (EDV) and therefore SV.**

How do blood gas differences in arteries / veins effect oxygen diffusion in exercise?

Get increased difference in AV gradient: drives oyxgen diffusion into cells

What happens to the levels of paO2 in arterial blood during high levels of exercise?

At high levelss of exercise the paO2 in the **arterial blood declines slightly**

Why does O2 consumption decline slowly and may not reach resting levels for up to an hour after exercise?

Initially during exercise, **ATP and phosphocreatine** are used up and these need to be **re-synthesised**: which uses oxygen.

Why does O2 consumption decline slowly and may not reach resting levels for up to an hour after exercise?

Initially during exercise, **ATP and phosphocreatine** are used up and these need to be **re-synthesised**: which uses oxygen.

During exercise, changes in autonomic factors (inhibition of parasympathetic and increase in sympathetic) are controlled by WHAT?

**Central command**: area in brain that mediates autonomic responses (increase in sympathetic / decrease in parasympathetic) to exercise. **Happens at same time as brain tells muscles to move**: e.g. The increase in heart rate, even within the first beat, is proportional to the force developed Once begun, chemical and metabolic tweaks to the system: chemoreceptors, baroreceptors

How is resp. response regulated when initiating exercise?

**Central command:**generates autonomic signals: increase stimulation in excercising skeletal muscle, increase in resp muscles. - Happens before CO2 / 02 changes = why there’s a need for **neuronal changes driving this** CO2 chemoreception contributes to driving ventilation

explain structure of olfactory epithelium

- **still** ciliated pseudostratified columnar resp. epithelium **-** **but thicker.** **NO GOBLET CELLs !! - olfactory cells: **have sense receptor cilia on surface. connect to**olfactory nerve - **olfactory (Bowmans) glands**: secrete serous secretion that serves as a trap and solvent for odiferous substances

5 differences between structure of trachea and bronchi?

1. **Respiratory epithelium** is **not as tall** in the **bronchi**, and contains **fewer** **goblet cells.** 2. The lamina propria has **more elastic tissue than the trachea** 3. A muscularis mucosae begins to take shape between the lamina propria and submucosa 4. There are **fewer submucosal, seromucous glands** 5. Cartilage is found in **plates** rather than **rings**

what are the 4 layers that exist between the bllod and inspired air in the blood-air barrier?

**capillary endothelium fused basal lamina alveolar epithelium (type 1 pnemocyte\_ surfactant**

fill in the table xox

Clara cells have which three functions? [3]

* They produce one of the components of surfactant. * They act as stem cells, i.e. they are able to divide, differentiate and replace other damaged cell types. * They contain enzyme systems which can detoxify noxious substances