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Airways > Airways B Midterm > Flashcards

Airways B Midterm Flashcards

1
Q

What actions are most likely to cause iatrogenic retropharyngeal abscesses?

A

Failed NGT placement

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2
Q

What is the age for end of development in humans?

A

7 years old

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3
Q

What is the age for peak incidence of foreign body aspiration?

A

2-3 years old

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4
Q

How should you examine and evaluate the airway of patients who have undergone radiation?

A

Manual exam of the larynx with swallowing

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5
Q

How should you manage the airway of a patient with Ludwig’s angina?

A

Nasal intubation

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6
Q

How should you induce anesthesia in patients with LeFort fractures?

A

RSI w/ great preO2

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7
Q

What airway adjuncts do you NOT use in patients with a LeFort II fracture?

A

NAW, NETT, NGT

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8
Q

What airway adjuncts do you NOT use in patients with a LeFort III fracture?

A

Anode ETT

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9
Q

What muscle of the tongue depresses and protrudes it?

A

Genioglossus

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10
Q

What anatomical structures make up Waldeyer’s ring?

A

Adenoids, lingual, nasopharyngeal, and palatine tonsils

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11
Q

What anesthetic should you use for management of tonsillar abscess drainage?

A

GETA with short-acting IV anesthetic, sevo or des, and short acting NMB

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12
Q

What airway adjunct should you consider for management of tonsillar abscess drainage?

A

Anode tube

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13
Q

What auscultatory sound is caused by an orificial airway lesion?

A

Stridor

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14
Q

What auscultatory sound is heard in patients with asthma?

A

Wheezes

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15
Q

What are complications associated with nasotracheal intubation?

A

Epistaxis, abrasion, hemorrhage, infection, perichondritis, chondritis, sinusitis

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16
Q

What is a primary tracheostomy?

A

Tracheostomy done within 24 hours of intubation

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17
Q

What is the function of the atlanto-occipital joint?

A

To provide flexion and extension of the head

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18
Q

Does hoarseness occur more in males or females?

A

Females

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19
Q

What lab values should you check following a parathyroidectomy?

A

Ca2+

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20
Q

What is the most common cause of stridor in 2 year olds?

A

Laryngomalacia

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21
Q

What should the FiO2 be kept under when the surgeon is lasering the airway?

A

30%

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22
Q

Where is squamous cell carcinoma most commonly found on the body?

A

In the mouth, orally

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23
Q

Why do obese patients desaturate more quickly?

A

They have a lower FRC

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24
Q

What can interrupt function of the right RLN and cause hoarseness?

A

Aortic aneurysm

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25
Q

What surgeries often use McIvor mouth gags?

A

Pharynx surgeries, i.e. tonsils

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26
Q

What vocal cord injury is associated with being intubated for over 72 hours?

A

Ulceration

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27
Q

What vocal cord injury is associated with being intubated for 3-21 days?

A

Granulomata

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28
Q

What vocal cord injury is associated with being intubated for more than 2 weeks?

A

Cicatricial stenosis

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29
Q

What is the position of the vocal cords immediately following interruption of the RLN?

A

Paramedian

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30
Q

How do you manage the airway of a patient presenting with facial burns, including lips and nasal hairs

A

Oral intubation

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31
Q

For repair of a lower lip laceration under MAC, so long as oxyhemoglobin saturation remains satisfactory (>94%), what is the safest FiO2 to provide the patient?

A

21% room air

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32
Q

At the conclusion of a general anesthetic for total laryngectomy, how should the patient be breathing/supported?

A

Spontaneous

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33
Q

How would you select an oral airway size for an acromegalic patient?

A

Increase size

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34
Q

Would you use a nasal airway for an acromegalic patient?

A

No

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35
Q

How would you select a laryngoscope for an acromegalic patient?

A

Increase size

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36
Q

How would you select an ETT for an acromegalic patient?

A

Use the regular size

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37
Q

If hoarseness is due to arthritis of a joint, which joint is most likely involved?

A

Cricoarytenoid

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38
Q

An increase in lung water would produce which breath sounds?

A

Rales

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39
Q

What is the surgical requirement for postop airway safety after a tracheostomy?

