Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Spring '20/ L. Basic's Test 3- OP, EENT, OR Hazards > EENT > Flashcards

EENT Flashcards

1
Q

HOW MANY CATARACT OPERATIONS ARE PREFORMED EACH YEAR

A

> 2 MILLION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

WHICH ANESTHETIC TECHNIQUE IS USED FOR MOST EYE PROCEDURES

A

USING MAC AND SOME SORT OF REGIONAL EYE ANESTHETIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

WHO DO WE USE GENERAL ANESTHESIA FOR IN OPHTHALMOLOGY

A

PROLONGED DURATION

MORE INVASIVE ORBITAL PROCEDURES

THOSE PATIENTS WHO CANNOT STAY STILL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

NORMAL EYE PRESSURE

A

10-22MMHG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

WHAT DOES SUSTAINED INCREASED IOP DURING ANESTHESIA HAS THE POTENTIAL TO PRODUCE (4)

A

ACUTE GLAUCOMA

RETINAL ISCHEMIA

HEMORRHAGE

PERMANENT VISUAL LOSS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

OPHTHALMOLOGY FACTORS OF INCREASED IOP VENOUS CONGESTION:

A

OBSTRUCTION FROM EPISCLERAL VEINS TO THE RIGHT ATRIUM MAY CAUSE INCREASED IOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

BODY POSITION THAT INCREASE IOP

A

TRENDELENBURG/TIGHT CERVICAL COLLAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

HOW MUCH DOES STRAINING. RETCHING/COUGHING CAN INCREASE IOP UP TO

A

STRAINING/RETCHING/COUGHING UPON INDUCTION CAN INCREASE IOP UP TO 40 mm Hg OR MORE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

OPHTHALMOLOGY FACTORS OF INCREASED IOP

A

HIGH PRESSURE DURING GLOBAL SURGERY CAN CAUSE VITREOUS HEMORRHAGE AND EXPULSION OF EYE CONTENTS WHICH MAY LEAD TO PERMANENT DAMAGE

ARTERIAL HPTN

COMPRESSION OF GLOBE FROM FACE MASK TO TIGHT

LARYNGOSCOPY AND TRACHEAL INTUBATION

SUPRAGLOTTIC AIRWAY HAS MINIMAL EFFECT

HYPOXEMIA AND HYPOVENTILATION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

WHAT DECREASES IOP

A

HYPERVENTILATION AND HYPOTHERMIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

OCULOCARDIAC REFLEX:

A

SUDDEN PROFOUND DECREASE IN HR IN RESPONSE TO TRACTION ON THE EXTRAOCULAR MUSCLES OR EXTERNAL PRESSURE ON THE GLOBE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

OCULOCARDIAC REFLEX: MORE COMMON IN WHAT TYPE OF PATIENTS

A

YOUNG PATIENTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

OCULOCARDIAC REFLEX: MOST OFTEN ENCOUNTERED DURING WHAT SURGERY

A

MOST OFTEN ENCOUNTERED IN STRABISMUS SURGERY BUT CAN OCCUR DURING ANY TYPE OF OPHTHALMIC SURGERY.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

REFLEX ARC

A

TRIGEMINAL NERVE AFFERENT LIMB - GENERATES AN EFFERENT VAGAL RESPONSE

RESULTING IN…

VARIETY OF DYSRHYTHMIAS: JUNCTIONAL; SINUS BRADY; ATRIOVENTRICULAR BLOCK; BIGEMINY; PVC; V-TACH; ASYSTOLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

efferentneuron

A

can bring

the response from the CNS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

afferentneuron

A

must

bring the stimulus to the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

OCULOCARDIAC REFLEX - WHAT HAPPENS WHEN YOU REMOVE THE SURGICAL STIMULUS

A

PROMPT REMOVAL OF THE INSTIGATING SURGICAL STIMULUS FREQUENTLY RESULTS IN RAPID RECOVERY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

WHAT MEDICATION CAN ABATE THE OCULOCARDIAC REFLEX

A

WITH ADMINISTRATION OF PARASYMPATHOLYTIC SUCH AS ATROPINE OR GLYCOPYRROLATE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

HOW CAN THE OCULOCARDIAC REFLEX BE STOPPED WITH ANESTHESIA?

