test 3 part 5

Question 1

sx of lambert eaton syndrome

Answer 1

1. proximal muscle weakness in pelvic and truncal areas
2. bulbar dysfx
3. decreased DTR
4. posttetanic potential of muscle contraction
5. muscle weakness is more significant in the morning and usually improves throughout the day

Question 2

Eaton-Lambert syndrome is most often associated with carcinomas, particularly ___________________

Answer 2

small cell lung cancer

Question 3

with myasthenia gravis sx are improved with ________________ or ___________; with eaton-lambert syndrome, sx are improved with _______________

Answer 3

anticholinesterases; steroids; activity

Question 4

tx of Eaton-Lambert syndrome?

Answer 4

1. therapeutic goal is to increase amount of ACh in the synaptic cleft
2. potassium channel blockers
3. acetylcholinesterase inhib
4. immunologic therapies
5. Tx underlying malignancy

Question 5

________________ is a group of x-linked recessive mutation in the dystrophin gene

Answer 5

muscular dystrophy

Question 6

_______________, pts will present with progressive proximal muscle weakness and wasting. most are wheelchair bound by age 12

Answer 6

muscular dystrophy

Question 7

what do most patients with muscular dystrophy die from? and by what age?

Answer 7

2ndary cardiopulmonary failure by age 30

Question 8

treatment for muscular dystrophy

Answer 8

no cure, supportive tx

Question 9

perioperative complications to expect with muscular dystrophy

Answer 9

rhabdomyolysis
hyperkalemia
malignant hyperthermia
cardiac arrest

Question 10

__________________ is characterized by an elevation in serum creatinine and myopathic pattern on EMG

Answer 10

muscular dystrophy

Question 11

muscular dystrophy anesthetic complications

Answer 11

1. CV evaluation for progressive cardiomyopathy and fx’al status
2. pulmonary eval for restrictive lung disease/compromise
3. risk for aspiration
4. avoid succ
5. avoid malignant hyperthermia triggering agents (succ, halogenated inhalation agents)

Question 12

what should be your anesthetic plan for pt with muscular dystrophy

Answer 12

TIVA

Question 13

anesthesia considerations for myotonia

Answer 13

1. cold environment may trigger
2. high incident of PPC
3. avoid DMR
4. NMDR okay
5. Avoid etomidate
6. risk for malignant hyperthermia

Question 14

T/F: over 80% of perioperative strokes occur in the postoperative period

Answer 14

true

Question 15

where doe most nose bleeds occur

Answer 15

anterior portion of the nose of the ICA and ECA (kiesselbachs plexus)

Question 16

which type of nose bleed can you typically stop by holding pressure on the cartilaginous part of the nose or with some neosynephrine

Answer 16

anterior

Question 17

which type of nose bleed is hard to treat, may require embolization, surgery, silver nitrate, ballooning and/or packing

Answer 17

posterior

Question 18

which nose bleed has greater risk of airway compromise d/t blood in both nostrils and the posterior pharynx

Answer 18

posterior

Question 19

posterior nose bleed is usually due to damage to which artery

Answer 19

sphenopalantine

Question 20

larynx of an adult is located at C__________

Answer 20

4-6

Question 21

enlargement of this tonsil is usally a compensatory mechanism after tonsillectomy or with autoimmune d/o and if enlarged will cause UNANTICIPATED difficult airway

Answer 21

lingual tonsils

Question 22

at what cervical vertebrae is the larynx located in an infant

Answer 22

C3-C4 (more anterior)

Question 23

what is the only complete ring in the upper airway

Answer 23

cricoid cartilage

Question 24

the cricoarytenoid joint is a _____________ joint; thus can be an issue with what disease process

Answer 24

synovial; RA

Question 25

if you do a lot of vigorous manipulation of an airway (ex: jaw thrust) you risk injuring what nerve

Answer 25

hypoglossal (XII)

Question 26

there is a risk of nerve palsy of the ______________ nerve when using LMA and N20

Answer 26

hypoglossal (XII)

Question 27

glossopharyngeal nerve provides sensory innervation to what structures

Answer 27

velleculae base of the tongue roof of the pharynx tonsils undersurface of soft palate

Question 28

describe the process of a glossopharyngeal nerve block

Answer 28

1. anesthetize the tongue with topical anesthesia 2. inject where the tongue meets the palatoglossal arch using 23 or 25 g needle 3. ASPIRATE 4. inject 1-2 cc of lidocaine on both sides

Question 29

____________ nerve runs transverse to the palatoglossal folds

Answer 29

glosspharyngeal

Question 30

what is the risk with a glossopharyngeal nerve block

Answer 30

that you do an intracarotid injection

Question 31

describe the physiological process of the gag reflex

Answer 31

1. glossopharyngeal, vagus, and spinal accessory nerves share nuclei in the medulla 2. stimulation like suctioning the back of the oropharynx sends afferent impulses via glosspharyngeal N to medulla 3. vagus nerve via efferent impulses send signals for all muscles to contract --> + gag reflex

Question 32

what are the 2 main branches of the vagus nerve that innervate the larynx

Answer 32

1. superior laryngeal nerve 2. recurrent laryngeal nerve

Question 33

_______________ is responsible for sensation above the vocal cords, and ______________ is responsible for sensation below the vocal cords (subglottic)

Answer 33

superior laryngeal nerve; recurrent laryngeal nerve

Question 34

the external branch of the superior laryngeal nerve is responsible for?

