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Airways > Airways A Final > Flashcards

Airways A Final Flashcards

1
Q

Name of sinus located behind the conchae

A

Sphenoidal sinus

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2
Q

What vertebral level is the hyoid bone

A

C3

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3
Q

What vertebral level is the thyroid cartilage

A

C4-C5

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4
Q

What vertebral level is the cricoid cartilage

A

C6

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5
Q

Which bones suspend the larynx

A

Skull and mandible

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6
Q

Which bones stabilize the larynx

A

Sternum and scapulae

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7
Q

What are the tubercles directly lateral to the interarytenoid incisure

A

Corniculate

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8
Q

What are the tubercles lateral to the corniculate tubercles

A

Cuneiform

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9
Q

What position are the vocal cords in during phonation and effort closure

A

Midline

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10
Q

What position are the vocal cords in when a patient is anesthesized

A

Paramedian

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11
Q

What position are the vocal cords in during maximum inspiration

A

Lateral

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12
Q

Whats the most common reason for airway obstruction in an anesthesized patient

A

Tongue falling against the posterior pharyngeal wall

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13
Q

Which vertebral level is the major carina located

A

T6

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14
Q

What is the inner diameter of a face mask

A

22mm

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15
Q

What is the outer diameter of the ETT connector

A

15mm

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16
Q

What is the outer diameter of the elbow

A

22mm

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17
Q

What is the inner diameter of the elbow

A

15mm

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18
Q

What is the definition of risk

A

The probability of injury or loss; the likelihood of doing harm

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19
Q

What happens to the lower C spine during DL alignment

A

Flexes

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20
Q

What happens to the atlanto-occipital joint during DL aligmnment

A

Extends

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21
Q

What is the appropriate inter-incisor distance for managing the airway

A

Equal to or greater than 4cm

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22
Q

What can you see in a MAL1 view

A

Tonsils, uvula, both palates

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23
Q

What can you see in a MAL2 view

A

Uvula, both palates

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24
Q

What can you see in a MAL3 view

A

Both palates

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25
Q

What can you see in a MAL4 view

A

Hard palate

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26
Q

What are the motions of the TMJ

A

Rotate and glide

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27
Q

What is the appropriate thyromental distance for managing the airway

A

6.5cm

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28
Q

What is the appropriate mandibular length for managing the airway

A

Greater than or equal to 9cm

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29
Q

What is the medical term for nose bleed

A

Epistaxis

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30
Q

What muscle do you test to assess motor function of CN VII

A

Orbicularis oculi

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31
Q

What is the fulcrum point for the larynx

A

Hyoid bone

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32
Q

What are the suspenders and stabilizers of the larynx

A

Extrinsic laryngeal muscles

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33
Q

What are the 2 suspension points of the larynx

A

Mastoid and styloid processes

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34
Q

What are the 2 stabilization points of the larynx

A

Sternum and scalpula

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35
Q

What is the large muscle that makes up the floor of the mouth

A

Mylohyoid

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36
Q

What is macrogenia

A

Large chin

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37
Q

What is micrognathia

A

Small jaw

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38
Q

What is macrognathia

A

Large jaw

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39
Q

What is mandibular prognathism

A

Jaw jets out in front of upper teeth

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40
Q

Where do I place my fingers during jaw thrust maneuver

A

Behind the angle of the mandible

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41
Q

Where do I not place my fingers during jaw thrust maneuver

A

Submental space

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42
Q

How many phases of swallowing are there

A

3

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43
Q

What is the purpose of swallowing

A

To move solids and liquids to the stomach

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44
Q

What are the 3 phases of swallowing (deglutition)

A

Oral, pharyngeal, esophageal

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45
Q

Which arches relax during the oral phase of swalling

A

Palatoglossal

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46
Q

Whats the last step of the oral phase of deglutition

A

Food bolus moves into the oropharynx

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47
Q

What occludes during the pharyngeal phase of swallowing

A

Nasopharynx

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48
Q

What closes during the pharyngeal phase of swallowing to prevent aspiration

A

Larynx

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49
Q

What is the vocal cord action to prevent aspiration

A

Adduct

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50
Q

What is the aryepiglottic fold action to prevent aspiration

A

Adduct

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51
Q

What does the epiglottis do to prevent aspiration

A

Fold over the glottis

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52
Q

What aerodigestive activities are inhibited during the pharyngeal phase of swallowing

