Larynx

LARYNX

Q. 1

Why is a child abler to breathe and suckle at the same time 

 A

Short soft palate

 B

Short tongue

 C

High placed larynx

 D

Small pharynx

Q. 1

Why is a child abler to breathe and suckle at the same time 

 A

Short soft palate

 B

Short tongue

 C

High placed larynx

 D

Small pharynx

Ans. C

Explanation:

High placed larynx 

  • A baby can suck milk into mouth and because of its palate its mouth is separated from its nasal cavity so white it is sucking in milk it can also breathe through its nose.
  • When the infant has to swallow the soft palate rapidly moves upward to close off the hack of the nasal air tube.
  • At the same time, the epiglottis closes off the larynx and guides the milk into the esophagus (food tube).
  • Because of these factors infants can breath and swallow in quick succession.

–  Its lumen is short and. funnel shaped and disproportionately narrower than that of adult.

It lies higher in the neck than the adult larynx.

-It rest the upper border of the infant epiglottis is at the level of the second or third cervical vertebrae.

–   When larynx is elevated it reaches the level of first cervical vertebrae.

– This high position enables an infant to use its nasal airway to breathe while sucking.


Q. 2

TRUE about infant airway compared to adult airway are all, EXCEPT:

 A

The relatively large size of the tongue

 B

Epiglottis is omega shaped

 C

Larynx is funnel shaped

 D

None of the above

Q. 2

TRUE about infant airway compared to adult airway are all, EXCEPT:

 A

The relatively large size of the tongue

 B

Epiglottis is omega shaped

 C

Larynx is funnel shaped

 D

None of the above

Ans. D

Explanation:

Differences in airway anatomy make the potential for technical airway difficulties greater in infants than in teenagers or adults. The airway of infants differs in five ways:

(1) the relatively large size of the infant’s tongue in relation to the oropharynx increases the likelihood of airway obstruction and technical difficulties during laryngoscopy;

(2) the larynx is located higher (more cephalic) in the neck, thus making straight blades more useful than curved blades;

(3) the epiglottis is shaped differently, being short, stubby, omega shaped, and angled over the laryngeal inlet; control with the laryngoscope blade is therefore more difficult;

(4) the vocal cords are angled, so a “blindly” passed endotracheal tube may easily lodge in the anterior commissure rather than slide into the trachea; and

(5) the infant larynx is funnel shaped.

Ref: Miller’s anesthesia-7th ed, Chapter 82.

Q. 3

Shape of adult larynx is:

 A

Cylindrical

 B

Funnel shaped

 C

Inverted funnel shape

 D

None of the above

Q. 3

Shape of adult larynx is:

 A

Cylindrical

 B

Funnel shaped

 C

Inverted funnel shape

 D

None of the above

Ans. A

Explanation:

Classic teaching has been that the adult larynx is cylindrical and the infant larynx is funnel shaped.
 
Ref: Miller’s anesthesia-7th ed , Chapter 82.

Q. 4

Which of the following feature of airways can make babies enable breathing while suckling breast milk?

 A

Short, wide tongue

 B

Small pharynx

 C

Higher position of larynx

 D

Small soft palate

Q. 4

Which of the following feature of airways can make babies enable breathing while suckling breast milk?

 A

Short, wide tongue

 B

Small pharynx

 C

Higher position of larynx

 D

Small soft palate

Ans. C

Explanation:

Paediatric larynx:

  • Infant’s larynx is positioned high in the neck opposite C3 or C4 (vocal cord level ) at rest and reaches C1 or C2 during swallowing.

  • This high position allows the epiglottis to meet soft palate and make a nasopharyngeal channel for nasal breathing during suckling.

  • The milk feed passes separately over the dorsum of tongue and the side of epiglottis, thus allowing breathing and feeding to go on simultaneously.

Ref: Diseases of Ear, Nose and Throat by PL Dhingra, 4th edition, Page 262.


Q. 5

Which of the following is MOST important in separating the esophagus from the larynx, and must consequently be carefully passed behind during endoscopy?

 A

Arytenoids

 B

Cricoid cartilage

 C

Epiglottis

 D

Pharynx

Q. 5

Which of the following is MOST important in separating the esophagus from the larynx, and must consequently be carefully passed behind during endoscopy?

 A

Arytenoids

 B

Cricoid cartilage

 C

Epiglottis

 D

Pharynx

Ans. C

Explanation:

Endoscopists are very careful when guiding the endoscope past the epiglottis, which is a pear-shaped portion of elastic cartilage that can be moved during swallowing to close the larynx, preventing swallowed material from eventually entering the lungs.

  • The arytenoids are the site of the attachment of the vocal cords  within the larynx.
  • The cricoid cartilage is in the more distal portion of the larynx.
  • The pharynx is shared by the respiratory and gastrointestinal tracts.
Also know:
  • The thyroid cartilage forms a median elevation, called the laryngeal prominence (“Adam’s apple”), and lies inferior to the hyoid bone.
  • The epiglottis is an elastic cartilage, shaped like a spoon, that is posterior to the root of the tongue.
  • The cricoid cartilage is shaped like a signet ring, with the broad part of the ring facing posteriorly.
  • The arytenoid cartilages are shaped like a pyramid.

Q. 6

The narrowest part of larynx in infants is at the cricoid level. In administering anesthesia this may lead to all except.

 A

Choosing a smaller size endotracheal tube

 B

Trauma to the subglottic region

 C

Post operative stridor

 D

Laryngeal oedema

Q. 6

The narrowest part of larynx in infants is at the cricoid level. In administering anesthesia this may lead to all except.

