Ears nose and throat Flashcards
(36 cards)
Which of the following laboratory values is increased in patients with untreated hypothyroidism?
Thyrotropin-Patients with hypothyroidism have decreased levels of triiodothyronine (T3) and thyroxine (T4). An increased thyrotropin level is diagnostic of hypothyroidism and normal thyrotropin levels indicate adequate medical control of hypothyroidism.
A poorly-controlled hyperthyroid patient is undergoing emergency surgery for an appendectomy. At what point would the patient be most likely to experience a thyrotoxic crisis?
After case is finished
Following induction and intubation of a patient with hypothyroidism, the blood pressure falls to 80/40 mmHg. The most appropriate intervention for this patient would be to administer
Ephedrine-in patients with hypothyroidism, the administration of alpha agonists such as phenylephrine could substantially increase the systemic vascular resistance against a heart that has limited capacity to compensate by increasing its contractility. Epinephrine 50 mcg would increase both the SVR and contractility, but a 50 mcg dose may be enough to result in hypertension and arrhythmias. Atropine would serve to increase the heart rate but would not address the issue of blood pressure. The best option for these patients is to administer small (2.5 - 5mg) doses of ephedrine while monitoring filling pressures and the ECG closely.
Which of the following laboratory findings would be consistent with a diagnosis of hyperparathyroidism?
The hallmark laboratory finding in hyperparathyroidism is a serum calcium level greater than 5.5 mEq/L or an ionized calcium level greater than 2.5 mEq/L.
You are performing a general anesthetic on a patient undergoing a parathyroidectomy. Which of the following signs and symptoms would be most closely associated with hyperparathyroidism?
Shortened QT interval-The principal pathologic feature of hyperparathyroidism resulting in symptoms is hypercalcemia. The elevated serum calcium concentrations can result in a shortened QT interval, prolonged PR interval, hypotonia and skeletal muscle weakness (as opposed to hyperreflexia). Hyperparathyroidism is often associated with hypertension and the influence of parathyroid hormone on the renal excretion of bicarbonate results in increased serum chloride concentrations which results in a mild metabolic acidosis.
You have extubated a pediatric patient following tonsillectomy and the patient exhibits inspiratory stridor. You know that inspiratory stridor most commonly represents
inspiratory stridor-inspiratory stridor results from upper airway obstruction. Lower airway obstruction results in expiratory stridor.
The ‘Rose’ position for tonsillectomy may be contraindicated in patients with what disorder?
Achondroplasia-The Rose position involves extension of the neck in the supine position with the use of a shoulder roll. Neck extension may be contraindicated for patients with high risk for subluxation of C1 and C2 such as achondroplasia and some patients with Down’s syndrome.
All of the following pathologies are associated with sarcoidosis except:
A-cor pulmonae B-Chronic extrinsic restrictive lung Disease-restrictive C-restrictive cardiomyopathy D-Hypercalcemia
Sarcoidosis is associated with diffuse granulomatous lesions resulting in intrinsic restrictive lung disease, cor pulmonale, and restrictive cardiomyopathy which may present as heart block and dysrhythmias. Other classic signs are hypercalcemia, hepatic granulomas, splenomegaly, and involvement of the parotid gland and facial and optic nerves.
All of the following are causes of chronic extrinsic restrictive lung disease except:
flail chest, sarcoidsosis, obesity, pectus carinatum
sarcoidosis-Chronic extrinsic restrictive lung disease is often due to deformities of the thoracic cage such as pectus carinatum, pectus excavatum, kyphosis, scoliosis, and flail chest as well as obesity and neuromuscular disorders. Sarcoidosis is a cause of chronic intrinsic restrictive lung disease.
During general anesthesia for a parathyroidectomy for relief of hyperparathyroidism, you should monitor the ECG closely for:
shortened QT-Hyperparathyroidism results in hypercalcemia and hypophosphatemia which can distort the ECG resulting in a shortened QT Interval and prolonged PR interval.
The most common causative agent of acute epiglottitis is
The most common causative agent in epiglottitis is Haemophilus influenza type B. The condition typically affects children ages 2-6 years. It can rapidly progress from sore throat to dysphagia to complete airway obstruction. The incidence of epiglottitis has increasingly become a disease of adulthood because of the widespread use of the Haemophilus influenza vaccines in children.
Which of the following is not true concerning the anesthetic management of a patient with hyperparathyroidism? (select two)
The predominant pathology in a patient with hyperparathyroidism is hypercalcemia. Patients with hypercalcemia may exhibit hypertension, ventricular arrhythmias, prolonged PR interval, shortened QT intervals, and a greater predisposition towards digoxin toxicity. Hypoventilation should be avoided because acidosis increases the ionized calcium level and can worsen the problem. Lactated ringer’s solution contains calcium, therefore normal saline would be the preferred solution.
You are consulted by the emergency department for a patient exhibiting inspiratory stridor, drooling, sore throat, dysphagia, tachycardia, fever, and prefers a sitting, sniffing position to breathe easier. You suspect that this patient suffers from
Although this patient exhibits symptoms associated with epiglottitis, the diagnosis is a misnomer. The patient with epiglottitis actually suffers from generalized irritation and severe edema of all of the supraglottic structures. Some academics have even suggested renaming the condition supraglottitis to more accurately reflect the pathology.