A

A stay suture in place to ensure access to trach

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40
Q

How do you calculate time to hypoxia/desaturation time?

A

FRC/VO2

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41
Q

What is the incidence of postop hoarseness?

A

3%

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42
Q

What is the resolution for postop hoarseness?

A

Usually resolves on its own in 1-3 days

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43
Q

What is a secondary tracheostomy?

A

A tracheostomy that takes place more than 24 hours after intubation

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44
Q

What are the increased risks with a secondary tracheostomy?

A

Bleeding and infection

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45
Q

What are the causes of postop stridor?

A

Supraglottic edema, RLN injury (rare), hypocalcemia (rare)

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46
Q

What position should a gravid patient be in for airway examination?

A

Supine

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47
Q

What is the proper management for ulceration of vocal cords?

A

Strict voice rest and observation

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48
Q

What is the proper management for cicatricial stenosis?

A

Surgery

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49
Q

How do you calculate oxygen consumption?

A

Kg^0.75 x 10

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50
Q

What is the appropriate ETT position for the McIvor mouth gag?

A

Midline on the tongue (on spatula/groove) and between the tongue and flange

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51
Q

What do rales sound like?

A

Crackling, high pitched

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52
Q

What do rhonchi sound like?

A

Vibrating, low pitched

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53
Q

What does stridor sound like?

A

Shrill, high pitched

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54
Q

Is wheezing high-pitched or low-pitched?

A

High pitched

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55
Q

Hoarseness persisting more than 2 weeks requires what action?

A

Otolaryngoscopy

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56
Q

What is the most frequent laryngeal malignancy?

A

Squamous cell carcinoma

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57
Q

What is the flow-volume loop of a patient with thyroid disease?

A

Extrathoracic, inspiratory plateau

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58
Q

What airway device should be used for a patient with a laryngectomy?

A

Laryngoflex

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59
Q

What are the functions of the larynx?

A

Protection, effort closure, phonation, air passage

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60
Q

What is the vertebral level of the hyoid bone?

A

C3

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61
Q

What is overjet?

A

Upper teeth jet over the bottom teeth horizontally

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62
Q

What is the etiology of otitis media with nasotracheal intubation?

A

Misplaced nasal tube in the eustachian tube

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63
Q

What is the concentration of heliox most commonly used in hospitals?

A

80/20

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64
Q

What is secreted from the parotid glands?

A

Saliva

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65
Q

What is the hallmark for laryngomalacia?

A

Inspiratory stridor

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66
Q

Which tracheal rings are involved in an elective tracheostomy?

A

2nd or 3rd

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67
Q

How does gastric pressure change in a gravid patient with 1 child?

A

Increases by 7-17cmH2O

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68
Q

How does gastric pressure change in a patient pregnant with twins?

A

Increases by 7-40cmH2O

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69
Q

How does gastric pressure change with a gravid patient in the lithotomy position?

A

Increases by 7-24 cmH2O

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70
Q

Who is the main manufacturer of tracheostomy tubes?

A

Shiley

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71
Q

What are the intermediate and long-term risks of a tracheostomy?

A

Ischemia, necrosis, erosion, dilation, stenosis

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72
Q

What gas can produce significant ischemic lateral-wall injury?

A

Nitrous oxide

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73
Q

Which trach tube has a foam-filled cuff and an adjustable flange?

A

Kamen-Wilkinson trach

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74
Q

What are the 2 critical considerations for proper placement of a trach tube?

A

1) No traction on trach

2) Optimum cuff pressure

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75
Q

Which trach tubes are all metal and can come with or without a cuff?

A

Jackson trach

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76
Q

What piece of equipment maintains stomal patency for future access?

A

Trach button

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77
Q

Which trach tube maintains stomal patency for suctioning and permits speech?

A

Kistner trach

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78
Q

Which trach tube is also known as the “talking trach”?

A

Fenestrated trach

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79
Q

What is the proper end-of-case management for a laryngectomy?

A

A laryngectomy tube (NOT TRACH TUBE) sutured to skin with patient spontaneously breathing

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80
Q

What airway device has a laryngeal limb that provides airflow, a tracheal limb that serves as a stent, and an exposed limb that allows for PPV?