Answer 34

motor innervation to the cricothyroid muscles tenses the vocal cords

Question 35

unilateral superior laryngeal nerve damage

Answer 35

usually no tx over time cords will move medial --> changes in voice/voice tiring

Question 36

bilateral superior laryngeal nerve damage

Answer 36

1. aspiration risk, may need tracheostomy 2. loss of sensation above cords 3. inability to adduct --> floppy cords

Question 37

the recurrent laryngeal nerve provides sensory innervation ________________; and motor innervation to all intrinsic laryngeal muscles except _________________

Answer 37

below cords; cricothyroid muscle

Question 38

____________ is the ONLY nerve responsible for ABDUCTION of the vocal cords

Answer 38

recurrent laryngeal

Question 39

unilateral damage to the recurrent laryngeal nerve will cause ?

Answer 39

hoarseness

Question 40

bilateral damage/bilateral partial damage to the recurrent laryngeal nerve will cause?

Answer 40

1. unopposed adduction by the cricothyroid via the SLN 2. inability for cords to abduct 3. aphonia 4. stridor which can lead to death

Question 41

you extubate a patient, you hear immediate stridor. The patient is away but cannot speak. you stick the glidescope down to visualize the cords, they are closed (adducted). What do you think has happened? what is your intervention?

Answer 41

bilateral damage to recurrent laryngeal nerve immediately reintubate and use laryngoscopy to evaluate cord fx

Question 42

describe how you would perform a superior laryngeal nerve block

Answer 42

1. find hyoid bone and greater cornu of hyoid bone at angle of the mandible 2. walk off the hyoid bone to the thyrohyoid membrane 3. here you will inject small amount of local then go about 2-3 mm deep and inject 2mL of lidocaine 4. repeat on other side

Question 43

how would you perform a transtracheal block?

Answer 43

1. find cricothyroid membrane. go to middle and do skin wheel of local 2. 22 g angiocath with 5 mL syringe, add 3-5 mL of lidocaine 3. aspirate constantly - you want air bubbles 4. when get bubbles remove the needle while advancing catheter and inject lido 5. tell patient to take deep breath as you are injection 6. if they cough it will help spread the local

Question 44

what is the risk of a transtracheal block

Answer 44

tearing the mucosa with the needle

Question 45

the ______________ muscles lengthen (tense) the vocal cords; the ___________ muscles shorten (relax) the vocal cord

Answer 45

cricothyroid; thyroarytenoid

Question 46

___________________ muscles abduct (open) the glottis, while ______________ muscles adduct (close) the glottis

Answer 46

posterior cricoarytenoid; lateral cricoarytenoid

Question 47

length of vocal cords to carina is approximately _____________ cm

Answer 47

10-15`

Question 48

the __________________ mainstem bronchi diverges at a 20 degree angle is approximately 2.0 cm in length; while the _________________ mainstem bronchi diverges at 45 degree angle is approximately 5.0 cm in length

Answer 48

right; left

Question 49

you want to do a mallampati assessment on your patient, how would you want them positioned?

Answer 49

sitting upright and open mouth as wide as possible while at same time protruding tongue as far as possible but with no phonation

Question 50

__________________ is an indirect assessment for relating the size of the base of the tongue in relation to the oral cavity

Answer 50

mallampati

Question 51

what is the 12 point airway assessment?

Answer 51

1. length of upper incisors 2. involuntary: maxillary teeth anterior to mandibular teeth 3. voluntary: protrusion of mandibular teeth anterior to maxillary teeth 4. intercisor distance > 3 cm 5. oropharyngeal class (mallampatti)

Question 52

what is the definition of a difficult mask ventilation

Answer 52

inability of unassisted anesthesia provider to maintain SaO2 > 92% or to prevent/reverse signs of inadequate ventilation at any point during the anesthetic

Question 53

indicators that someone is going to be difficult mask ventilation

Answer 53

1. > 55 years of age 2. presence of a beard 3. no teeth 4. hx of snoring 5. BMI > 26 6. additional risk factors: mallampati >2, macroglossia, small TMD

Question 54

complications from mask ventilation

Answer 54

1. injury to buccal branch of facial nerve 2. injury to eye 3. triggering of oculo-cardiac reflex 4. bruising 5. inflation of stomach

Question 55

how do you know you are effectively mask ventilating a patient?

Answer 55

1. chest rise 2. fogging in the mask 3. CO2 waveform 4. you will feel it in the bag 5. good seal 6. quiet air is not seeping out and making noises as it hits between cheeks and mask

Question 56

what is the goal with preoxygenation/denitrogenation

Answer 56

ETO2 > 90% and ETN2 <5%

Question 57

when preoxygenating/denitrogenation, you should have fresh gas flow (FGF) of _____________ and FiO2 of ____________

Answer 57

5-8 L/min; 100%

Question 58

if doing TV preoxygenation/denitrogenation, it should be done for how many minutes

Answer 58

3-5 min

Question 59

if you do not have time to do TV preoxygenation/denitrogenation for 3-5 min; how would you perform it?

Answer 59

1. 8 deep breaths in 2 minutes 2. 4 deep breaths in 30 seconds

Question 60

______________ is noisy inspiration from turbulent gas flow in the upper airways

Answer 60

stridor