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airway anatomy Flashcards

1
Q

cricothyroid does what to the airway

A

cords tense (which elongates)

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2
Q

what do the vocal cords attach to anteriorly and posteriorly

A

anteriorly: thyroid
posteriorly: aretynoids

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3
Q

all extrinsic laryngeal muscles end in

A

-hyoid (except digastric)

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4
Q

muscles that depress the larynx include (3)

A

thyrohyoid
omohyoid (superior and posterior belly)
sternohyoid

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5
Q

muscles that elevate the larynx include (8)

A

digastric (anterior and posterior belly)
mylohyoid
stylohyoid
sternohyoid and omohyoid
thyrohyoid
sternothyroid
omohyoid (superior belly)
sternohyoid

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6
Q

where does the superior laryngeal internal nerve provide sensory innervation

A

posterior side of epiglottis to level of vocal cords

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7
Q

where does the superior laryngeal external nerve provide motor innervation

A

cricothyroid muscle (tenses vocal cords)

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8
Q

acute injury to SEM branch causes what

A

hoarseness but not respiratory distress because cord can not be tensed

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9
Q

where does the RLN provide sensory innervation

A

below the vocal folds to the trachea

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10
Q

where does the RLN provide motor innervation

A

all intrinsic laryngeal muscles except cricothyroid

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11
Q

risk factors specific to left RLN injury (more frequent) include (4)

A

PDA ligation, left atrial enlargement (secondary to mitral stenosis), aortic arch aneurysm, thoracic tumor

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12
Q

what happens with acute bilateral RLN injury

A

tensing action of cricothyroid muscles act unopposed, will be in respiratory distress. presents similarly to laryngospasm.

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13
Q

3 cranial nerves that innervate upper airway

A

glossopharyngeal
trigeminal
vagus

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14
Q

3 branches of trigeminal nerve (CN5) and what they innervate

A

V1 ophthalmic aka anterior ethmoidal (nares and anterior 1/3 of nasal septum)
V2 maxillary aka sphenopalatine (turbinates and septum)
V3 mandibular aka lingual (anterior 2/3 of tongue)

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15
Q

sensory innervation of glossopharyngeal nerve (CN9)

A

oropharynx and anterior side of epiglottis. this includes soft palate, tonsils, posterior 1/3 of tongue, vallecula, anterior side of epiglottis

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16
Q

afferent and efferent limbs of gag reflex

A

afferent: glossopharyngeal
efferent: vagus

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17
Q

at the level of the ______, the SLN divides into internal and external branches

A

hyoid

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18
Q

the internal branch of the SLN penetrates which membrane

A

the thyrohyoid membrane between the greater cornu of the hyoid bone and the superior horn of the thyroid cartilage

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19
Q

the right RLN loops under the __________ while the left RLN loops under the ____________

A

right RLN loops under subclavian artery while left RLN loops under the aortic arch

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20
Q

considerations for glossopharyngeal nerve block

A
  1. insert needle at base of palatoglossal arch (anterior tonsilar pillar) to a depth of .25-.5cm. (aspiration of air means needle is too deep. aspiration of blood means withdraw from carotid and re direct medially)
  2. insert 1-2mL of LA
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21
Q

considerations for superior laryngeal nerve block

A
  1. anesthetic injected at inferior border of greater cornu of hyoid bone
  2. Once 1mL is injected outside of the thyrohyoid membrane, 2-3mL is injected 3mm deep to the thyrohyoid membrane. (aspiration of air means needle is too deep)
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22
Q

considerations for RLN block

A
  1. puncture CTM and advance needle in caudal direction
  2. after aspiration, but before injection, tell the patient to take a deep breath. during that inspiration, inject 3-5mL of LA into the tracheal lumen. the patient will cough and it will go upwards towards the cords.
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23
Q

the adult larynx lies anterior to which cervical vertebrae?

A

C3-C6

24
Q

3 paired and 3 unpaired laryngeal cartilages

A

paired: aretynoid, corniculate, cuneiform
unpaired: thyroid, epiglottis, cricoid

25
Q

the only bone in the body that does not articulate with another bone

A

hyoid

26
Q

narrowest fixed region of airway in kids less than 5 years

A

cricoid ring

27
Q

narrowest dynamic region of airway in kids less than 5 years

A

vocal cords

28
Q

laryngospasm pathway (afferent and efferent limbs)

A

afferent limb: internal branch of SLN
efferent limb: external branch of SLN (cricothyroid) and RLN (lateral cricoaretynoid, thyroaretynoid- both close glottis)

29
Q

pre anesthetic risk factors of laryngospasm (5)

A

<1 year old
exposure to second hand smoke
GERD
active or recent URI (<2w)
reactive airway disease

30
Q

order in which you should treat laryngospasm

A
  1. FiO2 100%
  2. remove noxious stimuli
  3. deepen anesthetic
  4. CPAP 15-20cmH2O
  5. open airway
  6. larsens maneuver
  7. administer succ
31
Q

dose of succ IV and IM for laryngospasm (adult)

A

IV 1mg/kg
IM 4mg/kg (also for children)

32
Q

dose of succ IV and IM for laryngospasm (neonates/infants)

A

IV neonate or infant 2mg/kg
IM neonate or infant 5mg/kg

33
Q

when administering succ to a kid under 5, you should co administer

A

atropine .02mg/kg

34
Q

anesthesia induced obstruction at the level of the tongue is related to

A

geniglossus muscle relaxation (most common)

35
Q

anesthesia induced obstruction at the level of the soft palate is related to

A

tensor palatine muscle relaxation

36
Q

what do hyoid muscles help keep open in upper airway

A

hyopharynx

37
Q

angle of right mainstream bronchus

A

25 degrees

38
Q

angle of left mainstream bronchus

A

45 degrees

39
Q

where does trachea begin and end

A

C6 to T4/5

40
Q

how many cm long is trachea

A

10-13cm

41
Q

type of cells in trachea

A

ciliated columnar epithelium

42
Q

sensory innervation to trachea

A

vagus nerve

43
Q

blood supply to trachea (4 arteries)

A

inferior thyroid artery
superior thyroid artery
bronchial artery
internal thoracic artery

44
Q

what does the carina correspond to

A

angle of louis

45
Q

type of cells in carina

A

ciliated columnar epithelium

46
Q

type of cells in mainstem bronchi

A

cuboidal epithelium

47
Q

what allows air movement between alveoli

A

pores of Kohn

48
Q

what type of cells in alveoli

A

squamous epithelium

49
Q

type 1 pneumocytes

A

provide surface for gas exchange.
-flat squamous cells
-cover 80% of alveolar surface
-form tight junctions

50
Q

type 2 pneumocytes

A

produce surfactant
-resistant to O2 toxicity
-capable of cell division
-can produce type 1 cells

51
Q

type 3 pneumocytes

A

macrophages
-fight lung infections
-produce inflammatory response

52
Q

what is present in alveoli of smokers and patients with acute lung injury

A

neutrophils

53
Q

distance from incisors to larynx then larynx to carina

A

13cm then 13cm (26cm total)

54
Q

in children less than 3 years old, what is the angle of the mainstem bronchi on both sides

A

55 degrees

55
Q

what type of cells decrease as airway bifurcates

A

goblet cells
ciliated cells

Apex Flashcards (71 decks)

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