A

Montgomery T-Tube

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81
Q

How should you manage the airway of a patient with retropharyngeal abscess?

A

Oral ETT with or without FFOB

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82
Q

Which laser is used for cuts and cauterizing of more superficial tissue?

A

CO2

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83
Q

Which laser is used on deeper tissue and can be transmitted by cornea?

A

YAG

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84
Q

Where is the glottis in infants?

A

C3-C4

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85
Q

How are the vocal cords situated in infants?

A

Horizontal and concave

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86
Q

How does the epiglottis differ in infants?

A

Longer, omega shape, stiffer, horizontal

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87
Q

What are the branches of the facial nerve superior to inferior? (two zombies butchered my cat)

A
  • Temporal
  • Zygomatic
  • Buccal
  • Mandibular
  • Cervical
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88
Q

How do you determine the type of anode ETT tube you should use?

A

Depends upon surgery and direction of ETT and circuit (cephalad or caudad)

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89
Q

What is the long-term complication associated with flexible fiberoptic bronchoscopy?

A

Infection

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90
Q

What are the only three possible FFOB directional movements?

A
  • Longitudinal
  • Rotational
  • Angulation
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91
Q

What does the longitudinal movement of the FFOB allow?

A

Allows you to enter and leave the airway

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92
Q

What does the rotational movement of the FFOB allow?

A

To move through approximately 180 degrees either clockwise or counterclockwise

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93
Q

What does the angulation movement of the FFOB allow?

A

Flexion and extension of the tip from 90 degrees to 180 degrees

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94
Q

What are the size measurements of the Aintree catheter?

A

4.7mmID x 6.5mmOD x 56cm L

95
Q

With which sized ETT tubes can Aintree catheters be used?

A

7.0 and above

96
Q

What structure must you see before sliding an ETT introducer into the larynx?

A

Tip of the epiglottis

97
Q

What are the complications associated with ETT introducers?

A

Tracheal abrasion, hemorrhage, hematoma, infection, abscess, mediastinitis

98
Q

What length ETT introducer is used with a 6.0 ETT?

A

66cm

99
Q

What length ETT introducer is used with a 7.0 ETT?

A

70cm

100
Q

What does HPOV stand for?

A

High-pressure oxygenation and ventilation

101
Q

What does RGW stand for?

A

Retrograde guide wire-assisted endotracheal intubation

102
Q

What is the minimum length of a J-wire required for RGW-assisted intubation?

A

60cm

103
Q

What is the primary purpose of HPOV?

A

To oxygenate (not ventilate)

104
Q

Which type of airway obstruction is HPOV used for?

A

Ball-valve obstruction

105
Q

What type of airway obstruction will not be helped with HPOV?

A

Complete upper airway obstruction

106
Q

In which direction should the 3-way stopcock be turned for HPOV assembly?

A

All ports open

107
Q

What is the long-term complication associated with HPOV?

A

Barotrauma

108
Q

What is the name of the conventional ETT with an integrated bronchial blocker?

A

Univent

109
Q

What is the name of the bronchial blocker that has a specialized connector?

A

Ardnt endobronchial blocker (Cook)

110
Q

What device is required for Ardnt endobronchial blocker placement?

A

FFOB

111
Q

Which bronchial blocker has 2 distinct proximal balloons and bifurcated distal extensions?

A

Rusch EZ-blocker endobronchial blocker

112
Q

What is the leading cause of obstetric anesthetic mortality?

A

AIRWAY - failure to secure and aspiration

113
Q

What are the airway risk factors associated with pregnancy?

A
  • Failure to intubate
  • Aspiration
  • Hypoxemia
114
Q

What factors can cause a decrease in gastric emptying of pregnant patients?

A
  • Progesterone
  • Labor (stress)
  • Narcotic
115
Q

What contributes to increased gastric acidity in pregnant patients?

A

Gastrin

116
Q

Does NPO status eliminate risks in pregnant patients?

A

No

117
Q

What factors can decrease gastro-esophageal sphincter tone?

A
  • Reflux patients
  • Anticholinergics
  • Narcotics
  • NG tube
118
Q

What are 3 contributing factors of intubation failure?

