A 35-year-old woman comes to the physician for a scheduled laparoscopic cholecystectomy. In the operating room, a laryngeal mask airway has been placed to deliver continuous anesthesia and ensure proper oxygenation during the surgery. This mask is composed of an air tube with an inflatable or self-sealing cuff. It is inserted through the mouth until the cuff rests against the top of the glottis and helps keep the airway open. Under normal conditions, the rima glottidis is opened by which pair of muscles?

A 65-year-old woman is brought to the emergency department because of fatigue and weight loss. She also has been having recurring headaches and difficulty swallowing. Recently, the patient’s fluid intake has decreased because of frequently aspirating fluids when attempting to drink. She has lost 9 kg (20 lb) over 3 months. Physical exam shows loss of skin turgor and dysphagia. A CT scan of the head shows a skull base tumor occupying the space behind the jugular foramen. Involvement of which of the following structures is most likely responsible for these findings in the patient?

A 34-year-old woman comes to the physician for a scheduled partial thyroidectomy. In the recovery room, she has been having difficulties drinking fluid and is noted to aspirate into her lungs. The patient failed her swallow evaluation. Physical examination shows that the area of the piriform recess above the vocal fold of the larynx was anesthetized. Which of the following nerves was most likely injured?

A 38-year-old man comes to the physician because of a large mass in his lower anterior neck. The patient works at a nuclear power plant. He says that the lump does not cause any pain, but he has some difficulty swallowing. An ultrasound examination confirms a benign tumor of the thyroid gland and a partial thyroidectomy is performed. Twenty-four hours following the surgery, physical examination shows the patient could not abduct the true vocal cords. Which of the following muscles was most likely denervated during the operation?

A 55-year-old man comes to the office because of pain while chewing for the past 3 months. Physical examination shows hoarseness of voice and pain on swallowing. A lateral x-ray of the neck shows a mass at the tracheoesophageal groove. Which of the following nerves is most likely affected by the mass?

A 44-year-old woman comes to the physician 2 weeks after undergoing a thyroidectomy for multiple benign thyroid nodules. Physical examination shows injury to the left external laryngeal nerve. An injury to this nerve may result in which of the following symptoms?

A 34-year-old woman is brought to the emergency department with difficulty breathing. She was trying out food at a new restaurant in town 30 minutes ago. Her temperature is 37.6°C (99.68°F), pulse is 105/min, respirations are 28/min, blood pressure is 120/80 mm Hg, and oxygen saturation is approximately 80%. Physical examination shows a swollen tongue protruding from her mouth. The patient's oxygen saturation does not improve with bag-mask ventilation. Intubation is unsuccessful because of massive soft tissue edema of her pharynx. A decision is made to perform a cricothyrotomy. After palpation of the neck to identify the appropriate landmarks, an incision should most likely be made at which of the following locations?

A 45-year-old woman is brought to the emergency department because of difficulty breathing. Her vital signs are within normal limits. Physical examination shows clear breath sounds bilaterally. An x-ray of the chest shows a tumor invading the lung surface anterior to the hilum. Which nerve is most likely compressed by the tumor to result in dyspnea?

A 62-year-old man comes to the physician because of a 3-month history of progressive voice softening. Vital signs are within normal limits. Physical examination shows clear lung sounds bilaterally and no murmurs are heard. A CT scan of the chest shows a growth located within the aortic arch adjacent to the left pulmonary artery. Which neural structure is most likely being compressed to cause the changes in the patient’s voice?

A 34-year-old man is brought to the emergency department because of a sharp, localized pain over the anterior thoracic wall, cough, and shortness of breath. Physical examination shows decreased breath sounds, dullness to percussion, and decreased tactile fremitus in the right lower lung fields. An x-ray of the chest shows blunting of the right costophrenic angle confirming right sided pleural effusion. Through which intercostal space along the midaxillary line is it most appropriate to insert a chest tube to drain the effusion fluid?

A 72-year-old woman is brought to the emergency department by her family because she has been excessively tired and unresponsive at times. The family says the patient has been losing weight. Physical examination shows ptosis and miosis of the right eye. Cardiac examination shows no murmurs, and lungs are clear to auscultation bilaterally. There is tenderness to palpation of the chest in the upper right thorax. Which of the following is the most likely diagnosis?

A 33-year-old man is brought to the emergency department after being involved in a motor vehicle collision. His temperature is 37°C (96.8°F), pulse is 80/min, and blood pressure is 119/89 mm Hg, and a central venous line is placed. Which of the following structures is used as a landmark to verify that the tip of the catheter of the central venous line is in the correct place? 

A 34-year-old man is brought to the emergency department with a sharp, localized pain over the thoracic wall. Physical examination shows dullness on percussion and an x-ray of the chest shows a pleural effusion. A chest tube is inserted to drain the effusion through an intercostal space. At which of the following locations is the chest tube most likely to be inserted?

A 3-year-old boy is brought to the emergency department after a fall from a tree. The patient complains of severe pain over the right side of his chest. Physical examination shows dullness on percussion in the lower lobes of lungs bilaterally. An x-ray of the chest shows a rib fracture at the midaxillary line, atelectasis, and hemothorax resulting from the accumulation of blood in his pleural space. What is the most likely source of bleeding to cause the hemothorax?

A 34-year-old man is brought to the emergency department for severe shortness of breath. The patient had been diagnosed earlier in the week with Guillain-Barré syndrome. His thoracic wall contracts and relaxes violently, but there is little movement of the abdominal wall. The degenerative disease has obviously affected the muscle that is most responsible for increasing the vertical dimensions of the thoracic cavity (and pleural cavities). Which of the following is the most likely cause of his disease?