EENT Lecture (Exam 2) Flashcards by Kimberly Diane Hill

The ________ is the outermost layer of the eye and appears white.
A. Retina
B. Choroid
C. Cornea
D. Sclera

D. Sclera

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The ________ is the clear anterior part of the sclera.
A. Retina
B. Cornea
C. Iris
D. Ciliary body

B. Cornea

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Which of the following structures produces aqueous humor?
A. Iris
B. Retina
C. Ciliary body
D. Choroid

C. Ciliary body

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Which of the following are components of the uveal tract?
Select 3
A. Retina
B. Iris
C. Choroid
D. Cornea
E. Ciliary body

B. Iris
C. Choroid
E. Ciliary body

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The choroid layer of the eye is a layer of posterior blood vessels that:
Select 2
A. Is a source of hemorrhage
B. Produce vitreous humor
B. Transmit electrical signals to the brain
C. Protect the lens from ultraviolet light
D. Perfuse the retina

A. Source of hemorrhage
D. Perfuses the retina

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True or False

The iris contains both sympathetic and parasympathetic innervation that controls pupil size.

True

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Which of the following statements correctly describe the sympathetic innervation of the iris?
Select 3
A. Originates from the carotid plexus
B. Travels through the oculomotor nerve
C. Synapses in the ciliary ganglion
D. Innervates the dilator muscle
E. Travels through the ciliary ganglion
F. Innervates the iris sphincter muscle

A. Originates from the carotid plexus
D. Innervates the dilator muscle
E. Travels through the ciliary ganglion

Causes dilation - mydriasis

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Which of the following statements correctly describe the parasympathetic innervation of the iris?
Select 3
A. Travels through the carotid plexus
B. Originates in the oculomotor nerve
C. Synapses in the ciliary ganglion
D. Innervates the dilator muscle
E. Travels through the ciliary ganglion
F. Innervates the iris sphincter muscle

B. Travels through the oculomotor nerve
C. Synapses in the ciliary ganglion
F. Innervates the iris sphincter muscle
Causes constriction -miosis

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True or false

The ciliary body is responsible for producing aqueous humor

True

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The retina is responsible for converting light into __________ signals that are sent to the brain.
A. Electrical
B. Thermal
C. Chemical
D. Mechanical

A. Electrical

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The __________ humor fills the central cavity of the eye and helps maintain intraocular pressure.
A. Aqueous
B. Synovial
C. Serous
D. Vitreous

D. Vitreous

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What is A?

Sclera

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What is B?

Choroid

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What is C?

Retina

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What is D?

Sclera

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What is E?

Cornea

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What is F?

Ciliary body and muscle

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There are a total of __________ extraocular muscles responsible for eye movement.
A. 4
B. 5
C. 6
D. 8

C. 6

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The ophthalmic artery is a branch of the __________ artery.
A. External carotid
B. Vertebral
C. Subclavian
D. Internal carotid

D. Internal carotid

majority of blood supply to orbital structure

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The ophthalmic vein drains directly into the __________.
A. Cavernous sinus
B. Superior sagittal sinus
C. Jugular vein
D. Inferior petrosal sinus

A. Cavernous sinus

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The optic nerve (CN II) transmits neural signals from the __________ to the brain.
A. Iris
B. Retina
C. Cornea
D. Choroid

B. Retina

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Control of extraocular muscle movement involves cranial nerves __________.
A. III, IV, VI
B. III, V, VII
C. II, III, V
D. III, IV, VI

D. III, IV, VI

Oculomotor (III), Trochlear (IV), Abducens (VI)
## Footnote

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Which cranial nerve is primarily responsible for touch and pain sensation in the eye?
A. Optic (CN II)
B. Oculomotor (CN III)
C. Trigeminal (CN V)
D. Facial (CN VII)

C. Trigeminal (CN V)

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Matching

Match the Facial Nerve (VII) function with the

A -> 3
B -> 2
C-> 1

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What is considered the normal range for intraocular pressure (IOP)? A. 5–10 mmHg B. 10–20 mmHg C. 15–25 mmHg D. 20–30 mmHg

B. 10–20 mmHg ## Footnote 7

At what value is IOP considered pathological and may lead to symptoms? A. > 15 mmHg B. > 20 mmHg C. > 25 mmHg D. > 30 mmHg

C. > 25 mmHg ## Footnote 7

Intraocular pressure is primarily based on which two factors? A. Retinal fluid and trabecular network B. Aqueous fluid and choroidal blood volume C. Optic nerve pressure and blood supply to retina D. Scleral thickness and choroidal plexus

B. Aqueous fluid and choroidal blood volume ## Footnote 7

Intraocular perfusion pressure is calculated using the difference between: A. Systolic pressure and IOP B. Diastolic pressure and IOP C. MAP and IOP D. CVP and IOP

C. MAP and IOP **Blood supply to retina & optic nerve depends on intraocular perfusion pressure** ## Footnote 7

Which structure regulates outflow resistance of aqueous humor, affecting IOP? A. Trabecular meshwork B. Retina C. Ciliary body D. Iris sphincter

A. Trabecular meshwork ## Footnote 7

Chronic elevation in IOP due to sclerosis of the trabecular meshwork is associated with __________. A. Closed-angle glaucoma B. Diabetic retinopathy C. Cataracts D. Open-angle glaucoma

D. Open-angle glaucoma ## Footnote 7

Which of the following can cause the **most significant** increase in intraocular pressure? A. Coughing, straining, vomiting B. Normal blinking C. Intubation and emergence D. Forceful lid squeeze

C. Intubation and emergence "Intubation and emergence cause the most significant increases because kind of combination you have coughing and bucking, specifically on emergence because you are waking them up so it's important to have a smooth emergence." ## Footnote 8

Which of the following can lead to increased intraocular pressure (IOP)? Select 2 A. Supine positioning B. Facial nerve block C. Scleral rigidity D. Nasal cannula use E. Changes in intraocular content

C. Scleral rigidity E. Changes in intraocular content ## Footnote 8

Coughing, straining, or vomiting may increase IOP by approximately: A. 5-10 mmHg B. 10–20 mmHg C. 20–25 mmHg D. 30–40 mmHg

D. 30–40 mmHg ## Footnote 8

A forceful lid squeeze can increase intraocular pressure by: A. 20 mmHg B. > 70 mmHg C. 30–40 mmHg D. < 10 mmHg

B. > 70 mmHg ## Footnote 8

Which patient positions are associated with "external pressure" increased IOP? A. Supine, prone, and Trendelenburg B. Lateral, prone and semi-Fowler's C. Sitting, supine and reverse Trendelenburg D. Supine, lateral and Trendelenburg

A. Supine, prone, and Trendelenburg ## Footnote 8

A normal blink increases intraocular pressure by approximately: A. 5 mmHg B. 10 mmHg C. 25 mmHg D. 40 mmHg

B. 10 mmHg ## Footnote 8

Which of the following medications increase intraocular pressure (IOP)? Select 4 A. Succinylcholine B. Mannitol C. Atropine D. Ketamine E. Sugammadex F. Midazolam E. Neostigmine

A. Succinylcholine C. Atropine D. Ketamine E. Neostigmine SNAK ## Footnote 9

Which of the following increase intraocular pressure (IOP)? Select 4 A. Hypocapnia B. Hypercapnia C. Intraocular blocks D. Hypotension E. Hypoxia F. Hypertension

B. Hypercapnia C. Intraocular blocks E. Hypoxia F. Hypertension ## Footnote 9

Which of the following statements about succinylcholine (SCh) and intraocular pressure are TRUE? Select 4 A. Succinylcholine increases IOP by 6–10 mmHg B. Succinylcholine decreases aqueous humor outflow C. Succinylcholine increases aqueous humor outflow D. Succinylcholine increases central venous pressure E. Succinylcholine Increases choroidal blood volume F. Succinylcholine increases IOP by 8–10 mmHg

B. Succinylcholine decreases aqueous humor outflow D. Succinylcholine increases central venous pressure E. Succinylcholine increases choroidal blood volume F. Succinylcholine increases IOP by 8–10 mmHg Effects last ~ 5-10min ## Footnote 9

Ketamine increases intraocular pressure by about ________ mmHg d/t the increase in **MAP.** A. 1–2 B. 2–3 C. 5–7 D. 8–10 ## Footnote 9

B. 2–3 ## Footnote 9

Hypercapnia increases intraocular pressure by causing __________. A. Corneal abrasion B. Iris atrophy C. Choroidal congestion D. Scleral thinning

C. Choroidal congestion ## Footnote 9

Ocular blocks increase IOP by approximately how much? A. 5–10 mmHg B. 8-15 mmHg C. 15-18 mmHg D. 20-25 mmHg

A. 5–10 mmHg **Returns to baseline in 5min** ## Footnote 10

**Peribulbar blocks** result in **higher IOP** compared to other ocular blocks due to: A. Stimulation of the optic nerve B. Smaller volume of local anesthetic C. Larger volume of local anesthetic injected D. Muscle fasciculations

C. Larger volume of local anesthetic injected (5-10ml) ## Footnote 10

Which of the following agents have **no significant effect** on intraocular pressure (IOP)? Select 3 A. Nitrous oxide B. Mannitol C. Non-depolarizing neuromuscular blockers D. Short-acting opioids E. Midazolam

A. Nitrous oxide C. Non-depolarizing neuromuscular blockers E. Midazolam *Sugammadex* ## Footnote 11

Which of the following agents decrease intraocular pressure (IOP)? Select 4 A. Mannitol B. Acetazolamide C. Succinylcholine D. Echothiophate E. Timolol F. Atropine G. Long-acting opioids

A. Mannitol **(lasts 5-6 hrs)** B. Acetazolamide D. Echothiophate E. Timolol *Short-acting opioids* ## Footnote 11

# True or False The IOP-lowering effect of volatile agents is partially due to relaxation of intraocular muscle tone.

False The IOP-lowering effect of volatile agents is partially due to relaxation of **extraocular** muscle tone. ## Footnote 11

The oculocardiac reflex is also known as the: A. Ciliochoroidal reflex B. Pupillovagal reflex C. Trigeminovagal reflex D. Oculooptic reflex

C. Trigeminovagal reflex ## Footnote 12

Which of the following can trigger the oculocardiac reflex? Select 3 A. Medial rectus traction B. Deep volatile anesthesia C. Retrobulbar block D. Pressure on the globe E. Scleral rigidity

A. Medial rectus traction - extraocular muscle traction C. Retrobulbar block D. Pressure on the globe ## Footnote 12

The oculocardiac reflex is most likely to occur during: A. Adult cataract surgery B. Pediatric strabismus repair C. Retinal detachment repair in adults D. Periorbital trauma

B. Pediatric strabismus repair ## Footnote 12

Which of the following are common cardiovascular effects of the oculocardiac reflex? Select 3 A. Tachycardia B. AV block C. Ventricular ectopy D. Tachycardia E. PVCs F. Bradycardia

B. AV block C. Ventricular ectopy F. Bradycardia ## Footnote 12

In severe cases, the oculocardiac reflex can progress to: A. Respiratory depression B. Atrial fibrillation C. Seizures D. Asystole

D. Asystole ## Footnote 12

In an awake patient, the oculocardiac reflex may also be accompanied by: A. Hyperthermia B. Hiccups C. Nausea D. Auditory hallucinations

C. Nausea ## Footnote 12

The **afferent limb** of the oculocardiac reflex begins with the ________ division of the ________ nerve. A. Ophthalmic; Trigeminal B. Maxillary; Facial C. Mandibular; Trigeminal D. Frontal; Oculomotor

A. Ophthalmic; Trigeminal ## Footnote 12

The **afferent signals** of the oculocardiac reflex travel from the *orbit* through the ophthalmic nerve and synapse in the ________ ganglion and the sensory nucleus of near the _________ ventricle. A. Facial; 1st B. Gasserian; 4th C. Trochlear; 3rd D. Trigeminal; 2nd

B. Gasserian; 4th ventricle **synapses with the motor nucleus of the vagus nerve** ## Footnote 12

After synapsing in the brainstem, the **efferent limb** of the oculocardiac reflex travels via the ________ nerve to the ________, causing *bradycardia and decreased inotropy.* A. Trigeminal; extraocular muscles B. Facial; lacrimal gland C. Vagus; heart D. Glossopharyngeal; carotid sinus

C. Vagus; heart ## Footnote 12

# Put in Order Put the following steps in the correct order for managing the oculocardiac reflex (OCR) during surgery: A. Administer glycopyrrolate IV B. Tell the surgeon to stop traction C. Assess ventilation D. Surgeon infiltrates rectus muscle with local anesthetic

B → C → A → D Prevention/Pretreatment B – Tell the surgeon to stop traction C – Assess ventilation - **worsened by hypercapnia & hypoxia** A – Administer glycopyrrolate (or atropine IV) D. Surgeon infiltrates rectus muscle with local anesthetic ## Footnote 13

What is the standard IV dose of glycopyrrolate used incrementally to treat oculocardiac reflex bradycardia? A. 2 mg B. 1 mg C. 0.1 mg D. 0.2 mg

D. 0.2 mg ## Footnote 13

What is the appropriate IV dose range of atropine for the treatment of bradycardia during the oculocardiac reflex? A. 0.1–0.5 mcg/kg B. 1–3 mcg/kg C. 7–10 mcg/kg D. 15–20 mcg/kg

C. 7–10 mcg/kg ## Footnote 13

# True or False The oculocardiac reflex tends to fatigue and become less sensitive with repeated stimulation.

True ## Footnote 13

Open-angle glaucoma is a **progressive optic neuropathy** and is also known as “________ glaucoma.” A. Chronic B. Narrow-angle C. Acute D. Closed-angle

A. Chronic ## Footnote 14

# True or False Open-angle glaucoma is the most common form of glaucoma.

True ## Footnote 14

Open angle glaucoma can be caused by **trabecular meshwork sclerosis** causing chronic pressure elevation and has which following symptoms? A. Acute and painful B. Gradual and painless C. Sudden and severe D. Episodic and fluctuating

B. Gradual and painless ## Footnote 14

Which of the following best describes the visual changes in **open-angle** glaucoma d/t increasing IOP? A. Only central vision loss B. Central vision loss followed by peripheral vision loss C. Peripheral vision loss followed by central vision loss D. Only peripheral vision loss

C. Peripheral vision loss followed by central vision loss *Increase IOP d/t increased vitreous humor and **outlet obstruction*** ## Footnote 14

Which of the following is a surgical treatment option for open-angle glaucoma? Select 2 A. Trabeculoplasty B. Phacoemulsification C. Retinal cryopexy D. Trabeculectomy D. Corneal transplant

A. Trabeculoplasty D. Trabeculectomy **Lower IOP / decrease fluid production** ## Footnote 14

Which of the following best describes the pathophysiology of closed-angle glaucoma? A. Gradual optic nerve damage due to trabecular meshwork sclerosis B. Chronic inflammation of the sclera causing optic atrophy C. Decreased aqueous humor production from the ciliary body D. Obstructed aqueous drainage due to anterior chamber angle closure

D. Obstructed aqueous drainage due to anterior chamber angle closure ## Footnote 15

What is the primary cause of acute intraocular pressure (IOP) rise in closed-angle glaucoma? A. Excessive aqueous humor reabsorption B. Open trabecular meshwork outflow C. Acute pupillary dilation blocking fluid drainage D. Retinal detachment

C. Acute pupillary dilation blocking fluid drainage ## Footnote 15

# True or False Closed-angle glaucoma is typically painless and the rise in IOP develops rapidly.

False Rapid rise in IOP – **painful** ## Footnote 15

Which intervention must be performed within 24 hours to prevent blindness in acute closed-angle glaucoma? A. Laser iridotomy B. Administration of atropine eye drops C. Trabeculectomy D. Topical beta-blockers

A. Laser iridotomy Laser iridotomy creates an opening in the iris to allow fluid to drain into the **front** chamber of the eye ## Footnote 15

Which of the following *substances* may contribute to the development of closed-angle glaucoma? (Select 4) A. Marijuana B. Antihistamines C. Timolol D. Cocaine E. Ecstasy F. Glycopyrrolate

A. Marijuana B. Antihistamines D. Cocaine E. Ecstasy * Antihistamines & decongestants may **↑IOP d/t pupil dilation** ## Footnote 15

Which medications or drug classes have **anticholinergic** effects that may worsen closed-angle glaucoma? (Select 4) A. Benzodiazepines B. Ipratropium bromide C. Antidepressants D. Phenylephrine E. Scopolamine F. Ephedrine

A. Benzodiazepines - **relax sphincter muscle of iris** B. Ipratropium bromide C. Antidepressants -**pupil dilation & ↑ aqueous production** E. Scopolamine - **AVOID** ## Footnote 15

What is the primary mechanism of action of *topical* **Acetazolamide** when treating **open aka 'chronic glaucoma'**? A. Beta-adrenergic blocker B. Carbonic anhydrase inhibitor C. Alpha-2 agonist D. Muscarinic antagonist

B. Carbonic anhydrase inhibitor ## Footnote 18

What electrolyte abnormality is commonly associated with systemic absorption of Acetazolamide? A. Hypokalemia B. Hypernatremia C. Hyperchloremia D. Hypocalcemia

A. Hypokalemia ## Footnote 18

A common side effect of systemic absorption of Acetazolamide is: A. Postoperative bradycardia B. Intraoperative bronchospasm C. Postoperative nausea D. Intraoperative hyperkalemia

C. Postoperative nausea *and vomiting* ## Footnote 18

**Echothiophate** is another topical treatment for 'chronic glaucoma' and a(n) ________. A. Reversible acetylcholinesterase inhibitor B. Irreversible acetylcholinesterase inhibitor A. Reversible carbonic anhydrase inhibitor B. Irreversible carbonic anhydrase inhibitor

B. Irreversible acetylcholinesterase inhibitor ## Footnote 19

Systemic absorption of echothiophate leads to inhibition of __________. A. liver enzymes B. renal clearance C. plasma cholinesterase D. cytochrome P450

C. plasma cholinesterase ## Footnote 19

Which drug may cause prolonged muscle paralysis when used in a patient taking echothiophate? A. Rocuronium B. Succinylcholine C. Vecuronium D. Cisatracurium

B. Succinylcholine ## Footnote 19

# True or False Echothiophate use increases the metabolism of ester local anesthetics.

False Ester LAs may accumulate and echothiphate inhibits metabolism, leading to accumulation and risk of toxicity. ## Footnote 19

How long may it take for plasma cholinesterase activity to normalize after discontinuing echothiophate? A. 24–48 hours B. 1–2 weeks C. 4–6 weeks D. 6–8 months

C. 4–6 weeks ## Footnote 19

Which topical ophthalmic drugs may lead to bradycardia or bronchospasm due to systemic effects? Select 2 A. Phenylephrine B. Atropine C. Pilocarpine D. Acetazolamide E. Acetylcholine

C. Pilocarpine E. Acetylcholine **Used for lens extraction and causes pupillary constriction** ## Footnote 20

Which of the following are possible effects of systemic absorption of **phenylephrine**? Select 3 A. Bradycardia B. Hypertension C. Arrhythmias D. Cardiac events E. Pupillary constriction

B. Hypertension C. Arrhythmias D. Cardiac events ## Footnote 20

Phenylephrine is a medication that causes __________ by stimulating α₁-adrenergic receptors. A. Pupillary dilation B. Pupillary constriciton C. Muscle paralysis D. Aqueous humor outflow

A. Pupillary dilation ## Footnote 20

One drop of 10% phenylephrine solution contains how much medication? A. 2.5 mg B. 1 mg C. 10 mg D. 5 mg

D. 5 mg (much larger than IV dose) ## Footnote 20

In ophthalmic surgery, phenylephrine is typically used at a concentration of __________ to minimize systemic side effects. A. 0.1% B. 2.5% C. 5% D. 10%

B. 2.5% ## Footnote 20

What is the primary mechanism of action of **Timolol** in the treatment of **glaucoma**? A. Increases aqueous humor outflow B. Inhibits cholinesterase C. Decreases aqueous humor production D. Stimulates the iris sphincter

C. Decreases aqueous humor production ## Footnote 21

Timolol is a ________ **beta blocker** used in glaucoma treatment. A. Selective B. Non-selective C. Alpha-adrenergic D. Cholinergic

B. Non-selective ## Footnote 21

Which of the following are potential adverse effects of systemic absorption of timolol? (Select 3) A. Bronchospasm B. Bradycardia C. Seizures D. CHF exacerbation E. Pupil dilation

A. Bronchospasm B. Bradycardia D. CHF exacerbation **contraindicated in asthma🫁 , CHF💔 & conduction defects** ## Footnote 21

Which are true regarding **Netarsudil**? (Select 3) A. It is a EGFR inhibitor B. It treats glaucoma C. It increases aqueous outflow D. It decreases aqueous production E. Its a Rho kinase inhibitor

B. It treats glaucoma C. It **increases** aqueous **outflow** - through the trabecular meshwork E. Its a Rho kinase inhibitor ## Footnote 21

Which of the following best describes a cataract? A. Inflammation of the retina B. Retinal hemorrhage C. Displacement of the optic nerve D. Opacity of the crystalline lens

D. Opacity of the crystalline lens ## Footnote 22

Which of the following are true about the treatment for cataracts, **phacoemulsification**? (Select 2) A. Uses micro scissors to fragment the lens B. Requires general anesthesia in most cases C. Involves a small 3 mm incision D. Ultrasonic vibration fragments lens E. Always requires retrobulbar block

C. Involves a small 3 mm incision D. Ultrasonic vibration fragments lens ## Footnote 22

Which of the following is a key component of phacoemulsification? A. Corneal transplant B. Application of laser to the sclera C. Irrigation and aspiration of fragments D. Retinal detachment repair

C. Irrigation and aspiration remove *lens fragments* ## Footnote 22

# True or false In phacoemulsification cataract surgery, the natural crystalline lens is replaced with an artificial intraocular lens after the fragmented pieces are removed.

True ## Footnote 22

Cataract surgery typically uses the following anesthesia: Select 2 A. general B. spinal C. topical D. monitored deep sedation E. regional

C. topical E. regional GA is RARE and IV medications are minimal ## Footnote 22

Use of a ________ during cataract surgery raises concern for **fire risk** when supplemental oxygen is administered. A. phacoemulsification probe B. femtosecond laser C. cryotherapy device D. YAG laser

B. femtosecond laser ## Footnote 22

What is the primary indication for performing a keratoplasty (corneal transplant)? A. Replace a damaged or infected cornea B.Reduce intraocular pressure in glaucoma C. Correct refractive errors of the lens D. Treat cataracts with lens opacity

A. Replace a damaged or infected cornea ## Footnote 23

Which of the following is required during a corneal transplant (keratoplasty) procedure? A. Voluntary eye movement B. Deep general anesthesia C. Complete eye akinesia D. Use of succinylcholine for rapid intubation

C. Complete eye akinesia (loss of voluntary movement) ## Footnote 23

Which of the following are important anesthesia considerations during keratoplasty? (Select 3) A. Prevent eye squeezing B. Encourage coughing to maintain ventilation C. Prevent oculocardiac reflex D. Ensure adequate eye perfusion E. Increase IOP to maintain globe pressure

A. Prevent eye squeezing ( ↑IOP >70mmHg) C. Prevent oculocardiac reflex D. Ensure adequate eye perfusion * Good analgesia postop * No coughing / movement ## Footnote 23

Which of the following are true regarding using mannitol and IOP during corneal transplant? (Select 2) A. Effects can last 2 to 5.5 hours B. Has a short duration of action (< 30 min) C. Effects can last from 1.5 to 6 hours D. Causes mydriasis to aid visualization E. Maintains low and stable IOP

C. Effects can last from 1.5 to 6 hours E. Maintains low and stable IOP ## Footnote 23

Which of the following anesthesia techniques is *preferred* for keratoplasty? Select 2 A. Topical drops B. Ketamine induction C. Retrobulbar block D. Inhalational induction E. Peribulbar block

C. Retrobulbar block E. Peribulbar block * **Topical- Poor option d/t duration & pain at end** * Remember Ketamine increases IOP by 2-3mmHG d/t increased MAP ## Footnote 24

General anesthesia may be used in keratoplasty for patients who: (Select 3) A. Are claustrophobic B. Are unable to lie flat C. History of glaucoma D. Are pediatric E. Have long QT syndrome

A. Are claustrophobic B. Are unable to lie flat D. Are pediatric * **Restless w/tremor** ## Footnote 24

Which of the following are benefits of **regional** anesthesia in keratoplasty? (Select 2) A. Intraoperative analgesia only B. Increased incidence of PONV C. Quicker recovery and discharge D. Reduced oculocardiac reflex

C. Quicker recovery and discharge D. Reduced oculocardiac reflex * Intraop & postop analgesia * Both peribulbular and retrobulbar cause akinesia * Less PONV ## Footnote 25

Which of the following statements about retrobulbar and peribulbar blocks are true? (Select 3) A. Both provide eye akinesia B. Retrobulbar block typically increases IOP by 4–6 mmHg C. Peribulbar block can increase IOP up to 4–6 mmHg mmHg D. Sub-Tenon’s block causes the greatest IOP increase E. Peribulbar block can increase IOP by 5-22 mmHg

A. Both provide eye akinesia B. Retrobulbar block typically increases IOP by 4–6 mmHg E. Peribulbar block can increase IOP by 5-22 mmHg ## Footnote 25

Which of the following blocks does not significantly change intraocular pressure (IOP)? A. Retrobulbar block B. Peribulbar block C. Sub-Tenon’s block D. Epidural block

C. Sub-Tenon’s block ## Footnote 25

Which of the following is a contraindication to regional anesthesia for keratoplasty? A. Eye infection B. Pediatric age C. Claustrophobia D. Surgery duration under 1 hour

A. Eye infection * Surgery greater than 2hr - general preferred ## Footnote 25

What is the primary goal of a **trabeculectomy** procedure? A. To increase aqueous humor production B. Create a filtration bleb and enhance aqueous drainage C. To remove the lens and replace it with an artificial one D. To constrict the pupil and relieve intraocular pressure

B. Create a filtration bleb and enhance aqueous drainage ## Footnote 27

# T/F Trabeculectomy is the first line treatment for glaucoma and reducing IOP

False After medications have failed a trabeculectomy is performed ## Footnote 27

**Mitomycin-C and 5-FU** are used during trabeculectomy, what is true about these drugs? Select 3 A. They are antimetabolites B. Prevent postoperative nausea C. Enhance surgical success D. Reduce intraocular pressure by direct drainage E. Prevent flap scarring F. Stimulate aqueous humor production

A. They are antimetabolites C. Enhance surgical success D. Prevent flap scarring ## Footnote 27

What is the most likely cause of pterygium formation? A. Chronic sun exposure B. Contact lens use C. Genetic mutation D. Vitamin A deficiency

A. Chronic sun exposure - in tropical regions "AKA surfers eye" 🏄 ## Footnote 28

Indications for pterygium excision include: Select 3 A. Cosmesis B. Corneal involvement C. Refractory glaucoma D. Visual disturbance E. Cataract formation

A. Cosmesis B. Corneal involvement D. Visual disturbance ## Footnote 28

What is the mechanism of action of **Mitomycin-C (MMC)** used during pterygium excision to **prevent recurrence**? A. Increases vascularization of conjunctiva B. Inhibits DNA synthesis as an alkylating agent C. Blocks acetylcholine receptors D. Reduces aqueous humor production

B. Inhibits DNA synthesis as an alkylating agent ## Footnote 28

Pterygium excision is typically performed under what type of anesthesia? A. General anesthesia B. Retrobulbar block C. Topical anesthesia D. Spinal anesthesia

C. Topical anesthesia ## Footnote 28

The recurrence rate of pterygium excision ranges between _________. A. 5–13% B. 15–20% C. 30–80% D. 55-60%

C. 30–80% ## Footnote 28

Which of the following best describes **ectropion**? A. Outward turning of the lower eyelid B. Inward turning of the upper eyelid C. Drooping of the upper eyelid D. Inflammation of the conjunctiva

A. Outward turning of the lower eyelid ## Footnote 29

Ectropion is can be caused by __________ or _________ lid pathology: A. Age-related changes; mechanical B. Mechanical; congenital C. Congenital; infectious D. Inflammatory; traumatic

B. Mechanical; congenital ## Footnote 29

Entropion is characterized by the __________. A. Inward rolling of the lower eyelid B. Thickening of the conjunctiva C. Inversion of the upper eyelid D. Outward turning of the lower eyelid

A. Inward rolling of the lower eyelid ## Footnote 29

Which of the following statements are true regarding both entropion and ectropion? Select 2 A. Both can result from age-related changes B. Both require general anesthesia due to surgical complexity C. Both are typically managed under local anesthesia with sedation E. Both conditions are always congenital

A. Both can result from age-related changes C. Both are typically managed under local anesthesia with sedation ## Footnote 29

A blepharoplasty removes _____ and considered plastic surgery A. excess skin from the pharynx B. blebs from inner cornea C. nasal polyps D. redundant tissue of the eyelid

D. redundant tissue of the eyelid ## Footnote slide 30

During a blepharoplasty a ____ approach is used vs a skin approach A. transcornal B. open C. transconjunctival D. laparoscopic

C. transconjunctival ## Footnote slide 30

Anesthesia management for a blepharoplasty includes (select 2) A. local with sedation B. General C. MAC no local D. IV general no local

A. local with sedation B. General ## Footnote slide 30

Ptosis is defined as drooping of the upper eyelid and often ___ A. causes blindness B. impacts visual field C. causes pain D. common infection source

B. impacts visual field ## Footnote slide 31

Ptosis can be caused by all the following except A. aging B. trauma C. environmental D. congenital

C. environmental ## Footnote slide 31

Ptosis is caused by dystorphy of the A. levator muscle B. lateral rectus muscle C. medial rectus muscle D. ciliary body and muscle

A. levator muscle ## Footnote slide 31

Ptosis repair is done by ______ with ________ anesthesia A. keratoplasty; general B. trabeculectomyl local w/ sedation C. blepharoplasty; local w/ sedation D. ptyergium excision; general

C. blepharoplasty; local w/ sedation ## Footnote slide 31

Malalignment of visual axis is known as A. ptosis B. miosis C. ectropion D. strabismus

D. strabismus ## Footnote slide 32

Strabismus can cause A. miosis B. diplopia C. hemorragic cornea D. blindness

B. diplopia ## Footnote sllide 32

# True or false strabismus repair is the most common eye surgery in children

true ## Footnote slide 32

What are the four common conditions associated with strabismus (select 4) A. trisomy 21 B. treacher collins C. cerebral palsy D. hydrocephalus E. Pierre Robin F. Myotonic dystophy

A. trisomy 21 C. cerebral palsy D. hydrocephalus F. myotonic dystophy ## Footnote slide 32

What are 2 common risk associated with strabismus repair (select 2) A. tachycardia B. malignant hyperthermia C. PONV D. post op pain

B. malignant hyperthermia C. PONV 50-80% minimize opioids ## Footnote slide 32

What is a good choice of post op pain management for strabismus repair A. ketorolac B. morphine C. dilaudid D. fentanyl

A. ketorolac ## Footnote slide 32

Anesthetic management for strabismus repair (select 2) A. general B. MAC C. regional D. sedation

A. general C. regional ## Footnote slide 32

A patient comes in with eye trauma. What should be a consideration for this patient specifically mentioned in lecture? A. H/H B. x-rays C. CT scan D. full metabolic panel

C. CT scan (additional head/ neck trauma) "If the patient comes in with eye trauma, they need to be investigated for additional head or neck trauma, so they'll need to have a CT done and determine the extent of the damage." ## Footnote slide 33

What anesthetic management should be considered on an eye trauma case A. regional B. general C. MAC D. neuraxial

B. general ## Footnote slide 33

Due to the trauma factor of the eye injury what induction drug of choice should be use A. Rocuronium 1.2mg/kg B. succinylcholine 1mg/kg C. rocuronium 0.6mg/kg D. vecuronium 2mg/ kg

A. rocuronium 1.2mg.kg "High-dose rock rocuronium might be a better choice if you want to RSI them that way." increased IOP possible ## Footnote slide 33

Which of the following are anesthetic considerations for eye trauma patients? (select 5) A. decrease gastric volume/ acidity B. avoid hypocapnia C. oral RAE tube D. PONV common E. Succ increase IOP F. inadequate block or light anesthesia increase IOP G. HOB easily accesible

A. decrease gastric volume/ acidity C. oral RAE tube D. PONV common E. Succ increase IOP F. inadequate block or light anesthesia increase IOP Avoid HYPERcapnia, generally HOB away ## Footnote slide 33

Eye surgery usually requires ____ of the eye A. akinesia B. starbismus C. contraction D. relaxation

A. akinesia (immobility) ## Footnote slide 34

What are the advantages of regional anesthesia over general anesthesia for eye surgery? A. less post op analgesia B. more PONV C. faster ambulation D. more pain

C. faster ambulation Block gives post op analgesia less PONV faster post op ambulation ## Footnote slide 34

How can we as anesthesia help eliminate CO2 and O2 build up and prevent claustrophobia A. bair hugger B. cut a hole in the drapes C. versed D. air blower under drapes

D. air blower under drapes ## Footnote slide 34

# true or false Eye blocks are typically done with a 1:2 ratio of bupivacaine 0.25% and lidocaine 4% w/o epi

False 1:1 ratio of bupivacaine 0.75% and lidocaine 2% w/o epi ## Footnote slide 34

Hyaluronidase is added to eye blocks to ___ (select 2) A. eliminates tissue permeability B. worsen onset and quality C. speed tissue penetration D. prevent anesthetic damage to extrocular muscles

C. speed tissue penetration D. prevent anesthetic damage to extrocular muscles 7.5 units/mL facilitates tissue permeability, improve onset and quality of block ## Footnote slide 34

Where is the retrobulbar block placed? (select 2) A. behind globe of eye B. inside muscular cone C. inside globe of eye D. behind muscular cone

A. behind globe of eye B. inside muscular cone ## Footnote slide 36

Retrobulbar block promotes akinesia of all the following except A. extraocular muscles B. CN IV C. CN II D. CN III E. CN VI

B. CN IV ## Footnote slide 36

For the retrobulbar block sensory block of ____ and ____ are achieved (select 2) A. sclara B. conjunctiva C. cornea D. extraocular

B. conjunctiva C. cornea ## Footnote slide 36

What are the complications of retrobulbar block? (select 4) A. cerebral spinal leak B. retrobulbar hemorrhage C. hematoma D. increased ICP E. optic nerve injury F. globe perforation

B. retrobulbar hemorrhage C. hematoma E. optic nerve injury F. globe perforation ## Footnote slide 36

What are some considerations for retrobulbar block (select 3) A. monitor IOP B. LA toxicity from IV injection C. decreased IOP D. seizures, high spinal from arterial injection

A. monitor IOP B. LA toxicity from IV injection D. seizures, high spinal from arterial injection - high brain levels ## Footnote slide 36

What type of needle is used to minimize risk of ocular perforation during a retrobulbar block A. 5cm 18 gauge blunt IV B. 4 cm 22 gauage angled C. 2cm 24-26 gauge catheter D. 3cm 23-25 gauge blunt atkinson

D. 3cm 23-25 gauge blunt atkinson ## Footnote slide 36

How much LA is injected during a retrobulbar block? A. 3-4mL B. 2-3ml C. 5-6mL D. 1-2mL

B. 2-3ml ## Footnote slide 36

# True or false some intorsion on downgaze is expected because the superior oblique muslce is outside the muscle cone and remains unblocked

true ## Footnote slide 36

Which cranial nerves are blocked by the peribulbar block (select 2) A. II B. III C. IV D. VI

B. III D. VI incomplete akinesia- does not block CN II ## Footnote slide 37

What is true regarding peribulbar block compared to retrobulbar block (Select 2) A. lower risk of retrobulbar hemorrhage B. easier to perform C. complete akinesia D. no intraocular injection or high spinal risk

A. lower risk of retrobulbar hemorrhage B. easier to perform incomplete akinesia complications include intraocular injection, high spinal ## Footnote slide 37

Which are true regarding peribulbar block? (select 4 ) A. perform 20 min preop B. 3mL injection above and below orbit C. more painful D. 1st injection is inferior with 23 guage @junction of 1/3 and inner 2/3 of lower orbital rim (5mL) E. 2nd injection superior/nasally beneath superior orbital notch

A. perform 20 min preop B. 3mL injection above and below orbit D. 1st injection is inferior with 23 guage @junction of 1/3 and inner 2/3 of lower orbital rim (5mL) E. 2nd injection superior/nasally beneath superior orbital notch LESS painful ## Footnote slide 37

Topical eye anesthesia uses ______ A. 2% lidocaine B. 0.75% bupivacaine C. 0.5% proparacaine D. 0.5% ropivacaine

C. 0.5% proparacaine ## Footnote slide 39

0.5% proparacaine in topical eye anesthesia is limited to (select 3) A. ciliary body B. conjunctival C. cornea D. anterior sclera E. iris

B. conjunctival C. cornea D. anterior sclera NO block of iris and ciliary body ## Footnote slide 39

The superior laryngeal nerve has 2 branches. The external branch controls____ (select 2) A. motor to cricothyroid B. sensory to laryngeal mucosa C. inferior pharyngeal muscles D. vocal cords

A. motor to cricothyroid C. inferior pharyngeal muscles ## Footnote slide 42

The superior laryngeal nerve has 2 branches. The internal branch controls____ A. motor to cricothyroid B. sensory to laryngeal mucosa above the vocal cords C. inferior pharyngeal muscles D. superior pharyngeal muscles

B. sensory to laryngeal mucosa above the vocal cords ## Footnote slide 42

The recurrent laryngeal nerves have motor innervation to the _____ A. extrinsic muscles of vocal cords B. crictothyroid muscle C. inferior pharyngeal constrictor muscles D. intrinsic muscles of larynx

D. intrinsic muscles of larynx ******EXCEPT cricothyroid and inferior pharyngeal constrictor muscles****** ## Footnote slide 42

Recurrent laryngeal nerves provide sensory _____ (select 2) A. lower trachea B. below vocal cords C. above the vocal cords D. upper trachea

B. below vocal cords D. upper trachea ## Footnote slide 42

Unilateral recurrent laryngeal nerve damage will present as A. obstruction B. hoarseness C. stridor D. dyspnea

B. hoarseness ## Footnote slide 42

Bilateral recurrent laryngeal nerve damage will present as (select 3) A. obstruction B. hoarseness C. stridor D. dyspnea E. croup