A

Breathing, coughing, sneezing, vomiting

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53
Q

What elevates during pharyngeal phase of swallowing to receive food bolus

A

Hypopharynx

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54
Q

What action moves the food bolus toward the esophagus during the pharyngeal phase of swallowing

A

Pharyngeal peristalsis

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55
Q

What 3 structures constrict during the pharyngeal phase of swallowing to produce pharyngeal peristalsis

A

Superior, middle, and inferior pharyngeal constrictor

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56
Q

What moves food bolus into the stomach during the esophageal phase of deglutition

A

Esophageal peristalsis

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57
Q

What positions are pharynx and larynx in during esophageal phase of deglutition

A

Rest

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58
Q

During what phase of breathing does deglutition occur

A

Expiration

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59
Q

What vertebral levels does the esophagus extend to

A

C6-T11

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60
Q

What are the 4 layers of the esophagus

A

Muscosa, submucosa, muscular layer, fibrous layer

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61
Q

What is achalasia

A

Increased tone at LES, incomplete relaxation of LES

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62
Q

What are the 3 signs and symptoms of achalsia

A

1) Progressive dysphagia
2) Noctural regurgitation
3) Aspiration

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63
Q

What can a diverticulum impede the placement of

A

NG/OG tube

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64
Q

What’s another name of Zenker’s Diverticulum

A

Pharyngoesophageal diverticulum

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65
Q

What is Zenker’s Diverticulum

A

Outpouching of esophageal mucosa between the cricopharyngeus muscle and inferior pharyngeal constrictor

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66
Q

What is the ratio of M:F for Zenker’s Diverticulum

A

1.5 Males:1 Female

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67
Q

Does Zenker’s Diverticulum occur more in older or younger patients?

A

Older

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68
Q

What side does Zenker’s Diverticulum occur in most often

A

Left side, 90%

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69
Q

What is the most common hiatal hernia

A

Axial (sliding) - 95%

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70
Q

What are the two types of hiatal hernias

A

Axial (sliding) and nonaxial (paraesophageal)

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71
Q

Patients with hiatal hernias are at high risk for what?

