Airway Anatomy (1.1) Flashcards by Kelly K

Which muscle(s) tense the vocal cords?

airway anatomy

-Cricothyroid: “Cords Tense”

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Which muscle(s) relax the vocal cords?

airway anatomy

-ThyroaRytenoid: “They Relax”

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Which muscle(s) ABduct the vocal cords?

airway anatomy

-Posterior CricoArytenoid: “Pulls Cords Apart”

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Which muscle(s) ADduct the vocal cords?

airway anatomy

-Lateral CricoArytenoid: “Let’s Close Airway”

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Describe the Trigeminal Nerve’s (CN V) sensory innervation of the upper airway.

airway anatomy

V1 (opthalamic) = nares & anterior 1/3 of septum
V2 (maxillary) = turbinates & septum
V3 (mandibular) = anterior 2/3 of tongue

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Describe the Glossopharyngeal Nerve’s (CN IX) sensory innervation of the upper airway.

airway anatomy

-Posterior 1/3 of tongue
-Soft palate
-Oropharynx
-Vallecula
-Anterior side of epiglottis

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Describe the Superior Laryngeal Nerve’s (CN X) sensory innervation of the upper airway.

airway anatomy

-Internal branch: posterior side of the epiglottis to the level of the vocal cords
-External branch: no sensory function (only motor innervation to the cricothyroid muscles)

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Describe the Recurrent Laryngeal nerve’s sensory innervation of the upper airway.

airway anatomy

-Below the vocal cords to the trachea

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How does recurrent laryngeal nerve injury injury affect the integrity of the airway?

airway anatomy

Bilateral:
-acute: respiratory distress d/t unopposed action of the cricothyroid muscles
-chronic: no respiratory distress

Unilateral:
-no respiratory distress

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How does Superior Laryngeal Nerve injury affect the integrity of the airway?

airway anatomy

Bilateral: hoarseness but no respiratory distress

Unilateral: no respiratory distress

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Name 3 airway blocks and identify the key landmarks for each one.

airway anatomy

-Glossopharyngeal nerve block: Palatoglossal arch at the anterior tonsillar pillar
-Superior laryngeal nerve block: Greater cornu of hyoid
-Transtracheal nerve block: Cricothyroid membrane

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What are the 3 paired and 3 unpaired cartilages of the larynx?

airway anatomy

Paired:
-Corniculates
-Cuneiforms
-Arytenoids

Unpaired:
-Epiglottis
-Thyroid
-Cricoid

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What is the treatment for laryngospasm?

airway anatomy

-100% FiO2
-Remove noxious stimulation
-Deepend anesthesia
-CPAP 15-20 cm H2O
-Open the airway (head extension, chin lift)
-Larson’s maneuver
-Succinylcholine (peds: 0.02 mg/kg, no IV=submental administration)
-Rocuronium if not able to get succinylcholine

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Contraction of which muscles widens the glottis aperture?

airway anatomy

Posterior cricoarytenoid

post-lesson quiz

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Which structures are anesthetized by injecting lidocaine at the base of the palatoglossal arch?

airway anatomy

Oropharynx and vallecula

cranial nerve 9

post-lesson quiz

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During a pediatric inhalation induction, the patient develops a “rocking horse” breathing pattern with a kiss if the capnograph waveform. What is the most likely diagnosis?

airway anatomy

Laryngospasm

post-lesson quiz

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A patient bites down on the ETT during anesthetic emergence. Pink, frothy sputum is noted inside the breathing circuit. Which maneuver explains the pathophysiology of this complication?

airway anatomy

Muller’s

inspiration against a closed glottis

post-lesson quiz

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Calculate the dose of IM Succinylcholine for a 16 kg patient.

airway anatomy

64 mg (child/adult dose = 4 mg/kg)

post-lesson quiz

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Match each intrinsic muscle of the larynx with its action on the vocal cords.
1. thyroarytenoid
2. cricothyroid
3. posterior cricoarytenoid
4. lateral cricoarytenoid
a. shortens
b. elongates
c. abducts
d. adducts

airway anatomy

1a
2b
3c
4d

pre-lesson Q1

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Muscles innervated by the RLN

airway anatomy

aryepiglottic
interarytenoid
vocalis
thyroarytenoid
lateral cricoarytenoid
posterior cricoarytenoid

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Muscles innervated by the SLN external branch

airway anatomy

cricothyroid

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Which muscles are classified as intrinsic laryngeal muscles?

airway anatomy

cricothyroid
thyroarytenoid
interarytenoid
vocalis

lesson 1 flashcard

Which muscles are classified as extrinsic laryngeal muscles?

airway anatomy

omohyoid
mylohyoid
digastric
sternohyoid
thyrohyoid

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The superior laryngeal nerve innervates the: (Select 2)
a. cricothyroid muscle
b. trachea
c. posterior third of the tongue
d. underside of the epiglottis

airway anatomy

a. cricothyroid muscle
d. underside of the epiglottis

pre-lesson Q2

Which landmark is identified for a superior laryngeal nerve block? a. greater cornu of hyoid bone b. superior horn of thyroid cartilage c. cricothyroid membrane d. palatoglossal arch ## Footnote airway anatomy

a. greater cornu of hyoid bone ## Footnote pre-lesson Q3

What cartilaginous structure is not visible during laryngoscopy? a. corniculate b. arytenoid c. cuneiform d. epiglotis ## Footnote airway anatomy

b. arytenoid ## Footnote pre-lesson Q4

What makes the cricoid cartilage unique? ## Footnote airway anatomy

-only complete cartilaginous ring in the airway ## Footnote lesson 4 flashcard

What is the narrowest region of the adult airway? ## Footnote airway anatomy

the level of the vocal cords ## Footnote lesson 4 flashcard

What's the narrowest part of the pediatric airway? ## Footnote airway anatomy

fixed: cricoid ring dynamic: vocal cords ## Footnote lesson 4 flashcard

Which maneuver is efficacious for the treatment of laryngospasm? a. Larson b. Valsalva c. Muller d. Bainbridge ## Footnote airway anatomy

a. Larson ## Footnote pre-lesson Q5

What non-depolarizing NMB can be given IM? ## Footnote airway anatomy

Rocuronium ## Footnote lesson 5 flashcard

What are the risks of Valsalva's maneuver? ## Footnote airway anatomy

-increased pressure in the thorax, abdomen, and brain ## Footnote lesson 5 flashcard

