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APA3 levi 2019 S.Horvath > ENT > Flashcards

ENT Flashcards

1
Q

which nerves supply the ear

A

auriculotemporal. greater auricular, auricular branch of vagus, tympanic

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2
Q

N20 diffuses into the middle ear, so you should avoid it or limit to less than __ %

A

50

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3
Q

when would you use facial nerve monitoring

A

during middle ear, mastoid, and inner ear procedures near facial nerve

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4
Q

head ___ position will reduce venous pressure and bleeding

A

up

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5
Q

ASA 1 hypotensive technique consists of MAP __-___, intraopsystolic >preop diastolic, HR __

A

50-60

hr 60

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6
Q

small doses of cocaine are ___, decrease HR.

while higher doses of cocaine do what on the CV system?

A

vagotonic.

tachy, htn, VT, direct myocardial depression leading to MI VF sudden death

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7
Q

what is Samter’s triad?

A

NSAID sensitivity in patients with asthma and nasal polyps leading to severe bronchospasm

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8
Q

whats the dose for rectal tylenol

A

10-15mg/kg

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9
Q

whats the dose for zofran

A

100-150mcg/kg

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10
Q

what is larsons maneuver

A

gentle positive pressure with anterior pressure at angle of ramus check

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11
Q

bleeding tonsil - post-op bleeding ____ with age

A

increases

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12
Q

bleeding tonsil - primary bleeds occur within __h and are usually ____

A

6h, venous or capillary

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13
Q

what are suggestive s/s of bleeding tonsil?

A

unexplained tachycardia, excessive swallowing, pallor, restlessness, sweating, increased capillary refill time.

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14
Q

what is a late light of bleeding tonsil?

A

hypotension

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15
Q

how should you intubate a bleeding tonsil patient?

A

RSI, head down if tolerated

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16
Q

how should you mask the patient?

A

lateral or head down

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17
Q

presence of stridor indicates

A

4-5

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18
Q

Dysphagia: significant and suggests ____ obstruction; if associated with carcinoma, implies ____ ____ extension

A

surpaglottic. upper esophageal

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19
Q

___ stridor suggests extra thoracic airway obstruction

A

inspiratory

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20
Q

____ stridor suggests intrathoracic airway obstuction

A

expiratory

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21
Q

___ laser is most commonly used in microlaryngoscopy

A

CO2

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22
Q

what are the risks associated with the laser?

A

airway fire, stray laser beam hazardous to OR personnel

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23
Q

what are the 3 things needed for fire

A

fuel, oxidant, and ignition(heat) source

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24
Q

YAG laser = ___ lens googles

A

green

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25
Q

Argon laser = ____ lens googles

A

amber

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26
Q

CO2 = ___ lens

A

clear

27
Q

what is the fastest way to stop O2 in the case of an airway fire

A

disconnect circuit

28
Q

what are the issues associated with supraglottic jet ventilation

A

misalignment leads to poor ventilation, blood smoke, debris blown into trachea, VC may vibrate, cant monitor etCO2, spike pneumomediastinum, pneumothorax, sq emphysema

29
Q

subglottic jet vent has ___ risk barotrauma than supraglottic

A

greater

30
Q

High frequency ventilation (HFV) involves ___ tidal volumes with ___ rates via 3.5-4mm catheter

A

small, rapid

31
Q

HFPPV (positive pressure ventilation) resp rates =

A

60-120

32
Q

HFJV (jet ventilation) resp rates = ____ and tidal volumes = ?

A

resp rates =100-140.

tidal volumes less than dead space

33
Q

what do you do to avoid OR pollution by anesthetic gases if you are insufflating agent via a small catheter in the nose or nasopharynx?

A

use a high intensity suction catheter near the mouth to clear

34
Q

how can you assess for adequacy of ventilation with a riding bronchoscope?

A

chest rise - tidal volume and etco2 will not return via circuit

35
Q

T/F A rigid bronchoscope provides better visualization, suction, and control of bleeding. Control ventilation d/t danger of movement and risk of hypoventilation.

A

TRUE.

36
Q

the venturi bronchoscope uses the same principles of ____

A

sanders type injector

16g jet on side arm of laryngoscope or bronchoscope

37
Q

PCO2 accumulates ____ for every minute of apnea

A

3-4torr

38
Q

Risks of fiberoptic bronchoscope: ___ from over zealous suctioning, and ____ from sedation

A

hypoxemia, hypoventilation

39
Q

GETA fiberoptic - ETT no smaller than ____

A

8-9

40
Q

If FOB occupies too much cross section of eat or scope too tight in larynx, ____ occurs, which ____ venous return and CO

A

PEEP, decreases

41
Q

T/F Esophagoscopy requires a large ETT

A

false. use smaller size ETT. may need to drop cuff to allow passage of scope

42
Q

which procedure carries the complications of perforation of hypopharynx, massive hemorrhage, dysrhythmia as heart is stimulated by passage of scope

A

Esophagoscopy

43
Q

If FB is in the esophagus, cried pressure can cause?

A

perforation, esp if object is sharp

44
Q

FB can cause collapse of trachea if it presses on post tracheal wall (absence of cartilage support). what could be useful?

A

reinforced tube

45
Q

inhaled foreign body - which is worse - organic or inorganic ?

A

organic. it can soften, expand, and fragment.

46
Q

T/F In near complete occlusion, pushing laryngeal/tracheal fb into mainstream bronchus has resulted in reducing obstruction temporality.

A

TRUE

47
Q

If known organic material, position ___ with affected side _____ to minimize fragment spread

A

lateral, affected side DOWN

48
Q

racemic epi treatments may be repeated every ___ min

A

30

49
Q

whats the dose for decahedron for foreign body removal?

A

0.5-1.5 mg/kg

50
Q

what is the etiology of epiglottis? haemophilus influenza type ___ (less now) and ___ ___ ____. viral cause is _____ virus.

A

haemophilus influenza type B and group A strep.

viral - parainfluenza virus

51
Q

epiglottitis is typical in which age group?

A

3-5yo

52
Q

epiglottitis peaks which time of year ?

A

spring and fall

53
Q

what are the 4 D’s associated with epiglottitis?

A

dysphagia, dysphonia, dyspnea, and drooling

54
Q

T/F epiglottitis patients present with hoarseness.

A

FALSE. stridor maybe on inspiration, NO hoarseness is present.

55
Q

lateral neck x-ray “____” at epiglottis

A

thumb sign

56
Q

epiglottitis patient sitting upright, leaning in a sniffing position is referred to the __ position

A

tripod

57
Q

T/F induce child with epiglottitis with sevo, N20, O2

A

FALSE just sevo and 100% fio2

58
Q

How should you determine your ETT size for epiglottitis?

A

intubate orals or nasally with tube 0.5-1.0 size smaller than usual

59
Q

Does the epiglottitis patient usually get extubated?

A

no they remain intubated for 24-48h

60
Q

Trach ties are not to be changed for the first ___ days. Collapse of tissue around stoma makes correct passage hard to find

A

7

61
Q

T/F Late complications of tracheostomy include tracheal stenosis, erosion of major blood vessels, erosion of esophagus.

A

TRUE

62
Q

If tracheostomy tube is dislodged in early postop period what do you do?

A

reintubate from larynx. try a smaller size tube.

63
Q

if you emergently need to ventilate a patient with an uncuffed trach tube in place…. ?

A

may pass small 5.5ett thru plastic trach tube to establish positive pressure.

APA3 levi 2019 S.Horvath (16 decks)

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