A

Aspiration

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72
Q

What are the 4 main risk factors for aspiration

A

Full stomach, GERD, hiatal hernia, upper GI diverticula

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73
Q

What is the bony protrusion from bones in the oral cavity

A

Torus

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74
Q

What is the posterior process on the axis

A

Dens

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75
Q

What is the large hole in the bottom of the skull

A

Foramen magnum

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76
Q

Which vertebrae have vertebral foramen

A

Cervical

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77
Q

What facets are on the atlas and axis

A

Superior and inferior facets

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78
Q

What is the condyle on the base of the skull

A

Occipital condyle

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79
Q

At what vertebral level are the vocal cords located

A

C4/C5

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80
Q

What vertebral level should the tip of the ET tube end

A

T2

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81
Q

What are the orders of axial alignment for a DL

A

Laryngeal, pharyngeal, oral

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82
Q

How do you bring the laryngeal axis into alignment for a DL

A

Folded sheets

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83
Q

How do you bring the pharyngeal axis into alignment for a DL

A

Atlanto-occipital extension

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84
Q

Where do the gas exchange airways begin

A

Respiratory bronchioles

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85
Q

Where to the upper conducting airways begin and end

A

Nose—>glottis

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86
Q

Where do the lower conducting airways end

A

Terminal bronchioles

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87
Q

What cranial nerve innervates the trachea

A

Vagus

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88
Q

What nerve innervates the sensory portion of the RLN

A

Vagus

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89
Q

What landmark do you use to assess the major carina ventrally in a physical exam

A

Sternal angle

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90
Q

What is the landmark for the dorsal portion of the major carina

A

T5-T7 in Xray of upright adult

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91
Q

What procedure requires anesthesia of the major carina

A

FFOB

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92
Q

At what angle does the right mainstem bronchus branch at in adults and infants

A

20 degrees in adults

30 degrees in infants

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93
Q

RUL takes off within how many centimeters of mainstem origin

A

2cm

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94
Q

At what angle does the left mainstem bronchus at in adults and infants

A

40 degrees in adults

47 degrees in infants

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95
Q

How long is the left mainstem bronchus

A

5cm

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96
Q

What is physiologic deadspace

A

Total deadspace in the patient

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97
Q

What is anatomic deadspace

A

Volume of the conducting airways

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98
Q

What is alveolar deadspace

A

Exchange airways that are not being perfused

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99
Q

What is normal per kilo amount of dead space

A

2.2ml/kg or 1ml/pound

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100
Q

Anatomical dead space is decreased by what

A

ETT tube, tracheostomy, laryngectomy

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101
Q

Which dead space is increased by the volume of the tube

A

Physical dead space

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102
Q

How much does intubation decrease anatomical dead space

A

By half

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103
Q

How do you calculate physical deadspace of an ETT

A

pir^2h

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104
Q

How do you calculate net change in deadspace with an ETT

A

Anatomical deadspace/2 + physical deadspace of ETT

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105
Q

What are the 4 functions of the larynx

A

1) Air passage into and out of the lungs
2) Protect lungs from solids and liquids
3) Phonation
4) Effort closure

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106
Q

What 4 actions cause effort closure of the larynx

A

1) Coughing
2) Lifting
3) Defecation
4) Parturition

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107
Q

From a lateral view of oral muscles, what muscle under the tongue appears to fan out

A

Genioglossus

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108
Q

From a lateral view of oral muscles, what 2 muscles are inferior to the genioglossus muscle

A

Geniohyoid and mylohyoid

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109
Q

From a lateral view of oral muscles, what large muscle extends vertically from the tongue to the hyoid

A

Hyoglossus muscle

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110
Q

From a side view of oral muscles, what muscle branches off the hyoglossus muscle posteriorly and connects to the styloid process of the skull

A

Styloglossus muscle

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111
Q

What muscle attaches to the hyoid bone and styloid process and appears diagonal in a lateral view of oral muscles

A

Stylohyoid muscle

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112
Q

From a lateral view of the muscles of the neck region, what is the order from posterior to anterior of the muscles that stabilize the larynx (TOS)

A

Thyrohyoid, omohyoid, sternohyoid

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113
Q

What 4 muscles suspend the larynx

A

Digastric, mylohyoid, stylohyoid, geniohyoid

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114
Q

Which 3 extrinsic laryngeal muscles, all connected to the hyoid, form the floor of the mouth

A

Mylohyoid, digastric, stylohoid

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115
Q

What is the name for the horns of the hyoid bone

A

Cornua (greater and lesser)

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116
Q

Why are the greater cornua important anatomic landmarks for an airway exam

A

You can use them to palpate and move the hyoid

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117
Q

What membrane attaches to the hyoid bone

A

Thyrohyoid membrane

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118
Q

What ligament attaches to the hyoid bone

A

Hyoepiglottic ligament

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119
Q

What are 3 examples of hyaline cartilage in the larynx (CAT)

A

Cricoid, arytenoid, thyroid

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120
Q

What are 3 examples of elastic cartilage in the larynx

A

Epiglottis, corniculate tubercles, cuneiform tubercles

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121
Q

What is the general shape of the thyroid cartilage

A

Shield

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122
Q

What are the wings of the thyroid cartilage called

A

Alae

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123
Q

What is the midline fusion of alae called (2 names)

A

Prominentia laryngis/Adam’s apple

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124
Q

What is the cephalad attachment of the thyroid cartilage

A

Thyrohyoid membrane

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125
Q

What is the caudad attachment on the thyroid cartilage

A

Cricothyroid membrane

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126
Q

Where are the vocal cords located in relation to the thyroid cartilage

A

Midline, interior

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127
Q

What are the 2 functions of the thyroid cartilage

A

1) Protect larynx

2) Suspends 7 of the 8 laryngeal folds

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128
Q

What suspends the thyroid cartilage from the hyoid bone

A

Superior cornu

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129
Q

What suspends the cricoid cartilage from the thyroid cartilage

A

Inferior cornu

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130
Q

What type of cartilage is cricoid cartilage

A

Hyaline

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131
Q

What is the general shape of the cricoid cartilage

A

Signet ring

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132
Q

What are the 2 functions of the cricoid cartilage

A

1) Supports arytenoid cartilages

2) Tilts for tensing VCs

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133
Q

How do you locate the cricoid cartilage on a physical ecam

A

It is the midline, rounded prominence below the prominentia laryngis

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134
Q

What is the cephalad attachment of the cricoid cartilage

A

Cricothyroid membrane

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135
Q

What is the caudad attachment of the cricoid cartilage

A

Trachea

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136
Q

What type of cartilage is arytenoid cartilage

A

Hyaline

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137
Q

What is the general shape of arytenoid cartilage

A

Pyramid

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138
Q

What is a unique aspect of arytenoid cartilages

A

They are the action center of the larynx

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139
Q

What is the attachment of the muscular process of the arytenoid cartilage

A

Cricoarytenoid muscles

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140
Q

What is the attachment of the vocal process of the arytenoid cartilage

A

Vocal cords

141
Q

What are the 4 functions of the arytenoid cartilages

A

1) Movement of vocal cords
2) Rotates on vertical axis
3) Glides or slides on base
4) Intermediary for vocal cord tensing

