Quiz 8 (Greg Study Guide)

Question 1

What intrinsic laryngeal muscles adduct the vocal cords?

Answer 1

lateral cricoarytenoid, transverse arytenoid

Question 2

What muscle moves the eyes laterally/abducts?

Answer 2

lateral rectus

Question 3

What extrinsic laryngeal muscle aids in swallowing?

Answer 3

inferior pharyngeal constrictor

Question 4

What kind of approaches can you use for a peribulbar block?

Answer 4

superior temporal, medial, inferior temporal

Question 5

What are some ways to prevent ETT fire during ENT procedures?

Answer 5

deliver minimum O2 concentration necessary (30%); for unavoidable open O2 delivery, deliver 5-10 L/min of air under drapes to wash out O2; stop O2 at least 1 minute before electrocautery/laser, coat head hair and facial hair with water soluble lubricating jelly, suction oropharynx with metal cannula to catch leaking O2 and N2O

Question 6

What intrinsic laryngeal muscles relax the vocal cords?

Answer 6

thyroarytenoid and vocalis

Question 7

What muscle moves the eye upward/supraducts and is located above the eye?

Answer 7

superior rectus

Question 8

What is a consideration when surgeons are using a laser in the throat?

Answer 8

limit FiO2 to less than 30%

Question 9

What extrinsic laryngeal muscle causes inversion of the aryepiglottic fold?

Answer 9

thyroepiglottic

Question 10

What extrinsic laryngeal muscles draw the hyoid inferiorly?

Answer 10

sternohyoid, thyrohyoid

Question 11

Why might you do a peribulbar block versus a retrobulbar?

Answer 11

patients at risk for globe puncture (high myopia, significant enopthalmos, previous scleral buckling procedures, staphylomas)

Question 12

What nerves provide sensory innervation to the larynx?

Answer 12

SLN internal (branch of vagus)- above vocal cords, RLN-below vocal cords, glossopharyngeal- superior epiglottis and base of tongue

Question 13

What muscle moves the eye nasally/adducts?

Answer 13

medial rectus

Question 14

What should you ensure before extubating after a tonsillectomy?

Answer 14

that throat packs have been removed, airway has been suctioned, and patient is fully awake

Question 15

What is the oculocardiac reflex?

Answer 15

trigeminal-vagal reflex generated by pressure on the globe, orbital structures, or conjunctiva, or by traction on the EOMs- results in bradycardia, dysrythmias

Question 16

What are some ways to minimize blood loss during ear surgery?

Answer 16

epinephrine containing solutions, elevation of patients head (but increases risk of VAE)

Question 17

If using nitrous, how soon should it be stopped before graft placement?

Answer 17

30 minutes

Question 18

What muscle moves the eye downward/infraducts and is located below the eye?

Answer 18

inferior rectus

Question 19

what is a common undesired effect of middle ear surgery, and what can you use to prevent it?

Answer 19

PONV; scopalamine patch

Question 20

Describe a peribulbar block

Answer 20

Needle is directed outside of muscle cone and the anesthetic is injected- the extraconal pressure spreads the agent inside the muscle cone- requires more volume of LA than retrobulbar block

Question 21

What extrinsic laryngeal muscle draws the thyroid cartilage caudad?

Answer 21

sternothyroid

Question 22

What could you do to minimize the incidence of postextubation stridor and laryngospasm after a tonsillectomy?

Answer 22

topical spray of 2% lidocaine on the glottic and supraglottic areas

Question 23

What extrinsic laryngeal muscle folds the thyroid cartilage?

Answer 23

stylopharyngeus

Question 24

Describe a retrobulbar block

Answer 24

Pt looks up and needle inserted through the skin in infratemporal area above inferior orbital rim- needle advanced into muscle cone (retrobulbar space) and 2-4 mL of LA injected after negative aspiration

Question 25

What are some potential complications of a retrobulbar block?

Answer 25

trauma to optic nerve, blood vessels, or globe which can lead to loss of vision; respiratory arrest if anesthetic agents enter CSF of optic nerve, seizures

Question 26

What should you always assume in a patient with PTH?

Answer 26

full stomach- should do RSI

Question 27

What gas should you avoid in middle ear procedures?

Answer 27

nitrous

Question 28

How do you resolve an oculocardiac reflex?

Answer 28

remove stimulus, ensure adequate depth of anesthesia, 2-3 mg of atropine for complete vagal blockade or glycopyrrolate (can pretreat)

Question 29

After injecting local anesthetic for a retrobulbar block, what happens next?

Answer 29

eyelids are closed, digital pressure is applied, and after a few minutes the eyelids are open and the globe is inspected for akinesia

Question 30

What is PTH?

Answer 30

post-tonsillectomy hemorrhage- most common emergency pediatric airway surgery

Question 31

What intrinsic laryngeal muscle tenses and elongates the cords?

Answer 31

cricothyroid

Question 32

Can you use an LMA for tonsil surgery?

Answer 32

yes

Question 33

What intrinsic laryngeal muscle abducts the vocal cords?

Answer 33

posterior cricoarytenoid

Question 34

What intrinsic laryngeal muscles close the glottis?

Answer 34

aryepiglottic, oblique arytenoid

Question 35

How should you transport a patient to PACU who has had a tonsillectomy?

Answer 35

in the "tonsil position"- 1 side of head slightly down to allow secretions to drain out of mouth (adults may prefer high fowler)

Question 36

Which muscle rotates the eyeball on its horizontal axis temporally (extorts the eye and elevates the eyeball)?

Answer 36

inferior oblique

Question 37

What are the paired cartilages of the larynx?

Answer 37

arytenoid, corniculate, cuneiform

Question 38

What provides motor innervation to the larynx?

Answer 38

RLN- all intrinsic muscles except cricothyroid, SLN- cricothyroid

Question 39

Which muscle rotates the eyeball on its horizontal axis toward the nose (intorts and depresses)?

Answer 39

superior oblique

Question 40

How should a patient be positioned if intubating due to PTH?

Answer 40

slight head down to protect trachea and glottis from aspiration of blood

Question 41

Why might surgeons want you to limit NMB use in ENT procedures?

Answer 41

they want to evaluation function of nerves intra-op

Question 42

What are the unpaired cartilages of the larynx?

Answer 42

thyroid, cricoid, epiglottis

Question 43

What medication is contraindicated for post op pain after a tonsillectomy?

Answer 43

codeine- potential for metabolic conversion to high levels of morphine

Question 44

What are some considerations when doing ear surgery?

Answer 44

patient may be turned 180 degrees, avoid coughing (consider remifentanil), avoid muscle relaxant if nerve monitoring, varying time frame of surgery