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Week 1 Flashcards

1
Q

Anatomical functions of the nose

A
  • Inhaled air warmed by conchae and septum
  • Filtration and obstruction of foreign particles
  • Assist with phonation and sensation of smell (CNI)
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2
Q

Anatomical structure of pharynx

A
  • Connects nose, mouth, larynx and middle ear.

- Posterior oral structure.

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3
Q

Macintosh blade

A

Curved blade
Indirectly grabs/lifts epiglottis
-Vallecula is space anterior to the epiglottis at root of tongue. Where blade is place

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4
Q

MIller Blade

A
  • Straight blade

- Directly grabs the epiglottis

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5
Q

Function of pharynx and tonsils

A
  • assists phonation
  • initiates deglutition (swallowing)
  • defense against infectious pathogens
  • enlarges with inflammation and tumor
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6
Q

Waldeyer’s Rings

A
  • ringed arrangement of lymphoid tissue in pharynx

- includes palatine tonsil (what we normally think of tonsils) and lingual tonsil (at back of tongue)

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7
Q

Mallampati classification

A
  • used to predict ease of endotracheal intubation
  • Class 1-4
  • Class 1-2: easier intubation
  • Class 3-4 harder intubation
  • Class 1: full view of uvula, tonsils pillars, and soft palate
  • Class 2: partial view of uvula or uvular base, partial view of tonsils, soft palate
  • Class 3: soft palate only
  • Class 4: hard palate only
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8
Q

Glossoptosis

A

Collapse of oropharynx, tongue dropping posteriorly

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9
Q

Macroglossia is

A

Large tongue

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10
Q

Micrognathia

A

Small jaw, mandible

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11
Q

Prognathism

A

Protruding jaw, mandible

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12
Q

Microgenia

A

Small chin

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13
Q

Microstomia

A

Small mouth

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14
Q

Malocclusion

A

Upper protrusion “buck teeth”, overbite

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15
Q

Difference in anatomic location of larynx in adults vs children

A
  • Adults: located anterior to 3rd-6th cervical vertebrae

- At birth: level at C3-4

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16
Q

Function of the Larynx

A
  • Airway protective sphincter
  • Closes off airway during swallowing
  • Supports vocal cords
  • modulates speech
  • provides autoPEEP
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17
Q

What is the narrowest portion of the adult upper airway

A

Rima glottidis

-This is the opening between the true vocal cords and the arytenoid cartilages of the larynx

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18
Q

What are the 3 compartments of the larynx?

A

Supraglottis compartment: above vocal cords

 - Epiglotis
 - False vocal cords

Glottis (Ventricle): at cords

 - True vocal folds
 - Rima glottidis

Infraglottis Compartment: below cords

 - Cricoid cartilage
 - Trachea
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19
Q

Arytenoid cartilage

A

Allows the vocal folds to be tensed, relaxed, or approximated

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20
Q

Extrinsic muscles of the larynx

A
  • attach larynx to bone or pharynx

- move larynx during swallowing

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21
Q

Intrinsic larynx muscle sets

A
  • two sets of intrinsic larynx muscles
    • one set alter the size and shape of the larynx
      • innervated by the Recurrent Laryngeal Nerve (RLN)
    • other set move the true vocal cords
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22
Q

In the second set of intrinsic larynx muscles, which one is not innervated by the RLN?