142
Q

What type of cartilage is the epiglottis

A

Elastic

143
Q

What is the function of the epiglottis

A

Folds to help protect laryngeal adieus

144
Q

What type of cartilage is corniculate cartilage

A

Elastic

145
Q

What is a unique aspect of the corniculate cartilages

A

Cartilages of Santorini

146
Q

What is the function of the corniculate cartilages

A

Spring-like action produces recoil assistance with seperation of arytenoids and reopening of the glottis

147
Q

What type of cartilage is cuneiform cartilage

A

Elastic

148
Q

What is a unique aspect of the cuneiform cartilages

A

Cartilages of Wrisberg

149
Q

What are the 2 functions of the cuneiform cartilages

A

1) Stiffens aryepiglottic folds

2) Spring-like action facilitates reopening of the glottis

150
Q

What type of joints are in the larynx

A

Synovial

151
Q

What are the 2 joint pairs in the layrnx

A

Cricothyroid joints, cricoarytenoid joints

152
Q

What are the 2 movements of the cricothyroid joint

A

Rotate and glide

153
Q

What are the actions of the cricothyroid joint

A

1) Cricoid cartilage rotates

2) Gliding produces cricoid cartilage shift on thyroid cartilage

154
Q

What are the 2 movements of the cricoarytenoid joints

A

Rotate and glide

155
Q

What does lateral gliding of the cricoarytenoid joint cause

A

Lateral rotation and forward, downward movement

156
Q

What does medial gliding of the cricoarytenoid joint cause

A

Medial rotation

157
Q

What type of tissue is the vocal ligament

A

Elastic

158
Q

What are the 2 muscles of the vocal cords

A

Vocalis muscle and thryoarytenoid muscle

159
Q

What type of cells make up the vocal cords

A

Stratified squamous epithelium

160
Q

What are the 4 actions of the vocal cords

A

Abduction, adduction, shortening, tensing

161
Q

What actions does the Recurrent Laryngeal Nerve produce

A

Adduction, abduction, shortening

162
Q

What action is the Superior Laryngeal Nerve responsible for

A

Tensing

163
Q

What is the only intrinsic laryngeal muscle that is not a pair

A

Transverse arytenoid muscle

164
Q

What is the only instrinsic laryngeal muscle that is innervated by the Superior Laryngeal Nerve

A

Cricothyroid muscle

165
Q

What 3 intrinsic laryngeal muscles adduct the vocal cords

A

Lateral cricoarytenoid, oblique arytenoid, transverse arytenoid

166
Q

What instrinsic laryngeal muscle abducts vocal cords

A

Posterior cricoarytenoid

167
Q

What intrinsic laryngeal muscle tenses the vocal cords

A

Cricothyroid

168
Q

What 2 intrinsic laryngeal muscles shorten the vocal cords

A

Thyroarytenoid, vocalis

169
Q

What 2 intrinsic laryngeal muscles close the glottis

A

Aryepiglottic, thryoepiglottic

170
Q

What action of the cricoid cartilage do the cricothyroid muscles produce

A

Tip and move cricoid cartilage posteriorly

171
Q

What nerve provides supraglottic sensory innervation to the cricothyroid muscle

A

Internal branch of the Superior Laryngeal Nerve

172
Q

What nerve provides motor innervation to the cricothyroid muscle

A

External branch of the SLN

173
Q

What is the landmark for blocking the SLN

A

Superior horn of the hyoid bone

174
Q

What 2 muscles oppose the action of the cricothyroid muscle

A

Vocalis and thyroarytenoid muscles, they contract and pull arytenoids and shorten the vocal cords

