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671A - Anesthesia I > Week 12 - Basic Airway Anatomy > Flashcards

Week 12 - Basic Airway Anatomy Flashcards

1
Q

What separates the upper airway from the lower airway?

A

Cricoid cartilage

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2
Q

What does the upper airway consist of?

A

Nose, mouth, pharynx, hypopharynx, larynx, and cricoid cartilage.

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3
Q

What does the lower airway consist of?

A

Trachea, bronchi, bronchioles, terminal bronchioles, respiratory bronchioles, and alveoli

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4
Q

What is the purpose of the nose?

A

Mucosa which warms and humidifies the air

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5
Q

What 3 arteries supply blood to the nose (nasal mucosa)?

A

Maxillary (sphenopalatine), ophthalmic, and facial (septal)

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6
Q

What nerves innervate the nose?

A

Trigeminal nerve –> Maxillary and ophthalmic branches

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7
Q

Parasympathetic nerve innervation of the nose?

A

Facial nerve (Cranial nerve 7) and the pterygopalatine ganglion

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8
Q

Sympathetic nerve innervation of the nose? What does this cause?

A

Superior cervical ganglion –> This causes vasoconstriction and shrinkage of the nasal tissue.

This response is BLUNTED by general anesthesia and will actually cause engorgement of the nasal tissue, resulting in increased bleeding during nasal manipulation.

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9
Q

What medication can be used in the nose prior to manipulation to reduce bleeding?

A

Phenylephrine spray –> Constricts these arteries to decrease bleeding.

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10
Q

What separates the nasal cavity from the oral cavity?

A

Hard and soft palate

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11
Q

What is the purpose of the soft palate?

A

To rise when eating to prevent aspiration –> Prevents passage of food or water via the mouth to nose

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12
Q

What structure in the mouth can fall back against the nasal passage during general anesthesia, when paralytics are used or with sleep?

A

Soft palate –> This can cause airway obstruction blocking air movement from the nasal passage and may present with signs similar to OSA

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13
Q

What two things can cause the soft palate to stretch and become more movable, which hinders its ability to prevent aspiration?

A

Obesity and age

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14
Q

What organ fills the majority of the oral cavity?

A

The tongue –> Involved in the tasting and ingestion of food.
When it relaxes via sleep or during paralysis, this can cause potential obstruction.

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15
Q

What is the purpose of the uvula?

A

Protects the passageway from the oral cavity to the oropharynx –> this structure is part of the soft palate and also help prevent food or liquid from going up your nose when you swallow.

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16
Q

What can occur if the uvula becomes swollen, enlarged, or injured?

A

Can cause airway obstruction

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17
Q

What two disorders can cause airway obstruction via macroglossia?

A

Beckwith-Wiedemann Syndrome and Down Syndrome

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18
Q

Where would you find the palatine tonsils?

A

Sits on both sides of the posterior opening of the oral cavity –> Walnut shaped. They are partially buried in the soft tissue at the base of the tongue

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19
Q

What are kissing tonsils indicative of?

A

Enlarged palatine tonsil that are touching, can be seen primarily in the pediatric population –> Prepare for a difficult airway.

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20
Q

What are the 3 compartments of the FAIR-INKS?

A

Nasopharynx, Oropharynx, and Laryngopharynx (hypopharynx)

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21
Q

What compartment in the pharynx is most anterior at the level of C1, and contains the eustachian tubes and adenoids?

A

Nasopharynx

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22
Q

What compartment in the pharynx is at the level of C2-C3 and is bound superiorly by the soft palate and inferiorly by the epiglottis?

A

Oropharynx

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23
Q

What compartment in the pharynx is at the level of C5-C6 and is posterior to the larynx?

A

Hypopharynx or Laryngopharynx

24
Q

What is another name for the oropharynx?

A

Fauces –> Part of Mallampati

25
Q

What is the purpose of the esophageal sphincter?

A

This can be found in the upper esophagus at the hypopharyngeal boarder, arising from the cricopharyngeus muscle –> Acts as a barrier to prevent regurgitation in a conscious patient.

26
Q

What are the three primary nerves that share nuclei in the medulla that innervate the muscles of the pharynx, larynx, and soft palate?

A

Glossopharyngeal, vagus, and spinal accessory

27
Q

What are the afferent and efferent nerve pathways when the posterior wall of the pharynx is touched?

A

Afferent –> Glossopharyngeal takes the impulse to the medulla where they synapse with nuclei of the vagus nerve
Efferent –> Vagus nerve takes impulse back to the posterior pharynx resulting in a gag reflex (muscles of the pharynx elevate and constrict)

28
Q

What are the two branches of the vagus nerve? What do they innervate?

A

The superior laryngeal nerve and the recurrent laryngeal nerve –> These innervate the hypopharynx

29
Q

What are the two branches of the superior laryngeal nerve?

