Airways B Midterm Flashcards
1
Q
What actions are most likely to cause iatrogenic retropharyngeal abscesses?
A
Failed NGT placement
2
Q
What is the age for end of development in humans?
A
7 years old
3
Q
What is the age for peak incidence of foreign body aspiration?
A
2-3 years old
4
Q
How should you examine and evaluate the airway of patients who have undergone radiation?
A
Manual exam of the larynx with swallowing
5
Q
How should you manage the airway of a patient with Ludwig’s angina?
A
Nasal intubation
6
Q
How should you induce anesthesia in patients with LeFort fractures?
A
RSI w/ great preO2
7
Q
What airway adjuncts do you NOT use in patients with a LeFort II fracture?
A
NAW, NETT, NGT
8
Q
What airway adjuncts do you NOT use in patients with a LeFort III fracture?
A
Anode ETT
9
Q
What muscle of the tongue depresses and protrudes it?
A
Genioglossus
10
Q
What anatomical structures make up Waldeyer’s ring?
A
Adenoids, lingual, nasopharyngeal, and palatine tonsils
11
Q
What anesthetic should you use for management of tonsillar abscess drainage?
A
GETA with short-acting IV anesthetic, sevo or des, and short acting NMB
12
Q
What airway adjunct should you consider for management of tonsillar abscess drainage?
A
Anode tube
13
Q
What auscultatory sound is caused by an orificial airway lesion?
A
Stridor
14
Q
What auscultatory sound is heard in patients with asthma?
A
Wheezes
15
Q
What are complications associated with nasotracheal intubation?
A
Epistaxis, abrasion, hemorrhage, infection, perichondritis, chondritis, sinusitis
16
Q
What is a primary tracheostomy?
A
Tracheostomy done within 24 hours of intubation
17
Q
What is the function of the atlanto-occipital joint?
A
To provide flexion and extension of the head
18
Q
Does hoarseness occur more in males or females?
A
Females
19
Q
What lab values should you check following a parathyroidectomy?
A
Ca2+
20
Q
What is the most common cause of stridor in 2 year olds?
A
Laryngomalacia
21
Q
What should the FiO2 be kept under when the surgeon is lasering the airway?
A
30%
22
Q
Where is squamous cell carcinoma most commonly found on the body?
A
In the mouth, orally
23
Q
Why do obese patients desaturate more quickly?
A
They have a lower FRC
24
Q
What can interrupt function of the right RLN and cause hoarseness?
A
Aortic aneurysm
25
What surgeries often use McIvor mouth gags?
Pharynx surgeries, i.e. tonsils
26
What vocal cord injury is associated with being intubated for over 72 hours?
Ulceration
27
What vocal cord injury is associated with being intubated for 3-21 days?
Granulomata
28
What vocal cord injury is associated with being intubated for more than 2 weeks?
Cicatricial stenosis
29
What is the position of the vocal cords immediately following interruption of the RLN?
Paramedian
30
How do you manage the airway of a patient presenting with facial burns, including lips and nasal hairs
Oral intubation
31
For repair of a lower lip laceration under MAC, so long as oxyhemoglobin saturation remains satisfactory (>94%), what is the safest FiO2 to provide the patient?
21% room air
32
At the conclusion of a general anesthetic for total laryngectomy, how should the patient be breathing/supported?
Spontaneous
33
How would you select an oral airway size for an acromegalic patient?
Increase size
34
Would you use a nasal airway for an acromegalic patient?
No
35
How would you select a laryngoscope for an acromegalic patient?
Increase size
36
How would you select an ETT for an acromegalic patient?
Use the regular size
37
If hoarseness is due to arthritis of a joint, which joint is most likely involved?
Cricoarytenoid
38
An increase in lung water would produce which breath sounds?
Rales
39
What is the surgical requirement for postop airway safety after a tracheostomy?
A stay suture in place to ensure access to trach
40
How do you calculate time to hypoxia/desaturation time?
FRC/VO2
41
What is the incidence of postop hoarseness?
3%
42
What is the resolution for postop hoarseness?
Usually resolves on its own in 1-3 days
43
What is a secondary tracheostomy?
A tracheostomy that takes place more than 24 hours after intubation
44
What are the increased risks with a secondary tracheostomy?
Bleeding and infection
45
What are the causes of postop stridor?
Supraglottic edema, RLN injury (rare), hypocalcemia (rare)
46
What position should a gravid patient be in for airway examination?
