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Head/Neck > Airway/Larynx/Swallowing > Flashcards

Airway/Larynx/Swallowing Flashcards

1
Q

What region of obstruction is characteristic of inspiratory stridor?

A

Supraglottic/glottic

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2
Q

What region of obstruction is characteristic of biphasic stridor?

A

Subglottic

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3
Q

What region of obstruction is characteristic of expiratory stridor?

A

Tracheobronchial

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4
Q

How do neonates breathe?

A

Obligate nasal breathers

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5
Q

What is the typical presentation of nasal foreign bodies in young children?

A

Unilateral malodorous rhinorrhea

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6
Q

What is the function of the larynx?

A

Conduit for ingested material into esophagus, protection of lower airways from aspiration, and intricate structures utilized in phonation

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7
Q

What is the difference in position between the adult and neonatal larynx?

A

Neonatal larynx is at the level of C2 and contacts the palate and epiglottis directly (provides airway protection and helps with feeding), adult larynx lies at the C7 vertebral body

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8
Q

What nerve provides sensory innervation tot he larynx? Muscle innervation?

A

Sensory: superior laryngeal

Motor: recurrent laryngeal

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9
Q

What is the pathway of the recurrent laryngeal nerve?

A

It travels into the upper thorax from the skull base, loops around cardiovascular structures, and then goes back up to innervvate vocal cords

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10
Q

What is the supraglottis? Glottis? Subglottis?

A

Supraglottis = area above vocal cords

Glottis = vocal cords

Subglottis = cricoid cartilage

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11
Q

What is the function of the cricothyorid muscle?

A

Laryngeal tilting which stretches and tightens the vocal folds (inflection of voice)

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12
Q

What is the function of the posterior cricoarytenoid muscle?

A

Actively abducts the larynx

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13
Q

What is the laryngeal adductor reflex?

A

A reflux for adductor stimulus that leads to rapid closure of the laryngeal muscles to prevent penetration and aspiration into the airway

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14
Q

Why is left vocal cord paralysis more common than right?

A

The left recurrent laryngeal nerve has a long course around the heart and is at high risk for injury

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15
Q

What is the most common cause of stridor in neonates?

A

Laryngomalacia - immature supraglottic opening at birth (omega shaped epiglottis)

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16
Q

What is subglottic stenosis?

A

Stenosis of the subglottic ring that can be congenital or acquired during intubation injury

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17
Q

What is the most common subglottic tumor in neonates?

A

Subglottic hemangioma

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18
Q

What is the presentation of subglottic hemangioma?

A

Usually presents with cutaneous hemangioma, worsens with crying, improves with calm and steroids, often mistaken for croup.

Treated with propanolol for 12 months

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19
Q

What is a tracheosophageal fistula?

A

A congenital connection between the trachea and esophagus and is associated with esophageal atresia

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20
Q

What is complete tracheal rings?

A

Results from failure of development of the trachealis muscle posteriorly, leading to a stenotic and rigid fully enclosed ring. Highly associated with cardiac anomalies.

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21
Q

What is the epiglottis?

A

Laryngeal cartilage in oropharynx guarding the entry to larynx

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22
Q

What is a valleculae?

A

Recesses in oropharynx anterior to the epiglottis on either side of the glosso-epiglottic fold at the back of the tongue

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23
Q

What is the piriform recess?

A

Interval on each side of the laryngopharynx between the cricoid cartilage and posterior edge of thyroid cartilage of larynx

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24
Q

What are vestibular folds?

A

False vocal folds that overlay true vocal folds

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25
Q

What is the vestibule of the larynx?

A

Entryway into larynx between aryepiglottic folds above vestibular (false) folds below

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26
Q

What is the ventricle of the larynx?

A

Compartment on each side between the false vocal cords above and the true vocal cords below

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27
Q

What is the rima glottidis?

A

The space between the two vocal cords

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28
Q

What is the quadrangular membrane?

A

Connective tissue wall of the vestibule (lower edge forms false vocal cords)

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29
Q

What is the triangular membrane?

A

Conus elasticus bounding the infraglottic cavity, forms the cricothyroid ligament

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30
Q

What are vocal ligaments?

A

Superior portion of the conus elasticus (focal fold is what vibrates)

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31
Q

What is the function of the posterior cricoarytenoid?

A

Rotates the arytenoid cartilages laterally to pull the cords apart (abduction) during inspiration

only muscle that abducts

32
Q

What is the function of the lateral cricoarytenoid muscle?

A

It rotates the arytenoid cartilages medially to adduct the vocal folds, closes airway to protect it (also aids with coughing)

33
Q

What is the function of the transverse arytenoid?

A

Pulls the arytenoid cartilages together for complete adduction

34
Q

What happens if lateral cricoarytenoids contract without transverse arytenoids?

A

The vocal cords close but not completely, leading to a whisper

35
Q

What are the functions of the cricothyroid muscle?

A

pulls thyroid cartilage down toward cricoid cartilage to stretch and tense vocal cords, raising pitch of voice

36
Q

What are the functions of the thyroarytenoid muscle?

A

Pulls the thyroid cartilage posteriorly toward the arytenoid cartilages to shorten and relax the vocal ligaments and folds, lowering pitch of voice

37
Q

What is the function of the thyroepiglottic muscle?

A

Pulls the epiiglottis forward to open the larynx

38
Q

What is the function of the aryepiglottic muscle?

A

It helps close the epiglottis

39
Q

What is A?

