NBCRNA APEX UPDATED ACTUAL
Exam Questions and CORRECT
Answers
What muscle abducts the vocal cords? - CORRECT ANSWER - posterior cricoarytenoid
What is the only muscle that tenses (elongates) the vocal cords? - CORRECT ANSWER -
cricothyroid "cords tense"
What muscle opens the glottis? - CORRECT ANSWER - thyroepiglottic
What two muscles close the glottis? - CORRECT ANSWER - aryepiglottic
oblique arytenoid
What muscles adduct the vocal cords and arytenoids?
- there are two - CORRECT ANSWER - lateral cricoarytenoid
transverse arytenoid
What muscle shortens the vocal cords? (relaxes?)
- there are two - CORRECT ANSWER - thyroarytenoid "they relax"
vocalis
The cricothyroid muscle is innervated by? - CORRECT ANSWER - external branch of SLN
- the only branch that tenses (elongates) the VCs
The internal branch of the SLN is purely?
- sensory or motor? - CORRECT ANSWER - sensory
,Recurrent laryngeal innervates... - CORRECT ANSWER - below vocal cords --> the trachea
Branches off vagus in thorax
Motor: all intrinsic except cricothyroid
Glossopharyngeal innervates... - CORRECT ANSWER - the vallecula
topside of epiglottis
soft palate
oropharynx
post 1/3 of tongue
tonsils
*afferent limb of gag reflex*
CN IX - sensory
Superior laryngeal innervates... - CORRECT ANSWER - posterior epiglottis --> vocal cords
Internal branch is sensory - underside of epiglottis
External branch is motor - cricothyroid muscle
Trigeminal (V) V3 innervates... - CORRECT ANSWER - anterior 2/3 tongue
Trigeminal nerve (V) contains what 3 branches? - CORRECT ANSWER - V1 ophthalmic
(anterior ethmoidal) - nares/ant 1/3 septum
V2 maxillary (sphenopalatine) - turbinates/septum
V3 Mandibular (lingual)
Superior laryngeal nerve block: - CORRECT ANSWER - 3ml at the inferior aspect of the
greater cornu of hyoid bone bilaterally
- helps tolerate FO intubation once past the oropharynx
,Glossopharyngeal block: - CORRECT ANSWER - 1-2 ml at the tonsillar pillar bilaterally
Transtracheal block: - CORRECT ANSWER - 3-5 ml through the cricothyroid membrane
What is most likely to injure the left RLN while sparing the right RLN? - CORRECT
ANSWER - Mitral stenosis (LA enlargement compresses the nerve and may present as
hoarseness)
PDA ligation
Aortic arch aneurysm
Thoracic tumor
Causes of left OR right RLN injury: - CORRECT ANSWER - parathyroid or thyroid surgery
external pressure from LMA/ETT
neck tumor
neck extension
Where does the right RLN loop?
left RLN loop? - CORRECT ANSWER - under the right subclavian artery
- left under the aorta (more susceptible to injury)
For the patient in sitting position, order the cartilages from superior to inferior:
cricoid
epiglottis
arytenoid
corniculate - CORRECT ANSWER - epiglottis
corniculate
arytenoid
, cricoid
How many unpaired cartilages present in the larynx?
Paired? - CORRECT ANSWER - 3 unpaired
3 paired
9 cartilages total
Where is the adult larynx located?
Infant larynx? - CORRECT ANSWER - C3-C6
Infant is C2-C4
What is the narrowest part of the airway? adult/infant - CORRECT ANSWER - Vocal cords
for adult
Cricoid for infant, if paralyzed = vocal cords
Risk factors for intraoperative laryngospasm? - CORRECT ANSWER - GERD
Exposure to 2nd hand smoke
recent URI
Age < 1 year
HYPOcapnia
light anesthesia
saliva or blood in the upper airway
What is the definition of laryngospasm? - CORRECT ANSWER - Sustained and involuntary
contraction of the vocal cord Adductors that result in the inability to ventilate.
