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1 APEX > Respiratory - Airway Anatomy > Flashcards

Respiratory - Airway Anatomy Flashcards

1
Q

What nerves provide motor innervation to the larynx?

A

External SLN, RLN

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2
Q

What nerve is responsible for motor function of the cricothyroid muscle?

A

external superior laryngeal nerve

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3
Q

What nerves provide sensory innervation to the larynx?

A

internal SLN, RLN

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4
Q

Sensory innervation above the vocal cords is provided by which nerve?

A

internal SLN

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5
Q

Sensory innervation below the vocal cords is provided by which nerve?

A

RLN

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6
Q

Which vocal cords attach anteriorly to the thyroid cartilage and posteriorly to the arytenoid cartilage?

A

true vocal cords

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7
Q

Which intrinsic muscles of the larynx adjust length (tension) of the vocal ligaments? (3)

A

cricothyroid, vocalis, thyroarytenoid

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8
Q

Which intrinsic muscle of the larynx elongates (tenses) the vocal ligaments?

A

cricothyroid

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9
Q

The cricothyoid muscle is innervated by which nerve?

A

external SLN

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10
Q

Which intrinsic muscles of the larynx shortens (relaxes) the vocal ligaments?

A

vocalis, thyroarytenoid

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11
Q

The vocalis and thyroarytenoid muscles are innervated by which nerves?

A

RLN

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12
Q

Which intrinsic muscles of the larynx abduct or adduct the vocal folds?

A

thyroarytenoid, lateral cricoarytenoid, posterior cricoarytenoid

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13
Q

Which intrinsic muscles of the larynx adduct the vocal folds?

A

thyroarytenoid, lateral cricoarytenoid

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14
Q

Which intrinsic muscles of the larynx abduct the vocal folds?

A

posterior cricoarytenoid

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15
Q

Which nerve innervates the thyroarytenoid muscle?

A

RLN

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16
Q

Which nerve innervates the lateral cricoarytenoid muscle?

A

RLN

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17
Q

Which nerve innervates the posterior cricoarytenoid muscle?

A

RLN

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18
Q

Which intrinsic muscle of the larynx closes the laryngeal vestibule?

A

aryepiglottic

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19
Q

Which intrinsic muscle of the larynx closes the posterior commissure of the glottis?

A

interarytenoid

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20
Q

Which nerve innervates the aryepiglottic muscle?

A

RLN

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21
Q

Which nerve innervates the interarytenoid muscle?

A

RLN

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22
Q

What does the CricoThyroid muscle do to the vocal cords?

A

“Cords Tense”

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23
Q

What does the ThyroaRytenoid muscle do to the vocal cords?

A

“They Relax”

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24
Q

What does the Posterior CricoArytenoid muscle do to the vocal cords”

A

“Please Come Apart” - abduct

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25
Q

What does the Lateral CricoArytenoid muscle do to the vocal cords?

A

“Lets Close Airway” - adduct

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26
Q

Do the extrinsic or intrinsic muscle of the larynx allow movement for breathing, swallowing, and phonation?

A

extrinsic

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27
Q

How do the Stylohyoid, Geniohyoid, Mylohyoid, Throhyoid, Digastric, and Stylopharyngeus move the larynx?

A

elevate the larynx

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28
Q

How do the Omohyoid, Sternohyoid, and Sternothyroid move the larynx?

A

depresses the larynx

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29
Q

What nerves provide sensory innervation to the airway?

A

trigeminal (CN 5), glossopharygeal (CN 9), SLN, RLN

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30
Q

What nerve provides sensation to the nares and anterior 1/3 of the nasal septum?

A

V1: opthalmic

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31
Q

What nerve provides sensation to the turbinates and septum?

A

V2: maxillary

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32
Q

What nerve provides sensation to the anterior 2/3 of the tongue?

A

V3: mandibular

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33
Q

What nerve provides sensory innervation to the soft palate, oropharynx, tonsils, posterior 1/3 of tongue, vallecula, and anterior side of epiglottis?

A

glossopharyngeal

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34
Q

What nerve is the afferent limb of the gag reflex?

A

glossopharyngeal

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35
Q

Which branch of the SLN does not have sensory innervation?

A

external SLN

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36
Q

Which nerve provides sensory innervation to the posterior side of the epiglottis?

A

internal SLN

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37
Q

Which nerve provides sensory innervation below the vocal cords to the trachea?

A

RLN

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38
Q

What nerve provides motor innervation to all intrinsic muscle of the larynx except the cricothyroid?

A

RLN

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39
Q

Where does the SLN divide into internal and external branches?

A

hyoid

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40
Q

Which branch of the SLN enters the cricothyroid membrane?

A

external

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41
Q

Injury to the trunk of the SLN or the external branch leads to what symptom?