A

CAN BE ERADICATED BY INSERTING A REGIONAL ANESTHETIC EYE BLOCK THEREBY ABOLISHING ITS AFFERENT ARC.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

IN ELDERLY WHAT ARE WE CONCERNED WITH USING PARASYMPATHOLYTICS

A

WATCH HEART RATE IN ELDERLY IF USING THE PARASYMPATHOLYTICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

TELL ME ABOUT CHILDREN AND THEIR DEPENDENCE ON HR. HOW DO WE TREAT THIS

A

CHILDREN ARE MORE DEPENDENT ON HR TO MAINTAIN C.O., PROPHYLACTIC IV ADMINISTRATION OF ATROPINE (0.01-0.02 MG/KG) MAY BE PRUDENT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

WHAT IS THE MOST COMMON CAUSE OF POST OP EYE PAIN AFTER GENERAL ANESTHESIA

A

CORNEAL ABRASIONS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

EXPLAIN THE REASONS FOR CORNEAL ABRASIONS (3)

AND TREATMENT?

A

TAPE INCORRECTLY

TAKING TAPE OFF TO EARLY

STETHOSCOPE/NAME BADGE
HITTING EYE;

ABX OINTMENT AND EYE PATCH USUALLY RESULTS IN CORNEAL HEALING WITHIN A DAY OR TWO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ACUTE GLAUCOMA

A

PAINFUL. PRESENCE OF MYDRIATIC (DILATED)PUPIL MAY BE DIAGNOSTIC. URGENT MATTER NEEDING OPHTHALMOLOGIST. IV MANNITOL OR ACETAZOLAMIDE CAN DECREASE IOP AND RELIEVE PAIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

POST-OP VISION LOSS- painless loss of vision (2)(rare)

more frequent risk

A

ISCHEMIC OPTIC NEUROPATHY
BRAIN INJURY

THE PRONE POSITION
CARDIAC SURGERY

(ISCHEMIC OPTIC NEUROPATHY). OPHTHALMOLOGY CONSULT IS NECESSARY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

OTOLARYNGOLOGY- WHEN SHOULD NITROUS NOT BE USED?

A

NOT IF SURGERY IS IN THE MIDDLE EAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

MYRINGOTOMY AND TUBE INSERTION INDICATION FOR SURGERY?

A

CHRONIC OTITIS MEDIA: DRAINS MIDDLE EAR OF FLUID. MYRINGOTOMY CREATES THE OPENING IN TM THEN TUBE PLACED TO HELP DRAIN FLUID.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

WHAT TYPE OF ANESTHESIA IS USED WITH OTOLARYNGOLOGY

A

USUALLY MASK CASE/ NO IV/SUCC DART IS NEEDED (WHAT IS IT?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

WHAT ARE THE TWO MOST COMMON PROCEDURES PERFORMED ON THE MIDDLE EAR AND ACCESSORY STRUCTURES

A

TYMPANOPLASTY AND MASTOIDECTOMY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

TYMPANOPLASTY AND MASTOIDECTOMY - TELL ME ABOUT THE POSITION PROBLEMS

A

SOMETIMES REQUIRES EXTREME DEGREES OF LATERAL ROTATION. EXTREME TENSION ON THE HEAD OF THE STERNOCLEIDOMASTOID MUSCLES MUST BE AVOIDED.

CAN CAUSE C1 AND C2 SUBLUXATION (MISALIGNMENT) OF WHICH CHILDREN ARE ESPECIALLY PRONE DUE TO LAXITY OF LIGAMENTS OF THE CERVICAL SPINE AND THE IMMATURITY OF ODONTOID PROCESS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

HOW DO YOU DELIVER NITROUS IF YOU MUST DELIVER IT FOR EENT CASES

A

MIDDLE EAR AND SINUSES ARE AIR-FILLED, NONDISTENSIBLE CAVITIES. NITROUS SHOULD NOT BE USED. IF HAVE TO USE IT CUT 50% WHEN TYMPANIC GRAPH TO AVOID PRESSURE DISPLACEMENT.

32
Q

HOW SOON IS NITROUS REABSORED AFTER D.C

WHY IS THIS A PROBLEM FOR THE MIDDLE EAR?

HOW LONG WILL THE EFFECTS LAST?

