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Fa: Sim 3 > 1. ENT, OMFS, Optho > Flashcards

1. ENT, OMFS, Optho Flashcards

1
Q

A

A

temporal bone

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2
Q

B

A

external acoustic meatus (ear canal)

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3
Q

C

A

maileus

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4
Q

D

A

incus

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5
Q

F

A

semicircular canals

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6
Q

E

A

stapes

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7
Q

G

A

cochlea

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8
Q

J

A

eustachian tube

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8
Q

H

A

vestibular nerve

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9
Q

I

A

cochlear nerve

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10
Q

L

A

tympanic membrane

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11
Q

K

A

tympanic cavity

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12
Q

external ear surgery

A

reconstuction of ear or auditory canal

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13
Q

external ear surgery: anesthetic plan

A

GA w/LMA
or
local

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14
Q

middle ear/mastoid surgeras

A

myringotomy/tube insertion
cholesteatoma
stapedectomy

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15
Q

BMT

A

clears middle ear effusions due to dysfunctional eustachian tube

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16
Q

cholesteatoma

A

erodes bone that can spread to mastoid and surrounding structures

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17
Q

inner ear surgery

A

access to brain cavity for neoplasm
cochlear implant

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18
Q

meneirs disease cause

A

labryrinth and/or semicircular canal issues

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19
Q

meneirs disease symptoms

A

vertigo hearing loss

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20
Q

BMT: anesthetic plan

A

fask mask sevo technique

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21
Q

longer ear surgery: anesthetic plan

A

LMA
or
ETT

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22
Q

is it better to mechanically ventilate or spontaneously ventilate a patient when surgeon is using surgical microscope?

A

mech ventilate
- SV causes movement of head/abdomen

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23
Q

what 2 things should you avoid in ear surgery?

A

coughing
straining

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24
Q

what is CI in ear surgery?

A

nitrous

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25
Q

how to avoid coughing/straining?

A

give narcotics
lidocaine jelly on tube
deep extubation

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26
Q

can you paralyze in ear surgery

A

sometimes

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27
Q

which ear surgeries have incr PONV

A

middle
inner

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28
Q

superficial nasal surgery: anesthetic management

A

local
or
MAC

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29
Q

non-superficial nasal surgery: anesthetic management

A

GA

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30
Q

4 types or nasal surgeries

A

external
cavity
sinus
bony structure

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31
Q

what is nasal bony structure surgery used for?

A

access for craniotomies
airflow corrections

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32
Q

most common airway in nasal surgery

A

ETT taped to side/mandible

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33
Q

intraoral procedures

A

tonsillectomy
adenoidectomy
palatal surgery

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34
Q

laryngeal procedures

A

lesion removal
airway endoscopy
laser surgery

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35
Q

head and neck procedures

A

parotid
thyroid
nasopharyngeal tumor
neck dissection
laryngotomy
uvalopalatoplasty

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36
Q

tonsillectomy most common airway

A

ETT
(LMA possible, but rare)

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37
Q

do you need to paralyze for tonsillectomy?

A

no

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38
Q

can you give NSAIDs for tonsillectomy

A

yes - do not increase bleeding

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39
Q

decadron dosing for tonsillectomy

A

0.05-0.15 mg/kg

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40
Q

decadron effects during tonsillectomy

A

decr pain
decr PONV
incr food tolerance

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41
Q

3 major concerns for tonsillectomy

A
  1. incr PONV risk
  2. incr bleeding
  3. airway fire risk
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42
Q

what FiO2 to decrease airway fire risk

A

FiO2 < 40%

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43
Q

is laryngospasm more liekly with ETT or LMA

A

ETT

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44
Q

techniques to mitigate extubation laryngospasm

A

topical lidocaine: 4mg/kg
IV lido: 1 mg/kg
IV mag
subhypnotic propofol: 30-50 mg

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45
Q

rescue position

A

lateral

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46
Q

what does the rescue position do?

A

promotes secretions out of mouth instead of down airway

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47
Q

bleeding tonsil management

A

reintubation (difficult) w/small ETT
trendelenburg
OG

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48
Q

bleeding tonsil: S+S

A

tachycardia
excessive swallowing
decreased cap refill
restlessness

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49
Q

bleeding tonsils are _______ in nature

A

venous

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50
Q
A

oral RAE

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51
Q
A

nasal RAE

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52
Q
A

micro laryngeal tube (MLT)

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53
Q
A

laser tube

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54
Q

why is the balloon yellow on the MLT

A

to highlight where the cuff/vocal cords are for the surgeon

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55
Q

what is different about the laser tube?

A
  • 2 cuffs
  • resists the effects of laser
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56
Q

yellow cuff on laser tube

A

air

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57
Q

clear cuff on laser tube

A

saline w/methylene blue

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58
Q
A

wire tube

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59
Q

what is unique about wire tubes?

A

resist kinking
can still be occluded

60
Q

what central access should you avoid in head/neck surgery?

A

jugulars

61
Q
A

montandon tube

62
Q

what is a montandon tube used for

A

larynx removal

63
Q

what is the impact of radiation therapy or lesions on airway?

A

increased scarring will decrease mobility
== more difficult airway

64
Q

what happens if carotid sinus is manipulated?

A

vagal

65
Q

what should you ensure you pt has in pre-op prior to head/neck surgery?

A

2 contralateral IVs
type and screen

66
Q

what sedation drips are tracheostomy pts typically on?

