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Anaesthetics > Airway and Respiratory Anatomy > Flashcards

Airway and Respiratory Anatomy Flashcards

1
Q

Trachea extends from where to where? Levels!

A

Cricoid cartilage at C6
Tracheal bifurcation at carina T5-6
Lies midline anterior to oesophagus

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2
Q

Length of trachea

A

15cm

5cm above sternal notch or 8cm if neck fully extended

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3
Q

Patency of trachea is maintained by what?

A

C rings of cartilage anteriorly

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4
Q

The thyroid isthmus overlies which tracheal rings?

A

2-4

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5
Q

Characteristics of right main bronchi

What relevance is this to aspiration?

A

Shorter wider and vertically placed compared to left
RUL arises 2.5cm from carina
More likely to aspirate into apical bronchus of right lower lobe as it is the first segmental bronchus arising posteriorly.

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6
Q

Lung lobes

A

Right - 3 split by horizontal and oblique fissure

Left - 2 plus lingula (middle lobe remnant)

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7
Q

What are the layers that enclose the lung?

A

Visceral
Parietal attached to chest wall and mediastinum
Pleural cavity in between layers which contains serous fluid

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8
Q

What causes negative intrapleural pressure?

A

Outward spring of rib cage and elastic recoil of lungs

Thoracic cage volume increases the negative intrapleural pressure and the lungs inflate

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9
Q

Which part of the lung remains vulnerable during some procedures?

A

2-4cm above mid third of clavicle exposed to intravenous procedures and nerve blocks (intercostal and brachial plexus)
Surgery on adrenal and kidney also problematic as lung extends to Costo diaphragmatic recess.

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10
Q

How many bronchopulmonary segments are there?

A

10 each with own blood supply and distinct lung parenchyma

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11
Q

Bronchioles is also called what? What condition occurs at this lung level?

A

Primary lung lobule

Asthma as it contains smooth muscle and no cartilage

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12
Q

Alveoli are lined with what?

A

Single layer of fine non ciliated cuboidal epithelium

Separated from capillary network by fine basement membrane

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13
Q

What produces lung surfactant?

A

Type II pneumocytes situated in alveoli

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14
Q

How does lung surfactant work?

A

Prevents air sacs from collapsing

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15
Q

Mediastinum is made up of how many compartments?

A

Space between the 2 pleural cavities

4 - ant, post, middle and superior

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16
Q

A mass in which mediastinal compartment would concern anaesthetists?

A

Anterior

Loss of muscle tone post-induction would allow mass to fall back against the heart and great vessels and major airway

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17
Q

What is the most important muscle of respiration?

A

Diaphragm
Contributes to 60-75% tidal volume
Flattens to push Abdominal contents down and ribs up and out
1.5cm in quiet resp, 13cm movement in deep resp

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18
Q

What is the nerve supply of the diaphragm?

What happens if this nerve is damaged?

A

C3-5 phrenic

Damage causes a upward ipsilatersl paradoxical movement of diaphragm

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19
Q

What else does the diaphragm contribute to?

A

LOS

Disrupted in hiatus hernia

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20
Q

What muscles help with forced expiration?

A

Abdominal and diaphragm

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21
Q

What limits diaphragmatic movement?

A

Abdominal distension -pregnancy/ obesity/ pneumoperitoneum

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22
Q

What is the function of the external intercostal muscles?

A

Slope down and forward to pull ribs up and out on inspiration
Increases anteroposterior and lateral thorax diameter

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23
Q

What are the functions of the internal intercostal muscles?

A

Slope down and back

Only use in active expiration pulling ribs down and in

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24
Q

What do the innermost intercostal muscles do?

A

Stabilise chest wall linking ribs

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25
Q

What is the nerve supply to the intercostal muscles?

Why do nerve blocks at this nerve not affect respiration significantly?

A

T1-T11

Diaphragmatic contribution 65-70%

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26
Q

Accessory muscles function how?

A

Scalene - elevate first 2 ribs
SCM - elevate sternum
Small muscles of head and neck and nasal flaring

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27
Q

What is the depth of trachea tube insertion?

A

F - 21cm at the lips

M - 23cm at the lips

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28
Q

What phase is a CXR taken in?

A

Full inspiration

At lest 6 ribs visible anteriorly and 10 posteriorly

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29
Q

What is the safe triangle in chest drain insertion?

A

Emergency - 2nd ICS Midclavicular line just above 3rd rib

Formal drain - 5th ICS (below 5th rib but just above 6th rib, midaxillary line

30
Q

Airway assessment consists of what?

A 
Mouth opening 
Dental 
MP
Jaw protrusion
Neck extension
Thyromental distance
31
Q

What anatomical variants prove tricky for airway management?

A 
High arched palate
Small mouth 
Receding chin
Large tongue
Beard
Poor dentition
TMJ disease
Tonsilar hypertrophy
32
Q

What acquired issues are difficult in airway management?

A 
Burns
Tumours 
Abscess
Radiotherapy 
Scarring
33
Q

What happens to the airway under anaesthesia?