Tensor palatine opens? - CORRECT ANSWER - nasopharynx
Exam Questions and CORRECT
Answers
What muscle abducts the vocal cords? - CORRECT ANSWER - posterior cricoarytenoid
What is the only muscle that tenses (elongates) the vocal cords? - CORRECT ANSWER -
cricothyroid "cords tense"
What muscle opens the glottis? - CORRECT ANSWER - thyroepiglottic
What two muscles close the glottis? - CORRECT ANSWER - aryepiglottic
oblique arytenoid
What muscles adduct the vocal cords and arytenoids?
- there are two - CORRECT ANSWER - lateral cricoarytenoid
transverse arytenoid
What muscle shortens the vocal cords? (relaxes?)
- there are two - CORRECT ANSWER - thyroarytenoid "they relax"
vocalis
The cricothyroid muscle is innervated by? - CORRECT ANSWER - external branch of SLN
- the only branch that tenses (elongates) the VCs
The internal branch of the SLN is purely?
- sensory or motor? - CORRECT ANSWER - sensory
,Recurrent laryngeal innervates... - CORRECT ANSWER - below vocal cords --> the trachea
Branches off vagus in thorax
Motor: all intrinsic except cricothyroid
Glossopharyngeal innervates... - CORRECT ANSWER - the vallecula
topside of epiglottis
soft palate
oropharynx
post 1/3 of tongue
tonsils
*afferent limb of gag reflex*
CN IX - sensory
Superior laryngeal innervates... - CORRECT ANSWER - posterior epiglottis --> vocal cords
Internal branch is sensory - underside of epiglottis
External branch is motor - cricothyroid muscle
Trigeminal (V) V3 innervates... - CORRECT ANSWER - anterior 2/3 tongue
Trigeminal nerve (V) contains what 3 branches? - CORRECT ANSWER - V1 ophthalmic
(anterior ethmoidal) - nares/ant 1/3 septum
V2 maxillary (sphenopalatine) - turbinates/septum
V3 Mandibular (lingual)
Superior laryngeal nerve block: - CORRECT ANSWER - 3ml at the inferior aspect of the
greater cornu of hyoid bone bilaterally
- helps tolerate FO intubation once past the oropharynx
,Glossopharyngeal block: - CORRECT ANSWER - 1-2 ml at the tonsillar pillar bilaterally
Transtracheal block: - CORRECT ANSWER - 3-5 ml through the cricothyroid membrane
What is most likely to injure the left RLN while sparing the right RLN? - CORRECT
ANSWER - Mitral stenosis (LA enlargement compresses the nerve and may present as
hoarseness)
PDA ligation
Aortic arch aneurysm
Thoracic tumor
Causes of left OR right RLN injury: - CORRECT ANSWER - parathyroid or thyroid surgery
external pressure from LMA/ETT
neck tumor
neck extension
Where does the right RLN loop?
left RLN loop? - CORRECT ANSWER - under the right subclavian artery
- left under the aorta (more susceptible to injury)
For the patient in sitting position, order the cartilages from superior to inferior:
cricoid
epiglottis
arytenoid
corniculate - CORRECT ANSWER - epiglottis
corniculate
arytenoid
, cricoid
How many unpaired cartilages present in the larynx?
Paired? - CORRECT ANSWER - 3 unpaired
3 paired
9 cartilages total
Where is the adult larynx located?
Infant larynx? - CORRECT ANSWER - C3-C6
Infant is C2-C4
What is the narrowest part of the airway? adult/infant - CORRECT ANSWER - Vocal cords
for adult
Cricoid for infant, if paralyzed = vocal cords
Risk factors for intraoperative laryngospasm? - CORRECT ANSWER - GERD
Exposure to 2nd hand smoke
recent URI
Age < 1 year
HYPOcapnia
light anesthesia
saliva or blood in the upper airway
What is the definition of laryngospasm? - CORRECT ANSWER - Sustained and involuntary
contraction of the vocal cord Adductors that result in the inability to ventilate.
Tensor palatine opens? - CORRECT ANSWER - nasopharynx