175
Q

What muscle extends from the oblique arytenoids to the lateral epiglottis

A

Aryepiglottic muscle

176
Q

What artery does the Right RLN travel around

A

Subclavian

177
Q

What artery does the Left RLN travel around

A

Aortic arch

178
Q

What membrane is pierced by the internal branch of the SLN

A

Thyrohyoid

179
Q

Is the internal branch of the SLN sensory or motor

A

Sensory

180
Q

What region does the internal branch of the SLN innervate

A

Supraglottic region

181
Q

Is the external branch of the SLN sensory or motor

A

Motor

182
Q

What muscles do the external branch of the SLN innervate

A

Cricothyroid muscles

183
Q

How do you confirm oxygen is flowing in a hand-operated, self-inflating bag

A

Listen to the distal end

184
Q

How do you confirm oxygen is flowing in an oxygen source with a reservoir

A

Reservoir bag fills up

185
Q

How do you confirm that you can manually ventilate before attaching the patient to the device

A

Occlude patient port and squeeze bag so you can generate and hold positive pressure

186
Q

What ventilatory rate do you provide patients during transport from the ICU?

A

6-8 breaths/minute for effective alveolar ventilation without hyperventilation

187
Q

What can happen to the brain if you hyperventilate your patient during transport from the ICU

A

Hyperventilation will drive the CO2 down which decreases cerebral blood flow and increases chance of cerebral ischemia

188
Q

What can happen to the brain if you hypoventilate your patient during transport from the ICU

A

Hypoventilation will drive the CO2 up and increase cerebral blood flow, thus increasing chance for edema in the brain

189
Q

What is the prevalence of anisocoria

A

40%

190
Q

What is acromegaly

A

Abnormally large head and neck features

191
Q

What are the largest salivary glands

A

Parotid

192
Q

What glands should be examined during airway exam

A

Lacrimal, parotid, submandibular, sublingual, thyroid

193
Q

What is another name for parotid duct

A

Stensen duct

194
Q

What is another name for submandibular duct

A

Wharton’s duct

195
Q

What is a treatment of dry eyes

A

Punctal plugs

196
Q

What does PERLA stand for regarding an eye examination

A

Pupils Equal and Reactive to Light and Accommodation

197
Q

What is exophthalmus

A

Bulging eyes, may not close completely

198
Q

What causes bilateral exophtalmus

A

Hyperthyroidism

199
Q

What causes unilateral exophthalmus

A

Orbital tubor

200
Q

What is ptosis

A

Drooping of the eyes

201
Q

What types of edema can occur with the eyes

A

Periorbital edema, conjunctival edema, scleral edema

202
Q

What is angle of the atlanto-occipital gap

A

35 degrees

203
Q

What is leukoplakia

A

White patches inside the mouth

204
Q

What is the condition where the pharyngeal arches and wall are severely swollen and red

A

Pharyngitis

205
Q

What is the condition where the palatine tonsils are coated with a liquidy white substance

A

Exudate

206
Q

What is the condition where the gums grow over the teeth

A

Gingival hyperplasia

207
Q

What is the therapy for gingival hyperplasia

A

Dilantin

208
Q

What is the condition where the gums appear red and irritated

A

Gingivitis

209
Q

What condition results in receding gums

A

Peridontitis

210
Q

What is the I:E ratio of a normal flow-volume loop

A

I:E equal, 50:50

211
Q

What is the I:E ratio of a flow-volume loop with extrathoracic variable obstruction

A

E > I

212
Q

What shows up on the flow-volume loop when there is an extrathoracic variable obstruction

A

Inspiratory plateau

213
Q

What shows up on the flow-volume loop when there is an intrathoracic variable obstruction

A

Expiratory plateau

214
Q

What is the I:E ratio of a flow-volume loop with intrathoracic variable obstruction

A

I > E

215
Q

What shows up on the flow-volume loop when there is a fixed obstruction

A

Inspiratory and expiratory plateaus

216
Q

What is on X axis of flow volume loop

A

Time

217
Q

What is on Y axis of flow volume loop

A

Flow

218
Q

What surgeries can fix a partial airway obstruction

A

Tracheostomy

Cricothryotomy (emergency only)

219
Q

What would you hear during auscultation of a patient with a partial airway obstruction

A

Inspiratory and expiratory stridor

220
Q

What observations would you make on a patient with partial airway obstruction

A

Dyspnea, stress, breathing pattern, retractions

221
Q

Pharmacologic support of a partial airway obstruction must acheive what

A

Improved flow across an orificial lesion

222
Q

What nonsurgical techniques could help manage a partial airway obstruction

A

Intubation or other physical airway device

223
Q

What is the change in flow when going from air to 100% O2

A

90%

224
Q

What is the change in flow when going from 100% O2 to 70% heliox

A

260%

225
Q

What is the change in flow when going from 100% O2 to 80% heliox

A

330%

226
Q

What is the flow volume loop pattern of a goiter

A

Fixed

227
Q

What is the flow volume loop pattern of a tracheal obstruction

A

Fixed

228
Q

What is the flow volume loop pattern of subglottic stenosis

A

Fixed extrathoracic (maybe variable?)