A patient with morbid obesity lists obstructive sleep apnea in their history. Which of the following conditions would you least expect to associate with sleep apnea?
Anemia-Patients with obstructive sleep apnea typically develop hypercarbia, polycythemia (not anemia), pulmonary hypertension, and right-sided heart failure as a result.
Parathyroid hormone
increases blood calcium levels-Parathyroid hormone increases serum calcium levels by promoting the breakdown of bone, regulation of renal calcium excretion, and altering the GI absorption of the mineral. Parathyroid hormone also facilitates the excretion of phosphate. It may be increased in patients with parathyroid dysplasia, hyperplasia, or benign tumor (adenoma) of the gland.
Which of the following is not a potential complication of hypoparathyroidism?
The signs and symptoms of hypoparathyroidism (most commonly caused by surgical excision of the gland) are due to the resulting hypocalcemia and include hypotension, congestive heart failure, muscle weakness, cramps, and irritability.
All of the following should be avoided in the patient with symptomatic hypoparathyroidism except
ketamine-The symptoms of hypoparathyroidism are due to the underlying hypocalcemia. These patients will have some degree of myocardial depression making etomidate and ketamine appropriate choices for induction. Hyperventilation should be avoided due to the risk of further reducing ionized calcium levels. Sodium bicarb and citrated blood products can also lead to decreases in ionized calcium levels. Finally, careful titration of muscle relaxants in parathyroid dysfunction patients is prudent due to the unpredictable responses that they may elicit.
symptoms of hyperparathyroidism
Patients with hyperparathyroidism will exhibit signs and symptoms related to an underlying hypercalcemia (elevated serum ionized calcium level). These signs and symptoms include renal stones, polyuria, hypertension, ventricular arrhythmias, muscle weakness, and osteoporosis. Surgical excision is the standard treatment for the condition.
Thymectomy is used to treat
Thymectomies are commonly performed to treat myasthenia gravis patients. This autoimmune disorder appears to regress when the breeding ground for the immune cells responsible for nicotinic destruction is resected. Polymyalgia rheumatica (or ““muscle rheumatism””) is an inflammatory condition that mainly occurs in the elderly; it is associated with giant-cell arteritis. Rhabdomyolysis is the breakdown of muscular tissue due to any cause.
Which of the following structures are at the highest risk of damage during a tracheotomy?
cricothyroid muscle-Three cartilages compose the larynx: the epiglottis, the thyroid, and the cricoid cartilage. The cricothyroid membrane stretches between the thyroid and cricoid cartilages. The cricothyroid and vocalis muscles attach to the vocal cords off of these cartilages and are susceptible to damage during the cricothyrotomy procedure. The innominate artery and inferior thyroid veins are also at risk of damage during surgical access to the trachea. Lastly, the recurrent laryngeal nerve is at risk of damage during dissection
A patient scheduled for breast reduction surgery has preoperative labwork which demonstrates severe hypothyroidism. You should
Cancel surgery-A patient presenting for elective surgery with uncorrected hypothyroidism should be canceled until further evaluation and correction of the problem (until they are euthyroid). If the patient presents for emergency surgery, thyroid hormone should be administered in an attempt to correct the hypothyroidism if at all possible
Which of the following steps would be a prudent approach to reducing the risk of puncturing the endotracheal tube cuff during tracheal dissection for placement of an tracheostomy?
advance tube towards carina-As the surgeon enters the trachea, there is risk of damage to the endotracheal tube cuff from either the scalpel or an electrocautery unit. The most prudent method of reducing this risk is to advance the tube toward the carina so that as the trachea is entered surgically, the cuff is well below the surgical site. Because an inflated cuff is the principal barrier between the high oxygen concentration being delivered to the patient and a source of ignition (the electrocautery unit), deflating the cuff is not advised at this point in the procedure. As the maintenance of a patent airway could be severely compromised at this point in the procedure, it is important not to remove the endotracheal tube until the surgeon has secured the airway.
Taking which of the following actions would indicate a proper understanding of the appropriate anesthetic management of a patient undergoing a high tracheal resection?
maintain pt in head down position-During tracheal resection, a high FiO2 should be maintained throughout the case to ensure adequate oxygenation of the functional residual capacity so temporary interruptions in ventilation are tolerated without hypoxia. During this procedure, the resection may be performed around an endobronchial or double-lumen tube and the patient should be kept in the head-down position to prevent aspiration of blood and surgical debris. An arterial line should be placed in the left radial artery to provide continuous monitoring of blood pressure during periods of compression of the innominate artery.
A child suspected of having epiglottitis presents to the emergency department. You have been called because the patient’s ventilatory status is declining and airway management may be needed. Which of the following would be the best approach for intubating this patient?
inhalation induction in OR, use 1/2 smaller size ett Because agitation and struggling can result in the dynamic collapse of the airway with subsequent total airway obstruction, care should be taken to keep the patient calm and relaxed. Excessive manipulation of the patient should be avoided and absolutely no attempt to evaluate the airway should be made in the unanesthetized patient. Inhalation induction with the child in the sitting position is acceptable. After the child becomes drowsy, he/she is placed supine and mask ventilated while intravenous access is acquired. Intubation is then performed with a styletted tube using an endotracheal tube that is 1/2 size smaller than normal.
