Chapter 70 - Laryngoscopy, Bronch, Esophagoscopy

Question 1

Why should you biopsy the esophagus when evaluating for food impaction?

Answer 1

to rule out eosinophilic esophagitis (dx with 15 eosin/hpf including after tx with PPI)

Question 2

how many hours are required to cause esophageal damage with button batteries?

Answer 2

2-3 hours

Question 3

how does the stroboscope work

Answer 3

uses microphone or EMG activity
flashes light source based on fundamental frequency of VC
Creates appearance of VC wave in slow motion

Question 4

laryngoscopy view grades

Answer 4

I- entire VC
II- partial VC
III- only arytenoids
IV- no laryngeal structures viewable

Question 5

ETT size

Answer 5

Newborn: 3.5
Approach 1yo: 4
2yo: 4.5
Beyond: (Age +4)/4
Typical male adult: 8
Typical female adult: 7.5

Question 6

Length, diameter and cross-sectional area of trachea: Child vs Adult

Answer 6

Child: 5.4cm long

16-18yo: 12.2cm long, 3x diameter, 6x cross-sectional area

Question 7

Indications for esophagoscopy

Answer 7

Children: dysphagia for solids, refractory reflux, food impaction, FB
Adult: dysphagia, GERD, hematemesis, atypical chest pain, r/o cancer

Question 8

Complications of esophagoscopy

Answer 8

trauma to lips/tongue/throat, teeth, aspiration pneumo, hypotension, arrhythmia, pneumothorax, bleed, esoph perf

Question 9

When to do esophagoscopy after caustic ingestion

Answer 9

12-48 hours after

long enough to allow damage to present, but not so long you allow perf

Question 10

Acidic vs Alkaline caustic ingestion

Answer 10

Acidic: coagulation necrosis, coagulum protects deeper tissues
Alkaline: liquefaction necrosis, deeper injury

Question 11

Caustic esophageal injuries grading system

Answer 11

0- NL
1- edema/hyperemia mucosa
IIa- friable, hemorrhage, ulcer, erosion, blister, exudate, membrane
IIb- also with deep or circumferential ulceration
3a- small scattered necrosis
3b- extensive necrosis
4- perf

0-IIa: PO ok
IIb+: total esophageal rest
IIb+: frequent complications like stricture, necrosis

Question 12

How do button batteries injure tissue?

Answer 12

electrolytic current –> produces hydroxide

Question 13

Most common location of esophageal FB

Answer 13

just distal to cricopharyngeus (strong concentric muscle, capable of moving object distal to it, other parts of esophagus may not be able to)

Question 14

Where zenker’s form

Answer 14

pseudo-herniation posteriorly between oblique and fusiform fibers of cricopharyngeus or inferior constrictor and cricopharyngeus (Killian Triangle)