A

Internal –> Provides sensory input to the vocal cords, which includes the base of the tongue, epiglottis, aryepiglottic folds, and arytenoids
External –> This branch provides motor function to the cricothyroid muscles of the larynx

30
Q

What do the left and right recurrent laryngeal nerves wrap around? Where does this branch innervate?

A

Right RCL –> wraps around right subclavian artery
Left RCL –> wraps around aortic arch
Subglottic area and trachea

31
Q

Which branch of the vagus nerve if injured can cause respiratory distress leading to death?

A

Traction of the recurrent laryngeal branch –> Patient will present with stridor and hoarseness in unilateral damage
Bilateral damage can present with stridor which can deteriorate into respiratory distress/death

32
Q

True or False
Injury to the superior laryngeal nerve will cause respiratory distress?

A

False –> Only recurrent laryngeal nerve

33
Q

What are the three components that make up the larynx? What is the purpose of these components?

A
  1. 3 single cartilages –> Thyroid, cricoid, and epiglottis
  2. 3 paired cartilages –> Arytenoid, corniculate, cuneiform
  3. Intrinsic and extrinsic muscles

Protection from aspiration of the lower airway, patency between the hypopharynx and trachea, protective gag and cough reflexes, and phonation

34
Q

What cervical vertebrae level would you find the larynx?

A

C3/C4 - C6

35
Q

How is the thyroid and cricoid cartilage connected?

A

Via the cricothyroid membrane

36
Q

What makes up the superior vallecula?

A

The space between the epiglottis and the base of the tongue

37
Q

What makes up the inferior vallecula?

A

The space between the inferior edge of the epiglottis and the true vocal cords.

38
Q

What are the two functions of the intrinsic muscles of the larynx?

A

Control the tension of the vocal cords and opening and closing of the glottis

39
Q

What are the primary functions of the extrinsic muscles of the larynx?

A

To position the larynx during phonation, breathing, and swallowing.

40
Q

To what structures do the extrinsic laryngeal muscles connect?

A

Connects the larynx, hyoid bone, and neighboring anatomical structures.

41
Q

What are the responsible arteries of blood supply of the larynx?

A

Superior laryngeal artery to the supraglottic area and the inferior laryngeal artery to the subglottic area.

External carotid –> superior thyroid artery –> superior laryngeal artery

Thyrocervical truck –> inferior laryngeal artery

42
Q

Where can the trachea be found?

A

Space below the cricoid cartilage but above the carina –> About 10-20 cm long

43
Q

Which cartilage in the body is the only complete ring?

A

Cricoid cartilage

44
Q

Where is surfactant made?

A

Type II alveolar cells which come from cuboidal cells –> Surfactant begins being secreted at weeks 16-26

45
Q

How long will alveolar development proceed after birth?

A

3 years after birth –> From the 3rd year of life to adulthood, now lung growth continues.

46
Q

What shape is tracheal cartilage? How many of these do we have?

A

C shaped, not complete rings like the cricoid cartilage. 16-20 of these C-shaped structures starting directly inferior to the cricoid cartilage.

47
Q

What is the posterior side of the trachea formed of?

A

Muscle, this is called the trachealis muscle –> This aids in the forceful movement of air out of the trachea during constriction and accommodation of the esophagus when swallowing.

48
Q

What is the primary function of the trachealis muscle?

A

Constrict the trachea causing air to more forcibly exit the trachea.

49
Q

When does the bronchi turn into the bronchioles?

A

When these passages become 0.8-0.6 mm in size. You will also see the disappearance of the c shaped tracheal cartilage rings at this point.

50
Q

What is the function of the bronchi?

A

To provide humidification and warming of inspired air as it passes to the alveoli.

51
Q

What is the angle of bifurcation of the right and left mainstems?

A

Right –> 25-30 degrees
Left –> 45 degrees

52
Q

Which structure of the airway is richly innervated with nerves?

A

Carina –> extremely sensitive to sensory stimulation
Sympathetic = T1-T5 ganglion
Parasympathetic = branches of the vagus nerve

53
Q

How does the trachea end?

A

Bifurcating into the right and left mainstem bronchi

54
Q

What nerve innervates the diaphragm?

A

Phrenic nerve –> C 3, 4, and 5 keeps the diaphragm alive

55
Q

What 4 structures does the diaphragm arise from?

A

Septum transversum, dorsal esophageal mesentery, pleuroperitoneal folds, and body wall mesoderm

56
Q

Where is the diaphragm developed? Where is its ultimate destination?

A

Forms in the cephalic region –> descends into position between the abdominal and pleural cavity

57
Q

Drugs that impair fetal development can cause the development of what within the diaphragm?

A

Diaphragmatic hernia (hole in the diaphragm) –> Organs in the abdomen (such as intestines, stomach, and liver) can move through the hole in the diaphragm and upwards into a baby’s chest.

671A - Anesthesia I (22 decks)

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