229
Q

What is the flow volume loop pattern of glottic SCCa

A

Fixed

230
Q

Who invented the LMA

A

Brain

231
Q

What are some advantages of an LMA

A

Less stimulating, no muscle relaxant required, less increase in intrathoracic, intra-abdominal, and intraocular pressures, less CV stimulation, provides post op airway

232
Q

What are some disadvantages of an LMA

A

Failure rate, complications and adverse events

233
Q

Where does the LMA seat

A

Above the larynx (supraglottic seal)

234
Q

What material is an LMA made of

A

Silicone

235
Q

What’s the angle between the airway tube and body of the mask

A

30 degrees

236
Q

OD of the LMA connector

A

15mm

237
Q

What are some contraindications for LMA use

A

GERD, not NPO, hiatal hernia, obesity, pregnancy, bowel obstruction, acute pancreatitis, high resistance/low compliance respiratory disease, patient positioned with limited airway access, upper airway pathology

238
Q

How can you prevent torque when securing an LMA

A

Tape to zygomatic region, use circuit tree

239
Q

What cathether on an LMA can facilitate endotracheal intubation

A

Aintree

240
Q

What nerves can be stimulated with an LMA

A

IX and X

241
Q

What are some acute risks that could occur with LMA use

A

Failure to acheive a good seal, failure to provide safe PPV, hypoxemia, hypoventilation

242
Q

What does ACDF stand for

A

Anterior cervical discectomy and fusion

243
Q

What is the endpoint for fiberoptic airway procedures

A

To have a patient answering yes-no questions after the ETT is in place

244
Q

What sedation is used for airway anesthesia

A

Propofol infusion or a neuroleptic technique with fentanyl and droperidol

245
Q

What anesthetic method is directly applied for anesthesia of the oral cavity and oropharynx

A

Topical spray - Lidocaine 4%

246
Q

What anesthetic method is indirectly applied for anesthesia of the oral cavity, nasal passage, pharynx, larynx, and trachea

A

Aerosol - use an aerosol generator (particles 10-100 microns) with heliox and Lidocaine 4%

247
Q

What anesthetic method is directly applied for anesthesia of the VCs, trachea, and carina

A

FFOB injection via suction port or injection port - Lidocaine 4%

248
Q

What anesthetic method is indirectly applied for anesthesia of the supraglottic region

A

Transtracheal injection

249
Q

What is transtracheal injection

A

Using a 20 gauge catheter to inject ~5mL of Lidocaine 4% through the cricothyroid membrane

250
Q

How much Lidocaine 4% is used for a transtracheal injection

A

5mL

251
Q

What membrane is pierced during a transtracheal injection

A

Cricothyroid membrane

252
Q

What area is anesthesized with a Superior Laryngeal Nerve Block

A

Supraglottic region

253
Q

What muscle can you block with an SLN block

A

Cricothyroid

254
Q

What drug do you use with an SLN block and how much do you use

A

3mL of 1% Lidocaine

255
Q

Where is the Lidocaine 1% injected during an SLN block

A

Greater horns of hyoid bone

256
Q

What anesthetic is used for a Sphenopalatine Nerve Block and how much

A

10mL of Cocaine 4%

257
Q

What topical application is used for a Sphenopalatine Nerve Block

A

Pledget strips for anesthesia and vasoconstriction of both nasal passages

258
Q

What 2 drugs, when mixed with 4mL of Lidocaine 4%, are used as topical anesthetics and vasoconstrictors for the nasal passages

A

Oxymetazoline 0.05% (1.5mg or 3mL), Phenylephrine 10% (2000mcg or 0.2mL)

259
Q

What drug is administered preoperatively as an antisialogogue and how is it administered

