NBCRNA APEX UPDATED ACTUAL Exam Questions and CORRECT Answers

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