[Professional title exam] Intensive lecture 01 at the anesthesia junior and intermediate test center

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Questioner 1.
If left internal jugular vein cannulation is performed, the most likely structure between the common carotid artery and the vertebral artery is __________
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Resolving the thoracic duct The internal jugular vein is located within the carotid sheath, most of the time anterolateral to the carotid artery and vagus nerve (Figure 1), originating from the jugular foramen of the skull, and joining the subclavian vein behind the clavicle to form the brachiocephalic vein
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In many patients, the internal jugular vein runs over the carotid artery, and penetration of the needle too deep during puncture may lead to mispenetration of the artery, especially when the puncture direction is inward
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Figure 1 Neck anatomy
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Pay attention to observe the relative positions of the internal carotid artery, internal jugular vein and thoracic duct.
Behind the carotid sheath and its contents are the transverse process of the vertebral column, scalene muscle, nerve root and vertebral artery and vein
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It has been reported that during the puncture of the internal jugular vein, the needle was inserted too deeply and the vertebral artery and vein were mistakenly penetrated and the catheter was placed
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Because these vertebral vessels are very close to the nerve roots, mispenetration of the vertebral artery and vein is also a possible complication of brachial plexus block with the intermuscular groove approach
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The thoracic duct protrudes from the thoracic cage between the esophagus and the pleura, arcuates behind the carotid sheath, runs down the anterior side of the vertebral vessels, and opens into the venous angle formed by the internal jugular vein and the subclavian vein
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Injury to the thoracic duct by accidental penetration is rare but has been reported in left central venous catheters (including internal jugular and subclavian catheters) and may result in chylothorax or cutaneous chyle leakage
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Questioner 2.
The structure referred to by the letter B in Figure 2 is __________
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Explanation Figure 2 Anatomy of the larynx and trachea Anatomy of the cricothyroid membrane: On the superficial surface of the larynx, the thyroid cartilage (A) and cricoid cartilage (C) of the larynx are connected by the cricothyroid membrane (B)
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This film is generally 2-3cm wide and 1cm high
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The anterior attachment point of the vocal cords is approximately 1 cm above the upper border of the cricothyroid membrane
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Therefore, access to the airway through this membrane (eg, a cricothyroidotomy) keeps the operator away from these critical structures
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The only caveat is that the cricothyroid artery, a branch of the superior thyroid artery, generally traverses the superior lateral aspect of the cricothyroid membrane
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Therefore, it is wise to make an incision on the lower side of the cricothyroid membrane and limit the width of the incision (although in a critical juncture of rescuing the patient, when doing a cricothyroidotomy, small blood vessel damage will not be your focus.
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In about 40% of people, the thyroid cones extend up the midline, so they may be damaged during a cricothyroidotomy
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Question 3.
A patient is going to be intubated through the nasal awake trachea.
In order to anesthetize the nasal mucosa, it is necessary to block the _____ nerve? Analysis of the trigeminal nerve: Nasal sensation is innervated by the V1 and V2 branches of the trigeminal nerve
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The V1 branch of the trigeminal nerve, the ophthalmic branch, enters the anterior ethmoid nerve and provides sensory innervation to the anterior part of the nasal septum
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The V2 branch of the trigeminal nerve, the maxillary nerve branches into the greater and lesser palatine nerves, providing most of the sensory innervation of the turbinates and nasal septum
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The glossopharyngeal nerve provides sensory innervation to the pharynx, the posterior third of the tongue, the anterior surface of the epiglottis, and the tonsils
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The vagus nerve provides sensory innervation to the base of the tongue, posterior epiglottis, arytenoid cartilage, etc.
via the medial branch of the superior laryngeal nerve
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The vagus nerve provides sensory innervation to the vocal folds and trachea via the recurrent laryngeal nerve
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The facial nerve branches are responsible for sensing the anterior 2/3 of the tongue, while the glossopharyngeal nerve is responsible for the posterior 1/3 of the tongue
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Questioner 4.
Among the blood vessels of the coronary system, the __________ branch is mainly responsible for the blood supply to the ventricular septum
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Analysis of the left anterior descending branch: The left and right coronary arteries originate from the left and right coronary sinuses at the root of the aorta, respectively, and pass through the surface of the heart under the epicardium.

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The left anterior descending artery (LAD) originates from the left coronary artery (LCA), runs downward from the anterior interventricular sulcus to the apex of the heart, and then continues to travel upward along the posterior interventricular sulcus.
PDA) confluence
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The LAD is responsible for the blood supply to the anterior wall of both sides of the ventricle, the apex of the heart, and the anterior 2/3 of the ventricular septum
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Figure 3.
Anatomy of the coronary artery in the heart.
The circumflex branch is a branch of the LCA, which surrounds the left atrium and the left ventricle.
About 45% of people supply blood to the sinoatrial node through the branch from the circumflex branch to the right atrium
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The right coronary artery (RCA) arises from between the pulmonary trunk and the right atrial appendage, runs along the coronary sulcus to the posterior side of the heart and matches the circumflex branch from the LCA
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RCA is responsible for the blood supply of the right atrium and right ventricle.
55% of people supply blood to the sinoatrial node through the branch of the sinoatrial node of the RCA.
In addition, the RCA also supplies blood to the posterior 1/3 of the ventricular septum through the PDA
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Questioner 5.
The left recurrent laryngeal nerve surrounds the __________ (large blood vessel)? Analysis of the aorta: The left and right recurrent laryngeal nerves are branches of the vagus nerve
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The vagus nerve emerges from the carotid sheath and descends into the thoracic cavity, and then gives off a recurring branch that surrounds the upper part of the trachea and esophagus
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The recurrent branch then ascends and innervates all the intrinsic muscles of the larynx except the cricothyroid
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The right recurrent laryngeal nerve surrounds the right subclavian artery, while the left recurrent laryngeal nerve hooks around the aortic arch, to the left of the ligamentum arteriosus, a distinction that is embryologically coincidental
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The vessels of the 4th pharyngeal arch include the right subclavian artery and the left side of the aortic arch.
During fetal development, the recurrent laryngeal nerve originating from the 6th pharyngeal arch is pulled down and into the thoracic cavity as the great vessels grow into place
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Because the aortic arch is more caudal, the left recurrent laryngeal nerve has to travel a longer distance before reaching the larynx
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