A

precedex
propofol
fentanyl

67
Q

A

A

outer cannula

68
Q

C

A

inner cannula

68
Q

B

A

cuff inflation line

69
Q

D

A

obturator

70
Q

F

A

cuff

70
Q

E

A

pilot balloon

71
Q

outer cannula

A

keeps stoma open

72
Q

obturator

A

guides outer cannula into stoma during placement

73
Q

inner cannula

A

fits inside outer cannula

74
Q

what cannula can be removed for cleaning

A

inner cannular

75
Q

what kind of trach tube do you ned for PPV

A

cuffed (pilot balloon)

76
Q

when are cuffless trach tubes indicated?

A
  1. pts with tracheal problems
  2. pts ready for decannulation
77
Q

fenestrated trach cuffed tube indication

A

pts on ventilator but unable to tolerate speaking valve

78
Q

fenestreated trach cuffless tube

A

pts w/difficulty using speaking valve

79
Q

most common trach tube type

A

cuffless

80
Q

immature trach

A

<7 days old

81
Q

mature trach

A

7+ days old

82
Q

Proximal XLT trach

A

longer proximally to bypass thick neck tissue

83
Q

Distal XLT trach

A

longer distally to bypass tracheal stenosis
or for longer tracheas (tall people)

84
Q

what type of ventilation does ambu bag provide

A

PPV only
(cannot SV)

85
Q

options to provide O2 to SV pt on trach

A

mapleson w/T piece
trach mask
simple face mask over trach

86
Q

extreme risk factor in cleft palate repair

A

blood loss

87
Q

how do you reduce blood loss in cleft palate?

A

permissive hypotension
surgeon uses local w/epi

88
Q

what do you need if you are going to allow permissive hypotension?

A

art line

89
Q

lefort 1

A

horizontal maxillary

90
Q

lefort 2

A

pyramidal

91
Q

lefort 3

A

???

92
Q
A

lefort 1

93
Q
A

lefort 2

94
Q
A

lefort 3

95
Q

lefort 2 and 3 are associated with

A

higher blood loss
CSF leak

96
Q

which lefort has highest CSF leak potential

A

lefort 3 with cribiform disruption

97
Q

what procedures are CI in lefort fractures

A

nasal intubation
NG insertion
PPV

98
Q

airway for zygomatic arch or mandible fracture

A

nasal rae

99
Q

CN 2

A

optic nerve

100
Q

optic nerve function

A

neural signal from retina

101
Q

CN 3

A

oculomotor

102
Q

CN 4

A

trochlear

103
Q

CN 6

A

abducens

104
Q

which CN control extrinsic eye muscles

A

CN 3
CN4
CN 6

105
Q

CN 5

A

trigeminal

106
Q

what does CN 5 control

A

touch and pain

107
Q

normal intraocular pressure

A

10-20 mmHg

108
Q

what happens if you increase IOP

A

decrease blood flow

109
Q

oculocardiac reflex

A

trigemiovagal response that can cause severe bradycardia/asystole

110
Q

what causes oculocardiac reflex?

A

retraction on extraocular muscles

111
Q

most potent muscle for oculocardiac reflex

A

medial rectus muscle

112
Q

oculocardiac reflex is a ______ pathway

A

afferenbt

113
Q

what exacerbates oculocardiac reflex?

A

hypercapnia
hypoxia

114
Q

what can prevent oculocardiac severe bradycardia?

A

0.2mg glyco

115
Q

acetazolamide class

A

carbonic anhydrase inhibitor

116
Q

acetazolamide indication

A

treats glaucoma by decreasing IOP

117
Q

acetazolamide SE

A

alkaline diuresis can cause hypokalemia

118
Q

echothiphate class

A

topical anticholinesterase

119
Q

echothiphate indication

A

glaucoma

120
Q

echothiphate SE

A

inhibits plasma cholinesterase
– prolongs sux

121
Q

pilocarpine / acetylcholine class

A

cholinergics

122
Q

pilocarpine/ acetylcholine SE

A

pupil constriction
bradycardia
acute bronchospasm

123
Q

timolol class

A

beta blocker

124
Q

timolol indication

A

glaucoma

125
Q

timolol SE

A

bronchospasm
CHF exacerbation
caution w/COPD

126
Q

common comorbidies in optho patients

A

HTN
DM2
OSA

127
Q

sedations for optho blocks

A

small dose versed
PO alprazolam / diazepam
12.5-50 mcg fentanyl
50-100 mcg alfentanil
30-50 mg propofol

128
Q

what do surgeons need to perform optho facial nerve block?

A

akinesia

129
Q

which block provides eyelid akinesia

A

retrobulbar block

130
Q

retrobulbar block SE

A

hemorrhege
incr IOP
intra-arterial injection induced seizures

131
Q

posterior peribulbar block

A

lower hemorrhage
2 injections
longer onset
incomplete akinesia

132
Q

sub-tenons block

A

longer onset
sedation required

133
Q

optho topicals

A

tetracaine 0.5%
lidocaine 4%

134
Q

optho long duration surgeries: managment

A

GA
LMA or ETT

135
Q

which airway increases IOP

A

ETT

136
Q

which airway can interfere with opthomalogist

A

LMA

137
Q

what shoud you avoid in optho surgery

A

nitrous

138
Q

what is in vitreous gas bubble

A

sulfur hexaflouride
perflouopropane

139
Q

what is a major issue with optho

A

PONV

140
Q

optho surgeries that require GA

A

enucleations
vitroretinal surgery
orbital surgery

141
Q

most common peds eye case

A

strabismus correction

142
Q

rate of PONV in ped strabismus cases

A

50–80%

143
Q

common SE during peds strabisums case intraop?

A

bradycardia

144
Q

urgent eye case

A

open globe
retinal detachment
corneal foreign body

145
Q

semi-urgent eye case

A

orbital fx blow-out
tumor
chronic retinal detachment

146
Q

emergent eye case

A

chemical burn to cornea
central retinal artery occlusion

Fa: Sim 3 (10 decks)

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