Supine
47
What is the proper management for ulceration of vocal cords?
Strict voice rest and observation
48
What is the proper management for cicatricial stenosis?
Surgery
49
How do you calculate oxygen consumption?
Kg^0.75 x 10
50
What is the appropriate ETT position for the McIvor mouth gag?
Midline on the tongue (on spatula/groove) and between the tongue and flange
51
What do rales sound like?
Crackling, high pitched
52
What do rhonchi sound like?
Vibrating, low pitched
53
What does stridor sound like?
Shrill, high pitched
54
Is wheezing high-pitched or low-pitched?
High pitched
55
Hoarseness persisting more than 2 weeks requires what action?
Otolaryngoscopy
56
What is the most frequent laryngeal malignancy?
Squamous cell carcinoma
57
What is the flow-volume loop of a patient with thyroid disease?
Extrathoracic, inspiratory plateau
58
What airway device should be used for a patient with a laryngectomy?
Laryngoflex
59
What are the functions of the larynx?
Protection, effort closure, phonation, air passage
60
What is the vertebral level of the hyoid bone?
C3
61
What is overjet?
Upper teeth jet over the bottom teeth horizontally
62
What is the etiology of otitis media with nasotracheal intubation?
Misplaced nasal tube in the eustachian tube
63
What is the concentration of heliox most commonly used in hospitals?
80/20
64
What is secreted from the parotid glands?
Saliva
65
What is the hallmark for laryngomalacia?
Inspiratory stridor
66
Which tracheal rings are involved in an elective tracheostomy?
2nd or 3rd
67
How does gastric pressure change in a gravid patient with 1 child?
Increases by 7-17cmH2O
68
How does gastric pressure change in a patient pregnant with twins?
Increases by 7-40cmH2O
69
How does gastric pressure change with a gravid patient in the lithotomy position?
Increases by 7-24 cmH2O
70
Who is the main manufacturer of tracheostomy tubes?
Shiley
71
What are the intermediate and long-term risks of a tracheostomy?
Ischemia, necrosis, erosion, dilation, stenosis
72
What gas can produce significant ischemic lateral-wall injury?
Nitrous oxide
73
Which trach tube has a foam-filled cuff and an adjustable flange?
Kamen-Wilkinson trach
74
What are the 2 critical considerations for proper placement of a trach tube?
1) No traction on trach
| 2) Optimum cuff pressure
75
Which trach tubes are all metal and can come with or without a cuff?
Jackson trach
76
What piece of equipment maintains stomal patency for future access?
Trach button
77
Which trach tube maintains stomal patency for suctioning and permits speech?
Kistner trach
78
Which trach tube is also known as the "talking trach"?
Fenestrated trach
79
What is the proper end-of-case management for a laryngectomy?
A laryngectomy tube (NOT TRACH TUBE) sutured to skin with patient spontaneously breathing
80
What airway device has a laryngeal limb that provides airflow, a tracheal limb that serves as a stent, and an exposed limb that allows for PPV?
Montgomery T-Tube
81
How should you manage the airway of a patient with retropharyngeal abscess?
Oral ETT with or without FFOB
82
Which laser is used for cuts and cauterizing of more superficial tissue?
CO2
83
Which laser is used on deeper tissue and can be transmitted by cornea?
YAG
84
Where is the glottis in infants?
C3-C4
85
How are the vocal cords situated in infants?
Horizontal and concave
86
How does the epiglottis differ in infants?
Longer, omega shape, stiffer, horizontal
87
What are the branches of the facial nerve superior to inferior? (two zombies butchered my cat)
- Temporal
- Zygomatic
- Buccal
- Mandibular
- Cervical
88
How do you determine the type of anode ETT tube you should use?
Depends upon surgery and direction of ETT and circuit (cephalad or caudad)
89
What is the long-term complication associated with flexible fiberoptic bronchoscopy?
Infection
90
What are the only three possible FFOB directional movements?
- Longitudinal
- Rotational
- Angulation
91
What does the longitudinal movement of the FFOB allow?
Allows you to enter and leave the airway
92
What does the rotational movement of the FFOB allow?
To move through approximately 180 degrees either clockwise or counterclockwise
93
What does the angulation movement of the FFOB allow?
Flexion and extension of the tip from 90 degrees to 180 degrees
94
What are the size measurements of the Aintree catheter?
