PIMP questions

Question 1

Name the structures and anatomical boarders of the upper airway!!

Answer 1

1. Nasopharynx
   
   • Anterior to C1
   • Contains base of skull and soft pallet, eustachian tubes, adenoids.
   • Accounts for 2/3 the upper airways resistance
   • Sensory innervated by the maxillary and trigeminal nerves
2. OroPharynx
   
   • Anterior to C2-3
   • Soft palette to epiglottis
3. Hypopharynx
   
   • C5-6
   • Posterior to larynx, epiglottis, cricord cartilage
4. Larynx
   
   • C3-4 to C6
   • Epiglottis and cricoid cartilage
   • Protects the airway, provides airflow, cough and gag reflex, and produced phonation

Question 2

Name the structures and anatomical borders of the glottis region.

Answer 2

• Base of tongue to the corniculate cartilage
• Epiglottis, true and false cords and glottis

Question 3

Muscles involved in Laryngospasm?

Answer 3

1. Lateral Crycoarytnoid
2. Crycothyroid
3. Thyroarytnoid

Question 4

Describe the superficial Vasculature of the neck

Answer 4

EXTERNAL CAROTID → Superior thyroid → superior Laryngeal → supplies the supraglottic region of larynx

INFERIOR THYROID ARTERY→ inferior laryngeal → supplies the infraglottic region

Question 5

What is Stridor? What is stertor? what is teh difference b/t them?

Answer 5

• Stridor- Partial obstruction of Larynx, trachea, or bronchi and is heard on both inspiration and expiration
• Stertor- Obstruction above the larynx and is only heard on inspiration (snoring)
• Differences- both are due to turbulent airflow of the respiratory tract due to partial obstruction

Question 6

What are the types of stridor?

Answer 6

1. Inspiratory- @ or above cords
2. Biphasic- inspiratory and expiratory in the subglottic or trachea
3. Expiratory- Small bronchioles (asthma)

Question 7

What is Wheezing? Where does it occur vs Stridor?

Answer 7

• Obstruction of the lower smaller airways
• Stridor is obstruction of the upper airway up to the layrynx

Question 8

Explain Law of LaPlace?

Answer 8

Pressure needed to expand an alveolus if directly proportional to the surcase tension and inversly proportional to the radius

2T=Pr

So larger alveoli need less pressure to stay open than smaller alveoli

Question 9

Describe Bernouilis Principle!

Answer 9

Flow through a constricted tube increases it’s velocity and decreases it’s pressure on the walls

Question 10

Name the branches of the trigeminal nerve

Answer 10

Opthalmic→ ciliary → Ethmoid → forame rotudom → maxillary → infraorbital → foramen ovale → mandibular → lingual and inferior aveolar

Question 11

Name the branches of the Facial nerve

Answer 11

Temporal facial division → temporal, zygomatic cervical facial division → bucal, marginal, cervical

Question 12

Calculate ml/hr

Answer 12

mcg/kg/min X 60gtt/min X kg

mcg/mL

Question 13

Name local Maxes

Answer 13

• Bupivacaine/ Ropivacaine
  
  • Plain 2.8mg/kg or 175 max
  • W/epi 3.2mg/kg or 225 max
• Lidocaine/Mepivacaine
  
  • Plain 4.5mg/kg or 300 max
  • W/epi 7mg/kg or 500mg max

Question 14

Name the Epi strengths in mcgs

1: 100,000
1: 200,000
1: 400,000

Answer 14

1:100,000 = 10 mcgs

1: 200,000 = 5 mcgs
1: 400,000 = 2.5 mcgs

Question 15

Name local Strengths in mg

1%

0. 5%
1. 25%

Answer 15

1% = 10mg

0. 5% = 5 mg
1. 25% = 2.5 mg

Question 16

Talk about Ancef!!

Answer 16

• Bacteriacidal
• inhibits cell wall synthesis
• Gram + staph and strep
• Gram - ecoli
• 1st generation Cephalosporin
• 500mg-1g
• 30 min onset

Question 17

Talk about clindamycin

Answer 17

• Bacterialstatic
• inhibits protein synthesis @ the ribosomal subunit
• Gram + cocci and Anerobes
• 600-900mg
• Max 40mg/kg
• lincusamide

Question 18

what is high output faliure

Answer 18

dyastolic dysfunction

Seen in trauma, sepsis

increase CO more than normal which overloads pulmonary system causes pulm edema secondary to an increased diastolic pressure in the left ventricle