A

hoarseness

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42
Q

The SLN and RLN are branches of which nerve?

A

vagus

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43
Q

Damage to the aortic arch can damage which branch of the vagus nerve?

A

RLN

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44
Q

Which branch of the RLN is more susceptible to injury?

A

left

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45
Q

What does bilateral injury to the RLN cause?

A

paralysis of vocal cord abductors

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46
Q

Bilateral injury to the RLN leads to which muscles being unopposed?

A

cricothyroid muscles (“Cords Tense”)

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47
Q

What are two symptoms of bilateral RLN injury?

A

stridor and respiratory distress

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48
Q

Does unilateral paralysis of a branch of the RLN cause respiratory distress?

A

no

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49
Q

Which procedures or situations lead to potential RLN damage? (5)

A

excessive pressure (ETT cuff or LMA), thyroid sx, parathyroid sx, neck stretching, tumor

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50
Q

What procedures risk damage to the left RLN?

A

PDA ligation, mitral stenosis, aortic aneurysm, thoracic tumor

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51
Q

What is the landmark to blocks the SLN?

A

greater cornu of hyoid

52
Q

How do you block the SLN?

A

1mL LA above thyrohyoid membrane, 2mL beneath thyrohyoid membrane

53
Q

What indicates your needle is too deep during SLN block?

A

air aspiration

54
Q

What is the key landmark for a transtracheal block?

A

cricothyroid membrane

55
Q

How do you perform a transtracheal block?

A

insert the needle in the cricothyroid membrane in a caudal direction. As the person takes a big breath in inject 2-3mL. Pt coughs and LA sprays the vocal cords from the inferior side.

56
Q

Where is the needle inserted for a glossopharyngeal block?

A

base of palatoglossal arch

57
Q

Inadvertently injecting LA into the carotid artery during glossopharyngeal block will manifest as what symptom?

A

seizures

58
Q

What are the paired laryngeal cartilages?

A

corniculate, cuneiform, and arytenoid

59
Q

Rheumatoid arthritis and SLE can significantly restrict which laryngeal cartilages?

A

arytenoid

60
Q

What are the unpaired laryngeal cartilages?

A

epiglottis, thyroid, cricoid

61
Q

What provides the mechanical barrier between the laryngeal opening and the pharynx?

A

epiglottis

62
Q

What ligament connects the epiglottis to the thyroid cartilage?

A

thyroepiglottic

63
Q

What is the largest cartilage in the larynx?

A

thyroid cartilage

64
Q

What is the most caudal part of the larynx?

A

cricoid cartilage

65
Q

What cartilage forms the only complete ring in the airway?

A

cricoid cartilage

66
Q

What is the narrowest part of the airway in adults and peds?

A

Adults: vocal cords. Peds: cricoid ring

67
Q

What are the anterior ligaments of the larynx?

A

thyrohyoid and cricothyroid

68
Q

What is the only bone in the body that does not communicate with another bone?

A

hyoid

69
Q

What membrane is emergently punctured to secure the airway?

A

cricothyroid

70
Q

What are potential complications of laryngospasm? (5)

A

Complete airway obstruction, negative pressure pulmonary edema, gastric aspiration, cardiac arrest, and death

71
Q

Which population is laryngospasm most common?

A

children < 1

72
Q

What are risk factors for laryngospasm? (5)

A

active or recent URI, second hand smoke, RAD, GERD, age < 1

73
Q

What are intraoperative risk factors for laryngospasm?

A

light anesthesia and airway manipulation, secretions, hyperventilation, hypocapnia, tonsillectomy, adenoidectomy, nasal/sinus sx, laryngoscopy, bronchoscopy, palatal

74
Q

What are the afferent and efferent branches of laryngospasm?

A

afferent: internal SLN. Efferent: external SLN and RLN

75
Q

What membrane is responsible for tensing the vocal cords during laryngospasm?

A

cricothyroid

76
Q

What membrane is responsible for adduction of the vocal cords during laryngospasm?

A

lateral cricoarytenoid and thyroarytenoid

77
Q

What are signs of laryngospasm?

A

inspiratory stridor, suprasternal and supraclavicular retraction, rocking horse chest wall, diaphragmatic excursion, lower rib flailing

78
Q

How much CPAP reduces the risk of laryngospasm?

A

5-10 cmH2O

79
Q

How do we treat laryngospasm?

A

100% FiO2, remove noxious stimuli, deepen, CPAP 15-20 cmH2O

80
Q

What is the maneuver to open the airway during laryngospasm?

A

larson

81
Q

What is the IV dose of Succ for adults and peds for laryngospasm?

A

Adults/children: 1mg/kg. Neonate/infant: 2mg/kg

82
Q

What is the IM dose of Succ for adults and peds for laryngospasm?

A

Adults/children: 4mg/kg. Neonate/infant: 5mg/kg

83
Q

What route of administration has the fastest onset of action for laryngospasm treatment with succ?

A

submental

84
Q

What is firm pressure to the laryngospasm notch called?

A

Larsons maneuver

85
Q

Where is the laryngospasm notch located?

A

behind the earlobe

86
Q

What are the borders of the laryngospasm notch? Posterior, anterior and superior

A

posterior - mastoid process
anterior - ramus of mandible
superior - skull base

87
Q

What is the goal of the Larson maneuver?

A

break a laryngospasm by causing the pt to sigh

88
Q

How long is the Larson maneuver performed?

A

3-5 seconds, released for 5-10 seconds. repeat

89
Q

What is exhalation against a closed glottis?

A

valsalva maneuver

90
Q

What are the risk of the valsalva maneuver?

A

increased pressure in the thorax, abdomen and brain

91
Q

What is inhalation against a closed glottis?

A

mullers maneuver

92
Q

what is the risk of mullers maneuver?

A

negative pressure pulmonary edema

93
Q

What are the borders of the upper airway?

A

mouth/nares to the cricoid cartilage

94
Q

What is the primary function of the upper airway?

A

warm and humidify air, filter, prevent aspiration

95
Q

How do we replace the function of the upper airway in an intubated patient?

A

HME to warm, humidify and filter. ETT cuff to prevent aspiration

96
Q

What creates the negative pressure to draw air into the lungs?

A

diaphragmatic contraction and chest wall expansion

97
Q

What conditions reduce the diameter of the pharynx and impair patency? (2)

A

reduced pharyngeal dilator muscle tone

negative pressure during inspiration

98
Q

What conditions reduce the overall size of the pharynx and impair patency? (5)

A

obesity, large tongue, hypertrophy of tonsils/adenoids, small craniofacial structures, craniofacial deformity

99
Q

What muscle opens the nasopharynx?

A

tensor palatine (soft palate)

100
Q

What muscle opens the oropharynx?

A

genioglossus (tongue)

101
Q

What muscle opens the hypopharynx?

A

hyoid muscles (epiglottis)

102
Q

Select (state) the three muscles that dilate the muscles of the pharynx?

A

tensor palatine, genioglossus, hyoid muscles

103
Q

What are the borders of the lower airway?

A

trachea to the alveoli

104
Q

Where does the trachea begin and end?

A

C6 - T4/5 (carina)

105
Q

What type of cells make up the trachea?

A

ciliated columnar epithelium

106
Q

What nerve provides sensory innervation to the trachea?

A

vagus

107
Q

The inferior thyroid artery, superior thyroid artery, bronchial artery, and internal thoracic artery provide blood supply to what lower airway structure?

A

trachea

108
Q

What anatomical structure corresponds to the Angle of Louis?

A

trachea

109
Q

What type of cells make up the trachea?

A

ciliated columnar epithelium

110
Q

State the length and angle of the right mainstream bronchi.

A

2.5cm long, 25 degree angle

111
Q

State the length and angle of the left mainstream bronchi.

A

5cm long, 45 degree angle

112
Q

What type of cells make up the mainstream bronchi?

A

coboidal epithelium

113
Q

What type of cells make up the alveoli?

A

squamous epithelium

114
Q

What allows air movement between alveoli?

A

pores of kohn

115
Q

Describe type 1 cells.

A

surface area for gas exchange, flat squamous cells, 80% of alveolar surface area, form tight junctions

116
Q

Describe type 2 cells

A

produce surfactant***, capable of division, produce type 1 cells

117
Q

What do type 3 cells do?

A

fight lung infection and produce inflammatory mediators

118
Q

When are neutrophils present in alveoli?

A

smokers and acute lung injury

119
Q

What is the distance from the incisors to larynx?

A

13cm

120
Q

What is the distance from the larynx to carina?

A

13cm

121
Q

What makes the distance from the incisors to the carina change?

A

Neck flexion and extension. (mainstem or extubation above the cords)

122
Q

As the airway divides/bifurcates, what characteristics of the airway increase? (3)

A

number of airways, cross sectional area, muscular layer

123
Q

As the airway divides/bifurcates, what characteristics of the airway decrease? (4)

A

airflow velocity, amount of cartilage, goblet cells, ciliated cells

124
Q

What cells produce mucus and which ones clear mucus?

A

goblet produce, ciliated clear

125
Q

What structures are included in the conducting zones of the airway? (6)

A

trachea, mainstem bronchi, lobar bronchi, small bronchi, bronchioles, terminal bronchioles

126
Q

What structures are included in the respiratory zones of the airway? (3)

A

respiratory bronchioles, alveolar ducts, alveolar sacs

1 APEX (9 decks)

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