4.7mmID x 6.5mmOD x 56cm L
95
With which sized ETT tubes can Aintree catheters be used?
7.0 and above
96
What structure must you see before sliding an ETT introducer into the larynx?
Tip of the epiglottis
97
What are the complications associated with ETT introducers?
Tracheal abrasion, hemorrhage, hematoma, infection, abscess, mediastinitis
98
What length ETT introducer is used with a 6.0 ETT?
66cm
99
What length ETT introducer is used with a 7.0 ETT?
70cm
100
What does HPOV stand for?
High-pressure oxygenation and ventilation
101
What does RGW stand for?
Retrograde guide wire-assisted endotracheal intubation
102
What is the minimum length of a J-wire required for RGW-assisted intubation?
60cm
103
What is the primary purpose of HPOV?
To oxygenate (not ventilate)
104
Which type of airway obstruction is HPOV used for?
Ball-valve obstruction
105
What type of airway obstruction will not be helped with HPOV?
Complete upper airway obstruction
106
In which direction should the 3-way stopcock be turned for HPOV assembly?
All ports open
107
What is the long-term complication associated with HPOV?
Barotrauma
108
What is the name of the conventional ETT with an integrated bronchial blocker?
Univent
109
What is the name of the bronchial blocker that has a specialized connector?
Ardnt endobronchial blocker (Cook)
110
What device is required for Ardnt endobronchial blocker placement?
FFOB
111
Which bronchial blocker has 2 distinct proximal balloons and bifurcated distal extensions?
Rusch EZ-blocker endobronchial blocker
112
What is the leading cause of obstetric anesthetic mortality?
AIRWAY - failure to secure and aspiration
113
What are the airway risk factors associated with pregnancy?
- Failure to intubate
- Aspiration
- Hypoxemia
114
What factors can cause a decrease in gastric emptying of pregnant patients?
- Progesterone
- Labor (stress)
- Narcotic
115
What contributes to increased gastric acidity in pregnant patients?
Gastrin
116
Does NPO status eliminate risks in pregnant patients?
No
117
What factors can decrease gastro-esophageal sphincter tone?
- Reflux patients
- Anticholinergics
- Narcotics
- NG tube
118
What are 3 contributing factors of intubation failure?
- Upper airway edema
- Adiposity of head/neck/trunk
- Breast enlargement
119
How is FRC changed in pregnant patients?
Decreased by 20%
120
How is oxygen consumption changed in pregnant patients who have carried to term?
Increased by 20%
121
How is oxygen consumption changed in patients who are in active labor?
Increased by 60%
122
How is Cimetidine administered for pregnant patients?
300mg IV 60 minutes prior to surgery
123
How is Metoclopramide administered for pregnant patients?
10mg IV 30 minutes prior to surgery
124
How is sodium citrate administered for pregnant patients?
30ml PO immediately prior to surgery
125
How does Cimetidine work to decrease airway complications in pregnant patients?
Histamine H2 antagonist that decreases stomach acid production and decreases risk for aspiration
126
How does Metoclopramide work to decrease airway complications in pregnant patients?
Helps with stomach emptying and GERD
127
How does sodium citrate work to decrease airway complications in pregnant patients?
Neutralizes acid in the GI system
128
At what age are patients considered an increased airway risk due to their age?
80 or older
129
What comorbidity do many geriatric patients have that would hinder mouth opening and C-spine motion?
Arthritis
130
How is thoracic compliance changed in the majority of geriatric patients?
Decreased
131
How is vital capacity changed in the majority of geriatric patients?
Decreased
132
How is FRC changed in the majority of geriatric patients?
Unchanged
133
What aspects of the geriatric airway can indicate a difficult BMV?
Edentulous and loose facial skin
134
How is the ability to cough and protect the airway changed in the majority of geriatric patients?
Decreased
135
What airway adjuncts could be used to improve BMV of elderly patients?
Oral airway and face mask strap
136
How does an increased prevalence of osteoporosis in geriatric patients pose an airway risk?
Increased fracture risk
137
According to Dr. Hall, what class of drugs should be avoided in patients over 70 unless they're visibly stressed or anxious?
Benzodiazepines
138
What are the divisions of the thyroid gland?
Right lobe, left lobe, isthmus
139
How many parathyroid glands do humans have?
4
140
Which laryngeal nerves are contiguous with the thyroid gland?
RLNs
141
What monitoring is very important during thyroid surgeries?
Nerve testing and NMB monitoring
142
What are the airway and surgical risks during the maintenance phase of thyroid surgeries?
Hemorrhage
143
Where does the left side of the vagus cross under?
Aortic arch
144
Where does the right side of the vagus cross under?
Subclavian
145
Which cranial nerve is protected in the larynx by thyroid cartilage?
Vagus
146
What muscle is the only vocal cord abductor?
Posterior cricoarytenoid
147
What is the overall effect of RLN INJURY?
Vocal cord adduction
148
What are the acute effects of unilateral RLN injury?
Affected vocal cord will move to median position, opposed by the normal VC
149
What are the long term effects of unilateral RLN injury?
Affected vocal cord may force the normal cord away from midline
150
What are the acute effects of bilateral RLN injury?
Upper airway obstruction
151
What are the long term effects of bilateral RLN injury?
Resolution of edema, no problems
152
What is the overall effect of RLN INTERRUPTION?
Paramedian vocal cord position
153
What are the acute effects of bilateral RLN interruption?
Upper airway open
154
What are the long term effects of bilateral RLN interruption?
Aspiration and dyspnea
155
What are the 2 lobes of the parotid glands?
Superficial and deep
156
How many parotid glands do humans have?
2
157
What is another name for the parotid duct?
Stenson's duct
158
Which cranial nerve transverses the parotid gland?
Facial
159
What makes up the majority of parotid gland diseases?
Adenoma (benign tumors)
160
What is the name for parotid inflammation?
Parotitis
161
How should electrodes be placed to optimize NMB monitoring?
- Maximum current density
- Minimal current dispersion
- Close to the nerve
162
When should the sensory threshold be tested during facial NMB monitoring of parotid surgeries?
Before induction - watch facial expression
163
When should the motor threshold be tested during facial NMB monitoring of parotid surgeries?
After induction, before the muscle relaxant
164
What is a supramaximal stimulus?
Stimulus that activates all muscle fibers served by the stimulated nerve without directly stimulated the muscle fibers
165
What is the empiric setting for NMB monitoring?
25mA above motor threshold, so 40mA (25mA+15mA)
166
What is the end point for neuromuscular blockade reversal?
TOF 4/4 --> sustained tetanus --> TOF ratio > 0.9
167
What type of anesthesia should be used for a patient for peritonsillar abscess surgery?
General
168
What airway device should be used for a patient with a peritonsillar abscess?
Anode ETT tube
169
What induction drugs should be selected for a surgery on a peritonsillar abscess?
Short-acting IV anesthetic and short-acting muscle relaxant
170
How should the airway of a patient undergoing surgery for a peritonsillar abscess be managed post-operatively?
Careful oral suctioning with flexible catheter, patient awake and alert
171
What is trismus?
Inability to open the mouth fully
172
What is the airway management plan for a patient undergoing surgery for Ludwig's angina?
FFOB NETT sedation
173
How should induction proceed for a patient undergoing surgery for Ludwig's angina?
IV induction AFTER intubation is complete and confirmed
174
How should the airway of a patient undergoing surgery for Ludwig's angina be managed postoperatively?
The patient will remain intubated
175
What is angina ludovici?
Cellulitis of the floor of the mouth
176
What does angina mean in greek?
Strangling
177
What is the airway management plan for a patient undergoing surgery for acute epiglottitis?
Oral ETT
178
How should the airway of a patient undergoing surgery for acute epiglottitis be managed postoperatively?
Patient will remain intubated
179
What causes acute epiglottitis?
An infection by H. flu
180
What anticholinergic and dose should be considered for a patient presenting with acute epiglottitis?
Atropine 10mcg/kg IV
181
What signs would indicate the resolution of acute epiglottitis?
Decreased WBCs, fever abates, air leak develops
182
What airway devices are used during surgery for chronic recurrent tonsilitis?
McIvor retractor and anode oral ETT
183
What is a major periop risk of surgery for chronic recurrent tonsilitis?
Hemorrhage
184
What obscures the DL view in patients presenting with kissing tonsils?
Significant lymphoid tissue
185
Are thermal airway injuries more prevalent in males or females?
Males
186
What are the primary goals of managing an airway affect by thermal injury?
Maintain airway patency and oxygenation
187
What is the projected status of patients presenting with facial, oral, or nasal burns?
