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ANES 512b Midterm > Chapter 34: Thyroid Disease + Surgery > Flashcards

Chapter 34: Thyroid Disease + Surgery Flashcards

1
Q

How much does the thyroid weigh?

A

30 g

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2
Q

Where does the isthmus usually lie?

A

Midline

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3
Q

Main anatomical points of thyroid:

A

Right lobe, left lobe, isthmus

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4
Q

What is most common issue with thyroid gland?

A

Enlargement

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5
Q

Parathyroid glands: How many? Size?

A

4 4 mm x 6 mm

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6
Q

Most common source of problems in parathyroid gland?

A

Endocrine disorder

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7
Q

Which nerves are contiguous with the thyroid gland?

A

RLNs

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8
Q

What increases risk for injury or loss of nerve?

A

Thyroid malignancy

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9
Q

What adjunct is necessary when operating on thyroid?

A

Nerve testing and NMB monitoring

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10
Q

Range of testing device for RLNs in thyroid surgery?

A

0.5-2 mA

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11
Q

The thyroid gland is contiguous with what airway structure?

A

Trachea

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12
Q

What is a goiter?

A

Enlargement of thyroid gland

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13
Q

Where can goiters grow? What are they called in their respective positions?

A

Can grow in chest (intrathoracic) or in neck (extrathoracic)

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14
Q

What is your biggest concern regarding goiters?

A

They tend to shift the trachea and therefore shift the glottis.

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15
Q

What type of disease may deviate and/or compress the trachea?

A

Thyroid disease

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16
Q

In what thyroid case would the patient require intubation post-operation?

A

Only the patient with tracheal malasia would remain intubated for 2-5 days as the surrounding tissue healed.

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17
Q

Immediate risk to thyroid disease/surgery?

A

Interruption/injury to one/both RLNs

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18
Q

This tool is used for:

A

Mediastinoscopy

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19
Q

Condition demonstrated in this picture

A

Intrathoracic goiter

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20
Q
A

Mediastinoscopy

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21
Q

Pathway of the RLNs:

A

Transverses chest (right vs. left difference)

Ascends in neck lateral to airway

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22
Q

Which cranial nerve is contiguous with thryoid gland?

A

Vagus (CN X)

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23
Q

Origin of RLNs?

A

Vagus nerve (CN X)

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24
Q

What anatomical structures protect RLNs?

A

Protected in larynx by thyroid cartilage

25
Q

RLNs serve what?

A

posterior cricoarytenoid muscle and other laryngeal muscles EXCEPT cricothyroid

26
Q

What muscle is the only primary vocal cord abductor?

A

posterior cricoarytenoid muscle

27
Q

RLN runs along track of which artery?

A

Laryngeal branches of superior and inferior thyroid arteries

28
Q

If the RLN is interrupted, position of the VCs?

A

Paramedian

29
Q

If RLN is injured (but not interrupted), VC at what position?

A

Abducted (lateral)

30
Q

What are some destructive effects of the thyroid gland on mechanical integrity of the upper airway? Where might these effects occur?

A

Cartilaginous destruction

Extrinsic compression

Can occur in neck and/or mediastinum

31
Q

What are three questions you should ask yourself if patient has previously had thyroid surgery?

A

Where is the lesion(?)

Where will the ETT cuff be(?)

What will happen after extubation(?)

32
Q

What routine actions may cause INJURY to RLNs?

A

Retraction, clamping, or electrocautery

33
Q

What routine surgical actions/tools may cause INTERRUPTION to RLNs?

A

scalpel or electrocautery

34
Q

INJURY to RLN: overall effect to vocal cords?

A

VC adduction

35
Q

In ACUTE UNILATERAL injury to RLN:

A

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

36
Q

In LONGTERM UNILATERAL injury to RLN:

A

Affected VC may force the normal VC away from the midline

37
Q

BILATERAL ACUTE injury to RLNs:

A

Upper airway obstruction

38
Q

Result of LONGTERM BILATERAL injury to RLNs:

A

Dyspnea, aspiration, but then resolution of edema, no problem

39
Q

Position of VCs during inspiration after RLN paralysis:

40
Q

Position of VCs during phonation during after RLN paralysis (compensated):

A

Closed (midline)

41
Q

Position of VCs during inspiration in the case of bilateral RLN paralysis

A

Paramedian

42
Q

What are some possible diagnoses for stridor after parathyroid or thyroid surgery?

A

Edema in the supraglottic or glottic regions

RLN damage

Hypocalcemia

43
Q

How much does a parotid gland weigh?

44
Q

Why must you use NMB monitoring when working with the parotid glands?

A

To ensure no damage was done to the facial nerve

45
Q

Name the two lobes of the parotid gland:

A

Superficial

Deep

46
Q

Which duct mediates secretions from the parotid gland?

A

Stenson’s duct

47
Q

What are the branches of the facial nerve?

A

Temporal

Zygomatic

Buccal

Mandibular

Cervical

48
Q

Branches of the buccal nerve?

A

Upper + lower

49
Q

What is the most common disease of the parotid gland?

The other source?

A

Benign adenoma (75%)

Other: malignancies (25%)

50
Q

What disorder do these images demonstrate?

51
Q

What is trismus?

A

Lock jaw (TMJ issue)

52
Q

Facial nerve branches require how many stimulators for each branch the surgeon wishes to monitor?

53
Q

Describe the optimal positioning of a NMB nerve monitor.

A

Close to the nerve being monitored

Maximal current density

Minimal current dispersion

54
Q

Best way to monitor sensory threshold while using an NMB nerve stimulator on the facial nerve?

A

Watch facial expressions prior to induction

55
Q

Explain the premise of the supramaximal stimulus using an NMB nerve stimulator:

A

Activate all muscle fibers served by the stimulated nerve without directly stimulating the muscle fibers

56
Q

Describe the empiric setting of the NMB nerve stimulator.

A

We want to set it to be 25 mA above motor threshold, which is 15 mA: so we set it to 40 mA.

57
Q

How should you give rocuronium? How long after dosing should you wait to test? What should your TOF ratio be?

A

Give in 5 minute increments.

Wait 4-6 minutes in order to test.

TOF ratio: >0.4

58
Q

End point for ending case following reversal of NMB: TOF ratio should be what?

ANES 512b Midterm (12 decks)

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