A
  • Upper airway edema
  • Adiposity of head/neck/trunk
  • Breast enlargement
119
Q

How is FRC changed in pregnant patients?

A

Decreased by 20%

120
Q

How is oxygen consumption changed in pregnant patients who have carried to term?

A

Increased by 20%

121
Q

How is oxygen consumption changed in patients who are in active labor?

A

Increased by 60%

122
Q

How is Cimetidine administered for pregnant patients?

A

300mg IV 60 minutes prior to surgery

123
Q

How is Metoclopramide administered for pregnant patients?

A

10mg IV 30 minutes prior to surgery

124
Q

How is sodium citrate administered for pregnant patients?

A

30ml PO immediately prior to surgery

125
Q

How does Cimetidine work to decrease airway complications in pregnant patients?

A

Histamine H2 antagonist that decreases stomach acid production and decreases risk for aspiration

126
Q

How does Metoclopramide work to decrease airway complications in pregnant patients?

A

Helps with stomach emptying and GERD

127
Q

How does sodium citrate work to decrease airway complications in pregnant patients?

A

Neutralizes acid in the GI system

128
Q

At what age are patients considered an increased airway risk due to their age?

A

80 or older

129
Q

What comorbidity do many geriatric patients have that would hinder mouth opening and C-spine motion?

A

Arthritis

130
Q

How is thoracic compliance changed in the majority of geriatric patients?

A

Decreased

131
Q

How is vital capacity changed in the majority of geriatric patients?

A

Decreased

132
Q

How is FRC changed in the majority of geriatric patients?

A

Unchanged

133
Q

What aspects of the geriatric airway can indicate a difficult BMV?

A

Edentulous and loose facial skin

134
Q

How is the ability to cough and protect the airway changed in the majority of geriatric patients?

A

Decreased

135
Q

What airway adjuncts could be used to improve BMV of elderly patients?

A

Oral airway and face mask strap

136
Q

How does an increased prevalence of osteoporosis in geriatric patients pose an airway risk?

A

Increased fracture risk

137
Q

According to Dr. Hall, what class of drugs should be avoided in patients over 70 unless they’re visibly stressed or anxious?

A

Benzodiazepines

138
Q

What are the divisions of the thyroid gland?

A

Right lobe, left lobe, isthmus

139
Q

How many parathyroid glands do humans have?

A

4

140
Q

Which laryngeal nerves are contiguous with the thyroid gland?

A

RLNs

141
Q

What monitoring is very important during thyroid surgeries?

A

Nerve testing and NMB monitoring

142
Q

What are the airway and surgical risks during the maintenance phase of thyroid surgeries?

A

Hemorrhage

143
Q

Where does the left side of the vagus cross under?

A

Aortic arch

144
Q

Where does the right side of the vagus cross under?

A

Subclavian

145
Q

Which cranial nerve is protected in the larynx by thyroid cartilage?

A

Vagus

146
Q

What muscle is the only vocal cord abductor?

A

Posterior cricoarytenoid

147
Q

What is the overall effect of RLN INJURY?

A

Vocal cord adduction

148
Q

What are the acute effects of unilateral RLN injury?

A

Affected vocal cord will move to median position, opposed by the normal VC

149
Q

What are the long term effects of unilateral RLN injury?

A

Affected vocal cord may force the normal cord away from midline

150
Q

What are the acute effects of bilateral RLN injury?

A

Upper airway obstruction

151
Q

What are the long term effects of bilateral RLN injury?

A

Resolution of edema, no problems

152
Q

What is the overall effect of RLN INTERRUPTION?

A

Paramedian vocal cord position

153
Q

What are the acute effects of bilateral RLN interruption?

A

Upper airway open

154
Q

What are the long term effects of bilateral RLN interruption?

A

Aspiration and dyspnea

155
Q

What are the 2 lobes of the parotid glands?

A

Superficial and deep

156
Q

How many parotid glands do humans have?

A

2

157
Q

What is another name for the parotid duct?

A

Stenson’s duct

158
Q

Which cranial nerve transverses the parotid gland?

A

Facial

159
Q

What makes up the majority of parotid gland diseases?