A

QUICKLY REABSORBED

NEGATIVE PRESSURE RESULTING IN SEROUS OTITIS, DISARTICULATION OF THE OSSICLES IN THE MIDDLE EAR, AND HEARING IMPAIRMENT

LAST UP TO 6 WEEKS AFTER SURGERY.

33
Q

PRESERVATION OF FACIAL NERVE IS IMPERATIVE

A

SURGEON ISOLATES THE NERVE AND VERIFIES ITS FUNCTION BY ELECTRICAL STIMULATION. THIS IS DONE BY BRAINSTEM AUDITORY-EVOKED POTENTIAL AND ELECTROCOCHLEOGRAM MONITORING. COMPLETE MUSCLE RELAXANT NEED TO BE AVOIDED.

34
Q

USING AN OPIOID RELAXANT DURING OTOLARYNGOLOGY CASE-

A

IF AN OPIOID RELAXANT TECHNIQUE IS CHOSEN AT LEAST 30% OF THE MUSCLE RESPONSE AS DETERMINED BY A TWITCH MONITOR SHOULD BE PRESERVED. THIS MAY SUGGEST THAT IT IS NOT NECESSARY TO AVOID NMB, HOWEVER, YOU MAY NOTICE MOST SURGEON MAY NOT WANT THEM USED.

35
Q

Nitrous Oxide:

SOLUBLE?

DIFFUSE?

PRESSURE?

A

More soluble than nitrogen in the blood
Diffuses into air-filled cavities quicker than nitrogen diffuses out
This increases middle ear pressure and can dislodge tympanoplasty grafts
Acute d/c of high concentrations of nitrous oxide markedly decreases cavity pressure and may cause serous otitis
Should be avoided or if used, use in moderate concentration < 50% and d/c 15-30 minutes prior to graft application

36
Q

Epinephrine

A

Frequently injected during EAR microsurgery to decrease bleeding and improve visual field.
Systemic uptake may precipitate tachydysrhythmias
Epi in concentration limited to 1:200,000 solution should be used
Reverse Trendelenburg decreases venous congestion and the use of volatile anesthetics to decrease systolic arterial blood pressure help with bleeding as well
Use of vasoactive drugs and controlled hypotension is controversial

37
Q

Emergence: OTOLARYNGOLOGY

A

Coughing and bucking increase venous pressure, which can lead to graft disruption or acute bleeding
Deep extubation may be beneficial. Why would you not want to deep extubate?

38
Q

PONV: OTOLARYNGOLOGY

A

Manipulation of vestibular apparatus often causes PONV after middle ear surgery
What factors exacerbate this PONV? Page 532

39
Q

Difficult Airway: LARYNGOSPASM- what mediates it

A

Laryngospasm:
Mediated through vagal stimulation of the superior laryngeal nerve
Abrupt intense, prolonged closure of the larynx with compromise of ventilation can occur upon:
Instrumentation of the endolarynx
Blood or foreign body presence
Inadequate depth of anesthesia

40
Q

Laryngospasm: CHILDREN- what happens with a brief laryngospasm

A

In children even brief laryngospasm is particularly perilous as a peripheral oxygen saturation decreases precipitously as a result of a small FRC and relative high CO.

41
Q

Laryngospasm- what ensues?

temporal reduction in brain stem firing to what nerve makes the cords relax

A

If airway is completely obstructed, the anesthesia provider may be unable to ventilate despite an adequate mask fit
Ensuing hypercarbia, hypoxia, and acidosis elicit an automatic sympathetic response producing hypertension and tachycardia
Temporal reduction in brainstem firing to the superior laryngeal nerve eventually causes relaxation of the vocal cords.

42
Q

LARYNGOSPASM Treatment Modality:

A

100% O2 vial positive-pressure face mask ventilation
Placement of an oral/nasal airway
Deepening of anesthesia with IV anesthetics
Small doses of succinylcholine (0.25 – 0.5 mg/kg)
Tracheal intubation may be necessary in refractory cases
To reduce encountering laryngospasm, the use of IV or topical lidocaine (4% lidocaine spray) prior to laryngoscopy and endotracheal intubation

43
Q

TONSILLECTOMY & ADENOIDECTOMY (T&A) ISSUES (4)

what is very important in these cases

A

AIRWAY OBSTRUCTION
BLEEDING
CARDIAC ARRHYTHMIAS
CROUP (POST-EXTUBATION AIRWAY EDEMA).