A

Loss of muscle tone

Pharyngeal airway loses patency

34
Q

What manoeuvres aid airway patency?

A

Jaw thrust

Chin lift

35
Q

What adjuncts can be used to improve airway patency?

A

NPA/OPA
LMA
ETT

36
Q

What is the function of the nose?

A

Warm humidify air by pseudostratified ciliated columnar epithelium and mucous serous glands
Smell
Speech resonation

37
Q

What is the widest part of the nasal airway?

A

Below the inferior turbinate

38
Q

What are the advantages and disadvantages of nasal intubation?

A

A- Better tolerated. Leaves oral cavity free for surgery

D- Bleeding, false passage in skull fractures, infection

39
Q

What is the function of the palate?

A

Separates nose and mouth during swallowing

40
Q

What does the hard palate consist of?

A

Palatine process of the maxilla and the horizontal sort of the palatine bone

41
Q

What nerves supply the gag reflex?

A

Afferent - glossopharyngeal CN IX

Efferent - vagus CN X

42
Q

Pharynx is made up of what?

A

Oropharynx, nasal pharynx and laryngopharynx

43
Q

Where do fish bones lodge?

A

Piriform fossae, recesses either side of the larynx

44
Q

What are the pillars of fauces?

A

Palatine tonsils lymphoid tissue between palatoglossal and palatopharyngeal arches
Hypertrophy in childhood

45
Q

What is the nerve supply to the tonsils?

A

3 nerves
Glossopharyngeal, maxillary,mandibular
Anaesthetic to the tonsilar bed most effective analagesia

46
Q

Swallow reflex

A

Closure of laryngeal sphincter
Upward movement of larynx behind base of tongue
Inhibited breathing
Lateral channeling of food by epiglottis into piriform fossae
Epiglottis lid over trachea

47
Q

What are the articulating cartilages of the larynx?

A 
Thyroid 
Cricoid
Epiglottis
Arytenoid (with superior cricoid)
Corniculate
Cuneiform visible on laryngoscopy at aryepiglottic folds
48
Q

Where do the intrinsic muscles of the larynx attach

A

Arytenoids, pivot to adjust vocal cord position

49
Q

What are the false cords?

A

Vestibular folds (mucous membrane that covers the free borders of the intrinsic ligaments of the larynx)

50
Q

Where is the narrowest part of the airway?

A

The glottis - gap between true vocal cords

Also known as the Rima glottidus

51
Q

What do the extrinsic larynx muscles do?

A

Attach to hyoid and work with other muscles to move the larynx up and down during swallowing

52
Q

What do the intrinsic larynx muscles do?

A

Open the vocal cords during inspiration
Close cords and laryngeal inlet during swallowing
Alter tension of cords during phonation

53
Q

What are the vocal cord abductors?

A

Posterior cricoarytenoids

54
Q

How does abduction of vocal cords on inspiration occur?

A

Pull posterior ends of arytenoid cartilages together. Pivot then abducts the anterior ends of the cartilages to which vocal cords are attached.

55
Q

What are the vocal cord adductors? (Close)

A

Lateral cricoarytenoids and transverse arytenoids

56
Q

Aryepiglottis and thyroepiglottis do what?

A

Laryngeal sphincters -close laryngeal inlet during swallowing

57
Q

Cricothyroid muscle does what?

A

Tensor of cords

Pivot at cricoid cartilage on the thyroid cartilage

58
Q

What muscle relaxes the cords?

A

Thyroarytenoids

59
Q

Vocalis muscle does what?

A

Fine tunes cords

60
Q

What is the sensory supply to the larynx?

A 
Vagus
Branches to:
Superior laryngeal nerve 
(Above cords) internal branch 
Recurrent laryngeal nerve (below cords)
61
Q

What branches of the superior laryngeal nerve are there?

A

Internal - sensory to interior larynx and vallecula

External - motor supply to cricothyroid muscle

62
Q

What happens with superior laryngeal nerve damage?

A

Temporary Hoarseness

Aspiration risk

64
Q

What does RL nerve supply?

A

Sensation below vocal cords

Motor to all intrinsic muscles of larynx apart from cricothyroid

65
Q

Bilateral vocal cord/ SLN palsy causes what?

A

Severe respiratory distress

Stridor due to flaccid cords

66
Q

Cricothyroid membrane lies where?

A

Between thyroid and cricoid cartilage

Avascular band

67
Q

What can be damaged in a surgical airway?

A

Vocal cords

Causes subglottic stenosis

68
Q

What are the paths of the right and left RL nerves?

A

Right passes under subclavian artery then ascend to larynx in tracheo-oesophageal groove

Left passes under aortic arch to ascend in same groove

69
Q

What equipment do you need for an emergency cricothyroidotomy?

A

6 ett
10 blade scalpel
GEB
Suction

72
Q

Unilateral RL nerve damage results in?

A 
Vocal cord palsy
Hoarseness
Poor glottis closure
Poor cough (cannot generate positive intrathoracic pressure)
Aspiration risk
73
Q

Neurovascular bundle lies where in relation to run surface?

A

Inferior surface

Anaesthetics (12 decks)

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