A

Adenoma (benign tumors)

160
Q

What is the name for parotid inflammation?

A

Parotitis

161
Q

How should electrodes be placed to optimize NMB monitoring?

A
  • Maximum current density
  • Minimal current dispersion
  • Close to the nerve
162
Q

When should the sensory threshold be tested during facial NMB monitoring of parotid surgeries?

A

Before induction - watch facial expression

163
Q

When should the motor threshold be tested during facial NMB monitoring of parotid surgeries?

A

After induction, before the muscle relaxant

164
Q

What is a supramaximal stimulus?

A

Stimulus that activates all muscle fibers served by the stimulated nerve without directly stimulated the muscle fibers

165
Q

What is the empiric setting for NMB monitoring?

A

25mA above motor threshold, so 40mA (25mA+15mA)

166
Q

What is the end point for neuromuscular blockade reversal?

A

TOF 4/4 –> sustained tetanus –> TOF ratio > 0.9

167
Q

What type of anesthesia should be used for a patient for peritonsillar abscess surgery?

A

General

168
Q

What airway device should be used for a patient with a peritonsillar abscess?

A

Anode ETT tube

169
Q

What induction drugs should be selected for a surgery on a peritonsillar abscess?

A

Short-acting IV anesthetic and short-acting muscle relaxant

170
Q

How should the airway of a patient undergoing surgery for a peritonsillar abscess be managed post-operatively?

A

Careful oral suctioning with flexible catheter, patient awake and alert

171
Q

What is trismus?

A

Inability to open the mouth fully

172
Q

What is the airway management plan for a patient undergoing surgery for Ludwig’s angina?

A

FFOB NETT sedation

173
Q

How should induction proceed for a patient undergoing surgery for Ludwig’s angina?

A

IV induction AFTER intubation is complete and confirmed

174
Q

How should the airway of a patient undergoing surgery for Ludwig’s angina be managed postoperatively?

A

The patient will remain intubated

175
Q

What is angina ludovici?

A

Cellulitis of the floor of the mouth

176
Q

What does angina mean in greek?

A

Strangling

177
Q

What is the airway management plan for a patient undergoing surgery for acute epiglottitis?

A

Oral ETT

178
Q

How should the airway of a patient undergoing surgery for acute epiglottitis be managed postoperatively?

A

Patient will remain intubated

179
Q

What causes acute epiglottitis?

A

An infection by H. flu

180
Q

What anticholinergic and dose should be considered for a patient presenting with acute epiglottitis?

A

Atropine 10mcg/kg IV

181
Q

What signs would indicate the resolution of acute epiglottitis?

A

Decreased WBCs, fever abates, air leak develops

182
Q

What airway devices are used during surgery for chronic recurrent tonsilitis?

A

McIvor retractor and anode oral ETT

183
Q

What is a major periop risk of surgery for chronic recurrent tonsilitis?

A

Hemorrhage

184
Q

What obscures the DL view in patients presenting with kissing tonsils?

A

Significant lymphoid tissue

185
Q

Are thermal airway injuries more prevalent in males or females?

A

Males

186
Q

What are the primary goals of managing an airway affect by thermal injury?

A

Maintain airway patency and oxygenation

187
Q

What is the projected status of patients presenting with facial, oral, or nasal burns?

A

Rapid loss of airway patency due to laryngeal edema

188
Q

In order of best to least, what airway devices are best to manage an airway of a patient with thermal injury?

A

Oral ETT > Nasal ETT > Tracheostomy

189
Q

What are the risks associated with nasal intubation in patients with thermal injury?

A

Infection - sinusitis, otitis, sepsis

190
Q

What are the risks associated with tracheostomies in patients with thermal injury?

A

Wound and mediastinal infection

191
Q

How can you simply evaluate the need for continuing or discontinuing airway support in patients with thermal injury?

A

Cuff-leak test

192
Q

What is the acceptable leak in the cuff-leak test that will indicate airway support can be safely discontinued in patients with thermal injury?

A

5-10cmH2o

193
Q

What are unacceptable leaks in the cuff-leak test that will indicate airway support cannot be safely discontinued in patients with thermal injury?