A. obstruction C. stridor D. dyspnea ## Footnote slide 42

Bilateral RLN damage has bilateral vocal cords _____ positioning and a tracheostomy is required A. lateral B. extension C. paramedian D. flex

C. paramedian ## Footnote slide 42

External ear surgery is common for (select 2) A. cochlear impant B. foreign body removal C. removal of tumors/cancer D. myringotomy

B. foreign body removal C. removal of tumors/cancer ## Footnote slide 43

Middle ear surgery is common for (select 4) A. cochlear impant B. tympanoplasty C.endolympathic sac D. myringotomy E. strapedectomy F. mastoidectomy

B. tympanoplasty D. myringotomy E. strapedectomy F. mastoidectomy ## Footnote slide 43

Inner ear surgery is common for (select 3) A. cochlear impant B. tympanoplasty C.endolympathic sac D.labyrinth E. strapedectomy

A. cochlear impant C.endolympathic sac D.labyrinth ## Footnote slide 43

Inner ear surgery can be associated with (select 2) A. Meniere disease B. vertigo w/ or w/o hearing loss C. treacher collins D. trisomy 21

A. Meniere disease B. vertigo w/ or w/o hearing loss ## Footnote slide 43

Ear surgery anesthetic considerations should be (select 5 ) A. GETA B. RAE tube C. hypertension D. Use N2O E. laser precautions F. facial nerve monitoring G. PONV H. always awake extubation

A. GETA B. RAE tube E. laser precautions F. facial nerve monitoring G. PONV NO N2O deliberate HYPOtension gentle emergence- consider deep extubation if appropriate ## Footnote slide 44

The use of N2O in ear surgery is not recommended due to what law stating that N2) diffuses into cavities faster than nitrogen? A. Newtons B. poiseuilles C. Schmidts D. Ficks

D. Ficks ## Footnote slide 44

What can be a complication of using N2O in ear surgery (select 2) A. increased mobility of tympanic membrane B. less sedative effect C. barotrauma D. graft displacement

C. barotrauma D. graft displacement Barotrauma d/t LIMITED mobility of the tympanic membrane ear pressure increases causing graft displacement tympanoplasty- middle ear open, graft placed, then closed ## Footnote slide 44

Which medications should be avaoided in the anesthesia plan for a patient presenting for a tympanoplasy and mastoidectomy? (select 2) A. Rocuronium B. N2O C.succinycholine D. zofran

A. Rocuronium (avoid ND-NMB) B. N2O Hope this is right it was her question but she didn't answer it so hoepfully she wont be any more specific then this ## Footnote slide 45

Nasal surgery is often used for all the following except A. tubrinectomy B. septoplasty C. foreign body removal D. polyp excision E. myringotomy F. rhinoplasty

E. myringotomy ## Footnote slide 46

Preop assessment for nasal surgery should focus on (select 2) specifically mentioned in lecture A. OSA B. allergies C. hypertension D. cancers

A. OSA C. hypertension and Samter triad ## Footnote slide 46

Samter triad is a focus point for preop assessment for patients undergoing nasal surgery. What does this consist of? A. malignant hyperthermia B. nasal polyps C. asthma D. allergies E. sensitivity to ASA and NSAIDS

B. nasal polyps C. asthma E. sensitivity to ASA and NSAIDS ## Footnote slide 46

What can the samter triad lead to in nasal surgery A. laryngospasm B. post extubation croup C. malignant hyperthermia D. bronchospasm

D. bronchospasm ## Footnote slide 46

Nasal surgery anesthesia consist of A. local no sedation B. local with sedation C. GETA D. sedation no local

B. local with sedation Local w/ sedation vs GETA ## Footnote sllid 46

If general anesthesia needs to be used in nasal surgery what type of airway will be used A. LMA B. nasal RAE C. oral RAE D. tracheostmy

C. oral RAE ## Footnote slide 46

Due to risk of intraop/post op bleeding the patient should be instructed to hold NSAIDS and ASA for how long before procedure A. 4-6 days B. 3-4 weeks C. 48 hours D. 1-2 weeks

D. 1-2 weeks ## Footnote slide 46

A throat pack may be placed around the ETT for prevention of blood and debris from entering the pharynx and larynx. What is an important ansthesia consideration regarding thrat packs? A. document in and out time B. ischemia risk C. aspiration risk D. document weight of pack to determine blood loss

A. document in and out time ## Footnote slide 46

Nasal surgery will often require vasoconstrictor use using all of the following except A. cocaine 4% B. phenylephrine C. ephedrine D. oxymetazoline

C. ephedrine ## Footnote slide 47/48

What is the max dose of cocaine for nasal surgery A. 2 mg/kg B. 1 mg/kg C. 1.5 mg/kg D. 0.5 mg/kg

C. 1.5 mg/kg ## Footnote slide 47

How does cocaine work for vasoconstriction in nasal surgery A. block reuptake of norepi B. activated arteriolar constriction C. inhibits release of norepi D. stimulated relaxation of the venous supply

A. block reuptake of norepi ## Footnote slide 47

If a patient comes in with a history of CAD and HTN and they are taking MAOIs which drug should be avoided for vasoconstriction? (select 2) A. phenylephrine B. cocaine C. oxymetazoline E. ephedrine

B. cocaine C. oxymetazoline- avoid with MAOIs ## Footnote slide 47

# true or false phenylephrine for the use of vasoconstriction in nasal surgery can be used with or without lidocaine

true ## Footnote slide 47

What is the initial dose of phenylephrine for nasal surgery in the use of vasoconstriction? A. 250mcg B. 1000mcg C. 400 mcg D. <500mcg

D. <500mcg ## Footnote slide 47

Due to the risk of severe HTN with the use of phenylephrine for vasoconstriction in nasal surgery, what drugs would be use to treat the HTN A. direct vasodilators B. beta blockers C. calcium channel blockers D. alpha receptor antagonists

A. direct vasodilators D. alpha receptor antagonists AVOID BB and CCB as they may worsen cardiac output and produce pulmonary edema ## Footnote slide 47

Oxymetazoline is a selective ____ and partial _____ and should be avoided in patients on MAOIs A. selective alpha 2 and partial beta agonist B. selective alpha 1 and partial alpha 2 agonist C. selevtive beta and partial alpha 1 agonist D. seletive alpha 1 and partial alpha 2 antagonist

B. selective alpha 1 and partial alpha 2 agonist ## Footnote slide 48

For nasal surgery what are some anesthetic considerations for emergence? (select 3) A. gastric suctioning B. prevent coughing C. always awake extubation D. avoid pressure on face

A. gastric suctioning B. prevent coughing / bucking D. avoid pressure on face ## Footnote slide 48

Endoscoptic sinus surgery is often for all of the following except A. nasal polyposis B. sinusitis C. epistaxis control D. tumor excision E. foreign body removal F. nasal reconstruction

F. nasal reconstruction ## Footnote slide 49

Anesthetic considerations for endoscoptic sinus surgery include (select 2) A. controlled hypotension B. TIVA with prop and remi C. LMA D. nasal dilation

A. controlled hypotension - blood free field B. TIVA with prop and remi - smoother wake up ETT>LMA nasal vasoconstriction ## Footnote slide 49

Nasal vasoconstriction can be achieved by all the follwoing except A. lidocaine 1% w/ epi 1:100,000 injected B. afrin C. cocaine D. epi soaked pledgets E. ephedrine

E. ephedrine ## Footnote slide 49

What are some anesthesia considerations for endoscopic sinus surgery with image guided surgical system (select 2) A. requires special headset B. HOB rotated 180 degrees C. hypertension needed D. maintain full nutrition until 2 hours before

A. requires special headset B. HOB rotated 180 degrees ## Footnote slide 50

Potential complications from endoscopic sinus surgery include all the following except A. orbital hemtatoma B. blindness from orbital trauma C. optic nerve injury E. CSF leak F. carotid or ethmoid artery invasion G. cranial cavity entry H. hemorrhage I. ulnar nerve injury

I. ulnar nerve injury ## Footnote slide 50

Tonsillectomy and adenoidectomy is typically done for what conditions? (select 3) A. tonsillar hypoplasia B. recurrent tonsillitis C. malignancy D. tonsillar hypoplasia

B. recurrent tonsillitis C. malignancy D. tonsillar hypoplasia ## Footnote sllide 51

# true or false Adenoids are lymphoid tissue posterior to nasal cavity in roof of nasopharynx and an adenoidectomy is required when hyperplasia causes nasopharyndeal obstruction

true ## Footnote slide 51

For a patient coming in for a T/A procedure you should assess for all the following except A. OSA B. Cor pulmonale C. pulmonary HTN D. RV hypertrophy E. cardiomegaly F. LV heart failure

F. LV heart failure ## Footnote slide 51

What type of ET tube should be used for a T/A procedure A. Nasal RAE B. wire reinfored ETT C. LMA D. oral RAE

B. wire reinfored ETT D. oral RAE monitor for kinking/ bending ## Footnote slide 51

Anesthetic considerations for T/A procedure include all the following except A. stimulating so consider remifentanil B. PONV C. Post op pain D. always deep extubation E. LA injection F. risk for post op hemorrhage

D. always deep extubation tonsillar LA injection can help with post op pain ## Footnote slide 52

What pain medications should be avoided in T/A procedures A. morphine B. dilaudid C. Ibuprofen D. tylenol

C. Ibuprofen (NSAIDS) ## Footnote slide 52

What are considerations for post op hemorrhage following a T/A procedure A. surgical emergency B. usually occurs within 6 hours C. IV fluid resuscitation D. RSI E. suction F. awake extubation

All of these!!! | sorry don't hate me ## Footnote slide 52

Patients with nasal polyps, asthma, and sensitivity to aspirin are at risk for _____ during their procedure A. laryngospams B. croup C. stridor D. bronchospasm

