78 Questions
Which of the following best defines extrapulmonary airways?
Airways outside the lungs that conduct air to and from the respiratory zone
Why are thyromental distance and atlanto-occipital flexion and extension part of an airway assessment?
To determine the potential difficulty in achieving a clear airway for intubation
What is the function of Waldeyer’s tonsillar ring?
To protect the airway from aspiration
Which structures are visible during direct laryngoscopy?
Glottis and vocal cords
What is the primary function of the nasal epithelium and nasal mucosa?
Producing mucus to trap inhaled particles and microorganisms
What is the significance of Larson’s maneuver?
To assess the patency of upper airway during ventilation
What is the function of conducting airways in the respiratory system?
To warm and moisten the air
Which bone forms the superior part of the nasal septum?
Ethmoid
What maneuver may relieve laryngospasm by applying forcible jaw thrust with bilateral digital pressure on the body of the mandible?
Larson's maneuver
What is measured to determine mouth opening and the ability to align axes for laryngoscopy?
Inter-incisor gap
In which position does the sniffing position improve laryngoscopy view by displacing the tongue and aligning the oral, pharyngeal, and laryngeal axes?
Extension position
Which joint mobility is needed to obtain the sniffing position for laryngoscopy?
Atlanto-occipital joint
What is the normal measurement for thyromental distance that correlates to the submandibular space for tongue displacement during laryngoscopy?
> 6 cm
What is the main function of intrapulmonary airways in the respiratory system?
To participate in gas exchange
Which bone is posterior portion of hard palate and found above uvula?
Palatine bone
Which bone creates turbulence for protection and conditioning in the respiratory system?
Ethmoid
What test measures the mobility of the temporomandibular joint in preparation for airway manipulation?
Mandibular protrusion test
Where does the cribriform plate transmit olfactory nerves?
Ethmoid bone
What is the space between the lips/cheeks and gums/teeth known as?
Oral vestibule
Which muscle constitutes the bulk of the tongue mass and is responsible for protruding the tongue?
Genioglossus
What is the sensory innervation for the anterior 2/3 of the tongue for taste sensations?
Chorda tympani branch of CN VII
Which muscle tenses and opens the nasopharynx?
Tensor Veli Palatini
The soft palate is continuous with which folds?
Palatoglossal and palatopharyngeal folds
Which artery provides blood supply to the tongue?
Lingual artery
Which structure is raised during deglutition to close isthmus of the pharynx between oral and nasal pharynx?
Soft palate
Which cranial nerve is primarily responsible for the sensory function of the nose?
CN I
What type of epithelial lining is found in the respiratory epithelium of the nasal cavity?
Pseudostratified ciliated columnar epithelium
Which artery supplies rich blood to the nasal cavity?
Sphenopalatine artery
Which area is known as a critical site of chronic epistaxis (nosebleed)?
Kiesselbach's area
What is the purpose of the paranasal sinuses?
Resonate sounds of speech and produce mucus
What is the surgical procedure that accesses the pituitary gland via the sphenoid sinus?
Transphenoidal hypophysectomy
Which cranial nerve provides sensory innervation to most of the nasal mucosa?
CN V
What can happen if the mucus flow from the paranasal sinuses is obstructed?
Sinusitis
What is the role of the sympathetic fibers in the nasal cavity?
Control blood vessel dilation
What is the primary function of the nasal mucosa?
Humidify and warm inspired air
What condition can affect the health and function of the nasal cavity and paranasal sinuses?
Allergies and polyps
What structures play an essential role in respiration, speech, and filtering out particles and pathogens?
Nasal cavity and paranasal sinuses
Which of the following muscles originates below the hyoid bone and depresses the hyoid bone and the larynx?
Sternohyoid
Which muscle is responsible for elongating the vocal cords?
Posterior cricoarytenoid
What is the landmark for Larson's maneuver used to elevate the larynx?
Mastoid process
Which nerve innervates the vocal cords?
Recurrent laryngeal nerve
Which muscles modify the laryngeal inlet and narrow the inlet?
Aryepiglottic and oblique arytenoid muscles
What is the emergency surgical airway technique used in a respiratory emergency?
Cricothyrotomy
Which structure corresponds to the fauces?
Pharyngeal tonsils
Which arteries supply the trachea?
Superior thyroid arteries
What is the function of the Nasopharynx?
Innervation by the trigeminal nerve (CN V)
Which structure forms an incomplete ring around the pharynx?
Waldeyer's tonsilar ring
What is the unique characteristic of the laryngeal inlet?
Bounded by the epiglottis, aryepiglottic folds, and cuneiform and corniculate cartilages
What is the main responsibility of the External Circular Layer of pharyngeal muscles?
Fibers extend laterally and circle the pharyngeal wall
Which muscle is responsible for elevating the larynx and pharynx during swallowing and speaking?
Palatopharyngeus muscle
What determines the visibility of oral structures for airway assessment?