A

Epiglottis

40
Q

What is B?

A

Aryepiglottic fold

41
Q

What is C?

A

Aryepiglottic muscle

42
Q

What is D?

A

Oblique arytenoid muscles

43
Q

What is E?

A

Transverse arytenoid muscle

44
Q

What is F?

A

Posterior cricoarytenoid muscle

45
Q

What is G?

A

Oblique part of cricothyroid muscle

46
Q

What is H?

A

Straight part of cricothyroid muscle

47
Q

What is I?

A

Thyrohyoid membrane

48
Q

What is J?

A

Opening for internal laryngeal nerve

49
Q

What is the function of the thyrohyoid?

A

Elevates the larynx with the superior hyoid muscles (helps with swallowing)

50
Q

What is the function of the sternothyroid?

A

Pulls thyroid cartilage down towards the cricoid cartilage, helping stretch vocal cords and raise pitch of voice

51
Q

What is the function of the external laryngeal nerve?

A

Branchiomotor to cricothyroid muscle

52
Q

What is the function of the internal laryngeal nerve?

A

Pierces thyrohyoid membrane to provide visceral sensory and parasympathetic innervation to all of the larynx above vocal cords

53
Q

What is the function of the inferior laryngeal nerve?

A

Visceral sensory and parasympathetic to the larynx below the vocal folds, branchiomotor to all muscles of larynx except cricothyroid

comes from the vagus nerve

54
Q

What is the ramus communicans?

A

A communicating sensory branch from the inferior laryngeal nerve to the superior laryngeal nerve

55
Q

What primordia does the mucosa of the larynx come from?

A

Pharyngeal arches four and six

56
Q

What larynx structures come from pharyngeal arch four?

A

Most of epiglottis, most of thyroid cartilage

57
Q

What larynx structures come from pharyngeal arch 6?

A

Cricoid and arytenoid

58
Q

What is the only laryngeal muscle that can maximally open the airway by abducting the vocal folds?

a) thyroarytenoid
b) lateral cricoarytenoid
c) cricothyroid
d) posterior cricoarytenoid
e) transverse arytenoids

A

d) posterior cricoarytenoid

59
Q

What laryngeal nerve is the sensory limb of the cough reflex?

a) external
b) superior
c) internal
d) recurrent
e) inferior

A

c) internal

60
Q

Where does food often get trapped?

a) piriform recess
b) vestibule
c) valleculae
d) infraglottic cavity
e) ventricle

A

a) piriform recess

61
Q

A deformed or undersized thyroid cartilage might be the result of deficient population of ectomesenchyme in which pharyngeal arch?

a) 1
b) 2
c) 3
d) 4
e) 6

A

d) 4

62
Q

What are the three phases of swallowing?

A

Oral, pharyngeal, and esophageal phases

63
Q

What occurs in the oral phase of a swallow?

A

Lips seal bolus in oral cavity –> tongue transports bolus to oropharynx

64
Q

What occurs in the pharyngeal phase of a swallow?

A

Nasopharynx is sealed by soft palate contact to superior pharyngeal constrictor –> bolus propeled through the pharynx (tongue base and posteiror pharyngeal wall) while larynx is sealed off to prevent aspiration

65
Q

What occurs in the esophageal phase of swallowing?

A

Bolus tranpsorted to cervical esophagus through upper esophageal sphincter

66
Q

What nerual signals lead to an oropharyngeal swallow?

A

It is under control of a central pattern generator

67
Q

What is the difference in nerve control between primary and secondary peristalsis?

A

Primary = dependent on extrinsic innervation, secondary = dependent on an intramural nerve network (myenteric plexus)

68
Q

What is the most likely cause of dysphagia associated with coughing or aspiration?

A

Oropharyngeal

69
Q

What is the most likely cause of dysphagia associated with chest pain?

A

Esophageal

70
Q

What is the most likely cause of dysphagia associated with only solid food?

A

Mechanical cause (ex. stricture)

71
Q

What is the most likely cause of dysphagia associated with solids and liquids?

A

Motor disorder

72
Q

What are the two main tools to evaluate oropharyngeal dysphagia?

A

Viddeofluoroscopy (aka MBS), fiberoptic endoscopic evaluation of swallowing (FEES)

73
Q

Dysphagia, or impaired swallowing is:

a) a symptom of larger impairment
b) unique to only older adults
c) limited inetiology, usually only to those with neurological impairment
d) synonymous with aspiration

A

a) a symptom of larger impairment

74
Q

When discussing invasion of food or liquid into the airway, _______ is defined as ingested material below the level of the true vocal cords, whereas ______ is defined as ingested material above the level of true vocal cords.

a) penetration; aspiration
b) aspiration; penetration
c) aspiration; dysphagia
d) aspiration; superficial aspiration

A

b) aspiration; penetration

75
Q

A 64 y.o. man with a history of DLBCL diagnosed 2 years ago presents with weight loss, hypernasality, fluxuating voice changes, low-grade fever. Imaging is remarkable for new cranial nerve lesions impacting CN X, XII. Chest x-ray on admission is notable for bilateral lower lobe infiltrates. Patient denies difficulty swallowing. What is notable about this patient’s history and complaints that would be concerning for possible dysphagia?

A
  • involvement of CN X and XII may interfere with oral and pharyngeal phases of sawllowing
  • fever and bilateral lower lobe infiltrates
  • weight loss could be secondary to swallowing impairment

Head/Neck (17 decks)

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