A

Greater than 20cmH2o

194
Q

What chemical associated with fire and chemical accidents produces pulmonary edema?

A

Acrolein

195
Q

What accidents can cause the accumulation of carbon monoxide?

A

Fires and incomplete combustion

196
Q

What chemical is released upon polyurethane conflagration?

A

CN (cyanide)

197
Q

What chemical is released upon PVC conflagration?

A

HCl

198
Q

What is caused by exposure to HCl from PVC conflagration?

A

Severe mucosal burns in airway

199
Q

What is spondylitis?

A

Vertebral inflammation

200
Q

What anatomical characteristics are associated with Klippel-Feil Syndrome?

A

Vertebral fusion of the C-spine

201
Q

What anatomical characteristics are associated with Arnold-Chiari Malformation?

A

Small posterior fossa, caudal displacement, hydrocephalus

202
Q

What is Juvenile Rheumatoid Arthritis?

A

An inflammatory, multiple-organ disease that affects the C-spine, TMJ, and cricoarytenoid joint

203
Q

What are the body proportions of an achondroplastic dwarf?

A

Normal trunk, shortened extremities, enlarged forehead

204
Q

What is achondroplastic dwarfism?

A

Developmental disorder with decreased proliferation of growth plate cartilage

205
Q

What anatomical differences of an achondroplastic dwarf will increase the difficulty of their airway management?

A
  • Large head
  • Short maxilla
  • Large mandible
  • Cervical instability
206
Q

What movement should you avoid when positioning an achondroplastic dwarf ?

A

Hyperextension

207
Q

What is polyarthropathy?

A

Synovial inflammation and granulation

208
Q

What are the signs and symptoms of polyarthropathy?

A

Morning stiffness, PIP stiffness, pain, swelling

209
Q

What is spondyloarthopathy?

A

Progressive arthritis of spine and pelvis

210
Q

What effect of spondyloarthopathy can severely hinder airway management?

A

Fixed cervical spine

211
Q

What is DJD?

A

Degenerative joint disease

212
Q

What is DJD of the TMJ?

A

Degeneration of articular cartilage

213
Q

What are the symptoms of DJD of the TMJ?

A

Limited inflammation and pain with use

214
Q

What are the symptoms of DJD of the cervical spine?

A

Limited inflammation, pain, paresthesias, motor involvement

215
Q

If suction is inadvertently applied to the lungs by an NG tube that enters the trachea beside a cuffed ETT, what action should be taken following removal of the NGT?

A

Give continuous positive pressure and hold

216
Q

What is the perfusion pressure of tracheal mucosa?

A

25cmH2O (18mmHg)

217
Q

What is the narrowest part of the airway in patients 7 and younger?

A

Cricoid cartilage

218
Q

What is the narrowest part of the airway in adults?

A

Glottis

219
Q

What is the action of the cuneiform cartilage?

A

Stiffens aryepiglottic folds to help reopen glottis

220
Q

What is ankyloglossia?

A

Stiff tongue

221
Q

What does abnegation mean?

A

Denial or refusal

222
Q

What is innervated by the motor branch of the SLN?

A

Cricothyroid muscle

223
Q

How does heliox compare to O2?

A

Increased heat capacity, increased viscosity, decreased density

224
Q

What drug/dose is used for nasal vasoconstriction?

A

2000mcg phenylephrine

225
Q

What is the action of the posterior cricoarytenoid?

A

Abduct vocal cords

226
Q

What is anisocoria?

A

Unequal pupil size

227
Q

What type of cartilage makes up cricoid, arytenoid, and thyroid cartilages?

A

Hyaline

228
Q

What type of cartilage is the epiglottis and cuneiform/corniculate cartilages?

A

Elastic

229
Q

When does an acute airway complication occur?

A

During performance of a procedure, administration of a drug, etc.

230
Q

When does an intermediate airway complication occur?

A

During the existence of a drug or device in a patient

231
Q

When does a long-term airway complication occur?

A

After elimination of a drug or removal of a device from a patient

232
Q

Which laser type can cause severe retinal damage?

A

YAG

233
Q

Which laser type can cause severe heat injury to the anterior eye?

A

CO2

Airways (3 decks)

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