A

Cricothyroid

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23
Q

What are the functions of the extrinsic muscles of the larynx

A
  • larynx moves upward during swallowing

- as the epiglottis goes down

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24
Q

3 important laryngeal membranes

A
  1. Thyroid membrane
  2. Quadrangular membrane
  3. Cricothyroid membrane
    • inferior to true vocal cords
    • emergency airway: where a cric would be completed
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25
Recurrent laryngeal nerve (RLN)
- Vagus new branch (CN X) - provides sensory innervation of infraglottis - motor innervation to all of larynx except cricothyroid muscle - Stimulation causes abduction of VC - damage to RLN causes VC addiction
26
Superior Laryngeal Nerve
- Vagus nerve X - Divides into 2 nerves - Internal SLN: stimulation causes laryngospasm - External SLN: motor innervation of cricothyroid muscle
27
Vallecula
- Space anterior to the epiglottis at root of tongue | - Where Mac blade indirectly lifts the epiglottis by placing pressure on the hyoepiglottic ligament
28
Epiglottis positioning
Breathing: -positioned upright to allow air passage during inspiration Swallowing - epiglottis covers glottis to protect airway - larynx raised upward by muscular contractions - epiglottis pressed downward by base of tongue
29
Vocal cords
False vocal cords - upper vestibular folds - close during swallowing True vocal cords -responsible for vocal sounds
30
Abduction of vocal cords
- move apart - passive resting motion - abduct during inspiration - posterior cricoartynoid is only abductor muscle - RLN stimulation opens vocal folds
31
This is the only abductor muscle of the vocal cords
Cricoarytenoid Innervated by RLN
32
Adduction of vocal cords
- move together - RLN responsible for adduction of VF - SLN tenses the VF via the cricothyroid muscle
33
These airway structure are involved in the modification of sound
- pharynx/oral cavity | - tongue/lips
34
What role do the vocal cords play in sound modification?
- pitch - control VC tension - intensity - loudness related to force of air passing through VC
35
Sellick Maneuver
- AKA cricoid pressure - cricoid ring is a complete ring of cartilage found between the cricothyroid membrane and trachea. - pressure placed on cricoid posteriorly closes the esophagus
36
What is purpose of cricoid pressure
- prevents gastric regurgitation - aligns glottis opening during intubation - prevents ventilation of air into stomach
37
What is the narrowest part of upper airway in children?
Cricoid ring - cone shaped, narrowing inferiorly - until age 8 years Reason why will sometimes use unruffled ETT’s in children
38
What are conduction airways?
- do not participate in gas exchange, ventilation, but not perfusion. - portion of each breath wasted. - anatomical dead space, portion of each breath is wasted ventilation
39
Endotracheal tube reduces dead space in upper airway to about how much?
100mL
40
What percentage of normal breath remains in airway?
30%
41
What is acinus?
- includes all respiratory structures - respiratory bronchioles - alveolar ducts and sacs - alveoli -site of gas exchange
42
Gas exchange in the alveoli occurs by what proceeds?
Simple diffuse
43
What are PS-CC?
- pseudostratified ciliated columnar epithelium - move mucous blanket and trapped particles out - disabled by smoke
44
what are goblet cells?
- release mucous granules into airway lumens - creates mucous blanket - moistens air - traps particles - increases with injury and infection
45
What are Clara cells?
- Located in smaller bronchioles which lack goblet cells - produce mucus-poor, water material - combines with surfactant and mucus - assist with cleaning small airways - reduces surface tension in bronchioles
46
What are the cell types of the alveolar wall?
- Type I Pneynocyte - covers 95% of alveolar wall - designed to increase alveolar surface area - facilitates gas exchange - unable to regenerate - Type II Pneumocyte - secretes surfactant: mixes with water molecules and diminishes surface tension which reduces force necessary to inflate alveali, prevents alveolar collapse during expiration. Important in neonate. - regenerate type I pneumocyte
47
Functions of the larynx
- protect the lower airway from aspiration - latency between the hypopharynx and trachea - protective gag and cough reflexes - phonation
48
What is the function of the bronchioles?
Provide humidification and warming of inspired air as it passes to the alveoli
49
What is simple diffusion
Allows for gaseous exchange between airspace and pulmonary capillaries
50
What type of cell make up 95% of the alveolar wall?
Type I Pneumocyte
51
What are Type I Pneumocytes?
- squamous epithelial Cell - unable to regenerate - increase alveolar surface area - control fluid movement between interstitium and airspace - simple diffusion takes place here
52
What are Type II Pneumocytes?
- secretes surfactant* - repairs alveolar epithelium after injury - regenerate PC I
53
What do the intrinsic muscles for the larynx do?
Controls the movement of the laryngeal cartilages of the vocal cords
54
Which intrinsic muscle elongates the vocal cords?
Cricothyroid *this is the only intrinsic muscle innervated by the SLN
55
What intrinsic muscle shortens the vocal cords?
Thyroarytenoid
56
What intrinsic muscle abducts the vocal cords?
Posterior cricoarytenoid
57
What intrinsic muscle adductor the vocal cords?
Thyroarytenoid
58
What laryngeal muscle is responsible for laryngospasm reflex?
Cricothyroid
59
The superior Laryngeal Nerve branches off of what nerve?
Vagus nerve
60
At what level do the superior laryngeal nerve branch in the the internal and external branches?
At the level of the hyoid
61
