1 Airway Anatomy

Question 1

Airway anatomy innervation

Answer 1

All RLN except cricothyroid= external SLN

Question 2

Action: aryepiglottic, interarytenoid

Answer 2

Closes laryngeal vestibule. Closes posterior commissure of glottis

Question 3

Function of extrinsic larynx muscles

Answer 3

Breathing, swallowing, phonation

Question 4

Muscles that elevate larynx 6

Answer 4

Stylo/genio/mylo/thyrohyoid, digastric, stylopharyngeus

Question 5

Muscles that depress larynx

Answer 5

Omo/sternohyoid, sternothyroid

Question 6

Airway anatomy innervated by SLN, internal and external branch

Answer 6

Internal: sensory, epiglottis to top of VC. External: motor, cricothyroid

Question 7

What is innervated by V1, V2, V3

Answer 7

1: Nares, ant 1/3 septum. 2: turbinates and septum. 3: ant 2/3 tongue

Question 8

What does CN IX provide sensory info for

Answer 8

Soft palate, oropharynx, tonsils, post 1/3 tongue, vallecula, ant epiglottis, afferrent limb of gag

Question 9

SLN: what does it provide sensory innerv to, which branch

Answer 9

Posterior epiglottis to level of VC, internal branch

Question 10

True vocal cords are ___ and not ___

Answer 10

Ligaments, innervated

Question 11

What area does RLN provide sensory info to

Answer 11

Below VC to trachea

Question 12

Which side of vagus does the recurrent laryngeal loop around the aorta

Answer 12

Left

Question 13

SLN: internal branch goes to ___, external branch goes to ____

Answer 13

Internal: thyrohyoid, external: cricothyroid

Question 14

Nerve damage to what leads to hoarseness

Answer 14

Damage to external branch of SLN

Question 15

What does the right RLN loop under

Answer 15

Subclavian A

Question 16

RLN injury to either side can occur from what: 6

Answer 16

ETT pressure, LMA pressure, thyroid or parathyroid sx, neck stretching, tumor

Question 17

Which 4 things lead to RLN injury only on the left side

Answer 17

PDA ligation, LA enlargement (mitral stenosis), aortic arch anuerysm, thoracic tumor

Question 18

How to do SLN block

Answer 18

Anes at inf border of greater Cornu of hyoid: 1 ml above thyrohyoid, 2 ml beneath thyrohyoid. If asp air too deep

Question 19

How to do transtracheal block

Answer 19

Needle in caudal direc in cricothyroid membrane. Pt takes deep breath and inject 3-5 ml LA, pt coughs

Question 20

How to do glossopharyngeal block

Answer 20

Needle in base of palatoglossal arch 0.25-0.5 cm deep, if asp air= too deep. If blood redirect (could be carotid). 1-2 ml LA both sides

Question 21

Cuneiform are ____ to corniculates. Both provide structure to ___ ___

Answer 21

Lateral. Aryepiglottic folds

Question 22

Adult vs peds: shape and narrowest region of larynx

Answer 22

Adult: cylinder, VC. Peds: funnel, cricoid (fixed)VC (dynamic)

Question 23

Laryngospasm is most common in which age

Answer 23

<1 year old, children

Question 24

Laryngospasm reflex pathway

Answer 24

Afferrent: internal branch SLN. Efferent: external branch SLN and RLN

Question 25

CO2: too high or too low leads to inc risk laryngospasm

Answer 25

Too low —> risk. Too high: preventative

Question 26

IM dose of sux for laryngospasm in peds and adults, atropine dose to give at which age

Answer 26

Peds: 5 mg/kg if neonate/infant, 4 if child or adult. <5 y/o needs atropine 0.02 mg/kg

Question 27

Which maneuver leads to neg p pulm edema

Answer 27

Mullers maneuver

Question 28

3 muscles that can lead to a/w obstruction/where

Answer 28

Tensor palatine (nasopharynx), genioglossus (oro), hyoid muscles (hypo)

Question 29

Tracheobronchial tree: ____ divisions of smaller airways. Airflow velocity ___ as you move down the tree

Answer 29

23, slows

Question 30

Lower airway beginning/end

Answer 30

Tracheo/alveoli

Question 31

Trachea begins/ends C__-T__ Sensory innerv, epithelium type, blood supply

Answer 31

6-4. Vagus. Ciliated columnar. Inferior thyroid, superior thyroid, bronchial, and internal thoracic arteries

Question 32

Alveoli: how many we have, epithelium type, what allows air movement between them

Answer 32

300 million at 9 years old. Squamous. Pores of kohn

Question 33

Carina: what level, corresponds w what, epithelium

Answer 33

T4-5, angle of louis, ciliated columnar

Question 34

Mainstem bronchi: length and take off of each side, epithelium type

Answer 34

Right: 2.5 cm long, 25 degree take off. Left: 5 cm, 45 degree. Cuboidal

Question 35

Pneumocytes: type 1 function, junctions, cell type

Answer 35

Surface for gas exchange, 80% of surface, squamous, tight junctions

Question 36

Type II pneymovyte functions

Answer 36

Provide surfactant,t resistant to 02 toxicity, can do cell division and make type I cells

Question 37

Type III pneumocyte: what they are and function

Answer 37

Macrophages, fight infection and produce inflammation

Question 38

____ are in alveolus of smokers and ppl w acute lung injury

Answer 38

Neutrophils

Question 39

Neck ___ makes distance from incisors to carina ___ while extension makes it ___

Answer 39

Flexion- shorter. Longer

Question 40

More likely to mainstem and aspirate on which side of bronchus

Answer 40

Right

Question 41

<3 year old anatomical diff of bronchi

Answer 41

Both take off at 55 degrees

Question 42

3 aspects that increase as airway bifurcates

Answer 42

Number of airways, area, and muscular layer

Question 43

4 things that decrease as airway bifurcates

Answer 43

Airflow velocity, amt of cartilage, goblet cells (make mucus), ciliated cells (clear mucus)

Question 44

Order of the cartilages superior to inferior

Answer 44

Epiglottis, corniculate, arytenoid, cricoid

Question 45

Where is the infant larynx located

Answer 45

C2-4