A

0.3mg glycopyrrolate intramuscularly

260
Q

What is the preferred technique for anesthesia of the airway

A

1) Glycopyrrolate injection preop
2) Aerosol lidocaine treatment in POHA
3) Nasal preparation with spray combination
4) Propofol infusion
5) Lidocaine 4% injection through FFOB

261
Q

Who developed early endotracheal equipment

A

Magill

262
Q

What is the purpose of the bevel on ETTs

A

Facilitate passage through vocal cords

263
Q

OD of ETT machine connector

A

15mm

264
Q

What are some benefits of the ETT cuff

A

Prevent aspiration, PPV, decreased cost of gases

265
Q

What determines ETT size

A

Patient height

266
Q

What is a Cole ETT

A

Pediatric - no cuff, has a shoulder, is tapered

267
Q

What volume should be in syringe for ETT cuff inflation

A

6mL

268
Q

What is stridor

A

High-pitched, shrill vibrating sound

269
Q

What produces a stridor sound

A

Orificial partial airway obstruction in the upper conducting airway

270
Q

What does wheezing sound like

A

High-pitched musical or whistling sound

271
Q

What produces a wheezing sound

A

Tubular partial airway obstruction in lower conducting airway

272
Q

What is stertor

A

Snoring sound

273
Q

What produces a stertor

A

Moveable tissue or loose material in upper conducting airways

274
Q

What does rhonchi sound like

A

Low-pitched, vibrating

275
Q

What produces rhonchi sounds

A

Turbulent flow around loose material (mucus) in the larger bronchi

276
Q

What does rales sound like

A

High-pitched, crackling sound; crepitations

277
Q

What produces rales

A

Opening of small airways closed by increased lung water, in the lower airways

278
Q

Are rales heard during inspiration, expiration, or both

A

Inspiration

279
Q

Ruleouts for direct VC involvement in hoarseness

A

NECK - Recent URI, chronic inflammation, allergy, excessive voice use, malignancy, polyps, VC dysfunction

280
Q

Ruleouts for indirect VC involvement in hoarseness

A

NECK - Contiguous infection or inflammatory disease, lyphadenopathy, malignancy, thyroid disease

281
Q

What nerves are subject to infectious, inflammatory, or malignant processes

A

RLN, SLN, Vagus

282
Q

Ruleouts in the chest for hoarseness

A

Bronchial malignancy, mediastinal mass, TB, aortic arch aneurysm, right subclavian artery disease

283
Q

What artery does the right RLN pass

A

Subclavian

284
Q

What artery does the left RLN pass

A

Aortic arch

285
Q

Ruleouts for cricoarytenoid joint disease for hoarseness

A

Dislocation of joint, arthritis, gout

286
Q

How long must hoarseness last to require otolaryngologic workup

A

2 weeks

287
Q

Pathophysiology of routine post hoarseness (pharyngitis)

A

Denudation of epithelium, edema, cricoarytenoid inflammation

288
Q

Incidence of postop pharyngitis

A

3%

289
Q

Do more males or females complain of postop pharyngitis

A

More females than males

290
Q

Incidence of postop ulceration

A

1%, more females than males

291
Q

Incidence of postop granuloma formation

A

1:10,000, more female than male, 50% bilateral

292
Q

Occurence and onset of cicatricial stenosis

A

Rare, onset 2+ weeks

293
Q

What percentage of closed claims included death or brain damage

A

85%

294
Q

What percentage of closed claims included difficult intubation

A

17% (87 cases)

295
Q

What percentage of closed claims included esophageal intubation

A

18% (94 cases)