D. bronchospasm (sempters triad) ## Footnote slide 53

OSA surgery includes all the following except A. pharyngreal nerve ablation B. uvulopalatopharyngoplasty C. uvulopalatal flap D. T/A E. genioglossus advancement F. maxillomandibular advancement G. polysomonography

A. pharyngreal nerve ablation ## Footnote slide 54

What is polysmonography? A. determine if a person is lying about how much they snore at night B. is used to determine occurace rate withourt severity C. determines severity of number of these respiratory events per hour D.determines oxygen level only of each event

C. determines severity of number of these respiratory events per hour ## Footnote slide 54

Which of the following factors is most likely to contribute to a difficult airway in a patient with obstructive sleep apnea (OSA)? A. Bradycardia B. Macroglossia and redundant pharyngeal tissue C. Increased functional residual capacity D. Hypovolemia

B. Macroglossia and redundant pharyngeal tissue ## Footnote slide 55

What is the purpose of administering dexamethasone preoperatively in patients with OSA? A. To reduce pain B. To prevent bradycardia C. To reduce airway edema D. To reduce gastric acid secretion

C. To reduce airway edema ## Footnote slide 55

In a patient with OSA undergoing ENT surgery, which of the following is the best choice for an endotracheal tube? A. Nasal RAE tube B. Standard oral ETT with flexible stylet C. Oral RAE tube taped midline D. Uncuffed ETT to reduce trauma

C. Oral RAE tube taped midline ## Footnote slide 55

When do postoperative obstructive episodes most commonly peak in patients with OSA? A. On postoperative day 3 B. On postoperative day 1 C. Immediately post-extubation D. After discharge from PACU

A. On postoperative day 3 ## Footnote slide 55

Which of the following strategies is recommended for anesthetic management in patients with OSA? A. Liberal opioid use for analgesia B. Avoid preoperative steroids C. Use of long-acting benzodiazepines D. Minimize opioids and sedatives

D. Minimize opioids and sedatives ## Footnote slide 55

Which of the following conditions are commonly associated with OSA? (select 4) A. Metabolic syndrome B. Coronary artery disease (CAD) C. Diabetes mellitus type 2 (DM2) D. Hyperthyroidism E. Cor pulmonale

A. Metabolic syndrome B. Coronary artery disease (CAD) C. Diabetes mellitus type 2 (DM2) E. Cor pulmonale ## Footnote slide 55

What is a risk factor for OSA surgery A. post op hypocardia B. post op hypoxia C. post op AFib D. post op hyperventilation

B. post op hypoxia ## Footnote slide 55

Panendoscopy is commonly performed for which of the following purposes? A. Sinus drainage and turbinate reduction B. Cataract evaluation C. Surveillance and biopsy of head and neck tumors D. Vocal fold injection for spasmodic dysphonia

C. Surveillance and biopsy of head and neck tumors ## Footnote slide 56

Which of the following procedures is typically included in a panendoscopy? A. Myringotomy, nasal polypectomy, and tonsillectomy B. Laryngoscopy, bronchoscopy, and esophagoscopy C. Tracheostomy, thyroidectomy, and mediastinoscopy D. Colonoscopy, gastroscopy, and laryngoscopy

B. Laryngoscopy, bronchoscopy, and esophagoscopy ## Footnote slide 56

A patient scheduled for panendoscopy has a distorted airway anatomy that precludes endotracheal intubation. Which airway technique may be used instead? A. LMA B. Oral RAE tube C. Cricoid pressure with mask ventilation D. Jet ventilation or rigid bronchoscope

D. Jet ventilation or rigid bronchoscope ## Footnote slide 56

Which of the following pathologies is most commonly associated with panendoscopy? A. Head and neck cancer B. Cervical spine fracture C. Glaucoma D. Pericardial effusion

A. Head and neck cancer ## Footnote slide 56

Panendoscopy procedures may involve laser use on the vocal cords. What is a key anesthetic concern in these cases? A. Use of high FiO₂ to reduce fire risk B. Risk of laser-induced airway fire C. Placement of thoracic epidural D. Insertion of a nasogastric tube

B. Risk of laser-induced airway fire ## Footnote slide 56

# Panendoscopy Which of the following describe characteristics of anterior commissure laryngoscopy during panendoscopy? (Select 2) A. Head “suspended” with laryngoscope B. Typically non-stimulating C. Stimulating D. No airway manipulation involved E. Requires no opioid use

A. Head “suspended” with laryngoscope C. Stimulating ## Footnote Slide 57

What anesthetic consideration is most appropriate for a panendoscopy involving a suspended laryngoscope? A. Use a benzodiazepine for sedation only B. Avoid opioids to prevent respiratory depression C. Consider using a potent, short-acting opioid like remifentanil D. Maintain spontaneous ventilation at all times

C. Consider using a potent, short-acting opioid like remifentanil ## Footnote Slide 57

Which of the following are valid airway management strategies for panendoscopy? (Select 4) A. Microlaser / laser ETT B. Supraglottic airway with jet ventilation C. Jet ventilation with rigid laryngoscope D. Transtracheal jet ventilation E. Tracheostomy

A. Microlaser / laser ETT C. Jet ventilation with rigid laryngoscope D. Transtracheal jet ventilation E. Tracheostomy ## Footnote Slide 59

Which of the following are considered atypical endotracheal tubes used in airway surgeries such as panendoscopy? (Select all that apply) A. Nasal RAE tube B. Oral RAE tube C. Wire-reinforced (armored) tube D. Laser-resistant (metal) tube E. Metal tubes

All of the above ## Footnote Slide 60 lecture

Which of the following are key features provided by microlaser endotracheal tubes during airway surgery such as panendoscopy? (Select 3 that apply) A. Airway protection B. Ventilation control C. EtCO₂ measurement D. Prevention of cuff rupture E. Lung isolation capability

A. Airway protection B. Ventilation control C. EtCO₂ measurement *all meta EET* ## Footnote Slide 61

The double cuff design of microlaser tubes may contain ___ to detect cuff rupture and prevent airway fires. A. Epinephrine B. Nitrous oxide C. Methylene blue or saline D. Air

C. Methylene blue or saline */ sterile H2O* ## Footnote Slide 61

What are disadvantages of the microlaser (MLT) tube? (Select 3) A. Higher ventilation pressures due to narrow diameter B. Could make surgical access challenging C. Tube ignition possible when laser is in use D. Reduces airway protection E. Improves surgical visibility

A. **Higher ventilation pressures** due to narrow diameter B. Could **make surgical access challenging** C. **Tube ignition possible** when laser is in use ## Footnote Slide 61

What is a major risk associated with supraglottic jet ventilation? A. Pneumothorax due to overventilation B. Barotrauma due to high-pressure oxygen delivery C. Bradycardia from vagal stimulation D. Bronchospasm from dry gases

B. **Barotrauma** due to high-pressure oxygen delivery *High-pressure O2 “breaths” @ 20-50 PSI 1 second on / 3 seconds off* ## Footnote Slide 62

The ___ effect in SJET occurs when each oxygen pulse pulls in room air, increasing volume but diluting oxygen concentration. A. Boyle’s B. Bernoulli C. Venturi D. Murphy

C. Venturi ## Footnote Slide 62

Which of the following is the appropriate anesthetic technique for supraglottic jet ventilation during panendoscopy? A. Volatile agent via face mask B. TIVA C. Inhalational induction with sevoflurane D. Volatile agent via ETT E. Spinal anesthesia

B. TIVA ## Footnote Slide 62

What are limitations of supraglottic jet ventilation during panendoscopy? (Select 3) A. Cannot measure tidal volume (Vt) B. Cannot measure EtCO₂ C. Requires volatile agents D. Not optimal for obese patients E. Causes minimal airway stimulation

A. Cannot measure tidal volume (Vt) B. Cannot measure EtCO₂ D. Not optimal for obese patients ## Footnote Slide 62

Which of the following positioning aids help achieve extended head and flexed neck for panendoscopy procedures? A. Neutral neck with chin strap B. Shoulder roll + head ring (donut) C. Reverse Trendelenburg D. Towel under knees E. Beach chair position

B. Shoulder roll + head ring (donut) ## Footnote Slide 63

Which of the following is an essential safety step when using a throat pack during panendoscopy? A. Inflate the cuff with methylene blue B. Document when it’s in and when it’s out C. Leave it in place for recovery D. Remove only after extubation E. Use saline-soaked gauze

B. Document when it’s in and when it’s out ## Footnote Slide 63

Which of the following anesthesia approaches are appropriate for panendoscopy? A. Spinal anesthesia only B. GETA +/- NMB C. Ketamine-only sedation D. MAC with nasal cannula E. Awake fiberoptic without ETT

B. GETA +/- NMB *Mordecai: can be used without a neuromuscular blocker, depending on whether or not the surgeon is gonna be doing visual nerve monitoring.* ## Footnote Slide 63

Which of the following are appropriate anesthetic considerations to reduce the risk of airway fire during panendoscopy? A. Use high FiO₂ to ensure adequate oxygenation B. Avoid nitrous oxide and maintain low FiO₂ C. Administer N₂O to prevent coughing D. Keep FiO₂ above 90% throughout the case E. Use desflurane to suppress airway reflexes

B. Avoid nitrous oxide and maintain low FiO₂ *Mordecai: And then we wanna avoid nitrous because we're using a lower FIO2.* ## Footnote Slide 63

Which of the following best describes the common indications for thyroidectomy? A. GERD, vocal cord paralysis, asthma B. Thyroid CA, goiter, hyperthyroidism C. Epiglottitis, tracheomalacia, angioedema D. COPD, sleep apnea, sinusitis

