CC boards study guide

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  1. The
    cricopharyngeus muscle receives sensory innervation primarily from the:
    • The
    • cricopharyngeus muscle, an integral part of the upper esophageal sphincter,
    • receives sensory innervation primarily from the glossopharyngeal nerve (CN IX).
    • It receives motor innervation primarily from the vagus (CN X) and to a lesser
    • extent from CN IX. It acts as a barrier to regurgitation in the conscious patient.
  2. Arterial blood supply to the larynx arises from the
    uperior and inferior thyroid arteries

    • The superior thyroid artery, a branch of the external
    • carotid, gives rise to the superior laryngeal artery. This artery supplies the
    • supraglottic region of the larynx. The inferior laryngeal artery, a branch
    • of the inferior thyroid artery, supplies the infraglottic region of the larynx.
  3. The ansa cervicalis innervates the
    sternohyoid muscle

    • The ansa cervicalis, a component of the cervical plexus, provides motor innervation
    • to the sternohyoid and the inferior belly of the omohyoid muscles.
  4. Chassaignac's tubercle may be palpated at
    the cricoid cartilage at C6

    • Chassaignac's tubercle is an anatomic landmark for the placement of interscalene
    • and cervical plexus blocks. It is the transverse process of the verterbal body at C6 and may be palpated lateral to the cricoid cartilage.
  5. Cerebrospinal fluid flows from the third to the
    fourth ventricle via the:
    cerebral aqueduct of Sylvius

    • CSF is secreted by the choroid plexus in lateral ventricles 1 and 2, flows through the
    • foramen of Munro to the 3rd ventricle, through aqueduct of Sylvius (A.K.A. cerebral aqueduct) to 4th ventricle
    • and through the foramina of Magendie and Luschka (A.K.A. lateral and medial apertures of 4th ventricle) to
    • the subarachnoid space.
  6. Organs designated as preportal organs include the
    stomach, small intestines, pancreas and spleen

    The preportal organs are the stomach, spleen, pancreas, small intestine, and colon.
  7. Motor innervation of the superior oblique muscle of the
    eye is supplied by the
    trochlear nerve

    • Although the majority of extraocular muscles receive motor innervation
    • from the oculomotor nerve (CN III), the trochlear nerve (CN IV) provides motor innervation to
    • the superior oblique muscle of the eye. The abducens (CN VI) provides motor innervation to the
    • lateral rectus muscle of the eye.
  8. Of the following, the therapeutic intervention that causes the
    least ventilatory compromise in the prone patient is the:
    use of a Jackson table

    • The degree to which pulmonary mechanics are altered are suggested
    • to be frame-dependent and not dependent on body habitus. Use of the Jackson table resulted
    • in the smallest change in pulmonary compliance and peak airway pressures when compared with
    • use of the Wilson frame and chest rolls.
  9. Components that comprise the thin filament of the contractile
    apparatus include
    actin, troponin, tropomyosin
  10. The sinus which is in close proximity to the optic
    chiasma and the hypophysis is the:
    • The sphenoid sinuses are paired and may extend into
    • the basal part of the occipital bone. The roof of the sinus has close connections
    • with the optic canal and the chiasmatic groove (upward) as well as to the hypophysis
    • toward the back. Pituitary tumor surgery may be achieved via a trans-nasal approach
    • through the sphenoid sinus. Overall, the paranasal sinuses play an important role
    • as the site of infectious processes.
  11. The parietal cells of the stomach are responsible for the secretion of:
    :hydrochloric acid Parietal cells in the stomach secrete hydrochloric acid in response to the sight and smell of food; pepsinogen is also secreted by the chief cells at this time. Gastrin is secreted by the G cells in response to gastric distention. Other gastric secretions include serotonin, histamine and mucus. Secretin and pancreatic bicarbonate are released in response to duodenal acidity.
  12. functions of the spleen
    • Functions of the spleen include: hematopoiesis in the fetus,
    • blood filtering by splenic sinusoids, removal of foreign antigens by macrophages,
    • IgM production, and removal of aged RBCs and abnormal blood cells. The spleen has
    • a minor role as a reservoir of platelets but has no specific reservoir function
    • for RBCs.
  13. the portal triad consists of the:
    hepatic artery, portal vein, bile duct
  14. In the cardiac myocyte, the area which delineates the
    border between two separate sarcomeres is known as the
    • The "Z" band, named from the German zuckung (twitch) line,
    • bisects each "I" band of the sarcomere. The "I" band represents the region of the
    • sarcomere which contains thin filaments only while the "A" band is characterized
    • by an area of overlap of thick and thin fibers. The "M" band is present centrally
    • within the "A" band and is composed of thick filaments which form a hexagonal
    • matrix of myosin binding with protein C.
  15. The pneumotaxic center:
    • The pneumotaxic respiratory center is in the rostral pons.
    • Its primary function is to limit the depth of inspiration When maximally activated,
    • the pneumotaxic center increases ventilatory frequency; however, it performs no
    • pacemaking function and has no intrinsic rhythmicity.
  16. When performing a glossopharyngeal nerve block, the branches
    of the nerve are most easily accessed via
    • The glossopharyngeal nerve provides sensory innervation
    • to the following areas: posterior third of the tongue, the vallecula,the anterior
    • surface of the epiglottis, the walls of the pharynx, and the tonsils. When
    • performing a glossopharyngeal nerve block, the nerves are most easily accessed
    • as they traverse the palatoglossal folds, the soft ridges that extend from the
    • posterior aspect of the soft palate to the base of the tongue bilaterally.
  17. Primary branches of the trigeminal nerve (CN V) include the
    ophthalmic nerve, maxillary nerve, mandibular nerve
  18. During the division of the tracheobroncheal
    tree, loss of cartilage occurs at approximately the:
    16th generation