List 6 complications of laryngospasm. ## Footnote airway anatomy

a. airway obstruction b. negative pressure pulmonary edema c. pulmonary aspiration of gastric contents d. cardiac dysrhythmias e. cardiac arrest f. death ## Footnote lesson 6 flashcard

Tensor palatine muscle relaxation will most likely cause airway obstruction at which level? a. hard palate b. soft palate c. epiglottis d. tongue ## Footnote airway anatomy

b. soft palate ## Footnote pre-lesson Q6

When compared to the trachea, which factor is greater in the terminal bronchioles? a. total cross-sectional area b. airflow velocity c. amount of cartilage d. quantity of goblet cells ## Footnote airway anatomy

a. total cross-sectional area ## Footnote pre-lesson Q7

What vertebral level corresponds with the adult trachea? ## Footnote airway anatomy

C6 ## Footnote lesson 7 flashcard

What type of pneumocyte produces surfactant? ## Footnote airway anatomy

type 2 ## Footnote lesson 7 flashcard

What 2 landmarks correspond with the carina? ## Footnote airway anatomy

T4-5 Angle of Louis ## Footnote lesson 7 flashcard

What structures permit air movement between alveoli? ## Footnote airway anatomy

pores of Kohn ## Footnote lesson 7 flashcard

What type of pneumocyte provides the surface for gas exchange? ## Footnote airway anatomy

type 1 ## Footnote lesson 7 flashcard

Describe the relationship between the neck position and the tip of the ETT. ## Footnote airway anatomy

the tube goes where the nose goes ## Footnote lesson 7 flashcard

How many unpaired cartilages are present in the larynx? ## Footnote airway anatomy

3 | 3 pairs and 3 unpaired = 9 total ## Footnote review exam

For the patient in the sitting position, order the cartilages from superior to inferior. (1=sup, 4=inf) a. cricoid b. corniculate c. epiglottis d. arytenoid ## Footnote airway anatomy

1c 2b 3d 4a ## Footnote review exam

Which of the following is most likely to injure the left RLN while sparing the right RLN? a. mitral stenosis b. parathyroidectomy c. external pressure from an ETT d. external pressure from a LMA ## Footnote airway anatomy

a. mitral stenosis | d/t left atrial enlargement compressing the nerve ## Footnote review exam

Which muscle abducs the vocal cords? ## Footnote airway anatomy

posterior cricoarytenoid | abduct = pulls cords apart = PCA ## Footnote review exam

All of the following are landmarks for Larson's maneuver except the: a. skull base b. mastoid process c. ramus of mandible d. mandibular body ## Footnote airway anatomy

d. mandibular body ## Footnote review exam

Where is the adult larynx located? a. C2-C4 b. C3-C6 c. C4-C7 d. C5-T1 ## Footnote airway anatomy

b. C3-C6 | infant: C2-C4 ## Footnote review exam

The cricothyroid muscle is innervated by the: a. external branch of the SLN b. recurrent laryngeal nerve c. internal branch of the SLN d. glossopharyngeal nerve ## Footnote airway anatomy

a. external branch of the SLN ## Footnote review exam

Match the upper airway dilator muscle to its function. 1. tensor palatine 2. hyoid muscles 3. genioglossus a. opens nasopharynx b. opens hypopharynx c. opens oropharynx ## Footnote airway anatomy

1a 2b 3c ## Footnote review exam

Match the nerve to the structure that it innervates. 1. reccurent laryngeal 2. trigeminal 3. superior laryngeal 4. glossopharyngeal a. posterior epiglottis b. anterior tongue c. trachea d. vallecula ## Footnote airway anatomy

1c 2b 3a 4d ## Footnote review exam

Which type of pneumocyte produces surfactant? ## Footnote airway anatomy

2 | 1: gas exchange 2: surfactant 3: macrophages ## Footnote review exam

In preparation for an awake intubation, you anesthetize the upper airway with aerosolized lidocaine. Shortly after you being the procedure, the patient is unable to tolerate the scope just beyond the epiglottis but before the vocal cords. Which regional technique will increase the patient's ability to tolerate the rest of the procedure? a. 2 mL at the tonsillar pillars bilaterally b. 3 mL at the inferior aspect of the greater cornu of the hyoid bone bilaterally c. 4 mL at the thyroepiglottic membrane d. 5 mL at the cricothyroid membrane ## Footnote airway anatomy

b. inferior aspect of the greater cornu of the hyoid bone bilaterally | SLN coverage ## Footnote review exam

Risk factors for intraoperative laryngospasm include: (Select 3) a. deep anesthesia b. hypercapnia c. GERD d. recent URI e. exposure to second hand smoke f. old age ## Footnote airway anatomy

c. GERD d. recent URI e. exposure to second hand smoke ## Footnote review exam