B. Thyroid CA, goiter, hyperthyroidism ## Footnote Slide 64

What is the recommended management for a patient with hyperthyroidism undergoing thyroidectomy? A. Delay surgery until symptoms worsen B. Administer TSH to stimulate thyroid uptake C. Hyperthyroidism should be treated preoperatively D. Proceed with surgery under MAC only

C. Hyperthyroidism should be treated preoperatively ## Footnote Slide 64

Which of the following is NOT a symptom of thyrotoxicosis? A. Sinus tachycardia / A-fib B. MI / CHF C. Nervousness / tremulousness D. Insomnia E. Heat intolerance F. Weight loss G. Bradycardia

G. Bradycardia ## Footnote Slide 64

Which of the following airway complications should be anticipated in a patient with a large goiter undergoing thyroidectomy? A. Epiglottitis and airway edema B. Deviated trachea or airway stenosis with risk of collapse after induction C. Laryngospasm triggered by volatile anesthetics D. Upper airway obstruction due to excessive secretions

B. Deviated trachea or airway stenosis with risk of collapse after induction ## Footnote Slide 64

Which of the following complications may occur in a patient with a large goiter? A. Bronchospasm B. Horner syndrome C. Myasthenia gravis D. Pulmonary embolism

B. Horner syndrome ## Footnote Slide 64

What major vascular complication can be caused by a large substernal goiter compressing mediastinal structures? A. Subclavian steal syndrome B. Superior vena cava (SVC) obstruction C. Thoracic aortic aneurysm D. Inferior vena cava thrombosis

B. Superior vena cava (SVC) obstruction ## Footnote Slide 64

What is the primary electrolyte abnormality associated with hyperparathyroidism requiring parathyroidectomy? A. Hyponatremia B. Hypocalcemia C. Hypercalcemia D. Hyperkalemia

C. Hypercalcemia ## Footnote Slide 65

Which of the following preoperative treatments is appropriate for severely elevated calcium levels in parathyroidectomy patients? A. Dexamethasone and insulin B. Fluids, furosemide, bisphosphonates C. Epinephrine and beta-blockers D. Magnesium sulfate and mannitol

B. Fluids, furosemide, bisphosphonates ## Footnote Slide 65

Require ___ Ca++ & PTH Redraw Ca++ & PTH ___ parathyroid excision A. elevated; 1 hour after B. baseline; 10 minutes after C. low; 30 minutes after D. corrected; immediately after E. normal; the next day

B. baseline; 10 minutes after Require **baseline** Ca++ & PTH Redraw Ca++ & PTH **10 minutes after** parathyroid excision ## Footnote Slide 65

Which of the following monitoring considerations may be appropriate during a parathyroidectomy? (Select 2) A. CVP catheter for fluid resuscitation B. Foley catheter for urine output C. Arterial line for ease of blood draws D. NIM endotracheal tube for nerve monitoring E. ICP monitoring to assess for cerebral edema

C. Arterial line for ease of blood draws *Ease of blood draws* D. NIM endotracheal tube for nerve monitoring *Identification of recurrent laryngeal & vagus nerves* ## Footnote Slide 65

Which of the following positioning aids is commonly used during a parathyroidectomy to optimize surgical exposure? A. Trendelenburg wedge B. Lithotomy stirrups C. Shoulder roll D. Arm board with wrist strap

C. Shoulder roll ## Footnote Slide 65

Which of the following is a recommended extubation strategy to prevent coughing or bucking after parathyroidectomy? A. Administer succinylcholine B. Perform awake fiberoptic extubation C. Deep extubation D. Administer epinephrine before extubation

C. Deep extubation ## Footnote Slide 65

A tracheostomy is typically performed between which tracheal rings? A. 1st and 2nd B. 2nd and 3rd C. 3rd and 4th D. 4th and 5th

B. 2nd and 3rd ## Footnote Slide 66

Tracheostomy is not best for ____ situations. It is common for the patient to already be intubated, often due to ____. A. emergent; ventilator weaning failure B. elective; post-op nausea C. emergent; successful extubation D. urgent; upper GI bleeding

A. emergent; ventilator weaning failure Tracheostomy is not best for **emergent** situations. It is common for the patient to already be intubated, often due to **ventilator weaning failure** ## Footnote Slide 66

During a surgical tracheostomy, why is the endotracheal tube (ETT) withdrawn slightly and slowly when instructed? A. To allow for surgical visualization B. To reduce risk of hypoxia C. To prevent rupturing the cuff D. To check tube placement

C. To prevent rupturing the cuff ## Footnote Slide 66

Match the surgical tool to the appropriate FiO₂ strategy:

A → 2 **Cautery → low FiO2** B → 1 **Scalpel → higher FiO2 acceptable** ## Footnote Slide 66

Which of the following is a risk associated with using a Shiley tracheostomy tube during tracheostomy placement? A. Increased FiO₂ delivery B. Bronchospasm C. False passage creation D. Vocal cord damage

C. False passage creation ## Footnote Slide 66

Which specific airway equipment should be readily available during a tracheostomy to facilitate secure airway management? A. 7.5 mm standard endotracheal tube B. LMA size 4 C. 6.0 mm ID reinforced endotracheal tube D. 5.0 mm uncuffed nasal RAE tube

C. 6.0 mm ID reinforced endotracheal tube ## Footnote Slide 66

What is the primary purpose of a neck dissection and laryngectomy? A. Treatment of thyroid disorders B. Prevention/treatment of head and neck cancer C. Correction of airway stenosis D. Management of GERD

B. Prevention/treatment of head and neck cancer ## Footnote Slide 67

What treatment is commonly associated with a partial laryngectomy? A. Chemotherapy B. Tracheostomy C. Radiation D. Total laryngectomy

C. Radiation ## Footnote Slide 67

In a total laryngectomy, the ___ is removed and an ___ is created. A. trachea / IV line B. larynx / airway stoma C. epiglottis / ETT cuff D. vocal cord / IV catheter

B. larynx / airway stoma In a total laryngectomy, the **larynx** is removed and an **airway stoma** is created *Likely close to sternal notch* ## Footnote Slide 67

The extent of neck dissection during a free flap procedure is primarily related to: A. Patient age B. Tumor size only C. Lymph node involvement D. Airway obstruction

C. Lymph node involvement ## Footnote Slide 67

A neck dissection procedure may be supplemented with ___ to aid in tissue repair. A. Radiation B. Corticosteroids C. Microvascular free tissue transfer D. Tracheostomy

C. Microvascular free tissue transfer ## Footnote Slide 67

Which of the following are standard anesthesia considerations for neck dissection and laryngectomy procedures? A. Single 20G IV and nasal cannula B. One large bore IV and central line C. Two large bore IVs, arterial line, and NIM ETT D. PICC line, Foley catheter, and oral RAE ETT

C. Two large bore IVs, arterial line, and NIM ETT ## Footnote Slide 68

What is the primary reason fluid administration is minimized during neck dissection procedures? A. To prevent renal dysfunction B. To maintain blood pressure C. To reduce airway edema D. To prevent bradycardia

C. To reduce airway edema ## Footnote Slide 68

The use of vasoactive agents like ___ and ___ should be avoided in free flap cases to prevent graft ischemia. A. Ephedrine and dopamine B. Phenylephrine and norepinephrine C. Glycopyrrolate and atropine D. Nitroglycerin and labetalol

B. Phenylephrine and norepinephrine ## Footnote Slide 68

Which of the following best describes a Le Fort I fracture? A. Oblique fracture involving the zygomatic arch and orbit B. Vertical fracture extending through the frontal sinus and nasal bones C. Horizontal fracture involving the inferior nasal aperture D. Fracture through the mandibular condyle and ramus

C. **Horizontal fracture** involving the inferior nasal aperture ## Footnote Slide 69

Le Fort I fractures separate___ components from ___ facial structures. A. Nasal; midfacial B. Upper maxillary; skull base C. Teeth and lower maxillary; upper D. Mandibular; zygomatic

C. Teeth and lower maxillary; upper Separates **teeth and lower maxillary** components from **upper** facial structures ## Footnote Slide 69

Which findings may be associated with Le Fort I fractures? (Select3) A. Trismus B. Dental fractures C. Significant blood loss D. Loss of smell E. CSF rhinorrhea

A. Trismus B. Dental fractures C. Significant blood loss ## Footnote Slide 69

Which of the following best describes a Le Fort II fracture? A. Horizontal fracture involving the inferior nasal aperture B. Triangular fracture that crosses the nose and infraorbital rim C. Fracture through the zygomatic arch and mandible D. Vertical fracture involving the frontal bone and ethmoid sinus

B. **Triangular fracture** that crosses the nose and infraorbital rim *and through the entire lower maxilla* ## Footnote Slide 70

Le Fort III fractures are the most severe type and are characterized by a fracture that __________. A. separates the teeth from the maxilla B. passes through the infraorbital rim and nasal bridge C. parallels the base of the skull D. involves only the mandible

C. parallels the base of the skull * Fx of nasal / orbital / zygoma * Cribriform plate may be involved Separation of nasopharynx and base of skull ## Footnote Slide 71

What airway concern arises with a Le Fort III fracture due to maxillary mobility? A. Laryngospasm B. Bronchospasm C. Airway occlusion D. Trismus

C. Airway occlusion ## Footnote Slide 71

# True or False Le Fort III fractures are the most common type of Le Fort fracture.

False Le Fort III fractures are **NOT common** ## Footnote Slide 71

Which two injuries must be ruled out when preparing a patient with Le Fort fractures for anesthesia? A. Pneumothorax and liver laceration B. Head/neck injury and possible chest trauma C. Pericardial effusion and spinal cord injury D. Pelvic fracture and renal injury

B. Head/neck injury and possible chest trauma ## Footnote Slide 72

Which of the following is NOT typically a concern with Le Fort fractures during anesthesia? A. Full stomach B. Limited range of motion C. Hyperthyroidism D. Bloody airway