What is the clinical presentation of superior laryngeal nerve injury?
Injury to the trunk of the SLN or the external branch causes hoarseness
62
What nerve does the Recurrent Laryngeal Nerve branch from?
Vagus nerve
63
What is the clinical presentations of Recurrent Laryngeal nerve injury?
- acute bilateral paralysis of vocal cord abductors * this pt is at risk for stride and respiratory distress - unilateral injury results in ipsilateral paralysis of cord abductors. Does not cause respiratory distraess - chronic injury is well tolerated and does not cause respiratory distress
64
What can cause injury to the RLN, either side?
- external pressure from ETT or LMA - thyroid surgery - parathyroid surgery - neck stretching - tumor
65
What can cause RLN injury, left side only?
- PDA ligation - alert atrial enlargement (mitral stenosis) - AAA - thoracic tumor
66
What are the 3 key airway blocks?
- glossopharyngeal - superior laryngeal - trantracheal
67
What forms the main support of the larynx and attaches to the thyroid cartilage?
Hyoid bone
68
What does the thyroid membrane do?
Attaches the larynx (specifically the thyroid cartilage) to the hyoid bone
69
What does the cricothyroid membrane do?
- Attached the cricoid and thyroid cartilages - where an emergency airway is secured - where the needle of a tracheal block is placed
70
What are the corniculate and cuneiform cartilages?
The cuneiform cartilages are lateral to the corniculates Often mistaken for the arytenoids during direct laryngoscopy (these change be seen)
71
What does the epiglottis cartilage do?
Provides a mechanical barrier to the pharynx and laryngeal opening -contains the vallecula, space between the base of the tongue and the anterior side of epiglottis
72
What is the thyroid cartilage?
- provides structure and protection to the larynx | - forms the Adam’s apple
73
This is the only complete cartiginous ring in the airway
The cricoid
74
According to apex, what are the 2 narrowest parts of the pediatric airway?
- vocal cords (dynamic) | - cricoid ring (fixed)
75
What is Larson’s Maneuver?
-the application of firm pressure to the laryngospasm notch located just behind the earlobe. Pressure is applied bilaterally towards the base of the skull. Pressure should be applied for 3-5 seconds, then released for 5-10. Repeat until laryngospasm broken This will: - displace the mandible anteriorly to help open the airway - often breaks the laryngospasm by causing the lightly anesthetized pt to sigh
76
What are pre-anesthetic risks of laryngospasm?
- active or recent upper airway infection - exposure to second hand smoke - reactive airway disease - GERD - age < 1 year
77
What are intra-op risks of laryngospasm?
- light anesthesia with concurrent airway manipulation - saliva or blood in airway - hyperventilation - hypocapnia - surgical procedures involving the airway: tonsillectomy, adenoidectomy, nasal/sinus, laryngoscopy, bronchoscopy, palatal
78
Signs of laryngospasm
- inspiration stridor - suprasternal and supraclivicular retraction during inspiration - “rocking horse” appearance of chest wall - increased diaphragmatic excursion - lower rib flailing
79
What factors reduce the likelihood of layngospasm?
- avoidance of airway manipulation during light anesthesia - CPAP 5-10 cm/H2O during inhalation induction as well as immediately post extubation - tracheal extubation when deeply anesthetized or fully awake *not in-between* - Laryngeal lidocaine - IV lidocaine prior to extubation - hypercapnia/hypoventilation - PaO2 < 50mmHg
80
How do you treat laryngospasm?
- FiO2 100% - Remove noxious stimulation - deepen anesthesia by increasing concentration of inhalation agent or with small dose of propofol or lidocaine - CPAP 15-20 cm/H2O while instituting maneuvers to open the airway (head extension, chin lift, Larson’s maneuver) - succinylcholine IV or submental - children <5 should receive atropine with succinylcholine to prevent bradycardia
81
What is Valsalva’s maneuver?
- exhalation against a a closed glottis or obstruction | - risk: increased pressure in the thorax, abdomen, and brain
82
What is Muller’s maneuver?
- inhalation against a closed glottis or obstruction | - risk: subatmospheric pressure in the thorax ——-negative pressure pulmonary edema
83
What are the cartilaginous structures of the larynx?
- 3 unpaired - 3 paired *framework of 9 structures
84
What is the carina?
Divides the 2 bronchi - about 25cm from the teeth - at level of T5-7 *generally incubate 21-23cm at teeth
85
Which bronchial main stem is straighter?
The right
86
Where does the conduction airway end?
Respiratory bronchiole
87
What type of alveolar cell increases alveolar surface area?
Type 1 pneumocyte
88
Up until the age of 5years, both bronchi do what?
Branch off from the long axis of the trachea at 55 degrees
89
Things that increase as the airway bifurcates:
- number or airways - cross-sectional area - muscular layer
90
Things that decrease as the airway bifurcates:
- airflow velocity - amount of cartilage - goblet cells (produce mucus) - ciliated cells (clears mucus)
91
Mnemonic to remember muscles that abduct the vocal cords
Please Come Apart Posterior CricoArytenoid
92
Mnemonic for muscles that adduct vocal cords
Let’s Close Airway Lateral CricoArytenoid
93
During anesthesia, the airway can obstruct in what places?
- soft palate: relaxation of the tensor palatine muscle - tongue: relaxation of the genioglossus muscle - epiglottis: relaxation of the hyoid muscles
94
The carina corresponds with what anatomical landmark?
Angle of Louis
95
Mnemonic to remember which muscles tense and relax vocal cords
CricoThyroid: cords tense ThyroaRytenoid: they relax

Respiratory (4 decks)

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