    Subdivisions, A.K.A. airway generations, are utilized to classify branching of the tracheobronchial tree. The trachea comprises 0 generation and the airways further divide until the alveolar sacs and alveoli are reached terminally at the 23rd generation. The airways begin to lose cartilage just distal to the small intrasegmental bronchi. This occurs at approximately the 16th airway generation.
  19. Sensory innervation of the larynx below the level of the vocal cords is provided by the:
    • recurrent laryngeal nerve
    • The larynx receives innervation from two major nerves.
    • The superior laryngeal nerve branches into two nerves: the internal branch which
    • provides sensory innervation to the larynx above the vocal cords and the external
    • branch which provides motor innervation to the cricothyroid muscle. The recurrent
    • laryngeal nerve provides sensory innervation to the larynx below the vocal cords
    • and motor innervation to all of the muscles of the larynx with the exception of
    • the cricothyroid muscle.
  20. dead space equation
  21. Dead space can be estimated using the Bohr

    • VD/VT = (PACO2
    • - PECO2)/PACO2
  22. Causes of increased peak inspiratory pressure
    and unchanged plateau pressure include
    • I:E ratio, increased
    • airway resistance, bronchospasm, kinked endotracheal tube, secretions and
    • foreign body aspiration.
  23. β-2 stimulation results in
    • Sympathetic activity mediates
    • bronchodilation and decreased secretions via the β-2 receptors. α-1 receptors stimulation
    • also decrease secretions, but may cause bronchospasm.
  24. Arterial oxygen tension can be approximated
    by the formula:
  25. Arterial oxygen tension can be approximated
    • by the formula:
    • PaO2 = 102 - (Age/3)
  26. Most airway resistance comes from
    medium-sized bronchi (before the 7th generation)

    • Normal total airway resistance is
    • about 0.5 - 2 cm H2O/L/s, with the largest
    • contribution coming from medium-sized bronchi (before the
    • 7th generation).
  27. Stimulation of vagal afferents and
    efferents of the bronchi is associated with

    Vagal afferents in the bronchi are sensitive to histamine and multiple noxious stimuli. Vagal activation results in bronchoconstriction, which is mediated by an increase in cGMP.
  28. Laminar flow in the airways is found
    in bronchioles < 1 mm in diameter

    • Laminar flow normally occurs only
    • distal to small bronchioles (< 1 mm). Flow in larger airways is probably turbulent.
  29. β2-adrenergic agonists produce bronchodilation
    increasing intracellular cAMP

    Activation of β2-adrenergic receptors on bronchiolar  smooth muscle activated adenylate cyclase, which results in the formation of  intracellular cAMP.
  30. Capnographic evidence of bronchospasm includes:
    increased slope of phase III

    • In the normal capnogram, phase III is nearly
    • flat with a slope approaching zero. With obstruction, the slope of
    • phase III increases.
  31. The dichotomous division of the tracheobronchial tree is estimated to involve
    23 divisions

    • Dichotomous division, starting with the trachea
    • and ending in alveolar sacs, is estimated to involve 23 divisions. Gas
    • exchange can occur only across the flat epithelium, which begins to
    • appear on pulmonary bronchioles (generations 17 - 19).
  32. α-1 stimulation results in (regarding airway)
    • bronchoconstriction and
    • decreased secretions

    • Sympathetic activity (T1 - T4) mediates bronchodilation
    • and also decreases secretions via β2 receptors. α1-adrenergic
    • receptor stimulation decreases secretions, but may cause bronchospasm.
  33. Dead space ends and gas exchange begins at the
    respiratory bronchiole

    • Gas exchange can occur only across the flat
    • epithelium, which begins to appear on the respiratory bronchiole
    • (generations 17 - 19).
  34. Sympathetic innervation of the lung
    originates at
  35. Sympathetic innervation to the lung
    • originates at T1 - T4. Sensory and parasympathetic innervation
    • of the lung is provided by the vagus nerves.
  36. In the adult, carbon dioxide stores are
  37. Methylxanthines produce bronchodilation
    • Traditionally, methylxanthines are
    • thought to produce bronchodilation by inhibiting phosphodiesterase, but their effects appear to be much more complex. Additional pulmonary effects include increased catecholamine release, histamine blockade and diaphragmatic stimulation.
  38. The inhibition of ventilation, preventing
    over-inflation of the lung, is controlled by the:
    pneumotaxic center

    • Two pontine areas influence the dorsal
    • (inspiratory) medullary center. A lower pontine (apneustic)
    • center is excitatory, whereas an upper pontine (pneumotaxic)
    • center is inhibitory.
  39. Prior to pneumonectomy, preoperative laboratory criteria necessitating split lung function testing includes
  40. Split lung function testing is indicated if pneumonectomy is
    contemplated in a patient not meeting any of the following criteria:

    • PaCO2 > 45 mmHg
    • FEV1 < 2 L
    • FEV1 / FVC < 50% of predicted
    • Maximum VO2 < 10 mL/kg/min
    • Maximum breathing capacity < 50% of predicted
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