296
Q

Auscultation proved to be unreliable in what percentage of closed claim cases

A

48%

297
Q

Occurence of anethesia related obstetric mortality

A

1:500,000

298
Q

Leading cause of obstetric anesthetic mortality

A

Failure to secure airway, aspiration

299
Q

Name for the medial cleft of upper lip

A

Philtrum

300
Q

What connects the tongue to the base of the mouth

A

Lingual frenulum

301
Q

5 branches of the facial nerve

A

Temporal, zygomatic, buccal, mandibular, cervical

302
Q

Vertebral levels of the esophagus

A

C6-T11

303
Q

What pressure is needed to open the GE junction of someone with a hiatal hernia

A

4 cmH2O

304
Q

What pressure is needed to open the GE junction of someone with GERD

A

1 cmH2O

305
Q

What pressure is needed to open GE junction

A

16 cmH2O

306
Q

What are the 5 different radiodensities

A

FABBM

Fat, air, bone, barium, metal

307
Q

Which Lefort fracture still allows you to perform nasal intubation

A

Lefort 1

308
Q

Where is the anterior commissure

A

Superior to the cords in a DL view

309
Q

What is otisis media

A

Inflammation of the middle ear

310
Q

Which vertebrae allows the head to rotate

A

C1 - atlas

311
Q

Which vertebrae allows the head to move up and rown

A

C2 - axis

312
Q

What passes through the foramen of the thyrohyoid membrane

A

Internal superior laryngeal nerve

313
Q

What does BSSO stand for

A

Bilateral sagittal split osteotomy

314
Q

What is the Valsalva maneuver

A

Moderately forceful attempted exhalation against a closed airway, usually done by closing one’s mouth, pinching one’s nose shut while pressing out as if blowing up a balloon. Deviation from normal results indicates problems with vagus reflex

315
Q

Effect of Mueller maneuver

A

Decreases intrathoracic pressure by breathing against a closed glottis.

316
Q

What is a pathophysiologic effect of a bilateral RLN injury

A

Stridor

317
Q

What is ankyloglossia?

A

Stiff tongue

318
Q

How can you calculate the time it will take for an apneic patient to become hypoxic

A

FRC (35ml/kg)/VO2(kg^0.75*10)

319
Q

What does “RAE” stand for, as in an Oral RAE tube

A

Ring, Adair, Elwyn

320
Q

The infraorbital nerve provides sensory innervation to which part of the nose?

A

Vestibules

321
Q

How can you calculate the correct inflation volume for LMAs

A

5mL x size of LMA

322
Q

How can you confirm proper placement of an LMA

A

Observe capnogram and auscultate for proper placement

323
Q

Proper action order for RSI

A

1) Preoxygenate
2) Cricoid pressure (Sellick maneuver)
3) Induction
4) Place tube
5) Confirm
6) Remove cricoid pressure

324
Q

Insufflation pressure for a laparoscopic nephrectomy

A

15 cmH2O

325
Q

Identification of the arytenoid muscular process

A

Outside ring

326
Q

Physical attributes of heliox

A

Increases heat capacity, increases viscosity, decreases density

327
Q

What is the etiology of otitis media with nasotracheal instrumentation

A

Blockage of eustachian tube

328
Q

What airway generation are the terminal bronchioles

A

17th

329
Q

How much phenylephrine is required for nasal vasoconstriction

A

2000mcg

330
Q

How can you manipulate the larynx during a DL

A

Dorsal depression of the thyroid cartilage

331
Q

What branch do you block with an SLN block

A

Internal sensory branch

332
Q

What is the definition of abnegation

A

Denial or refusal

333
Q

Who invented the grade views of the airway

A

Cormack and Lehane

334
Q

What hemodynamic effects does Mueller manuever cause

A

It lowers pulmonary blood pressure

335
Q

Indication for ETT introducer

A

When you don’t have a direct visualization of vocal cords

336
Q

What happens to vocal cords immediately following injury to both RLNs

A

Adduction

337
Q

What happens to vocal cords immediately following interruption of both RLNS

A

Paralyzed to paramedian position

338
Q

Which lobe of the lungs is most often affected when inadvertent endobronchial intubation occurs

A

Right upper lobe

339
Q

What does an extra thoracic flow volume loop tell you about the position of your ETT

A

The tip of the tube is behind the lesion

340
Q

Compared to air and oxygen, what advantages does heliox offer for various airway management situations?

A

Heliox has less density so it improves gas flow past partial airway obstructions

341
Q

Describe the anterior attachments of the vocal cords

A

Thyroid cartilage, midline inferior

342
Q

Describe the posterior attachments of the vocal cords

A

Vocal process of arytenoids

343
Q

TMJ compartment for initial mouth opening

A

Inferior - 50% - rotate

344
Q

TMJ compartment for late mouth opening

A

Superior - 50% - gliding

345
Q

How do you measure for the correct nasal airway size

A

Distance from nares to tragus

346
Q

During which phases of deglutition does peristalsis occur

A

Pharyngeal and esophageal

347
Q

During which phase of deglutition does larynx closure occur

A

Pharyngeal

348
Q

During which phase of deglutition does nasopharynx occlusion occur

A

Pharyngeal

349
Q

What is the true joint of the larynx

A

Cricoarytenoid

Airways (3 decks)

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