PRE-OP ASSESSMENT IMPORTANT

44
Q

TONSILLECTOMY & ADENOIDECTOMY (T&A)- HOW DO WE DELIVER ANESTHESIA

A

MASK A CHILD UNLESS WILL TOLERATE AND IV START. IF GOING TO BE A TRAUMATIC EXPERIENCE MASK ANESTHESIA IS PREFERRED.

45
Q

TONSILLECTOMY & ADENOIDECTOMY (T&A)- WHAT TYPE OF TUBE IF THEY NEED TO BE INTUBATED

A

ORAL RAE TUBE TO KEEP OUT OF WAY OF SURGEON

46
Q

(T&A) AIRLEAK

A

AN AIR LEAK OF 20 cm H2O PEAK AIRWAY ASSURES REDUCTION OF TISSUE EDEMA, A CRITICAL FACTOR FOR PEDS WHO HAVE A NARROWER AIRWAY DIAMETER THAN ADULTS. (WHAT IS THE MAX PRESSURE FOR ADULTS?)

47
Q

(T&A) TYPE OF PATIENTS

A

YOUNG AND HEALTHY

48
Q

(T&A) PONV/pain

A

IV DECADRON < EDEMA

POSTOP PAIN

PONV.

49
Q

T&A AIRWAY OBSTRUCTION REASONS

A

SECRETIONS OR BLOOD ON THE VOCAL CORDS

RETAINED PHARYNGEAL PACK (always chart it was removed)

50
Q

airway obstruction after T&A sometimes may create what

A

SOMETIMES MAY CREATE NEGATIVE-PRESSURE PULMONARY EDEMA. THIS PRESSURE IS TRANSMITTED TO INTERSTITIAL TISSUE AND PROMOTES FLOW OF FLUID FROM THE PULMONARY CIRCULATION INTO THE ALVEOLI.

51
Q

T&A- CHILDREN LESS THAN 4 SUSCEPTIBLIITY

A

YOUNG CHILDREN < 4 YEARS ARE SUSCEPTIBLE TO AIRWAY OBSTRUCTION AS LATE AS 24 HOURS POSTOP AND MAY BENEFIT FROM PROLONGED POST OP MONITORING.

52
Q

Tonsils & Adenoids. Sevo 8%,

A

Tonsils & Adenoids. Sevo 8%, IV start once down. Induction drugs: Specific body weight- Fent, Propofol may or may not give atropine . Intubation or oral airway, tape tube down, turn bed around: Iv to remain patent, keep circuit and airway secured, no kinks, clamped . May want a 20 mm leak for a pediatric tube = to decrease barotrauma and other pulmonary trauma, assess for laryngeal edema by deflating cuff and assess for leak. Decadron sometimes given.

53
Q

WHEN DOES BLEEDING AFTER T&A OCCUR

A

OCCURS WITHIN A FEW HOURS AFTER SURGERY

54
Q

EBL AFTER T&A

A

EBL IS UNDERESTIMATED B/C OF SWALLOWING AND ARE CONSIDERED A FULL STOMACH

55
Q

WHAT ADMINISTRATION FOR T&A IS CRITICAL

A

FLUIDS

56
Q

RSI IS NEEDED- WHAT WILL YOU HAVE READY?

A

PROBABLY SUCTION?

57
Q

EPIGLOTTITIS- caused by what

affecting children between what ages

A

ACUTE EPIGLOTTITIS IS AN INFECTIOUS DISEASE CAUSED BY Haemophilus influenza TYPE B. OFTEN AFFECTING CHILDREN BETWEEN 2 & 7 YEARS OLD

58
Q

EPIGLOTTITIS HX

A

OFTEN A HISTORY OF SUDDEN ONSET OF FEVER AND DYSPHAGIA

59
Q

EPIGLOTTITIS SYMPTOMS

A

PHARYNGITIS TO AIRWAY OBSTRUCTION
RESPIRATORY FAILURE CAN BE RAPID (WITHIN HOURS).
AGITATED, DROOLING, LEANS FORWARD HOLDING THE HEAD IN AN EXTENDED POSITION.

