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Apex > Respiratory Anatomy > Flashcards

Respiratory Anatomy Flashcards

1
Q

Name the 5 INTRINSIC muscles of the airway

A

Cricothyroid
Thyroarytenoid
Lateral cricoarytnoid
Posterior cricoarytnoid
Vocalis

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2
Q

What does the Cricothyroid do

A

Elongates (tenses cords)
“Cords Tense”

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3
Q

What does the thyroarytenoid muscle do?

A

Shortens (relaxes cords) ~ muscles shorten
“They relax”
This leads to ADDuction of cords

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4
Q

What does the posterior cricoarytnoid muscles do

A

ABDucts vocal cords
“Please come apart”

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5
Q

What do the lateral cricoarytenoid muscles do?

A

ADDuct the vocal cords
“Let’s Close Airway”

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6
Q

What is cranial nerve 5

A

Trigeminal Nerve

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7
Q

How many branches are there to the trigeminal nerve

A

3
Ophthalmic nerve (V1)
Maxillary Nerve (V2)
Mandibular (V3)

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8
Q

What does the opthalamic nerve innervate?

A

First 1/3 of the nasal septum

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9
Q

What does the maxillary nerve (V2) innervate?

A

Turbinates, posterior 2/3 of the nasal septum

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10
Q

What does the mandibular nerve innervate?

A

Anterior 2/3 of the tongue

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11
Q

What does the glossopharyngeal nerve innervate?

A

Posterior 1/3 of the tongue, oropharynx, vallecula, and anterior side of epiglottis

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12
Q

What cranial nerve is the glossopharyngeal nerve

A

9

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13
Q

What is cranial nerve 10?

A

The Vagus nerve

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14
Q

What two nerves originate from the Vagus?

A

Superior laryngeal
Recurrent laryngeal

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15
Q

What does the superior laryngeal nerve divide into?

A

Internal branch (pierces the thyrohyoid membrane
External branch

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16
Q

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

A

Sensory.
Posterior side of the epiglottis to the level of the vocal cords

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17
Q

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

A

Cricothyroid muscle

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18
Q

Acute injury to the superior laryngeal nerve causes what?

A

Hoarseness

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19
Q

What does the recurrent laryngeal nerve innervate?

A

Below the level of the vocal cords to the trachea

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20
Q

What happens with injury to the recurrent laryngeal nerve?

A

Unilateral: hoarseness
Bilateral: strider/resp distress

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21
Q

Where do the recurrent laryngeal branches loop?

A

Right: under the right subclavian artery
Left: under the aorta (this is more susceptible to injury)

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22
Q

What are the three cranial nerves that innervate the upper airway?

A

Trigeminal
Glossopharyngeal
Vagus

23
Q

What 3 nerves must you block for an awake fiberoptic?

A

Glossopharyngeal
Superior laryngeal
Recurrent laryngeal

24
Q

Where is your site of injection for a glossopharyngeal block?

A

Base of the palatoglossal arch (tonsillar pillar)

Must repeat on the other side!

25
Q

Where is your site of injection for a superior laryngeal block?

A

Greater Cornu of the hyoid bone

Must repeat on the other side!

26
Q

Where is your site of injection for a recurrent laryngeal block?

A

Puncture the Cricothyroid membrane and advance in a CAUDAL direction

Coughing is good!

27
Q

Where does the ADULT airway lie?

A

C4-C6

28
Q

What are 3 functions of the larynx?

A

Airway protection, respiration, and phonation

29
Q

How many cartilages does the larynx have?

A

9 (3 PAIRED cartilages)
3 unpaired cartilages

30
Q

What are the 9 cartilages of the airway?

A

Paired: arytenoids, cuneiform, corniculate

Unpaired: thyroid, epiglottis, cricoid

31
Q

What is the narrowest region of the airway in adults?

A

The glottis opening

32
Q

What is the narrowest region of the airway in kids?

A

It’s tricky!
Narrowest fixed region: cricoid ring
Narrowest dynamic region: vocal cords

33
Q

What is the laryngospasm reflex pathway?

A

Afferent limb: internal branch of the SLN
Efferent limb: external branch of the SLN or recurrent laryngeal nerve branches (thyroarytenoid and lateral cricoarytenoid branches)

34
Q

What are some pre-anesthetic risk factors to laryngospasm

A

Resp infections
Second-hand smoke
Reactive airway disease
Age < 1 year

35
Q

What are some intra-anesthetic risk factors for laryngospasm?

A

Light anesthesia
Saliva/blood
Hyperventilation/hypocapnia
Surgical procedures of the airway (tonsils, palate, nasal/sinus, laryngoscopy)

36
Q

How do you break a laryngospasm

A
  1. 100% FiO2
  2. Remove stimulation
  3. Deepens anesthetic (prop)
  4. CPAP 15-20 (with larsens)
  5. Administer Sux (IM 4mg/kg; IV 1mg/kg)
37
Q

What is Larsen’s maneuver?

A

Firm pressure on laryngospasm notch. Pushes mandible anteriorly and causes patient to sigh

38
Q

What is a valsalva’s maneuver?

A

Exhalation against a closed glottis (coughing, bucking, bearing down)

Increases pressure to in thorax, abd, and brian

39
Q

What is Muller’s maneuver?

A

Inhalation against a closed glottis (patient bites ETT)

Negative pressure pulmonary edema due to subatmospheric pressure in thorax

40
Q

What causes obstruction at the level of the tongue?

A

Genioglossus muscle relaxation

41
Q

What causes obstruction at the level of the soft palate?

A

Tensor palatine muscle relaxation

42
Q

Where does the trachea begin and end?

A

Begins C6
Ends T5 (carina)

43
Q

Where is the carina and what does it correspond with?

A

T5 and it corresponds with the Angle of Louis

44
Q

What allows movement between cells?

A

Pores of Kohn

45
Q

What do type 1 pneumocytes do?

A

Gas exchange
Cover 80% of alveolar surface

46
Q

What do type 2 pneumocytes do?

A

Produce surfactant

47
Q

What does type 3 pneumocytes do?

A

They are macrophages

They fight lung infection and produce inflammatory responses

48
Q

Are neutrophils present in the airway?

A

They are present in patients who are smokers or with acute lung injury.

49
Q

What is the distance from the incisors to the larynx?

A

13 cms

50
Q

What is the distance from the larynx to the carina?

A

13 cms

51
Q

What is the tot distance from the incisors to the carina

A

26 cm

Think the entire length of an ETT

52
Q

What increases as the airway progresses?

A

Number of airways
Total cross-sectional area

53
Q

What decreases as the airway progresses (I.e goes from the trachea to the bronchioles)

A

Airway velocity
Airway cartilage
Goblets cells
Ciliated cells

Apex (47 decks)

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