Mallampati score
Which nerve supplies the motor and most sensory innervation to the pharynx?
Vagus nerve (CN X)
Where does the Laryngopharynx bifurcate to?
Trachea and esophagus
What is the potential site for upper airway obstruction?
Nasopharynx
Which technique is used to visualize the vocal cords for endotracheal tube placement?
Direct laryngoscopy
Where does the Oropharynx lie?
Posterior to the oral cavity
What are the subdivisions of pharynx?
Nasopharynx, oropharynx, laryngopharynx
What is the primary function of the ligaments in the larynx?
To hold the laryngeal cartilages together
Which area is known as the 'pill box' of the larynx?
Vallecula
Which cartilage forms the narrowest fixed part of the upper airway in infants?
Cricoid cartilage
Which pair of cartilages sit atop and articulate with arytenoids, are visible during laryngoscopy, and are located in the ary-epiglottic fold?
Arytenoid and Corniculate cartilages
What is the function of the vestibular folds in the laryngeal cavity?
Protecting the true vocal cords
During normal respiration, what position does the rima glottidis assume?
Narrow, slit-like position
What is the function of infraglottic/subglottic cavity in the laryngeal cavity?
Assists in respiration
What happens during whispering in terms of the rima glottidis?
Air is allowed to pass between the arytenoid cartilages
'Valsalva maneuver' involves which action related to the rima glottidis?
"Sealing" of the rima glottidis
'Rima glottidis' is best defined as:
"Opening between true cords and arytenoid cartilages"
What is unique about Cuneiform cartilages compared to other paired cartilages?
They do not communicate with other cartilages directly
Which cartilage forms the skeleton of the larynx and is formed by 9 cartilages?
Thyroid
What is the function of the ligaments in the larynx?
To hold the laryngeal cartilages together
What is the significance of a Grade IV view in Cormack-Lehane Score?
The inability to see the glottic opening
Which cartilage is described as a 'leaf-shaped elastic cartilage' and is attached to the tongue by the median glossoepiglottic fold?
Epiglottis
What is the role of the cricoid cartilage in the pediatric airway?
It is the narrowest fixed part of the upper airway
What is the significance of vestibular folds in the larynx?
They are superior to true cords
Which ligament joins the thyroid cartilage to the hyoid bone?
Thyrohyoid ligament
During which process does the rima glottidis assume a narrow, slit-like position?
Normal respiration
"Corniculate cartilages" are visible during which medical procedure?
"Laryngoscopy"
"Arytenoid cartilages" sit atop which part of another cartilage?
"Cricoid"
Study Notes
- Pharynx: a musculo-osseous tube extending from the base of skull to the level of the sixth cervical vertebra (C6)
- Pharynx has four layers: mucosal layer, muscular coat, and a thin fascial layer
- Subdivisions of pharynx and their functions: Nasopharynx, Oropharynx, and Laryngopharynx
- Nasopharynx: lies posterior to the nasal cavity, includes pharyngotympanic tubes, and is mostly innervated by the trigeminal nerve (CN V)
- Oropharynx: lies posterior to the oral cavity, includes the root of tongue and lingual tonsils, palatopharyngeal arch, palatine tonsils, and the isthmus of the fauces (oropharyngeal isthmus)
- Laryngopharynx: posterior to the larynx, bifurcates to the trachea and esophagus, and contains the piriform fossa and aryepiglottic folds
- Waldeyer's tonsilar ring: lymphoid tissue forms an incomplete ring around the pharynx
- Pharyngeal muscles: two layers – external circular and internal longitudinal – responsible for swallowing and speaking
- External Circular Layer: fibers extend laterally and circle the pharyngeal wall, including superior, middle, and inferior pharyngeal constrictors, and the cricopharyngeus muscle
- Internal Longitudinal Layer: elevates the larynx and pharynx during swallowing and speaking, including the stylopharyngeus, palatopharyngeus, and salpingopharyngeus muscles
- Innervation of pharyngeal muscles: the pharyngeal plexus supplies the motor and most sensory innervation to the pharynx, with motor fibers derived from the vagus nerve (CN X) except for the stylopharyngeus muscle (CN IX)
- Mallampati score: determines the visibility of oral structures for airway assessment, with a Class 1 score indicating visible structures and higher scores indicating less visibility
- Upper airway obstruction: potential sites include the nasopharynx and oropharynx, and can be poorly tolerated without local anesthetic
- Larynx: the organ of voice production extending from the hyoid bone to the trachea, with unique characteristics such as the cricoid cartilage and the hyoid bone, and the laryngeal inlet bounded by the epiglottis, aryepiglottic folds, and cuneiform and corniculate cartilages
- Direct laryngoscopy: a technique used to visualize the vocal cords for endotracheal tube placement using a laryngoscope.
Test your knowledge of laryngeal assessment techniques, including the Cormack-Lehane Score, and the anatomy of the laryngeal cartilages. Understand the grading system for visibility of the glottic opening and the structure of the laryngeal skeleton.
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