Anatomy Flashcards
What supplies the lateral tip of 4th digits cutaneous nerve
Median
Tibial nerve blocks ….
Planter surface of foot
3 nerves blocked for awake intubation are …
- Anterior tonsillar pillar (at the base) – blocks glossopharyngeal (only the tonsillar, lingual & pharyngeal branches are blocked here, not the whole nerve)
- Inferior aspect of greater cornu of the hyoid bone – blocks the INTERNAL branch of the superior laryngeal nerve
- Transtracheal – recurrent laryngeal
what is the area called between epiglottis and vocal cords? which innervation? how to block it?
Hypopharynx, which is to say the portion of the oropharynx below the level of epiglottis. This area is innervated by the internal branch of the superior laryngeal nerve, which itself is a branch of the vagus nerve. Remember that the external branch caries motor innervation (to the cricothyroid muscle). It is effectively blocked by injecting 3-5 cc of lidocaine at the inferior aspect of greater cornu of the hyoid bone. The block will reliably cover the internal branch and many cases cover both branches (sensory (internal) and motor (external)).
Why we perform transtracheal block instead of blocking the recurrent laryngeal nerve percetaneous along trachea sides b/l?
To avoid motor blockade and therefore avoid hoarseness or stridor. (recurrent laryngeal not only innervates trachea, but vocal cords as well as larynx, and by blocking it outside trachea, it could cause abduction of vocal cords by losing its motor function and result into hoarseness or stridor).
Which muscle responsible for vocal cord abduction?
Posterior cricoarytenoid
There is only one tensor muscle called … and its is innervated by …
Cricothyroid
external branch of laryngeal nerve (the only muscle not innervated by recurrent laryngeal).
which vocal cord side affected if patient presents with hoarseness with expanding ascending thoracic anyresum?
the left sided vocal lost motor because the left recurrent laryngeal nerve courses under aortic arch before coursing back up to the glottis.
What is the most sensitive indicator test/exam for difficult intubation?
Mallampati
Second would be reduced thyromental distance
The most specific indicator test for difficult intubaiton is ..
Thyromental distance (99% specificity) Followed by neck movement and mouth opening
Even though Mallampati score is the least specific test, it is still relatively specific (80-90% by most estimations).
The indicator test for difficult intubaiton that has the most PPV is …
History of difficult intubation.
the narrowest airway area is …
glottic opening in adults
cricoid cartilage in neonates. (meaning passing the tube beyond vocal cords then might be tighter to pass it through cricoid cartilage).
the takeoff right upper bronchus is located … cm below carina.
In normal individuals the right upper lobe bronchus comes off the right main bronchus 2 cm (slightly less in women) below the level of the carina. In less than 0.5% of individuals, the right upper lobe bronchus takeoff is directly off the trachea, near the level of the carina.
With a right sided double lumen tube, the bronchial lumen would enter the right main bronchus and a special Murphey’s eye needs to be lined up with right upper lobe bronchus takeoff to ensure ventilation of this lobe. This is not possible with an individual with an abnormal location of the right upper lobe bronchus takeoff. This is a common boards topic and more likely to appear in the advanced exam here on out. The anatomy itself, on the other hand, has high basic exam potential.
the alveolus composed of pneumocytes I participating in … and pnumocytes II participates in …
alveolar capillary gas exchange, where type 2 produce surfactant.
Type 2, far more numerous than type 1 and can differentiates to type 1 (where type 1 cant be differentiate to type 2).
sensory innervation to lungs provided by …
Vagus Nerve.
Essentially all respiratory sensation distal to the vocal cords is ultimately vagal. The vagus nerve also supplies the parasympathetic innervation to the lung, which mediates bronchoconstriction and bronchial secretions
Sympathetic fibers originating from T1-4 supply …
the sympathetic innervation to the lung and mediate bronchodilation.
Also supply the sympathetic stimulation to the heart and are referred to as the cardioaccelerators, where they increase heart rate and contractility. Loss of T1-4 (by way of high spinal, for example) can result in bradycardia. Of very high importance, the T1-4 sympathetic fibers travel up through the stellate ganglion first before coursing to the heart as the cardiac nerves (very high potential for an exam question and something that you might miss when you only study the explanations of questions you got wrong!!!).
Coronary Blood Supply?
You can think of the LV as 6 walls: anteroseptal, inferoseptal, inferior, inferolateral, anterolateral, and anterior walls (the term posterior wall has fallen out of favor). Some walls have have dual supply, but in general the below list should be adequate for the anesthesia boards anteroseptal LAD inferoseptal RCA & LAD inferior RCA inferolateral RCA & LCx anterolateral LCx anterior LAD
Ventricular septum supplied by
LAD
anteroseptal LAD inferoseptal RCA & LAD inferior RCA inferolateral RCA & LCx anterolateral LCx anterior LAD
