Respiratory

Question 0

Functions of the larynx

Answer 0

Phonation, respiration, airway protection

Question 1

How do the blades work around the valeculla

Answer 1

Mac blade - slides into vallecula and will pull epiglottis forward.

Miller blade - actually picks up the epiglottis

Question 2

Where is the larynx located?

Answer 2

Cervical vertebrae 3-6

Question 3

How do the vocal chords attach?

Answer 3

Angles of the thyroid (A) and the arytenoids (P)

Question 4

Narrowest point of the airway in adult and child

Answer 4

Pediatric - cricoid cartilage

Adult - glottic opening

Question 5

List the 9 cartilages of the larynx

Answer 5

2 arytenoid
2 cuneiform
2 corniculate 
Thyroid
Cricoid
Epiglottis

Question 6

Describe laryngeal intrinsic muscle innervation

Answer 6

Recurrent laryngeal nerve via CN X

Except for the cricothyroid muscle which is innervated by the external branch of the superior laryngeal nerve

Question 7

Innervation of the tongue

Answer 7

Back 1/3 of tongue gets supply from CN IX (glossopharyngeal)

Question 8

Innervation of the nasopharynx

Answer 8

CN V (trigeminal)

Question 9

Muscles that open and close the glottis

Answer 9

Lateral cricoarytenoids - adduct
Arytenoids - adduct
Posterior cricoarytenoids - aBduct

Question 10

Muscles that put tension on the vocal cords

Answer 10

Cricothyroid - elongates vocal cords
Vocalis - shortens vocal cords
Thyroarytenoid - shortens vocal cords

Question 11

List extrinsic laryngeal muscles

Answer 11

Sternohyoid, omohyoid, thyrohyoid

The move the larynx as a whole

Question 12

Level of the carina

Answer 12

5th cervical vertebrae.

Question 13

Angles of trachea bifurcation

Answer 13

R side - 25 degrees

L side - 45 degrees

Question 14

PMH to ask about pre-op

Answer 14

Radiation to head and neck
Burns to head or neck
C-spine problems 
TMJ pain
RA
Abscess or tumors
Prior intubation or tracheotomy
Dysphasia or stridor
Snoring or OSA
Ankylosing spondylitis

Question 15

Steps for mallampati evaluation

Answer 15

Sit upright
Neck neutral
Open mouth
Stick tongue out far
Don't say AH

Question 16

What’s a good thyromental distance

Answer 16

4 finger breadths or 6-6.5mm

Question 17

what is the risk of using a head strap during intubation?

Answer 17

May cause facial nerve palsies with nerve compression

Question 18

what does the sniffing position do?

Answer 18

aligns all all three axis: oral, pharyngeal, laryngeal

Question 19

what is the goal of supplemental oxygen pre-intubation?

Answer 19

increased the FRC of Oxygen and decrease the nitrogen in FRC

Question 20

during RSI, how can you pre-oxygenate?

Answer 20

4 vital capacity breaths in 30 seconds

Question 21

How long should you give O2 in a normal pre-surgical intubation?

Answer 21

3-5 minutes of 100% O2 at >5L/min

Question 22

what size tube can you place over an #4 LMA?

Answer 22

6 OETT

Question 23

what is a major complication of oral airways?

Answer 23

LARYNGOSPASM, bleeding, soft tissue damage

Question 24

what are some contraindications to nasal airway insertion?

Answer 24

epistaxis, nasal trauma, basal skull fractures, anticoagulation, adenoid hypertrophy

Question 25

How far down do you want your OETT to be?

Answer 25

4 cm above the carina, 2 cm below the vocal cords

about 23 cm in males and 21 cm in females

Question 26

what are is the sensory innervation of the airway?

Answer 26

glossopharyngeal (back 1/3 of the tongue), recurrent laryngeal, internal branch of the superior laryngeal

Question 27

What is the motor innervation of the airway?

Answer 27

external branch of the superior laryngeal nerve (above the cords), recurrent laryngeal nerve (below the cords)

Question 28

what are some major complications of tracheal intubation?

Answer 28

trauma to airways, esophageal intubation, laryngospasm, sore throat, endobronchial intubation

Question 29

what is the induction sequence for tracheal intubation?

Answer 29

pre-oxygenation, sniffing position, monitors, induction agent, test ventilation, paralytic drug, eyes taped, mask-bag ventilation until muscle movement stops, laryngoscopy, intubate, confirm ETT placement with bilateral breath sounds and ETCO2, ventilate with bag or machine, maintenance anesthetic, tape OETT

Question 30

what is a major indication for an airway block?

Answer 30

an awake intubation and/or a suspected difficult airway

Question 31

what are 2 major complications for airway blocks?

Answer 31

systemic toxicity and hematoma formation

Question 32

what does a transtracheal block do?

Answer 32

blockes RLN

anesthesia below the vocal cords

through the cricothyroid membrane

Question 33

What does a superior laryngeal block do?

Answer 33

blocks internal SLN and the supraglottic region

goes through the thyrohyoid membrane

Question 34

What anatomical landmark are you looking for in a SLN block?

Answer 34

the cornu of the hyoid bone.

Then go 1/4 inch caudal and 1/4 inch medial

Question 35

What spread transtracheal anesthesia?

Answer 35

coughing

Question 36

what is one important feature of SLN blocks?

Answer 36

they need to be done bilaterally

Question 37

When would you do a glossopharyngeal nerve block?

Answer 37

when local anesthetic on the back of the throat is not enough

Question 38

what should you aspirate during a glossopharyngeal block?

Answer 38

nothing… if you get air, you’re too deep

if you get blood, pull needle out and redirect medially

Question 39

What is a common alternative to a glossopharyngeal block?

Answer 39

nebulized lidocaine