Rapid loss of airway patency due to laryngeal edema
188
In order of best to least, what airway devices are best to manage an airway of a patient with thermal injury?
Oral ETT > Nasal ETT > Tracheostomy
189
What are the risks associated with nasal intubation in patients with thermal injury?
Infection - sinusitis, otitis, sepsis
190
What are the risks associated with tracheostomies in patients with thermal injury?
Wound and mediastinal infection
191
How can you simply evaluate the need for continuing or discontinuing airway support in patients with thermal injury?
Cuff-leak test
192
What is the acceptable leak in the cuff-leak test that will indicate airway support can be safely discontinued in patients with thermal injury?
5-10cmH2o
193
What are unacceptable leaks in the cuff-leak test that will indicate airway support cannot be safely discontinued in patients with thermal injury?
Greater than 20cmH2o
194
What chemical associated with fire and chemical accidents produces pulmonary edema?
Acrolein
195
What accidents can cause the accumulation of carbon monoxide?
Fires and incomplete combustion
196
What chemical is released upon polyurethane conflagration?
CN (cyanide)
197
What chemical is released upon PVC conflagration?
HCl
198
What is caused by exposure to HCl from PVC conflagration?
Severe mucosal burns in airway
199
What is spondylitis?
Vertebral inflammation
200
What anatomical characteristics are associated with Klippel-Feil Syndrome?
Vertebral fusion of the C-spine
201
What anatomical characteristics are associated with Arnold-Chiari Malformation?
Small posterior fossa, caudal displacement, hydrocephalus
202
What is Juvenile Rheumatoid Arthritis?
An inflammatory, multiple-organ disease that affects the C-spine, TMJ, and cricoarytenoid joint
203
What are the body proportions of an achondroplastic dwarf?
Normal trunk, shortened extremities, enlarged forehead
204
What is achondroplastic dwarfism?
Developmental disorder with decreased proliferation of growth plate cartilage
205
What anatomical differences of an achondroplastic dwarf will increase the difficulty of their airway management?
- Large head
- Short maxilla
- Large mandible
- Cervical instability
206
What movement should you avoid when positioning an achondroplastic dwarf ?
Hyperextension
207
What is polyarthropathy?
Synovial inflammation and granulation
208
What are the signs and symptoms of polyarthropathy?
Morning stiffness, PIP stiffness, pain, swelling
209
What is spondyloarthopathy?
Progressive arthritis of spine and pelvis
210
What effect of spondyloarthopathy can severely hinder airway management?
Fixed cervical spine
211
What is DJD?
Degenerative joint disease
212
What is DJD of the TMJ?
Degeneration of articular cartilage
213
What are the symptoms of DJD of the TMJ?
Limited inflammation and pain with use
214
What are the symptoms of DJD of the cervical spine?
Limited inflammation, pain, paresthesias, motor involvement
215
If suction is inadvertently applied to the lungs by an NG tube that enters the trachea beside a cuffed ETT, what action should be taken following removal of the NGT?
Give continuous positive pressure and hold
216
What is the perfusion pressure of tracheal mucosa?
25cmH2O (18mmHg)
217
What is the narrowest part of the airway in patients 7 and younger?
Cricoid cartilage
218
What is the narrowest part of the airway in adults?
Glottis
219
What is the action of the cuneiform cartilage?
Stiffens aryepiglottic folds to help reopen glottis
220
What is ankyloglossia?
Stiff tongue
221
What does abnegation mean?
Denial or refusal
222
What is innervated by the motor branch of the SLN?
Cricothyroid muscle
223
How does heliox compare to O2?
Increased heat capacity, increased viscosity, decreased density
224
What drug/dose is used for nasal vasoconstriction?
2000mcg phenylephrine
225
What is the action of the posterior cricoarytenoid?
Abduct vocal cords
226
What is anisocoria?
Unequal pupil size
227
What type of cartilage makes up cricoid, arytenoid, and thyroid cartilages?
Hyaline
228
What type of cartilage is the epiglottis and cuneiform/corniculate cartilages?
Elastic
229
When does an acute airway complication occur?
During performance of a procedure, administration of a drug, etc.
230
When does an intermediate airway complication occur?
During the existence of a drug or device in a patient
231
When does a long-term airway complication occur?
After elimination of a drug or removal of a device from a patient
232
Which laser type can cause severe retinal damage?
YAG
233
Which laser type can cause severe heat injury to the anterior eye?
CO2
