Functional Anatomy

Question 1

What does the glossopharyngeal nerve innervate?

Answer 1

1. Posterior 1/3 of the tongue 2. Soft palate 3. Oropharynx

Question 2

What does the recurrent laryngeal nerve innervate?

Answer 2

1. Vocal cords 2. Larynx (below vocal cords but above trachea) 3. Trachea

Question 3

Which branch of the superior laryngeal nerve is sensory and what does it innervate?

Answer 3

Internal 1. Hypopharynx (oropharynx below the epiglottis) 2. Vocal cords

Question 4

What does blocking the base of the anterior tonsillar pillars block?

Answer 4

Glossopharyngeal nerve

Question 5

What does blocking the inferior aspect of the greater cornu of the hyoid bone block?

Answer 5

Internal branch of the superior laryngeal nerve

Question 6

What does a transtracheal nerve block do?

Answer 6

Blocks the recurrent laryngeal nerve

Question 7

What does the external branch of the superior laryngeal nerve innervate?

Answer 7

Motor innervation to the cricothyroid muscle (used for pitch of voice)

Question 8

A patient with an ascending thoracic aortic aneurysm develops hoarseness. What would you find with the vocal cords on fiberoptic bronchoscopy?

Answer 8

Partially abducted vocal cords on the left only (since the left recurrent laryngeal takes off just under the aortic arch vs. the right side which comes off at the level of the glottis)

Question 9

Which exam finding is most indicative of a difficult airway: Mallampati class, TM distance, mouth opening, neck ROM

Answer 9

Mallampati class (number two is TM distance)

Question 10

Which is the least specific indicator of a difficult intubation: Mallampati class, TM distance, mouth opening, neck ROM

Answer 10

Mallampati class (it is the most likely to incorrectly identify a non-difficult airway as a difficult airway)

Question 11

What two axes become nearly aligned in the sniffing position?

Answer 11

Pharyngeal and laryngeal (the oral axis is usually perpendicular to the laryngeal axis which becomes about 30 degrees in the sniffing position)

Question 12

What is the narrowest part of the adult airway?

Answer 12

Vocal cords (in neonates, it is the cricoid cartilage - immediately beneath the vocal cords)

Question 13

What do the type I pneumocytes do? Type II?

Answer 13

I: Responsible for gas exchange II: Produce surfactant, can become type I pneumocytes, and are more numerous

Question 14

What nerve innervates sensation to the lungs?

Answer 14

The vagus nerve; also innervates the PSNS to the lungs (bronchoconstriction and secretions)

Question 15

What supplies the sympathetic innervation to the heart and what is its course?

Answer 15

Sympathetic chain (T1-T4) which travels through the stellate ganglion first before going to the heart

Question 16

What layer of the aortic wall does dissection create a false lumen?

Answer 16

Media

Question 17

Where does the IJ run in the neck?

Answer 17

Between the anterior and posterior heads of the SCM just superior to the clavicle and lateral to the carotid artery

Question 18

What supplies the anterior spinal artery (at the various levels)?

Answer 18

Superior origin: vertebral artery Upper thorax: posterior intercostal arteries Lumbar/Sacral: Artery of Adamkiewicz

Question 19

Where does the Artery of Adamkiewicz originate from?

Answer 19

A single posterior intercostal artery between T8-L1, usually on the left side

Question 20

Where does the spinal cord end in adults? Children?

Answer 20

Adults: L1 Children: L3

Question 21

What is the difference between cervical, thoracic, lumbar , and sacral nerve roots?

Answer 21

Cervical nerve roots pass above their respective vertebrae and the others pass below (hence a C8 nerve root below the C7 vertebrae)

Question 22

What vertebral level is the inferior tip of the scapula? Superior aspect of the iliac crest? Posterior superior iliac spine?

Answer 22

1. T7 2. L4 3. S2

Question 23

What vertebral level would you aim for to block the stellate ganglion? Celiac plexus?

Answer 23

1. C7
2. L1

Question 24

Describe the sensory innervation of the hand

Answer 24

See image

Question 25

Where is the median nerve relative to the branchial artery?

Answer 25

It is medial to the branchial artery

Question 26

What innervates the sensation to the thigh?

Answer 26

Most of it is innervated by the femoral nerve except for the medial portion by the obturator nerve and the lateral portion by the lateral femoral cutaneous

Question 27

What nerves innervate the lower leg?

Answer 27

The lower leg is mostly innervated by the sciatic nerve except for the medial aspect which is saphenous (from femoral nerve)

Question 28

What does the sural nerve innervate? What is it a branch of?

Answer 28

The posterior-lateral lower leg; branch of the tibial nerve

Question 29

What nerves does the ankle block include?

Answer 29

Deep nerves: posterior tibial and deep peroneal

Superficial nerves: Sural, saphenous, and superficial peroneal

Question 30

What nerve innervates the plantar surface of the foot?

Answer 30

Posterior tibial nerve (branch of the tibial nerve)

Question 31

At what vertebral level does the trachea start? The carina?

Answer 31

Trachea: C6

Carina: T5

Question 32

What vertebral levels do you have the cardiac accelerator fibers?

Answer 32

T1-T4

Question 33

Where does the subarachnoid space end in adults? In children?

Answer 33

Adults: S2

Children: S3

Question 34

For an interscalene block, what muscles do you go between?

Answer 34

The anterior and middle scalene muscles