CWMP - Trachea

Question 1

Approximate length of trachea distal to subglottic space

Answer 1

10-13 cm

Question 2

What is the 1st cartilaginous ring of the airway?

Answer 2

Cricoid cartilage

Question 3

What is the narrowest part of the trachea?

Answer 3

subglottic space

Question 4

Internal diameter of subglottic space

Answer 4

2cm

Question 5

Origin of vocal cords

Answer 5

Arytenoid cartilages

Question 6

To which part of the cricoid cartilage does the arytenoids articulate to?

Answer 6

Posterior plate of the cricoid cartilage

Question 7

True of the trachea EXCEPT

a. distal trachea has 18-22 rings
b. distal trachea internal diameter is 2.3cm
c. C shaped hyaline cartilaginous structures that provide rigidity to the posterior and lateral tracheal walls
d. each arterial branch supplies 2-3cm of the trachea.
e. NOTA

Answer 7

D

Question 8

most common cause of injury to the trachea

Answer 8

overinflation of the endotracheal cuff

Question 9

Full thickness injury of the trachea during endotracheal intubation can fistulae between these two structures

Answer 9

innominate anteriorly and esophagus posteriorly

Question 10

In circumstances of prolonged ventilatory support and high airway pressure, cuff pressure monitoring goal should be to maintain pressure at this level

Answer 10

<20mmHg

Question 11

Intubation-related risk factors for tracheal stenosis

Answer 11

T - ransverse rather than vertical incision on the trachea
T - raumatic intubation
O- ver sized tracheostomy tube
P - rior tracheostomy or intubation
P - rolonged intubation
H - igh tracheostomy through the first tracheal ring or cricothyroid membrane

Question 12

How do you minimize risk for prosttracheostomy stenosis

Answer 12

Rapid downsizing
Use of smallest tracheostomy tube possible
Vertical tracheal incision

Question 13

Primary symptoms of tracheal stenosis

Answer 13

Stridor and dyspnea on exertion

Question 14

The following statement/s is/are true

a. Stenosis caused by tracheostomy is most commonly due to weblike fibrous growth
b. Stenosis due to intubation is due to excess granulation tissue
c. both
d. neither

Answer 14

D.
Tracheostomy - granulation tissue
Intubation - weblike fibrous growth

Question 15

What is the acute management of severe stenosis and respiratory compromise?

Answer 15

rigid bronchoscopy

Question 16

Most common site of intubation injuries, and how is it accessed?

Answer 16

upper third of trachea, access through a collar incision

Question 17

Two main cuases of tracheoinnominate artery fistula

Answer 17

low placement of a tracheostomy

hyperinflation of the tracheal cuff

Question 18

Where should tracheostomy be placed?

Answer 18

3rd-4th tracheal rings

without reference to the location of the sternal notch

Question 19

What to do initially with significant bleeding of tracheoinnominate artery fistulas ?

Answer 19

Hyperinflate the endoctracheal cuff to temporarily occlude arterial injury

Question 20

In caes of bleeding tracheoinnominate artery fistulas, what should be done if hyperinflation of the endotracheal cuff to occlude artery does not work?

Answer 20

Tracheostomy incision should be immediately opened widely and a finger inserted to compress the artery against the manubrium.

Question 21

What is the treatment of tracheoesophageal fistula from prolonged endotracheal mech. vent. support and concomittant indwelling nasogastric tube?

Answer 21

Remove esophageal tubes
Endotracheal cuff should be placed below the fistula
To minimize aspiration, gastrostomy tube should be placed
Jejunostomy tube for feeding

Question 22

Most common primary tracheal neoplasm (2)

Answer 22

Squamous cell carcinomas

Adenoid Cystic carcinoma

Question 23

Which tracheal neoplasm?
A type of salivary gland tumor, generally slow growing, spread submucosally and tend to infiltrate along nerve sheaths and within the tracheal wall

Answer 23

Adenoid Cystic carcinoma

Question 24

Which tracheal neoplasm?

Often present with regional lymph node metastases and are frequently unresectable at presentation

Answer 24

Squamous cell carcinomas

Question 25

True about Tracheal neoplasm evaluation and treatment

a. should include neck and chest computed tomography and rigid bronchoscopy
b. If the tumor is judged to be completely resectable, primary resection and anastomosis is the treatment of choice
c. both
d. neither

Answer 25

C

Question 26

How much of the trachea can be resected with primary anastomosis?

Answer 26

50%

Question 27

Tracheal adenoid cystic carcinomas and squamous cell carcinomas are sensitive to radiotherapy. What is the dose used?

Answer 27

50Gy or greater