C. Hyperthyroidism ## Footnote Slide 72

What is the primary purpose of a Le Fort osteotomy? A. Repair of orbital fractures B. Management of head trauma C. Correction of maxillary deformities D. Treatment of obstructive sleep apnea

C. Correction of maxillary deformities *Corrects malocclusion of teeth by movement of maxilla and/or mandible* ## Footnote Slide 73

# True or False Le Fort osteotomies are usually performed in older patients with severe facial trauma.

False Usually young patients (< 30 yo) ## Footnote Slide 73

Which of the following is NOT an anesthesia consideration for Le Fort osteotomies? A. Nasal intubation B. Awake extubation C. High-volume fluid resuscitation D. Deliberate hypotension E. Jaw wiring or tight banding

C. High-volume fluid resuscitation *Minimal fluid resuscitation* ## Footnote Slide 73

Which of the following is a recommended anesthesia consideration for Le Fort osteotomies to prevent postoperative nausea and vomiting (PONV)? A. Deep extubation B. High-dose opioid administration C. Opioids / multimodal with PONV prophylaxis D. Fluid overload for volume expansion E. Early ambulation post-op

C. Opioids / multimodal with PONV prophylaxis ## Footnote Slide 73

Which of the following is a potential airway concern in a patient with angioedema? A. Bronchospasm B. Tracheomalacia C. Total airway obstruction D. Central apnea

C. Total airway obstruction ## Footnote Slide 74

Which of the following are known causes of angioedema? (Select 3) A. Hereditary C1 esterase deficiency B. ACE inhibitor therapy C. Hyperthyroidism D. Anaphylaxis E. Diabetic ketoacidosis

A. Hereditary C1 esterase deficiency B. ACE inhibitor therapy D. Anaphylaxis ## Footnote Slide 74

Which interventions are appropriate in the management of airway compromise due to angioedema? (Select 4) A. Epinephrine administration B. Large-bore nasopharyngeal airway C. Antihistamines and corticosteroids D. H2 receptor antagonists E. Intubation with smaller endotracheal tube

A. Epinephrine administration C. Antihistamines and corticosteroids D. H2 receptor antagonists E. Intubation with smaller endotracheal tube ## Footnote Slide 74

Acute epiglottitis involves inflammation of the ___. A. Vocal cords and trachea B. Arytenoids, aryepiglottic folds, and epiglottis C. Lingual tonsils and oropharynx D. Cricoid cartilage and subglottis

B. Arytenoids, aryepiglottic folds, and epiglottis *Haemophilus influenzae strain* ## Footnote Slide 75

What is the typical age range for pediatric patients affected by acute epiglottitis? A. 6–12 months B. 1–3 years C. 2–6 years D. 7–12 years

C. 2–6 years *May impact adult patients too* ## Footnote Slide 75

Which of the following is NOT a common clinical signs of acute epiglottitis? A. Drooling B. Barking cough C. Muffled voice D. Fever E. Stridor F. Sore throat

B. Barking cough ## Footnote Slide 75

What is the most concerning complication of acute epiglottitis? A. Pneumonia B. Otitis media C. Total airway obstruction D. Septic arthritis

C. Total airway obstruction ## Footnote Slide 75

Which of the following is not appropriate management strategies for pediatric acute epiglottitis? A. Calm inhalation anesthesia induction B. Use of a smaller ETT C. Prevent crying during exam D. Rapid IV induction E. Rigid bronchoscopy F. Maintain spontaneous ventilation

D. Rapid IV induction ## Footnote Slide 76

Which of the following is a key diagnostic approach for confirming adult acute epiglottitis? A. Chest X-ray B. Oral thermometer measurement C. Oropharyngeal exam and fiberoptic nasopharyngoscopy D. Electrocardiogram

C. Oropharyngeal exam and fiberoptic nasopharyngoscopy ## Footnote Slide 76

Which of the following are part of the medical management for adult acute epiglottitis? (Select 4) A. Inhaled mist B. Corticosteroids C. Oral decongestants D. Antibiotics E. Awake fiberoptic intubation

A. Inhaled mist B. Corticosteroids D. Antibiotics E. Awake fiberoptic intubation *ICU admission* ## Footnote Slide 76

What is the most common initial source of infection in Ludwig angina? A. Parotid gland B. Submental abscess C. Mandibular molars D. Maxillary sinus

C. Mandibular molars * Spreads to submandibular, sublingual, submental, and buccal spaces * Associated with trismus ## Footnote Slide 77

In Ludwig angina, airway compromise may occur due to ___. A. Spasm of the vocal cords B. Forward displacement of the tongue C. Posterior displacement of the tongue D. Collapse of the trachea

C. Posterior displacement of the tongue ## Footnote Slide 77

Which of the following are airway risks associated with Ludwig’s Angina? (Select 2) A. Tongue displaced anteriorly B. Vocal cord paralysis C. Tongue displaced posteriorly D. Airway occlusion in supine position E. Tracheal deviation

C. Tongue displaced posteriorly D. Airway occlusion in supine position ## Footnote Slide 77

What is a major airway risk during surgical drainage of Ludwig angina? A. Laryngospasm B. Bronchospasm C. Abscess rupture causing tracheal or lung soiling D. Vocal cord paralysis

C. Abscess rupture causing tracheal or lung soiling ## Footnote Slide 77

Which of the following airway management strategies is most appropriate for a patient with Ludwig’s Angina based on severity, imaging findings, and surgical preferences? A. Rapid sequence induction and oral intubation B. Bag-mask ventilation followed by cricothyrotomy C. Elective tracheostomy followed by incision and drainage D. Supraglottic airway placement under deep sedation

C. Elective tracheostomy followed by incision and drainage ## Footnote Slide 77

Which airway management strategy is most appropriate in a patient with Ludwig's Angina who presents with severe trismus and distorted oral anatomy? A. Rapid sequence oral intubation B. Laryngeal mask airway placement C. Nasal fiberoptic intubation D. Awake direct laryngoscopy

C. Nasal fiberoptic intubation ## Footnote Slide 77

Which of the following is NOT a recognized symptom of laryngeal trauma? A. Pain in the larynx region B. Subcutaneous emphysema C. Hoarseness D. Hemoptysis E. Dysuria F. Abrasions G. Indentation H. Discoloration I. Stridor J. Dyspnea K. Dysphagia

E. Dysuria ## Footnote Slide 78

Why should cricoid pressure be avoided in patients with suspected laryngeal trauma? A. It increases subglottic edema B. It exacerbates vocal cord dysfunction C. It increases the risk of cricotracheal separation D. It causes epiglottic displacement

C. It increases the risk of cricotracheal separation ## Footnote Slide 78

What is a preferred method to secure the airway in severe laryngeal trauma? A. Mask ventilation B. Nasal airway insertion C. Elective tracheostomy D. Oral endotracheal intubation with cricoid pressure

C. Elective tracheostomy ## Footnote Slide 78

Operating room fires are most likely to occur during which type of procedure? A. Orthopedic surgery B. Neurosurgery C. ENT surgery D. Cardiac bypass surgery

## Footnote Slide 79

Which of the following are components of the operating room fire triad? A. Fuel B. Water source C. Oxidizer D. Ignition source E. Temperature regulation

A. Fuel C. Oxidizer D. Ignition source ## Footnote Slide 79

Which of the following is NOT a recommended strategy for preventing airway fires in the OR? A. Use laser-safe endotracheal tubes (ETTs) B. Avoid nitrous oxide (N₂O) C. Have 2nd ETT available D. Use air-filled ETT cuffs without dye E. Keep a 50 mL saline syringe readily available for fire suppression

D. Use air-filled ETT cuffs without dye *Use laser safe ETT / use dye & NS in cuff* ## Footnote Slide 80

What is the recommended maximum oxygen concentration to reduce the risk of airway fire? A. 100% B. 80% C. 60% D. 30%

D. 30% *Inform surgical team if high FiO2 required* ## Footnote Slide 80

Place the following steps in the correct order for managing an airway fire: A. Discontinue oxygen and nitrous oxide B. Remove burning endotracheal tube (ETT) and place in water C. Stop ventilation D. Pour saline into the airway E. Call for help and stop the procedure F. Use CO₂ fire extinguisher G. Remove sponges and flammable material from airway

1. E. Call for help and stop the procedure 2. B. Remove burning endotracheal tube (ETT) and place in water 3. C. Stop ventilation 4. A. Discontinue oxygen and nitrous oxide 5. G. Remove sponges and flammable material from airway 6. D. Pour saline into the airway 7. F. Use CO₂ fire extinguisher ## Footnote Slide 81

Which of the following is NOT an appropriate step after extinguishing an airway fire? A. Re-establish ventilation B. Resume 100% oxygen and nitrous oxide administration C. Examine the endotracheal tube (ETT) for retained fragments D. Avoid oxidizer-enriched environments if possible E. Consider bronchoscopy

B. Resume 100% oxygen and nitrous oxide administration ## Footnote Slide 81

Which of the following is NOT a recommended management step during a non-airway operating room fire? A. Stop the flow of airway gases B. Remove drapes and all burning/flammable materials C. Use CO₂ fire extinguisher if needed D. Increase oxygen concentration to 100% E. Extinguish burning materials with saline

D. Increase oxygen concentration to 100% ## Footnote Slide 82

Which of the following are appropriate management steps after a non-airway fire has been extinguished? (Select 3) A. Maintain ventilation B. Increase FiO₂ to 100% C. Assess for inhalation injury if patient not intubated D. Administer bronchodilators prophylactically E. Assess for burns

A. Maintain ventilation C. Assess for inhalation injury if patient not intubated E. Assess for burns ## Footnote Slide 82

EENT Lecture (Exam 2) Flashcards

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