 A

Choosing a smaller size endotracheal tube

 B

Trauma to the subglottic region

 C

Post operative stridor

 D

Laryngeal oedema

Ans. A

Explanation:

A i.e. Choosing a smaller size endotracheal tube

  • Endotracheal tube that passes through the glottis may still impinge upon the cricoid cartilage; the cricoid cartilage is the narrowest point of the airway in children younger than 5 years of ageQ
  • Mucosal trama can cause post operative edema, stridor, croup & airway obstruction() in subglottic & glotic region
  • The appropiate size of tube is estimated by an age based formula, which provides only a rough guide line however. Exceptions include premature neonates (2.5 to 3 mm tube) and full term neonates (3-3.5 mm tube)
  • Correct tube size is confirmed by easy passage into the larynx and the development of gas leak at 15-20 cm H20 pressure. So the size of ETT depends on age, easy passage & gasleak at 15-20 cm H20 pressure.

Q. 7

True about larynx in neonate:

 A

Epiglottis is large and omega shaped

 B

Cricoid narrowest part

 C

It extends till C4,5,6 vertebrae

 D

a and b

Q. 7

True about larynx in neonate:

 A

Epiglottis is large and omega shaped

 B

Cricoid narrowest part

 C

It extends till C4,5,6 vertebrae

 D

a and b

Ans. D

Explanation:

 

Infant’s Larynx Differs from Adult in:

1. It is situated high up (C2 – C4).° (in adults = C3 – C6)

2. Of equal size in both sixes (in adults it is larger in males)

3. Larynx is funnel shaped

4. The narrowest part of the infantile larynx is the junction of subglottic larynx with trachea and this is because cricoid cartilage is very small

5. Cartilages:

    1. Epiglottis is omega shaped, soft, large and patulous.
    2. Laryngeal cartilages are soft and collapse easily
    3. Thyroid cartilage is flat
    4. Arytenoid cartilage is relatively large

6. The cricothyroid and thyrohyoid spaces are narrow

7. The submucosal tissue is thick and loose and becomes oedematous in response to inflammation

8. Vocal cords are angled and lie at level of C8

9. Trachea bifurcates at level of T9



Q. 8

Narrowest part of infantile larynx is:

 A

Supraglottic

 B

Subglottic

 C

Glottic

 D

None of the above

Q. 8

Narrowest part of infantile larynx is:

 A

Supraglottic

 B

Subglottic

 C

Glottic

 D

None of the above

Ans. B

Explanation:

 

The diameter of cricoid cartilage is smaller than the size of glottis, making subglottis the narrowest part


Q. 9

Laryngofissure is:

 A

Opening the larynx in midline

 B

Making window in thyroid cartilage

 C

Removal of arytenoids

 D

Removal of epiglottis

Q. 9

Laryngofissure is:

 A

Opening the larynx in midline

 B

Making window in thyroid cartilage

 C

Removal of arytenoids

 D

Removal of epiglottis

Ans. A

Explanation:

Q. 10

All are true statement about tracheostomy and larynx in children except:

 A

Omega shaped epiglottis

 B

Laryngeal cartilages are soft and collapsable

 C

Larynx is high in children

 D

Trachea can be easily palpated

Q. 10

All are true statement about tracheostomy and larynx in children except:

 A

Omega shaped epiglottis

 B

Laryngeal cartilages are soft and collapsable

 C

Larynx is high in children

 D

Trachea can be easily palpated

Ans. D

Explanation:

 

Infant’s larynx differs from adult in:

  • It is situated high up (C2 – C4).Q (in adults = C3 – C6)
  • Of equal size in both sixes (in adults it is larger in males)
  • Larynx is funnel shaped
  • The narrowest part of the infantile larynx is the junction of subglottic larynx with trachea and this is because cricoid cartilage is very small
  • Epiglottis is omega shaped, soft, large and patulous.
  • Laryngeal cartilages are soft and collapse easily
  • Short trachea and short neck.
  • Vocal cords are angled and lie at level of C4
  • Trachea bifurcates at level of T2
  • Thyroid cartilage is flat. The cricothyroid and thyrohyoid spaces are narrow.

Tracheostomy in Infants and Children                                                                                                              

Trachea of infants and children is soft and compressible and its identification may become difficult and the surgeon may easily displace it and go deep or lateral to it injuring recurrent laryngeal nerve or even the carotid.

During positioning, do not extend too much as this pulls structures from chest into the neck and thus injury may occur to pleura, innominate vessels and thymus or the tracheostomy opening may be made twoo low near suprasternal notch

Tracheostomy in Infants and Children                                                                                               

The incision is a short transverse one, midway between lower border of thyroid cartilage and the suprasternal notch. The neck must be well extended.

A incision is made through two tracheal rings, preferably the third or fourth.



Q. 11

Function of larynx ‑

 A

Speech

 B

Protection of airway

 C

Conduit of air

 D

All

Q. 11

Function of larynx ‑

 A

Speech

 B

Protection of airway

 C

Conduit of air

 D

All

Ans. D

Explanation:

Ans. is ‘d i.e., All 

There are three important functions of larynx, which are of real concerns to the clinician :‑

  • Provision of airway
  • Larynx serves as a conduit for air and waste gases to and from lungs.
  • Protection of airway
  • Larynx prevents the passage of secretions of food and of other forein material into the upper respiratory tract.
  • Phonation
  • Larynx serves as organ of voice.


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