What does the glossopharyngeal nerve innervate?
1. Posterior 1/3 of the tongue 2. Soft palate 3. Oropharynx
What does the recurrent laryngeal nerve innervate?
1. Vocal cords 2. Larynx (below vocal cords but above trachea) 3. Trachea
Which branch of the superior laryngeal nerve is sensory and what does it innervate?
Internal 1. Hypopharynx (oropharynx below the epiglottis) 2. Vocal cords
What does blocking the base of the anterior tonsillar pillars block?
What does blocking the inferior aspect of the greater cornu of the hyoid bone block?
Internal branch of the superior laryngeal nerve
What does a transtracheal nerve block do?
Blocks the recurrent laryngeal nerve
What does the external branch of the superior laryngeal nerve innervate?
Motor innervation to the cricothyroid muscle (used for pitch of voice)
A patient with an ascending thoracic aortic aneurysm develops hoarseness. What would you find with the vocal cords on fiberoptic bronchoscopy?
Partially abducted vocal cords on the left only (since the left recurrent laryngeal takes off just under the aortic arch vs. the right side which comes off at the level of the glottis)
Which exam finding is most indicative of a difficult airway: Mallampati class, TM distance, mouth opening, neck ROM
Mallampati class (number two is TM distance)
Which is the least specific indicator of a difficult intubation: Mallampati class, TM distance, mouth opening, neck ROM
Mallampati class (it is the most likely to incorrectly identify a non-difficult airway as a difficult airway)
What two axes become nearly aligned in the sniffing position?
Pharyngeal and laryngeal (the oral axis is usually perpendicular to the laryngeal axis which becomes about 30 degrees in the sniffing position)
What is the narrowest part of the adult airway?
Vocal cords (in neonates, it is the cricoid cartilage - immediately beneath the vocal cords)
What do the type I pneumocytes do? Type II?
I: Responsible for gas exchange II: Produce surfactant, can become type I pneumocytes, and are more numerous
What nerve innervates sensation to the lungs?
The vagus nerve; also innervates the PSNS to the lungs (bronchoconstriction and secretions)
What supplies the sympathetic innervation to the heart and what is its course?
Sympathetic chain (T1-T4) which travels through the stellate ganglion first before going to the heart
What layer of the aortic wall does dissection create a false lumen?
Where does the IJ run in the neck?
Between the anterior and posterior heads of the SCM just superior to the clavicle and lateral to the carotid artery
What supplies the anterior spinal artery (at the various levels)?
Superior origin: vertebral artery Upper thorax: posterior intercostal arteries Lumbar/Sacral: Artery of Adamkiewicz
Where does the Artery of Adamkiewicz originate from?
A single posterior intercostal artery between T8-L1, usually on the left side
Where does the spinal cord end in adults? Children?
Adults: L1 Children: L3
What is the difference between cervical, thoracic, lumbar , and sacral nerve roots?
Cervical nerve roots pass above their respective vertebrae and the others pass below (hence a C8 nerve root below the C7 vertebrae)
What vertebral level is the inferior tip of the scapula? Superior aspect of the iliac crest? Posterior superior iliac spine?
1. T7 2. L4 3. S2
What vertebral level would you aim for to block the stellate ganglion? Celiac plexus?
Describe the sensory innervation of the hand
Where is the median nerve relative to the branchial artery?
It is medial to the branchial artery
What innervates the sensation to the thigh?
Most of it is innervated by the femoral nerve except for the medial portion by the obturator nerve and the lateral portion by the lateral femoral cutaneous
What nerves innervate the lower leg?
The lower leg is mostly innervated by the sciatic nerve except for the medial aspect which is saphenous (from femoral nerve)
What does the sural nerve innervate? What is it a branch of?
The posterior-lateral lower leg; branch of the tibial nerve
What nerves does the ankle block include?
Deep nerves: posterior tibial and deep peroneal
Superficial nerves: Sural, saphenous, and superficial peroneal
What nerve innervates the plantar surface of the foot?
Posterior tibial nerve (branch of the tibial nerve)
At what vertebral level does the trachea start? The carina?
What vertebral levels do you have the cardiac accelerator fibers?
Where does the subarachnoid space end in adults? In children?
For an interscalene block, what muscles do you go between?
The anterior and middle scalene muscles