ENT

Question 1

How does concomitant URTI, a common finding, affect myringotomy tube insertion?

Answer 1

It doesn’t. Threshold for cancellation is much higher as patients aren’t intubated. Only recommendation is post-op O2.

Question 2

[T/F] Young children aremore prone to subluxation of the c-spine.

Answer 2

T. Due to the laxity of the c-spine ligaments and the immaturity of the odontoid process.

Question 3

How is the facial nerve monitored during middle ear surgery? (2)

Answer 3

Brainstem auditory-evoked potential and electrocochleogram monitoring, which requires that complete muscle relaxation be avoided.

Question 4

How is avoidance of bleeding in middle ear surgery accomplished?

Answer 4

Relative hypotension, keep- ing the mean arterial pressure 25% below baseline, is effective.

Question 5

Why do some people feel that N2O should be avoided in middle ear surgery? (2)

Answer 5

N2O diffuses along a concentration gradient into the air-filled middle ear spaces more rapidly than nitrogen moves out. Furthermore, after N2O is discontinued, it is quickly reabsorbed, creating a void in the middle ear with resulting negative pressure.

Question 6

How long does it take pressures to build in the middle ear if N2O is used?

Answer 6

N2O results in pressures that exceed the ability of the eustachian tube to vent the middle ear within 5 minutes, leading to pressure buildup.

Question 7

Negative pressure in the middle ear after discontinuation of N2O can cause? (3)

Answer 7

This negative pressure may result in serous otitis, disarticulation of the ossicles in the middle ear (especially the stapes), and hearing impairment, which may last up to 6 weeks after surgery.

Question 8

How does the age of onset suggest the cause of stridor?

Answer 8

Laryngotracheomalacia and vocal cord paralysis are usually present at or shortly after birth, whereas cysts or mass lesions develop later in life.

Question 9

What is the most common cause of stridor in infants and what is the cause?

Answer 9

Laryngomalacia. It is most often due to a long epiglottis that prolapses posteriorly and prominent arytenoid cartilages with redundant aryepiglottic folds that obstruct the glottic opening during inspiration.

Question 10

How is laryngomalacia diagnosed?

Answer 10

Direct laryngoscopy and rigid or flexible bronchoscopy.

Question 11

The size of a bronchoscope refers to the (internal, external) diameter.

Answer 11

internal

Question 12

How can you compensate for gas leaks during bronchoscopy? (3)

Answer 12

High fresh gas flow rates, large tidal volumes, and high inspired volatile anesthetic concentrations. Manual ventilation at higher-than- normal rates is most effective in achieving adequate ventilation.

Question 13

What is the common age window during which epiglottis occurs?

Answer 13

2-7.

Question 14

What are the characteristic signs and symptoms of epiglottis? (10)

Answer 14

sudden onset of fever
dysphagia
drooling
thick muffled voice
preference for the sitting position with the head extended and leaning forward
retractions
laboured breathing
cyanosis may be observed in cases in which respiratory obstruction is present.
However, in the early stages, the patient may be pale and toxic without respiratory distress

Question 15

What is the absolute fail in the management of epiglottis?

Answer 15

Visualization of the epiglottis in the un-anaesthetized patient. The pressure differential on inspiration is exaggerated in the patient with airway obstruction. This dynamic collapse of the airway may become life-threatening in the struggling, agitated patient, and every attempt should be made to keep the patient calm.

Question 16

What is the radiological sign indicating epiglottis?

Answer 16

thumb print sign, caused by thickening of the aryepiglottic folds and swellng of the epiglottis

Question 17

What equipment should be ready in the OR when attempting to intubate a patient with epiglottis?

Answer 17

laryngoscopy, rigid bronch, tracheostomy

Question 18

What is the best way to induce a patient with epiglottis?

Answer 18

inhalation

Question 19

What tube size should be used in a patient with epiglottis?

Answer 19

0.5cm smaller than usual

Question 20

When do you usually extubate a patient with epiglottis?

Answer 20

Tracheal extubation is usually attempted 48 to 72 hours later in the OR,

Question 21

What is the problem in using Xray to diagnose foreign body aspiration?

Answer 21

90% are radiolucent, and air trapping, infiltrate, and atelectasis are all that are noted.

Question 22

How does the nature of the aspirated material affect management?

Answer 22

Vegetable items expand with moisture encountered in the respiratory tract and can fragment into multiple pieces, thus cre- ating a situation in which the original foreign body is in one bron- chus and, with coughing, a fragment is dislodged and transported to the other bronchus. Oil-containing objects, such as peanuts, cause a chemical inflammation, and sharp objects cause bleeding in addition to the obstruction.

Question 23

What is the absolute fail in the management of foreign body aspiration? (2)

Answer 23

No sedation should be administered before removal. Use of N20 before removal (air trapping).

Question 24

Acute desaturation during foreign body removal should make you think?

Answer 24

pneumothorax

Question 25

What are the post-removal management steps after foreign body removal?

Answer 25

Often, vigorous irrigation and suctioning distal to the obstruction are required to remove secretions and prevent the possibility of postobstructive pneumonia. Steroids are administered if inflammation of the airway mucosa is observed.