Basic Anatomy

Question 1

Narrowest part of adult airway? Neonates?

Answer 1

Glottic opening (between vocal cords)
For neonates, it's the cricoid cartilage.  An ETT that easily passes the cords may be tight at level of cricoid cartilage and could cause ischemia.

Question 2

Type 1 vs Type 2 pneumocytes

Answer 2

Type 1: thin walled epithelial cells that allow gas exchange between alveolar lumen to capillaries

Type 2: small cells, produce surfactant, differentiate into Type 1 pneumocytes, and are far more numerous than type I pneumocytes.

Question 3

Aneurysm of the aortic arch affects which structure of the airway?

Answer 3

Left main bronchus, the arch crosses up, over and behind the left main bronchus and could compress this structure.

Question 4

The sniffing position brings which axis more parallel to each other

Answer 4

The laryngeal and pharyngeal axis. The oral axis remains perpendicular to the laryngeal (and now pharyngeal) axis.

Question 5

Nerve roots:

• C1 nerve root passes…
• C8 nerve root passes
• T1 nerve root passes…
• L4 passes

Answer 5

• C1 nerve passes above C1 vertebrae
• C8 passes above T1
• T1 passes above T2
• L4 passes above L5 vertebrae

7 Cervical vertebrae
12 Thoracic vetrebrae
5 Lumbar vertebrae
5 sacral vertebrae

8 cervical nerves
12 thoracic nerves
5 lumbar nerves
5 sacral nerves

Question 6

Location of the Internal jugular vein in the neck?

Answer 6

Courses anterior to the anterior and posterior heads of the stercleidomastoid muscles, lateral to the carotid artery.

Question 7

Sensation of the lung is provided by what nerve?

Answer 7

The vagus nerve.

Vagal: supplies parasympathetic innervation of lung, mediates bronchoconstriction and bronchial secretions.

T1-4 sympathetic fibers: mediate bronchodilation, increase HR.

Question 8

Brachial plexus passes between…

Answer 8

Anterior and middle scalene muscles

Question 9

Supplies of the heart
Anteroseptal =
Inferoseptal = 
Inferior = 
Inferolateral = 
Anteriolateral =
Anterior =

Answer 9

Anteroseptal = LAD
Inferoseptal = RCA & LAD
Inferior = RCA
Inferolateral = RCA & LCx
Anteriolateral = LCx
Anterior = LAD

Question 10

Where do the subclavian artery and vein course?

Answer 10

Vein = anterior to the anterior scalene
Artery= between the anterior and middle scalenes

Both course superior to the 1st rib and enter thorax

Question 11

The superior aspect of the iliac crest coordinates with which vertebreal level?

Answer 11

L4

Question 12

The tip of the scapula coordinates with which vertebreal level?

Answer 12

T7

Question 13

The facet joint is innervated by which branch of the spinal nerves?

Answer 13

Posterior branch of the posterior division of spinal nerves

Common source of back pain. Can be treated by a medial branch block, must block both above and below the joint for full affect.

Question 14

The takeoff of the R upper lobe bronchus comes off where in relation to the carina?

Answer 14

About 2cm below the carina.

Question 15

What is Type 1 Atrial flutter and where do you need to ablate to treat it?

Answer 15

Type 1 or “typical”: reentrant circuit involving the “cavo-tricuspid isthmus. Essential, its a currant in the R atria.

Question 16

At what vetebreal level is the coeliac (celiac) plexus?

Answer 16

L1, the celiac plexus innervates the foregut, liver, kidneys, spleen, pancreas and gallbladder.

The celiac block treats visceral pain fibers as well as sympathetic fibers allowing unopposed parasympathetic activity –> diarrhea and hypotension

Question 17

In adults and neonates what vertebral level does the spinal cord end?

Answer 17

Neonates: L3 (usually switches to L1 by 2 months)
Adults: L1

Question 18

What is the least specific indicator for difficult intubation?

Most specific?

Answer 18

Mallampati III
-While Mallampati is the most sensitive indicator for difficult intubation, it is the least specific (around 80-90%).

Most specific is the thyromental distance (99% specificity) followed by neck movement and mouth opening.

Question 19

Which muscles abduct the vocal cords? Which cause tension of the vocal cords?

Answer 19

Abduct: Posterior cricoarytenoids

Tense: Cricothyroid muscle (inntervated by the external branch of the superior laryngeal nerve.) This muscle tilts the thyroid cartilage helping to tense the vocal cords

Question 20

The recurrent laryngeal nerve innervates which muscles of the larynx?

Answer 20

All of the muscles except the cricothyroid muscle (innervated by the external branch of the superior laryngeal nerve, branch of vagus nerve)

Question 21

Where is the location and effects of a stellate nerve block?

Answer 21

Location: C6 or C7 level at the transverse process.

Effects: allows unopposed parasympathetic effects and ipsilateral horner’s syndrome (vasodilation –> flushing, nasal stuffiness, arm vasodilatation