NBCRNA APEX Exams Questions With 100% Verified Answer
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NBCRNA
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NBCRNA
NBCRNA APEX Exams Questions With
100% Verified Answers
What muscle abducts the vocal cords? - answerposterior cricoarytenoid
What is the only muscle that tenses (elongates) the vocal cords? - answercricothyroid "cords
tense"
What muscle opens the glottis? - answerthyroepiglottic
What two musc...
NBCRNA APEX Exams Questions With
100% Verified Answers
What muscle abducts the vocal cords? - answer✔posterior cricoarytenoid
What is the only muscle that tenses (elongates) the vocal cords? - answer✔cricothyroid "cords
tense"
What muscle opens the glottis? - answer✔thyroepiglottic
What two muscles close the glottis? - answer✔aryepiglottic
oblique arytenoid
What muscles adduct the vocal cords and arytenoids?
- there are two - answer✔lateral cricoarytenoid
transverse arytenoid
What muscle shortens the vocal cords? (relaxes?)
- there are two - answer✔thyroarytenoid "they relax"
vocalis
The cricothyroid muscle is innervated by? - answer✔external branch of SLN
- the only branch that tenses (elongates) the VCs
The internal branch of the SLN is purely?
- sensory or motor? - answer✔sensory
Recurrent laryngeal innervates... - answer✔below vocal cords --> the trachea
Branches off vagus in thorax
Motor: all intrinsic except cricothyroid
Glossopharyngeal innervates... - 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... - answer✔posterior epiglottis --> vocal cords
Internal branch is sensory - underside of epiglottis
External branch is motor - cricothyroid muscle
Superior laryngeal nerve block: - answer✔3ml at the inferior aspect of the greater cornu of hyoid
bone bilaterally
- helps tolerate FO intubation once past the oropharynx
Glossopharyngeal block: - answer✔1-2 ml at the tonsillar pillar bilaterally
Transtracheal block: - answer✔3-5 ml through the cricothyroid membrane
What is most likely to injure the left RLN while sparing the right RLN? - 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: - answer✔parathyroid or thyroid surgery
external pressure from LMA/ETT
neck tumor
neck extension
Where does the right RLN loop?
left RLN loop? - 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 - answer✔epiglottis
corniculate
arytenoid
cricoid
How many unpaired cartilages present in the larynx?
Paired? - answer✔3 unpaired
3 paired
9 cartilages total
Where is the adult larynx located?
Infant larynx? - answer✔C3-C6
Infant is C2-C4
What is the narrowest part of the airway? adult/infant - answer✔Vocal cords for adult
Cricoid for infant, if paralyzed = vocal cords
Risk factors for intraoperative laryngospasm? - 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? - answer✔Sustained and involuntary contraction of the
vocal cord Adductors that result in the inability to ventilate.
Tensor palatine opens? - answer✔nasopharynx
Genioglossus opens? - answer✔the oropharynx
Hyoid muscles open? - answer✔the hypopharynx
Landmarks for the Larson's maneuver? - answer✔posterior: mastoid process
superior: skull base
Anterior: ramus of mandible
Muller's maneuver? - answer✔inhaling against a closed glottis
Which type of pneumocystis produce surfactant? - answer✔type 2
Three types of pneumocytes? - answer✔type 1 - 3
type 1 - cover 80% of alveolar surface
type 3 - macrophages that fight lung infection
Most common etiology of hypoxemia in the PACU? - answer✔V/Q mismatch: specifically
atelectasis
Result as FRC becomes smaller and there is less radial traction to hold the airways open: -
answer✔result is atelectasis, R -> L shunt, and hypoxemia
Intrapleural pressure becomes positive during: - answer✔The ONLY time intrapleural pressure
becomes positive is during forced exhalation, and pneumothorax
What is transpulmonary pressure? - answer✔alveolar pressure - intrapleural pressure
- always positive, keeps airway open
- Intrapleural always negative - keeps lungs inflated
What muscles provide the most significant contribution to forced exhalation? - answer✔rectus
abdominus
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