60
Q

EPIGLOTTITIS- WHY ARE THEY FATIGUED?

A

FATIGUE FROM BREATHING AGAINST A NEARLY CLOSED AIRWARY

61
Q

EPIGLOTTITIS - WHEN DOES ANESTHESIA COMMENCE

A

ANESTHESIA COMMENCES ONLY WHEN ALL EMERGENCY AIRWAY EQUIPMENT IS OPEN AND READY AND SURGEON ADEPT AT RIGID BRONCHOSCOPY AND TRACHEOSTOMY PRESENT

62
Q

WHY IS INHALED INDUCTION OF ANESTHESIA PREFERRED in epiglottis

A

AND INHALED INDUCTION OF ANESTHESIA MAINTAINING SPONTANEOUS VENTILATION IS PREFERRED

63
Q

IS EPIGLOTTITIS DIRECT VISUALIZATION PREFERRED

A

DIRECT VISUALIZATION OF THE GLOTTIS SHOULD NOT BE ATTEMPTED B/C STIMULATION OF THE PATIENT AND STRUGGLING MAY RESULT IN COMPLETE AIRWAY OBSTRUCTION.

64
Q

EPIGLOTTITIS-MEDICATION PRIOR TO INDUCTION

A

ATROPINE TO AVOID BRADY AND DRY SECRETIONS

65
Q

EPIGLOTTITIS- ETT SIZES?

A

SMALL ETT WITH RANGE OF SIZES

66
Q

EPIGLOTTITIS- ANY DIFFICULTY-

A

IF ANY DIFFICULTY, THE SURGEON SHOULD INTERVENE AND SECURE THE AIRWAY WITH A RIGID BRONCHOSCOPE OR ESTABLISH A SURGICAL AIRWAY

67
Q

THYROID AND PARATHYROID

A

HYPERTHYROID MANIFESTS WITH SIGNS OF MASSIVE CATECHOLAMINE RELEASE INCLUDING TACHYCARDIA, HPTN, DIAPHORESIS

68
Q

THYROID- SURGICAL MANIPULATION ANESTHETIC CONSIDERATIONS

A

SURGICAL MANIPULATION OF HEAD AND NECK CAN OCCLUDE A STANDARD ETT. AN ARMORED ETT MAY BE BENEFICIAL

69
Q

POST OP THYROID AND PARATHYROID

A

POST OP BE WARE OF AIRWAY OBSTRUCTION AND VOCAL CORD DAMAGE

70
Q

HOW DO WE MONITOR RECURRENT LARYNGEAL NERVE INTEGRITY DURING THYROID AND PARATHYROID SURGERY

A

AN ELECTROMYOGRAPHY (EMG) TO MONITOR RECURRENT LARYNGEAL NERVE INTEGRITY USING A SPECIAL ETT AND EMG MONITOR MAY BE USED

71
Q

ELECTROLYTE ISSUES

A

PARATHYROID INJURY OR REMOVAL MAY CAUSE HYPOCALCEMIA WITH CLINICAL SIGNS OF TETANY CARDIAC DYSRHYTHMIAS AND LARYNGOSPASM

72
Q

LEFORT 2

A

a triangle fracture- running from the bridge of the nose, through the medial and inferior wall of the orbit beneath the zygoma through the lateral wall of the maxilla and pterygoid plates.

73
Q

LEFORT 3

A

separates the midfacial skeleton from the cranial base traversing the root of the nose, the ethmoid bone the eye orbits and the sphenopalatine fossa.

74
Q

LEFORT 1

A

horizontal fracture of the maxilla extending from the floor of the nose and hard palate through the nasal septum and through the pterygoid plates posteriorly .

75
Q

which lefort classification causes little difficulty for anethesia

A

before 1 fracture can be intubated orally or nasally.

76
Q

can you nasally intubate lefort 2 or 3?

A

nasal intubation may aid the surgeon but great concern is given as the patient may have basilar skull fracture- inadvertent etc placement in the intracranial space may cause meningitis and could inflict damage on the brain itself.

77
Q

will blood loss be a concern with major facial trauma

A

yes- these patients MUST be typed and crossmatched.

Spring '20/ L. Basic's Test 3- OP, EENT, OR Hazards (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions